There are a lot of things that could have been done differently to prevent this situation from happening.  However, aside from hiring a school nurse to be full time, the idea of an admin office storing all of the children's medications is absurd.  It sounds like this school is storing medicines for serious conditions in the same manner they store books and other school supplies.  One significant change could involve the children keeping track of their own medications, such as inhalers, so that it does not become a chaotic mess.  The problem here is obviously the age of elementary school children and the notion that they probably shouldn't be dispensing drugs themselves.  However, there may be a way around that.  If the child is taught by both the parents and the physician on how to take their medication, there is no reason for the situation described above.  

Of course, there are exceptions to each case and there would still be a need for a nurse's office and for some medications to be kept with them.  Yet no child should have to suffer, especially when the solution should have been so readily available.  Health care in the school systems are not going to be amazing based on school district funds and the number of students, however, they should be at least at the minimum standard of care and not endangering the lives of these students.