HOUSE OF REPRESENTATIVES

H.C.R. NO.

229

TWENTY-THIRD LEGISLATURE, 2005

H.D. 1

STATE OF HAWAII

  
   

HOUSE CONCURRENT

RESOLUTION

 

REQUESTING THE DEPARTMENT OF HEALTH TO EVALUATE THE IMPACT OF THE PHYSICIAN "ON-CALL" CRISIS ON THE QUEEN'S MEDICAL CENTER TRAUMA CENTER'S ABILITY TO PROVIDE EMERGENCY MEDICAL SERVICES IN THE STATE OF HAWAII AND TO RECOMMEND APPROPRIATE PRIVATE SECTOR AND GOVERNMENT RESPONSES TO THE "ON-CALL" CRISIS TO ENSURE CONTINUED ACCESS TO TRAUMA LEVEL CARE.

 

 

WHEREAS, a trauma center for treating life-threatening injury is essential to the health and well-being of our community; and

WHEREAS, The Queen's Medical Center operates the only trauma center in the State of Hawaii with a Level II Trauma Center designation from the American College of Surgeons; and

WHEREAS, several hospitals across the State provide emergency medical services at their facilities; and

WHEREAS, the federally-mandated Emergency Medical Treatment and Labor Act requires that hospitals medically screen patients that come to an emergency department to determine if an emergency medical condition exists, and if so, to stabilize the patient; and

WHEREAS, the Emergency Medical Treatment and Labor Act allows the transfer of a patient to another hospital after all possible stabilizing efforts have been made, if the patient's condition requires a "higher level of care" not available at the original hospital; and

WHEREAS, while many hospitals across the State rely on physicians to be on-call to address the emergency medical needs of patients who come into the emergency room, the need for specialists to be on-call at The Queen's Medical Center is particularly acute because of the demands required to maintain the Trauma Center; and

WHEREAS, the specialists that are needed to meet the trauma and emergency medical needs of the State include, among others, neurosurgeons, orthopedic surgeons, hand surgeons, plastic and reconstructive surgeons, and general trauma surgeons; and

WHEREAS, several factors have had a negative impact on the availability of physicians to be on-call for emergency services and trauma care, including a negative effect on the physician's private practice and the physician's personal quality of life, uncompensated care, low reimbursement rates, and liability and medical malpractice concerns; and

WHEREAS, the reduction in the number of physician specialists willing and available to be on-call has created a crisis for emergency departments at hospitals across the State of Hawaii and across the nation; and

WHEREAS, increasingly, hospitals across the nation are looking to government for assistance in addressing this crisis; and

WHEREAS, the Healthcare Association of Hawaii is currently involved in discussions and efforts to address this crisis; now, therefore,

BE IT RESOLVED by the House of Representatives of the Twenty-third Legislature of the State of Hawaii, Regular Session of 2005, the Senate concurring, that the Department of Health, possibly through inclusion as a function of the State Health Planning and Development Agency, is requested to conduct a study to evaluate the impact of the physician on-call crisis on the ability of The Queen's Medical Center Trauma Center to provide emergency medical services in the State of Hawaii and to recommend any appropriate government and private sector actions in response; and

BE IT FURTHER RESOLVED that, due to the complexity of this issue and the desire to expedite implementation of any potential solutions so that patient care is not compromised, the Department of Health is requested to conduct the study in two parts:

(1) Part I to address the impact of the on-call crisis on the Trauma Center and the role of the Trauma Center in the emergency medical services system that exists for the State; and

(2) Part II to address the impact of the on-call crisis on the provision of non-trauma emergency medical services and to the patient transfer process that occurs when patients are in need of a higher level of care; and

BE IT FURTHER RESOLVED that the Department of Health is further requested to include, in particular, an analysis of the pertinent issues including:

Part I

(1) A description of the on-call issue and its impact on the Level II Trauma Center;

(2) Identification of the factors that have contributed to the on-call issue becoming a crisis;

(3) The experience and response of other states and cities facing a similar crisis;

(4) The response of The Queen's Medical Center to address this crisis and keep the Trauma Center operational; and

(5) The role of the Trauma Center in the State Comprehensive Emergency Medical Services System; and

Part II

(1) A description of the impact, if any, of the on-call crisis on the delivery of non-trauma emergency medical services at select hospitals across the State including neighbor island hospitals; and

(2) An analysis of how the decision to transfer patients is made, including a description of the transfer process, and recommendations to improve this process, if any, to enhance patient outcomes; and

BE IT FURTHER RESOLVED that the Department of Health is also requested to identify and analyze any appropriate government response to the on-call crisis including:

(1) Options to address trauma/emergency department medical services that go uncompensated;

(2) Options to address liability concerns faced by on-call physicians;

(3) An analysis that looks at the pros and cons of mandating that physicians "take call" in order to:

(A) Obtain or maintain a license to practice medicine in the State of Hawaii; or

(B) Receive privileges to admit patients to a hospital located in the State of Hawaii; and

BE IT FURTHER RESOLVED that the Department of Health is requested to interview and seek the input of as many stakeholders as possible, including:

(1) The John A. Burns School of Medicine;

(2) The Hawaii Health Systems Corporation;

(3) The Healthcare Association of Hawaii;

(4) The Queen's Medical Center/The Queen's Health Systems;

(5) Kaiser Permanente;

(6) Hawaii Pacific Health;

(7) Emergency medical service providers at the county level;

(8) Medical malpractice insurance providers;

(9) The Hawaii Medical Services Association; and

(10) The Hawaii Medical Association; and

BE IT FURTHER RESOLVED that the Department of Health is requested to report findings and recommendations, including any necessary proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2006; and

BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Health and the President and Chief Executive Officer of The Queen's Medical Center.

Report Title:

Queens Med. Center; Trauma Center; DOH Study On-Call Crisis