Pull Together on Trauma Centers

The 13 private and public hospitals that serve as trauma centers in Los Angeles County--meaning they maintain 24-hour teams of specialists for handling the most difficult medical emergencies--say they can’t continue to care for ever-increasing numbers of uninsured patients. Some centers have threatened to close, and the county could ill afford shutdowns of this sort.

Such was the glum image painted in an emotional public hearing Monday by surgeons, paramedics and even high-profile patients like entertainer Dick Clark, who was treated in a trauma care facility after an auto accident. Witnesses at the legislative hearing declared that “people are dying” because the county is not paying hospitals enough to care for uninsured and underinsured patients, from gunshot to home accident victims, who show up at the trauma centers.

Los Angeles County supervisors bear some blame for portraying the county as a victim of indifferent federal and state regulators. In fact, Gov. Gray Davis in last May’s budget boosted the Medi-Cal payments that the state gives Los Angeles to treat uninsured patients in emergency facilities, and the Clinton administration in June approved $900 million over five years to help the county reduce hospital expenses by encouraging outpatient clinics.

The supervisors addressed the immediate crisis Monday by agreeing to increase county payments to private trauma centers for the next two years. That will ease tensions that erupted between county supervisors and hospitals in June when the trauma centers rejected a long-term contract because of a dispute about county payments for indigents.

Davis could help by signing a bill just sent to his desk, AB 1455, by Assemblyman Jack Scott (D-Altadena), that would strengthen the penalties that state regulators can levy against private health plans that fail to pay county-based trauma emergency rooms for providing care. Second, he should consider using some of the state’s $590 million in unspent federal Healthy Families funding to extend health insurance to adults in working-poor families, which would reduce the numbers of uninsured people using the trauma centers.

Dr. Don Gaspard, medical director of trauma services at Pasadena’s Huntington Memorial Hospital, characterized the problem well, pointing out that the county thinks the state should pay, the state thinks the county should pay and both think the federal government should intercede. “It’s a three-ring circus,” he said.

It is tempting to declare a pox on all their houses. However, without a functioning trauma care network the county cannot fulfill its obligation under state law to act as health care provider of the last resort for indigents and to coordinate emergency health care for all. Politicians at all levels will have to dig harder for funds--and cooperation.