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RELATED STORY: NWTH officials clear the air EmCare Firm ready to continue ER services at NWTH By George
Schwarz A move by the Amarillo Emergency Group physicians from Northwest Texas Healthcare System to Baptist St. Anthony's Health System will not jeopardize Northwest's trauma designation.
And recruiting those physicians and buying a new helicopter won't necessarily help BSA gain a competitive trauma care designation. Those are two of the observations officials made as the two hospitals square off over emergency care. "We will Day One provide qualified ER physicians to the practice," said Dr. David T. Grinbergs, chief executive officer - Southwest Region for EmCare, the firm that will replace AEP. "We have a model and we're pretty far into stages of recruiting a group and plan on starting when the current group exits, which I believe is 12:01 a.m. on May 30," he said. "And we will have a full complement of qualified physicians at 12:01 a.m. on May 30 to appropriately and very adequately continue the excellent care that's been provided there and maintain and even enhance some of the services." The group will also continue the designation the hospital has, including the trauma status and bedside teaching and other EMS needs, he added. Those EMS needs include supporting the Panhandle Emergency Medical Services System, or PEMSS, said Dr. Nathan Goldstein, Northwest's chief medical officer. (See story below.) Goldstein said EmCare is a major national provider of emergency room physician coverage. "They're a huge group in Texas," he said. "They have a lot of people employed." There are few groups that could send experienced people to cover the ER and recruit full-time people within the short time Northwest had for the transition. EmCare is going to staff the ER with board-certified emergency room physicians and internists. They will also provide physician assistants to staff less urgent patient areas. The idea is to provide more coverage for the nonemergency patients that come to the ER, Goldstein said. "We plan to do it a little differently such that we have a greater number of providers to try to enhance the throughput so people don't have to wait as long." They bring other options to the table — they have proven protocols that have been used in academic and Level I trauma centers and management experience to optimize patient flow, Goldstein said. The core group will include 12 to 14 physicians. All of the physicians will be Advanced Trauma Life Support certified and qualified as emergency physicians. They will have board certification and will enhance the level of service. EmCare grew out of the Baylor Medical Center, which is a Level I, or the highest designated, trauma center and still provides care for Baylor. The firm has the contract for John Peter Smith Hospital in Fort Worth, which has emergency medicine residency and fellowship programs. The 34-year-old firm is the largest emergency physician practice management company in the country with some 380 hospitals in 40 states, so the firm can bring "best practices" to clients. It has several consulting divisions that also provide management services, Grinbergs said. Even if some in the initial group of doctors lack full certification — some will be board eligible, — that's beside the point, Goldstein said. "That's actually not even the goal. The goal is to have enough boarded people to provide the same level of quality care to critically ill patients as we've always done." "You don't need a neurosurgeon to sew up a scalp laceration," he said. Goldstein said he doesn't anticipate the hospital's staff would leave to follow the AEP group to BSA. "Many of the staff are very unhappy at how this came all about," he said, adding that the unilateral decision to leave with no prior discussion was the case. All they did was tell Northwest they were exercising their 90-day notice, with no discussion about if there were problems or other issues that could be rectified or addressed. He said they are good physicians and good people and had nothing bad to say about them. "I think we've had a 15-year relationship," he said. "I would have thought after 15 years, though, there would have been some dialogue prior to their departure." Goldstein said the critical piece to a trauma center is the staff and surgical sub-specialists who provide the services for the patients. "It's the American College of Surgeons that certifies trauma centers, it is not the national organization of emergency physicians," Goldstein said. For a trauma center, good ER doctors are important to keep patients alive in order to get the patient to the operating room. "A hospital can have a board-certified advanced trauma life support certified family practitioner in the emergency room, you can have a trauma center, but if you don't have a neurosurgeon or orthopedic surgeon, you can't," he said. The loss of the trauma center designation isn't at risk as long as Northwest has an emergency room with ATLS-certified physicians, Goldstein said. "We have no intention of being in jeopardy (of losing designation)." For BSA to get a Level II trauma center approval, it must have neurosurgeons and orthopedic surgeons who take call only for BSA. They can't be on call elsewhere. Under the rules, these physicians have a very short time frame for getting to the hospital, which is why most Level I and II trauma centers have people on campus, he said. The Department of State Health Services has urged Northwest to raise it designation to Level II. That's not realistic. The surgical sub-specialists in Amarillo provide care to both hospital emergency rooms. It didn't make sense to have them dedicated to one emergency room, he said. "You can get, you accomplish that, depending on how much money you're wiling to pay. I am sure if they're willing to pay a lot of money they can get whatever they want." Steve Janda, of the DSHS, did not return repeated calls. BSA also has a hurdle for providing care inside Amarillo. Goldstein said the city must provide a permit for any ambulance system to operate within the city limits and the city decided a long time ago to limit it to one provider, the one that the hospital district owns, which is AMS. When the hospital sold, that continued and AMS is the only one with the permit. Whether BSA will ask the city for a permit, which must come before the City Commission, isn't certain, but sources said the city rumor mill is the request is coming soon. The city was contacted this week about the procedures for seeking such a permit. Northwest has made a significant proposal to UHS for more ambulances and, Goldstein said, he has spoken with the city manager about an additional location for placing ambulances. Goldstein said. "The only way they can get a permit is to show need." E-mail
comments about this story Posted: April 3, 2008
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