Northwest Indiana's trauma dilemma

Hospital takes on effort to establish region's first trauma center

November 4, 2011

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Indiana’s State Trauma Care Committee meets Friday morning in Indianapolis. The committee’s mandate is to ensure that Hoosiers have access to trauma care, treatment that’s for the worst injuries such as crashes and gunshot wounds.

The problem is, most Hoosiers don’t live close to a dedicated trauma center. A recent study by the American College of Emergency Physicians placed Indiana near the bottom in the nation in the number of trauma centers per one million residents.

Nowhere does that study ring truer than in Northwest Indiana, a five-county region that’s home to more than 800,000 residents but is without its own certified trauma center.

Patients with the most severe injuries now must be transported by air or ambulance to trauma centers in Chicago, the south suburbs, South Bend or even as far away as Indianapolis.

There’s an effort afoot to create Northwest Indiana’s first center for trauma care and pediatric intensive care unit, but the prognosis isn’t good.

“I find that this area not having a trauma center or pediatric center kind of crazy. We have this area up there and there’s nothing for babies or kids,” said 33-year-old Kwana Shaw of Schererville, Indiana.

Shaw painfully knows firsthand what it means for this area not to have a trauma facility nearby.

Her story centers around her 13-month-old son, Josiah, who died in a violent episode.

On Jan. 28, 2008, Shaw had left Josiah at a friend’s house in Gary, Indiana, about 20 miles from Schererville. Shaw had an interview that day, but the appointment was canceled. She retrieved her son from her friend’s place and was about to head to her aunt’s nearby home for a visit. But when she approached her sport utility vehicle, something was amiss.

“Someone was waiting for me with a weapon. They told me to give them my keys but that was after I had put my son in the vehicle and strapped in the car seat. Before I could even hand over my keys I was shot. So they eventually got my keys, took my keys and took off in my vehicle,” Shaw said.

A bleeding and frantic Shaw called 911 with her cell phone as the assailant took off with Josiah still in the car. The bullet penetrated Shaw’s pelvis, hit her spine and ruptured a kidney.

She was transported to Methodist Hospitals Northlake Campus near downtown Gary, where emergency room doctors worked to save her life.

Dr. Nicholas Johnson prepares for an arriving trauma case at Methodist Hospital. Meanwhile, police found Josiah in Shaw’s vehicle a few blocks from where the incident occurred.

Josiah had been shot twice. He too was rushed to Methodist. 

Josiah’s injuries were extremely severe, penetrating trauma injuries. Doctors at Methodist did what they could to stabilize him, but they decided the boy needed more advanced care at a pediatric intensive care center. The nearest one to Gary is at the University of Chicago’s Comer Children’s Hospital, more than 20 miles away from Methodist Hospital.

As U of C’s Medevac Helicopter was on its way to Methodist, Josiah died. Shaw suspects that her son could have been saved with better facilities.

“If they had a trauma center here, some kind of pediatric unit for kids, he may have had a chance for somebody to work on him and possibly help him. He would still be here,” Shaw said.

Indiana’s trauma care committee knows of Shaw’s experience because she’s testified before its members, at the invitation of Dr. Michael McGee.

“You never get used to death or seeing it or being involved in it, but I think when it’s a child, it affects you profoundly, deeply and emotionally,” said Dr. McGee, who is Medical Director of Emergency Services at Methodist Hospitals.

Dr. McGee actually rushed to the hospital to assist in responding to Josiah’s injuries, but he was too late.

“Our docs had done all they could. They had (Josiah) ready for the EMS to come and take the patient to the U of C. And right before they were about to take off, the patient died,” Dr. McGee said. “Our docs were profoundly affected and I was profoundly affected.”

McGee still feels extreme disappointment about what happened that night, enough so that he’s leading the charge for Methodist Hospital to become Northwest Indiana’s first trauma care center and pediatric intensive care unit.

Even without a dedicated trauma center, Methodist’s ER staff do what they can to treat trauma victims who arrive on a daily basis. A steady stream of patients arrive from car wrecks off the Indiana Toll Road, accidents at nearby U.S. Steel, and shootings at crime scenes.

Gary is routinely ranked high for the number of homicides around the country for cities its size.

“When I first started here four years ago, I was terrified when I came into work because I was so worried that a trauma patient would have some injury that I couldn’t do deal with and needed specialty care or some definitive care that I wouldn’t be able to at least arrange for the patient in this hospital,” said Dr. Nicholas Johnson, who was a resident at University of Chicago’s Medical School before arriving at Gary Methodist.

“When I came here and I learned that trauma patients, no matter where you were in Northwest Indiana, no matter what type of injury you had, were brought directly to the closest hospital, it surprised me,” Dr. Johnson said.  “I didn’t think anywhere in the country still operated like that, and it really sets us back in the times. It’s almost embarrassing.”

A trauma center is not a typical ER. Trauma centers need more surgeons and specialists, they have to be ready at any time, and they need access to the latest equipment and technology.

All that takes money. Lots of it.

Methodist Hospital’s attempt to create a trauma center doesn’t come from a need for prestige. Hospital officials say there’s a real need.

“We’re pretty much known as the trauma area here in Gary, Indiana. When somebody gets shot, even if it’s out of the jurisdiction, they’ll bring the patient here. Other facilities don’t have as much experience,” said Dr. Ahmed Zegar.

Doctor Zegar has worked in the ER at Methodist for 16 years. He worries that not having a certified trauma center nearby diminishes a patient’s chance of survival.

“We have to transfer out to another facility and that actually will require time, delay in care and sometimes worsening in the diagnosis and prognosis in the case,” Dr. Zegar said.

On a recent evening at the hospital, Jonathon Robinson arrived to the ER with his 7-year-old daughter, Phaydra, who was having a severe asthma attack. The child ended up needing to be transferred to a pediatric ICU in South Bend.

Robinson said he didn’t realize Methodist couldn’t handle the case and that the entire region is without such an advanced facility.

“I believe for the people that are here in the Northwest Indiana area, it’s an inconvenience as far as transporting. We have to drive and go that way. It would be more convenient for us to have something like that closer especially for her condition,” Robinson said. “She’s a severe asthmatic, so, it would help out a lot.”

Even medical professionals feel the need for more advanced services.

Emory Garwick serves as Emergency Medical Services coordinator at Methodist Hospital. He’s been waiting for more than 25 years for Northwest Indiana to develop a facility to treat severe trauma.

“I think a combination pediatric trauma and medical intensive care should be our priority,” Garwick said. In 1986, Garwick himself suffered an incredible loss.

“I lost a child due to trauma in 1986. My child did pass away,” he said.

At the time Garwick lived in South Haven, a small town east of Valparaiso, Indiana, when tragedy struck his 16-month old son, Jonathan.

“My wife was putting him into our car. And, our drive way was on a hill. And somehow the car came out of gear and rolled over him,” Garwick said.

Although he lived some 30 minutes away, Garwick son was actually treated at Methodist Hospitals South Campus in Merrillville, a suburb south of Gary, because the hospital operated a sort of trauma-type alert system.

That involved doctors who worked on a “trauma team” and would head to the hospital as the ambulance was en route.

“That morning, we had three trauma docs here to meet us. They gave my child every chance to survive,” Garwick said. “Because he had a chance, it’s kept my sanity and it’s allow me to continue my career in EMS that I don’t know if I would have if he had not gotten appropriate care.”

Proponents of a trauma center at Methodist Hospital say such a facility would require millions of dollars, and there’s a debate about where it should come from.

Indiana has eight trauma centers right now, the closest to Gary lies an hour away in South Bend. Each trauma center is privately operated and the state doesn’t kick in any money.

Methodist, though, wants financial assistance from the state, a stance that  Dr. McGee says is common.

“Most states that fund trauma have a state tax that goes toward trauma. At this particular time, this state does not have that,” he said.

Dr. McGee is citing his own experience, which includes work at trauma centers at Stroger Hospital in Chicago, Bellevue Hospital in New York City and Emory University Hospital in Atlanta.

Dr. McGee is a member of Indiana’s trauma care committee.

“This committee was not set up to provide funding. I found out that most of the hospitals have to provide funding individually for trauma care,” Dr. McGee said.

Indiana’s trauma care committee may not have money as part of its mandate, but members acknowledge that situation puts hospitals and communities in a tough spot.

“I know Northwest Indiana hospitals struggle with how to create a trauma care center,” said Dr. Gregory Larkin, health commissioner for the state of Indiana. “It’s not a totally easy decision because trauma care centers require a considerable amount of resources. It’s not as simple as opening up the door.”

Dr. Larkin says although the state doesn’t offer money, communities and health care systems around the state should have the incentive of developing a trauma center because doing so can save lives.

“We do know that when a trauma care system is implemented, there’s a projected 15 to 30 percent reduction in preventable deaths and a significant reduction in disabilities,” Dr. Larkin said. 

But critics of the state’s current position on trauma care funding should change.

Longtime Indiana state Rep. Charlie Brown, D-Gary, says Indiana has cash to help Methodist create a trauma center or at least to get the ball rolling — the state just hasn’t used it.

“Already we have $3 million sitting in the budget for the architectural and engineering studies for the hospital. The Governor [Mitch Daniels] is still hesitant about releasing that money,” Brown said.

Brown says he hopes to get the money freed up when Indiana legislators return to session in January.

“It is criminal that in all of Northwest Indiana there’s no trauma center, but yet we have the network of the highways and then the other violent issues that create trauma that are mostly here in the Northwest Indiana area,” Brown said. “All of that automatically tells you this area needs a trauma center.”

Brown also sees the establishment of a trauma center in the economically struggling city of Gary as a development tool. From his perspective, each trauma patient transferred to Chicago or the south suburbs hurts Indiana.

“We are losing $2 billion annually that goes over into Illinois for overall healthcare,” Brown said.

If Methodist Hospital in Gary ends up creating a trauma center, it would be bucking a trend; nationwide, trauma centers are closing their doors because of dwindling funds — that’s especially true for hospitals that serve the poor and the uninsured.

Even trauma centers in Illinois that are close to Northwest Indiana have been shuttered due to high costs.

The debate over funding is critical.

“It would require not only a commitment by local municipalities but a commitment by the state,” said Gene Diamond, Regional CEO for Franciscan Alliance, a private non-for-profit Catholic hospital chain based in Northern Indiana. Franciscan Alliance used to run a trauma center at St. James Hospital in south suburban Olympia Fields, which Diamond says was closed in 2008 due to high costs.

Diamond says these days, it would be difficult for Franciscan to open something like St. James in Northwest Indiana, at least without government help.

“We have looked at it carefully on several occasions in the past. We’ve looked to the experience of our sister hospital St. James. At this stage of the game, it doesn’t make sense for us to do it,” Diamond said.

Northwest Indiana is home to nearly a dozen hospitals, with no less than three separate hospital systems operating them. In short, it’s a very competitive market.

Diamond said it’s unlikely the hospitals systems could collectively operate a trauma center together, but perhaps could agree to send trauma patients to a facility nearby.

Undaunted, Gary’s Methodist Hospital plans to begin collecting data on the number of trauma cases handled by each hospital in Northwest Indiana to justify the need; such data collection is the first step in becoming a certified trauma center as required by the American College of Surgeons.