ORANGE COUNTY VOICES MEDICINE : County Must Act to Solve Crisis in Emergency Care

As the trauma center of the Fountain Valley Regional Hospital and Medical Center closes Wednesday, it is critical that Orange County residents regroup to save what is still viable of our nationally acclaimed regional trauma system.

The loss of the Fountain Valley facility is a severe blow to the trauma network in Orange County, but if the Board of Supervisors moves quickly and shows vision, it need not prove to be a fatal blow.

The trauma center is closing largely because it could not survive the heavy case load of indigent victims it treated. When Fountain Valley’s facilities are no longer available, the majority of the victims will be redirected to either UCI Medical Center in Orange or Western Medical Center-Santa Ana. Each hospital is losing in excess of $2 million each year on indigent trauma care, and the added economic burden of caring for Fountain Valley’s indigent is quite likely to lead to restriction of current trauma services at these facilities--or possibly the failure of these centers as well.

As trauma services at hospitals with specialized trauma equipment and personnel are restricted, the burden of trauma care will be shifted to emergency rooms at other hospitals that are neither funded nor equipped to deal with trauma patients, indigent or otherwise. It does not take extraordinary insight to see that such a series of events would lead to a severe lowering of trauma and overall emergency care for all Orange County residents.

A coalition of the four trauma centers, including Mission Hospital Regional Medical Center, has recently attempted to define the bottom line for maintaining the existing trauma centers and for developing a sufficiently stable economic climate in the trauma system to attract a fourth center. They recommend the following:

* Make all uninsured trauma victims automatically eligible for county-sponsored indigent care funds.

* Adjust indigent care reimbursement rates to cover the cost of indigent care (to be independently audited and renegotiated on a yearly basis).

It is clear that the current county policy of distributing state funds to cover indigent care has been ineffective, as has leaving the funding of indigent care to the private sector’s already financially strained hospitals and doctors.

The state Welfare and Institution Code places responsibility for indigent care squarely on our county Board of Supervisors. This fact and our present crisis demand that the supervisors now take a strong role in saving the laudable health-care system that has, until the past few years, been a model system for metropolitan medical planners throughout the world.

In addition to implementing the suggestions of the trauma coalition panel, there are other steps the county would be well-advised to consider:

* First, it is imperative that the county recognize that only its immediate action will solve the emergency-care crisis. It must not hesitate to take a strong leadership role in developing funding sources and in developing innovative strategies to reduce the costs of emergency care.

* Second, the county must infuse monies from its general fund into the indigent care fund budget. This has been accomplished effectively in Los Angeles County.

* Finally, the county must work with the Orange County Medical Assn. and hospital council to develop birthing centers, primary-care clinics and other cost-effective alternatives to traditional care that will lower the financial demand on county funds, which may then be freed for indigent trauma patient expenses.

The trauma system benefits all of Orange County. The failure of the supervisors to assist Fountain Valley underscores the county’s reluctance to accept these challenges. Thus, the future of our regional trauma systems, to say nothing of the general health-care standard in the county, is now in the hands of the public. If we were to put sufficient pressure on our elected officials, this system, so vital to us all, could still be saved.