/Millions swept from nationally lauded trauma care system

Millions swept from nationally lauded trauma care system

A controversial bill that was passed at the close of the 2016 legislative session directed millions of dollars from trauma treatment into the state’s general funds. While both political parties are in agreement that trauma care should be paid for, others worry that the highly regarded system may become a victim of the state’s ongoing budget problems. “The money is gone, and it’s threatening this important system. Why? Rep. Jay Hughes (D-Oxford) stated that it was necessary to pay a significant budget deficit. “And now, we’re in danger of going from worst to worse.” The Budget Transparency and Simplification Act has been controversial since its introduction. Advocates claimed that the law would help free up millions of dollars through sweeping fees paid by state agencies for services to the general fund. Detractors protested, accusing the Republican-led Senate to using the swept funds to pay for an unanticipated hole in the state’s budget. The law is a problem for both legislators and agency leaders, regardless of their motivations. Many agency heads confess that they struggled to understand the new rules and how they affect their budgets. Some problems have been solved. The Department of Health has made some progress. But, there is one question: Will it have to take $4.5 million out of its budget to fill the gap in the trauma system’s funding? The funding system is one of the unique aspects of the trauma care system. Instead of relying on an annual general funds appropriation, the Legislature in 2008 attached a number of fines to “risky” behavior that makes a trauma care system essential, such as speeding tickets and ATV purchases. These fines were to be paid directly into the trauma fund. No other department can touch them. The sweeps bill provided a loophole by directing a portion of these fees to the general fund, before they reached trauma care. These “criminal assessment fees” included moving vehicle violations, which annually account for a third of the $22million trauma care system budget. The remaining two-thirds of trauma fees were unaffected. Mississippi Today was contacted by many trauma care advocates who stated that they believe the funds were stolen by accident. They would like to see the session in January reopen these funds. “Every legislator I’ve spoken to understands the importance of trauma care and EMS. So I believe in their attempt (the sweeps bill) to pass it, which was done close to the end of session, I think there were some oversights that caused some problems that we need to look at and modify,” stated Bill Oliver, chairman of ad hoc Task Force on Trauma System, which the Board of Health established this summer to address funding issues. The Department of Health stated that it wanted the Legislature to amend the sweeps bills for fiscal year 2018. This would allow all fees related to trauma to flow back directly into trauma care. “Those funds were originally created for trauma care,” Dr. Mary Currier said, the state’s health officer. “So we would love it to return to the way that it was. And I believe that’s what people (in Congress) want.” However, some Republican leaders stated that the rerouted trauma fees work better in the general fund. This is where the Legislature can control how the trauma care system spends its money. I believe the idea of transferring those fees into the general fund and then reappropriating them is transparent. “It’s not just trauma funds. It’s all funds. Making sure they know how the dollars are spent and what the benefits of it is,” stated Sen. Terry Burton (Republican from Newton). “… It may have been unintentional but we will ensure they get the funds.” For some lawmakers, it is not as important where the funds are located as how they are spent. Bubba Carpenter (Republican from Burnsville), who is also a paramedic and author of the bill, stated that former Rep. Herb Frierson personally assured him that the Legislature would not appropriate trauma care funds for anything other than trauma care. He said that he would not have voted in favor of the bill if he believed otherwise. Carpenter stated that Carpenter was certain that the sweeps bill would not affect the EMS funds when he voted for it. “… There will be a lot of fighting on the floor if this changes.” However, the statute protecting the funding has already changed. No matter how many legislators say trauma funds will be used for trauma, the general fund money can be used to support any department. Some Republican leaders claim that this was always part and parcel of the plan. “It just fits in line with all the other,” stated Sen. Buck Clarke (R-Hollandale), who co-authored Budget Transparency and Simplification Act. It’s difficult to say that education funding is a priority. Health care is. According to Thad Waites (a member of the state Board of Health), the Mississippi state trauma care system is a shining example of a state in which health ranks “overall number 1 in all the wrong places.” The Journal of Trauma Care and Acute Care Surgery in 2012 praised the program and its funding system as “prescient” and an example for other states. According to all reports, Mississippi’s trauma system has achieved its goal of reducing injury and death from traumatic injuries. For every 100,000 people in Mississippi, there were 26.6 motor vehicle fatalities in 2008. This number has dropped to 20.3 deaths per 100,000 residents by 2014. That’s a decrease of 24 percent. The national rate fell 17 percent during the same period. Oliver stated that “great trauma care meant that patients were transported to the right place at a right time. The golden hour was the key to that. This is when EMS providers arrive on the scene and can get them to the correct hospital. “So this created a system where hospitals across the state worked together with EMS providers to create protocols. This allows us to know which hospitals are best equipped to handle certain incidents. Because trauma surgeries are unplanned by nature, whole teams must be present at hospitals 24 hours a day. This team includes trauma surgeons, nurses and anesthesiologists, as well as specialized equipment. You don’t plan to see a trauma patient at certain times of the day so you don’t schedule them like you would for a knee replacement. Richard Roberson, vice-president for policy at Mississippi Hospital Association, said that you have to have them available or on call in order to deal with them when they arrive. Roberson stated that restoring funding for trauma care is a top priority in the next legislative session. He said that he believes it will be fixed after speaking with legislators. Roberson stated, “I believe people when they say it was an unexpected consequence.” Irony is a key feature of the current funding problems for trauma systems. Some believe that legislators bypassed state general funds in order to ensure future legislatures wouldn’t have the power to cut funding for the system in the event of a budget deficit. Oliver stated that a legislative taskforce recommended the creation of funding mechanisms like these moving violations to ensure future funds were available for trauma care. Some legislators point out that the trauma system is nearly ten years old and may need to be reassessed. “One of my concerns for a while is that some things that were done years back… are not sound anymore,” said Sen. Briggs Hopson, R-Vicksburg. Senator Briggs Hopson (R-Vicksburg) stated that there is no reason for the money to be there. He also said that it could be a problem in another part of the state that urgently needs those funds. “The idea was for it to be put all in one big pot and let agencies come in to explain their needs.” According to a recent report by the Center for Mississippi Health Policy, the trauma care system has been falling short of its funding goals for many years. The Legislature had estimated that the trauma fund would generate $38 million annually in 2008. Since 2009, funding levels for trauma care have averaged around 60% of the authorized amount. This totaled to $24.5 million in 2016 for both the EMS operating fund and the trauma care system. Oliver stated that it is becoming more obvious that we must not reduce trauma funds in order to preserve the current efficient system we have in the state. The most critical criticism that Democratic legislators have levelled at the sweeps bill is the speed with which Republican leaders passed the bill, which was 184 pages long, through the Legislature in just hours. This left little time for Senate and House members to read it. Hughes stated that if Hughes had had the time to go through it and verify that trauma funding was in it, then the bill would have been more difficult to pass. Hughes added that he believes that if it had been delayed, it would have caused additional questions to be asked. “… We had to rely upon the assurances of (the leadership) “this is the truth — take my word for It.” Hughes stated that he recalls Frierson reassure Carpenter on the House floor that no trauma care funds would be touched. Frierson was unable to be reached for comment. Frierson was the Department of Revenue commissioner in June. He apologized to the House for the $56 million in mistakes he made in crafting the law. These issues, according to Republican leaders, are common for large pieces of legislation and can be fixed in January. Laura Hipp spokeswoman for the Lt. Governor. Tate Reeves sent an email. The reason the Legislature rerouted trauma care funds is not relevant. However, there’s one question: What happened to $4.5 million that was taken from trauma care in this fiscal year? According to the Legislative Budget Office, this amount was already appropriated to Department of Health as part of the $63 million general fund appropriation. The Legislative Budget Office says that FY 17’s health department was funded with special funds and general funding to ensure the same level of funding. The Legislative Budget Office stated in a statement that they made the first payment in fall and that the second one would be paid in January. Clarke supports this claim, stating that funding for trauma care was part of the Department of Health’s 2017 general fund allocation. Clarke stated, “That’s all they have in their appropriation bill.” Clarke said that they had to reduce them slightly (but we still said that there was money for trauma centers) but Dr. Currier was unaware that this money was part of the 2017 appropriation. Currier stated that “We are still responsible for paying out the money we paid out in 2015.” Currier added that ($4.5 million) must be taken out of the health department appropriation. The 2017 trauma care appropriations were often disputed by legislators and agency heads when they were asked about them. Both Republican and Democratic lawmakers both claimed that approximately $9 million was diverted into the general fund by the Legislature for 2017. This is the amount the Department of Health needed to appropriate its funds. Because trauma care funds for fiscal 2017 were collected in calendar 2016, the actual amount of funds that are missing is closer to $4.5million. The trauma care system was able to receive half its funding prior to July 1st. The Department of Health estimates that the full amount of approximately $9 million will be swept in 2018. The 2017 Budget Bulletin doesn’t include a line item for trauma treatment. Although the appropriations bill for the health department does mention trauma care, it only states that the Legislature will not reimburse the criminal assessment fees of the trauma fund. The Legislature says it will reimburse all court assessments in a lump sum equaling the amount collected in fiscal 2015. Toby Barker (Republican from Hartesburg) stated that reimbursements will be made for all other court assessments in a lump sum equal to the amount collected in fiscal 2015. Barker sent an email explaining that the Trauma Care System Fund was excluded from the reimbursements in order to ensure that the amount wouldn’t be capped for FY 2017, in the event that assessments exceed 2015 levels. “…But, it was found that the amount collected for Trauma Care System Funds has been declining over the past years.” The Legislative Budget Office stated that the Legislature allocated nearly $9 million to trauma care in 2017. This figure Barker claimed exceeded the amount the fund would have received if the funds had flowed directly to the trauma care fund. The 2017 Budget Bulletin shows that the Legislature reduced the Department of Health by 3 percent between 2016 and 2017, from $65million to $63million. The cut would be 10% if the $63 million budget for the Department of Health in fiscal 2017 includes $4.5 million more for trauma care. 2018 will be the same. Clarke stated that the Legislature will give $9 million to the Department of Health from the state’s general funds to replenish trauma care funds. In its budget proposal for fiscal 2018, the Joint Legislative Budget Committee recommended a 8.24 percent reduction in health. This, combined with the mid-year budget cuts by the governor, brings the 2018 general fund allocation to the department of health to $57million. This $57 million includes $9 million for trauma treatment. The Department of Health’s general funds appropriation was cut by more than 25% between 2016-2018. Rep. Steve Holland (D-Plantersville), who was the author of the 2008 legislation creating the trauma care fund, said that it is hypocrisy to expect the board would make up the difference. “There is no way that could happen,” said the Department of Health. It also stated it will continue to work with the Legislature on the issue when session begins next week. We are aware that this is a process. But, what we need to do is ensure that the right person is there at the right moment. This saves lives. Liz Sharlot, Communications Officer for the Department of Health, stated that Mississippi’s trauma care system is vital. Oliver said that he believes that this error is temporary and that the Legislature will work quickly to restore funds. Oliver stated that “it’s something the state should be proud off, and I believe it is, so we just want make sure it’s properly funded.”