GRESHAM, Ore. - A mother is looking for answers after she's told she must take her 8-year-old daughter out of school and off school property to feed her every day.
"It seems very unfair. No one else has to take their kids out of school to feed them at lunch," said Beverly Hanset-Burch.
But her daughter, Bonnie, has special needs, and somewhere a decision was made that the school and staff could not support them anymore during lunch.
Bonnie was born with arthrogryposis, a congenital disorder. She needs a lot of assistance to get through daily life. She can't eat solid food and has been plunge fed since she was 2 years old.
"I had hoped that Bonnie would get stronger and be able to feed herself, but fighting against her abs muscles is just not working right now. She doesn't have the strength in her upper body," Beverly said.
Bonnie's in the third-grade at East Gresham Elementary and since kindergarten an aide has plunge fed Bonnie at lunch.
But suddenly policy changed. Beverly was notified Monday the school district's nurses would no longer be giving directives to aides to perform medical procedures and feeding Bonnie is considered a medical procedure.
"They say it's dangerous," Beverly said. "We've had no danger. It's been fine. Nothing has happened with Bonnie."
According to Beverly, the Multnomah Education Service District now requires Bonnie be fed off campus.
According to Gresham Barlow School District spokeswoman Athena Vadnais, the district operates under rules set forth by the MESD. When the education service district changed their policy, the district followed suit.
Vadnais said the plunging method must be overseen by a licensed nurse and the school cannot make exceptions from the MESD rules. She said the school offered an alternative.
Bonnie said the alternative recommended by the educational service district was an expensive food pump machine that beeps frequently and draws unnecessary attention to her daughter.
MESD spokesman Mark Skolnick said he could not comment about specific students because of privacy concerns. He did say, however, that MESD nurses follow guidelines set forth by the Oregon State Board of Nursing.
He said school nurses no longer use the plunge method because it requires "continuous, forceful pushing of the syringe to administer." That causes concern that a nurse wouldn't be able to tell if there was a blockage, which could harm the student.
"I'm frustrated. I want my daughter to be in the cafeteria with other children eating with her typical peers like she has been (since) kindergarten, first, second and half of third-grade," Beverly said. "I feel like it's going to make other kids say, 'Where's Bonnie?' and make her freakish or something when she's a vibrant little girl who deserves a free and appropriate public education with her typical peers and less restrictive environment and needs supports in a place to help get that education."
Beverly said there were three people at the school trained and able to feed Bonnie and she just doesn't understand why things had to change.
Multnomah Education Service District (MESD) and Gresham-Barlow School District (GBSD) are aware of the situation at East Gresham Elementary School.
MESD and GBSD are unable to comment on the health care of a specific student, respecting confidentiality requirements.
MESD provides professional registered nursing services to the Gresham-Barlow School District, the seven other public school districts in Multnomah County, and to school districts throughout the region. MESD's registered nurses provide nursing assessment and management of all known health conditions of school children while at school.
MESD school nurses develop protocols to manage nursing procedures which follow the scope of practice defined by the Oregon State Board of Nursing, in accordance with the Oregon Nurse Practice Act.
The process for determining health care protocols for students under the care of MESD nurses begins with a nursing assessment. When assessment determines a feeding procedure is required, MESD nurses follow nursing practice guidelines to ensure the safest procedure is used. Nursing practice supports gastrostomy tube feeding by gravity or through a pump.
The plunge method, which MESD nurses no longer use in a school setting, requires continuous, forceful pushing of the syringe to administer. When thick blended food is forced through a tube using a plunger, a primary concern is that by forcing the plunger, the person feeding the child is unable to determine if a blockage is present. A blockage could mean that the tube placement has been dislodged, leading to injury to the abdominal cavity, peritoneum, or stomach wall.
Nurses can and do delegate gastrostomy tube administration of feedings using the gravity or pump method. This method is standard nursing practice and considered safe because the nurse can readily identify if there is a blockage preventing the flow of the feeding.* It is necessary to identify a blockage in order to prevent potential harm to the person receiving the feeding.
The goal of both MESD and GBSD is to provide a safe school environment and promote attendance for all students. MESD and GBSD understand the rules and regulations required by IDEA and Section 504 of the Rehabilitation Act and follow these requirements with all students who qualify.
*Source: Hootman, J. (1996). Quality nursing interventions in the school setting: Procedures, models, and guidelines. National Association of School Nurses, Inc.