Hospitals Want Ballot Issue on Tax Subsidy for Trauma Centers

At least three of the six hospitals in San Diego County’s trauma care network say they are losing so much money on uninsured patients that they want the county supervisors to consider putting an initiative on the June ballot to levy a tax to subsidize the system.

Administrators of Palomar Medical Center in Escondido and a lobbyist for Scripps Memorial and Children’s hospitals in San Diego said Tuesday they are pushing for the plan because each hospital is losing an average of $1 million a year.

“We never expected to do more than break even under the best of circumstances,” said Robert Edwards, president of Palomar Pomerado Hospital District. “ . . . But there comes a time when we would like to have . . . the people understand what the cost to the community is.”

In response to the hospitals’ requests, San Diego County Supervisor George Bailey on Tuesday sent letters to county and trauma-center officials convening a meeting next month to discuss ways of easing the trauma system’s financial pinch.

But he expressed skepticism about the likelihood of public backing for a new tax.

“I doubt if there would be support for it,” Bailey said in an interview. “Only one of the hospitals is a public hospital. . . . I think it would be an uphill battle. I’m not saying people would not support it.”

Bailey’s letter came after Palomar Medical Center, the only trauma center in North County, threatened to pull out of the three-year-old system if it does not receive state or county help in paying the bills of uninsured patients. Under the system, certain hospitals are designated as trauma centers to provide emergency care for the most seriously injured patients. Such patients are taken to a trauma center, even though another hospital might be closer.

Palomar is the first hospital in the system to state publicly that it is considering withdrawing simply because of the program’s cost. Grossmont Hospital dropped out in January, 1985, amid controversy over its ability to provide adequate trauma care.

Trouble Elsewhere

In Los Angeles County, four hospitals have dropped out, citing the high cost of so-called uncompensated and undercompensated care. Complaints there and elsewhere in California have prompted unsuccessful attempts to find state funding for the centers.

Elsewhere in the country, other trauma systems are facing the same problem. Gail Cooper, chief of emergency medical services for San Diego County, said the number of hospitals participating in the Dade County, Fla., system has dropped from six to one.

In the case of Palomar, administrators blamed a rise in trauma cases involving illegal aliens without insurance or money. They said an analysis of the hospital district’s bad debt traced more to undocumented foreigners than to U.S. citizens.

Edwards estimated that one-third of the trauma patients brought in to his center are unable to pay their bills. In the case of expensive services like neurosurgery, he said as many as 80% of all cases may involve uncompensated care.

In addition, Edwards said the hospital must pay specialists simply to be on call for the trauma center since there are fewer in North County to share the load. In San Diego, physicians are not paid simply to be on call because the hospitals need not do it as often.

Edwards said the hospital has several options.

“We can raise our rates substantially for the trauma care,” he said, “in which case the trauma patients who are insured would pick up the entire tab for those who aren’t. Or you try to do what we’re trying to do--get some legislation to spread (that cost) out.

“The third option is to drop out.”

Palomar officials met Friday with Bailey and proposed a countywide ballot initiative on a tax to subsidize the trauma system. Edwards suggested a sales tax, gas tax or addition to the property tax.

Bailey said Tuesday that he was calling for a Sept. 14 meeting of hospital and county officials to discuss the need for additional money. But he expressed some skepticism about a new county tax and minimized the significance of a possible withdrawal from the system.

“Looking in the past, Grossmont dropped out and the other private hospitals were able to compensate,” Bailey said. “If (Palomar) can’t afford to stay in, they have the same alternative certainly that Grossmont had.”

Grossmont withdrew in January, 1985, five months after joining the program. Hospital officials said they were losing $11,000 a month and could not afford to hire more trauma surgeons, and the hospital’s trauma service to one patient was under county investigation.

But on Tuesday, a lobbyist for two other trauma system hospitals, Scripps Memorial and Children’s, said both those hospitals “share the concerns that Palomar has.” Spokeswomen for Mercy Hospital and UC San Diego Medical Center said their hospitals face similar issues.

Ben Clay, the lobbyist for Scripps and Children’s, said the costs of trauma care at Children’s are especially high because of the peculiar difficulties of treating children. Many cases end up costing $30,000 to $50,000, he said.

Clay said trauma cases tend to involve young people, many of whom are in no position to pay.

“So when a patient shows up who’s 19 or 21 years old, who’s just left home, whose parents’ insurance doesn’t cover him or he hasn’t started his first job, and he’s been injured in a motorcycle accident, who pays?” Clay said. “ . . . The hospital eats it.”

Clay said a Children’s Hospital official asked the board of supervisors last month to set up a committee to look into the problem of trauma system funding and explore “countywide funding mechanisms.”

Last month, Gov. George Deukmejian vetoed a plan to spend $30 million in state funds to subsidize trauma centers statewide. The move prompted Los Angeles County trauma officials to predict that their system would crumble as a result.

Other proposals to raise money for the system statewide have included an unsuccessful scheme to increase the fee charged to telephone users to pay for the 911 emergency telephone system.