Criticisms in Report ‘Stun’ Area Trauma Center Chief

The director of the trauma center at Fountain Valley Community Hospital said Thursday that he was stunned by criticism of its operation and called attacks on the center’s quality of care “ridiculous.”

Dr. William M. Thompson said many of the concerns of a team of surgeons and nurses that reviewed procedures at the four trauma centers in Orange County centered on technical issues, not substantive medical problems.

Thompson cited as examples the review team’s criticism of the hospital’s trauma center for using too few X-rays and too many periotoneal lavage procedures, in which an incision is made in the abdominal wall to check for abdominal bleeding. “To have it put out as a quality of care thing is ridiculous,” Thompson said.

Renewed for 120 Days

The county’s Emergency Medical Services Department on Wednesday notified the hospital, based on the survey team’s findings, that it was renewing its certification as one of the four trauma centers in Orange County for only 120 days, rather than a possible two years.

On the same day the department renewed the certification of the trauma unit at the UCI Medical Center for one year and of Mission Community Hospital in Mission Viejo and Western Medical Center in Santa Ana for two years.

The center at Fountain Valley Community Hospital has treated 3,000 patients since it began operation five years ago, Thompson said, and the review team looked at about 70 cases during its one-day inspection. The hospital handles about 40% of the trauma cases in the county, the biggest case load of the four centers.

No ‘Great Emergency’

Dr. John West, who like Thompson helped to pioneer the establishment of trauma centers in the county but who is not affiliated with the Fountain Valley hospital, said that although he had not seen the review team’s report, “I don’t feel there’s any great emergency here. I don’t think people should have any concerns about going to Fountain Valley.”

Robert Love, acting director of the county Health Care Agency, declined to comment on the report of the surveyors, who were brought in from Los Angeles County, on the grounds that the report is confidential. The hospitals also declined to release the findings.

But Thompson said after seeing the report that “we’re stunned. Not just me, the whole hospital is, because we fundamentally believe we do run a good trauma center” and have taught other hospitals how to establish the specialized facilities.

Love said that the county overall has “a superior emergency medical system,” but said the agency wanted “to discover areas where (the trauma centers) are not working at an optimal level and to bring them up to standards.”

Thompson said the report on his hospital was based on a review of patients’ charts from January, 1983, to July, 1984. He said those charts were outdated and had already been extensively reviewed by the hospital’s trauma center.

West noted that the whole concept of trauma centers was new. The system of setting up special centers with special equipment, staffed around the clock by physicians, nurses and technicians experienced in treating severe injuries sustained from automobile accidents, shootings, stabbings and falls began in Orange County in 1980.

Paramedics are directed to take severely injured patients to the designated trauma centers, even if they pass emergency rooms of other hospitals. West said that since the system was instituted, the number of preventable deaths in the county has dropped from more than 70% to less than 10%.

Differing Opinions

West said that because the procedures used by trauma centers have been recently developed, there is a “certain amount of arbitrariness built in to evaluating the judgment” of trauma doctors and reasonable people can differ in their opinions on what steps should have been taken to treat a patient.

“If someone sits around and bleeds to death . . . everyone agrees something is wrong,” West said, but when someone is brought in to a hospital suffering severe liver damage as the result of a car crash, doctors may not agree on the specific procedures needed to save the patient.

He said he expected that Fountain Valley would not lose its certification after the 120-day period. The hospital has the right to object to the findings and will be looked at again in about three months, according to Betty O’Rourke, program director for the Emergency Medical Services department in the Health Care Agency.

Thompson said the hospital “will do whatever is necessary to meet the requirements, to meet what are the reasonable or realistic requirements of the county” and retain certification as a trauma center.

Too Many Tests?

Thompson said that he felt the reviewers “are used to having a different hospital and a different-looking chart” and sometimes “couldn’t find things in the chart in the way they’re used to finding them.” He said the trauma center could simply change their charts to satisfy that objection.

He said there were also criticisms that too many tests were done in some cases and too few in others. He said the report indicated the surveyors believed doctors were doing some procedures to make more money, although he pointed out that the trauma teams were not paid on the basis of how many patients they treated or how many tests they performed.

At UC Irvine, spokeswoman Kathy Jones said medical center officials took no issue with some recommendations in the review team’s report, but that in other cases “there were some questions about specific methodology that they plan to take up with the county.”