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The Nation

Vegas' Only Trauma Unit to Close Today

Health: Fifty-seven of 58 surgeons have quit, entirely shuttering the hospital's center. Doctors cite exposure to costly malpractice insurance lawsuits.

July 03, 2002|TOM GORMAN | TIMES STAFF WRITER

LAS VEGAS -- The only trauma center serving this city of 1.4 million residents--and an expected holiday weekend influx of a quarter-million visitors--will close at 7 a.m. today for lack of doctors.

All but one of the 58 trauma-trained orthopedic surgeons serving the county-operated University Medical Center have quit, citing exposure to costly medical malpractice lawsuits.

With their departure, the hospital was forced to close its trauma center altogether, making other specialists--including vascular, thoracic, plastic and other surgeons--unavailable as well, administrators said.

Seriously injured victims of car and boating accidents, shootings and other life-threatening incidents will be taken to local emergency rooms, which provide reduced levels of care.

Once stabilized, those patients may be airlifted to the Loma Linda University Medical Center in San Bernardino County or trauma centers in Salt Lake City, Phoenix or elsewhere in Southern California, officials said.

The 10-year-old University Medical Center trauma unit served not only patients in southern Nevada, but those from Needles and Barstow, Calif., to the injured in southern Utah and northern Arizona. The center saw more than 11,000 patients a year and claimed to be among the 10 busiest in the country.

Trauma care was introduced nationwide in the late 1960s to address the "golden hour"--the initial 60 minutes after a serious injury when appropriate and timely treatment can mean the difference between life and death.

"Most communities--certainly with populations of a million or greater--have at least one trauma center," said Dr. David Hoyt, medical director of trauma at the American College of Surgeons, which sets trauma center standards.

While trauma centers in some cities have closed because of various financial pressures, never before has a city this size lost its only one, Hoyt said.

"This is a tragedy to our community's public health, the darkest day I can recall," said Dr. John Fildes, the Las Vegas trauma center's medical director. "Closing the trauma center means the standard of care that our community has come to rely on is going to be turned back 20 years."

Erin Kenny, a Clark County commissioner who heads the hospital's board of directors, said she was more disappointed than angry at the doctors, calling their actions tantamount to a protest strike over escalating malpractice insurance premiums.

"I wouldn't want to be the doctor who has to look into the eyes of a family whose loved one was killed because there was no trauma center," she said. "That will be devastating, and I'm fearful it will become a reality in very short order."

The closing was precipitated by sharply rising costs of malpractice insurance in southern Nevada.

According to the Nevada State Medical Assn., about 140 physicians in Clark County--about 10% of the region's doctors--have quit or retired since February or are threatening to do so because insurance premiums have doubled or more this year.

Because trauma doctors are independent and separately insured contractors at the center, they are targeted as "deep pockets" by litigious patients because lawsuits against publicly run University Medical Center and its medical school physicians are capped at $50,000, said Dr. Anthony B. Serfustini, chief of the trauma center's orthopedics department.

"If a patient wakes up as a quadriplegic through no fault of mine, and after they settle with UMC and a medical school physician and the anesthesiologist for $50,000 each, they'll then go after me for another $5 million," he said. "They'll take my house, my '81 Toyota Land Cruiser, my savings, my kids' college tuition fund. They'll take it all."

Doctors here want the type of tort reform embraced by California in 1975, which among other things limits jury awards to $250,000 for malpractice pain and suffering.

In April, Nevada established its own, state-operated insurance company to make available less expensive liability insurance, especially for obstetricians. Officials are hoping to expand coverage for other, high-risk specialties.

"Long-term, lasting solutions ... will require legislative action," said Gov. Kenny Guinn, who plans to call a special legislative session to address the problem.

In the meantime, local emergency rooms are preparing for more--and harder--work.

At Sunrise Hospital and Medical Center and Sunrise Children's Hospital, the emergency room has been fortified with extra X-ray equipment and a blood bank; two surgery rooms also have been set aside for trauma cases, spokeswoman Ann Lynch said.

Still, trauma specialists--including those who had worked at University Medical Center but also have privileges at her hospitals--will not staff the emergency room around the clock, she said.

"You won't be getting the trauma team that flies into action when the ambulance hits the door," she said. "Many of our staff haven't been in trauma service for years, and they're doing their best in a few days to brush up and get ready.

"No emergency room will meet the standard of care that the trauma center did," she said. "There's just no way, and we realize that."

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