School Nurse Fails to Recognize Appendicitis in a Seven-Year-Old Girl

This case involves a seven-year-old girl who complained of severe abdominal pain to her second-grade teacher, her school principal, and her school’s nurse. The child was frequently disciplined for disturbing the classroom setting and for complaining of nausea and dizziness. Early in the morning (9:30 AM) the child first complained to her teacher of severe abdominal pain. By 10:00 AM, the child was noted to be laying on the ground in her classroom, crying because the pain became overwhelming. At this time, the school’s principal was asked to speak with the child – and he brought her to the school’s infirmary. The infirmary/school nurse advised the principal that the child was probably “faking” and should be sent back to class immediately. She was then reprimanded by the principal and instructed to sit in her seat for the rest of the day without speaking. The child did this until her appendix likely ruptured and she passed out and became unconscious. An ambulance was called and an emergency surgery was ordered. The child required four subsequent procedures and was discharged after a three-month hospital stay.

Question(s) For Expert Witness

1. Is it a departure from the standard of care for a school nurse to fail to offer a more thorough workup of this child / i.e. contact her parents or call an ambulance, to have the child brought to an ER?

2. If a child is clearly in significant pain and discomfort, does the school nurse have an obligation to ensure that proper care and monitoring is ordered?

Expert Witness Response E-004490

I have worked as a school nurse for eighteen years and have served on various committees which develop guidelines and policies for school nurses. It is absolutely the school nurses responsibility to err on the side of caution. We are trained with this thought in mind. If there is even a slight likelihood that the child isn’t “faking” and actually requires medical assistance, it is imperative that the school nurse calls a local ER, the child’s parents, the pediatrician, and an ambulance. This should never be delayed for the reason illustrated in your case above. This nurse should lose her license and I believe the principal is negligent, too. Any child who presents with complaints of severe abdominal pain (who is laying on the ground, complaining, etc.) deserves immediate medical attention.