Idaho's emergency health care system has slipped one step further off the national radar.
Although the Saint Alphonsus Regional Medical Center Web site still says so, the hospital is no longer a "Level Two" trauma care center.
That designation comes from the American College of Surgeons, a national certifying body that judges trauma centers based on a wide range of criteria, including availability of surgical specialists and equipment.
There are four levels of certification: Level One is the highest ranking, and is most often achieved by hospitals attached to a full medical school. Idaho has no Level One trauma centers; the nearest ones are in Salt Lake City, Utah, and Portland, Oregon.
In fact, now that St. Al's has dropped from the ACS verification list, Idaho has only one facility--Eastern Idaho Regional Medical Center in Idaho Falls, a Level Three trauma center --with the ACS stamp of approval.
"It's a big committment on the hospital's part to say, 'We take trauma seriously,'" said Lynette Sharp, the director of Flight and Trauma Services at Eastern Idaho Regional Medical Center. Other medical experts say the designations can allow a facility to care for patients that might otherwise have to go elsewhere, an expensive proposition in Idaho.
Saint Al's lost its Level Two designation some time last year, but word of that hadn't gotten out, and Saint Al's wasn't advertising the news.
"I learned from a staff member a couple of months ago," said Dia Gainor, the Idaho bureau chief for the state's Emergency Medical System.
To get the seal of approval from the American College of Surgeons, hospital trauma centers have to undergo an expensive and rigorous process of upgrading their care and submit themselves to a multi-day survey by a team of out-of-state reviewers. Just to get a team to come to a hospital costs $9,000, according to ACS. Once there, the reviewers need to find a system of critical injury management that is on a par with hospitals around the country.
In fact, when they wanted to get their Level Three certification in 1999, officials at Eastern Idaho Regional Medical Center asked for a preliminary survey to see if they were ready.
They weren't. It wasn't until five years later, with lots of money spent on upgrading their systems and equipment, Sharp said, that they got their Level Three certification from the ACS.
"The resources that are required for this are huge," Sharp said.
But it's well worth it, she said. Aside from being able to assure locals that they had a first-rate trauma center in their midst, Sharp said visitors to the tourist havens of Eastern Idaho and Yellowstone are often mindful of just what sort of hospital care is available to them if a trip goes awry.
"Consumers are looking for that," Sharp said. "If something happens, what's available?"
Boise's other major hospital, Saint Luke's, has not sought out the designation, said spokeswoman Beth Toal.
Saint Al's officials said patients in their trauma center shouldn't notice anything different since the loss of the ACS designation.
"The level of service we're providing has not changed at all," said Ted Ryan, the director of Emergency Services at Saint Al's. With more than 600 physicians on their medical staff and six designated general trauma surgeons on call all day, every day, Ryan said, patients can still consider Saint Al's the "go-to" trauma center in Idaho.
The ACS designation, Ryan said, "is more of a formality than anything else."
Not so, say national emergency-care experts.
"It's a big negative for the community," to lose that ACS designation, said Mary Pat McKay, the director of the Center for Injury Prevention and Control at the Ronald Reagan Institute of Emergency Medicine at George Washington University.
McKay also chairs the Trauma Care and Injury Control Committee for the American College of Emergency Physicians, which gave Idaho a "D" for its emergency health care earlier this year.
According to McKay, the designation is more than just a handy advertising tag. National research is already showing that care in verified Level One and Two trauma centers is better than similar, but un-designated, hospitals. According to a study published in The New England Journal of Medicine earlier this year, mortality rates of patients treated in Level One trauma Centers were significantly lower than at non-certified hospitals.
"People are more likely to survive in Level One and Level Two trauma centers," McKay said.
She also said the likelihood of a patient needing to be transferred to another hospital with a higher designation after they're stabilized will increase. For Idaho patients, that would mean a long trip, by any number of methods, that would also be costly and inconvenient.
But both Ryan and Sharp say that is unlikely, given that the quality of care at Saint Al's is still very high. "Do we transfer people out because we're not ACS verified? No, we don't," Ryan said.
Saint Al's didn't lose the ACS designation, Ryan said, because they lost any important links in their patient-care chain.
"We had some contracting issues that did not allow us to pursue re-verification," Ryan said. "Those contractual issues have been resolved."
The hospital, Ryan said, is in the process of hiring a new medical trauma director, and said one should be in place by this summer. "The search took a lot longer than we anticipated," Ryan said. He would not elaborate on other "contractual issues," he said, because of privacy concerns.
But, Ryan said, "There was never an interruption of patient care services."
Within the state's health care bureaucracy, no one is watching what happens inside trauma centers. Idaho does not have oversight of its hospitals, according to state Health and Welfare Department officials, who have expressed full confidence in the trauma care at Saint Al's. Gainor, who oversees the state's emergency medical system, said she is "not at all" concerned.
Nationwide, Level Two and One facilities are becoming more scarce, according to McKay. In fact, in Oregon, only one Level One facility exists, and no other ACS-verified hospitals exist. None are listed for Washington. But both those states have their own statewide designation system to certify hospitals and their trauma care facilities. Idaho state leaders and the Legislature have not seen fit to set up such a bureaucracy.
"We're not experts on what goes on inside," said Tom Shanahan, a spokesman for the Idaho Department of Health and Welfare. "We really don't have any jurisdiction once you go into that hospital."
Ryan said Saint Al's isn't done for good with the American College of Surgeons, and has not ruled out seeking Level Two verification some time in the foreseeable future. But for now, hospitals like his are waiting and watching the state, to see if they do indeed pursue a state verification system.
Whether they do or not, Ryan said, his confidence in his own trauma center remains unshaken.
"In my mind, if my wife or kids were seriously hurt, I would want them flown to this hospital in this city," Ryan said. "The quality here is outstanding."