These costs represent a huge potential liability for health care providers and payers. Researchers Wendy Max and Dorothy Rice cite an American Surgeon study which found that of patients admitted with intentional injuries at a Los Angeles trauma center, 75 percent of their hospital costs were uncompensated.⁸³ Such a financial burden has forced hospital centers to close the doors of their trauma care centers. During the years studied�1986 and 1988�one-third to two-thirds of these patients suffered gunshot wounds. Donald Trunkey, in his commentary, "Impact of Violence on the Nation's Trauma Care," in the Winter 1993 edition of Health Affairs, cited a national hospital survey which found that 61 trauma centers reported having terminated their services.⁸⁴ Trunkey noted, "This survey of hospital administrators identified twenty-six factors that may have prompted or contributed to the closure of these trauma centers. Four of the five leading reasons for closure involved costs: the perceived cost of uncompensated care; high operating costs, specifically, costs associated with trauma services; inadequate reimbursement from medical assistance programs; and reduced compensation for trauma patients under the Medicare prospective payment system...."⁸⁵

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