Freeman Hospital to Pull Out of L.A. Trauma Care Plan

In a move that will further destabilize Los Angeles County’s beleaguered trauma center network, Daniel Freeman Memorial Hospital in Inglewood announced Monday that it will withdraw from the program, citing the financial burden imposed by treating large numbers of indigent patients.

The decision by the county’s third busiest trauma facility, to take effect June 15, will place an additional load on other hospitals and make it more difficult for critically injured patients in central Los Angeles County to rapidly obtain specialized medical care.

“This has an impact on every single citizen in the county, not just the people who live in the poor area where (Daniel Freeman) happens to sit,” said Virginia Price Hastings, director of the county’s trauma center program. “We all use the airport, we go to the Forum, we go to the (Hollywood Park) race track.”

Danger of Collapse

Dr. Albert Yelin, chairman of the Southern California Committee on Trauma of the American College of Surgeons, predicted that Daniel Freeman’s action may trigger “even bigger problems that could cause the entire system to collapse.”

“As indigent patients are shifted from one hospital to another, there may be a domino effect that will force other hospitals to reconsider their participation,” he said.

Daniel Freeman’s decision, which is to be discussed at the Board of Supervisors meeting today, is the latest blow to the once highly touted trauma center program. The Los Angeles County network was set up to assure that critically injured patients anywhere in the county would be within a 20-minute ambulance ride of a hospital where a specially trained surgeon and other personnel would be available around the clock to back up emergency room staff.

When the program was established in 1983, after years of contentious planning, it was cited as a model for other cities in the nation. At the time, hospitals competed to sign up for the program.

Big Losses Cited

Now, participation has become less attractive, especially for those hospitals in poor neighborhoods that treat large numbers of uninsured trauma patients. Hospitals have cited state and county cutbacks in government health care programs for the poor, including decreased Medi-Cal reimbursement rates.

James D. Barber, administrator at Daniel Freeman, said the nonprofit hospital, operated and managed by Sisters of St. Joseph of Carondelet, a Roman Catholic order, and its physicians absorbed about $2 million in losses on the trauma center in 1986. Last year the hospital treated 1,283 trauma patients, 55% of whom were classified as indigent.

Daniel Freeman’s withdrawal will mean that paramedics will bring fewer victims of accidents or violence to its emergency room; other emergency services at the hospital will not be affected.

Barber said the amount the hospital is reimbursed under Medi-Cal and other government programs falls far short of meeting the actual cost of the care. In effect, the hospital suffers more because of its high volume of poor patients.

“Without (adequate) financial support at the county, state or federal level, the trauma center can no longer be sustained,” Barber said.

As an additional factor in Daniel Freeman’s decision, Barber cited the emotional and financial strain on the private physicians who have exclusively staffed Daniel Freeman’s trauma center. Unlike most of the county’s other busy trauma centers, there are no physicians-in-training to help care for the patients.

Source of Stress

“Trauma care creates high stress, disrupts private practice, increases exposure to malpractice and remains largely unreimbursable, especially for physicians performing surgery,” Barber said.

Hastings said the county sought to relieve the financial burden on Daniel Freeman with a negotiated plan, set to take effect May 1, that would send 35% to 50% of the trauma patients treated at Daniel Freeman to neighboring trauma centers, including County-Harbor UCLA Medical Center in Torrance, UCLA Medical Center and Martin Luther King Jr. Medical Center. Barber said that was not enough.

Daniel Freeman will be the second major hospital to withdraw from the trauma system in less than two months. On Feb. 23, Hollywood Presbyterian Medical Center, previously the county’s fourth busiest trauma center, dropped out of the program, citing similar financial troubles. Together, Hollywood Presbyterian and Daniel Freeman cared for about 23% of the county’s 10,000 trauma patients in 1986.

In February 1985, California Hospital Medical Center in downtown Los Angeles dropped out.

Boundaries Redrawn

After Hollywood Presbyterian withdrew, county health officials tried to patch up the system by redrawing boundary lines governing the delivery of patients. Patients who previously would have been directed to Hollywood Presbyterian were divided among other trauma centers, primarily Cedars-Sinai Medical Center and County-USC Medical Center. Such patching may be impossible after Daniel Freeman’s withdrawal, according to Hastings and Yelin.

“There are no other hospitals that can accept that patient load within a 20- to 30-minute drive,” Yelin said.

Nearly 100 hospitals in Los Angeles County have emergency rooms, but only 20 are designated as trauma centers. In 1986, the busiest trauma centers were County-USC Medical Center, which treated about 2,000 trauma patients; Martin Luther King Jr. Medical Center, 1,800 patients, and Daniel Freeman and Hollywood Presbyterian, 1,000 patients each.