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State rule changes afoot for hospital pediatrics

A state agency aims to make Florida the first with separate standards for children's care.

Florida hospitals that care for children soon must adhere to new state standards for pediatric care, and parents will know for the first time which are best equipped to provide the care their children need.

The state Agency for Health Care Administration will send copies of the new standards to hospitals within two weeks, and it hopes to implement them as soon as July 1.

The rules make Florida the first in the nation to develop separate standards for pediatric care. State officials say the rules are designed to ensure that hospitals have the necessary equipment, staffing and experience.

"One thing this will address is who's who _ what standards they meet and what services they're licensed for," Scott L. Hopes, director of AHCA's Office of Health Policy, said Thursday. "There's a lot of hospitals that don't acknowledge that children require different services. Children are not small adults."

Under the standards, for example, anesthesiologists working with a child younger than 2 must treat at least 25 children that young each year to ensure they have adequate experience.

The standards mean some hospitals no longer will be able to offer certain services unless they add staff or equipment, but how it may affect specific hospitals is unclear.

The standards also will designate hospitals as primary, secondary, tertiary and quaternary pediatric hospitals, with primary hospitals offering the most basic services. The ratings will be made public.

Only a few hospitals, including All Children's Hospital in St. Petersburg and Jackson Memorial in Miami, would qualify as quaternary, which requires a pediatric research program and all levels of care, including organ transplants.

Most large urban or teaching hospitals, such as Tampa General Hospital and Tampa Children's Hospital at St. Joseph's, would meet the tertiary requirements.

AHCA officials acknowledged that some hospitals likely will challenge the rules, which could delay implementation.

Michael D. Aubin, administrator of Tampa Children's Hospital, said some of the new standards seem too stringent and won't give parents a clear indication about the care their child will receive.

His hospital expects to challenge them.

"What you really want to do is create a general awareness about the standards of care for the public," he said.

"But to get into the esoteric gets a little crazy. Whether a hospital does research doesn't really have a lot of bearing on the care your child receives."

AHCA decided to develop the standards to address cases in which children received poor care at hospitals that weren't equipped to deal with them.

Florida has long had general rules for hospitals that set staffing limits, equipment requirements and other standards, but advocates of pediatric standards say children often require special care.

Administering anesthesia to a 10-pound baby, for instance, is different than administering it to a 180-pound man.

"When you take your child to an emergency room, there should be someone there who knows how to take care of pediatric patients, and it should have pediatric equipment," said Dr. Jeane McCarthy, a St. Petersburg neonatologist who served as a consultant to AHCA.

"You don't have that right now. If you take a child to an emergency room, you don't know that there's anyone there who knows anything about pediatrics."