Streams

Trauma Center

Thursday, July 12, 2001

Any disease or injury is traumautic, but in emergency rooms, such as this one at St. Barnabas, a private hospital, the medical definition of trauma is quite specific. It is defined by gunshot wounds, stabbings, and head and spinal injuries. A trauma center, though, is not so easily classified.

Dr. Kenneth Schwartz, Chief of Surgery, St. Barnabas: a trauma center is not really bricks and mortar. A trauma center is a set of people and facilities put together.

Dr. Kenneth Schwartz is chief of surgery. He and other hospital officials believe trauma victims in the Bronx are not well served. New York City's eight million people have19 level-one trauma centers. Six are in Manhattan alone. Los Angeles County, with almost 10 million people, has six trauma centers. In the Bronx, there are two -- Lincoln Hospital and Jacobi Medical Center, both city hospitals. Dr. Schwartz believes St. Barnabas, sitting between them, would help trauma victims, whose very survival depends on a successful race against time.

Schwartz: Close access for 911, for these EMS drivers to get to a place quickly -- and, obvioulsy, to drop them off at a place with qualified people and facilities, I can't see that being anything but improving health care.

But Dr. Ronald Simon, director of trauma at Jacobi Medical Center, which is less than three miles from St. Barnabas, says less is more when it comes to trauma. Many trauma specialists nationwide believe trauma victims, who often suffer from highly-complicated, multiple injuries, are best helped by doctors who've handled a lot of these specialized cases. He points out that two trauma advisory committees looked into whether the Bronx needs a third trauma center. He's a member of one of the committees.

Dr. Simon: And they both independently came to the same conclusion: that there's no evidence of a community need; that transportation times in the Bronx are very very short; and that there is significant concern that the addition of a third trauma center will dilute trauma centers' experiences and result not in an improvement, but will actually cause a, a loss of quality of care for all of the trauma centers.

But the State Hospital Review and Planning Council still voted last month to designate St. Barnabas as a trauma center for one year. They also recommended that the state health department study the city's trauma system. Paul Macielak (Mace-lack), vice-chairman of the Council, says he doesn't know for sure if survival rates are affected by volume, because there are conflicting studies on the issue.

Paul Macielak: I do know that this application, like a number of applications, it tends to be a very provincial mindset by people who have the franchise, if you will, and they in many cases don't want another competitor in the marketplace.

Trauma can be depressingly lucrative. The crack epidemic of the late 80s and early 90s spawned a multi-million dollar business. That crime wave has ebbed, but Jacobi and Lincoln still estimate a loss of $11.5 million dollars if St. Barnabas opens its doors. And critics allege that private hospitals, with their own ambulances, steer the most lucrative cases to their emergency rooms.

Patrick Bankhen, president of Uniformed EMTs and Paramedics of the NYC Fire Department: we used to call it wallet biopsies.

Patrick Bankhen is president of the emergency medical technicians' and paramedics' union, which has long accused private ambulance services of "cherry picking."

Bankhen: Before they wanted to -- before they even knew about the person's chief complaint, the question was, does this guy look like he has insurance? Because, if he's a liability, we don't want to bring him home and cost our employer money.

Last month, controller Alan Hevesi, who's running for mayor, issued a report that found seventy percent of private ambulances take patients with life-threatening illnesses to private facilities, even if a public hospital is closer. And he says they're twice as likely to steer patients to their hospitals if they're insured. City officials dismissed the report, and representatives of private hospitals denied the charges. St. Barnabas officials vehemently deny that their ambulances will do this. They say they've already been treating trauma victims, and they're seeking the official designation as a center in order to provide higher quality care.

The state health commissioner, Dr. Antonia Novello, is still considering whether to approve St. Barnabas Hospital as a trauma center. For WNYC, I'm Amy Eddings in the Bronx.

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