Operating Insulin Pump Not Same as Injecting Drugs

When an Educational Assistant’s assignment was changed from helping to manage a student’s diabetes by monitoring her blood glucose level and then prescribing either a snack or increased activity to entering data into the student’s new insulin pump, the union grieved.

The union alleged that the new assignment violated an express provision in the collective agreement prohibiting employees from administering medication by injection.

An Educational Assistant (E.A.) at a primary school, L. E. was part of a team trained and assigned to help manage a kindergarten student’s diabetes.

The team took turns checking the student’s blood glucose level every day at 2 p.m. The process involved taking a drop of blood from the girl’s finger, transferring the drop to a strip and then inserting the strip into the blood glucose monitor. If the reading was low, the student was given a snack, if the reading was high she was assigned increased physical activity.

In 2007 the student was fitted with an insulin pump. The cellphone-sized pump — carried in the pocket or attached to a belt — delivers insulin continuously through a small plastic tube to a needle that remains under the skin. While the pump continuously trickles a base dose of insulin according to pre-programmed settings, the pump is also designed to deliver a surge or bolus dose to compensate for meals. To determine the size of the bolus dose to be administered, the pump requires that two pieces of data be entered — namely the recipient’s current blood glucose level and the carbohydrate level of the planned meal.

Enhanced liability

In contrast to her previous duties, which only required that L.E. monitor the student’s blood glucose level and administer food or exercise, she was now required to operate the pump by entering the data from the strip and the supplied carbohydrate numbers for the food. L.E. was, in essence, administering medication by injection and this amounted to an enhanced degree of responsibility and liability beyond an E.A.’s pay grade, the union said.

The union argued that the parties had put their minds to the appropriate degree of responsibility for an E.A. with respect to administering medications and had specifically drawn the line at injections, and the collective agreement reflected this understanding.

The employer argued for the plain language meaning of the collective agreement proscription against administering medication by injection. The E.A. was not giving an injection but operating a pump. Any injection that occurred, happened when the needle attached to the pump was inserted under the skin — a procedure that was performed by others.

Programming function

The arbitrator agreed, ruling that operating an insulin pump was not equivalent to administering an injection. “The E.A.’s function is a programming function as it is the device which determines whether medication is required and ‘administers’ that medication.”

The arbitrator disagreed with the union’s argument that because the E.A.’s input is required to prompt the surge or bolus dose, L.E.’s actions were tantamount to administering medication by injection.

“I do not agree that any distinction between the manner in which the basal insulin is delivered and the manner in which the bolus or surge of insulin is delivered transforms the E.A.’s actions so that it can be said that, in the latter instance, the E.A. ‘administers medication by injection.’ In the case of both the basal trickle and the bolus or surge of insulin it is the pump, and not the E.A., which ‘delivers’ or ‘administers’ the medication to the student.”

Reference: Toronto District School Board and Canadian Union of Public Employees, Local 4400. Louisa M. Davie— Sole Arbitrator. Tim Gleason for the Union and Brenda Bowlby for the Employer. January 20, 2010. 13 pp.

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