Harris shifts patients to JPS amid shortage of neurosurgeons
Star-Telegram Staff Writer
Harris Methodist Fort Worth Hospital for months has been forced to turn away emergency patients with brain and spine injuries because of a shortage of neurosurgeons, and the problem could escalate this summer if several key physicians follow through on threats to leave.
The downtown hospital, which is a level 2 trauma center, has just four neurosurgeons available to treat trauma cases - only enough to cover every other day, said Lillie Biggins, vice president of operations. Ambulance crews routinely are told to take victims of car wrecks and falls and others with serious neurological injuries to the publicly funded John Peter Smith Hospital a few blocks away.
"We're a large, community hospital that basically serves as a safety net for this community," Biggins said. "Periodically, we've had some challenges. The one that we've been in the throes of now, for some time, is neurosurgery."
The shortage is not expected to affect the hospital's accreditation as a level 2 center, which will be up for renewal this year.
What it means
For many patients, it means they must get treatment at the busy emergency room at JPS, also a level 2 trauma center, where five neurosurgeons take turns covering trauma duties around the clock.
Biggins said the staffing shortage at Harris hasn't delayed treatment for any patients, because emergency responders are informed in advance on the days that they should go straight to JPS with potential neurosurgery cases.
For people who drive to the hospital's emergency room on their own, Biggins insists that Harris is prepared to treat most everyone or to transfer those who need an unavailable specialist.
"We don't want to scare our citizens in this community," she said. "The care is here. It's just not in this place, every other day, for that particular service."
Physician complaints
Recently, several neurosurgeons have notified Harris that they're considering withdrawing their services if their burden isn't lightened.
Biggins said the specialists agree to 60-day contracts and can choose to step down whenever those expire.
"It's always a possibility. I've gotten numerous letters from physicians saying, 'You know, if things don't change, I'm going to serve my notice,' " Biggins said. "They're just tired."
One neurosurgeon is trying to recruit to her practice another surgeon who could take on some of the trauma shifts, Biggins said.
What about the other doctors?
"That's a moving target, any given day," Biggins said.
Those physicians did not respond to calls this week.
Shifting responsibilities
At JPS, Dr. Rajesh Gandhi is bracing to pick up the slack if Harris cuts back further on trauma care. As JPS' medical director for trauma services, he has developed a contingency plan to bolster that hospital's staff and make more patient beds available beginning next month.
"We serve a very large community, and my goal is to make sure that the community is taken care of," Gandhi said. "We have a plan, so it's not a kind of fly-by-the-seat-of-your-pants thing. It's a planned increase in staffing."
As the county's only level 2 trauma centers, Harris and JPS are accustomed to cooperating to ensure that patients have round-the-clock access to care.
Almost 90,000 patients visited Harris' emergency department last year, Biggins said. But the number of trauma patients admitted to the nonprofit hospital fell to 2,303, a drop of almost 7 percent from 2006.
At the same time, the neurosurgeons at JPS saw their work grow 84 percent to 794 consultations last year, Gandhi said.
Long-term impact
So far, the hospitals' efforts have been successful, said Steve Janda, who directs the office of emergency medical services and trauma systems at the Texas Department of State Health Services.
The agency, which gives hospitals their trauma-center designations, was informed promptly when the shortage of neurosurgeons arose, Janda said. And Harris administrators have been providing monthly reports about how many patients are being treated or transferred.
"The system seems to be working out in a satisfactory way," Janda said. "The main thing we want to make sure is that the EMS providers in that area, as well as referring hospitals, know ahead of time."
Although trauma centers are expected to make neurosurgical care available, Janda said the health-services agency has worked previously with several Texas hospitals that have endured temporary gaps in coverage. Regulators scrutinize those hospitals more closely, but they've never revoked a trauma center's credentials over neurosurgery access.
"We need to be convinced that they are actively working to recruit and to fill that gap," Janda said.
Harris' certification as a level 2 trauma center will be reviewed this year by the American College of Surgeons, which conducts assessments that the state relies on to award its credentials.
Dallas' experience
Harris' neurosurgery woes are familiar to administrators at Methodist Dallas Medical Center, a level 2 trauma center that experienced a shortage in 2003.
When two neurosurgeons left that hospital's rotation, the remaining two were available to see trauma patients only 14 to 20 days each month, said Chief Nursing Officer Sam Ruffing.
That meant Parkland Memorial Hospital and Baylor University Medical Center had to take on extra patients.
Methodist was able to ease the crunch after about six months, when a local physician stepped in temporarily, Ruffing said. Now, the hospital has four neurosurgeons accepting trauma calls, with a fifth slated to join the staff in July.
Recruiting challenges
Biggins said Harris would like to attract as many as five additional neurosurgeons, but a nationwide shortage of the specialists has made for fierce competition.
She noted that nine neurosurgeons left the area about three years ago, but only four have arrived to replace them. And a doctors group that previously served both local trauma centers now focuses exclusively on JPS' patients.
"In an ideal situation, you would have enough physicians where a doctor would have to cover no more than one shift a week," Biggins said. "We don't have enough people to do that right now."
Caroline Steinberg, who is vice president for trends analysis at the American Hospital Association, said community hospitals across the country are having a hard time providing adequate specialist coverage - especially among neurosurgeons and orthopedic surgeons. Biggins said Harris is working aggressively to add more neurosurgeons to its staff. In the meantime, the hospital may try to hire out-of-town doctors to take on the job temporarily.
"We'd like to see the physicians get a kudo for just stepping up," she said.
TRAUMA TROUBLES
Neurosurgeons may steer clear of trauma patients for a number of reasons. Among them:
Professional independence. Although doctors typically aren't employed by hospitals, specialists traditionally have agreed to be available for emergency patients as part of their access to a hospital. That has changed in recent years, as doctors rely less on community hospitals and perform more procedures at specialty hospitals, outpatient surgery centers and even in their own offices.
Uninsured patients. Many emergency-room patients lack health insurance or the money to pay their medical bills, said Dr. Alex Valadka, a Houston neurosurgeon who served until recently as a committee chairman at the American College of Surgeons.
Liability concerns. On-call specialists take on greater insurance risks as they treat new patients and may have to perform unfamiliar procedures, said Caroline Steinberg of the American Hospital Association.
Lifestyle. With neurosurgeons in demand at private practices nationwide, they have little incentive to take on an unpredictable trauma schedule that could pull them away from their families, Valadka said.
- Maria M. Perotin
mperotin@star-telegram.com
