Hospitals Say City Schools Use Them as a Cure-All
[The New York Times, 18 May 2004]
By Elissa Gootman and Sara Rimer
New York City public school officials have inappropriately flooded hospital emergency rooms with hundreds of children in recent years as a way to deal with everything from behavior problems to undiagnosed learning disabilities, hospital officials and lawyers said yesterday.
Public interest lawyers and emergency room doctors say that the practice is not new, but that it has become more common in recent years. Experts point to a variety of factors, including a general backlog in mental health services, a lack of qualified mental health professionals in the public schools and, in some cases, teachers unable to cope with disruptive children.
Experts said that particularly in the wake of the 1999 shootings at Columbine High School in Colorado, some school officials may have erred on the side of caution when determining whether children were truly a threat to themselves or others. That is the general standard schools use before calling 911 for psychiatric emergency services. In other cases, schools simply send children as an act of desperation. The practice was first reported yesterday in The Daily News.
“This has become a very accepted mode within the school system of dealing with common misbehavior,” said Kim Sweet, a lawyer with New York Lawyers for the Public Interest. “Certainly the schools are under a lot of pressure to achieve, and that leads to a greater intolerance of classroom distractions, and many of these kids are providing classroom distractions.”
Dr. Andrew Bell, director of the Child and Adolescent Crisis Intervention Program at North Central Bronx Hospital, said that about five years ago he noticed that schools seemed to be calling 911 more frequently, and for younger children. In the past few years, Dr. Bell has worked with schools in the Bronx to get the numbers down, by encouraging guidance counselors to consult with him before summoning emergency personnel.
“I can only imagine what it would be like to be a teacher in a classroom of 35 children and have one child that is knocking over a desk,” he said. “From the perspective of the school, I can understand how this would be seen as a crisis.”
“The children have all sorts of horrible things going on -- abuse, domestic violence, trauma,” Dr. Bell said. “There are expectations of us that we can fix all the problems.”
Some experts are less forgiving of the schools, saying they believe some school officials call 911 in cases where there is no indication that a child may harm someone.
“It seems to be becoming more and more of a tool that the schools and principals specifically are using,” said Nelson Mar, the education law specialist at Legal Services for New York City in the Bronx. “I think this is just one part of a lot of things the school tries to do to get a child out of their school if they find that a child is a behavior problem or the child isn't doing well in school.”
One woman, who refused to be identified because she works in the city schools, said her son, an 8-year-old second-grader at a Queens school, was taken to the emergency room at Elmhurst Hospital Center in March after school officials said he cried uncontrollably when another child pushed him.
“They called the ambulance and everything,” the mother said of her son’s hospital visit. “He was very upset, he was scared, he didn’t want to go back to school.”
The Department of Education said in a statement that principals are not supposed to send children to the emergency room without parental consent.
“In extreme cases the procedure is to attempt to calm the student, call school safety, the child's parent and E.M.S.,” the statement read. “The parent and E.M.S. decide whether the child should be taken to a local hospital’s emergency room.”
Dr. Stacey Suecoff, director of the pediatric emergency department at St. Barnabas Hospital in the Bronx, said she was studying school referrals to the emergency room in an effort to get a handle on the numbers. According to preliminary information, she said, of the 168 children who were referred to the hospital’s emergency room in the last school year and given a psychiatric diagnosis, only six were admitted. In the rest, problems like attention deficit and mood disorders were diagnosed, she said.
“So many of the school referrals are ‘dumps’ of misbehaving children,” Dr. Suecoff said. “There are kids who are disruptive in class, kids who probably do have a psychiatric history, who do have some sort of behavioral disorder. But there are also kids whom the school officials smell pot on their clothes and put them in an ambulance.”
Dr. Sandra Runes, the director of child and adolescent outpatient psychiatric services at Lincoln Medical and Mental Health Center in the Bronx, said the number of people under 18 arriving at the hospital’s emergency room for psychiatric or behavioral issues had skyrocketed in the past decade, to about 65 a month last year from about 20 a month in the mid-1990’s.
Dr. Runes said she was trying to track how many of these children are sent by their families and how many are sent by their schools.
“A significant percentage of the kids sent from schools are sent for reasons that could be managed elsewhere than an emergency room,” she said. “All the hospitals from the Bronx are saying this has happened to them.”
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