L.A. County Backs Tougher Law on School Health Exams

Thirteen years ago, the Legislature decreed that first-graders receive physical examinations intended to detect child abuse, vision and hearing deficiencies, anemia, heart murmurs and other health problems.

But within the Los Angeles Unified School District, 14,938 first-graders, or 28%, had not received their health screening by December’s deadline. And within the district’s San Fernando Valley schools, the percentage was higher--4,044 children, representing 30% of the first-graders in the area, had not been examined.

Other districts with a significant number of unchecked children this school year include: Newhall (46%), Palmdale (39%), Sulphur Springs (37%), Burbank (29%), Glendale (29%) and Las Virgenes (19%), Los Angeles County records show.

Countywide, 30,030 children, or 22% of first-graders in public schools, did not receive physicals by the 1988 deadline. Statewide, 24% of first-graders attending public schools did not receive them in 1987, the last year for which complete figures are available.

In contrast, within the Los Angeles Archdiocese, only 8% of the first-graders did not visit a doctor. Most private schools throughout the state posted similar numbers.

Legislation Pushed

Alarmed by the large numbers of public schoolchildren who are not seeing a doctor, Los Angeles County health officials have asked for legislation to pressure school districts to improve their figures.

The county is vigorously supporting a bill that would financially penalize school districts for every child who does not receive a physical or whose parents do not sign a waiver foregoing an exam. The measure would require the state to withhold average daily attendence money, called ADA, for each of these children. This could mean a loss of thousands or millions of dollars, depending on the size of the school district.

Based on its ADA allotment, the Los Angeles district could have lost $36.8 million this year if the bill had been law.

“If there is no penalty, what is the urgency of the schools to do it?” asked Dr. Sydney Smith, the county’s director of child health and disability prevention, a vocal advocate of the legislation.

The reaction of local school officials has ranged from ambivalence to outright hostility over the bill, which is being sponsored by Assemblywoman Teresa P. Hughes (D-Los Angeles). The legislation, which sailed through the Assembly Education Committee earlier this month on a 14-0 vote, is before the Assembly Ways and Means Committee.

‘Another Intrusion’

“I’m going to be frank. It’s another health department intrusion into the operation of school districts,” J. Michael McGrath, superintendent of the Newhall School District, said of the bill. “Whether it’s good or bad is beside the point.”

Virginia Hayes, director of Los Angeles district’s nursing services, said she supports the goal of the bill but worries about its effect.

“We’re not opposed per se to the concept, but withholding ADA will make it very difficult not only for us but for smaller districts,” she said.

Stiff monetary sanctions would serve to jolt some district administrators who do not make the screening a high priority because there are no teeth in the present law, Smith contended. While health screenings are required if a parent does not obtain a waiver, children are not prevented from attending school if a waiver is not granted, as is the case in many cities on the East Coast and in the Midwest, he said.

In contrast, a child who is entering school for the first time in California is barred if he or she has not obtained all necessary state-mandated immunizations for such diseases as polio, diphtheria, measles and whooping cough.

In talks with school officials, Smith said he has detected a blase attitude about the screenings. “Some say nobody is going to bother us. What are you going to do about it? We’re not going to lose anything if we don’t comply.”

Citing the need for physicals, Smith said the exams conducted by private doctors detect health problems in 40% of the first-graders examined. While some of the problems are minor, it is still a staggering number, he said. Less intensive health screenings at schools, often conducted by nurse practitioners, detect trouble in 10% to 15% of the children examined, he added.

Less than one-third of the school districts in Los Angeles County, which maintain an affiliation with a consulting physician, do their own screenings.

School officials interviewed agreed that the exams are crucial because they detect problems that could hamper a child’s education if left unnoticed. They noted that the checkups are the first for some poor children, who are examined for free if their families meet poverty guidelines.

“A kid can be very bright, but if he is sick or he has a physical disability, he can’t use what God gave him,” said Dr. Helen Hale, Los Angeles Unified’s medical director of student medical services.

But school health coordinators say getting parents to agree is a paper-work nightmare. Many districts begin notifying parents at the beginning of kindergarten that their child must be examined by the time he or she reaches first grade.

But some parents are apathetic and never bother to take their children for a physical, health authorities said. Others, classified as the working poor, fall through the cracks--they do not qualify for free exams, but they cannot pay for a doctor’s visit. And there are parents who have complied with the requirement, but who never bothered to get their physician to fill out the form that the school district needs, officials said.

“My frustration really is with parents complying,” said Frida Martinez, Glendale Unified School District’s health coordinator. “There is no excuse for kids not to get care in this country.”

The state Department of Health Services has not announced its position on the bill. But department officials are concerned that the districts might use a loophole in the legislation to circumvent its intent. The bill would continue the practice of allowing parents to sign waivers exempting their children from exams. Now, parents may object to the exams primarily on religious or philosophical grounds.

School districts, however, could have parents who fail to comply sign waivers so that ADA money will not be withheld, said Gordon Cumming, chief of the state’s child health and disability prevention branch. He and other health officials suspect that some districts are already routinely using the waiver when parents will not cooperate.

“That’s one of the dilemmas,” Cumming said. “What’s hoped is that if you push people into it, more will get the exam, but the alternative is they may all sign waivers.”

SCHOOL HEALTH SCREENINGS Chart shows the percentage of students who had not received screenings by Dec. 1988.

Overall Results L.A. Unified: 28 Valley*: 30 L.A. County-wide: 22 L.A. Archdiocese: 8 * Valley schools accounted for 4,044 (30%) of the 14,938 students (28%) in the district who were not screened. Other Area Districts With Significant Numbers Newhall: 46% Palmdale: 39 Sulphur Springs: 37 Burbank: 29 Glendale: 29 Las Virgenes: 19 Source: State and County Departments of Health Services