Health officials in Maryland and the District of Columbia say an end is in sight to years of bickering among hospitals concerning where seriously injured shock-trauma patients are sent.
Two task forces, set up in September by Maryland Gov. Harry Hughes and D.C. Mayor Marion Barry, have met twice and have concluded that the problems were greatly exaggerated and easily solved, according to participants on both sides. They have drafted a "memorandum of understanding" that they expect to sign soon.
With six designated shock-trauma centers in the District, one each in Prince George's and Montgomery counties, as well as a major shock-trauma center in Baltimore, medics at the scene of serious accidents in the region have several options of where to take patients. When patients are taken by helicopter, the choice of hospitals within a few minutes' traveling time becomes even greater.
"The metro region is lucky to have such depth of expertise," said Dr. Donald Thomas, who heads the Washington Hospital Center's emergency room. "But there's been room for improved collaboration."
At the center of the dispute are the critically injured patients in the Maryland suburbs, especially the 500 or so each year who are airlifted to hospital trauma centers for resuscitation and treatment.
Prince George's General Hospital in Cheverly and Suburban Hospital in Bethesda have long been designated by Maryland as the trauma centers for their respective counties, and the state has a large and prestigious shock-trauma center at the University of Maryland Hospital in Baltimore.
But officials at Washington Hospital Center's MedStar unit in the District, which receives about 1,500 trauma patients each year and is equipped with a helicopter, have maintained that many suburban patients are closer to MedStar than to Maryland hospitals.
Washington Hospital Center officials have sent lobbyists to Annapolis and given helicopter rides to state legislators in an effort to persuade them that this is the case. That behavior has prompted some Maryland hospital officials to accuse MedStar of being greedy for shock-trauma patients.
Officials at Prince George's General Hospital and Suburban Hospital said they worry that the Washington Hospital Center, by comparing itself to the University of Maryland shock-trauma center in Baltimore, has pushed the two suburban shock-trauma centers into the background.
While the income that shock-trauma patients provide for hospitals is a factor, hospital officials said it is a minor one. They said these patients are a small percentage of the hospitals' total patients and may cost the hospitals a great deal of money if they are not insured. And about 85 percent of shock-trauma patients are automatically sent to the nearest hospital.
At stake, they said, are prestige and other intangibles that come from treating shock-trauma patients.
Shock-trauma facilities provide hospitals with "a certain amount of luster," said Dr. Willie Clifton Blair, chief of the trauma center at Prince George's General Hospital. And, he said, "The more you do, the more proficient you become," so the quality of care improves.
Dr. Richard Meyers, director of the trauma center at Suburban Hospital in Bethesda, agrees. "It's the one thing that keeps a hospital going 24 hours a day," he said. "If you don't have it, you become an 8-to-4 hospital, and during other portions of the day it is really not fully staffed."
With these things at stake, he said, bickering over where shock-trauma patients are taken becomes "a serious problem. I think everybody should be concerned about what's going on."
Nobody is suggesting that seriously injured patients have suffered because of squabbling over which hospital should receive them. But the pride of competing trauma centers has been bruised and, according to some doctors, there has been concern that patients will not be sent to the proper hospital.
"For the first time we have reached a general understanding," said Dr. Andrew McBride, the District's public health commissioner, who headed the D.C. task force. " . . . I'm not sure it's going to satisify all parties 100 percent, but I'm optimistic."
McBride said Maryland and the District seem ready to agree on boundaries to define the closest shock-trauma unit from any location. They would be flexible, he said, to consider traffic conditions and space availability at a particular hospital for a shock-trauma patient.
The agreement would create a "tier" system among the District's six designated trauma centers: D.C. General Hospital, George Washington University Hospital, Georgetown University Hospital, Howard University Hospital, Greater Southeast Community Hospital and the Washington Hospital Center's MedStar unit.
The tier system, which McBride said would be based on capacity and "not on judgmental things," would help Maryland officials decide which District hospital would be best for their shock-trauma patients. They have complained about receiving no such guidance from the District, and about lobbying by individual hospitals. Provisions for interjurisdictional payments for shock-trauma patients will be part of the accord, McBride said.
"We're at the tail end of negotiations," he said. "It's been very positive . . . . I'm optimistic an agreement will be concluded shortly."
"This is the first concrete thing that's been hammered out, in dealing with adult trauma services, between the two jurisdictions," said Maryland task force member William E. Clark, director of field services for the Maryland Institute of Emergency Services.
"We have worked out, previously, speciality things, like eye injuries and burns and pediatric trauma. The remaining issue is the adults. Everybody was geared up for a lot of animosity, and it just was not there.