THE PHILADELPHIA School District wants to upgrade and expand health services, officials announced yesterday, but could it come at the expense of school nurses?

Superintendent William Hite said the district will explore the option to contract with private providers to offer students more access to health services, which have been drastically reduced because of budget cuts, leaving many schools without a full-time nurse. He said the move does not mean the district will get rid of the 183 nurses it employs.

"The . . . nurses that we have have been doing extraordinary work, and this is an attempt to also provide them with hopefully what could be a resource or more resources that will provide for more children having access to quality care, particularly in schools," Hite said.

The maneuver is viewed by some as an attempt to phase out current nurses, who are represented by the Philadelphia Federation of Teachers, which is already in a contract dispute with the school district over its collective-bargaining agreement. The district has tried to remove contract language related to school nurses, but the union has refused.

PFT president Jerry Jordan called the district's latest effort "a shortsighted, 'Band-Aid' solution," according to a statement released by the union. He said school nurses have specific training and qualifications that can't simply be contracted out.

"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," Jordan said.

Why not just hire more nurses? The district said it hopes an agreement with a provider - or multiple providers - would bear no cost to the district, but be reimbursed by public insurance or other sources.

The district provides health services to 218 district schools as well as 95 private and parochial schools in the city, at a cost of $23.7 million this year. With the recent reductions - 100 school nurses have been laid off since 2010-11 - the district has only one nurse for about every 930 students, which meets federal and state guidelines but is much higher than the recommended ratio of one to 750 students, Hite said.

Privately run school-based health centers have become popular across the country. About 1,930 schools had health centers or programs in 2010-11, according to School-Based Health Alliance, a nonprofit devoted to improving health for kids. Several Philadelphia charter schools have such centers, often staffed with nurse practitioners who can write prescriptions, administer vaccinations and conduct physicals.

As part of the district's request for proposal, potential providers could serve one school or several schools, or phase in services over a period of time. They could also have staff work alongside district nurses or assume district nurses as their own employees.

Donna Cooper, executive director of Public Citizens for Children and Youth, a local youth-advocacy organization, lauded the idea of expanding medical care to kids, but said the district must ensure that providers offer high quality and reliability.

"Everything has to be at least as good, if not better, than what we have," she said.

Last school year, two children in city public schools died without a nurse on duty. Sebastian Gerena, 7, collapsed at Jackson Elementary because of a rare congenital heart defect. Laporshia Massey, 12, died after suffering an apparent asthma attack at Bryant Elementary.

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