Decide on Trauma Care

The Board of Supervisors seems content to let the marketplace make the tough decisions about how many and which hospitals should be in the county’s trauma care system.

Last week the supervisors postponed for another six months their final decision on the lineup of hospitals that will treat severely injured patients. The board’s attempt to compromise between those who want to add to and those who want to subtract from the current six trauma centers seemingly pleased no one.

Board members are being told by the county director of health services that the trauma system should be trimmed from six hospitals to four. Several of the hospitals in the system are complaining that their trauma teams are not getting enough work, and their costs are not being met.

At the same time, Tri-City Hospital in Oceanside continues to lobby intensively for inclusion in the system, arguing that patients in the county’s northwest corner deserve a center near them.

In the past, we supported giving Tri-City trauma center status. But a recently completed study of the system, which began operating in August, lends credence to the argument that having the best possible emergency rooms is more important than having them geographically spread around the county.

Among other positive results, the study showed that, compared with statistics gathered in 1982, the death rate for people who entered the trauma care system dropped from 26.4% to 10.5%.

The result of the six-month delay in sorting out the trauma system is to leave nearly all the hospitals in the system in limbo, along with Tri-City, which has been told that it may yet be included if it improves in several areas where it has been found wanting. This hardly seems fair or wise.

Tri-City has gone to considerable expense in hopes of being named a trauma center, and it would no doubt do the job if it were designated. Similarly, hospitals such as Scripps Memorial also have gone to great expense while functioning as trauma centers, only to be disappointed at the lower than expected number of trauma cases.

Making the decision to drop hospitals such as Scripps Memorial, Sharp, Mercy or Palomar will not be easy because of the political clout they exercise and because lives literally are at stake. But it seems clear that the number of adult trauma centers should be reduced by at least one. The system will be better served if the supervisors decide now which hospitals will comprise the system based on the best information available to them, rather than allowing one or more of the hospitals to simply lose interest or run out of money while waiting for the decision to be made.