Final UTMB Layoffs Will Downgrade Sealy Hospital's Trauma Status - @ JEMS.com


Final UTMB Layoffs Will Downgrade Sealy Hospital's Trauma Status

Extra patients are already stretching 2 remaining Level 1 centers


 
 

Harvey Rice | | Wednesday, November 26, 2008


GALVESTON -- Five emergency room doctors lost their jobs Monday at the University of Texas Medical Branch hospital, part of a purge that will downgrade its trauma center status and contribute to an emergency room shortage in the Houston area, emergency room administrators said.

The cuts came as John Sealy Hospital opened its operating rooms, senior care and pediatric operations for the first time since Hurricane Ike struck Sept. 13. The operating rooms closed after only a few hours because of faulty air filters.

Five patients were admitted on the first day, including a woman who drove 100 miles from Cleveland for surgery.

UTMB laid off 125 doctors and faculty Monday, the last day of a five-day round of layoffs to pare 3,000 jobs from its work force of 12,000. Five emergency room physicians were let go, officials said.

The layoffs are expected to cut the $40 million monthly payroll in half, helping staunch financial losses since Ike temporarily shut down the hospital and caused $710 million in damages.

The emergency room will drop from 15 doctors to eight, although it was rated last month by the American College of Surgeons as having the best patient survival rate in the nation for a large hospital, said Dr. Brian Zachariah, medical director for the emergency department.

The emergency room, which has been closed for all but minor injuries since the storm, won't be reopened until the operating rooms have been up and running for about two weeks, Zachariah said.

When the ER opens, it will be with half the staff and will lose the Level 1 trauma center designation given to the best-equipped and -staffed emergency rooms, Zachariah said.

"My understanding is we do not plan to maintain a Level 1 emergency room," Zachariah said.

Only one doctor will be available 24 hours a day instead of the two to four doctors before the storm.

`Drastic reduction'

Critically injured and seriously ill patients once handled by the emergency room will now be transferred to one of the two remaining Level 1 emergency rooms in the Houston area: Memorial Hermann Hospital and Ben Taub Hospital.

Zachariah said UTMB administrators are calculating that there will be less demand for emergency room services because of the drop in population on Galveston Island. No one knows exactly how much the population has dropped from its pre-storm 60,000 level.

The emergency room was seeing between 150 and 200 patients a day before the storm but will be capable of seeing only 55 patients a day when it reopens, Zachariah said.

"That's a pretty drastic reduction," he said. "I'm a little concerned that the estimate is too low and that we're going to be busier than we think and not be able to take care of them."

Zachariah said UTMB's trauma center served a nine-county area before the storm. If the emergency room is overwhelmed, patients will have to be transferred, he said.

"We're worried about that and think that's going to create some problems," Zachariah said.

The shutdown of UTMB's emergency room already is overwhelming the other two Level 1 trauma centers in the Houston area and placing a burden on the Level 3 centers, said Dr. James McCarthy, medical director of emergency services at Memorial Hermann.

October, usually the slowest month for Memorial Hermann's emergency room, was the busiest month this year in more than a decade, with the number of patients jumping from a normal 450 to more than 600.

"The amount of time we've had to say we're full has more than tripled," McCarthy said. "We are at capacity on a daily basis."

Once the two Level 1 emergency rooms are full, ambulances take patients to Level 3 trauma centers where doctors are on call rather than being at the hospital. McCarthy said studies show that the patient survival rate drops 30 percent at a Level 3 emergency room.

"If there is anything good about the storm, it's going to get Houston to address its trauma needs," he said.

Environmental contaminant

McCarthy said emergency rooms don't make money, so opening or expanding an existing Level 1 emergency room would probably take state funding.

One possible solution is opening one or more Level 2 trauma centers, which are the same as Level 1 but don't include research, he said. McCarthy said there are no Level 2 trauma centers in the Houston area.

Taxpayers usually oppose funding for trauma centers because so many patients are uninsured, but McCarthy said they should consider whether they want an emergency room available if they or their loved ones are seriously injured.

The UTMB emergency room will open about two weeks after the operating rooms are back in business, but that won't be for at least a week, said David Marshall, interim hospital chief operating officer.

Twenty of the hospital's 25 operating rooms were in use before the storm, but only 12 opened Monday, he said. Ten of those were closed at about 11:30 a.m. when tests showed that filters had failed to keep an environmental contaminant from the air, Marshall said.

JoAnne McCorkle, 68, who drove from Cleveland, was admitted for a lung operation, but the procedure was canceled and she will have to return in a week, said her husband, Robert McCorkle.

The two functioning operating rooms are reserved for the maternity ward, which opened Oct. 13, Marshall said.




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