Sidebar: Not Enough Care to go Around
While cutting tile last year, Jake Bleed sawed through the bone of his ring finger. The 31-year-old resident of North Little Rock, Arkansas, waited for about six hours at nearby Baptist Health Medical Center while the medical staff there called all over town—and ultimately as far away as Dallas and Memphis—to find a hand surgeon to reattach his finger. Finally, a willing surgeon was located in Louisville, Kentucky. But even though Bleed had insurance, he would have to hire a private plane to get himself there, at a cost of $4,300. In the end, he charged the cost to two credit cards, and his finger was saved. His insurer eventually reimbursed him for the cost of the plane, but his plight highlights the fact that trauma care in the United States is not only geographically arbitrary, but in many places, nonexistent. Only eight states—New York, New Jersey, Maryland, Illinois, New Mexico, California, Oregon, and Washington—have fully functional, regionally coordinated trauma systems. The remaining states have partial systems, and 12—including Arkansas—have no trauma system at all.
Although President Bush has signed a bill authorizing $12 million to states for the purpose of bolstering trauma care systems, many on Capitol Hill are reluctant to set aside federal funds for a service they think should be paid for by states, says Wayne Meredith, medical director for trauma programs at the American College of Surgeons. Meanwhile, numerous state legislatures have also failed to find the dollars to support trauma systems. To aggravate matters, emergency care services are heavily utilized by the uninsured, placing a huge financial burden on the medical centers that serve them.
For the same reason, doctors, too, often go unpaid and are opting out of performing emergency care, worsening critical shortages of neurosurgeons, orthopedists, and hand surgeons—the very types of specialists Bleed needed at short notice.
Funding a trauma system doesn’t take much. A half-penny sales tax in Miami-Dade County underwrites its outstanding system. In Arkansas alone, says J. Michael Gruenwald, a surgeon on the Arkansas governor’s advisory council on trauma, it is estimated that a well-funded trauma system would prevent 200 to 600 deaths each year. If deficiencies were plugged across the nation, experts say, many thousands of lives each year could be saved. “You don’t get much better return on your investment than that,” Meredith says.
