Friday, September 11, 2009

Level I Challenge for Coroner’s Office

We were already on track for a significant increase in the number of deaths in Lake County that involve Coroner office investigation (approximately 15%) this year. Most deaths (about 80%) require little or no investigation, e.g. hospice deaths, natural deaths from normal disease processes.

Then came the news that a local hospital will begin operating as a Level I Trauma Center October 1st. We knew it was coming, but couldn’t get concrete numbers on how many individuals (victims of trauma) that are currently flown out of our county would now be staying for treatment and potentially dying in county. The folks that are flown out are the most severely injured and unfortunately many succumb to their injuries despite the best care possible.

Now we know that the hospital projects that about 300 folks currently flown out will be going to their hospital for care. It must be an incredible undertaking on their part to prepare for that caring and that rather precipitous jump in treatment volume. But no one consulted us on how that will impact our functioning; apparently they felt we would just take up the potential jump in case volume. I’ve already submitted my budget for 2010 and it includes cuts because of concern for Lake County’s limited resources projected by County administration, not service expansion possibly mandated by this change in the county milieu.

I don’t mean to sound cold about these individuals dying, but the reality is that these things must be thought about as well. These deaths will challenge our resources, staffing, autopsy services, and toxicology testing. Planning is difficult because we don’t know how many more deaths will need investigation or what will be necessary in our death investigations for these individuals. For example, will they have had enough testing (x-ray, CT, MRI, toxicology) during their in-hospital care to preclude the need for autopsy?

These are interesting times and our personnel will rise to the challenge, but a bit of number projection and information about possible cases would have been nice.


Crazy4glf said...

Dr. Keller,
While I empathize with the prospect of your office seeing an increase in responsibility, I currently believe that it is atrocious that someone injured in Wauconda or North Chicago has to be taken to Lutheran General Hospital in Park Ridge.
That Lake County does not and has not have a Level I Trauma Center demonstrates what can only be seen as a perpetual oversight, in my view.

Also, consider the situation where someone is injured, flown to Lutheran General at significant expense, and their family lives in Lake Bluff.
Given that, at least anecdotally, hospital and long-term care facility patients who are visited consistently experience better outcomes, this creates a strain on the injured person's family.

Also, when not flown to Lutheran, I understand the other closest Level I Trauma Center is Froedert near Milwaukee.

Also, it -could- be possible that a closer facility may reduce mortality and (additional/en route) morbidity).

Finally, I think that even if our area did not have a Level I Trauma Center, if Illinois mandated helmets for motorcyclists where those who chose not to had provisions in their health insurance that their co-pays and/or out-of-pocket expenses were higher if involved in an accident, and other preventive or mitigating efforts would go a long way.

Dr. Richard Keller said...

Well put.

It certainly has been my belief, since my years in ER Medicine here in Lake County, that this county does need a Level I Trauma Center and I am glad it is finally happening.