Board Gives Tri-City Another Chance to Join Trauma System

The final makeup of San Diego County’s fledgling network of trauma care hospitals was postponed for six months Tuesday by the Board of Supervisors in an effort to give Tri-City Hospital of Oceanside a chance to qualify as a sixth center.

The board’s decision, reached after 3 1/2 hours of testimony and debate, pleased Tri-City officials, who argued that the sprawling northern coastal area of San Diego County needs a trauma center because of the time now required to transport seriously injured victims to hospitals farther south. Busloads of North County residents and a bevy of area politicians attended the meeting.

However, both county health officials and members of the existing trauma network expressed disappointment and anger at the decision, which they said could have a deleterious effect on the level of care and could slow improvement of the system.

The county health staff had recommended that the trauma system be maintained at its present level of five hospitals for adults and one for children under 14, pointing to a recent exhaustive review that showed the system has remarkably reduced the rate of preventable deaths from auto accidents, knifings and other major injuries classified as traumas.

Doctors from the five hospitals, although they did not strongly oppose the county’s proposal, had preferred that supervisors cut the number of trauma centers to four, saying that the number of trauma cases so far indicates that there may be too few patients to maintain the skills of specialized trauma surgeons and to keep the centers afloat economically.

But supervisors were unwilling to deny permanently Tri-City’s hopes to become a sixth center, choosing instead to try to factor political considerations into the equation. Tri-City officials pushed strongly for the hospital’s immediate designation as a trauma facility, saying it already is serving as a de facto trauma center for many patients because of weather conditions and mechanical limitations in the Life Flight helicopter service used to take North County patients south.

The other supervisors refused to back a motion by Paul Eckert, who represents North County, for immediate trauma center designation for Tri-City. They cited four major shortcomings in the hospital’s trauma-level care that had been presented to them in a closed session earlier this month by doctors on a special independent review team.

The board chose instead to support a motion by Supervisor George Bailey to give Tri-City six months to upgrade the quality of its neurosurgery, its educational program for trauma workers, its clinical training of nurses and the skills of its interim trauma center director.

“We will re-examine Tri-City to see if significant improvements have been made and to consider at that time whether it should be included in the system,” Bailey said. The motion, passed unanimously by the five-member board, also gave three-year trauma-center designation to the present members of the system--UC San Diego Medical Center and Mercy, Sharp Memorial and Scripps Memorial hospitals, all in the City of San Diego. Children’s Hospital received a three-year certification as the pediatric trauma center, and Palomar Hospital in Escondido was given a six-month temporary trauma-center designation while it continues to correct deficiencies judged less serious than those at Tri-City.

Supervisors Susan Golding and Brian Bilbray, in voting for the motion, made it clear that they want assurances from county health officials in six months that the addition of Tri-City, even if it meets all standards, will not hurt the system.

“The question we have not addressed is what is the maximum number of units in the system that it can absorb so the quality can remain high in individual centers,” Golding said.

But the co-chairman of the special committee of physicians and county staff members that oversees trauma care predicted that the system will suffer as a result of the half-year hiatus before a final decision on the number of hospitals is reached.

“It’s incredulous that nothing really happened and there was no real decision on the ideal number for trauma centers,” said Dr. Steven Shackford, a UCSD surgeon. He said that hospitals given the three-year designation will be reluctant to lay out funds and gear up for the long haul if uncertainty persists over the number of trauma centers. Data released last week showed that each of the present centers is losing money.

Although Shackford said that UCSD is committed to the system despite the cost, other hospitals, such as Scripps Memorial, could find the costs of staying in too onerous. Scripps is now the designated facility for trauma patients in coastal North County, where Tri-City hopes to take over.

“Five is really too many,” Shackford said. “The quality could go down. . . . No one would say that six is acceptable.” Shackford said that even with the present five, economics will force at least one to drop out. Both he and A. Brent Eastman, the chief of trauma at Scripps, said the board should have faced the numbers issue.

Board members argued that the medical community should decide which remains and which does not, and that economics is not the supervisors’ major concern. But Shackford said that a hospital’s level of care could decline before it dropped out the system, possibly leading to problems with the treatment of patients.

“The unanswered question as yet is whether the system will be safe with six,” said a county official who asked not to be named. “That is what the board will have to face.”