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Sometimes, parents are reluctant to let schools know that children are being treated for various disorders because they don’t want their children to be labeled by their illness.
School nurses: Let us help to monitor meds

Citing Riley case, say their role in kids’ lives is vital


The Patriot Ledger

School nurses say that monitoring children on psychiatric medications has become more difficult in recent years, in part because time-release medicines mean they no longer administer as many doses in school.

In the wake of the death of a Hull 4-year-old who was allegedly overdosed on psychiatric medication, several nurses are calling for better communication from doctors and parents, saying their role in monitoring children on all kinds of medications remains vital, whether they give the drugs or not.

“These are powerful medications and they should be monitored,” said Marie DeSisto, president of the Massachusetts School Nurse Organization.

In Rebecca Riley’s case, investigators said that the school nurse at the Johnson Early Childhood Center in Weymouth had discussed her medication with the girl’s psychiatrist. She told Rebecca’s mother that the staff was concerned because the child was too lethargic from the drugs to fully participate in school, investigators said. Investigators have not said whether medication was given in school.

Rebecca’s psychiatrist, Dr. Kayoko Kifuji, has voluntarily surrendered her license to practice medicine until the state Board of Registration in Medicine completes an investigation. Rebecca’s parents, Michael and Carolyn Riley, have been charged with intentionally giving her too much of a powerful drug used to treat hyperactive kids and killing her.

Ideally, school nurses say, they should be up-to-date on all medications children are taking, and should be in touch with children’s doctors. Several nurses said communicating with doctors is more difficult now because of privacy rules.
There is no indication that school personnel reported their concerns about Rebecca to the state Department of Social Services. School officials have declined to discuss her death.

That Rebecca’s school nurse knew the little girl was taking medications enabled her to observe her behavior and notify Rebecca’s mother and her psychiatrist of her concerns.

That’s not always possible, school nurses say. Marjorie McEttrick-Maloney, the nurse leader for the Plymouth school district, said schools in that town, like many others, send forms out at the beginning of the year asking parents to report what medications their children are taking.

While most parents fill them out and send them back, she said sometimes parents forget to notify the school when medications or dosages change.

Sometimes, parents are reluctant to let schools know that children are being treated for various disorders because they don’t want their children to be labeled by their illness. The advent of medications that can be given only once or twice a day makes it easier for parents to avoid revealing that information.

“Because they are long-acting medications, a lot of (parents) just choose not to disclose and take care of the medication administration at home,” said Sally Deike, continuing education director for the National Association of School Nurses in Silver Spring, Md.

Ideally, school nurses say, they should be up-to-date on all medications children are taking, and should be in touch with children’s doctors. Several nurses said communicating with doctors is more difficult now because of privacy rules.

McEttrick-Maloney said sometimes nurses are unable to get any information about what students are taking. Parents must sign releases for doctors to provide information to school nurses. If parents won’t provide that permission, nurses are out of luck.

The situation is different when nurses are administering medication in school. McEttrick-Maloney said nurses have the authority to withhold doses of medication if they’re concerned about it harming a student, and they must then notify the child’s doctor of their actions.

“From a nursing perspective, we always look at the dose, and if it’s an excessive dose, the nurse always reserves the right to call the physician,” she said. “If you’re physically administering the medication, you’re in a different position than if you’re not administering it.”

Deike said parents need to inform school nurses of medication their children are taking, even if they don’t want other school staff to know.

“If they say, ‘I don’t want everybody to know about it,’ we have to respect that,” she said.

Julie Jette may be reached at jjette@ledger.com.