Some hospitals are prepared to handle the most complex types of trauma cases 24 hours a day, seven days a week. Others have varying degrees of ability to handle trauma patients. Texas law allows the Department of State Health Services to designate hospitals in four categories (Level I–IV) based on their trauma capability.
Many hospitals seek the highest trauma designation possible because Texas law requires ambulances in emergency medical service (EMS) personnel to transport trauma patients to recognize trauma centers. This is a lucrative business source for designated hospitals.
Level I Comprehensive Trauma Centers
Texas Administrative Code Section 157.125 links Level I trauma designation requirements to the current essential criteria defined by the American College of Surgeons.
Thus, Texas hospitals seeking Level I trauma designation must meet standards including:
• 24 hours a day, seven days a week in-house coverage by general surgeons.
• Prompt availability of care in surgical and other medical specialties including orthopedics, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial surgery, pediatric, and critical care medicine.
• The hospital must be a referral source for nearby community hospitals.
• The hospital must provide continuing medical, nursing, and other education of the members of the trauma team.
• The hospital must operate teaching and research efforts to generate innovations in providing trauma care.
• The hospital must have a certain volume of severely injured from a patient on an annual basis.
In the entire State of Texas, there are currently 18 Level I comprehensive trauma centers:
• Baylor Scott & White Medical Center – Temple (Temple)
• Baylor University Medical Center (Dallas)
• Children's Medical Center of Dallas (Dallas)
• Dell Children’s Medical Center (Austin)
• Dell Seton Medical Center at The University of Texas (Austin)
• Harris Health System Ben Taub Hospital (Houston)
• John Peter Smith Hospital (Fort Worth)
• Medical City Plano (Plano)
• Memorial Hermann - Texas Medical Center (Houston)
• Methodist Dallas Medical Center (Dallas)
• Parkland Memorial Hospital (Dallas)
• San Antonio Military Medical Center (Fort Sam Houston/ San Antonio)
• Texas Children’s Hospital (Houston)
• University Hospital (San Antonio)
• University Medical Center (Lubbock)
• University Medical Center of El Paso (El Paso)
• University of Texas Medical Branch (Galveston)
• UT Health East Texas Tyler Regional Hospital (Tyler)
The other trauma centers
Texas also has designated 23 Level II Major Trauma Centers, 58 Level III Advanced Trauma Centers, and 192 Level IV Basic Trauma Centers.
Trauma standard of care
If a person is involved in a horrific motor vehicle collision or other accident, the ambulance will go to the nearest trauma center with appropriate capabilities to take care the patient.
As the Texas naming convention suggests, the standard of care requires Level I trauma facilities to have comprehensive trauma capabilities, Level II trauma facilities to have major trauma capabilities, Level III, centers to have advanced capabilities, and Level IV trauma facilities to have basic capabilities. Hospitals with no trauma designation, it follows, have even less than the basic capabilities.
In other words, a Level I trauma center is required to follow a higher standard of care than a lower-designated trauma center or hospital with no trauma designation at all.
Trauma medical malpractice
We’re currently working on a medical malpractice case involving a Level I trauma hospital in the Dallas Fort Worth area. This case is an example of a system failure in a hospital that’s required to perform at a high-level in trauma cases but didn’t even meet the most basic standard of care that’s expected of any hospital.
The story begins with a man in his 50s who was involved in a high-speed motor vehicle collision. Fortunately, he was able to get out of the car, but a short time later his legs gave out and he head-planted into the grass.
Someone called 911 and an ambulance showed up at the scene. The emergency medical service (EMS) providers documented the 65-mph wreck, how the patient fell and hit his head in the grass, and that he was behaving incoherently.
EMS followed their protocol and transported him by ambulance to the nearest Level I trauma center. The patient had severe pain from multiple broken ribs, a lacerated spleen, lacerated liver, and abdominal bleeding.
When the patient arrived at the emergency department of the Level I trauma hospital, the nursing staff noted that he was not in a c-collar, which is a protective device that immobilizes and protects the cervical spine and neck. Two minutes after arrival, the nursing staff documented in the medical record that a physician assistant had cleared the patient’s cervical spine.
An emergency physician ordered diagnostic radiology imaging of the head, thoracic spine, and lumbar spine. Conspicuously missing from the orders, though, was a CT scan of the cervical spine and neck. The emergency room nursing staff, trauma surgeon, and physician assistants didn’t speak up and recommend or order a cervical spine radiologic workup.
As a result, the ER, trauma, anesthesia, and operating room teams ignored the patient’s neck and prepared him for surgery to address his serious abdominal injuries.
I’ll fast-forward. After surgery, the patient emerged from anesthesia with diminished sensation and motor function in his lower extremities. The intensive care unit (ICU) night shift nurse didn’t report these findings to any doctor, but instead kept her attention on any potential complications from the abdominal injuries.
By the time the morning shift nurse arrived in the ICU, the patient’s status had worsened, with sensory and motor deficits spreading to the upper extremities. The morning shift nurse applied a c-collar to immobilize and protect the patient’s cervical spine and notify the physician.
Unfortunately, the trauma surgery and spine surgery teams continued the disappointing bungling that’s shocking for a hospital with a Level I comprehensive trauma designation. Spine surgery was delayed another day, by which time it was too late, leaving the patient with permanent paralysis.
If you’ve been seriously injured because of poor hospital or trauma care in Texas, then contact an experienced, top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.