In the heart of Syracuse, New York, a crisis is unfolding within the walls of Upstate Golisano Children's Hospital. The issue is not just a medical one; it's a reflection of a broken system and a society's failure to address the needs of its most vulnerable.
The Problem: A Hospital Turned Into a Holding Cell
Upstate Golisano, the city's sole pediatric trauma center, has become an unintended refuge for children with severe behavioral and social issues, many of whom exhibit violent tendencies. These children, referred to as "social admissions," are not there for medical or psychiatric treatment. Instead, they are abandoned by their caregivers, left with no other option but to seek safety in a hospital setting.
The annual cost of caring for these children is staggering, exceeding $1 million. Yet, the real cost is the impact on the hospital's staff, particularly the pediatric nurses who are trained to care for sick and dying children, not to manage violent behavior.
A Dangerous Workplace
Nurses at Upstate Golisano describe a workplace where they feel like jailers, always at risk. Injuries sustained by these nurses include shattered eye sockets, scratches, and bites. The violence is not isolated to a specific ward; it occurs in areas where children are recovering from surgery, undergoing chemotherapy, or being treated for life-threatening infections.
The hospital's response has been inadequate. Initially, they provided protective gear, including helmets, Kevlar sleeves, and shin guards, but these were later removed by state regulators due to their design for martial arts, not for protecting nurses from children.
A Lack of Support and a Culture of Fear
Doctors and nurses at the hospital are frustrated and fed up. In a letter to the administration, pediatric doctors demanded a stop to the practice of placing violent children on medical, surgical, and oncology units. They also asked for an end to admitting children solely for social and behavioral reasons.
The administration's response has been lackluster, according to those who have left the hospital. Some nurses and doctors have resigned due to the risk posed by these violent children, and those who remain fear speaking out publicly.
The Impact on Patient Care
The presence of these violent children has a detrimental effect on the care of other, more critically ill patients. Matt Mittiga, a former pediatrician at Upstate, described the struggle to manage these children without disrupting the care of sick children in adjacent rooms. The noise and violence are a constant distraction, and the nurses bear the brunt of these attacks, being in close proximity to these children at all times.
A Nationwide Problem, but a More Severe Issue in Syracuse
Social admissions are a nationwide issue, stemming from a shortage of residential placements for children with psychological and behavioral problems. However, the problem is more acute in Syracuse due to the lack of pediatric mental health care in rural areas and the city's high child poverty rate, which increases the risk of mental health and behavioral issues.
The cost of caring for these children is significant, and the hospital often bears this burden, as the children are not receiving medical or psychiatric care. These children can stay in the pediatric wards for up to a year, taking up beds that could be used for children with actual medical needs.
A Sense of Rejection and Despair
The children left at the hospital often feel rejected and abandoned. They know they are not wanted, and their prolonged stay in the hospital only exacerbates their conditions. They are bored, confined to their rooms, and receive little to no schooling or visitors.
Dr. Christopher Lucas, who oversees the psychiatric care of pediatric patients at Upstate, said, "Most of the kids know that they're in a hospital because people don't want them, so they feel rejected."
A Potential Solution: A Dedicated Unit
The Children's Hospital of Philadelphia has created a specific unit for children abandoned due to behavioral problems. This model could be replicated at Upstate Golisano. While there are no immediate plans to include such a unit in the hospital's upcoming $450 million annex, some of the new pediatric ER beds will be better suited for kids with behavioral issues.
The true solution, however, lies in keeping these children out of the hospital in the first place. This requires community action, more residential beds, and support from agencies responsible for these children.
A Call for Action
A pediatric nurse who wrote to the hospital's CEO on behalf of her colleagues demanded changes, including a dedicated 24-hour security detail for units with violent children. The nurse emphasized that the safety of frontline staff should be a priority over the construction of a new annex or administrative pay increases.
The situation at Upstate Golisano is a stark reminder of the failures of our society to address the needs of children with behavioral and social issues. It is a crisis that demands immediate attention and action.
