Chesco eyeing trauma care

Philadelphia Business Journal – John George

COATESVILLE — Brandywine Hospital has a full-time neurosurgeon on staff for the first time since it closed its trauma center in 2002 in what may be a precursor to resuming trauma care in Chester County.

Chester County, with 485,000 residents, is the largest county in Pennsylvania without a trauma center to care for critically injured patients. High medical malpractice insurance costs factored into the decision to close the trauma center.

“We are interested in reopening a level-II trauma center, and we hope this is a first step in doing that,” said Mark A. Benz, Brandywine’s president and CEO.

Benz said the hospital would need financial help to do so because of the costs it would incur to hire three neurosurgeons to provide 24-hour, seven-day-a-week coverage in a trauma center.

Chester County last month established a task force comprised of federal, state and county officials; business and health-care industry representatives and community leaders to study if a new trauma center is needed and, if so, how to generate public and private funds to help support one.

U.S. Rep. Jim Gerlach, R-Chester, said the panel is a result of a 2007 Chester County Trauma Center study that found support for establishing a new trauma center at either Brandywine Hospital in Coatesville or Chester County Hospital in West Chester because of their centralized locations in the county. The report determined running the trauma center would cost between $5 million and $8 million a year, an expense neither hospital can afford.

“We’re going to explore all funding opportunities,” Gerlach said. “Chester County really needs a trauma center. We are the largest county in the state [without a trauma center], and the only county in southeastern Pennsylvania that doesn’t have one.

The study also found the average transport time, by ambulance or helicopter, to get Chester County patients to a trauma center in an adjoining county is about 73 minutes. The optimum time for treating trauma patients is under 60 minutes. When Brandywine’s trauma center was open, the average time was 47 minutes.

“One of our biggest concerns,” Benz said, “is the population is growing rapidly in Chester County and the traffic is growing with it. That 73 minutes is going to get longer.

“Brandywine was forced into closing its trauma center in 2002 primarily because it was the height of the medical malpractice insurance crisis in southeastern Pennsylvania. Trying to employ neurosurgeons around the clock was too prohibitive. That was the primary reason for closing the trauma center.”

Dr. Andrew Freese, Brandywine’s new medical director for neurosurgery, is quite familiar with the malpractice insurance climate in Pennsylvania, having spent 14 years in Philadelphia at Thomas Jefferson University Hospital and Graduate Hospital before escalating premium costs drove him to move his practice to Minnesota in 2004.

“I had never lost or settled a suit, but my malpractice insurance premiums were well over $200,000 a year,” he said. “The fear was they were going to hit $300,000. My family was looking at an economic calamity. In 2004 we finally said that’s it.”

Freese took a job as director of spinal surgery and vice chairman of neurosurgery for the University of Minnesota. He decided to come back now because his family missed this area and because of some of the steps the state had taken to control insurance premiums. He noted a rule eliminating venue shopping, by having cases tried in the county where the alleged malpractice occurred, has helped stabilize rates in Chester County.

“It’s still expensive to practice in Philadelphia, but in Chester County the rates have dropped precipitously,” Freese said. “I can get coverage for about $130,000 or $140,000. Also, because the malpractice rates have driven a lot of neurosurgeons out of the area, there’s a huge demand for neurosurgeons in this county. I think I’ll be the only full-time [hospital-based] neurosurgeon based in Chester County.”

Paoli and Chester County hospitals rely on neurosurgery coverage from physicians who are based outside the county. Jennersville Regional Hospital in West Grove transfers its neurosurgery cases to larger hospitals.

Paoli works with two neurosurgeons based out of Bryn Mawr Hospital in Montgomery County. Both hospitals are part of Main Line Health.

Chester County Hospital officials said they would consider a trauma center if the task force determines the West Chester medical center is the best option.

“Regardless of significant economic and medical staffing issues, the growth of Chester County in the years to come compels us all to plan together on how best to create a level-II trauma center over the next few years,” said H.L. “Perry” Pepper, the hospital’s president and CEO. “The Chester County Hospital understands that many citizens would like to have such a unit at our hospital and if that is the outcome of a rational and objective planning process we stand ready to do our best to meet that need.”

Dr. Richard D. Donze, senior vice president for medical affairs at Chester County Hospital, said the number of staff neurosurgeons at his hospital has slipped from five to one over the past several years as doctors have either left the region to practice elsewhere or retired.

“Neurosurgeons are typically itinerant,” Donze said. “They don’t have enough cases at one hospital to keep them busy. Sharing one [neurosurgeon] with other hospitals is not ideal, but that’s what we have. There is a limited availability for emergencies.”

Phoenixville Hospital added a neurosurgeon earlier this year when Dr. Sagi Kuznits joined its staff.

Kuznits had been with Main Line Health before establishing a private practice in Limerick, Montgomery County, to serve patients in western Montgomery and northern Chester counties along the Route 422 corridor. He is splitting his time between Phoenixville Hospital and Pottstown Memorial Hospital which, like Brandywine, are owned by Community Health Systems Inc. of Franklin, Tenn.

Stephen M. Tullman, CEO at Phoenixville, said the arrangement is mutually beneficial.

“He’s providing coverage for the ER here and at Pottstown and providing neurosurgery at both hospitals,” Tullman said. “We hadn’t had neurosurgery [at Phoenixville Hospital] in the four years since I’ve been here.” | 215-238-5137

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