6 Other Trauma Centers Vow Not to Follow Grossmont in Pulling Out : But Scripps Fears North County Competition

Grossmont Hospital’s sudden withdrawal from the county trauma system Thursday has raised a question:

Which of the county’s six remaining trauma centers will back out next?

The hospital’s withdrawal followed a month of controversy regarding its severe financial losses from the trauma center, a questionable death and the hospital’s failure to provide in-house trauma surgeons, as county officials required.

County Emergency Medical Services (EMS) Director Gail Cooper said Friday she “wouldn’t be surprised” if at least one other trauma center drops out in the next 12 months.

A trauma center should handle as “an absolute minimum” one patient a day to keep the center solvent and to keep the skills of its doctors and nurses well-honed, she said. But according to figures Cooper released, some San Diego County trauma centers are handling considerably fewer patients than that.

November figures for trauma patients indicate that the UC San Diego Medical Center, Mercy Hospital and Sharp Hospital trauma centers are doing well by Cooper’s standards. But trauma centers at Scripps Memorial and Grossmont were close to the “absolute minimum” decreed by Cooper. And Children’s Hospital was far below it.

Despite those figures and the negative publicity Grossmont has received from its troubles with trauma care, there appears to be no danger yet of the other hospitals abandoning the county’s five-month-old trauma care system. Officials from each of them say they are confident that their hospital will not be the next to drop out.

Some said they are doing as well as expected, even if they serve only a few patients. Others said they believe that a trauma center should be continued as a public service--even if it loses money.

The patient rate at Children’s Hospital, for example, is what the hospital expected, said Dr. Irvin Kaufman, director of in-patient services and a key member of its trauma team.

“Our average is 21 a month,” he said. “It’s higher in the summer and lowest in the winter months, when kids are in school and have less time to get run over or fall off buildings.”

Tri-City Hospital in Oceanside--which has twice been rejected by county health officials for the trauma center designation--still wants very much to run a trauma center and isn’t at all dismayed by Grossmont’s problems.

Despite Grossmont’s negative experience, “we’re more eager than ever to become designated,” said Tri-City spokesman Mark T. Havel. The hospital is still actively pursuing a lawsuit against the county to gain the trauma designation, he added.

Havel believes that a trauma center at Tri-City would have plenty of business. “The incidence of trauma in the Tri-City area is larger and greater than any other area in the county,” he contended.

With Grossmont’s withdrawal--presumably creating an opening in the system--the county supervisors “should have no excuse” not to designate Tri-City, Havel said.

Expected Monetary Loss

Officials at Palomar Hospital in Escondido, which opened its trauma center on Jan. 1, said they weren’t worried by Grossmont’s withdrawal.

“We went into this knowing we’d probably lose money but our stance is that this a community service,” said Palomar Administrator Bob Harenski. He estimated that Palomar’s trauma center will receive 1.5 to 2 patients a day.

In county trauma patient figures for November, the latest month for which they were available, UCSD received 56 trauma patients; Mercy, 53; Sharp, 52; Scripps, 36; Grossmont, 32, and Children’s, 14.

Though EMS Director Cooper believes one or more trauma centers may be forced to drop out, “I can’t speculate on who will jump ship next,” she said. She noted that each trauma center should handle an “absolute minimum” of “one major case a day . . . and the ideal would probably be closer to three patients a day.”

With the entrance of Palomar’s trauma center into the system last week, a new hospital is vying for a limited number of trauma patients. And already Scripps hospital is worried about the competition, William Hillyer, chairman of Scripps’ board of directors, acknowledged Friday.

Hillyer said he was concerned about the possibility of losing patients to Palomar. And he said Scripps’ trauma patient business could be weakened even further if Tri-City is allowed to open a trauma center.

“We hope to make it (the trauma system) work. We can’t if there are too many trauma centers,” Hillyer said. “There’s a serious question about Palomar and Tri-City being put into the system too. That would take away patients that would otherwise go to Scripps. We have to have a sufficient number of trauma patients to make it not only cost-efficient but to give the physicians the practice necessary to maintain their expertise.”

At present, Scripps has no intention of dropping out of the trauma system, Hillyer said. But he cautioned, “We’ll operate it for a time and see if it works. If the volume isn’t there, then we’d have to make a judgment as to whether to drop out.”

Scripps’ trauma chief, Dr. Brent Eastman, said he is convinced that Scripps will stay in the trauma system. Still, the county currently has too many trauma centers, Eastman said. He said that three or four would be ideal to handle the county’s estimated 2,000 trauma cases a year; a patient load of about 500 cases a year would be ideal.