Gaps in care exposed when toddler needed emergency transport

BURNSVILLE, N.C. (WLOS) — A local family is demanding answers after their three-year-old needed emergency brain surgery, but the system meant to help couldn’t.

Pediatric units were full, air crews were grounded, and transports were unavailable.

News 13 investigates the gaps that expose vulnerabilities and underscores why every family with specialized health care needs should have a plan B.

AMELIA’S HEALTH EMERGENCY

“She is one of a kind,” said Stephen Prater, sitting in his Yancey County living room, holding his three-year-old daughter, Amelia. “She is very vocal when she doesn’t get her way. Very outgoing,” and “Hey,” said Amelia softly. “Wild,” continued Stephen, smiling at his daughter. “Hey,” he said back to her.

When three-year-old Amelia wasn’t acting like herself in mid-October, her parents, Stephen and Abby Prater, knew something was wrong.

“She was throwing up, nauseous, and just really tired that day,” Stephen said.

Stephen and Abby Prater with their daughter, Amelia. (Photo: WLOS Staff)

A CT scan at Blue Ridge Regional Hospital in Spruce Pine flagged a life-threatening concern.

“Her shunt was dislodged out of the spot that it’s supposed to be,” Abby said.

Amelia suffered from a brain bleed and a blood clot at three weeks old.

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“That caused her ventricles to swell, giving her the hydrocephalus, which is why she has the shunt in her brain,” explained Abby.

Amelia needed a pediatric neurosurgeon, but Mission Hospital’s Pediatric Unit and ICU were full, and the hospital doesn’t have one on staff. Levine Children’s Hospital in Charlotte was the nearest option, but the weather grounded air transport.

“Pretty much Wings, Atrium, and Med Center Air, I guess, and MAMA all refused to fly,” said Stephen Prater.

Medical transport units parked at Mission Hospital, including their MAMA ground unit. (Photo: WLOS Staff)

That left a ground transport, and Mission Health System’s Blue Ridge Crew was already out on a long-distance transport.

“That’s pretty much where the nightmare started,” said Stephen.

TRANSPORT TROUBLES

Mission Hospital said, “While many hospitals rely primarily on county EMS, patient transfers at Mission Health are managed collaboratively between our Patient Logistics Center and Medical Communications Center based on clinical priority.”

Its MedCom Team coordinates transport for the health system. EMS directors told News 13 they weigh several factors.

“What’s available, what the capabilities are, and then can that local service handle the impact to their 911 side of their general services to lose a truck for 8 to 10 hours,” said Jamie Judd, Buncombe County EMS division manager.

News 13 uncovered that overnight resources are limited, both for interfacility transport and 911 calls.

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“A lot of our western [North Carolina] counties run two or three ambulances a day and may drop back to two at night, and so they have a limited resource,” explained Judd.

It’s the same for Mission Hospital, which has more units currently than five years ago, including a second air base in Franklin. But in the early morning hours during Amelia’s emergency, without an available transport, MedComm reached out to other county EMS vendors, and so did hospital staff.

“The doctor was on the phone calling, the nurse, her nurse, the charge nurse, and the other nurse on the floor; they were all on the phone trying to find somebody who would take and transport,” said Stephen.

Smaller EMS agencies in Yancey and Mitchell Counties could not ignore 911 needs, their main responsibility.

“A smaller EMS agency like us, that’s a minimum of a six-hour turnaround time, so that’s way too long to take a local resource away,” said Kristy Bryant, Yancey County EMS director.

Kristy Bryant, the EMS director for Yancey County, N.C. (Photo: WLOS Staff)

North Carolina rules specify training requirements for ambulance staff, but there are no regulations around the number of inter-hospital transports, leaving the Praters with a tough decision: risk waiting or drive Amelia themselves.

“The nurses and the doctor that night were amazing, they walked us through everything that we would need to do. As soon as we walked out the door that night, I was just praying that we could make it there,” said Abby.

When they were five minutes away from the hospital in Charlotte, Abby says Amelia “woke up just vomiting constantly.” Rushed into surgery, the shunt was replaced.

“She’s my world, and like I said, that’s probably one of the scariest nights of my life,” said Stephen.

HOW OFTEN THIS HAPPENS ISN’T TRACKED

According to EMS directors, the Praters aren’t alone in this.

“I can’t give you a number, but I know that that has happened in the past,” said Bryant.

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The family filed a complaint with Mission Health System and the North Carolina Department of Health and Human Services.

“They need to make the changes and the right changes to make sure this doesn’t happen again to not just us, but anybody,” said Stephen.

Amelia Prater. (Photo: WLOS Staff)

Mission Hospital’s response to the Praters in a letter is that the hospital is re-evaluating its bed capacity and apologized for the transfer experience, claiming extensive efforts were made.

In a statement provided to News 13, the health system’s representative said:

“When our own MAMA crews are not able to immediately transport for any reason, we coordinate with EMS agencies from around western North Carolina to help secure the available resources. Certain events like inclement weather are out of our control and may prevent or delay emergency service vehicles from operating as usual, but we are proud of our clinical and logistical teams for their compassionate response in these emergent situations.”

Yancey County EMS has raised the issue at a peer review meeting.

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“When instances like this come up, we will bring that to their attention and hope to have some open dialogue on what they’re trying to come up with to rectify the situation,” explained Bryant.

EMS WARNING

EMS emphasizes that families should be aware of potential gaps in specialized transport care.

“Unfortunately, we do hear the stories of that happening. The goal would be that they would have continual care during their transport, but ultimately it’s up to their family, their guardians, to make the decision what’s the most appropriate in the time and resources that are available,” said Judd.

During a recent peer-review meeting, Yancey County EMS explained they are now advocating for a policy change when it comes to allowing other outside air medical resources to be contacted when Mission Health System’s air units are grounded. It’s a policy issue News 13 continues to follow up on.

We want to hear about other medical issues occurring in western North Carolina. Email your experience to [email protected].