Surgeons Call Off Boycott at Trauma Center : Health: Palomar Medical Center’s emergency facility reopened after 12-hour shutdown.

San Diego County health officials shut Palomar Medical Center’s trauma center for 12 hours Tuesday after learning of a boycott planned by the facility’s orthopedic surgeons, disgruntled over stalled contract negotiations.

Seven of Palomar’s orthopedic surgeons intended to stage a strike beginning Tuesday, saying they were being treated unfairly and paid insufficiently. But they changed their minds Tuesday morning after Palomar administrators, in a letter sent Monday night to the doctors, reminded them that Palomar requires a 90-days notice before a physician can resign from on-call duty.

“If they do not comply with the 90-day notice . . . the (hospital) could suspend the orthopedic surgeons’ privileges at the hospital,” said Tom Spindler, Palomar’s chief operating officer. “This morning the orthopedic surgeons decided that they would follow the 90-day notification guidelines.”

Dr. Paul Milling, spokesman for the orthopedic surgeons and chairman of Palomar’s orthopedic section, refused to comment Tuesday on the group’s apparent reversal. Milling referred inquiries to his attorney, Virginia Bonar. Bonar did not return repeated phone calls.

In an interview Monday, Milling said the seven orthopedic surgeons were “the work horses of trauma,” and had tired of the long hours of often caring for patients who frequently were unable to pay the doctor’s fee. At Palomar, the orthopedic surgeons were able to collect 39% of their fees, Milling said.

The doctors, he said, were saddled with caring for indigent patients while neurosurgeons at other hospitals were free of this burden. At Mercy Hospital in San Diego, only five of the 58 orthopedic surgeons work an on-call shift, Milling said.

“We have been committed to providing the best care for trauma patients at Palomar, and in the wider geographic area,” Milling said. “Taking on this ‘extra duty’ for a hospital-contracted program disrupts family life, our private practice, and our personal health.”

The orthopedic surgeons have been working at the trauma center since June without a contract, though they had been negotiating with hospital officials, Milling said. The orthopedic surgeons have now agreed to continue working until a contract has been hammered out, Spindler said.

Milling declined to discuss the doctors’ demands or their current salary levels. Nationwide, orthopedic surgeons are among the highest paid medical specialists, earning a gross income of $466,070, according to Medical Economics, an industry analyst.

But Spindler said that Milling had verbally agreed in July to the hospital’s offer of a new contract that included a $520 stipend for each 24-hour on-call shift, a figure that represented a 5% increase over the previous stipend.

“We thought we had an agreement during the summer, that evidently was not the case,” Spindler said. “They decided the terms we agreed upon were not acceptable.”

Notified Monday night of the doctors’ plan to boycott the trauma center, county health officials decided to shut the trauma center and send patients to the county’s five other trauma centers, starting one minute after midnight Tuesday.

It is not yet known whether, in fact, any patients were diverted to the other centers, said Paul B. Simms, deputy director of San Diego County’s Department of Health Services.

Palomar is the only North County trauma center, covering 1,400 square miles extending north to Riverside County and include Julian, Escondido, San Marcos, Fallbrook and Vista.

“We restored Palomar to full trauma status at noon (Tuesday),” Simms said.

But Simms and other experts say the crisis at Palomar signals a far graver question: Who will bear the cost of caring for the indigent as county budgets diminish?

In fact, the proposed strike by Palomar’s doctors would have been a copy of the walkout earlier this month by neurosurgeons at Scripps Memorial Hospital in La Jolla. At Scripps, the doctors walked out, shutting the trauma center to head injury cases for five days.

Counties throughout the state are facing similar problems. In Los Angeles County, 21 hospitals refused to treat head injury cases, citing a shortage of neurosurgeons willing to work an on-call shift.

“There is a crisis coming, and the Legislature and Board of Supervisors are going to have to face it,” Simms said. “I consider this the tip of the iceberg.”