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Originally published Thursday, February 28, 2013 at 11:49 AM

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Chicago violence drives push for more trauma care

In a storefront office on Chicago's violence-plagued South Side, young activists meet in pursuit of a single goal: pressuring the University of Chicago Medical Center to reopen a trauma department it closed 25 years ago.

AP Medical Writer

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CHICAGO —

In a storefront office on Chicago's violence-plagued South Side, young activists meet in pursuit of a single goal: pressuring the University of Chicago Medical Center to reopen a trauma department it closed 25 years ago.

The trauma facility was shut down long before most of these college students were even born. But they and others believe restoring it will help save people wounded in the city's maelstrom of gun violence, many of them poor and black.

"This fight is very important to us," said one of the group's organizers, Veronica Morris-Moore. "If the issue were affecting white students at the university as much as people of color in the community, the university would put more effort into this."

Chicago's experience reflects a nationwide trend: An increasing number of U.S. hospitals have closed trauma departments for financial reasons, and impoverished minority communities are frequently the hardest hit. The issue touches a nerve in neighborhoods where other services are also unfairly distributed. But it's also complex, with no clear evidence that lives have been lost.

In Chicago, the young activists' cause is personal. Their friend Damian Turner was hit by a stray bullet in 2010 just blocks from the university and died in an ambulance on the way to a downtown trauma center 10 miles away. He was 18. The group has timed demonstrations to coincide with his birthday and date of death.

The group has met resistance from the University of Chicago hospital, and the evidence isn't clear that opening a trauma center on the South Side would save lives.

That's because Chicago's existing trauma system already does a good job of getting severely injured patients to one of six trauma centers within 30 minutes. Researchers in Chicago and elsewhere have not found a clear link between longer travel times and increased risk of death.

"The question of whether time matters in trauma is much more complicated than what it seems on the surface," said Portland, Ore., researcher Dr. Craig Newgard, lead author of a study of more than 3,600 trauma patients that found no significant link between travel time and death. "There's no magic number, and there's no magic distance."

Most injuries can be treated at any hospital emergency room, but the patients in greatest danger need hospitals with on-call surgeons, other specialists and ready operating rooms. The Centers for Disease Control and Prevention says Level 1 trauma centers - the nation's top level of trauma care - can lower the risk of death by 25 percent.

Experts also agree that not every hospital should be a Level 1 trauma center. Trauma teams perform better if they handle more cases. The American College of Surgeons says at least 1,200 cases a year is standard for the best care.

Plus, there's no agreement about the ideal distribution of trauma centers, and no federal or state requirements for where they should be located. That leaves economic forces to push trauma centers out of poor areas where patients can't pay because they lack adequate insurance.

Nationwide, 16 million Americans saw a 30-minute increase in driving time to the nearest trauma center from 2001 through 2007, according to one study. Poor and black communities, along with rural areas, were more likely to be affected.

But when trauma centers shut down, "it's not always clear that those closures result in worse outcomes, including risk of death," said lead author Dr. Renee Hsia of the University of California, San Francisco.

Still, advocates are lobbying Congress for federal money to prevent the U.S. trauma system from further unraveling.

"This has become an area of much controversy as we are having trauma centers go up where they are not needed and closing where they are desperately needed," said Jennifer Ward of the Trauma Center Association of America.

When the city's trauma care network started in 1986, there were nine trauma centers. Since then, four hospitals dropped their adult trauma departments or closed entirely, including two adult trauma centers on the city's South Side: the University of Chicago facility and the now-shuttered Michael Reese Hospital.

Lack of funding for expensive trauma programs is the most commonly cited reason for closures. Reese was said to be losing $3 million a year on trauma before it closed.

Chicago still has enough trauma centers for a city its size, but they're unevenly distributed - clustered on the North and West sides, leaving the far South Side and the southeast side underserved, said a doctor who helped set up Chicago's trauma network in 1986 and has watched it change.

"The number of trauma centers is right," said Dr. Gary Merlotti, chairman of surgery at Chicago's Mount Sinai Hospital, one of the hospitals in the system. "People need to understand that more trauma centers is not better. If you had too many, outcomes would actually deteriorate."

Unmistakably, the activists' argument carries emotional weight: With increasing gun violence on the South Side, they say, victims shouldn't have to travel by ambulance 30 minutes to reach top-level trauma care. They want a nearby trauma center.

With help from the Occupy Chicago Press Committee, a Facebook page and a rap video on YouTube, they're getting their message out. Most recently, Morris-Moore and other protesters, many of them black, staged a sit-in at the university medical center's new $700 million facility. Police arrested four of her fellow activists that day.

The group put out a fact sheet quoting a Chicago researcher, Dr. Marie Crandall of Northwestern University Feinberg School of Medicine, who has analyzed data specifically on Chicago gunshot victims and found transport times affect survival.

Last year, Crandall told two news organizations about her data. She told The Associated Press she can't talk about her findings until her paper is published in April.

"People are really grasping for this data because it can inform discussions about certain issues in the city," Crandall said, apologizing because the medical journal's publication policy prevents her from discussing her conclusions.

With more than 500 homicides in Chicago last year, many of them shooting deaths, the controversy seems sure to persist.

"Nothing is more tragic than loss of life," Crandall said. "Even when people survive gunshot wounds, the stress and damage take a toll. ... This is really a disease of young people, and it just cuts them down."

University of Chicago hospital officials say they're doing their part to address health care disparities on the South Side. And the hospital runs a children's trauma center that takes patients through age 15.

"Most of the South Side residents can get to a trauma center within 25 minutes, and it's well within the so-called golden hour" when time is critical, said Dr. Jeffrey Matthews, chairman of surgery at the University of Chicago Medical Center.

"I think we're a very easy target" for protests, Matthews said. But he added: "The closer one gets to providing the actual care, the more one realizes how complicated the issue is."

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