I was on hospital duty a few days ago when a woman in labor came into our local hospital with two very serious problems. First, she wasn't due for another 14 weeks. Second, she was a drug user, which was the reason for the early onset of labor.
Her case is a vivid example that made me reflect on the intricate (but I hope not unsolvable) relationships among health care, social problems, and economics we're facing today.
Our hospital isn't equipped to handle infants at high risk, and this baby was as high-risk as they come, so we notified Valley Children's Hospital in Madera, CA. They immediately sent a helicopter transport team to take the baby to their neonatal intensive care unit (NICU) after it was safely delivered by C-section. The team consisted of 2 respiratory technicians and 2 highly skilled nurses, an ambulance driver, an EMT (and of course the helicopter pilot).
At our hospital, the staff for the delivery required an ob-gyn, an anesthesiologist, a pediatrician (me), a surgical nurse, a nursery nurse, a respiratory therapist, and a nurse to log all the medications and procedures for billing purposes and in case something went wrong and we had to defend our actions.
All these specially trained people were required for the delivery of a 1- to1½ -pound baby boy.
Fortunately, the C-section went like clockwork, and he was transported to the NICU in stable condition. His chances of survival are very good, and he may even live a normal life if his 2 months in the NICU are uneventful. Preemies are subject to brain hemorrhage, intestinal obstruction, and renal, cardiac, and pulmonary problems based strictly on their gestational age.
Even if they survive intact enough to be discharged at 4 pounds, they require close supervision by a number of specialists in the organs mentioned above, along with a neurologist, because these kids usually have developmental delays as well.
And let's not forget why this baby was born premature in the first place - the mother's drug problem. That means that social services and child protective services are called in to protect the infant along with giving the mother counseling for her drug habit. As you can see, it has taken and will take a whole village to give this baby a chance at a normal life.
Why am I writing about this? Because by the time this infant leaves the NICU, the cost to taxpayers will be in excess of $1 to $2 million.
In most cases, infants are released to their parents, one or both of whom may continue to be addicts. It's hard enough to care for a high-risk baby under the best of circumstances. I'm a pediatrician, but even I would be hard-pressed to provide continuous around-the-clock attention if I were a parent in such a situation.
Many of these infants end up physically abused or neglected by one or both parents because the parents can't handle the stress and frustration. They don't have a life anymore except to take turns caring for their fragile baby, and they begin to blame it for all their misfortunes...
The very next day, a 20-year-old meth user presented at 26 weeks with twins! Same scenario, but times two. So in 24 hours I witnessed 3 medical cases that will cost California taxpayers between $3 and $6 million dollars this year alone!
But shouldn't we do everything to save a child, no matter the risk or the cost?
The culprit is drug abuse, another cause of our escalating health care costs. If we can put a stop to our growing drug problem, we'll be able to prevent situations like these. Drug abuse is rampant among most social and economic groups, but incarceration seems to do very little, since drugs are scarcely unknown in prisons.
However, I've been witness to one solution that seems to work very well -- adult drug court. I'm lucky to know Judge Glade Roper. He set up one of the first drug courts in California. At first I was skeptical, but over the last 10 years I've seen many people recover.
I've listened to mothers and fathers tell audiences their story of drug dependence and how they lost their children because of their addiction. After completing drug court, they were clean for the first time in many years and their kids were no longer ashamed of them. Their stories brought even the most hardened listeners to tears.
Drug court does more than cut the costs linked to incarceration. When potential moms stop using drugs, they're more likely to give birth to healthy, full-term babies instead of high-risk preemies, thereby saving the state millions on health care every year. Not to mention saving families as well.
We must keep looking for other realistic and doable ways to curb our out-of-control health dilemma and the drug problems in this country. The future for these 3 infants, born of drug use and before their time, will be bleak unless a resolution is found.