Knoxville NICU CEO on transports: “There’s risk in everything we do but you can mitigate that risk”

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Amid controversy, Ballad Health has defended their plan to consolidate the region’s two neonatal intensive care units at Niswonger Children’s Hospital in Johnson City, arguing the Tri-Cities doesn’t have enough babies in need of higher level care to support the duplication of services at Holston Valley Medical Center in Kingsport. 

“I’m not ok with compromising quality and safety at any level and unless you have the volumes to sustain it, unless you have physicians there to support it, then it’s not the level of service we should have at those facilities,” Niswonger’s CEO Lisa Carter said. 

News Channel 11 traveled to Knoxville to get a second opinion from their leaders in NICU care.

Knoxville’s city center is home to two level three NICUs. 

“There is a need for both of us to exist from a strictly number of babies who need to be cared for basis,” said East Tennessee Children’s Hospital CEO Keith Goodwin in reference to UT Medical Center’s level three NICU. 

This is where Knoxville’s service area differs from the Tri-Cities. 

Currently, Goodwin said about 46 babies occupy their level three NICU daily. For comparison, Ballad has said Holston Valley Medical Center’s NICU cares from eight babies daily. 

Goodwin agreed that volume is an important metric in healthcare. 

 “So you need volume for expertise, you need critical mass for subspecialty support and all of that has to get paid for somehow, some way,” he said. “So volume influences the amount of money that you can get, which influences the number of physicians you can bring on board.” 

Goodwin said level three NICUs aren’t money makers 

Ballad Health CEO Alan Levine said in a recent letter to the Tennessee Department of Health that they lose about $1.5 million annually operating Holston Valley’s Unit. Levine said they would save just over $1 million by converting it to a level one nursery. 

“If you have a very low census, it’s going to be very expensive because the infrastructure costs are going to be to some degree the same whether you see five patients or 25 patients,” Goodwin said. “But for five patients, you’re going to have trouble recruiting the subspecialties.” 

Levine also acknowledged this struggle in his letter. He said Holston Valley Medical Center is operating functionally as a level two nursery due to the lack of subspecialties currently. 

That’s, in part, why about five to 10 babies a year are transported to Knoxville from the Tri-Cities, mostly for specialty surgical intervention, according to Carter and Goodwin. 

Goodwin thinks if Ballad expands their pediatric subspecialties as promised, those babies will be able to receive care closer to home. 

Goodwin said about half of their nearly 900 NICU admissions are transferred from outside the metropolitan center for higher level care annually. 

He said it’s not uncommon for them to transport from 100 miles away. 

Holton Valley Medical Center is 24 miles from Niswonger Children’s Hospital but if NICU services are downgraded in Kingsport, the commute for Southwest Virginia families could be much further. 

Critics are concerned that babies, especially following unanticipated high-risk births, will be lost during longer transports. 

In response to that concern, Carter said, “If it were standard of care to have every delivery facility be a level two, three or four NICU then that would be a valid concern, but it’s not feasible to do that.” 

“Transport doesn’t come without risks,”  ETCH’s Director of Critical Care Shelly Moore White said. “There are obviously risks. You’re stabilizing a baby, loading them into an ambulance and transporting them from one stop to another.” 

But she said strict protocols, highly-trained staff and mobile NICU capabilities make transport an overall safe process. 

“To my knowledge, in 40 years, we’ve never lost a baby,” she said. “Is there a risk? There’s a risk in everything we do but you can mitigate that risk.” 

Carter said Ballad Health recently reviewed their data and they’ve never lost a baby during transport either. 

The state still has yet to approve the NICU consolidation plan. 

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