Not being familiar with this case, I can only speculate, but here is my hypothesis.
If the details of the story are accurate (unlikely) then the initial transfer to a facility of equal care was likely due to bed space. I have a sneaking suspicion that he was sent to the hospital 45 minutes away due to Medicaid status. The closer hospital may very well not accept Medicaid.
The second transfer occurred because of his deterioration. He was clearly not a regular peds floor patient, especially in a hospital that does not specialize in peds. So the second transfer was to a higher level of care.
In the story it describes his last words s being charted in the nursing notes. I am not sure if they mean he was transferred with an RN (CCT) or if that was charted at the hospital prior to transfer.
In any case, this is an example where we would have used our helicopter. Due to the instability of the patient, prolonged transfer time due to distance and traffic, rotor wing transport is appropriate in this situation, although I have very little doubt that a pedi critical care team most likely could have managed this patient without adverse effect.
They way we operate is that a memorandum of transfer has to be filled out describing the need for transfer (typically higher level of care) and detailing the diagnosis, referring physician, and accepting physician. There has to be a physician to physician report, and at that point our attending determines whether the patient is stable to be transferred by a private service, or if they need our critical care team. Then, based on mileage, traffic status, patient acuity, referral request, etc we determine mode of transport.
Like I said, I am not in the know on this particular case, but being a pediatric transport medic, I can already identify a few areas where the process is likely to have broken down.
A truly sad story all around. I hope the family finds peace, and the medical professionals involved learn from the series of tragic errors.
