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Northwest Indiana may get its first trauma center

BY SARAH TOMPKINS
sarah.tompkins@nwi.com, 219-836-3780 | Sunday, November 8, 2009

"Trauma alert, plus one," a muffled voice says over the intercom at 9:30 p.m. "Trauma alert, plus one."

Emergency room doctors, residents, nurses and other medical staff briskly pull on gloves and blue medical gowns and gather in the trauma bay at the Methodist Hospitals Northlake Campus in Gary. EMS workers wheel in a young man who was shot in the abdomen.

About 20 minutes later, he's taken from the trauma bay to get CAT scans.

"If we were a trauma center, what would have happened is the operating staff would have been here, ready to do surgery," said Dr. Nick Johnson, associate director of emergency medicine and trauma medicine coordinator, who led the medical team of 12 on a recent Saturday night.

Instead, he said, the nursing coordinator was spending time calling doctors who might be able to come in and perform surgery on the man.

Northwest Indiana has nearly a dozen hospital emergency rooms but no trauma center, which means area patients with severe injuries often wait longer than necessary for care or, in special cases, must be transported to hospitals in Illinois or elsewhere in Indiana that have trauma centers.

Dr. Michael McGee, chief medical director of emergency medicine at Methodist Hospitals, said getting a trauma patient treated within an hour of injury could mean the difference between life and death.

When an emergency room can't stabilize a severe trauma patient, physicians are forced to spend precious time calling hospitals with trauma centers to find a facility to accept the patient.

"Two hours later, when they go into shock, nothing is going to help them go in the right direction. It doesn't matter if they are at the best trauma center in the country," McGee said.

About one quarter of Methodist emergency department visits are trauma cases, according to hospital numbers.

Currently, region hospitals send their most critical patients to trauma centers in Chicago, Indianapolis and South Bend.

But if Northwest Indiana had a trauma center of its own, an on-call staff of specialists and surgeons could be assembled and attending to a patient in 15 minutes.

Creating a trauma center in the region

Methodist Hospitals Northlake Campus is trying to become a Level 2 trauma center, and the Gary hospital plans to submit an application to the American College of Surgeons in the next few weeks. A Level 2 trauma center has an operating room promptly available and an on-call staff response time of 15 minutes. A Level 1 trauma center, which is a step up because it's staffed around-the-clock, has personnel dedicated to an operating room at all times, has specialists in the hospital 24 hours a day and admits at least 1,200 trauma patients a year.

If Methodist completes the verification process and can muster permanent funding, Northwest Indiana would have a medical facility with neurosurgeons, orthopedic surgeons and other specialists on call 24 hours a day. High-level care, including surgery, would be available immediately, and fewer patients would be transferred.

State Rep. Charlie Brown, D-Gary, who has been working with a state task force to bring a trauma center and teaching hospital to the region, said Methodist Hospitals has become the "uncertified trauma center of Northwest Indiana."

"Ambulances just normally gravitate toward Methodist because Methodist over the years has been receiving patients who require trauma treatment," Brown said.

About 10 percent to 15 percent of trauma patients in the United States suffer from penetrating trauma -- gunshots, stabbings or other injuries that pierce the skin -- Methodist Hospitals' McGee said.

In 2007 and 2008, more than half of the Methodists' severe trauma patients suffered gunshot wounds or stabbings.

Almost half the trauma patients in 2007 were there because of gunshot wounds alone.

"It only makes sense to have a hospital near a location that is easily accessible and where there's the highest number of penetrating incidents," McGee said.

With Gary located near three major highways, he said ambulances could get patients to the hospital quickly from most locations in the region for specialized immediate care.

On a recent Saturday night, for instance, EMTs wheeled four badly injured patients into the Gary emergency room. They had been in a head-on collision, and two of the adult patients needed orthopedic or reconstructive surgery. Because there were no specialists on call, the patients waited until Monday for surgery.

Many hospitals are trying to attract and keep speciality surgeons by paying stipends to them to be on call for trauma cases. But the increased demand in specialists is further complicated by a national doctor shortage.

At Memorial Hospital of South Bend, which runs a Level 2 trauma center, the solution is to pay up to $1,000 for a specialist to take a single 24-hour on-call shift.

Nationally, a majority of Level 2 trauma centers give on-call compensation, according to the Trauma Information Exchange Program. These centers provide expensive, specialized care to many underinsured or uninsured patients, much like Level 1 centers but with fewer beds and less access to medical residents. Per 12-hour or 24-hour shift, specialists can get paid as much as $3,200.

Funding a trauma center

Bringing a Level 2 trauma center with the required specialists to Methodist Hospital would cost between $6 million and $8 million, according to McGee.

The hospital expects to rely on future state legislation to fund the trauma center -- funding that could be drawn from motor vehicle and court fines and cigarette and gaming taxes. A funding plan that would've generated $10 million a year statewide by adding $18 to the cost of more than two dozen traffic fines stalled earlier this year in the state Senate.

"This is how most states pay for their trauma centers. They all have some sort of way to fund their trauma systems," McGee said. "Indiana is one of about two states of the 50 states without trauma coordination."

The Indiana State Department of Health formed a task force in 2004 to develop, organize and maintain a state trauma system. Five years later, the state does not have a coordinated system. Despite repeated attempts to contact someone, no one from the state was available to comment.

State funding can help, but for St. James Hospital and Health Center in Olympia Fields, Ill., it was not enough. State Medicaid funding was insufficient and St. James couldn't staff all the specialists needed to maintain trauma certification, said Gene Diamond, CEO of Sisters of St. Francis Health Systems Northern Region.

"St. James just decided it no longer could continue to serve as a trauma center," he said.

Diamond said Illinois' financial problems kept the state from making timely payments to the hospital. St. James, which served a large portion of Northwest Indiana trauma patients, stopped serving as a Level 1 trauma center in July 2008.

Northwest Indiana has a lot of trauma cases, Diamond said, but he did not know if it had the volume of patients necessary to support a trauma center. His company's local hospitals -- St. Anthony Medical Center in Crown Point, St. Anthony Memorial in Michigan City, St. Margaret Mercy Healthcare Centers in Dyer and Hammond and Franciscan Physicians Hospital in Munster -- do not have the infrastructure to support a Level 1 trauma center right now.

"The angels are in the details when it comes to what would be required to establish and sustain a Level 2 or Level 1 center," he said. "The Sisters of St. Francis would be willing to consider the development of a Level 2 or a Level 1 trauma center if there were funding sources that would be perpetual."

Worth the effort

In addition to serving the community, a trauma center with specialty surgeons would help a hospital by attracting nontrauma patients seeking specialty care, Methodist Hospitals' McGee said.

A local trauma center also would reduce the number of patient transfers, which add to the cost burden.

Out of Methodist Hospitals' 235 severe trauma cases in 2007, 24 were transferred, McGee said. The cost of airlifting a patient to the University of Chicago Medical Center is about $7,000, and ambulance transfers cost about $1,500, McGee said.

Transfers burden not only the patients' families financially but also strain the trauma centers receiving the patients, McGee said.

"It's a burden among those trauma centers, because they have their own patient population," he said.

Gary's Brown agreed.

"The area is too large not to have a center," Brown said. "It's unconscionable that all of these years, all of these decades, there has not been a trauma center in all of Northwest Indiana, and we have to rely on emergency services in Illinois for people that live here."

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