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The case of Laporshia Massey and treating asthma in Philadelphia's schools

By Eileen DiFranco on Oct 16, 2013 11:47 AM

I’ve been a school nurse in Philadelphia for almost 25 years. I’ve seen lots of blood and a finger almost amputated by a door accidentally slammed. I’ve seen head injuries, seizures, and high and low blood sugar levels in diabetics. The very worst moments I’ve experienced as a school nurse, however, are those that were spent with children who were having an asthma attack.

Asthma is a sneaky, dangerous disease. It can emerge full-blown in a child who never, ever before had an asthma attack. It can resurface after years of quiescence. It can occur in a child whose disease has been well-controlled until their insurance is dropped and parents can’t afford to pay for inhalers out of pocket. We know that asthma affects almost 20 percent of kids in Philadelphia. That’s a lot of kids. We now know, from sad experience, that asthma can kill an otherwise healthy, active child.

For instance, one girl -- I'll call her M. -- came to see me during her 9th-grade year and told me she had a bad cold that made her feel awful. She had trouble, she said, “catching her breath.” Although she denied ever having asthma and her school health records corroborated her assertion, when I listened to her lungs with my stethoscope, she was wheezing. I called her father and advised him to seek immediate medical care. When he tried to tell me that M. had a “little cold,” I responded by saying that if she were my child, I would take her to the doctor’s and failing that, to the hospital. The father called the next day to thank me. His daughter had been admitted to the hospital with a diagnosis of asthma. 

Aside from M.’s comments about feeling “awful” and saying that she was having trouble catching her breath, she looked like a child with a bad cold. I see children like that every winter during flu season and, indeed, all they have is a bad cold. It was only in my training as a nurse, where listening to a child’s lungs is part of the physical assessment, that I knew there was something wrong.

We don’t know the particulars of Laporshia Massey’s attempt to communicate her distress to a responsible adult who would know what to do. We don’t know whether she carried a rescue inhaler to school every day, which is permissible according to School District regulations. We don’t know the severity of her illness. We also don’t know the time when Laporshia first reported her symptoms or to which responsible adult she spoke.

We do know, however, that there was no nurse in the building that day, a nurse who, if she or he became aware of Laporshia’s condition, would have known to listen to her lungs with a stethoscope and take appropriate action based upon what she or he heard.

The School District would have the public believe that a “plan” developed by the nurse should suffice for emergencies like Laporshia’s illness. Even the most carefully developed and orchestrated plan cannot take into account the staff’s lack of assessment skills that are part of a nursing practice. A plan is not a substitute for the expertise of a certified school nurse.

The “doomsday” budget did not, however, just remove nurses from what should be an encompassing web of caring adults. The majority of schools have no regular counselor in the building on any given day, no vice principals, and a greatly reduced number of secretaries. Obviously, these key personnel do not have the training to determine whether a child is having an asthma attack. But each would have provided another set of eyes, ears, hands, and brains to consult in an emergency. Sadly, Laporshia became ill in a school where there simply were not enough adult hands on deck to help her.

Very significant numbers of our students with asthma -- and other serious health conditions -- attend schools staffed by skeleton crews. Each of these schools is a mere step away from a potential disaster. The hardest-working principal, the most caring teacher, and the most dedicated nurse cannot hope to make up for the fact that all of Philadelphia’s schools are dangerously understaffed. There are huge holes in our children’s safety net, gaps in care put there deliberately by adults who pretend otherwise. How many more children are going to fall through those holes?

Eileen M. DiFranco, R.N., is a certified school nurse who has proudly served the schoolchildren of Philadelphia for 23 years. She is a lifelong resident of Philadelphia.

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Comments (19)

Submitted by Rich Migliore (not verified) on October 16, 2013 2:00 pm
Thank you.
Submitted by Kelly Diffily (not verified) on October 16, 2013 2:02 pm
As the mom of a kindergartner who just entered the Philadelphia School system, and who has both asthma and anaphylactic food allergies, I couldn't agree more with everything you've said here, and it is this *exact* scenario that I fear most as a parent who leaves her child in the care of PSD each day (and, amidst all the budget cuts, is why cuts to school nursing is what I've been screaming to my legislators about loudest about for months). I only hope Laporshia Massey's death brings light to this issue.
Submitted by Meg (not verified) on October 16, 2013 2:01 pm
"There are huge holes in our children’s safety net, gaps in care put there deliberately by adults who pretend otherwise. How many more children are going to fall through those holes?" We have been covering these holes for a very long time. My site has had the limited support of a iurse only three days a week for years. It is unbelievably risky and dangerous to open any building with little ones without a full time professional on site. I cannot tell you how many times I have contacted a parent myself, describing the situation and prodding them to come and get their child because the situation felt wrong to me, but we had no one in the nurses office to support that call. I cannot tell you how often I have said that a child could just put their head down because we had no nurse and a nap was the best I could offer. "You can't be sick, because I have no nurse today" should never be said in any of our schools, but I have said it tooooo often.
Submitted by Ron Whitehorne on October 16, 2013 2:10 pm

The huge numbers of children with chronic asthma and respiratory problems creates a situation where having a nurse on hand is critical.   It also raises a whole other concern related to austerity in our schools...the conditions of our buildings many of which are plagued with air quality issues, mold and other environmental problems.   The District does not monitor, let alone seriously address these problems.   Parents, teachers and the community should demand that tests of the air quality at Bryant be done.

Submitted by Lisa Haver (not verified) on October 16, 2013 3:01 pm
Eileen Di Franco was interviewed in the Daily News this morning about this tragedy. vhttp://www.philly.com/philly/news/20131016_Help_us__First_Lady_Corbett.html?viewAll=Y&#comments School nurses have organized a silent candlelight vigil in honor of Laporshia tomorrow, Thursday at 6:15 at 440.
Submitted by Anonymous (not verified) on October 16, 2013 6:09 pm
Eileen, that was beautifully said and well-thought out. I have said those very things to many people since this tragedy came to light. The absence of a medical professional to assess this child's condition was very likely the catalyst for her death. Thank you for your continuing work.
Submitted by Mrs. T (not verified) on October 16, 2013 6:05 pm
well said, Eileen. Nurses are vital to the well being of all kids with medical problems. One day we did not have a nurse, a kid came down to the office in the midst of an asthma attack while the secretary was on the phone. By the time she got off, we had to call 911, who got there the minute the kid stopped breathing. What a scare!
Submitted by Anonymous (not verified) on October 16, 2013 9:19 pm
Eileen well put. In the past two weeks we have called 911 three times for children having asthma attacks and no nurse in the building. In is extremely frightening. A child can go from being in mild distress to severe distress in an instant.
Submitted by Anonymous (not verified) on October 16, 2013 9:00 pm
Thank you Eileen for your commentary and for always being an advocate for all of the children in the SDP. You've sounded the alarm many times and it fell on deaf ears maybe this time they'll start to listen.
Submitted by Diane Mohney (not verified) on October 16, 2013 10:10 pm
A thorough commentary on what might have been a preventable tragedy. The idea that schools can function with skeleton staffs is the creation of callous minds. I hope we can take our schools from the hands of non-educators and corporate interests and put them in the hands of those who really care about the welfare of children and their education.
Submitted by Anonymous (not verified) on October 16, 2013 10:43 pm
Thank you Eileen. You hit the nail on the head with all of your points especially about the so-called 'plans' nurses are expected to put in place. Even one of the SDP nursing supervisors attempted to blame the school nurse for the tragedy at Bryant Elementary School. You speak truth to power and your voice has resonated throughout the nation. God bless you and your tireless efforts!
Submitted by Anonymous (not verified) on October 16, 2013 11:27 pm
Eileen, thanks for your words of truth regarding what we do as certified school nurses for the SDP. I am a school nurse of 20 years myself and I have seen many situations with asthmatics and head injury students. We make a professional assessment and then call parents to inform them to pick the child up immediately or we have to call 911. We often make a judgement and parents refuse to listen and give us a hard time. Many if these students have been in crisis and sick for days and sent to school for the school nurse to deal with. This story was sad but did not have to happen. There are times when parents will not answer the phone or the number is out of service. Then a nurse supervisor would not support the nurse in this situation.
Submitted by Denise Johnson-White (not verified) on October 17, 2013 8:51 am
Eileen, I thank you so much for your well written statements on the necessary need for more school nurses and other needed staff. What we truly want is for the School District to care about the children. Let us not have this tragedy repeat itself.
Submitted by Patricia LaRue (not verified) on October 17, 2013 11:59 am
As the mother of a child with severe asthma and a nurse, I applaud your outspokenness on this very important topic. There have been many days that I kept my daughter home during asthma flare ups because there was no nurse at the school. It is so sad that it took a child's death to enlighten people to this extremely important topic. My child has had since 2 and been hospitalized 4-5 times. During flare-ups, I keep her home so I can monitor her. My daughter did not always know when she needed to take an inhaler or nebulizer treatment, but I would hear the cough and the wheeze that she did not. Even if there were a nurse, my daughter may not have tried to go to her, and the nurse sure would not have come to her! Fortunately, the frequency of my child's asthma attacks is decreasing with age. Unfortunately, she is now applying to high schools and her attendance is going to be a problem. Despite being on Honor Roll and having a Gifted IEP (which is also not being provided due to lack of funding) since admission to public school in 3rd grade, she may not make it into the better high schools. Thank you for taking the time to inform and educate the City of Philadelphia on the crisis that is our SD and your daily struggles.
Submitted by school nurse (not verified) on October 17, 2013 1:26 pm
* Sounds like your daughter's chronic medical condition has affected her attendance. This should not be held against her. Ask you medical doctor to explain this in writing. Ask your school guidance counselor to have the letter attached to the application. (Of course, that is, IF you have a counselor!) With the recent tragedy in the loss of a child with asthma, you should be commended to monitoring her health. A full time nurse does more than emergency care. We KEEP students in school when they have a chronic condition and are well enough to be in school. This is an overlooked aspect of the nurse role. Best of luck.
Submitted by Anonymous (not verified) on October 17, 2013 8:20 pm
Well said. Eileen. Ms. Di Franco is one of the small number of competent, professional, and dedicated Philadelphia Certified School Nurses remaining after all the budge cuts/furloughs to take care of the large number of Philadelphia's school children. Review the City of Philadelphia's published data on the number of chronic diseases among Philadelphia's children (22.8% have asthma)- many of whom are economically disadvantaged and do not have continued access to adequate, coordinated, comprehensive healthcare. As said many times before, the school nurse may be the first or most frequently utilized health care person a child will see who has the skills and knowledge to direct and tap community resources for that child and/or family. School health/nursing is essential for a child to remain healthy and to learn better. Not to hire nurses back is an accident waiting to happen- but wait- that has already happened! Support School Nurses! Support School Health!
Submitted by Anonymous (not verified) on October 17, 2013 8:53 pm
Eileen, well put! Hopefully, but probably not realistically knowing the dumb, selfish decisions the SDP leaders make as well as Corbett and Nutter, there may be another tragedy before they get schools adequately staffed with qualified employees to help prevent this.
Submitted by Jacqueline (not verified) on October 19, 2013 9:52 am
I worked in the school district for 36 years and was astounded at how many children had asthma. I am also the mother of an asthmatic son who is a graduate of the school district. Mercifully before all the budget cuts, he was never in a building without a nurse. One thing that deeply concerns me about the cuts to nurses is how many children with asthma are not being treated as effectively as they could be by their doctors. My son's entire life was changed by daily use of inhaled steroids and a once daily allergy pill. Once he started taking those, his need for his rescue inhaler went to almost never. So many of my students relied solely on a rescue inhaler to treat their asthma. I imagine that they don't have access to the same excellent medical care my son had. This is not the fault of the school district, of course, but it does put an added burden on school personnel. Children who are not being treated with the latest asthma medications will have more attacks and need more emergency care. Who is there to provide it?
Submitted by Anonymous (not verified) on October 19, 2013 11:39 am
This tragedy could have been totally avoided!! A Nurse should be in every school every day!!! Where the hell are you Jerry Jordan?? Get your ass in gear and get these Nurses back to our schools!! In addition, if you see anyone have breathing difficulties, you call an ambulance, not drive the child home. Every second counts when it comes to asthma. Adults couldn't even use common sense and as a result this beautiful girl and her family have suffered!! And Corbett only released the $45 million because it took the death of a child!!! He is a piece of shit!! Get out and vote DEMOCRAT and oust his sorry ass!!

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