A Beacon for the Babies
Cross-Community Collaboration Brings the Best in Pediatric Care to the Midlands
By Kristine Hartvigsen
It’s a child’s most gripping nightmare. Chilly corridors flooded with garish industrial light, faceless people coming at you with enormous hypodermic needles, and noisy machines that seem intent on swallowing you up. Children dealing with serious illnesses are not simply miniature adults who are sick. They have far different perspectives, fears, and needs − primary among them not being terrified by the place where they must go for treatment.
Developers of children’s hospitals recognize this and design facilities to counter children’s most immediate anxieties. They also continually work to provide services in high-need pediatric subspecialty areas such as neurology, cardiology, child psychiatry, gastroenterology, radiology, and child abuse. The Midlands is fortunate to have one of four freestanding children’s hospitals in South Carolina – Palmetto Health Children’s Hospital. The others are in Greenville, Florence and Charleston.
Walking into Palmetto Health Children’s Hospital, families feel the friendly embrace of natural atrium light, cheerful colors, and a three-story fabric mobile of two affable dolphins. Designers paid meticulous attention to every detail, from lobbies to patient rooms to play therapy rooms. Young children especially need their mommies and daddies, so Children’s Hospital deliberately includes the entire family in treatment and accommodates their active participation in their children’s care. Vulnerable children also need reassuring surroundings that help make them feel that they have some sort of control.
Despite hours enduring medical procedures and chemotherapy to combat neuroblastoma, 7-year-old Gamecock baseball fan Baylor Teal enjoyed his visits to Children’s Hospital. “He would say, ‘Daddy, I think I have another fever,’” recalled Sam Tenenbaum, president of the Palmetto Health Foundation. “He knew that a fever automatically resulted in a trip Children’s Hospital. He looked forward to it. He wasn’t scared at all.”
University of South Carolina baseball players dedicated their performance at the 2010 College World Series in Omaha, Nebraska, to Baylor. They had his initials stitched into their caps, and many players shaved their heads in solidarity with the ebullient little boy. Sadly, Baylor passed away peacefully while watching the Gamecocks play on television.
Coping with a serious illness is understandably stressful on families. The goal of a children’s hospital is to locate all resources a child needs conveniently in one place, to make a child’s care as seamless as possible so a family doesn’t need to be separated traveling to multiple cities for care.
Tenenbaum encourages people to tour the Children’s Hospital and see all its comforts and amenities. “The color and the way it’s painted is really vibrant,” he said. “It’s bright. There are play rooms so children can be children even though they may be sick.” There are multiple engaging murals exploring various themes, including rainforest, polar, and aquatic environments. Special family spaces allow parents to stay close while their children are being treated.
Established during the merger that formed Palmetto Health, the Palmetto Health Foundation plays a pivotal role in securing resources for the Children’s Hospital as well as all operations under the Palmetto Health umbrella.
“We support everything from the children’s hospital to hospice,” Tenenbaum explained. “It’s amazing how many elements we have within Palmetto Health … including an Administrative Medical Committee that looks at needs. It could be equipment or programs. It could be hiring a subspecialist. There are lots of needs. We field requests, and sometimes donors will come to us and say they want to do something specific for the hospital. One put up $800,000 for us to match to build a behavioral emergency room. We have the only behavioral emergency room in the Midlands right here.”
Caughman Taylor, M.D., senior medical director of Palmetto Health Children’s Hospital, enthusiastically describes the hospital’s ongoing progress.
“The most exciting thing is the growth in programs and services we have made. We have hired pediatric subspecialty physicians in such areas as urology, movement disorders (such as tics), autism, and Attention Deficit Disorders (ADD),” Dr. Caughman said. “Because there is such a shortage across the country, we have had a hard time getting subspecialists here. ... The ability to bring so many subspecialist positions is allowing us to meet the needs, lower the waiting lists, and bring expertise that did not exist before here in the Midlands and the state. We can reach out on a larger scale into more communities, including Florence, Orangeburg, and Sumter.”
A non-profit partnership with the USC School of Medicine (USCSM) is a vital component in expanding access to care in surrounding communities. It integrates Palmetto Health’s physician practices and USCSM’s clinical departments to form the Midlands’ largest multi-specialty medical group. USCSM’s campus in Greenville (added in 2011) further strengthens collaboration with the Greenville Hospital System, which since 2009 has jointly owned and operated Palmetto Health Baptist Easley Hospital.
“We are one of three major children's trauma centers,” Dr. Caughman said. “If your child experiences major trauma, s/he will be flown to one of these centers.”
Dr. Brandon Emery with Lexington Pediatric Practice is proud of Lexington Medical Center’s nursery, neonatal intensive care unit, and outpatient pediatric services. LMC does not provide inpatient care for pediatric patients because of Children’s Hospital.
“We have excellent resources in the area,” he said. “Our pediatric patients who need inpatient care are sent to Palmetto Health Children’s Hospital. The care team at Children’s Hospital constantly communicates with non-staff pediatricians. It is a pretty open dynamic … and even though we are based at LMC, we are still involved in our patients’ care.”
A shortage of pediatric subspecialists and surgeons has been a challenge since 2010. Other trends in children’s health overwhelmingly focus on the overall health of the “whole child.”
“There has been a shift over the past 5-10 years to more preventive health care and making patients healthier over the long term,” Lexington’s Dr. Emery asserted. “It really started once childhood obesity hit the news.”
While consumers have a greater awareness about the availability of vaccinations to prevent disease, Dr. Emery has encountered distrust of the Centers for Disease Control (CDC) and other government agencies with regard to vaccine recommendations. “It cycles. There was some improvement after the measles outbreak in California … we have done such a good job improving health because of vaccines.”
The human papillomavirus (HPV) vaccine is a promising means for preventing cervical cancer. However, it remains controversial. “Does it increase risky behavior? That’s not certain,” Dr. Emery said. “But the HPV vaccine works, and it has minimal side effects … we’re continuing to fight that battle. With any new kind of vaccine, there is always pushback with it. The longer it’s out there, the benefits will be seen. But it is not required, and there is a stigma attached to it, so there are still substantial numbers of people not immunized.”
A study in the journal Pediatrics in August documented a decrease in the number of children’s hospitals using CT scans on pediatric patients. Drs. Emery and Taylor both acknowledged that trend.
“Absolutely, there has been a shift away from using CT scans on children,” Dr. Emery said. “Appendicitis used to be diagnosed with a CT scan all the time. Now, with good quality ultrasounds, we can diagnose with far less exposure to radiation. In my practice, I order probably twice as many ultrasounds as CT scans.”
“Our trends are not much different from those in adult health care,” Dr. Taylor noted, “except finding subspecialists is so much more acute.” He continued, “We are working in the community to improve health overall. Caregivers work together to ensure that outcomes are better and that quality of life is better. A lot of that has to be focused outside the hospital.”
To that end, Palmetto Health continues to establish satellite clinics in communities that need them. Children’s Hospital now has a community liaison whose job it is to engage communities and promote health, to identify areas of need, and to make people aware of available hospital resources, as well as Medicaid coverage for children. An estimated 65 percent of Children’s Hospital patients receive Medicaid.
“We treat more than 80,000 patients annually at Children’s Hospital,” the Foundation’s Tenenbaum said. “We have children coming to us from all over the state and some from out of state.”
Meanwhile, the Foundation continues its tireless work. “There are 22,000 non-profits in South Carolina. A lot of good institutions compete for nonprofit dollars,” Tenenbaum continued. “You have to be able to tell the story of the impact you are having. … We have the No. 1 trauma unit in the state. Trauma doesn’t produce dollars; it saves lives. The Children’s Hospital doesn’t produce dollars. It saves lives. People need to know the story. It does cost money, and we need to support it. We focus on quality medical care from A to Z.”
Quality is the operative word behind the formation of the South Carolina Children’s Hospital Collaborative, a non-profit organization that meets monthly to serve the singular mission of delivering the highest quality health care available.
“We have always been focused on quality, but now we are part of a national network,” Dr. Taylor explained. Moving forward, the Children’s Hospital’s focus will be on trauma and neurological rehabilitation. “We are trying to build the state's first neurological rehabilitation unit to care for pediatric victims of car accidents, stroke, and other brain trauma. Accidents and trauma are the No. 1 killer of children.”
Children’s Hospital also hopes, some day, to develop an epilepsy monitoring unit and a pediatric gastrointestinal unit.
“Our Foundation has just been phenomenal,” Dr. Taylor said. “And the reason is that the community recognizes our needs.”
“In the end, it’s about loving your neighbor. We know we are providing the best medical care,” Tenenbaum concluded. “The children here get the best quality medical care that is available in the country, period.”