Cleveland Clinic’s proposal to operate a level 1 trauma center on its main campus has faced pushback from local health systems and lawmakers in recent months.
The situation reflects a longstanding debate that’s played out in trauma markets for decades, with the key question being: when does a region need another high-acuity center, and who gets to decide?
Cleveland is the latest market to test that question. Here’s where things stand:
1. The health system shared plans to pursue level 1 verification with the American College of Surgeons and state regulators in January. As part of this effort, the system would expand its emergency department and recruit additional trauma specialists, with the new trauma center launching in 2028. If approved, the trauma center would be the third such facility in Cleveland alongside MetroHealth and University Hospitals.
2. Cleveland Clinic’s plan quickly faced pushback from MetroHealth. In early February, MetroHealth President and CEO Christine Alexander-Rager, MD, sent a letter to Cleveland Clinic President and CEO Tomislav Mihaljevic, MD, urging the system to reconsider. Dr. Alexander-Rager argued that the market’s current trauma network is appropriately sized for the region’s population and patient volumes, and expressed concern that adding a third trauma center would not support sufficient case volume needed to preserve clinical expertise and skill at the existing centers.
3. Now, local lawmakers are also pressing Cleveland Clinic for more details. Members of the Cuyahoga County state legislative delegation sent a letter to the system in late March, requesting more information on the proposal. Requested information includes whether an additional level 1 trauma center is needed in the region, how it could affect patient outcomes and case volumes across existing providers and how the system plans to staff the facility amid ongoing workforce shortages.
4. Lawmakers also urged the system to pause their plan pending an independent regional needs assessment. The system’s initial consultation for a provisional designation from ACS is scheduled for June 10. If it’s granted, the system could begin seeing trauma patients under provisional operations as soon as July, according to lawmakers.
5. A spokesperson for Cleveland Clinic confirmed to Becker’s April 17 that it was responding to lawmakers’ letter but declined to share additional details. In a previous statement, the system noted it transfers several hundred trauma patients annually to other systems and argued that keeping them within the system could improve outcomes.
“Cleveland Clinic is the largest healthcare provider in the state of Ohio,” the statement said. “We currently treat the most complex medical conditions with expertise in high acuity care on our main campus. We are well positioned with a vital depth of resources and a comprehensive spectrum of services to care for patients.”
“We care deeply about our community and providing Level 1 trauma care will help us better serve our patients and region.”
6. On June 10, MetroHealth announced it will not seek reverification for its level 2 pediatric trauma center designation, citing a decline in pediatric trauma cases and a regional shortage of pediatric neurosurgeons. The system said it will stabilize and transfer pediatric trauma patients to UH Rainbow & Babies Children’s, the city’s only level 1 pediatric trauma center, as needed.
“When pediatric trauma cases are declining and pediatric neurosurgeons are in critically short supply, concentrating that care at the region’s high-volume children’s center strengthens it. Spreading it thin would dilute it,” Dr. Alexander-Rager said. “We make trauma decisions based on community need and patient outcomes — that’s the standard that tells us when to step back and when to invest and grow.”
MetroHealth will retain its level 1 adult trauma center designation, continue treating pediatric emergencies in its ED and remain a comprehensive burn care center for both children and adults. A system spokesperson said “in practice, almost nothing will change when it comes to how we provide emergency care for our youngest patients.”
7. Becker’s has reached out to Cleveland Clinic and the American College of Surgeons for an update on the June 10 American College of Surgeons consultation and will update this story if additional information is received.
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