Shoring up critical care

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Of the 63 acute-care hospitals in South Carolina, only 23 participate in the state trauma system. Only four hospitals offer the highest-level of trauma care.

In the past decade, two hospitals dropped out of the trauma system — one just last year — and two others scaled back services. Health-care officials fear more hospitals may drop out of the system. The number of trauma surgeons, meanwhile, has dropped from 12 to only six.

What this means is that lifesaving emergency trauma care is becoming less available to critically injured South Carolinians. Most patients needing trauma care have been injured in car accidents, although other injuries requiring the highly specialized care include falls, gunshots, assaults and stabbings.

But hospital trauma care is very expensive to maintain, costing $138 million a year. About 12,000 critically injured patients need trauma care every year. But because about one in four patients in South Carolina has no insurance, hospitals sometimes must absorb the costs of trauma care. The highest level hospitals lost $18.3 million in 2001. The entire system operates at a loss of about $30 million.

The trauma system doesn't include merely hospitals but also ambulance service, rehabilitation centers and doctors and nurses with specialized trauma training.

Lawmakers last year created a fund to provide formula-based financial aid to trauma centers. But lawmakers provided no actual funding.

The hospitals that run the trauma system this year are seeking $28.6 million from the Legislature to shore up the system. Lawmakers are not likely to be sympathetic at a time when there are so many other pressing needs in the state — including basic health care, prisons, the Highway Patrol and higher education.

Lawmakers may be more supportive of fee proposals that would provide funding for the system — such as including surcharges on vehicle insurance and gun and ammunition sales, as well as increasing fines on motor vehicle violations. The motor-vehicle fines especially make sense because car accidents make up 70 percent of trauma cases.

The faltering state trauma system, unfortunately, is not high on the list of priorities of the public — and therefore may not be a priority for state lawmakers. State leaders, however, should recognize that bolstering the state's trauma system will save the lives of more South Carolinians.