Asthma death in Philly school

[Stitchy's mom]

I was just wondering what everyone thought about the little girl who died from an asthma attack in Philly. The parents are saying that the reason she died was because there wasn't a nurse at her school that day. I guess I'm wondering why the school didn't call 911 if she was having trouble breathing. I've got about 20 -30 kids with asthma at my school and I feel that if there's any doubt (inhaler/neb isn't working, meds aren't at school) I'm just calling 911. I would hope that if I'm not there (sometimes I leave a bit early to get to a class) that our staff would just call 911. The surgeons say "When in doubt, cut it out." I say "When in doubt, ship them out." I would much rather have a parent chew me out because I just cost them X dollars at the ER than to have a child die on me!

[Madras]

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?

Haha ok so I possibly came off dramatic! (Sorry waking up from my night shift) Parents should take the reins on responsibility if they are contacted about their child becoming ill..... I would leave work to come assess mine and make appropriate decisions. I guess what I meant was if it sounded like an emergency over the phone it would make more sense for me to tell them to call 911, EMS is located across the street from the school and get him to the ER, rather than the extra time it would take for me to get there, assess, determine an emergency then run 'em back to the hospital.

Having a nurse with sharp assessment skills is a benefit in the school environment. Would I expect the health aide to pick up on an appendicitis vs. a tummy ache from the pizza for lunch. Know the signs of status asthmaticus, or notice the type 1 kid acting "strange".

You are right though, there are 16 more hours in the day that kids spend with lay parents. It's wishful thinking on my part that every parent would know what to do.

A part of nursing is also teaching. I think if it would have been a nurse handing off that child he/she would have given a professional opinion based on assessment of what that lay parent should do next. Whether the parent followed through with the teaching is on them.

[LadyFree28, BSN, LPN, RN]

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.[/quote']

I am referring to a letter the my own family member have received ; as I stated before; there is a lawsuit in PA courts regarding this violation; they filed as soon as they started cutting nurses earlier this year.

[LadyFree28, BSN, LPN, RN]

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?[/quote']

Jolie,

Feel free To disagree; this is not "misplaced outrage", this is a continuing issue on lack of access to health care; especially in inner cites, as well as issue regarding first aid and decision making that educators are forced to be in; as someone who lives an has experienced Philly schools first hand; as a pediatric nurse in my community, as well as a student almost 20 years ago.

If anything, this gives more fuel to the fire of the ongoing lawsuit that the school nurses have with the state; there are extraneous politics and other issues that are occurring, much to the detriment of the children; again, thinking about Healthy people 2020-health disparity it's REAL.

I read the articles you both supplied; it is still an issue that I first posted about and maintain my opinion that this was unfortunate of ALL sides; however, a licensed nurse, or at least access to one should be provided; even if they have to triage by phone. There is nothing better than having an expert in health; the state has decided to cut and eliminate school nurses. The nurse in the article even stated they don't have enough

man power to educate staff or even make sure that they can make sure they are aware if what to do when a medical emergency arises.

There are various signs of an asthma attack; people don't wheeze, and no one can know what a child has unless there is an assessment, again, like I said, a lot of times, most children discover that they have asthma is during a status asthmaticus; or shall I say, in MY community. The NIH program I participated in my area had statistical trends that has shown this; once they implemented teaching, as well as atypical signs of an asthma attack; it takes 6-12 times for the parents and children to adhere to the teaching, decreasing ER visits and increasing compliance.

These state cuts are undercutting serious issues and the strides by this asthma study( this is a concerted joint effort by the local children's hospitals in the city.

It not just this tragedy; there have been reports with children getting incorrect medication by teachers as well in the past year; there has been a perfect storm brewing; and it has just gotten worse.

Again, I'm speaking from working in the community; this EXACT community; I am well aware of limitations, but this is outrageous, and the warnings fell on deaf ears. This is a systematic failure, I don't disagree; however this is just the surface of WHAT is going on in Philly schools in regards of chronic medical issues to technology dependent children-I can't even START with the issues that have been seen in nurses eyes that accompany children to school.

Most people in the trenches that I have worked with are outraged, from the teachers to the principals; the children are losing; and that's why a lawsuit is occurring; unfortunately, again, there are not enough school nurses, and that is the real issue, and it's a MESS. There needs to be a solution, so the liability is not placed on the school's shoulders and this doesn't happen again, if anything, that is the bigger issue.

[Jolie, BSN]

I will agree to disagree. Access to primary care is undoubtedly lacking in many inner cities, but I disagree that it was a factor in this case. Laportia was diagnosed, had medications and was skilled in using them, which is evidence that for her, primary care was not the issue. Parental responsibility was. Her father had not even so much as informed the school that his daughter had asthma. He and his fiance failed to mention it during 2 phone calls. Both declined to pick the child up from school. He did not seek care for over 2 hours after his daughter arrived home and immediately ran for her inhaler.

The one point on which we may agree is that the Philadelphia Public School system did not save this child from her father, but based upon the information presented in the press, I don't know how they could have done so.

[LadyFree28, BSN, LPN, RN]

I know how it would've been prevented; having a nurse in the building; in Philly schools, the nurse is a key factor in the stop gap of many health issues that these kids face. A nurse would've called the parent and asked the parent questions of the child's health history; a school official stating "your child is not feeling well" as compared to "Your child is not feeling well, she stars she cannot breathe; I assessed her and she seems to be having signs and symptoms of asthma; does your child have asthma?" is a FAR more different conversation and level; that cannot be replaced my teachers...for time and in maintaining the content of the thread; the teacher-parent relationships in school; and the history of prior incidents in the school and this community is a whole other animal in itself as well.

Once the teacher said "there's no nurse, just try to stay calm" as was quoted in the article; that (partially or equivocally) sealed her fate.

[brithoover]

I don't get why nurses need to be in schools. This does not happen in canada..

[Jolie, BSN]

By the same token, the father stating to the teacher, "My daughter has asthma. I will come check on her," could have accomplished the same thing as a nurse's assessment. Had the school staff been aware of the child's condition, they may have accessed a nurse by phone.

The teacher did not "seal the child's fate." The father did that.

[SaoirseRN]

Where I am from, school nurses are not the norm. None of my schools had them and none of my daughter's schools have them. I do see that when a population is accustomed to school nurses, that the lack of same seems like a big issue. And maybe it is.

I think the larger issue here is the lack of disclosure to the school on the part of the parents, as well as their refusal to pick up their sick child.

[LadyFree28, BSN, LPN, RN]

Below is the analysis report on the ongoing issue of the cuts to school nurses:

http://www.elc-pa.org/ELC_SchoolNurseReport_May2013.pdf

I also know several colleagues that are working on EBP on establishing an increased presence in school nurses in PA.

Again, the school nurse is the bridge to access to healthcare in for children in many urban areas of the US; Philly is no different.

[Jolie, BSN]

Again, the school nurse is the bridge to access to healthcare in for children in many urban areas of the US; Philly is no different.

But this child didn't lack healthcare. She lacked a responsible parent.

[LadyFree28, BSN, LPN, RN]

But this child didn't lack healthcare. She lacked a responsible parent.

She did lack healthcare; she didn't have access to a licensed professional to intervene.

You can disagree and say the parent was irresponsible; I disagree; could be of ignorance; into experience, irresponsibility and be misconstrued as ignorance on many occurrences.

Again, my point is access of healthcare is done mostly at the schools in the neighborhoods by the school nurse; it has always been this way; it is part of the urban fabric in this city.

Again, I work here and live here, and have come across parents that are similar; there are a percentage, despite all the good efforts of asthma education; still fall into the fail safe of thinking their child is ok or will "outgrow it"; there are people that STILL need consistent reinforcement until we are blue in the face with teaching.

Unless we were there to confirm it was irresponsibility; then I will withhold such information; what I am knowledgable about is there has been a recent pattern if med errors and other near misses due to the decline of school nurses; meaning there are no one who is present to deal with emergencies and make informed judgements for the health of the children; that is the REAL issue; unless you have been following the recent incidents and near misses in the past year that is occurring due to non licensed and adequately trained individuals are administering meds or not even adequately equipped to make decisions on calling 911 or handling medical emergencies, AGAIN, one has NO idea the issues that are occurring in the schools and the communities without the vital work of school nurses; again, it's not doing the students ANY good; I think that's were we agree; and in reality, that's what the point really is, at least in my opinion; and that's what position and point I'm staying at.

Feel free to carry on the thread...I'm sticking to my opinion and facts and eye witness experiences that I have; my EBP.

[Laurie52]

She did lack healthcare; she didn't have access to a licensed professional to intervene. You can disagree and say the parent was irresponsible; I disagree; could be of ignorance; into experience irresponsibility and be misconstrued as ignorance on many occurrences. Again, my point is access of healthcare is done mostly at the schools in the neighborhoods by the school nurse; it has always been this way; it is part of the urban fabric in this city. Again, I work here and live here, and have come across parents that are similar; there are a percentage, despite all the good efforts of asthma education; still fall into the fail safe of thinking their child is ok or will "outgrow it"; there are people that STILL need consistent reinforcement until we are blue in the face with teaching. Unless we were there to confirm it was irresponsibility; then I will withhold such information; what I am knowledgable about is there has been a recent pattern if med errors and other near misses due to the decline of school nurses; meaning there are no one who is present to deal with emergencies and make informed judgements for the health of the children; that is the REAL issue; unless you have been following the recent incidents and near misses in the past year that is occurring due to non licensed and adequately trained individuals are administering meds or not even adequately equipped to make decisions on calling 911 or handling medical emergencies, AGAIN, one has NO idea the issues that are occurring in the schools and the communities without the vital work of school nurses; again, it's not doing the students ANY good; I think that's were we agree; and in reality, that's what the point really is, at least in my opinion; and that's what position and point I'm staying at. Feel free to carry on the thread...I'm sticking to my opinion and facts and eye witness experiences that I have; my EBP. [/quote']

Who provides health care to these children when they are not at school? Is this not the responsibility of the parents? That this child died of an asthma attack is tragic, but I feel the responsibility for this lies with the parent. The father had asthma and knew how serious it could be and he chose to do nothing when the school called and in the next 2 hours that she was home.