Report Title:

Trauma Care

Description:

Requires the distribution of a percentage of disproportionate share of hospital payments to The Queen's medical center on an annual basis to ensure the availability of physicians on-call for trauma care.

HOUSE OF REPRESENTATIVES

H.B. NO.

3142

TWENTY-THIRD LEGISLATURE, 2006

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

RELATING TO TRAUMA CARE.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that trauma care in Hawaii is in a state of crisis and recognizes that trauma care is a public health priority.

The legislature further finds that trauma centers are vitally important. A trauma center is different from other hospitals since it guarantees immediate availability of specialized surgeons, anesthesiologists, other physician specialists, nurses, and resuscitation life support equipment twenty-four hours a day. The emergency departments of hospitals may be staffed by an emergency physician day and night, but only trauma centers are able to handle the most severe, life threatening situations, where highly skilled, quick and intensive intervention within the early period of trauma may mean the difference between life and death.

As the American College of Surgeons noted in its Trauma System Consultation report, extreme isolation and limited physician re-supply capability renders Hawaii uniquely vulnerable to natural disasters that may occur in a mid-Pacific environment.

Injury is the leading cause of death for persons between the ages of one to forty-four in the State of Hawaii. This is more than the deaths caused by cancer and heart disease combined. This underscores the seriousness of traumatic injury as a public health problem in the State. When injuries are serious, the specialized equipment and prompt access to physicians available in trauma centers can make a significant difference in the patient's health outcome. Trauma centers have been shown to reduce preventable deaths by more than twenty per cent as compared to other hospital care.

The Queen's Medical Center has long been recognized as a statewide destination hospital for critically ill or injured patients. Over the past twenty years, it has worked to become a verified level II trauma center and is the only recognized trauma center in the State today.

As the single definitive trauma care medical center, The Queen's Medical Center provides care for the vast majority of trauma patients on Oahu, pediatric and adult, as well as more serious trauma patients transferred in from the neighbor islands because of the lack of designated trauma centers elsewhere in the State. Currently, one thousand five hundred trauma patients receive trauma care at The Queen's Medical Center per year.

Physician availability for care of trauma patients is lacking or inconsistent in some areas of the State and for some specialties. This increases the demand for inter-facility transfer, and places additional burdens on the trauma center at The Queen's Medical Center.

Because of this burden, The Queen's Medical Center is currently operating its trauma center at a cost of approximately $29,700,000 per year, and at a loss of approximately $6,000,000 per year. There currently is no method for recovering expenses associated with the cost of readiness, idling costs, or opportunity costs associated with being the only designated trauma center in the State. Furthermore, The Queen's Medical Center accepts all trauma patients without regard for a patient's ability to pay or type of insurance plan. While it currently receives federal funding from disproportionate share hospital payments, such payments and other funding are not enough to ensure the viability of The Queen's Medical Center trauma center.

Disproportionate share of hospital payments are additional payments in the medicaid and medicare programs that help hospitals finance care to low-income and uninsured patients. These payments ensure that communities have access to high-cost services including trauma care. However, the disproportionate share of hospital payment provided to The Queen's Medical Center is allocated to all areas of the hospital including the trauma center and is not enough to sustain the trauma center, even after accounting for all other sources of funding.

Typically, the cost of running an emergency department is far higher than the total payments received from patients who are treated. The Queen's Medical Center incurs high additional costs from having to pay physician specialists to provide emergency call coverage. Between 2000 and 2004, thirty trauma centers closed across the nation as hospitals faced volume increases, higher costs, liability concerns, and low or no payment for trauma services. Should The Queen's Medical Center trauma center have to close because of one or more of these problems, the State will be without a recognized, certified trauma center, and the people of Hawaii will suffer. As many as thirty-five per cent of trauma patients in the United States die because optimal acute care was not available.

A weakened trauma center decreases the State's readiness to respond not only to a normal flow of critically injured patients but to unforeseen disasters and emergencies as well. The tragic events of September 11th and Hurricane Katrina illustrate that trauma readiness and availability is every bit as important, and as much an issue of public safety, as police and fire services. Skilled trauma services with the capacity to handle a surge in demand are a fundamental necessity in responding to natural disasters and man-made disasters.

Therefore, the purpose of this Act is to sustain the trauma care resources currently available by supplementing dedicated funding sources.

SECTION 2. Effective for fiscal year 2006-2007 and each year thereafter, the department of human services shall distribute disproportionate share of hospital payments to The Queen's Medical Center to provide financial assistance to ensure the on-call availability of physicians for trauma care; provided that the amount of disproportionate share of hospital payments distributed shall be fifty per cent of the amount of funds provided to The Queen's Medical Center for fiscal year 2005-2006.

SECTION 3. This Act shall take effect on July 1, 2006, and shall be repealed on June 1, 2013.

INTRODUCED BY:

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