The Legislative Budget Board (LBB), a ten-member panel made up of Gov. Rick Perry, Lt. Gov. David Dewhurst, Speaker of the House Tom Craddick, and seven members of the Texas House and Senate, should soon convene to decide whether to fund various projects not addressed in the current biennial budget. Among proposals to be considered are school textbook funding and more money for nursing homes.
I offer one other item for the LBB to address: the full restoration of the roughly $77 million in trauma care funding left in limbo in the current state budget. This is a matter where, speaking plainly, lives hang in the balance.
At issue are dedicated funds collected through a system of fees and driver's license surcharges on bad drivers – which I created in 2003 as part of House Bill 3588 – that help keep Texas' trauma care network viable. The dilemma is that the lion's share of trauma care funds collected over the next two years will remain unspent. About $63 million in trauma funds were appropriated over the biennium, while it is expected that available revenues will be $77 million more.
Texas' trauma care system was at a point of crisis prior to the creation of the current funding method. Trauma centers were closing and others were frequently in a state of diversion as they became overwhelmed. Patients needing emergency trauma care were literally dying while trying to find an open bed. Whether the patient had insurance or not made no difference in their survival odds.
Worse, the erosion of trauma care had a domino effect on all other emergency services. Trauma centers create a pool of talent that is capable of responding to other tough cases on a 24/7 basis. A trauma facility that permanently closes creates a hole in the care network that risks unraveling for more than just trauma cases. Shifting care to the trauma facilities that remain open creates additional strains and care disruptions for the other emergency cases that come through the doors.
The trauma system – and the emergency room system to which it was attached – was stressed to the point of breakdown under normal loads. We were left with little capacity to respond to a catastrophic event, such as a hurricane, terrorist attack, major industrial accident, or pandemic disease outbreak.
The creation of a stable source of trauma care funding in 2003 was a major turning point in resolving this crisis. What it did was partially close the revenue gap for hospitals that volunteered to operate trauma facilities. This targeted funding was sufficient to stabilize the trauma network and even encourage its expansion.
In the immediate aftermath of the bill, a sizable number of applications were received to either acquire or upgrade trauma care certifications. Memorial Hermann Hospital in Houston even agreed to add 40 additional trauma care beds.
All of this was done on the reasonable assumption that all of the funds dedicated to trauma care under HB 3588 would actually end up going to trauma care.
However, this isn't what happened. As mentioned earlier, the new biennial budget left the majority of trauma funds unappropriated.
The response has been both swift and negative. Two facilities in Houston are dropping their trauma certifications. Other hospitals around the state are waiting to see what happens with the LBB before deciding whether they too will shut their trauma care doors.
Texas now risks setting back the progress made at a time when it needs its trauma system more than ever. If this situation is not addressed, it could have negative consequences for far longer than this current budget cycle.
Trauma care is not provided in isolation. It requires a seamless system that covers the entire state. A car wreck victim in rural Texas must be evaluated, stabilized, routed to appropriate care, and then receive treatment. It is a web of relationships that must function. Strain on one segment is felt in the entire web. If enough links fail, the web may collapse and people die.
Stable trauma care funding has already produced tremendous benefits for our state; using all of the money in the fund for the purposes for which it was collected will compound this benefit.
On the other hand, not following through will inevitably lead to the erosion of the trauma care network. It might not erode quite as fast, but it will still wear away. It will be far more difficult and expensive to persuade trauma facilities to come back once they have closed.
The prudent course, both financially and for public safety, is to prevent those closures by restoring the trauma funds as soon as possible.
