Sunrise trauma effort set back

Dan Kulin

Tuesday, May 25, 2004 | 10:53 a.m.

Sunrise Hospital and Medical Center's effort to open a high-level trauma center was dealt a setback Monday when a consulting firm told a Clark County task force that opening a center there would hurt nearby University Medical Center.

The consultants said opening a low-level trauma center on the south side of the Las Vegas Valley at St. Rose Dominican Hospital's Siena Campus, however, would be good for area residents and not hurt UMC financially. UMC has the only trauma center in the valley.

Dr. John Fildes, medical director at UMC's trauma center, said the report from consulting firm the Abaris Group affirmed what he has been saying all along -- that UMC is "doing an excellent job" now, and opening a trauma center at Sunrise would hurt UMC.

The consultants and Fildes say there aren't enough trauma cases to financially support two high-level trauma centers so close together. UMC and Sunrise are less than three miles apart.

However, Fildes said there is, and will be, enough of a need within the next three years to support both UMC and a low-level trauma center in the southern part of the valley.

The Abaris Group's report says a trauma center at Sunrise would take 1,422, about one-third, of UMC's trauma patients, while a St. Rose trauma center would take about 400 patients.

"Generally they break even," Abaris Group President Mike Williams said. "Sunrise would hurt UMC. If they lose 35 percent of their patients it would destabilize UMC."

The report comes after officials from the American College of Surgeons said in own report, which will be heard next month, said the area will need additional trauma centers to keep up with population growth. But they also said any decisions should only be made after studying the need for additional centers, which the Abaris report did.

Both studies are being done for the Clark County Health District.

Dr. Michael Metzler, director of trauma services at Sunrise, said he's not convinced by the Abaris Group's report. He questioned data provided by the firm that showed the annual number of trauma center patients increased just under 5 percent from 1994 to 2003.

Metzler said he thinks the number of trauma center patients has and will increase at a rate more in line with the population explosion the area has seen in the past 10 years. During the past four years the county population has grown by about 20 percent, which should mean there will be sufficient demand for trauma center services to keep UMC and Sunrise busy.

"I don't think it would destroy UMC," he said.

But Fildes defended the consultant's figures, saying trauma prevention measures, such as increased use of seat belts, air bags in cars, pedestrian bridges over Las Vegas Boulevard and numerous other changes, would all reduce the number of serious injuries.

Clark County Manager Thom Reilly said the conclusion of the Abaris report mirrors the concerns that the county has had.

More trauma centers would not mean more access to trauma services. It would mean that financially and in staffing, the community would be divided, Reilly said.

"My bigger concern is what's good for the community," he said. "It's probably dangerous to place two trauma centers too close together.

"Our community wants a trauma center that is cost effective, that avoids duplication of services."

Adding any new trauma center capable of responding to the most intensive of emergencies needs to be done in "a data-driven decision making process," he said.

"These kinds of services are very hard, very expensive to reproduce," Reilly said. "The cost is not just dollars. It's expertise. It's staff. It's education and research.

"If you start one, you could eliminate the ability of another to start up."

The Trauma System Assessment Citizens' Task Force, which heard the consultants' report Monday, will hear another report on this matter from the American College of Surgeons on June 7. The task force could decide then, or on June 14, what changes, if any, should be made to the areas' trauma service.

The task force recommendation will go to the County Health Board, which is scheduled to discuss the issue June 24. The board will then decide what to recommend to the State Division of Health, which will ultimately decide whether another hospital gets a trauma center designation.

Task force members said Monday that it was too soon to say what they might recommend, although several said they were looking at the situation with concern for the financial stability of UMC.

"What's driving this issue is the economics; do you destabilize UMC?" Bob Forbuss, task force co-chairman, said.

Task force member Dr. Max Doubrava, an anesthesiologist, said that while it is "premature for me to come down on one side or another," he thinks the financial well-being of UMC is "No. 1 on everyone's mind."

"I would really like to see a second unit, but we don't want to hurt UMC. Maybe we need several level threes," he said, referring to the lower-level trauma center designation.

St. Rose and Sunrise have both asked to be made trauma centers.

St. Rose is asking to become a level III trauma center, which means the hospital would have surgeons available, or nearby and on call, around the clock.

Sunrise is asking to be a level II trauma center, which means the hospital would have trauma surgeons and other trauma staff at the hospital at all times.

UMC is a level I trauma center. The difference between levels I and II is that a level I trauma center also does teaching and research, while a level II trauma center does not, Metzler said.

St. Rose CEO Rod Davis said the consultants' report was "good news in a sense" because it supported their conclusions.

Davis said his hospital is asking for the trauma center designation because they see a need in the community.

St. Rose, a nonprofit organization, could eventually expand a level III trauma center to a level II, if continued growth makes that a necessity, Davis said.

Metzler, who was hired to start a trauma center at Sunrise, said his hospital is also trying to fill what they see as a public need.

In addition to the increased demand for trauma services, which Metzler said will come with continued population growth, opening a trauma center at Sunrise would give the area a second high-level center in case UMC's center was shutdown for some reason.

"If UMC goes down, the next closest trauma center is seven hours away," Metzler said, referring to a center in Reno.

Sunrise, which is owned by a for-profit company, wouldn't profit from running a trauma center, he said.

"We feel it's a break-even proposition," Metzler said.

Williams said that Sunrise officials told him they would expect to break even on a trauma center, but having a trauma center would help Sunrise attract more specialists.