Fountain Valley Trauma Unit Gets Full Certification

Fountain Valley Regional Hospital’s trauma center, which four months ago was severely criticized by a review team and recertified for only 120 days, has won a full 20-month extension on the recommendation of a second team.

Hospital Administrator Craig Myers received the notification Tuesday from the health-care agency that oversees Orange County’s four trauma centers.

Officials of Fountain Valley’s trauma center, the county’s busiest, were stunned by the first evaluation and charged that the criticisms were unwarranted. They noted that the turnabout in evaluators’ conclusions is not the result of changes in the trauma center.

‘Not One Whit’ of Change

“We have changed not one whit,” said Dr. William Thompson, trauma director. “We were doing a good job then (before the first evaluation) and we’re doing a good job now . . . I don’t know how they arrived at that (first) survey report.”

Thompson declined to comment further because he had not read the second survey report.

Tom Uram, director of the county health-care agency, said that the second evaluation team’s report was confidential and that he could not comment on the differences between the two reviews.

In the Orange County trauma system, a patient with life-threatening injuries--suffered in traffic collisions, knifings, shootings, falls or other accidents--is taken by paramedics past the nearest hospital emergency room to a specially staffed and equipped trauma center.

There, a waiting surgeon and trauma team immediately perform a battery of tests to determine the extent of injuries and, if necessary, take the patient into an operating room within minutes.

Orange County’s system was the first in Southern California and one of the first in the nation. It has been used as an example nationwide to illustrate how trauma deaths can be prevented.

The county’s four trauma centers--at Fountain Valley, UCI Medical Center in Orange, Western Medical Center in Santa Ana and Mission Community Hospital in Mission Viejo--were evaluated last summer by a team of trauma surgeons who reviewed patient charts from 1983 and 1984.

Western Medical Center and Mission Community were recertified for a full two years, and UCI Medical Center’s certificate was renewed for one year. Fountain Valley, however, was recertified for only 120 days, with a second evaluation to be conducted within 90 days.

Too Many Tests

Reviewers from the first survey criticized Fountain Valley for performing too many diagnostic tests, such as X-rays and peritoneal lavages, in which a small incision is made in the abdomen and a tube inserted to check for internal bleeding. The survey also criticized Fountain Valley for failing to transfer trauma patients to other hospitals when its emergency room was overflowing.

Fountain Valley trauma officials--many of whom have been critical of the county’s management of the trauma system--countered that the attack on the quality of care was “ridiculous.” Doctors at both Fountain Valley and UCI Medical Center charged that the evaluations of the four trauma hospitals were uneven, with the most critical member of the review team assigned only to their hospitals, and not to Mission Community and Western Medical Center.

After the first review, Fountain Valley on its own brought in experts from two respected trauma centers--Cook County Hospital in Chicago and the Maryland Institute for Emergency Medicine--to review the same patient charts. The two evaluators, who had no connection to the county’s second review team, found no problem with Fountain Valley’s treatment methods and recommended no changes, trauma director Thompson said.

One of the experts told The Times that members of the first review team had criticized Fountain Valley for using techniques which they did not like but which were not wrong, especially considering that the patient recovered.

In the wake of last summer’s reviews, a committee representing the county’s four trauma centers is developing “standards of practice” that will dictate when certain diagnostic techniques are called for, the chief of UCI Medical Center’s trauma service said.

Fountain Valley Administrator Myers said that since last summer’s harsh review, the hospital has made a few changes, “mechanical types of things,” such as adjusting the way information is recorded on trauma patients’ charts. But there has been no change in the way patients are treated, he said.

“All they (reviewers) have to go on is the paper work,” Myers said. “That’s what we focused on.” He added that he had not had time Tuesday to fully read Uram’s seven-page letter, which summarizes the evaluators’ findings, so he could not comment on the differences between the two reviews.

Myers said he expected the report to suggest some improvements. “When we get surveyed by any agency, there are always recommendations. We always can improve.”

Uram said the second review team--two physicians from Los Angeles, a surgeon from San Antonio, Tex., and a trauma nurse coordinator from West Covina--recommended full recertification for Fountain Valley. Uram, as chief of county health-care services, has the ultimate authority to certify trauma centers.

The 20-month extension puts Fountain Valley on the same certification schedule as Mission Community Hospital and Western Medical Center. UCI Medical Center will be re-evaluated about the middle of next year, Uram said.

Myers said the hospital harbors no ill feelings because of the two divergent evaluations.

“We wanted to get the full (two-year) designation,” Myers said. “We felt we deserved it, we received it, and now we go on from here.”