The Journal. - Why So Many Emergency Rooms Are Failing Kids in America

Episode Date: November 17, 2023

A Wall Street Journal investigation found that only 14% of emergency departments nationwide have been certified to treat kids. WSJ’s Melanie Evans explains why this is a problem across the country, and one family recounts their son’s experience in an ER. Further Reading: -Find Hospitals Deemed Ready to Treat Children in Your Area  -Children Are Dying in Ill-Prepared Emergency Rooms Across America  -Emergency Rooms Are Failing Kids. This Hospital Stepped Up.  Learn more about your ad choices. Visit megaphone.fm/adchoices

One afternoon in 2017, just a few days after their son Mason turned four, Nizieta and Dorian Setlari got a call from his daycare. Mason was experiencing some pain, but he couldn't explain to them where. He was just crying. And I go pick him up and I ask him, I saw him sitting in one corner of there and just crying and pointing his hands in his belly, and I say, my belly hurt, my belly hurt.

And I pick him up and I bring him home. After they brought him home, they gave him Tylenol and cooked his favorite food. But the next day, Mason still wasn't feeling better. I touched his belly and it was distended, like very hard. And I told Corey that we have to take him to a doctor right away because something is wrong, something is going on. So the Setlaris did what any parents would do. They took Mason to the nearest emergency room. And what happened there changed Mason's life forever.

A Wall Street Journal investigation has found that a lot of emergency rooms in the U.S. are unprepared to see children. Only about 14% of emergency rooms nationwide are certified to treat children or specialize in treating kids. And most parents have no idea. It's something the Setlaris learned the hard way. We saw ER. We saw it's a hospital. He's sick. We're taking him to the doctors. We trust the doctors.

Who you can trust if you don't trust them? We trust the doctors. Who you can trust if you don't trust them. Welcome to The Journal, our show about money, business, and power. I'm Ryan Knudsen. It's Friday, November 17th. Coming up on the show, how America's emergency rooms are failing children. It's called the Firecracker McCrispy. It has the crispy, juicy, tender chicken you love, topped with crispy jalapenos and a super tasty sweet and spicy sauce.

You'll wish this spectacle of flavor never ended. Try the new Firecracker McCrispy today at participatingating McDonald's Restaurants. Last year, the Wall Street Journal got a tip that some emergency rooms in the U.S. were unprepared to handle kids. And our colleagues Melanie Evans and Liz Esley White decided to look into it. Here's Melanie. I know from having covered hospitals for a number of years that the quality of medical care inside of hospitals is different from one hospital to the next. And it is very hard to know as a patient

where to go to get really good quality care. And when it comes to emergency care for kids, Melanie and Liz found that it's even harder to find answers. There are no nationwide standards when it comes to emergency room preparedness for kids, though there are for adults. There are a few states that set standards, but they're mostly voluntary and rarely made public. So they started digging, and eventually they found a few things that shed some light on how bad the situation is. And the problem is much bigger than they initially thought. First, they found a 2021 survey that went out to emergency rooms across the country.

It's an assessment hospitals can use to determine their own readiness when it comes to children's emergencies. So there's a scale. It's a 100-point scale. The scale was developed by doctors and medical societies like the American Academy of Pediatrics. And this is a series of questions that an emergency department can answer that gives them a sense of, do they have the right equipment? Can they properly dose medication for children? Are their staff trained to a degree that when a kid comes through the door, they feel more comfortable responding

or preparing that child to be quickly transferred wherever they need to go. About 70% of ERs in the country responded to the survey. So in that 2021 assessment, half of the hospitals scored below 69.5. And if you look at all of the research that's been done about this score, you need to hit an 88 to see real survival benefits for kids. So if you translate that into a school grade, that's like half of all hospitals that responded to this are getting a D. Yes. The last time this survey went out, in 2013,

it showed a pretty similar score. But there's really nowhere people can go to see how their local hospital is doing on this scale. So next, Melanie and Liz decided to create their own list, and they surveyed all 50 states. So we could sort of look around the country and just actually map how many of the nation's hospitals have some sort of verified readiness to treat kids or are children's hospitals. And what we found is that 14% of the nation's emergency departments met that standard. Wow. That seems like a shockingly low number. There's a lot of empty space on that map. There are more hospitals that have taken steps to prepare for kids, but they operate in states that don't have public standards. I just have to say,

like, you know, my son is almost a year old now, and I had no idea that every emergency room in the United States wasn't just all the same. Yeah. We turned to an emergency department as a place where you take an emergency. By definition, you expect that it would be prepared for whatever comes through the door. What kinds of things are happening to kids as a result of emergency rooms not being prepared? So children are dying.

Children who are critically ill are four times as likely to die in a less prepared emergency room. And this is based on research published in 2019. Oh my god. Why are so many emergency rooms across the country not prepared to treat kids? across the country not prepared to treat kids. A lot of emergency departments don't see many children. Doctors and nurses have a lot more experience caring for adults than they have for children. And if you're an emergency department that is mostly dealing with adults,

you're going to be paying more attention to adults. And we heard this again and again, like children are not small adults. They have conditions that are more common in children that if you don't have a lot of experience, you may miss. Some doctors told the journal that treating kids in an emergency is extra challenging. They say kids don't yet know how to articulate their pain and it can be hard

for doctors to diagnose conditions that are more common in kids when they don't see that many cases. They also said that intubating children can be trickier than intubating adults. Kids have smaller airways, and they're positioned at a different angle than in adults. And children lose oxygen faster than adults. And so in that situation, what you have is a doctor who maybe doesn't have a lot of experience with a child, has to have the right size equipment, and then they're just under an incredible amount of pressure regardless. So when we talked to people who have studied readiness, they emphasized that this is about ensuring that hospitals and doctors and nurses are well prepared to respond. And that means, do you have the right size equipment? Do you know where it is? Do you have sort of appropriate materials to reference so that you give a child the correct dose of a medicine?

Back in 2017, when Mason was ill, the Settlaris thought that any emergency room would be prepared to treat him. So they just went to the one closest to their house. What happened there became the subject of a lawsuit against the hospital and the ER doctors. The hospital and the there became the subject of a lawsuit against the hospital and the ER doctors. The hospital and the doctors denied the allegations in the lawsuit. The following account is based on court documents and medical records. Mason's parents said they took

him to the emergency room around 7 p.m. and according to the medical records, Mason was admitted to the ER at 8.48. They lay him down in the bed. The doctor came after a while. He was like, oh, what's up, kiddo? How are you? You're fine. Just give him some popsicle and apple juice, he was telling the nurses. He's like, oh, don't worry, it's just a virus. Mason's doctors at the emergency room discussed sending him home, and the Settlaris said they started filling out discharge paperwork. But after a shift change, a new doctor examined Mason, and Nesieta still had more questions. And I asked her, why is the heart rate so high?

The heart rate was like 170 180 like 85 was just going up by Mason laying in the bed like he wasn't even active doing something and I was very worried like how I'm gonna take him home what I'm gonna do home with him because he's like that's not normal. He was like yellowish, the face, like lips very dry. Like, I still remember that time. And I'm like, can you guys do something? The doctors ordered an x-ray. It had been nearly four hours since Mason had been admitted. Dory was in the car to start the car, to bring it closer.

Yeah, I was outside, you know. I was with discharge paper in my hands. Then they took the x-ray. They brought Mason in the room. And the doctor called me in the hallway. She's like, Mom, just stop with the paperwork, with the discharge papers. I have to tell you something. And I'm like, mom, just stop with the paperwork, with the discharge papers. I have to tell you something. And I'm like, what's going on?

She's like, we found a mass on Mason's Bailey. And I got very scared. In my brain, there were so many thoughts like, is he going to survive or what was going to happen? Like, what is that? It changed the whole world to me. I thought it was the end for me. Because the whole time they were so calm and calming us down. Like, oh, it's nothing.

It's just a virus. You're going to go home. He's fine. And then the whole thing changed. The doctors said they needed to send Mason to a specialized children's hospital. So they climbed in an ambulance with their son and raced down the highway.

She was driving very fast because she was worried. She was worried that maybe something's got to happen in the ambulance. She knows something bad is... Because the lady, the nurse in the back, when she saw the heart rate very high, she was telling me, Mom, keep talking to him because we're losing him and she said that she was knocking in the window of the ambulance to tell the lady the driver to hurry up but even as soon as we get into the trailer hospital 10 minutes later, his heart stopped over there. Because his condition was unstable, his oxygen dropped down. And they were telling us to keep talking to Mason. Just keep talking because we're losing him, they were saying.

I see over there, they got like 30 people all over him, you know, nurses, doctors. Like, rushing. all over him, you know, nurses, doctors. Like, rushing, like... So, I mean, you barely made it in time for him to get... Yes. Time, yeah, but... The only problem is, this hospital, the first hospital, if they send us, like, a couple hours before, like, three,

two, three hours before, none of those is going to happen, you know? The hospital declined to comment because of the ongoing litigation. The attorney representing the doctors didn't respond to us. The doctor at the children's hospital explained to the Settlaris that Mason had twisted intestines, something that's more common in babies and toddlers than adults. Early imaging scans typically detect this issue in time for a relatively non-invasive procedure that can take care of it. But if it's not caught early, children can end up in surgery.

He was supposed to not go through all that. Like, the time made the difference. If we could take him there sooner. But when we got there, he became septic. That's why he ended up, like, they took him to the surgery. His heart stopped. They leave his belly open. They put him in an ECMA machine,

which basically supports your lungs and your heart. Mason stayed on life support for about six weeks, and he was at the hospital for nearly four months. And for a while after that, he needed a wheelchair, oxygen, and an external feeding tube in order to function. The Settlaris say he went through many more surgeries, including a gallbladder removal, and one that inserted mesh into his stomach to keep it pieced together. Mason's story is one that hospitals and parents

around the country are hoping to avoid. So how can they be better prepared? That's next. That's next. Seth and Riley's Garage Hard Lemonade. A delicious classic with a vibrant taste of fresh lemons. The perfect balance of sweet and sour with a crisp, zesty edge. Welcome to The Garage, the place of refreshing hard lemonade. Available at the LCBO. Must be legal drinking age.

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vibe with friends even more this semester. POV. You're unlocking more perks for less with RBC. Up to $330 in value is a combined total of three available offers, each in accordance with the respective terms and conditions. Limited time offer ends October 31st, 2024. Conditions apply. Visit rbc.com slash student offers. As Melanie was looking at hospital readiness for children's emergencies, she found one hospital in Colorado that had managed to pull up its score. It's called Grand River Health, and it's located near the western slope of the Rockies. It's one of the smallest hospitals in the country, with only about 10 beds in the emergency room.

in the country with only about 10 beds in the emergency room. Three years ago, Grand River scored just 51 points on the 100-point assessment for pediatric readiness. But it wanted to do better. Here's Melanie. And the steps they took were not terribly expensive. They started training staff, and they asked staff, what are the things that you're not comfortable with? One of the challenges the doctors brought up is a tracheostomy.

It's a rare, life-saving procedure for when you can't get a breathing tube down a kid's throat and have to cut a hole in their neck in order to get it in. And so they brought in some goat and sheep carcasses with airways the size of a child's, and they practiced. They practiced the procedure. They practiced what could go wrong and how they would respond. And it was an opportunity for doctors to get some of that hand-on experience and troubleshoot for something that may not happen very often. But when it does, if it goes wrong, a child could die. So they just started asking a lot of questions, and then where they found something that needed to be addressed, they fixed it.

They've done training for nurses on how to use equipment. They reworked some of the setup of the emergency department to color code equipment and medications based on a child's weight so that in an emergency, a nurse could quickly grab the right sized equipment. And so after all of that work, the hospital took that 100-point assessment, and they scored a 97.5, which is almost double what they scored the first time they took it. That's a huge improvement. Yes, they would have been in like the bottom 25% the first time they took it, and now they are in the top 10% nationally.

they took it. And now they are in the top 10% nationally. So what does that say about how easy or how difficult it is for hospitals to improve? So I talked to researchers who study this and they said it worked exactly as it should. This is not an expensive endeavor and it is not a difficult endeavor. Any emergency department should be ready and Grand River is a perfect example of what it looks like. What are parents supposed to do about this? I mean, like, how can they possibly figure out if a hospital near them is ready to treat kids? I had one grandfather reach out to me and ask, how do I know if my hospitals are ready? You know, I've got five grandkids.

And I told him he could ask his local hospitals if they have taken the 100-point assessment and what score did they get. And 88 or higher is a hospital that's prepared. The name of the 100-point test is the National Pediatric Readiness Project Assessment. Mason Setlari is now 10 years old. He likes soccer and watching garbage trucks drive around the neighborhood with his dad. So how would you describe what effect this has had on Mason's life?

Oh, so much. Yeah, so much. First of all, he didn't enjoy his childhood. Mom, he's asking so many questions, like, why am I different than others? Why I don't play sports? Why my brother doesn't do this therapy? Like, emotionally, I don't don't know like he's asking why he has those scars why he has the smiling belly he calls it a smiling belly the smiley belly we

say because he has the surgery open belly and that's why it looks like a smiley. It's a joke between him and I. Yeah. I mean, how do you think your life would be different if you had known that maybe you should have just taken him straight to the children's hospital in the first place? At beginning, we thought every hospital in USA, it's great hospital, you know? And we took him there.

But now I don't take, even though it's five minutes you know and we took him there but now I don't take even though it's five minutes away from my house I don't take the risk anymore but I wish I wish if we knew it earlier that this hospital is specialized and the other hospital and they send us the right right time there, you know, we're not in another place. It could make a difference. It could. Because for Mason to be with us, it's a miracle

today. It could have been worse. And we don't want another family or another kid to go through that. Well, thank you so much for talking with us today. We really appreciate it. Thank you. Thank you. That's all for today, Friday, November 17th. If you want to see the database that Melanie and Liz created for children's hospital readiness,

there's a link to it in our show notes. The Journal is a co-production of Spotify and The Wall Street Journal. Additional reporting in this episode by Liz Essley-White. The show's made by Annie Baxter, Kylan Burtz, Catherine Brewer, Maria Byrne, Victoria Dominguez, This was made by Our engineers are Our theme music is by Additional music this week from Fact-checking by Thanks for listening. See you Monday.