Task force urges creating trauma care system

Dan Kulin

Tuesday, June 15, 2004 | 11:08 a.m.

Faced with a decision on whether to create a new trauma center in the Las Vegas Valley, a Clark County task force instead recommended Monday that the county create a system to oversee and coordinate trauma care.

The task force, which will make its recommendations to the county Health Board, still faces the question of whether to recommend approval of the offers from Sunrise Hospital and Medical Center and St. Rose Dominican Hospital, both of which would like to open trauma centers. The task force is scheduled to meet again on June 22.

The task force voted 6-1 to recommend the creation of a trauma system. Task force members also said that county officials should ask the state for the authority to take control of trauma care issues in Clark County. County Chief Health Officer Dr. Donald Kwalick said the details of such an agreement between the state and county would need to be negotiated.

A trauma system would operate under the authority of the Health Board, and would be led by an advisory committee with some staff members to assist with evaluating and coordinating trauma care, Kwalick and others said.

Task force member Steve Hill said a trauma system needs to be in place before any new trauma centers open.

Task force member Max Doubrava, who voted against the recommendation, said he thinks a trauma system can be developed while Sunrise prepares to open a trauma center.

Doubrava pushed for recommending Sunrise be allowed to open as a Level III trauma center, or be given a temporary trauma center designation. If the Sunrise trauma center proves to financially drain UMC, then Sunrise would have to close its trauma center, Doubrava said.

But others didn't support Doubrava's suggestions.

Dr. Otto Ravenholt, a task force member and former county chief health officer, said he thinks that once a trauma center designation is given to a hospital, even a temporary designation should be considered permanent.

Dr. John Fildes, medical director at UMC's trauma center, said he thinks the task force is moving in the right direction "in baby steps."

Dr. Michael Metzler, director of trauma services at Sunrise, said he's still confident Sunrise officials have presented a good case to county officials.

With only one trauma center in Clark County, Southern Nevada is the metropolitan area least prepared to take care of its trauma patients, according to a 2003 survey by the National Inventory of Hospital Trauma Centers. On average, states build one trauma center for every 500,000 residents, according to the study. Clark County's population is more than 1.6 million.

Comments from task force members indicated the group generally supports accepting St. Rose's offer to start a low-level trauma center at its Siena Campus in Henderson.

The members agreed earlier this month that the Las Vegas Valley needs more trauma centers, but stopped short of saying how many or what level they should be. Also, some members of the county Health District's Trauma System Assessment Citizen's Task Force appeared split on whether to recommend the county accept Sunrise's offer to open a high-level trauma center.

Officials with the county-run University Medical Center, which now has the only trauma center in the valley, oppose Sunrise's offer to open a Level II trauma center, which UMC officials say would take patients away and hurt UMC financially. UMC officials support opening a Level III trauma center at St. Rose instead of the Sunrise center.

Level I and II trauma centers have trauma doctors in the hospital around the clock, whereas at a Level III trauma center the trauma doctors are on call.

On Monday, Mike Walsh, UMC's chief financial officer, told the task force that if UMC lost 1,000 trauma patients a year, it would lose $3.8 million a year, which would be made up with $1.5 million in cuts throughout the hospital, plus $2.3 million in additional subsidies from the county. The county budgeted a $15 million subsidy for UMC for the current fiscal year, he said.

UMC's argument received a boost from Culinary Union Local 226 Secretary-Treasurer D. Taylor, who told the task force on Monday that the trauma system wasn't broken and is not in crisis.

Sunrise officials argue population growth would keep UMC from seeing the drop in trauma patients it predicts. In addition, Sunrise officials say the community needs a second trauma center as a back-up in case something happens, such as a terrorist attack, that either closes or overwhelms UMC.

Opening a trauma center would allow Sunrise to expand its medical programs to take care of sicker patients and attract more specialists, they said.

The task force's work to date is scheduled to be reviewed today by a subcommittee of the county Board of Health. The full Board of Health is scheduled to meet June 24, and could be presented with the task force recommendations then.

Ultimately, the Board of Health will make a recommendation to the State Health Administrator, who has the power to designate new trauma centers.