More trauma centers likely on the way in Northwest Indiana

A couple of those facilities now plan to become trauma units as well.

Officials at Franciscan St. Anthony Health hospital in Crown Point and Valparaiso's Porter Regional Hospital said they intend to apply for trauma status in the coming months. Both would be Level III "in-process" trauma centers, meaning they would be designated by the state for ambulance-transport purposes but still have to be certified by the American College of Surgeons within two years.

"Methodist Northlake is not going to be able to absorb all of that trauma, and certainly there's a need to have something in the southern part of the county for those patients whose transport time would be a lot longer to Gary," said Janet Doms, administrative director of emergency services for Franciscan Alliance's northern Indiana region, which includes Crown Point.

Indiana, one of only a handful of states without a statewide trauma network, has been trying to institute a more formalized trauma system in recent years, and Northwest Indiana hospitals are slowly but surely getting on board.

First, the state created a division of trauma and injury prevention within the health department. Then, it instituted a triage-and-transport rule that advises paramedics to bring traumatically injured patients — those who are at risk for loss of life or limb — to the nearest trauma center if it's less than 45 miles away. And it started the "in-process" designation, essentially giving hospitals two years to audition for the ACS, which has a rigorous certification process.

"I don't think there's any question that care in Northwest Indiana has improved, not just by the fact that Gary Methodist has become an 'in-process' trauma center, but (also) because other hospitals are working toward that and, as a result, are becoming better in the delivery of trauma care," said Art Logsdon, assistant commissioner at the Indiana State Department of Health.

"When hospitals become trauma centers, it's not just their trauma care that improves, it's other processes in the hospital because of the quality improvement they have to undergo."

Treating trauma nothing new

For years, Northwest Indiana hospitals have been receiving trauma patients, stabilizing them and, if need be, transferring them to higher-level trauma centers. Northwest Indiana has no Level I or Level II trauma centers, and Gary Methodist is its first and only Level III. The closest Level I unit is in Oak Lawn.

Because trauma is a significant investment and many trauma patients having little to no insurance coverage, some hospitals are reluctant to seek the designation. Roughly half of states provide funding to trauma centers to make up for that expense, through measures including bullet taxes and fines collected from traffic tickets. Indiana is not one of them.

Instead, the state has been nudging hospitals into becoming trauma centers through the triage-and-transport rule. That rule, however, isn't a law, so the decision on what hospital to go to is ultimately up to the paramedics and the patient. Still, Indiana has more than doubled its number of trauma centers in the past two years, to 19, and officials expect that number to grow.

Porter Regional Hospital hopes to apply to the state by the end of the year to become a Level III center, said Steve Lunn, CEO of Porter Health Care System.

"One of the advantages we have here at Porter is our new facility," he said of the hospital that opened in 2012. "When it was built, it was built with the thought in mind to be not only a trauma center but (also) a regional trauma referral center."

Lunn says that looking further into the future, the hospital intends to become a Level II center. While a Level III facility must have general surgeons available within half an hour, a Level II center is required to have them at the bedside within 15 minutes, as well as orthopedic surgeons and brain surgeons, among other specialties. Level I facilities have general surgeons on site around the clock and are also considered teaching hospitals.

Some local stakeholders have advocated for the construction of a new Level I trauma center connected to Gary's Indiana University Northwest, which has a satellite medical school. A state-funded feasibility study released last year recommended against the idea, however, saying existing hospitals already have too many empty beds.

"I still haven't given up yet on trying to pursue an academic medical center here in Gary," said state Rep. Charlie Brown, a Gary Democrat.

Meanwhile, Dr. Pat Bankston, associate dean of the medical school at IUN, has been trying to rally support among local hospitals to partner in hosting medical residents (essentially doctors in training), increasing the educational aspects of the participating facilities. "Having a residency program in emergency medicine could help at least one of the hospitals become a Level I trauma center," he said.

Changes in where patients go

Officials at Munster's Community Hospital said it already has much of the staffing and facilities in place to be a Level II trauma center but has not made any decisions on whether to apply for the formal designation. Dr. Alan Kumar, chairman of Community's emergency medicine department, said an internal study indicated becoming a Level III trauma center would only bring one extra patient to the hospital per day.

"We're comfortable in our ability to take care of any patient who walks in the door based on the infrastructure we already have," he said.

While none of the Northwest Indiana hospital systems would disclose exactly how much it has or would cost to become a trauma unit, the feasibility study for the academic medical center estimated the price tag for Community Hospital at between $1.44 million and $4.01 million; Porter Regional at between $4.3 million and $8.97 million; and Methodist Northlake at between $2.77 million and $4.36 million, depending on the level of trauma center they were to become.

While Methodist's trauma volume has increased significantly since it got the trauma designation last August, other Northwest Indiana hospitals said they haven't seen a huge dip in theirs, perhaps because the patients are spread out over a wide geographic area.

Doms, of Franciscan, said she expects the number of trauma cases to pick up at St. Anthony if it earns the designation, as it would then start receiving cases from southern Lake as well as parts of neighboring counties. Franciscan Alliance had planned to apply for trauma status for its hospital campuses in both Crown Point and Dyer but is focusing its efforts on St. Anthony for the time being.

To apply for the state designation, a hospital must have been activating trauma calls for three months prior. St. Anthony plans to begin that process Monday and submit its application by the end of the year. "We do have surgeons who are ready and prepared to begin taking trauma calls," Doms said.