- The Washington Times - Sunday, July 7, 2002

The closure of Las Vegas' only Level-I trauma center this week is believed to be the nation's first in an urban area of more than 1 million residents and one of the first caused by an inability of doctors to find affordable medical liability insurance.
But no one rules out the possibility that sharply rising insurance rates could become a factor in more such shutdowns of trauma facilities, which provide rapid treatment for critical injuries when timely care can make the difference between life and death.
"In some single-hospital communities, the liability crisis could push some" trauma centers or other units where risks are considered greater "to the edge," Rick Wade, senior vice president of the American Hospital Association, said in an interview.
"Trauma centers usually close because they are small and have financial competition," said Dr. John Fildes, medical director of the 10-year-old trauma unit at the University of Nevada Medical Center (UMC) in Las Vegas, reportedly one of the 10 busiest in the United States, which closed for business at 7 a.m. Wednesday.
"But we were forced to close" as a result of mass resignations of physicians from "high-risk" activities because they've been unable to find medical malpractice insurance they can afford, Dr. Fildes said in a telephone interview. He said the physicians concluded this drastic step was necessary to "protect their livelihoods and their families."
"Everyone has been charged two to three times higher rates" this year than last, he added.
As a result, 11 of UMC's 13 general trauma surgeons and 57 of 58 orthopedic surgeons resigned from trauma-care responsibilities.
The impact of the closure is certain to be felt in a resort city that has 1.4 million residents, attracts 36 million visitors per year, and serves a 10,000-square mile area in four states Nevada, California, Arizona and Utah, according to Dr. Fildes.
A Level-1 trauma center has an array of specialists, such as neurosurgeons, spinal surgeons and orthopedic surgeons on duty at all times to fly into action in situations such as vehicle crashes, shootings or stabbings, or diving accidents. Trauma care is designed to provide life-saving treatment during the so-called "golden hour," or the first 60 minutes after an injury.
The American Medical Association said it is "greatly concerned" about the closure of the trauma unit in Las Vegas. "With the nearest trauma center now one hour and 20 minutes away by air and more than five hours by car 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," the AMA said in a statement.
Dr. Donald Palmisano, the AMA's president-elect, noted that the "chances of survival decrease precipitously" after the "golden hour," because a patient can then go into shock. "There is simply no substitute for trauma care for our most severely injured patients," he said.
Dr. Fildes agreed. He said he foresees more deaths as a result of the shutdown of the Las Vegas trauma center. "It's unrealistic to think we can have beneficial effects by transporting [a critically injured patient] an hour or so out-of-state," he said.
Cheryl Persinger, spokeswoman for UMC in Las Vegas, said the hospital has a liability cap of $50,000. Meanwhile, specialists in fields considered among the most risky, such as obstetrics and neurosurgery, pay $150,000 to $175,000 yearly for malpractice insurance.
Said Dr. Fildes: "Doctors cannot buy" medical liability coverage of "over $1 million, yet the average settlement [in the Las Vegas area] has been over $1 million for the past seven years. Doctors become personally liable."
He explained that the medical liability crisis in Nevada came to a head when the insurer, St. Paul, pulled out of the liability market. Dr. Fildes said that "left 60 percent of physicians uninsured" and sent them scrambling to find other coverage at far higher rates than they had previously paid.
To rectify the situation, the doctors want Nevada to enact medical liability insurance reform with a cap on damages that juries can award. They are facing strong opposition from the Nevada Trial Lawyers Association.
Nevada's Gov. Kenny Guinn has given physicians, insurers and trial lawyers until July 26 to try and solve the problems. If they fail, Mr. Guinn will come up with his own strategy and may call a special session of the state legislature next month to consider it, his spokesman, Brian Catlett, said.

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