Huntington to Stay in Trauma Business Despite Money Loss

Despite financial losses from a smaller than expected patient load, the San Gabriel Valley’s largest trauma treatment center--Huntington Memorial Hospital here--will stay in the county trauma center program for at least another year, officials say.

The trauma center at Arcadia’s Methodist Hospital of Southern California also is treating fewer patients than expected, but officials there will not say whether the program is losing money. The valley’s two other trauma centers, at Queen of the Valley Hospital in West Covina and Pomona Valley Community Hospital in Pomona, are reported to be meeting patient load and financial expectations.

Officials at all four centers say the program is achieving its major objective--saving lives.

The county set up the program in 1983 to improve the survival chances of critically injured people. There are 20 trauma centers countywide, each with a 24-hour in-house team that includes an anesthesiologist, a trauma surgeon, an operating room staff and a support team.

20 Minutes Travel Time

Each center has geographic boundaries designed to ensure that a patient can be taken to the hospital within 20 minutes.

The program replaced the practice of paramedics taking all seriously injured people to the nearest 24-hour emergency room whether or not it had the staff on hand to perform immediate surgery. Most trauma patients are victims of traffic accidents. Others are victims of violent crime or have been in other kinds accidents, such as falls, resulting in head injuries.

Huntington, which opened its trauma center Dec. 15, 1983, had expected 400 patients a year but had seen only 229 through November, 1984, according to spokeswoman Kay Murphy. And the hospital, which has a capacity of at least 750 trauma patients a year, does not know why the figure is so low, she said.

“The program is costing us about $600,000 a year,” she said, “and while we don’t yet know how much money we are losing, we definitely have a financial loss. Our goal is to break even.

“We can’t lose a great deal of money on one program but we feel this one is effective and that patients are saved because of the system. We will remain in the program for at least another year, but in the future we would have to consider pulling out,” Murphy said.

In December, California Hospital Medical Center in Los Angeles withdrew from the trauma program saying that the inordinate number of impoverished patients had added up to a multimillion-dollar financial drain.

Virginia Price-Hastings, trauma program chief for the county Department of Health Services, said that while the county has not yet evaluated the program, any hospital incurring losses from a lack of patients might be forced to drop the service.

Would Want an Alternate

“But we wouldn’t want a hospital to drop the program unless there is another hospital meeting the 20-minute criterion,” she said. “In the San Gabriel Valley, for example, if Methodist dropped out, most people (in Methodist’s boundaries) could be taken to Huntington or Queen of the Valley in 20 minutes.

“There are always rumors about hospitals wanting to drop out. Huntington and Methodist are not seeing a large number of patients but Pomona and Queen of the Valley have a high number.” Murphy of Huntington said, “We don’t know why we have fewer patients than we anticipated. We are not a high trauma area but our proximity to Methodist (which is less than 10 miles away) could be a factor.”

She declined to speculate whether the freeway configuration could be a factor. Most trauma cases result from car and motorcycle accidents, and Huntington and Methodist have few freeway miles in their boundaries compared to Queen of the Valley and Pomona Community.

Huntington’s boundaries are South Pasadena and San Marino to the south, Michillinda Street to the east and Glendale, La Canada Flintridge and a small portion of Los Angeles to the west. All four centers have the San Gabriel mountains as their northern boundaries.

While California Hospital dropped the program because of the number of indigent patients rather than a low patient count, Huntington has a reasonable number of insured patients. Seventy percent of the patients are covered under various programs that pay at least 77% of the costs.

Huntington became a trauma center, Murphy said, because its emergency room has always been a major emergency center for the area and because the hospital offers a residency program in emergency room care.

Methodist, which joined the program last July, averages about 188 patients a year. Eileen Mauch, trauma nurse coordinator there, said she is happy with the program. “We can do in 10 to 15 minutes what used to take two hours,” she said, “but we need volume to offset the cost and eventually the program will have to be subsidized.” There is no government subsidy.

Lewis Wagman, the hospital’s senior vice president for administration, said 60% of the patients have insurance, but declined to say what the program was costing or whether the hospital was losing money or breaking even. He did say, “We are concerned with non-insured patients. We would like government funding for this.”

He also said that the program is expensive because of the requirement that the surgical team be on the premises. “Most of our doctors live within 10 to 15 minutes of the hospital and could respond quickly to a call,” he said. “But some other hospitals in the program don’t have doctors living that close and that criterion is not negotiable.”

When asked if Methodist would consider dropping out of the program, he said, “We are always evaluating our programs. We have a 60-day notice clause with the county.”

The boundary lines for Methodist are the Pomona Freeway on the south, the 605 Freeway on the east, and Michillinda Street and San Gabriel Boulevard on the west.

Abutting Methodist’s territory is the area served by Queen of the Valley, which goes to Grand Avenue in West Covina on the east, the 605 Freeway on the west and south to Hacienda Heights.

Queen of the Valley reported 852 trauma patients a year and said it is breaking even financially, even though the program costs $1 million a year. Sixty-three percent of its patients are insured.

The hospital began operating as a trauma center last February and, said spokesman Mary Ann Harvey, “we went into it partly for the prestige of being a trauma center and because we feel emergency services are one of our major services. Thirty-nine percent of our patient admissions come from emergency so we were afraid we would lose some of those patients if we didn’t become a trauma center, and this would mean losing money.”

While spokesmen for Methodist and Huntington say they do not have a consistent pattern of trauma patients, Queen of the Valley officials report that their heaviest load occurs weekdays during commuting hours.

Pomona Valley Community, on the other hand, gets most of its patients Saturdays between 8 p.m. and 4 a.m.

Pomona, which opened its trauma center last July, is breaking even financially with about 540 patients a year. The program costs the hospital $500,000 a year and about 40% of the patients have private insurance, according to Randy Stoll, vice president for administration.

“We do know that we provide more efficient care than before and this should result in decreased deaths, but we have no statistics to prove it,” Stoll said.

According to Huntington’s Murphy, her hospital believes patients are saved because of the system, but she said there is no way of proving it.

Pomona’s boundaries abut those of Queen of the Valley and go south to the Orange County line and, technically, east to the San Bernardino County line.

But, said Stoll, “We do get patients from the west end of San Bernardino County, which is 20 minutes away from us. It is not a formal designation but for those patients the closest trauma center is Loma Linda University Medical Center.”

Stoll and Price-Hastings of the county both said that at this point the area of concern in the program is to be sure the paramedics stay within the boundaries so centers get their fair share of patients.

Price-Hastings added that Alhambra, Monterey Park and San Gabriel are not covered by the trauma program because those cities do not have paramedics. Bob Salsameda, trauma coordinator for Queen of the Valley, said, “Our initial objective was to just live through the first year of the program. But now we are trying to work together with other hospitals and other people involved because the program is fragmented.”

Salsameda hopes hospitals, paramedics and the Department of Health Services can hold conferences jointly so that the entire program becomes more cohesive. He said trauma is the third leading cause of death in the United States.