The University of Toledo Medical Center is seeking to downgrade from a Level 1 trauma center, a designation that has equipped it to handle the most severe cases from trauma patients for nearly 30 years.
Daniel Barbee, the hospital’s CEO, justified the decision in a news release Thursday as “a response to the changing health care needs of the Toledo region.”
He added that UTMC, the former Medical College of Ohio hospital, is gravitating toward a transition into a community hospital. But the center will also remain a teaching hospital, he said.
“We’re constantly evolving to meet the needs of our community,” Mr. Barbee told The Blade on Thursday. “I think the timing of this move is just right. Toledo needs primary care. The city’s population is 280,000 and we have three Level 1 centers. Columbus has 900,000 people and they have only two. Cincinnati has only one.”
J. Adam Maguire, a spokesman for AFSCME Ohio Council 8, a UTMC union, slammed the decision, calling it a “bad move” for patients who need immediate care in the surrounding area.
“It doesn’t only hurt our members that work in that hospital, it hurts the community and the people that receive those services,” Mr. Maguire said. “This is a bad move for the community. This is something we were concerned about; we’ve been voicing our concerns for a long time now, and it’s clear that the relationship that the University of Toledo has with ProMedica is a better relationship than the University of Toledo [Medical Center] in South Toledo.”
“If somebody was in a severe car accident in this area, they wouldn’t go to UTMC anymore, they would actually have to go to Mercy [Health St. Vincent] or [ProMedica] Toledo [Hospital],” he added of the potential downgrade.
Mr. Barbee wouldn’t say whether the hospital was pressured by the American College of Surgeons to downgrade, but said the number of major trauma patients UTMC receives yearly doesn’t warrant a demand for the center to remain Level 1.
“You have to have 1,200 traumas per year to keep a Level 1 and we’ve been on the bubble for years,” he said. “The majority of major traumas go to other hospitals.”
According to the American Trauma Society, a Level 3 center is described as having “demonstrated an ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.” Level 3 centers have “24-hour immediate coverage by emergency medicine physicians,” but aren’t required to have 24-hour in-house coverage from general surgeons like a Level 1 does. A Level 3 center does require “the prompt availability of general surgeons and anesthesiologists.”
Level 1 centers, however, provide “prompt availability” of specialists in areas such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric, and critical care, according to the organization’s website. Level 3 only requires prompt availability of general surgeons and anesthesiologists.
There are also Level 2 trauma centers in the United States. Mr. Barbee said the decision to opt for a Level 3 instead of a Level 2 was a “financial” one.
“We talked about it,” he said when asked about a Level 2 designation. “The only difference between a Level 1 and a Level 2 is volume. The reason is a financial decision. We feel the decision to move to a Level 3 is cost-effective and will allow us to provide needed primary care to our community.”
The move could bring an uptick in trauma treatment for the remaining two Level 1 centers in Toledo, should UTMC’s application to downgrade be approved. But Dr. John Leskovan, the Trauma Medical Director of Mercy Health, said he doesn’t think the two hospitals would become over-saturated with patients.
“We’re ready and capable to accept trauma patients,” he said. “Mercy Health has dedicated a lot of resources and we’ve always had a plan for an influx of patients.”
Dr. Leskovan also said he isn’t concerned about a trauma patient in the vicinity of UTMC needing immediate attention as a problem.
“All patients that need to be stabilized should be taken there,” he said adding that they would then be transferred to a Level 1 as is the case from a “rural facility.”
In 2017, University of Toledo President Sharon Gaber announced in a video that UTMC was keeping its doors open and would remain a teaching hospital despite speculation to the contrary.
Mr. Maguire said Thursday the union feels like they were misled by Ms. Gaber.
“At that point in time, Sharon Gaber, who had not issued a response to the union, had issued a public response on a YouTube video stating that the hospital was not going to close and basically claiming the union was crying wolf,” he said.
Mr. Maguire added: “Well now we know two years later, in fact, what we were talking about in 2017, is the case. ... Their intentions were to remove services from UTMC and that hurts the community.”
Mr. Barbee disagrees, insisting that the hospital has been upfront about where it was headed for years.
“We’re doing exactly what we said we were going to do,” he said. “I think we have a wonderful relationship with the union and I appreciate the fact that change can be frightening. But, we’ve been very transparent. I notified the union before I notified my employees about the decision. I felt I owed it to them.”
A spokesman for the American College of Surgeons declined to comment on specifics of the UTMC proposal to downgrade to Level 3, writing in a statement, “we’re not able to share information about a specific trauma center’s verification,” adding that “it is up to the trauma center to share that information.”
Toledo currently has three Level 1 medical centers: Mercy Health St. Vincent Medical Center near downtown Toledo, ProMedica Toledo Hospital in West Toledo, and UTMC.
UTMC has been a Level 1 center since 1992. No timeline for when it could transition to a Level 3 was provided.
First Published August 1, 2019, 4:37 p.m.
