Officials try to save San Jose trauma center
Elected officials and residents in the Bay Area’s largest county are trying to stop the impending closure of a trauma center that treats thousands of people annually for severe heart attacks, major car accidents and strokes.
Opponents of the closure say it could lead to delayed care and worse outcomes for patients, many of whom are lower-income or uninsured.
Regional Medical Center of San Jose plans to shut its Level II Trauma Center on Aug. 12, citing a decline in utilization over the past several years. The hospital did not elaborate on how many fewer trauma patients it is getting or why. The hospital’s emergency room will remain open.
Located in East San Jose and owned by the nationwide forprofit health care operator Hospital Corporation of America, the hospital also plans to end a program that treats the most severe heart attacks, known as STEMI (ST-segment elevation myocardial infarction), and downgrade its stroke program.
The hospital also blamed declining patient numbers for the STEMI closure but did not elaborate on the reason it is downgrading its stroke program from comprehensive to primary services. The downgrade generally means less specialized care.
“This is a public safety issue,” said Supervisor Cindy Chavez in a statement Monday. “The result in delayed access to essential trauma services could lead to longer transport times, delayed care and potentially increased death rates.”
Regional Medical Center is one of three adult trauma centers in Santa Clara County and sees nearly 2,500 patients per year — about a quarter of all reported trauma patients in the county, according to a memorandum prepared by Santa Clara County Emergency Medical Services that analyzed the impact of the proposed closure.
Shuttering the center would mean patients and ambulances would have to drive farther to the next closest trauma units — Santa Clara Valley Medical Center, about 8 miles to the southwest, or Stanford Hospital in Palo Alto, about 27 miles northwest. Those hospitals would have to absorb a higher volume of patients.
Trauma centers in California operate at several different levels depending on the severity of cases they can treat and the level of specialty care they can provide; Level I is the highest. They generally treat patients who need more urgent or specialized care than standard emergency departments.
“The higher volumes expected at SCVMC and the longer transport time to Stanford Hospital could delay care and worsen outcomes for major trauma patients,” the county EMS memorandum said.
And patients would have to drive to Kaiser Permanente San Jose, O’Connor Hospital or SCVMC, all in San Jose, for specialized STEMI care.
Regional Medical Center is the only comprehensive stroke center on the east side of the county and receives about 20% of all stroke cases, the highest concentration of stroke patients among all hospitals, the county said. It also serves about 65% of uninsured stroke patients in the county.
The Board of Supervisors is slated to review the EMS report Tuesday on the impact of the closures. The state will decide whether to approve the closure or downgrade of services, the county said.
In a February statement announcing the closures, Regional Medical Center said it was working to ensure a smooth transition for patients with other Bay Area hospitals that have the appropriate range of services.
“We are working closely with our medical staff to maintain continuity of care for our patients,” the statement said. “We will continue to provide emergency care services to all patients.”
There is a strong link between trauma center closures and increased risk of dying among injured patients who have to travel farther for care, according to a 2014 study led by Dr. Renee Hsia, a professor of emergency medicine at UCSF.
The study, which analyzed trauma center closures in California during 1999-2009, found that inpatient mortality increased by 21% among patients who had to drive farther to the nearest trauma center as a result of a closure. And patients who had to drive farther tended to be younger, lower income, more likely to have Medi-Cal insurance and more likely to be people of color.
Trauma centers located in areas with higher concentrations of low-income residents on Medicaid — which pay hospitals at lower rates — tend to lose money, while centers in affluent areas where a higher proportion of residents are commercially insured tend to make more money, Hsia said.
Hospital “systems tend to divest themselves of centers that don’t make money,” Hsia said. “These aren’t just one-off closures. Hospitals tend to act as economic entities because that’s the system we as a society have created for them.”
The rate of trauma center closures across the country accelerated in U.S. urban areas between 1990 and 2005 compared to 1981-91, with about 300 trauma centers shutting down in the latter period, according to a separate study led by Hsia.
“It’s not just a local problem,” she said. “This is what’s happening across the country. The implications are large, and the solution needs to be more fundamental.”