"The Ronan Report" provides insight about the activities at the Western Maryland Health System in Cumberland, Maryland, and about the changes taking place in healthcare today from a CEO's perspective.

Thursday, June 21, 2018


If there was ever a time to re-engage my blog, now is it.

Since early June, I have been reading and hearing so much misinformation regarding the WMHS Pediatric Unit.  We are NOT abandoning children by closing our Pediatrics Unit.  The term “closing” is a regulatory term that we have to use even if we are transitioning our unit from virtually a single Pediatric inpatient bed on an adult patient unit to a five bed Pediatric Observation Unit adjacent to the Emergency Department.  Unfortunately, last Saturday’s newspaper headline stated that the unit was closing.  If you just read the headline and not the article, I can see how one would think that the Pediatric unit was actually closing, but again, that is not the case.

Beginning in early August 2018, any child requiring an overnight stay will be cared for in a dedicated, secure unit that is being newly constructed next to the ED.  The child can remain in the unit up to 48 hours; after that, clinical decisions will be made as to transfer or discharge to home.  This unit will be staffed by Pediatric Advanced Life Support trained nurses along with Emergency Department physicians and physician assistants.  Pediatricians will continue to attend to children in the unit, as well.  Because we have so few pediatric patients (for the first nine months of the fiscal year, we have admitted 44 children who have stayed an average of 1.93 days), our Pediatric staff nurses cannot maintain their expertise, nor can we recruit dedicated Pediatric nurses because we admit so few children.  The ED staff are very well trained in caring for and treating both adults and children.  In fact, last year we treated close to 9,500 Pediatric patients in the Emergency Department with 86 being admitted to WMHS and about 300 being transferred to a Pediatric Specialty hospital due to their chronic or critical condition.  As a parent and a grandparent, I can’t imagine why a parent or guardian wouldn’t want their very ill child treated in a specialty facility where the specialists treat thousands of children each year. 

Some have said just bring the specialists to Cumberland and we do, but caring for children on an outpatient basis usually for chronic or follow up care in Pediatric Cardiology and Neurology.  With a two hour travel distance and so few patients, it is unrealistic to think that specialists would come to Cumberland to perform surgery on one child.  There are physician shortages in virtually every specialty for both adults and children and areas such as ours have the greatest challenges in recruiting.  WMHS like so many other community hospitals have had to resort to alternatives in the care and treatment of children.  We are using more digital technology, telemedicine, and partnerships to address the needs of children and through our affiliation with UPMC, these advancements will continue to grow.  In Maryland, 33 out of the 47 hospitals, have Pediatric Units.  Eighteen of those hospitals have a length of stay for Pediatrics of less than a day and there are nine Maryland hospitals similar to WMHS with a length of stay of less than two days.  Over the last 30 years, Pediatric beds in Maryland have decreased by more than half from 882 to 385.  More and more children are being cared for in the most appropriate location, a specialty hospital, when they have a critical or chronic condition.

I certainly recognize the hardship for families who have to travel out of the area if their child is very ill.  Our staff at WMHS will work with the specialty hospital as well as throughout our community to assist with this hardship to the extent possible.  Although such transfers have been occurring for the last several years, we will become more engaged in the process and assist these families in navigating the challenges that they face when such circumstances arise.

I hope that the information contained within this blog helps to clarify the circumstances surrounding Pediatrics at WMHS.

1 comment:

  1. In all due respect, this is nothing more than spin by WMHS. You criticize the newspaper for their headline about the Pediatric Unit closing. The fact is that you have closed the Pediatric unit years ago. But, you are arguing over the word “closing”. You, yourself said, “the term closing is a regulatory term that we have to use”. You have to use it because it is fact! You will not be admitting Pediatric patients to the pediatric unit because it is closed. You instead will be “transferring “ pediatric patients to the observation unit. Just because it is new and cost millions of dollars does not mean that it is what is best for this community.
    WMHS has been using the following statistics to reinforce their decision for an observation unit. According to your numbers, 9500 children have been seen by ED. 86 were admitted to the hospital and few of those stayed more than 48 hours. 300 were “transferred “ to another hospital for chronic or critical conditions. The number that you neglect to report is how many your ED referred to another hospital. The original Pediatric Unit has been closed for years. What effect does that have on your statistics? According to your own blog, “ transfers have been occurring for the last several years”. Your data is scewed because your hospital has not fully served children for years. Families have been sent out of town for broken bones, dehydration, and other minor illnesses that used to be handled in our hometown. Your data may serve your spin but does not show the full story.
    You also say that you recognize the hardship to families. Do you know that MA children will not be able to receive care for more than 24 hours? Please review this document from MDH.
    If children with MA stay in your observation unit over the 24 hour period, their family will be charged out-of-network for the additional time in the hospital. That means that families who live in poverty will have even less care for their children who are in the most need.
    Lastly, on June 14 your staff was asked how they plan to help families who have to go out of town and have many needs. Your staff stated that once they helped the families to get to the receiving hospital, it was that hospitals responsibility to help that family. When I met with Mr. Karstetter I asked if they have worked with local agencies to help prepare for family ‘s needs. His response was something to the effect of that the hospital can’t do everything. So, how exactly is WMHS going to be more engaged in the process? I have contacted the County Commissioners to request their help to get community agencies together to help families during their medical crisis.
    Every parent wants the very best care for their child. Chronic and critical illness is an excellent reason to transfer a child. But, please explain to families why WMHS refers their child to another hospital for common childhood illnesses. This means they need to pay for transportation, hotel, food and possible loss of income.
    WMHS’s decision is not taking into consideration the community. Very sad!