County Trauma Network Dealt a Crucial Blow

In what officials called a fatal blow to Los Angeles County’s crippled trauma network, Huntington Memorial Hospital in Pasadena announced Friday that it will drop out of the emergency-care system because of mounting financial losses.

The hospital’s action leaves the San Gabriel Valley without a trauma center and opens another gaping hole in the trauma network, which was hailed as the nation’s finest when it opened in 1983. Once Huntington’s trauma center closes May 1, the network will have just over half the 23 medical facilities it started with.

County emergency-care officials predicted that the closure of Huntington’s trauma unit will have a domino effect on the remaining 12 hospitals, already strained beyond capacity. When even more patients flood into these facilities, one after the other will be forced to close, officials said.

“This kills it,” said David Langness, vice president of the Hospital Council of Southern California. “The county’s trauma network is now history. The demise of large trauma centers like Huntington’s means that those remaining will be in severe and immediate jeopardy as well.”

The county this week offered Huntington $1.6 million in Proposition 99 tobacco tax funds to remain in the trauma network. However, hospital officials said the county’s offer was not nearly enough to offset the $3.7-million loss incurred by the trauma center last year. The hospital’s board of directors voted unanimously to withdraw from the trauma network Thursday night.

“It took a lot of careful soul-searching and debate to do this, but we simply could no longer afford to absorb the loss,” said Dr. Allen W. Mathies Jr., Huntington’s president and chief executive officer. “We believe the trauma network is an important concept, but we can no longer sustain such a loss without jeopardizing the viability of our other services.”

Huntington’s withdrawal means that more than 1 million residents in the San Gabriel Valley and Eastern San Fernando Valley, who at one time were served by five trauma centers, will now be served primarily by the trauma unit at Los Angeles County-USC Medical Center or by emergency rooms at nearby community hospitals. Emergency rooms, unlike trauma centers, are not required to have specialists, such as neurosurgeons, on the premises.

Officials said the overflow of trauma victims from Los Angeles County-USC probably would be taken to Cedars-Sinai Medical Center, which has been suffering large financial losses because of a crunch at its trauma center. Cedars-Sinai officials have been negotiating with the county to try to find a way to reduce the hospital’s annual trauma load of 1,200 patients--by far the largest among private hospitals in the county.

The loss of another trauma center means that severely injured victims at one end of the county will be much more than 20 minutes by ambulance from the nearest trauma center, the original criterion for eligibility in the once-sprawling network.

“This means that there will be some (patients) who die,” Mathies said at an afternoon news conference at the 98-year-old Pasadena hospital. “The question that the public has to answer is are (those patients’) deaths worse than raising taxes.”

But Huntington physicians and county trauma network officials said the biggest impact of the latest closure may be among high-risk, indigent people in downtown and South Los Angeles, which have constituted a sizable portion of Huntington’s trauma cases in recent years.

Several emergency-care officials said the decision by Huntington was triggered by complaints from hospital physicians who were upset over a lack of reimbursement for the hospital’s high volume of indigent patients. Doctors at the hospital said they were tired of treating victims of gang violence from South-Central Los Angeles and other areas far outside the bounds of Huntington’s mostly upper-class service areas.

“You can’t help but be unhappy that when you have a patient due for surgery and you have to postpone it to deal with a gunshot victim from South-Central,” said Dr. David Faddis, a trauma surgeon at Huntington. “Nobody was happy with the situation, but I’m sure most of the surgeons would agree that if they could have kept the trauma center open, they would have.”

When the trauma system was established in Los Angeles County it was so popular that more than 30 hospitals competed to be included in the network, believing that it would bring in millions of dollars.

But as it turned out, most hospitals lost millions, in part because of the financial squeeze placed on them by new government and health insurance cost controls. More important, however, many surgeons and other specialists who staffed the trauma centers revolted when they discovered that so many of their patients could not pay their bills.

“This is a devasting blow, maybe the final blow,” said Virginia Price-Hastings, chief of the county trauma network. “I don’t think the end is far off, but under any circumstances, this is a very major setback for health care in Los Angeles County.”

BACKGROUND

Although trauma centers and emergency rooms may treat patients with life-threatening injuries, only trauma centers are required to have a surgeon and anesthesiologist on hand, as well as a number of other specialists--such as neurosurgeons--available within 20 minutes. This special staffing is designed to ensure quick surgical capability for patients who are bleeding from injuries to vital organs, such as the brain, lungs, heart and accompanying vascular system.

L.A. COUNTY’S TRAUMA CENTERS CENTERS STILL OPEN 1. Westlake Community Hospital, Westlake Village 2. Henry Mayo Newhall Memorial Hospital, Valencia 4. Northridge Hospital Medical Center 5. Holy Cross Hospital, Mission Hills 8. UCLA Medical Center 9. Cedars-Sinai Medical Center, Los Angeles 12. Childrens Hospital of Los Angeles 15. County-USC Medical Center, Los Angeles 17. County-Harbor UCLA Medical Center, Torrance 18. County-Martin Luther King/Drew Medical Center, Los Angeles 22. St. Mary Medical Center, Long Beach 23. Memorial Medical Center of Long Beach CENTERS CLOSED 3. Antelope Valley Hospital Medical Center, Lancaster 6. St. Joseph Medical Center, Burbank 7. Santa Monica Hospital Medical Center 10. Hollywood Presbyterian Medical Center 11. California Medical Center, Los Angeles 13. Huntington Memorial Hospital, Pasadena (Closes May 1) 14. Daniel Freeman Memorial Hospital, Inglewood 16. Methodist Hospital of Southern California, Arcadia 19. Presbyterian Intercommunity Hospital, Whittier 20. Queen of the Valley Hospital, West Covina 21. Pomona Valley Community Hospital