Tri-City Ready for 3rd Trauma Status Bid : Hospital Already Treating Most of Area’s Trauma Patients, Doctor Says

At 10 a.m. Tuesday, officials from Tri-City Hospital in Oceanside will try--for the third time--to persuade the county Board of Supervisors to designate their facility as a trauma center.

Sixty-three percent of trauma patients in the Tri-City area of Vista, Carlsbad and Oceanside already are being treated by the hospital because Life Flight helicopters weren’t available or because paramedics and doctors didn’t realize that patients had traumatic injuries, according to a study by a Tri-City doctor.

Yet none of those patients have suffered as a result, because the hospital is fully qualified to be a trauma center, the doctor--emergency physician Steve Karas--and Tri-City officials maintain.

Therefore, Tri-City should be designated as a trauma center, because it’s already functioning as one, officials there argue.

The findings, developed on Karas’ Apple computer, “are interesting figures and we will certainly look at them,” James Forde, director of the county Department of Health Services, said Friday.

But Forde still expressed opposition--as he did at a Jan. 8 county board meeting--to adding Tri-City until county staff can evaluate the effectiveness of the entire county trauma care system since it started Aug. 1. Forde’s staff has been planning to submit a full-scale review of the system to the board in April.

To designate Tri-City as a trauma center now would “just create a lot of work and activity and disruption to the trauma system that may again have to be repeated in April or whenever new (trauma) designations are made,” Forde said.

Karas said his work indicates that of 116 trauma cases in North County from September to December, 33% to 28% of the total--had to be handled at Tri-City because the Life Flight helicopter based at UC San Diego Medical Center wasn’t available. The helicopter was handling other cases in 18 instances, had mechanical troubles in one case, was grounded by bad weather in seven cases, couldn’t transport three patients because they were too “combative,” and took four patients to Tri-City because they had extremely severe injuries, which required immediate attention.

In an additional 35% of the 116 cases, patients weren’t initially identified as trauma cases because the extent of their injuries wasn’t clear, Karas said. They were taken to Tri-City, where doctors discovered they were trauma cases.

A trauma patient is defined as someone suffering severe, life-threatening head injuries or damage to several major bodily organs. Sometimes trauma injuries are largely internal, hence they aren’t obvious to paramedics.

As a result, “very serious cases are not being taken care of by trauma centers,” Karas said.

Karas met Thursday with county emergency medical services director Gail Cooper. “He presented us with some data and demonstrated a computer programming package . . . I really wouldn’t want to comment until I’ve had to chance to analyze the data,” Cooper said.

Cooper said that she, like Forde, continues to oppose the designation of Tri-City for the time being.

“We want an opportunity to examine data for the (trauma) system that’s already in place . . . If Tri-City is implemented, it changes the whole system design . . . “

Karas’ information will be included in Tri-City’s presentation to the board, Tri-City spokesman Mark Havel said Friday.

Asked to forecast whether the board will vote to designate Tri-City on Tuesday, Havel declined to answer directly but added: “We’re optimistic. We feel that the new board has an open mind, and we feel that they’re going to listen to the facts and make the right decision.”

Whether the board will vote to designate Tri-City is hard to say, pro-Tri-City Supervisor Paul Eckert said Friday. On Jan. 8, when the board voted to hold Tuesday’s hearing, “I thought . . . there was just no way the supervisors weren’t going to designate Tri-City. The evidence (on the hospital’s behalf) was conclusive to even the most uninformed.

“And yet, it didn’t happen.”

The designation of Tri-City could hurt the trauma business at Scripps Memorial Hospital-La Jolla, the nearest trauma center, Scripps board chairman William Hillyer told The Times earlier this month. Scripps officials couldn’t be reached for comment Friday.

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

Tri-City officials have offered to drop a lawsuit against the county if the board designates Tri-City as a trauma center. The suit was filed in December because of the board’s refusal to designate Tri-City, which angered hospital officials and North County residents who feared that trauma patients’ survival might be compromised by the long transport time to the other trauma centers.

In another development, Eckert said he was planning to meet with Forde and other county health officials before Tuesday’s board meeting to discuss dropping the trauma review team, chaired by Dr. Frank Ehrlich of Johnstown, Pa. Last year, the seven-member team of doctors, nurses and other health officials conducted two series of reviews of hospitals seeking designations as trauma centers.

“They’ve (the team members) lost all credibility with me now because of the fact they recommended Grossmont (as a trauma center) and it appears Grossmont was no more prepared than Tri-City or Palomar were originally,” Eckert said.

Grossmont dropped out of the trauma system last month, citing excessive costs and its inability to guarantee that trauma surgeons would be available.