Roy Exum
About a month ago I learned Erlanger Hospital’s nurses were being forced to endure unfair and shameful working conditions and I stood up for them. The hospital’s Board of Trustees took delight in chastising me … and talking a lot … but in the end it’s said I did more for the nurses than they did. That, in and of itself, disgusts me; it is not my place to police, criticize, nor expose Erlanger’s shortcomings. But if my words can deter just one preventable death, a lack of popularity within a crowd of the repeatedly dysfunctional doesn’t even make my eyes blink. The hospital made some key changes and, while colossal under-staffing problems remain, Erlanger – which is still Hamilton County’s greatest asset – has hopefully improved in at least one area.
The Hospital’s newest nightmare to be outed has been simmering for well over a year and I am assured comes as of no surprise to its trustees. It is now alleged the children’s neonatal unit is among the worst in the United States for a hospital its size. This is exacerbated, of course, because Erlanger’s NICU is, quite candidly, the only choice a “preemie” has within 100 miles of East Third Street when seconds matter in a newborn’s life.
Last week a group of neonatologists in our area contacted me to say they were “gravely concerned” about the care of babies who are admitted to Erlanger’s Neonatal Intensive Care unit. Since I know nothing about the delicate art, nor the difference in mortality and morbidity in premature births, allow me to share some of what I have learned with the grim belief several trustees know about this appalling catastrophe but have not mentioned the lack of oversight or concerns in recent board meetings.
It seems that until December of 2018, the hospital had a for-profit contract with a group known as Mednax that provided Erlanger with NICU services. The contract was not renewed and since it is believed the NICU has been managed by a combination of Vanderbilt and UT personnel. It is also believed the day-to-day operation and management of the NICU unit has been “in house.”
However, most NICU units in the United States maintain a national database through the Vermont Oxford Network. By comparing statistics, VON has become invaluable as a means for identifying areas of improvement for NICU units across the country. It has been learned that Erlanger’s VON input for 2019 allegedly “shows an inordinate amount of mortality in premature babies.”
The numbers that are being skipped across Tennessee and the Southeastern United States report a 70 percent mortality in babies born between 23- and 26-weeks’ gestation (average gestation is 280 days, or 40 weeks.) It is also reported Erlanger’s 2019 mortality rates for infants born between 27- and 29-weeks’ gestation is 50 percent. Again … 50 percent.
Here is the alarming news: “For a baby born at 23 weeks gestation, 70 percent mortality is expected. However, 70 percent cumulative mortality for all babies between 23 and 26 weeks is not normal and should warrant serious investigation,” according to most-reliable and well-versed sources. “In fact, the (determining “tools” most widely used by experts) disregards any gestational age (more than) 25 weeks because the survivability is expected to be so high (commonly higher than 80 percent)."
Fortunately, babies born between 23 and 26 weeks are not as common as babies born at higher gestational ages. Once again according to medical experts, “With a small denominator (total number of patients), anytime the numerator (deaths) changes by just a little, a NICU could have seemingly wonderful outcomes, or terrible outcomes, and nothing has changed in the NICU practice.”
Therefore, in the words of one neonatologist who is candidly “professional” in his analysis yet “gravely worried about Erlanger’s outcomes” said, “ … a “50 percent mortality in babies born between 27 and 29 weeks, if accurate, is ‘criminal.’ Never in my professional career have I seen that degree of mortality in a NICU of Erlanger's size.”
“My motivation in reporting this to you is because myself and my colleagues have devoted our lives to taking care of babies,” one area neonatologist wrote to me, “and we are all have a visceral reaction to this information.” (“visceral” is doctor-speak for “felt in or as if in the internal organs of the body” or, “deeply emotional.” You think?
Sour grapes? I am convinced this is not the case, not some former Mednax-employed doctor bitter that the contract was not renewed in 2018. Proof? Hamilton Memorial Hospital in Dalton would, in the past, send critical “preemies” to Erlanger. Several months ago it was learned Dalton specialists stopped relying on Erlanger, sending their most-critical to Atlanta instead. Yes, Atlanta is an hour further, but “it comes down to trust.” Please, how can an Erlanger-hired physician, in no way connected to the hospital’s NICU yet duty-bound to provide the best medical to the people in our region, stand idly by, knowing that every chain is gauged by its weakest link?
Erlanger’s chief of staff is said to be a pediatrician, for heaven’s sake, yet he must be aware of what the neonatologists have revealed, no? It is also believed the effort to build a new children’s hospital fizzled into an ornate office building, that the de-emphasis of the Children’s Hospital dream has been appalling to those who donated millions and were given broken promises in return. The once-proud Children’s NICU is now part of the main hospital and … the results now speak volumes.
I know, I know … Erlanger’s board will soon issue some comment about this latest “attack” on Erlanger, like it’s my fault the “50 percent mortality is criminal.” Please, talk amongst yourselves for all I care. Instead, on behalf of every pregnant mother within 100 miles, I plead that Erlanger do whatever it takes ‘stat’ to properly staff an adequate number of qualified nurses and doctors immediately to its floundering NICU unit. And not because outside neonatologists across the state, in Georgia, Alabama and North Carolina are “gravely concerned,” but because somewhere in our orbit right now, there is a problem gestation ticking … and that precious kid is going to need a chance. Real soon.
Be there for that baby.
royexum@aol.com