Other Charleston hospitals reject MUSC argument that more NICUs would increase infant mortality

  • Posted: Monday, January 20, 2014 9:00 p.m., Updated: Tuesday, January 21, 2014 7:46 a.m.

Trident Medical Center wants to add four beds to its North Charleston nursery to offer the highest level of neonatal intensive care, despite recent arguments made by Medical University Hospital physicians who said that would hurt the state's most vulnerable newborns.

The project would cost an estimated $1.6 million, but state regulations prohibit Trident from upgrading its nursery to offer Level 3 care because it's within 60 miles of Medical University Hospital, one of five designated regional perinatal centers in South Carolina. Perinatal refers to the period around the time of birth.

Trident Health CEO Todd Gallati said the hospital has asked the S.C. Department of Health and Environmental Control to make an exception to this rule.

"If we were any other hospital in any other region, with the amount of deliveries and experience we have, we wouldn't have a regulation problem here," Gallati said. "But just because we're in the footprint of that 60 miles, (it) restricts us. We find that arbitrary."

The existing state regulations were written to concentrate expertise at the five regional perinatal centers. Advocates for this system of regionalization say the model is better for babies because doctors and nurses at these facilities become better at their jobs as they treat more and more challenging cases.

Deregulation would dilute this expertise, said Breana Lipscomb, director of program services and government affairs for the South Carolina chapter of the March of Dimes.

"There's really not a demand for more Level 3 facilities based on the number of very low birth-weight deliveries that we have," she said.

Lipscomb said 1.7 percent of all infants born in South Carolina in 2012 were considered very low birth-weight babies, weighing less than 1500 grams - about 31/4 pounds. That's a decline from 2 percent of all deliveries in 2004, she said.

"Many other states envy the system we have in place," she said. "It's kind of like if it's not broken, why mess with it?"

Whether or not DHEC grants Trident Medical Center's request for an exception, the department may still consider changes to its current perinatal rules.

A working group organized by the South Carolina Hospital Association has been studying the issue for months. It is expected to make recommendations to the state health department board this year. Any changes ultimately would require legislative approval next year.

"There's not a single nursery in South Carolina that's upgraded its nursery above a Level 2 in two decades," said Dr. Art Shepard, a Trident Health neonatologist and a member of the perinatal regulations working group. "The powers that be are very powerful. They don't want that."

Medical University Hospital doctors who spoke at a DHEC board meeting in Columbia this month argued that science is on their side. If more hospitals in the state are allowed to build Level 3 nurseries, the number of premature babies that each regional perinatal center treats will decrease. That, in turn, could threaten staff expertise and, ultimately, jeopardize infant mortality, they said.

"We strongly support the regulations as they are written," said Dr. Scott Sullivan, the division director of maternal-fetal medicine at MUSC, during the DHEC board meeting. "We believe we need the concentration of expertise in the regional perinatal centers."

Dr. Steven Shapiro, chief medical officer at Roper St. Francis Healthcare, said that argument doesn't hold up. "I wish that MUSC would drop the hyperbole," he said.

Other hospitals in the region already are helping Medical University Hospital care for some of these smallest, sickest newborns, especially when the Medical University's neonatal nursery is full, he said.

Also, Shapiro noted that South Carolina has made little progress in the past decade aligning the state's infant mortality rate with the significantly lower national average.

"Maybe status quo is not the best," he said. "We can look where we are and where we've been for 10 years. That may be an argument to consider making some tweaks in the regulations."

Shepard isn't convinced the rules will change.

"It might be kind of nice for South Carolina to get out there and do something innovative instead of doing the same thing over and over," he said, but, "despite evidence and despite people's best efforts, I'm afraid that just the status quo will prevail."

Reach Lauren Sausser at 937-5598.

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