Wednesday, October 15, 2008

Carle Clinic (Urbana, IL) abandons pediatric cancer patients

Kudos to reporter/writer Debra Pressey with the Champaign-Urbana (Illinois) News Gazette. She wrote a great article that brings to light yet another oddity in the medical profession.

Carle Clinic Association (and Foundation Hospital) apparently has one (yes, only one) pediatric oncologist caring for the children (and their families) struggling with cancer. And that one pediatric oncologist has decided to return to a (admittedly less stressful) pediatric practice.

Moreover, that one pediatric oncologist does is not even board certified in pediatric hematology-oncology. (Mark Musselman, M.D. is only board certified in general pediatrics.)

The decision by Carle Clinic Association to suspend the pediatric oncology department is is disturbing on several levels:

1. What are the ethical implications of Carle Clinic effectively abandoning its pediatric oncology patients? It would have been better to keep the program open even if its only pediatrician is not board certified in pediatric hematology-oncology.

2. Is Carle Clinic providing referrals for these Carle patients to a board certified pediatric hematologist oncologist (as opposed to a pediatrician board certified only in general pediatrics)?

They should provide the referrals - even if the patients are covered under the Carle physician owned HAMP.

3. How on Earth did Carle Foundation pass accreditation with the Joint Commission when they only had one (1) general pediatrician on staff?

4. Why would
Mark S. Musselman, MD, have accepted a position on the council for Illinois State Medical Society?

On 08-06-2008, Dr. Musselman accepted the position of Pediatric Oncology
, Council on Education & Health Workforce

5. Was Dr. Musselman ever board certified in pediatric oncology/hematology?

The Carle Clinic web-site indicates Musselman is board certified in general pediatrics. But he is not board certified in pediatric hematology-oncology. Query whether he is "board eligible" in that field.

Even Carle Clinic does not identify the doctor as board certified in pediatric hematology-oncology. Certainly the sole doctor at the children's cancer program should be board certified in pediatric hematology-oncology.

Check the American Board of Pediatrics web-site (the ABP is the group that board certifies physicians). You can place any doctor's name in the search format to check the status of your pediatrician's board certific
ation status.

Board certification is very important. You should always make sure that your physician and surgeon is either board certified or, at a minimum, board eligible.


In the United States, eligibility for sub-specialty certification in pediatric hematology oncology requires that the physician is not only board certified in general pediatrics but also has an unrestricted license to practice medicine in the U.S. (Canada, or the country in which they practice) and has successfully completed an accredited pediatric hematology-oncology training program.

Successful completion of a pediatric hematology oncology program requires not only that fellows acquire clinical competence in treating children with hematologic and oncologic disorders, but also that they participate in scholarly or research activity beginning in the first year.

Lastly, board certification then depends on successful completion of the subspecialty examination, which is offered every two years.

Who the heck is protecting the patients in Illinois?

Ms. Pressey's article reads:

Patti Welander thinks about the countless nights during her young son's ordeal with cancer that his doctor, Mark Musselman, came to the hospital to see him.

Often, she'd feel bad about interrupting Musselman's evenings, but he was so devoted to his patients he never seemed to mind.

"He never complained about that," she said.

Now, Welander and other parents of children being treated by Musselman at Carle Foundation Hospital's pediatric hematology/oncology program say they just can't believe what Carle officials have told them: The program will end Oct. 31 because Musselman, its only doctor, chose to switch to a general pediatrics practice at Carle Clinic.

"None of the parents are buying a single word of it," said Jane Clark, whose 10-year-old son, Hunter, is also a cancer survivor patient of Musselman's. "Everybody is really upset."

Musselman couldn't be reached for an interview, but Welander said all he would tell her was that the pediatric cancer program at Carle is being "re-invented."

But that doesn't answer her questions about what happens to her 10-year-old son, James.

"We have a close relationship with this doctor who saved our son's life, and this has a huge impact on our family," she said.

Both she and Clark remember the days before Carle started this special diagnostic and treatment program for kids with cancer and blood disorders – the days when families like theirs had to travel out of the area for hospitalizations, surgeries, treatments and follow-up.

They remember the strain and heartache they faced trying to stay with a gravely sick child in an out-of-town hospital and still hang on to their jobs and care for the rest of their children.

Both Clark's and Welander's sons see Musselman only for follow-up these days. But as any parent whose child has had cancer can tell you, it's never really over.

"All of us worry about, oh, God, what if there's another relapse and then our lives are lived on the road again," Clark said.

Maureen Elsbernd, whose 8-year-old son, Nathan, sees Musselman every few months since his treatment for leukemia ended, said there must be a lot going on behind the scenes that parents haven't been told.

She has so much respect for Musselman, she said, "I can't imagine what kind of situation is going on there that made that happen."

Welander said she suspects cutting the program was a budget move, especially after the hospital just cut its work force to save money.

"I'm sorry that pediatric oncology was not a money-maker for them," she adds.

Carle Foundation CEO Dr. James Leonard said parent reactions like those have been painful – and understandable – in the aftermath of a tough decision the hospital and Musselman wrestled with since spring.

The pediatric cancer program lost money, Leonard acknowledged – several hundred thousand dollars a year. In the 12 months between July 1, 2007, and June 30, 2008, it lost $600,000, Carle spokeswoman Gretchen Robbins said.

Despite the losses, suspending the program isn't a budget move, Leonard said.

While parents learned about the suspension of the cancer program the same week Carle hospital cut its staff, the decision about the cancer program was actually made months ago, he said. The hospital has been winding down the program quietly through the summer, but Musselman's departure was postponed several times because of his dedication to the children.

Leonard said he wants to assure the community that Carle is committed to finding a way to keep pediatric cancer care close to home, and it is searching for a way to offer it under a different model. That wasn't resolved in time to avoid a gap in care.

"I feel bad, and I wish we could put something in place, but we haven't been able to do that," he said.

So what was wrong with the current model?

Leonard said the pediatric cancer program grew so much that it became too much for one doctor, leaving Musselman always working or on call.

"It's about his family. It's about being tired. All those things came into play," he said.

Recruiting a second pediatric hematology/oncology specialist to work with Musselman became an issue because the practice still isn't quite large enough to support two full-time physicians, Leonard said. The hospital would have had to find another job to fill the rest of the second doctor's time, and that issue wasn't resolved.

For now, arrangements are being made for each child in the program to continue seeing Musselman or primary care doctors at Carle Clinic or to be referred out of the area for more specialized care, Leonard said.

As for the donations raised for the pediatric cancer program through such events as Clark's annual Cruisin' 4 Kids with Cancer and the Splash of Hope fundraiser organized by Elsbernd and other parents, Leonard promises that money will continue to be used for pediatric cancer patients at Carle.

The Carle Development Foundation has raised about $140,000 in the last six years in two funds supporting the pediatric cancer program, and about half of the money has been spent, according to Robert Driver, development foundation vice president.

The biggest chunk of what remains – $35,000 – was raised by a recent employee giving campaign at Carle and Health Alliance Medical Plans, he said.

Driver said Carle anticipates continuing to use the money to support the needs of children with cancer through such things as sending them to Camp COCO, a special camp for kids with cancer and blood disorders, and for support group activities.


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