Trauma Network Needs Intensive Care : Hospitals: The San Gabriel Valley will be left out of the county system when Huntington Memorial's center closes in May.

By ELIZABETH LU

March 1, 1990 12 AM PT

TIMES STAFF WRITER

When Huntington Memorial Hospital in Pasadena closes the San Gabriel Valley’s last trauma center in May, accident victims here may not get the care they need to save their lives, a county health official said.

The hospital announced Friday that, after a $3.7-million loss last year, it will pull out of Los Angeles County’s trauma care system May 1.

“It’s a major setback for health care in the San Gabriel Valley,” said Virginia Price-Hastings, chief of the county’s troubled trauma center network.

It will mean that many accident victims lose the chance for critical care during the “golden hour,” the first hour after an injury when the chances of survival are greatest, she said.

Emergency rooms also treat life-threatening injuries, but unlike trauma centers, they do not have surgeons and anesthesiologists on duty at all times. “Trauma (care) saves 50% more lives than in a comparable emergency room,” said David Langness, a spokesman for the Hospital Council of Southern California.

And emergency rooms also face increased demand. Space at emergency rooms frequently becomes so tight that many are forced to close temporarily when they are full, and patients and paramedics often end up “shopping” for an open one.

The county’s trauma network began in 1983 with 23 participating hospitals, but will have just 12 left when Huntington leaves. The network was designed to guarantee that patients with multiple life-threatening injuries to vital organs such as the heart, brain and lungs could be rushed to a trauma center and a waiting surgical staff within 20 minutes.

San Gabriel Valley residents are well-covered by a medical response plan for major disasters such as earthquakes, Price-Hastings said, but are vulnerable when it comes to treatment for daily trauma injuries. The county plan is not activated and its network of emergency medical workers are not summoned for daily cases, she said.

“A lot of the public think trauma care is for gang members” Price-Hastings said. But she said most trauma cases result from car and motorcycle accidents.

Statistics from the hospital council show that although 17% of trauma victims are shooting or stabbing victims, 44% are injured in car accidents.

“Every time we get behind the wheel, we expose ourselves,” Price-Hastings said.

After Huntington’s announcement, about 50 people telephoned the hospital, fearing that the emergency room would be closed, hospital spokeswoman Peg Kean said. She reassured them that, like the other trauma centers that have dropped out of the county network, Huntington will keep its emergency room open.

Once a model trauma network, the county’s system has rapidly deteriorated, mainly because hospitals say they are losing millions of dollars each year on trauma care. Health experts cited as major problems reduced Medi-Cal and Medicare reimbursements and uninsured patients who cannot pay.

At Presbyterian Intercommunity Hospital, which serves communities including Hacienda Heights and whose trauma center closed last summer, 18% to 20% of the trauma patients had no medical insurance, hospital President Lowell Smith said. Medi-Cal reimburses only 50% and Medicare 60%, he said.

The potential collapse of the county’s trauma network shows that what is needed is “nothing less than a program of universal, comprehensive health care coverage,” said Stan Dorn, staff attorney for the National Health Law Program in Los Angeles.

Los Angeles County’s soaring population of about 8.8 million exacerbates the problem, Langness said. During the first year the county operated its network, 4,500 trauma patients were treated; by last year, the number had skyrocketed to 14,000, he said.

The first San Gabriel Valley trauma center to leave the network was Pomona Valley Community Hospital, which closed its center in 1986. Queen of the Valley in West Covina followed in 1987. Last year, Methodist Hospital of Southern California in Arcadia pulled out in January, and Presbyterian Intercommunity Hospital in Whittier followed suit in August.

At Huntington and Methodist, officials emphasize that staff surgeons live in the community and are able to get to the hospital within 20 minutes of being called. But Price-Hastings said being on call is not as good as being in the hospital when the patient arrives. “They may or may not get there to save a life,” she said.

Spokesmen for some current and former trauma centers, however, said requiring on-duty surgeons and anesthesiologists is simply too costly--no less than $500,000 a year at Queen of the Valley Hospital, for example, said Jim Haden, chief executive officer of the hospital. He said that before the trauma center closed, the hospital asked the county to ease the requirements for the trauma center designation. The county turned down the request.

Without a trauma center in the San Gabriel Valley after May 1, the closest trauma center will be Los Angeles County-USC Medical Center in Los Angeles. Located near the intersection of the San Bernardino and Golden State freeways, the 2,045-bed facility is just outside the valley’s western end, more than 30 miles from Pomona on the eastern edge.

Depending on traffic and where the accident occurred, the ride to County-USC could take an hour or more. And even if paramedics can rush a trauma patient to County-USC within 20 minutes, there is a growing possibility that the patient could be turned away for lack of room.

Long the hospitals of last resort when other facilities are full, county hospitals have also been forced to close trauma centers after reaching capacity. At County-USC, for example, the trauma center had to close down for more than 50 hours in December and more than 90 hours in January, Price-Hastings said. Those months are among the busiest in the year, she said.

Any patient who could not reach an open trauma center within 20 minutes would have to be transferred to a hospital emergency room, where a surgeon and anesthesiologist may not be immediately available.

Complicating the situation is the steady rise in the use of emergency rooms, a result of growing population, demise of trauma centers and the fact that emergency rooms are often the major access to health care for indigent patients.

At Huntington last spring, for example, a woman who lived in a Pasadena motel called 911 and was rushed to the emergency room where, in what was her first contact with a doctor in eight months of pregnancy, she gave birth to a girl.

Emergency room visits at Pomona Valley Hospital jumped from 4,200 in 1986 to 5,500 in 1989, spokeswoman Laura Elek said.

At Huntington, the largest hospital in the San Gabriel Valley, the emergency room reached capacity and had to close five times in January and three times in February, Kean said. The closures usually occurred at night and lasted one to four hours, she said.

Some hospitals have been known to close their emergency rooms even though there are vacancies.

Last February, county health inspectors issued warnings to Greater El Monte Community Hospital and Inter-Community Medical Center in Covina for temporarily closing their emergency rooms to ambulance traffic in late January even though they still had empty beds. Greater El Monte said its two vacant beds weren’t equipped with medical monitors, and Inter-Community said the county’s warning resulted from a misunderstanding.

Price-Hastings said that hospitals have generally complied with closure rules but that the county will continue to monitor the closures and issue warnings if needed. Hospitals with vacancies that intentionally close emergency rooms will be reported to state licensing authorities, she said.

BACKGROUND

Beginning in 1983, 23 hospitals in Los Angeles County joined a new trauma center network designed to guarantee acute care to any accident victim within 20 minutes. Trauma centers and emergency rooms treat life-threatening injuries, but only trauma centers are required to have surgeons and anesthesiologists on duty around the clock. Because of soaring costs and the inability of many trauma patients to pay, 10 hospitals have left the network. On May 1, Huntington Memorial Hospital will become the 11th to drop out, leaving San Gabriel Valley residents without any trauma center.

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