Louisville's University Hospital treated more than 700 people with gunshot wounds in 2003-04. The cost: More than $18 million.
And those numbers aren't shrinking: Officials say University Hospital is on pace to see 400 gunshot victims this year, at an estimated cost exceeding $10 million.
Gun violence "is a huge, huge public health problem," said Dr. William Smock, an emergency medicine specialist who directed a recent study that outlined those numbers.
And it has implications beyond those shot.
While gunshot victims represent just 6 percent of University's trauma patients, the cost of treating them is virtually eating up the hospital's indigent care budget, according to the study, which the hospital undertook with federal grant money aimed at reducing gun violence.
Last year, the hospital received $7 million from the city to help cover the cost of all indigent care, for all types of treatment. But that's nearly what it cost to treat gunshot victims who couldn't pay, Smock said.
"This is sucking the (indigent care) money dry," Smock said.
About one-third of the $18 million in hospital charges for gunshot cases in 2003 and 2004 were covered by private insurance, Medicare and Medicaid. The rest involve patients who either have no insurance or are considered indigent and cannot pay, Smock said.
And there are other costs to the community -- for prolonged rehabilitation, loss of job productivity, disability payments and emotional costs, he said, adding that the initial treatment is just "the tip of the iceberg."
The study, which looked at all 720 gunshot victims who came through the hospital in 2003 and 2004 -- those who lived and those who did not -- was funded with a federal grant from the U.S. Attorney's Project Safe Neighborhoods program.
Members of a safe neighborhoods working group, which includes the U.S. Attorney's office, local prosecutors and police, met last week to hear about the study.
That's important, Smock said, because the key to stemming gun violence -- like preventing disease -- is understanding it.
"Once you understand why it's occurring, what are the risk factors ? then you can develop programs to stop it," Smock said. "It's a challenging issue to address because the number of guns that are out there is staggering.
"We get victims that come in and they still have a gun on them."
The violence takes a toll on the doctors and nurses who treat patients.
"The hard part is seeing what families go through," said Dr. Timothy Price, an emergency doctor at University, which, as the area's trauma center, handles the bulk of such cases. "You see the aftermath."
By the numbers
Earl Murphy recalled sitting in the waiting room at University, awaiting news about his 17-year-old son, Johnathan Watson-Murphy, who shot in the head minutes before, outside his western Louisville home.
"They came out and told us that he wasn't going to make it," Murphy said.
According to the University report, Watson-Murphy is an example of those at greatest risk for homicides and assaults with guns:
He was African American, like 70 percent of homicide victims.
He was under the age of 28, like more than half of all victims.
And he lived in western Louisville; 26 percent of homicide and assault victims live there, or downtown.
The study, which reviewed demographics ranging from victims' age and race to ZIP code, also showed that white men overwhelmingly make up the largest number of people who commit suicide by gun, at 88 percent.
About 75 percent of victims came from Jefferson County, while the rest lived in surrounding counties and Southern Indiana.
And women are at far less risk of being shot, making up only 13 percent of the total 720 victims, the study found.
New study approach
There is no national database on firearm injury, but the Centers for Disease Control and Prevention statistics show that more than 30,000 people were killed by firearms in 2002.
The University study showed that 229 of the gunshot victims treated there in 2003 and 2004 died.
While no other area hospital has done the kind of comprehensive study prepared by University, Kosair Children's Hospital has been tracking the number of gun-related injuries it sees since August 2003. There has been a total of 42, including 14 from BB or pellet guns, said Brian Rublein, a hospital spokesman.
The University study reflects a new approach to studying firearm violence by using trauma center data, said Rose Cheney, executive director of the Firearm Injury Center at the University of Pennsylvania.
The center, which conducts similar research as part of its mission to reduce firearm violence, has found data supporting Louisville's findings on the cost of gun violence. It "is something that's becoming very costly," Cheney said.
She added that such data can be used to help agencies like police and hospitals do a "better job of tailoring your responses."
Louisville Metro Police Chief Robert White said he believes the data confirms that police are doing the right thing by putting extra resources, even for short amounts of time, in neighborhoods that see more shootings.
"Obviously we're targeting the right places," White said.
And Thomas Dyke, an assistant U.S. attorney in Louisville, said members of the safe neighborhoods group found the study underscored the need to tighten prosecution of gun crimes -- and do more in the area of prevention. "We need to be able to develop some kind of intervention so that we can keep it from happening," Dyke said.
Dr. Adewale Troutman, director of the Metro Health Department, said he thinks research like Smock's can help the community design intervention strategies. But, "we have a long way to go," he said, adding that police cannot do it alone.
He said health department officials would work with Smock to begin to craft possible solutions, which might include work in public schools, gun safety education and efforts to reduce demand for illegal drugs.
White encourages that multi-agency approach.
"We can't do it by ourselves," White said. The study "speaks to the importance of us working together."
Smock said one aspect of the University study -- showing that more than 50 people have been treated more than once for gunshot wounds since 1996 -- has prompted him to begin another study.
Among those repeat victims, about half are 21 or younger, said Smock, who wants to study strategies for keeping young gunshot wound victims off the streets.
"The goal," Smock said, "is to prevent assaults and homicides."