By David Wren
The Sun News
Copyright 2008 The Sun News
MYRTLE BEACH, S.C. — McLeod Regional Medical Center’s decision in 2006 to lower its trauma center designation left many S.C. residents without a nearby Level II care facility, and the state’s voluntary trauma system means no hospital must step up to fill the void.
McLeod officials, in a letter to the S.C. Department of Health and Environmental Control, said they made the decision to drop from a Level II to a Level III trauma center because Carolina Lifecare was overloading its emergency room in Florence with patients that could have been treated at Grand Strand hospitals.
The unnecessary patient transfers were “taxing our medical center resources to a negative extreme” and “maximizing the use of physician resources to the point of dysfunction,” Marie Segars, McLeod’s senior vice president, wrote in the letter.
“While the Grand Strand area has hospital facilities with similar capabilities in orthopedics, general surgery and neurosurgery, an inordinate number of patients are being arbitrarily transported to McLeod based on Carolina Lifecare’s policies,” Segars wrote.
Segars and other McLeod executives met with Carolina Lifecare officials, court documents show, but Segars said “little consideration was given to our requests for a different policy.”
Kelvin Oakley, Carolina Lifecare’s clinical manager, said the Myrtle Beach-based medical helicopter service did not make unnecessary patient transports to McLeod.
“When we were transporting to McLeod, they got an average of one patient every three days,” he said. “That’s a long shot from a number that would overstress a trauma center.”
Matthew Smith, battalion chief of medical operations for Horry County Fire Rescue, said he understands McLeod’s decision was based on complaints from that hospital’s orthopedic surgeons.
“They were getting calls at three in the morning for things that they felt could have been handled by on-call doctors in Horry County,” Smith said.
McLeod officials did not return telephone calls to The Sun News.
McLeod’s decision left Anderson Area Medical Center, located in the Upstate, as S.C.'s only Level II facility.
Carolina Lifecare now transports Level II trauma patients to New Hanover Regional Medical Center in Wilmington, N.C.
A former administrator at that hospital also complained about Carolina Lifecare, saying in an affidavit that helicopter transports were made without prior notification on several occasions.
That created “confusion and the loss of important time in commencing treatment of the patient,” said Eveline Saltmarsh, director of New Hanover’s helicopter transport program in early 2006.
Smith said he thinks those complaints stemmed from New Hanover’s desire to be the primary medical transport agency for Horry County.
New Hanover officials did not return telephone calls to The Sun News.
Rene Kilburn, vice president of operations for Palmetto Health Richland Hospital in Columbia, called McLeod’s decision to lower its trauma rating “an unusual and alarming event.”
Kilburn, in an affidavit filed as part of a lawsuit involving Carolina Lifecare, said the state “has a shortage rather than a surplus” of trauma treatment facilities.
“The full effects of the closing of the Level II trauma center at McLeod have probably not yet been fully felt, but those effects will almost certainly not be favorable for the trauma treatment system in South Carolina,” Kilburn said.
S.C. hospitals are not required to participate in the state’s trauma system.
“DHEC sets the standards and hospitals decide themselves whether they will participate in the program,” said DHEC spokesman Thom Berry. “Hospitals can move their level up and down, depending on their particular circumstances.”
The decision to participate in the state’s trauma system can make it difficult for hospitals to recruit because many specialists want to avoid trauma calls, which could expose them to a greater risk of medical malpractice claims.
It also can be an expensive decision, because hospitals must have special equipment and additional staffing to qualify.
Trauma centers also must absorb the costs of treating indigent patients who need expensive, specialized care.
National studies show the average annual cost of operating a trauma center is at least $3 million.
Level I centers, for example, must have in-house emergency medicine, general surgery and anesthesia capabilities 24 hours a day.
Level II facilities must have emergency surgeons on call at all times and they must be able to arrive at the hospital when the patient does.
Guidelines for Level III facilities are not as strict, but they still must have organized trauma teams and be able to promptly treat the majority of injured patients around the clock.
Experts say those costs can outweigh the benefits -- which include fewer deaths, better patient care and competitive advantage over other hospitals -- especially if trauma centers are needlessly overloaded.
“The obligations ... can become a deterrent to the maintenance and operation of a trauma treatment center,” Kilburn said in her affidavit, “if the center begins receiving an inordinate number of patients who could more appropriately have received the treatment they need elsewhere.”