Tufts Medical Center wants top trauma designation, but competitors seek delay

By Liz Kowalczyk, Globe Staff

Tufts Medical Center is seeking to become a “level one’’ trauma center, an elite designation that would bring more prestige and potentially more patients to the Boston teaching hospital.

But the surgery chiefs at four of Tufts’ competitors are questioning whether the city needs another top trauma center and have asked public health officials to delay their decision.

Tufts won approval three years ago to become a level two trauma center. Before then, Tufts, in Boston’s Chinatown neighborhood, was the only major Boston teaching hospital not approved as an adult trauma center.

As a result, ambulances carrying victims of car accidents, falls, or violence often bypassed that hospital for Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women’s Hospital, or Massachusetts General Hospital -- all state-designated trauma centers.

Now, Tufts wants to take its role a step further. The hospital has asked the American College of Surgeons to designate it as a level one trauma center. The state Department of Public Health must give final approval.

To become a level one trauma center, a hospital must prove it would treat more than 1,200 trauma patients a year, many of them seriously injured, and conduct top-flight research. Tufts said it meets both requirements. Trauma cases have more than doubled at the hospital in the past three years, reaching more than 1,000 last year -- patients that previously would have gone to competitors.

“Level one tells the community and referring physicians and hospitals we really have met the highest standard,’’ said Dr. Brien Barnewolt, head of emergency medicine. “We’re proud of that.’’

But in a letter to Massachusetts Public Health Commissioner John Auerbach last week, surgery chiefs at the four other hospitals argued that designating a fifth level one trauma center in the city could harm public health by diluting physician and staff expertise.

“The delivery of high quality care requires experience and experience requires (patient) volume,” they wrote. In other words, doctors get better by doing lots of cases, and more trauma centers means fewer cases for each one.

Dr. Keith Lillemoe, surgery chief at Mass. General, said adding a fifth level one trauma center in Boston doesn’t seem like the best use of resources, particularly since some other regions of the state have thin trauma coverage.

“Why doesn’t someone look at what we really need?’’ he asked.

The surgery chiefs -- including Dr. Michael Zinner at the Brigham, Dr. Gerard Doherty at Boston Medical Center, and Dr. Elliot Chaikof at Beth Israel Deaconess -- asked the health department to delay its decision until the American College of Surgeons finishes an assessment of the state trauma system, which was commissioned by the health department.

Barnewolt called the letter “a little self-serving. If we have met the criteria, there’s really no reason to wait,” he said.

For all hospitals, caring for patients within their own networks will become increasingly important as insurers change how providers are paid by putting them on a budget to treat all of a patient’s medical needs.

Madeleine Biondolillo, director of health care safety and quality for the health department, said in a written statement: “Tufts Medical Center is currently undergoing a review process by the American College of Surgeons in an effort to be verified as a Level 1 Trauma Center. The Department awaits the determination of the ACS review and cannot comment further at this time.’’

Liz Kowalczyk can be reached at kowalczyk@globe.com.