There was little time to spare after 17-year-old Griffin Weathers was shot in the chest in 2018.
He was losing blood fast, and needed surgery to have any chance of survival.
An ambulance rushed Weathers the 10 minutes to nearby High Point Medical Center. It’s the closest hospital and the place where paramedics are supposed to take patients with immediately life-threatening injuries.
But High Point Medical Center was not really equipped to save the teenager’s life. It is not a designated trauma center and does not have the doctors, surgeons and anesthesiologists that come with that designation. So shooting victims like Weathers often need to be transferred to another hospital for surgery.
At 11:05 p.m., almost exactly two hours after he was shot, Weathers arrived by helicopter at Wake Forest Baptist Medical Center in Winston-Salem — a hospital that would have taken paramedics just 12 more minutes to reach from where they found him.
For shooting victims like Weathers, every minute matters. He finally entered surgery 135 minutes from the time he was shot. The decision to save roughly 10 minutes in an ambulance cost him two hours of precious time.
Dayne and Gina Weathers, Griffin’s parents, said they don’t fault the people who took their son to High Point Medical Center or the doctors and nurses who treated him — they were doing their jobs.
But they are confused. Confused why Griffin Weathers went to a hospital that was not prepared to do surgery on him when one that could was close by. Confused why a hospital in a town ravaged by gun violence doesn’t have a trauma center anymore.
“Who is it that makes that decision?” Dayne Weathers asked. “Someone needs to address that.”
The decision makers
In North Carolina, there are 17 hospitals with trauma center designations. Of the state’s 15 most populous cities, High Point, the ninth largest, is the only one without a trauma center.
Formerly known as High Point Regional and owned by UNC Health, the hospital had a trauma designation as recently as 2014, but cut it after years of financial struggles. It’s now owned by Wake Forest Baptist Health.
“The trauma designation was allowed to lapse for several reasons including the cost of operating a Level 3 trauma center relative to the trauma volumes that were seen in the emergency department,” Alan Wolf, a spokesperson for UNC Health, wrote in an email. “Mostly, it was a duplicative service when there are two other trauma centers that offer higher level services within 20 miles of High Point Regional, including one in the same county.”
In a statement, Dr. Jim Hoekstra, the president of High Point Medical Center, said the hospital is an “active, appropriate participant in a vibrant trauma system.”
“The High Point Medical Center emergency department providers are experts at stabilizing trauma patients who need immediate care, and then transferring them to a trauma center for more definitive care,” Hoekstra said. “Trauma center designation is not as important as the quality of care provided locally at High Point Medical Center for trauma victims. We believe that being part of a trauma system of care... assures the best care for trauma patients from the High Point region.”
‘A lot of gray area’
Population 111,714, High Point has gained a violent reputation, with some residents taking to calling it “Little Chicago.” Between 2017 and 2020, more than 400 people were shot in the city. Sixty of them died from their injuries.
From 2017 to 2019, a higher percentage of shootings in High Point resulted in death compared to Greensboro and Durham, two other cities in the state that tracked shootings for that time period, according to data from each city. While fatal shootings are more common in High Point, there are fewer shootings per 10,000 residents than in Greensboro and Durham.
Dr. Marie Crandall, a professor at the University of Florida College of Medicine, studies traumatic injuries and how access to trauma care impacts health outcomes across the United States.
Crandall reviewed The Stabile Center for Investigative Journalism’s findings for this story, and said the data showing people dying from shootings in High Point at higher rates than other cities is “persuasive,” in that it may show a correlation between the higher rate of death and a lack of timely trauma care. However, she noted that it would be impossible to draw concrete conclusions without knowing more about each death: For example, what caliber of weapon was used, the severity of the injury suffered, or how many of the shooting victims were dead before paramedics arrived.
Often, High Point patients who have been shot need to be transferred to nearby hospitals with trauma centers, either Moses Cone in Greensboro or Wake Forest Baptist Medical Center in Winston-Salem. The entire transfer process usually takes 60 to 90 minutes, according to interviews with doctors, nurses and flight paramedics in North Carolina.
Yet, because of ambulance destination policies set by the North Carolina Office of EMS and by Guilford County EMS offices, shooting victims in High Point are regularly taken to the hospital there first.
The North Carolina College of Emergency Physicians helps set the destination guidelines for emergency medical services in the state and individual counties use those guidelines to set their own destination policies. A nonprofit with more than 1,000 members, the group lobbies on behalf of doctors in the state, and advocates for better emergency care, according to its website.
The policies are meant to direct patients to the hospital that can provide the most appropriate level of care for their injuries. They also allow for paramedics to use their judgment.
Dr. Darrell Nelson, an emergency physician at Wake Forest Baptist Medical Center, co-chairs NCCEP’s Emergency Medical Services Committee, and helps write the policies for paramedics to determine which hospital to take a trauma patient to. He called High Point’s location — about 30 minutes away from two neighboring trauma centers — “unique,” and said the distance puts paramedics in a “difficult” position when determining where to take a shooting victim.
According to North Carolina’s policies, which are based on CDC recommendations last updated in 2011, trauma patients who are not in extreme shock and are able to breathe on their own are supposed to be taken to the nearest trauma center — even if it is 30 minutes away. However, Nelson said policy should not supplant provider judgment, and it is unfair to retroactively judge paramedics for snap decisions they made in moments of high stress.
“If you think someone is injured enough that they could die in that 30 minutes, it makes it tough, and I can see how you defer to High Point for stabilization,” Nelson said. “Unfortunately, just the position of the city of High Point in relation to trauma centers leaves a lot of gray area because you have to allow for a lot of judgment.”
For paramedics treating shooting victims in High Point, Kyle Paschal, deputy director of Guilford County Emergency Services, said the destination policy makes it clear which hospital to go to, preventing a clear decision from becoming needlessly complex.
“Is it difficult for those guys to make that decision?” he said. “No. I think they make a lot harder decisions during their shifts.”
The N.C. Department of Health and Human Services, which oversees the N.C. Office of EMS, referred questions about the trauma policy to local EMS departments.
Dr. Eileen Bulger chairs the American College of Surgeons’ Committee on Trauma, a group that aims to help patients get the best care after suffering a traumatic injury. She said although it is impossible to issue a blanket protocol for all patients, it generally makes more sense for shooting victims to be taken to a nearby trauma center where surgery can be done, versus the closest local hospital.
The lack of a trauma center can be a problem for any shooting victim, not just the ones arriving in ambulances. A handful are dropped off at the emergency room by someone who was with them when they were shot.
On the night of Dec. 23, 2019, 27-year-old Kalon Ewing arrived in High Point’s emergency room with a bullet wound to his stomach. He and another person, who was shot in the shoulder, had arrived there in a car. He was transferred to Wake Forest Baptist Medical Center but died there the next day.
At 12:30 a.m. on Christmas Eve, John Austin Shoaf’s best friend drove him to the emergency room in High Point after Shoaf, 18, was shot in a drug deal turned robbery for $350 worth of marijuana, according to police statements at the time. It’s not clear from police records who was robbing who. Doctors ordered Shoaf flown to Wake Forest Baptist Medical Center where he died of his injuries.
After years of losses and with the facility in need of several improvements, the board of directors opted in 2014 to sell High Point Medical Center to UNC Health. Known then as High Point Regional, the hospital reported losses of nearly $12.2 million in the five years before the sale, according to tax documents filed with the IRS.
To try and stave off further losses, the leadership at UNC began slashing programs and budgets to stabilize the hospital’s finances, according to former employees of the hospital who requested anonymity due to stipulations in their severance agreements. Part of those cuts included the hospital’s Level III trauma center.
“High Point Regional continued to offer all the clinical services required of a Level 3 trauma center, including a 24/7 emergency department, orthopedics, general surgery and anesthesia,” Wolf, of UNC Health, wrote in an email. “The cost savings associated with restructuring the program were administrative expenses. That included the elimination of a trauma program coordinator and the medical directorship.”
There are three levels of trauma centers in North Carolina: Level I, Level II and Level III — with Level I being the best. Just over half of the trauma centers in North Carolina carry the Level III designation, which can provide all of the services that a Level I or Level II center can, except for neurosurgical procedures, according to Bulger, the chair of the American College of Surgeons’ Committee on Trauma. Additionally, surgeons at Level III hospitals might not be in the building 24/7, but one is always on call.
All three tiers can treat shooting victims, Bulger said.
Jeffrey Miller, 71, served as president of High Point Medical Center for 26 years before retiring in 2014. In a telephone interview, he said maintaining a trauma designation is a “very complicated and expensive thing that the big hospitals do.”
“We couldn’t justify our size having a 24-hour, 7-day-a-week trauma surgeon on duty, for example,” he said. Additionally, Miller said the designation placed a strain on hospital staff, as they were required to track certain statistics about patient outcomes and types of injuries to maintain their Level III status. The only reason High Point had a trauma designation at all was because staff thought it was necessary in order to provide the highest level of care, he said.
“It required a lot of data collection that we couldn’t see did us any good,” Miller said.
Physicians and surgeons also had to either be in the hospital or on call 24/7, and the hospital couldn’t afford the extra salary. Before cutting the program, the staff had been unable to hire a medical director to run the trauma center. The hospital couldn’t afford to pay that person for the additional work, according to former hospital employees.
Trauma centers have been closing across the United States for decades, according to a 2011 article published in Health Affairs. In 1990, there were at least 1,125 trauma centers in the United States. By 2005, 339 of those centers had closed.
Now, there are at least 535 trauma centers recognized by the American College of Surgeons. The organization does not count every trauma center in the country, and it is up to state and local governments across the United States to determine which hospitals meet the standards for being a trauma center. In North Carolina, the state designates which hospitals are trauma centers.
Most trauma centers close because of how expensive they are to run, and the inability of patients to pay their bills after care. One family interviewed for this story said they were billed more than $100,000 for the care their child received after being shot and killed in High Point.
When trauma centers close, it affects some neighborhoods more than others. In studies of these “trauma deserts” in Los Angeles and Chicago, majority Black and Latino census tracts were more likely to be farther away from hospitals with trauma centers than majority white census tracts.
In fall 2017, Wake Forest Baptist Health, the owners of Wake Forest Baptist Medical Center in Winston-Salem, signed a letter of intent to buy High Point Regional from UNC. The acquisition became final in September 2018, with Wake administrators publicly lauding the merger because it would provide better care for seriously injured patients.
Dr. Kevin P. High, president of the Baptist health system, said in a news release at the time that buying High Point Regional would help “better deliver the right care at the right place.”
Hoekstra, the hospital president, said in his statement that restoring a trauma center would not be a financial decision, but rather would be based on the hospital’s “clinical capabilities and what is best for the care of our trauma patients.”
The golden hour
In trauma medicine, speed to definitive care is often the most important thing in determining if a victim will live. This concept is known as “the golden hour.” Originally coined in a 1975 article by R. Adams Crowley, founder of Baltimore’s Shock Trauma Institute, the golden hour refers to “the first hour after injury,” which may largely determine a critically injured person’s chances of survival.
Suzanne Prentiss, the executive director of the American Trauma Society, a group dedicated to the elimination of needless death and disability from injury, said speed is especially crucial for treating penetrating traumatic injuries, like bullet wounds.
In 2010, researchers at Baylor University Medical Center found that a majority of traumatic injury-related deaths occur almost immediately after the injury. The next most frequent time of death was within four hours of someone being injured. These are known as “early deaths,” and Prentiss said they are the ones that proper trauma care can have a chance at preventing.
“Time is important in any trauma,” Prentiss said. “There are only so many tools you have in the field, and you’ve got to get them to an operating room. You’ve got to get to a place where they can find the source of the bleeding.”
From 2017 to 2019, 14.1% percent of shootings in High Point were fatal, according to data obtained in a public records request. In Greensboro and Durham, the only other two cities to respond to public records requests for this story, 9.8% of shootings in the same time period were deadly. Both of those cities have hospitals with trauma centers.
Miller, the former president of High Point Medical Center, said the higher percentage of fatal shootings in High Point cannot be directly attributed to the city’s lack of trauma center.
“A lot of that is driven by the gang wars going on here,” Miller said.
However, fewer people are being shot in High Point than in Greensboro and Durham. About eight people were shot in High Point per 10,000 residents, compared to 10.8 shootings per 10,000 residents in the other two cities in the years data was provided.
Researchers have linked physical distance from trauma centers with an increase in mortality from gunshot wounds, with studies in Chicago, Detroit and southern Los Angeles.
In Durham, Emergency Medical Services Director Mark Lockhart said the abundance of trauma centers in the area is part of the reason why more shooting victims survive.
“We’re trauma center rich, if you will,” Lockhart said.
Durham County is home to Duke University Hospital, a Level I trauma center, and neighbors Wake and Orange counties both also have Level I trauma centers. Shooting victims in Durham County are almost always taken directly to a trauma center, Lockhart said.
On paper, High Point may also be considered an area that’s “trauma center rich,” with Winston-Salem’s Wake Forest Baptist Medical Center 20 miles to the west, and Cone Hospital 20 miles to the north.
From 2017 through 2020, Guilford County EMS took 48 of the 206 shooting victims it treated in High Point to the hospital there. The other victims were taken to Winston-Salem and Greensboro. The data didn’t include the severity of each patient’s wounds, only that they were gunshot wounds.
“We take them to where we feel like is the best place for the patient’s condition at the moment,” Paschal, of Guilford County Emergency Services, said. “If there’s an airway compromise that we can’t resolve in the field we would certainly have to take them to the nearest facility because there’s no way they can live through that.”
‘He was already gone’
Not all bullet wounds are treatable and many still result in death, no matter how fast a person gets into an operating room. Serious penetrating trauma to the head, for example, almost always results in death.
In November 2017, Centell Carter, 31, was at the High Point apartment of his friend Donald Davis. It was just after 8 p.m. when the gun went off.
When police arrived, Davis frantically waved at them from his balcony, telling them to come upstairs and help his friend.
Guilford County EMS arrived and worked on him diligently. He had a pulse. Paramedics took him to High Point Regional Hospital in an ambulance because his wound was life-threatening. Hours later Carter was flown to Wake Forest Baptist Medical Center for surgery.
Nicole Carter, Centell’s mother, is a nurse technician at Cone Hospital in Greensboro. She arrived at Baptist sometime after midnight, hours after her son got shot. He was in the ICU at that point, and she remembers a nurse coming to talk to her as soon as she arrived.
“Do you know where Centell was shot?” the nurse asked. She did not. It was his head. Soon, Nicole Carter was able to see her son, who was hooked to machines; his head was wrapped in bandages.
“I knew by looking at my son that he was already gone,” she said. The family took Centell Carter off of life support that afternoon.
Davis told police the gun went off by accident and eventually pleaded guilty to involuntary manslaughter. A judge gave him a suspended sentence of three years, ordering probation.
Nicole Carter doesn’t know why there was a gun out at all and insists her son was not the kind of person to get mixed up with things he shouldn’t. She still struggles to understand what happened that night, and continue on without him. “To be honest, I have my good days and I have my bad days,” she said, trying to hold back tears.
10 minutes becomes 2 hours
A teenager with an independent streak that bordered on rebellious, Griffin Weathers was tall, dark-haired, fit and popular in school. Like most 17-year-old boys, he thought he was practically invincible.
As a young child, Griffin, or “Griff’ as his parents call him, had serious behavioral issues. Diagnosed with attention deficit hyperactivity disorder, attention deficit disorder and oppositional defiance disorder, he could, at times, be a “real pain in the ass,” said his father, Dayne Weathers.
Gina Weathers said before “the accident,” Griffin was turning a corner as a young person. A senior in high school, he had been accepted into High Point University where Gina worked in the admissions office.
On April 9, 2018, Griffin was getting ready to go to the gym with a friend; his mom had just come home from work. Gina Weathers remembered being annoyed Griffin had left the kitchen sink full of shaker bottles from his protein shakes. He asked if he could wash them later, because he was running late for the gym.
She agreed. Griffin gave her a hug and kiss, telling her, “I love you, Mom” before leaving the house.
Instead of going to the gym, Griffin Weathers drove to an apartment complex on the northside of High Point to sell another teen, Tylar Harris, a small amount of marijuana. Harris, then 16-years-old, pulled a gun on Weathers, attempting to rob him, according to police records.
There was a struggle, and the gun went off. Harris shot Griffin Weathers in the right side of his chest, according to Weathers’ medical records. Someone at the apartment complex heard the shooting and called 911; an ambulance arrived around 9:10 p.m., according to a local news report.
The paramedics originally decided Weathers should go to Wake Forest Baptist Medical Center, about a 22-minute drive away, where the doctors could do surgery promptly upon his arrival. Weathers was alert and talking when the ambulance arrived, according to his medical records.
But then his blood pressure dropped, and the paramedics changed their minds. They decided to go to High Point Medical Center where doctors and nurses could try to stabilize him. High Point’s hospital was a 10-minute drive away.
When Weathers arrived at the High Point emergency department at 9:39 p.m. he was still awake, but told nurses and doctors he couldn’t feel his legs. Within three minutes of his arrival he began receiving a blood transfusion. Four minutes later they stuck a breathing tube down his throat. At 9:50 p.m., a doctor at High Point called Baptist and asked if Weathers could be transferred there for surgery.
Before being airlifted out, Weathers was seen by a High Point surgeon, who determined that the hospital wouldn’t be able to operate on him in a timely manner anyway, according to Weathers’ medical records.
There was trouble getting Weathers ready for transfer. His blood pressure would not stabilize — he had been receiving blood transfusions since arriving in the emergency room — and it wasn’t until 10:45 p.m. that the flight crew felt comfortable enough to load him in the helicopter and fly to Winston-Salem.
By the time the helicopter landed at 11:05 p.m., the Weathers family was standing in the Baptist emergency department waiting room. A flight nurse told the family Griffin had received more blood transfusions in the helicopter.
He was rushed into surgery but had lost too much blood. The bullet damaged his aorta, liver and pancreas.
Almost two-and-a-half hours after getting shot in an apartment complex parking lot 22 minutes away, Griffin Weathers died on the operating room table.
Lee Sanderlin is an investigative reporting fellow at the Columbia University School of Journalism’s Stabile Center for Investigative Journalism. He previously worked as a newspaper reporter in the Triad.