Tri-City to Get 3rd Try for Trauma Status : Supervisors Agree to Jan. 22 Hearing for North County Hospital

Despite opposition from county health officials, Tri-City Hospital in Oceanside won a new chance to become a trauma center Tuesday when its officials persuaded the San Diego County Board of Supervisors to hold a hearing Jan. 22 on its long-frustrated bid for trauma designation.

The action stemmed from the board’s formal ratification, on Tuesday, of Grossmont Hospital’s early withdrawal from the county’s 5-month-old trauma system. Tri-City officials have maintained that Grossmont’s withdrawal eliminates a key argument--that there are too many trauma centers already--against adding Tri-City to the system.

Supervisor Paul Eckert also criticized the county Department of Health Services for allowing unclear wording in a contract with Grossmont Hospital that might have contributed to the death of a trauma patient Dec. 25.

Eckert, who represents much of North County and was elected vice chairman of the Board of Supervisors Tuesday, asked the board to allow Tri-City officials to present, for a third time in eight months, their case for designation.

The board voted 5-0 to allow Tri-City officials to return at 10 a.m. Jan. 22 to present a half-hour argument.

“Tri-City Hospital is ready, willing and qualified,” Tri-City attorney Greg Garrett told the board. “We’re the only hospital that has passed the county test and has not been designated.” In early 1984, a medical review team concluded that neither Tri-City in Oceanside nor another North County hospital, Palomar in Escondido, was qualified for trauma status.

The board gave the hospitals a second chance to apply for the designation in October. Then, both received well above the passing score of 70 on the 110-point evaluations; Palomar received 90.4; Tri-City, 90.1. The board, however, concerned that the county already had seven trauma centers, decided to designate only one North County hospital--the one with the higher score, Palomar.

Tri-City then sued the board of supervisors, charging that Northwest San Diego County residents’ lives are being endangered by the absence of a trauma center there.

On Tuesday, Tri-City officials promised to drop the suits if the board approves Tri-City’s bid for trauma designation before the suit is heard Feb. 1 in Superior Court in Vista.

James Forde, county health services director, expressed mild resistance to holding another hearing on Tri-City’s trauma status this month. Forde said there would be too much work for his staff to prepare for another designation now. Forde asked the board to consider using the schedule he had previously proposed for the trauma system. Under that schedule, a team of medical experts would conduct on-site visits from March 7 to 30 at Tri-City and at the six existing trauma centers. On April 30, Forde would give the board of supervisors a report of the team’s findings and its recommendations regarding whether any trauma centers should be added or dropped.

The board unanimously overrode Forde’s objection and decided to hold the Jan. 22 hearing. “I’m comfortable waiting until the re-evaluation (of whether to designate Tri-City), but I want to give Tri-City a chance to talk,” argued new Supervisor Susan Golding.

The county trauma centers are now UC San Diego Medical Center and Mercy, Palomar, Children’s, Sharp and Scripps Memorial-La Jolla hospitals.

Also on Tuesday, Eckert criticized the county health department staff for allowing ambiguous wording in the trauma contract with Grossmont. The wording might have played a role in the death of a trauma patient at the hospital, he said.

“I would contend that what we adopted is not very clear,” Eckert said, addressing Forde and his aides. “We’re here because your plan, as well-designed as it was, did not work. Maybe the hospital (Grossmont) didn’t do what it was supposed to do--but you were the judge (of that).”

In a two-page letter submitted to the board Tuesday, Grossmont administrator Ron Dahlgren quoted the contested passage. It says, in part, “Definitive surgical care is instituted by the on-call trauma surgeon, who arrives in a timely manner consistent with established standards.”

‘Immediately Available’

Dahlgren said that he and the county had informally agreed that the passage means that the trauma surgeon would be “immediately available.”

But the definition of “immediately available” became an issue last month after trauma patient Navy Chief Petty Officer Nickey Trevino died Dec. 25. Trevino lay in Grossmont’s trauma unit for 36 minutes with gunshot wounds. Because no trauma surgeon was available, Trevino was taken by helicopter to the UC San Diego Medical Center trauma center, where he died.

After Trevino’s death made headlines, Dahlgren publicly maintained that “immediately available” meant that the hospital would try its best to get a trauma surgeon to the trauma unit. But Forde maintained that “immediately available” means that a trauma surgeon would always be at the trauma unit when a patient arrived.

On Thursday, Dahlgren asked Forde to drop Grossmont from the trauma system five days earlier than originally planned because of its inability to guarantee that a trauma surgeon would be present whenever a trauma patient arrived. Forde agreed, and the supervisors ratified the withdrawal Tuesday.