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Everyone likes the idea of a statewide trauma care network and can see why Arkansas needs one, but the key to legislative approval will be figuring out a way to pay for the system, according to backers.

“We seem to be getting support,but you never know. It’s easy to agree with a concept,” said Don Adams, vice president of the Arkansas Hospital Association. “But the devil’s always in the details, so until we get these details worked out, it’s difficult to know.” The state’s Trauma Advisory Counsel has estimated the cost of establishing the trauma network, a trauma database, funding for treating uninsured patients and salaries for on-call physicians at around $30 million. The proposed law would establish a fund under the state Department of Health and Human Services and be overseen by the Health Division.

The concept supported by the Hospital Association, state Department of Health and Human Services and the counsel, among others, would fund the trauma network by adding $25 to traffic fines for speeding and other moving violations and $50 to the penalty for driving while under the influence.

“That’s really about the only way that we think we can get a reliable source of income on that,” Adams said. “The problem we have is that there are some other people that think that fine money is their money.” Adams said supporters of the network hope to reach some sort of accommodation with municipal agencies, the state police and others who receive funding from traffic tickets. “Some think that legislators will be hesitant to raise these fines by that much, particularly on the moving violations, and others think that it needs to be more than that,” Adams said. “We think we’re getting close to figuring out numbers that everyone can agree on.”

The fine for a first offense of driving under the influence ranges from $150 to $1,000 and can include court costs of $300.

State Rep. Gene Shelby, MD, DHot Springs, is one of the proposed bill’s sponsors.

“I don’t know that we have any formal opposition at this point,” Shelby said. “But we’re kind of talking to organizations that could be impacted by this.”

Once the funding details in the bill are hammered out, supporters will look for ways to leverage as much of that money as possible through the Medicaid program, Shelby said. Medicaid now reimburses providers for some trauma care.

It has been nearly five years since Arkansas put rules and regulations into place that would govern trauma centers and a trauma network, but the state remains the only one in the country lacking even a single designated trauma center. Arkansas is one of only three states without a functioning trauma system. The American College of Emergency Physicians has ranked Arkansas’s emergency medical system last in the nation.

The problem, according to the Hospital Association and other supporters, is that it costs money to become certified as a Level 1 or 2 trauma center, the two highest ranks for trauma centers. One expense is keeping specialists on call for trauma related injuries.

Hospitals also lose money treating emergency room patients who do not have healthcare insurance.

The Hospital Association hopes the proposed legislation will address those issues, and the association and Health Department have pushed hard for the trauma system.

The Hospital Association president listed establishing the statewide network at the number-two spot in the group’s list of its 2007 goals.

Adams said a trauma network will save lives while reducing medical treatment costs as well as rehabilitation expenses.

According to the National Highway Traffic Safety Administration, Arkansas ranks in the top five states in terms of motor-vehicle-related deaths per capita and for unintentional injuries. A statewide network would coordinate hospitals so that trauma victims would be sent to the hospitals best able to treat their injuries.

The state Department of Health has estimated a trauma network could save somewhere between 200 and 600 lives each year.

The proposed statewide trauma network would rank hospitals depending on the trauma care provided. A Level 1 center would provide the highest level of care, and its services would include on-call specialists and anesthesiologists available in the emergency room.

Arkansas’s Health Division expects that only one or two hospitals would receive Level 1 trauma center certification, but 10 or so might eventually achieve the Level 2 designation. Participation in the trauma network would be voluntary.


March 2007

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