500,000 Are Left Without Trauma Care as Inglewood Hospital Drops Out

A swath of western Los Angeles County that is home to half a million people was dropped Friday from the Los Angeles County regional trauma network.

The exclusion, precipitated by the withdrawal of Daniel Freeman Hospital in Inglewood from the trauma system on Monday, marks the first time since the advent of the network in 1984 that an urban area has been left without trauma care.

The system is intended to ensure that trauma patients--generally victims of automobile collisions and other accidents and crimes of violence--are within a 20-minute ambulance ride of a hospital staffed around the clock with specialized surgical and medical personnel and equipment.

Under the plan disclosed Friday, most trauma patients from Baldwin Hills, the Crenshaw District, Culver City, El Segundo, Fox Hills, Ladera Heights, Marina del Ray, Playa del Rey and Westchester will be transported to the nearest hospital with an emergency room. At these hospitals, a specially trained surgeon and other personnel may not be available to back up the emergency room staff.

About 430,000 people live in the affected communities, according to a 1986 population estimate by Donnelley Demographics, a computerized database.

The affected area also includes Los Angeles International Airport. Although trauma patients from the airport would be transported to the nearest emergency room, Virginia Black, spokeswoman for the county Department of Airports, said a separate countywide disaster plan exists for major catastrophes, including plane crashes, and includes mobilization of additional medical personnel.

Virginia Price Hastings, director of the county’s trauma center program, said that trauma coverage would be maintained for the other communities now served by Daniel Freeman.

Trauma victims in Inglewood and Hawthorne will be transported east to Martin Luther King Jr. Hospital. Trauma victims in Lawndale will be taken by paramedics south to Harbor-UCLA Medical Center in Torrance.

In addition, paramedics will have the option to transport some patients from the uncovered communities to neighboring trauma centers, including Cedars-Sinai Medical Center and UCLA Medical Center in Westwood, on a case-by-case basis, Hastings said. This will primarily occur in the evening and the early morning hours, when traffic congestion is at a minimum and more distant hospitals can be reached within 20 minutes.

Otherwise, most patients from the uncovered areas will go to such hospitals as Daniel Freeman, Brotman Medical Center in Culver City, Centinela Hospital Medical Center in Inglewood and Robert F. Kennedy Medical Center in Hawthorne.

Officials at Daniel Freeman Memorial Hospital announced their intention to drop out of the trauma network in April, citing unexpectedly high costs associated with treating large numbers of indigent trauma patients. Hospital officials have complained that the reimbursement they receive from the state and county for treating patients unable to pay their own bills fails to cover hospital costs.

In recent weeks, county health officials have worked to redraw the boundaries of delivery zones for neighboring trauma centers. They have conceded since April that as a result of Daniel Freeman’s withdrawal some areas would be outside the 20-minute delivery time. No specific areas were identified until Friday.

Hastings said she and other county health officials remained “hopeful” that Daniel Freeman would agree to stay in the trauma center program “a little while longer.”

Their optimism was fueled by the expectation that additional funds, including $9.9 million approved by a legislative budget conference committee on Wednesday, would become available from the state to help private hospitals defray the costs of treating indigent trauma patients.

But the last-minute negotiations to keep Daniel Freeman in the system collapsed Thursday.

“We just didn’t see any indication that anything would be settled in the near future,” said Jim Barber, Daniel Freeman’s administrator. “If all the issues were addressed, we definitely would be interested in reactivating the trauma center.”

Currently, Daniel Freeman is the third-busiest trauma hospital in the county. Its decision to quit the network leaves 19 hospitals in the program. The hospitals include three county hospitals and four rural trauma centers, which treat a relatively small number of patients.

Hollywood Presbyterian Medical Center, previously the fourth-busiest trauma center in the county, left the network in February, also citing financial hardship caused by treating large numbers of uninsured patients.