Document text
How bad is it? Mail Tribune / Bob Pennell Accident victims from outside Jackson County who used to come to Medford hospitals for treatment may be transported to Eugene or Bend now that Rogue Valley Medical Center and Providence Medford Medical Center have reduced their level of trauma care. Ambulances will still transport Jackson County patients with life-threatening injuries to the local hospitals. Southern Oregon's trauma system scales back on the level of care it can provide. The change could send some badly hurt ER patients elsewhere in Oregon By BILL KETTLER Mail Tribune If you have a bad accident, pray it happens in Jackson County. If you should wreck your rig somewhere beyond the county line, you might wake up in a hospital in Bend or Eugene - or even Portland - instead of one of Southern Oregon's two major medical centers. Valley's lack of surgeons leaves trauma system short There's one thing on which all the players in Southern Oregon's trauma-care system can agree - finding a solution won't be easy. Hospital administrators want to maintain their role as a regional medical hub that accepts transfer patients from surrounding rural counties. Surgeons want to provide adequate treatment for their patients, most of whom reside in Jackson County. Right now, there aren't always enough physicians to do both. "Doctors are trying to take care of more patients, and take care of transfer patients at the hospitals, too," said Dr. Jon Gell, medical staff director at Providence Medford Medical Center and Rogue Valley Medical Center. The two hospitals currently share trauma responsibilities - Rogue Valley Medical Center takes trauma calls one day, Providence Medford Medical Center handles them the following day, and so on. Ambulance crews know which hospital takes trauma calls on any given day. Each hospital has arrangements to provide additional trauma care if an airplane crash or some other disaster suddenly creates more patients than one hospital can handle. Gell said hiring surgeons solely to handle trauma isn't a viable option here because they wouldn't have enough work to keep them busy. Big-city trauma surgeons handle a steady stream of accident victims, shootings and stabbings, but emergencies like that happen relatively infrequently here. "We only need a trauma surgeon about 60 or 70 times a year," Gell said. "We don't have a big enough 'knife-and-gun club' to make it worthwhile to have trauma surgeons. They'd end up competing with other surgeons." Putting money into the trauma system to compensate surgeons who can't work while they're on call would help solve the problem, said state Rep. Dr. Alan Bates, D-Ashland. "We'd have no trouble getting plenty of trauma surgeons if we paid them properly," Bates said. He plans to introduce legislation in Salem to provide a permanent funding source for the trauma system. Bates said the community could decide that one of Medford's two hospitals should become Southern Oregon's regional level 2 trauma center. "It would help to have one hospital do all the trauma in one place," he said. "Duplicating services is terribly expensive, and that's what we're doing now with trauma." Medford's other hospital could become a strong level 3 trauma center that could provide backup for the level 2 trauma hospital, said Dr. Elliott Meyerding, trauma director at both hospitals. "That's what other communities this size do," Meyerding said. "They concentrate their resources in one level 2 hospital." Relinquishing high-level trauma services would cost a hospital money, said Susan Werner, trauma program manager for Oregon's Department of Human Services. "Right now, trauma is a paying proposition for the hospitals," Werner said. Medford's two hospitals aren't the only ones to scale back their trauma service. Salem Hospital stepped down to level 3 trauma care in 1999, when physicians and hospital managers realized they could not handle the extra patients who were transferred there for level 2 care. Werner said people in Southern Oregon will have to decide what level of trauma service they can support in an era when doctors will be in increasingly short supply. The state sets standards of service, she noted, but does not require hospitals to participate at any specific level. "The trauma system is voluntary," Werner said. "Anybody can play. Communities have to decide how they're going to play." In March, Rogue Valley Medical Center and Providence Medford Medical Center asked state regulators to scale back their level of care for people with life-threatening injuries. The two hospitals can no longer guarantee that surgeons will respond to those critical emergencies within 30 minutes. The change, approved in early April, means little for most people who come to local emergency rooms. But some seriously injured patients, especially those from outlying areas who would have come to Medford for treatment, will find themselves in a hospital farther from home. For patients and their families, treatment and recovery could be inconvenient at best. "That would make it a lot harder to take care of a family member," said Dr. Jon Gell, medical staff director at both hospitals. To understand what's happening, it helps to know how Oregon hospitals handle major trauma cases - people who have multiple life-threatening injuries. Emergency room doctors often can't handle those cases alone. They get help from on-call surgeons who drop what they're doing day or night and come to the hospital to put accident victims back together. Oregon hospitals developed a trauma system for treating major injuries in 1985. Hospitals are rated from 1 down to 4 based on their equipment and staffing. Accident victims are transported to the nearest hospital that can provide the level of care they need. Hospitals may transfer patients to a higher level of care, but transfers between hospitals at the same level are prohibited. "The level 1 and level 2 facilities commit to a higher standard and provide additional physician resources 24 hours a day, seven days a week," said Susan Werner, trauma program manager for the Department of Human Services. "We want to be able to assure you that the hospital you're being transferred to is going to take better care of you than the hospital you're in." Medford's two hospitals have stepped down to level 3 care, the same category as most of the hospitals in the region. That means they can no longer accept transfer patients from other level 3 hospitals, such as Three Rivers Community Hospital in Grants Pass and Merle West Medical Center in Klamath Falls. Those patients now have to go to one of Oregon's three remaining level 2 hospitals - McKenzie Willamette or Sacred Heart in Eugene or St. Charles in Bend - or one of the state's two level 1 hospitals, both in Portland. Eric Stewart of Medford found out how the system worked April 20 after he rolled his pickup in Klamath County. Stewart was transported to Merle West Medical Center in Klamath Falls. Doctors realized he needed more care than they could provide and transported him to St. Charles Medical Center in Bend, the nearest level 2 hospital. Stewart spent nearly two weeks in the Bend hospital before he was released Thursday. The Medford hospitals asked state regulators to downgrade their trauma status after administrators and surgeons could not agree on compensation. Gell said physicians have received compensation of $600 per day. Level 2 hospitals in Eugene pay $900; Bend's pays $1,200. Local surgeons want a bigger daily stipend from the Medford hospitals because they can't do their regular work on days when they're on call. "Under the state trauma system, surgeons need to be immediately available to the operating room, which means they can't schedule elective surgeries," said Dr. Elliott Meyerding, director of trauma at Providence Medford and RVMC. Meyerding said recent increases in malpractice insurance rates and low Medicare reimbursements for older patients "make it very difficult for surgeons to cover their overhead" with the per-diem reimbursement. Physicians, hospital administrators and state regulators all acknowledge that Jackson County has not recruited enough new surgeons, orthopedists and other specialists to maintain level 2 trauma status at Medford's two hospitals. While the need for new physicians has been especially acute here, rural hospitals across Oregon have struggled to recruit medical specialists in many fields during the past few years because physicians can earn so much more in other states. The shortage surfaces prominently in trauma care because the state trauma system has specific staffing requirements for each service level. "Trauma is the canary in the coal mine," Gell said. "We're not as deep (in staff) as we were 20 years ago. "What's being played out in Medford is being played out in other hospitals," he said. "It's getting harder for emergency room doctors to find help." Gell noted that Medford hospitals had at least 12 orthopedists several years ago, but their numbers have shrunk to just six. Local surgeons' ranks have swelled to 12 after falling into single digits, but that still means surgeons have one day on trauma call in every 12 - a day they can't work - in addition to an emergency-room backup-call day every sixth day. Hospital administrators say that if they pay trauma surgeons more, other doctors who respond to emergency calls will want more, too. "You have to choose where you spend wisely," said Roseanne McLaren, senior vice president at RVMC. Some states provide financial support for their trauma physicians, but Oregon isn't one of them. California and Washington support their trauma system with state dollars. Oregon requires specific staffing levels at each level of trauma certification, but legislators have not approved any money to support hospitals and trauma physicians. "If there were funds mandated this would be a nonissue," said Shirley Martin, assistant administrator for patient care services at Providence Medford. "The surgeons would be compensated for their time." The Medford hospitals have asked state regulators for a variance to allow them to accept level 3 transfers. Officials could decide within several weeks to allow outlying hospitals to transfer patients to Providence and RVMC. The surgeons and the hospitals also have arranged to meet with a consultant to try to find a long-term solution. "Everybody's got their viewpoint and we haven't been able to straighten this out yet," said Gell, the medical staff director at both hospitals. "The bottom line is both surgeons and hospitals want a solution to this problem," said Meyerding, the trauma surgeon. In the meantime, both hospitals will continue to provide emergency care that essentially meets level 2 standards "about 98 percent of the time," Meyerding said. "Each hospital is level 3 and that's where it stands now. In reality, the care that's delivered to local residents is often level 2. We don't have the capacity to accept patients from outside at that level and also provide that level of care for our community. "We need help to meet this unfunded mandate." Reach reporter Bill Kettler at 776-4492, or e-mail [email protected] Mail Tribune Home | Ottaway Newspapers, Inc. | Dow Jones & Co., Inc. | Privacy | Contact Us Copyright � 2001 Mail Tribune, Inc.