LAUSD Will Be Prepared for Allergy Emergencies

As the number of children with life-threatening allergies climbs, the Los Angeles Unified School District is taking a new approach to prevent and respond to serious reactions.

One allergy specialist describes the move as a model for the nation, but a legal expert says it could be a liability for the massive district.

By the end of this month, all 580 school district nurses and 65 substitute nurses will have been shown how to administer a preloaded epinephrine shot--the standard medication given to someone experiencing a severe allergic reaction to food or an insect sting. The nurses’ training is costing the district $30,000. In turn, the nurses have been given the responsibility to train other school LAUSD personnel--from school secretaries to principals--to use the so-called EpiPen if a nurse is not on campus.

The change is a major one for the 722,000-student district, which up to now relied on a staff of nine district physicians to train personnel at a specific school that had a highly allergic student. A doctor would visit the school only after a parent submitted a written request to the district’s Student Health & Human Services office in Los Angeles.

“Through training, prevention and working with the community, LAUSD will become the model school district for the rest of the schools in the United States,” predicted Anne Munoz-Furlong, founder of the Food Allergy Network, a nonprofit organization based in Fairfax, Va. “I know of no other school district the size of L.A. that has this program in place.”

However, making nonmedical staff responsible for determining when a child should receive the shot creates a potential liability for the school district, cautioned Alan Calnan, professor of law at Southwestern School of Law in Los Angeles.

“Being a temporary custodian, the schools have a special relationship with children to provide basic medical services. On top of that, if you undertake to provide a specific medical service and you do it in a negligent fashion, that enhances your responsibility. They’re stuck between a rock and a hard place in terms of liability,” Calnan said.

District Will Protect Employees

Maria Reza, administrator of health and human services for LAUSD, said employees performing assigned duties, including administering an EpiPen shot, are “subject to defense and indemnification by the LAUSD.”

“What’s the option? If we’re here to do the best we can for kids and a life is threatened, we need to respond,” Reza said. “We will do what we need [to do] to ensure the safety of our kids. That’s no different than we’ve ever done. Now the world is changing and we have to keep pace.”

The schools do not have a supply of EpiPens, which are prescribed to patients by their doctors. Each campus relies on parents of allergic children to provide the EpiPen for their children, according to Joyce Jacob, a San Fernando Valley-based nursing coordinator with LAUSD.

Three years ago the district had fewer than 30 requests from parents for EpiPen training, said Karen Maiorca, director of nursing services for LAUSD. Last school year, there were 164 severely allergic students in the district with doctor’s orders to receive a dose of epinephrine in the event of a severe reaction, she said.

As the number of children being diagnosed with severe allergies increases, the district is conducting workshops on EpiPen procedures with all of its nurses so that they can train other school personnel in a more timely manner. All LAUSD high schools, three-quarters of the middle schools and more than half of the elementary schools have full-time nurses, but some of the smaller campuses have a nurse only once a month.

“In years past, there weren’t many food-allergic children. Now, it’s becoming very commonplace,” Maiorca said. “It was obvious [the doctors] wouldn’t be able to keep up with the need. I think 100% of the nurses knew how to use [the EpiPen], but it’s not just a matter of handing it out.”

Recognizing symptoms and giving the proper medication quickly are critical during an allergic reaction. Severe reactions could include breathing difficulties, a drop in blood pressure or shock, which in some cases could be fatal if not treated immediately. Ninety percent of allergic reactions are caused by eight foods: peanuts, tree nuts such as walnuts and pecans, fish, shellfish, eggs, milk, soy and wheat, according to the Food Allergy Network.

About 100 people die nationwide each year from allergic reactions to food, and about 50 people die annually from insect stings, according to the Food Allergy Network. It is estimated that 3% of school-age children have a food allergy and 1 in 150 has a peanut allergy, according to Munoz-Furlong.

Trained Personnel Called a Necessity

LAUSD officials are unaware of any food allergy deaths on campus, but were unable to say how many times the EpiPen has been administered by school personnel in recent years.

Having a medically trained person on campus every school day is essential, said Randy Benigno, principal of 850-student Monlux Elementary School in North Hollywood.

“This is why we need a full-time nurse in every school. They’re asking us to be experts when a child’s life is at risk,” he said.

Even though Monlux has a nurse on campus four days a week, its only student with known severe food allergies recently had a reaction in an after-school class. Although Earl Eugenio, 10, didn’t eat the peanut butter that his classmates were having, he still broke out in hives on his neck. The nurse had already left for the day, so an office staff member gave the fifth-grade student his prescription antihistamine, and his condition improved within 25 minutes, said his mother, Orpha Eugenio. To date, he has not needed the EpiPen, she said.

To keep her son safe, Eugenio regularly reviews the school cafeteria menu, stays in close contact with his teachers and has taught Earl to never share food. While he has had other allergic reactions to food, this was the first episode at school.

“Because of the diligence of the mother and Earl, we’ve only had one reaction,” said school nurse Kathleen McGroarty.

Earl said he feels safe at school, but he’s “disappointed” that he can’t eat everything that other kids can.

The district is tallying the number of students with allergies who bring an EpiPen with them to school. However, officials are concerned that there are more than the known number of 164 students with life-threatening allergies. Statistically, there should be more than that in the huge district, Maiorca said.

“The need has to be higher,” she said. “Either families aren’t telling us or they may be sending an EpiPen to school with the child and not telling us. Not every parent is sophisticated enough to know what to do.”

To raise awareness among teachers, nurses, parents and food service workers, the district is considering distributing a manual that contains information about food allergies, said Dr. Shobha Naimpally, student medical services director for LAUSD. The School Food Allergy Program, edited by Munoz-Furlong, includes tips on reading food labels, planning classroom parties and field trips, as well as what the law states about treating allergic children.

Naimpally is working with the Food Allergy Network and the Southern California chapter of the Asthma & Allergy Foundation of America to secure funding so that each of the district’s 790 schools will have the manual within a few months, she hopes.