By Lori Yount
Chattanooga Times Free Press
Copyright 2008 Chattanooga Publishing Company
CHATTANOOGA, Tenn. — Erlanger, the only hospital in a 100-mile radius that can handle the most severe trauma patients, is asking to be considered for financial assistance to cover the almost $5 million it spends each year treating critical patients from Georgia.
“Patients don’t use political boundaries,” said Jim Brexler, CEO of Erlanger Medical Center. “We are part of the Georgia market.”
About 30 percent, or more than 6,000, of Erlanger’s trauma patients each year come from Georgia, records show.
Georgia lawmakers are considering several proposals that would raise money for the state’s 14 trauma centers.
One proposal would set aside $53 million in the state budget for trauma care, and a bill passed by the House this month would add a fee to vehicle registration and raise $70 million annually. Erlanger officials want to make sure they are part of the discussion.
“We should get equal consideration with the passage of bills in Georgia,” Mr. Brexler said.
Dennis Ashley, chairman of the Georgia Trauma Care Network Commission, said he’s open to discussions with Erlanger. But he said it’s too early to determine whether the Chattanooga hospital would receive any funding from Georgia’s trauma money.
Georgia trauma centers are the commission’s first priority, he said.
“Certainly it’s the centers in Georgia we’ll make sure we save first,” Dr. Ashley said.
Erlanger officials said they will keep taking Georgia patients even if they don’t get the money.
One of the hospital’s three Life Force air ambulance helicopters is based in Calhoun, Ga.
“We believe in serving the area, and we should be able to receive funds to continue to serve hospitals,” said Roger Forgey, Erlanger’s senior vice president for regional operations. “We’re concerned on being able to continue funding.”
Mr. Brexler said Tennessee last year “stepped up to plate” by providing $11 million to trauma centers statewide, some of which will go to the Chattanooga hospital. Now, he said, it’s Georgia’s turn -- with Erlanger included.
Funding remains uncertain
Last year, the Georgia Legislature created a trauma fund as a source to dedicate money to the state’s 14 hospitals. So far there is no money in the fund, but lawmakers said it was one of their top priorities to change that this session.
“It’s unthinkable to me we’d go away without doing something to fund trauma in the budget,” said Georgia Sen. Cecil Staton, R-Macon, a leader in trauma care legislation.
He said he expects $53 million in the midyear budget, which has yet to be agreed on by legislative leaders, to go toward funding trauma centers through June 30.
The House last week also passed a bill that would charge a $10 fee for owners to register their vehicles each year, which lawmakers said should bring in $70 million for trauma care annually.
However, its passage depends on approval from two-thirds of the Senate and voters approving a property tax reform measure that eliminates the property tax on vehicles and caps assessment values. That measure has faced criticism from Gov. Sonny Perdue and others as being a reckless tax cut in the face of an economic downturn.
The $53 million at least would be a start, Dr. Ashley said.
“It helps slow the hemorrhage of the trauma system,” he said.
But it’s a sustainable source of trauma-care funding that is really needed, Dr. Ashley said. When the Legislature failed to pass trauma funding last year, one hospital dropped its trauma center designation and all four Level I centers considered dropping out of the fledgling system, said Dr. Ashley, who is the director of trauma and critical care at the Medical Center of Central Georgia, a Level 1 trauma center in Macon, Ga.
A Level I trauma center maintains a full range of trauma care 24-7, including certain specialists at least on-call at all times. These centers also have research and residency program requirements.
About 10,000 patients are treated each year in Georgia’s trauma centers, and an estimated 30,000 trauma patients receive care at the state’s other hospitals.
“It’d be catastrophic if this legislative session closed and we come out without any trauma funding,” Dr. Ashley said.
Gov. Perdue’s proposal to add fines to people who exceed the speed limit by a large amount still is alive in the Legislature and could bring in more than $10 million for trauma care each year.
Whatever the source of money, Sen. Staton said Erlanger’s unique situation should be taken into consideration, and he said he doesn’t know of any reason why Erlanger couldn’t be included in Georgia trauma funding.
“They’re really keeping that 30 percent (of Erlanger’s Georgia trauma patients) from coming down here and crowding up Georgia hospitals, and capacity is an issue,” he said. “They need to be included in some conversations and continue to be included.”
Where to go?
Erlanger’s request seems “fair,” said Georgia Rep. Martin Scott, R-Rossville.
His grandfather had a stroke at his home near Rossville, Ga., last month and was taken to Erlanger, the closest and highest level trauma center.
“We have to continue in cooperation with them because they serve us well,” Rep. Scott said.
And as metro Atlanta trauma centers reach capacity and divert patients elsewhere, emergency responders are taking even more North Georgia patients to Erlanger, said North Georgia EMS coordinator David Loftin.
“We’ve had problems getting people into trauma centers for years,” he said.
The Atlanta area has eight trauma centers, one of which is Level 1 and two that specialize in children’s trauma. The Level 1 center, Grady Memorial Health, faces losing state funds unless its leadership is successfully changed into a non-profit board, which state lawmakers are in the process of overseeing.
The flight paths of 12 trauma transport helicopters are between the top trauma centers in Chattanooga and Atlanta, so transport can be quick and, in general, North Georgians receive good emergency care, Mr. Loftin said.
Of Georgia’s 14 trauma centers, two are in North Georgia, and both are classified as Level II -- Hamilton Medical Center in Dalton and Floyd Medical Center in Rome, Ga.
“Our trauma centers here are not nearly in as bad a shape as Grady,” Mr. Loftin said. “They’re a lot more stable.”
But a hospital’s commitment to provide a trauma center doesn’t come with a money commitment from the state, and the centers rack up millions of dollars in uncompensated costs.
Georgia now allocates about $1 million each year in trauma care funding to be split among the 14 centers.
At Hamilton Medical Center in Dalton state funding covers less than 5 percent of the uncompensated costs of treating trauma patients, said Matthew Crumpton, the hospital’s trauma director.
Level II centers send more and more patients on to Level I centers such as Erlanger not because they don’t have the facilities, but because they can’t afford to attract enough specialists to be on-call all the time, he said. About 51 of the 658 trauma patients at Hamilton in 2007 were transferred to Erlanger, many of them to Erlanger’s Level 1 burn unit, records show.
“There are a lot of specialists who shy away from trauma because it’s an uncompensated area,” Mr. Crumpton said. “It makes it difficult to maintain a readiness level.”