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Effect of the Uniform Accident and Sickness Policy Provision Law on Alcohol Screening and Intervention in Trauma Centers

Gentilello, Larry M. MD; Donato, Anthony MA; Nolan, Susan MA; Mackin, Robert E. BS, MFA; Liebich, Franesa MS; Hoyt, David B. MD, FACS; LaBrie, Richard A. EdD

Journal of Trauma and Acute Care Surgery: September 2005 - Volume 59 - Issue 3 - p 624-631
doi: 10.1097/01.ta.0000179309.34613.27
Article Titles

Background: Alcohol screening and intervention in trauma centers are widely recommended. The Uniform Accident and Sickness Policy Provision Law (UPPL) exists in most states, and allows insurers to refuse payment for treatment of injuries in patients with a positive alcohol or drug test. This article analyzed the UPPL’s impact on screening and reimbursement, measured the knowledge of legislators about substance use problems in trauma centers, and determined their opinions about substance use-related exclusions in insurance contracts for trauma care.

Methods: A nationwide survey of members of the American Association for the Surgery of Trauma was conducted. A separate survey of legislators who are members of the Senate, House, or Assembly and serve in some leadership role on committees responsible for insurance in their state was also performed.

Results: Ninety-eight trauma surgeon and 56 legislator questionnaires were analyzed. Surgeons’ familiarity with the UPPL was limited; only 13% believed they practiced in a UPPL state, but 70% actually did. Despite lack of knowledge of the statute, 24% reported an alcohol- or drug-related insurance denial in the past 6 months. This appeared to affect screening practices; the majority of surgeons (51.5%) do not routinely measure blood alcohol concentration, even though over 91% believe blood alcohol concentration testing is important. Most (82%) indicated that if there were no insurance barriers, they would be willing to establish a brief alcohol intervention program in their center. Legislators were aware of the impact of substance use on trauma centers. They overwhelmingly agreed (89%) that alcohol problems are treatable, and 80% believed it is a good idea to offer counseling in trauma centers. As with surgeons, the majority (53%) were not sure whether the UPPL existed in their state, but they favored prohibiting alcohol-related exclusions by a 2:1 ratio, with strong bipartisan support.

Conclusions: The study documents strong support for screening and intervention programs by both trauma surgeons and legislators. Surgeons experience alcohol-related insurance denials but are not familiar with the state law that sanctions this practice. A majority of legislators are also not familiar with the UPPL but support elimination of insurance statutes that allow exclusion of coverage for trauma care on the basis of intoxication.

From the Department of Surgery, The University of Texas Southwestern Medical School (L.M.G.), Dallas, Texas, Division on Addictions, Harvard Medical School (A.D., R.A.L.), Boston, Massachusetts, Department of Surgery, University of California at San Diego (S.N., R.E.M., F.L.), and Insurance Legislators Foundation (D.B.H.), Albany, New York.

Submitted for publication July 6, 2004.

Accepted for publication June 13, 2005.

Supported by Robert Wood Johnson Foundation grant 046488.

Address for reprints: Larry M. Gentilello, MD, Department of Surgery, The University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9158; email:

© 2005 Lippincott Williams & Wilkins, Inc.