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F I S C A L I M P A C T R E P O R T

SPONSOR Lujan

ORIGINAL DATE

LAST UPDATED

1-28-06

2-7-06 HB 266/aHBIC/aHAFC

SHORT TITLE Trauma System Fund Authority Act

SB

ANALYST Collard

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

Or Non-Rec

Fund

Affected

FY06

FY07

See Administrative Implication

Recurring

General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

Duplicates SB 356

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Human Services Department (HSD)

Aging and Long-Term Services Department (ALTSD)

Developmental Disabilities Planning Council (DDPC)

Higher Education Department (HED)

SUMMARY

Synopsis of HAFC Amendment

The House Appropriations and Finance Committee amendment to House Bill 266, as amended

by the House Business and Industry Committee, strikes the appropriation contained in the bill.

Synopsis of HBIC Amendment

The House Business and Industry Committee amendment to House Bill 266 requires the trauma

system fund authority to report annually, not only to the Health and Human Services Committee,

but also the Legislative Finance Committee. Additionally, the amendment designates $2 million

of the fund, previously intended to strengthen and stabilize the trauma system, to support other

designated trauma centers and potential new centers.

House Bill 266/aHBIC/aHAFC – Page

2

Synopsis of Original Bill

House Bill 266 appropriates $6 million from the general fund to create the trauma system fund to

provide funding to sustain existing trauma centers, support the development of new trauma cen-

ters and develop a statewide trauma system as follows: $4 million to support trauma services at

the University of New Mexico hospital in the first year of the fund's existence; $2 million to

strengthen and stabilize the trauma system; and no more than five percent of the fund may be

used by DOH for administrative costs, including monitoring, trauma system development and

technical assistance. Funds may be expended in fiscal year 2006 and subsequent fiscal years.

The bill also creates the trauma system fund authority, consisting of nine members, representa-

tive of the state trauma needs that will develop criteria for, monitor and oversee distribution of

the funds and report annually to the Health and Human Services Committee.

FISCAL IMPLICATIONS

The appropriation of $6 million contained in this bill is a recurring expense to the general fund.

Any unexpended or unencumbered balance remaining at the end of any fiscal year shall not re-

vert to the general fund.

ALTSD notes the $6 million appropriation is a positive starting point to turn the situation around.

However in subsequent years, additional funds may be required to adequately meet the needs of

all New Mexicans, especially those in rural communities.

HED notes this bill would help secure improved funding for the University of New Mexico Hos-

pital (UNMH), under the auspices of the UNM Health Sciences Center (HSC). Currently, HSC

receives appropriations from the state legislature for healthcare at the university hospitals

through line-items in the state budget. This method of funding creates challenges in accommo-

dating increasing program size and costs for healthcare delivery. This bill would help address the

impact of uncompensated care at the UNMH and other trauma centers. The bill would also help

address the ability of HSC to build its academic programs and growing clinical revenues.

This bill creates a new fund and provides for continuing appropriations. The LFC has concerns

with including continuing appropriation language in the statutory provisions for newly created

funds, as earmarking reduces the ability of the legislature to establish spending priorities.

SIGNIFICANT ISSUES

DOH is in support of this bill, which came out of the interim work of the Health and Human Ser-

vices Committee. The appropriation contained in this bill resulted from the Trauma Task Force

Report. That report states:

“[The] New Mexico trauma care system and services are on the brink of

collapse. Trauma centers are facing a breakdown caused by the surge in

patients, the decline of specialty physicians and nurses to provide care and

the lack of funding to sustain trauma center designation. These facts mo-

tivated the New Mexico legislature to pass House Memorial 20 in the

2005 New Mexico Legislature. The Governor’s Trauma Task Force was

created to make recommendations to address the crisis. Thirty-six physi-

cians, hospital administrators, emergency medical personnel, insurers,

House Bill 266/aHBIC/aHAFC – Page

3

Medicaid professionals, rehabilitation administrators, injury prevention

specialists and others statewide served on the Governor’s Trauma Task

Force, meeting monthly to confront trauma system challenges.”

DOH notes the bill defines a “statewide trauma system” as a coordinated continuum of care that

includes injury prevention, emergency medical, acute care hospital and rehabilitative services

and that is subject to accountability and system improvement. Such trauma system development

would strengthen all health care statewide. The bill also identifies DOH as the responsible au-

thority statutorily.

ALTSD indicates access to trauma centers is particularly significant to the brain injury popula-

tion the department serves through both the Traumatic Brain Injury (TBI) Trust Fund and Mi Via

(self-directed waiver brain injury services), and to the general population that will need trauma

services because of brain injury.

ALTSD states strategically placed trauma centers throughout New Mexico with specialty trained

medical staff can reduce fatalities and long-term disabilities related to TBI. Quick response dur-

ing the “golden hour” (the first hour after a TBI) can make the difference between death, living

with a life-long disability and significant recovery.

New Mexico’s current trauma system is ill equipped to provide TBI patients with adequate spe-

cialty treatment that could save their lives and prevent them from having long-term disabilities.

PERFORMANCE IMPLICATIONS

DOH indicates the bill is consistent the Epidemiology and Response program’s objective #1: To

improve the state’s capacity to respond to public health emergencies.

ADMINISTRATIVE IMPLICATIONS

DOH notes five percent of the fund may be used by DOH for administrative costs, including

monitoring, trauma system development and providing technical assistance to include the crea-

tion of at least 2 new FTEs and maintenance of 2 existing FTEs currently funded through federal

grants and contracts. DOH also notes existing trauma rules and regulations will need to be re-

vised and promulgated prior to fund distributions.

DUPLICATION

House Bill 266 duplicates Senate Bill 356.

OTHER SUBSTANTIVE ISSUES

ALTSD research indicates the Centers for Disease Control and Prevention (CDC) estimate that

5.3 million Americans currently have long-term or a lifelong need for services because of a TBI

related disability. Fifty thousand people in the U.S. will die from a traumatic brain injury this

year.

When a brain receives a traumatic injury, its first response is to swell into the cavity of the skull.

Because the skull doesn’t allow the brain to expand, the swelling causes the destruction of blood

House Bill 266/aHBIC/aHAFC – Page

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vessels, cuts off oxygen to the brain and cells begin to perish. As cells die there is an additional

release of chemicals that destroy other neurons (National Transportation Safety Board). Trauma

medical teams can often stop or reverse the process before permanent damage or death occurs if

the person receives trauma care within the “golden hour.”

Brain injury related deaths and no-fatal traumatic brain injuries are significantly high risk factors

in New Mexico. A CDC study of persons with TBIs conducted in seven other states indicated

that 16.9 percent died before being admitted to the hospital. Of those that were admitted an addi-

tional 5.6 percent died while receiving acute care. Approximately 35 percent of those hospital-

ized experienced the onset of long-term disability. (National Highway Traffic Safety Administra-

tion [NHTSA]).

More than half of the New Mexico’s population lives in rural areas. The likelihood that a motor

vehicle crash will result in a fatality is between three and eight times greater for rural residents

over those that live in urban areas (Journal of Head Trauma, Rehabilitation/November-

December 2003). This is due to two major factors in this state: the additional response time it

takes to transport an individual from a rural area, and not having adequately trained trauma spe-

cialists available regionally. It is not unusual for a New Mexican that sustains a TBI to be trans-

ported to a local hospital only to be transported to a trauma center hours and sometimes days

later, far past the “golden hour” window.

Nationally, 24 percent of crashes occur on rural roads, but nearly 59 percent of crash deaths oc-

cur on rural roads. “Delay of delivering emergency medical services is one of the factors con-

tributing to the disproportionately high fatality rate for rural crash victims.” The average elapsed

time from rural crash to a hospital (not necessarily a trauma center) is rarely within the “golden

hour”. (NHSTA, study conducted in Arizona, Louisiana, Michigan, Montana, Nevada, North

Dakota, Texas and Wyoming).

Vehicle crashes cause less than 25 percent of all TBIs. Other TBI causes include injuries from:

firearms, falls, shaken baby syndrome, assaults and sports accidents. Virtually every person that

sustains a TBI, no matter the cause, requires quick specialized care in close proximity to the

scene of the injury.

Only 60 percent of New Mexico’s citizens are in close proximity (within 90 miles) to a trauma

centers. Currently New Mexico has only three trauma centers: one level one at UNMH in Albu-

querque and two level threes in Santa Fe and in Farmington (New Mexico Trauma Care Crisis

2006, report responding to House Memorial 20). Optimum trauma services for persons with TBI

are complex and require a neurologist and neurosurgeons on call 24 hours, triage medical staff,

fast transport and specialty treatment to turn the situation around. UNMH is often the only

trauma center in the state that is staffed and able to treat TBI quickly and adequately. Many are

transported to El Paso, Lubbock, Tucson and even Denver. Trauma care rarely happens within

the “golden hour.”

DDPC indicates New Mexico is experiencing an injury and trauma care crisis. New Mexico has

the highest unintentional death rate in the nation and is tied for first in violent death rates. New

Mexico has the highest mortality rate in the United States for traumatic brain injury. Brain in-

jury is the leading cause of death and disability for people under the age of 45. Every 21 seconds

someone in the United States sustains a traumatic brain injury, and each year 1.5 to 2 million

people sustain a traumatic brain injury as a result of DUI, domestic violence, sports injuries and

House Bill 266/aHBIC/aHAFC – Page

5

falls. Trauma accounts for more years of lost productivity before age 65 than heart disease, can-

cer and stroke combined.

DDPC research indicates, in addition to the high volume of injuries and associated costs, there is

a shortage of qualified physicians, nurses and trauma related specialists. Trauma centers must

maintain continual in house or on call coverage by 15 different medical specialists who must

meet additional training requirements. There is a significant shortage of these specialists in New

Mexico. An example: New Mexico has only five pediatricians who have completed a fellowship

post residency in pediatric emergency care. All five physicians are at UNMH and two arrived

only recently. One of the two groups at highest risk for TBI are zero-to-four year olds.

WHAT WILL BE THE CONSEQUENCES OF NOT ENACTING THIS BILL

DDPC notes the nationally recommended ratio for a major level one trauma center is 1 per

500,000 people. New Mexico has one major trauma center for the entire population of 1.8 mil-

lion. Citizens don’t have access to timely and specialized care that will best address their needs

and increase their likelihood of an optimal recovery. According to the CDC the direct medical

costs and indirect costs such as lost productivity of TBI totaled an estimated $56.3 billion in the

United States in 1995. Timely and specialized care is crucial in order to reduce lifelong disabil-

ity related costs and increase the productivity and quality of life of persons with brain injury.

KBC/nt:yr