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In 2009, Ethan Belcher a first grader at Kelly Elementary School in Wichita, Kansas was excused from class to use the restroom. While using the urinal, his pants came in contact with an undiluted general-purpose disinfectant solution that had puddled onto the floor. According to court documents, after returning to class, the student began “complaining of burning and stinging” near his left hip area, (The Wichita Eagle, 2018). The student was sent to the nurse and returned to class with an ice pack. The teacher became concerned as the student’s condition worsened and he was carried to the nurse’s office for further examination. It was then discovered the student had a five inch by four-inch wound on his left hip area. Ethan was taken to the hospital where doctors later determined the student had suffered a third-degree chemical burn. Ethan had to undergo several surgeries and major skin grafting while spending a month in the burn unit. His mother filed a lawsuit alleging the Wichita School District was negligent in ensuring her son’s safety at school. A settlement was reached out of court in February 2014.
Application to Readings
HISTORY OF SCHOOL NURSING
School nursing dates back over a hundred years and the basic need to provide a safe and sanitary environment in which to attend school and learn was the focus. A safe, healthy environment continues to be one of the main components of a successful school health program today. Over 90% of all children spend their days inside school buildings making them vulnerable to array of environmental hazards (healthyschools.org, 2018). Some potential sources of exposure in schools include biological and chemical hazards, air, food and water contaminants (Schwab, 2005). These exposures during childhood can have a lifetime impact due to student’s developing organs, body size and vulnerability. All children are at risk of developing future health and learning difficulties due solely to the environment of their school (healthyschools.org, 2018). Students must be able to learn in an environment free of hazardous contaminants posing health risks to them. Currently, the Environmental Protection Agency (EPA) regulates chemicals found in school buildings and every chemical used in schools must have a Material Safety Data Sheet (MDSD) that describes chemical properties, storage, disposal, potential hazards, as well as protective equipment and spill handling procedures (EPA.gov, 2018). Many schools have started adopting green cleaning programs by selecting alternative products to help minimize health risks. States play a critical role in the implementation of a healthy school environment by setting guidelines to encourage school districts to formulate the best plan possible to ensure all student’s health and safety.
SOURCE AND CLASSIFICATION OF LAWS
The lawsuit filed by Ethan’s mother on behalf of her son, against Wichita School District was a case law or law of judicial decision. Although this lawsuit was settled out of court it was determined a civil action lawsuit alleging negligence on part of the Wichita School District and co-defendant, former school nurse, Cynthia Ann Thomas. The tort action of negligence does not require any intent but results from a breach of legal duty (Schwab, 2005). Ethan’s mother argued the school system was negligent in ensuring her son’s safety at school. First, for allowing hazardous chemicals to spill on the floor, second, for failing to train custodians in the proper handling and storage of chemical agents and finally, that the school nurse failed to examine and identify the student’s injuries as well as initiate the proper care and treatment of a chemical burn.
Ethan Belcher’s mother, Martha Smith, filed a lawsuit alleging negligence against Wichita School District in permitting hazardous chemicals to collect on the bathroom floor where students could be harmed and failing to properly train employees on safe use and storage of chemical agents (The Wichita Eagle, 2018). The undiluted cleaning solution, which is normally diluted 2 to 3 ounces per gallon of water, soaked into the student’s clothing causing a third-degree burn wound. The lawsuit also names the school nurse as co-defendant in the case stating she failed to assess the student’s injuries as well as failed to identify and treat the chemical burn. According to court documents, during the initial health room visit the school nurse gave the student an ice pack but never assessed the area causing discomfort. It was later determined at the hospital the wounds likely worsened and increased in size due to the delay in treatment at school. “Liability in a negligence action does not require intent on the part of the defendant but proof that the defendant’s conduct did not conform with a standard of care” (Schwab, 2005). It appears the school district and school nurse were negligent in ensuring Ethan’s safety and health while at school. If this case had gone to court the four elements of negligence would have had to be proven with more than 50% of the evidence indicating the school district and school nurse were at fault in causing injury to the student. The school had a duty to keep a healthy environment free and safe of hazards and the school nurse had a duty to assess the student’s health concern/complaint. Since the school nurse failed to assess the needs of the student she then was unable to execute the duty owed which establishes a breach of duty. This leads to a proximate cause. The school nurse failed to assess for injuries, and take action resulting in further harm to the student. The student sustained an injury or damages in the case proving all four elements of negligence were present (Schwab, 2005).
STANDARDS OF PRACTICE
All school nurses have a duty to assess our students who are in our care and collect all information needed to make a sound judgement in the treatment or outcome of a student’s health situation (ANA, 2015). In relation to this case, the student appeared to have a complaint of burning and stinging that was not thoroughly assessed. According to court documents, the nurse gave the student an ice pack and he returned to class.
As school nurses we are required to analyze information in our assessment to determine a potential problem (ANA, 2015). Due to the limited assessment the school nurse conducted, she was unable to formulate a proper diagnosis or health issue in a timely manner. The student’s health continued to decline which resulted in an emergency.
To identify an expected outcome for a plan, the school nurse must be able to accurately assess and diagnosis the health situation (ANA, 2015). In this case the school nurse’s assessment and diagnosis failed to deliver a favorable outcome due to a poor initial assessment. This resulted in not being able to develop an expected outcome or facilitate care in an efficient manner. The student suffered a third-degree burn and an extensive recovery.
STANDARDS OF PROFESSIONAL PERFORMANCE
The environmental health of Kelly Elementary School in relation to this case was unsafe. Schools use chemicals in a variety of ways daily. The appropriate storage and proper management of chemicals must be maintained to help ensure the environmental health and safety of students. It only takes one incident to break a community’s trust. Toxic chemicals are associated with several serious health problems and in this case a young boy developed a third-degree burn with permanent scarring. The school nurse can assist in promoting a safe and healthy work environment by advocating for safer products to reduce environmental risks (ANA, 2015).
This legal case shows the serious health hazards which can result from an unsafe environment. All schools use chemicals daily in a variety of ways from cleaning agents to classroom chemistry labs, elementary to high school level. It is imperative schools have a safe and effective chemical management program. Improper use of chemicals can impact our student’s health and safety as well as cost schools financial stress and possible school closure or legal issues. Improving chemical management through proper training of staff, regular inventory assessment to dispose of chemicals that are outdated or unauthorized, and appropriate storage with accurate labeling can help the environmental health of schools (EPA.gov, 2018). An area I feel strongly is incorporating green cleaning products into environmental health programs. Many school districts have begun to adopt green cleaning programs and practices. “Green cleaning” products reduce the harmful effects on health and the environment by using safe effective alternatives that are environmentally friendly. The school nurse has the knowledge and understanding of environmental health issues and is in a pivotal position to advocate for a successful sustainable healthy school environment (NASN, 2018). A healthy school environment can create lasting benefits to students and staff!
- American Nurses Association, (2015). Nursing: Scope and Standards of Practice (3rd Edition Silver Spring, MD: ANA (pages 4-5).
- Environmental Law Institute, (2018). Retrieved from: https://www.eli.org/buildings/green-cleaning-schools
- Environmental Protection Agency, (2018). Retrieved from https://www.epa.gov/schools/role-states-fostering-environmental-health-programs-k-12-school
- Healthy Schools Network, (2018). Retrieved from https://www.healthyschools.org/coalition.html
- National Association of School Nurses, (2018). Retrieved from https://www.nasn.org/advocacy/professional-practice-documents/position-statements/ps-environmental-health
- Schwab, N.C. & Gelfman, M.H.B. (2005). Legal Issues in School Health A resource for School Administrators, School Attorneys, School Nurses. Lincoln, NB: Authors Choice Press.
- The Wichita Eagle (2018). Retrieved from https://www.kansas.com/news/article1132426.html
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