Failed to Bid for Trauma Care Funds, County Says

In a surprise admission, a top Los Angeles County official said Monday that no lobbying effort was made to persuade Gov. George Deukmejian to approve millions of dollars in emergency funding for the county’s shrinking trauma care network.

Chief Administrative Officer Richard B. Dixon said that county officials had assumed that the governor understood the gravity of the situation and would approve money that might discourage private hospitals from dropping out of the trauma network.

In the last year, three private hospitals have withdrawn from the network, one more will pull out in three weeks and several others are reportedly reassessing their participation.

Question on Responsibility

In vetoing nearly $30 million in statewide trauma funds earlier this month, Deukmejian said he regards trauma networks as a local rather than a state responsibility. Dixon said Monday that Deukmejian’s veto message and an additional explanation of the veto contained in a letter to The Times indicated that the governor misunderstands the trauma funding issue. The county’s trauma network, Dixon said, has always depended heavily on state financial support.

But Dixon said the county may be partly to blame for the vetoes.

“I make an assumption that we did not do an adequate job of educating (the governor’s) staff as to the relationship (between the trauma network and the state),” Dixon said. He added that the county had received no indication from the governor’s office that the trauma funds, inserted into the budget by a legislative conference committee, were in any jeopardy.

Dixon won support from Supervisor Deane Dana, a political ally as well as a close friend of the governor. When Deukmejian vetoed the funds, Dana expressed shock, saying “I don’t know where the governor is coming from.”.

Lack of Communication

“I think we should have made a great effort and we have no choice now but to go back and make everyone understand,” Dana said Monday. “Lack of communication is a great problem in our society. I meant it when I said (recently) that the trauma network will collapse in a year, and some have said in six months (without new funding).”

Supervisor Ed Edelman, meanwhile, expressed surprise at Dixon’s disclosure.

“I would have assumed our staff in Sacramento would have lobbied the hell out of the governor to get these health care programs maintained in the budget,” Edelman said. He said he will ask his fellow supervisors today to step up local efforts to inform the governor on the issue.

Although the governor has built a reputation for adhering closely to his positions, county officials expressed guarded optimism Monday that they will be able to change his mind on the trauma issue. In the past, with the help of Deukmejian allies Dana, Mike Antonovich and Pete Schabarum, the county has occasionally persuaded the governor to spare programs from his annual budget vetoes.

Deukmejian, who has been under attack, even by some supporters, for vetoing trauma care funding, said in a letter to The Times published Friday that “trauma centers have never been a state-funded program. They were initiated by counties and have always been funded at the local level.

“In light of this fact,” Deukmejian wrote, “I find it very ironic that county officials are now attempting to pass the buck and blame our Administration for their own unwillingness to fund a county program.”

Reimbursements Halted

Dixon said Monday that Deukmejian is incorrect, that state funding has--until late last year at least--partly underwritten the local trauma network. State funds had been directed to numerous private trauma hospitals to offset what it costs them to provide continuing care to uninsured indigent trauma patients once they have been stabilized. Last year, after Deukmejian vetoed more than $10 million in health funds in a dispute with the Legislature, the county stopped reimbursing the private hospitals.

Two weeks ago, Deukmejian vetoed nearly $30 million in trauma network funds as well as $69 million intended to help care for so-called medically indigent adults, the working poor who neither can afford nor qualify for other forms of health insurance. Los Angeles County would have received about $27 million of the indigent adult funds and about $13 million from the trauma funds, officials said.

Trauma network advocates said the $27 million would have paid for about 400 beds in county hospitals to which stabilized indigent patients in the private hospitals could have been transferred for continuing care. These transfer beds were considered crucial to encouraging the remaining private hospitals to stay in the trauma network.

The county contends that the state owes it the $27 million under a 5-year-old agreement to pay for most of the health care for indigent adults. Under that agreement, the state had agreed to reimburse 70% of the cost of caring for indigents, but until now the reimbursement level has been closer to 60% and even lower in some years.

In response to Dixon’s comments, Dr. Bruce E. Haynes, director of the state’s Emergency Medical Services Authority, said Monday that the governor’s office was aware of most of the problems that the county’s trauma care network is facing. However, Haynes said, the governor believed that if the county considered trauma care a high priority, it should have allocated for that purpose some of the $30 million in discretionary funds the county receives from the state.

Nothing in Budget

In the county’s $7.6-billion budget adopted last week, no money was set aside for trauma network relief. County officials said instead that they will work toward approval of trauma money when the Legislature reconvenes next month. Two Los Angeles Democrats, Assemblyman Mike Roos and Senate President Pro Tem David Roberti, are backing legislation that would restore the $30 million that Deukmejian vetoed for the state’s trauma hospitals.

Los Angeles County’s trauma network was established in 1983 to provide a countywide system of specially equipped and staffed emergency rooms for victims of serious injuries. The system has tried to guarantee that no patient would be more than a 20-minute ambulance ride from the nearest trauma center.

In the last year, two of the system’s largest private hospitals--Daniel Freeman Memorial and Hollywood Presbyterian--have pulled out of the network, citing financial losses due to a lack of county hospital beds available for the transfer of stabilized indigent trauma patients.

Two other hospitals have dropped out, California Hospital Medical Center in 1985 and Pomona Valley last year, for similar financial reasons. Santa Monica Hospital has announced that it will withdraw from the network Aug. 11, leaving 18 hospitals in a system that once had 23 participants.

Several other hospitals, concerned that many of the indigent trauma patients that were once cared for at Daniel Freeman and Hollywood Presbyterian will now be taken to their facilities, are weighing their continued participation in the network.

Much of the trauma network’s problems were outlined in a “white paper” prepared by the Hospital Council of Southern California in an attempt to persuade Deukmejian and the Legislature that some sort of relief was necessary to save the system. But Dixon said Monday that the position paper, a joint product of the hospital council and the county, was never forwarded to Sacramento.

“I really don’t think (the paper) would have gotten anybody’s attention,” Dixon explained.