Trauma surgeons' payment discussed

State, hospital officials seek compensation plan

August 22, 2002|By Kristine Henry | Kristine Henry,SUN STAFF

Higher automobile and motorcycle insurance and surcharges on traffic tickets are two of the options lawmakers are studying as they look for ways to compensate the surgeons who staff the state's shock trauma centers.

House Speaker Casper R. Taylor Jr. held a meeting yesterday with several legislators and officials from various shock trauma facilities to discuss the recent closure of the trauma center at Washington County Health System in Hagerstown. They are looking for ways to reopen the Hagerstown facility as well as address the funding issues that centers across the state are facing.

The Washington County hospital suspended its trauma program in early June when surgeons refused to work the required number of shifts to keep the center operating.

It was one of nine such centers in the state, and while it is closed, ambulances and helicopters are taking patients to Baltimore, Bethesda or Cumberland.

The Hagerstown trauma center was staffed by doctors who are not full-time employees of the hospital but who have private practices and agreed to take shifts at the hospital.

At issue is the amount of compensation those doctors should receive when they set aside blocks of time during which they cannot meet with their regular patients or perform scheduled surgeries.

Though the problem came to a head in Hagerstown, lawmakers said it's one facing all centers in the state.

General fund preferred

Del. John F. Wood Jr., a St. Mary's County Democrat, said at the meeting yesterday that he hopes to have "something on the table" by January that would address doctors' compensation. He said that formal proposals for funding the added cost have not been put forward but that a $20 surcharge on traffic citations had been mentioned, as had a surcharge on motor vehicle insurance.

"My personal feeling is I'd rather see it come out of the general fund," Wood said after the meeting, but he noted that budgets are tight and that the general fund isn't a likely source.

Del. Michael E. Busch, an Anne Arundel County Democrat, said at the meeting that funding from insurance makes sense because "there is a direct relationship between shock trauma and motor vehicles."

"The vast majority of Marylanders, and I'm one of them, want to know that if anything happens to us on the road, that there is care for everybody," Busch said.

Aug. 2 incident

The impact of a closed center was underscored Aug. 2 when a Glen Burnie man was critically injured in an all-terrain vehicle accident.

The accident happened eight miles from Hagerstown, but Justin N. Fishell, 25, had to be transported by helicopter to the University of Maryland Shock Trauma Center in Baltimore.

News of the trip, which lasted 1 1/2 hours, raised widespread concern in Washington County. Fishell, who remains hospitalized, was listed in stable condition yesterday.

Taylor said he hopes the federal government can supply the needed funding, which he estimated at $10 million to $20 million. He said that the federal government gives the state about $500 million a year to make up for under-compensated care but that none of the money can be used to pay doctors.

He wants a boost in funding and permission to pay shock trauma physicians with the funds.

"It's outrageous that the federal government is tying our hands," he said. "They give us money, but then we can't give it to the doctors. How the hell are you supposed to run a trauma center without doctors?"

Closer to reopening

James P. Hamill, president of the Washington County hospital, said the center is getting closer to reopening. But when it does, it will likely go from a Level 2 center to a Level 3.

While Level 2 facilities have trauma surgeons on the premises at all times, Level 3 facilities require only that they be on call.

Taylor said he hoped the center could open by Labor Day, but Hamill said that was likely too optimistic.

He declined to give a firm timetable for the reopening.

Not only has the closure prompted worries about timely medical care, it has also caused unease about the costs associated with helicopter transports.

In its quarterly bulletin this month, the Washington County public school system reminded its 2,400 employees that "air ambulance to a medical facility is not a covered item under our CareFirst policies. This is of great importance with the closing of [the local trauma center]. These trips by air ambulance can run from $6,000 to $10,000 per trip."

Most helicopter transports are handled by the Maryland State Police, who do not charge accident victims or their insurance companies. Occasionally, however, a private air ambulance will be used, and the patient will be billed.

Workers covered

However, the approximately 700 employees who work for the county will have the cost of private air transportation covered if they need it, said Washington County Administrator Rodney M. Shoop.

He said the county, which is self-insured, would direct CareFirst to include that benefit in the county's plan.

"It's in the best interest of our employees and their families," Shoop said.

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