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South Carolina trauma system in trouble

by Heather Woolwine
Public Relations
Sirens wail and gears grind as an ambulance races past morning commuters on the way to work. A three-car accident has left a victim suffering from critical injuries. 

Lucky for him, a trauma team awaits his arrival in the ER and will save his shattered life this day.

But what if the ambulance arrived at the ER, and there was no trauma team?

Although it may seem like a stretch, the scenario is not so unbelievable due to funding problems facing the state’s trauma system.

“While it’s heartbreaking for any of us involved in South Carolina’s trauma system to lose a patient,” said Doug Norcross, M.D., MUSC Trauma Service director, “it’s all the worse when a father, son, mother, or sister dies simply because the resources and expertise needed to care for them were not available quickly enough or not available at all. Unless we act now to preserve and enhance our trauma system, there will be far more unnecessary tragedies.”

Norcross challenged South Carolina legislators last May to take an in-depth look at the state’s system and support new legislation in an effort to save that system.

“South Carolina’s trauma system is eroding,” he said. “We must either commit to saving our system or settle for more lost lives and lost support for our families and businesses. Which will it be?”

The legislation, introduced by Sen. Harvey Peeler and Rep. Denny Neilson and scheduled to hit the House and Senate floors again this month, authorizes South Carolina DHEC to set standards for levels of trauma center designations, regulate trauma centers, impanel a statewide trauma advisory council and establish a trauma care fund for administration and oversight of the system. 

In essence, the bill opens a bank account for the state’s trauma system.

Unfortunately, however, it does not fund that account.

But Norcross and his colleagues sponsoring the bill, the South Carolina Hospital Association and DHEC, hope to seek funding within the next year or two as the state’s budget improves. 

Suggestions of where money might be found include levying an additional fee for all moving violations or seatbelt tickets, adding a fee to fines for those convicted of drunk driving, or even adding a tax to alcohol or gun purchases.

Norcross and DHEC have suggested a mechanism to directly collect from auto insurers and legal settlements related to hospital visits involving trauma care. 

“With legal settlements and the resolution of a suit, there is no lien created for the hospital, so even though a patient may receive a substantial amount of money in relation to an accident, etc., we rarely get paid for the trauma care that patient received,” Norcross said. “The same thing happens with auto insurance companies. In both situations, money should be automatically delegated to pay the injured party’s hospital and medical bills directly from the insurance company. Then let the insurance companies duke out the rest.”

Nationally, for every dollar spent on food, 59 cents is spent on trauma care, by far creating the most expensive public health problem. With accident injury costs at approximately $4 billion annually (including lost wages and productivity), South Carolina needs a relatively small chunk of that figure, $28 million, to fund the state’s trauma system.

The system consists of Levels I - III trauma units, with a Level I designation meaning most severe traumas can be handled at that location.

“The public expects high levels of trauma care, but 75 percent of the public doesn’t understand that trauma care is not uniform across all hospital emergency rooms,” Norcross said.

MUSC Medical Center has the Level I designation, and although hospital administration continues to pool together resources and move money from different programs to keep the trauma unit going, Norcross remains guardedly optimistic about the future.

“We’re in a difficult situation,” he said. “It’s no wonder that we’ve lost so many doctors when there’s no relief. Physicians who choose ER work often not only deal with crazy hours and increasing insurance premiums but they also make substantially less money. They are perpetually operating at a loss. It’s no wonder that physicians have a difficult time dealing with those situations for very long.”

In July 2001, 11 surgeons in South Carolina dedicated their practices largely to trauma care, but now only eight do so in some capacity. Of these eight, three are new to the area, one is now part-time, and another has substantially decreased his involvement. Subsequently, only three trauma surgeons continue to serve in the same role as they did in 2001.

Already this past year, Georgetown Memorial Hospital pulled out of the trauma system; Self Memorial in Greenwood lost its trauma director and has yet to find a replacement; Carolinas Hospital System dropped from a Level II to a Level III unit; and while MUSC continues to care for many burns, serious burn patients must leave the state to receive the appropriate care once stabilized.

Speaking to the South Carolina legislature last May, DHEC commissioner Earl Hunter said, “The state’s 24 trauma centers stand ready to treat the most seriously injured patients, yet their participation is voluntary. Trauma care is highly specialized and expensive and these trauma centers are losing money and staff. Trauma centers are not emergency rooms. Their existence is not mandated by law, nor do they receive public funding…we cannot stand by idly while this hemorrhaging continues.”

“Physicians, nurses, and hospital administrators have willingly donated hundreds, if not thousands of hours to support a trauma system for South Carolina,” Norcross told the legislature last May. “But they need support. To quote my esteemed colleague, Dr. Ed DesChamps, DHEC state EMS medical director, ‘we have a volunteer-based trauma system, and the volunteers are getting tired.’”
 
 

Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.