Philadelphia Trauma Center Closure Could Mean More Shooting Deaths—And Tough-on-Crime Talk

Just after midnight on Oct. 25, a man walked into Temple University Hospital in Philadelphia. He had been shot 15 times. The man was critically injured, but he underwent surgery and was expected to survive, according to a report later that day by ABC 6.

Temple is one of five adult trauma centers in Philadelphia. These medical facilities are specifically designed to treat serious injuries like gunshot wounds. Quick access to a Level 1 trauma center like Temple can determine whether a shooting becomes a murder, according to recent research. And over the last three years in the city, a trauma center has shuttered, and some emergency departments have cut back on staff. 

At the same time, gun homicides in the city have risen. Nearly 200 more people were shot in the city in 2018 than in 2017, and shootings were up roughly 5 percent in 2019, according to data published through Open Data Philadelphia. Fatal shootings have risen more than 20 percent since 2016 and at times have outpaced the rise in actual shooting incidents.

According to Alex Vitale, a professor of sociology at Brooklyn College and author of “The End of Policing,” this rise in homicides will most likely trigger a push for more police and incarceration.

“People will begin to call for emergency interventions and those interventions always revolve around policing and more prison time,” he said. “The challenge is trying to change the narrative. … More police is not the only available emergency response to an uptick in homicides.”

In an August paper, Giovanni Circo, a professor of criminal justice at the University of New Haven, and Andrew Wheeler, a criminology and criminal justice professor at the University of Texas at Dallas reviewed more than four years of gunshot wound data published by the city of Philadelphia and found that the likelihood someone would die increased with every minute it took for the patient to reach a trauma center.

“If you’re shot in the head and you’re right there at the hospital, the probability [you will die] is around 40 percent,” Wheeler told The Appeal. “But if you’re shot in the head and you have to travel 30 minutes, it winds up being closer to a 55 percent [chance of dying].”

Wheeler and Circo found this pattern existed regardless of the location of the injury. The longer it took to get a patient to a Level 1 trauma center, the more likely the person would die.

Research in Chicago, Detroit, and New York has also found that the farther a person is from a trauma center when they are shot, the more likely they are to die. And access to life-saving care is not equally distributed: A 2019 study found Black-majority areas in Chicago, Los Angeles, and New York were more likely to be farther from trauma centers. Other research has also found that low-income communities are more likely to suffer from a lack of access to trauma care.

In recent years, hospitals in Philadelphia have cut back on emergency department staff and resources. In 2017, Temple, which cares for the most shooting victims, cut 30 percent of its board-certified emergency room doctors and replaced most of them with medical interns and residents. Jefferson Torresdale Hospital eliminated its advanced life support ambulance services.

In 2019, Hahnemann University Hospital lost the one remaining physician it needed to keep its trauma center open. When the contract for that physician ended in June, the hospital could no longer maintain its trauma center designation, Pennsylvania Department of Health spokesperson Nate Wardle told The Appeal. Hahnemann completely closed the hospital a few months later.

Maureen May, president of the Pennsylvania Association of Staff Nurses and Allied Professionals raised concerns in the summer that reducing the city’s capacity to treat serious injuries could exacerbate an uptick in gun violence. “This June, we saw an extremely deadly weekend with 19 shootings, leaving five dead and 28 wounded,” she wrote in an op-ed in the Philadelphia Inquirer in July. “Now is not the time to reduce our capacity to care for those who have had serious trauma.”

Wheeler and Circo’s analysis did not specifically look at what effect Hahnemann’s closure had on the city’s ability to treat trauma patients. However, Wheeler said based on their model, the city could expect to see up to an additional 10 deaths annually as a result of the increased travel time patients have to take because Hahnemann closed.

A 2016 study of the effects of closing Martin Luther King Jr. Hospital in Los Angeles on gunshot mortality had similar findings: The closure resulted in thousands of patients having to travel farther for trauma care, and deaths from gunshot wounds rose in the two years after the closure to 7.5 percent from 5 percent .

Other factors, like increases in the severity of injury or caliber of firearms used, can also affect the lethality of gunshot injuries. When asked if the Philadelphia Police Department had seen any change in the caliber of weapon used, severity of injuries or other factors that may be contributing to the rise in lethality, a spokesperson said the department was still “evaluating the trend” and could not provide an answer because it would be “speculative.”

State and local lawmakers have pointed to the rise in gun violence in the city to justify new tough-on-crime measures and to attack Larry Krasner, Philadelphia’s reformer district attorney who was elected in 2017. 

State Representative Martina White, a Republican whose district includes parts of Philadelphia, called gun violence in the city a crisis that was fueled by “criminals believing they won’t be held responsible” by Krasner and his office. She sponsored a bill, which passed in July, that gave Attorney General Josh Shapiro the ability to prosecute gun crimes without consulting Krasner first. In August, state Representative Todd Stephens, a Republican, introduced a bill that would impose a five-year mandatory minimum sentence for gun crimes. Stephens, in a press release, attributed the increase in violence in Philadelphia to “violent criminals” who were being “treated too leniently.”

But experts say the attacks are misguided.

“Every time there seems to be an uptick in violent crime in a jurisdiction that has elected a reform-minded, progressive prosecutor, that’s a narrative that people who are much more attached to the tough-on-crime approach use to say, ‘Look at what’s happening. We’re electing these people. They’re letting criminals go free and now we’re all less safe,’” said Lara Bazelon, a law professor at the University of San Francisco.

Although increased enforcement alone may lead to short-term decreases in violence, Vitale said, it can actually do more harm than good by undermining trust between the community and police. Murders disproportionately occur in communities of color, he noted, which can prompt a tough-on-crime response. “If these problems were occuring in other communities, there might be more openness to solutions that don’t just rely on putting more people in prisons,” he said.

When society views crime, including murder, as an issue solved solely through incarceration, the larger social, economic, and personal dynamics and circumstances that lead people to commit crimes are also missed, Vitale said.

“We need a whole range of preventative interventions,” he said. “High-quality healthcare, including mental health and trauma services are important tools in addressing certain of these dynamics, but not necessarily all of them.”