Restrictions on Access to Trauma Centers Ordered : Medicine: Critically ill people in areas of the county no longer served by a trauma center will be taken to the nearest emergency room. The action is designed to ease the load on those hospitals still remaining in the system.

In an effort to stop further hemorrhaging from Los Angeles County’s rapidly fading trauma system, emergency network officials Wednesday ordered paramedic crews and hospitals not to transport critically ill patients to trauma centers if they are injured outside the service area of the hospitals with trauma centers.

The action, taken to ease the load on remaining trauma centers in the system, means that most people seriously injured in areas of the county no longer served by a trauma center will be rushed to the nearest emergency rooms, which are not required to have a surgeon on hand or a specialist readily available.

“What it means is that there is no doubt that more patients will now die,” said Virginia Price-Hastings, chief of trauma and paramedic programs for the county. “We’ve been saying all along that with the withdrawal of every trauma hospital, patient care will suffer. It’s just that with each one, it gets worse.”

Last Friday, Huntington Memorial Hospital in Pasadena announced that it will drop out of the county trauma network May 1 because of mounting financial losses. Huntington’s withdrawal will leave the San Gabriel Valley without a trauma center and will open another gaping hole in the county’s emergency care network.

When Huntington drops out, the trauma network, hailed as the nation’s finest when it opened seven years ago, will have just 12 of the original 23 participating hospitals.

Health care officials have said that the loss of each trauma center has a domino effect on hospitals remaining in the network. When even more patients flood into those facilities, it strains them beyond capacity, forcing more to close.

Price-Hastings, who called the loss of Huntington a potentially fatal blow to the trauma network, said that the decision to restrict patient transport was made to try to ease the trauma load at the eight private hospitals remaining in the network so that they will not drop out.

Three of those hospitals, Cedars-Sinai Medical Center near the Fairfax district of Los Angeles and Holy Cross Medical Center and Northridge Hospital Medical Center in the western San Fernando Valley, have been operating at nearly double their trauma capacity because of the recent withdrawal of other hospitals from the network.

“We’re trying to prevent the domino effect here,” Price-Hastings said. “We need to control the volume of patients going into the remaining trauma hospitals.”

Under the county’s order, people critically injured around Los Angeles International Airport, in the San Gabriel Valley and in other areas not served by a trauma center may still be taken to one of the county trauma hospitals. However, that will happen only if the paramedics can reach the trauma hospital within 20 minutes and if the facility is not filled.

“This may give the trauma hospitals a little breathing room, but it’s being done at the expense of the trauma patients,” said David Langness, vice president of the Hospital Council of Southern California. “Ever since the trauma system began failing, we’ve had some avoidable deaths. Now, we’ll just have more of them.”

Trauma system officials were particularly concerned about the effect that Huntington’s withdrawal would have on Cedars-Sinai, now considered the linchpin of the remaining trauma network because of its size and location. Cedars-Sinai officials said they were gravely concerned when Huntington announced it was dropping out, fearing that Cedars would receive hundreds of Huntington’s trauma cases.

Tom Priselac, chief operating officer at Cedars-Sinai, said that it is too early to predict if the county’s action comes soon enough to stem the flow of trauma cases at the hospital. Cedars, which contracted with the county to handle about 700 trauma cases when it joined the network, treated nearly 1,250 last year, many from outside its service or “catchment” area.

In a related development, a bill authored by Sen. Alan Cranston (D-Calif.) that would give $75 million to trauma centers around the country, cleared the Senate Labor and Human Resources Committee on Wednesday and will now go to the full Senate for a vote.

However, it may not be enough to help stop the continued degeneration of the county’s critical-care system, according to network officials.

“If we can’t stop the trauma centers from being inundated, then they’ll be forced to close their doors,” Price-Hastings said. “It’s a very serious public health care problem. We’re just doing what we can.”