The Cleveland Clinic’s decision to open a new trauma center at its main campus was driven by the belief its world-renowned hospital should be treating patients — not transferring them to nearby hospitals.
The hospital provided its most detailed rationale for adding a Level I trauma center in a recent response to a series of questions that state Democratic lawmakers sent in March. The letter strongly rebuts an argument that MetroHealth’s CEO made earlier this year, which contended that adding another trauma center in town could endanger patients by diluting the volume of injuries trauma teams see and therefore their skills.
“Suggestions that Cleveland Clinic would pursue any course of action that could jeopardize patient lives are unfounded, misleading, and dishonest,” the hospital wrote in the letter.
The new trauma center is instead part of a strategy to create faster access to healthcare, especially for the neighborhoods around the hospital’s main campus, it said.
The Cleveland Clinic did not, however, commit to a formal assessment of whether more trauma care is needed in the region, as lawmakers had asked.
“Our focus is meeting the tangible needs of patients who come to us for care rather than estimated needs in a business assessment,” the hospital wrote in its statement.
The Clinic said that the need is apparent because of how many people arrive at its doors seeking trauma care but have to be transferred to other hospitals — about 600 annually. The Clinic can’t treat them in its health system due to Ohio laws, which require a high-level trauma designation for certain injured patients. Last year, more than 100 of the Clinic’s own employees and their family members had to seek care elsewhere because the hospital didn’t have the right trauma center.
The hospital also said it alone didn’t determine the need for more trauma resources: the Jack, Joseph and Morton Mandel Supporting Foundation recognized it, too. The philanthropy recently gave a multimillion-dollar gift to the Clinic, of which $30 million will go toward supporting emergency and trauma care on its main campus.
The Clinic’s response didn’t satisfy all lawmakers’ questions. Ohio Sen. Nickie Antonio, who signed the letter, said she would still like to see more data: For example, the Clinic said that traumas were rising but not by how much. Rep. Darnell Brewer, who also signed it, wrote that the hospital’s response raises more questions than it answers.
“If the Clinic intends to claim a regional need, then regional data — not internal inconvenience — must be provided,” he wrote.
Lawmaker hopes to see more coordination between hospitals
Antonio’s major takeaway from the Clinic’s response is that the city’s three major hospital systems – the Clinic, MetroHealth and University Hospitals – need to sit down and work out a plan to coordinate trauma care. That could include detailing which hospitals cover which service areas.
“The missing step is, frankly, breaking out the geography in the area and getting some agreements across all the entities,” Antonio said.
The Clinic wrote in the letter that it has discussed its trauma plans with the Northern Ohio Trauma System (NOTS), which coordinates trauma care in the region, and its members, which include University Hospitals and MetroHealth. But it’s limited in how far those conversations can go.
“While Cleveland Clinic will work through NOTS to ensure the best outcomes for our communities’ injured patients, discussion of what service lines a hospital should offer – whether with NOTS or directly with other member hospitals – is not appropriate based on antitrust principles,” the letter wrote.
Antonio said she’s not familiar with antitrust laws surrounding how hospitals work together. But she said hospitals have worked together in the past to coordinate things like response to the opioid crisis or Medicaid expansion.
“To be in the room with each other is not impossible,” she said.
Hospital transfers, continuous care central to Clinic’s argument in need for new trauma center
The hospital has already said that the number one concern they wish to address with the new trauma center is limiting transfers outside of its system. Cleveland Clinic has “significant expertise” in caring for patients who are severely injured but instead has to send them to other hospitals.
Trauma patients are transferred between hospitals for a couple of reasons. For one, if they are driven to an emergency department without a trauma center designation — like the Cleveland Clinic’s main campus — the hospital must transfer them to a trauma center. Patients sometimes also have to be transferred when they first go to a lower-level trauma center — like the Level II trauma centers the Clinic runs at Fairview and Hillcrest hospitals — but need higher-level care.
Adding a Level I trauma center at the Cleveland Clinic’s main campus would decrease the risk of infection and delayed care that comes with transfers, the letter said. It could also improve the continuity of care for Cleveland Clinic patients that come to them for trauma care, the letter added.
“Given the medical complexity of many of the patients we treat, having immediate access to their medical record while providing trauma care may be critical to inform their treatment,” the letter read.
Brewer was skeptical that transferring patients amounted to the need for a new trauma center. He asked for data showing that transfers in the region result in increased mortality or delays in care.
The hospital added that it has the expertise to provide high-quality specialized care when a person is recovering from their injury.
“Outcomes for these patients will be better if we can offer continuity of care, treating them from trauma through their follow-up specialty treatment,” the letter read.
That’s especially true for neurological care, for which the Clinic is opening a new institute next year. Between 30% and 50% of trauma cases involve injuries to the brain, spine or nerves, the hospital wrote, so trauma care often requires immediate and ongoing neurological care.
“This facility – one of the most advanced in the world – will provide patients with the best neurological care possible,” the hospital wrote.
How the Clinic will build its workforce
Lawmakers asked the Clinic how they would recruit staff for the trauma center without “destabilizing” existing hospitals. MetroHealth has spoken publicly about its fear that trauma staff would be poached from its hospital.
The Clinic said it anticipates attracting top talent from across the nation and does not intend to proactively recruit from other local hospitals to fill its positions.
“As an example, we are actively recruiting for our Level 2 center in Canton and have attracted candidates from all over the country and even globally,” the hospital wrote.
The Cleveland Clinic also said it would develop its own medical education program to train residents in trauma and surgical critical care, further enhancing the pool of trauma-trained physicians in the region.
