Cash-strapped schools eliminate nurses

By BETH FOUHY : Associated Press Writer
Jun 8, 2003 : 1:59 pm ET

SAN FRANCISCO -- When 7-year-old Aaron Kovsky was diagnosed with juvenile diabetes, his father called the school to explain his son's new medical regimen.

Aaron would need to prick his finger four times a day to test his blood sugar, and give himself a shot of insulin if his sugar was elevated. And if Aaron's sugar level ever fell too low and he lost consciousness, he'd need an emergency shot of the hormone glucagon.

But Steve Kovsky learned there was no nurse in Aaron's school or any other elementary school in Moraga, an affluent suburb of San Francisco. And the district superintendent and school principal refused to authorize other staff members to administer glucagon, saying they lacked sufficient medical training.

"We determined school was not a safe environment for Aaron," Kovsky said. "So we brought him home. It was traumatic for him, and traumatic for us."

It's a crisis facing millions of children with diabetes and other chronic health conditions across the country, as cash-strapped school systems eliminate nurses along with other "nonessential" positions. Last year, there was just one school nurse for every 3,521 students, according to the National School Nurses Association.

In California, only 5 percent of schools had a full-time nurse this year, down from 7 percent in 1998, according to surveys by the California State PTA.

Moraga's elementary schools lost full-time nurses 20 years ago, relying instead on nurses from the high schools for emergencies. But budget cuts are forcing layoffs of two of the five remaining nurses this year, said superintendent Rick Schaefer.

As the number of students with serious medical needs and drug prescriptions grows, untrained school personnel -- often secretaries, clerks or coaches -- are being asked to perform duties from dispensing Ritalin to giving epinephrine shots for bee-sting reactions.

"When you look at the kinds of medications administered every day in school, it's incredible and scary," said Nancy Spradling, executive director of the California School Nurses Organization.

"Asthma rates are way up. Diabetes is way up. And a lot of kids were born as preemies who would not have survived 10 years ago, giving us some medical issues we're not prepared to deal with," she said.

The federal Americans With Disabilities Act, passed in 1990, requires public schools to offer full access to education for children with special medical needs. But the mandate carries no funding, and many school systems struggle to comply.

Children with Type 1 or juvenile diabetes, like Aaron, often present the biggest challenge. They need to monitor themselves carefully to avoid long-term damage to the eyes, kidneys, nerves and heart. And in the rare instances when their blood sugar drops suddenly, quick intervention is needed to prevent a hypoglycemic coma from causing brain damage or death.

But many teachers' organizations and school administrators balk at taking responsibility, citing liability concerns and lack of medical training.

They are "concerned that someone who maybe doesn't have the correct training could end up hurting a child, just by trying to do the right thing," said Leslie Getzinger, a spokeswoman for the American Federation of Teachers.

Insulin can cause irreversible brain damage if administered incorrectly. While children over the age of 7 can generally give themselves insulin shots, most states forbid anyone else but a registered nurse to administer the injection.

At least five states -- Virginia, North Carolina, Washington, Tennessee and Wisconsin -- have laws or executive orders to provide some coverage for diabetic youngsters where there are no school nurses. Most involve administration of glucagon, which poses no health risk. Only Virginia allows non-medical personnel to be trained to administer insulin.

Aaron Kovsky stayed out of school for a week and a half, until the district agreed to hire a certified diabetes educator to train the principal, secretary and Aaron's teacher to give him a glucagon shot if he needs it.

But Schaefer and others said such solutions don't replace the value of a school nurse in dealing with children's emergencies.

"When I went to school, there was a nurse, Miss McDonald," said Francine Kaufman, a pediatric endocrinologist and outgoing president of the American Diabetes Association. "She had the whole white outfit, and the hat. But Miss Mcdonald doesn't exist anymore, and it's a problem."