Tax Funds Offer Trauma Centers a ‘Ray of Hope’

Los Angeles county officials said Tuesday that the county’s deteriorating network of emergency rooms and trauma centers could well be stabilized and possibly rebuilt with funds the county will soon receive from new taxes levied on cigarettes and tobacco products.

Supervisor Ed Edelman called the funds a “ray of hope on the horizon” for the county’s beleaguered emergency services network.

It remains to be seen exactly how much money the county will receive from Proposition 99, the initiative passed last November that raised taxes on tobacco products. But the county’s chief administrative officer, Richard Dixon, told the supervisors Tuesday that it will be enough so that “you will be able to stabilize the emergency room and trauma system and possibly begin rebuilding it.”

Dixon’s forecast came after a compromise was hammered out last week between the state Legislature and Gov. George Deukmejian specifying how Proposition 99 money will be spent. His comments came moments before a public hearing was convened by the Board of Supervisors to consider a report that recommends 24 ways to improve emergency services in the county.

The key finding of the report by the county Emergency Medical Services Commission is that the system’s biggest problem has been “lack of money,” Commission President Dr. Stephen L. Michel said.

But others argued that the system needs an overhaul, not just better funding.

“Even if the system were drowning in money, we still would not have a well-managed, coordinated, unfragmented system,” said Fred Hurtado, president of United Paramedics of Los Angeles.

Network Called ‘Abominable’

Alan Cowan, chief of paramedics for the Los Angeles City Fire Department, blasted the emergency services network as “abominable.” He said, “It makes me want to barf.”

He described a situation last week when up to 10 major hospital emergency rooms or trauma centers reported themselves full and, therefore, were allowed under county guidelines to temporarily close themselves to rescue ambulances. This left paramedics roaming around town with sick patients in search of an available hospital bed, Cowan said.

He said he doubts that all the closures were legitimate and suggested that some may have occurred for financial reasons, in an effort to divert those patients who are unable to pay their bills. “There are hospitals inappropriately diverting patients all over this city.” Cowan charged.

‘Disconcerting Frequency’

Michel said in an interview that it seems that some hospitals close themselves to ambulance traffic with “disconcerting frequency . . . it gives me pause for thought.”

Hospital officials contend that the source of the problem is that too many patients--many of them uninsured and unable to pay their bills--are overwhelming a dwindling number of emergency facilities.

Last month, the 10th trauma center of the original 23 permanently bowed out of the system. On busy nights, half a dozen of the remaining 13 may be full and temporarily closed, health officials say. As a result, millions of people living in wide swaths of the county are served by no trauma center at all, or by one that may well have no space when they need care.

Troubled by the disintegration of the trauma center system, the Los Angeles County Medical Assn. last month passed a resolution pronouncing it “dead.”

Ways to Improve Care

In its report, the Emergency Medical Services Commission recommended 11 short-term ways of improving care without additional funding. These included determining the feasibility of activating Olive View Medical Center, a county-operated hospital in the San Fernando Valley, as a trauma center.

Another recommendation was to determine whether a patient has medical insurance before deciding which hospital he should be taken to, provided this would not compromise his care.

This recommendation drew fire from Hurtado, the paramedics union chief, who said it would “open a Pandora’s box and increase the disparity that currently exists between those patients who can afford medical insurance and those who can’t.”

The commission also recommended 13 long-term suggestions for modifying the county’s emergency services network--including the hiring of an outside consultant to study and evaluate the suggestions.