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Limited trauma program possible

August 13, 2002|by LAURA ERNDE

laurae@herald-mail.com

Washington County Hospital's trauma center most likely will be downgraded to a lower-level center if it reopens at all, the hospital's president and chief executive officer said Monday.

While a Level II certification requires trauma surgeons to be available at the hospital at all times, a Level III certification gives surgeons 30 minutes to arrive. A Level III status would help alleviate staffing burdens, James P. Hamill said.

"I think it's highly unlikely it will reopen as a Level II. We're focusing on a very effective Level III ... because it makes less demands on resources and people's time and it would be easier," he said.

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Washington County Hospital has run a trauma center for about 20 years. It's been classified as a Level II center since 1996, when the Maryland Institute for Emergency Medical Services Systems revamped its certification system.

The hospital shut down the trauma program on June 1, saying there were not enough surgeons to cover the shifts. Trauma surgeons have said that they were willing to keep working while they discussed issues of staffing and compensation.

Neither Hamill nor the doctors have been willing to discuss the details of their negotiations publicly.

Washington County Hospital has operated the only Level II trauma center outside the Baltimore-Washington metropolitan area, Hamill said. Most Level II centers are teaching hospitals that have the benefit of resident doctors to meet the rigorous staffing demands, he said.

"It's been kind of extraordinary that people have hung in there and tried to do this as best as we can," Hamill said.

Researching back several years, the hospital has been unable to find a trauma case that would have been significantly affected by having a surgeon on call rather than in-house, he said.

The Maryland Institute of Emergency Medical Services Systems does not have a preference about the level at which the Washington County trauma center operates, said Mary Beachley, director of the office of hospital programs.

"We would like them back, whether they're a Level II or a Level III," she said.

Many of the same standards apply to Level II and III trauma centers, she said.

According to the institute, other differences are:

-- A Level II requires a doctor with hospital privileges to be on duty in the intensive care unit at all times and a Level III does not.

-- A Level II requires an anesthesiologist to be in the hospital at all times while a Level III requires an on-call anesthesiologist with a certified registered nurse anesthetist.

But the biggest difference is the in-house trauma surgeon, she said.

Guidelines developed by the American College of Surgeons allow doctors 30 minutes to get to the hospital, Beachley said.

But when Maryland developed its new standards, it required Level II trauma centers to have a surgeon at the hospital 24 hours a day because of traffic concerns in the Baltimore-Washington area, Beachley said.

Hamill said he has been meeting with doctors and others involved in the trauma program to come up with a solution.

"I'm not satisfied with the progress to date but I think everybody's trying to work through the issues," Hamill said.

A meeting of the Trauma Center Task Force is set for Wednesday.

William J. Wright, who is on the hospital board of directors and the task force, said Monday that the hospital and its surgeons were doing everything possible to solve the problem.

"We all wish that there was a half-hour sitcom solution, but in life there isn't," he said. "We need to give Jim Hamill and those doctors time to work it out and I believe they're working as quickly as they can."

Wright said he believes the community can be well served by either a Level II or a Level III trauma center.

Lois Harrison, chairwoman of the hospital board of directors, said she was instructed to refer all questions to the hospital's public relations office.

Other board members could not be reached for comment Monday.

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