Key Departures Wound UCI’s Trauma Center

Two former physicians who worked in Orange County’s premier trauma center, at UC Irvine Medical Center, say they recently quit after years of service because conditions had deteriorated so much they feared they could not ensure an acceptable level of patient care.

A third physician, who took over as acting director of the center after her colleagues left, just gave notice she will leave next month for another job. Though the reasons for Dr. Gail Tominaga’s exit remain unclear, it marks the complete departure of the full-time staff at UCI’s trauma center. They take with them, collectively, nearly 30 years of experience in critical care.

UCI--the busiest, highest-caliber trauma center in the county, with a blossoming reputation and a patient load of more than 1,500 per year--is scrambling to recover.

Two of the former trauma surgeons say they left because the quality of care for which the center had become known was in danger.

“A little at a time, frustration mounted,” said Dr. Gianna Scannell, explaining why she took a job as an associate professor at a Florida university last December after nine years at UCI’s trauma center. By the time she left, Scannell said, the center had declined to the point that “it was a mess.”

The center’s on-call staff, who supplement care provided by full-timers, was padded with surgeons who had little or no trauma experience, she said. Some were slow to act or did not know what to do after patients--suffering from severe car accident injuries to gunshot and knife wounds--were wheeled through the door.

She recalled a case in which a patient shot in the abdomen suffered massive internal bleeding that went unnoticed by the on-call surgeon. The patient might have died, she said, had the problem not been caught and remedied by an alert surgical resident in training.

Scannell left about three months after the departure of Dr. Ken Waxman, a trauma surgeon with a national reputation who had directed UCI’s center for 13 years. Waxman, now surgical education director at Cottage Hospital in Santa Barbara, said the center was not staffed with enough medical residents and he had to struggle against internal pressures to add physicians to the call list who were not suitably experienced in trauma.

The lack of support, he said, meant that he had to spend stints as long as 72 hours at the hospital to ensure adequate patient coverage.

“We had built an extremely good service; I believe we were providing very high-quality care. But it was becoming more and more of a struggle to provide the level of care we had in the past . . . I was not going to stay and not provide the same level of care.”

Tominaga, the third physician, could not be reached for comment.

UC Irvine officials say the quality of care at the center is as good as it ever was, although medical center executive director Mark Laret conceded Friday that the departure of the three experienced surgeons was “not ideal.”

The timing isn’t ideal either, as the center faces its routine certification review by the American College of Surgeons in June. Certification is required for UCI to operate as a trauma center.

“No. 1, we are totally committed to trauma [care] here,” Laret said. “We are the only level-one center; we are the largest in Orange County. We will maintain our position here. We also stand for quality of care in the service we deliver here.”

Dr. Samuel Wilson, chairman of UCI’s surgery department, said the university has a plan in place to deal with the vacancies and the upcoming review. The departing physicians will be replaced by this summer with three recent graduates of residency programs, all of them trained in trauma care.

“These are surgeons who are extremely expert at what they do,” Wilson said.

Wilson, a vascular surgeon who said he also is experienced in trauma, will direct the trauma center for at least a year.

The county’s Emergency Medical Services division--which makes the ultimate decision on certifications based on findings by the College of Surgeons--has met with university officials to discuss the review and the turnover. The discussions began soon after Waxman left, said Dr. Bruce Haynes, medical director of the division.

“I think [the turnover] is a legitimate cause for concern,” Haynes said. “I don’t think they have the same kind of depth that they had before. But they have committed to us that they are going to redevelop that depth.”

UCI may face “some difficulties” during its review, Haynes said, but he does not anticipate it will fail. “It’s in nobody’s interest to close it down, when they are seeing 1,500 patients are year,” he said.

Haynes said he could not comment specifically on UCI’s plan to hire recent graduates of residency programs as full-time staff in the trauma center. In general, however, he said “one would expect that at a university teaching institution they would have people with a broad range of experience, a depth of experience.”

He maintained that UCI’s trauma center is staffed with fully qualified surgeons. No special credentials are required for trauma care, although some surgeons do obtain certification in critical care. All three of the doctors who left UCI had that certification, for example.

“They’ve been filling in with fully qualified surgeons but people who don’t always have the same recent experience that the surgeons who left have,” Haynes said. “They’ve made great effort to have these people take recent classes and [get] education . . . to get the facility up to speed. We don’t think there are any patient care problems right now.”

A recent list of physicians on call includes trauma specialists at Western Medical Center, cancer and thoracic surgeons.

“The way Dr. Wilson is covering the department, the bases are covered,” said 19-year general surgeon Dr. Elliott Brender of Garden Grove. “Any general surgeon who is taking emergency back-up call . . . around Orange County sees trauma.”

Both Waxman and Scannell said trauma requires specialized experience and focused commitment, pointing out that the American College of Surgeons recommends trauma surgeons treat at least 50 patients a year.

Scannell attributed many problems at the trauma center to Wilson, who she said had little actual trauma experience but “pushed all three of us [experienced physicians] out.” Waxman declined to discuss Wilson, other than to say the doctor had tried to relax existing policy so that under-experienced physicians could cover trauma call. He succeeded after Waxman left, Waxman said.

Scannell questioned Wilson’s qualifications to head the program, saying she believed he had not cared for trauma patients at UCI since arriving about four years ago. A source familiar with Wilson’s career at Harbor-UCLA Medical Center, where he worked for about 10 years, also said Wilson was “not involved in day-to-day care of trauma patients there or in the management of [the] trauma [center].”

Wilson said his experience at Harbor indeed prepared him for his position as director of trauma. “Trauma is a very important part of general surgical training,” he said. “I served 10 years as chief of surgery at one of the busiest trauma hospitals in the country and one of the most recognized hospitals in the country.”

Wilson declined to address Scannell’s allegations that he tried to push the full-time trauma surgeons out, saying such turnover is typical.

The new trauma director said he plans to do more than maintain UCI’s good reputation--he vowed to make it better by adding to its clinical and basic research programs.

“As a university, we have the obligation to contribute to making advances in trauma care,” he said. “I want to make [this] a nationally recognized center.

Some outsiders say UCI was making strides in that direction under Waxman--but that now the university’s leadership in the county and its stature as a major player is in jeopardy.

“I would like to know why the chairman of the department of surgery would disassemble a program that was already actually pursuing research in trauma,” said Dr. Tom Shaver, director of trauma at Mission Hospital Regional Medical Center. “Why did he do that?”

Shaver said UCI, as the county’s lone level-one trauma center, is supposed to lead the community not just in research, but in community and resident education and in clinical care.

”. . . After losing [all three experienced physicians] who have committed their professional lives to trauma care, who else do they have with experience and training?” Shaver said. “What do they have left? The top trauma people, the dedicated people, are gone.”