Trauma center facts, function, and medical malpractice

Trauma centers are specialized hospital emergency rooms equipped to treat patients with major traumatic injuries including car wrecks, gunshot wounds, and falls.

The American College of Surgeons establishes criteria the hospitals must meet to be designated as a trauma center, which must be reviewed and verified on-site by a committee. Each state has enabling laws that provide for the requirements for official designation as a trauma center.

The Texas Department of State Health Services has currently designated 285 trauma facilities in four different levels described as Levels I-IV. As with other states, the most sophisticated and equipped designation is Level I. Emergency medical personnel are required to take patients to the nearest operating trauma center with appropriate capabilities to treat each patient.

There are currently 18 Level I comprehensive trauma facilities in Texas. These include: Baylor University Medical Center, Dallas; Children’s Medical Center of Dallas; Dell Children’s Medical Center, in Austin; Dell Seton Medical Center at The University of Texas, and Austin, East Texas Medical Center—Tyler; Harris Health System Ben Taub Hospital, in Houston; John Peter Smith Hospital, in Fort Worth; Medical City Plano; Memorial Hermann Hospital, in Houston; Methodist Dallas Medical Center; Parkland Memorial Hospital, in Dallas; San Antonio Military Medical Center, at Fort Sam Houston, in San Antonio; Scott and White Memorial Hospital, in Temple; Texas Children’s Hospital, in Houston; University Hospital, in San Antonio; University Medical Center, in Lubbock; University Medical Center of El Paso; and University of Texas Medical Branch, in Galveston.

There are currently 22 Level II major trauma facilities in Texas. These include: Baylor Scott and White Hillcrest Baptist Medical Center, in Waco; Baylor Scott and White Medical Center—Grapevine; CHI St. Joseph Regional Health Center, in Bryan; CHRISTUS Mother Frances Hospital—Tyler; CHRISTUS Spohn Hospital Corpus Christi—Shoreline ; Clear Lake Regional Medical Center, and Webster; Conroe Regional Medical Center; Cook Children’s Medical Center, in Fort Worth; Covenant Children’s Hospital, in Lubbock; Covenant Medical Center, in Lubbock; Del Sol Medical Center, a campus of Las Palmas Del Sol Healthcare, and El Paso; McLane Children’s Scott & White Hospital, and Temple; Medical Center Hospital, in Odessa; Medical City Denton; Memorial Hermann The Woodlands Hospital; campground Rock Medical Center; Seton Medical Center—Williamson, in Around Rock; Texas Health Heroes Methodist Hospital—Fort Worth; Texas Health Presbyterian Hospital Dallas; Texas Health Presbyterian Hospital Plano; United Regional Healthcare System (11th Street), in Wichita Falls; and Valley Baptist Medical Center, in Harlingen.

In addition, there are currently 54 facilities that hold Level III advanced trauma facility designation in Texas, and 191 facilities currently designated as Level IV basic trauma facilities in Texas.

Population and the number of trauma centers

The American College of Surgeons recommends at least one Level 1 trauma facility for every one million residents in a geographical area. Reviewing the list above, it is easy to see that some areas, including the Houston metropolitan area, come up short on this goal.

In fact, although Harris County, Texas has a population of over four million people, there are no hospitals in the county north of the Texas Medical Center that hold a Level I or Level II trauma designation. On May 1, 2018, Houston Northwest Medical Center, a hospital that is part of the HCA mega-chain of hospitals, became the first hospital in northwest Harris County to seek Level II trauma designation. Similarly, in the summer of 2017, Cypress Fairbanks Medical Center began its process of seeking Level II trauma center status. Once a hospital is approved to start the process of seeking Level II designation, the State of Texas treats it as if it has already achieved that status.

I recently read that my friend Darrell Pile (we served together on the board of the Houston Northwest Chamber of Commerce), who is CEO if the Southeast Texas Regional Advisory Counsel, predicted that within the next two years the nine-county region that his organization covers will be served by eight or more Level II trauma centers. He explained that Level II facilities provide nearly the same services as Level I facilities, but must have a faster response rate in more surgical specialty availability than Level III hospitals.

The fact that more hospitals are seeking higher Level II trauma designation is good news for patients, considering that these hospitals must have trauma, orthopedic, neurosurgery, urology, obstetrician, cardiovascular, and hand surgeons available 24/7 within a 15-minute time window. Yet, with six to eight million people in the Greater Houston area, there is still room for development, in that we need a total of six to eight trauma centers.

Medical malpractice in trauma centers and emergency rooms

As a Houston, Texas medical malpractice attorney, I speak quite regularly with clients who have concerns about care that they received in a hospital emergency room or trauma center. I always explain to them that the Texas legislature has made it rather difficult for a patient or family member to bring a medical malpractice lawsuit against healthcare providers in a hospital emergency room or trauma center.

Generally speaking, the plaintiff in a medical malpractice case has the burden of proof based on a standard called preponderance of the evidence. At trial, I explained this term to juries as meaning more likely than not.

In contrast, plaintiffs filing a medical malpractice lawsuit against doctors or hospitals related to care provided in a hospital emergency room must meet a higher standard called wilful and wanton negligence. At first glance, it is apparent that this term is nonsensical. A standard requiring willful conduct is typically reserved for criminal cases. The Texas Supreme Court clarified that this poorly-worded standard is equivalent to gross negligence.

Under Texas law, wilful and wanton negligence, or gross negligence, includes both objective and subjective components.

To meet the requirement of the subjective component, the plaintiff must provide proof of the defendant’s actual awareness or state of mind, examining whether the defendant knew about the danger caused by his or her conduct. The objective component requires proof that, despite having actual awareness of risk, the defendant proceeded with conscious indifference to consequences to the patient.

The evidentiary requirements of this complex law are a reason why I always recommend that patients and family members seriously injured by healthcare in a hospital emergency room contact an experienced medical malpractice attorney, without delay, to review their potential claim.

When discussing possible emergency room medical malpractice claims with potential new clients, my colleagues at Painter Law Firm and I focus on specific questions about what the healthcare providers knew and did not know at the relevant time. Of course, our goal is to make a judgment call as to whether we believe there is a likelihood of evidence that could meet the higher standard of proof required by Texas law for emergency room cases.

What you can do

Sometimes busy emergency room providers tend to jump to conclusions without going through a proper diagnostic process, including testing. If you find yourself in a position where you feel like you are being rushed out the emergency room door, I suggest you ask your doctor and nurses some specific questions.

A differential diagnosis refers to a list of all the potential diagnoses that your physician should consider as potential causes of your signs and symptoms. The standard of care requires the physician to rule in and out each of those potential causes before discharging you. For some conditions, this can be done by physical examination, but for others, diagnostic testing, like lab work or a radiology scan, may be necessary.

Ask your physician what is in his or her at differential diagnosis list, what has been ruled out, and how. In my experience, these types of questions cause physicians to think twice about making a hasty discharge order. They also cause physicians to stop, pause, and consider you as an individual patient, rather than just another number or statistic.

We are here to help

If you or someone you love has been seriously injured by medical or hospital malpractice, our experienced medical negligence attorneys can help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.

All consultations are free and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case.


Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.