Trauma Centers on Financial Life Support in North Fulton

publication date: May 22, 2008

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author/source: By Alan Sverdlik / STAFF

“My God, she’s just a little girl,” a trauma center nurse at the Medical Center of Central Georgia remembers blurting out when confronted with a limp body on a stretcher.

Pronounced dead on arrival at the Macon hospital one afternoon last fall, the 14-year-old, whose head smashed against a Plexiglas barrier when her taxicab collided with another vehicle, might have been saved had the ambulance arrived within what trauma specialists call “the golden hour.”

But even at breakneck speed, the trip from Dougherty County, deep in the state’s pecan belt, to downtown Macon took much longer – certainly long enough for an untreated cerebral hemorrhage to end a life.

“If you get in a bad accident on I-75 south of Macon, you’re good enough as dead,” says Harry Geisinger, a state legislator from Roswell (R-48) who unsuccessfully fought for a bill that might have averted the calamity that befell the teen.

Already underserved by its network of 15 trauma centers, most of them overwhelmed and underfinanced, Georgia’s emergency care crisis deepened this year when the General Assembly killed a number of proposals that would have raised money for hospitals that specialize in traumatic injuries. The crisis reflects a wrenching paradox in an era of improvements in emergency care, improvements that have saved thousands of lives but cost more than most patients can pay, leaving cash-strapped providers with all or part of the bill.

“Today, one’s chances of surviving a serious, life-threatening wound are many times greater than they were 10 years ago, thanks to new developments in emergency medicine,” says Dr. George Peligros, a Stanford University medical school professor who has held several positions with the American College of Emergency Physicians. “The training and technology is quite expensive, though, and most hospitals these days are primarily concerned with their economic existence. So they’re faced with an existential dilemma: Do you offer medicine’s very latest if it’s eventually going to put you out of business?”

Two years ago, a legislative study committee looked into the state of Georgia’s trauma care network and found the system wanting, particularly when put side by side with other states. Experts told the committee that 700 Georgians who lose their lives each year would have been saved in locales with adequate trauma care, where emergency medical technicians regularly drop off the badly hurt within “the golden hour,” past which few can survive. Part of Georgia’s poor ranking – and perhaps why svelte New Jersey came in near the top – can be excused by geography. “Land-wise, we’re the largest state east of the Mississippi.” Geisinger says.

That didn’t temper the sorrow of Maryanne Jarrard, however. Interrupting legislators as they debated one of the doomed trauma bills, the Alpharetta housewife approached the microphone on the state Senate floor and recounted how her 22-year-old son had died in a five-car pile-up on I-75 near Tifton. He died, she said, “because help was too far away.”

“We’re in real tough times here,” she went on. “I don’t know what the solution is going to be. The ultimate answer, of course, is money. It’s not going to change until somebody in a high position has a family member die because they couldn’t get treatment at a trauma center.”

There are four “Level One” trauma centers in Georgia – Grady Memorial Hospital and its large, public peers in Macon, Augusta and Savannah. These hospitals take the most seriously injured victims of car accidents, airplane crashes, fires and shootings, some of whom arrive by helicopter. A complicated calculus of staff training, specialty board certifications, technology and accessibility to population centers determines levels, which range from one to four. North Fulton Regional Hospital’s trauma center is designated “Level Two.”

Careful not to focus too intently on Grady, representatives of the major trauma centers, like North Fulton Regional Hospital’s Dr. John Harvey, presented their predicament to legislators as one that affected vast swaths of Georgia. But somehow Grady loomed over the discourse.

In 2006 alone, Grady had been forced to write off more than $40 million in unpaid bills for trauma care, its officials said.

Signs of stress on other centers, which under state law must treat all trauma patients, insured or not, also came to the fore, if not as dramatically.

It was largely an airing of the crisis’ symptoms, but also potential cures that got endorsements from House Speaker Glenn Richardson, Governor Sonny Perdue and Lt. Gov. Casey Cagle. To offset the huge costs incurred by the network, a number of solutions were proposed: a $10 fee on vehicle license tags; higher Medicaid reimbursement for trauma services; a $200 fine on “super speeders” – those found guilty of exceeding the speed limit by more than 15 mph; a surcharge on temporary cellular phones, the centerpiece of a bill proposed by Geisinger.

Ultimately, none became law as the session came to an end, leaving the issue of trauma centers and long-term state aid in limbo until next year. Most political insiders attributed the inaction to infighting in the higher ranks of the leadership, rather than partisanship or concern that it was all a disguise to bail out Grady.

Harvey says he was “exceedingly disappointed that in the last hours of the legislature, the initiatives seemed to stall.” But in the meantime, he and North Fulton Regional Hospital CEO Joe Austin say his trauma unit will carry on.

Austin says trauma centers are a vital part of disaster response, and since the team is called in in only 1.6 percent of North Fulton’s 38,000 annual emergency cases, he won’t have to make any hard decisions about it until the funding crisis is resolved.

At their inception, trauma centers were considered a pedigree, but with all their money troubles and the reluctance of government to underwrite losses, they’ve become health care’s white elephants.

“If they were considered all that prestigious, people would be jumping into them instead of jumping out of them,” Austin says.

Fulton County Commissioner Lynne Riley calls the crisis “a terrible thing,” adding, “Every citizen wants to know that when the day comes when they’re in a life-and-death situation, they’ll get the best of the best care.”

The majority of North Fulton residents will never have a need for a trauma center.

It’s the treat of that one time, though, that may cause area politicians to think long and hard about the consequences of not having one nearby.

GEORGIA TRAUMA CENTER CRISIS TIMELINE

1979: The American College of Emergency Physicians is founded with the mission of upgrading emergency medicine, establishing a board that certifies doctors, nurses, emergency medical technicians and other health care personnel as specialists. Hospital emergency rooms, until then primarily manned by residents and general practitioners, begin hiring board certified staff.

1980-1985: Emergency walk-in clinics open up around the country, offering treatment of minor injuries and ailments. The concept catches fire as entrepreneurial doctors establish local and national chains. Hospitals get into the increasingly profitable business by opening up satellite, emergency room-style clinics in the communities they serve. Despite assumptions that the walk-ins will take pressure off emergency rooms by treating patients who don’t require true emergency care, large, public hospitals say they are on the brink of financial collapse as uninsured patients continue to use their emergency rooms as doctors’ offices.

1990-present: Trauma center networks, the brainchild of the still-evolving field of emergency medicine, are established in most states in a move supposed to revolutionize the treatment of life-threatening injuries. But the high cost of treating uninsured trauma patients and limited assistance from Medicaid and other government programs put the centers under severe financial strain. Inner-city hospitals like Grady Memorial bear the brunt of charity care, and subsidize their operations with revenue from other services. Grady and similar hospitals around the country ask states to bail them out.

2006: A committee convened by the state Legislature determines that Georgia’s network of 15 trauma centers underserves the state, particularly the southern and western counties. It estimates that 700 lives are lost each year because of failures in the system – an avoidable disaster. The committee says other states are much further along in reforming trauma care.

2008: The General Assembly fails to provide long-term state aid for hospitals that specialize in trauma care, including North Fulton Regional in Roswell. Bickering and Byzantine rivalries between important political players are blamed for the inaction. The issue is expected to rise again in next year ’s legislative session.
Among the options for funding trauma care include:

• The imposition of a $10 fee on annual care registration, proposed by House Speaker Glenn Richardson. Projections say it could raise $74 million annually.
• Diversion of the .25 mill property tax levy the state already collects. The measure, projected to raise $90 million, came out of conference between the state House and Senate.
• Increasing fines on those found guilty of driving at speeds well in excess of the limit. Proposed by Gov. Sonny Perdue a year ago, the “super speeder” measure could raise an extra $25 million a year.
• Levying a surcharge on purchases of disposable cell phones, proposed by Roswell legislator Harry Geisinger.