LIMA — Dozens of times since January 2012, doctors at St. Rita’s Medical Center and Lima Memorial Health System have had to transfer from their Level II neonatal units to Level III units babies that didn’t used to have to make the trip.
The transfers are the result of the Ohio Department of Health changing some guidelines to rules. The Ohio Health Department said the rules are in place to ensure the safety of infants and their mothers. Local physicians and care providers say the new rules take away their decision-making and judgment, impose undue burdens on infants and families, and add unnecessary costs to the health care system.
For a year, both local hospitals and state Rep. Matt Huffman, R-Lima, have sought a waiver from the new rules. Having been unsuccessful, Huffman plans to introduce legislation this week that would return more of the decision-making to doctors.
“The bill will simply say, notwithstanding those rules, if in the opinion of the treating physician, it’s more of a problem to send a baby to Columbus than to keep him in Lima, then he doesn’t have to do that,” Huffman said. “You know, maybe if a baby’s really sick, he shouldn’t get a 100-mile ride to Columbus.”
While the doctors in Lima delivering and caring OVERSET FOLLOWS:for babies may be top-notch, the Ohio Department of Health has a more broad responsibility, said department spokeswoman Tessie Pollock.
“I think there’s a disconnect in what Rep. Huffman would like the rules to be and what we mean them to be to ensure the health and safety of babies and their mothers, even as physicians come and go,” Pollock said.
The state now requires some babies born early, with low birth weights or needing ventilators, to be cared for in larger hospitals with higher levels of care, typically nearly two hours away. Huffman was frustrated by the heavy representation of Cleveland, Columbus and Cincinnati on the health panel deciding the new rules.
Previously, the Ohio Department of Health had guidelines, the same as national associations and boards, for when Level II nurseries had to send babies to a Level III nursery, but left much of the decision-making in the hands of physicians. In January 2012, the Health Department changed those guidelines to rules.
Now, when a hospital has a baby born at less than 32 weeks of gestation, weighs less than 1,500 grams (about 3.31 pounds), or needs to be on a ventilator more than 24 hours, the hospital must transfer the baby.
From Lima, the closest Level III hospitals are in Columbus, Toledo and Dayton.
That has meant that in 2012, St. Rita’s transferred about 50 patients out of about 1,500 births and LMH transferred about 30 patients out of 700 births they wouldn’t have otherwise. Those numbers don’t include babies the hospitals would have transferred before the rule changes.
While the number of families affected isn’t a large percentage of overall births, those families affected by the change face significant challenges, that begin with geography, care providers said. A family needing to move from a Level II to a Level III in Cleveland, Columbus or Cincinnati could go a few minutes or a few blocks. Not so in Lima.
“You have to uproot yourselves and your family and go to a bigger city,” said Joan McBride, LMH’s clinical nurse manager and a registered nurse for 17 years. “That’s financially difficult; you have to find housing, food. It pulls you away from work, and your other children. It’s a lot to think about.”
McBride said she understands the state’s concerns, especially about Level II neonatal units keeping babies they shouldn’t have and leading to bad outcomes, but that hasn’t been the case in Lima. Outcomes of specific hospitals were not considered when the change was made; in fact, Lima’s hospitals had good outcomes with these babies.
“They should be making exceptions for facilities that continue to provide excellent care,” McBride said.
Ohio has an infant mortality problem; it ranks 39th among the states, meaning that it has the 11th worst infant mortality rates in the country. The effort to address the problem began several years ago when Gov. John Kasich wanted to find things in health care costing the state a lot of money that shouldn’t be.
However, this rule change isn’t an effective way to combat things such as low birth weight babies, said Dr. Vanessa Stallkamp, chair of the obstetrics department at St. Rita’s.
The rules do allow for exceptions now, Pollock said. If a doctor believes a transfer would endanger an infant or fetus, if a patient’s legal guardian refuses the transfer, or if a doctor at a Level III facility approves the retention at a Level II facility, the patient doesn’t have to be transferred, Pollock said.
Pollock also said hospitals can choose to become Level III neonatal nurseries, and that the Ohio Health Department can offer technical assistance for that process.
Stallkamp, Dr. Jack Liggett, Dr. Romero Vicente and Dr. William Scherger, during an interview Friday, gave multiple reasons why these transfers rarely make sense, but why their hands are now often tied.
•A mother pregnant with healthy twins, one of whom has a low weight. One baby stays in Lima; the other is transferred.
•A baby making good progress on a ventilator, who needs a day and a half, or two days. The doctors recounted multiple stories about a baby taking a $5,000 ambulance ride from Lima to Columbus, because the 24-hour ventilator time limit is up, only to be on a ventilator only a few more hours once arriving. Even though the baby is healthy and breathing on his own, he’s now in a Level III nursery because insurance companies don’t fund transfers back.
•A mother in early labor who is sent to a Level III nursery, but then doesn’t give birth until closer to her due date, at which time she has a healthy baby.
Often, a long ambulance ride is the last thing an infant needs, Scherger said. And, many times, babies that need some level of special help are born to parents with health issues or low incomes. The hospital is required to transfer the baby, but not the mother. Romero said he often transfers babies of parents without a means to pay for housing or food, or without a reliable enough car to get to another city.
Both hospitals also have formal relationships with Level III facilities. LMH is part of the Promedica system, which includes Toledo Children’s Hospital. St. Rita’s last year formalized an informal relationship with Nationwide Children’s Hospital in Columbus. They both already have state-of-the art telemedicine capacity and can consult with neonatologists there, doctors said.
Romero expressed the doctors’ frustrations that their judgment has been supplanted without flexibility: “They’re just no human touch on these rules.”