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HCA trauma plan reveals politics behind lifesaving service

The clock starts ticking with each emergency call. Paramedics have an hour to get trauma victims to a hospital to have the best chance of saving their lives.

So how worried should you be if your accident happens in Pasco County — and the closest trauma center is miles away in St. Petersburg or Tampa?

The answer is controversial. The HCA hospital chain last week said it could save lives by partnering with the University of South Florida to add trauma centers to five Florida hospitals, including Hudson's Regional Medical Center Bayonet Point. But local hospitals fear the addition could hurt the quality of the region's existing trauma care.

"If I were to look at this from the outside, it would be Chevrolet, apple pie and America. How could you not be for something like that?" asked Tim Eixenberger, who oversees trauma at Bayfront Medical Center in St. Petersburg. "It would just seem intuitive that you would want more of these, rather than less."

But Bayfront and the other existing trauma centers — Tampa General Hospital and St. Joseph's Hospital — say they have strong response times and outcomes. A Pasco car crash victim, for example, typically arrives at St. Joseph's in 20 minutes by helicopter, comparable to the time it takes an ambulance to arrive from a closer neighborhood.

The dispute reveals the intense politics behind a lifesaving service. Trauma centers are complicated to run and often lose money, but can bring prestige and new patients. HCA proposes to spend millions on its additions — which still require state approval — even as local hospitals seeing declining trauma volume question the need for them.

"Our affiliation with USF will bring additional trauma care to Floridians who clearly need greater access to these critical services, particularly within the first hour of injury, the 'golden hour,' " said Dr. Jonathan Perlin, chief medical officer for HCA, in a statement. The company declined an interview request.

• • •

For unknown reasons, trauma volume is down throughout Tampa Bay. One factor may be fewer people on the roads in a bad economy. While less trauma is a good thing, the impact on hospitals is mixed.

In the past three years, St. Joseph's has seen a 24 percent decline in injuries serious enough to trigger trauma alerts, even as it prepares to open a $35 million expansion of its critical care tower next month.

A new center, officials worry, could cause their numbers to drop below the 500 alerts a year needed to ensure the trauma team stays on top of its game.

"They have that skill set because they see this over and over," said Dr. Mark Vaaler, St. Joseph's vice president of medical affairs.

As the region's only Level I trauma center and burn unit, Tampa General receives some of the most serious cases. But it also recorded a drop in the number of trauma patients it saw in 2009.

And at Bayfront, trauma patient volume has declined by about 21 percent over the past five years. In 2009, Bayfront lost $4.5 million caring for trauma patients. Its leaders fear a double hit from the HCA proposal, which would also add new trauma services to Blake Medical Center in Bradenton.

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Based on population studies, state health officials can approve as many as two more trauma centers servicing Pasco and Pinellas. It would allow three in Manatee, Sarasota and De Soto counties, a region currently with none. Hospitals seeking to open trauma centers also must meet rigorous standards for staffing and equipment.

But in a 2005 study, USF researchers concluded that "Tampa Bay has adequate trauma center access." A county-by-county analysis revealed that mortality rates from trauma cases (not including burn victims) were lower in Pasco and Hernando counties than in Hills­borough and Pinellas.

USF public health professor Jay Wolfson, one of the authors, said that's not to say the region can't do even better.

"I don't think you can have too much good care for trauma at the community level," said Wolfson, who hopes to be involved in the USF-HCA research partnership. "Saying that services are adequate is one thing. Saying that they are as good as they could be is something else."

• • •

HCA had decided to create the new trauma centers when it approached USF about running the medical services, said Dr. Stephen Klasko, dean of the medical school. A young institution with national ambitions, USF jumped at the opportunity.

"We're frankly happy that they didn't go to a university outside of Florida," he said. "We think it's great for the patients in the state, and we know it's great for USF."

USF will run the HCA trauma centers independent of its trauma service at Tampa General, which shouldn't see changes.

The first recruits are coming from out of state, said Dr. David Smith, chief of surgery at USF, responding to local concerns that staffing the new services would require recruiting away from existing trauma programs. He said many from outside the region are interested in joining a five-hospital trauma network with a major research mission.

USF won't bear the financial risk. HCA plans to invest $20 million in capital improvements at the five hospitals. It estimates that paying physicians and others will cost $7 million to $10 million per hospital each year. If USF profits from its reimbursement arrangement with the hospital chain, Klasko said, the money will go into research.

Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322. For more health news, visit www.tampabay.com/health.

HCA trauma plan reveals politics behind lifesaving service 11/25/10 [Last modified: Thursday, November 25, 2010 6:59pm]

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