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A Southwest Ambulance crew arrives Tuesday night at the University Medical Center Trauma Center, which could stop operating around the clock next month and could close entirely in June. Photo by Craig L. Moran.

Wednesday, February 20, 2002
Copyright © Las Vegas Review-Journal

MALPRACTICE RATES TAKE TOLL: UMC trauma center at risk

County told facility might have to cut hours or, possibly, close

Southern Nevada's only emergency trauma center could stop operating around the clock next month and could shut down entirely in June, making it another casualty of skyrocketing medical malpractice rates.

University Medical Center's Trauma Center may be forced to close from 7 p.m. on March 12 until 7 a.m. the next day because there are not enough trauma surgeons to fill the shift, medical center officials on Tuesday told Clark County commissioners, who act as the board of trustees for UMC.

Other shifts throughout March also may remain uncovered and the center could have to shut down entirely come June, when insurance expires for most of the trauma surgeons, said the center's medical director, Dr. John Fildes.

Two of the 12 trauma surgeons already have quit working for the trauma center and four more may soon follow, Fildes said. The highly trained surgeons, like many area doctors in dozens of other specialities, are having trouble affording their skyrocketing rates for medical malpractice insurance.

"There is a very real danger of the trauma center closing completely in June," Fildes said after the medical center board meeting. "All the remaining surgeons have rearranged their schedules and have taken on extra shifts, but as work hours go from 60 to 80 hours a week, patient safety is at risk."

If the trauma center does have to limit hours, car accident victims, those with gunshot wounds and other critically injured patients would have to go to area emergency rooms, where doctors are usually not trained to do surgery.

"ERs cannot offer the same kind of care," said Dr. Dale Carrison, director of University Medical Center's emergency department. "I can't operate because I'm an emergency physician, not a surgeon. If it's a car accident and there's internal bleeding, I hope there's a surgeon around. Otherwise, I'll be giving the patient blood and calling trauma docs in other states, begging them to take my patient."

Trauma center surgeons care for the most critically injured patients 24 hours a day, seven days a week. The center sees between 10 and 20 patients per shift, and approximately 11,000 patients per year, including patients from Nevada and parts of California, Arizona and Utah.

The UMC facility is the only advanced trauma center of its kind in the state. To keep it operating full time throughout March and open in the future, commissioners were asked to allow the medical center to hire the trauma surgeons on a part-time basis, providing malpractice protection under the center's umbrella policy, which limits jury awards to $50,000. Commissioners directed medical center officials to bring the proposal back to the next board meeting on March 5 with more details.

"We are the only trauma center, there is no other place to go," Commissioner Erin Kenny said. "If we lose these trauma physicians, there is no other option."

Although some commissioners were hesitant to make a quick decision and said the problem might be better addressed by the Legislature, they all wanted more details and asked to hear other possible temporary solutions at the next meeting.

A March 5 decision approving part-time hiring wouldn't be too late to reopen the trauma center full time March 12, said William Hale, the medical center's chief executive officer.

Medical center officials believe the temporary part-time hiring would bring back at least one of the trauma surgeons, allowing the center to remain open full time.

"One should come back and that will keep us afloat," Fildes said.

Fildes declined to disclose the names of the two doctors who quit, saying they wished to remain anonymous. One of the doctors no longer practices medicine and the other continues to do general surgery in private practice, thus lowering his malpractice rates, Fildes said.

Currently, most trauma physicians have their own private practices for general surgery and are considered independent contractors. They work in shifts at the trauma center and carry their own medical malpractice insurance.

Insuring the doctors would not cost the medical center anything up front, but if claims are filed in the future, the center would have to pay litigation costs or jury awards. Jury awards, however, are limited to $50,000 for both economic and punitive damages because University Medical Center is a government-owned, public hospital, Hale said.

Other Las Vegas doctors also are being forced to close their practices or retire early because of medical malpractice rates, some jumping to $200,000 annually from $40,000. Health officials predict at least one-fifth of Las Vegas doctors and possibly as many as half will close their practices by the end of summer if lower malpractice rates cannot be negotiated.

The crisis in medical malpractice insurance was precipitated when St. Paul Companies in December stopped offering malpractice insurance because of increasing jury awards. Frivolous lawsuits, large jury awards and the pullout of St. Paul forced the remaining companies to raise rates, doctors and insurance company officials say.

Malpractice attorneys, however, say that poor underwriting skills by insurance companies and a bad economy are forcing companies to raise rates. They say companies are no longer making money off investments and are now raising malpractice rates to make up for it.

Gov. Kenny Guinn has called for a public hearing March 4 to address the medical malpractice issue.