Losing the 'Golden Hour' : Medical care: The closing of Huntington Memorial's trauma center may mean the difference between life and death for Glendale accident victims.

By PHIL SNEIDERMAN and ELIZABETH LU

March 8, 1990 12 AM PT

TIMES STAFF WRITERS

Glendale residents, at one time encircled by trauma centers, are about to fall farther outside the reach of hospitals that provide special treatment for life-threatening injuries.

When the trauma center at Huntington Memorial Hospital in Pasadena closes in May, local accident victims may not get the lifesaving care they need, county health officials said.

The hospital announced Feb. 23 that, after a $3.7-million loss last year, it will pull out of Los Angeles County’s shrinking trauma-care network May 1. Huntington’s trauma center has been treating severe injury victims from the east side of Glendale and nearby communities.

“It’s a major setback for health care,” 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 60 minutes after an injury, when the chances of survival are the greatest, she said.

Paramedics say five to 15 trauma cases usually originate in Glendale each month.

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.

The end of trauma care at Huntington Memorial comes less than a year after the network lost St. Joseph Medical Center in Burbank, which also treated patients from Glendale. Hollywood Presbyterian Medical Center, just southwest of Glendale, left the trauma network in 1988.

“With Huntington gone, the whole San Gabriel Valley is without a trauma center,” said Truman Chaffin, director of Los Angeles County’s Emergency Medical Services Agency. “There’s also a gap in the Glendale-Burbank area since St. Joseph withdrew last year.”

Chaffin said he considers those two areas, along with the Inglewood community, as the three most critical holes in the trauma network. To plug these gaps, the county is offering part of its $42-million share of Proposition 99 tobacco tax funds to hospitals that remain in or rejoin the trauma network.

The county is trying to persuade St. Joseph to reopen its trauma center so the Burbank-Glendale area is not left uncovered, Chaffin said.

St. Joseph might rejoin the network, but only under certain conditions, said Daniel Fahey, the hospital’s chief operating officer.

“Until we see there’s a guaranteed continuation of funds from Proposition 99, and there’s an ease of access to these funds by the physicians who treat trauma patients, we as a hospital are not in a position to have further discussions with the county,” he said.

After May 1, Glendale’s trauma patients will go to County-USC Medical Center whenever an ambulance can reach that hospital within 20 minutes. The decision is based on the distance from the trauma center and traffic conditions. If the trip will take more than 20 minutes, local trauma victims will go to the nearest of the city’s three hospitals.

“Glendale does have access to three good emergency departments,” Chaffin said. “But that does not mean a surgeon is there to handle a trauma case.”

But emergency rooms also face an increased demand. Frequently, they become so burdened that they must close temporarily, and patients and paramedics often end up “shopping” for an open one.

“We are going to be impacted,” said Rick Hayne, emergency room director at Glendale Memorial Hospital. “We are going to see more patients who would have gone to a trauma center. And we’ll have to deal with them.

“We have the ability to take care of them. But can we do it within the ‘golden hour’? That’s the question.”

The county’s trauma network, launched in 1983 with 23 participating hospitals, 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 waiting surgical staff within 20 minutes.

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

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.

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, the hospital council’s 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.

After May 1, even if paramedics can rush a Glendale trauma patient to County-USC within 20 minutes, there is a growing possibility that the patient could be turned away for lack of room.

County-USC’s 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, she said.

Officials at existing and former trauma centers argue that requiring on-duty surgeons and anesthesiologists simply costs too much--no less than $500,000 a year at Queen of the Valley Hospital, said Jim Haden, its chief executive officer.

He said that, before its trauma center closed, the hospital asked the county to ease the requirements for the trauma center designation. The county refused.

Even without the designation, Glendale emergency rooms have treated trauma patients, hospital officials said.

It is difficult to foresee the local effect of Huntington Memorial’s withdrawal from the trauma network, said Jeanette Abundis, nursing director for critical care and emergency services at Glendale Adventist. Growing gang violence could lead to more crime victims being treated at Glendale emergency rooms, she said.

With 17 beds, Glendale Adventist is the city’s largest emergency room, treating almost 25,000 people last year for minor and major medical problems. Abundis said the department was filled about 10 times last year, requiring that paramedics take patients elsewhere, unless the heartbeat or breathing had stopped.

At Glendale Memorial, with seven emergency beds, a “saturation” closure occurred eight times during February, director Hayne said.

But the loss of another trauma center near Glendale is not necessarily a great cause for alarm, said David Austin, vice president of Professional Ambulance, which has had a paramedic service contract with the city since 1975. “The number of trauma patients in the city of Glendale is a very small percentage,” he said.

Austin said his company transported nine trauma patients during February and has rarely surpassed 20 in one month. Overall, his company transported 8,053 patients in Glendale during 1989.

Contrasted with other parts of Los Angeles County, Austin said, Glendale has little violent crime and few severe traffic accidents.

BACKGROUNDBeginning 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