“Qualified local physicians should not be blocked from deciding who will provide care to local families”

Newborn babies with critical health problems, often at their first breath, are among a hospital’s most fragile patients. Some babies are so premature and small that they almost fit in one hand of the doctor who delivers them.

Thanks to the advancement of medical technology, and the skill and training of neonatologists and pediatricians, these once hopeless babies can most often be granted the gift of life.

Care for these sick babies has been provided by highly trained and skilled neonatologists and pediatricians in the Neonatal Intensive Care Unit (NICU) at Kaweah Delta Medical Center.

However, the Kaweah Delta Healthcare District Board of Directors, with the urging of hospital administrators and support of the Medical Executive Committee, have decided to close the NICU to any physicians other than those contracted through Valley Children’s Medical Group.

This would give all rights to manage patient care in the NICU to a Valley Children’s neonatology team under an exclusive contract, and would NOT allow other qualified, skilled and experienced local physicians to care for babies in the NICU.

The undersigned physicians encourage the Kaweah Delta Health Care District’s Board of Directors to reconsider their decision, which would become effective in less than 14 days.

This would allow qualified local doctors to continue to care for at least some of their tiny intensive care newborns rather than be denied access by an unusual “single provider” contract.

We are not aware of any other hospital in California that has signed a similar exclusive services contract, and a Department of Health Services directive (2000) prohibits this if a hospital has a contract to provide services to Medi-Cal patients, which Kaweah Delta has had for many years.

Over the last 14 years, local doctors have partnered with Kaweah Delta to develop the NICU from a Level I to a Level III facility, thereby increasing the complexity of cases that can be successfully managed at the hospital.

Because of this effort and commitment, Kaweah Delta now provides the highest level of NICU care in Tulare and Kings counties. This has allowed many more mothers with high risk pregnancies who deliver their babies at Kaweah Delta to anticipate that their babies could receive excellent care locally in most situations.

Local obstetricians, family physicians and pediatricians have developed mutual trust and cooperative working relationships that now go back for over a decade.

The closure of the NICU will eliminate their ability to work together in this way, and to decide together who should care for their sickest patients.

Additionally, it is possible that local obstetricians, if denied the ability to choose who provides care for a high-risk baby, may choose to send pregnant mothers out of the area to deliver their babies.

Valley Children’s Hospital, Fresno’s Community Regional Medical Center, and many other regional hospitals all provide excellent back-up care for babies needing a higher level of intensive care. Local neonatologists and pediatricians currently send patients to all of them based on each baby’s clinical needs.

We believe that parents and local doctors should continue to be able to decide where a baby should be sent if he or she needs a higher level of care.

Valley Children’s Hospital has earned an excellent reputation and we do not question their medical expertise. However, we are puzzled why Kaweah Delta’s management and Board of Directors would decide to close the NICU to anyone except providers under an exclusive contract.

The NICU should be open to any physician who is qualified, skilled and experienced to provide care for NICU patients, providing the physician follows hospital policies and procedures, provides safe care and meets the quality standards required.

If financial incentives have been offered to or from Valley Children’s Hospital and its providers, the public and local doctors should be offered a full disclosure of the details.

Relationships between doctors — and between doctors and patients/parents — are built over time.

Establishing this new exclusive arrangement with a single pediatricians group makes health care an impersonal business where highly trained local physicians are treated as if they are simply replacement parts on a sophisticated assembly line.

The residents of Visalia and Tulare County deserve better, as do the physicians committed to the care of those babies needing advanced medical care.

We believe there are significant benefits to having a Neonatal Intensive Care Unit that is open to all qualified neonatologists and pediatricians.

It lets local obstetricians and parents choose the doctor they want to provide care for their child.

In many cases their choice may be a doctor who has taken care of their other children over many years, or cared for the children of family members or friends.

Visalia is called the “Jewel of the Valley” because this is a generous and caring community.

We owe our babies the same personalized local care we have delivered for many years – which has resulted in a Level III NICU at Kaweah Delta Medical Center.

If you agree, contact your Hospital Board member to vote to reverse the decision to close the NICU to an exclusive provider group (Valley Children’s Medical Group).

Qualified local physicians should not be blocked from deciding who will provide care to local families.

Board of Directors of Kaweah Delta Healthcare District:
Zone 1: Herbert Hawkins
Zone 2: Lynn Havard Mirviss
Zone 3: John Hipskind, MD
Zone 4: Carl Anderson
Zone 5: Nevin House

Robert Allen, MD
Ana Carolina Coll, MD
Elizabeth Enderton, DO
Liliana Gelvez, MD
George H. Latta, MD, MBA
Christine Nelson, MD
Monica Rivera, MD
Ivan Sarria, MD
Darinka Shaw, MD
David Sine, MD
Kealani Sine, MD
Lance Tomooka, MD
Cathy Ruifang Xu, MD
Kirk Coverston, MD
Gurtej Dhillon, MD
Chawki Gerges, MD
Onsy Said, MD
Side Xi, MD

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  1. This is an appalling decision. I worked at KDDH in the NICU as an RN for close to 10 years, and have over 30 years experience in the field, including 13 years at Valley Childrens Hospital in the NICU. The neonatologists, specialists, and pediatricians who care for the babies in the KDDH NICU are among the finest I’ve been blessed to work with. This decision by the KDDH Board is outrageous, and worst of all, NOT in the interest of the patients and families. They should be ashamed!

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