Trauma Care in a Crisis

When I was 16, I saw someone die for the first time.

He was a junkie who had crawled, literally, into the emergency room of Capitol Hill Hospital after suffering multiple stab wounds while tripping out on LSD. He had no wallet, no insurance and no chance. He did, however, have an unregistered handgun.

I watched as the ER staff gathered around him, wielding scalpels, needles and spare blood. I watched as they hooked him up to a bunch of machines I didn't understand, and I watched when he died four hours later. His body was covered, his toe was tagged and his medical bill was mailed to the hospital accounting office.

John Doe didn't get a funeral, but he did get a paragraph in the next morning's Washington Post story about the day's murders. John Doe's was one of five murders that day in Washington: One from an armed robbery, one from domestic abuse and three from drug-related violence.

In Washington, D.C., more than half of all trauma center patients are admitted with gunshot or stab wounds. At D.C. General Hospital, nearly 60 percent of emergency room patients have been shot or stabbed. Most of these wounds come from drug-related violence. And most of these patients cannot pay their medical bills.

Last year, I read in my volunteer newsletter for Capital Hill Hospital that that the emergency room had gone out of business and closed down for good. "Who ever heard of an emergency room going out of business? They have plenty of customers," I thought.

More than plenty.

In inner-city hospitals everywhere, the number of homeless men and women who check into emergency rooms and trauma centers rises dramatically on cold, rainy days. Destitute AIDS patients come to emergency rooms to die, and pregnant mothers in labor, with no prenatal care and no insurance, arrive when it's too late to turn them away.

When uninsured patients can't afford primary care for routine maladies, they turn into emergency maladies and needlessly fill emergency room beds for longer than they should. Emergency rooms have become the last resort.

The number of uninsured patients showing up at emergency room and trauma center doors is driving hospitals to close them down at an alarming rate. A hospital can be reimbursed by the government for as little as 3 percent of a patient bill, which means a loss of $194,000 on a $200,000 bill. An urban emergency room may handle more than 200 patients in a 12-hour shift. Many hospital emergency rooms have been shut down in the past several years. In Los Angeles County, a recent study showed, almost half of hospital emergency rooms have closed in recent years.

Once again, medicine is being asked to solve all society's problems.

The emergency room is supposed to be the place you go when you break a leg, cut your hand or have a dangerously high fever. The trauma center is designed for ultra-emergencies such as car accidents or head injuries--only the most life-threatening cases. Neither is meant to deliver babies or shelter the homeless. And neither can afford to put drug dealers and gang members back on the streets, only to lose another $100,000 the next time someone shoots them.

Like inner-city elementary school teachers who regularly feed and dress neglected children, emergency room doctors and nurses are being asked to shoulder society's problems with fewer resources than ever. And while most politicians and taxpayers would insist on the hospital's moral obligation to treat all emergency cases that come its way, nobody is willing to help pay for it.

Recent studies scream loudly about the trauma care crisis and call for congressional action. The less that politicians are willing to compromise and the less that the American taxpayers are willing to pay taxes to solve the problems of drugs, AIDS, homelessness, handgun control and poverty, the more emergency rooms are going to close down.

Even if Congress and the president did compromise on national healthcare, legislation alone could not solve these problems, unless it could win the war on drugs, end handgun use, wipe out the health problems of the poor, eliminate homelessness, find a cure for AIDS, and end alcoholism. Fat chance.

Legislation is not going to work especially because Congress won't have the guts to infuriate the public, and the public won't make any sacrifices until we reach a true crisis point. (Or until some senator's daughter dies after she is turned away from an over-crowded emergency room.)

A few members of Congress--all from urban districts--have given the issue enough thought to come up with a handful of proposals. Most of these proposed solutions involved pumping millions of dollars into the system: Rep. Dante Fascell (D--Fla.) suggested channelling seied drug dealers' assets into trauma care; Democratic Rep. Henry Waxman's bill would give financial help to hospitals in the cities with the worst drug-related violence.

Some state governments have at least tried to dream up creative ways to raise money for emergency care: Maryland added $2 onto every $10 traffic ticket; California made a one-time $10 increase in driver registration fees.

But while a money transfusion may tide these hospitals over until next year's gang warfare season, it will not even come close to solving the problems. For hospitals to keep taking emergency cases, the public has to start addressing a host of social ills it has ignored all-too-conveniently in the past.