Who will care for our sickest children?

Pediatric hospitals are turning some of them away

Dear readers: A version of this article, co-authored with friend and colleague Jon Roberts, was published today in The Boston Globe. So it can be read either here or there. (I generally resort to a paywall at Substack only when another publication also has rights.) It describes the situation in Massachusetts, but the problem is broadly national.

Also, my apologies for suddenly being so prolific! I promise you a break soon. Finally, the cartoon I purchased this time for the article is a bit obscure, but I figure even a sad article about babies needs a happy babies picture. I like to think of the two babies at the bar representing the authors.

By Jon Roberts and Matt Bivens

One of us recently cared for a sick toddler and was concerned that the child could have leukemia. This was in a community emergency department just 10 miles from Boston Common — practically a stone’s throw from some of the world’s leading pediatric care centers.

Not one of those centers would accept the patient.

Emergency physicians like us are comfortable with the initial stabilization and diagnosis of seriously ill or injured children. We do it all year long. But eventually we need to transfer the care of these children to pediatric specialists.

There are still some community hospitals with strong pediatric care units; South Shore Hospital in Weymouth and St. Luke’s Hospital in New Bedford come to mind. But these are the exceptions. The rule is that when it comes to caring for sick children, the resources, funding, and expertise are concentrated at academic pediatric centers.

Yet all too often now, those centers don’t open the door when the community doctor calls.

When the academic center hears about a sick kid and then says “No, sorry,” hours of tense phone negotiations ensue. Frightened parents and their child are left in limbo, while community physicians plead in turn with each of the state’s five academic pediatric centers — Children’s Hospital of Boston, Mass General for Children, Boston Medical Center, UMass Children’s in Worcester, and Baystate Children’s in Springfield. When that fails, they look even farther afield, for a pediatric center in Connecticut, Rhode Island, or New Hampshire.

Earlier this month, colleagues at southern Massachusetts emergency departments repeatedly had to helicopter sick children to Maine — flying over multiple Boston pediatric hospitals. In the case of the toddler with possible leukemia, after many hours of phone calls, he was accepted on a second try to Hasbro Children’s in Providence. He is a Boston-area kid, but he had to be transported to another state because Boston’s academic hospitals declined to see him that day.

This ongoing crisis of critical pediatric care has stressed Massachusetts for months. We are moved to comment on it in part because we dread that it is about to get worse. This winter, even as infections including respiratory syncytial virus, influenza, and COVID-19 bring more sick children to hospitals, there will be fewer pediatric beds.

Tufts Children’s Hospital closed its 41-bed operation in July, with ramifications for Boston and the state that we all have yet to come to terms with. Massachusetts also stands poised to lose a 20-bed inpatient unit in Springfield, which Shriners Hospitals for Children has announced it will close. This follows a national trend: Hospitals across America over the past decade have shut down about 20 percent of all pediatric beds.

Why is this happening?

In part because kids are not lucrative.