Tufts Medical seeks listing as trauma center

Opponents say Boston already has too many

Tufts Medical Center is seeking to become a major trauma center, a plan that could affect where ambulances take some of the region's most seriously injured patients.

While Tufts in Boston's Chinatown neighborhood treats some trauma cases now, it is the only major Boston teaching hospital that is not a state-designated adult trauma center. As a result, ambulances carrying trauma patients often bypass 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.

Tufts, which has weathered tough economic times in recent years, wants to join the system, a plan some surgeons at the city's existing trauma centers are not happy about. The trauma designation carries prestige and potential increases in patients and revenue.

Tufts executives and physicians said that becoming a designated trauma center will improve the quality of care for all its patients, because the hospital would be required to add surgeons, speed up the results from imaging and lab tests, and improve other services to qualify.

While emergency room physicians and trauma doctors work in cooperation, trauma centers are designed to treat more seriously injured patients immediately, usually those hurt in car accidents, falls, stabbings, and shootings. Many require immediate surgery. The four designated Boston trauma hospitals said they treat a total of about 8,000 trauma patients a year.

"We want the Good Housekeeping seal of approval," said Ellen Zane, Tufts chief executive. "It tells everybody that we are very serious about offering a high quality of care."

But competitors, who could lose patients to Tufts if it becomes an official trauma center, argue that Boston already has too many trauma centers.

Reigniting a longstanding debate about how to provide the best care to the region's residents, these rivals say the several million dollars needed to establish a trauma center could be better spent elsewhere.

"There is a critical point beyond which too many cooks in the same kitchen may produce more harm than good," said Dr. George Velmahos, chief of trauma at Mass. General. He said that if patients are spread among too many trauma centers, doctors won't see enough cases to gain expertise at treating massive fractures, internal bleeding, and head injuries.

"Eventually, trauma center patients go to one of many centers rather than a limited number of centers of excellence," Velmahos said. Adding more centers in Boston - where the existing trauma centers sit, at most, a few miles apart - would "most likely be an excess," he said. Meanwhile, rural Massachusetts may need more trauma care, he said.

Since Tufts' Floating Hospital for Children is a state-designated pediatric trauma center, Tufts executives said they have some of the infrastructure already in place.

Zane said the Longwood Medical Area has three trauma centers, including those at Brigham and Women's, Beth Israel Deaconess, and Children's Hospital Boston. "Longwood is not a neighborhood where people live," Zane said. "There are zero trauma centers in Chinatown, which is a neighborhood where people live."

South Shore Hospital in Weymouth also is seeking approval as a trauma center, while Caritas Christi Health Care System is considering whether to build a trauma service at Caritas Good Samaritan Medical Center in Brockton.

There are no national guidelines for how many trauma centers cities should have. Greater Boston has four Level 1 adult trauma centers. Level 1 centers are required to have the widest range of specialty surgeons in the hospital 24 hours a day, and must have research and residency programs.

Tufts and South Shore are seeking Level 2 designations; such facilities are not required to do research or train residents.

To become a state-designated trauma center, hospitals must have their programs verified by the American College of Surgeons. This means that the college has given the program its stamp of approval and has determined - for a Level 2 center - that it has an operating room open and ready at all times, a trauma surgeon within 15 minutes of the hospital 24 hours a day, and neurosurgeons and orthopedic surgeons on call at home 24 hours a day.

Emergency medical personnel decide where to take patients based on the proximity of a hospital and whether it is a designated trauma center.

Tufts officials said they now treat 400 to 500 trauma cases a year, mostly minor traumas involving patients who walk to the hospital or are driven to Tufts because they receive their routine care there. Tufts named a chief of trauma - Dr. Reuven Rabinovici - a year and half ago.

American College of Surgeons staff visited the hospital in December, recommended improvements, and are scheduled to return in November, when they could make a final decision. Once the hospital has the college's stamp of approval, the state Department of Public Health could designate it as an official trauma center.

This week, state health officials told Tufts to change the language on its website extensively describing its trauma service. Hospitals are not allowed to advertise themselves as a trauma center without state designation.

Even though Tufts expects an increase of 100 to 200 cases a year if it becomes a designated trauma center, executives said they expect only to break even on the service, and are not seeking state designation to make a profit. Zane said she foresees the designation increasing the number of cases referred to the hospital, because some physicians now are reluctant to send trauma cases to Tufts because it lacks the designation.

"This is really about serving the patients who have come here and will continue to come here," said Dr. Brien Barnewolt, head of emergency medicine.

The state health department recently established a statewide trauma committee, consisting mostly of physicians, that will try to determine whether trauma care is better in some regions of the state than in others and whether patients in Western Massachusetts, for example, have to travel too far for care.

Trauma patients have a better chance of recovery if physicians can begin treatment quickly, usually within an hour or two.

Velmahos and some other trauma surgeons also want the group to study whether Boston has too many trauma centers.