Every Christmas, a fire truck roars up to Shriners Hospitals for Children in Boston, Santa Claus emerges, and the hospital’s young patients — children suffering from critical, painful burn injuries — have a reason to smile.
It’s a tradition cherished by the firefighters who run a foundation that helps burn survivors. But they don’t know how long it will last.
The Tampa-based Shriners Hospitals organization, citing a decline in the number of acute burn injuries in children, said it is considering a plan to consolidate burn care across its 22-hospital network. This could include closing services in Boston, which has been serving children since the 1960s and is one of the few centers in the world focused on treating children with life-threatening burns.
It remains unclear whether the Boston hospital would close entirely, or if some services would remain open under the plan.
But in a city that has long been a destination for medical care, such a retreat would represent a rare blow. The Shriners hospital here, which employs about 250 people, is the only verified burn center in New England exclusively for children.
“It would be devastating for the burn victims and burn survivors in the Greater Boston area,” said District Fire Chief Dennis Costin, president of the Boston Firefighters Burn Foundation, which puts on the annual Christmas party. “Shriners Hospital is dedicated to these children.”
Patients from New England and around the world seek care at the Boston hospital. Some come with wounds so critical that they need urgent treatment to save their lives. Children badly injured by fires, boiling water, and other causes may require years of surgeries and other follow-up care as their bodies grow and their skin changes.
Shriners Hospitals officials have provided scant details about their consolidation plan, and they did not make any executives available for an interview.
In an e-mail, spokesman Mel Bower said hospital leaders have a responsibility to monitor the “financial efficiency” of the care they deliver. The number of patients with acute burn injuries has been dropping in recent years, Bower said — although he did not respond to a request for specific patient numbers in Boston.
Data collected by Massachusetts Center for Health Information and Analysis show inpatient discharges at the Boston location fell to 223 in 2016 from 456 three years earlier — though patients were staying longer, and the number of clinic visits rose over the same period.
“By consolidating our burns services and utilizing technology and other resources available to us, we believe we can serve our domestic and international patients more effectively and efficiently,” Bower said.
Hospital officials are expected to finalize their consolidation plans in July.
Four Shriners locations nationwide offer burn services, and two of those — the hospitals in Boston and Cincinnati — are targeted for cuts.
Bower said most of the acute burn patients in Boston are from outside the United States, and they could be treated at Shriners facilities in Galveston, Texas; Northern California; or Mexico City.
If burn services in Boston close, local patients may have to travel long distances for treatment. Or they may be able to go next door to Massachusetts General Hospital, which is affiliated with Shriners and where officials say they would try to treat children with severe burn injuries if Shriners shutters services.
Mass. General has a burn center for adults, and its doctors already provide care at Shriners under a contract between the two organizations.
“We don’t know yet what this means,” said Dr. Jay Austen, Mass. General’s chief of plastic and reconstructive surgery and chief of burn surgery. “But we do know that MGH and our physicians and nurses and administrators will do everything we can to care for the children who need us.”
But Mass. General, like most hospitals, bills insurers and patients for its services. Shriners Hospitals are funded primarily through an endowment and take pride in serving patients regardless of their ability to pay.
For this reason, for lower-income families, particularly from outside the United States, Shriners Hospitals may be the only option for patients who otherwise would not be able to get treatment.
Care for the most complex burn injuries can cost hundreds of thousands or even millions of dollars. Treatment could include surgeries to remove and repair damaged skin, days or weeks spent in intensive care, and many sessions of physical therapy.
Shriners Hospitals are also rare because they have burn centers designed just for children, from the bright colors and ample toys to the availability of child psychologists to help with the emotional toll of recovering from a serious injury.
Many patients come to the Shriners facility in Boston from other hospitals that are unable to treat the most severe and complex burn injuries. Dr. Emory Petrack, chief of pediatric emergency medicine at Tufts Medical Center’s Floating Hospital for Children, said he was surprised and concerned to learn that Shriners may be closing services in Boston.
Petrack said he didn’t yet know where Tufts would refer young burn patients if Shriners wasn’t an option.
“When we need help — either because the patient has such a severe burn that they need to be hospitalized, or they just need really good burn care follow-up — Shriners has been invaluable,” he said.
Tufts refers a handful of patients to Shriners each year, and Boston Children’s Hospital said it refers about one patient there every 12 to 18 months.
Shriners Hospital in Boston “has an honored place in Massachusetts medicine,” said Dr. Henry L. Dorkin, a pediatrician who is president of the Massachusetts Medical Society. “The loss of any facility such as that and the trained personnel that come with it means the rest of the health care community would have to take the load.”
Shriners Hospitals are supported and managed by the Shriners fraternity, an exclusively male organization dating back to the 19th century, recognizable by their ubiquitous red fezzes. They are known for providing charity care and did not start billing insurance companies, as most hospitals do, until about seven years ago. The organization’s endowment totaled $7.85 billion at the end of 2016, according to financial statements.
The hospitals treat patients like Juan, who was 8 years old when he fell into a pot of boiling water over an open fire at home in Guatemala, suffering burns on his buttocks and his feet. Sitting and walking became painful or impossible. He spent weeks recovering at Shriners Hospital in Boston.
Where Juan comes from, children die of such injuries unless they’re able to leave the country for intense, specialized care, said Dr. Catherine Bartlett, a Northampton-based pediatrician who helped the boy get treated at Shriners.
“When you’re treating something like burns, you need to have a center where that’s what they do,” she said. “It’s very specialized care.”
Bartlett, who has treated children around the world through nonprofit organizations, said it may make sense for Shriners Hospitals to consolidate burn services if there is less demand for those services. But hospital officials should have a contingency plan for patients, she said.
The plan to close services in Boston is particularly puzzling to Costin, the district fire chief, because when firefighters visited the hospital at Christmas, it seemed to be full, Costin said.
In addition to sharing presents and sweets for the holidays, firefighters visit with Shriners patients regularly, taking them bowling, ice skating, mini golfing, and on other outings. They also help patients’ families with food and housing while the families are in town for treatment.
“I’d really hate to see that end,” Costin said.