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Trauma crisis: Missed cues

September 02, 2002|by LAURA ERNDE

laurae@herald-mail.com

When Washington County Hospital offered labor contracts to its three neurosurgeons earlier this month, they mailed the documents to the wrong office.

It turned out to be a minor glitch in the effort to reopen the hospital's trauma center, because the contracts were ultimately hand-delivered.

But it demonstrates the kind of persistent miscommunication between administrators and surgeons that led to the trauma center's closing June 1.

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Neither surgeons nor hospital administrators interviewed for this story wanted to cast blame for the closing. They say that would only have the potential to set back negotiations that are moving toward reopening the trauma center.

Surgeons agreed to talk on the condition their names not be used.

The facts surrounding the closing suggest that misunderstandings and personality conflicts played a large role in the shutdown.

Signs of trouble began more than a year ago when some surgeons approached the hospital's new president and chief executive officer, James Hamill, with concerns about understaffing and compensation.

Long hours spent handling trauma cases and dealing with busy private practices were taking a toll on their personal lives, surgeons said.

Hamill said doctors nationwide have been getting financially squeezed as their expenses keep going up and their Medicaid and private insurance reimbursements keep decreasing.

In response, Hamill said the hospital agreed to increase their pay from $65 an hour to $100 an hour to staff the trauma center 24 hours a day.

Trauma surgeons say they had other overriding issues - such as the need for more operating room technicians and priority in scheduling operating room time immediately before and after their trauma shifts - which were never addressed by hospital officials.

Hamill started the process of recruiting other surgeons, thinking that would help alleviate the pressure of round-the-clock shifts. But it only frustrated the surgeons, who said they felt Hamill - who has no medical background - was acting without their consultation.

Hard feelings

Around April, the three neurosurgeons asked to take a break from the hectic pace that some felt might compromise their ability to do their job safely. In response, neurosurgeons say they got a letter from a hospital attorney threatening to report them to state and federal agencies if they didn't keep working.

The letter upset the neurosurgeons, who had been offering their specialized services at no cost to the hospital. Trauma surgeons took the side of their colleagues.

In May, in an effort to get the administration to resolve the problems, the general surgeons submitted a schedule that left shifts uncovered. Although surgeons say they had a contingency plan, hospital administrators said they had to take the schedule seriously.

Surgeons said they offered a solution that would have kept the trauma center open while talks continued. They suggested downgrading the trauma center from Level II to Level III, allowing surgeons to be on call instead of in-house 24 hours a day. They say they were also willing to take a pay cut so the neurosurgeons could be compensated.

Hamill, however, said he never saw a formal offer and tried unsuccessfully to meet with doctors before he felt he had no choice but to close the trauma center.

Closing the trauma center created even more hard feelings on the part of the surgeons.

The two sides never met for face-to-face talks until about six weeks after the trauma center closed.

Meanwhile, the hospital organized a task force made up of community members and hospital officials to try to reopen the trauma center.

In July, the hospital brought in an independent panel made up of statewide trauma experts to offer suggestions. After two months, little or no progress was being made on reopening the trauma center.

Back in spotlight

Then a serious accident at the Mason-Dixon Dragway in early August turned the spotlight back onto the issue.

On Aug. 2, a Glen Burnie, Md., man was critically injured when he fell off his all-terrain vehicle at the U.S. 40 dragway, which is eight miles from the hospital. It took 90 minutes for Justin Fishell to reach the University of Maryland Shock Trauma Center.

Although Washington County Hospital's emergency room offered to stabilize the patient, there was some confusion and the ambulance crew decided to treat him in the field until a medevac helicopter could get there.

Fishell, 25, survived and was released to a rehabilitation program last week.

A week later, Maryland State Police Superintendent Col. David Mitchell wrote a scathing letter to the editor published in The Herald-Mail accusing doctors of shirking their duty to the community.

"The doctors of the Washington County Hospital Trauma Center should review their Hippocratic oath. The people of Western Maryland deserve better," Mitchell wrote.

Both administrators and surgeons said Mitchell's uninformed opinion only served to aggravate the sensitive negotiations.

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