The following is a work of opinion submitted by the author in response to the Aug. 13 article "Two Philly school-based clinics seeking insurance payments for effective, low-cost care."

There is a danger when any organization lacks an institutional memory. A handful of schools had school-based clinics back in the early to late '90s. I know because I worked at the one located at Stetson Middle School. All of the clinics failed and were eventually closed. There were many reasons for this, and it would be a good thing to investigate these reasons before rushing out to establish clinics in more schools, wasting already scarce medical dollars.

The school-based clinic began with great fanfare after a clinic in the Midwest "proved" that their clinic decreased the numbers of teen pregnancies. Schools all over the country jumped on the school clinic bandwagon, as did schools in Philadelphia.

People wanted health clinics, but did they need them? Apparently, no one conducted a very important study—what we in nursing literally call a "needs assessment."

I transferred to Stetson from a school I loved with great joy, thinking that the clinic would solve most of my students' health problems. It didn't. Why?

Not another doctor

First of all, as the article says, if students have a primary care provider, why is additional care needed at school? Parents need education on when to use the ER, not another medical home that will fracture their already fractured health care. My students used Maria de los Santos Clinic, which was located right down the street from Stetson. They didn't need or want another doctor at the school.

Focus on mental health

Second, as a school nurse with almost 24 years of experience, I can attest to the fact that perhaps 1 percent of the kids I see in school on a weekly basis need to visit their primary care provider. (I don't know about you, but I didn't take my own kids to the doctor every time they were sick.) Most of them need to go home and go to bed.

The reality is that children are the healthiest section of our population. Children are absent for very complex reasons with health being only a part of those reasons. Schools would do better to rehire the laid-off mental health specialists rather than even thinking about providing primary care.

Nurses can handle it

Third, the vast majority of illnesses treated in school can be handled by the school nurse. Kids with asthma bring their inhalers and their nebulizers to school. If they have a problem, they go to the nurse's office to use them. Why would insurance pay for a visit to a medical provider when the school nurse provides exactly the same type of care?

If an asthmatic is truly in crisis—and this varies year-to-year and student-to student—the child needs to go to the ER, regardless of the presence of a clinic or a school nurse.

In addition, only the kids whose parents signed consent forms could actually use the clinic.

Cost-benefit analysis

Fourth, 20-year-old studies by individuals and by the Government Accounting Office proved that the effects of clinics are not significant. Student achievement and attendance fluctuated from year to year and had nothing to do with the presence or absence of clinics. I'm sure those who would want to know can find the report.

What about weekends?

Fifth, in order to be reimbursed by health insurance, the parents had to choose the clinic as their primary site. They couldn't do this because the clinic wasn't open on nights and weekends.

One of the many problems with education is that some people rush out to implement ideas before their worth has been proven beyond a doubt. We all want healthy children who attend school regularly. However, the inquiring mind might want to go back and investigate the demise of clinics fewer than two decades ago. There is no need to replicate a ship that sank.