Trauma Care in State of Shock : Huntington Withdrawal Sheds Light on Troubled System

The decision of Huntington Memorial Hospital in Pasadena to close its trauma center is understandable, but the timing isn’t. The hospital has faced rising losses in uncompensated care at the center for several years. The decision to close the Huntington center on May 1, however, ignores prospects for better public funding that will be tested in coming months.

The fundamental problem is a threadbare health-care system nationwide that fails to address the basic needs of low-income families. The result is that the health of all persons, regardless of income, is placed in peril. Nowhere is that more evident than in the collapse of the nation’s trauma centers.

The trauma-center crisis in California is concentrated in Los Angeles and Orange counties, but almost every trauma center and emergency room is suffering the impact of uncompensated care in a nation where 37 million persons are without health insurance. The hospitals and their medical staffs are being forced to bear a financial burden that belongs to the government. These burgeoning deficits are threatening the ability of hospitals to continue quality acute care for the communities they serve. So it is that Los Angeles County, which once had 23 trauma centers, will soon have only 12, one of them limited to pediatric cases. And Orange County, which once had four, now has three.

Emergency rooms lose less money and continue to operate effectively, 94 of them in Los Angeles County and 30 in Orange County. But the loss of the trauma centers is significant. They serve critically injured persons, most often the victims of traffic accidents, falls, shootings and stabbings. They can make the difference between life and death because they have specialist staffs always on duty, creating a unique teamwork among doctors, nurses and technicians ready for instant response. Emergency rooms must often call specialists from their homes to handle major injuries.

The closing of Huntington’s trauma center has been termed “devastating” by Virginia Price-Hastings, chief of the county’s paramedic and trauma-hospital program. It is the last trauma center in an area that stretches from Burbank east through the San Gabriel Valley to the county line. The closing will leave the largest gap in the county trauma network. Huntington, like 11 other hospitals in the county, has found that it simply cannot afford to continue the service. Last year, the hospital received compensation for only 38% of its trauma cases, running up a deficit of $3.7 million, more than double the loss in 1988.

Some help, but not enough, has been offered by the county from newly allocated tobacco-tax funds. For the current year, the county has offered Huntington $1.5 million, with a further agreement to reduce the burden by eliminating trauma cases from outside the hospital’s normal service zone, called “catchment area.” In recent months, 19% of the trauma cases had come from outside the zone. The tobacco-tax money is also being used in an effort to coax four of the dropout hospitals back into the trauma network while providing new funds to those that have remained in the network. Huntington will forfeit its share of the tobacco tax if it withdraws, county officials said.

In Orange County, a similar effort to mend the network is under way. Officials are trying to negotiate a replacement for Fountain Valley Medical Center, which withdrew from the trauma network last year. At the present time, Orange County is served by the trauma centers at UC Irvine, Western Medical Center in Santa Ana and Mission Medical Center in Mission Viejo.

There are two other relevant developments. A state task force has completed a mandatory state health insurance plan that would greatly reduce the number of uncompensated care cases, although its prospects for passage have been damaged by the governor’s opposition. And an initiative on the June ballot, to bring up to date the state budget limits of the Gann Initiative, holds the promise of freeing more state funds for basic health services.

This is a decisive moment in the state’s search for better health care. The tobacco tax provides some relief for hospitals and doctors providing uncompensated care. The days ahead will test the willingness of the governor and Legislature to respond appropriately to the financial crisis in health care. The June election will test the willingness of the voters to provide basic funds. Only when the test results are known can there be fully informed decisions on whether to preserve the trauma system.