Memorial Is Evaluating the Health of Its Trauma Unit

The trauma unit at Memorial Medical Center has had a fairly typical month.

The patients included a young woman who showed up with a stab wound in her stomach. A teen-age boy came in with a bullet in his neck. And a 28-year-old man was admitted after a car crash that left him in critical condition.

Those particular patients survived. Without the unit, medical officials say, some of them might not have.

They were among the estimated 1,200 patients that Memorial expects to treat this year for traumatic injuries. The hospital houses one of the largest trauma centers in the county, forming a major southern link in the countywide trauma network. The majority of trauma cases in Long Beach are handled at Memorial.

Yet the hospital’s trauma care, like that at other hospitals in Los Angeles County, faces an uncertain future. Strapped by mounting financial losses, Memorial officials say they are conducting a thorough evaluation that could culminate in eliminating the service. The resulting tremors have shaken local health-care providers, who fear that the loss of Memorial’s trauma unit could be a devastating, perhaps even fatal, blow to trauma care in Long Beach and possibly the county.

When asked in a recent interview if Memorial planned to close its trauma unit, Mike Dowell, vice president of ambulatory services, said: “Right now I’d say no. Ask me again tomorrow and I might say yes.”

David Langness, a spokesman for the Hospital Council of Southern California, was more direct in his assessment. “We’re considering the possibility seriously,” he said. “It would be a multiple tragedy. Long Beach’s trauma system is in great danger.”

The rumored closing has sent shock waves through the ranks of local hospital officials who, until recently, generally assumed that trauma care in Long Beach was relatively secure.

In 1983 when the county’s network of trauma centers was formed, they say, there was some opposition to the idea that Long Beach, unlike many other areas, would have two major centers within a two-mile radius. With Memorial at the city’s northern edge and St. Mary Medical Center just to the south, the critics argued, Long Beach residents would not be able to fill the beds at their end of the trauma network, which was designed to enhance emergency care by keeping fully trained medical/surgical staffs--rather than just emergency specialists--on 24-hour call.

In the early days of the system, the two hospitals even considered themselves competitors for trauma patients. But as the demands on them grew, officials at both hospitals say, so did their cooperation. Dividing the city into two roughly hewn service sectors, the hospitals coexisted, accepting each other’s overflow when necessary to make the system work smoothly.

But three years ago serious problems began emerging in the system countywide. As homelessness, gang violence and other social problems began pushing the number of indigent trauma patients upward, the hospitals serving them got caught in a squeeze. An estimated 50% of these patients were uninsured and unable to pay for the medical services. But county and state governments, caught in budget squeezes of their own, were increasingly unable to reimburse private hospitals for treating the indigents.

Facing huge financial losses, hospitals began dropping out of the trauma system. Of the 23 institutions providing trauma care in 1983, Langness said, 10 have since dropped out. And each time a hospital drops out, he said, the demands--and subsequent losses--to the remaining hospitals in its service area increase proportionately.

Memorial has suffered significant financial losses in its trauma program. Although officials there would not divulge exactly how much the trauma unit has lost, spokesman Ron Yukelson said that the hospital wrote off $19 million last year in charity services--a portion of which consisted of trauma care provided to uninsured patients. In addition, he said, the hospital lost about $95 million providing treatment that was not fully reimbursed by Medi-Cal, the state’s health-care program for low-income residents.

As a result, Memorial administrators created a series of ad-hoc committees to examine various services. One of the committees, charged specifically with reviewing the trauma program, according to Dowell, is expected to issue a report within 90 days that could recommend any number of options, including the unit’s closure.

“We do try to manage this charity pot very closely,” Dowell said. While the current review is part of a “routine process,” he said, it is also very serious. “We’ve been sheltered for a while,” Dowell said. “Now all the problems (experienced elsewhere) we are experiencing, too.”

Such talk has made officials at nearby St. Mary extremely nervous.

While St. Mary treats about 500 trauma patients a year, said David Tillman, associate administrator, the load constitutes only about a third of the total number of trauma cases in Long Beach, most of which go to Memorial. If Memorial closes, Tillman said, some of the overflow will be picked up by outlying hospitals. But St. Mary, he said, would expect the number of trauma patients to at least double, which could swamp the hospital and possibly force it to close its trauma center, too.

“It would be extremely difficult to handle,” Tillman said. “Our emergency room doesn’t have the physical space; our operating rooms would be distressed.”

Such a chain reaction would be devastating to the system countywide, according to Langness. “(Memorial and St. Mary) are the anchors for the southern county,” he said. “They are what has saved the network in Los Angeles by absorbing much of the load from the closures. There’s nothing in between anymore.”

So the delicate balance continues, with Memorial engaging in business as usual for the time being while medical practitioners throughout the county await the outcome of the giant’s deliberations.

“The issue comes down to (ordinary) health care continuing to grapple with indigent health care,” Dowell said. “(We are) trying to be thorough and expeditious.”