Children's hospitals forced to treat emergency cases amid continued doctors' strike

Social Affairs

Published: 23 Jul. 2024, 18:30

Children's hospitals forced to treat emergency cases amid continued doctors' strike

A child in a wheelchair heads toward a pediatrician's office during evening hours in Seoul on June 18. [YONHAP]

Despite their limited resources, children's hospitals are increasingly forced to treat more pediatric patients in emergency and critical conditions due to protracted walkouts at larger, better-equipped tertiary hospitals.

On July 10, a five-month-old infant experiencing labored breathing came to a children’s hospital in Gyeonggi. The baby — born premature — had an underlying condition of bronchopulmonary dysplasia, an illness where newborns’ lungs and bronchi do not develop normally.

Doctors in the children’s hospital transferred the infant in emergency condition to a larger tertiary hospital in Seoul, which is well-equipped with treatment options for critically ill patients.

However, the Seoul-based general hospital sent the baby back to the Gyeonggi-based children’s hospital after administering medication. The larger hospital refused to admit the infant because of “staff shortages.”

Forced to choose between sending the returned baby to another hospital or treating the patient at its end, the children’s hospital decided to take care of the infant.

The head of the children’s hospital decided to treat the patient because he didn't want the facility to appear like it was shifting its responsibility.

He said it was “burdensome to accept an emergency patient as there was no respirator,” adding that the entire staff was anxious "because the child’s condition could worsen.”

Tertiary hospitals experiencing work force outflows induced by junior doctors' monthslong walkouts often refuse to treat pediatric patients and send them to smaller children's hospitals.

Experts warned that pediatrician shortages could aggravate and structurally destabilize child medical services.

Children’s hospitals are usually larger than pediatric clinics run by community doctors. However, their services are comparatively limited compared to general and tertiary hospitals. Often registered as secondary hospitals, they treat patients with relatively mild pain or symptoms between the third and fifth levels of the five-tier pain classification system, dubbed the Korean Triage and Acuity Scale.

Patients on the first and second levels of the abovementioned scale are transferred to upper tertiary hospitals for more sophisticated checkups and treatment. However, the collective resignation of junior doctors at pediatric departments in general hospitals appears to have paralyzed such health services for child patients.

An entrance of Severance Children's Hospital in western Seoul in December last year [NEWS1]

Child patients have nowhere else to receive treatment other than children’s hospitals.

“Tertiary hospitals began asking more and more to send pediatric patients to children’s hospitals around April and May when doctors began to complain of fatigue due to overwork,” said Lee Hong-jun, head of the Korea Children’s Hospital Association.

On average, nine out of every 10 children’s hospitals have admitted more than one emergency pediatric patient a month.

According to the association’s survey conducted last month, only 12 percent of 50 hospitals said they do not have child patients coming in by ambulance. Some 78 percent answered that one to ten patients arrive at the hospitals by ambulance per month, and the remaining 10 percent said they have received more than 11 pediatric emergency patients each month. One hospital accepted more than 120 child patients in emergency conditions in a month.

Transferring hard-to-treat pediatric patients to larger tertiary hospitals is often arduous. Tertiary hospitals frequently reject children who are less likely to survive.

In such a situation, heads of children’s hospitals often directly get involved to find a tertiary hospital that could accept pediatric patients, calling multiple tertiary medical centers for over an hour.

“Tertiary hospitals nowadays only admit pediatric patients if their survivals are ensured at the moment of arrival,” a head of a children’s hospital told the JoongAng Ilbo on the condition of anonymity, noting those larger hospitals do not want to shoulder the risk of the children dying on their watch.

According to the survey, more than 72 percent of children’s hospitals have experienced difficulties sending their patients to tertiary hospitals.

The bigger problem lies in the difficulty of normalizing pediatric patient care in general hospitals because of the seemingly endless medical void and the intensified avoidance of pediatrics by junior and aspiring doctors due to the country's plummeting birthrate and legal burdens.

Although the country aimed to recruit 205 junior doctors in pediatrics in the first half of this year, only 53 applied. Most of them left their hospitals after a clash between doctors and the government led to a walkout of junior doctors in February. The medical community believes the striking junior doctors are less likely to return when the standoff is resolved.

Dozens of pediatric patients wait for their turn to see a doctor in a waiting area in a children's hospital in Gimpo, Gyeonggi, on July 12. [NAM SOO-HYOUN]

Children's hospitals are in a tougher position because there are not enough pediatricians to hire. Even if they want to expand their operations at night, the work force shortage leaves them no choice but to limit their services.

Parents with young children are experiencing difficulties in finding hospitals for treatment. They visit children's hospitals as a last resort.

“I had to inquire with multiple hospitals and people to find a medical facility that can accept my 25-month-old child with a high fever,” a 35-year-old mother said at a children’s hospital in Gyeonggi, adding that some hospitals declined to admit her child for being “too young.”

She said she would feel "desperate" if this hospital rejected her child, too.

Another 61-year-old woman who brought her grandchild to the children’s hospital noted that they had nowhere else to go despite the extremely long wait for treatment.

To streamline the patient transfer system and prevent patients from wasting their time on the road or an ambulance to find a hospital that can accommodate them, the government will establish a direct hotline between local pediatric clinics, children’s hospitals and higher tertiary hospitals.

“The Ministry of Health and Welfare recently completed receiving applications from hospitals willing to participate in the program and will embark on a review for selection,” an official from the ministry said.

Participating hospitals are expected to receive 200 million won ($144,298) in support from the government.

The Korea Children’s Hospital Association demanded the government incorporate the National Fire Agency into the scheme for swifter patient transfer. However, the Health Ministry official said more review was needed.

BY NAM SOO-HYOUN, LEE SOO-JUNG [lee.soojung1@joongang.co.kr]