Life and death in the emergency room - includes article on Dr. John West - part 1

Washington Monthly, Nov, 1985 by Paul Glastris

Beware the lobbyists

To get a picture of problems at the state level, it's worth taking a look at Pennsylvania. Approximately 50 hospitals in the state advertise themselves as trauma centers, but, according to officials, about six actually have the specialized staff and facilities that meet generally accepted standards such as those of the American College of Surgeons. Nor are there any state guidelines to insure that seriously injured patients get taken quickly to hospitals capable of treating them. As a result, the state's health department estimates that 1,300 injury victims die whose lives could be saved.

Trauma care advocates have been trying to do something about this for years, but the state's medical community hasn't let them get very far. David Boyd charges that millions of dollars provided by the federal government during the seventies were squandered on various unproductive committees. When EMS advocates attempted to publish an evaluation of hospitals in southwest Pennsylvania, an essential first step toward systematizing trauma care, the hospitals blocked the move. In 1981, the state health secretary, Dr. Arnold Muller, tried to institute the kind of state-wide, state-enforced systems Boyd and others had advocated; he gave up the next year, thwarted by lobbyists from the Pennsylvania Medical Society (PMS) and the Hospital Association of Pennsylvania (HAP). PMS and HAP, by the way, ranked fourth and fifth respectively on the list of PAC contributors to Pennsylvania politicians that year. To make matters worse, several hospitals threatened to sue, charging--if you can believe it--restraint of trade. Only one hospital, Lehigh Valley Medical Center in Allentown, managed to get the state's official trauma center designation before the program was terminated. When the state compared preventable trauma death rates in Allentown before and after the designation, it found a 33 percent drop.

In 1983, members of the state legislature proposed a bill to develop in the rest of the state the same system that saved lives in Allentown. But after months of fighting, the sponsors threw in the towel and let lobbyists for the hospitals and physicians association gut the legislation. "I talked to my committee chairman and others,' Rep. James Greenwood, the bill's House sponsor, told Andrew Schneider of The Pittsburgh Press, "and I finally realized the reality was that, unless this bill was blessed by the HAP, it would never get out of committee. There is a long record of that happening.' The bill's Senate sponsor, Roy Wilt, chairman of the Senate Public Health and Welfare Committee, agrees: "The political realities were that we'd never be able to move the bill into law. HAP and PMS are very persuasive.'

The law Governor Richard Thornburgh finally signed gives the state no power to designate, monitor or enforce the trauma center system. Instead, it leaves responsibility for setting "private, voluntary' standards for and maintaining the trauma "system' to an independent organization, the Pennsylvania Trauma Systems Foundation. The foundation is staffed primarily by members of the HAP and PMS. "We don't want the government involved,' says the HAP's chief lobbyist, Jack Wicks. "We want the free enterprise, competitive approach.'