New Trauma for Emergency Care

Part of the price of failing to provide adequate health-care funds has become more apparent with the announcement that another trauma center in Los Angeles County will be closed. The closing will mean a further deterioration in emergency medical care, which means fewer lives saved after traffic accidents, heart attacks and violent crimes.

Daniel Freeman Memorial Hospital, like California and Hollywood Presbyterian hospitals before it, is ending its trauma-center contract because it and its doctors face multimillion-dollar losses each year in uncompensated costs of emergency-room care. Those unpaid bills of medically indigent adults should be paid by the state and county, but they weren’t. In fact, the state under Gov. George Deukmejian has been cutting funds for the medically indigent, and has been compounding the problem by trying to reduce the fees paid to doctors and hospitals under Medi-Cal.

Some political leaders have seen the problem as a marginal one, faced by the 20% of California adults who have no health insurance. But the trauma-center closings will remind those political leaders that health services are interdependent, as strong as the weakest link, and failures to provide adequate financing can affect everyone--even those with gilt-edged health-protection policies. No one can know where he or she will be when a life-threatening trauma occurs.

The Los Angeles County supervisors have responded to the news in traditional fashion: They have ordered a survey of the situation. That is postponing what really needs to be done: addressing the problem of uncompensated care so that no hospital must withdraw from the vital trauma-center network, and letting loose a loud shout directed at Sacramento to get on with adequate funding--something that there has not been since 1982, when the then-governor, Edmund G. Brown Jr., and the Legislature, faced with a temporary budget crisis, precipitously dumped the problem of medically indigent care onto the counties.