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General Assembly pushes statewide trauma system

April 6, 2009

Indiana lawmakers are considering legislation to create a network that would coordinate hospital trauma programs and bring the centers to underserved cities and rural areas.

Senate Bill 464 would establish a committee to develop the statewide system and House Bill 1215 would create a way to fund it. Studies show $10 million could be raised annually by increasing court fees for speeding, driving with a suspended license, and other traffic violations.

Trauma centers provide comprehensive emergency medical services to patients suffering traumatic injuries, mostly from automobile accidents and violent crime.

Seven hospitals in Indiana have earned trauma center designation but only two, Methodist and Wishard in Indianapolis, are Level 1 centers that meet the most stringent guidelines. The two locations treat nearly 6,000 patients a year.

Advocates of a statewide system argue that a coordinated plan could bring all the trauma hospitals under one umbrella and provide funding to help others achieve trauma center status.

The Indiana Hospital Association has testified in favor of the bills.

"A hospital might send someone to a trauma center in South Bend or Fort Wayne, but there is no set policy," said Brian Tabor, the association's vice president of government relations. "Some believe a better-coordinated system would provide a higher level of patient care and save some lives."

Memorial Hospital of South Bend and Parkview Hospital in Fort Wayne, as well as Deaconess Hospital and St. Mary's Medical Center in Evansville, are Level II trauma centers. Riley Hospital for Children in Indianapolis is a Level 1 pediatric trauma center.

The Senate bill, led by Sen. Tom Wyss, R-Fort Wayne, passed unanimously in February. The measure has advanced to the House Committee on Rules and Legislative Procedures.

The House legislation, written by Rep. Charlie Brown, D-Gary, narrowly passed last month and has been referred to the Committee on Public Health. Most House Republicans voted against the bill, which suggests it faces a tough battle in the Republican-controlled Senate.

While House Republicans don't oppose a trauma system, they are less receptive to the proposed means to fund it, legislative insiders said.

The Health Finance Commission, which was composed of nearly two dozen legislators, recommended the House bill last summer. Findings from a study conducted late last year by the American College of Surgeons, the Chicago organization that verifies trauma status, bolstered the need for a statewide network.

The study cited a comprehensive statewide trauma system as a missing piece to help reduce Indiana's mortality rate from injury. Injuries are the leading cause of death for Hoosiers 34 years old and younger, according to the Indiana State Department of Health.

Indiana appropriates the least per-capita funding for public health programs, the report said: "This lack of focus ... is one reason Indiana lags behind many states in trauma system development."

Dr. William Millikan, medical director of St. Mary's in Evansville, has been involved in the discussions and assessed Indiana's lack of a system more bluntly.

"We're a bit embarrassed," Millikan said in comparing Indiana to neighboring states such as Ohio that already have trauma systems.

More than 30 states have a trauma care system, according to the U.S. Department of Health & Human Services.

The College of Surgeons study, funded by the state Department of Health and Indiana's seven trauma centers, made several recommendations. They include forming a governor-appointed board to advise the department in developing a trauma system, and establishing an Office of Emergency Care within the department to oversee both the trauma and emergency medical services programs.

The health department declined to make anyone available to discuss the recommendations.

The report also proposed crafting a detailed budget proposal to support the system's infrastructure and an assessment to determine the number of trauma hospitals needed within the state.

Where the need is

Gary in Lake County has one of the most pressing needs for a trauma center, which prompted Brown to introduce the legislation.

Trauma patients there were sent to a center in Olympia Fields, a Chicago suburb, before the center closed recently. The closure might have been hastened by the glut of patients from Indiana who couldn't reimburse the center for its costs, said a source familiar with the situation who asked for anonymity.

Methodist Hospital in Gary is the closest thing the area has to a trauma center and hopes to eventually become one, said Dr. Scott Bjerke, medical director of trauma services at Methodist in Indianapolis. The hospitals are not associated.

Brown's bill might help the Gary hospital overcome the huge expense of creating a trauma center.

"There's a lot of unreimbursed care in trauma centers," Bjerke said. "A lot of times it's young kids. They don't have insurance, but you can't just let them die."

Level 1 trauma centers operate around the clock, which accounts for much of the cost, Bjerke said.

Trauma centers in Dayton, Ohio and Louisville serve Hoosiers in the southern and eastern parts of the state.

But because time is critical for trauma patients, supporters of an Indiana network think they could receive better care from centers within the state.

The goal of a statewide system also is to provide rural residents the same standard of care as someone might receive in Indianapolis. Getting patients into surgery within an hour of suffering an injury is considered critical to their survival.

Eighty-four percent of U.S. residents can reach a Level 1 or II trauma center within 60 minutes, but only 24 percent of rural residents can get access within that time, according to Health Services Research Journal.

The numbers likely apply to Indiana.

"If you get run over by your tractor between here and Fort Wayne," Bjerke said, "it may take you six hours to get to a [trauma] hospital."

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