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SHORT TITLE Trauma System Fund Authority Act
SB 356
APPROPRIATION (dollars in thousands)
or Non-Rec
General Fund
(Parenthesis ( ) Indicate Expenditure Decreases)
Duplicates HB 266
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)
Synopsis of Bill
Senate Bill 356 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.
Senate Bill 356 – Page
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.
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,
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
Senate Bill 356 – Page
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.
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.
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.
Senate Bill 356 duplicates House Bill 266.
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
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
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
Senate Bill 356 – Page
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
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.
Senate Bill 356 – Page
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.