Yaroslavsky Issues Threat to the State Over Trauma Care

Supervisor Zev Yaroslavsky said Friday that if the state does not step in to fund Los Angeles County’s tottering trauma care system, he will place an initiative on the 2002 ballot to commandeer state money for local health needs.

Characterizing his proposal as a “grenade” left on the table, Yaroslavsky said the decision to go ahead with the effort “will be determined exclusively by whether we’ve received satisfaction from the governor and the Legislature on these issues.”

The threat, delivered at a packed news conference, is the latest step by county officials to get more funding for the 10 private hospitals in its trauma network, some of which have threatened to pull out if they are not paid more.

In the wake of news reports this week on the long-simmering crisis, supervisors are stepping up their efforts to preserve the network. On Tuesday they are scheduled to direct their staff to find a way to keep the system afloat for the next two years. But they say that only Sacramento can ensure the network’s long-term health.

Trauma centers are hospitals with round-the-clock surgeons and other medical staff specially trained and equipped to deal with severe injuries from freeway crashes, falls or gunshots. The network’s 10 nonprofit private hospitals and three county medical centers are the primary destination for seriously injured patients, whose lives would be at greater risk if they had to travel farther to another trauma center.

Five of the hospitals have sent the county letters saying they may have to close their trauma operations if the financial situation does not improve. Others are also at risk, health officials say. In a sign of the volatility of the situation, one of those that had told the county it might drop out, Providence Holy Cross Medical Center in Mission Hills, said Thursday that it had no plans to withdraw from the trauma network but said Friday that, without more money, it may eventually have to leave.

The state has cut the funds available to the trauma system in half this year alone. The money comes from tobacco tax dollars that were tapped in 1989 when the trauma system was last threatened with closure due to lack of funds.

In the ensuing years, that money has almost entirely dried up, dropping by 87% because fewer smokers has meant less tobacco tax revenue and the state has spent the dollars that remain on other projects .

“Now that they’re diminishing it,” said Virginia Hastings, head of the county’s Emergency Medical Services Agency, “we’re back in the same boat.”

But state officials say that, especially after receiving a $1-billion bailout of its health system in June that included state money, the county--with its $15-billion budget--has enough funds to take care of its trauma network.

“I’m cautiously optimistic, given the additional resources that are being put into the county, that they’ll be able to successfully resolve the additional stresses on their system,” said Glen Rossell, state undersecretary for health and human services.

This year the state diverted much of the tobacco tax money to programs to increase breast cancer screenings and access to health care for women and infants.

“Many of these are laudable programs, but in health care today, we have to make some very hard decisions,” said Mark Finucane, director of the county Department of Health Services. “Trauma care should be more of a priority.”

Yaroslavsky accused the state of making a “calculated decision” to leave counties to foot the bill despite a $13-billion surplus in Sacramento.

Under the terms of his initiative, which Yaroslavsky said is still being planned in consultation with health advocates and others, some of the hundreds of millions of dollars the state received from the nationwide settlement of lawsuits against the tobacco industry would be earmarked for funding local trauma services.

Yaroslavsky, who has successfully funded and passed three city and countywide initiatives in his career but never placed one on the state ballot, said that there would be other health care issues in the initiative too but that it was too early to identify them.

He said he will draw up and circulate the ballot language this fall, then start raising money and gathering signatures to qualify the measure for the ballot if the state does not step in.