Why Doesn't Bloomington-Normal Have A Level 1 Trauma Center? | WGLT

Why Doesn't Bloomington-Normal Have A Level 1 Trauma Center?

Dec 11, 2018

Bloomington-Normal has a lot of things that would make other communities jealous.

Constitution Trail. Four movie theaters. Two malls. Four colleges and universities. Nine golf courses. Two Walmarts. Plenty of places to eat local, drink local, and buy local.

One thing it doesn’t have is a Level 1 trauma center.

Peoria, Champaign-Urbana, and Springfield all have a Level 1 trauma center, the highest level of trauma care. Both Bloomington-Normal hospitals—OSF HealthCare St. Joseph and Advocate BroMenn medical centers—are Level 2 trauma centers. They can stabilize and begin treating trauma patients but aren’t required to have specialized doctors close by, such as neurosurgeons. Patients needing those services are often transferred to a Level 1 trauma center, usually in Peoria.

“It’s difficult. It’s really a human resource limitation more than anything else to have those kinds of personnel available 24/7,” said Dr. James Doherty, trauma director at Advocate Christ Medical Center in Oak Lawn, near Chicago. It’s one of the busiest trauma centers in Illinois.

"Having a trauma center is a luxury for a community. It truly is."

There are many reasons why Bloomington-Normal doesn’t have its own Level 1 trauma center, including cost and the challenge of finding enough doctors to meet state requirements. Those requirements are at the heart of a wrongful-death lawsuit filed this summer against Advocate BroMenn for allegedly mismanaging its trauma resources for several weeks in 2016.

The state requires Level 1 trauma centers like OSF HealthCare Saint Francis in Peoria to have a wide array of doctors available within 60 minutes, from neurosurgeons to vascular specialists to those with expertise with facial fractures. And they must have cardiothoracic surgical services—heart and chest experts—available within 30 minutes.

That makes Bloomington-Normal’s location a key factor too. It’s surrounded by Level 1 trauma centers in Peoria, Champaign-Urbana, and Springfield. Peoria is a 20-minute helicopter flight away.

“The resources are limited, so it’s a little bit easier to try and pool them in certain areas, rather than watering it down,” said Travis Wilson, who helps oversee EMTs and paramedics as manager for the McLean County Area EMS System. “There’s only so many trauma surgeons and neurosurgeons out there.”

The Illinois Department of Public Health (IDPH) regulates the state’s network of trauma centers. It’s a voluntary designation system, and hospitals are not compelled to become trauma centers at either Level 1 or Level 2, said Doherty, who serves on the state’s Trauma Advisory Council.

“It’s a big deal for a hospital. It’s a commitment of resources,” said Doherty.

Illinois’ newest Level 1 facility is at the University of Chicago, which in May reopened an adult trauma center that had closed in 1988 after losing millions of dollars each year treating patients without health insurance. The hospital estimates the trauma care will cost $48 million a year.

Is There A Need?

In Illinois, new trauma centers are only designated when there is an identified need, as determined by an area’s IDPH trauma center medical directors committee with advice from a regional trauma advisory committee. Factors include the number of expected trauma cases and whether there’s an estimated time of arrival to existing trauma centers over 25 minutes.

“For us in Peoria, we have those resources,” said Julie Matson, manager of trauma services at OSF Saint Francis. “At this point and time, we haven’t identified a need to have one anywhere else.”

All those services come at a cost, she said.

“It’s expensive to have these subspecialties on call. And if you have a Level 1 trauma center with a close enough proximity that your patients are gonna be safe, some facilities don’t choose to be a Level 1,” Matson said.

The state provides some limited funds to trauma centers, through a portion of money collected from traffic citations. Advocate BroMenn received $35,955 and OSF St. Joseph got $49,298 from the Trauma Center Fund payout last year, according to IDPH. OSF Saint Francis got $254,308. Distributions are based in part on how many trauma patients are served.

Certain physician resources are already concentrated in Peoria, Champaign-Urbana, and Springfield because they’re home to medical schools, said Wilson.

“It just works really well for staff there. Residents—physicians in training—are utilized quite heavily at these Level 1 trauma centers,” Wilson said.

What would a Twin City Level 1 trauma center mean for patients?

Experts tell GLT that Level 2 trauma centers—like those in Bloomington-Normal—are well-equipped to handle most trauma patients coming to their emergency rooms with gunshot wounds, injuries from a fall, or after a car crash. The difference between Level 1 and Level 2 is about what’s required—not what services are actually available.

Those first moments in any ER are called the “resuscitation” phase.

“Both Level 1s and Level 2s are very capable of taking care of that patient during that phase,” said Matson. “It’s really for after that, when they go onto the inpatient side, what sort of resources does that particular hospital have for that patient? That makes the difference of whether they get transferred.”

Advocate BroMenn typically transfers around two trauma patients each month to a Level 1 trauma center, a hospital spokesperson said. It’s about one per month at OSF St. Joseph. Most go to OSF in Peoria; burn victims are often sent to Memorial Medical Center in Springfield, which is a Level 1 with the only burn center in downstate Illinois, Wilson said. 

For the Normal Fire Department’s EMTs, the first thing they do upon arrival to a call is assess a patient’s injuries and decide whether it’s a “load-and-go”—meaning they’re aiming to be on scene for less than 10 minutes, said Chief Mick Humer. A trauma patient’s needs are different than, say, someone having heart problems, Humer said.

“A trauma patient needs a surgeon. And blood,” Humer said. “Those are load-and-go situations.”

Once loaded, Normal Fire’s average transport time to local hospitals is 5 to 6 minutes, Humer said. Occasionally, Normal EMTs will go directly to the hospital’s helipad and the patient will be put on a helicopter right away for transfer to a Level 1 trauma center, Humer said.

“Everything we do would be the same” if Bloomington-Normal had a Level 1 trauma center, Humer said.

“The patient would see the difference in availability of some of the surgeons, things like that, that happen once you get to the hospital," he said.

Meeting The Requirements

The state visits OSF Saint Francis every two years for a multiday evaluation to ensure it's meeting requirements, said Matson. Saint Francis is Level 1 for adult and pediatric patients.

Hospitals can face sanctions—and even civil lawsuits—if they fail to meet those requirements. That’s what happened at Advocate BroMenn last year.

That case traces back to the stabbing of Bruce and Nancy Petersen by their son in their rural Bloomington home on July 31, 2016. Nancy died at the scene, and Bruce was transported to Advocate BroMenn. But that day was one of 26 days in 2016 when Advocate BroMenn did not have a surgeon capable of cardiothoracic surgery on call within the required 60 minutes, according to a violation issued by the Illinois Department of Public Health. The hospital was relying on cardiovascular surgeons in and around Chicago, more than 60 minutes away.

The hospital didn’t tell EMTs about its lack of timely cardiovascular surgical capability or divert Petersen to OSF St. Joseph just 2 miles away, IDPH said. Instead, Petersen was flown to OSF Saint Francis in Peoria—an action that IDPH says delayed surgery by more than an hour. He died a few hours later.

Last fall, the hospital agreed to pay a $55,000 fine and submit a correction plan to the state.

After hearing about the IDPH case, Petersen’s estate sued Advocate and several doctors in July over what happened, seeking at least $50,000 in damages. That lawsuit remains pending.

“For a lengthy period of time in 2016, there was a very real risk that this could happen to anyone who presented to Advocate BroMenn with a penetrating chest trauma,” said Chase Molchin, a Bloomington attorney representing the administrator of Petersen’s estate.

“What we found looking through the Department of Public Health’s action is that it wasn’t a one-time occurrence and it had been going on for some time,” Molchin said.

After the IDPH fine last year, Advocate Vice President of Public Affairs Lisa Lesniak issued a statement to GLT but declined an interview.

“When this was first brought to our attention, we worked closely with the Department of Public Health to respond to their concerns, which dated back to mid-2016. We resolved the matter and continue to maintain our Level 2 trauma center designation. The safety of our patients is our top priority and we continue to ensure our emergency department is appropriately staffed to provide the highest quality care in the safest environment,” she said.

Doherty, the trauma director near Chicago, said having any designated trauma center is a big deal, because not all communities do.

“Having a trauma center is a luxury for a community, it truly is,” Doherty said. “Living in a community that has a Level 1 or a Level 1 trauma center means you’re more likely to survive an injury than you would not living in such a community.”

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