It’s the sort of problem usually left to doctors and nurses. But Lawrence school district workers soon may be grappling with it, too, despite some education experts saying it is out of their league.

The Lawrence district may become the first in Kansas to adopt a policy honoring do-not-resuscitate orders for medically fragile students.

After two years of wrangling, the school board is expected to give preliminary approval Monday to rules requiring DNR orders be honored by its 1,700 employees. The issue made it back onto the board’s agenda after Lawrence Police and Lawrence-Douglas County Fire & Medical officials agreed to collaborate with the district on following the policy.

“When it first came to me, my thought was ‘My God, why am I dealing with a DNR?'” said Leni Salkind, a school board member on the committee that wrote the policy. “As we worked on it, it became clear that it was important for the district to have a policy.”

The challenging ethical issue is on the radar screen of U.S. school districts because medical knowledge and technology has led to longer life spans for children who previously wouldn’t have survived to attend public school. In consultation with physicians, parents of children with serious or terminal illnesses are seeking orders to authorize withholding measures to restart heartbeat or breathing.

Parental concerns

Katy Buck, who coordinates duties of school nurses in the district, said she brought the issue to the attention of the board in 2000 because parents were approaching the district with do-not-resuscitate requests.

Buck said only a handful of the orders were expected to be in effect at any time in the 10,000-student district.

A life-threatening incident at school involving a student with a DNR would be equally rare, she said.

Buck said she expected the board to adopt the rules because they would bring district policy in line with common practice in the medical community.

“We should recognize that there may be times that parents write a request to the schools on do not resuscitate,” she said.

¢ See American Academy of Pediatrics policy statement

District policy now requires employees faced with a life-threatening emergency, including a student who stops breathing or has no pulse, to call 911, notify administrators and provide life-support assistance until paramedics arrive.

Under the new policy, staff would be expected to call 911 in response to a medical emergency involving a student covered by DNR orders. However, the scope of assistance would be limited in accordance with the order. For example, a teacher could make the ailing student comfortable but could not initiate cardiopulmonary resuscitation.

Reducing trauma

Mark Bradford, deputy chief of Fire & Medical, said the department’s staff would comply with DNR orders for Lawrence school students who had no pulse and were not breathing.

“They’re basically clinically dead, and they’re left as such,” he said. “It’s different for someone with shallow respiration. We don’t stand there and watch them die. We’d transport them to the hospital.”

In a break with tradition, he said, Fire & Medical agreed to transport deceased students from a school to Lawrence Memorial Hospital or a nearby funeral home. Removal of the body quickly might reduce the trauma felt by school children and teachers, he said.

“We know it’s not only bad for the family but also bad for the kids and teachers in that building,” he said.

Typically, dead people are taken from the scene by a funeral home.

Lawrence Police Chief Ron Olin said his department usually would investigate deaths as if each involved foul play. In other words, he said, the place a student died would be treated as a crime scene.

But the chief said police would minimize that investigative routine if the department was made aware of a student’s DNR order in advance of his or her death and if the student’s demise was observed by a credible witness.

“Clearly, we don’t want not to investigate something and then have it come full circle back to us at some later date,” Olin said. “I’m satisfied we’ve come to an acceptable policy.”

Under the proposed policy, each DNR order would be reviewed every six months and renewed at the beginning of each school year.

The DNR could be revoked at any time by a family, either orally or by written statement.

Students with a DNR would be required to wear a “medical alert” bracelet or necklace. The students also would be required to carry a copy of the DNR so it could be provided to paramedics or police responding to the scene.

Opposition

Despite the Lawrence district’s considerable effort refining the policy, the Kansas Association of School Boards doesn’t endorse it.

Paul Getto, a policy specialist with the association, said he wasn’t aware of any district in Kansas with such a policy on the books. Asking employees to make on-the-spot evaluations of a crisis raises medical, emotional and legal issues, he said.

“The educators are not trained to make that kind of decision,” Getto said.

Salkind, the Lawrence school board member, said the district had a obligation to serve all children – even the medically fragile. She said the policy would be beneficial to sick children in the district’s schools and allow students who have been held out of classes to return to school.

“We have kids in the district now who are staying home from school because without a policy we couldn’t honor the DNR,” Salkind said.

Jan Jenkins, executive director of Hospice Care of Douglas County, said the district’s proposed policy was a humane approach that offered children the option of death with dignity.

But she doesn’t expect every district employee to agree with the policy.

“I’m not naive enough to think that every teacher is going to be comfortable with this,” she said.

Teachers and students sharing a classroom with a child on a DNR need to be taught what might happen in an emergency, she said.

“It isn’t a matter of doing nothing,” she said. “That’s important to remember. We’re talking about comfort rather than cure.”

The board meets at 7 p.m. Monday at district headquarters, 110 McDonald Drive.