Defiant Oceanside Challenges County Over Trauma Policy

The City Council Wednesday revived an order prohibiting Oceanside paramedics from taking accident victims to hospitals outside the city, charging county officials with foot-dragging in efforts to resolve a continuing dispute over the transport of Oceanside trauma patients.

The order conflicts with county policy requiring that critically injured patients be transported to a designated trauma center. It will remain in effect until a Life Flight helicopter is based in North County and a scale used to determine whether injuries merit care at a trauma center is revised.

During a closed session later in the day, the council directed the city attorney to investigate any legal action the city might take against the county if any Oceanside paramedics are penalized for following the city policy. In August, while a similar order was briefly in effect, an Oceanside paramedic was suspended, but later reinstated, by the county.

Council members said their action, the latest volley in a war that has raged between Oceanside and the county since May, was intended to convey a message of dissatisfaction to trauma system officials and prompt more aggressive attempts by the county to solve the dispute.

“The only motion we’ve been able to get out of the county has been when we’ve stuck our feet in the sand and refused to move,” Mayor Larry Bagley said. “So I guess that’s what we’ve got to do now.”

Councilman Sam Williamson used tougher language, virtually demanding that the county “get their act together and get off their buns and fix this mess.”

David Janssen, assistant county administrative officer, called the council’s move “a real slap in the face.”

“I’m very disappointed that they’ve taken this action,” Janssen said. “We’ve had an excellent working relationship with the city up to this point, and we’ve made progress in setting up a program to solve their transport concerns. We are working diligently to put in place the few pieces that remain.”

Janssen said he is particularly concerned that the city’s action “puts the paramedics back in a position beyond their control, a position we do not like to see them in.”

“They may in the future be asked again to make a choice between a council decision and a medical order,” Janssen said. “And if there is a situation where a medical order is refused solely on the basis of a City Council decision . . . then we would be required to take some disciplinary action.”

Despite Janssen’s concerns, Oceanside Fire Chief James Rankin insisted after Wednesday’s meeting that his paramedics “support and agree with the council’s action.”

“We met with a representative group of (four) paramedics and discussed the various issues involved here and how they affect them,” Rankin said. “Although opinions vary, we feel that generally they believe the city is doing the right and appropriate thing.”

It appeared last month that county and city negotiators had reached a truce in the trauma feud, sparked by Oceanside’s contention that allowing paramedics to drive to the closest trauma centers, in Escondido and La Jolla, would leave the city unprotected for too long should another emergency occur.

At that time, the council approved an agreement that called for the county to station a Life Flight helicopter in North County; arrange for a back-up ambulance to serve Oceanside, Vista and Carlsbad, and expunge any evidence of suspension from paramedic David Snyder’s record.

In return, the council agreed to permit its paramedics to take patients to trauma centers outside the city. The council asked that the agreement be implemented by Sept. 11. It wasn’t, but believing the county was making progress on the plan, members agreed to extend the deadline two weeks.

On Wednesday, time was up, and the council was tired of waiting. Although Snyder’s record has been cleared of the suspension, there is as yet no helicopter in North County. In addition, county officials now say the back-up ambulance is not economically feasible because there are not enough calls to make providing the service cost-effective for a private ambulance company. The county has refused to subsidize the unit.

“They have made some gains, but we are still being put off, still being asked to wait a little longer,” Councilman John MacDonald said. “And I think we’ve given the other side plenty of time to resolve this and get a helicopter up here. Nothing even close to that has been achieved.”

Janssen disagreed. He said that Life Flight officials expect to station a helicopter at Palomar Airport by mid-October and maintained that “already, the policy agreement we reached with the city is having a positive impact in Oceanside.”

Janssen noted that sensitivity to Oceanside’s concerns among trauma physicians, who advise paramedics from hospitals, is reducing the number of cases that paramedics are ordered to transport outside of the city.

“Despite the council’s action, we will continue moving forward with this agreement,” Janssen said. “We believe the situation is being resolved and that there will be very few transports out of the city once all the pieces are in place.”

But getting those pieces in place--and thereby convincing Oceanside to lift its ban on transport beyond the city limits--will take two months or more, Janssen said. The helicopter may be available next month, but the city’s latest requirement will take longer. That requirement deals with the numbered scale used to rate a patient’s injuries to determine whether care at a trauma center is needed.

(Oceanside officials contend that the scale should be adjusted so that fewer patients are judged trauma cases required to leave the city for treatment.)

“(The scale) cannot just be arbitrarily changed because the city wants it changed,” Janssen said. “We have contract agreements with trauma centers throughout the county that require us to discuss all of this with them before any change is made.”

In addition, a thorough review of data and consultation with nurses, physicians, paramedics and numerous other actors in the trauma network are necessary before any adjustment to the scale is made, Janssen said.

He did add, however, that there is general agreement that the revisions in the scale sought by Oceanside will likely be made after the county’s evaluation.