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Texas Senate
August 30, 2002
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Senate Subcommittee Examines Trauma and Health Care Funding Issues in the Rio Grande Valley

The Senate Finance Subcommittee on Trauma Care traveled to the Rio Grande Valley today, August 30, 2002, to hear why high insurance rates are forcing doctors to leave the area.

Senator Eddie Lucio began the meeting by telling the subcommittee that while the Valley has good facilities, skyrocketing insurance rates are forcing doctors to go elsewhere to practice. He told of one Valley resident who had to go all the way to Houston for an emergency operation because no specialist was available locally. Senator Jon Lindsay said that the same problems occur to a certain degree in Houston as well. Subcommittee Chairman Chris Harris said that despite a looming state budget shortfall, medical care and compensation for doctors must be addressed in the state budget.

Doctors Robert Robles and Lorenzo Pelly led off the invited testimony. Robles told the subcommittee that "the system is broken and it needs to be fixed." He urged that the Legislature limit court-ordered damage awards for pain and suffering, certain liability awards and that insurance premiums themselves need to be limited. Chairman Harris said that some doctors have seen their malpractice costs jump from twelve to more than eighty thousand dollars a year. Robles added that any nursing homes forced to close by rising insurance costs would dump patients into a hospital system that simply can not accommodate them and that the hospitals themselves could then be forced to close

Dr. Pelly testified that trauma care patients from both sides of the border are overloading the emergency rooms. He said million dollar plus bills have been run up by Mexican citizens with no insurance whatsoever and that Texas taxpayers pick up the tab. Chairman Harris said that in effect, the U.S. Immigration and Naturalization Service is "dumping" these patients into the U.S. health care system for free medical care and there's nothing the state can do about it. Dr. Pelly said that well-to-do people from as far away as Mexico City are coming to Brownsville to give birth just to get the benefits of American citizenship. He also said Valley patients regularly die because the necessary doctors are no longer available.

Texas Department of Insurance Commissioner Jose Montemayor followed, telling the committee that when nursing home liability coverage becomes mandatory during the fall of 2003, it will be essential that all medical professionals be able to get it at an affordable price. Currently, the Department of Insurance can regulate premiums in only about a third of the medical insurance market. He said rates are doubling every five years statewide because of an increasing numbers of claims and their increasing cost. He reported that in the Valley, there are 350 claims per year for every one hundred doctors, more than ten times the overall state rate of 25 claims per hundred.

The next testimony came from a panel of hospital administrators. Bill Adams from Valley Baptist Medical Center, Louis Garcia of McAllen Medical Center, Charles Sexton of Valley Regional Medical Center, Dominic Dominguez of Brownsville Medical Center and Ruben Garza of Knapp Medical Center all testified about challenges they face regarding getting enough doctors to staff emergency rooms, the shortage of trained nurses and the fact that patients are forced to remain in the hospital long after they should have gone to nursing homes, simply because the nursing home beds are not available. Chairman Harris said that hospitals in other parts of the state have hospital districts which collect taxes to help support their operations and that until Valley taxpayers are willing to do the same, it's going to be hard to convince the Legislature to send any more money to Valley hospitals.

Jose Camacho, Executive Director of the Texas Association of Community Health Centers, testified that Medicaid beneficiaries need a regular source of care, that spending a little money on minor illnesses can help to prevent expensive emergency room visits later on.

Dr. Carlos Cardenas of McAllen testified on behalf of border medical associations, saying that there is indeed a crisis in medical care not only in the Rio Grande Valley, but all along the border. He said trauma patients require immediate attention and that when the specialists are not available, the patient may be permanently disabled because care wasn't given when it was needed. Dr. Bliss Clark of Harlingen said he left trauma care because he couldn't continue treating emergency room patients, and simultaneously defend himself against lawsuits, saying "from a purely business standpoint, it makes no sense to engage in that kind of activity." He also asked if hospitals were having trouble making money in the Valley, why are new ones being built.

Bill Aston and Javier Quiroga from the Harlingen and Brownsville EMS services testified that they are having trouble recruiting personnel due to low pay levels. Medicaid reimbursements are low as well, Aston said that it pays less than half the actual cost of a call, and many Medicaid claims are completely denied.

The Senate Finance Subcommittee on Trauma Care is chaired by Senator Chris Harris. Members include Gonzalo Barrientos, Robert Duncan, Troy Fraser, Mike Jackson, Jon Lindsay, Eddie Lucio, Steve Ogden, Todd Staples, Carlos Truan, John Whitmire and Judith Zaffirini. The subcommittee recessed subject to call of the chair.

Session video and all other Senate webcast recordings can be accessed from the Senate website's Audio/Video Archive.