FEATURED, FROM LEFT: John Paul Barajas, News Correspondent, KRGV News, interviews Raúl Barreda, MD, Trauma Surgeon, Acute Care Surgery, DHR Health, at the Edinburg Conference Center at Renaissance, on Wednesday, May 1, 2019, following a press conference where DHR Health officials announced they now featured the region’s first and only Functioning Level I Trauma Center.
Photograph Courtesy DHR HEALTH FACEBOOK
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Gov. Abbott approves plan authored by Sen. Hinojosa, sponsored by Rep. Guerra, supported by DHR Health, to significantly improve regional emergency medical service trauma system
By DAVID A. DÍAZ
[email protected]
Gov. Greg Abbott on Wednesday, June 16, 2021, endorsed a plan authored by Sen. Juan “Chuy” Hinojosa, D-McAllen, and sponsored by Rep. R.D. “Bobby” Guerra, D-McAllen, designed to significantly improve the regional emergency medical service trauma system in deep South Texas.
The measure, supported by DHR Health, went into effect immediately when it received the governor’s signature of approval.
Anchored in southwest Edinburg on a 130-acre site, with a growing presence in neighboring McAllen, Rio Grande City, Mission, and Brownsville, DHR Health offers some of the most comprehensive medical care on the U.S. southern border, with more than 1,400 nurses and 600+ physicians providing care in 70+ specialties and sub-specialties.
Senate Bill 1397 requires the Lower Rio Grande Valley Trauma Regional Advisory Council to work with stakeholders – such as hospitals, governments, community organizations – to develop guidelines for patient transfers and create a centralized patient transfer system.
“Senate Bill 1397 relates to establishing a coordinated system for the dispatch, triage, transport, and transfer of patients in certain trauma service areas Regional Advisory Councils, known as a RAC,” Hinojosa said. “Trauma Service Area V (TSA-V), located in the Rio Grande Valley, lacks a centralized system to coordinate the dispatch, triage, transport, and transfer of patients, resulting in too many patients being unnecessarily transferred hundreds of miles away to receive the care they should be able to receive within their own community.”
A RAC is an organized group of healthcare entities and other concerned citizens who have an interest in improving and organizing trauma care within a specified Trauma Service Area (TSA). RAC membership may include hospitals, physicians, nurses, EMS providers, rehabilitation facilities, dispatchers, as well as other community groups.
Medical triage (tri·age/tr??äZH/) is the process of sorting people based on their need for immediate medical treatment as compared to their chance of benefiting from such care. Triage is done in emergency rooms, disasters, and wars when limited medical resources must be allocated to maximize the number of survivors.
A hospital patient transfer includes the process of identifying an accepting physician and coordinating the workflow required to place a patient in the most appropriate patient care unit.
A bill is a type of legislative measure that requires passage by both chambers (House of Representatives and Senate) of the Legislature and action by the governor in order to become effective. A bill is the primary means used to create and change the laws of the state. “Bill” types include Senate and House bills, Senate and House joint resolutions, Senate and House concurrent resolutions, and Senate and House resolutions.
As the author of Senate Bill 1397, Hinojosa is the legislator who filed the measure and guided it through the legislative process.
Filed is used to refer to a measure that has been introduced into the legislative process and given a number.
As a sponsor of Senate Bill 1397, Guerra is the legislator who guided the measure through the House of Representatives after it had passed the Senate.
“There are 22 Regional Advisory Councils in Texas, and each of these organizations has the same objective – to reduce the incidence of trauma through education, data collection, data analysis, and performance improvement, according to the Texas Department of Health Services,” Guerra said. “Typically, this is accomplished via the provision of educational programs and performance improvement efforts designed to offer every provider guidance and motive to reduce the incidence of trauma, as well as improve outcomes of trauma patients.”
https://www.dshs.texas.gov/emstraumasystems/etrarac.shtm
The Rio Grande Valley is designated as Trauma Service Area “V”. Its members are comprised of representatives from Cameron, Hidalgo, Willacy, and Starr Counties. Development of the Rio Grande Valley TRAC began in 1993. Initial Bylaws and rules were adopted.
Prior to the passage by the Texas Legislature of Senate Bill 1397 and the signature by the governor, the Lower Rio Grande Valley Trauma Regional Advisory Council utilized numerous contracts with single ambulatory services that did not result in the most efficient or highest quality care for patients, Hinojosa said. With this system (as authorized by Senate Bill 1397) in place, emergency services will know what facilities have the capacity and providers available to best treat the patient.
“It is time that the Lower Rio Grande Valley Trauma Regional Advisory Council begin taking on the duties and responsibilities to bring its trauma system up to par with the level of services that the community demands,” Hinojosa said.
Hinojosa provided an example of the number of Valley patients transferred to hospitals outside of the Rio Grande Valley during the most recent five-year period.
“In looking at only trauma cases transferred to San Antonio, between 2015 and 2020, 1,176 trauma patients were transferred from the Rio Grande Valley to San Antonio,” Hinojosa said. “Seven hundred sixty were due to trauma, and 416 were due to burns.”
Raúl Barreda, MD, Trauma Surgeon, Acute Care Surgery, DHR Health, on Wednesday, March 31, 2021, at the request of Hinojosa, testified in support of Senate Bill 1397 before the Senate Committee on Health and Human Services.
“Within the past calendar year, dealing with a hurricane (Hanna, July 25-27, 2020), a flash freeze (Valentines week 2021), and a (COVID-19) pandemic overflow of ICU (hospital intensive care unit) beds, internists, or intensivists who are taking care of patients, a lot of times their first reaction is to go north to Houston, to San Antonio, to transfer this patient out when we do have resources available locally,” Barreda explained.
Barreda said Senate Bill 1397 would allow deep South Texas hospitals to set up a superior system of organizing patient care activities and sharing information among all of the participants concerned with a patient’s therapeutics (a treatment, therapy, or drugs) to achieve safer and more effective medical care.
When patients, as a result of lack of information, are unnecessarily transported to hospitals north of the Valley, their loved ones suffer, he noted.
“This is putting a huge socioeconomic burden on the families and people who are trying to work and visit their relatives or speak with their relatives. They can’t do that,” Barreda said. “With a population of 1.5 million documented people in this area, we need a coordination of care. That’s brought to light now. We need to be more proactive, instead of reactive, for the next emergency or pandemic that will hit.”
In addition to Barreda, Robert Haddad, Vice President and Counsel for Government Affairs and Policy, DHR Health, registered in support of Hinojosa’s Senate Bill 1397 during the Wednesday, March 31, 2021, public hearing on the measure by the Senate Committee on Health and Human Services.
DHR Health is the flagship teaching hospital for the University of Texas Rio Grande Valley School of Medicine and encompasses a general acute hospital with the only dedicated women’s hospital south of San Antonio, a rehabilitation hospital, a behavioral hospital, more than 70 clinics Valley-wide, advanced cancer services, the only transplant program in the Rio Grande Valley – and the only functioning 24/7 Level 1 Trauma Center south of San Antonio.
Doctors Hospital at Renaissance, Ltd (“DHR”) and its general partner, RGV Med, Inc. (“RGV Med”) own and operate a 519 licensed bed general acute care hospital located at 5501 South McColl in Edinburg. The facility is one of the largest physician-owned facilities in the United States that began as an ambulatory surgery center in 1997.
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The language of Senate Bill 1397, as contained in the final version signed into law by the governor, follows. The words or sentences that are underlined represent the new changes that were approved:
AN ACT
relating to regional protocols and processes for patient transfers and related services within the geographic area served by certain trauma service area regional advisory councils.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter E, Chapter 773, Health and Safety Code, is amended by adding Section 773.1141 to read as follows:
Sec. 773.1141. INFORMATION, GUIDELINES, AND PROTOCOLS RELATED TO CERTAIN PATIENT TRANSFERS AND RELATED SERVICES. (a) This section applies only to a trauma service area regional advisory council serving a geographic area that includes:
(1) at least one county located on the international border of this state; and
(2) at least one county adjacent to the Gulf of Mexico.
(b) For each trauma service area regional advisory council to which this section applies, the executive commissioner by rule shall:
(1) require the council to create an advisory committee composed of equally represented designated trauma hospital system members located within the geographic boundaries of the council or require the council to direct an existing advisory committee of the council established for a purpose similar to that described by this subsection to:
(A) develop guidelines for patient transfers; and
(B) periodically review patient transfers to ensure compliance with applicable guidelines;
(2) for the purpose of ensuring that patients located in the council’s geographic boundaries receive health care at the health care facility closest to and most appropriate for the patients, require the council to develop regional protocols and processes to assist the council in managing the dispatch, triage, transport, and transfer of patients; and
(3) require each hospital and emergency medical services provider operating within the council’s geographic boundaries to collect and report to the council data on patients transferred outside the council’s geographic boundaries.
SECTION 2. Not later than April 1, 2022, the executive commissioner of the Health and Human Services Commission shall adopt the rules required by Section 773.1141, Health and Safety Code, as added by this Act.
SECTION 3. This Act takes effect immediately if it receives a vote of two-thirds of all members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect on September 1, 2021.
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The bill analysis of Senate Bill 1397 – presented on Wednesday, May 19, 2021, to the House Committee on Public Health – provides more detailed information about the measure, such as its history and its goals.
A bill analysis is a document prepared for all bills and joint resolutions reported out of committee. A bill analysis may include background information on the measure, a statement of purpose or intent, and an analysis of the content of the measure.
Background and Purpose
It has been suggested that Trauma Service Area V lacks both tracking data and a centralized system for the dispatch, triage, transport, and transfer of patients and consequently does not have the most efficient utilization of trauma care and emergency medical service resources as evidenced by patients being unnecessarily transferred outside the region. There have been calls to establish a system to facilitate cooperation between emergency service providers and health care facilities in the area. C.S.S.B. 1397 seeks to address this issue by requiring certain regional advisory councils to collect data on patient transfers outside their geographic boundaries and to develop regional protocols and processes to assist the council in managing the dispatch, triage, transport, and transfer of patients within the geographic boundaries of
the council.
Criminal Justice Impact
It is the House Committee on Public Health’s opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.
Rulemaking Authority
(Note: “Rulemaking Authority” is the authority granted by the legislature to a state officer, department, agency, or institution to devise the details of implementation and enforcement of a statute. Rulemaking authority is imparted (established) through a bill.)
Rulemaking authority is expressly granted to the Department of State Health Services in SECTION 1 (Section 773.1141, Health and Safety Code) of this bill.
Analysis
Committee Substitute Senate Bill 1397 amends the Health and Safety Code to require the executive commissioner of the Health and Human Services Commission for each trauma service area regional advisory council serving a geographic area that includes at least one county located on the international border of Texas and at least one county adjacent to the Gulf of Mexico.
(A “substitute bill” is a complete, new bill or resolution recommended by a committee in lieu of the original measure. A committee will report a committee substitute rather than a large number of individual amendments when the committee wishes to make a substantial number of changes to the original measure.)
Committee Substitute Senate Bill 1397 required the following by rule:
• Require the advisory council to create an advisory committee composed of equally represented designated trauma hospital system members located within the council’s geographic boundaries or to direct an existing advisory committee of the council established for a purpose similar to ensuring that patients located in those boundaries receive health care at the closest and most appropriate facility to take the following actions:
•• develop guidelines for patient transfers; and
•• periodically review patient transfers to ensure compliance with applicable guidelines;
• Require the advisory council, for the purpose of ensuring that patients located in the council’s geographic boundaries receive health care at the facility closest to and most appropriate for the patients, to develop regional protocols and processes to assist the council in managing the dispatch, triage, transport, and transfer of patients; and
• Require each hospital and emergency medical services provider operating within the advisory council’s geographic boundaries to collect and report to the council data on patients transferred outside those boundaries.
Committee Substitute Senate Bill 1397 requires the executive commissioner, not later than April 1, 2022, to adopt the rules required under the bill’s provisions.
Comparison of Senate Engrossed and Substitute
(Note: “Engrossed” means the stage in a bill’s legislative progress when it has been passed by the chamber in which it was filed and all amendments to the bill have been incorporated into the text of the bill, which is then forwarded to the second house for consideration. A “substitute bill” is a complete, new bill or resolution recommended by a committee in lieu of the original measure. A committee will report a committee substitute rather than a large number of individual amendments when the committee wishes to make a substantial number of changes to the original measure.)
While Committee Substitute Senate Bill 1397 may differ from the engrossed in minor or nonsubstantive (having no significant impact ) ways, the following summarizes the substantial differences between the engrossed and committee substitute versions of the bill.
The substitute changes from the Department of State Health Services, as indicated in the engrossed, to the executive commissioner of Health and Human Services Commission the entity required to establish certain requirements by rule for each applicable trauma service area regional advisory council.
The substitute revises the requirements in the engrossed as follows:
• Gives the executive commissioner the option of requiring the advisory council to direct an existing advisory committee of the council to develop guidelines for and review patient transfers as an alternative to requiring the council to create an advisory committee to develop the guidelines and review the transfers; and
• Changes the nature of the requirement relating to ensuring that specified patients receive health care at the closest and most appropriate facility from providing for the advisory council’s duty to implement a centralized system for assisting the council in the dispatch, triage, transport, and transfer of patients to providing for the council’s duty to develop regional protocols and processes for assisting the council in managing the dispatch, triage, transport, and transfer of patients.
The substitute changes the deadline established by the engrossed for the applicable entity to adopt the rules from not later than January 1, 2022, to not later than April 1, 2022.
WHITE COAT CEREMONY LAUNCHES CLASS OF 2025 AT THE UNIVERSITY OF TEXAS RIO GRANDE VALLEY SCHOOL OF MEDICINE
The University of Texas Rio Grande Valley School of Medicine welcomed its sixth class of medical students with a White Coat Ceremony on Saturday, July 24, 2021, at the UTRGV Performing Arts Complex Auditorium.
Dr. Michael B. Hocker, the new dean of the UTRGV School of Medicine, was among the school’s leaders who greeted the 55 medical students and spoke of the important symbolism of the white coat.
“Those who take care of patients every day, you are the heroes and, maybe, the white coat is your cape – that piece of clothing you wear to help you in healthcare and education,” said Hocker. “It will serve you well as you look at innovation and discovery in medicine.”
The ceremony is an important first step in the career of a future physician, serving as a rite of passage at medical schools around the country. On Saturday morning, the new students committed to their future before friends and family with the recitation of the Hippocratic Oath and the donning of the white coat.
In this sixth class of UTRGV medical students, 24 of the 55 are from the Rio Grande Valley and 12 are UTRGV graduates, all selected from more than 7,545 highly competitive applications.
Keynote speaker Julie Ann Freischlag, FACS, FRSCE, MD, dean of the Wake Forest School of Medicine and CEO of Wake Forest Baptist Health, provided recorded remarks due to COVID-19 travel restrictions.
In her address, she addressed the leap students took at the beginning of their medical school journey during a pandemic that transformed the medical practice as a whole.
“The pandemic has shown us the value of teamwork and how we’re stronger together,” said Freischlag. “As you wear your white coat and treat each patient with dignity and respect, I want you to also think about how you are going to have a safe, healthy journey through these years so you can thrive in school and at home.”
Students’ inspiration, personal experiences
With the recitation of the Hippocratic Oath, students pledged to uphold the ethical standards of medical practice. As class representative, medical student Lesley Chapa, of San Juan, led the class in reciting the oath, an experience she describes as deeply personal.
Chapa was 10 years old when she contracted viral encephalitis, a serious inflammation of the brain, and was in a coma. She remembers the cultural and language barriers between her parents and the doctors during her treatment and recovery, which made the trauma even more stressful, she said.
“It inspired me, made me want to become a culturally aware physician, the kind I wish had been able to treat me back then,” she said.
As an undergraduate student, Chapa worked as an assistant in the Myles and Sylvia Aaronson Library at the UTRGV School of Medicine. Her interactions with the medical students she saw each day inspired her to pursue her goals, so she applied to the UTRGV School of Medicine.
“Day in and day out, I had the privilege to observe their relentless dedication and perseverance,” she said of the students she spoke with. “They inspired me to believe in my potential, improve my work ethic and take my shot. Now, it’s coming full circle.”
Another member of the new class, Aaron Carrillo, is excited to be the first in his family to become a doctor. A May 2021 UTRGV graduate of the Biomedical Sciences program (BMED), he said taking this step into medical school fulfills a deeply personal motive that his mentors helped him plan toward since he was an undergraduate student.
“One of the strongest men I knew, my grandfather, suffered from diabetes, hypertension and other medical complications that limited his mobility,” he said.
Seeing firsthand how the diseases took a toll on loved ones was a driving factor in choosing his career, he said.
“As a physician, I want to identify the health disparities that affect so many families in the Rio Grande Valley and take steps to address them,” Carrillo said.
Carlos Cisneros, from Brownsville, also joined the medical class of 2025 and donned his white coat on Saturday. Having graduated from the University of Texas at Austin in May 2021, he knows the next four years of medical training will be tough, but he is motivated to tackle the rigorous curriculum ahead.
His mother battled cancer when he was just 6 years old, and he was awed by the doctors at The University of Texas MD Anderson Cancer Center who saved his mother’s life.
“It was not until I was a bit older, in middle school, that I truly understood how amazing and inspiring doctors are,” Cisneros said. “I want to help heal the people of my community with that same high level of care and compassion I have witnessed.”
The event was streamed live and is available for viewing at:
https://www.utrgv.edu/school-of-medicine/education/white-coat-ceremony/.
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Karen Villarreal contributed to this article. For more on this and other Texas legislative news stories that affect the Rio Grande Valley metropolitan region, please log on to Titans of the Texas Legislature (TitansoftheTexasLegislature.com).
