Chronic diseases require rational school policies


ANYONE WHO suffers from chronic asthma knows just how frightening a sudden attack can be. As the airways close, breathing becomes difficult.

The experience is akin to drowning.

Last month, a Carroll County sixth-grader refused to stand idly by as a fellow student began gasping for breath on the bus ride home.

Both students had been diagnosed with asthma, but only one was carrying an inhaler and she understandably rushed to share it.

Heroine's reflexive act

Little did this heroine realize that her reflexive act of kindness would ignite a health policy controversy.

The girl unwittingly violated the Carroll Council school system's strict policy prohibiting the sharing of controlled substances, whether legal or not.

This is the cornerstone of the school system's zero-tolerance drug policy.

The girl was not suspended and no school privileges were revoked; carrying an inhaler is permitted on county school property.

Not a 'drug trafficker'

Nor was she labeled a "drug trafficker," as some news reports indicated.

But a notation was entered into her official school record, indicating the violation.

If she does it again, there will be serious consequences.

"Obviously, you can't have a rule that says kids can't give drugs to other students, whether prescription drugs or illegal drugs and [then] strictly ignore it," says Gary Dunkleberger, assistant superintendent of instruction for the Carroll County Board of Education.

Policy makes sense

For the most part, this policy makes sense.

Had the two asthmatic classmates on the school bus not been taking identical prescription medicine, the girl in distress may have been harmed rather than healed.

But the incident, and the school's handling of it, also illustrate the difficulty of formulating and implementing rational policies to deal with chronic illnesses such as asthma, diabetes or pediatric HIV.


Unlike some states, such as Wisconsin, Maryland has no state laws clarifying precisely which prescription drugs students may carry.

Local boards of education have almost total discretion over such matters.

In theory, a diabetic student who offers glucose tablets to another diabetic could end up in as much hot water as the Carroll County sixth-grader.

Only 40 percent of local school jurisdictions in Maryland have adequate nursing staff, according to a recent survey by the Maryland State Department of Education.

In Baltimore City alone, 38 schools lack even part-time nursing coverage.

Yet many students with chronic illnesses require medications during the day, under a nurse's care.

The purpose of a zero-tolerance drug policy, such as Carroll County's, is obvious.

Zero flexibility?

But zero-tolerance of illegal drugs should not be confused with or lead to zero flexibility when it comes to the appropriate use of legitimate prescription medications.

As treatment options for chronic, potentially life-threatening conditions increase, school systems need clear, sensible policies and the resources to implement them -- for children with chronic illnesses.

Dr. Clifford S. Mitchell is assistant professor of environmental health sciences at the Johns Hopkins University School of Hygiene and Public Health.

Amy L. Bernstein is an independent journalist.

Pub Date: 5/17/98

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