Where to Get Children’s Health Care

There are excellent healthcare options for your family in Southern California. Here’s how to access them.

One day in November, a mom and dad brought their 13-year-old son to the Exer urgent-care clinic in Calabasas. They thought he had the stomach flu – just something a doctor should see. They were wrong about the flu, but right to seek medical care. The doctors examined the boy, took blood tests, and determined that he had a serious gastrointestinal problem. They arranged for him to go to Mattel Children’s Hospital UCLA that same day, and doctors performed a CT scan and found he had an infected colon.

As an L.A. parent, you have options in caring for your children’s health – and your choices matter. Not all will be life-and-death, but all can make a difference in the quality of care your child receives and the experience you have.

Pharmacy Clinics

If your child needs care for something minor, a pharmacy clinic might be a good option. “What we do best is the ear infections, the sore throats, the rashes,” says pediatric nurse practitioner Debbie Palaski, who is State Practice Manager of CVS Minute Clinic in Burbank and the mom of three boys. The clinics also administer vaccines, including flu shots.

Minute Clinics don’t take X-rays or see patients under the age of 18 months, and the nurse practitioners who staff them can’t suture a cut or treat head injuries. They can, however, assess your child and refer you to a hospital – with a report about your child’s condition to take with you.

The clinics can also send a record of your child’s visit on to your pediatrician. “We truly don’t believe we work in a bubble,” says Palaski. “For parents who rely on their pediatricians, that’s a relationship that Minute Clinic really needs and wants to maintain.”

In the L.A. area, Minute Clinics also have a relationship with UCLA, which provides doctors for the clinic’s nurse practitioners to turn to for help and advice. “It’s a wonderful augmentation to what we do,” Palasky says.

If you plan to use Minute Clinic:

• Check your insurance network status. The Minute Clinic website (www.CVS.com/minuteclinic) lists the PPO, and HMO and MediCal options they accept, but Palasky suggests that parents check with their insurance company as well.
• Check the hours of the clinic.
• Try the text option. You can sign in at the clinic and receive a text message when you’ll be seen within 30 minutes.
• If you’re visiting for a school-sports physical, have the paperwork filled out ahead of time. It can be quite time-consuming, and they can’t begin the exam until the paperwork is complete.

Palasky says the Minute Clinics have proven to be a real draw for busy parents. Three new Minute Clinics opened in the L.A. area in 2014, with three more scheduled to open in 2015.

Urgent Care

When the pediatrician’s office is closed, or when health issues come up on short notice, families often find themselves in urgent-care centers. It’s important to know that staffing at these centers can vary, as can the types of issues they can treat.

Some are staffed completely by nurse practitioners and can handle minor issues you’d walk in to your pediatrician’s office for. Others are staffed by a combination of nurse practitioners and doctors, who might or might not be trained in emergency medicine. Some hospitals – including Children’s Hospital Los Angeles, Cedars-Sinai Medical Center and Mattel Children’s Hospital UCLA – offer urgent care centers connected to the hospital.

“Within the category of urgent care, you can really have some variability,” says Cherlin Johnson, M.D., who founded the Exer chain of urgent-care centers in 2012. Exer has clinics in Beverly Hills, Calabasas and Newbury Park, with a Northridge location set to open early in 2015. All of the doctors on staff are board-certified or board-eligible in emergency medicine, and can stitch up cuts, set broken bones, start IVs and handle all but life-threatening emergencies.

Johnson advises investigating an urgent-care center before you go. Ask what kind of practitioners and what types of facilities are on-site. Can they take X-rays, suture cuts or perform lab tests? Find out when they are open, and ask about holiday hours.

Also find out about insurance coverage. Johnson says most urgent-care centers accept some form of insurance, but it can be confusing. Check with the clinic itself, or with your insurance provider, so you don’t have surprises about coverage, co-pays, deductibles or out-of-network costs.

If your child is sick or hurt, Johnson advises against a wait-and-see approach. “If you are worried and thinking about going, go,” she urges. “Once that thought has popped into your mind, you’re not going to feel comfortable until you see a doctor.” Just give a quick call to let the clinic know what you’re coming in for and make sure it’s something they can handle.

And try to go at least an hour before the clinic is scheduled to close. “Don’t try to rush in 20 minutes before a place closes,” says Johnson. If you do, you’re likely to be referred to the nearest emergency room, where the wait time will be longer and the cost higher.

Hospitals and the ER

For some issues, nothing but a hospital will do. If your child is seriously injured, having trouble breathing or having a seizure, call 9-1-1. Otherwise, you can visit a hospital emergency department – including the one at your nearest community hospital.

At Huntington Memorial Hospital in Pasadena, about 30 percent of the patients they see in the emergency department are kids, according to Ernie Maldonado, M.D., who chairs the hospital’s department of pediatrics. The hospital also has a 24-hour pediatric consultation service for the ER, which Maldonado says is rare among community hospitals. At most community hospitals, “you’re not going to find a board-certified pediatrician seeing patients down in the emergency room 24 hours a day,” he says.

If a child needs to be admitted to the hospital, Huntington has a level-three Neonatal Intensive Care Unit, a pediatric unit and pediatric intensive care. Kids who need highly specialized care – such as oncology or kidney dialysis – are referred to children’s hospitals. But children’s hospitals also sometimes transfer patients back to Huntington. “Say they need to complete five more days of IV antibiotics. They’ll complete the course here,” Maldonado says. “It’s close to the family. It’s much more convenient for them.”

At Cedars-Sinai in L.A. children are treated in the Maxine Dunitz Children’s Health Center. “We provide the spectrum of services that you would see at any children’s center,” says Arthur Cho, M.D., medical director of the hospital’s Pediatric Inpatient Ward. This includes subspecialty and surgical care, as well as a kidney transplant program treating patients from infancy to adolescence and a congenital heart program. The hospital has a fully staffed ER with pediatrics expertise.

Cho says that size is the major difference between Cedars-Sinai and children’s “hospitals within a hospital” – such as Mattel Children’s Hospital UCLA, which is housed inside Ronald Regan UCLA Medical Center in Westwood. “How a parent decides which center to go to depends on a lot of factors,” he says. “We’re a smaller program. We offer a lot more direct care that offers more time with the families.” Some families, according to Cho, find the size and scope of the larger children’s centers overwhelming. “They all provide outstanding care,” he says. “It’s a matter of preference.”

Whichever hospital you choose, if you’re headed to the emergency room, doctors advise that you:

• Call your pediatrician first. She or he won’t likely give medical advice over the phone, but might be able to tell you whether you should take your child to an urgent-care center or proceed directly to the emergency room. Hospitals with urgent-care centers often evaluate patients and send them to either urgent-care or the ER as appropriate.
• Call the ER before you go. They might be able to estimate your wait time based on your child’s symptoms.
• Talk with the triage doctor or nurse. Once someone has given your child an initial evaluation, that person might be able to tell you whether your child needs to be seen in the ER or can wait for a pediatrician’s appointment the next day.

For kids who need to be admitted to the hospital, one big difference with a freestanding children’s hospital or larger dedicated children’s center can be the scope of specialty care they provide. “If a child is sick enough to need to go to a hospital, it almost always is a better bet to go to a children’s hospital,” says Divya Joshi, M.D., chief medical officer at Miller Children’s & Women’s Hospital in Long Beach. While some routine things can be handled at a smaller community hospital, children’s hospitals, she says, are better at complex health issues.

Miller Children’s is one of only eight free-standing children’s hospitals in California, and provides specialized care for children and young adults with conditions ranging from common to complex.

Another advantage to a larger, dedicated children’s facility is that they see a large number of patients, and so have more experience with rare conditions than a smaller facility might. “We see rare things a lot here, whereas in the community [hospital] they don’t,” says Tamiko Jordan, M.D., a pediatrician with Children’s Hospital Los Angeles and an assistant professor of clinical pediatrics at the USC Keck School of Medicine. “I had a child last year with leukemia who went to many adult ERs and was diagnosed with a variety of things.”

Another of Jordan’s patients was a teen boy who was having back pain and blood in his urine. At his local ER, he was diagnosed with a kidney infection, given antibiotics and sent home. His mother eventually brought him to CHLA, where doctors discovered that the boy had internal bleeding.

CHLA collaborates with USC Keck School of Medicine on a maternal-fetal health program that helps facilitate complex surgeries – including in-vitro heart surgery. Programs such as this, and the fact that all doctors who practice at CHLA are also on the faculty at Keck, means that although “the knowledge is always changing and the standards of practice are always changing,” CHLA doctors are up-to-date, Jordan says.

Dedicated children’s hospitals are also more likely to offer amenities such as art therapy programs, rooming-in for parents and programs for patients’ siblings. And both Joshi and Jordan say the atmosphere at a children’s hospital is unique. “Every single detail has been geared toward our children,” says Jordan of CHLA, including the brightly decorated carts used to transport food and medical equipment. “Our hospital really takes into account the whole experience of being here.”

And that difference extends to the staff. “Every single person you encounter has to have had training in their area of expertise as it relates to children,” says Miller Children’s Joshi, adding this means that the X-ray technician knows how to talk with a 2-year-old who won’t sit still. “We live and breathe children. This is why we all do what we do.”

Part of what parents do is take care of their kids when they are sick or hurt – but sometimes they need help. Taking a moment to find out about your local clinics, urgent-care centers and hospitals can put you in touch with that help so that you can make sure your child gets the best care, as quickly as possible.

Christina Elston is Editor of L.A. Parent.