California’s highest court ruled unanimously on Monday, saying that — with the consent of a doctor and students’ parents — unlicensed school employees can administer insulin shots to diabetic students if a nurse is not available. The court’s justices said that their decision places the burden on each student’s physician to decide whether insulin may be administered by school personnel.

"State law in effect leaves to each student's physician, with parental consent, the question whether insulin may safely and appropriately be administered by unlicensed school personnel, and reflects the practical reality that most insulin administered outside of hospitals and other clinical settings is in fact administered by laypersons," Associate Justice Kathryn Mickle Werdegar wrote for the court.

The ruling came eight years after the original lawsuit, filed by four elementary school students with diabetes from two California school districts. The students wanted to receive insulin shots and blood sugar readings while at school. Now, based on the court’s ruling, even in the absence of a nurse or doctor, schools will have trained personnel on staff to assist diabetic children.

“The operative word in this Supreme Court ruling is a ‘trained’ person," said Lynda Burlison, immediate past president of the southern section of the California School Nurses Organization. “We are going to spend the next six months coming up with what trained means, if schools don’t hire a nurse.”

While many praised the court’s decision, some organizations say that it sets a bad precedent. According to the Los Angeles Times, the American Nurses Association called the ruling “a disturbing precedent for California and the nation.”

"This decision lowers [the] level of care for children who are entitled to receive healthcare services at school and puts them at risk for medication errors that could have severe health consequences," the association said.

But the American Diabetes Association believes that the court’s decision is an appropriate step in the right direction. There are an estimated 14,000 students with diabetes attending California schools. For them, this ruling means broadening the availability of personnel who can help with their day-to-day needs and not having to rely on the few nurses within the school system.

“Students with diabetes will no longer be placed in situations that endanger their health, their safety and their access to educational opportunities,” said Dwight Holing from the American Diabetes Association. “Sometimes [parents] have had to quit their job or jeopardize their employment because of the constant need to provide care when a school nurse wasn’t available. Today that ends.”