School Health System Unable to Handle Influx of Ill Students

The first-grader who recently emigrated from El Salvador suffers from internal parasites. The high school junior from central Los Angeles has tuberculosis. The seventh-grader from the west San Fernando Valley has been sexually abused and needs psychological counseling.

Lunch boxes are not the only things children are bringing to school these days in the mammoth Los Angeles Unified School District. Increasingly, medical professionals say, students are arriving too sick to learn.

The influx of students who are chronically ill or require extra medical care because of learning disabilities comes at a time when the district is slashing funds for school health programs and choking on red tape. In July, the board laid off all but three of its 50 doctors. Regulations prohibit the 500 school nurses from treating patients. Some of the district’s 350 school psychologists are so overworked they have taken stress leaves.

“It’s killing staff. We’ve stretched them past the point of reasonableness,” said Dr. Charles Espalin, who heads the student guidance services for 70 psychologists in Gardena and South-Central Los Angeles.

“We’re all in over our heads,” said Helen Hale, the district’s chief doctor. “There’s too much to do and the educational dollar was never intended for health care.”

Educational reformers such as Horace Mann and John Dewey never dreamed that public schools would one day have to grapple with homeless students, gun-toting youth gangs, crack addiction, AIDS and waves of Third World immigrants who bring with them medical problems that have not been seen in the United States for generations.

“Most of our students are new to the country and many come from places where tuberculosis is rampant,” Dr. Michele Roland said of students at Los Angeles High School, where she heads one of three health clinics in the district.

Roland said up to 60% of the students she tests at the school have positive TB results. For many, it is their first visit to a doctor. Internal parasites, skin infections, venereal diseases and complications from polio are other health problems seen with increasing frequency in Los Angeles schools.

Immigrants are by no means the only burden on the school health system. Many inner-city children are also ravaged by contagious diseases, lifelong effects of poor prenatal care, unsanitary living conditions and abuse by drug-addicted parents. Dysfunctional families, child abuse and drug abuse are also present in middle-class suburbia, although they may be less obvious there than in ghettos, health professionals say.

A district report in December commended the school system for its efforts to help sick children, but concluded that schools cannot be expected to solve the woes of an increasingly troubled society on their own. The report called for an overhaul of the district’s health care program to keep ill children from falling through the cracks. It urged that the district join forces with the Los Angeles County Department of Health Services to eliminate overlapping services and inefficient use of staff and resources.

School board President Jackie Goldberg is expected to introduce a resolution this month supporting this proposal. County officials and local colleges that train medical professionals have already pledged support.

Why should schools stay involved with health care? For one, teachers are often the first to spot illnesses. Problems such as an inability to concentrate, poor vision, severe ear infections, violent behavior, open sores, bruises or bloated stomachs are symptoms that have surfaced in classrooms.

Also, healthy children do better in school than sick ones.

Hale, the district’s chief doctor, said the school board is in the process of hiring 15 new doctors, mainly to assess the growing numbers of students with learning disabilities. During the fall semester, Hale was one of three district doctors fielding the medical needs of all 635,000 students in the Los Angeles school district.

One casualty of the medical layoffs were the 11,000 physical examinations that the district formerly gave to students who signed up for sports.

Lisa Protes, a doctor’s assistant at the Los Angeles High School health clinic, says doctors sometimes detect chronic or congenital heart ailments during physicals, such as that which felled Loyola Marymount basketball player Hank Gathers last year.

Protes said the clinic has only enough staff to serve students at Los Angeles High. Funded primarily by the Robert Wood Johnson Foundation, a New Jersey-based philanthropic organization, the clinic is staffed by Childrens Hospital of Los Angeles and offers medical and psychological services at no charge to students who provide signed parental consent forms.

Two other clinics serve students at Jordan High School in Watts and San Fernando High School in the northeast San Fernando Valley. The three clinics only serve students at the campus where they are located. There is no money to expand the program, which was launched in 1987.

“We just had a kid in here last week who had a thyroid tumor that had to be surgically removed,” Protes said.

“We’ve picked up leukemia, asthma, sickle-cell anemia, diabetes,” she said. The clinic has also diagnosed numerous cases of sexually transmitted diseases. Once, Protes said her medical team reached the victim of a campus shooting and started intravenous treatment before paramedics arrived.

Protes said parents of most Los Angeles High students have no medical insurance. Often, Protes said, students will call in sick to class, then come to school anyway so they can be treated at the clinic.

“The frightening thing is that even if I was at one school five days a week I still wouldn’t get everything done,” said Valerie Gordon, a district psychologist who divides her time between 122nd Street and Raymond Avenue elementary schools in South-Central Los Angeles.

Paperwork is another problem. For each child she sees, Gordon must fill out 20 forms. She is constantly juggling priorities for the 30 or so children who have been referred for testing and assessment at any given time. At the top of her list come students with behavioral problems such as 8-year-old James, who constantly picks fights with other children.

Last year, Gordon counseled James and his family, giving his parents tips on modifying their son’s aggressive behavior and spending hours doing family therapy. This week, James is back in Gordon’s office because of parental complaints that the boy is now behaving violently toward adults.

Students such as Lisa, a 7-year-old who is failing school quietly without drawing immediate attention to herself, land at the bottom of the heap, Gordon said.

Lisa lives with her grandmother and was referred to the psychologist because she could not read. After a one-year wait, Gordon has found time to give Lisa a battery of psychological tests. It turned out that the child’s emotional health was fine; Lisa merely needed glasses. Gordon says countless other children with simple handicaps also go untreated because there are not enough medical professionals to go around.

“We are failing to serve a lot of young people who need help,” said Espalin.