Overworked surgeons say trauma unit may close

Wednesday, July 24, 2002 | 10:52 a.m.

Orthopedic surgeons say they are hopeful the University Medical Center trauma unit can remain open at least through Aug. 26 but warn that it may have to close again if they don't get the help they are seeking from state lawmakers.

Even if the trauma center stays open, however, orthopedic surgeons who chose to return say they are getting stressed out because they are short-staffed and having to work extra shifts, doctors and a hospital administrator said.

Dr. Anthony Serfustini, UMC chief of orthopedics, said at one point he had to take three shifts and was "burning out" until he got relief this week.

"As far as taking care of patients we have the same amount of expertise as before," Serfustini said. "We're just doing it with less people and more shifts. But beyond four to six more weeks it won't work. It's draining and trauma will go down the tubes."

That is, he said, unless the state Legislature passes comprehensive medical malpractice insurance reforms doctors will advocate at the special session planned next week in Carson City.

Keeping UMC's trauma center open is a tenuous proposition, UMC Chief Executive William Hale told a Legislative committee this week. He said the trauma center, which closed after doctors pulled out because of rising medical malpractice insurance rates, could be "drastically reduced or eliminated" unless something is done to bring in more surgeons.

Serfustini and other orthopedic surgeons hope Nevada adopts laws similar to the tort reforms approved in California in 1975.

The California law includes a $250,000 cap on damages for pain and suffering, and a sliding scale for plaintiff's attorney contingency fees. The doctors also want a provision that would limit their liability to a percentage approved by a jury. If, for instance, a doctor was found responsible for only 1 percent of the malpractice, the physicians believe they should pay only 1 percent of the awarded damages.

Serfustini said he could live with a cap of $350,000 for non-economic damages because it would still be in line with those of nearby states that have caps. Utah and Colorado have $250,000 caps, though pain and suffering damages can be higher in Colorado under certain circumstances. The cap in Idaho is $400,000. There is no non-economic cap in Arizona or Washington and only for wrongful death in Oregon.

"We'd like to have geographical equivalency," Serfustini said. "What that would do is put us on equal footing with our peers in the intermountain West.

"It will be political suicide for the people who don't support significant tort reform. I'm afraid that a cap of $500,000 to $800,000 would not be enough. The reaction is that a number of doctors would leave. I plan on fulfilling my contract through Aug. 26 but as for the others, it's a free country."

Doctors and lawyers have staged a high-stakes publicity battle over the issue as the Legislature sets to meet next week. Trial lawyers say the caps aren't necessary and may be unconstitutional because people should have a right to sue over medical malpractice. Critics have charged that the doctors are playing politics with the trauma center's closure.

The state's only level one trauma center closed on July 3 when all but one of UMC's 58 orthopedic surgeons resigned because of skyrocketing medical malpractice insurance and the liability associated with high-risk trauma patients. Their departure drew criticism and negative advertisements from trial attorneys opposed to tort reform who charged that the doctors were holding the community hostage.

The center reopened July 13 with the return of nine general orthopedic surgeons, together with five spinal specialists and three hand specialists. But because UMC was hoping to reopen with at least 12 general orthopedic surgeons, those who returned are working extra shifts.

Another problem is that only six of the nine general orthopedic surgeons have signed the temporary UMC employment contract that binds them to the trauma center through Aug. 26, Serfustini said. The contract extended UMC's $50,000 liability cap to those doctors. Doctors want lawmakers to extend UMC's cap permanently to those physicians who deal with trauma, emergency room and indigent patients.

"With only six people having signed the contract we are required to take calls more frequently than we normally would," Dr. Mike Monroe, one of the orthopedic surgeons under temporary contract, said. "That puts a heavy workload on the trauma surgeons taking calls. Taking more than three or four calls a month significantly affects your practice. The stress on the doctor and the staff is much higher than for a doctor treating an elective patient."

Serfustini said there is no guarantee the trauma center will be able to keep the three general orthopedic surgeons who have returned but who have not signed the temporary employment contract. They can leave at any time. He said it is even possible some of the surgeons who signed the contracts may opt out sooner than Aug. 26 if the lawmakers don't pass legislation to their liking.

Dr. Michael Daubs, president of the Nevada Orthopedic Society and one of the spinal specialists who returned to the trauma center, said he does not believe the trauma center can stay open if it is reduced to the six general trauma surgeons under contract.

He has already applied for physician licenses in other states in anticipation that he may be forced to leave Nevada.

"Without tort reform physicians will have to decide whether they can continue to practice or not," Daubs said. "If favorable legislation isn't passed, a large number of doctors will leave the state."

As of this week, 29 Nevada physicians have closed their practices and 14 other took "early retirement" as a result of the rise in medical malpractice insurance rates, according to the Nevada State Medical Association.