Time to play some catch up on the trauma care front. Yesterday, the Tampa Bay Times released its latest salvo — I mean article — in its series that purports to be about trauma care. But it was really another part of its witch-hunt against one of Florida’s largest employers and health care providers – HCA. The article is singularly focused on undermining the research of Dr. Darwin Ang, an expert on trauma research at the University of South Florida College of Public Health who authored a study demonstrating that HCA is outperforming other trauma centers across the state.
My point of view on this whole debate is straightforward enough: let’s tell the whole story and then let the chips fall where they may.
One of the newspaper’s first challenges to Dr. Ang’s research is that “it’s impossible to independently verify the claims” since it’s not yet published. Well, the fact is that the research is scheduled for publication in the July Journal of Trauma and Acute Care Surgery. And the fact that it’s been accepted by an academic publication means that it’s undergone an extensive peer review process. Now, not being an academic researcher myself, I took a look at the Miriam Webster definition of peer review and thought I would share: “a process by which something proposed (as for research or publication) is evaluated by a group of experts in the appropriate field.” Again, I am no academic expert, but it sounds like an independent review to me. Also, the piece in the Times seems to indicate that it’s odd that Dr. Ang would research his own work. Again, I’m not an academic, but I thought that is what academics do – conduct studies of their own work. If the Times were Pinocchio, then I think their nose would have had a bit of a growth spurt on this one.
In the next assertion, the Times says — and I’m paraphrasing — that: HCA trauma centers have had no role in decreasing mortality rates across the state. Their trauma centers have treated patients with only minor injuries and the increased trauma volume has accounted for any decreased mortality rate, while the number of deaths due to trauma has remained static. This one is a big deal. Because if there’s been no impact, then why would we care if the centers remain open or not.
I am not a statistician. However, I understand from those who are that when using statistical methods, you should take into account factors like injury severity, co-morbidities, age, gender, race, and injury mechanism. This is done to ensure that there is apples-to-apples comparison. And yet the Times analysis did not do this. The HCA analysis showed that the HCA trauma centers had lower mortality, as well as significantly lower complication rates and lengths of stay compared to the rest of trauma centers in Florida. Since Dr. Ang has a degree in epidemiology and Leticia Stein does not, I’m going to give him the benefit of the doubt on this one rather than her “simple analysis.”
Drs. Tepas, Orban and Pracht, were very outspoken in their skepticism regarding Dr. Ang’s work in the Times piece. Stein accurately reflects Dr. Tepas’ affiliation with Shands Jacksonsonville and his stake in the trauma fight; however, she neglects to share some other relevant details. Back in 2006, Dr. Tepas, Orban and Pracht published their own research here with findings that are strikingly similar to those of Dr. Ang’s work that they now question: the conclusion states: “currently, 95% of citizens of the state have access to the trauma system within 85 minutes of injury; however, only 38% of trauma patients are triaged to a TC. Addition of 3 TCs would increase these percentages to 99% and 65%.” I think I have heard that somewhere before: additional trauma centers equals greater access to trauma care.
Finally, the piece suggests that it would be “silly” to pass laws based on untested research. While I think we’ve shown here that the research is anything but untested, let’s review the legislation that is being considered both in the House and Senate.
Both bills would allow trauma centers that have been designated since 2005 to continue to operate so long as they comply with state regulations. Last time I checked, this would apply not only to the HCA trauma centers, but also Shands UF, Bay Medical and Tallahassee Memorial. It has been argued by Shands, Tampa General and Bayfront that the trauma service areas went away when the Department of Health completed a 2005 assessment required in the 2004 legislation. The legislation clarifies the need issue for all trauma centers designated after the 2004 legislation. So, we’re not talking about passing legislation based on one study that only has impact on HCA’s trauma centers, in any event.
As we can see, there has been no search for truth here, but there is clearly a search for scandal — and perhaps the kind of journalism prize that comes with uncovering it.