Austin hospitals seeing more transfers

[Guest guest]

Anyone have any thoughts or opinions on this?

-Wes Ogilvie

Austin hospitals strained by hundreds of patients from outside area

ER doctors say they are exhausted, frustrated by increasing load

By _ Ann Roser_ (mailto:maroser@...)

AMERICAN-STATESMAN STAFF

Sunday, July 13, 2008

Patients from around Texas and even other states are increasingly being sent

to Austin for emergency medical care, which officials at the largest hospital

system in Central Texas say can put some lives at risk and strain a

shrinking number of specialists willing to treat people at local hospitals.

In the past year, six Seton hospitals received 517 patients from outside

their service areas, according to data from the Seton Family of Hospitals. Dell

Children's Medical Center serves 46 counties, while other Seton facilities,

including University Medical Center at Brackenridge, the region's only trauma

center, serve an 11-county area.

In general, the patients transferred into Austin are either critically

injured or seriously ill from a stroke or other medical condition, said Dr.

Ziebell, University Medical Center's chief of emergency medicine and

president of Seton's medical staff.

The number of transfer patients coming to University Medical Center and other

Seton hospitals jumped 61 percent, from an average of 33 per month from June

through November 2007 to an average of 53 per month from December through

May. They are coming from as far away as Abilene and Lubbock but also from

Dallas, Houston and San — larger cities that have multiple trauma

centers.

A few years ago, Austin sent some patients who needed emergency brain surgery

to San and Temple hospitals because of a lack of neurosurgeons on

call, but Austin's hospitals have since added neurosurgeons. Ziebell said few

transfer out now. Seton transferred eight patients in the past year to

hospitals out of the area: One went to a burn unit in Galveston; one went to

the

University of Texas M.D. Cancer Center in Houston for specialized

leukemia care; three needed organ transplants they could not get in Austin; and

three asked to be transferred back to hospitals in their hometowns for surgery,

he said.

As more and more seriously ill or injured patients come from other parts of

the state, specialists become increasingly unwilling to be on call for local

hospitals, Ziebell wrote in an e-mail. " So, if Austin-based neurosurgeons are

forced to provide care for an increasing number of patients from well outside

of Austin, they are likely to reach a point where they will say, 'Forget it;

I'm just not going to take call anymore.' "

He said he didn't have statistics showing how many doctors have stopped being

on call but said that as head of the ER, he has more holes to fill on the

call schedule.

San , which has three trauma centers, sent 37 patients to Austin

between January 2007 (when Seton started collecting data) and April 2008. And

the

Alamo City's trauma centers turned away patients from surrounding

communities who also went to Austin. San officials said one factor

leading to

those transfers was the deployment of doctors to Iraq from two military

hospitals with trauma centers.

Full hospital beds and a lack of available specialists are typically cited

when hospitals send patients to Austin, Ziebell said.

When a small community hospital gets a case it can't handle, its staffers

start looking for the nearest specialist. If the closest trauma center says it's

full, they turn to Austin or other more distant cities.

Statewide, fewer specialists are willing to be on call for emergencies after

hours, especially in such areas as neurosurgery, orthopedics, plastic

surgery, ophthalmology and other fields, doctors in Texas said. That means that

some

hospitals pay certain doctors just to be on call — something that doctors a

generation ago did as a community service.

Many expect the problem to worsen as a doctor shortage deepens, more surgeons

leave traditional hospital settings and new doctors don't feel obligated to

be on call.

" This has been an issue that has been brewing for the last three years ...

and the scale of the problem is huge, " said Dr. Ed Racht, medical director of

Austin- County Emergency Medical Services and chairman of the Governor's

EMS and Trauma Advisory Council. " It really became apparent in the (Rio

Grande) Valley first. The Valley was sending patients who needed neurosurgeons

to

San because they had no neurosurgical coverage. It shifts the

financial responsibility for care from one area to another. "

The law requires care

As a trauma center, University Medical Center receives the most critically

injured patients and must have specialists on call 24 hours a day. And

hospitals can't turn down requests from hospitals that say they can't care for

a

patient.

" Federal law says if a hospital declares an emergency and if we have the

specialists and the capacity to care for that patient, we have to do it, "

Ziebell said. " It's hard to believe that out of two Level I trauma centers in

Houston, that not one of them can provide care for one of their citizens. "

Houston

sent five patients to Austin during the 16-month period Seton analyzed, as

did cities in Houston's trauma region, such as Columbus, which sent 36.

Officials at other Texas trauma centers say they're also facing more

transfers.

& White, which operates a trauma center in Temple, said in a written

statement that the transfers it accepts from inside and outside of its region

have " grown in double digits, " according to Dr. Sibbitt, associate

chief medical officer.

" & White, over a similar period of time, accepted more than 1,500

transfers from Killeen, " Sibbitt wrote.

Killeen, however, is part of the & White trauma region; 52 patients

from Killeen and 10 patients from Temple were transferred to Austin from January

2007 through April of this year, Seton said.

Sibbitt said & White may transfer patients to Austin because the

patient requested it or because its trauma center was full.

Ziebell said transfer patients have a higher mortality rate at Seton

hospitals than other patients. He said 4.6 percent of the out-of-area transfer

patients died at Seton hospitals within a week, compared with 1.5 percent of the

regular patients who had been hospitalized for a week. He said though the

transfer patients could have been more critical, he thinks travel time was the

main factor.

In recent years, more doctors have invested in surgical hospitals where they

can set their own hours and not worry about treating emergency room patients

who can't pay and could be more likely to sue, said Dr. Bruce Moskow,

president of Emergency Service Partners, which provides the physicians who

staff the

ERs for Seton and about 20 other Texas hospitals. For those

doctor-investors, stopping hospital work also means no longer getting called in

the middle of

the night to come to the ER.

Dr. Dan , a neurosurgeon at University Medical Center, is on the

hospital's on-call schedule 12 nights a month — six times as the primary

surgeon

and six times as the backup. He said he almost always gets called in when

he's the main neurosurgeon to do surgery or evaluate a patient with a head

injury, aneurysm or brain tumor. Sometimes, he has to cancel his clinic work

and

elective surgeries the next day because he's still dealing with the on-call

load, he said.

The increase in transfer patients is " extremely frustrating, " said.

As an incentive to the doctors to take emergency calls, Seton is paying some

specialists as much as $5,000 a night to be on the call roster, even if they

don't have to come in, Ziebell said.

" The patients of Austin are paying for that, " he said, noting that people pay

through escalating health care costs, including higher health insurance

premiums.

St. 's HealthCare is paying for on-call specialists, too, but Dr. Steve

Berkowitz, the chief medical officer, declined to say how much. St. 's,

which doesn't have a regional trauma center but receives transfer patients at

its hospitals, said it has also seen an increase in transfers but did not

have data. " I don't believe these transfers in are having any substantial

effect on our system, " Berkowitz said.

Doctors turn away

In San , many neurosurgeons have stopped taking hospital calls, so the

hospitals are sending stroke patients to Austin and other cities for

treatment, said Suzanne Hildebrand, 61, who founded the Mothers Against Drunk

Driving chapter in Texas in 1981. After her husband suffered a stroke April 16,

she

joined a committee that is trying to get a stroke center established in San

.

More than seven hours after Ray Hildebrand, 68, collapsed at his job at the

San district attorney's office, where he worked as a criminal

investigator, hospitals in the city said no doctor was available to treat him,

Suzanne Hildebrand said. He was flown to Austin for treatment and was in a coma

for several days, she said.

" We're talking 7½ damn hours of basically holding him while (San

hospitals) made phone calls, " she said. The hemorrhage in his brain " was

inoperable by the time he got " to Austin. Her husband's recovery has been slow,

but

he is regaining some speech and movement, she said.

Ziebell said none of San 's hospitals — including its three trauma

centers — have obtained voluntary national certification to provide care to

stroke patients. Four Austin hospitals have that certification, which means they

can provide certain drugs and therapies in a coordinated way to stroke

victims.

Dr. , a critical care surgeon and chairman of the Southwest

Texas Regional Advisory Council on trauma issues, wrote to colleagues in a May

e-mail that it was " unacceptable " that after a year of discussion, no San

hospitals had obtained the certification " even though the stroke center

requirements represent only the minimal standards required for stroke care. "

Leni Kirkman, a spokeswoman for University Hospital, a trauma center in San

, said hospitals can treat stroke patients without being certified —

Kirkman said hers has doctors who do — but University's beds are often full.

" It's unconscionable to think we have so many resources in our community and

we haven't got this worked out, " Kirkman said.

Epley, the executive director of the advisory council that

belongs to, said doctors and hospitals officials in San are " working

feverishly on trying to establish stroke centers and a regional stroke system.

" It's unacceptable that the large urban centers are sending patients to other

large urban centers, " Epley said. " The best thing for patients in San

would be to stay in San , and the best thing for Austin patients

is

to stay in Austin. "

Ultimately, lawmakers may need to solve the problem, perhaps by establishing

when patients can be transferred and requiring doctors to take emergency

hospital calls in order to get hospital privileges, said Racht, the trauma

advisory committee chairman.

maroser@...; 445-3619

[Guest guest]

-Wes Ogilvie wrote: " Anyone have any thoughts or opinions on this? "

Yup... Hey Austin, welcome to the big leagues. Houston, San , and every

other major metropolitan area in this state have saturated hospitals and no

surge capacity. In the words of , MD, PhD, Chief of Emergency Medcine

at Harbor-UCLA Hospital, testifying before Congress::

" Over the last five years, my colleagues and I have witnessed an increasing

demand for

emergency department (ED) and inpatient services at Harbor-UCLA, coupled with

ever

decreasing resources. This has led to almost continual overcrowding and gridlock

in our

ED while, paradoxically, we are expected to maintain our hospital’s “surge

capacity,”

defined as the ability to provide care for a large influx of patients on short

notice in time

of disaster. Ours is not an isolated situation but, instead, reflects the

current state of

emergency healthcare in the United States and a paradoxical, almost

incomprehensible,

lack of recognition among some policy makers regarding the cause and effect

relationships that exist between the fiscal pressures that have led to decreases

in hospital

capacity, ED gridlock, and our dwindling surge capacity.

To those of us who work in the front lines of the medical care system, it is

irrational to

believe that an emergency care system that is already overwhelmed by the

day-to-day

volume of acutely-ill patients, would be able to expand its capacity on short

notice in

response to a terrorist attack or natural disaster. Moreover, any decrease in

the Medicaid

funding that supports the trauma center infrastructure and the funding of

graduate

medical education (GME) (funds which support the residents who provide the

majority of

care in our cornerstone academic and public healthcare institutions) will

severely cripple

our ability to meet the nation’s needs for emergency care, whether delivered

under

everyday conditions or in the extraordinary setting of a mass casualty incident.

http://oversight.house.gov/documents/20080505105545.pdf

" Just enough " and 'just in time' medical care will be part of the cause of our

healthcare system to collapse in the event of a catastrophic disaster, attack or

a pandemic.

" A prudent man foresees the difficulties ahead and prepares for them; the

simpleton goes blindly on and suffers the consequences. "

Proverbs 22:3

Subject: Austin hospitals seeing more transfers

To: texasems-l

Date: Sunday, July 13, 2008, 12:10 AM

Austin hospitals strained by hundreds of patients from outside area

ER doctors say they are exhausted, frustrated by increasing load

By _ Ann Roser_ (mailto:maroser (AT) statesman (DOT) com)

AMERICAN-STATESMAN STAFF

Sunday, July 13, 2008

Patients from around Texas and even other states are increasingly being sent

to Austin for emergency medical care, which officials at the largest hospital

system in Central Texas say can put some lives at risk and strain a

shrinking number of specialists willing to treat people at local hospitals.

In the past year, six Seton hospitals received 517 patients from outside

their service areas, according to data from the Seton Family of Hospitals. Dell

Children's Medical Center serves 46 counties, while other Seton facilities,

including University Medical Center at Brackenridge, the region's only trauma

center, serve an 11-county area.

In general, the patients transferred into Austin are either critically

injured or seriously ill from a stroke or other medical condition, said Dr.

Ziebell, University Medical Center's chief of emergency medicine and

president of Seton's medical staff.

The number of transfer patients coming to University Medical Center and other

Seton hospitals jumped 61 percent, from an average of 33 per month from June

through November 2007 to an average of 53 per month from December through

May. They are coming from as far away as Abilene and Lubbock but also from

Dallas, Houston and San — larger cities that have multiple trauma

centers.

A few years ago, Austin sent some patients who needed emergency brain surgery

to San and Temple hospitals because of a lack of neurosurgeons on

call, but Austin's hospitals have since added neurosurgeons. Ziebell said few

transfer out now. Seton transferred eight patients in the past year to

hospitals out of the area: One went to a burn unit in Galveston; one went to the

University of Texas M.D. Cancer Center in Houston for specialized

leukemia care; three needed organ transplants they could not get in Austin; and

three asked to be transferred back to hospitals in their hometowns for surgery,

he said.

As more and more seriously ill or injured patients come from other parts of

the state, specialists become increasingly unwilling to be on call for local

hospitals, Ziebell wrote in an e-mail. " So, if Austin-based neurosurgeons are

forced to provide care for an increasing number of patients from well outside

of Austin, they are likely to reach a point where they will say, 'Forget it;

I'm just not going to take call anymore.' "

He said he didn't have statistics showing how many doctors have stopped being

on call but said that as head of the ER, he has more holes to fill on the

call schedule.

San , which has three trauma centers, sent 37 patients to Austin

between January 2007 (when Seton started collecting data) and April 2008. And

the

Alamo City's trauma centers turned away patients from surrounding

communities who also went to Austin. San officials said one factor

leading to

those transfers was the deployment of doctors to Iraq from two military

hospitals with trauma centers.

Full hospital beds and a lack of available specialists are typically cited

when hospitals send patients to Austin, Ziebell said.

When a small community hospital gets a case it can't handle, its staffers

start looking for the nearest specialist. If the closest trauma center says it's

full, they turn to Austin or other more distant cities.

Statewide, fewer specialists are willing to be on call for emergencies after

hours, especially in such areas as neurosurgery, orthopedics, plastic

surgery, ophthalmology and other fields, doctors in Texas said. That means that

some

hospitals pay certain doctors just to be on call — something that doctors a

generation ago did as a community service.

Many expect the problem to worsen as a doctor shortage deepens, more surgeons

leave traditional hospital settings and new doctors don't feel obligated to

be on call.

" This has been an issue that has been brewing for the last three years ...

and the scale of the problem is huge, " said Dr. Ed Racht, medical director of

Austin- County Emergency Medical Services and chairman of the Governor's

EMS and Trauma Advisory Council. " It really became apparent in the (Rio

Grande) Valley first. The Valley was sending patients who needed neurosurgeons

to

San because they had no neurosurgical coverage. It shifts the

financial responsibility for care from one area to another. "

The law requires care

As a trauma center, University Medical Center receives the most critically

injured patients and must have specialists on call 24 hours a day. And

hospitals can't turn down requests from hospitals that say they can't care for a

patient.

" Federal law says if a hospital declares an emergency and if we have the

specialists and the capacity to care for that patient, we have to do it, "

Ziebell said. " It's hard to believe that out of two Level I trauma centers in

Houston, that not one of them can provide care for one of their citizens. "

Houston

sent five patients to Austin during the 16-month period Seton analyzed, as

did cities in Houston's trauma region, such as Columbus, which sent 36.

Officials at other Texas trauma centers say they're also facing more

transfers.

& White, which operates a trauma center in Temple, said in a written

statement that the transfers it accepts from inside and outside of its region

have " grown in double digits, " according to Dr. Sibbitt, associate

chief medical officer.

" & White, over a similar period of time, accepted more than 1,500

transfers from Killeen, " Sibbitt wrote.

Killeen, however, is part of the & White trauma region; 52 patients

from Killeen and 10 patients from Temple were transferred to Austin from January

2007 through April of this year, Seton said.

Sibbitt said & White may transfer patients to Austin because the

patient requested it or because its trauma center was full.

Ziebell said transfer patients have a higher mortality rate at Seton

hospitals than other patients. He said 4.6 percent of the out-of-area transfer

patients died at Seton hospitals within a week, compared with 1.5 percent of the

regular patients who had been hospitalized for a week. He said though the

transfer patients could have been more critical, he thinks travel time was the

main factor.

In recent years, more doctors have invested in surgical hospitals where they

can set their own hours and not worry about treating emergency room patients

who can't pay and could be more likely to sue, said Dr. Bruce Moskow,

president of Emergency Service Partners, which provides the physicians who staff

the

ERs for Seton and about 20 other Texas hospitals. For those

doctor-investors, stopping hospital work also means no longer getting called in

the middle of

the night to come to the ER.

Dr. Dan , a neurosurgeon at University Medical Center, is on the

hospital's on-call schedule 12 nights a month — six times as the primary surgeon

and six times as the backup. He said he almost always gets called in when

he's the main neurosurgeon to do surgery or evaluate a patient with a head

injury, aneurysm or brain tumor. Sometimes, he has to cancel his clinic work and

elective surgeries the next day because he's still dealing with the on-call

load, he said.

The increase in transfer patients is " extremely frustrating, " said.

As an incentive to the doctors to take emergency calls, Seton is paying some

specialists as much as $5,000 a night to be on the call roster, even if they

don't have to come in, Ziebell said.

" The patients of Austin are paying for that, " he said, noting that people pay

through escalating health care costs, including higher health insurance

premiums.

St. 's HealthCare is paying for on-call specialists, too, but Dr. Steve

Berkowitz, the chief medical officer, declined to say how much. St. 's,

which doesn't have a regional trauma center but receives transfer patients at

its hospitals, said it has also seen an increase in transfers but did not

have data. " I don't believe these transfers in are having any substantial

effect on our system, " Berkowitz said.

Doctors turn away

In San , many neurosurgeons have stopped taking hospital calls, so the

hospitals are sending stroke patients to Austin and other cities for

treatment, said Suzanne Hildebrand, 61, who founded the Mothers Against Drunk

Driving chapter in Texas in 1981. After her husband suffered a stroke April 16,

she

joined a committee that is trying to get a stroke center established in San

.

More than seven hours after Ray Hildebrand, 68, collapsed at his job at the

San district attorney's office, where he worked as a criminal

investigator, hospitals in the city said no doctor was available to treat him,

Suzanne Hildebrand said. He was flown to Austin for treatment and was in a coma

for several days, she said.

" We're talking 7½ damn hours of basically holding him while (San

hospitals) made phone calls, " she said. The hemorrhage in his brain " was

inoperable by the time he got " to Austin. Her husband's recovery has been slow,

but

he is regaining some speech and movement, she said.

Ziebell said none of San 's hospitals — including its three trauma

centers — have obtained voluntary national certification to provide care to

stroke patients. Four Austin hospitals have that certification, which means they

can provide certain drugs and therapies in a coordinated way to stroke

victims.

Dr. , a critical care surgeon and chairman of the Southwest

Texas Regional Advisory Council on trauma issues, wrote to colleagues in a May

e-mail that it was " unacceptable " that after a year of discussion, no San

hospitals had obtained the certification " even though the stroke center

requirements represent only the minimal standards required for stroke care. "

Leni Kirkman, a spokeswoman for University Hospital, a trauma center in San

, said hospitals can treat stroke patients without being certified —

Kirkman said hers has doctors who do — but University's beds are often full.

" It's unconscionable to think we have so many resources in our community and

we haven't got this worked out, " Kirkman said.

Epley, the executive director of the advisory council that

belongs to, said doctors and hospitals officials in San are " working

feverishly on trying to establish stroke centers and a regional stroke system.

" It's unacceptable that the large urban centers are sending patients to other

large urban centers, " Epley said. " The best thing for patients in San

would be to stay in San , and the best thing for Austin patients

is

to stay in Austin. "

Ultimately, lawmakers may need to solve the problem, perhaps by establishing

when patients can be transferred and requiring doctors to take emergency

hospital calls in order to get hospital privileges, said Racht, the trauma

advisory committee chairman.

maroser (AT) statesman (DOT) com; 445-3619

[Guest guest]

I currently work at a small transfer service out of New Braunfels,

and we have been transporting to Austin quite a bit lately. Yesterday

alone there were two calls from us there and we missed at least one

more. In the past week, just on my days on shift I've seen a

substantial increase in patients being transported from the New

Braunfels/San area to Austin.

>

> Anyone have any thoughts or opinions on this?

>

> -Wes Ogilvie

>

>

> Austin hospitals strained by hundreds of patients from outside area

> ER doctors say they are exhausted, frustrated by increasing load

> By _ Ann Roser_ (mailto:maroser@...)

> AMERICAN-STATESMAN STAFF

> Sunday, July 13, 2008

> Patients from around Texas and even other states are increasingly

being sent

> to Austin for emergency medical care, which officials at the

largest hospital

> system in Central Texas say can put some lives at risk and strain

a

> shrinking number of specialists willing to treat people at local

hospitals.

> In the past year, six Seton hospitals received 517 patients from

outside

> their service areas, according to data from the Seton Family of

Hospitals. Dell

> Children's Medical Center serves 46 counties, while other Seton

facilities,

> including University Medical Center at Brackenridge, the region's

only trauma

> center, serve an 11-county area.

> In general, the patients transferred into Austin are either

critically

> injured or seriously ill from a stroke or other medical condition,

said Dr.

> Ziebell, University Medical Center's chief of emergency

medicine and

> president of Seton's medical staff.

> The number of transfer patients coming to University Medical Center

and other

> Seton hospitals jumped 61 percent, from an average of 33 per month

from June

> through November 2007 to an average of 53 per month from December

through

> May. They are coming from as far away as Abilene and Lubbock but

also from

> Dallas, Houston and San †" larger cities that have

multiple trauma

> centers.

> A few years ago, Austin sent some patients who needed emergency

brain surgery

> to San and Temple hospitals because of a lack of

neurosurgeons on

> call, but Austin's hospitals have since added neurosurgeons.

Ziebell said few

> transfer out now. Seton transferred eight patients in the past

year to

> hospitals out of the area: One went to a burn unit in Galveston;

one went to the

> University of Texas M.D. Cancer Center in Houston for

specialized

> leukemia care; three needed organ transplants they could not get

in Austin; and

> three asked to be transferred back to hospitals in their hometowns

for surgery,

> he said.

> As more and more seriously ill or injured patients come from other

parts of

> the state, specialists become increasingly unwilling to be on call

for local

> hospitals, Ziebell wrote in an e-mail. " So, if Austin-based

neurosurgeons are

> forced to provide care for an increasing number of patients from

well outside

> of Austin, they are likely to reach a point where they will

say, 'Forget it;

> I'm just not going to take call anymore.' "

> He said he didn't have statistics showing how many doctors have

stopped being

> on call but said that as head of the ER, he has more holes to fill

on the

> call schedule.

> San , which has three trauma centers, sent 37 patients to

Austin

> between January 2007 (when Seton started collecting data) and April

2008. And the

> Alamo City's trauma centers turned away patients from surrounding

> communities who also went to Austin. San officials said one

factor leading to

> those transfers was the deployment of doctors to Iraq from two

military

> hospitals with trauma centers.

> Full hospital beds and a lack of available specialists are

typically cited

> when hospitals send patients to Austin, Ziebell said.

> When a small community hospital gets a case it can't handle, its

staffers

> start looking for the nearest specialist. If the closest trauma

center says it's

> full, they turn to Austin or other more distant cities.

> Statewide, fewer specialists are willing to be on call for

emergencies after

> hours, especially in such areas as neurosurgery, orthopedics,

plastic

> surgery, ophthalmology and other fields, doctors in Texas said.

That means that some

> hospitals pay certain doctors just to be on call †" something

that doctors a

> generation ago did as a community service.

> Many expect the problem to worsen as a doctor shortage deepens,

more surgeons

> leave traditional hospital settings and new doctors don't feel

obligated to

> be on call.

> " This has been an issue that has been brewing for the last three

years ...

> and the scale of the problem is huge, " said Dr. Ed Racht, medical

director of

> Austin- County Emergency Medical Services and chairman of the

Governor's

> EMS and Trauma Advisory Council. " It really became apparent in the

(Rio

> Grande) Valley first. The Valley was sending patients who needed

neurosurgeons to

> San because they had no neurosurgical coverage. It shifts

the

> financial responsibility for care from one area to another. "

> The law requires care

> As a trauma center, University Medical Center receives the most

critically

> injured patients and must have specialists on call 24 hours a day.

And

> hospitals can't turn down requests from hospitals that say they

can't care for a

> patient.

> " Federal law says if a hospital declares an emergency and if we

have the

> specialists and the capacity to care for that patient, we have to

do it, "

> Ziebell said. " It's hard to believe that out of two Level I trauma

centers in

> Houston, that not one of them can provide care for one of their

citizens. " Houston

> sent five patients to Austin during the 16-month period Seton

analyzed, as

> did cities in Houston's trauma region, such as Columbus, which sent

36.

> Officials at other Texas trauma centers say they're also facing

more

> transfers.

> & White, which operates a trauma center in Temple, said in a

written

> statement that the transfers it accepts from inside and outside of

its region

> have " grown in double digits, " according to Dr. Sibbitt,

associate

> chief medical officer.

> " & White, over a similar period of time, accepted more than

1,500

> transfers from Killeen, " Sibbitt wrote.

> Killeen, however, is part of the & White trauma region; 52

patients

> from Killeen and 10 patients from Temple were transferred to Austin

from January

> 2007 through April of this year, Seton said.

> Sibbitt said & White may transfer patients to Austin because

the

> patient requested it or because its trauma center was full.

> Ziebell said transfer patients have a higher mortality rate at

Seton

> hospitals than other patients. He said 4.6 percent of the out-of-

area transfer

> patients died at Seton hospitals within a week, compared with 1.5

percent of the

> regular patients who had been hospitalized for a week. He said

though the

> transfer patients could have been more critical, he thinks travel

time was the

> main factor.

> In recent years, more doctors have invested in surgical hospitals

where they

> can set their own hours and not worry about treating emergency room

patients

> who can't pay and could be more likely to sue, said Dr. Bruce

Moskow,

> president of Emergency Service Partners, which provides the

physicians who staff the

> ERs for Seton and about 20 other Texas hospitals. For those

> doctor-investors, stopping hospital work also means no longer

getting called in the middle of

> the night to come to the ER.

> Dr. Dan , a neurosurgeon at University Medical Center, is

on the

> hospital's on-call schedule 12 nights a month †" six times as the

primary surgeon

> and six times as the backup. He said he almost always gets called

in when

> he's the main neurosurgeon to do surgery or evaluate a patient

with a head

> injury, aneurysm or brain tumor. Sometimes, he has to cancel his

clinic work and

> elective surgeries the next day because he's still dealing with the

on-call

> load, he said.

> The increase in transfer patients is " extremely frustrating, "

said.

> As an incentive to the doctors to take emergency calls, Seton is

paying some

> specialists as much as $5,000 a night to be on the call roster,

even if they

> don't have to come in, Ziebell said.

> " The patients of Austin are paying for that, " he said, noting that

people pay

> through escalating health care costs, including higher health

insurance

> premiums.

> St. 's HealthCare is paying for on-call specialists, too, but

Dr. Steve

> Berkowitz, the chief medical officer, declined to say how much. St.

's,

> which doesn't have a regional trauma center but receives transfer

patients at

> its hospitals, said it has also seen an increase in transfers but

did not

> have data. " I don't believe these transfers in are having any

substantial

> effect on our system, " Berkowitz said.

> Doctors turn away

> In San , many neurosurgeons have stopped taking hospital

calls, so the

> hospitals are sending stroke patients to Austin and other cities

for

> treatment, said Suzanne Hildebrand, 61, who founded the Mothers

Against Drunk

> Driving chapter in Texas in 1981. After her husband suffered a

stroke April 16, she

> joined a committee that is trying to get a stroke center

established in San

> .

> More than seven hours after Ray Hildebrand, 68, collapsed at his

job at the

> San district attorney's office, where he worked as a

criminal

> investigator, hospitals in the city said no doctor was available to

treat him,

> Suzanne Hildebrand said. He was flown to Austin for treatment and

was in a coma

> for several days, she said.

> " We're talking 7½ damn hours of basically holding him while (San

> hospitals) made phone calls, " she said. The hemorrhage in his

brain " was

> inoperable by the time he got " to Austin. Her husband's recovery

has been slow, but

> he is regaining some speech and movement, she said.

> Ziebell said none of San 's hospitals †" including its

three trauma

> centers †" have obtained voluntary national certification to

provide care to

> stroke patients. Four Austin hospitals have that certification,

which means they

> can provide certain drugs and therapies in a coordinated way to

stroke

> victims.

> Dr. , a critical care surgeon and chairman of the

Southwest

> Texas Regional Advisory Council on trauma issues, wrote to

colleagues in a May

> e-mail that it was " unacceptable " that after a year of discussion,

no San

> hospitals had obtained the certification " even though the

stroke center

> requirements represent only the minimal standards required for

stroke care. "

> Leni Kirkman, a spokeswoman for University Hospital, a trauma

center in San

> , said hospitals can treat stroke patients without being

certified †"

> Kirkman said hers has doctors who do †" but University's beds are

often full.

> " It's unconscionable to think we have so many resources in our

community and

> we haven't got this worked out, " Kirkman said.

> Epley, the executive director of the advisory council that

> belongs to, said doctors and hospitals officials in San

are " working

> feverishly on trying to establish stroke centers and a regional

stroke system.

> " It's unacceptable that the large urban centers are sending

patients to other

> large urban centers, " Epley said. " The best thing for patients in

San

> would be to stay in San , and the best thing for

Austin patients is

> to stay in Austin. "

> Ultimately, lawmakers may need to solve the problem, perhaps by

establishing

> when patients can be transferred and requiring doctors to take

emergency

> hospital calls in order to get hospital privileges, said Racht, the

trauma

> advisory committee chairman.

> maroser@...; 445-3619

>

>

>

[Guest guest]

We have a similar problem in AZ, except that we are a net exporter of

patients.

Arizona has not seen fit to enact a " tort reform act " so that there are no

caps on damages that can be awarded in a malpractice suit. Therefore, many

physicians in the critical specialties have left the state.

At one time last fall, there were only TWO trauma surgeons on staff at

University Medical Center, Tucson's only Level I.

Since then 4 more have been recruited, but still, there are a total of 6

board certified trauma surgeons here in Tucson.

Some days there is no neurosurgery coverage, so patients are flown to

Phoenix, El Paso, San Diego, Las Vegas, or LA.

Some days there are no orthopods or plastics taking call anywhere in Tucson.

Further, Tucson has the problem of the illegal immigrant population. This

year there have been two MVCs that illustrate what can happen here.

Early in the year there was a one vehicle rollover on I-10 that produced one

DRT and 48 other injured, all of whom were transported to the 7 hospitals in

Tucson. All the air resources and ambulances were tied up doing this, and the

trauma center and other hospitals were inundated within a 30 minute period.

Not ONE of those patients was a citizen or insured or has any ability

whatsoever to pay anything for the care to anybody.

But a couple of months later, that record was broken when a bus carrying 60

illegals tried to outrun the Border Patrol and rolled, killing three or four

and sending the rest of them to, you guessed it, not only the Tucson hospitals

but the one in Oracle, the one in Casa Grande, and a couple of " heads " to

Samaritan in Phoenix where, as far as I know, two of them remain on a vent, and

there's one or two on vents here at UMC.

Again, not ONE insured or with ability to pay.

Now, why should any physician desire to practice here? How many non-pays

can a doctor handle?

If you're the only neurosurgeon on call in the city and suddenly you get 10

head injuries dumped on you, what are you expected to do?

The system is struggling. Five years ago we had two Level Is but TMC

dropped back to Level Two just because it wasn't making it with the indigent

case

load.

Who has the answer? I wish I did. But I don't.

GG

>

> Anyone have any thoughts or opinions on this?

>

> -Wes Ogilvie

>

>

> Austin hospitals strained by hundreds of patients from outside area

> ER doctors say they are exhausted, frustrated by increasing load

> By _ Ann Roser_ (mailto:maroser@...)

> AMERICAN-STATESMAN STAFF

> Sunday, July 13, 2008

> Patients from around Texas and even other states are increasingly being sent

> to Austin for emergency medical care, which officials at the largest

> hospital

> system in Central Texas say can put some lives at risk and strain a

> shrinking number of specialists willing to treat people at local hospitals.

> In the past year, six Seton hospitals received 517 patients from outside

> their service areas, according to data from the Seton Family of Hospitals.

> Dell

> Children's Medical Center serves 46 counties, while other Seton facilities,

> including University Medical Center at Brackenridge, the region's only

> trauma

> center, serve an 11-county area.

> In general, the patients transferred into Austin are either critically

> injured or seriously ill from a stroke or other medical condition, said Dr.

> Ziebell, University Medical Center's chief of emergency medicine

> and

> president of Seton's medical staff.

> The number of transfer patients coming to University Medical Center and

> other

> Seton hospitals jumped 61 percent, from an average of 33 per month from June

> through November 2007 to an average of 53 per month from December through

> May. They are coming from as far away as Abilene and Lubbock but also from

> Dallas, Houston and San larger cities that have multiple trauma

> centers.

> A few years ago, Austin sent some patients who needed emergency brain

> surgery

> to San and Temple hospitals because of a lack of neurosurgeons on

> call, but Austin's hospitals have since added neurosurgeons. Ziebell said

> few

> transfer out now. Seton transferred eight patients in the past year to

> hospitals out of the area: One went to a burn unit in Galveston; one went to

> the

> University of Texas M.D. Cancer Center in Houston for specialized

> leukemia care; three needed organ transplants they could not get in Austin;

> and

> three asked to be transferred back to hospitals in their hometowns for

> surgery,

> he said.

> As more and more seriously ill or injured patients come from other parts of

> the state, specialists become increasingly unwilling to be on call for local

> hospitals, Ziebell wrote in an e-mail. " So, if Austin-based neurosurgeons

> are

> forced to provide care for an increasing number of patients from well

> outside

> of Austin, they are likely to reach a point where they will say, 'Forget it;

> I'm just not going to take call anymore.' "

> He said he didn't have statistics showing how many doctors have stopped

> being

> on call but said that as head of the ER, he has more holes to fill on the

> call schedule.

> San , which has three trauma centers, sent 37 patients to Austin

> between January 2007 (when Seton started collecting data) and April 2008.

> And the

> Alamo City's trauma centers turned away patients from surrounding

> communities who also went to Austin. San officials said one factor

> leading to

> those transfers was the deployment of doctors to Iraq from two military

> hospitals with trauma centers.

> Full hospital beds and a lack of available specialists are typically cited

> when hospitals send patients to Austin, Ziebell said.

> When a small community hospital gets a case it can't handle, its staffers

> start looking for the nearest specialist. If the closest trauma center says

> it's

> full, they turn to Austin or other more distant cities.

> Statewide, fewer specialists are willing to be on call for emergencies after

> hours, especially in such areas as neurosurgery, orthopedics, plastic

> surgery, ophthalmology and other fields, doctors in Texas said. That means

> that some

> hospitals pay certain doctors just to be on call something that doctors a

> generation ago did as a community service.

> Many expect the problem to worsen as a doctor shortage deepens, more

> surgeons

> leave traditional hospital settings and new doctors don't feel obligated to

> be on call.

> " This has been an issue that has been brewing for the last three years ...

> and the scale of the problem is huge, " said Dr. Ed Racht, medical director

> of

> Austin- County Emergency Medical Services and chairman of the

> Governor's

> EMS and Trauma Advisory Council. " It really became apparent in the (Rio

> Grande) Valley first. The Valley was sending patients who needed

> neurosurgeons to

> San because they had no neurosurgical coverage. It shifts the

> financial responsibility for care from one area to another. "

> The law requires care

> As a trauma center, University Medical Center receives the most critically

> injured patients and must have specialists on call 24 hours a day. And

> hospitals can't turn down requests from hospitals that say they can't care

> for a

> patient.

> " Federal law says if a hospital declares an emergency and if we have the

> specialists and the capacity to care for that patient, we have to do it, "

> Ziebell said. " It's hard to believe that out of two Level I trauma centers

> in

> Houston, that not one of them can provide care for one of their citizens. "

> Houston

> sent five patients to Austin during the 16-month period Seton analyzed, as

> did cities in Houston's trauma region, such as Columbus, which sent 36.

> Officials at other Texas trauma centers say they're also facing more

> transfers.

> & White, which operates a trauma center in Temple, said in a written

> statement that the transfers it accepts from inside and outside of its

> region

> have " grown in double digits, " according to Dr. Sibbitt, associate

> chief medical officer.

> " & White, over a similar period of time, accepted more than 1,500

> transfers from Killeen, " Sibbitt wrote.

> Killeen, however, is part of the & White trauma region; 52 patients

> from Killeen and 10 patients from Temple were transferred to Austin from

> January

> 2007 through April of this year, Seton said.

> Sibbitt said & White may transfer patients to Austin because the

> patient requested it or because its trauma center was full.

> Ziebell said transfer patients have a higher mortality rate at Seton

> hospitals than other patients. He said 4.6 percent of the out-of-area

> transfer

> patients died at Seton hospitals within a week, compared with 1.5 percent of

> the

> regular patients who had been hospitalized for a week. He said though the

> transfer patients could have been more critical, he thinks travel time was

> the

> main factor.

> In recent years, more doctors have invested in surgical hospitals where they

> can set their own hours and not worry about treating emergency room patients

> who can't pay and could be more likely to sue, said Dr. Bruce Moskow,

> president of Emergency Service Partners, which provides the physicians who

> staff the

> ERs for Seton and about 20 other Texas hospitals. For those

> doctor-investors, stopping hospital work also means no longer getting called

> in the middle of

> the night to come to the ER.

> Dr. Dan , a neurosurgeon at University Medical Center, is on the

> hospital's on-call schedule 12 nights a month six times as the primary

> surgeon

> and six times as the backup. He said he almost always gets called in when

> he's the main neurosurgeon to do surgery or evaluate a patient with a head

> injury, aneurysm or brain tumor. Sometimes, he has to cancel his clinic work

> and

> elective surgeries the next day because he's still dealing with the on-call

> load, he said.

> The increase in transfer patients is " extremely frustrating, The increase in

> t

> As an incentive to the doctors to take emergency calls, Seton is paying some

> specialists as much as $5,000 a night to be on the call roster, even if they

> don't have to come in, Ziebell said.

> " The patients of Austin are paying for that, " he said, noting that people

> pay

> through escalating health care costs, including higher health insurance

> premiums.

> St. 's HealthCare is paying for on-call specialists, too, but Dr. Steve

> Berkowitz, the chief medical officer, declined to say how much. St. 's,

> which doesn't have a regional trauma center but receives transfer patients

> at

> its hospitals, said it has also seen an increase in transfers but did not

> have data. " I don't believe these transfers in are having any substantial

> effect on our system, " Berkowitz said.

> Doctors turn away

> In San , many neurosurgeons have stopped taking hospital calls, so

> the

> hospitals are sending stroke patients to Austin and other cities for

> treatment, said Suzanne Hildebrand, 61, who founded the Mothers Against

> Drunk

> Driving chapter in Texas in 1981. After her husband suffered a stroke April

> 16, she

> joined a committee that is trying to get a stroke center established in San

> .

> More than seven hours after Ray Hildebrand, 68, collapsed at his job at the

> San district attorney's office, where he worked as a criminal

> investigator, hospitals in the city said no doctor was available to treat

> him,

> Suzanne Hildebrand said. He was flown to Austin for treatment and was in a

> coma

> for several days, she said.

> " We're talking 7¢® damn hours of basically holding him while (San

> hospitals) made phone calls, " she said. The hemorrhage in his brain " was

> inoperable by the time he got " to Austin. Her husband's recovery has been

> slow, but

> he is regaining some speech and movement, she said.

> Ziebell said none of San 's hospitals including its three trauma

> centers have obtained voluntary national certification to provide care to

> stroke patients. Four Austin hospitals have that certification, which means

> they

> can provide certain drugs and therapies in a coordinated way to stroke

> victims.

> Dr. , a critical care surgeon and chairman of the Southwest

> Texas Regional Advisory Council on trauma issues, wrote to colleagues in a

> May

> e-mail that it was " unacceptable " that after a year of discussion, no San

> hospitals had obtained the certification " even though the stroke

> center

> requirements represent only the minimal standards required for stroke care. "

> Leni Kirkman, a spokeswoman for University Hospital, a trauma center in San

> , said hospitals can treat stroke patients without being certified

> Kirkman said hers has doctors who do but University's beds are often full.

> " It's unconscionable to think we have so many resources in our community and

> we haven't got this worked out, " Kirkman said.

> Epley, the executive director of the advisory council that

> belongs to, said doctors and hospitals officials in San are " working

> feverishly on trying to establish stroke centers and a regional stroke

> system.

> " It's unacceptable that the large urban centers are sending patients to

> other

> large urban centers, " Epley said. " The best thing for patients in San

> would be to stay in San , and the best thing for Austin

> patients is

> to stay in Austin. "

> Ultimately, lawmakers may need to solve the problem, perhaps by establishing

> when patients can be transferred and requiring doctors to take emergency

> hospital calls in order to get hospital privileges, said Racht, the trauma

> advisory committee chairman.

> maroser@...; 445-3619

>

>

[Guest guest]

Yes. None of them have any significant surge capacity. This is true

nationwide. What is it going to take to wake us up?

GG

>

> Gene- had a similar situation in Chandler when I was with MCSO as a reserve.

> Coyote flipped a beatup old van when a near-bald tire blew and he drove into

> the sand. One DRT (the coyote - poetic justice), 6 red tags still in the

> van. The yellows and greens disappeared into the scrub and we spent the

better

> part of the day searching for the rest.

> Â

> The Trauma Centers in Phoenix are only going to be able to absorb so much

> more and they too will go the way of Tucson.

>

> Â

> " A prudent man foresees the difficulties ahead and prepares for them; the

> simpleton goes blindly on and suffers the consequences. "

> Proverbs 22:3

>

>

[Guest guest]

Gene- had a similar situation in Chandler when I was with MCSO as a reserve.

Coyote flipped a beatup old van when a near-bald tire blew and he drove into the

sand. One DRT (the coyote - poetic justice), 6 red tags still in the van. The

yellows and greens disappeared into the scrub and we spent the better part of

the day searching for the rest.

The Trauma Centers in Phoenix are only going to be able to absorb so much more

and they too will go the way of Tucson.

" A prudent man foresees the difficulties ahead and prepares for them; the

simpleton goes blindly on and suffers the consequences. "

Proverbs 22:3

[Guest guest]

GG asked: " What is it going to take to wake us up? "

Legistators waiting for hospital beds.

  Phil Reynolds Jr.

115 Harold Dr.

Burnet, TX., 78611

HP

CP