Cedars-Sinai May Drop Out of County Trauma Network

Despite an infusion of $11.2 million into the Los Angeles County trauma care system, the coordinator of Cedars-Sinai Medical Center’s trauma program said Wednesday that there is “a 50-50 chance” that his hospital will pull out of the network, a setback that could doom the troubled system.

Dr. Stephen L. Michel, associate director of surgery at Cedars-Sinai, said the Westside hospital will reassess its participation in the county’s trauma network although the Board of Supervisors has approved additional funding in hopes of salvaging the financially ailing system.

The supervisors, distressed over the departure of five private hospitals and the pending loss of two more from the trauma network, had voted Tuesday to provide the extra money in an attempt to dissuade any more hospitals from defecting. But Michel told The Times that Cedars-Sinai, one of the 16 hospitals remaining in the system, has experienced such a crush of trauma patients recently that resources are being drained from other medical services, raising concerns over a decline in overall care.

Emergency Assistance

Trauma centers are high-tech emergency facilities where specialists are available around the clock to treat victims of serious accidents and crimes. Crucial to the success of a trauma network in saving lives is enough participating hospitals so that patients are never more than 20 minutes away from a trauma center.

Michel said that, like other hospitals, Cedars-Sinai may be forced to join the exodus unless more money is forthcoming or changes are made to ease the patient loads.

“The domino ripple effect is accelerating, and I think what happened yesterday was the smallest Band-Aid to entice the hospitals to remain in the system long enough for the elected representatives to scratch their heads and come up with a jury-rigged method of resolving this,” he said.

“But my frank concern is that I don’t think they will come up with something soon enough to keep one or two more trauma hospitals from dropping out of the system,” Michel added.

Michel said that his own hospital directors will review the matter over the next few months to determine whether they will remain part of the county system, but he added that they are balking at the county’s request that Cedars commit to stay at least another nine months in the trauma network. “I would say the chances are at least 50-50 that our board will say that regrettably, under the present circumstances, it is not prudent nor practicable for our hospital to maintain our present trauma caseload,” Michel said.

News that Cedars-Sinai was even contemplating leaving the system surprised county health officials who have been struggling to keep the trauma network in place until they can come up with some long-term funding.

It would be a devastating blow, said Virigina Price Hastings, chief of the department’s trauma program, if Cedars were to abandon the network.

Hastings said that Cedars presently serves a geographic area that includes Hollywood, West Los Angeles, Beverly Hills and stretches south of the Santa Monica Freeway, picking up trauma patients that had been serviced by Hollywood Presbyterian and Daniel Freeman Hospital in Inglewood, which have left the trauma network. Before the loss of those hospitals, Michel said, Cedars-Sinai was seeing 550 trauma patients per year with no more than 25% of them indigent. Today, he said, that number has mushroomed to nearly 800 trauma patients with more than half of those unable to pay for their individual health care, a cost that Michel said can amount to several times more than the average billing for cardiac surgery patients.

In addition, Michel said, the avalanche of new trauma victims has forced Cedars-Sinai to close its doors, not only to trauma patients but to other critical care patients, on 10 different occasions since Thanksgiving “because we had so many patients in our hospitals that we can’t get room for anybody else.”

Michel said that in those situations--the latest of which was Monday--hospital officials alerted paramedics that Cedars could not accept any more trauma victims.

Michel’s comments came after he appeared, along with other local health officials, at a news conference announcing the formation of a trauma center task force that will seek legislative help in Sacramento to fund trauma care programs.

The proposal by Assembly Speaker Pro Tem Mike Roos (D-Los Angeles) is aimed at coaxing more money from the state, which presently reimburses about 50% of the costs of caring for medically indigent patients.

Roos, who was accompanied by representatives of paramedic groups, private hospitals and the county, said his goal is to help not only Los Angeles County but the state’s regional trauma care system, which he said is “on the verge of financial collapse.”

Citing a report prepared last fall by the Assembly Office of Research, Roos said trauma centers statewide will lose about $100 million this year and physicians treating trauma patients will lose about $40 million.