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Hospital offers contracts to trauma doctors

August 22, 2002|by LAURA ERNDE

laurae@herald-mail.com

Washington County Hospital has offered labor contracts to surgeons in an effort to reopen the trauma center, hospital President and CEO James Hamill said Wednesday.

"We're a lot closer than we were before, but we're not there yet," Hamill said during a meeting of state lawmakers and trauma experts held in Annapolis.

The hospital closed the trauma center June 1, saying there were not able to cover all of the shifts with surgeons. Since then, the two groups have been trying to resolve complex issues of compensation and staffing that led to the crisis, he said.

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If enough surgeons sign contracts, the trauma center would reopen as a Level III center, which would require a surgeon to be on call and able to get to the hospital within 30 minutes, he said. Since 1998, the center had been certified as a Level II trauma center, a higher level that required surgeons to be at the hospital around-the-clock.

Washington County's trauma center crisis was a flash point for the statewide problem of doctors not getting compensated for providing trauma care, said House Speaker Casper R. Taylor Jr., D-Allegany.

Taylor organized Wednesday's meeting to explore how the state could help Washington County's trauma center reopen as well as fix similar problems boiling under the surface at other trauma centers.

Lawmakers, hospital administrators and statewide trauma experts attended. Surgeons were invited, but told Taylor they could not attend on such short notice. The meeting was called a week ago.

Toward the end of the two-hour meeting, Taylor said he was confident that Washington County's problem would be solved without state intervention. He asked doctors to be patient until the underlying issues can be addressed during the next legislative session in January.

Statewide, trauma doctors do not get reimbursed for taking care of patients who don't have health insurance. At Washington County Hospital, about 20 percent of trauma patients are uninsured.

Doctors used to make up their losses through reimbursements they received from treating insured patients, said Jay Schwartz, a lobbyist for MedChi - The Maryland State Medical Society - who attended Wednesday's meeting. But insurance companies have cut payments in recent years, he said.

At the same time, trauma doctors - who already have to pay higher malpractice insurance rates because of the inherently risky cases they handle - have seen their rates increase, said John Ashworth, director of the University of Maryland Shock Trauma Center.

Surgeons also have to sacrifice time away from their more lucrative private practices to be on call for trauma cases, Ashworth said.

Those dynamics are evident at all the state's trauma centers, said John Spearman, chairman of the Maryland Trauma Center Network.

"Many doctors say, 'as much as I love trauma my practice can't take it any more,'" he said.

In Washington County, another issue has been the relatively small pool of trauma doctors available to cover round-the-clock shifts.

Stepping down to a Level III trauma center would allow burned-out doctors to spend more time with their families, said Deb Addo, vice president for patient care.

But it will be an adjustment for some of the specialized surgeons, such as neurosurgeons, who previously were called only when their specialized services were needed. Under a Level III certification, they will be on call for general trauma cases, Addo said.

The hospital is now willing to pay all the surgeons for being on call. Previously, only the in-house surgeons were paid, she said.

Addo said the hospital is hoping surgeons will give their feedback on the proposed contracts by Monday.

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