How changes to Regional Medical Center’s trauma care heavily impacted health services in Santa Clara County

In the months before Regional Medical Center downgraded its trauma services last year, fewer patients were coming through the East San Jose hospital’s doors with life-threatening injuries from car crashes, stabbings and shootings. But on the other side of the city, Santa Clara Valley Medical Center’s volume of trauma cases surged — rising roughly 33% from 2023 to 2024, a Bay Area News Group analysis found.

The data illustrates the strain HCA Healthcare’s controversial decision to remove Regional Medical Center from its position as a lynchpin in the local trauma network had on the public hospital.

Santa Clara County took over operations of Regional Medical Center earlier this month in a $150 million deal, capping the end of a more than yearlong battle to preserve critical health care services in an area where over half of patients are either uninsured or recipients of Medi-Cal, the state’s Medicaid program.

Since April 1 — the day the hospital’s Level II trauma center reopened following a seven-month closure — trauma patients have started to come back, according to Dr. Yvonne Karanas, Regional’s interim physician executive. Karanas, who was a burn surgeon in Valley Med’s trauma center until recently, said the county’s takeover “came not a moment too soon.”

Valley Med is one of two Level I trauma centers in the county that offer the highest level of care for patients with life-threatening illnesses or conditions. The other is Stanford Health Care. Karanas described last year as a “really challenging time” as more patients filled the intensive care unit and needed surgery, often requiring surgeons to work late into the night.

Patient data from Valley Med shows that it cared for 87% more trauma patients in January than it did in the same month in 2024, and 73% more than in January 2023.

“The way people were working to keep up with the volume was not sustainable in the long run,” Karanas said in an interview.

Paul Lorenz, CEO of Santa Clara Valley Healthcare, the county-owned health care system, said that Valley Med started to see an increase in trauma patients immediately following HCA’s February 2024 announcement that Regional’s trauma center would close in August. The for-profit hospital chain, one of the largest in the country, said it had been experiencing an overall decrease in trauma volume since 2019, which the county has disputed.

From September 2023 to February 2024, Regional Medical Center reported a six-month average of 198 trauma patients a month. In the following six months that ended in August 2024, that number dropped to an average of 149 monthly patients, according to an analysis of data from emergency medical services routing patients to the hospital. In the same time period, Valley Med recorded an average of 331 trauma patients a month in the six months ending in February 2024, and after the announcement — when Lorenz said they started to see the numbers swell — the county hospital reported a six-month average of 423 patients a month.

“It did cost the county, in terms of a financial standpoint — but also from a human standpoint, from a staffing standpoint,” Lorenz said.

In late August, after the county announced that it had reached an agreement with HCA to purchase Regional Medical Center, the Board of Supervisors approved the addition of 62 new positions at Valley Med and O’Connor Hospital in San Jose, which does not have a trauma center, to help manage the impact of more patients across the board. The hirings cost $6.3 million this fiscal year.

Before the county swooped in with plans to buy Regional Medical Center, community advocates mounted a campaign to save the trauma center, protesting outside the hospital for weeks and urging Attorney General Rob Bonta to intervene. They called it a “life or death” situation, pointing to county statements that ambulance transport times from the areas north or east of Regional would likely take 20 to 25 minutes to reach Valley Med in ideal traffic conditions.

In July 2024, just weeks before the trauma center was set to close, HCA announced that it would instead downgrade the East San Jose hospital to a Level III facility — a designation typically found in facilities in rural areas to help stabilize patients. The move was met with criticism from both the county and community advocates because there would be no in-house trauma surgeon and other necessary specialists.

“Becoming a Level III facility is not like flipping a switch,” county spokesperson Peter Gallotta said in a statement. “Despite HCA’s public statements, there is no current established process within the county for a Level III designation, which is most commonly used in areas that do not have access to the kind of care present in Santa Clara County.”

And HCA knew that, according to a letter obtained by this news organization.

In the June 10, 2024, letter, Jackie Van Blaricum, president of HCA Healthcare’s Far West Division, told county emergency services leaders that HCA was closing Regional Medical Center’s Level II trauma center because the county’s requirements for that level of care exceeded those of the American College of Surgeons and that many specialty physicians wouldn’t accept the salaries it offered, which it described as “fair market value” pay.

“Further compounding the problem is the fact that the county, unlike other counties in California and throughout the country, does not recognize Level III or Level IV trauma centers,” Van Blaricum wrote.

Because the county has no Level III designation in its system, ambulances wouldn’t route patients with traumatic injuries to Regional Medical Center.

At an Aug. 21 news conference announcing the county’s purchase of Regional Medical Center, Van Blaricum said that it intended “to continue pursuing a Level III trauma program” in the interim, despite her previous acknowledgement that the county had no way to recognize it.

“We still need to be accredited by the county and the state,” she told reporters.

In a statement, HCA said Regional Medical Center “provided Level III trauma services between Aug. 12, 2024, and April 1, 2025, yet Santa Clara County did not recognize the Level III designation, thus forcing Emergency Medical Services not to bring trauma patients to RMC,” HCA said in a statement.

EMS data confirmed that no trauma cases were routed to the East San Jose hospital during that period.

Gallota, the county spokesperson, said that “even if a Level III designation was available, it was not clear that Regional Medical Center would have met the requirements at the time.”

“They did not have sufficient trauma care service capacity even before HCA officially ended Level II care on Aug. 12,” he said in a statement.

Van Blaricum acknowledged at the Aug. 21 news conference that even before the downgrade, it “did not have many of the specialists to actually pass an (American College of Surgeons) verification survey” for a Level II trauma center.

The American College of Surgeons declined to comment, stating that they “do not comment on individual centers.” The California Department of Public Health did not respond to a request for comment.

When asked about Van Blaricum’s comment, an HCA spokesperson said that Regional Medical Center “met all requirements for Level II trauma designation through its time as an official Level II center.” Many of those requirements, the spokesperson said, were met using “short-term contracting arrangements, though this approach was not considered sustainable long-term.”

“The decision to downgrade trauma was completely voluntary, and did not involve any regulatory action,” the HCA spokesperson said.

On April 1, county officials shot off confetti in the lobby of Regional Medical Center, welcoming the hospital into its health care system — the second-largest county-owned health and hospital system in the state.

County Executive James Williams called the purchase a “commitment to excellence and service.” The county has pledged to restore labor and delivery services, which HCA ended in 2020, and introduce new health services.

“It’s been really inspirational that the community has so much faith in our health care system,” Karanas said. “As soon as we opened the doors here as a county facility, the community came back.”

Harriet Blair Rowan contributed to this report.