Principal Rhonda Richetta can vividly recall days when students have come to her office door at City Springs School gasping for air.
The school has a large population of asthmatic elementary- and middle-school-age students who receive critical services — including daily breathing treatments — from a nurse practitioner in its health center.
Richetta fears that could change next year if the school is one of six that are slated to reduce their health care services because of proposed funding cuts from the city.
"It's a vital resource, and I just can't imagine what it's going to be like if we have a school nurse whose hands are tied because they can't provide those services," Richetta said, adding that more than 100 students are on the school's "medical alert list" for potentially life-threatening illnesses. The center provides critical health care to about 36 students a day, she said.
The school-based health centers, run by the Baltimore City Health Department, are usually staffed with a full-time nurse practitioner who is qualified to provide asthma treatments, immunizations, hearing and vision screenings, and mental health and substance abuse treatment.
If the health center ia downgraded, nurses could do little more than hand out medicine and make a phone call to the student's home, Richetta said.
"I don't want to have to stand there with a child gasping for air waiting for the ambulance," she said.
Health services are just one area where Baltimore schools will be affected by a dire city budget. While the school system gets most of its $1.23 billion budget from the state, more than $200 million is due to come from the city.
In the most recent budget proposal from Mayor Stephanie C. Rawlings-Blake, six of the 13 advanced health centers run in city schools would have to make do with basic services from a nursing assistant.
Additionally, the city has proposed cutting its contribution to crossing guards in half and eliminating funding for student bus passes.
That will force school officials to come up with $6.2 million to fund student transportation and a full force of crossing guards, and find ways to salvage some of the advanced services provided in health centers.
"We understand the dilemma that the city's in. … I think we're all in the same boat this year," said Michael Frist, chief financial officer for Baltimore schools.
The Baltimore school board was scheduled to adopt its budget Tuesday, and Frist said the school system will look to find money by cutting programs and shifting expenses.
He said school officials were in the process of assessing the impact of the city's cuts and had no concrete details of where the school system would look for additional funds.
The list of the six health centers slated to close has yet to be made final, said Brian Schleter, public information officer for the Health Department.
The criteria for determining the closures will include other funding sources available, the number of students who use the centers and the availability of other medical resources in the schools, Schleter said.
The cuts to the school system come as a result of an unprecedented budget situation for the city and as Rawlings-Blake works to mitigate the effect of funding shortfalls on city services, said the mayor's spokesman, Ryan O'Doherty.
"We have a $121 million deficit, and that's a significant challenge with the fact that we're making sure we're fully funding Baltimore City public schools," O'Doherty said.
The city also pays the school system's debt, teacher retiree benefits and termination leave.
Councilwoman Mary Pat Clarke, who chairs the Baltimore City Council's education committee, said she is concerned about all of the cuts to city schools but will particularly advocate for funding for crossing guards.
"We must have these crossing guards; that's a public safety issue right up front," Clarke said. "They will be funded; the question is how."
Clarke also said that school-based health centers were "crucial to the well-being of student bodies."
"We want to try to keep [the students] healthy, so they walk to the street corner, and cross safely with a crossing guard," Clarke said.