L+M has come a long way in improving child care

It is interesting that the most significant public comment so far over Lawrence + Memorial Hospital's proposed acquisition of The Westerly Hospital in Rhode Island involves the uncertain future of maternity care in Westerly.

It turns out some of the New London hospital's biggest challenges with Connecticut regulators have involved the care of newborns and children.

L+M was fined $13,000 in 2006 over the death of a newborn who suffered breathing and lung difficulties, brain injury, heart attack and the failure of several vital organs.

The Connecticut Department of Public Health, after an investigation, found that the hospital failed to evaluate and document its fetal monitoring on the mother. The state also said that an obstetrician was not immediately available during labor and delivery and that equipment to resuscitate the infant was not readily available.

The fine on L+M, announced in December 2006, was one of four imposed that year on Connecticut hospitals.

Questions about the care of newborns at L+M surfaced again in March of 2011 when Connecticut regulators entered into a consent order with the hospital in which L+M administrators agreed to correct numerous violations of state statutes and regulations that were uncovered during unannounced inspections by regulators over the summer of 2010.

The violations involved the death of one infant and the injuries of another who was dropped to the floor by its mother. The infant who fell was not evaluated by a pediatrician until 4˝ hours after the injury occurred. A scan eventually turned up a skull fracture, and the child was transferred to a hospital that could provide a higher level of care.

Another fatality cited in the violations was an 11-year-old girl who died of a ruptured appendix. The regulators in their inspection report gave a heart-wrenching account of the many misdiagnoses and miscues in the care of the girl, including numerous violations of state regulations and hospital policies, between the time she was admitted on April 7, 2010, vomiting and with abdominal pain, until she died two days later, after an unsuccessful hospitalwide resuscitation alarm.

The medical team appeared to ignore the worries of the family who noted the girl's breathing sounded like panting, a full day before she died.

The consent order with L+M, a high level of discipline by the state Department of Public Health, addressed a wide spectrum of violations that ranged from the ordinary, setting too low a temperature on kitchen dishwashers, to the more serious, delinquent medical orders, not taking pain assessments and the misuse of patient restraints, among them.

The two-year Connecticut order, which remains in effect through next month, is one of the things that state regulators in Rhode Island have said they will consider in deciding whether to give L+M a green light to go ahead with a $69 million purchase of The Westerly Hospital.

The consent order with L+M was the only one between state regulators and a Connecticut hospital in 2011. There were four orders with hospitals in 2009, three in 2010 and one in 2012.

In compliance with the order, L+M hired a clinical consulting team from Yale-New Haven Hospital, which reviewed key procedures and systems at the New London hospital cited in the violations report.

The 11-member Yale team gave L+M pediatric care in particular poor marks at the outset, identifying a range of problems, from poor nursing care to the lack of an intervention team to respond to emergencies involving children.

"Community pediatricians lack confidence in the care that can be delivered at Lawrence and Memorial," the Yale group said in one of its harshest criticisms.

Even before the Yale team issued its first report, though, L+M announced improvements to its pediatric services, including the opening of a new pediatric emergency room available on weekends and evenings, when pediatricians' offices are usually closed.

By the time of its last report, in August 2012, the Yale team said most all of its recommendations had been taken, and remaining corrective actions were in place.

"The processes and systems improvements to pediatric services are palpable," Yale said.

A spokesman for the state Department of Public Health said last month that the agency is satisfied with all the corrective actions that have been taken at L+M.

A spokesman for L+M said this week that the hospital now offers the only emergency pediatric care of its kind away from the larger cities of southern New England.

Indeed, it could be that, given all the scrutiny L+M has been given for its pediatric care, parents in the Westerly area should be cheered by the prospect of an L+M takeover of their failing hospital.

I suspect, in fact, that swift approval of the L+M application might be the best outcome both for parents and parents-to-be in southern Rhode Island.

This is the opinion of David Collins.

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