- The Washington Times - Thursday, July 11, 2002

Last week's closure of Las Vegas' only Level-I trauma center is a development fraught with troubling implications for Americans' future access to basic medical care and the ability to provide emergency medical services to casualties of a terrorist attack. It is also becoming case study No. 1 of the need for state governments around the country to embrace tort reform.

The facts are as follows: The Level-I trauma care facility at the University of Nevada Medical Center (UMC) in Las Vegas, one of the 10 busiest in the country, shut down July 3 following the mass resignation of trauma and orthopedic surgeons. A Level-I trauma center is staffed around the clock with a variety of specialists to provide emergency care to seriously injured patients, including the victims of car accidents, stabbings and terrorist attacks.

"With the nearest trauma center now one hour and 20 minutes away by air and more than five hours by car," the American Medical Association said, "the closure jeopardizes the cures of thousands of Las Vegas residents and vacationers, and puts added burden on local emergency rooms, which may not be able to provide optimal trauma care." Thus far, two individuals have died from trauma injuries resulting from traffic accidents in the area since the UMC closing. While police and hospital officials have declined to speculate whether those lives could have been saved if the trauma center had remained open, the adult daughters of one of the victims have questioned whether their father's death was preventable.

Dr. John Nowins, president of the Clark County OB/GYN Society, which serves the Las Vegas metropolitan area, told The Washington Times that local police and firefighters who are his patients say that, as a result of the UMC closure and a larger insurance crisis plaguing the state, Las Vegas is "totally unprepared" to face a terrorist attack.

The UMC surgeons resigned because they were unable to find liability insurance or were faced with skyrocketing insurance rates, some of which jumped from $40,000 to $200,000 a year. Dr. John Fildes, medical director of the UMC trauma center, said the insurance situation forced doctors to quit their jobs in order to "protect their livelihoods and their families."

Unfortunately, the UMC shutdown is but one illustration of how the worsening insurance situation is jeopardizing access to essential health care services, particularly in the Las Vegas area. On March 4, hundreds of Las Vegas doctors packed three rooms of a downtown office building for a hearing called by Gov. Kenny Guinn to discuss the insurance situation. "Officials with the 15 medical malpractice carriers licensed in the state said they were either pulling out of Nevada completely or using 'extreme caution' when underwriting new doctors," the Las Vegas Review-Journal reported. "Some officials said they would no longer insure any new obstetricians, surgeons, emergency-room physicians and other high-risk specialties." Others said they would consider underwriting new doctors in all specialties, but emphasized that they would be very particular about who they would insure.

"Since November, OB/GYNs have been quitting at a rate of one doctor per month because of excessive malpractice rates," Dr. Nowins of the Clark County OB/GYN Society testified at the March hearing. "We had 140 OB/GYNs. Based on our population of 1.5 million in [the Las Vegas metropolitan area], we cannot expect to adequately serve the health care needs of women in our community."

In an interview with The Times on Tuesday, Dr. Nowins said that, in addition to one or two OB/GYNs a month discontinuing their practices in the Las Vegas area, students at the University of Nevada Medical School are leaving the state as soon as they graduate. Dr. Nowins said he is concerned that a mass exodus of doctors could occur in the next few weeks, when their contracts come up for renewal and they find that new malpractice insurance is unavailable or unaffordable.

Mr. Guinn has indicated that he may call a special session of the General Assembly around July 26 for the purpose of tackling the insurance crisis. Nevada doctors' groups have launched a campaign to win public support for limits on attorneys' fees and a $250,000 limit on jury awards for pain and suffering. But Citizens for Justice, the political action committee representing the Nevada Trial Lawyers Association, is gearing up a campaign of its own to oppose any tort reform.

The fight seems to be gearing up along traditional political lines. Sen. John Ensign, Nevada Republican, has come out in favor of a reform proposal, and Mr. Guinn, a Republican, has indicated support for the idea. On the other hand, prominent Democrats are sounding defensive. Richard Perkins, the speaker of the Nevada Assembly, warned that the doctors' departures from the UMC trauma center constitute a strike, which could jeopardize public safety. In Washington, 10 House Democrats led by Reps. John Conyers, John Dingell and John LaFalce have called on the General Accounting Office to investigate the situation in Nevada and 10 other states where doctors are experiencing similar problems to see if insurance companies are the real villains.

One of the major purposes of the nearly $40 billion federal reorganization for homeland defense is to be able to limit death or injury in the aftermath of terrorist attacks. That goal will be defeated if the doctors and trauma centers are out of business. Nevada should promptly consider a wartime exemption for trauma centers from ordinary medical malpractice law.

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