Franklin Square’s cuts to pediatric services draw objections

Khalilah Barrier credits a doctor at the pediatric emergency room at MedStar Franklin Square Medical Center with saving her daughter’s life.

The doctor recognized that the baby’s abnormal breathing could be the sign of a dangerous heart condition and ordered an immediate transport to a specialty hospital. Without emergency surgery, the 4-monthold might have died in her sleep.

Barrier’s other children also have used the children’s emergency services at Franklin Square. A son went for a sports injury. Another son was admitted to the hospital, in the Rosedale area of eastern Baltimore County, for three nights with complications from the flu.

Barrier and others in the community are upset by the hospital’s decision last week to close the pediatric emergency room, lay off staff and eliminate inpatient care for children under age 16 other than babies just

born in the hospital. Now children will be seen in the adult emergency room. Any child with a condition that requires an overnight stay will be taken to another hospital.

Hospital officials said it was no longer economical to offer the services.

“It’s really unfortunate,” Barrier said. “They are getting rid of services that helped a lot of people.”

MedStar Health announced the decision last week, citing declining pediatric admissions amid a statewide effort to reduce hospitalizations to save money in the health care system. But the decision has caused an uproar from the community and hospital staff, who say MedStar has abandoned its mission to serve the community in the pursuit of profits.

“We are shocked this would be done,” said Mary Scott, who works at the hospital. “This is cold and calculated and all about money.”

CEO Samuel E. Moskowitz said the hospital is still dedicated to serving the community, and the changes reflect the direction that health care is moving.

“Treating fewer inpatients is a positive outcome as hospitals can no longer focus solely on admissions,” he wrote in an email late Wednesday.

Anxious hospital staff criticized the lack of transparency around the decision. Some in the community said plans to build a new surgery center on the hospital campus show where priorities lie.

The criticism put Moskowitz on the defensive. He explained the decision on his blog, Sam’s Corner.

Moskowitz called it one of the toughest decisions he has had to make. He blamed federal and state mandates to cut costs, reduce emergency room stays and shift more care out of the hospital into less expensive settings.

He noted that pediatric admissions to the hospital dropped more than 40 percent, from 461in 2013 to 264 last year. Visits to the pediatric emergency room fell 30 percent in the last four years, and operating a separate pediatric emergency room has become too expensive.

He said many pediatric patients now go to after-hours urgent care centers instead of emergency rooms for less severe conditions.

Even with the declines, critics said,14,000 children use the pediatric emergency room each year. Moskowitz said the adult emergency room would continue to care for these children. Critics said that would just overwhelm the hospital.

The changes leave a void in an area where there are few options for medical care, some parents said. They say they will have to drive further for care, to hospitals in Towson or Baltimore.

Some argue that an adult emergency center is not the place for children, who have different treatment needs. For instance, the procedure for resuscitating a child is different than that for an adult.

Jane Lashley’s 5-week-old son went to the emergency room for a virus and dehydration, and was admitted to the hospital. He stayed for almost a week.

“These kids are not little adults,” she said. “Babies are completely different than adults.”

Others said that transporting children to other hospitals can cause complications.

Moskowitz pointed out that the hospital already sends hundreds of children with more complex cases to other hospitals each year.

Franklin Square serves many low-income patients with transportation challenges, who can face difficulty getting to another hospital for inpatient care. Critics decried the firing of beloved doctors.

Many of the doctors who lost their jobs also worked at a nearby clinic and at the hospital’s outpatient offices, meaning many parents must find a new pediatrician.

Moskowitz said patients were being directed to other doctors at the hospital, or they can have their medical records sent to physicians outside the system. Hospital officials said they will recruit more physicians and have expanded their outpatient family medicine office to serve more patients. He also noted that the hospital expanded behavioral health services for children three years ago.

Dr. Anna Reed lost her job as part of the shakeup. She said she worries that the doctors and staff in the adult emergency room are not accustomed to treating pediatric patients. Emergency room doctors and nurses get far less training in pediatric care, she said, and many don’t use those skills often.

“It’s not only unsafe for the children, but it is so unfair to put this on the staff,” Reed said. “Even if I understand the reasoning for the closing, even though I don’t agree with it, there is not really a good reason why you would do it so quickly when it is so much of a safety hazard.”

Moskowitz acknowledged in his blog post that some staff had told him pediatricians and pediatric nurses needed to be a permanent part of the emergency room.

He also wrote that some staff “were critical on the lack of training and requested pediatric training be provided.”

“I am on record as making these commitments,” he wrote.

In his email, Moskowitz said that two emergency physicians are board-certified in both adult and pediatric emergency medicine. In the past, 50 percent of children treated in the pediatric emergency department were seen by emergency room doctors and the other half by pediatricians.

He said Franklin Square is following the path of most hospitals in the country, which have combined emergency rooms for younger and older patients. The hospital will retain the pediatric waiting room, and pediatric and adult patients will be separated “as best we can,” he wrote.

Dr. Joyce King, director of inpatient medicine for MedStar Franklin Square’s family medicine residency program, said the closings caught people off guard.

King said the decision was focused more on money than on patient care. She said most hospitals will make up for the lower reimbursement in practices such as pediatrics through more profitable areas such as orthopedics.

“The care of pediatric patients has always been under-reimbursed,” she said. “They are the lowest-paid specialty. But they are also kind of essential.”

She noted that the hospital’s residency program also is affected by the change. The next-closest pediatric program in which residents may participate in a rotation is in Washington, she said. Hospital officials are trying to determine how residents still can meet their requirements.

Moskowitz said in his email that all residency requirements would be met.