August 2004
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'Garden' provides medical home for low-income children
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There’s a dinosaur in one examining room and an elephant in the other. Margarita Aleman is negotiating an appointment time with a mother on the telephone. Nurses are anxiously awaiting the arrival of another child.
It would seem the typical setting for a pediatric practice. This one, however, is different. It’s a private practice in a public hospital – Ben Taub General Hospital.
El Jardin (the Garden),located on the fifth floor above the trauma center, provides a safe haven for children who need a physician. Shea Palamountain, MD, the pediatrician in charge and an assistant professor of pediatrics at Baylor College of Medicine in Houston, revels in the ability to give personal service to poor children who might have had difficulty obtaining it before.
For them, she said, El Jardin is a medical home. For her, it’s a dream begun in residency that is now coming true.
“We want to provide a stable, medical home with access to a physician 24/7,” said Palamountain. “We are providing bilingual medical homes for the children who are low-income.”
Jeffrey Starke, MD, chief of pediatrics at Ben Taub and a BCM professor of pediatrics, knew Palamountain when she was a resident. That dream began during her residency, he said.
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“Dr. Shea Palamountain is the perfect person to develop this new model. She is bright, articulate, engaging, and the ultimate advocate for children. She grew up in Houston, and her dream has been to provide the best possible care for vulnerable children in this city. Hopefully, through El Jardin, she is living that dream," he said.
She credits Starke, Ralph D. Feigin, MD, chair of pediatrics at BCM, and the administration at the Harris County Hospital District with making it all possible.
“Every child needs a medical home,” said Feigin. “Dr. Palamountain’s desire to establish one at Ben Taub General Hospital is an important step toward achieving that goal.”
“They gave me nursing support and clerical help,” she said. When she wanted the examining tables in the shapes of dinosaurs and elephants, they went along with that. In return, she hopes to keep her children as healthy as possible and out of the hospital’s already beleaguered emergency department.
“If the emergency rooms are full, that means there is not enough primary care in the community,” said Palamountain. When a mother has a sick child and no primary care physician to call, she is more likely to take that child to an emergency room.
In collaboration with the “Ask a Nurse” program in the hospital district, Palamountain’s patients can now talk to a nurse. That nurse will advise them about whether the child needs to be seen immediately or can wait until the doctor is available the next day.
“The nurses have my number if they need help deciding,” she said. Doctors in the emergency department also call her when her patients show up in the emergency department.
El Jardin uses open access scheduling. That means a child who is sick today is seen today.
“It keeps children out of the emergency room and in their medical home,” said Palamountain.
Many children lack a medical home because they have no health insurance. Most uninsured children are members of working families. However, the jobs held by their parents do not have health insurance or have insurance so expensive that employees cannot afford it.
Nine million children are uninsured in the United States, and 90 percent of them live in working families, according to the latest statistics from the Children’s Defense Fund. In Texas, 23 percent of the children lack health insurance, earning the state the poorest ranking in that category in a survey by the Children’s Defense Fund.
"The most important thing this community can do to improve the quality of life and future productivity of children is to ensure that each child has a medical home. When folks ask me what the goal is for the Ben Taub Children's Center [of which El Jardin is a part] my answer is to provide a medical home for every child and family who need and want one. Hopefully, El Jardin will provide a new clinical and business model that will convince the hospital district and the community that this is a feasible and desirable goal," said Starke.
Palamountain said many of the children in the hospital’s intensive care unit were sick at home for as long as a month previously. Their parents felt they had no place to take them.
“Now there is one place to go before that happens,” she said.
She and members of her staff take pride in providing good customer service. They will see drop-in patients, but they prefer that the patients make an appointment.
Many of the mothers who seek care for their children in public facilities are not used to being able to make appointments.
“We are educating our patients about how to use our services,” said Palamountain.
At the same time, she is working to provide one-stop care for her patients.
“We are working on rapid cycle time,” she said. “We want our patients seen in less than one hour – and that includes drawing blood.”
One way of doing that is maintaining constant contact with other members of the staff. She facilitates this with yellow walkie-talkies that staff members carry and that are present on the desk outside the examining rooms.
If a patient needs to be seen by a dietitian or other specialist, those people can be paged and they come right to the room.
“We will meet all their needs before they leave,” said Palamountain. “I think we have the potential to be the best Medicaid practice in Houston.”
She credits others on the staff with making that possible. For example, Aleman schedules the patients and creates the daily “huddle” sheets that everyone studies first thing in the morning. That’s when they plan for referrals, vaccinations and medications.
The staff and Palamountain also help them apply for insurance. Children who are uninsured are seen in the practice as are those with Medicaid, Harris County Hospital District cards, CHIP (Children’s Health Insurance Plan), private insurance and self pay.
Palamountain’s enthusiasm is bolstered by the support she has received from the hospital district and BCM officials.
“It seemed whatever I asked, they said yes,” she said.
Now she is prepared to say yes to the patients who are already appearing at her door.
“I want to make people feel like this is a place to be when you are sick,” she said.
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