After their message fell on seemingly deaf ears in 2006, Tennessee health officials lobbying in support of the Trauma Center Funding Act of 2007 were somewhat surprised to find that their wishes were not only heard this year, but were signed into law.
"I think a lot of my fellow trauma surgeons across the state were quite taken by surprise," said Dr. Julie Dunn, director of trauma services at Johnson City Medical Center and chairwoman of the Tennessee Committee on Trauma and the Trauma Care Advisory Council. "But of course everybody's pleased, and it's a huge benefit to the state of Tennessee."
Dunn and her colleagues found that almost every legislator was in favor of supporting the state's trauma care system, but the problem was finding the money.
"We were originally putting forth a mechanism of fees and fines," she said.
But fines on traffic violations tend to be an unstable source of funding, and many representatives felt adding additional fees to driver's license renewal would unfairly burden their constituents.
"It was Sen. (Rosalind) Kurita (D-Clarksville) who proposed an additional 2-cent tax on cigarettes, which was very surprising to us, and we weren't sure that was a doable thing," said Dunn. "But she and Sen. (James) Kyle (D-Memphis) managed to cobble together the votes in the Senate to make it pass.
"When it went through the Senate, that was a very big deal. Then it went over to the House side, and there were multiple attempts made to kill it by adding amendments. It was Rep. (Gary) Odom (D-Nashville) who really fought long and hard to not let it die. The debate went on for well over two hours. It was really pretty exciting."
The key to understanding why it's so important to support the state's trauma care network is understanding what exactly a trauma center is. Trauma centers aren't just emergency rooms, Dunn explained.
"People don't really appreciate the full spectrum of what it takes to be a trauma center," she said. "If you break your arm, you can go to any emergency room and get it splinted. If you have a heart attack, emergency rooms are there. But trauma care is very, very different."
Patients who have suffered trauma, whether from a car wreck, home accident or assault, often need many different kinds of medical care all at the same time, and in order to serve those patients, trauma centers have to have a host of specialists at the ready all the time.
A motorcycle accident, for example, might involve a head injury, broken back, broken leg and ruptured spleen.
"So what you're really looking at is a multi-system disease that requires more than one specialist to care for those patients," Dunn said. "By virtue of that, all those people have to be on standby to provide that care.
"I have a team comprised of a trauma attending (physician), a trauma senior resident, a trauma junior resident, and a host of nursing care that comes out of the woodwork to take care of these patients."
It's not enough to have a list of physicians who can be called in to examine the patient, "because there's not time for that," Dunn explained. "There's a thing called the golden hour, and they have to be taken care of very rapidly. A host of things have to be here at the ready."
For a level one trauma center like JCMC, it costs about $14 million a year just to be ready for whatever might come through the door. That's not counting the cost of providing care once the patient gets there. Because trauma centers are so expensive to maintain, many smaller hospitals across the state have had to give up their trauma designations over the last decade.
"We have lost 13 trauma centers in the last 10 years," said Dunn. "We have lost all the level twos in Memphis, and there is no level two in Nashville. There is no trauma center located between Nashville and Memphis, and I think that's a big void that I'd like to see corrected."
The extra 2-cent tobacco tax is expected to generate between $10 and $11 million each year, which will be used to support existing trauma centers and to establish a state office that will keep tabs on the health of the trauma system.
"I've got to have a trauma program manager and a numbers cruncher to gather data so we get a better handle on the state of trauma in Tennessee," Dunn said.
The biggest portion of the fund will help reimburse hospitals for the cost of providing trauma care to uninsured patients. It's estimated that Tennessee hospitals lose $50 million in uncompensated trauma care each year, Dunn said.
While Tennessee's legislators came to understand this year how difficult it is for the state's hospitals to provide trauma care, Dunn said her time in Nashville gave her a new appreciation for how difficult it is for the state's legislators to represent their constituents.
"It's very easy to sit at home and complain about what your legislators do and don't do, but being down in Nashville on a recurring basis made me appreciate that while my issue seemed so right, there are hundreds or thousands of issues that seem so right and so needy," she said. "I came to appreciate the fine line that (legislators) walk every day of the week to try and make things happen.
"Dale Ford (R-Jonesborough), Kent Williams (R-Elizabethton), Rusty Crowe (R-Johnson City) - they were not in support of the cigarette tax, but they were in support of trauma center funding, and it was a very difficult line for them to walk. A number of them voted for the cigarette tax after all. And I know that they're trying to balance their constituency and do the right thing for everyone. You know you can't make everybody happy, and I came to appreciate how difficult their job can be."