Loss of Lives Feared When Center Quits Network

When Daniel Freeman Memorial Hospital in Inglewood withdraws from the Los Angeles County trauma center network on June 15, critically injured people in the northern portion of the South Bay will no longer have quick access to around-the-clock surgical teams, and some lives could be lost, according to county and hospital officials.

Freeman, which became a trauma center nearly three years ago, announced in April it is pulling out of the network because it can no longer absorb the costs of treating and housing indigent patients who, the hospital said, made up between 55% and 60% of the 1,283 trauma victims it served during the last fiscal year. Losses exceeded $2 million, the hospital said.

Boundary changes made by the county on May 1 have moved about a third of the Freeman service area--primarily South Central Los Angeles and the Harbor Freeway corridor--into the service areas of trauma centers at Martin Luther King Hospital in Willowbrook and Harbor-UCLA Medical Center in Torrance, both county hospitals.

But Virginia Price-Hastings, chief of paramedic and trauma programs for the county Department of Health Services, said a substantial portion of Freeman’s service area--including Inglewood, Hawthorne, El Segundo, parts of Manhattan Beach and Lawndale, and portions of the Westside--no longer will be covered by a trauma center.

‘The System We Had Before’

She said this includes such crowded areas as Los Angeles International Airport, the Forum, Hollywood Park and a stretch of the San Diego Freeway.

“We revert back to the system we had before. And that is that patients go to the nearest emergency room,” Price-Hastings said. “They will have a physician on duty, but not necessarily a surgeon, who may have to be called in. The speed will vary from minutes to hours.”

The county trauma network, which will involve 19 hospitals after Freeman leaves, was established four years ago to save the critically injured who might die without immediate care by surgeons and anesthesiologists standing by when patients reach the hospitals. Typical cases are victims of traffic accidents or violent attacks who have life-threatening head, abdominal or chest injuries.

Although she could provide no data about the number of past victims would would have died if a trauma center had not been available, she speculated that with Freeman out of the system, some people will die.

“There’s no doubt about it,” she said. “It’s very depressing to see some part of the system fall apart, because we know that it works.”

Freeman spokeswoman Christie Ciraulo said a “good estimate” is that 50% of trauma victims are saved during the so-called “golden hour,” or the first hour after an injury. The rest die, she estimated.

UCLA Boundary Studied

Price-Hastings said the trauma center at UCLA Medical Center in Westwood is studying whether it can extend its boundary south of the Santa Monica Freeway to take in some of Freeman’s northern area and still meet the trauma network’s requirement that patients be transported to trauma centers within 20 minutes. The county also is talking to Santa Monica Hospital, which wanted to join the system three years ago, about providing trauma care in some of the Freeman area.

Brotman Medical Center in Culver City, which also wanted into the system, would be interested in joining under certain conditions, said spokeswoman Diane Sherman, who declined to specify the conditions.

Price-Hastings said no South Bay Hospitals have expressed interest in joining the system, which has suffered setbacks by the withdrawal of some hospitals and indications by others that they may pull out. Financial losses are the largest factors, either because of too little use of the centers--which are expensive to maintain--or too many indigent patients.

Spokeswoman Ciraulo said that after Freeman pulls out of the system, it will no longer maintain a 24-hour surgeon and anesthesiologist team in its emergency room.

“What this means is that we will have to call a surgeon as needed at his or her home,” she said. “The quality of care will be the same, but the speed at which it is expedited could be longer. It is conceivable some will not pull through.”

Officials say that hospitals are staffed with surgeons during the day who can quickly be summoned to emergency rooms, but late nights and early mornings are problems.

Trauma Claims Disputed

Claims that trauma centers save a significant number of lives in contrast to standard hospital emergency rooms are disputed by Dr. Leon Artzner, emergency room medical director at Centinela Hospital in Inglewood, which is expected to receive some patients now taken to Freeman. “That has been used to bring everyone into line to support the centers,” he said, arguing that data is insufficient to prove it.

Artzner said the hospital will make no changes in its emergency procedures because it can handle trauma cases as it did before Freeman--which is only a few blocks from Centinela--became the area’s trauma center.

Robert F. Kennedy Medical Center in Hawthorne also is expected to gain trauma patients and it is discussing how to accommodate the increase, spokeswoman Therese Brown said. The hospital’s emergency room has 24-hour physicians, and surgeons are at the hospital during the day. But at night a surgical team would have to be called for a trauma case, she said.

After Freeman said in April that it would pull out of the trauma system, Sister Regina Clare, its president, sent a letter about the move to Supervisor Kenneth Hahn, who spent more than three months at Freeman after a stroke Jan. 11. That letter sparked speculation that Freeman might change its mind if the county came up with $3.6 million in reimbursements and changed the system so that Freeman would receive fewer indigent patients and would be able to tranport indigents, once stabilized, to county hospitals.

Freeman spokeswoman Ciraulo, however, called the letter “an informational note sent at Hahn’s request and not a list of demands or a point of negotiating. “ She said, “We are out. . . . We are not negotiating.”

She said that while the boundary change is helpful because it has removed an area high in indigents, there is still the problem of reimbursement and patient transfers to county hospitals, which the county curtailed last year because of a money crunch for health care.

‘Much Soul-Searching’

“We feel terrible,” Ciraulo said, explaining that Freeman--a nonprofit hospital run by the Sisters of St. Joseph of Carondolet--firmly believes trauma centers save lives. “It took much soul-searching and much discussion and much consideration before we realized that there is one basic fact, that the financial stability of the hospital was being affected by being a trauma center.”

Price-Hastings indicated that the county has no money to reimburse trauma centers and that cuts in money for staff and beds have made it impossible to accommodate stabilized indigents in county hospitals.

“If resources are to come, they will have to come through the state,” she said, citing several pending bills in Sacramento to provide money for trauma care.

Both Ciraulo and Price-Hastings said that while the crisis at Freeman and other troubled trauma centers has focused on indigents, the loss of a trauma center affects everybody. “The public health issue is that everyone, including those who can pay, lose this service,” Price-Hastings said.

Ciraulo said, “A hospital pullout affects everyone. While it may be true that there is no one to care for a gunshot victim who can’t pay, it is also true we have no one to take care of a TRW employee driving on the 405 Freeway who crashes his car, and who is insured.”