Student Privacy Rules Arouse Fears Spokane Schools Redraw Rules On Keeping Student Medical Information Strictly Confidential

Students may be bringing more than textbooks to school.

But strict Washington state confidentiality laws could prevent classmates, principals, teachers and even nurses from knowing what potentially dangerous, contagious illnesses students carry.

The Spokane School District has redrawn rules for obtaining student medical information, touching off an ethics debate that concerns everyone from civil libertarians to school recess monitors.

Following the advice of the state superintendent of public instruction and the attorney general, the school district adopted a new rule that allows parents to shield their children’s medical records from educators.

That, education groups say, could endanger the safety of both teachers and students.

“The ones who truly need to know - the teachers, the principal - to create a safe environment for the student, often can’t,” said Carole Murphy, nursing coordinator for the school district.

Others, including the American Civil Liberties Union and health care givers, say a student’s right to privacy is paramount, guarding a child from discrimination.

“Think about how adolescents treat anyone who is different,” said Anne Stuyvesant, direct services coordinator for the Spokane AIDS Network. “The stigma will be there.”

The new waiver requires parental permission for nurses to release student medical information to anyone else. Each teacher or administrator must be specified by name and title.

In addition, waivers from parents would expire after 90 days, and any change in the student’s condition would require a new waiver.

Changes to the waiver follow state law, so board approval was not necessary.

“The student and parent have total control,” said Mary Brown, Spokane’s head of student services.

A Seattle couple used a similar waiver last year to prevent a nurse from talking to the physician of a critically ill student. The student came to school with a breathing tube in his throat after a tracheotomy, but the parents’ reluctance left the nurse to wonder what to do in case of an emergency.

“This could be an absolute nightmare,” said Brown.

Confidentiality of student medical records is governed by a complicated web of state and federal laws. Recent changes to state confidentiality laws prompted the Washington state attorney general and top school nursing administrators to analyze the statutes.

Last year they issued suggestions for school districts.

Idaho rules are far less clear. Jane Brennan of the Idaho Department of Education said she knew of no guidelines. “No one’s really brought that up,” she said.

The Washington guidelines say nurses can disclose medical information if there is immediate danger to the student or “community health.”

But schools have had difficulty balancing privacy and safety, in part because state medical confidentiality laws were written for businesses. Applying the laws to schools, students become employees, school districts employers.

In some cases, it’s easier for school districts to know about a student’s criminal history than a viral infection.

Each case is unique, prompting a school district lawyer to compare redrawing guidelines to “a law school exercise, with everyone saying, ‘Yeah, but what if …”’

A tuberculosis infection? “That’d probably be a judgment call. Some of them are. You can tell why it’s so difficult for us,” said Midge Malsam, head nurse for Central Valley School District.

Last fall, a pregnant teacher in Spokane’s District 81 was reassigned when a nurse discovered one of her students had a viral infection that could harm a fetus.

The nurse told the teacher of the student’s infection with cytomegalovirus, which can cause retardation, but didn’t have to, according to Judy Maire, head of health services for the state superintendent of public instruction.

Administrators wouldn’t give names, citing confidentiality.

“It’s up to the nurse to decide what is vital information,” said Maire.

Maire says teachers should treat every student as if he or she were infected with an incurable, fatal disease like HIV. If they did, the Spokane nurse wouldn’t have had to tell the teacher of the student’s infection, Maire said.

“If a kid has a bloody nose, we treat it like it carries blood-borne pathogens,” said Mike Cantlon, a teacher in Spokane’s Tessera program for gifted students.

But nurses also have gotten into trouble for not disclosing vital medical information which could protect teachers, classmates or even students themselves.

A Connecticut nurse resigned after keeping mum about a 16-year-old student’s pregnancy. The girl, who refused to tell her parents, delivered into a toilet bowl, and is being charged with manslaughter.

The case of the pregnant Spokane teacher is an example of why teachers need access to student medical information, says Lynn Jones, president of the Spokane Education Association.

“If I have a teacher exposed to an infectious or lifelong illness, they are with (students) six hours a day and have a right to know,” he said.

That knowledge also helps improve student education and safety, teachers say.

“If a student has something that could go wrong, if I knew that I could protect that child more. I could make it the least terrible, the less damaging situation,” said Shadle Park High School teacher Joyce Simpson.

Connecticut educators resolved the dilemma by allowing nurses to tell teachers, playground monitors and coaches a student’s symptoms and possible treatments without disclosing the medical diagnosis.

“For the teacher who doesn’t have a medical background, it’s much more important to know the symptoms,” said Nadine Schwab, a national expert in student medical record confidentiality and Connecticut’s chief administrator for school nurses.

For many in Spokane, the example set by young north Spokane AIDS patient Kara Claypool illustrates the importance of the complex issue.

Joyce Claypool could have kept her daughter Kara’s illness a secret, hidden by strict federal shield laws governing HIV/AIDS. Her teacher and classmates would have been left to wonder at their classmate’s breathing mask. Instead, the school rallied around Kara until her death.

Nurses and educators hope parents will follow Claypool’s example and not the one set by the protective Seattle couple.

“Most parents, because they are caring for their children, will understand the value of needing to know,” said Charla Dunham, national representative of the School Nurses of Washington.

, DataTimes MEMO: This sidebar appeared with the story: NEW RULES The new waiver requires parental permission for nurses to release student medical information to anyone else.