Trauma Center to Close; O.C. Care Crisis Seen

In a move that threatens Orange County’s fragile emergency care network, Fountain Valley Regional Hospital and Medical Center announced Tuesday that it will close its trauma center by Dec. 27.

A source said the trauma center had been losing more than $1 million a year.

Enormous unreimbursed costs and high malpractice liability premiums are forcing the hospital to withdraw as one of the county’s four trauma centers, said acting hospital administrator Richard E. Butler, who declined to detail the center’s losses.

Fountain Valley’s trauma center, one of the busiest in the county, cares for 1,000 seriously injured patients a year in a territory that extends northwest to Seal Beach, southeast to the outskirts of Laguna Beach, east to Santa Ana and as far north as Anaheim.

Orange County’s other trauma centers--critical care facilities that offer state-of-the art emergency equipment and medical specialists around the clock--are located at UCI Medical Center in Orange, Mission Hospital Regional Medical Center in Mission Viejo, and United Western Medical Center-Santa Ana.

At risk now in Orange County is not just a system of medical care, but lives, some experts on trauma care said.

UCI emergency physician Sandy Gordon noted that the survival of trauma patients depends on the “golden first hour.” If they get to a fully equipped operating room with the right specialist available within the first hour, they can be saved.

But if Orange County loses a trauma center, “We’re going to lose a lot of patients,” Gordon said.

Ron Roberts, a firefighter-paramedic at the Westminster Fire Department, agrees. “It is bad news. . . . Now it’ll take us that extra 10 or 15 minutes, even longer on the heavy traffic days, to get the patient into the trauma system.”

Betty O’Rourke, program manager for the county Emergency Medical Services agency, said Fountain Valley’s withdrawal would force her agency to redesign the entire 9-year-old trauma system in Orange County.

“We’re not starting all over since we still have three centers. But we certainly have to look at reorganization,” she said.

Dr. John G. West, a surgeon at St. Joseph Hospital in Orange who is an expert on trauma care, described the withdrawal as “disastrous.”

Inundated with indigent patients, other Orange County trauma centers may close as well, he said.

Ironically, when Orange County’s system began in 1980, “this was the model system, one of the first put together in the nation,” West said, and if it collapses, other trauma systems around the country may fail, too.

“This is going to have a ripple effect and Orange County is going to be a bellwether,” he said. “If Orange County, as rich as it is, can’t keep a trauma center open, what place can?”

Orange County’s experience appears to be echoing that of Los Angeles County, which has lost one trauma center after another. That system, which had 23 trauma centers when it began in 1983, has lost all but 13 centers, and on busy nights many of those are full and temporarily closed.

The major factor in those closures appears to be the same issue that forced Fountain Valley to announce its withdrawal--a heavy load of indigent patients.

“There’s no safety net when there’s a trauma center,” Fountain Valley’s Butler said. “You take virtually everything that comes in the door. You take a lot of bad cases (in which patients die). It’s very expensive and there’s no payment for those services. And there are liability issues. People are so injured, so ill, that satisfactory outcomes may not be possible--and any time that happens, you run the risk of a suit.”

Other problems for Fountain Valley were increasing difficulty in getting doctors to be on call for the trauma center. Last week Fountain Valley’s trauma center lost its status as one that offered neurosurgery because the hospital could not get a specialist to cover that area.

In addition, other specialists, including plastic surgeons, were dropping off the call list, said Dr. Peter G. Anderson, director of Fountain Valley’s emergency department.

Anderson, who helped set up Orange County’s trauma network, said he was “sad” about the decision by hospital directors earlier Tuesday to withdraw from the trauma network. But he understood the problem. “It pencils out in the red.”

Fountain Valley had threatened to drop out last December, saying it would close unless county officials agreed to subsidize it. But apparently officials reconsidered that decision and stayed in. However, Tuesday’s decision by the hospital board of directors to withdraw is final, Butler said.

Times staff writer Eric Bailey contributed to this story