Fifth-grader Fred Amey was upbeat when he arrived at an Ethel I. Baker Elementary School office for his appointment with the doctor.
Social worker Erin Ryan ushered him into a nearby room and took his vitals – blood pressure, blood oxygen level, temperature and weight – and recorded the stats on an iPad aimed at an empty chair.
What happened next could soon spread districtwide: As Fred, 11, sat in the chair, the face of a HippoMD doctor appeared on the iPad.
HippoMD, named after the Hippocratic oath for doctors, began testing telemedicine in early 2016 at John H. Still Elementary in the Meadowview area of south Sacramento. The company now serves about 3,000 students at five elementary schools, and both the district and the San Francisco-based company are working on a plan to expand the service across the Sacramento City Unified School District starting this fall.
It marks the first use of telemedicine among large school districts in Sacramento County. The idea, according to proponents, is to reduce chronic absenteeism among students in low-income neighborhoods who lack ready access to medical care.
Amaya Weiss, an executive community director for Sacramento City Unified, said the service means a student “can be linked to a doctor immediately, doesn’t have to work out transportation, doesn’t have to wait for an appointment, but rather is able to be seen and then is able to be sent back to class.”
The approach, however, has drawn the ire of school nurses. In March, all but one of the district’s 27 nurses signed a three-page protest itemizing their objections to the expansion and the use of nonmedical personnel to assist with doctor visits.
The nurses complained the district had violated its labor contract by using district resources to advance the interests of a for-profit company. They also objected to using teachers as “sales people,” referring to $500 bonuses that John Still teachers received toward classroom supplies if they got consent for nearly all students to use HippoMD. It is headed to arbitration.
Backers, however, say the service at John Still already has significantly reduced chronic absenteeism, and the school’s declining enrollment is showing signs of reversal, factors that could bolster the school’s attendance-based state funding.
Weiss said previously she would get permission from a principal and parents to drive some students to doctor appointments, a process that could take hours. Another bonus: “Some students who are scared of doctors love seeing the doctor over the screen because they know they are not going to get a shot,” she said.
Josh Golomb, chief executive officer for HippoMD, said the company has recruited six doctors who participate in the program and that more are in the pipeline.
Company and school officials say so far the firm has received no reimbursements for services and has spent more than $1.5 million on the rollout at five Sacramento City Unified schools.
Terms of further expansion are being negotiated, said Superintendent Jose Banda. He said that could result in a licensing fee paid by the district for use of the program, and a proposed pact could go before district trustees as early as next month.
John Borsos, executive director of the Sacramento City Teachers Association representing nurses, objected to the district entering an agreement with HippoMD without board approval. By law, expenditures for goods or services of less than $88,300 do not require board approval, district officials noted.
School officials say employees who stand in when nurses are not available are being trained on basic data-gathering requirements and laws on patient privacy. But nurses say those measures don’t stand up to a nurse’s medical background and experience.
“As school nurses, we can see 30 to 40 kids a day,” said Nho Le-Hinds, a nurse who serves students in seven schools in the district. “The kids come in all the time for different reasons. Maybe 20 percent of the time we would send them to a doctor for fever, severe vomiting, weird rashes, etc.
“The rest of the time it’s scratches or ‘My stomach hurts because I didn’t eat,’ or ‘I am having a fight with my best friend.’ Those types of things. So you do need medical knowledge to be able to triage. … This one can go here. This one can go back to class.”
Nonmedical personnel, she said, “are not trained to know what is a real headache, and what is a headache because they want to avoid class, and when it should be brought to the attention of a doctor.”
But parents and some teachers say they are thrilled with the service.
Erica Johnson said taking her three children enrolled at John Still to a neighborhood clinic is an ordeal. It takes time to get non-urgent medical appointments for her fourth-, fifth- and sixth-graders, she said. Then, when the day arrives, she’ll spend close to $18 for four all-day transit passes to the clinic.
Once there, she said, she and her family might wait for an hour or more to be seen.
“HippoMD has been a lifesaver for me,” she said.