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Clifton Honored for Work of Save Our ERs
Organization seeks to save lives by expanding trauma and primary care services
Guy Clifton, M.D., right, holder of the Nancy, Clive and
Pierce Runnells Distinguished Chair in Neurosurgery at the
UT Medical School at Houston, is working to expand
capacity for trauma centers in Texas.
Photo by Ester Fant
On a good day, you’re okay. On a bad day, you’re dead.
The people of Texas are taking that gamble. Guy Clifton, M.D., wants to improve the odds of winning.
Through Save Our ERs, an organization he founded in 2001, Clifton is working to expand services and capacity for emergency rooms and trauma centers across Texas. In the process, he also is looking for answers to the dilemma of providing quality health care for about 5.5 million uninsured Texans.
Clifton, professor and chairman of the Department of Neurosurgery at The University of Texas Medical School at Houston, received one of three 32nd Annual SAVVY awards presented April 14 by Foley’s and the Houston Chronicle.
SAVVY award winners are chosen for their extraordinary contributions, individual dedication and spirit of giving to the betterment of life in the Houston community. All proceeds from the awards banquet benefited charities, including Save Our ERs.
During the 2003 legislative session, Save Our ERs brought together a statewide coalition of health professionals, hospitals, businesses and politicians to spearhead legislation that provides additional funding for trauma care.
But that’s not the whole solution, emphasizes Clifton, who is the holder of the Nancy, Clive and Pierce Runnells Distinguished Chair in Neurosurgery. Because publicly funded clinics in Harris County can handle only 30 percent of the 800,000 uninsured, the remaining 70 percent are flooding emergency rooms with non-emergency health care needs.
By law, emergency rooms must care for patients regardless of ability to pay. Yet rendering non-emergency care takes up limited resources that otherwise would be available for true life-threatening emergencies.
Clifton first became aware of the problems in 1999. “It was apparent that the trauma system was starting to fail because hospitals didn’t have enough bed capacity to take care of the trauma patients,” he said. “So hospitals were going on divert – meaning, don’t send any patients here; we’re full. I had been here 13 years, and I don’t ever recall having to turn down patients for lack of a bed before 1999.”
An informal survey of all the trauma centers in the state found that they were providing $200 million a year in unfunded trauma care and losing a lot of money.
Through Save Our ERs Clifton; trauma surgeon James H. “Red” Duke, M.D., the John B. Holmes Professor of Medical Sciences at the UT Medical School; and Tim Schauer, director of government relations at Memorial Hermann Health Care System, led an effort in 2001 to pass state legislation adding $5 to the license plate fee to generate about $65 million for trauma services. Although the legislation passed the House, it was voted down in the Senate.
That year ended up being “the worst year for trauma care in my life,” Clifton said. “The trauma centers were on divert 25-30 percent of the time. At the same time, the mortality rate on the days that Ben Taub and Hermann were on divert was double for trauma transfer patients in the community.
“There were at least eight deaths of patients in this region who couldn’t get into a major facility,” he said. “They were sent to trauma centers from ERs that couldn’t provide full services. And there was no bed in the trauma centers. So it really was a disaster.”
When the legislation failed in 2001, Clifton began raising money for another attempt. Every hospital system in the city, a number of individuals and a number of foundations contributed to Save Our ERs. Money from foundations could be used only for education and research, but some of the other funds were available for lobbying, as well.
Save Our ERs retained firms that were experts in trauma care and emergency services to study and quantify the problem in Texas.
“What we found was stunning,” Clifton said. “We found that our $200 million figure statewide was accurate, that divert was occurring all over the state, that in 2001 there had been a 55 percent increase in divert from the prior year.
“The driving force for the problem was uninsured patients. The hospitals were losing so much money on uninsured patients that the hospitals simply said, ‘We have this much capacity, and we can’t afford to open more beds.’ We’d had a 20 percent increase in population for this region in a 10-year period with no increase in available trauma beds. That was the problem, and it was going on all over the state.”
Another study showed, Clifton said, “that delays in transfer of patients with almost any emergency condition from a small hospital to a big hospital were unacceptable.”
The Texas Department of Health standards call for transfer of emergency patients within two hours. The study found transfers occurring within that time limit in only 30 percent of patients. In the other 70 percent, delays were longer. In 10 percent, the delays were over six hours.
“Every single case where there had been a potentially preventable death had been the result of a six to eight hour delay in transfer,” Clifton said. “And we knew that there were probably a lot of patients being injured by transfer delays that were not recognized.”
Save Our ERs hired an expert group of lobbyists for the 2003 legislative session. Then during the session, one of the trauma centers in Dallas began to cave in. San Antonio acknowledged a very serious problem. A trauma center in Texarkana downgraded. One in Sherman closed. El Paso began to have a serious problem.
“So all of a sudden,” he said, “there was a potential solution, and every trauma center in the state was lobbying its legislator for relief. And that’s how the bill passed. If the problem had just been in Houston, the bill would not have passed.”
Based on a system used in New Jersey, the law created a point system for multiple offenders. Each moving traffic violation carries a certain number of points, with the largest number of points for drunk driving. The cumulative total of points determines the amount of fines, which go straight into a state fund for trauma services.
“A DWI will get you close to $1,000 a year for three years,” he said. “And we know we’ll collect because the state will not let you get your driver’s license if you don’t pay.”
Since the bill was passed statewide in 2003, a number of new trauma centers have opened. “In Houston, St. Joseph’s Hospital is going to come on line as a third big player in the trauma system, in addition to Hermann and Ben Taub,” Clifton said. “It really was a result of the hospitals knowing they will get money from this fund to help cover the cost of uninsured patients and stabilize their losses.”
Save Our ERs, the Houston Partnership, Harris County and other community groups now are looking at the whole issue of uninsured care. They have hired the Lewin Group to study how uninsured people gain access to the health care system and to propose options to better organize existing resources.
“Part of the trauma care problem is that emergency rooms are malfunctioning because they’re doing things they were never designed to do, such as delivering primary care,” Clifton said.
Sixty percent of patients in the emergency rooms of the five major safety net hospitals in the Houston area are uninsured and do not have life-threatening medical emergencies. Ten percent of true emergencies in those hospitals would have been preventable with routine primary care.
“So we’re spending the money in caring for the uninsured, but we’re spending it too late, too little and to the detriment of the whole health delivery system and certainly a detriment to the uninsured. This is no way to treat people,” Clifton said.
“Texas is now No. 1 in the country in the number of uninsured. So what I’m using Save Our ERs for is simply to let everybody know that this is not somebody else’s problem. This is affecting your health care and your children’s health care. Because the systems don’t work when the numbers are this high.”
“We could probably handle 10 or 15 percent uninsured without much difficulty,” he said. “But Texas leads the nation in the percentage of working people without health insurance – with 27 percent of working adults uninsured, and 27 percent is beyond the capacity of the system to absorb. This problem will affect everyone in the community on a bad day.”
— By Ina Fried, Public Affairs