To our community – From Dr. Greg Hudson
10/03/2009
To our community:
We thank you for your help, and we are humbled by the trust many of you place in us. Because we hang out with children all day, we pediatricians tend to be gentle and happy, except maybe during flu season. We don’t enjoy or seek out conflict. But there is one thing that everyone who crosses paths with us needs to know: Don’t mess with our kids, because if you do, by God’s help, we won’t stop fighting you as long as we have breath. Let me make one thing perfectly clear. Despite what you have heard about how the administration at S.O.M.C. is dedicated to the welfare of our children, despite what has been said about how our Inpatient Pediatric Unit was never closed, despite what you have read about how everything pediatric at our local hospital is just as good as ever only better, do not believe it, because it is not true.
I want to give you the facts about pediatric care at SOMC: how we came to where we are, where we are, and where we need to go.
How did we get here? For the entire eighteen and a half years I have been admitting children to our local hospital until about one month ago, every time I called 740-356-8341 the phone was answered with these words, “Hello, this is Pediatrics, may I help you.” One month ago this changed. As of one month ago our Inpatient Pediatric Unit was no more. Although we pediatricians were never consulted about this change, we were led to believe that our patients would still be cared for by pediatric nurses. This is one of the essential issues. The idea that a nurse is a nurse is a nurse is simply not true. Nurses develop expertise in their specialty that is vital to the care of their patients. They are the eyes and ears of the doctor, who is not with the patient most of the time. If I get bad pneumonia and need to be on a ventilator, I want an experienced Critical Care Nurse taking care of me. If I suffer major trauma, I want an experienced Emergency Nurse taking care of me. If I have a knee replacement, I want an experienced Orthopedic Nurse taking care of me. If I have noncritical asthma or dehydration or pneumonia, I want an experienced General Floor Nurse taking care of me. Children sick enough to be admitted to the hospital always need Pediatric Nurses to take care of them. In the Orthopedic/Family Care Unit that replaced our Inpatient Pediatric Unit this was not the case. We pediatricians informed the administration at SOMC by letter and later in a meeting that this situation was unsafe. We suggested that since the Inpatient Pediatric Unit had been closed to save money, perhaps moving it to an area near the Emergency Department (ED) would, not only make it less of a financial burden but could also help with pediatric patient care in the ED itself. Then, if the number of children admitted to the Inpatient Pediatric Unit was low, pediatric nurses could help take care of those children coming into the ED. The response from the hospital administration to our concerns and suggestions was bizarre.
These are the changes they made:
1. For approximately 24 hours we had our old Inpatient Pediatric Unit back.
2. Then for approximately 48 hours there was no place at all in the hospital to admit children. The pediatric nurses were moved to the ED, but we could not admit our patients there. I quote from the letter we received from Mr. Arnett and Dr. Stewart, “We will not create a dedicated inpatient pediatric unit at this time.” “Our pediatric patients can be observed and treated here for up to 23 hours. At any point that the treating physicians believe inpatient admission is warranted, we will arrange for transfer to a specialized children’s hospital.”
3. When the outcry against all admitted children being transferred away from home began, the policy was changed yet again: quoting from the, Pediatric Services Relocation Q & A sheet created by SOMC, “Children under the age of 18 who are in need of hospitalization for pediatric care will be placed under observation in the Emergency Department. They will then be assessed by a physician to determine if further observation, admittance into another appropriate unit within our hospital, or transfer to a children’s hospital is necessary.” This meant that children could be admitted to our hospital, but it had to be to another unit where there were no pediatric nurses. This was the same unsafe situation the administration had created when they closed the Pediatric Unit in the first place.
4. Now the policy on the admission of children to our hospital has been changed for the fifth time in the past month.
Where are we now? We still do not have our Inpatient Pediatric Unit back. There is a pediatric observation area in the ED. We are now being told by the SOMC administration that we can observe our patients there for as long as it is medically necessary, and that those children will be cared for by pediatric nurses. This is better than the Orthopedic/Family care and changes 2 and 3. However, there are serious problems and unanswered questions with this policy as well. Let me list some of them:
1. What happens when my child who is being treated in the pediatric observation area needs to stay longer than my insurance company will grant observation status? Always before, after one day of observation, patients were either discharged or admitted to an inpatient unit. How will the insurance company respond to the request for multiple days of observation? Will they pay or will I be responsible for the entire bill? If my insurance company won’t pay, will SOMC write off the bill, since very good things are happening there?
2. Any child can be observed in an Emergency Department by an Emergency Department Physician, but to be admitted to a pediatric inpatient unit your pediatrician, family doctor or another specialist must be consulted to take over care. What if for some strange reason ED physicians are pressured to provide extended observation care and not call your private doctor? It seems far fetched but such a possibility exists with this policy.
3. If there is only a pediatric observation area in the ED rather than an inpatient pediatric unit near but separate from the ED, what is to prevent the pediatric observation area from being declared a failure in a few months and being reabsorbed into the ED. When I called 740-356-8341 yesterday and today the phone is answered with the words, “Emergency Department”, not, “Pediatrics”.
4. What are the Pediatric Nurses going to do in the ED? They have been told that they have until noon on October 5th to decide whether they will stay in the ED or return to the Orthopedic/Family Care Unit. They have been told that if the number of children in the pediatric observation unit is low they will work in the ED as Emergency Nurses, not Pediatric Nurses. They have been told specifically that 80% of the patients they will care for in the ED will be adults. 80/20 is the adult/child ratio of patients that enter the ED. I don’t know about you, but if I’m having a heart attack I don’t want a pediatric nurse forced to take care of me.
5. Why won’t the SOMC administration reestablish for our community the Inpatient Pediatric Unit they destroyed one month ago? Mr. Arnett and Dr. Stewart told the pediatricians on October 2nd that they did not know what all of the requirements were to have an inpatient pediatric unit, so they refused to commit to reestablishing it. I cannot fathom how they could not know how to reestablish our unit, seeing how they were so efficient at destroying it.
6. The current administration at SOMC has already demonstrated their desire to close the Inpatient Pediatric Unit by doing so. Why should we believe that they want what is best for our children. Why should we trust them?
Where do we go from here? Our children need their Inpatient Pediatric Unit back. This is our hospital. It doesn’t belong to the administration, it belongs to us. Don’t wish for it to fail; don’t hope for Kings Daughter’s to put it out of business. Keep the pressure on the administration to do the right thing. Post, e-mail or fax this letter to everyone you think would want to know or could help. Flood the SOMC administration with calls, and tell them what our children need, and if change doesn’t come quickly we may need to resort to some sort of partial boycott. Please pray for the right change to come.
Thanks again,
Greg Hudson, MD
