Authorities Insist County-USC Is Plagued by Inadequate Funding, Not Turf Wars : Hospital: Administrators say they need more money for quality control programs.

The furor over funding shortages for public health intensified Monday in the wake of a critical report by the American College of Surgeons on trauma care at Los Angeles County-USC Medical Center.

The confidential report citing the hospital for serious lapses in care and “preventable deaths” was detailed in a story in The Times on Monday. The ACS assessment attributed the problem to a turf battle between surgeons and emergency medicine doctors over control of major trauma cases as well as inadequate patient records and quality assurance systems.

Dr. Robert E. Tranquada, dean of the School of Medicine at USC, on Monday largely dismissed the issue of turf battles, saying that whatever tensions existed between the specialties have been resolved. Nevertheless, Tranquada said he plans to meet with the chairmen of surgery and emergency medicine to monitor any interdepartmental tension in the area of trauma care.

But he acknowledged serious deficiencies in quality assurance programs at the hospital and blamed inadequate funding by the County Board of Supervisors and state political leaders.

Tranquada’s assertions were echoed by Irving Cohen, the County Department of Health Services’ top financial officer. Cohen, assistant director for administration and finance, said quality assurance programs at all six county-run hospitals have suffered over the years for lack of money.

“There is no doubt in my mind that we are under-funded throughout the system,” Cohen said. “Patient care usually gets the first priority for funding.”

But inadequacies in the hospital’s quality assurance system may be the most difficult problem to overcome, according to health officials.

The ACS is not the first national standard-setting body to fault the hospital’s quality control programs.

Last summer, County-USC was placed on conditional accreditation by the Joint Commission on the Accreditation of Healthcare Organizations. A major reason for this probationary status was poor internal monitoring of the quality of medical care.

Like the ACS, the commission considered it a serious failing. Without good quality-assurance programs, a hospital cannot pinpoint its problems or judge whether the care its medical staff provides is of good quality, said Dr. William F. Jessee, the commission’s vice president for accreditation.

Senior medical officials at County-USC defended themselves against the latest round of criticism by saying they were only trying to make the best use of scarce resources. The chief of the medical staff, Dr. Sol Bernstein, said he believed it was better to deploy the hospital’s limited staff in the front-line care of seriously ill and injured patients than to relegate nurses and other personnel to gathering data for quality-assurance studies.

But Jessee rejected this reasoning.

“If you continue to take the position that we don’t have time or money to measure what we are doing, then you are doomed to keep repeating the same mistakes over and over again,” he said in an interview Monday.

Because of County-USC’s conditional accreditation, the accreditation commission plans a return visit in January. While it is not specifically influenced by the findings of other review agencies, such as the ACS, Jessee said quality assurance mechanisms in the hospital’s trauma service will be closely scrutinized.

Cuts last August of $7.6 million from the public hospitals put doctors and nurses at County-USC in the position of having to turn away sick people for the first time in the hospital’s history. The hospital is a primary source of care for the county’s poor.

A Superior Court judge last week blocked those cuts in services from continuing, but it remains to be seen whether her order results in additional money for the hospitals.

Meanwhile, county trauma officials said Monday that they plan to change the makeup of the future review teams from exclusively surgeons provided by the ACS to multidisciplinary groups.