Trauma care here in critical condition

City 'on the brink' of losing top-level care, Carmona says

By Carla McClain

ARIZONA DAILY STAR

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Emergency-care crisis

This report is the latest news in the Star's sustained coverage of what doctors describe as a crisis in emergency care in Tucson's hospitals. If you missed last Sunday's related story, "Tucson ERs lack docs you may need," go to StarNet to find a link to it at www.azstarnet.com/dailystar

Dr. Peter Rhee

UMC's new director of trauma, critical care and emergency surgery arrived here from service in the U.S. Navy, where he holds the rank of captain and was director of the Navy Trauma Training Center in Los Angeles for the past five years.

During that period, he also served as professor of surgery at Los Angeles County Medical Center, part of the University of Southern California.

In 2005, he was deployed to Iraq to open the first surgical unit in Ramadi, after doing battlefield- trauma surgery at Camp Rhino in Afghanistan in 2002. Prior to that, he was head of surgical critical care at the Naval Medical Center in San Diego.

Among his awards and honors are the Legion of Merit, the Defense Meritorious Service Medal, and the Navy Commendation Medal.

Rhee has worked at some of the nation's busiest trauma centers, including Washington Hospital Center in Washington, D.C., and Harborview Medical Center at the University of Washington in Seattle, where he completed his fellowship in trauma and critical care.

He has also served as the director of the Trauma Readiness and Research Institute at the Uniformed Services University of the Health Sciences in Bethesda, Md., where he earned his medical degree in 1987, and holds academic appointments as professor of surgery and molecular and cellular biology.

Rhee is married, with two children.

Southern Arizona's lone level 1 trauma center — at University Medical Center — is in "catastrophic" shape and needs more than double the trauma surgeons it has now, says the center's new director.

After struggling through the summer seriously short of trauma surgeons — due to the resignations of three last spring — UMC has just hired Dr. Peter Rhee, a U.S. Navy trauma surgeon, to take over as the hospital's director of trauma, critical care and emergency surgery.

In his first media interview in Tucson, Rhee, 46, candidly admitted he took this position because it was the "most challenging job" out there.

"I see the potential of this trauma center over the long term," he said. "But the situation is catastrophic for the short term, to be honest. This program is going through its troubles."

The trauma center — which treats victims of severe, life-threatening injuries — suffers a severe shortage of funding for the trauma and specialty surgeons needed to adequately serve a Southern Arizona region of well over a million residents, Rhee says.

Though a startling, even alarming admission, it is completely accurate, says the founder of Tucson's level 1 trauma system, Dr. Richard Carmona, a trauma surgeon himself and the former U.S. surgeon general.

"He's right. We all need to step back and take a look at this. We're a big city now, but we are losing the excellence in trauma care we once had," said Carmona, who brought top-level trauma care to Tucson in 1985 and served as trauma director at Tucson Medical Center until the mid-1990s.

Tucson had a two-center system — at UMC and TMC — for nearly 20 years, until TMC closed its trauma service in 2003 because it was too expensive to maintain.

"UMC has done extraordinarily well on its own, a great job, but they are so stretched now. They are struggling on the margin to maintain level 1 status," Carmona said.

"Doing that is a very big strain, and they can no longer do it alone. The entire community needs to come together now to fund this vital resource. If we lose top-level trauma care — and we are on the brink — you can't grow your economic base. That's a vital medical service.

"We need the governor, the mayor, the City Council, the supervisors, the hospitals to come together and figure out what it's going to take. We need the will to do this."

Right now, UMC is operating with only two full-time trauma surgeons, supported by two part-time surgeons, who commute here from Phoenix and New York to help out.

Since the exits of the three trauma surgeons in June — including then-trauma director Dr. John Porter — UMC has called on surgeons from other parts of the hospital to do fill-in duty at the trauma center.

But UMC needs no less than 10 dedicated, full-time trauma surgeons to handle its load, said Rhee.

"The top priority is to get these surgeons here — the hired guns. We've got to get the pros, nationally renowned trauma surgeons to come in," Rhee said.

But he knows that hasn't been easy in the past, and it won't be easy for him.

"You talk about Tucson — the volume in this city, the population — it's as big as any major city," he said. "But in professional circles, Tucson's reputation is not so big. I'm working to get Tucson's name out there.

"The money we need to do this is here somewhere. We've just got to find it. I think this is solvable."

Aiming for 10 trauma surgeons is "a lot," Carmona said.

"If he gets five full time, that will be an achievement," he said. "He sounds like a guy with a lot of passion, trying to create the best service possible. We need that kind of passion now."

But this has to be a citywide movement, a citywide commitment, Carmona stressed.

He said Tucson must consider using taxing and bonding authority, possibly the formation of a hospital district, to get adequate funding for a level 1 trauma center. That's what has worked in other cities, he said.

"Trauma surgeons need a team. Over half of the patients with multiple injuries in a trauma center have head injuries. You need neurosurgeons, orthopedic surgeons, plastics, eye specialists, and you need them round-the-clock. The main problem has been retaining this kind of team," he said.

"We're just hanging on."

The doctors who run hospital emergency rooms around the city — which often must handle trauma overflow when UMC is overloaded — share Carmona's praise for UMC's mighty effort to run a top-level trauma center.

But UMC is forced to refuse too many serious injuries, often because it lacks intensive care beds for these patients, they say.

"The fact is, they're overwhelmed," said Dr. Steven Pike, emergency physician at St. Joseph's Hospital.

What Southern Arizona really needs is a second trauma center, say experts. The rule of thumb is one level 1 center per 1 million population. Now serving five counties, the UMC trauma center is handling a region larger than that, seeing some 4,500 to 5,000 patients a year.

"Absolutely, the city needs a second center," said Rhee. "But don't degrade the first trauma center in the process. Only when we get this trauma center in top working order — then we can think about a second one."

Tucson is growing — "the city is becoming a success," he said.

"But what any city absolutely must have is police and fire protection, emergency and trauma care. You want to be able to pick up the phone and know someone will respond to take care of you.

"You don't have that, you don't have a city."