This piece was produced in partnership with The Trace and Measure of America.

During the first 2020 presidential debate in June, then-candidate Mayor Bill de Blasio touted New York City’s drop in crime. But even as the number of shootings has dramatically decreased across the city over the past decade, a troubling trend has emerged: The proportion of people dying from gunshots has been rising in some pockets.

Data obtained from the New York Police Department and analyzed by The Trace/Measure of America/THE CITY shows this problem has been most severe in Queens.

We mapped the 12,000-plus shootings recorded by the NYPD between 2010 and October 2018, and our analysis found that the further away someone was from a Level I or II trauma center when they were shot, the more likely they were to die.

Nowhere fared worse than neighborhoods in southern Queens, particularly those below Hillside Avenue, where more residents live further than three miles from a trauma center than anywhere else in the city.

There used to be more trauma coverage in the borough. But in February 2009, two hospitals closed, and one of them contained a Level I trauma center.

In the following two years, the gunshot fatality rate in Queens jumped from under 16% to more than 23%. That put the borough’s gunshot fatality rate 30% higher than in the rest of the city.

Since then, every year except for 2016, the death rate from gunshots in Queens has been higher than in the city as a whole.

“How well your trauma system works, and how good your care is across the country is a big mosaic, and where you are will determine your outcomes,” said Dr. Robert Winchell, the former chair of the trauma systems committee for the American College of Surgeons.

Today, most areas of New York City have access to multiple trauma centers while southern Queens has only one: Jamaica Hospital Medical Center. But financial documents, audits and state reports indicate the facility is ailing.

The hospital was in the red 12 of the 13 years between 2005 and 2017. It finished that year with a deficit of more than $66 million, according to IRS filings and an independent audit.

“I’m not sure how you keep the doors open with that,” said Winchell, who is also chief of New York-Presbyterian/Weill Cornell Medical Center’s trauma division.

‘How Do We Start All Over?’

Early one Sunday morning in July, Carolyn Dixon, whose son, Darrell Lynch, died after he was shot in the leg in South Jamaica, Queens, in 2014, guided a conversation between four women. Each has lost a loved one to gun violence in the borough.

At the nondescript LIFE Camp office in Jamaica that specializes in gun violence prevention, the women discuss their social isolation, missed rent and utility payments, and the various challenges gun violence brings.

Sheena’s son was shot in her apartment. Angie’s husband was killed in front of a school. Beatrice’s voice wavered as she explained her inability to pass by the street where her son was fatally shot.

Dixon empathized: She still can’t take the bus or train without feeling claustrophobic, or hear fireworks pop without being transported to the moment of her son’s shooting.

“I was having nightmares of Darrell being murdered,” Dixon, now 61, said. “I was trying to figure out in my dreams what I might have done differently in order to protect him, which was nothing.”

On May 5, 2014, the mother and her 24-year-old son were driving back home in his car from their weekly lunch when they got a call that Dixon’s niece had been in a fender bender. She needed her aunt’s help to defuse the situation.

When Dixon arrived at 113th Avenue, she jumped in to keep the peace. The argument between the two groups had begun to cool down when 37-year-old Warren Green approached with his gun drawn.

According to court documents, Green knew those on the other end of the accident. He opened fire, hitting Lynch once in the leg.

Dixon screamed from her son’s Ford Explorer. Green then turned the gun on her and began shooting in her direction, shattering the rear driver’s side window.

Lynch grabbed for a gun he had tucked in his waistband, but fell and dropped it. Dixon scrambled to pick up the weapon — and shot at Green until he fled.

The mother and son attempted to drive to Jamaica Hospital. But Lynch was losing blood. He passed out behind the wheel, crashing into two other parked cars only feet away from where he was shot.

Dixon’s son was shot more than a two-mile drive from the nearest trauma center, which delayed the arrival of Emergency Medical Services (EMS) to the hospital.

Paramedic response time is another piece of the trauma system puzzle. Our analysis of EMS dispatch data found that Queens has the longest average time between when a shooting was logged by EMS and when the victim made it to the hospital.

Nearly half an hour passed between when the ambulance was dispatched and Lynch arrived at Jamaica Hospital, according to EMS records and court documents. He was pronounced dead 10 minutes after arriving at the hospital.

Green was eventually picked up in Atlanta for murder, and later pled guilty to manslaughter. But this does little to ease Dixon’s loss.

“Where do I go, and my family go, after this? How do we start all over? You’re not told how to live through the death of a child,” she said.

One Trauma Center, Eight Beds

Within three miles of where Lynch was shot, there is only one trauma center. It has eight intensive-care beds available to treat patients with severe or life-threatening injuries. In other areas of the city, there are up to 169 of these beds in trauma centers within three miles.

Some areas of Brooklyn also fall three miles outside of trauma center coverage. These neighborhoods, however, are equidistant from multiple trauma centers and hospitals, and see far fewer shootings than southern Queens does.

Most hospitals have an emergency room, but few have trauma centers that include specialized facilities, staff, and equipment and provide 24-hour access to critical care specialists to treat the most serious injuries.

For severe cases, treatment at a trauma center instead of a conventional hospital greatly improves a patient’s odds of living. One study presented at the American College of Surgeons Clinical Congress last year linked poor access to trauma centers with higher rates of death in more than half of the states in the U.S.

When it comes to gunshots in New York City, our spatial analysis found that the fatality rate for incidents that occurred more than three miles away from a trauma center was 27% higher than that for shootings that occurred within a one-mile drive.

The relationship between access to trauma care and the likelihood of surviving gun violence has received national attention in the past decade.

Dr. Marie Crandall is a University of Florida surgery professor who has conducted some of the leading research that has linked larger distances from trauma centers with increasing gunshot fatality. She is one of more than a dozen researchers who reviewed our analysis. Crandall said that while it does not show definitive causation, “The linear correlation between distance from a trauma center and case fatality rates is obvious.”

Cities across the country have exhibited similar trends.

Crandall identified “trauma deserts” on Chicago’s Southside in 2013 and found they were leading to more gunshot-related deaths. In 2016, Crandall also found that the closure of an urban medical center in South Los Angeles corresponded with an increase in the rate of death from gunshots. Criminologist Giovanni Circo found a similar relationship in sections of Detroit.

In the past two decades, trauma center closures across the U.S. have disproportionately affected low-income and minority communities, according to studies published in 2011 and 2017.

Dr. Elizabeth Tung, a physician at the University of Chicago, reviewed trauma coverage in Los Angeles, Chicago, and New York City. Her paper, which published this March in the Journal of the American Medical Association, concluded that black people are more likely to live in a trauma desert than their white peers, and that much of southern Queens has low access to trauma centers.

“We know trauma centers save lives,” Crandall said, “and they should be dispersed on a population and need basis.”

But so long as hospitals are driven by profit, she doesn’t believe this is going to happen. “In many cases, the business of medicine has taken precedence over the mission of patient care,” she said.

‘Our Lives Matter’

A decade ago, after St. John’s Queens Hospital in Elmhurst and Mary Immaculate Hospital in Jamaica, shuttered, the city comptroller’s office issued an alert warning of a “crisis in the hospital and health care system in much of Queens.”

The report recommended that the state Department of Health assess the city’s existing system and establish a long-term plan to integrate disparate health care systems.

Today, the 2.3 million residents of Queens still have the least access to trauma care in the city.

In a response to the mayor’s 2020 preliminary budget, the borough president and borough board said access to health care was one of Queens’ greatest challenges. Highlighting the four hospitals that had closed in the borough since 2008, they wrote that “Queens was already under-bedded and underserved, but these closures have further strained an already overburdened system.”

The New York State Department of Health, which oversees the statewide trauma system, said in an email that the department is carefully reviewing our analysis and findings. The department says that it is currently assessing areas of the state that may benefit from more trauma care, and expects the project to be completed by the end of 2020 or early 2021.

For the past year, Penny Wrencher, a resident of Far Rockaway whose son died from gun violence in Jamaica, has been circulating a petition to bring more trauma care to her area. Every neighborhood on the Rockaway Peninsula is more than a three-mile drive from a trauma center.

“We would like to bring your immediate attention to our need for more medical resources and treatment facilities that support trauma victims,” the petition reads. “Our lives matter.”

On Closure ‘Watch List’

Even while treating a high volume of the area’s shootings, Jamaica Hospital is facing its own struggles. According to Winchell, hospitals that frequently treat shooting victims, and are located in communities where patients struggle to cover medical bills, often run in the red.

The Greater New York Hospital Association included Jamaica Hospital on a “watch list” of facilities that might close. In its testimony to the state Senate this February, the organization wrote that these hospitals had less than 15 days of cash on hand and relied upon state assistance “just to keep the lights on and to meet payroll.”

The State Department of Health said that it has provided more than $250 million to Jamaica Hospital since 2017 to keep the facility going as it “develops and implements a plan to improve its financial sustainability.”

In an effort to revitalize Brooklyn’s hospital health care system, three of the Brooklyn hospitals on this list received $664 million to improve their services from Gov. Andrew Cuomo last year. The governor has not announced similar plans in Queens.

Jamaica Hospital, meanwhile, has logged low ratings for quality of care. The average time it took for the emergency room to treat and send home a patient was 4 hours and 47 minutes in the year ending October 2018 — the second longest statewide.

The federal government agency overseeing hospitals has handed Jamaica at least 48 violations since 2012. The hospital’s trauma center, however, passed a rigorous process to become a verified Level I center in 2016, and was re-verified earlier this year.

Former Jamaica Hospital staff said the financial constraints translated into antiquated equipment and infrastructure. “It’s an awesome place for training because you have to work with what you have, but it’s not the greatest health care,” said Dr. Sebastian Schubl, who directed the hospital’s trauma center between 2011 and 2016.

Representatives from Jamaica Hospital declined multiple interview requests and did not respond to repeated requests for comment on our findings.

Struggling to Move Ahead

After her son’s death, Dixon had reoccurring dreams of him sitting on a sidewalk curb, looking up at her for help. The shooting occupied her mind, disrupting everyday tasks.

Because she had shot at her son’s killer, Dixon was ineligible for federal and state victim compensation programs, which are already difficult for many to access. She lost her focus and her job, and eventually became homeless.

“Once you experience the death of a child, you’re never that same person,” she said. “I have to be willing to accept the new me.”

She now runs Where Do We Go From Here, an organization to help those living in the aftermath of day-to-day gun violence. But she can’t start her own trauma center, or keep a struggling one afloat.

Jamaica Hospital’s uncertain fate sparks outrage and disbelief among Dixon and each of the women she met with in July.

When asked about Jamaica Hospital’s potential closure, Dixon thought about politicians in New York, and responded: “It tells me you don’t care about the black and brown community.”