HOSPITALS LOSE TRAUMA TITLE; SERVICES REMAIN

New state regulations have left Southeast Missouri without any hospital designated as a trauma center.

But administrators at several Southeast Missouri hospitals said that their hospitals would continue to provide care for trauma patients, those suffering life-threatening injuries, even without a trauma-center designation.

Both Cape Girardeau hospitals Southeast Missouri Hospital and St. Francis Medical Center have decided they can't meet the manpower requirements needed to maintain a trauma-center designation.

The Missouri Delta Medical Center in Sikeston and two Poplar Bluff hospitals have taken similar actions, hospital officials said.

James Wente, administrator at Southeast Missouri Hospital, said Southeast and St. Francis had been "working together to try to comply with trauma regulations for well over the past year."

Wente said, "Both hospitals would prefer to be trauma centers if we could be, but the requirements are such it was not just cost effective. We finally just had to say no to something."

But he stressed, "Patients will still see the same quality care that they had before.

"We're simply not going to have a piece of paper on the wall that says we are a trauma center," said Wente. "We are going to provide the same level of care."

Glenn McFadden, executive vice president at St. Francis Medical Center, and Charles Ancell, administrator at Missouri Delta Medical Center, echoed Wente's remarks.

"We cannot promote ourselves as a trauma center," said McFadden. But he added that "we are going to continue to take care of trauma patients."

Ancell said the Sikeston hospital will continue to offer the same level of medical service. "It is a paper designation only," he said.

"It will not affect the equipment or the training of personnel," he emphasized. "We will take care of the (medical) cases in the same ways we always have."

In 1981, a trauma-center designation system was developed by the Missouri Division of Health.

It was a voluntary program in which hospitals were designated as trauma centers on the basis of meeting certain equipment and staffing standards, said Paul Guptill, director of planning for the Missouri Hospital Association.

Initially, about 45 Missouri hospitals voluntarily participated in the program, he said.

In 1987, a state law was enacted that included provisions dealing with the trauma center program, he said.

In 1989, rules and regulations were developed concerning the trauma center system, said Guptill. "And they were finalized in December 1989 and became effective in January 1990."

Those hospitals, such as the Cape Girardeau hospitals, which had been designated trauma centers under the original program, could continue to carry such designations while the hospitals were reviewed by inspection teams, he explained.

The on-site inspections are just now beginning around the state, although some hospitals like the ones in Southeast Missouri have elected not to seek continued designation as trauma centers, he said.

Under the state regulations, Guptill explained, if a person is suffering from a life-threatening injury, emergency personnel are supposed to transport that person to the nearest trauma center, provided the trip can be made within a maximum of 20 minutes.

Otherwise, the person is to be transferred to the nearest hospital, he said.

With no trauma centers now in Southeast Missouri, trauma patients will be treated at the nearest hospitals, hospital administrators said.

The state has three trauma center levels. Level 1 typically applies to teaching hospitals.

Both St. Francis and Southeast had been Level 2 facilities until last spring, when they voluntarily went to the lower Level 3 designation because of cost considerations, Wente said.

For a Level 2 designation, hospitals must now staff operating rooms 24 hours a day. "And that is just absurd," said Wente. "That just wasn't cost effective."

Said Wente, "I believe our hospitals are trying to be responsible to the community from the standpoint of keeping costs down."

Both Cape Girardeau hospitals subsequently found they weren't able to comply with even Level 3 requirements.

"We had manpower shortages and medical staff shortages that made it very difficult for us to stay in the trauma program," said Wente. "These regulations are so strict and so uncompromising, we just felt we would not be able to comply with them," said Wente.

Both Wente and McFadden said the regulations seemed geared for metropolitan hospitals, which have larger medical staffs.

"The regulations really did not fairly differentiate between the resources available in large metropolitan hospitals, particularly those affiliated with teaching institutions, or did not identify differences between those institutions and human resources available in an outstate area," said Wente.

McFadden said that to maintain a Level 3 designation, hospitals must have a certain number of surgeons on call to handle medical emergencies.

"We have five surgeons. The amount of call time would have been overwhelming to physicians," said McFadden. "That's the same situation that we are being told exists in Springfield and Joplin."

McFadden said Cape Girardeau would need at least two to four more general surgeons before the Level 3 requirements possibly could be met.

Ancell said that for Missouri Delta Medical Center to meet trauma-center requirements, the hospital would have to have two surgeons on call at any one time, one for general cases and one for trauma cases.

Ancell said the Sikeston hospital doesn't have a large staff of surgeons and the demands don't warrant it. "We just felt like it was an unrealistic requirement.

"It's just not fair and it's not reasonable to do that," said Ancell.