Ocala trauma center marks its anniversary
Published: Sunday, December 29, 2013 at 6:10 p.m.
Last Modified: Sunday, December 29, 2013 at 6:10 p.m.
A few days before Christmas 2012, John Bronzi was riding his motorcycle home so he could get his car and pick up his teenage daughter from work.
He didn't made it home.
The next time Regina Bronzi saw her 44-year-old husband was inside Ocala Regional Medical Center's new trauma center. He was the victim of a motorcycle/pickup collision.
“He broke both arms, pelvis and left leg (and had a) ruptured bladder,” she said. “And he had traumatic brain injury. But having a trauma center in town absolutely saved his life.”
John Bronzi — one of the trauma center's first patients — spent the next five months in the hospital. The former Ecolab employee's weight dropped from 230 pounds to 163.
“Before the accident I probably wouldn't have thought twice about” whether Ocala needed a trauma center, Regina Bronzi said. “Now, Ocala absolutely needs a trauma center.”
Not everyone agrees. UF Health Shands Hospital objected last year, saying patients would receive a higher level of care in Gainesville, since Shands has a Level I trauma center and ORMC's is Level II.
Shands and others also objected to the state Department of Health process through which ORMC was granted authority to open a trauma center. A legal challenge is still pending.
As ORMC marks the center's first anniversary, a statistical review seems in order.
Between its opening in December 2012 and Nov. 30, 2013, the ORMC trauma center treated 1,834 patients, of whom 866 met trauma standards.
Shands had predicted it would lose a quarter of its trauma cases if ORMC opened a trauma center. But during that same time period, the number of patients brought through the Shands trauma center's doors dropped only about 8 percent, from 2,720 to 2,495.
The number of trauma center patients who actually met trauma standards at Shands dropped about 14 percent, from 1,116 to 951.
Why is Ocala Regional getting more trauma patients than Shands is losing?
Darwin Ang, Ocala Regional's medical director of trauma services, said that about half of those patients in critical condition never would have been taken to a trauma center before Ocala Regional built one.
Instead, they would have been taken to traditional emergency rooms.
“And you can imagine the number of patients who never got out (of emergency rooms alive),” he said.
ORMC's trauma center serves Marion, Lake, Sumter and Citrus counties.
Ocala's trauma fatality rate is 3.1 percent, compared with Florida's 4.9 percent, he said.
“We have a lot of cases …who would not have made it another five minutes if they had gone somewhere else,” he said.
Dr. David Guzick, president of UF Health and senior vice president for health affairs, said it is difficult to say why Ocala Regional is seeing more trauma patients than Shands is losing.
Some of the increase could be due to patients who would have otherwise received appropriate care in emergency rooms now being taken to the trauma center.
Guzick said that in many cases there is a fine line between when someone needs to go to an emergency room versus a trauma center.
A 40-year-old patient with a broken arm would traditionally get good care at an emergency room, but if that patient were maybe 70 years old, he or she might be taken to a trauma center if one is in town.
“Other factors may also lead to a score that just exceeds the threshold for trauma coding. Such patients can be taken care of quite well in their local ERs. Sending such patients to a trauma center increases cost without improving the clinical outcome …,” he said.
The legal battle about ORMC's trauma center can be traced back to 2004, when the Florida Legislature told the Department of Health to update its rules concerning trauma centers. The rules had not changed since 1992.
But the department did not act. And in September 2011 an administrative law judge found that the department rules for determining the location and need for trauma centers were invalid.
In November 2011, the 1st District Court of Appeal upheld that administrative law judge's ruling. But the Department of Health granted Ocala Regional's proposed trauma center provisional status before the appellate court's decision technically took effect — thus allowing the new trauma center to slip in just under the legal wire.
Shands filed a lawsuit soon after Ocala Regional received approval from the DOH to open its trauma center and construction concluded. Shands said DOH did not have the authority to grant Ocala Regional permission, and also said Shands was improperly denied standing to object to the process.
Ocala Regional, which is owned by Hospital Corporation of America, argues that it followed the rules and that the trauma center is needed — and that the number of patients it has helped testifies to that need.
The DOH is working on a new set of guidelines as to how it will determine when a trauma center is needed. The current proposed plan would increase the number of trauma centers from 25 to as many as 43.
On Dec. 23, Shands asked the Florida Court of Apeals to shut down HCA's trauma centers.
Guzick said the issue of Ocala Regional's trauma center is complex and has brought other questions to bear.
Guzick said Shands' legal problem is not with Ocala Regional, but rather with the state Department of Health. But, Guzick also said that Ocala Regional knew about the recent court rulings that ordered the DOH to come up with new guidelines about allowing trauma centers, and Ocala Regional rushed to get its trauma center open.
Another problem is a medical one, he said.
Guzick said there had been an “equilibrium” among trauma centers and the number of patients needing that level of care, ensuring that trauma centers had the experience to meet the need but costs were also kept down.
Trauma centers are costly to build (Ocala Regional spent about $7 million) and expensive to operate (Guzick cited about $8 million annually).
“And we all pay for that … and what do we get (for the money)?” he asked.
Meanwhile, if there is a deluge of new trauma centers it will not necessarily mean that the quality of care will improve, he said.
Guzick cited three recent studies to support that theory.
One Florida study reviewed traumatic brain injuries between 2000 and 2010, comparing trauma centers with low and high volumes. The study showed that higher-volume trauma centers, such as Shands, had a 9 percent lower mortality rate than did lower-volume trauma centers.
Another study released this year showed that 34 percent of patients who did not meet trauma standards were nonetheless taken to trauma centers — and accounted for 40 percent of trauma costs.
A third study in the Journal of the American College of Surgeons showed that elderly patients referred to trauma centers had the same mortality as those treated in non-trauma centers, but had much higher costs: $35,069 versus $14,332.
“Our goal for Florida should be to establish a trauma system that provides optimal care for severely injured patients in regionalized programs that follows evidence-based rules,” Guzick said.
As for Regina Bronzi, she said the debate takes a backseat to her husband's survival.
“He wouldn't have lived long enough to get to Shands,” she said. “He's alive because of the trauma center here.”
Contact Fred Hiers at 867-4157 or email@example.com.