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Grossmont Hospital Severs Its Ties With Trauma Care Service

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Times Staff Writer

Grossmont Hospital abruptly ended its five-month stint in the county trauma system at 4 p.m. Thursday, five days earlier than planned, after the hospital acknowledged it could not guarantee that trauma surgeons would be available immediately to treat severely injured patients.

After the La Mesa hospital agreed to withdraw, county officials alerted Sharp Memorial Hospital in San Diego late Thursday to be ready to handle any East County trauma patients that would have otherwise gone to Grossmont.

Sharp officials expressed confidence that their trauma center has an adequate staff to handle the added responsibility.

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Grossmont’s sudden departure climaxed a month of controversy surrounding its trauma center.

Its role has been scrutinized by county officials, and this week the state Department of Health Services launched an investigation because of the Christmas Day death of a patient who spent 36 minutes at Grossmont without a trauma surgeon available to treat him.

Patient Died

The patient later died of a gunshot wound at UC San Diego Medical Center, where he was transferred.

On Dec. 3, a doctor and nurse appointed by the county criticized Grossmont’s trauma surgeons for not always being in the trauma unit when a patient arrived.

On Dec. 18, the Grossmont board voted to abandon its trauma center as soon as possible because it was losing an estimated $11,000 a month and the hospital could not afford to hire more trauma surgeons. Grossmont officials estimated it would cost $1.4 million to pay for 24-hour-a-day coverage by trauma surgeons, anesthesiologists, helicopter services and other trauma center services.

Normally, under county rules, a hospital that wanted to leave the system would have had to continue to serve for 45 days after asking to get out--in this case until Feb. 1.

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But in response to Grossmont’s request to withdraw, county officials agreed to ask the Board of Supervisors to vote Tuesday to release Grossmont from the trauma center contract and to shift responsibility for East County trauma patients to Sharp Hospital. Grossmont administrator Ron Dahlgren agreed to keep Grossmont in the trauma system until the board’s vote next week.

But that agreement began unraveling Thursday. By late afternoon, Sharp officials said they could pick up Grossmont’s trauma care load several days earlier than expected.

Sharp spokesman Ed Crawford said hospital officials don’t expect to need to make last-minute changes to take on additional patients.

Prepared to Serve

“We’ve been preparing since we’ve known that this service area was to become ours . . . We’re prepared to serve the area. I don’t expect any problems. We’ve alerted the (trauma) staff that needs to be involved, and they’re ready to serve the area,” Crawford said.

On Thursday, local news media received a press release from the office of county health services director James Forde saying county and state health officials had undertaken reviews of “the death of a patient who had been transferred from Grossmont District Hospital to the UCSD (San Diego) Medical Center.”

The patient was Nickey Trevino, a Navy chief petty officer who had been shot in El Cajon on Christmas Day. Trevino was taken to Grossmont Hospital at 12:29 p.m. where no trauma surgeon was available in the trauma center. Instead, the hospital “stabilized” Trevino and contacted the Life Flight helicopter at UCSD Medical Center. The helicopter took Trevino to UCSD at 1:12 p.m. He died there after surgery at 2:44 p.m.

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Forde, the county health services director, asked Grossmont to submit an explanation for the surgeon’s absence.

The hospital did so. But Grossmont would tell reporters only that the surgeon said he had another commitment. As a result of the hospital’s explanation to Forde, Forde concluded that the surgeon’s absence constituted “a deviation from the county’s trauma procedures,” according to a press release issued Thursday by Forde’s office. The county’s philosophy is that a trauma center should have a trauma surgeon available 24 hours a day because otherwise its service is not significantly different from an ordinary emergency room.

Nevertheless, Forde’s press release continued, “The administration and medical staff at Grossmont have assured me that they will be able to comply with county trauma standards through Jan. 8.”

But Grossmont administrator Dahlgren said that at about 3:30 p.m. Thursday, Forde and he were talking by telephone when Forde said he wanted Dahlgren’s written assurance that a trauma surgeon would be present as soon as a trauma patient arrived.

Dahlgren said he couldn’t make such a guarantee. Forde said he had “been getting a lot of pressure from different reporters about this subject,” Dahlgren said, “and felt he had to have a statement from me in writing that we’d agree the surgeon would be there at the time the patient arrived. I told him that . . . we’d have to have a paid physician in-house to provide that service, and that our medical staff at this point wasn’t prepared to do that and that I couldn’t guarantee that 100%.”

Consequently, after conferring with other Grossmont officials, Dahlgren asked Forde to remove the hospital from the trauma system immediately. Forde agreed. The removal took effect at 4 p.m.

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Official Order

The official order to drop Grossmont was issued by county emergency medical services director Gail Cooper, who said she was called in from vacation to do so.

Speaking on Forde’s behalf, Paul Simms, the county deputy director of health services, said Thursday, “Mr. Forde was notified this afternoon that Grossmont Hospital could not provide timely surgical coverage consistent with requirements of their provisional designation . . . (They) requested to be dropped immediately and we concurred.”

Simms said the hospital provided one set of information on its intentions Thursday morning, then flip-flopped that afternoon.

“As of 8 o’clock this morning, the department was advised that Grossmont had the ability and willingness and desire to fulfill the terms and conditions of the agreement through Jan. 8.”

That assurance was given either by Dahlgren or by Dr. David Thomas, chief of the hospital’s medical staff, in a telephone conversation with Forde, Simms said. But later the hospital requested that it be allowed to get out of the trauma care business.

Asked why the hospital administration would have flip-flopped, Simms replied, “That question you should probably ask Mr. Dahlgren . . . We don’t have that answer.”

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