Feature
Pediatrics Gets Growing
New specialists in pediatrics mean that the most advanced care is close to home
Written by Rebecca Budde • Photography by James Hawker
After staying 70 days in the hospital, Ella Cain, 17 months, will be going home. Her mother, Sarah Ginster, is thrilled to hear the news but has several questions and concerns about Ella’s future medical care. The team of providers encircles Ella’s bed and gives guidance and reassurance. “Ella was a very sick little girl,” says Gurpreet Mander, M.D., assistant professor. “But look how well she’s doing now.” Dr. Mander is director of SIU’s pediatric critical care division and director of the pediatric intensive care unit (PICU) at St. John’s Children’s Hospital in Springfield.
Last January, Ella received third- and fourth-degree burns in a house fire and was airlifted from Quincy to St. John’s Children’s Hospital (SJCH). Ella had multiple surgeries, infections and her lungs collapsed three times, but the SIU team came together to help her heal. “We had an excellent team of physicians for Ella,” says Ginster. “Dr. Mander treated us like we were the only patients in the PICU. We have grown to love every single person at the hospital who helped us. They not only saved Ella’s life, but they saved us in many ways too.”
Peggy Curtin, president of SJCH and administrator of St. John’s Ancillary Services and Mark Puczynski, M.D., medical director of SJCH and SIU professor and chair of pediatrics, have made SIU’s Department of Pediatrics and the children’s hospital the primary choice for pediatric care in the region. When Dr. Puczynski joined SIU and the children’s hospital in 2005, his goal was to create an environment in which the two entities functioned as a team. “We’ve eliminated the terms SIU and St. John’s,” Dr. Puczynski says. “We think as a group now; it’s ‘us.’”
Curtin agrees. “Our commitment is to focus on the provision of excellent pediatric care for the patients of our community. We are all linked to that outcome no matter where we are employed.”
SPECIALTY SHORTAGETo make the hospital run efficiently and provide a full spectrum of care for the patients in the region, Dr. Puczynski needed more physicians to help make pediatric care complete. Along with Curtin, he began the great task of not only retaining the “rock stars” currently on the faculty, but recruiting more in subspecialties that had vacant positions or only a single member, a trend seen throughout the nation, according to Dr. Puczynski. Seven years ago, the department employed fewer than 25 medical and surgical faculty members. By 2011, the total exceeded 50, filling vacancies in pediatric emergency medicine, endocrinology, dermatology, immunology, plastic surgery and hospitalists. The number continues to rise as Dr. Puczynski and Curtin continue to recruit the needed specialists. 
Dr. Chaudhary and Dr. Rodriguez are the team for pediatric infections disease.
Countless children and their families have been helped by the hospital’s expanded PICU. As Dr. Mander walks through the 8-bed unit, it’s easy to see that his passion for taking care of children runs deep. “I was 5 years old when I decided I wanted to be a pediatrician,” says Dr. Mander, “There’s no substitute for helping a family and a child.”
When Dr. Mander joined SIU in 2005, he says the PICU had very little consistency and was often closed due to staffing issues. Now, SJCH and SIU’s pediatric critical care division run the only PICU in the area, an air and land transport system, a pediatric sedation program and a fully accredited curriculum for pediatric residents in critical care. The hospital is also designated a state-recognized Pediatric Critical Care Center, which is the highest level of recognition by the Illinois Department of Public Health Pediatric Facility Recognition program. The designation confirms that the hospital and the staff of doctors provide the highest level of specialized pediatric critical care and emergency care services to meet the unique needs of pediatric patients. SJCH also is a state-recognized Emergency Department Approved for Pediatrics, which applies to hospitals that provide comprehensive emergency services and meet specific pediatric emergency care requirements.
The physicians of the young patients who need critical care often consult with the School’s specialists, called pediatric intensivists. Patients in the PICU often have multiple medical concerns requiring the attention of more than one specialist. An intensivist coordinates all aspects of the child’s care from medications and pain management to infections and surgeries. “Doctors in the PICU are like the team leader,” says Dr. Mander. “It’s medicine by committee; everybody’s input is important.”
But shortages made care more challenging. For example, in 2005, the broad spectrum of care provided by the Division of Pediatric Gastroenterology was left to a single member, M. Samer Ammar, M.D., assistant professor. The situation was “a large burden and a recipe for depression,” says Terry Hatch, M.D., professor and chief of the division of pediatric gastro-enterology, who joined the faculty in 2009.
In 2011, the division added a third physician, Charmaine Haikaeli Mziray-Andrew, M.D., assistant professor. “Dr. Andrew has a delightful presence, and people love her,” says Dr. Hatch. The team also includes a nurse, dietician, psychologist and speech therapist.
According to Dr. Hatch, a gastrointestinal concern is one of the most common reasons a child will see a specialist. Gastroenterology encompasses a variety of medical issues from digestive disorders such as gastro esophageal reflux and chronic abdominal pain to feeding disorders and nutrition. The doctors in this division become involved in a variety of situations, including ambulatory care, surgery or critical care.
And for the tiniest of patients who need critical care, the School’s Division of Neonatology runs two neonatal centers: a Level II nursery at Memorial Medical Center, and the region’s only Level III Neonatal Intensive Care Unit (NICU) at SJCH. The 40-bed NICU is also part of the Level III South-Central Illinois Perinatal Center. The NICU team, led by Daniel Batton, M.D., professor and chief of neonatology, consists of specially trained nurses, respiratory therapists, rehabilitation specialists, social service workers, pharmacists, nutritionists, neonatologists and pediatric residents. They provide care for approximately 500 seriously ill newborns each year. “We are privileged to have an experienced physician like Dr. Batton,” says Dharmendra J. Nimavat, M.D., neonatologist and assistant professor. “Under his leadership our division has matured and grown professionally.”
COMING HOMEAfter working alone for most of his 34-year career at SIU, Subhash C. Chaudhary, M.D., professor of pediatric infectious disease, now has a professional partner. Marcela Rodriguez, M.D., assistant professor of infectious disease, joined SIU’s pediatric team.
Dr. Chaudhary’s and Dr. Rodriguez’s pagers frequently buzz with requests to consult with another doctor regarding recurrent infections in a child or infant. “It’s like being a detective,” says Dr. Rodriguez. “When we receive calls, it’s because the doctors haven’t found the root of the problem. We have to look at all the details to completely resolve the infection.”
Though she is a new faculty member, Dr. Rodriguez is no stranger to SIU. Dr. Rodriguez completed her residency here and returned as a part-time faculty member last autumn after completing her fellowship in infectious diseases at Washington University in St. Louis. “The Department of Pediatrics is such a nice environment to work in,” says Dr. Rodriguez. “It’s like a small family; I felt like I needed to come back.”
And Rodriguez isn’t the only familiar face to return to the department. Two other graduates of the pediatric residency program are back. Laura Vargas, M.D., assistant professor of neonatology, brings the NICU team up to seven members. Giovanna Capriolo, M.D., assistant professor of pediatric critical care will join Dr. Mander and Dr. Basnet, making the critical care division three members strong.
Three more alumni have filled the needs in other areas. Steven Bowers, M.D., volunteer clinical professor, specializes in adolescent medicine and is a physician at Koke Mill Medical Associates. Dr. Bowers completed a combined residency in internal medicine and pediatrics at SIU in 1989, and he now supervises the adolescent medicine rotation for the School’s residents. Joe Conlon, M.D.,’99, associate professor of pediatric dermatology, often receives calls for consultation. He also works with the School’s residents in his Springfield Clinic practice. Patients with asthma and allergies can receive medical care from Jeffrey Lehman, M.D., ’01, clinical assistant professor of allergy and immunology and physician at the Asthma-Allergy Center in Springfield.
“It’s nice having your ‘kids’ come back home,” says Dr. Puczynski.
COMMUNITY OF CARETo further extend the network of pediatric care, Dr. Puczynski teamed up with colleagues at Washington University in St. Louis for clinical services.
Alan L. Schwartz, Ph.D., M.D., is chair of pediatrics at Washington University School of Medicine and physician-in-chief of the St. Louis Children’s Hospital (SLCH) as well as a friend of Dr. Puczynski. “When Mark joined SIU, we saw an opportunity to create a pipeline for faculty development and to establish a closer working relationship across key clinical services,” Dr. Schwartz says.
Cardiology was the first area of collaboration through Ramzi Nicolas, M.D., assistant professor in pediatrics who specializes in pediatric and fetal cardiology. Dr. Nicolas is a full-time faculty member at SIU and is part of the cardiology division at Wash U. “Most people don’t know that children can have heart problems, but approximately one percent of children are born with a defect,” says Dr. Nicolas. “It’s a big thing to take in as a parent, to hear that your child has a heart condition,” says Nicolas.
With Dr. Nicolas on the faculty, SJCH is now a destination for children with congenital heart disease in the mid- and southern Illinois area with a state-recognized pediatric ECHO lab. If the patient is in need of a cardiac catheterization or open-heart surgery, these services take place in St. Louis. “It takes a lot of anxiety away from parents since I see the patient here, and then I follow their care in St. Louis; I don’t send them to another doctor in St. Louis that they’ve never met,” says Dr. Nicolas.
Amy Taylor of Carrollton knows her way around SJCH and the children’s hospital in St. Louis pretty well. Her son, Hayden, 8, was diagnosed with a heart murmur at two days old; his first heart surgery took place the following day.
Hayden has had three open-heart surgeries and four catheterizations performed in St. Louis. “We love Dr. Nicolas,” Taylor says. “It’s nice to see him when we’re in St. Louis.”
The collaboration has expanded to nephrology, with the joint recruitment of Michael Seifert, M.D., in 2010. SIU had been without a pediatric nephrologist since the retirement of Randy Kienstra, M.D., in 2009. “By having a close working, integrated relationship with SIU School of Medicine, patients stay closer to home and their support systems, and they get the benefit of world-class acute care at SLCH as well as follow-up care in Springfield,” Dr. Schwartz says.
Dr. Nicolas explains details of patient Hayden Taylor's heart condition to Tim Mikesell, MS III (left) and third-resident Om Jha, M.D.
Dr. Seifert sees 9-12 patients on Tuesdays at SIU pediatric clinics in Springfield. With Dr. Seifert’s weekly clinic, local pediatricians can send their patients to SIU, rather than immediately referring them to a larger center in a big city such as St. Louis. “Patients are appreciative that we can keep as much of their care in Springfield as possible,” says Dr. Seifert, who grew up in southern Illinois. With an office at Wash U, Dr. Seifert can care for patients needing the next level of treatments, such as transplants, while staying available to SIU physicians for consults. Should SIU’s patients need that next level of care, they will benefit from seeing Dr. Seifert’s familiar face. “I can provide a direct connection for the next level of care,” he says.
Dr. Seifert enjoys the opportunity that SIU gives him to educate pediatric residents about nephrology issues, touching several areas of medicine. “I like the personal connection with residents,” says Dr. Seifert, who trained in Connecticut and Boston. “SIU has a great reputation for being an innovator in medical education.”
The SIU-Wash U pediatric connection will expand further with clinical research and other research endeavors that are in the works.
Dr. Puczynski and Peggy Curtin have the same vision and goals: to continue to build St. John’s Children’s Hospital to be the provider of exceptional pediatric care for south-central Illinois. They face many challenges — recruiting and retaining talented faculty, continuing efforts of outreach and building an infrastructure that supports the vision and mission. SIU’s continued partnership with SJCH, Wash U and other health-care organizations will make these goals a reality.
“This is our future, and we have to invest in it,” says Dr. Mander. “If you don’t take care of your kids, then what?” • • •