It was Lachlan's sixth birthday, but as he exhaled and blew out a candle, it was his mom who made a wish: for a hospital bed.
There are severe allergies and asthma in the kindergarten child. He was unresponsive to his mother when he was in the intensive care unit at Ascension St. John Medical Center in the state of Oklahoma.
The hospital made room for more adult beds by closing the children's floor. After coming down with Covid for the fourth time and with what appeared to be bilateral pneumonia, Lachlan was struggling to breathe in an overcrowded emergency room at the Children's Hospital at Saint Francis.
Preparing for battle is what we do. The mother looked frightened as she twisted the blonde ringlets that poked out from under Lachlan's Spider-Man headphones.
Hospitals across the country are closing down their children's units. More money is made from adult patients by institutions.
Henrico Doctors Hospital in Virginia ended its inpatient services for children. The hospital in Boston followed suit. The inpatient unit will close by the end of the year. In addition to Colorado Springs, Raleigh, N.C., and Doylestown, Pa., there are also other units that have closed.
They want to know if we should use the bed for an adult who needs a lot of expensive tests or if we should take care of kids. It's a no-brainer if you're a hospital.
Children's beds have been converted to adult I.C.U. beds in many hospitals during the Pandemic. Drug costs have increased 37 percent compared to prepandemic levels, staff shortages, inflation, and low Medicaid reimbursement have left some health centers operating on negative margins.
Young patients like Lachlan who have private insurance, occupy beds to recover from infections or asthma attacks but don't undergo lucrative, billable procedures like joint or heart surgeries that are more common among older patients.
Physician reimbursement through Medicaid, the insurance program for low-income people, is often only about 70% of the amount reimbursed through Medicare. More than a third of children in the US are covered by Medicaid.
Legislative efforts have not been made to keep hospitals from closing. The bill to grant funding to specialized children's hospitals has not moved past the assigned committee.
Increasing Medicaid reimbursement rates would be an important solution. With many state budgets already strained, experts say the regulatory move is unrealistic.
Children who are no longer admitted to a hospital are transferred to other hospitals. The pileup of critically ill children in E.Rs can cause patients' conditions to get worse.
Two weeks ago, an overwhelmed E.R. doctor in a small Boston area hospital wrote to his hospital's chief medical officer, "Picu kids don't belong here." The hospital that received the text message was not named.
The nearest open beds for children in Boston were in New Haven, Conn., and Vermont. While waiting for a bed to become available, the doctor considered intubating the child.
Waves of illnesses are over running many of the units that remain.
The two week January crush is over. Dr. Mauro- Small said that they couldn't find beds in May or August. There is no more cold weather. Respiratory season is throughout the year.
She said that a hospital in Massachusetts did not transfer a patient in a decade. According to patient charts reviewed by The Times, the staff at the E.R. asked eight hospitals in New England if they had room for a 2-year-old in atubated. Another patient was moved to the closest I.C.U. bed.
Dr. Mauro- Small said that at some point this would become a crisis. We're here.
When Ascension acquired St. John Medical Center, it was a community treasure. Both families and doctors objected to the closing of the children's unit.
Dr. Michael Stratton, a doctor in Muskogee, Okla., said that Ascension St. John had been the number one place to send a child in eastern Oklahoma.
A spokeswoman for Ascension St. John said in an email that the closing was due to a demand for more adult beds. She pointed to statements made in the past that said the Children's Hospital at Saint Francis was capable of taking the slack.
The Children's Hospital at Saint Francis occasionally reached full capacity and the staff transferred about 23 patients to other facilities so far this year, according to a spokeswoman.
She said that the E.R. was busy before the unit closed. She said that the hospital had not become overwhelmed. She said that volume is consistent with what they see during the season.
Families with chronically ill children often travel to Memphis, St. Louis and Rochester, Minn. The director of the University of Minnesota rural health research center said that the distances cause financial strain and cause them to forgo care.
For people in rural communities, travel to see a doctor is no longer possible. Johnny had to be home-schooled in order to travel eight hours to Dallas for his treatment.
A 2-year-old with an autoimmune disease in Fort Kipp, Mont., takes an 11-hour trip to get his medicine in Montana.
Rural regions where large health systems acquired community hospitals and consolidated to one campus saw the biggest decline in the number of inpatient beds for children.
Doctors say that a local hospital's ability to care for a critically ill child can be eroded if it is centered in a specialized center.
Patients who travel from two to three hours away are seen by Dr. Volle at the Southern Illinois University School of Medicine. In Illinois, the number of beds for children has gone down, and 48 of the state's counties have no pediatricians at all.
When the units don't have child-sized equipment, nurses and respiratory therapists are less comfortable with children's cases.
According to research, critically ill children are four times more likely to die in hospitals and twice as likely to die in trauma centers. Nine out of 10 children lived close to a less-prepared emergency department, even though only one-third of children had access to it.
A parent who is unaware of the wide variability could make a split second decision that could change their child's fate.
A family lives in a sunny suburb with a frozen custard shop and a dentist. Their front porch is home to a lot of things.
Their lives are not normal. The last time Lachlan needed to see an allergy specialist, his mother packed the car with his nebulizer and medication for a 14-hour drive to Denver, leaving her husband, their two other sons and her mother, who was undergoing cancer treatment, behind. She began planning a trip to Dallas after she was told that Lachlan's disorder appeared to be causing stomach ulcers.
The E.R. was so busy that they hooked him up to a pulse oximeter so he wouldn't be frightened by his heart rate.
Lachlan tugged at his collar bone and it looked like he was going to fall. He wasn't admitted for five hours. Ms. Rutledge cried as she looked at her face.
She yelled "I know you guys are exhausted at this hospital, and I get it" as she leaned over Lachlan's bed to level her eyes. The child won't be sent home so he can watch his vitals decline.
After 10 hours of taking steroids, Lachlan was discharged from the E.R. He sleeps in his parents bedroom so they can keep an eye on him.
All Rights Reserved © 2024
