Issue link: https://beckershealthcare.uberflip.com/i/644565
35 POPULATION HEALTH city, particularly unregulated gun sales coming across the border from northwest Indiana. We are not the only city with gangs. We are not the only city with poverty. We're not the only city with racial tension, but we happen to have a lot more guns on our streets than other cities and part of it is how guns get trafficked here. I'm certainly not saying I have all the specific statistics on this, but when I talk to families in my ICU, everybody has a gun. Ms. Cosgrove: I worked closely with law enforcement for multiple years and they say, "We cannot arrest our way out of this." ere are sig- nificant mental health issues and health issues in the fold that health- care professionals are capable of responding to, and we need them to step into that space. Chicago, like many other communities, can really benefit from implementing a full health system approach to violence. In communities with CeaseFire programs, we were able to reduce retaliation-related shootings by 100 percent. Overall reductions in homicides and shootings were anywhere from 40 to 70 percent in those communities. Illinois, like many other places across country, is looking for ways to reduce its budget, but the amount of money a gunshot victim costs is substantial. We're talking anywhere from upwards of $250,000 just to stay in the hospital for four or five days, and then you have transportation costs, which if a person has to go via helicopter is likely $20,000. e amount of money each conflict mediation saves is substantial and, we believe, worthy of investment. Dr. Bokhari: We've had some high-profile things happen with the community police being brought to the forefront. ey have to be more intimate within communities, yet carry out their charge of enforce- ment. at's one part of the dialogue. ere's also the question of how some of the population became dis- enfranchised. If people won't call law enforcement because they don't trust them, there's a big problem there. You see this across the board actually, where law enforcement is really weak or not trusted. In our country, the disenfranchised people have to be brought to the forefront. Q: How does gun violence impact hospitals, particularly in terms of finances, staff and reputation? Dr. Humikowski: In general, it depends on whose lens you are looking through. Imagine you are a well-insured average American with a problem and you want the very best medical center. If all other things are equal, you have a choice, and one hospital is in the hub of a neighborhood known to be afflicted by gun violence and one isn't, you are not going to pick the hospital that is. at's just common sense. From my perspective on South Side, I certainly get the sense that im- pacts us compared to some of our otherwise equivalent peers. We at the University of Chicago have a great tradition of research, investigation and scholarship, and we are fortunate we continue to attract a lot of folks who want to get that care. But at the end of the day, it's a different thing to drive to South Side of Chicago than the Gold Coast. e other side of that is trauma care is very expensive. It is notoriously one of the most expensive, if not the most expensive, branch for a hos- pital to run. It's talented, multidisciplinary professionals, systems-based care, and you have to do very high-acuity things very quickly and effectively. at's what all hospitals strive to do. It's the top of the line. If you can do trauma care well, you can do anything well. From that perspective, as a physician of the University of Chicago, I'm excited we will be able to offer that service for our community, because as I said, it represents the best of the best. [Editor's note: e University of Chicago plans to open a Level I trauma center on its Hyde Park campus in early 2018, in addition to expanding emergency room services and inpatient beds. South Side residents have pressed for better access to trauma care since UChicago closed its adult trauma center in 1988 for financial reasons. Protests reignited in 2010 af- ter a young man died from a shooting three blocks from the University of Chicago Medical Center.] Ms. Cosgrove: Violence overall is estimated to cost about $450 bil- lion dollars per year. Gunshot victims could even be in excess of even $1 million for some of the most critical patients. You also need to think beyond the visible wounds to the trauma that exists within that person and the community. is manifests in hospitals in multiple ways. Gunshot victims are disproportionately poor, underserved and underinsured. ey are oen single men who aren't eligible under the old form of Medicaid. Men, in general, are less likely to sign up even if they are qualified under the Affordable Care Act. Hospitals will likely be unable to bill for the cost of treating gunshot victims, so they have to take on those costs. For staff, it's incredibly stressful. You can imagine having someone's life in your hands on a regular basis and having to see the impact of gun violence on your community. ere's also the surrounding issues. You have police who are trying to investigate the case, upset family and friends who may want to retaliate, assailants who might be coming in to try to finish the job, which unfortunately has happened and is a significant stress to the hospital and staff. We call it vicarious trauma. ey may not have the gunshot wound themselves, but the trauma for the staff serving these individuals is significant. Dr. Bokhari: It depends on what population you are getting. In gener- al, you might get people that are insured or uninsured, so it is hard for me to say how it impacts finances. Most hospitals are a charity, and you are not supposed to be making a lot of money. It can be a drain on finances if somebody comes in who was trying to commit suicide, which is statistically more likely than a homicide. It uses resources and it is completely unnecessary. We have not been able to prevent that unnecessary spend. As far as staff goes, it is very psychologically taxing because it's so sudden. It's not like cancer where it is expected. It's emotionally taxing for the staff. Q: What is a hospital or health system's responsibility in addressing gun violence? What about individual physicians? Ms. Cosgrove: We've studied the benefits of hospital-based violence intervention programs and seen significant cost reduction and life-sav- ing measures. Upon presentation of a gunshot victim in hospital, within five years there is a 45 percent chance of reinjury. When we think about this contagious process, we need to get to heal that infected point so that person doesn't become a perpetrator later on. When someone comes in, if they are talking about retaliating, or even if family members or friends are talking about retaliating, the hospital system has the ability to treat those individuals. ere are communities doing it in Chicago and many other cities. We really recommend hav- ing a social worker or crisis response team available to respond to these victims. Ideally this is a person with personal experience, credibility and knowledge, who is able to establish trust. Dr. Bokhari: For health systems, gun violence usually comes through the ER or trauma systems. Some systems have a responsibility for prevention at a regional and local level, and we do a lot of that. We have teams of social workers and programs — for example, we are part of CeaseFire.