Anoxic Brain Injury - Nurse Accused of Not Treating Asthma

[Katillac]

I feel horrible for everyone involved in this situation.

LAKEVILLE, Minn. (FOX 9) - A family says their daughter suffered a traumatic brain injury and is now in a vegetative state after her school nurse in Lakeville, Minnesota didn't treat her asthma.

In a lawsuit filed on Thursday, the family's attorneys say the nurse at McGuire Middle School failed to properly evaluate her and sent her to gym class where she lost consciousness and had to be taken to the hospital. Now, they say she will require caretaking services for the rest of her life.

Leading up to the date of her medical emergency, the family says their daughter Aaliyah had a long history of asthma with severe exacerbations that required medical intervention. The school district and nurse were aware of the severity of her condition, according to the lawsuit.

https://www.fox5ny.com/news/family-minnesota-girl-in-vegetative-state-after-school-nurse-failed-to-treat-her-asthma

[ruby_jane, BSN, RN]

On 9/16/2019 at 6:45 AM, JenTheSchoolRN said:

Interesting. 124 is totally normal.

I will admit - I would not send a student I'd just given a neb treatment to to gym class. That student would sit the class out and do work in my office if possible and I'd monitor them.

Yup. Right there.

[DFLPN]

On 9/10/2019 at 8:32 AM, JenTheSchoolRN said:

A LPN or medical assistant cannot actually legally "assess" a student; meaning while they can administer treatments, looking at vitals (or lung sounds, etc) and then determining treatment is out of scope of practice. I

In my state, this is simply not true. If this were the case, no PDNS agency would ever hire LPN's. I used to work with kiddos with 'complex medical issues' and, many times, determined that they needed a PRN medication/treatment based on my assessment.

Regarding this lawsuit-I want to know why this kiddo went 30 minutes with no oxygen. Lakeville is not exactly a rural area, and EMT's should have been there under that time. CPR? So few facts published.

[ruby_jane, BSN, RN]

On 9/14/2019 at 9:26 PM, MunoRN said:

Here is the court filing: https://static.fox9.com/www.fox9.com/content/uploads/2019/09/Bowen-Complaint-file-stamped.pdf

Holy h-e-double-hockeysticks.

And I wonder...did the nurse have the peak flow meter and orders (I've never had one at school)? The nurse did not write a 504 plan - that's written by counselors. The IHP is written by a nurse.

So many more questions. Such a horrible turn of events.

[JenTheSchoolRN, BSN, RN]

On 9/19/2019 at 10:41 AM, DFLPN said:

In my state, this is simply not true. If this were the case, no PDNS agency would ever hire LPN's. I used to work with kiddos with 'complex medical issues' and, many times, determined that they needed a PRN medication/treatment based on my assessment.

Regarding this lawsuit-I want to know why this kiddo went 30 minutes with no oxygen. Lakeville is not exactly a rural area, and EMT's should have been there under that time. CPR? So few facts published.

It can vary by state, I'm guessing. My state, not so much in the school setting.

30 minutes without oxygen? I'm surprise, to be honest, that the child is actually still alive, be it in vegetative state. Even if EMS is taking longer, did a fire station respond? They hit my school first and bring me O2 in case I need it. I can use them for CPR help as well if needed (along with several staff trained in my building). As you said, little facts, many questions. Either way, I feel for this family - this is an outcome that we as school nurses want to avoid at all costs. I hope something valuable is learned for this school and district from this tragedy.

On 9/16/2019 at 7:45 AM, JenTheSchoolRN said:

I will admit - I would not send a student I'd just given a neb treatment to to gym class. That student would sit the class out and do work in my office if possible and I'd monitor them.

This is exactly what I am thinking. It says that no peak flow or follow up tx or assessment was done after the med was given. I am wondering if this is true- I am guessing there is no documentation of anything other than the albuterol given. Really sad case.

On 9/20/2019 at 7:33 AM, JenTheSchoolRN said:

30 minutes without oxygen? I'm surprise, to be honest, that the child is actually still alive, be it in vegetative state. Even if EMS is taking longer, did a fire station respond?

I had the same thoughts- 30 minutes makes zero sense to me- it sounds like either no one noticed she was passed out, or they are rural and it takes a really really really long time for EMS to respond and arrive. I don't understand the 30 minute gap in care.

[Schoolnurselpn]

On 9/10/2019 at 7:32 AM, JenTheSchoolRN said:

A LPN or medical assistant cannot actually legally "assess" a student; meaning while they can administer treatments, looking at vitals (or lung sounds, etc) and then determining treatment is out of scope of practice. In a school there isn't often another health care professional there to "check in with" and then get advised on treatment. So, yes, I asked this, because it may or may not matter in the situation - this article provides very few details.

Also in the school setting, RNs, LPNs, MAs, we all have to act on our orders - until very recently I have never had one for epi for asthma. I can't just grab my stock epi and give it for asthma even if I know it will work - my orders are for Epi for anaphylaxis only (one could argue that asthma symptoms are similar, but that is another discussion of the fine line of orders). My orders are from my school doc, who I cannot reach easily to amend them in real time. So I call 911.

So, yes, I know it can work - I'm not surprised at that. But in my career have not had a doc write a scrip for it for a student with asthma only and no allergies. Not sure if insurance would cover that way, to be honest.

Are you a nurse?

As an LPN working as a building nurse, what other option is there....call an RN to assess or do the best you can in an emergency situation.