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Crisis in the Trauma Center

The trauma center at Queen’s saves hundreds of lives every year. What happens if it closes?

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Most of us expect that, if we get seriously hurt, we’ll be taken care of. Listen to the news enough, and you notice that most victims in major car crashes are either “rushed to Queen’s” or “medevacced to Queen’s.” Last year alone, The Queen’s Medical Center received about 45,000 people in its emergency room, 1,500 of whom were trauma patients—those who suffered life-threatening injuries due to collisions, falls or violence.


Concerned in the Trauma Center: Queen’s emergency
room physician Lily Gallagher and cardiologist Raymond
Itagaki, vice chief of staff.

 

These are people like Irma May Baptiste. In 1998, she was driving through an intersection in Kaneohe when another driver ran a red light at 80 miles per hour, broadsiding her car.

Emergency technicians pulled Baptiste from the wreck and transported her to Queen’s trauma center. Baptiste’s back was broken in three places, one of her hips in two. One of her kidneys had to be removed. Her liver had to be stitched back together. In the process, Baptiste needed eight blood transfusions.

“I was in a coma for five days, and my mom was told that I might not make it,” says Baptiste, now 28. But she did. After a month-long hospital stay and a year of intense physical therapy, Baptiste fully recovered. “If it weren’t for Queen’s trauma center,” Baptiste says, “my accident could have been devastating.”

As the leading trauma center in the state, Queen’s treats practically all of Hawaii’s major trauma patients, including many transferred from other hospitals on Oahu and the Neighbor Islands. But for all its importance to the people of Hawaii, Queen’s is facing an alarming shortage of doctors in its trauma center. For financial and personal reasons, fewer and fewer physicians are willing to take emergency patients, crippling the hospital’s ability to care for critically injured patients in the Islands.

As the only trauma center in Hawaii certified by the American College of Surgeons, Queen’s must have surgeons, an anesthesiologist and various medical staff in-house 24 hours a day, as well as keep doctors in at least 15 other specialties on call at all times, ready to respond at a moment’s notice.

With each passing year, Queen’s is having a tougher time providing that safety net. Neurosurgeons, for example, perform one of the most crucial aspects of trauma care, but there are only four neurosurgeons at Queen’s willing to take emergency calls—down from eight just a few years ago.

“The four neurosurgeons, including myself, take calls five days a month, more or less, but that means there are some days when there are no neurosurgeons on call,” says chief of neurosurgery Michon Morita. “There were five days in January when there was no neurosurgeon on call. There was one day in February. Up until the past six months, that hadn’t happened in 10 years.”

What does that mean for patients who arrive in the ER in need of neurosurgery? They have to wait. That can mean crucial minutes lost when a patient needs immediate attention. And it isn’t just neurosurgeons in short supply. Queen’s Trauma Center struggles to find specialists such as gastroenterologists and anesthesiologists to respond to emergencies.

“The ER doctor will start calling neurosurgeons around town, and we’ll eventually find one,” Morita says. “But it’s uncomfortable to not have someone on call who has already cleared his schedule and promised to be available.”

Where have all the doctors gone? Many have been chased out by the higher cost of practicing medicine in the state, thanks to ever-increasing medical liability insurance premiums. These days, more doctors prefer to avoid emergency cases, in which the chances of lawsuits are higher.

“Hawaii is heading toward a crisis,” says former Hawaii health director Dr. Jack Lewin, who now serves as CEO and executive vice president of the California Medical Association. “The first places that high insurance premiums affect are emergency and on-call services. It’s those doctors who take the riskiest cases that have the highest malpractice premiums.”

Medical Insurance Exchange of California (MIEC), the largest of only three medical liability insurers in the state, raised its rates an average of 17.4 percent last year and an average of 26.2 percent the year prior, according to the state insurance commission. Another insurer, The Doctors Company, increased premiums an average of 26.9 percent last year and an average of 28 percent in 2003.

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,March

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