San Antonio officials, military leaders and local healthcare providers are fighting over how an upgraded Methodist Healthcare trauma center would impact Brooke Army Medical Center and its military medical readiness mission.
San Antonio is home to two Level I trauma centers able to handle the most complex injuries: University Hospital in the South Texas Medical Center and BAMC on the northeast side of town.
When Methodist Healthcare, the largest hospital system in San Antonio, proposed upgrading its flagship hospital in the South Texas Medical Center from from Level III to Level II trauma designation, officials from the City of San Antonio, military community and University Health expressed concern over how the change would impact BAMC and its ability to train military physicians.
On Tuesday a City Council committee debated a resolution expressing support for BAMC’s unique place in the medical ecosystem and the city’s military missions, which questioned some of the specifics of Methodist Healthcare’s plans.
The San Antonio Military and Veterans Affairs Department (MVAD) was notified in August of Methodist’s plans to apply for upgraded status on Oct. 1, according to its director, Retired Maj. Gen. Scott Jackson.
Jackson said that Level I facilities must see a certain number of patients to maintain their certifications, and a new Level II center in the city could decrease the total number of trauma patients BAMC sees.
The council’s debate comes after Jackson said senior leaders within the Pentagon “expressed concern over this potential infringement on BAMC volume” to him on a recent visit to D.C.
“We do know for a fact that the number of trauma cases are actually decreasing over the past years,” Jackson said at the meeting. “We’re not seeing an increase in demand.”
BAMC is the sole Level I trauma center in the entire Department of Defense network, though it does not exclusively treat military personnel.
It’s not the first time this has happened. In 2017, Methodist sought Level II status, only to receive pushback from the military medical community over the same concern about BAMC’s case volume.
The hospital, which has long been seen as a global gem for its hostage reintegration program and burn center that has treated everyone from Evan Gershkovich to Brittany Griner, and also treats civilian cases from across the South Texas medical system, along with training and teaching personnel.
“Treating critically injured patients provides our physicians, nurses, and operational medical teams with the hands-on clinical experience required to deploy at a moment’s notice and save lives in combat operations and humanitarian missions,” said BAMC’s Acting Chief of Public Affairs Robert Whetstone.
The city currently has no Level II facilities, which has resulted in Methodist at times having to transfer patients to higher designation hospitals.
Both Methodist and the Southwest Texas Regional Advisory Council (STRAC), which coordinates trauma care in the region, did not respond to interview requests.
Jackson said in a recent meeting with Methodist, officials expressed that the decision to apply for Level II status is about patient choice, and that they do not have a desire to compete with BAMC.
“They felt that if patients make an elective decision to come to Methodist for treatment, then they should be able to stay within the Methodist system if they required higher elevation levels of care,” he said.
Methodist does not need city permission to pursue a higher trauma status, which is designated by the Texas Department of State Health Services.
But last time it was in the works, City Council passed a similar resolution to the one being considered now, and the Methodist plan was abandoned. The current resolution calls on STRAC to help coordinate a solution to protect BAMC’s readiness mission.
The need for patient care
At Tuesday’s meeting, council members voiced concern over opposing Methodist’s upgrade if it could mean better patient care for San Antonians.
They tabled the resolution and are seeking more information from stakeholders.
“For me, the goal is San Antonio residents and others get the quickest care that they can, not have to go to Austin, not have to go to Houston,” said District 7 Councilmember Marina Alderete Gavito.
District 4 Councilmember Edward Mungia also voiced concern about how this decision could be felt 10 years down the line, as San Antonio’s population continues to grow.
“I don’t want to be in a position where I’m saying no to increased medical help in San Antonio,” he said.
University Health and BAMC have enjoyed a shared collaboration over the years, establishing a rhythm that University Health leaders fear could be in jeopardy if the Methodist upgrade comes to fruition.
“A new Level II trauma center can add capacity but the potential impact on this one-and-only civilian/military trauma partnership could be disastrous for South Texas and our nation’s military readiness,” said a University Health statement. “…The stakes are high.”
University officials also reaffirmed Jackson’s notion that trauma cases in the area have been decreasing over the last two years.
District 9 Councilmember Misty Spears, who accompanied Jackson to D.C., said she was also alarmed by hearing Pentagon leaders’ concerns.
“Protect BAMC at all costs is my approach,” she said.
BAMC as a hub
In 2005, a Congressionally authorized Base Realignment and Closure (BRAC) Commission recommended consolidating inpatient military healthcare services in San Antonio, and BAMC became the primary hub.
The move was seen as a huge win for the city, valued at around an $8 billion impact that produced 12,500 new jobs and made San Antonio an epicenter for military medicine.
But since then, the military landscape in the city has changed. The official shuttering of Army North and South this year was a move that military leaders hope is, an isolated one and not the beginning of more closures.
“Job number one remains no change in mission to Joint Base San Antonio. We don’t lose missions. We maintain what we’ve got, and ideally we grow,” Jackson told the San Antonio Report in September.
The San Antonio Report’s military and veterans coverage is supported by Report for America.
