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School Committee Grapples With DNR Policy

It's both a sensitive and uncomfortable subject, yet it's one that needed to be discussed. The subject of an official policy for how the public schools respond to a DNR (Do Not Resuscitate) order was brought before the School Committee at the June 9 meeting.

Director of Nursing, Judy Dagnese, sought approval for a policy on DNR orders, which would also support the addition of a MOST (Medical Orders for Scope of Treatment) order, as well. The proposal was spurred by an existing case of a Milford student whose parents had implemented a DNR order, before opting for other alternatives.

Dagnese explained that with both DNR and MOST orders, documentation would be required to be on the student's person at all times. A copy must also be forwarded to the Fire Department, "for when EMS (Emergency Medical Services) are activated".

"The MOST form is very clear as to what may or may not be done for the student," she noted, "and covers three areas: resuscitation, intubation and transfer to the hospital. If the form is not present when EMS arrives, they will do a full work-up (on the patient)." Both the MOST and DNR forms must be signed by the student's parents/guardians and their physician.

Committee member, Paul Mazzuchelli, wondered at whether the "severe decision that someone had to make" would be "reviewed every now and then" because, he added, "sometimes people change their minds". Dagnese reiterated that that situation had already occurred, with the parents changing their minds about a previous DNR order. "It was changed to something less severe," she noted, "where the parents want more done as opposed to a DNR."

Chairperson, Loriann Baranauskas confessed, "it stuns me to have to have a policy like this" but recognized that it "was necessary and important".

School Committee member, Patrick Kennelly, admitted to being personally opposed to the policy saying, "I respect the parents' rights and clearly, I don't think anyone in that situation takes it lightly, (but) to me it's contrary to the mission statements that we have in the public schools." He declined to support "this or anything like this" because "it's very challenging to allow such an occurrence to happen in a public school setting".

Dagnese then reminded Kennelly that "you understand we can't ignore it" and that the creation of such a policy has been recommended by the Massachusetts Department of Public Health and their legal department.

Kennelly countered by pointing out that "the state recommended it, but they can't force me (to accept it)". He clarified his stance by stating "I have no objections to what you're presenting, I just have a real strong conflict in my mind that it's contrary to our mission statement".

Baranauskas, on the subject of legality, noted that for any policy, it was standard procedure to seek a legal opinion before a decision is reached.

She then explained that "the Committee generally takes a first reading (of a policy proposal) under advisement" and then votes to approve or disapprove at the next scheduled meeting of the Board.


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