Trauma is the kind of injury that can kill you. It's the scene from ER that starts with flying gurneys, lots of blood and a doctor shouting a laundry list of incomprehensible instructions. That's if you're lucky. Because the fictitious hospital in ER is indeed a "trauma center." There is a surgeon present at all times and specialists on call 24 hours a day. What's more, the place is armed with a sophisticated pre-arrival notification system and staffed by specially trained and experienced nurses.

If you don't end up in an E.R. like the one in ER, you could very well end up like Amy Jackson. She's the much publicized small-town homecoming queen who died in 1992 from what some medical experts say were survivable injuries. Amy was airlifted from a small rural hospital in the San Luis Valley to Presbyterian/St. Luke's Medical Center in Denver. But P/SL failed to diagnose her torn aorta, and she died from the untreated injury the following morning. P/SL does have an emergency room, but it isn't a trauma center. Trauma experts noted at the time that a torn aorta is the most common cause of death in traffic accidents--something that experienced trauma personnel look for in cases like Amy's.

A bill now pending in the Colorado state legislature might have saved Amy's life, if it had been law back in 1992. Senate Bill S95-076--which is expected to pass this session--would require all hospitals in the state to participate in a coordinated system for getting severely injured patients to hospitals certified as trauma centers. Getting the right patient to the right hospital at the right time, as advocates like to describe it.

The concept sounds reasonable enough and, now that it's been three years since Amy's death, surely long overdue.

Actually, the legislation was long overdue before Amy's accident. The first bill proposing to form a statewide trauma system was introduced way back in 1987. But because of fierce market competition and turf battles, it has taken Colorado eight years, five bills, three task forces and a plethora of amendments to get even this close. The issue is still so touchy that the parties involved in the process are almost afraid to talk about it, fearing they'll jeopardize the compromise that has been so brutally wrought.

The crux of the problem is the virtual centerpiece of the bill. A statewide trauma network requires hospitals to transfer a certain percentage of their patients--and the insurance dollars that go with them--to other hospitals. In a highly competitive hospital marketplace, this is a far from popular idea. Trauma bill lobbyist Danny Thomlinson admits, "I heard from legislators, who had obviously heard from doctors and hospitals in their communities, that the real concern was that the larger metropolitan hospitals would get all of the trauma victims, and [the other hospitals] didn't want to see potential business lost."

The original impetus behind the legislation was the Colorado Trauma Institute, a private, nonprofit consortium of designated trauma centers that was created in 1983 by the state health department. Charged with developing standards of care for critical trauma patients and working for the ultimate adoption of a statewide trauma system, CTI has for the past twelve years served as Colorado's clearinghouse, registry, quality-control and lobbying center for trauma-care issues. Its board includes such renowned trauma and emergency-medicine experts as Dr. E. Eugene Moore of Denver General Hospital and Dr. Marilyn Gifford of Memorial Hospital in Colorado Springs. It was CTI that first brought a legislative initiative to state senator Dottie Wham in 1987.

Which was just one of the problems some hospitals had with the idea.
"We haven't always been supportive, because previous bills would've put the Colorado Trauma Institute in control of the whole statewide system," says Larry Wall, president of the Colorado Hospital Association, which supports the current version of the bill. "CTI is a private agency and private organization, and...a lot of our members didn't believe in being subject to the Trauma Institute, which they had no control over at all. Rules and regulations fit better within state government than they do in a private agency."

But Pennsylvania has made a private/public partnership work with its trauma system for ten years now. In 1985 a private, nonprofit group called the Pennsylvania Trauma System Foundation was written directly into that state's laws, with clear authority over an accreditation process for all Pennsylvania hospitals that seek to be called trauma centers.

Linda Dodge, executive director of CTI, says CTI tried a number of different approaches to legislation, including models that split responsibilities between the health department's Emergency Medical Systems division and CTI. "Over the years, we met with the Hospital Association to try to arrive at a workable model. Those negotiations were...unfruitful," Dodge says tactfully.

But Wall is convinced the folks over at CTI were merely protecting their own jobs: "CTI was for previous legislative efforts because [those bills] built a future for them. This year's bill didn't do that."

Another problem the Hospital Association had with previous incarnations of the trauma bill was the mandated use of criteria to determine whether or not a hospital qualified as a trauma center. National standards from the American College of Surgeons have been the baseline for trauma-center designation by CTI for ten years now (and have been used to certify ten hospitals in the state, with certifications pending on eleven more). But the Hospital Association (with 83 member hospitals) feared the criteria would be too stringent for some of its more rural, less well-staffed or less well-equipped hospitals.

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