Dr. John Dreyzehner
Dr. John Dreyzehner’s last day as commissioner of the Tennessee Department of Health (TDOH) was Friday. One of his final acts as commissioner was to send a letter dated two days before his departure, asking for details regarding Ballad’s plan to consolidate NICUs operating at Holston Valley Medical Center and the Niswonger Children’s Hospital on the campus of Johnson City Medical Center.
The plan is very unpopular in Kingsport, and the commissioner’s office has fielded a number of inquiries from Kingsport citizens, as have state legislators, Ballad executives and the news media.
Monday, Ballad released to the public its responses to Dreyzehner’s final round of questions. Pursuant to its duties, the commissioner’s office has been trying to determine if there would be deleterious effects to the patient community served by Ballad from having to travel to Johnson City from areas closer to Holston Valley. The following are excerpts from Ballad’s response.
TDOH: Please confirm how travel distance of affected families will be tracked.
Ballad: Children’s hospitals by their very nature are regional providers that serve large geographic catchment areas. Tracking mileage is not a standard practice as the region is defined and can vary based on patient origination. Patient origination data is available, and demonstrates that more than 500 newborns were transferred to Niswonger from distances greater than one (1) hour away from Niswonger, and as much as two (2) hours away. Distances like this are not unusual for children’s hospitals, and certainly, in Tennessee, fairly typical with respect to the regional perinatal centers, of which there are only five. The catchment area for Niswonger Children’s Hospital is 11,402 square miles which has not changed since the merger and will not change post NICU consolidation. The vast majority of Level III NICU services are provided at Niswonger today, so the distances are not a new issue.
We wish to emphasize once again that HVMC is only 24 miles from Niswonger Children’s Hospital. The only families that will be affected by this change are the approximately one hundred families whose babies will now be treated at Niswonger’s NICU instead of HVMC’s NICU. With the move to Niswonger’s NICU, some of these families may find their travel distances increased slightly (but no more than 24 miles). Other families may find that their travel distances actually decrease. As pointed out in our previous correspondence, Niswonger has adjacent housing for families available through the on-property Ronald McDonald House and sleeping accommodations for families at Niswonger. These services are not available at HVMC.
The commissioner’s office also has been trying to determine whether transporting infants to Johnson City could lead to deaths in cases where the infants might be treated sooner at a non-consolidated Holston Valley NICU.
TDOH: According to your December 28, 2018 letter, no babies expired in transport to JCMC. Please provide the Department with a list of the infant deaths pre-transport and post-transport during the last three years for all Ballad hospitals.
Ballad: There is no list of infant deaths pre-transport. Ballad does not deploy the transport team for newborns that are deceased.
To the best of our knowledge and belief, there have been no infant deaths during or after transport which could in any way be attributed to the transport of the newborn. The Department has the capacity, at any time, to review the details of the death of any newborn, and Ballad has always complied with the survey process whenever the State’s teams request such specific information.
To restate the Ballad policy, newborns born at Ballad hospitals are only transported once stabilized. Ballad follows the State’s Perinatal System Guidelines for Transportation which were approved by this Department and signed by the Commissioner. There have been no assertions that an infant death was caused by transport. There has never, in any survey conducted by the Department, been an allegation or finding that an infant death was related to transport.
Later in its query, the commissioner’s office asked:
TDOH: Regarding the proposed establishment of two Pediatric Emergency Departments in the region, please provide the Department with the financial analysis related to this proposal.
Ballad: The State directed Ballad to establish two Pediatric Emergency Departments in the Terms of Certification. As required, Ballad included the development of two Pediatric Emergency Departments in Kingsport and Bristol in the Children’s Health Services Plan that was submitted to the Department on July 31, 2018, and which is now posted on the Department’s website. With regards to the financial analysis, clinical analysis, and needs assessment for these Pediatric Emergency Departments, Ballad would direct the Department to the information previously provided as well as any information the Department relied upon during the COPA Application process in directing the implementation of the new Pediatric Emergency Departments.
Incoming Health Commissioner Dr. Lisa Piercey took over from Dreyzehner Monday.