Asthma death in Philly school

LadyFree28, BSN, LPN, RN · Oct 19, 2013

Philly is having a HORRIBLE time regarding their school district; they've had their school nurses cut; and they have sued the state in response to it.

Most of the teachers have no realm of experience with children regarding medications or anything else medically complex besides first aid; they triage it to the school nurse. Now teachers are working with NO NURSES in buildings, sometimes none coming in the building on most days; they have not been trained regarding what to so for children with chronic medical issues.

This has been a dangerous pattern; one child received the wrong medicine by a teacher, now this.

This tragedy shoes the importance of having licensed school nurses in the building AT all TIMES; this is unfortunate for the teacher as well. :down:

This will put fuel in the fire to the state not to allow cuts to school nurses!

Jolie, BSN · Oct 20, 2013

http://www.nbcphiladelphia.com/news/local/Lack-of-School-Nurse-Led-to-Daughters-Asthma-Death-Father-228280801.html

http://citypaper.net/article.php?He-says-his-daughter-might-be-alive-if-not-for-school-nurse-cuts-16461

Make no mistake. This girl’s death is tragic, because it was entirely preventable. But the responsibility does not belong with Philadelphia Public Schools, it belongs with her family. Please watch and read the above pieces which support the following:

Laporshia Massey had been diagnosed with asthma and had an inhaler and a nebulizer at home, which she was skilled in using, and which provided relief in the past.

Her father never notified her school of her health condition, nor did he arrange for her to have life-saving medication at school.

Laporshia reported feeling ill twice during the school day. Both times, her household was called. Her father answered the first call and declined to go to the school to pick her up. His finace answered the second call and likewise declined to pick up the child.

Believing the girl too ill to walk home, a school staffer gave her a ride.

Her father states that she immediately went for her inhaler upon arriving home at 3:00 pm. He drove her to the hospital after 5:00 pm when he noticed that her stomach was no longer moving. She died at the hospital.

Instead of filing suit against the school, this man ought to be defending child negligence charges.

LadyFree28, BSN, LPN, RN · Oct 20, 2013

True, she may have been alive if the parents were complicit in allowing the school was aware and had her inhaler on hand, and a nebulizer and that's a big IF, especially when most parents need EXTENSIVE reeducation in terms of caring for an asthmatic child; as well all are aware, reaching with chronic illness, especially asthma to asthmatic parents can be an arduous process, however, if a nurse was there, her expertise and clinical judgement would've been able to determine if the medication would or wouldn't been effective through providing an assessment

and had the child in an ER; THAT makes the difference; this could happen to a family that doesn't know their child has asthma; most people learn they have asthma when they have their first asthma attack.

A person with a degree in education doesn't have the background in health assessment to make such a determination. There still needs to be a school nurse present; as of TODAY and tomorrow, there still will be NO NURSES in many of Philadelphia's public schools, and THAT is unacceptable.

enuf_already · Oct 20, 2013

I agree with Jolie. This story is tragic. Saying that the fault lies with school because they don't have a nurse doesn't add up with dad's actions. The article states, "Asked whether he regretted not going to pick his daughter up from school, Burch said no, because he didn’t know the attack was severe. “No, I don’t because had I known it was that bad, I would’ve been there,” he said."

A school employee dropped the child off at home in dad's care at 3 yet he did not think it was necessary to take her to the hospital until after 5 PM. The article states dad drove her, not that he called 911.

A school nurse could have assessed the child and called 911 (but even dad did not feel this was necessary when he saw his child). If a school nurse had no inhaler or orders for treatment, calling the parent (which was done twice) was all they could do.

I am all for having nurses in schools (our school system has employed "health aides" for the last 10 years) but parents need to accept that they are still responsible for their child's health care.

Stitchy's mom · Oct 20, 2013

So, if we call parents and they say "Okay, she can last till the end of the day." what do we do? Can we override what parents want? Now I'm a bit terrified! I know that if I had a child die on me, no matter what the cause, I would be a mess. I've had patients die on me, but they coded or we knew they were near the end of life.

LadyFree28, BSN, LPN, RN · Oct 20, 2013

I agree with Jolie. This story is tragic. Saying that the fault lies with school because they don't have a nurse doesn't add up with dad's actions. The article states "Asked whether he regretted not going to pick his daughter up from school, Burch said no, because he didn’t know the attack was severe. “No, I don’t because had I known it was that bad, I would’ve been there,” he said." A school employee dropped the child off at home in dad's care at 3 yet he did not think it was necessary to take her to the hospital until after 5 PM. The article states dad drove her, not that he called 911. A school nurse could have assessed the child and called 911 (but even dad did not feel this was necessary when he saw his child). If a school nurse had no inhaler or orders for treatment, calling the parent (which was done twice) was all they could do. I am all for having nurses in schools (our school system has employed "health aides" for the last 10 years) but parents need to accept that they are still responsible for their child's health care.[/quote']
Yet, the dad stated "he didn't know it was severe", yet nurses KNOW how severe it would be.
Also, in Philly public schools, they request the information; if no nurse, no medicine can be bought in some of the schools.
Parents are only know what they know; if you've ever taught asthma education to lay people; and how many times it takes to teach the parents; then this wouldn't be a non-issue; even in status asthmaticus rescue inhalers DON'T work; NO ONE-not the parents not the teacher wouldn't know unless they are armed with a stethoscope and proficient health assessments.
I've worked and did my clinical rotation in public Health at an Asthma Clinic in Philly...NIH sponsored; unless you've worked in this situation; you don't know WHAT you know...

LadyFree28, BSN, LPN, RN · Oct 20, 2013

So if we call parents and they say "Okay, she can last till the end of the day." what do we do? Can we override what parents want? Now I'm a bit terrified! I know that if I had a child die on me, no matter what the cause, I would be a mess. I've had patients die on me, but they coded or we knew they were near the end of life. [/quote']
In a school setting; it's different; if the kid is actively having signs of status asthmaticus, at least in this school district, we send children to the hospital; at least when there was a nurse in the building. Smh...

Madras · Oct 20, 2013

Ughhh I hate this story. There is fault on all parties here! I 100% agree that a school nurse should be on premis at ALL TIMES! These are our children, and healthcare does not just occur at home, it is a continuum!

I have a kindergartener. Now everyone knows that most illnesses come to light in school aged kids AT SCHOOL. Unfortunately my school district only employees "health aides" with the occasional nurse coming in to review meds and IEP's and such. I work at the local hospital, I've made it extremely clear to his teacher, the health aide and the nurse that I've spoken to that if anyone ever has any doubts beyond a mild tummy/ear/headache or symptoms that persist you GET MY KID ON A RIG!

Parents need to mobilize and understand the importance and fight for our school nurses!

damrcngrl95 · Oct 20, 2013

As a parent of children with asthma, I put the most blame on the parents who were called twice. I know when my boys are starting to decline. I was this way even before I had any kind of medical training. I have been an elementary teacher and I don't believe that a teacher would pick up on the "asthma cough" my 8 year old gets before things get worse. Teachers on the whole will not have the insight that something is really wrong until it may be too late. The dad, who was called, would/should be very aware of the warning signs and failed to react to the call, failed to react to the child's reaction when she came home. This is a real shame.

Jolie, BSN · Oct 20, 2013

Lady Free,

Some of your points are well taken. I’m not suggesting that we eliminate school nurses. As a school nurse, it would be quite self-serving for me to pound the podium and declare that our children are unsafe without 100% RN coverage in every building. But that’s simply not true. And in the real world, it is not going to happen. Better to acknowledge that we have limited resources and utilize them efficiently and effectively than spend our time and energy fighting a battle we can’t and won’t win. With proper planning and education of administration, staff, students and families, it is possible to provide safe and effective care for children with a host of health needs in the school setting without 100% RN staffing every day in every building.

Far more children experience health emergencies in their own homes under the care of their own parents than in the school setting. This case is a perfect example of that. Laporshia reported illness twice during the day that her family refused to address. She was driven home by an adult so as to ensure her safe arrival and remove the risk of an unattended crisis. How can the father possibly decry the school’s response when he waited 2 more hours to seek the medical attention that he faults the school for not accessing prior to 3:00 pm? It is especially prudent to note that he was the only adult in this scenario with knowledge of the child’s health condition and possession of her emergency medications!

The child was not experiencing status asthmaticus, as evidenced by the father’s description of his daughter, “running up the stairs” upon her arrival home to retrieve her inhaler. Children in status asthmaticus don’t run. She experienced status asthmaticus 2 hours after arriving home, when “her stomach stopped moving.” Was he even present to assist her use of the inhaler and nebulizer? To witness her progression to respiratory arrest? Or did he go back to his nap after she came in the door? Was there even medication there for her to use?

Let’s please not rush to judgement of a school system over the mis-placed outrage of a “parent” who failed his own child.

Stitchy’s mom,

As a nurse, you assess the situation, make a determination of what is needed to provide care for the student at that moment, then set your plan into action. If 911 is warranted, they are called first, followed immediately by the parents. If the parents arrive at the school prior to the student leaving in the squad, they are legally entitled to accept or refuse emergency care for their child.

As described in the 2 articles referenced above, it is not likely that I would have done anything different than Laportia’s school did. I respectfully disagree with Lady Free’s comment that a severe attack is often the first sign of asthma. With anaphylaxis, yes. With asthma, no. Most children present with episodes of wheezing or coughing severe enough to warrant medical attention, often associated with respiratory illness prior to being diagnosed with asthma. Most responsible parents and medical providers arrange for inhalers and/or nebulizers long before severe asthma symptoms occur. These arrangements are easily accommodated in the school setting by nursing staff and by lay staff under the direction of the school nurse, when the parents make such needs known.

CecixLI,

Why is it the school’s responsibility to place your child on a rig for a possible minor illness, rather than your responsibility to go to school and assess her yourself? If nurses are required 100% of the time during the school day, how do children possibly survive the other 16 hours in the care of their lay parents?

Jolie, BSN · Oct 20, 2013

Also, in Philly public schools, they request the information; if no nurse, no medicine can be bought in some of the schools.

Please reference the school policy that states this. If Philly public schools are denying students' access to needed emergency medication during the school day, they are in violation of federal education and disability law.