Pediatric outreach is big commitment for UF’s College of Medicine… through expanded Children’s Medical Services network

In 1986, a 3-year-old Jacksonville boy named Matt Dennis became Florida’s first pediatric heart transplant patient. Today, all he remembers of the experience is the helicopter that whisked him to Shands at the University of Florida, where a surgical team waited.

“I was just a little kid, so I didn’t really know what was going on,” said Dennis, who made headline news after the operation. “People still ask me questions when they find out I had a heart transplant. I don’t mind talking about it; it’s just part of my life.”

Now a freshman at the University of North Florida, Dennis works for a contracting firm, plays basketball and plans to pursue a career in business management. He appears to be a normal 19-year-old, except that he made medical history.

Each year, thousands of Florida children like Dennis gain a better chance at leading a normal life, thanks to pediatricians from UF’s College of Medicine, who see patients in Gainesville and many other cities in Central and North Florida.

F. Jay Fricker, M.D., chief of pediatric cardiology at UF, travels to Jacksonville once a month to care for pediatric heart transplant recipients, including Dennis, at the UF Pediatric Cardiovascular Center there. The center is a collaborative effort between UF and Wolfson Children’s Hospital.

Dennis’ checkup is a precautionary measure, but an important one. At a recent Friday visit, Fricker administered heart function tests and asked Dennis a few questions, then pronounced him healthy, as expected.

Some pediatric clinics are part of permanent UF or Shands HealthCare programs where we see patients on a weekly or daily basis, said Terry Flotte, M.D., a professor and chairman of the college’s department of pediatrics. Additional outreach clinics involve faculty from various divisions of the pediatrics department who travel a few times each year to cities such as Tallahassee, Daytona Beach, Pensacola and Panama City, to provide subspecialty services.

“Many of the (places) we visit in our outreach clinics, especially in the Panhandle, wouldn’t have access to subspecialty care at all if we didn’t go there,” said Flotte, a pulmonologist who has participated in clinics in Panama City and Tallahassee. “Outreach enhances the quality of care we offer kids with special health-care needs.”

Many of UF’s pediatric clinics are conducted in partnership with the state Children’s Medical Services network, which coordinates and funds health care for economically disadvantaged children with special health-care needs.

“UF is particularly involved in providing services to more than 6,000 children enrolled in CMS from the 16 North Florida counties that comprise the CMS area headquartered in Gainesville, with a suboffice in Ocala,” Flotte said. “But we go well outside that area in offering outreach clinics.”

The CMS North Referral Center, housed in Shands at UF, coordinates hospital and outpatient services in Gainesville for patients who come from more distant parts of the state.

In 2001, UF pediatric physicians working at the Gerold L. Schiebler CMS Center in Gainesville provided primary medical care for more than 15,000 patient visits and primary care for hundreds of CMS patients at UF and Shands HealthCare facilities in Gainesville. UF pediatric experts provided subspecialty care for CMS patients at UF’s Health Science Center and Shands facilities in Gainesville on more than 13,000 occasions. Outside Gainesville, UF pediatricians conducted more than 500 CMS outreach clinics.

Pediatric outreach subspecialty care involves faculty from pediatric cardiology, endocrinology, gastroenterology, genetics, hematology and oncology, immunology and infectious disease, nephrology, pulmonology and surgical subspecialties.

“We see 8,000 pediatric cardiology outpatients a year in our combined ambulatory clinic programs in Gainesville and Jacksonville, but we need to build (the programs) up more,” Fricker said. “We serve an area reaching from Orlando up through South Georgia, west to the Panhandle and east to Jacksonville and the Space Coast, encompassing 7 million to 8 million residents. Our division also conducts outreach clinics in Lakeland, Daytona Beach, Tallahassee, Panama City and Pensacola.”

For the past decade, UF’s pediatric outreach clinics have been limited mainly to subspecialty care rather than general pediatrics because private-practice pediatricians have become much easier to find, said John Nackashi, M.D., a UF professor and chief of general pediatrics.

“I really liked going into the rural areas,” said Nackashi, who brought his expertise to communities such as Lake City, Ocala and Bronson from 1982 to 1999. “But I’m so glad those communities now have locally based primary care available five to seven days a week. I never anticipated they’d have so many pediatricians.”

The division’s road-trip routine didn’t change much over the years, Nackashi said. A physician — often Frank L. DeBusk, M.D., former chief of general pediatrics — would gather a small group of residents and medical students and drive to a county health department facility in the countryside. The UF personnel sometimes found local pediatricians accompanying their young patients, seeking treatment advice.

Florida’s CMS program might be limited to a handful of medical conditions if not for the efforts of UF faculty, said Arlan Rosenbloom, M.D., medical director of the Gainesville/Ocala CMS office.

CMS developed from the Crippled Children’s Program, a nationwide effort launched in the 1920s to address orthopedic conditions, Rosenbloom said. In 1973, the Florida program was renamed the Bureau of Children’s Medical Services and given greater status and autonomy. Initially led by Sarasota pediatrician F. Edwards Rushton, M.D., the bureau was subsequently directed by Gerold L. Schiebler, M.D., then chairman of the UF pediatrics department. Rushton and Schiebler greatly expanded the mandate and funding so that CMS would eventually cover all chronic diseases in children.

“Directing CMS was a very courageous and self-sacrificing thing for Dr. Schiebler to do in lieu of a scientific sabbatical,” Rosenbloom said. “Building on the pioneering leadership of Ed Rushton, he laid the groundwork for the CMS program we have today.”

In the 1970s and ’80s, UF led the way for regional program development in CMS, which in turn led to greater support that made it possible for teams of physicians to conduct outreach clinics. The UF model has since been adopted by other tertiary pediatric programs statewide.

All UF pediatric clinics rely on teamwork for their success. Fricker credits his colleagues — transplant coordinator Kelly Harker, a pediatric nurse specialist, and social worker Mary Freeman, M.S.W. — for help. Similarly, Flotte praises the CMS staff members who perform the logistical tasks that make UF outreach clinics possible.

Teamwork soon will enable UF’s pediatric clinics to use telemedicine for greater outreach service, said Max Langham, M.D., chief of UF’s pediatric surgery division and medical director of the CMS North Referral Center. Using the Internet, UF physicians in Gainesville will be able to carry out long-distance clinics for patients in other communities, assisted by local nurses or doctors working on-site.

The UF pediatric endocrinology division has the CMS pilot program contract for telemedicine clinics, which have been highly successful in Daytona Beach, and telemedicine facilities throughout North Florida are being used by the CMS-contracted Child Protection Team to provide efficient examinations without the need for long-distance travel.

“Telemedicine will help bridge the gap in communities where we hold outreach clinics every few months,” Langham said. “Hopefully we’ll be able to have patients come to the site with their primary-care pediatricians, so our experts can do a telemedicine consult where they can see the patient and speak to the doctor in real time. I think that’s a really exciting possibility.”