Broken Arrow, Oklahoma — On Lachlan Rutledge’s sixth birthday, as he gasped and blew out a candle, his mother made a wish.
Kindergarteners have connective tissue disorders, severe allergies, and asthma. These conditions led him repeatedly to the pediatric intensive care unit at Ascension St. John Medical Center in Tulsa, where his veins collapsed, oxygen levels were so low that he became unresponsive to his mother’s voice.
However, the hospital closed the children’s floor in April to make room for more adult beds. So on September morning, after her four Covid infections and what appeared to be bilateral pneumonia, Lachlan was struggling to breathe in the overcrowded emergency room at St. Francis Children’s Hospital. I was. This is the only pediatric hospitalization option left in Tulsa.
“We are always preparing for battle. It’s a matter of where we fight.
Hospitals across the country, from community medical centers to small local facilities, are closing pediatric wards. The reason is rigorous economics. Facilities make more money from adult patients.
April at Henrico Doctors’ Hospital in Richmond, Virginia Completion of pediatric hospitalizationTufts Children’s Hospital, Boston, July followedShriners Children’s New England said so close the inpatient ward by the end of the year. His Springs, Colorado in Raleigh, North Carolina and Pediatrics in Doylestown, Pennsylvania were also closed.
“They’re asking: Should we care for children who can’t make money, or should we use beds for adults who need a lot of expensive tests?” Children’s Hospital Medicine, Tufts Medicine Principal Dr. Daniel Rauch said he headed general pediatrics until it closed over the summer.
Many hospitals converted child beds to adult ICU beds during the pandemic, but are reluctant to switch back.Currently, drug costs are increasing 37% per patient due to staff shortages and inflation compared to pre-pandemic levels — Fewer Medicaid reimbursements and fewer federal subsidies granted during the pandemic some health centers are up and running negative margin When Passionate about prioritizing the most profitable patients.
Younger patients like Lachlan, who have private insurance, occupy beds to recover from infections and asthma attacks, but they have more profitable options, such as joint and heart surgeries, which are common in older patients. You will not receive any billable action.
Physician reimbursement through Medicaid, an insurance program for low-income individuals, often only about 70% A portion of the amount reimbursed through Medicare, an insurance program for seniors of all incomes. More than a third of her U.S. children are enrolled in Medicaid.
There have been no active legislative efforts to keep hospitals from closing or downsizing their pediatric departments.Democratic senators introduced a bill last year to fund Pediatric hospital It has not passed the assigned committee to improve the infrastructure.
Health policy experts say a key solution is to encourage hospitals to care for children by increasing Medicaid reimbursement rates. But further increases in Medicaid and private rates won’t come close to what hospitals can charge for paid adult surgery, and many state budgets are already under pressure, making any regulatory move impractical. says the expert.
Hospitals that no longer accept children rely on transfers to other hospitals’ pediatric departments. But when even the largest pediatric floor in the country reaches capacity, emergency rooms can pile up with seriously ill children, exacerbating patient conditions.
ER crash
An ER doctor at a small Boston-area hospital reviewed by The Times wrote to his hospital’s chief medical officer two weeks ago, “Pikachu kids shouldn’t be here.” (PICU is an acronym for pediatric ICU. I shared the message on the condition that the hospital was not specified.)
At the time, all the ICUs for children in Boston were full, and the closest available beds were in New Haven, Connecticut, and Vermont. The doctor who texted her considered intubating the child in the ER while waiting for a closer bed to become available.
As children return to school, a wave of illness hits many of the remaining units.
“Forget the two-week crash in January. We couldn’t find a bed in May, August, or September,” says Melissa Mauro-Small, M.D., chief of pediatrics at Signature Healthcare Brockton Hospital near Boston. said. “No more breathing season. All year round breathing season.”
A hospital in Plymouth, Massachusetts, which had not referred a patient to Dr. Mauro Small’s hospital in 10 years, most recently had 6 referrals in 10 days. According to patient charts reviewed by The Times, his ER staff at Lowell General Hospital outside Boston said he had to ask his eight hospitals in England if there was room for his two-year-old, who was intubated. I had to. Moved another patient to her closest ICU bed in Maine.
“At some point, this is going to be a crisis,” said Dr. Mauro Small. “And here I am.”
The St. John Medical Center in Tulsa has been a regional treasure for nearly a century since its acquisition by Ascension in 2013.
Dr. Michael Stratton, a pediatrician in Muskogee, Oklahoma, said Ascension St. John was “the number one place to send children” and that the closure of its pediatric department “was very damaging to all of eastern Oklahoma.” said.
A spokeswoman for Ascension St. John, where Lachlan had been in the ICU three times before the closure, declined to be interviewed but said in an email that the closure was driven by demand for more adult beds. said. She also said that St. Francis Children’s Hospital “More than can pick up the slack”
A spokeswoman for St. Francis Children’s Hospital said the hospital is sometimes at capacity and staff have transferred about 23 patients to other facilities, including in Arkansas, so far this year.
The ER “was busy even before St. John’s Pediatrics closed,” she said. Still, she said hospitals aren’t overloaded.
Some Oklahoma families with chronically ill children say they regularly drive to Memphis, St. Louis or Rochester, Minnesota. According to Katie Kojimanil, director of the University of Minnesota Rural Health Research Center, distance causes financial strain and, at worst, abandonment of care.
For people in rural areas, the closure of pediatrics has made it unacceptable to travel to what Dr. Rauch calls “bread and butter pediatrics.” His 16-year-old Johnny, who lives in Childress, Texas, had to be homeschooled so he could travel eight hours to Dallas for dialysis treatments three times a week, according to his doctor.
Jamal, a 2-year-old boy from Fort Kip, Montana, who has an autoimmune disease, regularly travels 11 hours to Billings, Montana to get an IV, said his mother Patricia.
“Children are not small adults”
The steepest declines in pediatric hospital beds were in rural areas where large health systems acquired community hospitals and consolidated pediatrics into one campus.
Focusing pediatric care in specialized centers could undermine the ability of local hospitals to treat critically ill children, doctors say.
“Children are not little adults,” said Dr. Meredith Bolle, a pediatrician at Southern Illinois University School of Medicine in Springfield, Illinois.the number of Pediatric hospital beds are declining in Illinoisand 48 in that county currently have no pediatricians at all.
“When nurses and respiratory therapists are unfamiliar with children’s cases, when units don’t have child-sized equipment,” Dr. Volle said. Treat them often enough to get good at it.
Severely ill children 4 times more likely to die hospital or double the chance of dying In a trauma center that scored low on the “pediatric readiness” test, according to the study. According to a nationwide survey, only one-third of her children had access to emergency departments. Very “pediatric friendly”,” And of those, nine out of ten lived near unprepared people.
Dr. Katherine Remick, executive director of the National Pediatric Preparatory Quality Initiative, said parents who are unaware of wide variability “may make split-second decisions that change the fate of their children.”
The Rutledge family lives in the sunny Broken Arrow suburb of Tulsa, home to a frozen custard shop and a dental practice called Super Smiles. Their front porch is home to potted succulents, an abandoned scooter, and a 140-pound Great Dane named Thor.
But their lives are far from ordinary. The last time Lachlan needed to see an allergy specialist, her mother packed her car with nebulizers and medications and drove her 14 hours to Denver. She left her husband and her other two sons, and her mother undergoing chemotherapy for two weeks. Later, when a doctor tells her that Lachlan’s disease appears to be causing stomach ulcers, but the only pediatric gastroenterologist at St. Francis Hospital has been away for months, she plans a trip to Dallas. started to
The ER was busy when Lachlan was in St. Francis as he struggled to breathe that September morning, so Lachlan hooked up the pulse oximeter himself, set the monitor to quiet, and monitored each heart rate spike. I tried not to scare him. .
Lachlan pulled his collarbone. His chest seemed to retract. Five hours later he was still not hospitalized. Mr. Rutledge’s hands trembled and tears rolled down his cheeks.
“I know you guys are exhausted in this hospital. “But you send this kid home so he can’t see his vitals drop.”
Lachlan was discharged from the ER 10 hours later and put on steroids to combat inflammation in his lungs. He sleeps in his parents’ bedroom so they can check his oxygen levels and give him nebulizer treatments every few hours throughout the night.