[Congressional Record (Bound Edition), Volume 153 (2007), Part 10]
[Extensions of Remarks]
[Pages 14415-14417]
[From the U.S. Government Publishing Office, www.gpo.gov]




               IN SUPPORT OF THE NATION'S TRAUMA SYSTEMS

                                 ______
                                 

                            HON. GENE GREEN

                                of texas

                    in the house of representatives

                         Thursday, May 24, 2007

  Mr. GENE GREEN of Texas. 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

[[Page 14416]]

     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.

[[Page 14417]]

       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.''

                          ____________________