By Melissa Murphy/ MMurphy@TheReporter.com
Last fall's announcement by NorthBay Healthcare that it plans to open Solano County's first trauma center has launched a new front in the battle for local hospital market share.
That the battle lines are being drawn was made clear last week at a meeting of the Solano County Emergency Services Cooperative -- the agency that sets criteria for establishing trauma centers. Cooperative members were reviewing the application process for creating a trauma center in Solano County as a result of NorthBay's plans to open a Level III center at its Fairfield hospital. During the meeting, Kaiser Permanente officials confirmed that they had hand-delivered a letter of intent just days before, announcing their interest in establishing a Level II trauma center -- and placing it at their Vacaville hospital.
Level III trauma centers are equipped to provide comprehensive medical services to patients suffering from traumatic injuries. However, injured children and patients with major injuries or head trauma are sent to Level I or Level II centers.
The move by Kaiser came as a surprise to many. Back in September, when NorthBay announced its trauma center plans, its leaders said their plan was to establish a Level III center at NorthBay Medical Center in Fairfield, but to move it eventually to VacaValley Hospital in Vacaville, following an expansion. Once moved, it would become a Level II facility, they said.
In its letter, Kaiser insisted it is the appropriate provider to offer trauma care in the county and defended its plan to open a Level II facility.
"We have the resources, expertise and physical capabilities to put one in place, plus the experience of being the largest provider of emergency medical services in this community," wrote Max Villalobos, CEO of Kaiser Permanente Napa-Solano.
In Solano County, patients are currently sent to the Level II trauma center at John Muir Medical Center in Walnut Creek or to the Level I trauma center at the University of California, Davis, Medical Center in Sacramento.
The difference between Level II and Level I centers is that Level I centers are also teaching facilities.
Ted Selby, Solano County's Emergency Medical Services administrator, explained that while there isn't a limit on the number of Level III trauma centers a county can have, the number of Level II centers is based on population, among other strict guidelines. Right now, the county has the population to support only a single Level II trauma center.
NorthBay believes it should ultimately provide that Level II care in Solano County.
"It's a natural progression to move from a Level III to a Level II," said Steve Huddleston, vice president of public affairs for NorthBay Healthcare.
He explained that NorthBay Medical Center has already been ramping up services which parallel the needs for a trauma center.
"It's the logical step," he said, adding that VacaValley Hospital needs an expansion anyway for logistical reasons.
Kaiser's announcement that it will seek a Level II trauma center in Vacaville came as such a shock.
"We're surprised," Huddleston said. "There seems to be a leapfrog (over) Level III. We're also surprised they want it in Vacaville and not Vallejo."
Selby agreed that NorthBay has made its plans clear for years.
"NorthBay's interest in taking on a trauma center has never been a secret," he said. "They've been open and upfront about their intentions."
Villalobos, who led the effort to establish Kaiser Permanente's first trauma center in the country in south Sacramento, countered that it is his understanding that Kaiser also has been interested in establishing a trauma center in Solano County for at least 10 years.
He added that before any designation is made, Kaiser believes Solano County Emergency Medical Services should conduct a complete, comprehensive study to assess the need for a trauma center in the county.
"We don't have a full understanding of the needs," Villalobos said, adding that there isn't updated information to show where most trauma cases are centered in Solano County.
Selby agreed that a new study would need to be done for a Level II facility, but disagreed that such a study would be needed for a Level III facility.
Huddleston contends that an updated look at the numbers in 2009 showed the county can more than handle a Level III center.
The county's own figures show that 309 trauma transports were sent out of the county in 2008, and that number increased to 376 in 2009.
Kaiser contends the figures should be re-examined.
"We're not sure it's accurate," Villalobos said. "There is no question that trauma care is needed, but we need to know where and how many."
However, Selby said, the state's Emergency Medical Services Authority confirmed that there is enough volume to warrant a Level III trauma center and there is no limit on the number of Level III centers a county can have.
"We believe that the local level of government is doing the right thing by moving forward with establishing an application process," Selby said.
And that was the action taken at last week's meeting. The Cooperative board voted 5-1 to approve the application process for hospitals to have a Level III trauma center in Solano County.
The lone dissenting vote came from Registered Nurse Erika Bauer -- Kaiser Permanente's representative to the board.
