State wants more information about Ballad's proposed NICU changes

Matthew Lane • Dec 14, 2018 at 8:00 PM

KINGSPORT — Before rendering a final decision, the Tennessee Department of Health will need additional information from Ballad Health about its plan to consolidate the region’s NICU services.

The request was made on Thursday by TDH Commissioner John Dreyzehner and was anticipated by Ballad officials.

“The Tennessee Department of Health’s request is an expected part of the state’s due diligence for proposed actions that require state approval. We are in the process of preparing our response,” said Teresa Hicks, spokesperson for Ballad.

Last month, Ballad announced changes to its trauma and neonatal intensive care services.

The trauma center at Holston Valley Medical Center would go from Level 1 to Level 3.

Level 3 NICU services would be realigned to the Niswonger Children’s Hospital in Johnson City, while Ballad would establish new pediatric emergency rooms in Kingsport and Bristol.


According to the Dreyzehner letter, the TDH will need additional information before approving the changes to the NICU services. The information provided to date has been largely general in nature, without a sufficient level of detail or specificity, the letter continues.

The letter includes 14 topics about which the TDH would like to have more information. Once the department receives this information, Dreyzehner said, the 90-day approval period would begin.

Here’s a summary of the topics listed in the letter:

— How Ballad will manage high-risk pregnancies occurring in a non-NICU facility.

— Estimated timeline of the transitions.

— Impact on deliveries at 32 to 35 weeks, infants treated for neonatal abstinence syndrome and other mother-infant diads.

— Plan for evaluating the impact of the proposed NICU merger.

— Rationale for not including actions in the NICU and Trauma Center proposals in any of the current drafts of the Health Services Plan that would be impacted by them if implemented.

— Management of infants born at 36 weeks needing a higher level of care at the time of delivery, but expected to stabilize in two to 24 hours.

— Estimated number of additional incoming transfers of infants and mothers to the Niswonger Children’s Hospital, and an assessment of its facility and staff capacity.

— Identification of opportunities to transfer infants no longer needing specialist services.

— Plan to minimize transportation barriers for families of NICU babies.

— Impact on Ballad staff and existing contractual arrangements with providers.

— The monthly diversion numbers for Holston Valley 32 to 35 week deliveries for two years prior to the merger and to the present day.

— Clarification of changes in transfer protocols and other changes for newborns previously transferred to Holston Valley.

— The financial analysis for the project, including the monetary investment to be made.

— Consideration of alternative models of service delivery.

The letter concludes by saying that any implementation by Ballad of the proposed changes prior to the receipt of the TDH’s formal approval will be considered a violation of the terms of certification.

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