Trauma Unit Dying as It Works to Save Lives

Sandwich in hand, Dr. Robert Fayer relaxed in a chair inside the cramped hospital staff lounge. It was 9:30 p.m. Tuesday, and Fayer was halfway into his 24-hour shift when the “Code 99” sounded. An emergency patient was being rushed in.

Fayer hurried down the hall to join other members of the trauma team at Fountain Valley Regional Hospital and Medical Center. A man in Santa Ana had downed a six-pack of beer and driven his pickup through a brick wall.

When paramedics wheeled the battered victim in, the trauma team swarmed. They poked and probed, moved his legs and checked for spinal damage. An X-ray was taken. Within minutes, Fayer reached his prognosis: This man was lucky, this man would live.

Pulling off his white surgical smock, Fayer shook his head. If only the prognosis for the hospital’s trauma center was so good. Even as Fayer and the others worked to save lives that evening, the pulse of the hospital’s elite, critical-care unit was beginning to fade.

Hours earlier, the board of directors had announced that the Fountain Valley hospital’s trauma center would close by year’s end. After nine years of healing the severely injured of Orange County’s northwest quadrant, the trauma unit would no longer be in the business of saving mangled souls plucked from car wrecks and troubled teen-agers carved by knives or riddled with bullets.

“We’ve seen it born, we’ve seen it fostered, we’ve seen it expanded,” Fayer said, flinging the smock into a hamper. “It’s unfortunate. Now we’re seeing it succumb. And the reason is economics.”

Flanked by some of the most impoverished and crime-riddled neighborhoods in Orange County, the Fountain Valley trauma center has labored under a heavy load since its inception in 1980 as part of the special network of medical units designed to handle critically ill or injured emergency patients.

Month in and month out, the center has been flooded by indigent patients ill-equipped to pay their medical bills. Hospital officials say only about half the people wheeled through the double doors of the trauma room carry medical insurance.

These are not easy cases. Apart from healing the battered victims of freeway accidents, Fountain Valley also patches up the crime casualties from lower-income areas straddling the Santa Ana River.

‘Knife and Gun Club’

“We call it the Knife and Gun Club,” Fayer remarked. “We’ve typically handled the most and the worst cases in the county.”

The result has been losses of more than $1 million a year for the center. Recent staff cuts and other austerity measures trimmed the annual loss to $500,000, according to Dr. Peter LaPort, a surgeon acting as medical director for trauma services at the hospital.

But it wasn’t enough.

A single patient can put the hospital deep in the red. Medical care for one young woman, an illegal alien hospitalized since she was hit by a car more than a month ago, has already reached $390,000. The woman has no insurance, but administrators can hardly ship her elsewhere.

“One whole side of her body was smashed to smithereens,” said Joan Boughey, the hospital’s administrative director of critical care and trauma. “She’ll be a long time here, a long time in rehab. And nobody else will take her.”

It is a troubling situation hitting hospitals all across the country.

“We have to take care of them,” said Peter Anderson, director of the hospital’s emergency department and one of the architects of the trauma network. “It’s just a matter of how many hit your door and whether you can survive when too many hit your door.”

The unceasing load of critically injured patients treated by the center has taken a toll on the staff. Liability insurance for the doctors has ballooned with the large number of high-risk cases. And turnover is high.

In recent years, all but one of the half-dozen neurosurgeons who worked with the trauma center have left. Hospital officials searched for months to find replacements, finally signing on a doctor from the Midwest. But the neurosurgeon left after only a few weeks, frustrated over the lack of payment, hospital employees said.

“After a while, doctors start saying: ‘Why do I need to be on call at a trauma center where so many patients don’t have insurance and there are so many high-risk patients that the chances of being sued are higher,’ ” LaPort said.

It was LaPort who announced the unhappy news on Tuesday to the surgeons and staff on duty at the trauma center. As the hours wore on into the night, word spread through the hospital and out into the police and paramedic network that serves as the delivery service for the trauma center.

Mike Ciraulo, a Santa Ana firefighter-paramedic, heard about it from a nurse after he wheeled in an accident victim. Ciraulo groaned and rolled his eyes.

“We’re going to have to call a Lifeflight helicopter in about every day now,” Ciraulo remarked. “It’s going to collapse the whole system. . . . Where are people going to go? L.A.?”

It was a common refrain. Nurses and doctors are concerned about the fate of the remaining three hospitals in the Orange County trauma-center network.

When Fountain Valley shuts its doors to trauma victims, it will only shift more cases to the units at UCI Medical Center in Orange, United Western Medical Center-Santa Ana and Mission Regional Hospital Medical Center in Mission Viejo. The move will stretch resources at the other centers and test their fiscal solvency, observers said.

Moreover, the critically injured in northwest Orange County will have that much farther to go for help.

“If Fountain Valley dropping out of the trauma system is just the leading edge of a complete collapse of the network, then, yes, more people will die,” LaPort said. “It’s an unhappy situation. . . . I hope my wife or kid is not in a traffic accident. We’re going to all feel less secure without a trauma network.”

Fayer agreed. Standing in his pea-green scrubs amid the bustle of the emergency room, he explained the importance of “the Golden Hour.”

For a victim of a car accident or a gunshot wound, the first 60 minutes is critical, he said. The sooner a doctor can see a seriously injured patient, the quicker the flow of blood can be staunched and the spread of infection halted. Potential complications can be averted.

“One knows that the longer the transit time for a patient, the more potential danger there is for mortality,” Fayer said. “My worry is that, with this center and potentially others closing, we could start to slip beyond that critical hour. And there’s going to be potential problems.”

The 58-year-old man who hit the brick wall did not fare badly. Though he croaked with pain as the trauma team bandaged his wounds and fitted him with braces, the accident victim escaped with no critical injuries.

Outside in the hallway, Fayer approached the victim’s brother, a chubby man with hands thrust in his pockets.

“Does he drink often?” the doctor inquired.

“No. Just once in a while,” the relative replied.

“Yeah. I guess this was the once in a while,” Fayer quipped.

As a precaution against head injuries, the accident victim was wheeled down the hall into a room outfitted with a CAT-scanner. While Fayer watched, a technician snapped 13 different shots of the man’s brain. The doctor studied each black and white image as it flashed onto a small screen.

Moments later, a nurse advised Fayer that tests on the man showed he had a blood-alcohol level twice the legal limit for driving. A confirmed nondrinker, Fayer grimaced. “We’ve had worse.”

Like the young man, who last fall was stabbed through the heart, all the way through, one side to another. Paramedics got to him quickly. Within 15 minutes, the youth was inside the cool, white walls of the trauma room, surrounded by surgeons and respiratory therapists and nurses and technicians.

Doctors opened his chest and sutured the holes. He walked out of the hospital a week later, according to Anderson, the hospital’s emergency department director.

“It’s easy if you have all the right players there, which is why this trauma system was set up,” Anderson said. “He would have died at maybe 99% of the places on Earth, but he didn’t die here.”

Neither did Tami Stoerrle.

In 1986, she was on the back of a former boyfriend’s motorcycle when they had a wreck. Stoerrle, 15 at the time, sustained a shattered skull, suffered multiple brain hemorrhages and many broken bones. She was unconscious for three weeks.

Dr. William Dobkin, the center’s last remaining neurosurgeon, managed to pull her back from the brink. Tuesday night, the young Huntington Beach woman, now 18, was sitting in the emergency room getting help for a bad cold when Dobkin strolled through.

Stoerrle smiled and waved to the doctor. “I’m alive because of him,” she said, pointing to Dobkin. “I owe it to him.”