Action on Trauma Center Delayed Pending Review

The San Diego County Board of Supervisors informally agreed Tuesday to delay action on Tri-City Hospital’s request to become a North County trauma center until April, when county officials expect to have completed a review of the entire trauma system.

Tri-City officials, who had hoped to win a trauma designation for the Oceanside hospital Tuesday, expressed disappointment and said the board’s decision leaves it open to a legal confrontation with the hospital’s lawyers on Feb. 1 in Superior Court in Vista. Tri-City sued the board last month over its failure to designate the hospital as a trauma center, but has offered to withdraw the suit if the county changes its mind.

County staffers also released a three-page report questioning the hospital’s claim that, from September to December, it treated 63% of the trauma patients in the Tri-City area because the Life Flight helicopter was unavailable or because paramedics and doctors didn’t recognize traumatic injuries.

In response, a Life Flight official said Tri-City had inflated the figures, and county health services director James A. Forde blamed the hospital for misidentifying many patients as trauma victims. But Tri-City officials insisted Tuesday that their data is accurate.

The board didn’t vote on whether to approve Tri-City, nor did Supervisor Paul Eckert--who represents much of North County --call for a vote.

Forde objected to admitting Tri-City on the grounds that county staffers need more time to review the trauma system.

The staff plans to give the board a report on the trauma system in April, one year after the board originally designated six hospitals as trauma centers: UC San Diego Medical Center and Grossmont, Children’s, Sharp, Mercy and Scripps-La Jolla hospitals. Since that time, Grossmont has dropped out of the system and Palomar Hospital in Escondido has been admitted.

On Jan. 8, at Eckert’s request, the board agreed to set aside half an hour Tuesday to hear Tri-City representatives’ third plea for designation in less than a year.

Tuesday’s hearing lacked the large crowds seen at two previous board hearings--in April and December--where supervisors considered Tri-City and other hospitals’ bids for trauma center designation.

Tri-City attorney Greg Garrett reminded the board of Tri-City’s 90.1 score--more than 20 points above the passing grade--in a review of its operations conducted by a seven-member medical team in October.

Although denied a formal designation as a trauma center, “Tri-City has been acting as a trauma center for the last many, many months,” Garrett added.

In a report submitted to The Times last week, Tri-City emergency physician Steve Karas said his work indicates that, of 116 trauma cases in North County from September to December, 33 of them --28%--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 that required immediate attention, the report said.

In an additional 35% of the cases--41 of 116--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, he said.

But on Tuesday, Forde said in a three-page statement submitted to the board that Karas’ data contains “a significant number of inaccuracies.”

Over the weekend, county staffers examined Karas’ data for 106 of the patients, Forde said. They concluded that there were “only 40 major trauma victims--or 38%--who should have been treated at a designated trauma center. The other 66 patients appear to be injured persons, but not serious enough to require the specialized resources of a trauma center.”

Nevertheless, Forde said, “This assessment is only a provisional one, given that much of the data we have received on the severity level of these patients was contained on incomplete hospital records.” Further study of Tri-City’s data will be conducted, Forde said.

Also, Life Flight director Dr. Bill Baxt told the board that from August to December there were 10 cases--not 33, as Karas claimed --in which both Life Flight helicopters were unavailable. Two cases involved bad weather and one involved mechanical problems, and in seven the helicopters were occupied with other cases, Baxt said.

Tri-City’s Garrett responded, “We are confident that we can substantiate our numbers. We’ve looked at a lot more data than the county has. . . . Dr. Karas has a lot of computer experience.” Karas generated his data on a computer.

Karas, who attended the hearing, also defended his work: “Forde’s definition (of trauma) is a narrow one . . . (It) isn’t like the way the system was set up.”

The three new members of the county Board of Supervisors--Susan Golding, Brian Bilbray and George Bailey--called for a delay in acting on Tri-City’s request.

Golding said the county has too many trauma centers already and that any action on Tri-City’s request should wait until the April report. “There are other residents in East County and South County that also don’t have a trauma center,” she said.

Similar sentiments were expressed by Bailey, who joked that “I do have a problem with changing (trauma centers) every month or so. . . . I can see no major problem with (designating) Tri-City except I say, ‘Wait until April.’ They have presented an excellent case for being in the trauma system. But we do have a responsibility to see that we take orderly action.”

Agreement came from Bilbray, who said that because trauma designation “is such an emotional, such a volatile issue,” new centers should be picked all at once, once a year, rather than haphazardly.

Richard Hachten, Tri-City chief executive officer, said after the meeting that he was disappointed but that the hospital will continue its fight, including the Superior Court engagement.