Waiting for Bioterror
Leaving Las Vegas--in the Lurch
In Las Vegas, a gaming town with an appetite for risk, little by way of a medical infrastructure ever developed. With the population exploding and 6,000 families a month moving into the Las Vegas area in Clark County, population 1.4 million, it is also dramatically short on hospitals. By a thumbnail calculation--for every 100,000 people you need 200 beds--the county, which has eleven hospitals, is 600 beds short, said Dr. John Ellerton, chief of staff at University Medical Center, where the trauma center closed.
Even if you build more hospitals, how would you staff them? The state ranks fiftieth in its nurse-to-patient ratio, and because of the malpractice crisis, ninety of the state's 2,000 doctors have closed their practices and another eighty-three said they have considered leaving, according to Lawrence Matheis, executive director of the Nevada State Medical Association. The overcrowded emergency rooms are closed to new patients 40 percent of the time. Paramedics often drive and drive, waiting for an open emergency room. In turn, patients can wait four hours for an X-ray, three for a lab test. "There is no surge capacity, minimal staffing, minimal equipment," said Dr. Donald Kwalick, chief health officer of Clark County. "Every hospital bed in this county is full every day."
At times, the populace and even the doctors have seemed strangely indifferent. One night this summer an ambulance crew from the private company American Medical Response got called to a casino, and as they wheeled a stretcher amid the gaming tables, not a single patron looked up. Their patient: a man with a possible heart attack slumped over a slot machine. "The purity of our devotion to individual liberties tends to diminish our security and humane concern," said Matheis.
The September 11 attacks did not entirely transform this mindset. Since 1998 the city had been included on a federal government list of 120 cities that should prepare for possible attack. Eleven of the world's thirteen largest hotels, one with more than 5,000 rooms, are here. But this August, even the president of the state's medical association, Dr. Robert Schreck, said he worried little about terrorism. Al Qaeda's intent is "to kill capitalism," he said, sipping wine in the lobby of the elaborate Venetian Hotel, home to a massive casino and dozens of stores. "Why would they hit us?"
But last year Nevadans began to lose their cool as the medical system disintegrated. As malpractice insurance premiums skyrocketed, about thirty of Clark County's ninety-three obstetricians closed down their practices. Insurers, trying to reduce risk by limiting the remaining obstetricians to 125 deliveries a year, left thousands of pregnant women to hunt for doctors, some by desperately rifling through the Yellow Pages under "D." This year, the last pediatric cardiac surgery practice packed up and left the state.
Not surprisingly, Nevada was also unprepared for the anthrax crisis. Last October, when Microsoft's Reno office got suspicious powder in the mail that initially tested positive, an "outbreak of hysteria" ensued, said Matheis. The Clark County health district got 1,200 phone calls reporting everything from sugar to chalk dust, and investigated 500 of them with its skeletal staff. The state had no stockpiled antibiotics, and without a lab in Clark County, samples were shipped 500 miles north to Reno for testing.
The new federal money for bioterror preparedness, $10.5 million for Nevada alone, will help enormously. Of that, more than $2 million will go to building a public health laboratory in Las Vegas. But the money will do nothing to solve the problems of staff shortages and soaring medical malpractice premiums that forced the trauma center to close in July.
By July 4, the city of Las Vegas awoke to maximum fear of terror and a minimal medical system, with the trauma center closed for a second day. Governor Kenny Guinn had called an emergency session of the legislature and vowed to make sure that doctors did not abandon the state. An official at the nearby Nellis Air Force Base called the chief of orthopedics, Dr. Anthony Serfustini, asking what to do in the event of injuries. The lanky surgeon said that he reminded the man, You're the Air Force. You can fly your pilots to San Bernardino.
The community's medical infrastructure had declined to a level not seen in twenty-five years, said Dr. Fildes. And on July 4, the inevitable happened. Jim Lawson, 59, a grandfather of nine, was extracted from his mangled car and rushed to a nearby hospital--one with a nervous staff and little up-to-date trauma training--and died about an hour later. His daughter, Mary Rasar, said that she believes the trauma center, had it been open, could have saved him.