What is wrong with the state of Texas? Have they no heart? Why is it that at the time of fiscal crisis, it’s always the “little” people whose services are eliminated first? The “little” people in this case would be babies who are either born sick or premature. The New York Times article, In Search of Cuts, Health Officials Question NICU Overuse, by Emily Ramshaw was shocking. The Texas state officials have set their sights on looking at “inappropriate admissions” to the neonatal intensive care units as a way of cutting costs. Allegedly, they have “data” that demonstrates that $36 million dollars could be saved every two years if they curtail “over-utilization” of NICU admissions. Admittedly, some of my ob-gyn colleagues brought this level of scrutiny upon themselves when they performed “elective” inductions and cesarean sections based on “maternal requests.” That was clearly a faux pas. Any medical school and residency training program worth their salt instilled in their students the necessity to have a clinical reason as justification before performing a medical or surgical procedure.
However, these elective procedures only represent a small percentage of NICU admissions. The main reason for NICU admissions are based upon premature births that represent 12 percent of the annual 4 million U.S. births. The Texas Commissioner of Health and Human Services thinks the Texas NICUs are “over-utilized.”It’s a pity he didn’t provide any examples. The NICU typically takes care of babies with very specific high risk conditions such as hyperbilirubinemia that causes jaundice and potential death, hemolytic disease of the newborn that, if untreated in an emergent manner could lead to death from the baby hemorrhaging, very low birth weight babies, respiratory distress syndrome, congenital heart disease and a myriad of other life-threatening problems. Without having medical training, it is mind-boggling how The Texas commissioner or anyone else can determine if a NICU admission is appropriate or not.
In today’s litigious climate of medical malpractice and lawsuits abound, it is not unreasonable for a baby to be admitted to the NICU for observation if its APGAR scores are low. Better safe than sorry. Does the state of Texas propose to ration healthcare to newborns in the same manner that insurance companies ration healthcare to adults? Will you now become gatekeepers regarding life and death decisions?
I strongly urge the Commissioner to rethink this issue. Budget cuts to NICU admissions will have a ripple effect. Not paying for life-saving NICU admissions will lead to an increase in the cost of paying for chronic debilitating illnesses that could have been avoid. Every baby that’s born deserves to live. Please don’t set the stage for them to die.