More kids rely on school clinics for health care

Ana Cortez tilts her pig-tailed head back and opens wide so nurse practitioner Gloria Baca can peer down her throat.

The 7-year-old won't be returning to her second-grade classroom at Gilbert Elementary School for a couple of days. She has bronchitis and will need antibiotics, fluids and bed rest.

Younger brother Victor, 6, sits nearby, next to his mother. He's spent the past two days at Banner Children's Hospital at Banner Desert Medical Center in Mesa after an asthma attack sent him into cardiac arrest.

So while Baca, who works for the hospital covering school-based clinics in four East Valley districts, only treats kids, she knows this is a teachable moment for the children's mother as well.

She explains to Anagelica Cortez that it's important to follow a plan to keep Victor's asthma under control. Baca has seen the children in the clinic before. The right equipment, and knowing what to look for, might have headed off Victor's attack.

"She would've been able to tell when he was in trouble," Baca said.

Though she arranges to see Ana for a check-up next week, Baca and the Valley's school-based clinics aren't equipped as primary care centers.

The 16 Banner Health Foundation-funded clinics serve children attending 96 schools in Mesa, Tempe, Chandler, Gilbert and Phoenix districts for things like ear infections, colds and flu, as well as immunizations and sports physicals.

Scottsdale Healthcare also runs clinics in Scottsdale schools.

"People are on the cliff," Baca said. "We just don't want them to go over."

School-based clinics have been around for decades, and Banner began its program in 1994, but a growing number of uninsured children are relying on them as their sole source of health care.

Banner Children's Hospital spends less than $700,000 to serve some 3,000 children each year - kids who might otherwise be treated at urgent care centers or hospital emergency departments.

"The best case is for somebody to have a medical home. At this point, with the funding we have, we really can't provide that," said Dr. Jeffrey Lobas, chief medical officer at Banner Children's, which took over clinic operations from Banner Occupational Health Services earlier this year.

"There's a safety-net function," he said. "But we're trying to be something more than, good-bye and good luck."

Most of the children Baca and other school-based clinicians treat can't get health insurance because of their immigration status. The rest are uninsured because their parents can't afford it.

Roughly 15 percent of Arizona children - or about 50,000 kids - are uninsured.

Like 9-year-old Luis Roman, who was in Baca's clinic Tuesday with his dad. The boy had a rash on his upper legs, and Baca has seen him before for skin and other allergies.

In addition to diagnosing the rash, and prescribing oatmeal baths and hydrocortisone, Baca checks Luis' other vitals. She may not see him again for months, and this is her chance to make sure he's doing OK otherwise.

Her diagnosis also allows the third-grader to head straight back to class. Often, a school nurse will have to keep a child out of school until their ailment is confirmed, just to be sure what they have isn't contagious.

The clinics allow students to be seen quickly - Luis, Victor and Ana were in and out in about 20 minutes - and get back to the real reason they're at school.

School nurses, teachers and other staff provide a steady stream of referrals.

"I wish we could have her more," Gilbert Elementary nurse Barbara Naleski said as Baca prepared to see her fourth patient of the morning.

Seventh-grader Brice Martin's counselor had brought him over from Gilbert Junior High so he could get a sports physical. Look for Brice playing wide receiver this season for the Tigers.