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Father questions WakeMed's pediatric care claims

Posted July 16, 2015

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— A Garner father is questioning the care his 7-year-old daughter received at WakeMed Children’s Emergency Department and says the doctor who treated her does not specialize in pediatric care, despite the fact that department is promoted as an ER for children.

Joe Rabiega says his daughter Cassie was in dance class on March 10 when she suddenly collapsed, hitting her head. She became disoriented and pale and began vomiting. He rushed her to WakeMed Children’s Emergency Department – the first children’s-only ER in the state.

“Basically, the initial thing we were told is it’s the virus that’s going around. She’s got a viral thing,” he said.

Rabiega wasn’t convinced. He filed complaints with the North Carolina Medical Board and a hospital accreditation group because he said he felt the emergency room physician, Dr. Brian O’Neal, did not address his concerns about his daughter’s symptoms.

“(O’Neal) actually said, ‘Oh, I’m not explaining this well to a child, am I?’” Rabiega recalled. “That was pretty much – maybe not specific, but pretty close – and at this point, I’m shocked."

A second doctor came in and wanted to do more tests, but after seven hours in the ER, Cassie was ready to go home. Rabiega said he later discovered that O'Neal is not a pediatric ER physician.

WRAL Investigates asked WakeMed for a response from O'Neal but he declined. As of Thursday, the medical board investigation into Rabiega's complaint was still open. The hospital accreditation group acknowledged receiving his complaint and sent a notice to WakeMed that a complaint was filed.

Dr. Amy Griffin, medical director of WakeMed Children's Emergency Department, admits not all of the physicians who work there are specialized in pediatric emergency medicine but says emergency medicine training alone covers pediatrics.

“Across the country, there’s actually a shortage of pediatric emergency physicians,” Griffin said. “You’re seeing children from zero to 18 in any emergency department and, across the board, pediatrics make up approximately 25 percent of any emergency department.”

When asked if that training is enough for a children’s emergency department, Griffin said, “Yes, it is.”

More than 80 doctors work in WakeMed’s emergency rooms across the county. Fifteen doctors rotate into the WakeMed Children’s Emergency Department. Nine of them are both emergency and pediatric specialists. WakeMed says nine is the most of any children's emergency department in the state.

They serve an ER that is one of the busiest in the state and sees more than 40,000 children each year. An additional 20,000 children go to other WakeMed ERs. WakeMed's website said its children’s ER is staffed with doctors and nurses "specially trained in both emergency medicine and pediatrics," which Griffin says is accurate.

“All the physicians are trained in emergency pediatrics and/or pediatrics,” she said.

This week, WakeMed changed its website to read that the staff is "specially trained in emergency medicine," removing the words "both" and "pediatrics." The website is now more in line with websites from four other pediatric ERs in the state, which state their physicians have emergency specialties, but not necessarily pediatric.

WakeMed points out the emergency room staff can tap the resources and expertise of the entire children’s hospital. Donald R. Gintzig, president & CEO of WakeMed Health & Hospitals issued a statement, saying, “WakeMed is proud to be the home of one of the most comprehensive centers of excellence for pediatric care in North Carolina and in the southeast. As the only children’s emergency department and children’s hospital in Wake County, we provide an invaluable resource to families when it is most needed. Our team includes pediatric specialists and subspecialists, nurses, therapists and support staff who are well trained, provide exceptional care and are dedicated to the health and well-being of our community’s children. This is both a privilege and responsibility to which we are all deeply committed.”

WakeMed also provided WRAL with an overview of the children’s ER, listing its many attributes.

After leaving the ER with no answers, Rabiega says he took Cassie to her pediatrician and then a neurologist, who diagnosed her with a seizure disorder. She’s currently undergoing more tests, but doctors say with her condition, Cassie should not swim alone or take part in risky activities, such as climbing trees.

“I didn’t just take the doctor’s word. I follow through. My whole purpose in telling this story is to advocate for other parents,” Rabiega said.

19 Comments

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  • Dirk Hamp Jul 17, 2015
    user avatar

    I am a practicing pediatric provider in Wake county. I refer to the Wakemed Peds ED, and I consult with the physicians there when transferring patients. I have six children some of which have been cared for there at one time or another, and I have friends who are parents. The Peds ED is an invaluable resource, separating the kids from the adult ED world, and the providers and staff are backed up by PICU, Peds Hospitalists, Peds Radiology and other specialists. I have practiced on other communities without dedicated Peds ED, and would not want to miss it.
    This does not take away from the concerns in this individual case, but no one can really judge unless knowing the specifics. It sounds as if the situation is being reviewed, and hopefully everyone can learn from it.
    Prayers for Cassie. But let's not underappreciate all the good that is being done there every day.

  • Tiffany Rabiega Jul 17, 2015
    user avatar

    From Joe Rabiega, the dad in the WakeMed story: I'm writing to clarify some details. My full complaint, posted on WRAL, provides a detailed description of the visit. I am not commenting to agree/disagree with anyone. This will be my only post. One comment suggests that we left against medical advice- this is completely untrue. I am assuming this is based on the following, "A second doctor came in and wanted to do more tests, but after seven hours in the ER Cassie was ready to go home." The only reason we saw a 2nd doctor was because I requested it (we were already discharged by the 1st doctor). The "tests" (a basic stand-up neurological exam) the 2nd doctor was going to do is something the 1st doctor should have done. We left with permission/clearance from the 2nd doctor. My goal in going public is to make sure that organizations are held accountable for representations they make. The purpose was to empower parents to make an informed decision based on clear and accurate information.

  • Steven Brown Jul 17, 2015
    user avatar

    How many of you would be ill to know that when you hire an attorney he or she does little for you but instead the paralegal does the legwork? I'd bet the pediatric ER is kind of the same way. There is most likely one or more pediatric specialists there at all times but only tend to those that really need their care and is trained to do so such as the infant who can't tell them why they hurt. A 7 year old can explain to any doctor how she feels so that is why someone who is not a pediatric specialist can diagnose them. Yeah, mistakes happen but this is not news worthy.

  • Deb Rodgers Jul 17, 2015
    user avatar

    He's absolutely right to question the qualifications of an ER staff, when it's stated they specialize in pediatric ER. My daughter was taken by ambulance to Western Wake even though I told them she had a brain shunt. I carried her MRI's w/ me to Western, they informed me they didn't have a pediatric neurosurgeon and she was transferred to UNC Children's Hospital. By the time she got there she was in cardiac arrest from shunt failure. She was gone at that point.

  • Erika Phipps Jul 17, 2015
    user avatar

    At least there is clarification being provided NOW so parents can make educated choices in medical care. There shouldn't be ambiguity, or worse inaccuracies, about the qualifications of those dealing with your distressed or even healthy child. Upfront disclaimers are fair and help us trust a hospital or practice's assurances of good care. Personally, I don't care if a doctor isn't a pediatric specialist so long as he treats children along pediatric guidelines, and certainly doesn't dismiss parental concerns and patient symptoms.

  • Kristin Byrne Jul 17, 2015
    user avatar

    According to Wake Med's website, the staff of the children's ER is specially trained in emergency medicine. Doesn't necessarily mean they're trained in pediatrics. Without the amount of people it takes to staff an ER, it would probably be impossible to staff one with people trained ONLY in peds.

  • Larraine Mandeville Jul 17, 2015
    user avatar

    I think some folks can't see the forest for looking at the trees. It is a children's Emergency Dept...that means they treat only children. If you live close enough isn't that preferable to having them in a regular ED with some of everything floating around (mean germs not people). Never did I ever think it was run by all pediatric ER specialists...it is what it is; an ED that treats ONLY children.

  • Jim Frei Jul 17, 2015
    user avatar

    Any normal person would assume that pediatric doctors would be the ones at a "children's emergency" room. Sounds like false advertising by Wake Med.

  • Vinnie Paul Jul 17, 2015
    user avatar

    Bingo. Glad that some folks on this thread understand what the issue is. We are in southern Wake county and in our pediatrician's office, there are signs posted in all of the rooms encouraging parents, if in an emergency, to take their children to WakeMed "Children's Emergency Department." We have also specifically asked our pediatrician about this and they as well have told us that they are the best equipped to handle pediatric emergencies. We have a brand new WakeMed "Emergency Healthplex" literally one mile from our house, yet are being told that if able, to instead drive a sick child 30 minutes to this specialized department. If this is what is being promoted and promised, then they better deliver on it.

  • Hubert Lee Dawson Jul 17, 2015
    user avatar

    If a hosptial is going to advertise as "the first children’s-only ER in the state." then it needs to deliver on that claim. Saying any ER certified doctor can treat a child simply invalidates any claim to be the first children’s-only ER in the state."

    I am glad this was revealed as some parents may have passed other ER's to make sure their children got to a "CHildren's ER" only to find out it is nothing more than closer ERs. Parents want the best for their children and that mean having the correct information which obviously Wake Med is embellishing at best.

    It is beginning to sound like Wake Med's reputation is based more upon slick advertising reps and ads than actual skilled medical staff.

    I would like to hear a follow up to this story about what the diagnosis of the child was. I would also love to hear the outcome at Wake Med but they probably will let it die a lingering "no comment, we are investigating" death and we will never know.

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