The following letter was sent to The Baltimore Post regarding the issue of Franklin Square’s decision to close some of their pediatric care units.
It is the policy of the Post to protect the identity of individuals to express their opinion without fear of retaliation.
The below letter is published as written.
In the early 1900s, the northeast pocket of Baltimore County, Maryland became the home to the world’s largest steel mill – Bethlehem Steel. The company served as a vital part of steel production for WWI and WWII and generations of laborers and their families were transplanted from Appalachia to keep up with the mill’s growing demands. At its peak in the 1960s, the mill employed 30,000 workers. Over the next two decades, the steel industry declined and with it, the 1970s and 80s led to massive lay-offs at Bethlehem Steel leading to a depression in the area that has yet to recover. This pocket of Baltimore County is now home to some of Maryland’s most vulnerable families. Here, many residents struggle quietly with drug abuse, domestic violence, and child abuse. The area suffers from the highest rates of teen pregnancy and low-birth weight babies in the state.
Since it opened its doors in 1969, then as Franklin Square Hospital, MedStar Franklin Square Medical Center (MFSMC) has been the only hospital in this part of the county. The hospital catchment area also includes thirty-seven schools, making pediatric care a critical aspect of its service. Its many outreach initiatives such as smoking cessation programs, flu vaccine drives, breastfeeding initiatives, the Healthy Babies Collaborative, and asthma control coordination with school nurses helped grow a relationship between the hospital and the communities it served. One of the critical outreach services was the Child Protection Team (CPT) started by Dr. Scott Krugman in 2000, the chairman of the Department of Pediatrics and a nationally recognized and respected pediatrician. The team cared for three hundred abused children each year with 24/7 social work and physician coverage and Franklin Square served as the Baltimore County center for child sexual abuse evaluations. This was the only program in the state of Maryland with these comprehensive services.
With its role as the only hospital in northeast Baltimore County, a geographically and economically isolated area, the hospital’s volume grew quickly and the Franklin Square emergency room became the busiest ER in Maryland seeing over 100,000 patients annually. By 2006, the community support of Franklin Square allowed a $200 million dollar building expansion. Due to increasing demand for pediatric care, around this same time, the pediatric ER and inpatient unit were created. In 2017, the pediatric ER saw 17,000 patients and over 800 children were admitted or kept for observation in the pediatric unit. Approximately 50% of pediatric patients serviced were Medicaid patients, for many of which transportation was a barrier to care and thus the availability of pediatric services there, on the bus line, was vital.
Unfortunately, on Tuesday, April 3rd, 2018, after decades of service to the community, the Department of Pediatrics at Franklin was notified by MedStar administration that Friday, April 6th the pediatric inpatient unit would be permanently closed and the previously separate pediatric emergency room would be combined with the adult ER. Dr Krugman, who had devoted over twenty years of his career to this hospital and community, was terminated immediately that day. Dr. Adrienne Suggs, who was instrumental in building the pediatric ER over the last fourteen years, was also terminated that day. Thirty staff members including nurses, technicians, and secretaries specifically trained for pediatrics, lost their jobs. Additionally, the eight pediatricians who staffed the inpatient unit and emergency room lost their jobs.
The fallout from this has been nothing short of a public safety disaster.
The MSFSMC adult ER providers were asked to assume the role of experienced emergency pediatric providers without recent experience to do so as the pediatric ER was in a separate space. Friday morning, April 6th, they were learning PALS – Pediatric Advanced Life Support, normally, a two day class. The adult ER nurses and medical technicians are untrained, unprepared, and terrified. Many had not seen a pediatric patient in over a decade and yet now the life of the blue newborn that is brought in by ambulance rests in their hands. Over the years, many older pediatric patients without life-threatening conditions were seen by adult ER providers, but critically ill infants and toddlers were treated and managed by pediatricians.
Emergency medical services were told the departments are “merging” so they continued to bring children in need of emergency care to MSFSMC ER expecting pediatric specialists.
Parents expected their children would be seen by pediatricians or at least physicians experienced in seeing children.
Patients in need of observation or admission from the surrounding communities will now have to be transferred to other hospitals. Many need a prior authorization as Franklin Square was the last MedStar hospital for inpatient pediatrics outside of Georgetown University Hospital in Washington DC– something extremely time consuming to do and especially intrusive on patient care for a busy ER provider.
The Child Protection Team was dissolved. Firing Dr. Krugman ended the program, and all social workers and covering doctors were terminated as well. No coordination occurred with other hospitals, so the hospitals were calling Dr. Krugman and asking what to do. It is highly likely that children who are physically abused are going to be missed or not reported because of not having a system in place. Children who are victims of sexual abuse will have to travel far for evaluation.
Medical imaging for pediatric patients who need sedation – gone.
Post-operative pediatric care for orthopedics, general surgery, and ENT, on a dedicated pediatric unit by a dedicated pediatric team – gone.
Pediatric rotation and pediatric faculty didactics by pediatricians for the Family Medicine Residency program – gone.
Dedicated pediatrics for the Georgetown medical students for whom we have been the community pediatrics cite – gone.
The decision of this administration was callous and irresponsible with complete disregard for the lives of infants and children, those who love and care for them, and those who have devoted their careers to taking care of people. Where is the responsibility to the community who has funded the expansion of this community hospital? Who will be the voice for the many poor and bruised here? Who will be held accountable when these children do not get the care they need?
This event has highlighted the national issues of inequitable access to healthcare, compromises to quality of care, and rising costs amidst already outrageously costly healthcare. Our healthcare system, the only one in a scale economy that is for-profit, is the most expensive in the world with healthcare spending at 17.9% of the GDP in 2016 (KaiserFamilyFoundation.org). Sadly, by measures of quality, we are nowhere near the top. And the for-profit mentality, where business people are blinded by the bottom line and not what constitutes good medicine, is ironically driving up the expense while simultaneously deteriorating care and access to care.
Between 1975 and 2010 the number of health care administrators grew by 3200% in US while doctors increased by 150%, keeping with population growth (Athena Insight, 2011). There is one healthcare executive for every 25 doctors in this country. Administrative costs account for 20-30% of healthcare spending. In contrast Medicare, a single-payer system, spends 3% in administration (Reid, 2010, p 38). Many point to doctors’ salaries as a cause of the cost of care but doctor salaries take up 8% as of healthcare costs (Jackson Health, 2011). Corporations like MedStar buy up hospitals monopolizing markets, increasing prices, and providing no transparency. They then eliminate historically non-profitable but vital services like pediatrics and other primary care specialties having completely lost sight of the role of physicians, converting hospitals in surgical centers with the only objective being profit. They claim non-profit status and escape taxation, while barely providing any meaningful charitable care.
We can no longer sit on the side lines as care is denied to our most vulnerable and needy and believe MedStar, corporations like it, and all those implicated need to be held accountable. The public deserves to know what is happening.
Medstar Franklin Square’s Mission reads: “MedStar Franklin Square Medical Center, a member of MedStar Health, provides safe, high quality care, excellent service, and education to improve the health of our MedStar Franklin Square Medical Center community.”
They have failed their mission on every account.
All of our children deserve the best care. We need to take back medicine.
Healthy System Dashboard retrieved from https://www.healthsystemtracker.org/dashboard/
Cantlupe, Joe (Nov 2017) The rise (and rise) of the healthcare administrator. Retrieved from https://www.athenahealth.com/insight/expert-forum-rise-and-rise-healthcare-administrator
Reid, TR (2010) The Healing of America (p 38) New York, NY : The Penguin Group
Jackson Healthcare (May 2011). Physician Compensation Eight Percent of Healthcare Costs. Retrieved from www.jacksonhealthcare.com/media-room/news/med-slaraises-as-percent-of-costs/