Years of cost-cutting have so deeply reduced capacity in Greater Cincinnati's health care system that emergency officials now doubt whether Tristate hospitals can adequately handle a disaster — be it natural or man-made.

        “Our capacity is already stretched on a routine basis. Yet the community expects us to be prepared to treat hundreds of casualties on a moment's notice,” said John Prout, chief executive of the TriHealth hospital group and chairman of the Greater Cincinnati Health Council.

GET INVOLVED

• What: The Ohio House of Representatives Quality Care Subcommittee plans to hold two more public hearings in Greater Cincinnati before issuing a report and recommendations to the legislature.     • When: May 20 and June 14.     • Where: The May 20 hearing will be at 1 p.m. at Mercy Franciscan Hospital-Western Hills. No time or place has been set for the June 14 hearing.     • Written comments: Those who cannot attend the hearings can write to subcommittee chairman Rep. Greg Jolivette, Riffe Center, 77 South High St., Columbus, OH, 43215-6111; or by fax: (614) 644-9494; or by e-mail: rep59@ohr.state.oh.us

        Mr. Prout was among 13 hospital administrators, doctors, business representatives and others who spoke Thursday before a standing-room-only crowd of about 75 people at the Madeira Community Building.

        The hearing on the state of health care in Greater Cincinnati was the first of three to be held by a state legislative subcommittee formed by Rep. Greg Jolivette, R-Hamilton. A report is expected a few weeks after its final, June 14 meeting.

        Doctors say years of lower-than-average pay in Greater Cincinnati have triggered a brain drain of certain specialists. On Thursday, speakers said emergency care and disaster preparedness rank among the first problems stemming from the doctor supply concern.

        In fact, Mr. Prout confirmed speculation that emerged months ago that Bethesda North Hospital will not be ready to serve as a full-scale trauma center by November

        That means Cincinnati will have only one trauma center — University Hospital — for the Tristate, while Cleveland has six, Columbus has four and Dayton has three.

        Concerned by this revelation, Rep. Bill Seitz, R-Green Township, asked whether Cincinnati hospitals would ask the state to delay implementing its new trauma system law.

        “That's one option under consideration,” Mr. Prout said.

        Since 1984, total bed capacity among Tristate hospitals has dropped 48 percent, while the area population grew 12 percent, according to the health council.

        None of this bodes well for emergency care, said Marc Johnson, a spokesman for the Hamilton County Fire Chiefs Association.

        “We don't believe our current system is capable of handling a disaster,” he said.

        But the doctor capacity issue isn't limited to hospitals, said Dr. John Larkin, president of the Academy of Medicine of Cincinnati.

        In 1991, Greater Cincinnati had 163 orthopedic surgeons. This year, it has 60. Half are over 50 years old and one-third no longer provide ER coverage, Dr. Larkin said.

        Low reimbursement from insurers has pushed Cranley Surgical Associates, a group of vascular and general surgeons, to cut its office locations from eight to three since 1999. It also has stopped providing care at two hospitals and dropped patients from one managed-care health plan because reimbursements were unacceptably low.

        “We've been trying to add two vascular surgeons for the past five years. We're zero for 12” on doctors accepting offers from the group, said Karen Palatchi, executive director for Cranley Surgical.

        Mr. Jolivette said many of the issues raised by speakers Thursday merit closer study.

        “We have to make sure our community has decent health care. If that means going to bat for the providers, we'll go to bat,” Mr. Jolivette said.

        Of the 13 speakers Thursday, two represented employers and insurers. Neither offered any information to rebut the supply and pay concerns raised by physicians and hospitals.

        They did say that Cincinnati isn't the only city with health system concerns, that employer cost-cutting pressure isn't the only factor involved, and that Tristate employees appear generally satisfied with their health care.

        “There are several contributing factors, including increased costs for hospital care, prescription drugs, physician services, legislative mandates, unhealthy lifestyle choices, an aging population, new technology and ever-increasing consumer demands,” said Kelly McGivern, president and chief executive of the Ohio Association of Health Plans.

        Several speakers suggested actions the state legislature could take:

        • Provide funds for a more thorough study of the doctor supply issue.

        • Make another attempt at lawsuit reform.

        • Strictly enforce a prompt-pay law that takes effect this summer and speed up payments from state Medicaid and workers compensation programs.

        • Require insurers to pay at least a minimum rate to doctors for emergency care.

        • Create a “level playing field” for doctors by easing antitrust restrictions.

        Whether a law is needed, subcommittee members said, they hope that simply holding public hearings will prompt some action.

        “One of the purposes of these hearings is to send a signal that if the parties involved aren't able to work something out, then they are at risk of a much less sanguine solution of some sort of legislative action,” Mr. Seitz said.

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