Trauma Care Starts Again at Palomar : Medicine: Three-month shutdown of North County’s only center for trauma patients ends after the hospital and surgeons reach a pay accord.

North County’s only trauma center came back on line Thursday morning after a three-month shutdown and received its first trauma patient almost immediately.

“We are needed. It only took us four minutes to get our first patient,” said Nancy Sayrem, spokeswoman for Palomar Hospital.

However, it was unclear whether the patient, a female car accident victim, even needed the trauma label--and the higher costs that go with it.

The county office of emergency medical services on Wednesday certified Palomar’s trauma unit as ready to reopen after the hospital reached an agreement to pay five orthopedic surgeons twice as much for them to be on call 24 hours a day.

“They will be providing a full complement of physicians every day, and thereby they will be conforming to the trauma standards that are required to be part of the county’s trauma system,” said Ron Yardley, spokesman for the county Department of Health Services.

Palomar closed its trauma center Dec. 23 when seven orthopedic surgeons walked out over what began as a pay dispute. Soon after, most of the surgeons decided they were tired of the risks and 24-hour on-calls and were not returning under any circumstances. But then five agreed to come back--not enough to staff the trauma center seven days a week.

Facing deadline for hiring enough orthopedic surgeons, the Escondido hospital forged an agreement with the five in which they will cover all seven shifts, said Tony Noronha, interim chief executive officer of the Palomar-Pomerado Health System.

“The people that we have interviewed, a lot of them were not going to be available until June or July,” Noronha said. “It came down to where the orthopedic surgeons agreed to do extra cover until the summer.”

The orthopedic surgeons agreed to a change in payment from their $520-a-night stipend to a guaranteed 75% of the billings for their work on the trauma unit, Noronha said, whether the patient eventually pays the bill or not.

One of the main concerns of the doctors had been delinquency on the part of trauma patients, about 40% of whom lack health insurance.

The new payment structure will mean more than doubling the hospital’s salary costs to the orthopedic surgeons, from $183,000 a year to about $376,000, he said.

The hospital had been facing a county health department-imposed April 25 deadline to fix its shortage of orthopedic surgeons or lose its trauma care credentials. Keeping the facility closed had cost the hospital at least $35,000 a month.

A sixth surgeon may be hired in the next 60 days, and a seventh may be hired shortly thereafter, according to Sayre, although it is unclear who they might be. A $60,000 recruitment search begun in January has yet to uncover any new surgeons willing to take on the trauma load.

Thursday’s trauma patient had suffered a head injury and was admitted to the intermediate care unit, one step below critical care, Sayre said. No surgery was needed, and the patient scored the highest possible on a scale of injury severity, with low scores being the most severe, Sayre said.

Under a study undertaken at Palomar immediately after the orthopedic surgeons walked out on Dec. 23, this patient would have been treated at Palomar without the trauma label, Sayre said. Trauma patients pay up to three times what regular emergency cases pay.

Dr. Paul Milling, one of the orthopedic surgeons who declined to return to the trauma unit, said he was “glad the war is over. I’m happy the way it is now.”

None of the five orthopedic surgeons who came back to the trauma unit returned a reporter’s phone calls.