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New trauma centers could do more harm than good

When Southern Nevada Health District board members vote later this month on whether more Level III trauma centers should be opened in Clark County — MountainView, Southern Hills and Centennial Hills hospitals have filed applications to do so — what happened to Giulian Grasso should be taken into consideration.

Four years ago, he was a healthy 15-year-old, dreaming of becoming a Navy SEAL. On April 22, 2012, while skateboarding in Boulder City, he hit a manhole cover and fell. The fall knocked him unconscious.

He was taken by paramedics to the closest trauma center, St. Rose Dominican Hospital, Siena Campus, a Level III trauma center not required to have trauma surgeons in-house. Medical personnel told his mother, LaDonna Grasso, that her son awakened during the ride and identified himself.

“We had to wait a long time for tests,” she said.

Once the tests were done, she said a doctor told her that Giulian had a brain bleed that couldn’t be handled by St. Rose. He’d have to be transferred to University Medical Center, where highly skilled Level I trauma surgeons could operate. UMC contracts with 147 specialists.

According to UMC records, by the time an ambulance brought Grasso to its pediatric trauma center, two hours and 47 minutes had passed since the first call for help. Within 20 minutes, he had lifesaving brain surgery. After the surgery, Grasso was placed in a medically induced coma until he could be transferred to a Philadelphia rehabilitation hospital.

“Doctors said if I had been in the right trauma center at the start, I probably would have walked out of the hospital,” 19-year-old Giulian Grasso said recently, sitting in a wheelchair in the Henderson home he shares with his mother. He is unable to use his left arm. He talks slowly and is trying to learn to walk again.

“To me, all Level III’s do is make it take longer to get the care you need,” Giulian Grasso said.

That belief is shared by Dr. Meena Vohra, chief of pediatrics at UMC’s Children’s Hospital of Nevada.

“Without proper tests, it’s hard to decide what shape a patient is in,” she said. “Giulian talked, so he was taken to a Level III. If it wasn’t there, he’d have immediately gone to UMC or Level II Sunrise and probably wouldn’t be so hurt now.”

Katie Ryan, a spokeswoman for St. Rose-Siena, said the only Level III hospital in Henderson performs its job well.

Representatives of MountainView, Centennial Hills and Southern Hills hospitals say that even more Level IIIs would enhance patient care. In a letter supporting Centennial Hills’ application for a Level III center, North Las Vegas Fire Chief Jeff Lytle wrote it would “potentially increase survivability rates for trauma patients.”

Yet statistics sent by St. Rose-Siena to the health district for the years 2010 to 2015 show its Level III center operated on just six of 2,866 patients. Seven patients went to intensive care.

More than 160 patients were transferred to UMC or Sunrise.

More than 2,300 patients were discharged and the rest were admitted to a basic floor.

So if data mean anything, the present Level III trauma center at St. Rose-Siena provides little critical or lifesaving care.

A 2006 study in the New England Journal of Medicine found a minimal difference in the outcomes of patients treated at a traditional emergency room or a Level III trauma center.

What is different between an emergency room and a Level III trauma center, however, is the “trauma activation fee” that goes into effect when a patient is taken to a trauma center. It is a fee for trauma expertise that is applied on top of the cost of whatever hospital care is provided.

According to UNLV’s Center for Health Information, St. Rose-Siena increased its trauma activation fee 83.7 percent from 2008 to 2014, from $4,848 to $8,906.

“It’s all about the money,” Giulian Grasso said. “I’ve only got half a brain now, and I figured that out.”

Paul Harasim’s column runs Sunday, Tuesday and Friday in the Nevada section and Thursday in the Life section. Contact him at pharasim@reviewjournal.com or 702-387-5273. Follow @paulharasim on Twitter.

 

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