“Achieving this designation is an indication of our elevated standard of neonatal care for high risk OB mothers, mothers of multiples and mothers seeking a higher level of nursery care to complement their birth plan,” Medical City Lewisville CEO Sharn Barbarin said. “This advanced designation is a tremendous honor and distinction, and it reaffirms our commitment to delivering excellence to the families of Denton County and surrounding communities.”
Medical City Lewisville received a Level III designation, with Level IV being the highest level of neonatal care that can be provided to critically ill infants. The designation, awarded in June, comes as a result of state legislation passed in 2013 requiring the Texas Department of State Health Services to establish and implement neonatal and maternal care level designations.
Why NICU levels matter
Before state-led standards, some hospitals were being untruthful about the care they could provide in their NICUs, said Debbie Lightfoot, a DSHS neonatal designation coordinator.
“Hospitals were advertising they were at a certain level when they really weren’t,” Lightfoot said. “These standards put forth for the designations will ensure patients get the outcomes they expect when choosing a hospital.”
Having a state-recognized designation helps add credibility to the NICU unit at MCL, said Dr. Maheshwar Thummala, a former NICU medical director and neonatologist at MCL.
“It gives us a stamp of approval for what we have been doing for years now as the highest-designated NICU in Denton County,” Thummala said.
In order to gain the designation, hospitals must have a site visit conducted by an external agency like the American Academy of Pediatrics. The entity then recommends a level for the hospital to consider seeking.
Stacy Holland, NICU manager for Texas Health Presbyterian Hospital in Flower Mound, said she believes having state standards helps protect women.
“In the past we were still designated, but it was different—It was self-declared,” she said. “But now all NICUs are being surveyed by a governing body and will receive a designation based on the same criteria. I think it’s a good thing. It’s for the benefit of the patient. We need to have more requirements.”
The designations must be renewed every three years; however, a hospital can request a change in designation at any time.
Levels of designation
As a Level III NICU, Medical City Lewisville can care for the sickest and smallest babies except for those who require complex surgery or have a critical illness.
“A Level IV NICU will have all kinds of pediatric subspecialists,” Thummala said. “Most importantly, they take in babies who need heart or brain surgery. Those are the kind of babies that need to be transported to a Level IV, but those are very few and far.”
Thummala said Level I units take care of babies who have no complications and are born full-term, and Level II units can care for sick babies who are born at least 32 weeks after conception.
A regional transfer center
MCL is also a regional transfer center, meaning several area hospitals transfer numerous mothers and newborns to Lewisville’s Level III NICU for advanced treatment.
“We have gotten babies from Las Colinas Medical City, Texas Health Presbyterian in Denton and in rural places like Gainesville,” Thummala said.
MCL has an annual average of 18-24 patients who are transferred. Thummala said women are often advised where to go ahead of time if there are expected complications.
“There are two situations where patients will be transferred,” he said. “One, if a mom walks into the obstetrician’s office and the OB-GYN finds there is a problem, they will tell the mom to go straight to Medical City Lewisville. Or there could be a mom at Medical City Denton or Las Colinas who is having complications, and she would be transported in an ambulance to Medical City Lewisville to deliver.”
Little Elm resident Jennifer Campbell proactively chose MCL. Campbell, who had a surrogate, had her friend to deliver her twins at the Lewisville NICU. The twins were born at 30 weeks at MCL, three weeks after she learned her babies would be born premature.
“Medical City Lewisville had great reviews online and with this new designation it further validates my choice to select them as the hospital to deliver my twins,” she said.
Awaiting designations
Although MCL is the only Denton County hospital to gain the NICU designation, several others have submitted applications, including Texas Health Presbyterian Hospital in Flower Mound.
“We submitted an application in May to be designated as a Level III [NICU unit],” Holland said.
Lightfoot said if any NICU in Texas intends to continue receiving Medicaid reimbursements for neonatal services, it will be required to undergo the designation process by Sept. 1.
