Officials didn’t completely shut door on expanding trauma care in Las Vegas

By Jackie Valley

Friday, June 24, 2016 | 2 a.m.

The board governing health-related decisions in Clark County entered its Thursday meeting with a mission to answer one looming question: Is the current trauma system meeting the region's needs?

The answer was less clear-cut than a simple yes or no.

In a 7-2 vote, the Southern Nevada Health District's Board of Health decided against adding more lower-level trauma centers at the moment while also acknowledging that more research could be a good thing.

The move rejected the bids of three local hospitals — Centennial Hills, MountainView and Southern Hills — to add Level 3 trauma centers.

But the two-pronged motion left open the possibility of revisiting the area’s needs by contracting an independent party to perform another study. At its next meeting, the board will discuss how to move forward with that idea, including the financial ramifications of doing so.

Board members Bob Beers, a Las Vegas city councilman, and Douglas Dobyne, who represents the business community, cast the only votes in opposition. They both cited an interest in adding at least one additional Level 3 trauma center.

“In my mind, there are two things; only one can be true,” said Beers, who chairs the board. “We either need to have a comparable facility to St. Rose way north or St. Rose shouldn’t be a Level 3 trauma center.”

Southern Nevada currently has three hospitals with trauma centers: University Medical Center operates the Level 1 trauma center, making it the landing spot for patients with the most severe injuries. UMC also has a Level 2 pediatric trauma center. Meanwhile, Sunrise Hospital and Medical Center has a Level 2 trauma center, so it also accepts people with severe injuries. St. Rose Dominican Hospital-Siena Campus, located in Henderson, contains a Level 3 trauma center, which accepts patients with less severe injuries such as falls and broken bones.

Collectively, those hospitals form what is referred to as the region’s trauma system.

The proposed expansion of the trauma system came about last fall. That’s when the three hospitals — two located in the northwest valley and one in the southwest — applied to the Health District for initial authorization to operate the lower-level trauma centers. In February, the Regional Trauma Advisory Board recommended the health board deny those applications.

MountainView and Southern Hills, both owned by the Hospital Corporation of America, cried foul, saying the advisory board was biased against them and had a vested interest in maintaining status quo in the valley’s trauma system. Five UMC doctors and nurses are members of the advisory board.

HCA has argued that patient comfort and safety would be compromised by not expanding trauma options. The hospitals say growth in the valley, especially in the northwest and southwest, left too many people too far away from prompt trauma care.

Officials from HCA also have contended that decision-makers focused on protecting UMC as opposed to patient care. HCA also said the approval process was tainted by conflicts of interest among various elected leaders, government officials and medical directors .

But opponents of the expansion proposals countered that adding trauma centers would jeopardize UMC's ability to provide quality care and train doctors, which would damage the overall quality of care in the valley. They also contended HCA was motivated not by a desire to improve the welfare of local residents, but by the opportunity to boost their profits.

The health board, in rejecting the proposals, followed the recommendation not only of the Regional Trauma Advisory Board but also the Office of Emergency Medical Services and Trauma System, which oversees the local trauma system. The OEMSTS, a subset of the Health District, determined that the existing trauma system was meeting regional needs, thereby not warranting any additional trauma centers.

The board’s vote capped more than three hours of presentations and public comment about the heated issue.

The applicants largely reiterated the same points they’ve made in the past — that additional Level 3 trauma centers would improve quality of care and transport times in rapidly growing regions along the valley’s perimeter.

“We’re here to complement the system, not disrupt it,” said Sajit Pullarkat, CEO of Centennial Hills Hospital, which is owned by the Valley Health System.

Bill Bullard, senior vice president of the Abaris Group, a trauma consulting firm, reminded board members that it’s a two-year process for opening a trauma center and, thus, critical to consider the region’s future needs.

In 2004, Bullard’s firm conducted a comprehensive needs assessment for Clark County and recommended adding one lower-level trauma center. That led to St. Rose opening a Level 3 trauma center. That same year, in 2005, political maneuvers at the state level resulted in Sunrise receiving authority to operate a Level 2 trauma center.

Last summer, HCA hired the Abaris Group to conduct another needs assessment of the regional trauma system. The HCA-commissioned report found that more trauma cases are occurring in the northwest and southwest valley, hence the hospitals’ bid for trauma centers in those areas.

Clark County Commissioner Chris Giunchigliani, who sits on the health board, called for an independent entity to conduct another study — outside of Health District analyses or other reports commissioned by local hospitals.

“I think, no matter what, the numbers don’t bear out a need for any additional (Level 3) trauma centers, but we ought to take a step back and look at what’s affecting the catchment area in the long run,” she said.

Giunchigliani also raised concerns about the financial incentives potentially motivating hospitals. Trauma centers can charge “trauma-activation fees” to cover the cost of preparedness, such as sophisticated medical equipment or paying on-call staff and specialists.

The trauma-activation fees charged by local hospitals were not revealed at the board meeting.

When public comment opened two hours into the discussion, a line quickly formed. Most speakers opposed any system expansion, citing fears about it dismantling UMC’s Level 1 trauma center and the added costs passed on to employers and consumers via the activation fee.

Pam Udall, director of communications for the UNLV School of Medicine, urged the board to vote against expansion. UNLV officials have repeatedly said any changes in patient volume to UMC could jeopardize residency programs, negatively impacting the regional effort to train and keep more doctors here.

“We want to make sure our medical students and residents have access to really rich environments to learn,” she said.

On the flip side, a fire chief from the Nevada National Security Site asked the board to consider adding a trauma center in the northwest valley, which could help service remote areas outside the valley.

Even so, MountainView, Southern Hills and Centennial Hills — all for-profit hospitals — ultimately lost the battle.

Bullard said it’s unfortunate the health board perceived his firm’s assessment as biased because HCA paid for it, but he was encouraged by their willingness to further study the region’s needs.

“I’m pleasantly surprised they are open to looking at this,” he said.

Officials from the Valley Health System declined to comment after the meeting.

The county’s chief health officer, Dr. Joseph Iser, said he wasn’t surprised by the board’s decision, given the ongoing confusion and uncertainty about trauma data. The state’s trauma registry currently can’t provide data from trauma centers. As a workaround, trauma centers in Southern Nevada have been providing their own data to the OEMSTS.

“If they want to hire someone (to conduct an independent study), I’m happy to come up with the budget,” he said. “I would not have recommended that.”

The OEMSTS is an unbiased body capable of assessing the region’s needs and making recommendations, he said.