Why trauma centers abandoned the South Side

Hospitals’ enthusiasm for trauma centers waned shortly after they got the bills

October 12, 2011

By Natalie Moore and Gabriel Spitzer

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Trauma centers take care of the most critically injured people. Car crashes, stabbings and gunshots are the most common wounds that require trauma care. Chicago is served by six trauma centers sprinkled around the city and nearby suburbs – but none is on the city’s South Side. Community members, activist groups and politicians have long suspected that the dearth of trauma centers in that part of town means the area is under-served.

A WBEZ analysis suggests that when it comes to ambulance run times from the scene to trauma centers, there are disparities. Put simply, patients living on the Southeast Side face longer ambulance run times than other residents in the city. Specifically, they have to travel an average of 50 percent longer to get from the scene of an emergency to a trauma center. More than half of the trauma-related ambulance runs that originate in that part of town exceed 20 minutes, which is considered a professional standard within the city. Those neighborhoods include Hyde Park, Woodlawn, Pullman, South Shore and the Southeast Side.

In this, WBEZ’s second part in a series on trauma care in Chicago, we look at why such a large swath of Chicago is without a dedicated adult trauma center.

A new approach at Cook County Hospital

Health experts say to understand the layout and makeup of the city’s current regional trauma center network, one should start with a short history lesson. Trauma care has deep roots in Chicago; in fact, the city is considered the home of the country’s first dedicated trauma center, which opened at Cook County Hospital in the mid-1960s.

David Boyd came to the hospital to run the trauma center in 1968. He said before 1966, trauma service at County was a mess; people waited hours for surgery and were sometimes sent to the wrong surgical specialist.

“We were treating it on Ward 61 tonight then Ward 62 the next night, and where’s Dr. Jones? We can’t find somebody, and it was just this mini-catastrophe organizationally, and we just didn’t have the people to do it,” Boyd said.

Then a couple of the hospital’s surgeons devised a new model for treating the critically injured. It meant consolidating services in one area – the third floor of Cook County Hospital. Surgical staff was ready, equipment was on the spot and specialists were on call. This was a nascent trauma center.

Boyd said it was an immediate success.

“It was a conceptual paradigm change,” Boyd said. “It’s not something you had to explain to somebody it just was– everybody got the gestalt right off the bat. You had to be pretty thick-headed, blind or something not to see that this was different. And not only different, but a heck of a lot better.”

Boyd eventually used Cook County Hospital’s concept to establish trauma centers around Illinois and, later, he built the first-ever trauma network. This model was replicated across the country, and Boyd went to Washington, D.C., to implement it for the federal government.

Beyond County Hospital: Chicago establishes trauma network

Chicagoans are currently served at six trauma centers: four lie in the city and two are in nearby suburbs. Ambulances sometimes deliver Chicagoans to other suburban trauma centers outside the network, but only under certain circumstances. That figure – six – is revealing because there was a time when many hospitals clamored to build trauma centers of their own.

Creation of Chicago’s own trauma network got underway in the mid-1980s. A city ordinance mandated trauma patients be treated at trauma centers. About 20 hospitals applied.

Gary Merlotti, a trauma director at Mt. Sinai Hospital, helped set up the city’s network. He said at the time, health professionals considered trauma centers “good business” and thought trauma centers would attract prestige, patients and dollars. The phenomenon was called “trauma creep.”

Merlotti said it only took six months for hospitals to realize that “trauma creep” doesn’t really happen.

“We’re gonna get a fair number of severely injured people with a fair number of uninsured patients,” Merlotti said. “They began to lose money and they began to lose interest in providing trauma care.”

Hospitals quickly started to drop out of the network.

A prominent example — and one raised by activists through the present day — is the University of Chicago. It opened its trauma center in 1986, but closed it in 1988 after hemorrhaging $2 million a year. At the time doctors said a majority of patients had no health insurance.

Stephen Weber, the hospital’s current chief medical officer, wasn’t around to see the closure in 1988, but cites other benefits the U of C hospital system provides.

“I think that the pride we feel around our pediatric surgery and trauma program is all encompassing,” Weber said.

The hospital said it’s made tough choices about where to spend money on specialty health care. The upshot is that the University of Chicago has maintained a trauma center for children, but not adults.

Support for trauma care evaporates

The U of C’s departure was part of a cascade of hospitals pulling out: Weiss on the North Side; Loyola on the West Side (although it’s still a trauma center, it’s not part of Chicago’s trauma network); and Michael Reese Hospital on the South Side. That meant the only center left to serve Chicago’s South Side was at Advocate Christ Hospital in southwest suburban Oak Lawn.

Merlotti said doctors needed to rejigger things to share the burden. People were afraid the whole trauma center system would unravel and Advocate Christ would be the next domino to fall.

“It would have put Christ in a position where it was not able to provide any services besides a trauma,” he said. “The volume they were seeing was already straining the emergency department and the capacity in the intensive care unit. This would have represented at least a two-fold increase and would have put them underwater.”

So they regionalized the network in such a way that Advocate Christ and the centrally-located centers (Mt. Sinai, Stroger and Northwestern Memorial Hospitals) agreed to divvy up the stream of South Side trauma patients. Merlotti said the current system works well, but he still wishes the University of Chicago would reenter the trauma center fold. He said it’s the South Side hospital that’s best equipped to take on the financial burden of trauma care.

The university has clearly stated that’s not going to happen. Instead, it’s focusing on other care specialties such as its burn unit.

WBEZ summarized findings on trauma-related ambulance run times and discussed them with university staff. They said the school ran its own numbers and concluded the South Side doesn’t need another trauma center.

“We’re blessed with some great trauma centers,” said Steven Weber. “As it exists right now, there’s not one of those that’s physically located on the South Side. In terms of whether that creates a disparity in outcome, there’s really not evidence. But happily for the patients that are affected — whether it’s a penetrating injury or blunt injury — it’s comforting and reassuring to know that they do have access to expert care within a short period of time.”

In the final installment of WBEZ’s series on trauma care in Chicago, we’ll take a closer look at whether disparities in ambulance run times affect patient health or survival.