Stephen E. Landay: Is there room at Shands for kids?

Published: Sunday, January 11, 2009 at 6:01 a.m.
Last Modified: Saturday, January 10, 2009 at 12:30 a.m.

There has never been an emergency room dedicated solely to the care of children in Gainesville. Over three years ago, the pediatricians in town met with Tim Goldfarb, the CEO of Shands Health Care, and urged him to create this kind of facility.

At that time, it was quite clear that his administration was principally focused upon garnering the funds needed to successfully complete the new cancer center on Archer Road. Our request was tabled...and, who knows, maybe even buried.

The cancer center is scheduled to open in the fall of 2009. In addition to providing advanced cancer care, it will house a new trauma center and the emergency room for the entire hospital complex.

Very regrettably, under current plans, there will neither be a waiting room designated and designed for children nor a collection of examination rooms where only they can be seen.

I was hoping that once the cancer center opened, the then-vacant "old" Shands ER might be converted into one just for kids. Apparently that is not on the drawing board, but I think the following circumstances have conspired to merit this commitment:

Shands at AGH is closing in 2009. The families that used to bring their children to its ER will have to find an alternative. That, most assuredly, will be the Big Shands.

At a recent meeting with most all of the pediatricians in town, Dr. Gary Gillette, the chief of the emergency department at North Florida Regional (NFR), acknowledged that some of the specialists at his hospital are uncomfortable consulting on pediatric emergencies because they feel that they either lack the expertise or the specialized support team required to deal with these problems. The pediatricians understood how some NFR staff could feel this way.

To ease their burden, Dr. Don Novak, Associate Chair for the Clinical Operation of the Department of Pediatrics and Pediatrician in Chief Shands Children's Hospital, stated that his faculty and residents would welcome caring for these children at the Shands ER, provided there were enough beds to accommodate the transfers. Those present applauded Dr. Novak's position, but we did wonder where Shands will seat and serve this swarm of new subjects in its emergency room.

Given the current volumes of pediatric patients seen at Shands UF, if one adds the anticipated additional patients from Shands at AGH and NFR Medical Center, the total visits may exceed 20,000 a year.

Ample patient demand

This level is sufficient to justify a dedicated pediatric emergency department in this community.

Not only do our families want and deserve this, so do the pediatricians. After all, in an effort to keep our patients from over-utilizing the already overburdened ERs in town, the Department of Pediatrics and the pediatricians in town have combined to create the Pediatric After Hours Clinic (PAH). As such, we represent the only group of specialists in Gainesville that hold an appointment-only regular evening and weekend clinic.

But PAH has only a limited number of appointments available, and it has a specific closing time (10 or 11 p.m. depending on if it is "sick season" or not).

Furthermore, PAH is not an emergency room so those patients deemed too sick to be seen there are directed to a local emergency room for their care.

Shands at UF is the trauma center for all of North Central Florida.

Understandably, those patients transported to its emergency room by EMS are triaged and examined first. Statistically, the vast majority of these patients are adults.

Long waiting times

Therefore, when sick but not gravely ill children seek care once PAH closes, all too often they must wait unconscionable periods of time (6 to 8-pus hours) before they even get placed into an exam room. And, while they wait, they are often exposed to adult patients whose medical conditions and/or behaviors are totally inappropriate for children to witness.

Perhaps the most frightening aspect of these extended waits is the potential that some parents, their patience (as well as their bodies) exhausted, will leave the ER before their child is examined. For some patient, this decision may be disastrous!

Like those who have had the misfortune of experiencing these grueling and exhausting delays in the emergency room, the pediatricians, too, have grown weary of waiting; waiting for the Shands Administration to serve our families better by creating an ER just for them.

The brick wall

We have raised our voices on this matter numerous times but we have run into a brick wall; and it is not one that is under construction for our proposed project. As yet, we haven't even been able to convince the administration, at the very least, to create a waiting room that is family-friendly, isolated from inebriates and the like. I believe than an alternative site for pediatric patients will lessen the load on the already overcrowded Shands adult ED, thereby reducing wait times for all patients. That defines a clearly win-winproposition.

Through their astonishing support of the Sebastian Ferrero Foundation, parents and business leaders in Gainesville have demonstrated that they value high quality, compassionate pediatric health care.

It is my profound hope that one day the Sebastian Ferrero Foundation's goal of creating a free-standing Children's Hospital will become a reality. But, as Goldfarb acknowledged in a recent feature in The Sun, it "will take a number of years if not a decade and a much more favorable economic climate" before funding is found for such a facility. For now, I'd celebrate the creation of a designated pediatric emergency room, viewing it as a real advance in efficient and safe patient care as well as another credible step toward achieving the ultimate objective of the magnanimous Ferrero family and the Sebastian Ferrero Foundation."

Stephen E. Landay is a Gainesville physician specializing in pediatrics and adolescent medicine.

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