Order by Oceanside on Emergency Care Draws County’s Fire

Council members here have ordered paramedics to stop transporting critically injured patients to trauma centers outside Oceanside beginning next week despite threats by county health officials to respond with an injunction or a move to decertify the city’s emergency medical personnel.

Oceanside officials argue that sending paramedics on a 30-minute drive to Scripps Memorial Hospital in La Jolla, the nearest certified trauma center, would leave the city unprotected for too long in the event of another emergency.

Mayor Larry Bagley, in a recent letter to the Board of Supervisors, outlined the city’s position and declared that, after Monday, paramedics would instead transport accident victims to Tri-City Hospital, which has failed three times to win admission to the emergency medical care network and is now suing the county to obtain designation as a trauma center.

In meetings last week, city and county health officials attempted to iron out their differences and craft a solution to Oceanside’s dilemma. The result, presented to the council Wednesday, was a county proposal to deploy an additional ambulance in North County to serve as a backup unit primarily for Oceanside, Carlsbad and Vista--at no cost to those cities.

For a time Wednesday, it appeared that councilmen were willing to embrace the county’s suggestion and abandon their plan to divert trauma traffic to Tri-City. But the tide quickly turned when members learned of two retaliatory actions the county might take if the city failed to comply with the proposal.

“This is pure blackmail,” Councilman Walter Gilbert said when city staff members told the council the county would seek an injunction today or Friday if the city stood by its July 15 deadline.

Mayor Larry Bagley was equally angry: “I was all ready to go with this (proposal), but not anymore. The county has responded with two threats and I don’t intend to make a decision under duress.

“They have threatened to decertify our paramedics . . . and I’m tempted to let them try it. They have also threatened an injunction, and I’m wondering if maybe it’s time to let them take us to court.”

A few more harsh words were said, then council members voted 5-0 to stand by their decision to keep Oceanside’s trauma patients in Oceanside--providing that a Life Flight helicopter is unavailable for trips beyond the city limits.

In May, Life Flight announced that although it would continue to serve Tri-City Hospital, it would no longer station a helicopter there. That decision came after hospital officials requested that Life Flight begin paying rent and maintenance on the helipad.

In the meantime, city staff members will pursue further negotiations on the proposal.

County officials expressed shock when informed of the Oceanside council’s action and perception that the county had issued threats. David Janssen, county assistant chief administrative officer, said, “I’m very surprised and disappointed, because I found our meetings positive, cooperative and productive.

“We went into this with the specific purpose of helping Oceanside solve their problem, and our proposal accomplishes that,” Janssen said. “There was never any discussion about any threats.”

Janssen conceded, however, that “going to court is obviously one option on the table. Our concern would be that if, after this deadline, a patient is taken somewhere other than (the trauma center) the paramedic is directed to take him to, then it could open us up to a lot of sticky questions about liability and legality.”

The same scenario could prompt the county to consider decertifying Oceanside’s 22 paramedics, Janssen said.

“If a paramedic unit was ordered by a base station to transport to Scripps and refused to do so, then we would look at whether that’s a violation of the paramedic’s professional obligation,” Janssen said.

County Department of Health Services Director James Forde said the county is responsible for emergency medical services and consequently has the authority to strip a paramedic of certification if he fails to abide by set policies and procedures.

But Oceanside Fire Chief James Rankin maintained that this is “a gray area of law” untested in court. Further, Rankin contended that a section of the state Health and Safety Code may protect Oceanside from decertification. The fire chief said he is awaiting additional information on the issue from the state legislative counsel.

Meanwhile, Janssen said he and county health officials plan to discuss the Oceanside trauma dispute with supervisors in closed session today. He said there is “no possible way” a resolution can be reached before the Monday deadline.

Oceanside is not the only city having trouble with the county’s fledgling, six-hospital emergency care system. City officials in El Cajon and Santee and some Spring Valley residents are also concerned about paramedics traveling to distant trauma centers and leaving their home base unprotected--particularly given the withdrawal of Grossmont Hospital from the trauma network in December.

Janssen said the proposal to station an additional ambulance in North County to respond to Oceanside’s situation “is really a pilot project that we hoped to transfer to other needy areas of the county if it’s successful.”

The proposal recommends hiring a private ambulance company to provide backup service 7 days a week, 24 hours a day to Oceanside, Vista, Carlsbad and unincorporated areas along Interstate 5 between Oceanside and north of Del Mar, Janssen said.

The ambulance would be stationed at an as yet undetermined location--possibly Tri-City Hospital--and costs of the service would be covered by patient billing.

While Rankin has expressed cautious support for that conceptual plan--and recommended Wednesday that the council approve it--he raised several concerns. These include the specific location of the paramedic unit and the possible use of the ambulance by the county should it not be in demand by the cities.

“We believe the concept has promise and merits further consideration,” Rankin said. “But we’re certainly not endorsing it as is. A plan like this will take time to work out.”

The proposal also would need the approval of the Vista and Carlsbad city councils.

The county proposal to station an additional ambulance in North County appears to hold the most promise for resolving Oceanside’s quandary. But two other options that might alleviate the city’s concerns have been discussed.

Jim Zanca, director of emergency medical services at UC San Diego Medical Center, said there is a “strong chance” that a Life Flight helicopter will return to North County and would most likely be based at Palomar Airport. Also, a Scripps Hospital official confirmed that “there has been talk” of using that facility’s Medevac critical care unit to help in transporting North County trauma patients.