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Trauma centers struggling in tight economy

WASHINGTON — Shelly Tomlin had a bad feeling when a horrendous crash left her stuck in traffic near her Eatonville, Wash., home. Her 17-year-old daughter, Ali, had left for school earlier, driving the same route.

Over the next few hours, Tomlin lived through a parent's worst nightmare as she learned her daughter suffered traumatic multiple injuries in the head-on collision that created the traffic jam. Ali was near death as she was flown by helicopter to Harborview Medical Center's trauma unit in Seattle. At one point, doctors had to slice open her abdomen while she was being treated in the emergency room to relieve increasing pressure inside her body. They didn't have time to get to the operating room.

"She would have died," Tomlin said of her daughter. "I know they saved her life."

Harborview, the only Level 1 trauma center in Washington state, Idaho, Montana and Alaska, treats between 6,500 and 7,000 of the most severely injured patients a year. It's one of the busiest in the nation.

But it and the 233 other Level 1 trauma centers nationwide are in need of some economic life support. Battered by rising costs while required to operate 24/7 year round and accept patients whether they can pay or not, nearly one in every 10 Level 1 centers has closed since 2000 while others have downgraded their level of trauma service.

On Thursday, Sen. Patty Murray introduced legislation to provide $200 million in grants to keep Harborview and other Level 1 trauma centers operating.

"Trauma can happen at any time and to anyone, whether it's a family in a highway crash, a gunshot victim or a construction worker in an accident - trauma centers must be available to provide immediate care," Murray said at a news conference, adding her bill may eventually become part of broader health care reform legislation.

Hospital emergency rooms treat broken legs, back sprains, broken ribs, lacerations and concussions. Trauma centers treat multiple fractures, paralysis, punctured lungs, stab wounds and brain injuries.

Bridget Valencia was a normal 7-year-old. She was always in motion and she liked school and reading. But earlier this month, she was struck by a car outside Amistad Elementary School in Kennewick, Wash. She suffered a broken pelvis, collapsed lung, broken ribs and bruises.

Initially treated at Kennewick General Hospital, within three hours Bridget was on a plane to Harborview, 200 miles away.

"It was a relief getting here there," said Bridget's father, Julio Valencia. "There were like eight doctors working on her. If they didn't send her to Harborview, she might not have made it."

Bridget is in a wheelchair now, wondering when she can walk again.

Dr. Ronald Maier said he likely won't be watching the last episode of "ER" and he hasn't tuned into "Grey's Anatomy" which is set in Seattle. But as surgeon-in-chief at Harborview's trauma unit, Maier has seen plenty of cases like Ali Tomlin and Bridget Valencia.

"If you are bleeding to death, you can't wait till the next day," Maier said at the news conference with Murray, adding the worst case he has seen in his 27 years as a trauma surgeon involved a man who had nearly cut himself almost in half with a chainsaw while clearing brush.

Dr. Robert Falcone, a surgeon at Ohio State University School of Medicine's Level 1 trauma center in Columbus described a similar case in which a four and a half foot rip saw at a saw mill sliced through a worker's chest and arm in an accident that is usually lethal. Falcone said the man survived because a co-worker stuck a hand in the injured man's chest and applied pressure to stop bleeding and a local emergency room doctor realized the trauma unit in Columbus was the only place to treat him.

"He was back on the job in six months," Falcone said. "We never leave anyone out in a lurch, but not everyone has access and some of the centers are struggling.".

Trauma is the leading cause of death in children and adults under 45 and is the fourth leading cause of death for all ages, Maier said.

Harborview treats about 5 percent of those suffering from the worst traumatic injuries in Washington state every year. The other 95 percent are treated at hospital emergency rooms or Level 2 trauma centers in hospitals in Spokane, Bellingham and Vancouver. Level 1 trauma centers are equipped with the most sophisticated medical equipment and staffed with specialists round the clock. While Level 2 centers offer comprehensive care, they aren't equipped or staffed to handle the most serious cases.

Maier said the number of trauma cases treated at Harborview have dropped 10 to 15 percent because people are driving less as a result of the recession and high gasoline prices. Car accidents are the leading cause of traumatic injuries. Yet even as the number of patients has dropped, trauma centers still have to be fully equipped and staffed.

Collectively, trauma centers loose about $230 million a year as a result of treating persons who don't have medical insurance or their insurance doesn't cover the entire cost. Maier said the Harborview Medical Center loses more than $100 million a year by treating uninsured or underinsured patients and predominately they're trauma unit patients.

"It's just a lot of things coming together at once," he said of the problems trauma centers face. "Usually the state bails us out, but they're facing a $8.5 billion deficit."

Ali Tomlin is pretty much recovered from the injuries she suffered in the traffic accident in late 2007, her mother, Shelly, said.

"Before the accident I would have thought trauma centers were important," Shelly Tomlin said. "Now, I understand how true it is. My daughter would have died. It is truly an amazing place."

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