Trauma center is why she's alive today
By Jerry W. Jackson
Sentinel Staff Writer

March 10, 2003

The stars were hidden by fog the night Nikki Deimler was driving to her boyfriend's house.

Cruising at 55 mph on an open stretch of John Young Parkway in south Orlando, Deimler lost control of the 1990 Dodge Caravan. There were no skid marks, police later wrote.

A thick concrete abutment took the full force of the van. The driver's side where Deimler sat crumpled into a mangled mass of steel and glass. Rescue workers from Station 58 needed 45 minutes to carefully pull her out.

Deimler's brain was swelling fast. The Fire Star helicopter crew swept her into the sky for a short but excruciating flight to nearby Orlando Regional Medical Center.

A team of surgeons and doctors met her at the door and saved her life that night in December 2001, with scant minutes to spare. When Deimler, then 19, awoke weeks later, nurses called her their Christmas miracle.

Today, Deimler fights back tears and trembles at the thought that she lived but others may now die because the region's only Level 1 trauma center plans to close April 1.

Neurosurgeons have told the hospital they won't continue to staff the Orlando center because they are too shorthanded. Hospital administrators contend that soaring medical-malpractice insurance premiums are partly to blame because doctors in such high-risk jobs are shying from states such as Florida.

Hospitals in Florida and many other states are battling to keep open emergency rooms and trauma centers. The national debate is now intensifying as lawmakers in Washington and various state capitals start to grapple with ways to stem the crisis.

House panel hears issue

On Tuesday, the U.S. House Judiciary Committee held a hearing on medical-liability legislation, debating a thorny issue that pits personal-injury lawyers against doctors -- and leaves patients in the middle.

"Emergency rooms and trauma centers are closing their doors because of high insurance costs," Judiciary Committee staff said in framing the issue.

"It's a bad trend," said Harry Teeter, executive director of the American Trauma Society, in Upper Marlboro, Md.

Industry specialists can cite only one other case, in Las Vegas, of a trauma center closing in the past year, and then only briefly. But Orlando Regional is far from alone in its struggle to maintain a trauma staff.

In Texas, another state with unusually high malpractice-insurance rates, Methodist Medical Center in Dallas lost a neurosurgeon in October, forcing it to transfer patients to already crowded Parkland Memorial -- and jeopardizing Methodist's Level 2 status. And Houston health-care officials are seeking state money to ease trauma-care shortages in a 13-county area around Houston and Galveston.

Even centers and emergency rooms that aren't threatening to close face critical physician shortages, members of the congressional committee were told. Leanne Dyess, a wife and mother of two from Vicksburg, Miss., testified that her husband is permanently brain-damaged because the Gulfport, Miss., hospital he was taken to after a one-car accident did not have the necessary specialist.

"Almost six hours passed before Tony was airlifted to the University Medical Center -- six hours for the damage to his brain to continue," she testified. Committee members said one doctor had quit his practice only days before Dyess was admitted, after the physician's insurance company terminated its medical-liability policies nationwide. The only other specialist capable of treating Dyess in the area was serving multiple hospitals and was unavailable at the time.

"On that hot night in July, my husband and our family drew the short straw," Leanne Dyess said.

Crucial time may be lost

Back in Central Florida, Deimler and her mother, Diana, strain to control their emotions as they think about the more than 1,500 Orlando-area trauma patients similar to Nikki who may end up diverted to hospitals in Daytona Beach, Melbourne or Lakeland. Those Level 2 trauma centers have neurosurgeons on call but not on site, and all involved agree that lifesaving minutes will be squandered.

Tampa, the nearest city with a Level 1 center, where neurosurgeons are always on duty, is 80 miles away.

"There's no way she could have made a flight to Tampa," Deimler said of her daughter and the 2001 accident. "They didn't think they could save her when she got to ORMC, and they were just minutes away."

"The doctors were wonderful," recalled Nikki, who still struggles to speak clearly after the crash. Wednesday, she had braces placed on her teeth, to straighten the ones that remain. She lost eight. Her jaw was broken in three places, and she had 19 hours of surgery to rebuild her face. Virtually every major bone in her body was broken. But she gives thanks to be alive.

"I don't understand why people sue their doctors when they don't like the results," said Nikki, who hopes one day to return to her job as a sales clerk at Florida Mall. Years of therapy lie ahead for lingering brain damage.

Meanwhile, the crisis in Central Florida already appears to be spreading. Days after Orlando Regional announced it would be forced to close its Level 1 center, Halifax Medical Center in Daytona Beach disclosed that its surgeons' contract had expired March 1, placing its Level 2 trauma center's future in doubt.

Trauma surgeons at Halifax have agreed to continue working under their old contract for now but say they won't continue unless Florida lawmakers, who gathered last week in Tallahassee for their annual legislative session, rein in malpractice-insurance premiums. Halifax is the only trauma center in Volusia County and one of only a handful close enough to Orlando to take accident victims if ORMC's trauma unit shuts down as planned.

Orange County's Emergency Medical Services advisory panel recommended last week that rescue crews take more patients to the region's Level 2 centers once Orlando Regional shutters its trauma unit. But representatives of the Level 2 centers say they are worried about their ability to take the overflow.

Halifax Medical Center -- one of the region's busiest hospitals when motorcyclists are in town for Bike Week and spring breakers are at the beach -- opened its trauma unit in 1982 at a time when it was trendy to do so. Within four years, Florida had 33 trauma centers as hospitals competed with one another by offering expanded services.

But costs mounted, and hospitals backed off. By 1990, 13 trauma centers remained, and some, including Halifax's, were on shaky financial ground.

Center serves wide area

Orlando Regional, which by statute serves five counties and by practice about 22, ended up having the lone trauma center in metropolitan Orlando almost by default because no one else wanted the job, said Joe Brown, ORMC spokesman.

"No one wants to apply for something that doesn't make money," Brown said. "Trauma centers are not moneymakers and probably never will be."

Orlando's center is one of only six Level 1 units in the entire state. Such centers must be capable of handling the direst cases; for example, they must have neurosurgeons on hand round the clock for brain and spinal-cord injuries. Level 1 centers also must have pediatric and burn specialists; a surgical team with an anesthesiologist in-house 24 hours a day; and mass-transfusion capability, as well as academic, outreach and prevention programs. All those cost money.

But high costs are only part of the problem. As malpractice-insurance costs have risen, specialists who pay the highest premiums have increasingly steered away from states such as Florida where rates are higher, said Curtis Rooney, senior associate director and counsel for the American Hospital Association.

States where a doctor's financial liability has been capped in some way have fared better, Rooney said. They include California, Louisiana, Colorado, Indiana and Wisconsin. Some states have tried but failed to limit damages because courts overturned the laws on various grounds.

"What you really need is a federal solution," Rooney said. The hospital association supports a U.S. House bill, known as the Help Efficient, Accessible, Low-Cost, Timely Healthcare Act, or HEALTH for short. It would cap certain damages in medical-malpractice cases.

Bills pass House, not Senate

Various forms of the legislation, modeled after the 27-year-old law that reformed California's medical-liability system, have passed the U.S. House seven times since 1995. It is expected to pass the House once again this year, but its odds remain long in the Senate.

Personal-injury lawyers argue that the legislation, which caps noneconomic damages at $250,000 -- the level California chose and that Florida is considering -- is misguided because caps are unfair to victims. They blame insurance companies for doctors' fast-rising premiums.

Others, including some consumer groups such as Public Citizen, have charged that some states, including Florida, have been too lax in cracking down on bad doctors, and that inadequate oversight has led to more malpractice cases and higher costs.

Dr. Ernest Block, director of trauma services for Orlando Regional Medical Center, said the community should not become fixated on the neurosurgery shortage at ORMC because rising malpractice-insurance costs are a problem for all physicians.

Block repeated Orlando Regional's commitment to reopen the hospital's Level 1 trauma center as soon as possible. But he said he fears he could be "the last one to turn the lights out."

Level 2 center no solution

Hospital officials say that merely downgrading the Orlando trauma center from Level 1 to Level 2 is not an option, even as a stopgap. The shortage of neurosurgeons would still exist, they say, and the hospital would not have enough of those specialists even for an on-call schedule, given the center's caseload.

But closing the center could cost lives. A study in Alabama found 9.8 people died for every 1,000 auto accidents in counties with no trauma center, twice the 4.8 deaths per 1,000 accidents in counties with trauma centers.

As the debate continues, Diana Deimler dreams of the day her daughter, her only child, will be independent once again.

Insurance has paid for much of the mountain of medical bills, for the 14 physicians who have worked on her or with her. But many of the costs for future therapy and braces will be borne by the single mother, and she is pondering how to ask for help.

She's grateful, though, that her first anguished cry for help that December night was answered by the trauma center.

Jerry W. Jackson can be reached at jwjackson@orlandosentinel.com or 407-420-5721.


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