Alaskans work dangerous jobs and play dangerous sports, and as a result they die from accidental injuries at the second highest rate in the nation. One might expect the hospitals serving such a hard-charging state to operate at the highest level of trauma care, but of Alaska's 24 hospitals, only five are designated trauma centers, and of those five, four primarily serve Alaska Natives.
Becoming a trauma center -- where patients who have suffered traumatic injuries can receive comprehensive care -- requires a hospital to fulfill certain requirements, some of which can be expensive. For example, a Level IV center must be able to stabilize a patient before transferring her to a larger facility, while a Level II center must have emergency doctors on hand and surgeons on call at all times. In Alaska, only Alaska Native Medical Center in Anchorage is designated as a Level II center.
One of the challenges to new trauma centers in Alaska is that many trauma patients don't end up paying their bills, lessening a hospital's incentive to attract those patients. Another issue is the perceived expense of having highly-paid doctors and surgeons on call at all times, said Frank Sacco, the chief of surgery and director of the trauma service at ANMC, and the chair of the Alaska Trauma Systems Review Committee.
"If we had a state trauma system, less Alaskans would die from injury," Sacco said. "Most Alaskans, when they are seriously injured, don't get the benefit of being treated in a trauma center."
This week Alaska legislators are considering the creation of a fund that would pay hospitals back when they treat patients who don't pay for their care. The catch? To qualify for any money, the hospitals would have to make the changes necessary to become designated trauma centers.
Sen. John Coghill, who introduced HB 168 and its related appropriation, HB 169, while serving in the House last year, said Alaska hospitals are providing solid care but improvements are possible.
"They're doing a yeoman's job now," Coghill said. "This is just to try and get them to a higher level."
The bills are intended to provide a carrot to encourage Alaska hospitals to become designated trauma centers. Having a trauma system -- a network of medical facilities and professionals -- in place can reduce an area's injury deaths by 15 to 25 percent.
The Senate and House bills call for the creation of a $5 million fund to compensate hospitals for care provided to patients who don't pay. Hearings were held Tuesday and Wednesday in the Health and Social Services Committees, and Coghill expects the bills to move on to Finance next week.
According to a 2008 report on Alaska's trauma system by the American College of Surgeons, while several Alaska Native hospitals have achieved designation as trauma centers, the same is not true of hospitals serving the majority population.
"To date, few of the facilities serving the majority population have made a similar commitment to achieving nationally recognized standards of trauma care," the report said.
Alaska is the only state without a Level I or Level II trauma center that primarily serves its majority population, and Anchorage is the largest city in the country that lacks a Level II center to serve the general population.
"ANMC doesn't have the capacity to care for all the trauma victims in Anchorage," said Ward Hurlburt, the state's chief medical officer and director of the Division of Public Health.
Besides the Level II center at ANMC, Alaska has four Level IV trauma centers, at Norton Sound Regional Hospital, Yukon Kuskokwim Delta Regional Hospital, Mt. Edgecumbe Hospital, and Sitka Community Hospital.
Trauma centers are currently the subject of national legislation as well. Bills introduced in the U.S. House and Senate would allocate $100 million for each year through 2015 in order to pay trauma centers back when they provide uncompensated care.
Not everyone agrees that trauma center designation is necessary for top-notch emergency health care, however. Although Anchorage's Providence Alaska Medical Center is not a designated trauma center, hospital spokesperson Kirsten Schultz said it provides the same medical care as a Level II trauma center.
The difference, Schultz said, is that a Level II trauma center has a published backup list of surgeons who are required to come in when called, while Providence has a list of surgeons that they call and ask to come in if the on-call surgeon is with a patient. Schultz said the voluntary system has worked 100 percent of the time.
Contact Joshua Saul at jsaul(at)alaskadispatch.com.