Palomar Signs Surgeons for Trauma Duty

Palomar Hospital announced at least a temporary solution Wednesday to its problem of finding enough neurosurgeons for emergency standby duty, and officials expect the hospital to be back in the San Diego County trauma system by Nov. 1.

But the hospital’s trauma unit--the only one in North County--could be in trouble again by early next year unless additional neurosurgeons can be persuaded to join the Palomar program.

Palomar chief administrator Robert J. Harenski announced Wednesday that three neurosurgeons have agreed to be on emergency call at an average fee of $650 a day, in addition to whatever charges they assess trauma patients. County regulations require trauma centers to have a neurosurgeon available 24 hours a day within 20 minutes after notification of a trauma emergency. Harenski said that the three doctors put under contract this week will rotate in 7 a.m.-to-7 a.m. 24-hour shifts.

Harenski identified the neurosurgeons as Dr. Theodore G. Obenchain of Escondido; Dr. Imad Shahhal, previously of Loma Linda Medical Center near Los Angeles, and Dr. Richard C. Ostrup of UC San Diego Medical Center in San Diego.

Palomar curtailed its trauma system participation Sept. 1 after the two neurosurgeons then providing coverage declined to renew their contracts, citing financial and administrative concerns. Since then, Palomar’s unit has been able to handle only those critically injured trauma patients with no head, spine or nervous system injuries that require neurosurgical treatment. The limitation has cut in half from 58 the monthly number of trauma patients, Harenski said.

Gail F. Cooper, chief of the county’s emergency medical services, said Wednesday that she expected the hospital to be fully reinstated, but cautioned that Palomar could face scrutiny again if problems reoccur. Palomar joined the county system in January, 1985.

Harenski acknowledged Wednesday that the agreements for the three neurosurgeons are only temporary.

Ostrup will leave San Diego County in January for a medical fellowship in Toronto. Obenchain said Wednesday that he will not participate beyond next June. He also said that he will consider giving a 30-day notice in January if Ostrup is not replaced quickly at that time.

Obenchain was one of the two neurosurgeons who left in September. “It’s too onerous a call schedule (with only two), you’re up all hours of the day and night on too frequent a basis, and it fouls up the elective type of practice neurosurgeons have chosen to go into to enjoy,” he said in a telephone interview.

Obenchain said he agreed to rejoin the program for only eight months, and only because Palomar had found a third neurosurgeon to share the burden.

“I rejoined because the trauma service was going to die here otherwise,” Obenchain said. “I’m coming back reluctantly. I don’t want to come back, but I’m doing so more or less to salvage the program. I’ve made it (clear) that I will be out by June.”

The $650-per-day standby fee also helped ease the situation somewhat, Obenchain said. Harenski said Wednesday that the fee is necessary because of a shortage of neurosurgeons in North County. None of the county’s other five trauma centers pays its neurosurgeons a special standby fee. (All the trauma centers pay their general trauma surgeons a daily standby fee because those doctors must physically be in the trauma centers at all times while on call and the doctors also perform certain administrative tasks.)

The new arrangement will cost Palomar about $300,000 per year, Harenski said.

He said that Palomar has hired a Miami-based personnel search firm to locate neurosurgeons who can be persuaded to move to North County. Harenski said that Palomar would help the doctors establish a practice in the area, give them privileges at the hospital and arrange for patient referrals from Palomar-affiliated doctors. In return, he said, new neurosurgeons would “see their responsibility to the community to provide” coverage for the trauma unit without demanding the daily standby fee.

“And if we can get enough neurosurgeons in North County, the (trauma service) won’t be seen as such a burden,” Harenski said. “We’re hoping that we don’t have to keep paying the (standby) money.”

Harenski said the hospital’s board of directors believes that additional neurosurgeons can develop successful practices in North County, based on population data and information provided by the search firm.

However, Obenchain, a nine-year resident of North County, said there may not be enough patients to justify more neurosurgeons.

“It takes a large population to keep just one neurosurgeon occupied,” he said. “And neurosurgeons don’t want to come into a community just to do trauma, because it’s not all that appealing by itself.”

“I don’t have a good answer” to the problem, Obenchain said.