Even the state director of the office that governs trauma centers said the move could hurt existing ones.
The Georgia Alliance of Community Hospitals sent a letter last month to Dr. Patrick O’Neal, the director of health protection for the Georgia Department of Public Health, to protest the move by the seven Hospital Corporation of America hospitals in Georgia that are seeking designation as Level III trauma centers.
The alliance represents the state’s community not-for-profit hospitals, which also operates most of the state’s trauma centers such as GRMC, which is a Level 1 trauma center.
Trauma centers have to get an adequate number of patients in order to develop the skills and training to be proficient, said the letter from alliance President Monty Veazey.
The American College of Surgeons’ Committee on Trauma recommends that a Level 1 trauma center admit at least 1,200 trauma cases a year to maintain proficiency. Last year, Georgia Regents saw about 1,600 adult cases, but that number is likely less because there were many the college would classify as children, said Dr. Colville Ferdinand, the chief of trauma and surgical critical care.
“Having the number of cases is really important,” he said. “We have a teaching commitment where we teach the future physicians in the state.”
Doctors Hospital said in an e-mail that it has “been providing lifesaving trauma services to Augusta residents and visitors for 20 years, and now we are seeking formal designation as a Level III trauma center.”
O’Neal, whose office would provide the designation after reviewing months of cases, said he was concerned about adding the trauma centers.
“My great concern with the HCA situation is that there may be a fairly marked change in the number of cases that a given trauma surgeon is able to handle because they get divided up among more hospitals than they need to be,” he said.
THE DECISION OF whether a hospital can pursue trauma designation goes first before its regional council, in this case the Region VI East Central Georgia EMS Council.
According to the minutes of that group from May 2013, Martha Garner of Doctors Hospital presented a letter from CEO Doug Welch asking for approval to seek the Level III designation. Columbia County Emergency Management Agency Director Pam Tucker made a motion to accept the letter and forward it to the state, and the vote was unanimous.
Ferdinand, who is a member of the council and was at the meeting, said he doesn’t recall voting for it but “the concerns that I am voicing now are concerns I had then.”
The state generally relies on the regional councils to know their needs better than the state office, so if one votes to designate a center, “we’re pretty much obligated to go ahead and designate that facility,” O’Neal said.
Normally, he would expect the council to approach the existing trauma center first and assess whether it still has the capacity to handle more patients. Ferdinand said GRMC does still have capacity.
“I was a little surprised that the regional council in Augusta made their most recent recommendation,” O’Neal said.
Tucker said if Doctors Hospital can meet all of the criteria for being designated a Level III trauma center, then it should be added.
“I don’t understand their logic for that or why they would be against it if they can provide the service,” she said.
“I can’t see them taking away (patients from GRMC) at all. I’m thinking about geographically if there is a higher level of lifesaving efforts they can make at Doctors as opposed to maybe it’s longer to get downtown, then I am all for that. I’m just looking at it as what’s best for the community.”
DOCTORS HOSPITAL SAID the state’s trauma care network is inadequate and “is not providing sufficient access to lifesaving trauma care within the Golden Hour,” the first hour after injury when survival chances are highest.
Ferdinand said adding Doctors Hospital as a Level III trauma center could prevent delivering timely care for some patients.
As a Level III, it would have to provide surgical care within 30 minutes, he said. That half-hour delay could be followed by the surgeon deciding the patient is too injured to treat at Doctors Hospital, which would lead to another delay as they are transferred, Ferdinand said.
“We set up a situation where the patient gets a delay in their care ultimately when they require a higher level of care than the center is capable of providing,” he said.
Doctors Hospital also would need a transfer agreement to a Level I or Level II trauma center, Ferdinand said. There have been no talks between Doctors Hospital and GRMC about this, he said.
However, Doctors Hospital maintained in a statement that it has a “Master Affiliation Agreement” with GRMC and has “a good working relationship” with the university’s colleges.
In its letter, the hospital alliance suggests an ulterior motive on the part of the HCA hospitals by enclosing an article from the Tampa Bay Times this year that uncovered very high “trauma activation fees.” These can be charged to a patient the minute they arrive, with some fees higher than $30,000 even if the patient was ultimately transferred elsewhere.
Doctors Hospital said its trauma activation fee will be $9,900 and is “based on the costs of assembling the trauma team. We have made significant investments to increase access to trauma care and recruited surgeons and other staff from outside Georgia’s existing trauma network.”
For a comparable Level III trauma patient, GRMC charges $1,949. Trinity, the only other trauma center in Augusta, does not charge such a fee, spokeswoman Rachel Covar said.
There is apparently no one regulating how much hospitals charge in activation fees.
O’Neal said his office doesn’t and neither does the Department of Community Health or the Department of Human Services. He suggested Insurance Commissioner Ralph Hudgens might be able to weigh in if the charges were excessive, but a spokesman said the office has no jurisdiction on the matter.