Brooke Army Medical Center’s top commander on Thursday warned the San Antonio City Council that a plan under consideration by a local hospital to create a new trauma center would threaten the Army's emergency medical mission.

Brig. Gen. Jeffrey Johnson told the council that Methodist Healthcare has considered adding a trauma center, an action that likely would reduce the number of people treated at BAMC’s emergency room.

“Adding additional trauma centers to San Antonio presents a direct threat to medical readiness” and the quality of care at BAMC and could hurt its poorest patients, Johnson told the council.

Johnson said he had learned that if Methodist went ahead with the project, Baptist Health System would be forced to build its own trauma center.

A Baptist spokeswoman, Patti Tanner, couldn’t confirm that. She and a Methodist spokeswoman said their hospital systems had made no decision on the matter.

The council unanimously approved a resolution supporting BAMC’s mission, with Mayor Ron Nirenberg and other members making clear they opposed any expansion of trauma facilities by Methodist or Baptist. The mayor said the threat to trauma care at BAMC could put its medical training mission in San Antonio at risk in a future base-closure round.

A senior University Health System executive also addressed the council and backed up Johnson’s arguments.

BAMC and University Hospital have the only Level 1 trauma centers in San Antonio and serve a 22-county region in Southwest Texas that has a population of more than 2.2 million people. Both treat all patients without regard to ability to pay, and need a minimum patient volume to maintain their certifications, Johnson said.

Methodist had considered adding a Level 2 trauma center, a scaled-down version without an education and research capacity, which can choose which patients are seen, Johnson said.

Methodist spokeswoman Palmira Arellano said the hospital was “just doing our due diligence and researching community needs.” She also said that “the unfortunate increase in natural disasters and tragic events that have occurred recently in the United States have caused many communities across the country to research the proper structure of trauma levels within their regions.

“As the largest health system in the region that has a proven record of quality care, it is our obligation to perform a community health needs assessment and help provide resources to meet those needs,” she added. “This includes the assessment and research of appropriate trauma levels in the San Antonio region.”

Asked about Johnson’s comments, Baptist issued a statement acknowledging BAMC’s “vital role in providing expert care for the most critically injured in our community” and expressing support for its military mission.

“I think how I would describe the risk is our ability, as the (Department of Defense’s) only Level I trauma center, it is the jewel for where trauma training can take place,” Johnson said in a later interview. “There is no other place in the DoD that can do it. So, if we were to lose the ability to train trauma, and sustain medical skills inside of trauma, our providers, our health professionals, would no longer be able to, on Day One, be able to meet our nation's (military) needs in a deployed setting. That's the essence of the risk.”

The BAMC emergency room logs 80,000 visits a year — four out of five of them civilians. If competition brings a reduction of patients at BAMC’s ER, it would force a Military Health System review that could end with a relocation of some of its missions, Johnson said. With fewer patients to treat, proficiency could decrease, creating the risk that trauma teams would be less prepared to save lives on the battlefield.

“We believe that the way we are currently postured, we don't have six months to train up in order to project health professionals around the world,” Johnson said. “We have to do that on Day One, as we did with hurricane relief, and as we continue to do with full-spectrum operations in settings across the oceans.”

Johnson cited a study published last summer in the Annuals of Surgery that found a 1 percent drop in the volume of patients at a trauma center led to a two-fold increase in mortality rates. A reduction in trauma patients is likely if more trauma centers were to open here, he said, noting that when two new facilities like the one Methodist has discussed creating in San Antonio went on line in Austin, a Level 1 trauma center there saw its volume fall by 45 percent.

Dr. Bryan Alsip, executive vice president and chief medical officer at University Health System, said that as often as people praise the military in San Antonio, the time was at hand for those around the city to show their unwavering support for it in a more tangible way.

“We are appropriately known as Military City, U.S.A., but fundamentally we are Military Medical City, U.S.A., which means that threats to the readiness of Brooke Army Medical Center’s trauma mission puts the entire future of our military’s commitment to San Antonio in serious jeopardy,” he told the council.

“We should not underestimate this warning,” he continued. “If our community cannot provide the commitment necessary to defend BAMC’s ability to maintain their mission readiness, our nation’s leaders will not hesitate to find another location that will be happy to welcome our military medical infrastructure.”

Nirenberg said Johnson first brought the problem to his attention last summer and likened it to the suburban growth that interferes with Air Force, Army and Navy training missions at the city’s three major installations and Camp Bullis in Northwest Bexar County.

Beyond the resolution, which offered the council’s support for “protecting BAMC’s mission through preserving the necessary critical trauma patient volume” needed for quality civilian care and military readiness, it wasn’t clear how — or if — the city could stop Methodist or Baptist if they moved forward.

Councilman John Courage wanted to add language saying the city wouldn’t consider or support zoning concessions or incentives for building new trauma centers in San Antonio. City Attorney Andy Segovia warned against the amendment, which wasn’t adopted, saying zoning decisions have to be based on specific issues.

Nirenberg said the intent of the resolution was to state a core value.

“By treating a large number of complex trauma cases from the civilian community whose injuries replicate wartime injuries, BAMC trains hundreds of military health professionals to go to war,” he said. “It’s not a stretch to say that protecting BAMC is a matter of national security. We will not take it for granted. We will protect it for our community, and the nation’s servicemen and women.”

Councilman Clayton Perry, a chairman on the area’s Military Transformation Task Force, said losing BAMC would hurt the city’s chances of gaining new military missions in a future closure round, adding, “It would cause a devastating setback to the military’s economic impact on the San Antonio region, which the Texas comptroller estimates to be $49 billion annually.”

The 2005 Defense Base Closure and Realignment Commission dramatically expanded BAMC footprint in the Alamo City. The BAMC expansion at Joint Base San Antonio-Fort Sam Houston cost $724 million for an eight-story tower with rooftop helipad for trauma cases, a partial hospital renovation and 5,000-car garage.

The closure round also created a $750 million Medical Education & Training Campus, a complex of instructional, dormitory and support facility buildings for the instruction of Air Force, Army and Navy combat medics.

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