Trauma Hospital Officials Offer a Critical Prognosis

This week’s announcement by Daniel Freeman Memorial Hospital that it intends to drop out of the county’s highly touted trauma care network does not appear to have triggered a stampede from the troubled system by its remaining private hospitals.

However, a number of the hospitals remaining in the network are pressing the Los Angeles County Board of Supervisors to increase financial support. They also are seeking relaxation of a key medical requirement set when the trauma system was established three years ago.

Failure to make such changes might result in further withdrawals, private hospital officials warned Thursday.

“I think it’s fair to say we’re assessing our role,” said Pete Makowski, chief operating officer of Queen of the Valley Hospital in West Covina. “Right now we feel comfortable in continuing to provide this special care, but that could change based on a number of factors.”

Queen of the Valley treated about 1,062 trauma patients last year, but Makowski said hospital officials are not yet clear what type of financial loss, if any, the facility experienced.

“The program is only as good as its weakest link,” said Lowell Smith, president of Presbyterian Intercommunity Hospital in Whittier. “If two or three more hospitals pull out, we might as well pull the plug on the whole thing.”

Two Hospitals Withdraw

The Times interviewed officials at all 15 urban trauma centers remaining in the system in the aftermath of the announced withdrawal earlier this week of Daniel Freeman Memorial Hospital and the closure Feb. 23 of the trauma center at Hollywood Presbyterian Medical Center. Four other trauma centers serve outlying areas and are less affected by the recent closures.

Officials at Daniel Freeman, the third busiest trauma center in the network, and Hollywood Presbyterian, previously the fourth busiest, both cited financial losses stemming from the treatment of indigent patients as the reason for their withdrawal from the system.

None of the hospitals contacted by The Times is considering an immediate pullout from the trauma system. Many asserted that they were losing money treating indigent patients, and some cited losses of as much as $1 million a year.

The major concessions the private hospitals will seek from the county, which has launched a review of the trauma network in the wake of the Daniel Freeman announcement, include:

- A preferential system that would permit designated trauma centers to transfer indigent trauma patients to county hospitals as soon as their condition is stable. Currently, hospital officials complain, it may take weeks to transfer indigents to County-USC Medical Center, Martin Luther King Jr./Drew Medical Center or other county-operated facilities.

- Reinstatement of a $5-million program, eliminated by the Board of Supervisors last year, that partially reimbursed private hospitals for emergency care of uninsured poor patients not eligible for Medi-Cal or Medicare.

- Elimination of the requirement that an anesthesiologist be on duty in all urban trauma center hospitals at all times. Some hospital officials contend this is unnecessary and very expensive. “In 2 1/2 years, we never had a case where the anesthesiologist had to have been in-house,” said Fred Meyers, president of Methodist Hospital in Arcadia.

- Abandonment of a proposed boost from $15,000 to $40,000 in the annual fee the member hospitals must pay the county for access to a required data-gathering system.

Virginia Price Hastings, director of the county’s trauma network, downplayed the prospects of any more hospitals leaving the program.

“None of them have really threatened to pull out,” she said. “They get together and they ventilate. . . . They have not come to us in a formal manner as Daniel Freeman did and say we are having these actual problems and what can you do to help us.”

Examine Changes

Hastings and other county officials say they are willing to examine changes in the system, but are unable to give ground on some issues for fiscal and public health reasons.

County health officials express sympathy for the alleged financial woes of some participating hospitals, but point to the county’s own looming budget shortfall of $170 million. This fiscal crunch makes them reluctant to open more county hospital beds or to restore the $5-million indigent emergency care subsidy.

Carl Williams, assistant county health director, said the county might examine the anesthesiologist question, but “our current position is we simply don’t have any data to justify our changing it at this time.”

His position won some support from Dr. John West of Orange, a nationally recognized trauma expert.

“In a dense urban area like Los Angeles, it is hard for me to believe that it makes any sense not to have the anesthesiologist in-house,” said West. “Ultimately, patients are going to be adversely affected.”

The Los Angeles County system, once considered a model for other cities, is designed to ensure that critically injured patients are within a 20-minute ambulance ride of a trauma center where a surgeon and other specialized medical personnel are on duty around the clock.

The impact of the closure of Hollywood Presbyterian’s trauma center less than two months ago already has been felt at Cedars-Sinai Medical Center in West Los Angeles, according to a spokesman there.

Cedars-Sinai has experienced a 30% increase in the number of trauma patients, according to Dr. Stephen L. Michel, trauma service director. About 65% of these additional patients are indigent.

But Michel said “no thought” has been given to withdrawing from the program. He added that the hospital will more fully evaluate the impact of Hollywood Presbyterian’s withdrawal in several months. He could not speculate on how Daniel Freeman’s departure, effective June 15, would affect Cedars.

Assessment Due in June

Among the hospitals claiming to be losing money on trauma care was Huntington Memorial Hospital in Pasadena. Dr. Allen Mathies, hospital president, said Huntington lost $850,000 last year in trauma center-related expenses. He said the hospital would assess in June whether to continue its participation in the program.

The largest reported loss by a private hospital contacted by The Times was by St. Joseph Medical Center in Burbank. Administrator James Sauer said the hospital is losing in excess of $1 million a year on trauma care but “we have not given thought to pulling out of the program. “As long as we are fiscally able, we will keep it open.

“I worry less about us than (the future of) the system in Los Angeles County,” Sauer added.

One indication of the problem is the stark contrast between the current situation and the intensive competition among hospitals to be designated for the system when it began three years ago. When private hospital officials were asked Thursday if they know of any non-trauma center hospital willing to fill the void created by the four hospitals that have left the program, the question was met with laughter.

“The only ones who lost are the ones who won,” said James Ludlam, attorney for the Hospital Council of Southern California.

The trauma center controversy will be aired April 28 at a special hearing before the Board of Supervisors.

TRAUMA HOSPITALS IN LOS ANGELES COUNTY

Hospital 1986 Trauma Patients 1. Westlake Cmty. Hosp.* 74 2. H. Mayo Newhall Hosp.* 162 3. Antelope Valley* 180 4. Northridge Hosp. 491 5. Holy Cross Hosp. 525 6. St. Joseph Med. Ctr. 586 7. Santa Monica Hosp.* 22 8. UCLA Med. Ctr. 367 9. Cedars-Sinai Hosp. 422 10. Childrens Hosp. of L.A. 116 11. Huntington Mem. 429 12. Daniel Freeman Hosp. 1108 13. L.A. Co./USC Med. Ctr. 1503 14. Meth. Hosp. of So. Cal. 400 15. Harbor/UCLA Med. Ctr. 593 16. M. L. King Med. Ctr. 1413 17. Presby. Intercommty. Hosp. 420 18. Queen of Valley Hosp. 607 19. Mem. Med. Ctr., Long Beach 575 20. St. Mary Med. Ctr. 396

Numbers reflect patients transported by paramedics and do not include walk-ins. * Designated rural trauma centers, expected to treat fewer patients. Daniel Freeman will close its trauma unit June 15; Hollywood Presbyterian has closed. Source: Los Angeles County Department of Health Services