A 7-year-old Philadelphia public school student died Wednesday after falling ill at a school where no nurse was on duty. Yet the absence of a trained healthcare practitioner was not unusual for a school district crumbling under budget cuts that have stripped vital resources from schools serving some of the city’s most vulnerable children.
The first grader reportedly collapsed in a classroom around 2 p.m. and was rushed to a hospital. By 4:30 p.m. the boy was pronounced dead.
"There is no net for the staff or the children," Ann Smigiel, a part-time nurse at the school, told the Philadelphia CityPaper. "There's no requirement to have any kind of medical team. It's my job as the nurse to make sure there's an emergency plan, and basically it is 911 ... The equipment isn't there, nothing is there for them."
Smigiel, the nurse at Andrew Jackson Elementary School where the boy attended, is only on duty Thursdays and every other Friday.
"You have a child perfectly normal one minute and then he’s dead. You can’t wrap your head around it."'
School district officials have not released detailed information on the cause of death or if the boy suffered from any prior health concerns. With few details available on the circumstances surrounding the boy’s death, it is unclear if a nurse on duty could have saved his life.
Wednesday’s death is a cruel reminder of just how tenuous the Philadelphia school system remains. The death marks the second time in about 8 months that a young student has died after becoming ill at a school with no full-time nurse on duty.
In September, 12-year-old Laporshia Massey fell ill at her Philadelphia elementary school and later died after suffering an asthma attack. A nurse was assigned to her school just twice a week. The day that she died was not one of those days.
The beleaguered Philadelphia School District has been collapsing under the weight of deep budget cuts and layoffs since the start of the school year. Republican Gov. Tom Corbett has cut nearly $1 billion from state education funding, and parents and opponents of the cuts have long argued that the economic starvation of the schools is creating an unsafe and dangerous school environment.
Laporshia's death sparked outrage and led to ramped up pressure on Corbett to release funding he'd withheld from the city in lieu of teachers union concessions. Just weeks after the girl's death, the governor released $45 million to the district, though he said the release of the money had nothing to do with her death.
Many of the other problems that school advocates had predicted have come to fruition, following the cuts and after the district shuttered two dozen schools over the summer and laid off nearly 4,000 teachers and other support staff.
Some schools don’t have enough desks for students, forcing many to stand along the walls or sit in window sills during class. Without adequate school supplies including paper, books and furniture, Mayor Michael Nutter resorted to a public plea on local television asking for donations.
Because of the cuts, the number of school nurses in Philadelphia has dropped from 289 to 179.
“We don’t know if a school nurse could have saved this young boy. But we do know every child deserves a full-time nurse in his or her school,” the American Federation of Teachers (AFT) wrote, along with city, state and national presidents, in a joint letter to Gov. Corbett. “We do know all parents deserve to know that their child will be safe and his or her most basic needs will be tended to at school. We do know that all Philadelphia children deserve better.”
"We cannot tolerate one more life lost, one more dream snatched from our children,” the letter continued.
“You have the power to fix what you have broken,” the AFT said. “Restore full and fair funding to all Pennsylvania schools. And do it now.”
Fernando Gallard, a spokesman for the school district, called the death “very tragic” but said “we don’t know if things would have changed if the nurse had been there or not.”
“We do know that this child did have a medical emergency,” Gallard said. “We had, on site, CPR trained personnel who were able to help the child and were able to transport the child quickly to Children’s Hospital.”
The school nurse is often seen as the first line of defense for sick schoolchildren. But that role has diminished in recent years, gone the way of the rotary phone.
As school budgets shrink across the country, districts have increasingly turned to cutting school nurses as a cost-saving measure. According to analysis by the National Association of School Nurses, only about 45% of all public schools have a full-time registered nurse on duty all day. Another 30% of schools have part-time nurses, while a quarter have no nurse at all.
Schools have often turned to para-professionals in the absence of school nurses. In Philadelphia, parents have been angered that teachers and untrained staff have had to administer EpiPens and handout medication.
While school districts across the country weather a broader shortage of school nurses, the impacts are felt more acutely in inner-city communities where environmental issues are a major contributor to widespread illnesses like asthma that are disproportionate and widespread. Inner-city and poor communities have been historically underserved and often lack adequate access to quality public health care. And students at schools without higher nurse-to-student ratios, or who have nurses in the building less often, tend to underperform their peers with more reliable access to care.
According to the National Center for Educational Statistics, of the 52 million American students in school on any given day, about 15% to 18% have chronic health conditions.
In response to the broader impact and implications of school nursing cuts, the National Association of School Nurses last year rallied for the passing of the "Student-to-School Nurse Ratio Improvement Act of 2013." The bill, which was introduced last year but has stalled in committee, would provide funding to examine the correlation between health services and academic outcomes.
In Philadelphia, which lost 100 nurses over the summer, more than 30% of the children between the ages of 5 and 12 have been diagnosed with asthma, a potentially deadly illness if not treated properly.
Back at the school where the 7 year old initially fell ill, Principal Lisa Ciarianca-Kaplan told the Philadelphia Daily News that the death was “devastating.”
"You have a child perfectly normal one minute and then he's dead,” she said. “You can't wrap your head around it."