The consent process they are using for care and services is MASSIVELY problematic, if it is true that mother signed a consent form for blanket treatment, TWENTY MONTHS AGO, in March of 2015. I cannot think of any other environment within healthcare that a blanket consent for any and all care would be legally valid for such an extended period of time. I wont spend too much space going into details, but nearly every health care setting requires signing HIPPA and insurance papers at a minimum of every 12 months, and pediatric procedures are consented typically "one" episode at a time. Why should poor kids treated at school be given LESS informed consent than what occurs in a clinic environment? Boggles the mind.
So there are large questions about consent for careis it the school districts responsibility, the dental providers, the social services agency who hosts the dental care, etc. Likewise, it is extremely problematic that it isnt clear whose responsibility it is to contact a parent, when that contact should occur, and what to do if they cant reach a parent.
I cannot fault what the dental professionals did (extractions) without knowing much more about the totality of the situation, and seeing the records. It looks like from the pics that the 3 deciduous teeth (baby teeth) removed were extremely close to coming out on their own. It could be that during the course of instrumenting and cleaning the childs teeth, the loose teeth were loosened to a point where if they left them, he was in more pain and risk (swallowing, choking, ongoing minior bleeding, etc) than if they just plucked them out, and ensured the bleeding stopped. There could have been food particles stuck under a hinged tooth, etc. Simply because they removed those teeth does not make it an incompetent decision, or even an unwise one.
The problem lies with the consent process, the parental notification process, and the liability of the school and the dental group, as well as questions about whether the child should have been allowed to walk home.
Did the school admin, or dental people, TRY to reach a parent to get more consent, or to come and get the child at the end of the day? What do they do if they cant reach a parent, and its the end of the school day? Did the child live in a defined walker zone, but also had the option to take a bus? Did he miss a school bus, or a city bus? We have only the mothers story to the press, and I am quite skeptical that this is the whole story. The school and the dental group cant say a thing, so we only have the sensationalized reporting, and half the story.
Part of the problem here is the desire to provide social services within the framework of the school system. I used to be supportive of this technique, but I think we should substantially modify our expectations, and our approach to how we try to encourage participation in social services among the rural and inner city poor. I think this mechanism of trying to provide some basic medical services and social services worked well about 50 years ago, when populations were more homogenous, and the overriding goal was to provide herd immunity for things like the widespread and devastating polio epidemic. But now we have traversed into an era where many medical, dental, and social services are not only promoted, but hosted by the school systems on school property, DURING the school day. This is a serious problem that has more serious issues and risks NOW, than benefits, IMO.
The goal of providing medical, dental, and social services on school property is to centralize the portal of entry to a menu of social services for poor families, and the convenience of providing "needed" care to a population of neglected kids that are there almost every day. That sounds very good on the surface, and in many third world nations, it is a model of public health that works extremely well.
However, IMO, it doesnt work well at all in rural and inner city USA, for many reasons. Imagine all of the legal and social ramifications of what could happen if some unlucky child got a shot of local anesthetic for dental care, and had a cardiac arrest right there in the school building??!!
Poor families often claim they have no money, resources, or time to get their kids needed carebut the other side of that issue is that many low income parents simply do not want to do what is needed to even get free services for their kids. There are many programs that give free bus passes, or even taxi vouchers, AND free care, and still the parents dont bring the kids in for care. So, by offering these charity services during the school day, we bypass the neglectful parents, and substitute the school system for what the parents should be doing. I know thats controversial to say out loud, but it is the harsh truth.
IMO, the dental professionals currently providing services to low income kids in that district will now probably pull out. And I think they shouldnot because Im heartless, and want poor kids to have a mouthful of rotten teeth, but precisely because of what has happened with the consent process, and liability for both the school district, and the health care providers. This family is almost certainly going to try to sue the district and the dental providers, and IMO, is laying the groundwork for that with the publicity, and seeking out a private dentist.
IMO, the role of the school is to *promote* social services, not PROVIDE them. Families should be given information on where to go to receive low cost, or free services. They should be REFERRED to county social services, which should be provided NOT on the campus of the school, for reasons of acute liability for the school and the medical providers. The kids who need dental care, for example, should be given information on free services, and how to contact a social worker if they need transportation, or signed up for Medicaid, etc.
If a family shows up for dental or other care at a clinic, then the clinic and the professionals are responsible for the consent process, etc. This muddling of the school with the social services agencies and the medical and dental providers is extremely problematic, IMO. You can even argue that providing free care off the campus better protects the privacy and dignity of the poor kids, since no one need know they are "poor" and getting the "free" care at school. If the parents don't follow thru on recommended services, that is another issue that should be resolved with child welfare agencies. Schools should be referring people to services, not providing them.
I still think the "free food" programs that occur during the school day are beneficial, and don't have a problem with those. But medical care, dental care, well-child checkups, immunizations, psychological services, etc-- SHOULD NOT be provided on the campus of a public school in the USA. And this case is a perfect example of why they shouldn't, IMO.
