New trauma unit gives nurses edge against time

By KARINA KOVAC kkovac@liherald.com

Once the “community spouse” invokes their right to refuse, and all of the other myriad requirements of the Medicaid application are met, the state Medicaid program must pay for the care of the institutionalized spouse.

After Medicaid has been granted, the county may institute a lawsuit seeking to recover the cost of care from the refusing spouse. Nevertheless, there are a few reasons why spousal refusal makes sense, even in light of this risk. First, in many instances, the county never invokes this right. Secondly, these lawsuits are often settled for signifcantly less than the cost of care provided. Thirdly, the payment to the county can sometimes be deferred until the community spouse dies. As one county attorney told us when agreeing to such an arrangement, “the county is going to be around for a long time”. Finally, even though the county may seek recovery, it is only for the Medicaid reimbursement rate and not the private pay rate. For example, if the private pay rate is $18,000 per month, which is what you would have to pay, the amount Medicaid has to pay is generally a quarter to a third less. The county may only pursue you for the amount they actually paid.

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In trauma unit 3 lies a 30-yearold man with obvious head trauma. He was hit by a car going way too fast on Merrick Road. “Can we establish an airway” a nurse yells, “I’ve got the glidescope” hollers another. Only the man in this scenario is just pretending, christening the new Mount Sinai South Nassau trauma unit with a fictitious trauma support emergency incident. But, as the hospital nurses know, many real-life similar cases will come in and out of the state-of-the-art ward.

The enemy the hospital is fighting with their $50 million expansion is time. The new trauma unit features a game changing open concept design plan and easier methods of communication that will cut down lost time. From gunshot wounds to emergency surgeries or even labor delivery and pediatric care, the nine new private room can handle anything thrown at them, including mass causality events.

“The beauty about this space is it allows us not only take care of trauma patients, but we can also take care of anybody that severely sick, so patients that come in with cardiac arrest or respiratory arrest. Having the space to be able to take care of these patients really makes a difference and allows us to do our work more easily,” said Margaret Puya, trauma program manager.

Time is critical in traumatic injuries. Once the ED is alerted of an impending arrival, the Trauma Team is mobilized through a paging system to immediately receive the patient. From admission to rehabilitation, the goal is to make the patient’s journey to recovery as seamless as possible.

Each room has operating room lights, rapid infusers, intubating equipment, ultrasound equipment, and standard procedural equipment. As well as things for the airway, chest, abdominal trauma, and orthopedic needs for fractures and more.

The new trauma unit is near and dear to Adhi Sharma, president of Mount Sinai, since he worked in trauma. He said seeing years long plans start to come to fruiting in this halfway point has nurses buzzing with anticipation.

“They've been working under confined conditions because of construction,” Sharma said, “So any expansion for them is freedom and this is a freedom to function in a clinical environment that supports the patient needs. We’re restructuring how we are going to provide care in the future, and making the hospital ready for all of the future advancements in science that will allow us to take even more care for our community and have patients here locally.”

He said the goal of the $50 million dollar expansion project is to be able to be a tertiary care center, so that residents don't have to go to Manhattan for expert care, they can get it in their backyard, and their families can visit them locally as well.

Upon its completion in the summer of 2025, the $ expansion project, which started in 2016, will nearly double the size of Mount Sinai South Nassau’s Emergency Department and increase its capacity from 65,000 annual emergency patient visits to an estimated 80,000. The total cost of this phase of the expansion is $5 million.