Valley hospitals feeling pressure

Wednesday, July 3, 2002 | 11:12 a.m.

Many local hospital officials say they fear that staff physicians will resign or seek leaves of absence in order to avoid the liability of having to treat trauma patients.

Southern Nevada's hospitals were put in that position beginning at 7 a.m. today when the University Medical Center's level one trauma unit closed due to the medical malpractice insurance dilemma.

It has been determined that patients who are victims of life-threatening injuries from weapons or traffic accidents will now be transported to the nearest hospital, where they will be stabilized. But hospital officials concede that they do not have the specialized staff or equipment to handle many of the patients with multiple injuries who normally would have gone to the trauma center.

That added risk, according to Nevada Hospital Association President Bill Welch, is why the other hospitals face the prospect that some of their staff physicians will choose to resign.

"It will happen," Welch said. "The question is not 'if' but 'how many?' We certainly have that fear, and I know the hospital chief executive officers are working hard with their staffs to prevent that from happening.

"Ultimately all the hospitals will be challenged by the same situations where their physicians will be asked to care for trauma patients that they normally wouldn't be called in for. Trauma patients involve additional risk and that will put everybody in this community in a difficult situation."

Surgeons and other medical specialties typically hold privileges at many local hospitals. But facilities such as Sunrise Hospital and Medical Center and St. Rose Dominican Hospital have already experienced small numbers of resignations, leaves of absence or early retirements in recent weeks from physicians who say they cannot afford to pay higher malpractice insurance premiums.

Dr. Stephen Jones, medical director of St. Rose, said the prospect of more physicians resigning from area hospitals to avoid handling trauma patients "is a concern we all share."

"We're hoping it doesn't snowball to the point where we can't provide services," Jones said. "Their concern is the liability. Some of the doctors may choose to restrict the number of hospitals they work in so that it diminishes their exposure from on-call duties. As the trauma patients are dispersed to community hospitals the physicians will be exposed to the liabilities that follow those patients."

At least one physician has already informed MountainView Hospital that he may resign if compelled to take on trauma patients. Mark Howard, the hospital's chief executive, said the physician is concerned about handling patients outside his specialty.

"Doctors are saying they can't accept the additional problems of doing trauma surgeries," Howard said.

Although he said that it is too early to tell whether doctors will resign from his hospital, Howard said that that remained "a real threat" unless the state adopted tort reform. Such reform, which is vigorously opposed by attorneys, would include caps on damages for pain and suffering.

"Do I worry about the trickle effect, yes," Howard said. "What specialties it will hurt first I do not know."

Like other area hospital officials, executives at the Valley Health System facilities -- Valley, Summerlin and Desert Springs hospitals -- met with emergency department staffs and other specialties after UMC announced that it was closing the trauma center.

"At this time it has not triggered any resignations or leaves of absence at the three hospitals," Mike Tymczyn, marketing director for Valley Health System, said.

But he said there is a possibility that that could change.

"We feel this could be the beginning of a domino effect among local specialty physicians," Tymczyn said. "We are trying to give them support so they will be there for us.

"We are not trauma centers by definition or qualification. We can do our best to stabilize someone but we do not have the physical plant to do what UMC did."

At Lake Mead Hospital Medical Center, Chief Executive Jeff Comer said efforts have been made to keep physicians on staff by increasing their reimbursements to treat indigent patients. The North Las Vegas hospital, which already treats its share of trauma victims such as gunshot wounds, expects that patient load to increase.

"Like everyone else in the valley I'm concerned about resignations," Comer said. "All of our surgeons have committed to me as of today. We're doing the best we can to take care of our patients. The problem we have is that our general surgeons are not specifically trained in trauma surgery as they are at UMC."

Welch, who met with area hospital representatives Tuesday in Las Vegas, predicted that many trauma patients will have to be flown out of state. And he said the fact that all hospitals will be taking trauma patients will further exacerbate the already overburdened emergency rooms and ambulance services in Southern Nevada.

"Many emergency departments in this community have not seen high-level trauma patients for quite some time," Welch said. "Staff will not be as familiar with these types of cases."

But Sunrise Hospital spokeswoman Ann Lynch said she doesn't think many patients will have to be airlifted out of the area.

"That will occur but not as much as people think," Lynch said. "Many of the surgeries that can be done in a trauma center we can do in a hospital. Where you run into trouble is someone with multiple injuries."

Lynch also discounted the possibility that hospitals will be setting themselves up for more lawsuits by handling trauma patients. She said physicians at Sunrise will not take unnecessary risks that would expose them to increased liability.

She also said she knows of no Sunrise physicians so far who have decided to resign because the hospital will be taking trauma patients.

"The reason that the resignations happened at UMC is that there is a $50,000 cap on liability for UMC and the physicians there were seen as the deep pockets," Lynch said.

All but one of the 58 orthopedic surgeons who had on-call duties at UMC's trauma center resigned Monday because they did not want to continue to handle the high-risk patients while the malpractice insurance dilemma persisted. Their departure forced the county-run hospital to close its trauma center, which had the only level one designation in the state.

On Tuesday UMC Chief Executive William Hale was given permission by the Clark County Commission, which also serves as the hospital board, to recruit nationally for new orthopedic surgeons. Hale expressed hope that the trauma center could reopen in three to six months if his recruitment effort succeeds.

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