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An Open Letter to the Texas EMS & Trauma Community:
From
Dr. Ed Racht
Chair of the Governor's EMS and Trauma Advisory Council
I have several reasons for writing this letter. As you know,
House Bill 2292 requires the consolidation of 12 Agencies within Texas Health &
Human Services into 5. That consolidation process has begun and a proposed
structure for the new system is being circulated by the Health & Human Services
Commission.
First, the timeline for change is extremely short. Comments
will be accepted by the HHSC up to February 13th (2 weeks). We have normally
had significant advanced notice to develop our positions and make them known.
That is certainly not the case with this process.
Second, the proposed structure dissolves EMS & Trauma Systems
into a series of functions split over several areas, creating a loss of a
specific identity. I think I share the opinion with many others that the loss
of an identity for EMS & Trauma at the state level would be a major step
backwards for Texas, to say the least.
Third, I have been overwhelmed the past 4 years with our ability
to make good decisions about EMS & Trauma care with the input of all those
involved. We have developed (I think... I hope) a mutual trust and a commitment
to solve our own problems. Personally, I think that's the way it should be.
While we don't always agree (thank goodness), we have chosen to work out the
differences between ourselves in open, productive (sometimes heated) discussion
& move forward by consensus. As a state, we should be proud of that philosophy
of decision-making. Our patients want us to solve problems for them, not vote
on their health care.
Finally, and probably most important, in my short time on GETAC,
I have grown to appreciate one single principle more than any other in my career
when it comes to dealing with elected officials and managers. When we speak as
a unified voice of individuals, agencies and organizations that struggle with
the challenges of EMS & Trauma Care delivery on a daily basis, people have no
choice but to listen. Fragmentation allows policy makers to calculate the
implications of not meeting one stakeholder's needs (as they should) and make
decisions they feel will negatively impact the least number of stakeholders (or
positively impact the most). Having been immersed in the reorganization
discussions this past week, it's clear to me that if we, as a group, believe we
need to maintain an identity for EMS & Trauma Systems, we must speak as a group
or we will not be heard. In this proposed reorganization, we are
"competing" with every single former TDH Program. In the eyes of those charged
with reorganization, we are not any more "special" than renal health, diabetes,
environmental health, or tattoo parlors (had to throw that one in...).
There are some realities too.
The Health & Human Services Commission had a tremendously
difficult task handed down by the Legislature. They must develop an acceptable
structure, cut costs and try to improve efficiency while trying to preserve
service. It is certainly not an easy charge & I believe we should support their
efforts as much as we can by giving them viable alternatives that more
appropriately meet our needs.
There has also been a fair amount of discussion in various
venues regarding what will happen (or what should happen) if the proposed
reorganization does dissolve BEM. Discussions include other organizations
taking up the responsibilities of BEM (Commissions, Board of Medical Examiners,
etc.), the creation of a new entity (Commission, stand alone regulatory agency)
or movement of EMS & Trauma to the law enforcement or homeland security
structures within the state. While the eventual position of EMS & Trauma
Systems is extremely important, the reality is that we must have a legislative
session to change the current agency positioning of EMS & Trauma Systems. Where
we will be in 2 years may be totally different from where we are today. However,
the current proposed reorganization is a separate discussion that involves the
preservation of EMS & Trauma Systems as an entity today. I would hope we would
all agree that longer term structural changes are always healthy to evaluate (as
you recall, this was an identified issue in our recent Strategic Planning
process & is part of the Plan itself).
So where to?
I strongly believe that if we want to be heard at all, we should
be unified. In order to be unified, obviously, we have to agree on what we are
unified about... The time frame for this process makes that an extremely
difficult task, but I'm confident that we can step up to the plate (remember HB
3588).
Several of our EMS & Trauma Systems colleagues have developed a
letter that proposes 3 options to preserve the EMS & Trauma identity within the
currently proposed structure. The letter also emphasizes several principles
that we have collectively lived by over the past few years. Of importance, it
emphasizes our desire to be part of the solution and, at the same time, continue
to provide service and minimize the risks to the public of any reorganization.
It is impossible for us to go through the process that's near &
dear to our hearts to reach consensus on this issue as has become our norm. My
hopes are that we can cash in on the relationships we have built over the past
several years and move our message forward quickly. That has been our strength
and I believe it will be our biggest asset in this whole process.
There is also a chronology of the Terrell bus crash. The
response to that event very graphically illustrates the power of all of us
working together... And the necessity of having an identity that holds us all
together.
The sample letter and the Terrell bus crash summary can be
accessed on the South Texas Regional Advisory Council (STRAC) website @
http://www.strac.org/Docs/Re-org/default.htm (thanks to STRAC for being
willing to post these on short notice).
I encourage you to send your comments, based on a unified
message, to Dr. Albert Hawkins and the members of the Health & Human Services
Commission, to participate in public hearings and to send letters to your
legislators and local elected officials.
I believe that this proposed reorganization process is
significant enough for us to spend some dedicated time together to discuss
potential impacts, future actions, etc. To that end, after hearing from many
of you (thank you, by the way), I have chosen to suspend the Committee and Task
Force meetings that had been scheduled for Thursday, 2/12/2004. Instead, we
will substitute a special GETAC meeting that afternoon to bring all stakeholders
together for discussion of the situation. I have asked BEM to post an agenda
for this meeting, which will begin at 1:00 pm on 2/12/2004, as well as for the
regular GETAC meeting, which will begin at 10:00 am on Friday, 2/13/2004.
Additionally, some of your colleagues are planning to get together informally
the morning of 2/12. All of these meetings are in the TDH Board Room and I
encourage you to participate.
On a closing note, there is an encouraging event that occurred
several days ago. After significant input, a "Plan B" proposal was promulgated
by the HHSC that created an identity for Mental Health within the proposed
structure. While I certainly don't know the details behind the change, it
suggests that the HHSC will evaluate changes and modify the structure if the
changes are appropriate. I think our need for a preserved identity and our
willingness to provide suggestions have potential if we're all singing off the
same sheet of music....
Sorry this is so long... I appreciate how much all of you
commit to EMS & Trauma Care in our state. I've always said that the journey is
more important than the destination.
I think we have the potential for this to be a great journey if
we all walk together....
Thanks...
Dr.
Ed Racht
Chair of the Governor's EMS
and Trauma Advisory Council
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