The University of Kentucky's challenge of a Northern Kentucky hospital's proposal to expand its care of the most premature babies might be brushed off as just a dustup over turf.
But what's at stake is an important policy concern for all of Kentucky and a potentially harmful precedent for preemies.
The state now has two Level III neonatal intensive care units, where the tiniest infants — those born before 32 weeks of gestation and weighed in grams — receive medical care. UK and Kosair Children's Hospital in Louisville operate the Level III NICUs. Depending on where their mothers live, Kentucky preemies are also cared for at Level III NICUs at Vanderbilt University in Nashville and Cincinnati Children's Hospital.
St. Elizabeth Healthcare is seeking permission to open a 12-bed Level III NICU at its campus in Edgewood. St. Elizabeth says its volume of premature births justifies the addition and that it would continue to transfer infants requiring major surgery or a higher level of care. (There are three levels of care within the level III NICU designation.)
St. Elizabeth also plans to contract for consulting services in cardiology and neurology and strike an agreement with a higher Level III NICU for consultations and surgery.
St. Elizabeth wouldn't take any business from UK because its medically neediest preemies are transferred to Cincinnati Children's, which, according to The Kentucky Enquirer, supports the St. Elizabeth plan.
So, what's the problem?
If St. Elizabeth receives state permission in the form of a certificate of need, other Kentucky hospitals will almost certainly seek to open Level III NICUs.
In fact, Central Baptist in Lexington has already started the process of seeking permission to convert up to 24 neonatal beds from Level II to Level III.
Research published in the New England Journal of Medicine and the journal Medical Care, shows that low birth-weight babies are 70 percent more likely to die when born at a hospital offering a less comprehensive array of neonatal services, as St. Elizabeth proposes, and handling fewer than 50 such cases a year. Both the quantity and caliber of the in-house pediatric physicians and nurses, and the volume of cases, are factors in the medical outcomes, according to the research.
Spreading a small volume of the tiniest babies across numerous hospitals would dilute the quality of care while undermining Kentucky's comprehensive Level III NICUs.
The certificate of need process is supposed to prevent the proliferation of health care facilities, services and major medical equipment that increase the cost of health care in Kentucky.
The cost of duplicative facilities and equipment is eventually borne by consumers in the form of higher insurance and hospital rates.
Decisions about Level III NICUs deserve the most careful consideration. Kentuckians shouldn't pay more so fewer premature babies can survive.