Pediatric Grand Rounds

Oct. 9, 2012
Sanger Hall, George Ben Johnston Auditorium

Thank you, Dr. Kirkpatrick, for that introduction.

And thanks to Bruce Rubin for the invitation to speak. You’ve shown tremendous leadership in VCU’s Department of Pediatrics and in disciplines more broadly. Pediatrics is one of eight areas that Sheldon and I decided to focus on three years ago, and we’ve made tremendous progress. It’s taken an enormous amount of work by so many partners, including Sheldon, John Duval, Leslie Wyatt and Coley Wortham.

I am so proud of Pediatrics at VCU, and so proud of the profound difference you make for Richmond every day.

Today, I want to talk to you about two things. One is VCU’s impact in the community and beyond, and the other is your role at a premier national research university that emphasizes research.

Let’s start by looking at VCU’s impact in the community. It is, in a word, profound. About 37 percent of inpatient pediatrics cases in Richmond are handled at VCU Health System and MCV Hospitals. That’s roughly the same number as at community hospitals, but it is a very different population of patients. With little exception, we see the most critically ill children with the most complex pathology, who require the most serious, delicate, complex care.

Over the last year, we have seen 80-100 percent of Richmond children who received inpatient care in oncology and surgical oncology, trauma, cardiac surgery, HIV, organ and bone marrow transplants, burn, rehabilitative care, and mental health.

We also saw between half and three-quarters of the children who received care in hematology, thoracic and vascular surgery, cardiology, and neurology.

Why is this? Why do our city’s most critically injured and ill children come to VCU far more often than our community hospitals, which may be closer, more convenient? The simple answer is that they cannot receive the same degree of care for complex issues anywhere else. Our community hospitals are remarkable, and have to be our partners in our overall mission to focus on better care of children. But we are distinct in this marketplace. Because of the complexity of care and the unique capabilities at CHoR at VCU, we provide the substantial majority of inpatient care in these most-serious cases.

We are the only Level 1 Trauma Center in Central Virginia; the only full-service hospital in our region dedicated to enhancing the comprehensive, coordinated pediatric care of children and their families; and we have the only 24-hour pediatric ER in Central Virginia.

Such advanced and complete care is more important than ever. The rate of chronic disease among children has doubled in the past two decades, according to the AMA. More than half of U.S. children ages 8 to 14 have suffered with a long-term health problem, such as obesity, asthma, a learning disability or other ailment. In the coming years, we will continue to see more children with more complex physical, mental, emotional needs.

Ensuring that these children are healthy should be paramount to all of us. There is a moral justification in caring for those most vulnerable. And investing in children’s health has significant economic benefits for a community, the World Health Organization tells us. Such investments mean we have healthier children, who are able to become better educated, more productive adults. This helps break the cycle of poverty and dependency. Meanwhile, those children who suffer with poor health during early years are more likely to be permanently impaired throughout their lives.

Children born into poor families have poorer health as children, receive lower investments in human capital, have poorer health as adults, will earn lower wages — and their children will be born poorer, continuing the cycle.

What we do matters in so many ways because it adds to the health and vitality of the community. That is why VCU will continue to support and prioritize your work to save children’s lives and maintain an ongoing commitment to children’s health on every level.

We’ve made several recent investments. My first project was a very significant investment in the new Emergency Department. Our $168 million Children’s Pavilion is now under construction, part of our $227 million master plan investment in children’s health facilities at VCU. These are all investments that support access to comprehensive, dedicated pediatric care, as are our significant investments in growing the pediatric faculty — 18 percent in two years. That includes the region’s first four pediatric nephrologists.

We are committed to total health and well-being through facilities and initiatives like CHoR, VTCC, Bridging Richmond and the Mary and Frances Youth Center. VCU’s commitment, along with the support of our partner, the CHoR Foundation, is to provide world-class health care for children; build specialty and subspecialty practices to support community pediatric care needs; collaborate across the community; advance teaching and research missions outlined in Quest; and continue to improve, enhance and add to our facilities.

Looking at the lifesaving and life-transforming work we do at VCU, it is apparent that our impact beyond Richmond must continue to grow. We are already making an impact on our world. Of course, with the Tapia twins last year, we know that there were very few hospitals around the world that could have performed that delicate procedure.

Then, six weeks ago, a newborn girl from Belize named Hanna Castillo arrived at CHoR at VCU. She suffered from a birth defect called esophageal atresia that kept her from eating. This is a condition that we see in only one of every 2,500-4,500 births each year around the world. But it’s a complex case, and if Hanna had stayed in Belize, she would not have survived. Little Hanna was only 7 days old when she arrived at CHoR, and only 3 weeks old when she underwent the thoracoscopic surgery that saved her life.

Surgically, this was less complex than the Tapia twins case. But for Hanna and her family, it was certainly no less important. And its impact on our world, because of what Hanna will go on to achieve, makes it no less significant.

This typifies the incredible, inspirational work you do every day — and its impact is felt far beyond Richmond and our commonwealth.

You’re also doing a great job with research, which is in line with Quest. VCU’s Department of Pediatrics is involved in nearly 100 current research projects, mostly clinical, totaling about $5 million. You’re conducting nearly 90 current clinical trials in fields from genetics to allergies to cancer. I appreciate your clinical and teaching contributions and solid research program with an eye on expanding research under Dr. Rubin’s leadership. You are really what Quest is all about.

It’s interesting that medical research is not popular in every circle — especially in pediatrics. A University of Michigan poll showed that only 30 percent of parents would allow their children to participate in medical research involving a new medication. And nearly 80 percent of parents want only FDA-approved medications for their children.

Despite this reality, the research in which you are all engaged saves lives, prepares many children for a better future and makes a tremendous economic impact. Research at medical schools and teaching hospitals adds $45 billion to the U.S. economy overall and supports nearly 300,000 jobs in the United States. Every dollar invested in research at medical schools and teaching hospitals results in $2.60 of economic activity.

Research is especially important as we look at funding issues in medical education. But competition for funding has never been greater. The outlook for 2013 is very much dependent on the upcoming elections and state of the economy, even beyond the Affordable Care Act.

How the economy continues to rebound will be the biggest driver for determining the level of funding we can expect. The current fight surrounding budget cutting at the NIH, many experts believe, is likely a decade-long trend. The NIH, by the way, is just one source of funding in VCU’s broad portfolio. We have to continue to improve our research portfolio and activity and continue to make a difference for so many people in so many places.

Thank you so much for everything you do for so many people, especially the children who need us the most. I am so proud of you. You represent everything that we have dreamed of in Quest.

We have a very special mission that is committed to teaching and research, but also because of our capacity to handle the most complex cases. Children need us.

We have great leadership from Dr. Rubin and his team, from the CHoR Foundation and our hospital leadership team, and from Sheldon. Together, we will continue to increase our portfolio as a national research university with a national reputation for medical and pediatric research that will allow us to continue to make a difference in so many lives.

Thank you for all you do. I’m happy to take your questions.