Trauma Center Offers Plan to Reopen

Palomar Medical Center in Escondido is proposing to reopen on a limited basis its trauma center, which closed two weeks ago, and accept trauma victims without broken bones by the end of this week.

However, San Diego County health officials said the proposal, revealed by hospital officials Monday, is inadequate and may not be approved.

Under the proposal to partly reopen North County’s only trauma facility, doctors at the hospital would determine if an incoming patient needs trauma care and, if so, activate the trauma team. But patients with broken bones who need an orthopedic surgeon would be transferred to another trauma center at least 20 minutes away.

The proposal is an attempt to provide some emergency service, despite the continuing pay dispute between Palomar and its seven orthopedic trauma surgeons that has kept the entire trauma center closed since Dec. 23.

Since the closure, Palomar has turned away 37 trauma patients and redirected them to trauma centers in other parts of the county, said Linda Fahey, an assistant administrator who coordinates Palomar’s trauma center.

It is uncertain how many of the patients who were sent elsewhere would have been accommodated under the proposal, Fahey said, but she estimated that about three-quarters of all trauma patients do not need an orthopedic surgeon.

San Diego County Health Department officials dislike the proposal and said Monday that, without using the orthopedic surgeons, Palomar’s trauma center does not meet existing trauma standards.

“Part-time trauma status is not feasible. It does not represent the best interests of critically injured patients in North County,” said Paul Simms, the county’s deputy health director.

“We will not endure a system where a facility is a trauma center for every type of problem but orthopedic problems. You cannot distinguish an orthopedic injury with 100% certainty from the field,” Simms said.

If doctors were to diagnose a person as not needing an orthopedic surgeon, but the diagnosis turned out to be wrong, the result could be fatal, Simms said.

“In that delay, we have jeopardized the health and safety of that individual, so I will not agree to part-time trauma designation,” Simms said.

The county has authority to remove a facility’s designation as a trauma center, but no such action has been taken. County officials say they haven’t seen Palomar’s full proposal.

A trauma center designation means that a center has the surgical resources and the technical and physical capacities to provide immediate surgical intervention to anyone suffering life-threatening, critical injuries, Simms said.

Without the orthopedic surgeons, Simms said, the Palomar Medical Center is just a well-equipped emergency room, not a trauma center.