Dylan Lipton-Lesser scrambles about a playroom as any 3-year-old might, wearing plaid shorts and a blue cape emblazoned with a D for Dylan.
But this isn't the playroom most parents would choose. It's in the Pediatric Intensive Care Unit of the Children's Hospital of Richmond at VCU Medical Center, part of Virginia Commonwealth University's downtown medical campus.
He runs from a guitar music therapist to his parents, Shirley Lesser and India Lipton, who is his birth mother.
It's the 20th time their son has been at VCU for surgical treatment. Dylan was born 11 weeks premature at HCA Virginia's Chippenham Hospital. Besides enduring the usual problems of being born so early, he suffers from hydrocephalus, a condition causing an excess of brain fluid. He spent 30 days at Chippenham's Neonatal Intensive Care Unit, and then was sent to VCU where he was treated for 70 days.
Whenever fluid builds up, Dylan needs help. He repeatedly goes to VCU, where catheters and other devices help reduce the fluid and thus pressure on this brain. He may be healthy for months but there are times when he must return to VCU within weeks.
"One time when he goes home with us, hopefully he'll never have to go back to the hospital," Lesser says, praising VCU for its care and commitment.
While Dylan seems well cared for, larger questions remain about how advanced pediatric care is in the Richmond area, and whether there's a need for a new, stand-alone and independent children's hospital unlike what exists in the market.
Children like Dylan seem to receive adequate care. But a group of pediatricians, community members and business leaders say there's a void locally in treating children who face serious health issues.
In 2013, 750 children had illnesses so severe that they left the Richmond area and sought pediatric care Maryland, Pennsylvania, North Carolina or other parts of Virginia, according to the Virginia Children's Hospital Alliance, a nonprofit advocacy group pushing for a $1 billion independent children's hospital.
For a decade, there's been a movement to erect such a hospital, led by billionaire businessman William Goodwin and his wife, Alice. It picked up steam in recent years and appeared to be headed toward reality — until hitting a sudden, huge bump May 21.
At a surprise news conference, VCU President Michael Rao and Bon Secours Virginia Health System chief executive Toni Ardabell announced that their institutions were dropping out of the planning for the independent hospital.
Rao complained of "the continuing instability" of the health care industry and said that "collaborative care" is a better approach than building a stand-alone hospital. Despite months of discussion, neither argument had been pushed in the public arena before. Rao and Ardabell declined interviews to elaborate on their positions.
The news came as a shock to some supporters — most notably, Goodwin, who had pledged $150 million to the project.
"I was caught totally by surprise," he says.
Since then, Goodwin's been struggling to revive the effort. But unless Bon Secours and VCU both participate, it would be nearly impossible to move forward. Even though the hospital would be independent, its success depends on the cooperation of other health systems.
One possibility is to bring in outsiders. There's been speculation that the University of Virginia might be interested. Goodwin is rector — the head of its board of visitors — there, but says recruiting it would conflict him. Mayor Dwight C. Jones has entered the debate too. He's bucking VCU and pushing a stand-alone children's hospital. But response from City Council has been noncommittal.
A true children's hospital is a centralized, dedicated facility that treats young patients exclusively for advanced and complex injuries and illnesses, using the definitions by Goodwin and PACKids, which stands for Pediatricians Associated to Care for Kids. The group of local pediatricians who back the project was founded four years ago.
While there are children's hospitals in Norfolk and Charlottesville, and several pediatric centers in Richmond, none can match such East Coast behemoths as Boston Children's Hospital, Children's Healthcare of Atlanta or Children's Hospital of Philadelphia, known as CHOP, which treat patients from around the world.
The hospital, which has 516 beds and was founded in 1855, is noted for extraordinary medical breakthroughs. Last week, its doctors performed the world's first dual hand transplant on an 8-year-old boy who'd lost his hands, feet and a kidney after becoming infected. The 10-hour-long surgery was successful. In another case, an oncology nurse at CHOP named Lisa Boornazian was instrumental in detecting a pattern of cancer in children from groundwater polluted by Ciba, a Swiss chemical company, in Toms River, New Jersey, according to a Pulitzer Prize-winning book by Dan Fagin.
The Richmond area simply lacks world-class pediatric facilities that draw the very best doctors and other professionals, says Dr. Keith Derco, a Henrico County pediatrician who is an official with PACKids.
Derco says the idea is to consolidate children's care at one facility in the area, which would develop higher levels of care for a regional and not just a local market.
"Many of us trained at places that had real children's hospitals," says Derco, who studied in Cincinnati, where pediatric services were consolidated at one facility. "By bringing everything together, they were able to go from a 'good' children's hospital to the No. 3-rated in the country."
Local hospitals — including Chippenham and Johnston Willis, owned by the for-profit Hospital Corporation of America, and the nonprofit Bon Secours — have pediatric wards that treat sick children. They also have neonatal intensive care units, or NICUs, that treat babies born prematurely.
VCU has the most facilities for pediatric care. Dr. Bruce K. Rubin, chairman of VCU's pediatric department, says it has 172 beds, including at VCU's Children's Hospital of Richmond and other area facilities. Of them, the most — 47 beds — are located at a Brook Road center for children needing specialized, long-term care, followed by 40 beds in the NICU downtown.
VCU also has the only certified facility for pediatric bone marrow transplants and has a 95 percent survival rate, Rubin says. It has special facilities for children burn victims and offers the only Pediatric Intensive Care Unit that has the highest certification in Central Virginia for treating trauma cases.
But there may be some confusion over what level of pediatric care that some units provide. The university is in the middle of building a new, $168 million Children's Pavilion at its downtown campus, between 10th and 11th streets on Marshall Street. It is an outpatient facility, and will have at least 72 examining rooms and two operating and two procedure rooms as well as 650 parking spaces.
The catch is that the Pavilion will offer exclusively ambulatory, outpatient care, which, by definition, means treating cases usually not severe enough for an overnight stay. In 2010, VCU bought the Children's Hospital of Richmond and its assorted facilities, including an 87-year-old, red-brick facility on Brook Road that offers children's long-term recovery.
That depends on how ambitious the grading is. The Children's Hospital of Richmond at VCU offers high-level treatment for trauma, bone-marrow transplants and other advanced areas, Rubin says: "We provide as high a level of care as anywhere else in the United States."
In a recent U.S. News & World Report Survey, VCU doesn't score well. It chalks up a 64.1 rating out of 100 in only one specialty, pediatric nephrology. By comparison, the University of Virginia Children's Hospital ranks roughly in the upper middle of 100 hospitals in four specialties. It was the only children's hospital that made the top-100 level.
The leading overall hospitals by various pediatric medical specialties are CHOP, the Boston Children's Hospital, Cincinnati Children's Hospital Medical Center and Texas Children's Hospital. CHOP, for example, was rated in the top three in the country in seven pediatric specialties.
Goodwin says building an independent children's hospital would allow high-level pediatric care to be expanded to North Carolina, West Virginia and perhaps Ohio.
"Health care for children is the result, but it will provide an economic stimulus, and create jobs — nice jobs," Goodwin says. "The medical profession is something that Richmond can advertise for."
Rao and Ardabell said during their May 21 news conference that trends in pediatric care have shifted from big, stand-alone facilities to scattered, outpatient clinics that offer preventive care.
There also have been uncertainties in financing as President Barack Obama's Affordable Care Act goes into operation.
Another issue, although it isn't mentioned specifically, is that big metropolitan hospitals get more than 50 percent of their revenues from federal Medicaid coverage for lower-income patients. Obama proposed expanding coverage to more people who may not have health insurance. In Virginia, that would mean an additional 400,000 lower-income people, but conservatives in the General Assembly have blocked the expansion.
A larger reason is that building a free-standing, independent children's hospital would require that VCU and Bon Secours shut down some, but not all, of their pediatric services and move them to the new hospital. While Bon Secours has yet to make a public statement about it, VCU is adamant against it.
"I absolutely support a free-standing [children's] hospital," VCU's Rubin says. But he worries that an independent, stand-alone version would fragment pediatric care in the area. He says it would be best if a "free-standing hospital were co-located with a teaching hospital." That, naturally, would be VCU.
Collaborating with other pediatric facilities is a good concept, he says. One way to do so would be to go to "an open staff model," with the HCA and Bon Secours operations. But cutting back on VCU's pediatric care to accommodate an independent children's hospital would be both painful and unnecessary, he says.
"We have added 60 new faculty members," he says. "They are top people and I'd hate to see them booked to leave."
Goodwin says that pediatric care in Richmond already "is very fragmented," and that VCU doesn't want a children's hospital that it can't control.
Bon Secours, meanwhile is opening a new pediatric cardiology clinic with the University of Virginia, as reported in the Richmond Times-Dispatch.
In the near term, the answer is uncertain because Bon Secours and VCU have maintained their positions. Unless an outside party can be found, both will be needed for an independent hospital.
In an attempt to keep the idea alive, Goodwin has suggested a scaled-down children's hospital of about 100 beds, rather than 200, which could be built up over the next 10 years.
Also working to make the idea a reality is the Virginia Children's Hospital Alliance, headed by Katherine E. Busser, a high-profile former executive from Capital One Financial. Her nonprofit launched another push for the hospital last fall but it broke apart when VCU and Bon Secours said no in May.
Mayor Jones also supports the stand-alone children's hospital. But City Council failed to support a symbolic statement from him last week. Council will address the issue again Sept. 14.
For Goodwin, the hospital experience has been a frustrating ordeal, illustrating how difficult it is to generate cooperation and trust in the Richmond area.
A little more than seven years ago, on April 9, 2008, he invited the leading players in the local health industry to a meeting at the Jefferson Hotel, a venerable downtown institution that he owns along with famed golf and beach resorts in South Carolina, the Sea Pines Resort and the Sanctuary at Kiawah Island.
The agenda was to discuss an independent, stand-alone children's hospital.
"There was not one negative thought at the meeting," Goodwin recalls. "There were no naysayers and we proceeded fairly rapidly to a consulting firm study."
But when the consulting study was ready six months later, VCU said behind the scenes that it didn't want to pursue the idea "unless it was a lean-to for MCV" — the old name for VCU's medical school. Goodwin said Bon Secours didn't like the idea of having the new hospital so closely tied to VCU.
For public consumption, the parties presented a vaguely united front, expressing openness to a children's hospital that was capable of handling advanced levels of care.
But the seeds of defeat had been planted. By coincidence, the hospital issues came out just as the Richmond Flying Squirrels, the city's Double-A minor-league baseball team, issued a public letter complaining about the lack of progress in the region to replace the aging Diamond stadium they'd been promised.
The hospital and the baseball stadium became linked as symbols of regional failure. Another tie between them is that the ballpark on North Boulevard could make a good location for a children's hospital, although there is no formal connection.
The area's reputation suffers in the meantime, Goodwin says. "Richmond, I think to the outside world, is seen as a lethargic city," he says. "People say you are nice but you don't do much exciting, except for the bike race."
But he holds out hope for a children's hospital, even though he may never see it materialize.
"I don't think we've given it a good go yet," Goodwin says. "We've gotten bogged down in some personalities, in some self-centered kinds of thoughts. [The hospital is] nothing we're going to see today. I'm not making it like I'm old, but we don't live multiple decades."