Establishes matching funds to maintain the Queen's Medical Center trauma care center. Makes an appropriation.

A BILL FOR AN ACT

SECTION 1. The legislature recognizes that trauma care is a public health priority and that it is in a state of crisis in Hawaii.

The legislature further finds that trauma centers are vitally important. A trauma center is different from other hospitals because it guarantees immediate availability of specialized surgeons, anesthesiologists, other physician specialists, nurses, and resuscitation life support equipment twenty-four hours a day, seven days a week. The emergency departments of hospitals that are not designated trauma centers are staffed by an emergency physician day and night, but they are not specialized to handle the most severe, life threatening situations. Highly skilled, quick, and intensive intervention within the early period of trauma may mean the difference between life and death.

The American College of Surgeons (ACS) noted in its Trauma System Consultation report that Hawaii’s extreme isolation and limited re-supply capability renders Hawaii uniquely vulnerable to natural disasters that may occur in a mid-Pacific environment.

Injury in the state of Hawaii is the leading cause of death for persons between the ages of 1 to 44. This is a higher rate of mortality than deaths caused by cancer and heart disease combined. This large disparity in the mortality rate underscores the seriousness of traumatic injury as a public health problem in the state. When injuries are serious, the specialized equipment and prompt access to physicians available in trauma centers can make a significant difference in the patient’s health outcome. Trauma centers have been shown to reduce preventable deaths by more than twenty per cent as compared to other hospital care.

The Queen’s Medical Center (Queen’s) has long been recognized as a statewide destination hospital for critically ill or injured patients. Over the past twenty years, Queen’s has worked to become a verified ACS Level II trauma center. Today, Queen’s is the only recognized trauma center in Hawaii.

As the single definitive trauma care medical center, Queen’s provides care for the vast majority of trauma patients on Oahu, pediatric and adult, as well as more serious trauma patients transferred from the neighbor islands. There are no designated trauma centers on any of the neighbor islands. Currently, 1,500 trauma patients annually receive their care at Queen’s. Transfers to Queen’s routinely occur from Oahu and other islands.

Physician availability for care of trauma patients is lacking or inconsistent in some areas of the State and for some specialties. This increases the demand for inter-facility transfers and places additional burdens on the Queen’s trauma center. Sole dependence on Queen’s creates a high level of vulnerability in the event of physical plant failure or overload from natural and man-made causes.

Because of this burden, Queen’s is currently operating its trauma center at a cost of approximately $29.7 million per year, and at a loss of approximately $6 million per year. Queen’s currently has no method for recovering costs associated with the cost of readiness, idling costs, or opportunity costs associated with being the only designated trauma center in the State. Queen’s accepts all trauma patients without regard for a patient’s ability to pay or type of insurance plan. While Queen’s currently receives federal funding from disproportionate share hospital (DSH) payments, such payments and other funding are not enough to ensure the viability of Queen’s trauma center.

DSH payments are additional payments from the Medicaid and Medicare programs that help hospitals finance care to low-income and uninsured patients. DSH payments ensure that communities have access to high-cost services including trauma care. However, the DSH payments provided to Queen’s, which are allocated to all areas of the hospital including the trauma center, are not enough to sustain the trauma center, even after accounting for all of Queen’s other sources of funding.

Typically, the cost of running a trauma center is far higher than the total payments received from patients who are treated. Queen’s incurs high additional costs from having to pay physician specialists to provide emergency call coverage. Between 2000 and 2004, thirty trauma centers closed across the nation as hospitals faced volume increases, higher costs, liability concerns, and low or no payment for trauma services. As many as thirty-five per cent of trauma patients in the United States die because optimal acute care was not available. Should Queen’s trauma center have to close because of these problems, the State will be without a certified trauma center and the people of Hawaii will suffer.

A weakened trauma center decreases a state’s readiness to respond not only to a normal flow of critically injured patients but to unforeseen disasters and emergencies as well. The tragic events of September 11th and Hurricane Katrina illustrate that trauma readiness and availability is every bit as important, and as much an issue of public safety, as police and fire services. Skilled trauma services with the capacity to handle a surge in demand are a fundamental necessity in responding to natural and man-made disasters.

The purpose of this Act is to sustain the trauma care resources currently available through DSH funds, by making a matching appropriation for the Queen's Medical Center to maintain its trauma care center.

SECTION 2. (a) There shall be appropriated annually a sum not to exceed fifty percent of the amount of disproportionate share hospital funds provided to Queen’s Medical Center within its previous fiscal year, which shall be for the purpose of maintaining the trauma center.

(b) This section shall be repealed on June 1, 2013, or at such time as a certified trauma center is located and operating in each of the counties, whichever date is earlier.

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $          , or so much thereof as may be necessary for fiscal year 2006-2007, for the Queen's Medical Center to maintain its trauma center.

SECTION 4. The sum appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 5. This Act shall take effect on approval; provided that sections 3 and 4 shall take effect on July 1, 2006.