This article was originally published in The Notebook. In August 2020, The Notebook became Chalkbeat Philadelphia.
The School District is inviting outside proposals with "bold and innovative ideas" for student health and medical services, a move that could result in the reduction of unionized school nurses, whose ranks have been decimated over the last several years due to budget cuts.
Superintendent William Hite and Chief of Student Support Services Karyn Lynch said at a press briefing that the goal of the 51-page request for proposals, issued Wednesday, is to provide more school-based health services for students while not increasing cost.
They said the District is open to all kinds of possibilities — from full-fledged school-based clinics to privatized, lower-cost nurses — and were interested in proposals that would cover one school, many schools, or the entire District.
Hite described the RFP as "starting an exploratory process intended to increase the availability, utilization, and breadth of high-quality student health services."
School nurses provide health screenings, dispense medication, treat minor illnesses and injuries, get to know students, and keep track of their medical needs. They are not equipped to do comprehensive exams or provide follow-up treatment.
"School nurses have been doing extraordinary work," Hite said. "This is an attempt to also provide them with what hopefully could be more resources, [so] more children have access to quality care."
Jerry Jordan, president of the Philadelphia Federation of Teachers, which represents the nurses, sees it differently. He issued a statement blasting the District for "using a budget crisis as an excuse to shirk their responsibility to provide basic services to Philadelphia’s students."
He called the move "a shortsighted, ‘Band-Aid’ solution" and an "insult to Philadelphia’s school nurses, many of whom … do a heroic job."
Jordan said the union would be "pursuing every option available to stop the privatization of our public schools." The move comes on top of a District move to outsource substitute teacher services.
Currently, the District spends $24 million on 183 school nurses, most of whom split their time among schools. The nurses serve 218 District schools and 95 private and parochial schools in the city.
"The vast majority of our schools have to share a nurse," said Hite. Having a nurse available on only some days or only a portion of a day "doesn’t provide the kind of environment we need to respond to the needs of children," he said.
Just 90 of the District’s schools have a full-time nurse; a handful of schools enrolling students with multiple disabilities have more than one nurse.
Neither Hite nor Lynch could say how this initiative would affect school nurses. It will depend on what kind of proposals come in, they said.
"What we’re trying to do is offer more," Lynch said. "We left a good deal of flexibility to see what will be in the best interest of the students we serve."
The RFP says that the District’s intent "is to provide high-quality, cost-effective and reliable health services to students in all District schools and programs."
"To bring the latest advances in health services to our schools, we need evidence-based, bold and innovative ideas from healthcare providers," it reads.
Jordan, however, noted that more than 26 percent of the city’s families live in poverty and that "the school nurse is the only medical professional many children see for health care. The District should not attempt to save revenue on the backs of poor students. They should instead be hiring more nurses to serve our children."
He said that in contract negotiations, which have been going on for nearly two years, the District has been seeking to eliminate all language regarding nurses. State law requires a school nurse at a ratio of one per 1,500 students, although the recommendation of professional organizations is one per 750 students.
Maura McInerney, senior staff attorney at the Education Law Center, did a study of school nurses when the District drastically cut their numbers and concluded that students at schools with part-time school nurses didn’t fare as well as those with full-time nurses.
"We have seen the devastating impact of the reduction," McInerney said. "A lot of times people are not familiar with how much school nurses do, especially in forming relationships with students and tackling behavioral issues, all of that."
She added: "As far as the District is seeking other options, ELC’s focus is ensuring that children’s health care needs are met. When you hear outsourcing, it’s important to ensure that we have highly trained and qualified school nurses" and that the District and providers see that there is a "value to having the consistency of a school nurse who has been there and working with the kids for years."
In January, the School Reform Commission held an informational District policy and strategy meeting on student health services. A presentation prepared for that meeting said that the "range of services required" for a mostly low-income population in which conditions like asthma and childhood obesity are common "is much more broad and complex than just managing illness and injury."
For instance, some 36,000 students in schools served by nurses have asthma, according to District figures.
Outside providers may be able to afford to provide school-based services, because they can be reimbursed for some of them through federal and state medical assistance programs and insurance companies. Now, most activities conducted in schools by nurses are not reimbursable.
But even for those that are, including some services provided for disabled students, the District has had difficulties doing all the paperwork required to obtain the reimbursements.
Lynch cited a model used by Universal Companies at its charters. Universal contracts with an organization called Education Plus, which opens clinics in schools with nurse practitioners.
A model through another organization, called the Oral Health Impact Project (OHIP), which does dental care in schools, could be duplicated for other health needs, its director, Lawrence Caplin, told attendees at the SRC meeting. That model, which has partnered with schools in Camden and Baltimore, includes a school nurse and has been used in some District schools.
"It would be ideal if some of the hospitals in the area responded. It would be ideal if the PFT responded to the proposal and provided a way that we might be able to better afford health services and augment our services," Lynch said. "We’re not predicting what the model is going to look like as much as we’re seeking what might be available and benefit the students we serve."
The District is asking for responses to the RFP by June 10 and hopes to begin implementation when school opens in September.