Taking children to the wrong trauma center can be a deadly mistake gasco abu dhabi address

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Well-intentioned paramedics started taking severely injured children to some of these new centers, which could do little to treat them. Local EMS officials and state regulators failed to monitor the impact of these new adult trauma centers on children.

• At least three children died after they were first taken to an HCA trauma center for adults despite meeting state criteria to go to a pediatric center. Those children then had to be transferred to get the care they needed. Their injuries may have proven fatal regardless of where they went. But in each case, time would have been saved if the child had been taken directly to a pediatric trauma center.

• The cost can be high, even for children with relatively minor injuries. HCA charged as much as $33,000 last year to patients just for showing up at their trauma centers, even if they can’t be treated and are shipped to another hospital within minutes.

Florida has designated 13 hospitals as pediatric trauma centers. Most of these centers treat adults too, but are required by the state to have surgeons experienced at operating on an infant’s brain or repairing a 5-year-old’s fractured pelvis.

The increase has come largely in three counties — Marion, Clay and Pasco — with new HCA centers, none of which have a pediatric trauma designation. Those centers benefited from the new business; they can charge tens of thousands of dollars in trauma activation fees to each patient.

Local officials welcomed the new centers because they gave residents faster access to trauma care and saved paramedics time. They also saved departments money on overtime pay and vehicle wear-and-tear from driving patients out of the county.

"In each of the 19 incidents where pediatric patients were transported to Ocala Regional Medical Center there are documented reasons for doing so, which abide by policies established by all counties in the North Central Florida Trauma Agency and are supported by the medical community," Marion County Fire Rescue spokeswoman Jessica Greene said.

The Marion County numbers are a stark contrast to those in Polk County to the south. Polk County is home to an adult trauma center, nonprofit Lakeland Regional Medical Center. It takes about as long to get to the nearest pediatric center — in Tampa — as it does in Marion County.

"In trauma, we talk about the ‘golden hour’ during which potentially fatal injuries can be reversed," said Dr. Barbara Gaines, director of pediatric surgery at the Children’s Hospital of Pittsburgh. "If you have a traumatic brain injury, the sooner the patient can get to some place that’s comfortable treating them, whether with a surgical procedure or intensive medical therapy, you assume the outcomes will be better."

Four veteran paramedics who reviewed Kayne’s EMS report questioned why rescuers who spent 15 minutes on the scene waited for a response from Ocala Regional. Most of them believed the boy should have been taken directly to Gainesville and that Ocala Regional erred in not redirecting them there.

"If Ocala did not have the ability to do immediate surgery, they should have directed paramedics straight to Shands," said Guy Haskell, a veteran paramedic and expert witness in Indiana who also is editor of EMS continuing education for Gannett Healthcare.

A Times review of state hospital data from 2010 through 2013 shows that young trauma patients spent an average of two hours — and in a few cases as long as five — at HCA’s new trauma centers before being transferred for treatment. That doesn’t include the time it took to drive or fly patients to two facilities.

Among the children whose treatment was delayed was a 6-year-old with an open head wound who spent more than three hours at Ocala Regional and a 5-year-old with a concussion who spent more than two hours at Lawnwood Regional Medical Center in Fort Pierce. Both children had to be transferred to have their injuries treated.

Topping the list was Regional Medical Center Bayonet Point in Hudson, whose five child trauma patients last year were charged an average of $60,000 each. One died. Two were sent home shortly after. Two were transferred to other hospitals within hours.

One big component of the HCA bill is the for-profit hospital chain’s trauma response fee, the price of activating a team of specialists to await a patient’s arrival. HCA’s response fees, levied on top of the cost of every medical procedure, are the highest in the state. Over the past four years, an average fee of $27,700 was tacked on to the bills of nearly 60 children who had to be transferred elsewhere for treatment.

But the vast majority of children who had CT scans at HCA trauma centers in Florida were not operated on by HCA surgeons, state data show. Most had to be sent elsewhere for treatment. Among the dozens of children scanned but never admitted to the hospital was a 1-year-old boy with a fractured femur who could not be treated at Lawnwood Regional. During his two-hour stay, the hospital gave him five CT scans and a $70,000 bill.

"The minute you recognize the child’s needs exceed your capability and capacity, you should be packaging that kid and putting him in an ambulance," said Dr. R. Todd Maxson, trauma medical director for Arkansas Children’s Hospital. "No other tests are required unless you are going to act on the data provided."

Patrick Shepler, a retired Clearwater Fire Rescue lieutenant who has taught paramedic courses at St. Petersburg College, reviewed Justin’s EMS report. He commended rescuers for spending less than six minutes on the scene before departing. But he thinks they headed in the wrong direction.

Times computer-assisted reporting specialist Connie Humburg and Times researcher Caryn Baird contributed to this report. Contact Kris Hundley at [email protected] or (727) 892-2996. Contact Alexandra Zayas at [email protected] or (727) 893-8413.