Trauma Center to close--Las Vegas now a more dangerous place

Las Vegas Review Journal ^ | July 3 2002 | Joelle Babula

[Mamzelle]

link

[Mamzelle]

University Trauma Center closes today because physicians are quitting due to ruinous malpractice premiums. This means trauma will fall on local Emergency Departments, who may not have surgeons ready to go at a moment's notice. Drive carefully!

[rellimpank]

--yeah--if you are hurt, sick or pregnant, call a lawyer--the doctors are all leaving town, thanks to lawsuits--

[Lockbox]

Thank you America for the citizens who value lawyers over doctors.

Thank you America where we do not except the fact that everyone will die sometime, but if it happens while a doctor is trying to help, we will sue.

Thank you America for having laws which allow people to sue a doctor for doing their best, but the patient dies, while having laws which prevent people from suing their lawyers for losing the law suit.

Thank you America for everyone wanting something for nothing.

If you want to know what’s wrong with America, start first by looking at ourselves. Time to clean up our act by stop wanting everything for free. We should stop believing that someone has to pay for our problems in life.

[Mamzelle]

Las Vegans ought to understand, now, that there are no laws forcing hospitals to maintain ERs. The hospitals can close them down if overburdened. The surgeons in the local hospital can resign their positions as well...

That trauma center took care of 11K patients/year.

[07055]

Who is John Galt?

[lindaloo]

The citizens of the United States have only themselves to blame for physician shortages due to rising malpractice insurance rates. We sit on the juries that hand out these huge settlements. We elect the judges that award huge, unrealistic sums in our current touchy feely society.

[demkicker]

Man this

[Mamzelle]

Because the local ED's are not equipped for the quick surgical response (though I'm sure they'll suck it up and do their darnedest), these same ED's will find themselves easy targets for lawsuits themselves...it's how it works..."If you didn't think you could deliver perfect care, you shouldn't have tried to deliver anything at all"--wait and see...

[Salvey]

Who is John Galt?

...and where is he, now that we need him?

[1tin_soldier]

We are, each and every one of us, John Galt. We must realize that everyday we strike a bargain with the world. When the terms of that bargain become undesirable, we must act. Bravo, former LV docs!

Can an underground/blackmarket healthcare market be far away? For my health's sake, I hope so.......

[JustTheTruth]

Trauma Centers are incredibly expensive to operate. Hospitals must have, for example: Trauma Surgeons on site 24 hrs/day, 7 days a week and Trauma Anesthesiologists on site 24/7 as well - with a backup team on call in case a second trauma comes while the first team is in the O.R.

It is not uncommon for the Trauma surgeons to be paid $2500/day just for availability - and to receive guaranteed payment in addition for services rendered - often to uninsured people with no assets. $2500 x 365 = $912,500 per year, not counting the cost to the hospital of covering them with malpractice insurance as well. You never know when the person whose life you save will sue you.

That $ amount is just for the one surgeon - add to that the costs of the back-up call physician team, the on-site trauma anesthesiologist, and many other specialists. Specialists such as neurosurgeons will no longer take Trauma Call without being paid an availability fee (big bucks per 24 hours). Orthopedic Surgeons must also be on call 24/7 - and, like the Neurosurgeons - be able to get there within 20 minutes or so after being called. Their days of doing it for free are over in most communities.

The hospital must also have a fully staffed trauma team of trauma ED and OR nurses, techs, etc. on call and waiting for an extra case - plus a fully equipped operating room with an extra set of everything expensive (including many types of power equipment and instruments "just in case" - all which must remain idle waiting for the next trauma OR case. The ICU must always have at least one empty ICU bed - staffed and held "just in case" for trauma patients. Many other specialists must also receive guaranteed payment from the hospital for trauma care - and for follow-up care. The costs run well up in the millions just for one hospital to do this.

Trauma patients can be either "blunt injury" types - car accidents - or the gun and knife club - the latter which frequently do poorly and which of course have no insurance.

To top it off, most Trauma Centers cannot charge extra for the "availability" costs of having all of these resources on standby. Trauma Centers often can't charge insurance companies/HMO's more than neighboring community hospitals or else the health plans will divert - if possible - the more profitable and discretionary care to the lower cost centers, leaving the Trauma Centers with no pay and crappy-pay patients only. It is rare to see a for-profit hospital in the Trauma business because it is such a money loser.

A huge factor is that the Federal government controls the financing of the training of physicians in this country after they leave medical school and go into Residencies and Fellowships. While Managed Care was reducing access to and utilization of care during the late 80's and into the mid-90's, the policy geniuses (?) in government concluded wrongfully that America would continue its downward trend of using physician care. They subsequently made dramatic reductions in the pipelines for physician training - in particular they cut down on specialists. Like the Soviet 5 year plans, this plan was also very bad. Just as the huge wave of baby boomers are now moving into those years where they need a lot of medical/health care, the supply of physicians is being cut back. It will take a decade to fix the pipeline - and that clock will only start running when the policy wonks wake up and make a decision to fix the situation. They're still clueless.

Doctors who have been screwed and demeaned for years by HMO's cutting rates now find that the doctors have become scarce commodities in the market - where physician supply is falling further behind the growing demand for physicians. Especially in small specialties such as neurosurgery. Orthopods and trauma surgeons are also gaining considerable market power and it is payback time to the HMO's in many markets. Continuing Medicare cutbacks in payment only exacerbate the problem and the determination of physicians to take revenge on the health plans. Unfortunately patients are also in some cases losing out as the market dynamics unfold.

Malpractice insurance cost is increasingly an issue - especially for Neurosurgeons who can get screwed in lawsuits with messed up trauma patients - but it is only one of a number of complex economic issues. After 9-11, many medical malpractice insurance companies are getting out of the med-mal. business entirely, and others are scrambling with huge premium cost increases to deal with their depleted capital and earnings situation. The current stock market slide is pushing up the need for higher premiums to maintain solvency and profitabiltiy at the insurance companies. As a result, doctors are taking big cost hits - and have concluded that they are not going to take it any longer. This is happening at the same time that average nursing wage inflation is in the 8-10% annual rate and has been for 4 years now due to the nursing shortage (which will get much worse before it gets better - the demographics and trends prove this).

I, for one, am glad to see the Vegas trauma docs hold out for regulatory reform in the malpractice arena. Most politicians just don't have the will to take on the politically powerful trial attorney lobby. You cannot make the physicians slaves to the State. This may backfire on the doctors from a public relations standpoint, but for a town like Las Vegas which has very few Trauma Surgeons and Neurosurgeons in the first place - maybe they can withstand the pressure and successfully put the black hat where it belongs - and bring about tort reform in that state and create precedent that can help do the same in other states.

Also, someone said that hospitals can close their ED's - but that is simply not true in every State that I know of. State regulations require General Hospitals to operate Emergency Departments as a condition of licensure. And Federal Regulations require them to take all comers into the Emergency Department regardless of ability to pay (for true medical emergencies).

[JudyB1938]

There were some of those doctors who asked for a leave of absence until they could figure out how to get medical insurance. UMC refused. So the doctors quit. Can't blame them.

BTW ... For serious cases which require speciality services, the patients will be flown to another hospital in another state.

[Mamzelle]

Just the Truth: That figure you quote for an orthopod/trauma surgeon at a first rate trauma center is about three times what they make, and top of the line at that...you are not taking into account that it takes three surgeons to cover one 24 hour period, and you'd better have some overlap. The specialist surgeons are among the most well-compensated of the physicians, but they do not clear near what that figure would suggest. Top salary for an ortho at his pinnacle at the most high-paying place in the country might be $400.

I'd be surprised at even that, because most of the attractions of being a doc at one of those institutions involve the moxie, the challenges/excitement, the prestige, and the research opportunities. Fun is a factor--which is how the military keeps its surgical specialists. That local ortho who set your kid's arm (I really like orthos, they are often former jocks and cuddly, friendly sorts-- was surprised to see that it was the affable orthos who fired the first volley of malpractice rebellion) likely brings down $250K if he's well-established, out of debt, about half that if he's straight out of residency_...and he'll be there for you when your daughter wrecks her new car. Along with the ENTs to put her nose back in place and wire her jaw, and the ER doc who gets them all out of bed.

How irrational a people we are, to ruin a system so effective at helping us...

Trauma Centers don't just sew people back together, they also are major research centers. They figured out not too long ago that a massive dose of hormones administered quickly after a spine injury will ameliorate damage, sometimes remarkably. You know, they improve all the time, and deliver better and better care all the time. Does our court system, filled with lawyers, claim as much?

It's like the better they get, the harder we work to shut them down...Ayn Rand would have nodded...

Trauma Centers are indeed incredibly expensive to operate. It isn't just the doc who gets sued, but the facility and staff as well. But to have one within an hour's helicopter's range saves lots of lives. The "golden hour" is where you can take many measures to reduce mortality and morbidity, especially with today's technology--like the hormones I mentioned earlier. (That's just an example...now that it's more widely known, a local ER can apply it just as well.)

Also, most hospitals require a neuro to take call if he is going to be on staff with staff privileges. This means he hasn't any choice whether or not to see emergency patients. So...some of them are just quitting...The neuros have a lawsuit target on their backs because they see the worst of the worst, and end up with many paralyzed and brain-damaged patients through no fault of their own. (But the juries don't mind blaming them.)

Maybe you can find a state that requires hospitals to keep an ER and keep it open 24/7...but I don't know of any, Even in this highly regulated country. The law won't be able to keep that Trauma Center in Nevada open, and won't be able to keep the OB wards in Mississippi open. (The next crisis will be rolling down the pike soon.) The law DOES require an ER to see everyone who comes through the door, though they needn't supply treatment to any that they judge non-emergencies. Most just treat anyway, since they've already spent the money to diagnose.

ERs are big money losers. They collect less than 40% of their billings. It amazes me that the boards of directors and bean-counters that run the hospital admins don't get together and decide to shut the doors of their ERs. When ERs are overburdened during a particular day, they can close their doors and warn ambulances to reroute.

Hospitals run ERs out of obligation for their communities, the sense that a hospital *should* provide an emergency service. There's no other reason for them to run them.

[Mamzelle]

As far as sending patients farther away, keep in mind that that fast care is important. The ER will find itself with COBRA violation problems if they must transport a critical patient any distance--the transportation time itself is dangerous. Should the ER doc keep the patient and get sued for doing so, or send the broken patient a far distance and get sued for doing so and also face COBRA fines and jail time?

Also, the local surgeons pay the same insurance rates...they just haven't gotten their bills yet. With this new burden falling on local hospitals, we'll see if a chain-reaction will set in.

[Hillary's Lovely Legs]

Who is George Jr? Certainly you can't mean the current president of the United States. Any moron knows that's he's not a junior and that is just a liberal's slur.

[LarryLied]

Tort Reform would cure (pun intended) this but George Jr. is moving as deftly as Clinton did.

And why don't we have tort reform? What is stopping Bush? Hmmmmm...?

[LarryLied]

Don't you get a kick out of it when liberals blame Bush for not doing what Democrats block him from doing?

[JudyB1938]

Exactly. Doctors have been warning for a long time what was coming, but nobody would listen to them. We won't lose ALL of the doctors though. The ones who work for UMC (the County) are pretty much protected, since they are covered by the County's insurance. I think the most anybody can sue UMC for is about $50,000.

Most doctors don't make the kind of money people think they do. And they have a lot of expenses and taxes to come out of their gross. By the time everything is taken out, they really don't have all that much to show for their years of sacrifice and training. And now with the skyrocketing malpractice insurance, there's no way doctors can stay in business. The premiums can be higher than the doctor's net! Nobody else has TO PAY to work on a job. Doctors are no exception!

[mountaineer]

Tort reform is more a matter for state legislatures than for Congress or the president.