Spokane7
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December 16, 2010 in City
Patients caught in hospital politics
NICUs fight for cases as Deaconess loses surgeons
Three-year-old Hudson Kramer kisses his 6-month-old sister Lily, as their mother, Brandy Kramer, holds Lily’s twin sister, Dahlia, at their home in Coeur d’Alene last week.
(Full-size photo)(All photos)
These are the places where the fragility of life is on full display.
Dozens of babies born months early, too little and too weak to breastfeed, their tiny lungs unable to capture ample oxygen, rest and grow inside special hospital bassinets. Their parents dream of the day when they can bring them home from these neonatal intensive care units, called NICUs.
Now an ongoing and increasingly ugly rift between Spokane’s two major hospitals has placed some of these families in the cross hairs of competition.
A key surgery group that saves dozens of premature infants each year has ruptured. Its doctors have taken sides, amid accusations of favoritism at the expense of patient care and safety.
In interviews and conversations, medical personnel and officials at Deaconess Medical Center worry that Providence Sacred Heart Medical Center is siphoning patients and wants to use its children’s hospital as leverage to dominate high-risk births and critical care for premature babies.
Their counterparts at Sacred Heart accuse Deaconess of pressuring physicians to keep patients at the smaller hospital against their judgment.
It has been unsettling for the medical community.
It’s been frightening for parents like Brandy Kramer.
After a nerve-wracking pregnancy ended in June with an emergency cesarean section, she found herself the mother of twin girls born at just 26 weeks and grasping for life after surviving a rare condition called twins-transfusion syndrome.
Lily arrived 1 pound 10 ounces. The nurses at Deaconess rushed her to a ventilator. Dahlia was born a minute later, 1 pound 14 ounces. She was whisked to her sister’s side and hooked to a machine to assist her breathing.
Kramer remembers how vulnerable her daughters seemed, the tubes and gauze, eyes scrunched shut, and their glistening skin.
After Kramer was discharged, she and her husband, Vinny Kramer, would drive every day from their Coeur d’Alene home to the hospital. They would pull on gloves and change diapers. Whisper to the girls.
They quickly fell into the embrace of the Deaconess NICU staff.
And then Dahlia got sick. Her abdomen became distended and doctors worried that her bowel might perforate.
Pediatric surgeon Dr. James Fischer wanted her put on strong antibiotics in hopes of avoiding surgery. Days later he left her in the care of colleagues and went on a scheduled vacation.
Dahlia had a medical condition called necrotizing enterocolitis. Part of her intestine was dying.
During Fischer’s absence it was decided that Dahlia would have surgery. Another surgeon in his practice was summoned to do the operation, a serious yet common procedure performed on dozens of premature babies every year at Deaconess.
About this same time, however, Fischer’s colleagues acted upon concerns they say they had harbored for months about Deaconess’ quality of care. They decided to resign their medical privileges at Deaconess and only perform such surgeries at Sacred Heart.
Dahlia would have to be moved.
Ann Seaburg, senior director of women’s and children’s services at Deaconess, said, “What could possibly justify moving a 2 pound baby by ambulance six blocks away for a surgery that has been done here hundreds of times?
“Just what is the issue here? Perhaps it’s not as convenient for the surgeon? That shouldn’t be the determining factor.”
NICU care offered by both for decades
Though the surgery group is owned by Sacred Heart, it was contractually bound to work at Deaconess, too.
A 2005 agreement signed by the hospitals’ chief executives closed the Deaconess pediatric unit and allowed its staff to migrate to Sacred Heart Children’s Hospital.
The five-year deal included an important proviso: Sacred Heart’s specialists would continue performing surgeries on premature babies at Deaconess.
NICUs are big moneymakers for hospitals. Regardless of a mother’s ability to pay her own hospital care, babies will be covered by Medicaid, and intensive care can run hundreds of thousands of dollars.
After years of losing money, Deaconess sold to for-profit Community Health Systems Inc. in 2008, and as the sale jelled, Sacred Heart called Deaconess managers to a meeting.
Peggy Mangiaracina, executive director of Sacred Heart Children’s Hospital, presented what amounted to a list of conditions if Sacred Heart was to continue providing surgical support to Deaconess’ NICU: The hospital needed radiologists and anesthesiologists specially trained in pediatrics, better equipment and other fixes.
Seaburg was surprised by the demands, but after the conditions were met the issues never resurfaced.
Then this year the sides tried to work out a new NICU surgery agreement.
Sacred Heart offered what Mangiaracina described as a fair-market contract requiring Deaconess to pay $525,000 per year. Deaconess declined.
As those dealings deteriorated, the surgery group began expressing new concerns about Deaconess.
Dr. Paul Thorne said he had been pressured by Deaconess staff to keep patients at Deaconess even if they would be better served at Sacred Heart.
Thorne recounted one baby with multiple congenital abnormalities whom he wanted to transfer to Sacred Heart. When his request met resistance, Thorne said he insisted and eventually the transfer was made. An emergency operation was performed on a Saturday night that required two pediatric specialists and a hastily arranged surgical team; it was a success.
“We couldn’t have pulled that off at Deaconess,” Thorne said.
Trouble caused by ‘political junk’
Brandy Kramer, meanwhile, was faced with a dilemma.
She was upset that surgeons wouldn’t operate on Dahlia at Deaconess. But she put her trust in Dr. Winston Chan, one of Fischer’s colleagues.
“As a mom I had to give control to these doctors and nurses and trust that they’re going to do what’s right for our family,” she said.
Seaburg supported Kramer’s decision but was privately upset by the episode.
“The bottom line is that we’ve been doing this kind of care here for 35 years and doing a damn good job of it,” she said.
At Sacred Heart, Chan successfully cut out seven inches of Dahlia’s bowel, stitched part of her intestine into her skin and attached a colostomy bag.
Dahlia spent three weeks recovering at Sacred Heart while Lily – at the insistence of the Kramers – stayed at Deaconess, where she was thriving.
Brandy Kramer ran back and forth between the NICUs, exhausted and worried.
Nurses at both hospitals tried to be supportive, though Kramer was bothered by the subtle suggestions that she should reunite Lily and Dahlia.
“I kept thinking the entire time this was happening that it was crazy what was happening to me and that my babies couldn’t be together,” she said.
When she spoke to her doctors about it, one of them called it “political junk” that has created a fissure in the Spokane medical community, she said.
“You could tell it was weighing on the doctors as well,” Kramer said.
When it was time, Brandy returned Dahlia to Deaconess.
When Fischer, the twins’ original doctor, returned, he said he was offended by the actions of his colleagues.
He was then presented with an ultimatum by Sacred Heart executives, he said, to resign privileges at Deaconess like the rest of his colleagues. He walked away from his practice instead and went to work for Deaconess.
“That’s wrong, and I didn’t deserve that,” he said.
He performed a second surgery on Dahlia with success.
Thorne and Chan defend their actions. They said difficult and complex surgeries on children should be done at Sacred Heart with its vast network of pediatric specialists.
Thorne said none of the surgeons were “coerced, guided or directed to not perform surgery at Deaconess.”
Fischer said he wants to help Deaconess preserve its NICU, which opened in 1975.
Sacred Heart insists it does not want the Deaconess NICU to close.
Seaburg said Deaconess intends to be successful but would like to re-establish a relationship with the Sacred Heart surgeons.
“We’re committed to the high quality care we offer. We want to stay local, but if we have to go outside to bring in surgeons and others to help us provide the best level of care, we will.”
White House honoree boasts roots in Colville 
deacon46 on December 16 at 7:31 a.m.
This, and similar issues for patients, is not about Politics. This the result for patients of two Corporations who are focused primarily on making money. The only difference between the two is that one doesn’t hide the fact that is totally in all that it does “for profit” while the other hides behind old worn out and hypocritical slogans and the Cross. The truth is that The future of Healthcare is here in Spokane.
Diana on December 16 at 8:53 a.m.
This kind of thing has been going on in Spokane for years. Nothing new here.
liberal_in_right_wing_land on December 16 at 9:38 a.m.
This is what happens when hospitals and medical companies are out to make money and not actually save lives. Here is your capitalism people, enjoy.
greenlibertarian on December 16 at 12:11 p.m.
Ain’t health care competition grand?
Diana on December 16 at 12:18 p.m.
B-b-b-but, the free market!
dfcalbreath on December 16 at 12:24 p.m.
This is a poorly written and poorly researched article. The Spokesman-Review has previously reported on the problems associated with doing complicated pediatric surgeries at Deaconess - inadequate facilities and staff, pressures to keep patients at Deaconess. As far as “making money” goes, look at who is providing the bulk of charity care in Spokane. It is not CMS - they are too busy accumulating money (the 2009 profit for the national company was $243 million - NY Times 12-10-2010). Providence is a non-profit entity and is not allowed by federal law to accumulate money or to show a profit. Whatever money Providence brings in must be spent on paying the bills, not lining the stockholders pockets. Providence is committed to high standards of care and facilities that simply are not available at Deaconess. Yes, the families are caught in the middle, but Sacred Heart did not start the problem. That responsibility lies somewhere else.
horse_feathers on December 16 at 1:23 p.m.
Thanks for that breath of fresh air known as the truth, Don.
IHike4Fun on December 16 at 3:26 p.m.
Good response Dan. Logical, well thought out and factual.
Scoutster on December 16 at 3:27 p.m.
First, do no harm.
addyh on December 16 at 3:30 p.m.
Don and Horse Feathers, I offer this comment received by e-mail from a Deaconess nurse:
As a 30 yr veteran nurse at Deaconess, I found this article to be extremely 1 sided. I don’t know why that should surprise me…the Spokesman-Review has most definitely been in Sacred Heart’s back pocket for as long as I can remember.
The other thing I found amazing in this article, was the comment supposedly made by the surgeons concerning the “quality of care.” I wonder if they are aware of how many Deaconess nurses pick up hours over at Sacred Heart and how many Sacred Heart nurses pick up extra hours at Deaconess? I’m reasonably sure that they don’t change their standards of practice according to which hospital they are working in on any given day.
***
This happens any time we write about Deaconess or Sacred Heart - people who work at both hospitals accuse us of favoring the other.
Addy Hatch, city editor
dfcalbreath on December 16 at 6:44 p.m.
Nobody is questioning the dedication and commitment of the nurses. They are hard-working and take their responsibilities seriously. The issue is with the parent organization. Deaconess has not provided the things needed for complicated pediatric surgery. To say otherwise is to misrepresent the realities of the situation. The nurses are not the issue - the willingness of the institution to provide the needed support is the problem.
sbrowand on December 28 at 10:14 a.m.
My daughter is a NICU survivor of Sacred Heart. Dr. Fisher has and will only be the surgeon to ever work on her congenital diaphragmatic hernia. For those of you who don’t know what a Congenital Diaphragmatic Hernia is, it is rare and very severe. For Dr. Fishers colleagues to do this to this very ill child, it is terrible! Just because you “feel” that the child isn’t getting the proper care does not mean to move the child 6 blocks when you could go and do it there. How would you feel if the child had died, or even gotten more ill while in transport?? The fact that they felt that the child didn’t have proper care, then right before the surgery, left their practice with Deaconess, it is selfish and cruel. Even though all my daughters care has and still will be at Sacred Heart, I am sick to my stomach to see what Sacred Heart has done to this family. THANK YOU DR. FISHER FOR DOING WHAT WAS RIGHT! If my daughter ever re-herniates, I will go to Deaconess for Dr. Fisher to repair it. SACRED HEART, SHAME ON YOU! And I would take this seriously, especially from a former NICU parent.
tiar on December 28 at 10:53 a.m.
I have to agree with Dr Thorne. My son was born at Deconess in August of 2008 , he had to have many life saving surgeries performed by Dr Thorne at deaconess but we asked many times to be moved to scared heart as many drs did not have privileges at deaconess. In one surgery deaconess did not have the medication that my son needed, so we had to wait over an hr for the medication to be brought over to deaconess.
There comes a time when a hospital needs to let go of a sick child that they cannot take care of. When that child need services that you cannot provide let them go so you dont kill them.
I feel that part of the reason my son is dead is due to the neglect of the drs at deaconess medical center NICU. I wil say that the nurses at both hospital were wonderful. But the dr that worked at deaconess left a really bad taste in my mouth for deaconess. If I ever have another child it will be born at Sacred heart where I know the care will be better and they are not afraid to let a sick child go where better care can be given.