Trauma care shortage critical
Studies call transfer delays life-threatening
By STEVE BREWER
Copyright 2002 Houston Chronicle
Some of the most seriously injured patients showing up in Houston-area emergency rooms are in danger of dying because of delays in transferring them to trauma centers better equipped to care for them.
The Texas Senate Subcommittee on Trauma Care will hear testimony at a public hearing beginning at 10 a.m. today at One Reliant Center, Room 500, 8400 Kirby Drive.
The delays are caused primarily by a statewide shortage of trauma beds and trauma nurses that leaves doctors and nurses at less-equipped hospitals scrambling to find space at trauma centers.
Save Our ERs, a coalition of local doctors, nurses, politicians and business leaders, released three reports Wednesday it says show the state's trauma care shortage is now life-threatening.
Among other findings, the group's reports say 70 percent of the patients reporting to 38 emergency rooms in the Harris County region last year had to wait at least three hours to be transferred to a trauma center. Doctors say waiting times of two hours or more are potentially life-threatening to seriously injured children and victims of heart attacks or head injuries.
About 10 percent of emergency room patients waited at least six hours to be transferred -- seriously decreasing the quality of their care and their chances of survival. The remaining 20 percent were transferred in two hours or less.
Save Our ERs surveyed 48 hospitals in Harris and eight surrounding counties, asking about their trauma and emergency care. At least 38 of the hospitals responded to most of the questions, and Save Our ERs officials say the answers are alarming.
Dr. Guy Clifton, a Save Our ERs co-founder and chief of neurosurgery at Memorial Hermann Hospital, predicted that the statewide shortage of beds in pediatric trauma care means an increasing number of seriously injured children will die for lack of trauma care.
Clifton said there are no numbers showing how many people have died because of delays in getting patients transferred to trauma centers, but he said doctors have plenty of anecdotal evidence. He said the problem will get worse unless the state Legislature takes action when it meets next year.
Clifton met with members of the Greater Houston Partnership's board Wednesday seeking political and financial support for a $1 million lobbying effort. Clifton and Save Our ERs want to persuade the Legislature to come up with $175 million next year to help alleviate the trauma care shortage in Harris County and elsewhere in the state.
"If it doesn't happen, I can tell you what will happen," Clifton said. "There will be more deaths. This is just the start. The population is not decreasing. ... You do the math. A lot more people will die."
Clifton's next step is today, when he testifies at a Houston meeting of a Texas Senate subcommittee on trauma care.
Clifton hopes the results of Save Our ERs' studies will help sway lawmakers to pony up -- despite the state's estimated $5 billion revenue shortfall next year.
Among the study results he is expected to cite are findings that:
- Fifty-seven percent of the people in area emergency rooms are there for primary-care needs, meaning they are tying up beds and resources needed for more severe cases.
- The majority of area hospitals have been forced to divert ambulances to other facilities and had to do it 77 percent more often in 2001 than in 2000.
- About 30 percent of the state's Level 1 and Level 2 trauma centers -- those best equipped to handle serious cases -- are routinely turning away new patients.
"That's like calling a fire department and hearing, `We don't have a firetruck for this problem' or calling the police and hearing one out of three times that officers aren't available," Clifton said.
The problem is acute in Harris County, which has a population that local health care experts say requires at least three Level 1 trauma centers -- emergency rooms that have trauma surgeons on duty permanently, specialists within easy reach and a teaching and research facility to back up the staff.
Harris County has two Level 1 trauma centers -- at Ben Taub and Memorial Hermann hospitals. Critics complain that the number of trauma care beds in the county has remained steady since 1990, despite a 20 percent population growth during those years.
The state's trauma centers have not expanded and are unlikely to do so, Clifton argues, because they have no financial incentive. According to the Save Our ERs studies, Texas hospitals spend at least $175 million a year providing free trauma care to uninsured patients.
Hospitals are able to offset only about $55 million of that expense by billing insured trauma patients or those who can pay at least part of their bill.
As the most populous county in the state, much of that financial burden falls in Harris County. Save Our ERs says public and private hospitals in Harris County lose $17 million a year providing trauma care to uninsured patients. Local government officials think the figures are considerably higher.
Officials with Save Our ERs say the solution is to have the state pick up the $175 million tab for uninsured trauma care. At the same time, they say, private and public health care providers need to enroll more people in federal health insurance plans. Both moves would make it financially feasible for hospitals to expand their trauma care.
Few people argue against increasing enrollment in federal health insurance programs, but efforts to persuade state lawmakers to part with $175 million may prove to be a colossal task.
A proposal to add $5 to license plate fees for trauma care died on the Senate floor during the last legislative session in 2001.
Clifton and his supporters hope to have more success this time. If they fail, he said, the losses will be more than financial.