Pursuit of level 3 trauma centers in Las Vegas all about profit

When Dr. Frank Nemec says money was the impetus for Southern Hills, MountainView and Centennial Hills hospitals seeking Level 3 trauma centers, we should listen.

He has been chief of staff at both Southern Hills and Sunrise hospitals, which, like MountainView Hospital, are owned by the largest for-profit hospital chain in the United States, the Hospital Corporation of America.

“It’s all about money, all about the trauma activation fee they could charge,” Nemec said. “That’s it. Millions of dollars.”

Nemec, the founder of Gastroenterology Associates, serves on the Southern Nevada District Board of Health. He talked outside district offices about why he felt the board did the right thing Thursday in voting to reject the hospitals’ applications for low-level trauma centers. He later expanded on his thoughts during a phone call.

“I can tell that we wouldn’t have even have had this discussion about trauma centers today if trauma activation fees weren’t involved,” he said. “This isn’t about trauma patients getting better care. What we should be most concerned about are the patients.”

Nemec has shown his concern for the heath of the community before.

In the wake of the 2007 hepatitis C outbreak in Las Vegas — 60,000 people had to be tested for hepatitis after the now-imprisoned Dipak Desai did not follow infection-control protocols during colonoscopies — Nemec helped spearhead a campaign that persuaded area health facilities to make safe injections and infection control part of ongoing training programs.

Unfortunately, Nemec said, some hospitals have realized that with the Affordable Care Act and the expansion of Medicaid — the number of uninsured has dropped dramatically — there is money to be made off a low-level trauma designation without making a significant investment in materials or manpower.

If a hospital has a Level 3 trauma designation, such as St. Rose Dominican Hospital, Siena Campus, it can charge thousands of dollars more for trauma expertise. St. Rose charges nearly $10,000 on top of regular medical treatment for trauma care.

Trauma activation fees at HCA hospitals in Florida are more than $30,000. There is no limit to what a hospital can charge.

Yet Nemec says a Level 3 trauma center, which the American College of Surgeons says is suited for rural areas but not suburban or urban areas, doesn’t offer any better medical care than a traditional emergency room.

“The only difference is that it’s codified that over a 24-hour period they have to have a surgeon available within 30 minutes,” he said. “And they enter into transfer agreements with high-level trauma centers. But most emergency rooms already have that. All the Level 3s do is drive up costs.”

Nemec said difficult trauma cases, where skilled specialists often perform life-saving surgery, have to be taken to either University Medical Center, the only Level 1 trauma center in Southern Nevada, or Sunrise Hospital, a Level 2 center.

According to the National Trauma Data Bank, more than 96 percent of trauma patients taken to UMC survive, even though many of them enter with only a 1 percent chance to live.

If you do end up in a Level 3 trauma center when you need more specialized care, you have to be moved, which makes a bad outcome more likely, he said.

“Delays don’t help,” he said.

During the public comment session of Thursday’s board meeting, Dr. Meena Vohra told the story of Giulian Grasso — his story was shared in this space last week — to board members. Because he had a closed head injury and was able to talk after a fall, he was taken to St. Rose. A 2½-hour delay in his arrival at UMC left the 15-year-old partially paralyzed and in a wheelchair.

Vohra believes many children are mistakenly taken each year to St. Rose, either by parents or paramedics. Health district statistics show that more than 160 pediatric and adult trauma cases at St. Rose were transferred to either UMC or Sunrise.

“If we can show a need is there for more trauma centers — and we haven’t — then we should OK more,” Nemec said.

Paul Harasim’s column runs Sunday, Tuesday and Friday in the Nevada section and Thursday in the Life section. Contact him at pharasim@reviewjournal.com or 702-387-5273. Follow @paulharasim on Twitter.