Public Health Law Map - Beta 5 - Medical and Public Health Law Site

4. Handicapped Children
Handicapped children have special rights under federal law. School physicians are
often caught between the needs of the handicapped child and the limited resources of
the school district. Special education programs and facilities for the handicapped are
expensive. If the school district employs only one speech therapist, the physician will
be pressured to limit the diagnosis of significant speech defect to the number of
children this therapist can treat. Since handicapped children are protected by federal
law and seldom pose a threat to other students, the school physician’s duty is clearly
to the student rather than to the school. The diagnosis of articulation defect must be
based on an objective evaluation of the speech performance of the individual child,
not on the willingness of the school to provide services.
Physicians must not compare one child with another to determine which will be
referred for special help or care. If both children require therapy, that should be the
physician’s recommendation. If there are not sufficient resources to provide for all
the handicapped children, then it is the duty of the school district to find the
resources. The physician cannot legally or morally withhold a diagnosis in order to
withhold special care. Irrespective of state law immunity for schools, a physician
who did so as a matter of routine might be sued under the federal civil rights act for
violating the child’s rights.
5. College Health Programs
College students face many of the same health problems as younger students, but the
legal problems are more complicated. The college student is often away from home
and without the usual support system in times of illness. Dormitories do not provide
chicken broth and dry toast to every student with the flu. They may even be the
source of food poisoning, measles, epidemic respiratory disease.
As in other school settings, the physician’s duty is to the patient, not the institution.
If the college food service is a frequent source of food poisoning, the college
physician should insist that something be done to correct the problem. Physicians
must not change the diagnosis from food poisoning to gastroenteritis of unknown
origin to avoid political problems. They should work with the college administration
to address particular health problems, but medical judgments should not be
compromised for administrative convenience.
Issues of consent and confidentiality do not change when the patient is a college
student. All residential schools should have a power of attorney to consent to medical
care for students who are still minors. It is risky to assume that they will all stay
healthy until they reach their majority. This is especially important for minors who
are far from home, particularly international students. It is also useful for students
who are not minors to consider a power of attorney to consent to medical care if their
parents are not readily available or if they do not want their parents involved in their
medical care decisions.
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