Palomar Hospital Dilemma : Trauma Care Caught in 2-County Struggle

A billboard near the Riverside County community of Rancho California assures Interstate 15 travelers that “The Care You Need Is Closer Than You Think.”

The advertisement, paid for by Palomar Medical Center in Escondido, refers to the Palomar Heart Center and not to Palomar’s trauma center--the closest emergency medical center to most of southwestern Riverside County. Paramedic ambulances are legally barred by state law from crossing the county line, unless there is an agreement, to deliver seriously ill or injured patients to Palomar or any other San Diego County hospital.

Palomar spokesmen say that the hospital has landed in the center of a trauma care brouhaha between Riverside and San Diego counties and is being painted as the “bad guy” in the controversy between the two county agencies that handle trauma care.

Problem Had Been Brewing

The problem had been brewing for months before San Diego canceled its reciprocal emergency services contract with Riverside on July 15 and is likely to continue long after a new two-county agreement is approved in the next few weeks.

Palomar, the only trauma center serving North San Diego County’s 550,000 or so residents, can’t assume the same responsibility for an almost equal number of residents of southern Riverside County unless more staff and space are added to the overloaded trauma center, hospital officials say.

Dr. David Cloyd, chairman of Palomar’s trauma unit, said his staff handles about 100 “major trauma” patients a month and “we have never turned a patient away.” But, he acknowledges, there must be a plan to end the serious financial burden and crowding that out-of-county patients and indigents place on the hospital and its trauma facilities.

During its 1987 fiscal year, the Palomar trauma center lost about $1.5 million, half from treatment costs for indigent illegal aliens. As a result, hospital district directors doubled trauma care costs for all patients. This year’s figures aren’t in yet, but the unpaid bills are expected to increase.

Cases From Riverside

During the early months of 1988, about a dozen accident victims were taken to Palomar from Riverside County without notice and often without medical insurance to pay for the costly emergency treatment they needed, Palomar trauma center officials said. So Palomar administrators billed Riverside County and the ambulance agencies who delivered the non-resident patients in an effort to recover about $600,000.

Caught in the bureaucratic maze are the Riverside County paramedics and ambulance companies faced with the invisible barrier that now prevents them from transporting seriously injured accident victims to Palomar, 20 minutes away, and forces them to head for the city of Riverside, an hour or so by ambulance, where the nearest available trauma center is situated.

In June, before the two-county agreement had been canceled, a Riverside County deputy coroner said a Rancho California accident victim might have been saved if a Life Flight helicopter from UC San Diego Medical Center, summoned by the California Highway Patrol and hovering over the accident scene, had received clearance to land and take the injured man to Palomar or some other trauma center. A communications snafu caused San Diego Life Flight personnel to recall the copter because it had received no authority from Riverside to land. Emergency medical services in the two counties were operating on different radio frequencies.

Riverside emergency medical services officials say the Palomar hospital, in Escondido, is the only trauma center within an hour’s drive of southern Riverside County. Medical treatment during that “golden hour” immediately after an accident, they say, is critical if the trauma victim is to have a chance at survival. They point out that Riverside’s trauma unit is in the more densely populated northwestern part of the county.

‘Working It Out’

Gloria Huerta, emergency medical care coordinator for Riverside County, concedes that the problem rests with Riverside County officials to resolve. And, she said, “we are working it out.”

Riverside County supervisors approved a new emergency services contract with San Diego County last week, Huerta said, and San Diego supervisors are expected to take the same action in the next few weeks. The new agreement is similar to the one that was canceled in July, allowing medical personnel from the two counties to cross county lines. Resumption of the two-county agreement will not resolve problems with Palomar, she said, because Palomar is still refusing to accept Riverside trauma patients. Talks among emergency-services authorities from both counties and Palomar administrators will begin Monday in an effort to reach an agreement with the Escondido medical center.

Communications problems among the various Riverside County and San Diego County emergency medical services “have been resolved already,” Huerta said, stressing that the incident involving the Life Flight helicopter could not happen again because all agencies are working on the same radio frequencies. Even so, Riverside County emergency medical services staff members will attempt to work out a formal agreement with Life Flight to serve the southern Riverside County area, she said.

Tom Spindler, interim administrator and chief executive officer of the Palomar-Pomerado Hospital District, said that the situation is more complex than just unpaid bills.

“We have a contract with San Diego County to serve San Diego trauma patients, and our ability to do that is at risk when, at no notice, we receive patients from Riverside who could overtax our facilities,” Spindler said.

He said negotiations on an agreement under which Palomar might serve “a certain number” of Riverside trauma victims might take some time to work out.