Intense competition among for-profit hospitals for lucrative trauma unit designations in Southern Nevada has lawmakers pondering a return to the days when the state decided trauma unit applications for Clark County.
“To put the facts on the table, this will take local politics out of trauma designation. It doesn’t belong in trauma,” Assemblywoman Maggie Carlton testified last week on Assembly Bill 317 before the Assembly Committee on Health and Human Services. “This needs to be a thoughtful, deliberate, data-driven process so that trauma centers don’t end up in more affluent areas and not where they are truly needed.”
The measure would require the state to determine areas that lack trauma care before the Southern Nevada Board of Health could make a determination on new trauma unit applications.
Carlton expressed frustration with the failure of Clark County officials to complete a trauma unit needs assessment since the the Board of Health rejected the last round of applications.
“It’s been two and a half years later and that community needs assessment still hasn’t been done. There are trauma applications in the queue right now,” Carlton testified.
On Wednesday, just days after Carlton’s testimony, the Regional Trauma Assessment Board released a 146-page document with an incomplete assessment of the need for more trauma units. The SNHD Board of Health is expected to make a recommendation in June on five pending trauma unit applications.
“It’s kind of antithetical. You think the more trauma the better, but that’s not necessarily true,” Carlton told her legislative colleagues. “It’s a very fine balancing act to make sure you have the right services in the right place for the right level of trauma. That golden hour is very important.”
“Years ago, in 2005, trauma designation moved from the state to Clark County,” Carlton told the Health and Human Services Committee. “I believe we need to bring this back to a two-tiered process that could ensure the shortage area could be developed and designated by the state.”
“We already have a system set up to where we could look at an area and decide is that a trauma, for lack of a better term, desert,” Carlton noted.
Another provision of the bill would assign an identifying number to all medical facilities to assist in collecting data on the cost of medical procedures.
Marcia Turner, Chief Administrative Officer of UMC, testified in support of AB 317, as did representatives from the Culinary Union and the Health Care Coalition, which represents health insurance needs for more than a quarter million Nevadans.
Insurance giant UnitedHealth voiced support for the measure, while hospitals and their associations testified in the neutral position.
Hospitals vying for a coveted trauma center designation in Clark County are pointing to a spike in the number of patients with low-level injuries transported to trauma centers since 2017 as evidence of the need for more centers.
But critics of the plan to add more trauma centers say the spike is due to a change in ambulance protocol and not an increase in injured patients.
“This appears to be because EMS (Emergency Medical Services) decided in the last couple years that step four (low-level injured) patients have to be transported to trauma centers instead of to an ER, even though that’s not consistent with national guidelines,” Stacie Sasso of the Health Services Coalition told the Regional Trauma Advisory Board (RTAB) on Wednesday. “This started happening in 2017 and then the Health District changed the protocol in 2018 to become a mandatory transport instead of a “may” transport.”
“This has driven up the number of trauma transports and making patients get care farther away from their home when an ER could have been closer and ERs are equipped to take care of these patients. This is not happening in other communities, based on research that we’ve done,” Sasso told the RTAB.
The Health Services Coalition opposes applications by five hospitals to add low-level trauma units.
Southern Nevada currently has three trauma units — a Level I at University Medical Center; a Level II at Sunrise Hospital; and a Level III at St. Rose Siena Campus.
Sasso added that a slight increase in ambulance transport times in the Las Vegas valley is likely due to the slower speeds traveled by EMS who stay close to the speed limit and do not use lights and sirens when transporting low-level “step three” and “step four” patients.
“There’s a proposal to take away the authority of you and my Board of Health to take away the authority to grant trauma centers,” Dr. Joseph Iser, Chief Health Officer of the SNHD, told members of the RTAB. “I believe there are people here involved in this legislation. I don’t believe this is a smart move and I just wanted to put that on the record.”
Clark County Commissioner Tick Segerblom, who sits on the Southern Nevada Board of Health, urged the RTAB to table any recommendation on adding trauma centers until state lawmakers act on the legislation before them.
The original version of AB 317 would have prohibited Level III trauma centers from charging “activation fees,” which hospital executives say defray the cost of being prepared to treat trauma patients.
Sunrise Hospital’s Level II Trauma Unit charges $53,153, but only for patients who arrive via ambulance. Trauma patients who arrive via other forms of transportation are not assessed the activation fee.