Replacement Trauma Center Seen Possible

As one of Orange County’s four trauma centers prepares to drop out of the nationally known but debt-ridden emergency network two days after Christmas, several Orange County hospitals are reportedly considering filling the gap.

Although no hospital has yet signed up with the county as a trauma center, administrators at several facilities have held “preliminary meetings” to discuss the idea, county officials said. None of the hospitals are expected to make a final decision until after the holidays, and any new trauma center would have to be certified by the county.

“I haven’t got anybody jumping up and saying they want to be a trauma center,” said Betty O’Rourke, manager of the county’s Emergency Medical Services, who in mid-October wrote to 10 north central county hospitals inviting them to start one.

But O’Rourke confirmed that she has had discussions with some of the hospitals. And sources added one hospital is “‘seriously considering” the invitation, while two others have expressed cautious interest.

Trauma centers are specially staffed and equipped to offer faster and more sophisticated medical care than standard emergency rooms to people suffering from severe, possibly life-threatening injuries, such as from car crashes, falls, shootings, and stabbings.

However, trauma centers throughout Southern California have lost millions of dollars--an estimated $5 million last year in Orange County--because often the patients who receive the costly care have no medical insurance.

Still, the prestige of offering landmark medical care appears to be sparking the interest of some Orange County hospitals.

“The prestige is still there,” a county official said. “You get hero points from your colleagues for providing that level of care.”

Further, the costs could be offset by the “good public relations” value of such specialized care and the promise of millions of dollars in new tobacco tax money soon to be distributed to trauma hospitals, O’Rourke said.

Among the hospitals that have expressed cautious interest in trauma care are 173-bed Los Alamitos Medical Center on the Orange County-Los Angeles County border and 141-bed Humana Hospital-Huntington Beach.

Administrators at the two hospitals noted that although they have not rejected the option of trauma care, neither have they seriously examined its costs.

“Right now we have to analyze it very carefully,” said Los Alamitos associate administrator Charlene Robinson. But, she added, “we haven’t ruled it out.” Los Alamitos officials still haven’t broached the idea to staff physicians or their parent corporation in Los Angeles and probably will not do so until after Christmas, she said.

‘Might Consider It’

At Humana, executive director Mark Aanonson said: “We don’t close our mind to anything. If they (county officials) had something in mind that might be workable, we might consider it.”

Aanonson acknowledged the public relations potential of having a trauma center. But he added that staffing and financing a trauma center probably have too many negatives. “All the money you have to pay out for standby fees and stipends (to trauma doctors) plus the occasional $200,000 to $300,000 bad debt, it’s not really attractive,” he said.

One source said 347-bed St. Jude Hospital and Rehabilitation Center in Fullerton is weighing the idea, but hospital president Paul Viviano adamantly denied that. He said he and his staff had looked at O’Rourke’s letter, given the idea “serious consideration” and soundly rejected it.

“We’re not interested at this time,” Viviano said. “Not unless the governor or the supervisors are going to provide a Christmas present--lots of additional reimbursement.”

The specialized centers are expensive because they are staffed 24 hours a day with a trauma surgeon and anesthesiologists, with neurosurgeons and other specialists on call. When the system works, paramedics speed badly injured accident victims to a trauma center for computerized tomography scans, surgery or other lifesaving care. Receiving the proper diagnosis and care in the first hour after a severe injury is crucial to the patient’s chance of survival, studies have shown.

Orange County’s network of trauma centers was a national model when it began in 1980. It opened with five centers, and for the last six years has operated with four--UCI Medical Center in Orange, Mission Hospital Regional Medical Center in Mission Viejo, United Western Medical Center-Santa Ana and Fountain Valley Regional Hospital and Medical Center. But in recent years, hospital officials have complained that they can’t afford to provide the care. When Fountain Valley’s directors decided to close the trauma center permanently Dec. 27, they blamed losses from uninsured patients that hit $1 million last year and were expected to triple in 1990.