JOHNSON CITY - Tennessee's emergency doctors believe the state's trauma care system is in critical condition, and they're asking state legislators to do something about it.
"What I'm asking them to do is look to see what kind of funding mechanism we can generate," 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.
Dunn and other members of the Trauma Care Advisory Council are lobbying in Nashville this legislative session to convince state leaders that the trauma centers in Tennessee deserve a piece of the budgetary pie. Last year was the council's first time presenting the idea, and the bill didn't get very far, but Dunn believes this year will be different.
"I think we did a very good job of educating our legislators last year. The timing was really pretty good if you look at Katrina and the tornadoes that hit Middle Tennessee," she said. "They started to realize just how critical this type of system was. The political climate was just not quite right. I think that's changed. It's not an election year this year, and I think the governor is not being taken by surprise by our educational effort. I think last year he just had some different priorities on his plate, and we're hoping we can make this a little bit more of a priority for him."
On Feb. 8, a bill was filed in the Tennessee Senate that would establish a "trauma center fund" to be shared by hospitals across the state. A companion bill was filed in the House of Representatives on Feb. 15. Among the bills' supporters are Lt. Gov. Ron Ramsey, R-Blountville, Rep. Nathan Vaughn, D-Kingsport, and Rep. Jason Mumpower, R-Bristol.
A trauma center is different from a regular emergency room in several important aspects, and the difference grows as the facility's trauma designation increases from level 3 to level 2 to level 1, Dunn explained. A level 1 trauma center like JCMC or Holston Valley Medical Center has to have a great number of services available 24 hours a day to be ready to handle whatever catastrophe comes through the doors.
"We have an OR on standby at all times; we have a CT scanner on standby at all times, and of course radiology has to be in house and available when the beeper goes off. And you have a host of specialists that have to be on the call panel and available: Trauma surgeons have to be in-house 24/7. Neurosurgeons ... orthopedic surgeons ... cardiac surgeons, vascular surgeons, oromaxillofacial surgeons - all have to be available and in your center to take care of these patients," Dunn said.
All that readiness comes at a cost. Even before you add in the cost of actually treating trauma patients, it costs about $14 million a year just to keep a level 1 trauma center in existence, Dunn said. As rates of uninsured patients rise in Tennessee, there are fewer dollars coming in from insurance companies to cover those costs, which has put many trauma centers in a state of financial emergency.
"It's put a huge financial strain on all our systems," Dunn said. "We're all being supported by other services within the hospital to stay above water, and that's sad to me."
In Middle and West Tennessee, trauma centers are losing their level 1 and 2 designations because they can no longer afford to pay doctors to be available around the clock.
"Memphis lost all its level 2s," Dunn said. "At Vanderbilt, there is only one level 1 and no level 2s, and there's nothing in between those two cities."
Here at home, Dunn is finding it "harder and harder to get subspecialists to cover this care. Pretty soon, I won't find a specialist who will come in at 2 a.m. to do this," she said.
The Trauma Care Advisory Council is asking state officials for $30 million, which would be divided among trauma centers in the state according to how many patients each one serves. A portion of that money would also go toward funding injury prevention efforts and post-hospital rehabilitation services.
"It would not take very much to get (the system) fixed," Dunn said. "We're talking 5 to 10 dollars on vehicle registration, or fines on moving violations in addition to that. That's what it would take to buff this system up. It's actually a very small (amount) a year. I'd be willing to pay $5 a year on my vehicle registration or my license renewal to know that this would still be here in five years.
"When you're looking at $30 (million) to $50 million, you're thinking, â€˜That's unreasonable,' but when you're talking person-for-person, it's not unreasonable at all."