Isaac Harrell photo
Confronted with Dr. Joseph Boatwright's tall, lanky frame and soothing smile, Norman Rockwell might have trouble envisioning a more perfect image of an old-time family doctor.
But Boatwright's wide, comforting grin and easy bedside manner vanish when he relates his frustration over coordinating adequate treatment for a child currently in his care.
The boy is just 6 weeks old, but he came into the world burdened by a weight heavier than his tiny shoulders ever should bear. Multiple health problems, many ascribable at some level to impoverished conditions in the North Richmond community into which he was born, leave him facing an endless list of follow-up appointments with medical specialists and sub-specialists.
It's a hard road to health for the boy and his family, made longer and far less easily traveled by Richmond's lack of a consolidated and comprehensive children's hospital.
"For my patient population," says Boatwright, whose office is in Jackson Ward, even a toll road to cross the river on the way to yet another specialist appointment "is a major obstacle."
That 70 cents might stand between a child and proper medical care is a tragedy, he says. But similar access issues have been borne by hundreds of thousands of Central Virginia children for decades. The result is at best frustration, and at worst surrender or the costly decision to seek care at a children's hospital in another state.
"If children were AARP users, this matter would have been solved decades ago," Boatwright says. "None of those children have a voice to say, ‘Hey, we are struggling.' "
But area pediatric doctors do have a voice. Since stepping forward in an unified show of resolve in March 2011, the action group they formed, PACKids (Pediatricians Associated to Care for Kids), has made strides few thought likely — or even possible — toward a comprehensive, state-of-the-art children's hospital.
Over the past months, PACKids has answered nearly every unresolved question that has in the past prevented the creation of a consolidated acute-care children's hospital in Central Virginia.
First, the group brought back to the table the three local entities — VCU Health System, Bon Secours Health System and HCA Virginia Health System — that everyone agrees must partner to make a children's hospital a reality.
Now the group seems poised to overcome the two greatest obstacles: how to pay for the facility and where to build it.
"You will not find in this town a single doctor — a single anybody — who doesn't want this hospital," says Dr. Ted Abernathy, a leader of PACKids. Abernathy is another kindly old doctor with the dulcet tones of a man used to taking the sting out of a shot.
The thing we know is, when people say we don't have a children's hospital, in fact, we don't have a freestanding children's hospital." And while that might seem a small point to those not faced with caring for chronically or acutely ill children, Abernathy says, it's a singularly important matter in successful treatment for young patients. "One of my friends said it best: We do better when we're all together — and the children will do better when they're all together."
In recent years, Abernathy credits VCU Health System with making the greatest strides toward accomplishing what PACKids now advocates.
In 2005, the publicly funded medical college announced plans to build a freestanding, comprehensive children's hospital. But in 2007, citing spiraling cost projections, the hospital dropped those plans, instead focusing its efforts in 2010 on a merger with Children's Hospital of Richmond, which, despite its name, is not a full-service acute-care children's hospital.
"It was a good effort, but the economics of it just proved infeasible," says John Duval, CEO of MCV Hospitals and Clinics at VCU Health Systems. He now approaches PACKids' renewed efforts with cautious optimism and a promise of cooperation in ongoing discussions over details of a possible facility.
"We're not opposed," Duval says. "But as we take up that feasibility, from my perspective, we have to make sure we address a number of key — essential — requirements, if you will, from our perspective."
Those include "the adjacency to the academic center," he says, citing VCU's importance in playing host to many of the specialties and research facilities that would be needed to make a proposed children's hospital work. But he also cites VCU's ongoing mission to ensure care that's accessible to low-income clients, who must live close and have access to transportation. "We have missions where adjacency ends up being important," Duval says. "Being accessible to bus routes — where those children live — is an important concern as well."
And then there's the money. By some estimates, such a facility in Richmond could cost as much as $500 million. Duval expresses doubt that such funding, especially in the current economic climate, can be located.
On both counts, PACKids believes it has answers.
One answer comes from an anonymous donor.
"We're the largest metro area in the country that does not have a children's hospital," says the donor, a local multimillionaire who admits that his name may well be the worst-kept secret in Richmond medical circles, but who nonetheless asked that he remain unnamed as a condition of being interviewed.
"We have supported a number of projects, and we would support this," he says, promising "to help when it gets to the point when it really is a community project — when all hospitals are working together."
He says that as a business leader, he understands and appreciates the dynamics that have in the past prevented Richmond from having a consolidated children's hospital. Giving up direct control, even potentially ceding revenues, to the group effort would be "difficult for me, and it would be difficult for anyone else."
But, he says, "that doesn't mean it's not still worthwhile — the try."
He would not discuss the size of his intended contribution to the effort, but sources involved in the project say that contribution may cover at least half of the estimated cost of $300 million to $500 million. The donor says a feasibility study is already under way, being funded through "a couple of foundations."
That study's conclusion regarding where the proposed new hospital should go remains likely the most controversial remaining issue to overcome. The donor says the study's results are expected by the end of the first quarter of 2012.
Dr. Frank Mazzeo, another PACKids leader, recently helped undertake a poll of some members on the issue of a location. Predictably, he says, VCU physicians favored a location close to the urban core, while suburban doctors showed less rigid preferences. But, he says, the survey also showed an awareness among doctors of what census data has shown is a growing trend: Poverty and lack of access to medical care is no longer concentrated to urban centers — it is now an equal issue for the suburbs.
There are many factors to weigh in determining location, says Dr. William Lennarz, vice president of pediatric medical affairs at Bon Secours. He says his organization will cooperate with VCU on a Richmond children's hospital, and — perhaps most importantly — is willing to abide by the feasibility study's recommendations.
When asked for comment, HCA officials expressed no opinion on location, saying in a statement that "building a children's hospital continues to be an intriguing and exciting idea that should be fully explored."
But the anonymous donor remains adamant that the study results apply scientifically impartial methods and should be honored.
"It's a deal breaker," he says, "because if you're going to spend $300 [million] to $500 million to do something, you should do it right. That includes the right location."
There's no disputing that high-quality medical care and services for children are available in Richmond, says Duval, making an assertion heartily supported by leaders of other area hospital groups and by the PACKids members.
And Duval cites national statistics that show consolidated services don't always equate to the best way to deliver care.
In nearly every area of pediatric specialty and sub-specialty, the greater Richmond area is home to world-class talent to rival that available at any consolidated children's hospital in the country.
But despite the availability of world-class care in Richmond — and Duval's assertions that delivery can be achieved efficiently even in a fractured system — many pediatricians say they continue to send chronic or acute-care patients to facilities outside of Central Virginia. Depending on the specialized treatment needed, patients may go to Maryland; Charlotte, N.C.; Atlanta; or Cincinnati. The shortest trip is to Norfolk.
Abernathy says it's hard to overemphasize just how cumbersome Richmond's fractured access can be in the treatment of a child and the well-being of a family faced with a long illness.
"What we have is probably some of the best specialists in the world down at VCU, but they're combined with adult services, so children come in contact with adult patients all the time," he says. "It's very hard for a child who's afraid already to be comforted when there's a sick adult next to them getting ready to be X-rayed."
Add to that the stress on a parent trying to juggle not just the X-ray appointment, but also visits to sub-specialists who practice out of different area hospitals or medical office buildings.
Take the case of the sick infant in Dr. Boatwright's care. He says he would send the child out of Richmond, but the family's income level precludes this. That leaves the parents juggling multiple appointments and follow-up visits at the Virginia Eye and Ear Hospital on River Road, a gastroenterologist at Stony Point, occupational therapists near Ginter Park, genetics testing downtown at VCU, and care for an abdominal hernia at St. Mary's Hospital in the West End.
"So far, he's only been able to see only one of those specialists," Boatwright says.
And then there's the matter of sharing medical records and of getting all those specialists on one page — let alone in one room — talking about the most effective way to coordinate treatment for the child.
At least for now, area pediatric doctors remain focused on the best way to coordinate discussions about a child's treatment — conversations that they hope one day will be commonplace.
But even if Richmond's three hospitals end up on the same page, most everyone involved agrees that a children's hospital likely wouldn't open its doors for seven to 10 years.
Nonetheless, participants harbor hope that even longstanding issues like the location can at last be resolved. Dr. Mazzeo, citing the survey he recently conducted, says that afterward, his committee met to discuss the results, and one of the "staunchest proponents" for an urban location seemed to soften in his position.
"He said, ‘Well, it looks like from these results that it should go downtown — and in Short Pump and across the river and in North Side,' " says Dr. Mazzeo, who notes that his colleague paused to reflect before concluding, "Maybe the hospital should be where it best serves the children."