Their role is to save the lives of the most critically injured, but that’s a costly task
By Brandon Larrabee
Florida Times-Union (Jacksonville)
Copyright 2007 Florida Times-Union
Distributed by McClatchy-Tribune Business News
ATLANTA — She still can remember the smoke and the smell.
Regina Purvis, who was 16 at the time, doesn’t remember how, exactly, that accident on the sharp curve on an October morning in 2004 happened. She does remember bouncing around in the 1992 G20 Infinity she was driving after it plowed head-on into a Ford Explorer. She was wearing a seat belt, but there was no air bag to protect her.
She remembers lying sideways, screaming, as a man and a woman at the scene pried her out of the car.
And Purvis remembers the expression on the face of one the emergency technicians after she was loaded into an ambulance and undressed.
“That’s when I knew that I was dying,” Purvis, now 18, said recently.
Already on her way to meet her daughter, Debbie Murphy rushed to the scene when someone managed to call Murphy on Purvis’ cell phone. When she later reached the hospital, Murphy was met at the door by a chaplain.
Murphy heard frequently that day that her daughter, a standout softball player, was going to die.
“They told us that four or five times,” Murphy said.
Her daughter’s kidneys were damaged, one of the largest arteries in her body had been severed, bones in her right leg were shattered, and most of her ribs were broken.
That Purvis survived is a credit, she said, to the medical staff at Gwinnett Medical Center, one of 15 trauma centers scattered throughout Georgia. Trauma centers are equipped to handle the severe injuries resulting from automobile and other kinds of accidents as well as injuries stemming from violent crime.
But the state’s trauma care system is itself in critical condition, according to lawmakers, advocates and hospital executives. Hammered by rising costs, an increase in uninsured or underinsured patients and falling economic fortunes, hospitals in the system are pleading for help.
“Fifteen hospitals are simply not enough for a state the size of Georgia,” said Sen. Cecil Staton, R-Macon, who co-chaired a joint legislative study committee on trauma care.
One state health-care official estimated during testimony to Staton’s committee that Georgia needed roughly twice the number of trauma centers it now has.
The lack of trauma centers costs lives. Georgia’s trauma fatality rates are about 20 percent higher than the national average, according to “It’s About Time,” a hospital-backed campaign pushing for measures to boost the system.
“That’s just unacceptable,” said Rep. Larry O’Neal, R-Warner Robins, who co-chaired Staton’s committee.
If the state’s numbers were in line with the rest of the nation, the group says, another 712 lives could be saved each year.
But those involved in the issue say saving the system will require a massive infusion of up to $80 million, a greater level of coordination among hospitals in the state and perhaps a long-term change to how the state pays hospitals.
“A lot of times we, as politicians, try to make everything sound like it is life or death,” O’Neal told his colleagues the day his committee’s report was given to House members. “I will tell you for sure, this one really is.”
The system
As the ambulance took Purvis to Gwinnett Medical Center in Lawrenceville, it was headed toward one of the state’s nine Level 2 trauma centers.
What most people think of as a hospital is referred to among health-care professionals and government agencies as an “acute-care hospital.” There are 152 of those in Georgia.
About 10 percent of those serve as trauma centers, and those centers are broken into four categories, with Level 1 trauma centers able to handle the most serious injuries 24 hours a day and Level 4 centers able to evaluate and possibly stabilize patients before moving them elsewhere.
Level 2 centers have many of the same abilities as Level 1 centers, but don’t perform as much medical research and don’t have the same residency requirements.
Level 3 centers often don’t have doctors with all of the specialties required of Level 1 and 2 centers.
Georgia has four Level 1 trauma centers, one Level 3 trauma center and one Level 4.
The four Level 1 centers are in Augusta, Savannah, Macon and Atlanta. All but two of the state’s Level 2 trauma centers are north of Macon; the other two are in Columbus and Thomasville.
A broad swath of Georgia between Macon and the Florida state line, with the exception of the area covered by Memorial Health University Medical Center in Savannah, has no access to a Level 1 trauma center.
That is significant, doctors say, because a patient’s chances of survival increase dramatically if he receives treatment during the “Golden Hour,” the first hour following a life-threatening injury.
“We unfortunately have areas of the state ... where you can’t get to a trauma hospital within an hour,” Staton said.
Since Murphy moved to nearby Barrow County in the years since her daughter’s accident, she’s had a chilling thought.
“If she’d been in Winder, where I live now,” Murphy said, “she’d be dead.”
Lack of coordination
But even in places where there are trauma care centers, the network is plagued by a lack of coordination and, in some cases, a lack of knowledge and equipment, particularly at smaller hospitals, whose staff aren’t trained to handle critically injured patients.
“We would argue that we don’t have a system,” said Gary Nelson, president of the Georgia Healthcare Foundation, a nonprofit group that studies and works to improve health care in the state. Instead, the trauma centers and hospitals almost function independently of each other, Nelson said.
“The whole goal is getting the right patient to the right hospital at the right time,” he said.
Bob Colvin, president and CEO of Memorial Health, thinks he has a model. The Savannah hospital has a state grant that allows it to work with other nearby, smaller hospitals on obstetrics, in case Memorial’s services are needed.
“The state has no such comparable system with trauma, which is crazy,” Colvin said.
In an ideal world, Colvin said, Memorial and other Level 1 trauma centers would be able to make sure their equipment was compatible with the equipment of smaller hospitals and trauma centers. That would make it easier to transfer patients from one facility to another.
Transportation also is an issue. Staton and O’Neal’s committee wrote that one of the state’s 10 emergency medical services regions covers 10,670 square miles, has only the trauma center in Thomasville, but has no air transportation to that hospital.
“Perhaps one of the most disturbing points made during testimony to the committee was that 20 counties in Georgia do not have a 911 system,” the study panel wrote in its final report.
And a shortage of health-care professionals also has to be factored into any plans to address the troubles with trauma care.
Whether to stay
But the main issue is money. According to the study committee report, Georgia hospitals, doctors and emergency medical services provide an estimated $250 million a year in uncompensated care - services and procedures that aren’t paid for by the patient, a private insurance plan or taxpayer-provided health care.
Reimbursements to hospitals from the joint state-federal Medicaid program, which provides health care to those living below the poverty level, was long ago slashed to about 85 percent of the costs hospitals incur for those patients.
As a result, trauma centers say they are sinking into the red. Colvin said Memorial could have lost $20 million last year, with final numbers pending, and will post its first loss in eight years. The hospital lost about $7 million on trauma care, Colvin said.
Medical College of Georgia Health System in Augusta lost about $8 million on trauma care in its last fiscal year, according to a recent opinion piece by Don Snell, president and CEO.
And so, as state leaders try to find a way to expand the trauma care system, some hospitals are taking a hard look at whether they can afford even to be a part of it.
“We have hospitals that are in crisis with respect to trauma care,” Staton said. “Some have even considered withdrawing from the trauma network. We can’t allow that to happen.”