Trauma Program to Lose Hollywood Presbyterian Unit

Hollywood Presbyterian Medical Center plans to withdraw this month from Los Angeles County’s trauma center program because of financial hardship caused by what it said is a “dramatically” increasing number of uninsured trauma patients.

The decision by the county’s fourth-busiest trauma facility, set to take effect Feb. 23, would place an increased burden on nearby hospitals and make it more difficult for some critically injured patients in central and western Los Angeles to obtain rapid specialized medical care. Hollywood Presbyterian treated 1,000 trauma patients in 1986, 45% of whom were indigent.

The hospital’s announcement comes as the county’s third-busiest trauma center, Daniel Freeman Memorial Hospital in Inglewood, said it is experiencing similar problems. The hospital treated about 1,283 patients in 1986, 55% of whom were indigent.

Crisis Seen

“We are as stressed as Hollywood Presbyterian, but we have made no decision to pull out of the system at this point,” said Jim Barber, Daniel Freeman’s administrator. “There is very much a crisis for the inner-city private hospitals which provide trauma care.”

Nearly 100 hospitals in the county have emergency rooms, but only 21 are designated as trauma centers. The centers’ most important features are that a specially trained surgeon and other personnel are available in the hospital around the clock to back up emergency room staffs.

Hollywood Presbyterian’s withdrawal would mean that paramedics will bring fewer victims of accidents or violence to its emergency room. Its other emergency services would not be affected.

Trauma care can be lucrative because patients such as car accident victims and those with gunshot wounds often require many specialized services. But when patients are unable to pay, the hospital often has to bear the cost.

“Hollywood Presbyterian clearly indicated it was a budget problem,” said Virginia Price Hastings, director of the county’s trauma center program.

She acknowledged that the program to guarantee trauma victims a 20-minute or less ambulance ride to a trauma center is being hurt by state and county funding cutbacks.

Hastings said the county will assess the impact of Hollywood Presbyterian’s intended withdrawal in a meeting Wednesday with Los Angeles city Fire Department paramedics and representatives of the nearest trauma centers: Cedars Sinai Medical Center, County-USC Medical Center and St. Joseph Medical Center in Burbank.

“We think we can still meet the 20-minute response time,” Hastings said, adding that Hollywood Presbyterian will continue to receive some critical patients during heavy traffic periods and others who could not survive a 20-minute ambulance ride.

The current situation represents a dramatic reversal in fortunes for the county’s trauma center program. When the network was being established by the county in 1983, hospitals vigorously competed to sign up.

Seek Reimbursement

Under the program, paramedics transport critically ill patients to the designated trauma centers. The trauma centers seek reimbursement from patients and their insurance carriers, including Medicare and Medi-Cal.

County officials said the difficulties experienced by Hollywood Presbyterian and Daniel Freeman reflect a more general strain on the county’s health-care programs, whose volume of patients increased 5% last year.

“(There) is a serious overcrowding problem that we’ve been experiencing at all county facilities,” said Robert Gates, director of the county’s Department of Health Services. “There has been a gradual and steady increase of poor people into the system.”

Gates and Hastings said the problems had been compounded by recent state cutbacks in Medi-Cal reimbursement rates and a decision by the county Board of Supervisors last year to eliminate $4.5 million from a $5-million program that reimburses private hospitals for giving emergency care to indigent patients.

“This is a sad day,” said Allene Nungesser, Hollywood Presbyterian’s chief executive officer, who informed county officials of the decision in a Jan. 23 letter.

Nungesser refused to say how much money Hollywood Presbyterian is losing on its trauma center. But one physician involved with the trauma center, who did not want to be identified, estimated that the annual shortfall in physician fees and hospital payments was about $2 million last year. Nungesser said the hospital and its doctors are currently reimbursed only 30 cents of every dollar spent on trauma care.

“This is a national problem, which is also being experienced in Miami,” said Dr. John West, an Orange County surgeon who is an expert on trauma centers. “The free market system for trauma centers simply won’t work in downtown areas with a lot of penetrating trauma (gunshots and stabbings) and drug traffic,” he said.

Nungesser said a number of factors led to Hollywood Presbyterian’s decision, including a “consistent overcapacity” of critical-care units and operating rooms and an inability to transfer indigent patients who had been stabilized to already crowded county facilities.

Hollywood Presbyterian projected that 1,200 trauma patients would be brought to its emergency room this year if it stayed in the program, compared to the 750 trauma patients it had expected to treat when it signed up three years ago. After quitting the program, the hospital expects to treat only about 250 to 300 trauma patients a year.

Hollywood Presbyterian is the third hospital to drop out of the county’s trauma center program for financial reasons. The others were California Hospital Medical Center in downtown Los Angeles in 1985 and Pomona Valley Community Hospital last October.

Closest Facilities

Many of the communities served by California Hospital Medical Center were subsequently picked up by Hollywood Presbyterian. Now Cedars-Sinai Medical Center in Los Angeles and County-USC Medical Center, already the busiest trauma center, are the closest facilities.

Pomona Valley Community Hospital said it was treating too few patients to justify the expense of maintaining its program. Pomona-area patients are now transported to Queen of the Valley Hospital in West Covina.

In total, paramedics transport about 10,000 trauma patients in Los Angeles County each year; an additional 500 such patients arrive directly at emergency rooms, according to Hastings. The busiest trauma centers in 1986 were County-USC Medical Center, which treated about 2,000 trauma patients; Martin Luther King Medical Center, 1,800 patients; Daniel Freeman, and Hollywood Presbyterian.

Times staff writer Jill Stewart contributed to this story. Trauma Hospitals in Los Angeles County 1. Westlake Community Hospital 2. Henry Mayo Newhall Memorial Hospital 3. Antelope Valley Hospital Medical Center 4. Northridge Hospital Medical Center 5. Holy Cross Hospital 6. St. Joseph Medical Center 7. Santa Monica Hospital 8. UCLA Medical Center 9. Cedars-Sinai Medical Center 10. Hollywood Presbyterian Medical Center 11. Childrens Hospital of Los Angeles 12. Huntington Memorial Hospital 13. Daniel Freeman Memorial Hospital 14. L.A. County/USC Medical Center 15. Methodist Hospital of So. California 16. Harbor/UCLA Medical Center 17. Martin Luther King Medical Center 18. Presbyterian Intercommunity Hospital 19. Queen of the Valley Hospital 20. Memorial Medical Center of Long Beach 21. St. Mary Medical Center