Madam Speaker, I rise to highlight the important role of our Nation's trauma systems. On March 27, 2007, this Chamber passed legislation I sponsored to reauthorize the Trauma Care Systems Planning and Development Act. This important…
Madam Speaker, I rise to highlight the important role of our Nation's trauma systems. On March 27, 2007, this Chamber passed legislation I sponsored to reauthorize the Trauma Care Systems Planning and Development Act. This important legislation was signed into law on May 3, 2007. However, while the bill awaited the President's signature, the Nation observed the critical importance of trauma systems and the role they played in ensuring that New Jersey Governor Jon Corzine received the quick and efficient health care he needed to survive injuries he sustained during an April 12 traffic accident.
I would request that this New York Times article entitled ``In Corzine's Fast Recovery, Doctors Cite Timing, Grit and Luck'' be inserted in the Record. This article outlines the important role that the Camden, New Jersey area's trauma system--and particularly its Level I Trauma Center, Cooper University Hospital--played in Governor Corzine's treatment.
[From The New York Times, May 13, 2007]
In Corzine's Fast Recovery, Doctors Cite Timing, Grit and Luck
(By Lawrence K. Altman)
An article on Sunday about the extensive medical care that
Gov. Jon S. Corzine of New Jersey received at Cooper
University Hospital in Camden after a traffic accident on
April 12 misstated the date of Mr. Corzine's release in some
copies. It was April 30, not May 1.
Camden, N.J.--Dr. Steven E. Ross was about to perform an
appendectomy shortly before 7 p.m. on a routine Thursday when
a nurse paged him to say the governor of New Jersey had
suffered an open femur fracture and severe chest injuries and
was about to land on the helipad atop Cooper University
Hospital here.
``Quite honestly, I didn't believe it,'' said Dr. Ross, who
directs the level one, or most highly accredited, trauma
center at the hospital. But he immediately alerted security
guards and the public relations staff so they would ``keep
people out of my hair'' and help him avoid ``the
distractions'' that can interfere with the care of V.I.P.'s.
Dr. Robert F. Ostrum was watching the Phillies-Mets game on
television at his home just across the Delaware River in
Philadelphia that Thursday, April 12, when an announcer
interrupted to say that Gov. Jon S. Corzine was being flown
to Cooper.
In his 25-year career, Dr. Ostrum, the chief trauma
orthopedist at the hospital, had repaired about 800 femur
fractures, including 200 open ones. He called his colleagues
and said he would come in, in part because of the patient's
prominence.
So began the medical odyssey to which Mr. Corzine, 60, owes
his life. He was not wearing a seat belt while riding in a
state vehicle clocked at 91 miles per hour and nearly became
one of the more than 43,000 people a year who die in car
crashes in the United States.
Instead, after 11 days in intensive care, eight of them on
a ventilator, and three operations on his leg, Mr. Corzine
was released from the hospital on April 30 and resumed his
official duties as governor six days later.
In their first extensive interviews, doctors and nurses who
treated Mr. Corzine here attributed his amazingly fast
recovery to his speedy arrival at a trauma center, his grit
in overcoming severe pain to begin rehabilitation, and luck.
Mr. Corzine still needs strong painkillers that can impair
judgment, but he has not allowed the doctors to disclose the
drugs' names or share his X-rays or medical chart. He has
also refused The New York Times's repeated requests for
interviews.
But in lengthy conversations with this reporter, who is a
physician, the medical team that saved his life revealed many
new details about Mr. Corzine's injuries, his treatment and
the first three and a half weeks of his recovery.
Over the first 24 hours in the hospital, Mr. Corzine
received 12 pints of blood, an amount roughly equivalent to
the total blood volume in his body. Most of the bleeding was
internal, into muscles and the chest from 15 broken bones.
But because the blood was replaced as he lost it, he
avoided shock, a key way in which immediate trauma care saves
lives.
The jagged femur had torn through his thigh muscles and
skin to create an open wound six and a half inches long--``By
our standards it was pretty large,'' Dr. Ostrum said--and to
repair it, doctors had to insert a titanium rod through
the center of the broken bones and screw them in place.
When Dr. Ostrum found that the longest rod was too short
for Mr. Corzine's femur, he added an extension. ``I didn't
shorten him,'' he recalled, smiling.
The day after the accident, Mr. Corzine's family brought
specialists in trauma and orthopedics from New York
University to review his case.
In the coming days, with Mr. Corzine unable to speak
because of the tube connecting his windpipe to the
ventilator, David Donaghy, a nurse, read his lips as one way
to respond to his wishes for more pain medication or ice
water.
And when Mr. Corzine could talk again after a week of
semiconsciousness, the chief topics of conversation were
baseball and the New Jersey Devils hockey team, the doctors
said.
Do What You Have to Do
About 500 of Cooper's 2,500 trauma cases each year arrive
via the helipad, with its view of the Philadelphia skyline.
As they waited for Governor Corzine to land on April 12, Dr.
Ross, a trauma nurse, a nurse anesthetist, a respiratory
therapist and an emergency medical technician received word
that he was conscious but on oxygen because of difficulty
breathing due to his chest injuries.
Intravenous fluids helped maintain his blood pressure.
Emergency workers had splinted his damaged leg.
When he arrived at 7:03 p.m., the team talked with him as
they wheeled him to a nearby resuscitation area for a quick
examination.
By 7:10, on the first-floor resuscitation unit, Dr. Ross
asked more detailed questions about what hurt him, his
general medical condition and what drugs he routinely took.
``Do what you have to do,'' Mr. Corzine told him, Dr. Ross
recalled.
An anesthesiologist injected sodium pentothal, a rapidly
acting barbiturate, to put Mr. Corzine to sleep, and
succinylcholine, a muscle relaxant, to allow doctors to
quickly insert a tube in his windpipe and connect it to a
mechanical respirator.
Hospital aides wheeled Mr. Corzine to the basement for CAT
scans looking for evidence of brain damage; tears in the
aorta, the body's main artery; or damage to the heart, lungs,
spleen, liver and intestines.
Mr. Corzine escaped those problems. But he had a number of
fractures: the femur, sternum, a collarbone, a vertebra and
11 ribs. The broken ribs were in the central area of the
chest, six on the left side and five on the right. Two of the
ribs on the left were broken in two places.
An enormous force is needed to break the thick sternum and
that many ribs in a chest cage that is designed to protect
the heart and lungs. Dr. Ross, who has treated about 100
patients with injuries like Mr. Corzine's, said the governor
was ``just lucky'' to have escaped heart and lung damage.
At 8:30 p.m., Dr. Ostrum began repairing the femur.
Aligning the pieces was difficult because the bone was broken
in two places, leaving one piece floating and unattached.
``Normally, you take the hip on one end and the knee on the
other and put them back together again like pieces of a
jigsaw puzzle,'' Dr. Ostrum explained. ``When you get more
pieces it gets more difficult.''
In the three-hour operation, Dr. Ostrum removed as much
dead muscle and other tissue as possible to help prevent
infection. The thigh wound needed to be cleaned in two
additional surgical procedures, on April 14 and 16.
About midnight that first Thursday, Dr. Ostrum and Dr. Ross
met with two of Mr. Corzine's three children, advising them
that he was in critical condition.
``All of us thought he would survive,'' Dr. Ostrum said. He
did not ``paint a bleak picture,'' he said, adding, ``but I
wanted them to understand the severity of the injuries.''
There were potential fatal complications: pneumonia; other
infections; acute respiratory distress syndrome; blood clots
in the leg that could travel to the lungs or other organs and
cause emergencies, if not sudden death. ``It's
counterproductive to tell somebody everything's going to
be fine, and then when you do have problems, hear,
`Doctor, you told us everything was going to be fine,' ''
Dr. Ross said. ``I would rather tell them about the
realities and have everybody happy when things go well.''
Mr. Corzine's children were ``not in any mental state to
ask specific medical questions at that point,'' he said,
adding: ``They were pretty distraught. They wanted to see him
as soon as they could.''
After talking with the family, the doctors reluctantly
participated in a news conference at the request of Mr.
Corzine's aides. They said they were hesitant in part because
of the federal Health Insurance Portability and
Accountability Act, which prohibits the release of a
patient's medical information without explicit permission. At
the time, Mr. Corzine was under heavy sedation.
One More Fracture
The first week was the diciest, with Mr. Corzine, who was
in an isolation room for security reasons, using a mechanical
ventilator because in one small area the broken ribs were
unable to help the lungs expand, creating what is known as a
flail chest.
The doctors still did not know whether Mr. Corzine was
paralyzed. So they reduced the amount of sedation to observe
his spontaneous movements and to ask him to follow their
commands. When he moved both arms and both legs, the doctors
became more optimistic.
Later, they performed a fuller examination.
``We just pat them down all over to make sure we did not
miss any fractures or dislocation,'' Dr. Ostrum said. After
the swelling subsided, they found that Mr. Corzine had also
dislocated the last joint in his right middle finger.
Trauma doctors measure recovery in part by what patients
want to talk about and do; when patients talk about subjects
other than their injuries, they take it as a sign of
progress. Mr. Corzine's doctors said they were encouraged
that baseball and the Devils' playoff run were among his
favorite topics.
At Cooper, doctors typically take turns caring for trauma
patients every day. But Dr. Ross said that as the director,
he wanted ``to keep an eye on things,'' so he accompanied the
duty doctor on daily rounds, a move that could mean stepping
on a colleague's toes.
``When one attending surgeon looks over another attending
physician's shoulder, they get irritable,'' Dr. Ross said,
adding with a smile, ``because we all know everything.''
Executive Decisions
Once he was off the ventilator, Mr. Corzine read several
newspapers each day, the doctors said, but he did not do
office work in the hospital.
In considering when Mr. Corzine could resume his official
duties, the two main doctors--along with Dr. Michael E.
Goldberg, the anesthesiologist who controlled his pain
medication--discussed the timing and criteria among
themselves and with members of the governor's staff, state
lawyers and the governor's personal physician, who declined
to be identified.
They considered what criteria might apply to the return to
work of lawyers and business executives, or of physicians
like themselves who care for critically ill patients.
Paramount was the worry that Mr. Corzine's pain medication
could impair his thinking.
So they interviewed him, informally testing his memory.
They discussed sports and current affairs. He said he was
less familiar with South Jersey than the central and northern
areas. The doctors were satisfied that he was absorbing the
information and asking appropriate questions.
``We gave him specific advice on how much we want him to
limit his formal schedule,'' Dr. Ross said. ``We pushed the
window back until he and we felt that he could respond if
somebody needed him at 3 o'clock in the morning for an
emergency.''
The doctors said Mr. Corzine seemed lucid, coherent and
sharp. ``You can't tell he is on any medication at all,'' Dr.
Ostrum said.
After visiting Mr. Corzine at Drumthwacket, the governor's
mansion in Princeton, on May 4, Dr. Ross decided that as a
New Jersey resident he was ``comfortable with him making
executive decisions on my behalf.''
Yet Mr. Corzine erred describing a broken bone in an
interview conducted last Sunday and broadcast the next
morning, the day he resumed his official duties. Speaking on
NBC's ``Today'' show, Mr. Corzine said he had broken his
tibia, the shin bone, not his femur.
Every Time They Cough
The main rehabilitation goal is for Mr. Corzine to restore
his leg motion, then improve its strength and endurance. He
uses arm crutches, instead of standard ones, to avoid
aggravating his ribs.
He has three daily physical therapy sessions and is
scheduled for monthly checkups through the summer. The
doctors plan to monitor X-rays periodically to determine how
well his femur is healing and when he can put weight on his
leg.
(After Mr. Corzine underwent an outpatient checkup Friday,
his office issued a statement saying all was going well.)
Mr. Corzine still is not out of the woods, Dr. Ostrum said.
A possible complication is osteomyelitis, a serious bone
infection. Also, rib fractures are generally painful for
weeks.
``You can fix every bone in their pelvis and both their
legs, and they will come back and complain about ribs every
time they take a deep breath, every time they cough, every
time they roll over in bed,'' Dr. Ostrum said.
Mr. Corzine, who has pledged to educate others about
wearing seat belts, has said he remembered getting into the
helicopter but virtually nothing about the first eight days
in intensive care.
That was good news to Dr. Ross. The drugs that Mr. Corzine
received in intensive care are the same that patients may
receive when undergoing procedures like a colonoscopy, to
ease their discomfort.
``One effect of the drugs is amnesia,'' Dr. Ross said. ``We
think it's a good thing that patients don't remember what
they go through in the I.C.U.''