School-based clinic is not safe care

Published 12:08 am Friday, September 30, 2011

I would like to take this opportunity to respond to a recent article in last Saturday’s newspaper concerning the school-based clinic.

My partner, Dr. Danita Weary and I share the concerns of Dr. David Timm about the necessity of and care given by the school-based clinic.

The article quotes the school principal stating that the clinic only treats children whose parents signed consent for treatment. A few things concern me about this.

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These consents were signed at registration, along with stacks of other papers. I have been told by several parents that they were not fully informed prior to signing consent for their child to be seen.

Several of these parents assumed triage of their sick child was to be done by the school nurse, as has been done in past years.

What if the child’s medical history changes from the time the initial form was signed? What if their allergy history changes? This could be a potentially life-threatening situation if a child was given a shot of antibiotics they were allergic to!

Do you think parents will remember to call and inform the school if their child has an allergic reaction to an antibiotic? Probably not; because they would not consider that the school would be giving their child a shot without a parent present.

The principal was quoted as saying, “Parents give the right to the clinic to treat their child and do whatever they want to do.” Really?

What if that treatment is not in the best interest of the child, or what if the child just completed a round of antibiotics for the same illness? These practitioners do not have the current medical history of the child available to them, unlike their primary care providers that have followed them for years.

What if that parent would have chosen a different treatment option for their child if given a choice?

I have serious concerns about the lack of medical history on these children being seen for treatment without their parents.

I would be negligent if I treated a child without a proper past medical history, history of the present illness, and any chronic or acute medications or treatments that child had received.

What middle school aged child do you know who can tell you what medications they have recently taken or if they are allergic to any medications? Not many of them, I assure you.

Interim superintendent Johnson said they have not received any complaints, but we, the local pediatricians are receiving the complaints when these children have come to us for follow-up.

My partner, Dr. Weary recently saw a child for follow-up from the school-based clinic. No lab tests were run and the child received two shots without the parent present.

The parent was given an assessment form, but did not know what Rocephin (an antibiotic) was or what Decadron (a steroid) was. The child also was given a referral to see an ear, nose and throat doctor which was unnecessary.

Another child was seen at our clinic for follow-up from the school-based clinic that had been seen for a sore throat. No tests were run and the child was given Amoxicillin (an antibiotic). Both of these children were sent back to class after they were seen! In my opinion, if a child is sick enough to receive two shots, they should not return to class to possibly infect everyone.

The director of the Jefferson Comprehensive Health Center stated that some of these children have never seen the dentist before, but they are not providing dental services.

She also states that private doctors use nurse practitioners, which we do. She states they are providing the same services that local doctors do. I disagree.

Our NP has access to my patient’s medical file, history and any recent treatments given by our clinic, the ER and the after hours clinic when she treats our patients. My partner and I are always available on site while our NP is seeing patients, while there is no supervising physician at the school-based clinic.

Therefore, in my opinion, we are not providing the same services.

I consider our services superior due to our years of training, experience and the specific pediatric training we have given our NP prior to her joining our practice.

Dr. Jennifer Russ is a board certified pediatrician.