Seven-year-old Sebastian Gerena died in May 2014 of rare congenital heart disease. When he collapsed at his Philadelphia elementary school, there was no school nurse on duty.
Eight months earlier in the city, 12-year-old Laporshia Massey died after suffering an asthma attack. When she complained about having breathing problems at her elementary school, once again there was no medical professional available.
In Philadelphia public school district's cash-strapped buildings, school nurses aren't a guarantee. As of October 2015, three of the district's schools didn't have any school nurses, according to the Philadelphia Inquirer. Another sixteen schools only had nurses on certain days of the week or at certain times.
A bill introduced in late February by Sen. Jon Tester (D-Mont.) seeks to fill some of these health care holes. If passed, the NURSE Act would allow schools and state agencies to apply for federal grant funds that would cover 75 percent of the cost of hiring a full-time school nurse. The grants would target under-resourced and low-income schools.
In the two Philadelphia cases, it is unclear whether a school nurse could have prevented the students' untimely deaths -- a wrongful death lawsuit for Laporshia brought against the city of Philadelphia was dismissed last year. But it's easy to believe that it may have helped.
"During times of tragedy, our community should not have to question whether an extra staff member or program would have made a difference," Philadelphia Public School superintendent William Hite said after Gerena's death.
Tester introduced the bill "because kids who are sick don’t perform well in school," he said. He says that schools now have less access to nurses than they did in previous eras amid budgetary constraints.
"It's gone the same way as the arts and physical education and all those kinds of things," Tester said. "I believe in reading, writing and arithmetic with the rest of them but when things get cut these are the kinds of things that go."
Sue Buswell, the Montana director of the National Association of School Nurses, says there has been an increase in students who are diagnosed with chronic health conditions like type 1 Diabetes, as well as students suffering from mental health issues.
"School nurses may be the only source of accessible health care for many of these children who are unable to see providers because they have no insurance or because of social determinants of health that prevent them from getting to health care and health care providers," said said. "A lot of those social determinants include things like poverty, hunger, homelessness, lack of transportation and language barriers."
In Montana, Buswell notes, 26 percent of students don't have school nurses in their district. A 2007 analysis from the National Association of School Nurses found that only 45 percent of public schools have a full-time, registered nurse.
"School nurses provide accessibility for all students to be able to be in the classroom, which is really the bottom line: getting kids in school and keeping them in school," Buswell said. "Schools with school nurses have lower drop-out rates, higher graduation rates, opportunities for parents to be at work and not have to come home to take care of their kids."