Trauma Care System Near ‘Collapse,’ Governor Told

Warning that Los Angeles County’s trauma care network “will collapse in the near future” without new funding, the Board of Supervisors has appealed directly to Gov. George Deukmejian for $20 million to shore up the troubled system.

If Deukmejian accedes to the written request, county officials said they might be able to entice Daniel Freeman Memorial Hospital in Inglewood back into the network. Daniel Freeman, one of the system’s busiest private hospitals, left the network on June 15, citing major financial losses due to unreimbursed treatment of indigent trauma patients.

Although he vetoed $30 million in trauma network funds early last month, Deukmejian has not completely ruled out a change of heart on the issue. In several public statements, however, Deukmejian has maintained that trauma networks are local programs and not a state responsibility.

Deukmejian spokesman Kevin Brett said Thursday that the governor “is always interested in communications with the board and will review the letter.” Brett added, however, that the governor’s position on the issue is “well defined and well known.”

The governor’s July 7 vetoes, as well as his subsequent defense of them, surprised even some of his closest allies on the Republican-dominated Board of Supervisors.

Then, after The Times disclosed on July 21 that the county had failed to lobby the Deukmejian Administration to head off the vetoes, the supervisors agreed that perhaps the governor did not understand the trauma care issue and voted to send him a “conciliatory letter.”

The letter, finally sent out Tuesday afternoon after numerous revisions, seeks the $20 million in trauma care funding in addition to apologizing to Deukmejian for not fully explaining the plight in Los Angeles County, where Daniel Freeman and four other hospitals have left the network. Many others are reassessing their participation.

The county set up the trauma care network in December, 1983, to guarantee to victims of serious auto and industrial accidents, as well as victims of violent crimes, a maximum 20-minute ambulance ride to a specially equipped and staffed emergency room.

In their four-page letter, the supervisors agreed with past Deukmejian comments that trauma networks are indeed local programs. But they added that the major reason the local network is failing is because the state has not lived up to a 5-year-old bargain to reimburse the county for caring for indigent patients.

70% of Cost

The state in 1982 had agreed to reimburse 70% of the cost of caring for indigent adult patients, but due to declining revenues has never followed through on the pact, the supervisors said. Consequently, the state owes the county more than $77 million, more than enough to plug the holes in the trauma system, they told Deukmejian.

However, the supervisors said the $20 million requested would meet the system’s “most critical” needs.

Because the state has not come through with the full indigent care funding, the county has been forced to shut down wards in its six public hospitals. Those ward closures, in turn, have made it increasingly difficult for the private trauma hospitals to transfer stabilized indigent patients to county facilities.

When the private hospitals are unable to transfer stabilized indigent patients, there is often no way that those facilities can be reimbursed for their continuing care, Deukmejian was told.

‘Beginning to Collapse’

“The (trauma) system is beginning to collapse in those areas of the county impacted by a disproportionately large number of indigent uninsured patients (most typically indigent victims of violent crimes),” the supervisors wrote. “It is our sincere belief that this vital public safety program will collapse in the near future without added funding.”

Specifically, the county is worried that Daniel Freeman’s withdrawal will heavily affect nearby trauma hospitals. As it is, the departure of the Inglewood hospital has left tens of thousands of people in the western part of the county outside of a 20-minute ambulance ride to a trauma center.

County officials said Thursday that the new money might help lure Daniel Freeman back into the network. Officials of that hospital have said they would be willing to renew their network membership if new money is found.

In a related development, county officials have proposed giving the 15 remaining private trauma hospitals, as well as 35 other hospitals, first crack at transferring indigent patients to scarce county hospital beds. Officials determined that these 50 hospitals carry the largest loads of indigent care patients, out of the 157 private hospitals in the county.

County supervisors will consider the plan next week.