Trauma Cases Fewer Than Projected; 2 Centers May Be Cut

Physicians in the 7-month-old San Diego County trauma system are performing surgery on only half the expected number of trauma patients, which prompted county staffers Tuesday to advise the Board of Supervisors to reduce the number of centers from six to four.

An official from one of the six trauma centers, Scripps Memorial Hospital-La Jolla, told the supervisors that the shortage of trauma patients might force the hospital to drop out of the system.

The board took no action Tuesday on the staff’s proposal, but it voted unanimously--with Supervisor Brian Bilbray absent--to launch a second round of performance evaluations of the hospitals in the system, to be done by the county staff. The board directed the staff to return by April 9 with recommendations regarding which hospitals should be allowed to continue as trauma centers and which, if any, should be dropped.

In planning for the system two years ago, county officials estimated that it would require an average of 50 patients per trauma surgeon per year--or 350 patients per hospital--for the center to be financially feasible and to ensure that each surgeon would keep his skills well-honed. Recent figures indicate that each surgeon will perform an average of 23 to 25 trauma surgeries per year, “considerably less” than the expected number, Gail Cooper, head of the county division of emergency medical services, said.

Cooper said she does not know exactly how many trauma patients the system has handled.

Based on the board’s action Tuesday, “the staff is supposed to come back giving them options showing what would happen if the trauma system was based on 350,000 (residents per service area) or 400,000 or whatever,” said James Forde, county director of health services.

Last week, Forde sent the board a memo recommending that the average area covered by each hospital’s trauma center be increased to include 500,000 residents. Doing so would, in effect, reduce the number of trauma centers in the county to four. Currently, the average service area has 350,000 residents.

Neither supervisors nor the county staff specified which trauma centers, if any, should be dropped. The trauma centers are UC San Diego Medical Center and Mercy, Scripps-La Jolla, Children’s, Palomar and Sharp Memorial hospitals. Originally, the board also had selected Grossmont Hospital, but that East County facility withdrew from the system in December. Later, the board named Palomar Hospital in Escondido as a trauma center.

Tri-City Hospital in Oceanside has been seeking trauma center designation and has sued the board for refusing to include it in the system. A Tri-City representative attended the board meeting Tuesday but declined to comment afterward.

Scripps-La Jolla has about 400,000 people in its area, Ben G. Clay, a professional lobbyist for the hospital, told the board. Clay argued that the area should be enlarged because experience indicates that the present area will not provide an adequate number of patients. He said he does not know exactly how many trauma patients the hospital is getting or how much bigger the area should be.

In discussing the performance evaluations, supervisors criticized Forde’s proposal that the review team give a hospital either a passing or failing grade rather than a numerical score, as was done in the past.

“The problem with numerical scores is that minor differences in scoring (between hospitals) may make it seem like there are major differences in quality,” Forde said. County Chief Administrative Officer Clifford Graves added that “any time you quantify something, you run the risk of making something appear more objective than it is.”

But Supervisor Susan Golding countered, “The numerical score helps them (the hospitals) determine why they did or didn’t qualify” as trauma centers.

Ultimately, Forde agreed to the use of some sort of numerical scoring system.

Supervisor Paul Eckert also asked the staff to take into account the amount of time that patients must travel to a trauma center. Currently, because of the lack of trauma centers in the northwestern and southern parts of the county, “we’re taking a fairly good length of time to get them to care,” Eckert said.