Hospital Rejecting Some Trauma Cases : Medicine: Neurosurgeons at Scripps Memorial in La Jolla refuse to treat patients with head injuries in pay dispute.

Scripps Memorial Hospital in La Jolla has closed its doors to all trauma center cases involving head injuries because the facility’s four neurosurgeons have gone on strike over a pay dispute.

Last month, 21 hospitals in Los Angeles County refused to treat head injury cases, citing a shortage of neurosurgeons willing to work on-call shifts in which they could be summoned to the emergency room at any hour. The action by Scripps was the first in San Diego County.

Starting Sunday, Scripps administrators began diverting patients with head injuries to the county’s five other trauma centers until an agreement can be reached with the four physicians. Scripps has temporarily agreed to pay some money to the four, but it is not yet clear how much and the doctors have not yet accepted, said Martin Buser, a senior vice president and administrator.

“Temporarily, we agreed to help while we find a permanent solution,” Buser said. “Trauma is a very valuable service. The unsung heroes are the physicians who rush in and take (emergency duty).”

The strike does not affect any cases other than head injuries that might ordinarily be brought to the hospital, Buser said.

Hospital administrators declined to name the four neurosurgeons, their current incomes, or how much money they want. In 1987, the national median net income of a neurosurgeon was $237,000 annually, making it the second-highest-paying medical specialty, according to the Medical Economics Co., an industry analyst.

The four Scripps doctors are asking to be paid for working a trauma duty shift, a service that some though not all trauma centers pay, hospital officials said. At Scripps, the neurosurgeons are expected to arrive at the hospital within 20 minutes of being called when they work a trauma shift, Buser said.

“Really what they want is some recognition financially for the fact that they provide care to trauma patients,” said Dr. Brent Eastman, chief of the trauma service.

Eastman estimated that, in 50% to 60% of the trauma cases, the neurosurgeons do not receive full payment because the patients lack medical insurance. At Scripps, doctors are not salaried and are paid by the patient or the patient’s insurance company, hospital spokesman Michael Bardin said. Only with “very few patients” would doctors not get any payment at all, Bardin said. But the decreased reimbursements offered by Medi-Cal pinch doctors’ pockets, Eastman said. The doctors hope the hospital will make up some of the difference.

“This is not a local problem but an economic crisis in trauma care across the country,” said Eastman, who is also chairman of the American College of Surgeons trauma division.

Dr. Kenneth H. Ott, Scripps’ chief of neurosurgery and one of the four, was unavailable for comment. His brother, Anthony Ott, sent out press releases about the squabble involving the hospital and its doctors.

All emergency rooms are required by law to have a list of specialists who are on call. At Scripps, 10 general surgeons, four neurosurgeons, 12 orthopedic surgeons and 15 anesthesiologists work on-call trauma shifts, Eastman said. Of those, only the neurosurgeons have declined to work until an agreement is reached, he said.

In San Diego County, health administrators have met for the past year with hospital representatives as well as doctors to try to avoid the very situation that happened at Scripps.

“We’re seeing a need to re-look how we use those specialists so we don’t abuse those resources,” said Gail Cooper, chief of the county’s Emergency Medical Services in an earlier interview.

Cooper said that neurosurgeons, as well as other specialists who work on trauma duty shifts, see the shift as disruptive to their private practices because it sometimes requires them to be up all night, unexpectedly working, and then to put in their normal workday. The situation is made more aggravating because the doctors are not always reimbursed for their work, since some of these emergency patients cannot afford the services, Cooper said.

Across the county, about 120,000 patients are transported to hospital emergency rooms each year. When the trauma system was first implemented in 1983, 22% of the deaths in hospital emergency rooms were deemed “preventable,” Eastman said. Today, with the trauma system in place, that rate has plunged to 1%.

“Just when we are proving the efficacy of the trauma system in San Diego, it is somewhat threatened because of economic viability,” Eastman said. “Ultimately, the question is whether society is willing to pay the bill. What’s it worth to save those lives, and is it worth it to have the trauma system?”