Study Says Much of State Lacks Trauma Centers

Nearly all of the Central Valley and huge swaths of Northern California lack ready access to high-level trauma care, a new report shows.

And the 42 centers that do exist maintain records so flawed that advocates cannot determine how much money it would take to keep the patchwork trauma system operating, according to the report by a coalition of trauma experts.

The state’s trauma network was much larger before years of managed care and low government payments pushed dozens of hospitals and hundreds of doctors out of the system. It is now so depleted that a victim of a serious car accident traveling the 311 miles from Santa Clarita to San Jose would have a reasonable chance of survival only if the wreck occurred within an hour of Fresno--where the region’s only trauma center is located.

Likewise, a hiker who fell off a cliff in Yosemite or a skier who was critically hurt at Lake Tahoe would probably be taken to nearby community hospitals, whose emergency rooms are not equipped to handle the most severe injuries, trauma experts say.

The problem has been compounded by the failure of dozens of counties in California to develop comprehensive plans for dealing with people who have traumatic injuries, according to the report, funded by the U.S. Centers for Disease Control and Prevention and led by the Sierra-Sacramento Valley Emergency Medical Services Agency. There is also no statewide plan for providing trauma care.

Trauma plans allow paramedics to coordinate care for accident victims and others through a regional hospital that is equipped to handle severe injuries. Emergency workers contact the trauma center while at the scene of an accident, describe a victim’s symptoms and are told whether to proceed immediately to the high-level center or to go to a nearby facility.

By contrast, when there is no such system, patients are routinely taken to the nearest hospital, where there often are no experts in traumatic injuries.

“If you’re not in an area where there’s a trauma plan, your chances of survival are nearly nil,” said Leonard Inch, regional executive director of the Sierra-Sacramento Valley emergency agency, which coordinates the trauma plan for a five-county area around Sacramento. “A lot of deaths are preventable.”

The already shaky network could become even less stable if hospitals continue to drop their emergency rooms and trauma centers. In Los Angeles County, where the number of trauma centers has dwindled to 13 from a high of 24 two decades ago, several centers threatened last summer to pull out of the trauma network unless they were better compensated. The county came up with temporary funding to stave off the crisis, at least until this summer.

A huge part of the problem is money: A third of the people who are treated in trauma centers don’t pay for their treatment. Many fail to pay because they lack coverage, but others do so because their insurance companies or HMOs have refused or delayed reimbursement, frequently claiming that the trauma center is outside the health plan’s network.

But even if health plans and HMOs paid more, it is likely that other sources of funding--probably state and local government--would be needed.

And that leads to another problem, says Inch of the Sierra-Sacramento trauma system: Not one of the hospitals with trauma centers surveyed was willing or able--because of what Inch called poor management--to determine how much it costs to treat injured patients.

He said none had estimates of the number of lives that had been lost because it took too long for injured people to arrive. So there’s no way to tell how much money it would take to fix the system--or how many lives could be saved.

“If we’re looking at public moneys to prop up or support trauma systems, we have to know the cost of doing business,” Inch said. “I can’t think of any other business that wouldn’t be able to look at cost information.”

In Sacramento, where advocates of improved emergency services complain that there is little interest in mandating--or paying for--a solution, a few legislators are struggling to ease the crunch.

“Trauma care is sort of like energy: You don’t think about it until the lights go off,” said Assembly Health Committee Chairwoman Helen Thomson (D-Davis), who will hold a hearing Feb. 13 on the issue.

State Sen. Jackie Speier (D-Hillsborough) on Tuesday introduced a bill meant to encourage more doctors and hospitals to stay in the trauma system. The bill, which is also designed to beef up the level of care available at routine emergency rooms, would require health plans to pay for emergency care directly at whatever hospital to which a member is taken after a serious injury.

The bill would outlaw the current practice of using middlemen--typically physicians groups that are contracted by a single hospital--to cover emergency care. Many of these groups are experiencing severe financial problems and, doctors complain, often delay or deny payment.

Another measure pushed by advocates for improved trauma care would institute a coordinated plan statewide.

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Trauma Center Shortage

The state’s trauma centers -- those few hospital emergency rooms equipped to handle the most severely injured people -- have been dwindling for years. This map shows the 42 high- level trauma facilities remaining in California.

Source: Sierra-Sacramento Valley Emergency Medical Services Agency