River Region Medical Center’s emergency room rating has been dropped by the state to the lowest possible, meaning transfers of patients to other facilities might become more customary.

The Mississippi State Department of Health lowered the rating from a Level III to Level IV in February, in part because of a decision not to hire a designated trauma surgeon or to designate one of its three practicing general surgeons to do the task, marketing coordinator Allen Karel said.

“It was a choice we made to not have a designated trauma surgeon, as it takes away from that surgeon’s ability to provide care for their regular patients,” Karel said.

Drs. Eugene Ferris, Mac Jarmon and Marco Hidalgo, who starts next week, make up the general surgery staff. A fourth, Dr. Stephen Sudderth, who practices independently, is listed on River Region’s active medical staff, Karel said. A separate staff of 13 ER physicians is contracted through ApolloMD.

River Region’s general staff can handle trauma cases and transfers aren’t a problem, Karel said.

“We haven’t ruled out the possibility of having a surgeon take on that role in the future,” Karel said. “However, there is a Level 1 trauma center just a short helicopter ride away should a patient need it.”

Helicopter ambulance rides to Jackson have cost as much as $11,000, and some, at least, are not covered by health insurance policies.

Conversely, the hospital is actively recruiting a complement to orthopedic surgeon Dr. William C. Porter, Karel said. A second orthopedist, Dr. Daniel P. Dare, practices independently.

Licensed acute-care facilities in Mississippi are required to participate in the Mississippi Trauma Care System, the state’s trauma program, as part of the federal Trauma Care Systems Planning and Development Act of 1990. Trauma ratings are renewed with the Mississippi State Department of Health every three years. Ratings from I to IV follow a hospital’s ability to deliver emergency medicine, general or trauma surgery, orthopedic surgery, neurological surgery, a post-anesthesia care unit, an intensive care unit and a surgical residency program.

Hospitals providing all the services are Level I. Only one, University of Mississippi Medical Center, is in the state, but Mississippi residents regularly use Regional Medical Center in Memphis and University of South Alabama Medical Center in Mobile, according to the state trauma fact sheet for 2012.

Five Mississippi hospitals are Level II — North Mississippi Medical Center in Tupelo, Baptist Memorial Hospital-Golden Triangle in Columbus, Forrest General Hospital in Hattiesburg, Memorial Hospital of Gulfport and Singing River Hospital in Pascagoula. Twelve are Level III and 60, now including River Region, qualify as Level IV. That designation covers emergency medicine, but leaves out the sole surgeon for emergencies and the care units.

In 2011, River Region’s ER treated 33,326 patients, down slightly from 33,517 in 2010. The hospital has treated about 17,000 so far this year. A lower rating means more complex head, neck and torso injuries will be taken to UMC in Jackson.

“Some immediate examples would be gunshot or penetrating wounds to the torso, neck and head,” Karel said. “This doesn’t mean that a patient may necessarily bypass our emergency room if we’re the closest facility to them.”

Only about 50 percent of all patients are delivered to any trauma center by an ambulance, said Jim Craig, director of health protection with MSDH. When someone is taken to a local hospital that isn’t capable of treating the injuries, each trauma center has nonpublic protocols to transfer the patient to an appropriate facility, Craig said.

The hospital application is not a public document as it contains both proprietary information and performance improvement and patient data, Craig said.