Medically Indigent Program - Washington State Hospital Association

Medically Indigent Program
and Trauma Care Fund
Medically Indigent Program
The Medically Indigent (MI) Program is a state-sponsored program that provides health care
to very sick or very injured uninsured people. Low-income people who are ineligible for Medicaid
or Medicare and who cannot afford to pay for their emergency medical care qualify for the MI
program. The program currently provides funding of only 40 percent of costs to hospitals for treating
life-or-death situations. It is a vital source of payment for many hospitals that already face a financial
crisis and are required to provide care in emergency situations regardless of patients’ ability to pay.
Trauma Care Fund
The statewide trauma care fund was created in 1997 to help offset the high cost of operating and
maintaining a statewide trauma care system. Payments from the fund are used to enhance medical
assistance payments for trauma cases. The payments improve the low Medicaid rates and also
serve as compensation for the many uncovered trauma cases. In 2002, enhanced payments from
the trauma fund were suspended. The loss of funding has hit hard the 70 designated trauma hospitals
and their physicians who treat trauma. Hospitals and physicians must treat trauma victims who
come to the emergency department. However, the loss of funding puts many hospitals and doctors
further into financial crisis. Suspension of trauma funding is also leading to difficulty in physician
recruitment and fewer physicians available to treat trauma patients, which affects all Washingtonians
who suffer traumatic injuries, not just those who qualify for Medicaid.
Washington State Hospital Association

Who is helped by Medically Indigent
and Trauma programs
Almost all hospitals in Washington state receive funding from the Medically
Indigent and Trauma care programs. Over 2,000 critically ill persons per
month across Washington get help from these programs.
Case Study Sites

Who Is Helped by Medically Indigent and Trauma Programs
People all across Washington are helped by the life saving services these programs
provide. Here are some of their stories:
Harrison Memorial
Harrison Memorial Hospital is a 297 bed hospital located in Bremerton. The hospital sees
49,000 patients a year in the emergency room. Last year the hospital provided $2.1 million
in charity care and forgave $2.7 million bad debt for patients unable to pay for their care.
All of the following patients were residents of Kitsap County.
• A 56 year-old single male was diagnosed with cancer. At the time of his diagnosis he
was uninsured, unemployed, and unable to cover major medical expenses. Diagnostic
and treatment regimens significantly improved his likelihood of cancer survival.
• A 45 year-old married female with one child was diagnosed with disease of the pancreas.
Her husband was unemployed at the time of her diagnosis and she was trying to support
the family through her own self-employment. They did not have health insurance.
• A 63 year-old male self-employed dentist was diagnosed with a bulging aorta with
serious risk of rupturing and possible death. The patient had numerous radiographic
and surgical procedures and a lengthy hospital stay. He did not have health insurance
and was unable to absorb the significant costs of medical procedures.
• A 20 year-old single female working as a receptionist was admitted for a diabetic
emergency with exceptionally high blood-acid levels. This was only one in a series of
hospitalizations resulting from her chronic diabetic condition. While the first hospital
received some payment for the first hospitalization, subsequent hospitalizations were
disallowed since the MI eligibility is limited to emergency services received over a
single three-month period in a given year.
Providence Everett Medical Center
Providence Everett Medical Center is a 463 bed hospital located in Everett. The hospital
sees approximately 75,000 patients a year in the emergency room. Last year the hospital
provided $5 million in charity care and forgave $11 million bad debt for patients unable to
pay for their care.
• A 14 year-old girl from Everett, Washington was violently assaulted while walking down
a bike path early one morning. She had been stabbed in the abdomen, puncturing her
aorta and other major arteries. The injury is very often fatal. When medics got to her,
she had lost a large amount of blood and was unresponsive. She was transported to
Providence Everett Medical center where she received immediate vascular surgery and
was able to make a slow but steady recovery.
• A 21 day-old baby boy was riding in his car seat when another vehicle struck the side of
the car at high speed. The impact created a two-foot intrusion to the passenger side
where the baby sat. At the scene medics found the baby with a weak pulse and an
extremely rapid heart rate. In addition to head injuries and broken ribs, the baby’s chest

wall had been punctured and he was unable to breath. He was treated urgently with a
chest tube which saved his life. After he was stabilized, he was tranferred to Harborview
for pediatric intensive care. During his rehabilitation, he spent a long time on
ventilation, but is now smiling and interacting with his family.
Harborview Medical Center
Harborview Medical Center is a 413 bed hospital located in Seattle. It is the state’s only
Level I adult and pediatric trauma center, caring for the community’s most seriously
injured patients. The hospital sees approximately 85,000 patients a year in the emergency
room. Last year the hospital provided $36 million in charity care and forgave $24 million in
bad debt for patients unable to pay for their care. Approximately half of all patients
entering the emergency department have injuries classified as serious, critical, or major.
Because of the high volume of trauma care provided at Harborview, the medical center is
provided with a block grant in trauma funds to help defray the high cost of providing this
complex care.
• A 40 year old self-employed welder from Marysville had a long history of seizure
disorders, but was unable to pay for his seizure medication. As a result, he was forced
to cut back on the medications necessary to control his seizures. One day while driving
he had a seizure, hit a telephone pole, and sustained fractures to his spine and one of his
legs. During evaluation and treatment at a community hospital, he had several more
severe seizures and had a breathing tube inserted. He was transferred to Harborview
where he was treated for two weeks for his seizure disorder and also received treatment
for his spine and leg fractures.
• A 48 year-old woman from Gold Bar had been experiencing severe headaches for over a
month. Upon admission to her community hospital, the headaches were accompanied
with dizziness. A CT scan showed a brain hemorrhage. She was transferred to
Harborview where surgery was performed to repair the hemorrhage. The patient
remained hospitalized for nearly a month. She returned home where she resumed her
life as a homemaker and sales manager.
• A 40 year-old laborer was working with an axe when he dislodged a piece of wire that
flew up and hit him in the eye, penetrating his eyeball. He came to Harborview from
Port Angeles for emergency surgical intervention. Surgeons brought him immediately to
the operating room to extract the wire, irrigate the eye, and ensure proper drainage to
the injured eye. He was hospitalized overnight.
• A 50 year-old self-employed truck driver and father of two from Lynnwood had been
experiencing pain to his left calf while walking. The pain gradually progressed to the
point where his pain was quite intense, even while resting. As a result of this pain, he
had to quit working. After three months of enduring the pain, he came to the
Harborview Emergency Department where he was found to have significant disease in
the arteries of his leg. He eventually required surgical intervention and nearly a week of
hospitalization.

Tacoma General Hospital
Tacoma General Hospital is a 298 bed hospital located in Tacoma. The hospital sees 82,000
patients a year in the emergency room. Last year the hospital provided $3.4 million in
charity care and forgave over $9 million bad debt for patients unable to pay for their care.
• A 49 year-old woman was involved in a nearly fatal automobile accident. She spent 44
days in the intensive care unit and another ten days in the hospital before being
discharged to an inpatient rehabilitation facility. During her hospital stay, she
underwent four surgeries.
• A 22 year-old man was airlifted to the Tacoma Trauma Center following a serious
snowboarding accident. While he was employed as a chef, he was uninsured. During his
three-day stay at Tacoma General hospital, the young man had one surgery and no
complications.
• A 19 year-old student suffered serious injuries in a motorcycle crash, sending him to
Tacoma General’s Trauma Center. The victim, who was wearing a helmet, spent five days
in the hospital and had one surgery.
Providence St. Peter Hospital
Providence St. Peter Hospital is a 390 bed hospital located in Olympia. The hospital sees
approximately 55,000 patients a year in the emergency room. Last year the hospital
provided $4 million in charity care and forgave $4 million bad debt for patients unable to
pay for their care.
• A 20 year-old Western Washington University student from Thurston County was rock
climbing on vacation in Canada when a heavy bolder fell, knocking her off the mountain,
and crushing her ankles and left leg. A friend climbed down the mountain and carried
her back to the top to get medical help. When they evacuated her to the local medical
center she was turned away because she had no insurance. She was then taken to
Vancouver Hospital, but because she had no insurance she received only superficial
treatment. A Vancouver doctor knew she could get care in the states and had her
transferred to Providence St. Peter Hospital, close to her home. She went through three
surgeries to fix her legs and was transferred to Harborview for another surgery where
she stayed for her recovery. Without the MI program, this woman may not have received
the treatment she desperately needed and could have been permanently disabled.
• A 44 year-old father of two children from Yelm, Washington had recently lost his job as a
construction worker and therefore also lost health insurance coverage for his family. His
wife did not have health insurance coverage through her work and they could not afford
private insurance. While he was doing odd jobs, a skill saw slipped and nearly severed
his entire left hand. He was transported reluctantly to the hospital and was very upset
upon arrival. He wanted to be released immediately because he could not pay the bill.
He said he would rather loose his hand than bankrupt his family. The Medically
Indigent program, however, helped defray the costs of his treatment, including multiple
surgeries and rehabilitation. He is currently in outpatient rehabilitation, is able to move
some of his fingers, and should be able to go back to work soon.

Southwest Washington Medical Center
Southwest Washington Medical Center is a 360 bed hospital located in Vancouver,
Washington. The hospital sees 112,000 patients a year in the emergency room. Last year,
the hospital provided $3.6 million in charity care and forgave $8 million bad debt for
patients unable to pay for their care.
• A 23 year-old male from Vancouver, Washington was struck at high speed by another
vehicle on the driver’s side. Despite wearing a seatbelt, he suffered multiple fractures
and injuries to his brain, face, arms, legs, and internal organs. He was unconscious and
in critical condition upon arrival at the hospital and required a full resuscitation team to
keep him alive. After being stabilized, he underwent neurological, orthopedic, and
plastic surgery. He spent 10 days in the intensive care unit, followed by 14 additional
days of hospital care. He was eventually discharged to a skilled nursing facility where
he was put on breathing and feeding tubes. He was later admitted for inpatient
rehabilitation and showed significant improvement. At the time of injury he had a
supportive family and was enrolled in a college masters program.
• A 21 year-old male passenger from Vancouver, Washington was in the backseat wearing
a seatbelt when he was involved in a motor vehicle crash. He sustained serious injuries
to his spine, spinal cord, lungs, internal abdominal organs, as well as significant brain
injury. He required multiple surgeries and intensive care. He was in the hospital 47
days, and then was transferred to an inpatient rehabilitation facility where he was put on
a ventilator. Although he was alert and slowly recovering from his brain injury, he
remained totally paralyzed from his neck down. Upon discharge from rehabilitation, he
had made progress in his ability to manage his power wheelchair. At the time of his
discharge, he hoped to finish his education and was learning to use a computer with an
assistive device.
Central Washington Hospital
Central Washington Hospital is a 206 bed hospital located in Wenatchee. The hospital sees
approximately 28,000 patients a year in the emergency room. Last year, the hospital
provided $1.8 million in charity care and forgave $1.5 million bad debt for patients unable
to pay for this care.
• A 22 year-old female from Entiat, Washington was involved in a snowmobile accident
and came to the emergency room with a fractured right upper leg and multiple fractures
of the right arm and elbow. She was admitted to the hospital and quickly taken to the
operating room for fixation of her fractures. After a lengthy stay of nine days in the
hospital, she was discharged with restrictions to a wheelchair for an additional six to
eight weeks.
• A 28 year-old male from East Wenatchee, Washington sustained a broken neck and
compression of the spinal cord from a diving injury. Surgeons at Central Washington
Hospital were able to stabilize his neck and reduce the spinal cord successfully. He was
expected to make a full recovery from his serious injuries. The man was single and
unemployed at the time of the accident and unable to pay his medical bills.

Deaconess Medical Center
Deaconess Medical Center is a 388 bed hospital located in Spokane. The hospital sees
34,000 patients a year in the emergency room. Last year the hospital provided $2.8 million
in charity care and forgave $3.5 million bad debt for patients unable to pay for their care.
• A 28 year-old mother and her 20 month-old baby girl from Four Lakes, Washington were
involved in a single car rollover. Both were ejected from the vehicle and sustained
multiple injuries. The mother sustained fractures to the ribs, collarbone, right upper
leg, and left lower leg. The baby sustained fractures to the spine, ribs, collarbone, upper
and lower right arm, and lower left leg. Both mother and baby had concussions with
brief loss of consciousness, injury to the lungs, and multiple cuts and bruises. The
mother was transported to the hospital by ground ambulance and the baby was airlifted.
Both underwent trauma surgery along with care from adult and pediatric orthopedic
surgeons, neurosurgeons, and intensivists. Both mother and baby remained in the
hospital for nine days, after which they were discharged with a long schedule for
rehabilitation and physical therapy.
• A 25 year-old male motorcycle rider from Fairfield, Washington was struck by a car.
Despite the use of a full-face helmet, he sustained a concussion with brief loss of
consciousness. He had multiple fractures to his spine, left upper and lower leg fractures
including ankle and foot, and several cuts and bruises. He also had significant lung
injury, a cut that penetrated his spleen, and nerve damage to his left arm. He was
airlifted from the scene and received trauma, orthopedic, and plastic surgery at the
hospital with multiple blood transfusions. He stayed in the hospital for 13 days, and
was then transferred to Harborview, as complications in his leg indicated the possible
need for amputation.
We need your help.
Both the Medically Indigent and trauma programs are continually threatened in terms
of the continuation of their funding. Last year the state suspended payments from the
trauma fund. The Governor’s budget proposes restoring these payments and
continuing the program into the next biennium. The Governor’s budget, however,
also proposes elimination of the Medically Indigent program.
Continuation of the Medically Indigent and trauma programs is critical for all of
Washington’s hospitals, and for very sick and injured uninsured persons in
communities across the state.

For More Information Contact:
Cassie Sauer
Director, Advocacy & Public Relations
(206) 216-2538
cassies@wsha.org
Claudia Sanders
Vice President, Policy Development
(206) 216-2508
claudias@wsha.org
Len McComb
Lobbyist
(360) 951-1661
lenm@localaccess.com
Washington State Hospital Association
300 Elliott Avenue West
Suite 300
Seattle, WA 98119-4118
Phone (206) 281-7211
Fax (206) 283-6122
www.wsha.org