Hospital Alters Children’s Anesthesia Policy

Responding to “overwhelming” patient concerns, officials at Kaiser Permanente’s Woodland Hills hospital said they will not allow anesthesiologists to sedate children younger than 2 unless they have in-depth pediatric training.

The hospital’s decision, which took effect Monday, followed a Times article last week in which general anesthesiologists at the Woodland Hills medical center questioned whether they were experienced enough to treat young children.

Their fears arose after the near-death of a 2-month-old baby who was being sedated for hernia surgery in 1999 and the death of a 19-month-old child being anesthetized for eye-muscle surgery the following year.

A prominent pediatric expert who reviewed the two cases for The Times found that Woodland Hills anesthesiologists used a breathing tube that was too small in the case of the 2-month-old and an inappropriate anesthetic gas on the 19-month-old.

“We were seeing an erosion of confidence” among patients after The Times’ article ran, said Dr. Thomas Schares, chairman of the hospital’s anesthesia department. “I needed to make a decisive step to regain confidence.”

The hospital received many calls from anxious patients and family members concerned about the safety of the hospital’s anesthesia program, Schares said.

“There was an overwhelming level of concerns being raised, even to a certain extent by some of our adult members who are having surgery,” he said, although the article did not address adult anesthesia.

The policy is an interim solution until Kaiser’s regional anesthesia chiefs develop a systemwide policy to handle pediatric cases, Schares said. He said he did not know when that process would be completed.

Schares, who has in-depth pediatric training, said he still believes that Woodland Hills’ use of general anesthesiologists to sedate infants was safe. The death of Jose Fajardo III, the 19-month-old boy, in 2000 was the only pediatric death linked to anesthesia in the hospital’s 16-year history, according to Kaiser.

Schares also defended the hospital’s continuing requirement that neonatologists, who specialize in caring for newborns, be on hand for all surgeries involving babies younger than 4 weeks (older if the baby is premature). The policy has been criticized by the hospital’s anesthesiologists and some outside experts who argue that neonatologists should not be considered a backup because they lack anesthesia training. Schares said the policy provides an extra safeguard.

Kelly Wray, whose son Grant suffered a cardiac arrest during anesthesia in 1999, said Tuesday that she is relieved that the hospital has changed its practices.

“It’s very sad that it had ... to hit the media for them to make the change,” said Wray, whose son was revived and is in good health. “But I’m sure glad to hear that they’re finally ‘fessing up to it and not wanting to do it anymore.”

The controversy at Kaiser dramatized a national debate in medicine about whether pediatric specialists are needed to anesthetize infants.

Infants and small children are at higher risk from anesthesia because they require more oxygen and their airways are narrower and more prone to becoming blocked. Many experts believe that the more experience and training an anesthesiologist has, the lower the chances of complications.

“The smaller the child, the smaller the margin of error,” said Newport Beach anesthesiologist Dr. Frank Sweeny, author of the upcoming book “The Anesthesia Fact Book: Everything You Need To Know Before Surgery.” “If you don’t react correctly and adroitly, the kid will likely suffer cardiac arrest and/or death.

“A guy who doesn’t know how to handle babies, they don’t get it,” he said. “They’re out of their league essentially.”

Even with specially trained pediatric anesthesiologists, a hospital needs enough cases to provide adequate experience for doctors and nurses to keep them competent, Sweeny said.

Others, however, said general anesthesiologists are capable of handling the cases -- and besides, there aren’t enough pediatric anesthesiologists nationally to handle the more than 3 million children’s anesthesia cases each year.

Under the new policy at Woodland Hills, only three anesthesiologists, including Schares, will be authorized to sedate children under age 2.

As the change was being announced, Woodland Hills doctors said they worried that hospital officials planned to retaliate against them to squelch future complaints. For instance, they said, after The Times’ article was published, the hospital threatened to fine on-call anesthesiologists if they routinely called in other anesthesiologists to assist them with surgeries on nights and weekends.

One anesthesiologist who spoke on condition of anonymity said the new policy would compromise patient safety by causing doctors to think twice before asking for help.

But Kaiser spokesman Jim Anderson discounted that theory, saying that concerns about patient safety are considered legitimate reasons to summon assistance.

“It’s only an illegitimate reason that would be any source of concern -- if someone were abusing the system,” he said.