L.A. to Get Downtown Trauma Center

Sun Nov 28 19:08:24 PST 2004

Source: By Jia-Rui Chong, Los Angeles Times
Date: November 11, 2004

California Hospital Medical Center in downtown Los Angeles announced Wednesday that it
would open the county's first new trauma center in more than a decade, a critical step in
the effort to shut down the trauma unit at Martin Luther King Jr./Drew Medical Center.

Under an agreement worked out with Los Angeles County officials, the new trauma center
would pick up two-thirds of the 1,800 most severely injured patients, such as people hurt
in traffic accidents or wounded by gunshots, whom King/Drew would normally treat in a
year. 

California Hospital officials have been discussing opening a trauma center for several
years but were worried about the expense. The high cost of running such units has led to
the closure of 10 in the county in the last two decades.

To overcome those concerns, California Hospital negotiated an agreement under which it
would receive about $2.9 million through June from the county to help cover the costs of
treating uninsured patients, officials said. The county's agreements with all trauma
centers will be renegotiated after June.

The announcement comes five days before a public hearing at which the county Board of
Supervisors could vote to shut down the King/Drew trauma center. County officials say the
closure would help them keep the rest of the troubled hospital open, but many South Los
Angeles community groups and elected officials fear that it would reduce medical services
in one of the county's poorest areas.

The deal with California Hospital still requires the Board of Supervisors' approval,
which could come Tuesday. 

County Department of Health Services spokesman John Wallace said he could not say whether
the cost to taxpayers of caring for trauma patients at California Hospital would be
greater or less than at King/Drew's unit.

King/Drew has already greatly reduced the number of patients it accepts at the trauma
center by frequently closing it to ambulances in recent weeks.

Typically, officials close the King/Drew unit to ambulance calls about 4% of the time —
usually because trauma bays are full. But since Oct. 16, the unit has been closed 81% of
the time, according to figures provided by Carol Meyer, director of the county's
Emergency Medical Services Agency. From Oct. 24 to Oct. 28, the trauma center accepted
patients brought by ambulances for only five hours total. 

By contrast, the county's two other trauma centers — at County-USC and Harbor-UCLA
medical centers — generally divert ambulance calls 1% or less of the time, Meyer said. 

Dr. Thomas Garthwaite, the county's director of health services, said the recent
diversions from King/Drew have been primarily because there were not enough nurses in the
hospital's intensive care unit to handle patients once they were stabilized.

"If we get a series of ill patients and a combination of trauma plus medical illness,
that just overwhelms the ability of nurses to safely manage those patients," he said,
adding that hospital administrators, not he, decide when ambulances will be diverted. "I
think we're increasingly appreciative of how overwhelming it can be for the nursing staff
too."

Nursing shortages are among the numerous problems plaguing King/Drew, the county-run
hospital in Willowbrook, just south of Watts. In the last year, the hospital has had a
series of lapses in patient care, including several that contributed to deaths, according
to regulators. Last month, the county confirmed that a 28-year-old patient died after a
nurse turned down the audio alarm on his vital-signs monitor, then failed to notice that
his heart was barely beating.

County officials say they want to close the trauma unit to let managers at King/Drew
focus on correcting problems in the rest of the hospital. The county recently hired an
outside consulting firm that has taken over day-to-day management of King/Drew, including
evaluating the performance of doctors and nurses.

California Hospital's decision to open a trauma unit is considered a crucial boost to the
county's plans, because it would partially fill the gap caused by the closure at
King/Drew.

The hospital on the southern edge of downtown, just north of the Santa Monica Freeway, is
about 10 miles north of King/Drew. Of the two others hospitals expected to take most of
the other trauma patients who would have gone to King/Drew, St. Francis Medical Center in
Lynwood is two miles east and Harbor-UCLA is 10 miles southwest.

Meyer of Emergency Medical Services hailed California Hospital's decision as an important
step in fixing the county's struggling trauma care system. There are now 13 trauma
centers countywide, down from 23 in the 1980s.

Most of the centers closed because of the heavy financial burden of handling uninsured
patients. In July, the county came close to an agreement with California Hospital, but
negotiations fell apart at the last minute over whether the center would be financially
viable.
Wallace said the county's pact with the downtown facility offers several safeguards
designed to make sure the hospital is adequately compensated for taking patients who
cannot pay. 

The county will pay the same rate for indigent trauma patients as it pays all other
private hospitals — about $21,000 for a seven-day stay. The county estimates that about
50% of California Hospital's trauma patients will lack health insurance and that about
80% of those will qualify for county reimbursement.

Initially California Hospital will be eligible for extra benefits that existing trauma
centers don't receive, Wallace said. The county wants to make sure the hospital can cover
the costs of medical services that patients need once they get out of the trauma center.

To help deal with those expenses through June, the county's five other public hospitals
will accept 10 transfers a month from California Hospital's trauma center if they have
room. In instances when they do not, California Hospital will keep the patient and
receive compensation from a pool of $420,000 set aside by the county. 

Much of the county money the hospital receives will be from the proceeds of Measure B, a
property tax assessment approved by voters in 2002 to benefit trauma care. California
Hospital's will be the first trauma center to open since Measure B passed.

A spokeswoman for California Hospital declined to comment on specifics of the deal but
said she believed the new center would be operating by Dec. 1.

"We're very excited," said spokeswoman Katreena Salgado. "We're ready. We've been ready
for a while."

County Supervisor Zev Yaroslavsky hailed the deal as a turning point.

"This year has been generally a horrible year for the county health system," he said.
"This is one of the first pieces of good news that we've had."

"This is something I was hoping would occur when we put Measure B on the ballot,"
Yaroslavsky said. "We hoped it would not only stabilize the EMS system in the county and
maintain the trauma net, but perhaps we would be able to see" the trauma system's
problems reversed.

The public hearing on the proposed closure of King/Drew's trauma unit, scheduled for
Monday at 3 p.m. at King/Drew Magnet High School, is expected to draw a large crowd.

Critics of the closure plan have accused the Board of Supervisors and top health
officials of turning their backs on residents.

They fear that critically ill people will have to travel farther for care. 

"Sweet" Alice Harris, 70, a longtime Watts activist, said opening a trauma center at
California Hospital would do little to ease her concerns because the facility is not in
South Los Angeles. 

"That was the purpose of Measure B, that we would have a trauma center in this area,"
said Harris, adding that it took her 30 minutes to get from her home to California
Hospital when visiting a sick friend. "Why would we let taxes go up for California
Hospital, as poor as we are? That's not fair."

Some community leaders have charged that the county is purposely trying to weaken the
King/Drew trauma center by diverting ambulances before the supervisors vote, a charge
Garthwaite strongly denied. 

"We're temporarily off line until we can have enough room here," he said. "We're not
closing down and putting plywood on the windows."

Two King/Drew trauma doctors said they had been surprised by the diversions because the
trauma center itself had not been busy, although it has continued to accept trauma
patients who arrive by means other than ambulances.

"I've never seen it like this before. It's pretty empty," said Dr. Bryan Hubbard, a
general surgeon in the trauma department who opposes the county's closure plan. 

"We've been closed," added Dr. Jonathan Heard, who said there had been no trauma patients
the last three times he had been on call, when usually there are up to five. "That's
basically because there's nowhere to move the patients" once they leave the trauma
center.

=====
Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service 
UC-Irvine

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