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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Where have all the doctors gone? Many have been chased out by the higher cost of practicing medicine in the state.


“My medical malpractice insurance premiums doubled from $25,000 to $50,000 over the past three years, without a single suit,” says cardiologist Raymond Itagaki, Queen’s vice chief of staff. “In 25 years, I’ve had three lawsuits, all thrown out. But my insurance keeps rising. But unlike other products or services, I can’t charge any more for what I do, because fees are regulated by the state.”

Doctors blame medical malpractice lawsuits for the steep insurance hikes. Liability insurers cover not only the cost of jury awards and settlements, which can run in the millions, but also the cost of defending physicians and hospitals. Trial attorneys, however, blame insurance companies for unnecessarily bleeding doctors with seemingly exorbitant premiums.

Hawaii physicians worry about another kind of insurance, too—patients’ health insurance, or lack thereof. That’s because emergency rooms often serve uninsured patients or those only partly covered by Medicare and Medicaid programs. Doctors, therefore, are much less likely to get paid for their emergency services than for the patients they see in their regular practices.

“Even though the Queen’s trauma center is the busiest in the state, we won’t turn anyone away, regardless of their ability to pay or what kind of insurance they have,” says Dr. Richard Friedman, Queen’s vice president of medical affairs. “We can’t turn anyone away.”

Doctors opt out of emergency cases for personal reasons, too. They know what it’s like to pull all-nighters in the ER, only to have to see full slates of their regular patients the next day. Younger doctors, especially those with families, seem less willing to work the kinds of hours their predecessors have.

“When you’re on call, you don’t have a life,” says Itagaki, who, at his busiest, responded to emergency calls about two nights a week. “It’s an imposition—you can’t travel, you can’t even have a glass of wine.”

No matter what the reason, the cost of handling medical emergencies in Hawaii is pushing our local hospitals into a crisis. And because of the nature of the work performed by Queen’s trauma center, its plight demands the most immediate attention.

Historically, doctors volunteered to take emergency calls. But emergency-staff shortages have forced hospitals to pay physicians stipends of about $1,000 per night to do so. That’s on top of the fees the physicians charge for their services, if they are actually called in to an emergency.

“Doctors have traditionally taken emergency calls for free out of a sense of duty, to provide services to the public,” says Paula Arcena, executive director of the Hawaii Medical Association. “But now there are more disincentives than incentives for them to be on call. Doctors are at a point where they’ve absorbed as much of the blow as they can.”

The cost of paying for on-call services has taken a hefty toll on local hospitals. Queen’s spends more than $32 million on its trauma center each year, with losses of $4.6 million. Earlier this year, Queen’s asked for an emergency $6.9 million appropriation from the state Legislature to help cover those costs—the first time it had ever done so.

North Hawaii Community Hos-pital on the Big Island now spends nearly $1 million annually to cover stipends for on-call doctors—an exp-ense it didn’t have to pay just four years ago. Like many Big Island hospitals, North Hawaii often doesn’t

have orthopedic surgeons on call during weekends and holidays. In those cases, the hospital must send patients with even minor fractures to Queen’s, further straining the overburdened trauma center.

“If there are no orthopedic surgeons available on the island, we have no other place to send them but Queen’s, because they have to be cared for,” says North Hawaii’s CEO, Stan Berry. “But by commissioning a helicopter, I may have just doubled the cost of caring for a broken hip versus taking care of the patient here. The families are incredulous. They don’t understand why there’s no doctor here to take care of the patient.”

Honolulu residents could end up going without doctors, too. If you think it can’t happen here, consider Las Vegas, whose only trauma center shut down for 10 days in 2002, when its remaining doctors walked out. In Florida, more than half of the state’s original 50 trauma centers have closed in recent years, jeopardizing emergency care in the state’s rural areas. Florida reports the highest medical liability in the nation, with even its OB/GYNs paying an average of $143,000 to $203,000 in insurance premiums annually.

This year, Hawaii’s Legislature is taking a hard look at proposals to curb the financial burden on local hospitals and doctors. Last month, local doctors turned out in force to testify in favor for a tort-reform bill, which they insist will keep their liability premiums down. The bill is modeled after a California law enacted in the late ’70s—capping noneconomic damages in medical malpractice lawsuits to $250,000; ensuring that the bulk of the awards or settlements go to plaintiffs, not their attorneys; and placing a three-year statute of limitations on filing medical lawsuits.

Local hospitals continue to look for more funding sources for on-call services and to spread out the trauma caseload among hospitals, hopefully easing the burden on Queen’s. Your life could depend on what kind of solutions Hawaii comes up with.

“Any one of us could get into a trauma situation, getting into a car accident or having a serious fall,” Friedman says. “If we didn’t have a trauma center here in Hawaii, we’d really be in trouble. It’s not just a physicians’ or hospitals’ problem. This crisis is scary, because it affects all of us in Hawaii.”


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