Ten-year-old Javier Avina collapsed in his Wallaceburg school with his emergency allergy medication unused and a asthma puffer that lacked a key medication, the investigating coroner has found.
Though school officials and police said last week everything possible was done to save Avina, Dr. Michael McElligott said one key intervention that might have saved his life was not available and a second may have been done too late.
It was either an allergic reaction or asthma that killed Avina April 5 at St. Elizabeth Catholic elementary school, McElligott said. Either way, Avina did not get all the care that might have saved him, the coroner disclosed Tuesday in an interview with The Free Press.
A nurse practitioner in December prescribed two puffers to Avina, who had asthma and also carried an EpiPen because he was allergic to peanuts and egg whites. The medical device delivers a dose of epinephrine, better know as adrenaline, to users experiencing a severe allergic reaction.
One of Avina’s puffers had lapsed and not been renewed, McElligott said, leaving Avina with a puffer that lacked a vital medication, one that reduces inflammation that can block breathing passages, and forcing him instead to rely on two puffs of a single medication whose overuse can place stress on the heart.
“The treatment was not the standard of care,” McElligott said.
Avina’s mother, Melodie Avina, told The Chatham Daily News her son complained about his puffer the night before he died. Javier told her his puffer felt full, but he wasn’t getting medicine out of it, that it felt as though he was inhaling air only.
The Walpole Island First Nation woman said school officials told her on the day he died Javier told his teacher he didn’t feel good and felt as though he was going to vomit. She said she was told he went to the bathroom and came back to class. When her son still didn’t feel well, he went to the school’s office to call his family, she said, adding an air mask was put on her son’s face while he was in the office.
The coroner said that teachers and the principal at St. Elizabeth knew Avina carried an EpiPen because of his allergies but did not use it, not when he became ill in his Grade 5 classroom, not even after he collapsed in the office — a fact police and the school did not disclose last week.
That EpiPen, whose needle delivers a precise dose of epinephrine, would have caused no harm if it was asthma rather than an allergic reaction, and its use can save the life of someone suffering a potentially deadly allergic attack called an anaphylactic reaction, McElligott said.
Paramedics who arrived did use the EpiPen, he said.
“It was used but maybe too late,” McElligott said. “I will speak to teachers. When in doubt, give the EpiPen. You can’t do any harm and it may have saved his life.”
Asked about the coroner’s comments, Dan Parr, the director of education for the St. Clair Catholic District school board, said, “I agree with the doctor’s presumptions. Based on the boy’s symptoms and his answers to their questions, it is most likely that the staff presumed the boy was experiencing an asthma attack. Other explanations may have occurred to staff, but the response time of the ambulance was very quick, and I presume the staff was very glad to have the boy cared for by the paramedics so quickly.”
Though St. Elizabeth brands itself a “nut-safe” school, McElligott said school officials can never eliminate the possibility that someone brings in nuts.
Though police say they have not yet found evidence of that happening, a parent whose child was in class with Avina says that’s what happened the day Avina died.
“We were all aware he was allergic,” the parent wrote in a Facebook message to The Free Press. “(My daughter) walked by (another) student in her class that was eating (a candy bar with peanuts).”
The parent says her daughter submitted statements to the school board and to police in Chatham-Kent.
Asked Monday if Javier had a peanut allergy and had been exposed to peanuts, police wrote, “We have no evidence to support the allegation of a peanut exposure at this time.”
Asked if they had interviewed all of those in Avina’s class, police didn’t say.
Published studies have found that even coroners often assume a death to be caused by asthma even when the underlying cause was an allergic reaction because the difference between the two isn’t clear in an autopsy unless specific tests are conducted.
Those tests have been ordered by McElligott: One looks for antibodies and the other an enzyme produced by someone suffering an allergic reaction.
“It could take about three months,” he said of the tests.
McElligott also is investigating the care Avina received in the years before that fateful day and has already found out the child had not been seen by a doctor since 2012 — by a now-retired allergist whose records the coroner has subpoenaed.
Though it would have been better if teachers had given Avina an EpiPen, one can understand why that did not happen, McElligott said. Teachers at the board hear once a year from a medical expert on when to use an EpiPen, but that may be insufficient to produce the right response during an emergency — in the case of Avina, it was only five to 10 minutes between when he appeared ill and when he collapsed.
“In all fairness to the teachers, things happened so fast,” the coroner said.
Before the coroner disclosed his preliminary findings, a woman who lost a daughter to an allergic attack at school, then played a role making schools safer places, said parents need to know precisely what authorities find.
“If you have a kid with a peanut allergy who is asthmatic, you’re going to want to know what happened,” said Kim Chinnick, whose nine-year-old daughter Kelly died Oct. 9, 1987, at a school in rural Pain Court outside of Chatham after coming in brief contact with frosting she didn’t know contained peanuts. “It certainly hits home,” she said of Avina’s death. “You send them off on the school bus one day and they don’t come home.”
will files from Ellwood Shreve of The Chatham Daily News