Bill would allow teachers and coaches to administer hydrocortisone injections

Trained school personnel can already administer insulin. Soon, they may be able to treat students with adrenal insufficiency

By: - March 14, 2023 1:00 pm
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Sen. Arthur Orr, R-Decatur, the chairman of the Senate Finance and Taxation Education Committee, on the floor of the Alabama Senate on March 7, 2023. Legislators gathered Tuesday for the first day of the Alabama Legislature’s 2023 regular session. (Brian Lyman/Alabama Reflector)

When her 13-year-old daughter has to travel to basketball and volleyball meetings, Valerie Collins follows along in case her daughter needs immediate medical attention – in her case, a steroid shot.

“I could have met them at the ballgame,” she said. “Now I have to travel to her school and follow her or travel with her to the game.”

Collins’ daughter, a seventh grader in Priceville in Morgan County, was diagnosed with Congenital Adrenal Hyperplasia when she was seven, a genetic disorder in which the two adrenal glands do not function properly.

Playing sports, and the potential for injury, requires it. 

“If she becomes injured, or loses consciousness for whatever reason, if her body becomes in stress, then she has to have an injection of the cortisol,” Collins said.

SB 52, sponsored by Sen. Arthur Orr, R-Decatur, would allow school personnel, including teachers and coaches, to administer injectable medicine to students with adrenal insufficiency.

“In order for [her daughter] to play sports, the parents or grandparents or school nurse has to be present at the games and on the bus while traveling in case she had an episode,” Orr said.

Trained school employees can already administer insulin shots to students with diabetes under the 2014 Alabama Safe at Schools Act. Orr said that Collins’ situation led him to drafting this bill. He said it would expand opportunities for students to take part in school activities by providing voluntary training to school personnel, such as teachers and coaches, to administer the injection.

“Plus, the school can’t provide a licensed nurse to every softball game or volleyball game,” he said.

Adrenal insufficiency is a rare hormonal illness that affects fewer than 200,000 people in the US. This condition occurs when the adrenal glands produce insufficient or no amounts of certain hormones, such as cortisol, aldosterone and androgens. Without enough cortisol, people with adrenal insufficiency can experience a variety of symptoms, such as fatigue, muscle weakness, and low blood pressure.

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There are different types of adrenal insufficiency, with Addison’s disease being the most severe and primary adrenal insufficiency being the most common. In some cases, adrenal insufficiency can become a life-threatening emergency, known as an adrenal crisis. This can occur when the body undergoes sudden physical or emotional stress and the adrenal glands are unable to produce enough cortisol, according to the Endocrine Society, a professional research organization of endocrine scientists and clinical practitioners.

The Adrenal Insufficiency Coalition recommends that those with adrenal insufficiency should carry an emergency kit with at least two vials and two syringes of cortisol replacement medication, and instructions on how to use them. 

Collins said the school has accommodated her daughter’s needs, providing a nurse when she can’t be there. The school usually asks her if she’s going to her games. In cases that she couldn’t come, they have provided a nurse, such as during the summer months, but the school has been able to provide a nurse.

Her daughter has an Individual Health Plan (IHP), Collins said, which explains what to do when a student needs medical attention.

“The school has been wonderful to work with, but it’s also going to be another person – if her coaches can be trained to administer her medicine. It’s just one more person that can help care for her,” Collins said.

Linda Lee, executive director of the Alabama Chapter of the American Academy of Pediatrics, said that the chapter is researching the bill with the Department of Endocrinology at the University of Alabama, Birmingham and the University of South Alabama.

The Alabama Department of Education did not return requests for interviews.


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Alander Rocha
Alander Rocha

Alander Rocha is a journalist based in Montgomery, and he reports on government, policy and healthcare. He previously worked for the Red & Black, Georgia's student newspaper, and Kaiser Health News, where he covered community health workers' successful efforts to vaccinate refugees in an Atlanta suburb. He is a Tulane and Georgia alumnus with a two-year stint in the U.S. Peace Corps.