The most sincere and unambiguous wisdom I have received for getting through the past two and a half years came from Mark, a 14-year-old who walked into Children’s Hospital Los Angeles in late 2020 and remained for five months as he awaited a heart-liver double transplant.
“It’s really a marathon. If you can’t run, you walk. If you can’t walk, you crawl. If you can’t crawl, you scoot. You do something. You have to keep going on,” he told me.
I was thinking of his prescient and inspirational words after reading a recent New York Times article, “As Hospitals Close Children’s Units, Where Does That Leave Lachlan?” It reports that many adult hospitals across the country — urban and rural — are eliminating pediatric beds for more lucrative adult beds. This leads families to search far and wide for pediatric beds elsewhere.
According to a study by Dr. Anna Cushing, pediatric specialist and fellow at Children’s Hospital Los Angeles (CHLA), hospital beds for children with asthma, pneumonia, viral infections and other serious illnesses have declined in the last 10 years, mainly in rural areas. As a clinician in our hospital’s Emergency Department (ED), Cushing shares that our ED in Los Angeles regularly sees patients who have traveled more than two hours to CHLA because they don’t have adequate pediatric emergency or hospital services in their community. Some facilities, like Riverside Community Hospital, have closed their pediatric units altogether. Lately, hospitals nationwide are seeing an influx of pediatric respiratory diseases, like respiratory syncytial virus and enterovirus, much earlier in the year than usual, putting further strain on ED capacity.
As families travel greater distances for health care, urban children’s hospitals like CHLA have been a haven for patients. Unfortunately, we face a greater set of challenges than ever before. These include a national staffing shortage of nurses and other health care professionals, constraints on pediatric care capacity and a pediatric mental health crisis that has only intensified since the pandemic.
How can we guarantee that children like Mark will receive the highest quality lifesaving care when they need it? We push forward and secure the necessary support so they can win their fight against disease and illness. We reject the notion that it is acceptable to cut beds for children because a child’s sickness isn’t as lucrative to the hospital as an adult patient’s ailment. We look for solutions close to home at our own facilities — with proper investments in infrastructure, workforce retention and technology — and seek out the support of lawmakers, reaching out across the aisles to find those additional dollars because children are truly our greatest investment in the future.
No matter the outcome of the November midterm elections, it is critical the 118th U.S. Congress prioritizes children’s health. Next year, the Children’s Hospital Graduate Medical Education (CHGME) program will be up for reauthorization, which provides funding to train the next generation of pediatric clinicians. Not only does Congress have the responsibility to ensure the program continues without interruption, but funding needs to be increased significantly. At current levels, CHGME gets less than one-half what its Medicare Graduate Medical Education hospital counterparts receive, despite this allocation training the majority of pediatricians and pediatric specialists nationwide.
To further address the strains on the pediatric workforce, including shortages of nurses and technicians and shrinking critical care capacity, Congress also needs to fund broader efforts to support the nation’s children’s hospitals. This past year, the House and Senate introduced the PATCH Act (Pediatric Access to Critical Health Care), which would provide $6 billion over 10 years for the expansion of pediatric care capacity at children’s hospitals nationwide, including investments in health care and digital health infrastructure, workforce retention and emergency preparedness.
Children’s hospitals are asking Congress for urgent, robust support to address the children’s mental health emergency, including proposals to expand evidence-based mental health care for youth advocated by the national Children’s Hospital Association, the American Academy of Child & Adolescent Psychiatry and the American Academy of Pediatrics. It is critical the new Congress acts on these priorities and, along with the states, protect Medicaid and the Children’s Health Insurance Program, which insure about half the children in the United States.
With successful treatment and access to comprehensive care, Mark is on the road to full recovery, thanks to his new liver and heart. Every child like Mark should have this opportunity for a brilliant, healthier future.
Paul S. Viviano is president and CEO of Children’s Hospital Los Angeles and chairs the Public Policy Committee of the Children’s Hospital Association.