About a year ago, Ruth Gellis, a Holocaust survivor who was 99 at the time, had to visit the emergency department at Dartmouth Hitchcock Medical Center.
Gellis, who lives in Hanover, waited 36 hours to get a bed.
“Everyone was doing their darndest and working for her really hard, but the bed just wasn’t available,” Wesley Miller, her son-in-law and the emergency management director at DHMC, said Friday.
Gellis’s injuries were less acute than those of other patients seeking care, and luckily, she’s doing much better now. Her experience at the emergency department was not unique: As DHMC faces staff shortages and budget cuts, its waiting rooms grow more crowded and doctors and nurses stretch themselves increasingly thin. Staff from DHMC and other New Hampshire hospitals met with U.S. Representative Maggie Goodlander to discuss these challenges facing trauma medicine across the country, particularly in rural areas.
Trauma injuries are the leading cause of death among Americans aged one to 44, according to Dr. Eric Martin, who specializes in trauma and acute surgery. Yet his branch of medicine — like most others — has faced major funding challenges in the last year, he said, largely due to the passage of HR-1, or President Donald Trump’s “Big Beautiful Bill,” which cut funding from Medicaid and the Affordable Care Act.
DHMC has the only Level One trauma center in New Hampshire, and is one of two between the Granite State and Vermont. As a result, trauma victims in the rural parts of both states flood Dartmouth Hitchcock for critical treatment. As more patients are unable to foot the cost of their medical bills, nonprofit hospitals like DHMC are taking on a greater share of the financial burden.
“It’s the system in crisis,” Goodlander said.
Part of HR-1 dedicated $50 billion nationally to fund the Rural Health Transformation Program, designed to expand access to healthcare in rural areas, like much of Northern New Hampshire. The Granite State received $204 million in funding for the program this year.
EMS director Ryan Gerecht called those funds “a drop in the bucket” compared to the funding cuts hospitals have faced as a result of the same bill. Last month alone, Dartmouth Health laid off 124 employees and eliminated 303 open positions.
Pediatric trauma surgeons are among the most short-staffed roles in the hospital system. Eileen Duggan, a pediatric trauma specialist at DHMC, explained that pediatricians — both primary care and specialists — typically earn less than their peers who work in adult care, officials said. And at Dartmouth Hitchcock, many of the children checked in for trauma-related injuries use Medicaid. Seventy percent of pediatric trauma patients, Duggan added, are sent to Hanover from smaller hospitals, often in more rural areas.
“Children don’t pay,” Duggan said. “I know that sounds really terrible.”
Kacie Boyle, a clinical nurse supervisor in the emergency department, said she watches parents from outside of the Upper Valley struggle to figure out how to stay with their sick or injured child when their lives — and sometimes, their other children — are several hours away from DHMC.
“And then staff are pulled away from other things to try and help,” Boyle said.
“Are you short-staffed?” Goodlander asked.
“Yes,” was Boyle’s immediate response.
Boyle has worked in the DHMC emergency department for 10 years, and said that the current staffing shortage is the worst she has seen. Though 10 years of nursing experience isn’t all that long, according to Boyle, she’s still one of the most experienced nurses in the room: worrisome in a Level One trauma center, where “you have to know how to care and intervene and act on things in a split second.”
A constant influx of trauma patients compounded with a severe personnel shortage means nurses in the emergency department, like Boyle, often have to make choices they never wanted to deal with, ones that prevent them from being the kind of nurses they strive to be.
As a result, she has watched many bedside nurses leave their posts, exacerbating the staffing problems hospitals are already experiencing. Many physicians, faced with similar moral dilemmas, have left the system, too.
DHMC is not just low on staff, but also on capacity. Dr. Jennifer Pope, an emergency physician and the vice chair of operations for the trauma department, said the hospital operates over capacity six days a week, and seven in the summer. Doctors see 25% of their patients in the waiting room, with more in the hallways, where they can fit extra beds. They can’t turn people away.
“This is not sustainable,” Pope said. “Dartmouth is in financial crisis. Hospitals can’t survive without over-accepting, which means boarding in the ED, which means decreased access to care, which means it’s dangerous for patients.”
For his part, Gerecht stays awake at night thinking about the state of the rural EMS system. Before becoming EMS director at DHMC, Gerecht worked in Washington, D.C. A stark resource deficit stares him in the face daily — one he can measure in blood.
More blood reserves exist in the Capital area for pre-hospital services than some rural New Hampshire hospitals can claim in total. There are only six units of blood available for pre-hospital services in the whole state, including two on a Boston Med Flight helicopter. Gerecht said doctors could easily use two whole units to keep one injured person alive.
Despite its cadre of skilled and experienced doctors, the DHMC trauma center is hardly prepared to deal with any sort of catastrophic event. Giving Goodlander a tour of the trauma bay after their talk, Martin gestured at its four beds.
“It doesn’t take much but a car crash with four or five people to kind of overwhelm us in here,” he told the congresswoman.
For the medical professionals at the table Friday afternoon, Goodlander’s visit gave them the opportunity to make one of their Congressional representatives aware of the importance of trauma care, its high demand and the challenges it faces with so much funding falling through.
“People think of cancer and heart disease all the time, but they don’t think about injury as a disease, and it really truly is,” Martin said.
