High Point Medical Center

The high costs associated with operating a trauma center were deemed unnecessary by hospital managers because there are two trauma centers that offered a higher level of services within 20 miles.

Editor’s note: This is the final installment of a three-part series.

HIGH POINT — Dayne and Gina Weathers don’t know whether their 17-year-old son, Griffin, would have survived if the ambulance drove the extra 12 minutes it would have taken to get him to Wake Forest Baptist Medical Center’s trauma unit instead of High Point Medical Center after he was shot in April 2018.

They don’t fault the people who made the decision or the doctors and nurses who treated him — they were doing their jobs.

But they are confused why a hospital in a town with a high level of gun violence doesn’t have a trauma center anymore.

“Who is it that makes that decision?” Dayne Weathers said. “Someone needs to address that.”

In North Carolina, there are 17 hospitals with trauma center designations. Of the state’s 15 most populous cities, High Point, the ninth largest, is the only one without a trauma center.

Formerly known as High Point Regional, the hospital had a trauma designation as recently as 2014.

After the hospital reported losses of nearly $12.2 million in five years, according to tax documents filed with the IRS, and with the facility in need of several improvements, the board of directors opted in 2014 to sell High Point Medical Center to UNC Health.

To try to stave off further losses, the leadership at UNC began slashing programs and budgets to stabilize the hospital’s finances, according to former employees of the hospital who requested anonymity due to stipulations in their severance agreements. Part of those cuts included the hospital’s Level III trauma center.

Alan Wolf, a spokesperson for UNC Health, explained the decision.

“The trauma designation was allowed to lapse for several reasons, including the cost of operating a Level 3 trauma center relative to the trauma volumes that were seen in the emergency department,” Wolf wrote in an email. “Mostly, it was a duplicative service when there are two other trauma centers that offer higher level services within 20 miles of High Point Regional, including one in the same county.”

There are three levels of trauma centers in North Carolina: Level I, Level II and Level III — with Level I being the best. Just over half of the trauma centers in North Carolina carry the Level III designation, which can provide all of the services that a Level I or Level II center can, except for neurosurgical procedures. Additionally, surgeons at Level III hospitals might not be in the building 24/7, but one is always on call.

“High Point Regional continued to offer all the clinical services required of a Level 3 trauma center, including a 24/7 emergency department, orthopedics, general surgery and anesthesia,” Wolf wrote. “The cost savings associated with restructuring the program were administrative expenses. That included the elimination of a trauma program coordinator and the medical directorship.”

Jeffrey Miller, 71, who served as president of High Point Medical Center for 26 years before retiring in 2014, said that maintaining a trauma designation is a “very complicated and expensive thing that the big hospitals do.”

“We couldn’t justify our size having a 24-hour, seven-day-a-week trauma surgeon on duty, for example,” he said.

Additionally, Miller said the designation placed a strain on hospital staff, as they were required to track certain statistics about patient outcomes and types of injuries to maintain their Level III status.

Physicians and surgeons also had to either be in the hospital or on call 24/7, and the hospital couldn’t afford the extra salary.

Before cutting the program, the staff had been unable to hire a medical director to run the trauma center. The hospital couldn’t afford to pay that person for the additional work, according to former hospital employees.

Trauma centers have been closing across the United States for decades, according to a 2011 article published in Health Affairs. In 1990, there were at least 1,125 trauma centers in the United States. By 2005, 339 of those centers had closed, and now there are at least 535 trauma centers recognized by the American College of Surgeons.

Most trauma centers close because of how expensive they are to run, and the inability of patients to pay their bills after care. One family interviewed for this story said they were billed more than $100,000 for the care their child received after being shot and killed in High Point.

In the fall of 2017, Wake Forest Baptist Health, the owner of Baptist Medical Center in Winston-Salem, signed a letter of intent to purchase High Point Regional from UNC. The acquisition became final in September 2018, with Wake administrators publicly lauding the merger because it would provide better care for seriously injured patients.

Dr. Kevin P. High, president of the Baptist Health system, said in a press release at the time that buying High Point Regional would help “better deliver the right care at the right place.”

Dr. Jim Hoekstra, the president of High Point Medical Center, said in a prepared statement the hospital is an “active, appropriate participant in a vibrant trauma system.”

“The High Point Medical Center emergency department providers are experts at stabilizing trauma patients who need immediate care, and then transferring them to a trauma center for more definitive care,” Hoekstra said. “Trauma center designation is not as important as the quality of care provided locally at High Point Medical Center for trauma victims. We believe that being part of a trauma system of care ... assures the best care for trauma patients from the High Point region.”

Hoekstra said that restoring a trauma center would not be a financial decision, but rather would be based on the hospital’s “clinical capabilities and what is best for the care of our trauma patients.”

Lee Sanderlin is an investigative reporting fellow at the Columbia University School of Journalism’s Stabile Center for Investigative Journalism. He previously worked as a reporter for The Enterprise.

Lee Sanderlin is an investigative reporting fellow at the Columbia University School of Journalism’s Stabile Center for Investigative Journalism. He previously worked as a reporter for The Enterprise.