Another Hospital Planning to Quit Trauma Network

In a further blow to Los Angeles County’s defection-plagued trauma care network, Santa Monica Hospital said Wednesday that it will pull out of the system, citing financial losses due to a lack of patients.

Hospital officials said the withdrawal, effective Aug. 11, is a result of the county’s refusal to assign it a specific service area. Because the hospital in Santa Monica is designated as one of the county’s four “rural” trauma centers, which have smaller staffs, it may treat only those trauma patients who are more than a 20-minute ambulance ride from a larger trauma center, such as UCLA Medical Center.

In other words, a person seriously injured in an automobile crash across the street from Santa Monica Hospital would be taken to UCLA’s trauma center, more than four miles away.

Difference in Centers

As a rural trauma center, Santa Monica Hospital is required only to have an anesthesiologist or other specially trained physicians on call, whereas the larger centers must have such personnel around the clock.

County health officials said Wednesday that they are evaluating Santa Monica Hospital’s move, but indicated that there is little chance the pullout will be averted.

“It was a very difficult and distressing decision to make,” said Leonard La Bella Jr., Santa Monica Hospital president and executive director. La Bella said the hospital has received so few trauma patients--56 since its center opened last July 15--that remaining in the network is no longer financially feasible. He said the trauma center has lost nearly $400,000 since it opened. Pomona Valley Community Hospital dropped out of the network in 1985 for similar reasons.

La Bella said the county has refused a bid by the hospital for a trauma service area that includes the Santa Monica city limits. Such a plan would boost Santa Monica Hospital’s trauma patient load by about 80 a year, he said.

Fifth to Withdraw

Santa Monica Hospital’s withdrawal would make it the fifth hospital to abandon the trauma network since it was launched in December, 1983, and the third since February. Hollywood Presbyterian pulled out on Feb. 23, and last week Daniel Freeman Memorial Hospital in Inglewood followed suit. Eighteen hospitals will make up the trauma network once Santa Monica pulls out.

The impending withdrawal, disclosed to county health officials last week, comes at a time when steps are being taken at both state and local levels to shore up a troubled system that hospitals once competed intensely to join.

Pending in Sacramento is legislation approved by a joint conference budget committee that authorized about $10 million in trauma center bail-out money to help the private Los Angeles-area hospitals remain in the system. That money has been held up in a partisan dispute in the Legislature.

Daniel Freeman, Hollywood Presbyterian and California Medical Center pulled out of the trauma network because they were receiving too many non-paying or uninsured patients. Due to a scarcity of county hospital beds, the three private hospitals were often unable to transfer these indigent trauma patients once they were stabilized.

In Los Angeles, health officials are developing a plan to give hospitals with the largest indigent patient caseloads first priority in transferring those patients to available county hospital beds.

No ‘Significant Impact’

Virginia Price Hastings, the county’s trauma network coordinator, said Santa Monica Hospital’s withdrawal, “does not have a significant impact from what I see.”

She explained that under county guidelines, the hospital would continue to receive trauma patients from remote coastal areas, such as Malibu, that are more than 20 minutes from the larger trauma centers. Under county regulations, a trauma patient more than 20 minutes away from a trauma center will be taken to the nearest hospital emergency room.

Hastings also indicated that there is little chance that any of UCLA Medical Center’s service area will be reassigned to Santa Monica Hospital. She added, however, that the county will consider assigning some of Daniel Freeman’s former trauma service area to Santa Monica Hospital. When Daniel Freeman left the network on June 15, a large portion of the county’s western region was left without a trauma center within a 20-minute ambulance ride.

La Bella said Santa Monica Hospital would consider assuming some of Daniel Freeman’s former service area, but only if Santa Monica were also included in a service area plan.