WISE — Ballad Health officials tried last week to assure county supervisors that the health system’s proposal to restructure trauma care will not cause harm to Southwest Virginia emergency patients.
Holston Valley Medical Center in Kingsport and Johnson City Medical Center hold Tennessee’s highest rating as Level I trauma centers, while Bristol Regional Medical Center is a Level II trauma center.
Ballad proposes reducing Holston Valley and Bristol to the lowest rating, Level III trauma.
The change will save money, eliminate duplication and allow Ballad to make big improvements to pediatric trauma care, without increasing danger for emergency patients, officials said.
But opponents told county supervisors that some local emergency patients are likely to suffer because of longer travel times.
Also, a retired local emergency room surgeon raised concern that downgrading two facilities’ trauma ratings would open the door for Ballad to eliminate all sorts of non-trauma care as well.
Coming first at supervisors’ Dec. 13 meeting was Norton Community Hospital chief executive Mark Leonard, who reminded supervisors that Ballad Health has continued to sustain smaller hospitals in the region that struggle financially.
This year alone, Ballad has invested almost $2.2 million in Wise County and Norton, he noted, adding a variety of testing equipment, adding patient beds and currently renovating a long-term care unit.
Ballad Senior Vice President Eric Deaton explained that about three weeks earlier, the health system unveiled its plan to integrate trauma care, with Johnson City remaining at Level I while the Kingsport and Bristol facilities change to Level III. Also, a new pediatric trauma center will be built at Niswonger Children’s Hospital in Johnson City and new pediatric emergency rooms and specialties will be established at Bristol and Holston Valley.
Further, Ballad intends to establish a new emergency call center that will coordinate the region’s emergency medical service communications, Deaton said.
Treatment of heart attacks and stroke care will continue to be handled as they are now, he noted, adding that the major trauma cases, only 10 percent of all cases, will go to Johnson City.
All three facilities will offer cardiothoracic, neurologic, obstetrics-gynecology, orthopedic and general surgery, Deaton said.
Last year, about 40 Wise County trauma patients came to Johnson City, he noted, but planned upgrades at Kingsport mean some of those patients could go there instead.
Ballad plans to develop a regional EMS steering committee, including Tennessee, Virginia and local rescue unit representatives, whose tasks will include addressing any concerns about transport times, Deaton said.
Another planned change affects helicopter transport. Ballad now works with two private providers and Virginia State Police, but intends to consolidate the private services under one company.
These changes in trauma care and related services will be worked out over 10 to 12 months, Deaton said.
District One Supervisor Fred Luntsford, who is also Appalachia’s town manager, said local EMS personnel are concerned.
Under Virginia’s trauma assessment guidelines, he explained, some patients must be taken to a Level II or Level I center. A lot of local folks will end up being transported to Johnson City although Kingsport is closer and more centralized to the Ballad service area, Luntsford said.
Deaton said Ballad would be meeting with Virginia EMS officials the following day.
The proposed changes are already part of the certificate of public advantage that state government approved for the Ballad merger, he noted.
Johnson City was chosen to remain Level I because it is one of Tennessee’s certified “safety net” hospitals in times of disaster and because it will be physically closest to the Niswonger pediatric trauma center, Deaton explained.
Luntsford expressed concern that the changes will put an additional burden on EMS providers to make decisions about where to take a patient.
Johnson City Medical Center trauma surgeon Dr. Bracken Burns said the answer, in part, is that Ballad will provide EMS personnel with a better system overall, better resources and additional education.
Kingsport resident Tim Bradshaw said he has previously lived in Wise and Scott counties and has been involved with emergency services for many years.
Just because the proposed trauma changes are already covered in the certificate of public advantage doesn’t mean it can’t change, he said: If some aspect of Ballad operations becomes a public disadvantage, Virginia and Tennessee authorities can step in.
Bradshaw urged supervisors to pass a resolution opposing the changes.
Dr. Mickey Spivey, a retired Kingsport emergency physician, said he supports the pediatric upgrade plans, but he believes downgrading Bristol and Kingsport’s trauma ratings would be dangerous.
Because of rural distances, rugged terrain and bad weather, it’s very difficult to get a lot of the region’s emergency patients to a proper facility fast enough to avoid lost-time complications, he said.
Meanwhile, almost two-thirds of Ballad’s service area is closer to Holston Valley than Johnson City, Spivey added.
Further, Level I and II trauma centers are required to maintain a lot of non-trauma specialties that might be lost, he said.
Level I requires 28 specialties on call 24/7, 11 of which are medical, Spivey said. Level II requires 24 specialties, also with 11 that are medical. Level III only requires four specialties, he said.
Shedding several of those specialty providers would reduce Ballad’s costs but increase the patient’s costs, Spivey explained.
He echoed Luntsford’s concern about the occasional requirement to transport certain patients to a Level I or II facility.
Along with more trauma cases going to Johnson City, next-day follow-up visits will increasingly go there as well, Spivey predicted.
Eliminating duplicated services to cut costs is great in business, but it’s lousy in emergency medical services, he said.
A trauma center is a commitment to save lives, Spivey said, suggesting that local government tell Ballad to operate Holston Valley and Bristol as Level II facilities instead of Level III.
Doing that will make Ballad’s proposal work, he said.
Gregory Woods, executive director of the Southwest Virginia EMS Council, said that group which serves 16 localities recommends for now that EMS agencies stick with the council’s existing triage/transport guidelines. Meanwhile, the council is developing a needs assessment tool for EMS providers, hospitals and other providers, he said.
The council’s trauma triage guidelines recognize levels I and II as the highest trauma criteria, Woods said. In the plan, rollover crashes require transport to a trauma center, but it doesn’t have to be the highest level available. Patients with an uncontrolled airway, bleeding or active cardiopulmonary resuscitation go to the nearest hospital.
The council studied a year’s worth of transports to the region’s three trauma centers, Woods noted. Out of 7,915 calls, 1,083 involved injuries. Of those, 160 required trauma care.
Wise County sent 70 patients to a trauma center, with 14 of those being injury calls. Six patients required trauma care: Three transported by Appalachia fire/rescue, one by Big Stone Gap rescue and two by Wise rescue, Woods said. They were all taken to Holston Valley.
If more Wise County patients go to Johnson City, it will add an estimated 276 miles per year to EMS travel and add nearly 400 minutes of time out of service while returning here, Woods noted.