Pay Dispute Shuts Palomar Trauma Center : Health care: Patients will be sent to other centers as orthopedic surgeons seek more money for on-call duty.

North San Diego County’s only trauma center once again shut its doors Monday morning, after hospital officials were unable to solve a pay dispute with its orthopedic surgeons.

Starting at 7:30 a.m. Monday, trauma patients who ordinarily would go to Palomar Medical Center in Escondido were sent to one of the county’s four other adult trauma centers: Scripps Memorial Hospital in La Jolla, Sharp Memorial in Kearny Mesa, UCSD Medical Center and Mercy Hospital in Hillcrest.

“It pokes a significant hole” in the county’s trauma system, said Dr. J. William Cox, director of the county’s Department of Health Services. “It’s certainly going to be an inconvenience, and it’s certainly going to place greater stress and strain on the remaining adult trauma hospitals.”

In October, Palomar closed its doors for 12 hours after county health officials learned of a planned boycott by the facility’s seven orthopedic surgeons. That action followed a summer of thwarted and stalled negotiations as the surgeons worked without a contract, which had expired in June.

The surgeons have long maintained that they were inadequately reimbursed for their 24-hour on-call duty, and that having to work the stint damaged their private practices and caused burnout.

In July, Palomar--where 40% of its patients are uninsured--began paying the orthopedic surgeons an on-call stipend of $520 a day, or a 5% increase over the previous stipend. But this money, almost $23 an hour over 24 hours, is not nearly enough to cover a surgeon’s expenses including liability insurance and office staff, as well as his own salary, said Dr. Paul Milling, one of the hospital’s seven orthopedic surgeons who man the trauma center.

In fact, he said, the stipend is less than a plumber earns working a night shift.

As of Monday evening, no patients have been diverted to other trauma centers, a Life Flight official said. Tom Spindler, Palomar’s administrator, said the hospital’s action was a temporary one, though the trauma center might remain shut for a week. In fact, loss of the trauma center would mean a $10-million hit to the hospital’s revenues, he said.

“We anticipate that we will resolve the issues either working with or without our current physicians,” Spindler said. “It is our goal to be back up and running as a trauma center just as quickly as we can.”

At Palomar and hospitals across the state, administrators are struggling to handle the ever-increasing problem of providing medical care for a growing population that has no insurance and that may not qualify for the state Medi-Cal program.

In September, neurosurgeons at Scripps Memorial Hospital went on strike, shutting that facility over the very concerns that Palomar’s doctors are now voicing. And, in August, 21 hospitals in Los Angeles County refused to treat head injury cases, citing a shortage of neurosurgeons willing to work the on-call duty.

In San Diego, the action at Palomar and Scripps Memorial is one that may well be duplicated at other facilities in the trauma network, Cox predicted.

“This is not a local problem. It’s a state problem and a national problem,” Cox said. “Unless we find a way to reduce the standards to a more reasonable and affordable ones, I wouldn’t be surprised if more dropped out. . . . Until this nation and society get (their) act together and decide to pay for what they want, the trauma system--the Cadillacs--are going to be gone.”

In light of Palomar’s troubles, Cox said the county would consider asking Tri-City Medical Center officials if they would like to join the trauma system.

And Tri-City hospital officials cautiously expressed an interest.

“It’s something we would probably consider,” said Larry Laux, chief financial officer. “Our feeling right now is the current trauma system is capable of coping. Right now, I don’t believe there is going to be a problem.”

Nationwide, orthopedic surgeons, who repair broken bones and severely damaged muscles, are among the highest-paid medical specialists. According to Medical Economics, an industry analyst, these surgeons earn a gross income of $466,070 a year.

Milling and other Palomar surgeons have declined to say how much they earn. “Give us a break, don’t worry about how much money we make,” said Milling, who helped start up the hospital’s trauma center.

“We are physically and mentally burned out because of physical and mental toil, the late hours and weekend work which trauma entails,” he said.

Indeed, hospital administrators and county officials readily acknowledge that the current trauma system has its flaws.

Last week, one orthopedic surgeon had a trauma patient who was unable to pay for the medical services, Palomar administrator Spindler recalled. But the surgeon had to cancel all his office appointments that day, yet still pay his staff.

In the weeks ahead, Spindler hopes Palomar can hammer out an agreement with the county that might ease the hospital’s financial responsibilities and lessen its costs for participating in the system. In turn, this might allow Palomar officials to sweeten the deal for its surgeons.

Over the six-year period that Palomar has participated in the trauma system, the hospital has lost $2 million, Spindler said. But in the last three years, Palomar has broken even. And clearly, hospital officials are reluctant to let go of their piece of the pie.

“The hospital is eager to be a trauma center, yet, unless the costs for providing that service are eased, this can’t go on forever,” Spindler said.