Last year's referendum failed by a relatively slim margin - about 130,000 votes - sending lawmakers back to the Capitol to find ways to pay for the trauma hospitals' surgeons, specialists and equipment. So Sen. Greg Goggans has a new idea: Take $10 of the money Georgians already pay for vehicle registration fees and place it in a trust fund for the trauma hospitals.
His proposal would mean no added fees for taxpayers - but it also would mean diverting money that's already used for other state services.
Elaine Frantz, who works at Memorial Health in Savannah, said she is hopeful the new proposal might pass. Memorial is a Level 1 facility, meaning it is equipped to treat the worst of traumatic injuries. Of the state's 17 trauma hospitals, only four are Level 1.
"Unfortunately, what I heard is that it may not pass because it wouldn't cost the public any more, but it would pull funds away from another state priority," Frantz said.
Last year's statewide referendum failed amid the weak economy.
"People I talked to who voted against it said they saw it as a tax, or didn't trust us to spend the money the way we say we're going to spend it," Goggans said.
Goggans' proposal would be on the 2012 ballot if approved by the Legislature. He said finding a way to fund the trauma care system will be among his top priorities in the Senate.
"This is a dedicated funding source that cannot be used for anything other than trauma," he said. "Without that, any attempt to improve our trauma system will fail."
Supporters said Goggans' proposal last year to add the $10 fee would have brought in $80 million a year for trauma hospitals - and helped save as many as 700 lives a year. It had strong support from groups like the Georgia Chamber of Commerce, but it could not overcome voter skepticism and opposition from the Georgia Tea Party Patriots.
Meanwhile, another stream of revenue the hospitals had been hoping for has not lived up to its promise - money from tickets issued to "super speeders." Part of that money was to go to the trauma network.
"They anticipated a pot of gold and it's not there," Frantz said, adding that nearly one in five trauma patients at Memorial have to pay out of pocket. "And there's a good chance that will be no pay. The hospital absorbs that."
Dr. Leon L. Haley Jr., chief of emergency medicine for the Grady Health System - the state's largest trauma hospital - called the situation challenging.
"Grady and the people who work at Grady work off of the mission of being part of the safety net," Haley said. "But you need to be able to support that mission. Any one year you lose that money, it's a big deal."
The importance of finding money is twofold. For one, the system needs to expand its reach into rural and South Georgia, where traumatic death rates are highest, according to a 2006 trauma study committee. For another, facilities have to absorb the cost when patients can't pay - in addition to paying the high price of running a trauma hospital. The committee study found that such hospitals provided $250 million worth of unpaid services that year.
Trauma care is a resource-intensive operation, requiring hospitals to keep teams of specialists on call around the clock. Many Georgians live outside of the "golden hour" radius of 150 miles or less that experts say is critical to saving lives.
"We have a severe shortage of trauma centers in the state, especially when you look at the south Georgia area," said Georgia Hospital Association spokesman Kevin Bloye. "We want to grow the network, but we're very concerned about those already providing the service. Or maybe they'll downgrade their designation to a Level 2. That would be disastrous."
Goggans' recent proposal to expand the hospitals' reach and maintain their current services may be more palatable to taxpayers, but it could be a tough sell for legislators.
"Any idea that looks at trying to support trauma care is a good idea," said Haley, the doctor at Grady, who also is a member of the trauma committee. "But something's going to lose. I don't know what that is. It would be unfair to me to say, 'Give us that 10 dollars."'
Without a new source of revenue, Goggans' proposal may only solve one problem and create another, said Alan Essig of the Georgia Budget and Policy Institute.
"The answer is to come up with additional revenues so we're not cutting one vital service to pay for another vital service," Essig said.
Otherwise, Essig said, the Legislature could set a dangerous precedent of set-asides for any number of issues, such as mental health education. He said Goggans' proposal could hamstring lawmakers in the future if they need to move money around in the budget.
Goggans dismissed the notion, saying that saving lives should be among the Legislature's first priorities. He also said revenues should improve by the time the referendum would be on the ballot.
"History has shown that states are not going to ramp up and improve unless there is dedicated funding," Goggans said. "It's not a tough choice to save a life. That should be the botttom line."
Senate Resolution 140: http://www.legis.ga.gov