Cleveland Clinic’s decision to open a trauma center on its main campus would be “reckless,” MetroHealth’s CEO wrote in a letter to the leader of the Cleveland Clinic earlier this week.
The move risks harming patients, and the Clinic should have included the community in the decision, wrote Dr. Christine Alexander-Rager to Cleveland Clinic CEO Dr. Tomislav Mihaljevic on Feb. 2.
“It is deeply concerning that this announcement appears to have been made without regional planning, stakeholder consultation or a demonstrated community need,” she wrote.
In mid-January, the Cleveland Clinic announced its plans to open a Level 1 trauma center for kids and adults at its main campus. Doing so would allow the hospital to treat severely injured patients, like those injured in car crashes or with traumatic brain injuries or gunshot wounds. First, the hospital must have surgeons and doctors qualified to handle a range of traumas working at all times.
The news immediately raised alarms at MetroHealth, the county’s public hospital, which runs its own adult and pediatric trauma centers across town. The hospital said the addition would harm patient outcomes and increase costs, adding that the area could not sustain another Level 1 trauma center.
The Clinic’s would be the third Level I trauma center within Cleveland city limits. In addition to MetroHealth, University Hospitals runs a Level 1 pediatric and adult trauma center in Cleveland, about a mile down the road from the Clinic’s main campus. Cleveland Clinic’s Fairview hospital, on the city’s far West Side, is a Level 2 trauma center, which can typically treat the same level of injury but doesn’t do research.
Alexander-Rager wrote that the city’s current trauma system successfully meets the community’s needs. Before the Clinic proceeds, she wrote that it should meet with trauma stakeholders, EMS leadership and community groups – and undergo a “transparent, data-driven assessment of community need.”
The Cleveland Clinic did not provide a comment on Alexander-Rager’s letter. But in their January release announcing the plans, the hospital wrote that it had observed a need for trauma care in their health system. Currently, trauma patients at the Clinic’s main campus have to be transferred to other hospitals.
“We know that reducing the risks associated with transfers outside of a health system supports safer treatment for patients in critical condition,” said Dr. Miguel Regueiro, who will be one of the leaders of the center.
The State of Ohio does not require hospitals to complete a needs assessment to become a trauma center. Instead, the American College of Surgeons, a national nonprofit, verifies or denies hospitals trauma status by reviewing their capabilities. The Cleveland Clinic said it hopes to open the trauma center by 2028.
Concerns around endangering patients, raising costs, poaching staff
In the letter, Alexander-Rager wrote that when fewer patients come into a trauma center, it’s harder for the surgeons, neurosurgeons, emergency physicians and nurses to keep their skills sharp.
Studies show higher-volume trauma centers achieve better survival rates, she wrote. She cited a study showing that increasing patient volume at trauma centers is associated with fewer deaths than expected, while losing volume is associated with more.
Alexander-Rager added that the cost of maintaining a trauma center – which includes an on-call, specialized workforce – is substantial. Spending dollars on a new trauma center would “divert resources from other pressing community health needs where our combined efforts could have a far greater impact,” she wrote.
She also added a third fear: losing staff at MetroHealth. She said the Clinic is already engaging in “aggressive recruitment efforts” throughout the community’s trauma systems.
“Evidence clearly suggests that trauma-system performance is deeply tied to volume and staff consistency,” she wrote. “By fragmenting our region’s existing talent pool, the Cleveland Clinic is needlessly diluting clinical expertise.”