The Golden Hour

To practicing trauma-center physicians, the “golden hour” is the time period between injury and getting a patient definitive treatment. Pretty clearly, there is an inverse relationship between survivability and the length of time between the accident and the proper medical attention (picture a helicopter landing on a battle field versus hand-carrying a stretcher across a war zone). Funny enough, there is also an inverse proportion between whether you have health insurance and survivability. With me so far?

As the battle lines are being drawn between those (1) who oppose the current healthcare reform measures and think we really need to let the system operate with a few minor tweaks (like reducing the rewards for lawyers who sue for medical malpractice) and (2) those who think having 46 million uninsured Americans is a disaster with a system that has increasing numbers of us going bankrupt because of unaffordable medical bills… it might be really good to focus on one tiny little statistic: “uninsured trauma victims ages 18 to 30 are dying at an annual rate 89 percent higher than insured victims with identically severe injuries” according to a study conducted by Children's Hospital Boston research fellow Dr. Heather Rosen and colleagues from three other hospitals and reported in the November 16 Sphere.com.

Federal law makes it very clear: all seriously injured emergency and trauma patients must be given equal lifesaving care, even if they can’t afford it. But somehow, despite the legal mandate, they don’t. The report is based on massive statistical and irrefutable information. Sphere: “The study, published [November 16] in the Archives of Surgery, examines the survival rates for patients brought to about 900 U.S. trauma centers between 2002 and 2006, analyzing some 690,000 patients who had suffered penetrating trauma -- such as wounds inflicted by a gun or knife -- or blunt trauma from vehicle crashes and falls. Earlier research found 18,000 extra deaths a year among uninsured victims of such injuries. Rosen and the other researchers chose to focus on the 18-to-30-year-old subset because they had fewer existing conditions -- comorbidity -- that muddy the evaluation of the cause of death.”

Strange that “right to life” advocates, those dealing with the viability of a fetus in the controversial debate surrounding abortion, tend also to be a large segment of those who support maintenance of the status quo on healthcare reform. Apparently, they believe in a right to life only exists prior to birth, but once a child is born, he or she is simply on his or her own. These are serious moral issues that must transcend the right of pharmaceutical companies and hospitals to make a profit. But somehow the threat of capping certain medical costs, creating a not-for-profit, government-administered very basic plan that competes with private plans – thus interfering with the American free market system – are more of a threat to these Americans than the raw need to save human lives.

If you ask the folks running trauma centers if that’s the reality in their hospitals (that the uninsured get second class treatment), there is nary a soul, not a practicing trauma-center physician in this country, who will confirm that they treat uninsured patients any differently. They’ll tell you that the follow-up care may fall short or that uninsured folks are in worse shape generally than those who are insured (but look at the ages of the victims!!!). Yet the study also shows that the uninsured get a lot fewer X-rays (or MRIs, CAT scans, etc.) and are much less likely to be admitted to the relevant hospital than a comparable person with insurance. Sphere: “[A]s a trauma social worker from Washington, D.C. -- who declined to allow… her name to be used because she isn't authorized to speak to reporters -- puts it: ‘They would never be foolish enough to tell a trauma surgeon to not order this or that test, or cancel a scan or expensive lab work because they found no insurance card in the patient's wallet.” … ‘What surgeon, ER doc or nurse would risk their license and violate federal law to keep the billing office happy?’ the social worker adds…

“Rosen cautions that the definitive cause for the higher death rate for uninsured people remains to be determined. Still, the hard number -- the nearly 90 percent jump in mortality rates for uninsured accident victims -- speaks loudly on its own. ‘Although the lack of insurance may not be the only explanation,’ she says, ‘the accidental costs of being uninsured in the United States today may be too high to continue to overlook.’” Yeah… I would suspect she is right.

I’m Peter Dekom, and I approve this message.