PDN in classroom- who holds liability?

[The Radiant Lotus]

I'm a medicaid PDN for a medically fragile child in a special ed classroom in a public school in upstate NY. I'm being faced with some new challenges related to who holds liability when he is under my care.

He is trached, vent dependent, tube fed, and very prone to soft tissue injuries. He is a total assist 1 person transfer and is in and out of various seating and equipment throughout the day. I have expressed that I should always be present and provide a verbal "OK" that he is ready to be transferred when the PT is moving him. But, despite a couple of sit-downs with the PT explaining the concerns that go along with a medically fragile student, he almost seems to be racing to get to the patient before I am by his side. He also repeatedly places the patient in situations that can (and have) caused injuries. As he is a licensed professional, where does the liability lie when the PT is working around medical equipment that is my responsibility?

To further complicate things, the PT is pushing hard to get the classroom TA's to transfer him, and he expects that he will be the one to train them. I've never had anyone so eager to do my job! I've managed to stave that off a couple of times, but I would love to find some documentation that supports my stance. Medicaid offers nothing to help, and my malpractice insurance company referred my to an attorney. Funds to cover that are non-existent now, so I'm hoping for another option.

Does anyone have any experience in this area? Or resources to offer?

Thank you!

[JustBeachyNurse, LPN]

Do you work for an agency? If so have you discussed with the clinical manager? (This is why I work for an agency. I have clinical nursing support and managers that deal with these very specific issues)

[JustBeachyNurse, LPN]

Check with NY DoE/BoN. Are you an RN or LPN?

What does the school nurse state? What is the school policy?

Documentation is your key, document thoroughly and objectively.

I'd simply ask if he is taking responsibility if when he or the TA's transfer and the ventilator is damaged or worse, the child is accidentally decannulated and loses his airway?

[The Radiant Lotus]

Thank you. I'm an LPN. School policy doesn't state anything specifically, and this student's medical severity has no precedence, so everyone is essentially making up the rules as they go. I practically write a book for every shift, so the documentation is there. I'm in the process of scheduling a time to talk with the district NP about these concerns. I would like to do some independent research before then so I've got knowledge on my side.

[JustBeachyNurse, LPN]

Who is writing & signing off on your plan of care? Who is your supervising RN?

Contact the BoN which in NY is under the DoE. I work for an agency but most of our p&p are proprietary. Try looking at special needs schools online many post P&P online

[Not_A_Hat_Person, RN]

I assume you are independent, not with an agency. When I worked at a school, we had regular interdisciplinary meetings with the parents, special educator, and care providers. Maybe that would help. If something happens to your client, the school could end up liable.