GALVESTON, Texas -- Hurricane Ike has turned the nation's top-ranked trauma center into a doc-in-the-box.
"If we can't put on a Band-Aid or a splint, we have to transfer you or send you home," says Brian Zachariah, director of emergency medicine at the University of Texas Medical Branch (UTMB) in Galveston. "We can't even give traditional emergency care."
UTMB's John Sealy Hospital, which typically handled more than 60,000 emergencies and 3,000 trauma operations a year from communities along the Gulf Coast, now must transfer injured patients elsewhere.
Medevac helicopters or ambulances carry people with severe injuries to Houston, 50 miles to the northwest, a detour that can stretch the "golden hour," when quick treatment is most likely to save a life, to the breaking point.
Doctors and paramedics say they have no choice. Three years after Hurricane Katrina slammed into New Orleans and shut down the city's famed Charity Hospital, Ike's storm surge flooded John Sealy and several other UTMB medical centers in Galveston, closing them for more than a month.
The storm, which made landfall on Sept. 13, flooded John Sealy's blood bank, pharmacy, laboratory and kitchens with several feet of water. Altogether, Ike cost the hospitals $710 million in damage, seven times the maximum insurance coverage available to the hospital, says Karen Sexton, UTMB health system's chief executive officer.
For weeks, construction crews have battled back, laboring to pump out ghostly hallways, eliminate mold and make repairs. But the storm's ravages weren't limited to the hospital building. Last Monday, acting on orders from university regents, officials finished a series of 2,500 layoffs throughout the UTMB system. Most came from John Sealy's 4,500 doctors and staff. Among them were 127 tenured professors at the medical school, officials say.
"It's a really hard time," Sexton says. "We have heroes on both sides, heroes who are staying and heroes who are going. I'm not sure any health care institution in the country has gone through anything like this."
The hopital may never be the same. It began reopening gradually last week and put a dozen or so beds into service. But tests revealed mold spores wafting into four of six operating rooms, postponing their use indefinitely.
Eventually, Sexton says, administrators plan to staff 250 of the hospital's 550 beds. The ER and trauma center are still closed, along with the lab, intensive care, pharmacy and other support services.
"We're one of three Level One trauma centers in the Houston-Galveston area," Sexton says. "We know the impact of being off-line. We hate it, but right now it's the safest thing to do for our patients."
Most major trauma patients now face a 50-mile helicopter ride to Ben Taub General Hospital or Memorial Hermann Hospital in Houston. "If the weather's bad, we're stuck with land ambulances and all the delays that entails," Zachariah says. Ambulances are now parked outside the ER day and night to transfer routine patients and for those days when helicopters can't fly.
April Mears, who works the hospital's transfer phones, says she's used to moving patients in, not out. "We never transferred people out. We've had to learn."
Fewer than 200 of the nation's 5,000 hospitals make the grade to become Level One trauma centers, as certified by the American College of Surgeons (ACS). This year, less than a decade after John Sealy achieved that milestone, the ACS notified the hospital that it had the lowest trauma death rate in the country, says Bill Mileski, chief of trauma services. Mileski declined to release the number, saying it is a rough estimate and he doesn't want to embarrass other medical centers.
The hospital learned of its achievement six weeks after the storm shut the center down, Sexton says. "It made us even more determined to find our way back and become a Level One trauma center again."
Mileski says: "Everybody focuses on the first hour, which is very dramatic, but that's just 1% of trauma care. These are people who are going to be in intensive care units for weeks, sometimes on a ventilator for months. You have to have all that ready, in addition to having specialists available."
Most of the hospital's trauma patients are injured in industrial accidents and car wrecks, he says. Many lack medical insurance. Each year for the past several years, Zachariah says, UTMB has spent about $130 million a year in indigent emergency care. The Texas Legislature repays just $119 million of that, he says.What can't be tallied is patients' suffering. "We had an offshore worker who was getting off his boat," Zachariah says. "A wave caught his foot between the boat and the gangplank. It broke all the bones in his foot. We had to send him to Houston. It's a pretty far piece."