SPECIAL COMMITTEE ON FAMILIES

MEETING

APRIL 25, 2000

 

MEMBERS:         Paul J. Noto (Chair), Lois Bronz, Amy Paulin

 

GUEST(S):Neil Abitabilo, Normet Hospital Association;

                              Marie M. DeRiso, Sound Shore Med. Center;

                              Mary D'Amico, Westchester Children's Assoc.;

                              Carlos Flores, Lawrence Hospital; Norma Dreyfus,

                              Pediatrician; Arthur Weintraub, Normet Hospital

Association; Joli Yuknek, M.D., Pediatric Emergency Physician; Michael Volk, W.C.Dept.

of Emergency Services, EMS; Emil Nigro, M.D. 

Phelps Hospital; Arthur Cooper, M.D., American

Academy of Pediatrics, Robbi Schlaff, County

Executive's Office, Cora Greenberg, Westchester

Children's Association: Ingrid Bent, County

Executive's Office

 

STAFF:                Tara Bernard, Peter Neglia, Sally Schecter

 

The meeting was called to order at 3:10 p.m.

 

Legislator Noto had everyone introduce themselves and explained that there had been some discussions concerning pediatric care in emergency rooms and that Dr. Dreyfus spent some time with the committee discussing articles that had appeared in various magazines and papers regarding this issue.  He went on to say that the Committee thought it would be a good issue for them to become involved in.  The County Government does not have direct jurisdiction over the operation of hospitals, but by using the resources of County government we can focus attention on certain issues.    We might have an impact and improve things that need to be improved.   We've asked representatives from the medical community to come in today to talk a little bit about the issue from their perspective as to what can be done and if we agree that we need to improve the quality of pediatric care in emergency rooms, what steps should be taken to  implement the improvements.  If it is a question of money, hopefully we can find a way to address it. 

 

Do the emergency rooms in the County have sufficient, adequate or appropriate equipment to treat pediatric emergencies? 

 

Dr Dreyfus said that a lot of the hospitals have the equipment but it is the need for 24 hour trained people if there is a very seriously ill or injured child.  Most of the hospitals have people on board some shifts. 

 

Mr. Weintraub started the discussion with the information that there are 14 acute care hospitals within the County, 4 specialty hospitals. 

 

Dr. Carlos Flores spoke for Lawrence Hospital.  The hospital sees approximately 4000 children a year.  Staffing in the past year is better than it was and in terms of equipment, Lawrence is doing okay.  Lawrence has the Braslow Tape, which is lined up with the colors.  There is room for improvement and growth.  All of the staff is PAL certified (Pediatric Advanced Life Support) but the hospital is not covered 24 hours a day by emergency trained physicians.  There are 7 hours a day when the hospital is not covered.  During those 7 hours they might see 2 or 3 children but it is cyclical, depending on the time of year.  The cost to cover those 7 hours would depend on whether the person just finished his residency or if the person was someone with experience.  The question was asked what is Pediatric Advanced Life Support?  Resuscitation.  One does not have to be a doctor to be PAL certified.  An EMS person could be PAL certified but when one goes to the Emergency Room, one would expect the level of care to be higher then what you would get in an ambulance.

 

Dr. Nigro spoke for Phelps Hospital.  About 8% of Phelps volume is Pediatrics.  Phelps has all Board Certified emergency physicians.  They have available back up but the majority of the children do not have life threatening illnesses so they do not have pediatricians on staff 24 hours a day because that level of specialty is not required.  They do have pediatricians available 24 hours a day, 7 days a week and if a child requires tertiary care, that child is transferred to Westchester Medical Center.

 

What is the Jaco requirement?  The Joint Commission of Accreditation requires hospitals to have specialty back up in a reasonable time frame, 24 hours a day, 7 days a week, 365 days a year and all hospitals go through Jaco accreditation which is monitored by HICVA and NYS Health Department.  The Dream Foundation donated to all hospitals the Braslow tape and the Braslow system.  The system enables a hospital to measure a child to see where they conform to on a chart which is color coded – if it is yellow,  the yellow drawer is opened and all the material and equipment is sized to fit that patient.  The Dream Foundation donated EMS kits to 3 or 4 of the volunteer ambulance corps that come into Phelps.   

 

The Committee is concerned about Sound Shore and Hudson Valley trauma centers.  If there was a severe trauma, an ambulance would  not make a distinction between a child and an adult and would go to the closer of the two hospitals and not the Medical Center.  Sound Shore does have 24 hour a day coverage in addition to the ER physicians being Board Certified and PAL.  They have 24 hour a day coverage with pediatricians because they have a pediatric unit and there is always back up.  In terms of trauma, if a patient comes in and is stabilized and needs intensive care, Sound Shore would automatically transfer that patient to the Medical Center. Hudson Valley is a level 2-trauma center that has to meet certain criteria.  Neither center applied to receive children.  Both centers applied to receive adults only.  The only hospital in Westchester County that is designated to receive severe trauma patients by ambulance is Westchester Medical Center.

 

Amy asked about the other 11 hospitals.    According to Mr. Weintraub, it is 11 out of 14 because there are 2 major systems, Pinnacle Group and the Health Star Group and they have continuing consultations and discussions among themselves.  The only hospitals that fall out side of that who aren’t here are Dobbs Ferry, St. Agnes and St. Joes.  Art Weintraub is not certain what the severity of the problem is.  If there is a problem, Normet has a responsibility to do something about it as the hospitals are there to serve the community.  He went on to say that he has to rely on the physicians who deal with this on a daily basis.  One can always strive for perfection and no matter what we’re never going to achieve the most ideal circumstance because there are always resource problems.  We need to pinpoint precisely what the gap is and how serious that gap is.  Every ER is different.  

 

The agencies within the Hudson Valley catchment area are aware that pediatric child cases that fit within a certain criteria need to go to a tertiary care center.  If a child is in cardiac arrest, they will go to the closest hospital.  We need to know what are the right places, get these kids to the right places and the community needs to know what they are.  We are not asking that each of the hospitals be equipped for pediatric trauma.  That is impractical.  We need to send a message out to the EMS people which hospitals have Board Certified PAL trained physicians on a 24 hour day, 7 days a week and who are close by.  The public is under the assumption that every emergency room in Westchester is meeting a standard of care. The purpose of this meeting is not to point out gaps in the system but for identifying the gaps that need improvement.  It might be a good idea to identify the hospitals that are best suited for pediatric care. 

 

PACES has a survey that they will give to Art.  After the results are in  we will have a follow-up meeting.  The PACES project is about coordination of information. 

 

We also need to be concerned about the impact of EMS.  There are about 40 dispatchers in Westchester County alone dispatching to any number of volunteer ambulances.  It is very difficult for ambulances to by-pass a hospital when a survey says another hospital is better equipped to handle something.  There is a whole community of ambulance companies that make on the spot judgments and it would be very hard to convince them to not make that judgment.  We don’t know if the staff in ambulances is properly trained and we don’t know if they have the proper equipment.  How do we set out some standards for EMS workers and do the equivalent surveys?

 

Art Weintraub will have the survey by Monday and we will meet on   June 14 at 3 p.m. 

 

The meeting was adjourned at 4:05 p.m.