Las Vegas Sun

March 28, 2024

Trauma cases to shift to nearest hospital

Local health care professionals concede that the planned closure of University Medical Center's trauma unit Wednesday morning will lead to loss of life for at least some future patients seriously injured by weapons or traffic accidents.

What medical authorities don't know is the extent to which all other Las Vegas Valley hospitals will be able to help keep loss of life at a minimum and prevent the transport of patients out of state.

When asked Monday if people could lose their lives, UMC chief executive officer William Hale said, "I do fear that."

"In my experience, a city of a million and half needs a trauma center, but it's not unusual for trauma centers to close," Hale said. "Everyone needs to remain calm and realize that every hospital will do their best to take care of you."

Closure of the state's only level-one trauma center means that Southern Nevada trauma patients will be transported to the nearest hospital for initial treatment, including UMC. If the patient is in need of a specialist not available at the first hospital, it is possible the patient could be transferred to another facility for further treatment.

But Clark County Health District spokeswoman Jennifer Sizemore said the closest hospital will get the patient first, even if its emergency room is closed. Exceptions will involve pediatric patients, who will continue to be served at UMC and Sunrise Hospital and Medical Center, and burn victims, who will also go to UMC.

Further details were to be hashed out today in Las Vegas at a private meeting of local hospital officials organized by the Nevada Hospital Association. But local hospital officials said they will follow a protocol similar to that used before UMC's trauma center opened in 1989. That protocol called for the nearest hospital to take the patient.

"While UMC has been where trauma cases have been sent, we have over the years handled trauma cases from people with gunshot wounds and other injuries who come in on their own," Ann Lynch, spokeswoman for Sunrise Hospital, said. "We anticipate, however, that that will increase quite a bit."

UMC, the county-funded hospital, announced Monday that it will close its trauma center at 7 a.m. Wednesday after failing to reach a compromise with orthopedic surgeons fed up with skyrocketing medical malpractice insurance premiums.

Because the trauma unit deals with high-risk patients, the surgeons told UMC officials Monday that they could no longer afford to work at the center unless the Legislature adopted tort reform, changing the way lawsuits like medical malpractice are handled and capping the amount juries can award in those cases.

The decision meant that UMC, which had 58 orthopedic surgeons as of June 1, is down to a lone orthopedic surgeon, who will continue to treat patients elsewhere in the hospital.

Dr. Michael Daubs, president of the Nevada Orthopedic Society, resigned from his on-call duties at UMC on June 14. He then received a letter the following week stating that he would lose his hospital privileges if he didn't accept trauma calls.

"Essentially what has happened is orthopedic surgeons have had to make the decision to reduce their liability exposure," Daubs said. "It comes down to exposing your family to huge liability. When faced with either resigning or taking trauma call, they had to resign."

The decision by the orthopedic surgeons was criticized, however, by Las Vegas attorney Dean Hardy, past president of the Nevada Trial Lawyers Association. The trial attorneys oppose tort reform.

"I don't know that I'm surprised but I'm disappointed," Hardy said. "With all the groups meeting and with the Clark County Commission coming out with a very positive attempt to keep the trauma center open, it is disappointing that the doctors wouldn't wait to see how things turned out and instead would be more focused on holding everyone else hostage. It's a really poor attempt to hold elected officials hostage."

The trauma center, first opened in September 1989 as a level two unit in UMC's old emergency room, was moved into a free-standing building that was constructed in 1992. The trauma center was upgraded to level one status -- the highest that can be attained -- in January 1999. The upgrade permitted the hospital to participate in certain laboratory work, clinical trials and epidemiological studies as well as the most complex trauma cases.

Last year, the trauma center treated 11,439 patients, 7 percent of whom were transferred from other facilities. Its 10,000-square-mile service area also included parts of California, Arizona and Utah.

Of the 3,009 admissions last year at the center last year, 41 percent came from vehicle crashes, 39 percent had other blunt injuries, 11 percent had gunshot wounds and 9 percent suffered from stab wounds.

UMC officials said they have no idea what percentage of trauma patients will have to be transported out of state. The closest trauma centers will now be in Palm Springs and Loma Linda, Calif., and Flagstaff, Ariz.

"We have not been sending people out of state for years," Dr. John Fildes, the trauma center's medical director, said. "In fact, we would get as many as 10 percent of our patients from Utah, Arizona and California. We have told those states to make other plans."

The problem with transporting out of state, Fildes said, is that in some cases "you'll die before you reach your destination." Even with patients who remain in Clark County, Fildes said, "It's very likely some lives will be lost."

The trauma center closure is not expected to impact the work performed by Clark County Fire Department emergency medical services personnel. But emergency medical services supervisor Brent Hill said the question now becomes whether trauma patients "will get proper care in a timely manner."

That includes basic activities such as efforts to control bleeding and promote breathing, he said.

"But there are times only surgery can take care of internal bleeding," Hill said.

Mercy Air Services plans to bring in additional staff and supplies in response to the trauma center's closure, company spokesman Mike Griffiths said. Part of the reason is that the air ambulances will have to make longer flights to transport patients out of state.

When a car wreck occurred in Boulder City, critically injured people normally would have been airlifted to UMC. But Griffiths said those patients likely will now be transported by ground ambulance to the nearest hospital, even though there is no longer a guarantee they will get the same level of care they would have received at the trauma center.

"You can call for help from the closest fire station, but it won't make a difference unless they have water," he said.

The closure will occur the day before the Independence Day holiday, which is traditionally a busy time for emergency rooms. The trauma center handled 30 patients last July 4. With this year's holiday falling on a Thursday, UMC spokesman Rick Plummer said more people are expected to start their weekends early.

"That means more visitors in town, more people out at the lake, more people setting off fireworks, more people celebrating and driving," Plummer said.

To meet patient needs, Lynch said more blood units will be on stock in the Sunrise emergency room. Portable X-ray machines have also been brought in to diagnose multiple fractures and other trauma injuries, she said.

"We will have more doctors, nurses and technicians on standby," Lynch said. "All of the area hospitals will be gearing up.

"Our physicians will do what has to be done to stabilize trauma patients. If they have to be sent to other area hospitals or to trauma facilities in Salt Lake City, Phoenix or Los Angeles, that decision will be made on a case-by-case basis."

Desert Springs Hospital spokesman Mike Tymczyn said the hospital chain that also includes Valley and Summerlin hospitals wanted to make sure people knew that "Las Vegans are not in danger because area ERs (emergency rooms) will take care of trauma patients."

"But we also must make it clear that because of the closure, the Las Vegas Valley is in a major public health crisis," Tymczyn said. "No hospital is capable of addressing major multiple system trauma as UMC was."

Mark Howard, chief executive officer at MountainView Hospital, said certain rooms at that facility will be designated as trauma rooms.

"With U.S. 95 in the northwest we would expect an increase in auto accident trauma victims," he said. "All of our emergency room doctors are board certified and have been thoroughly trained in trauma.

"Still, we would expect in cases like a van roll-over with six trauma patients that we would get two, another nearby hospital would get two and the other two patients would go to a third hospital."

Metro Police has already said, however, that the trauma center's closure would likely cause the local murder rate to rise.

The current medical malpractice insurance crisis has been blamed largely on the decision in December by St. Paul Companies of Minnesota to pull out of the medical liability market. That decision left 60 percent of Nevada's physicians without malpractice coverage and forced them to scramble for coverage from other insurers.

Many physicians complained that their new rates this year will have increased as much as 300 percent over last year. UMC first felt the impact of rising insurance premiums in March when some of its more than 1,400 staff physicians began resigning from the hospital. Those resignations snowballed to the point where the trauma center was operating on a month-to-month basis.

The Clark County Commission, which doubles as the UMC hospital board, declared a medical emergency last week. The board tried to keep the trauma center open by offering to extend UMC's $50,000 liability cap for damages to physicians who worked in the trauma center and emergency room, as well as those who serve indigent patients. Hale also was given authority to give the physicians more money per call.

But Hale said the negotiations with the orthopedic surgeons collapsed Monday.

"From what I've been told the only thing that will bring them back is tort reform," Hale said.

Daubs, the orthopedic surgeon, said one concern he and his colleagues had was that the $50,000 cap for physicians may not have been legal.

"And we're not looking for Band-Aids here," he said. "We need long-term solutions. We need long-term tort reform and we need to cap liability. We have to solve the overall problems to solve the trauma center problem."

The orthopedic surgeons are not the only physicians who have bolted from UMC. Dr. Ikram Khan, a Las Vegas surgeon who was on call for emergency room duties, said he may resign from the hospital as early as today because he was not granted a requested leave of absence in an effort to lessen the impacts the insurance dilemma will have on his practice.

"It's unfortunate that it has come to this situation," Khan said.

Dr. Raj Chanderraj, immediate past president of the Clark County Medical Society, said the closure of the trauma center will put pressure on the public to demand tort reform from lawmakers.

"People are going to lose their lives," Chanderraj said. "Either we ship them out or try to do the best we can to patch them up. Three out of four patients who go to the trauma center survive. It's anybody's guess what that number will drop to now."

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