In August, the South Side Chicago advocacy group Fearless Leading by Youth, or FLY, marched to vocalize their ongoing request that the University of Chicago Medical Center build a trauma ward to deal with severe injuries, such as gunshot wounds. But the evidence is mixed as to whether the University of Chicago Medical Center should build a trauma center, along with the best ways for the institution to give back to their community.
In August, the South Side Chicago advocacy group Fearless Leading by Youth, or FLY, marched to vocalize their ongoing request that the University of Chicago Medical Center build a trauma ward to deal with severe injuries, such as gunshot wounds.
FLY has an emotionally strong case. The protest marked the two-year anniversary of the death of the organization’s co-founder Damien Turner, who was shot a few blocks away from the University of Chicago Medical Center. Because the Medical Center lacked an adult trauma facility, paramedics whisked Turner nine miles north to Northwestern Memorial Hospital where he died.
The evidence is mixed as to whether the University of Chicago Medical Center should build a trauma center, along with the best ways for the institution to give back to their community.
A Trauma Desert
A distinct medical facility to treat victims of traumatic injuries is a fairly new idea. Prior to 1986, Chicago did not have an established trauma center network and paramedics would deliver patients to the nearest hospital emergency room.
In 1986, the Chicago Department of Public Health designated nine city and suburban hospitals as trauma centers, meaning these hospitals agreed to have the constant presence of medical personnel and equipment to perform emergency care. Such comprehensive service would confer a “Level 1” trauma center designation by the American College of Surgeons.
One of the nine hospitals was the University of Chicago Medical Center. According to a 1986 Chicago Tribune article, area hospitals sought the trauma designation equating it with income and prestige.
But by 1988 the University of Chicago Medical Center shut its adult trauma center down, while maintaining a trauma facility for children 15 years old and younger. Medical Center spokeswoman Lorna Wong explains that the “decision was made to concentrate resources in the clinical specialties where the University of Chicago can play the greatest role and where it has the most to offer.”
The Medical Center reassessed its resources because it turned out trauma centers amounted to an approximate $15 million in annual losses. The hospital was paying for the care of uninsured trauma victims and getting only partial government reimbursement for the treatment of Medicare and Medicaid patients.
When the now shuttered Michael Reese Hospital exited the trauma center network in 1990, South Side residents found themselves in a proverbial trauma desert. Victims of severe injuries who live in the neighborhoods that surround the University of Chicago – Hyde Park, Washington Park and Woodlawn, to name a few – have since been sent nine miles north to Northwestern Memorial Hospital, or about the same distance south to Advocate Christ Hospital in Oak Lawn. In other words, four years after Chicago created a trauma network the system already appeared to be failing the South Side.
Veronica Morris-Moore, an organizer at FLY, sees the University of Chicago's lack of a trauma center as an example of an elite institution washing its hands of a surrounding community that is mostly low-income and black. “It is a damaged relationship between the community and the University of Chicago,” says Morris-Moore, a 20 year-old Woodlawn resident who attends Harold Washington College.
U.S. Rep. Bobby Rush (D-Chicago) also excoriates the university. In February 2011, the South Side lawmaker of nineteen years declared on the House floor that, “Our family members are dying due to the tragic lack of Level 1 trauma centers in close proximity to those who need it.”
Rush counts among those family members his son Huey, who in 1999 was shot by alleged robbers a few blocks away from the University of Chicago Medical Center. Like Damien Turner 11 years later, paramedics transported Huey Rush to a hospital miles away where he died at the age of 29.
Unclear Need For South Side Trauma Center
A study in the March 2010 Annals of Emergency Medicine suggests that the extra miles Turner, Rush and other South Side patients had to travel made no difference in their probability of survival. Finding “no association between EMS intervals and mortality,” the study defies popular, but scientifically unproven, notions that there is a “golden hour” following a traumatic incident for the patient to survive.
However, transport times might make a difference for gunshot wound victims. Dr. Marie Crandall, a surgical critical care physician at Northwestern, has co-authored two pending studies showing that transport times affect survival for penetrating chest traumas, which are often gunshot wounds.
The first study, peer reviewed and set for publication this winter, examines patients in the Illinois Trauma Registry between 1999 and 2003 who were treated in Chicago, East St. Louis and Springfield. The second study, awaiting peer review, focuses on Chicago trauma patients between 1999 and 2009.
Crandall says the second study finds a “linear association between transport time and mortality” for gunshot wound victims. Individuals who were injured more than five miles from a trauma center had longer transport times and had higher mortality rates.
According to Crandall, these studies do not contradict but instead “supplement” the Annals of Emergency Medicine report, which did not focus on penetrating chest trauma in urban areas. “We are looking at a specific patient population that was a minority of patients studied in that analysis,” Crandall says.
Crandall says it is a fair to ask whether the University of Chicago Medical Center should bring back its trauma ward. She says, though, that a trauma center might not be cost effective given the unclear evidence of its necessity, and that resources would be shifted from other medical center units.
That is basically the position of the University of Chicago. “If we were to focus now on the demands of adult trauma care, we would have to build facilities, services and medical teams from the ground up,” Wong says. “This would take away resources from other life-saving services, including a neonatal intensive care unit, the South Side’s only burn unit, and Chicago’s only hospital-based emergency chopper response.”
U of C and The Surrounding Community
But this position depends on other hospitals maintaining their trauma centers. For example, Advocate Christ Hospital in Oak Lawn has stayed in the Chicago trauma network since its inception. Hospital spokeswoman Toni Gardner says that running the trauma facility has been a “financial burden”, but adds that “trauma center status is a statement to a community that a hospital is committed to providing the highest level of care to that community.”
There is not an overarching economic or ethical rationale that guides the behavior of private, not for profit hospitals like the University of Chicago Medical Center and Advocate Christ Hospital. “I do think that hospitals respond to the needs of communities,” says Brendan Carr, an associate professor of emergency medicine at the University of Pennsylvania. “But the University of Chicago has to make complex decisions about how to stay in business.”
The University of Chicago Medical Center seems in better business shape than Advocate Christ or Mount Sinai Hospital, a private medical center on the West Side that has a Level 1 trauma center and currently operates with a financial loss. The University of Chicago Medical Center reported $1.1 billion in 2011 operating revenue. A university report released in June touts that $237 million, or 21 percent, of this operating revenue was redirected to the surrounding community. In addition to the aforementioned life-saving services, money was spent on the treatment of thousands of South Side residents who are uninsured or on Medicare or Medicaid.
Meanwhile, FLY continues to attempt a meaningful dialogue with their university neighbor, with suggestions like community workshops about what residents should do when there is a traumatic injury. Morris-Moore says FLY is frustrated that the university never scheduled a follow-up community forum since an initial discussion in April 2011.
Wong notes that university officials have met with FLY and also speak on a “regular basis” with U.S. Rep. Rush. “We work closely with all facets of the community to deal with complex health issues,” Wong says.