Trauma centers, which can save the seriously injured with the latest in medical technology, are themselves succumbing to financial woes, two researchers said yesterday.
At least 66 hospital trauma centers have closed since 1983, including one in Maryland, leaving about 500 still operating nationwide, said John T. Dailey, a researcher for the National Study Center for Trauma and Emergency Medical Services in Baltimore.
Another researcher, Dr. Marcia Mabee, with a health care LTC consulting firm in Reston, Va., said her survey found that 92 hospitals had discontinued trauma care since 1985, with 457 remaining.
Trauma centers are falling victim to the fiscal problems besetting the nation's health care system, the two speakers said at the R Adams Cowley 14th National Trauma Symposium, which ended its four-day meeting at the Hyatt Regency Hotel yesterday.
Trauma centers are being squeezed by the increase in urban violence, rising health care costs and an increasing number of uninsured patients, Dr. Mabee said. Centers are closing because hospitals and doctors are unable to recover the costs of caring for poor victims of accidents and mayhem, she said.
Even though major urban areas like Chicago, Los Angeles and Miami have been hard hit, center closures are not just an inner-city problem, said Mr. Dailey. Two-thirds of the hospitals dropping trauma care have been in the suburbs, he noted.
"Trauma care and fiscal concerns have collided at hospital doors," Mr. Dailey said.
Maryland lost a trauma center last year when Southern Maryland Hospital Center in Prince George's County ceased its specialized emergency care for critically injured patients. Officials of the hospital in Clinton said they could no longer afford to provide the required staffing and facilities.
Mr. Dailey said Maryland's emergency medical system has been able to pick up the slack from that closure by diverting patients to the state's 10 other trauma centers.
But in other areas of the country, trauma center shutdowns have had a domino effect, overwhelming some of the remaining facilities with poor patients unable to pay for their care.
Four bills in Congress are intended to pump more federal aid into trauma care, with the most generous measure promising up to $55 million this year if it passes, Dr. Mabee said.
Complicating the prospects for those bills is the national debate about health care reform. Proposals from the Bush administration and others in Congress seek to help 35 million to 40 million people without health insurance while holding down soaring medical costs.
The argument against specialized, high-technology medicine is that it focuses on the last six months of life, she said. But trauma care is aimed at helping those under age 44, for whom accidents, gunshot wounds and other injuries are still the leading cause of death.
Treating patients with serious injuries at trauma centers costs up to three times the average hospital admission, Dr. Mabee said, but those patients are far more likely to survive and recover.
About 400 doctors, nurses, medical researchers and administrators from as far away as China attended the symposium, named in honor the founder of the University of Maryland's Shock Trauma Center, R Adams Cowley, who died last year.