A Model Expires : Running a Nationally Known Trauma Center Loses Its Appeal to Hospital Administrators

The tours used to come through at least once a month.

From San Diego, Los Angeles, even Dade County, Fla., doctors and health officials would trek to a small hospital beside the lima bean fields in suburban Fountain Valley.

They would watch as paramedics rushed a gravely injured traffic victim into a trauma room, where medical specialists would spring into action.

Saving “the near-dead,” one doctor called it. And the visitors would marvel at the work and vow to open a center like this back home.

Fountain Valley Community Hospital was a pioneer, joining in 1980 with four other Orange County hospitals to start one of the first trauma center systems in the nation.

Again and again, according to medical studies, prompt care at specially staffed centers such as Fountain Valley’s has saved people who would have died in a traditional emergency room.

These days, although the life-saving technology is as effective as ever, the luster of a trauma center has worn off.

Citing crippling expenses, 10 hospitals in Los Angeles County and two in Orange County have closed their trauma centers over the last six years. On Aug. 29, Fountain Valley officials said they would close theirs too. They plan to have their hospital out of the emergency network by the end of the year.

Fountain Valley, like other hospitals that have quit, cited heavy losses--as much as $1 million a year--from treating uninsured patients, as well as an inability to keep a neurosurgeon on the staff. Having a neurosurgeon on call 24 hours a day is one of the state requirements for a top-level trauma center.

Also, they said, some of center’s more undesirable patients--heroin addicts, armed robbery suspects who have been shot by police--have been scaring away some of the patients who do have private insurance.

“One side of the community would say, ‘You’re doing a great job saving lives,’ but others would complain . . . ‘you got this bandit who got shot and they’re in the room with me and I’m never coming back,’ ” said Dr. Malcolm J. Sperling, chairman of the partnership of doctors that owns the hospital.

Ironically, it is the national reputation of the trauma center, medical officials inside and outside the hospital say, that helped build Fountain Valley into a major medical center. Not only were talented doctors and nurses lured there, but the center and the desperately ill patients who came there prompted hospital officials to upgrade the entire hospital.

“It really converted a . . . community hospital to a major tertiary medical facility,” said Dr. William Thompson, former trauma director at Fountain Valley who is now chief of surgery at Humana Hospital-Huntington Beach.

Some observers also say that publicity from the trauma center helped Fountain Valley to make a lot of money. Sperling disputes that, saying the hospital was expanding anyway and that the trauma center was a money-loser all along.

Still, the hospital did grow rapidly after the trauma center opened. The hospital began as a 99-bed for-profit hospital in 1971. By 1980, when the trauma center opened, it had 214 beds.

One of Largest in County

Several years after the center opened, the hospital had added medical office buildings, a new wing and a neonatal unit, and had changed its name to one befitting a hospital with a broader mission--Fountain Valley Regional Hospital and Medical Center. It is now one of the county’s larger hospitals, with 287 beds, 630 doctors on the staff and more than 1,300 employees.

Emergency Department Director Dr. Peter Anderson agrees that adding the trauma center “forced the hospital to grow.” In the early ‘80s, he said, being designated a center meant “we were a hospital on the move.”

But times have changed. Now Fountain Valley administrators see the term trauma center as a synonym for debt.

Now, Anderson said, the issue is “not which hospital is on the move; it’s which will continue to keep their doors open. . . . Probably we’ll do much better without the trauma center.”

The closing of a trauma center has become a familiar story in Southern California.

The Los Angeles County trauma system, begun in 1983 with 23 hospitals--some of which sued to be included in the prestigious network--now has only 13.

And when they quit, “they cut their losses immediately,” each saving “well over a million dollars” a year in physician and licensing fees, said David Langness, vice president of the Hospital Council of Southern California.

Fountain Valley is the third hospital in Orange County to drop out of the trauma network.

Orange County’s model system, begun in June, 1980, after two years of planning and public debate, initially included five hospitals: one in the northern part of the county (Anaheim Memorial Hospital), one in the south (Mission Hospital in Mission Viejo) and three in the central area (Western Medical Center-Santa Ana, UCI Medical Center in Orange and Fountain Valley).

The withdrawals began in 1983 with Anaheim Memorial, which cited high costs and too few patients. Its replacement, St. Jude Hospital in Fullerton, lasted about six months before it, too, pulled out. And in leaving, St. Jude cited some of the problems that Fountain Valley now complains of: difficulty in keeping a neurosurgeon on call 24 hours a day and unpaid patient bills.

Orange County’s trauma network continued with only four hospitals, and it went from treating several hundred patients a year to several thousand this year.

Citing that history, some trauma experts argue that when Fountain Valley quits, the 1,000 patients a year that the Fountain Valley center is treating will simply be absorbed by the remaining centers. Or, they said, there will be another hospital to take its place.

“We used to have five. No one complained when we went down to four. We don’t see any major problem,” said Dr. Robert Bade, medical director of Orange County Emergency Medical Services, which oversees trauma centers, about the number of centers in the network.

Other experts, however, warn that Fountain Valley’s departure will leave a gaping hole in the trauma network. Trauma victims in northwest Orange County will have to wait longer and travel farther for care, they said, and some may die as a result.

The average county resident does not care about a trauma center’s closing, said Larry K. Ainsworth, executive vice president of Hoag Hospital in Newport Beach, but “when they realize that their chances of survival on the freeway have significantly diminished--that they’re playing Russian roulette--then they’ll realize” that a lifesaving system is gone.

From the beginning, Fountain Valley surgeon Sperling said, the trauma center was a risky venture--but the 35 doctors who started the hospital were used to taking chances.

Fed up with the management at one medical center and shut out of the old-boy networks at two others, Sperling said, the founders ignored derogatory remarks such as “doctors shouldn’t run hospitals” and raised $2 million to start Fountain Valley.

The new hospital was not, to be sure, a big-name facility like Hoag or St. Joseph Hospital in Orange.

“But we practice big-name medicine here,” Sperling says now.

In keeping with that goal, Fountain Valley’s owners jumped at the opportunity to open one of the nation’s first trauma centers. Reportedly, when the idea was broached, members of the board of directors responded that they never heard of such a thing. But they liked the idea, Sperling said. “We decided this was high tech--something we wanted for ourselves.”

And, of course, right away it was expensive--$20,000 to Orange County for a special survey of the hospital, $500,000 to build a trauma room, more money to staff the new center in a manner unheard of in hospitals back then, with anesthesiologists on duty 24 hours a day.

And early on, there were problems. “At the beginning, we weren’t losing that much. We felt the publicity” about trauma care “was worth the small losses,” Sperling said.

But that was not all, Sperling said. Trauma patients were taking up beds that Fountain Valley’s private patients could have used. “These patients all go into ICU (the intensive care unit) of course. They fill up our ICU. And they may not be paying a penny--and here’s our private patients whom we can’t really accommodate.”

Trauma surgeries also were tying up the operating room, angering both doctors and their private patients who might have surgery scheduled but were “bumped,” Sperling said.

In addition, some of the “rough” people who have been treated at the trauma center--gang members, people suspected of homicides--have frightened both the paying patients and the staff, Sperling and others said. They also said the people who visit these patients can be disturbing, sometimes arriving in groups of eight or nine at a time and often walking through the halls being boisterous and using offensive language.

Effect on Practices

Further, Sperling and Anderson said, Fountain Valley’s doctors have become increasingly annoyed as the demands of trauma care have hurt their private practices.

To cite an example of this complaint, Anderson told of the experience of a specialist who is on call for the trauma center. At 2 p.m. on a weekday, his office full of patients, he received a call from the trauma center. “His receptionist has to face all these patients and tell them: ‘I’m sorry, he may or may not come back.’ ” One patient reacted to such news recently by telling the receptionist, “ ‘Don’t sign me up for another appointment,’ ” Anderson said.

Finally, Sperling said, “the thing that propelled” the closure was that too many doctors were refusing to work on call for the trauma center. Besides the inability to retain a neurosurgeon, Sperling said, the hospital has found that plastic surgeons and infectious disease specialists do not want to see trauma victims because too many of those patients cannot pay.

Staff members of the hospital have greeted the decision to close the center with a mixture of sadness and relief, but hospital administrators say that its closing will enable the hospital to focus on other areas--cardiology, laser surgeries, oncology, obstetrics. The hospital just finished several new $750,000 labor-delivery-recovery suites and it is building a four-story, $18-million medical office building that will include a “cancer center” on one floor.

Speaking as a general surgeon who has had his operations “bumped” by trauma center patients, Sperling said the hospital will be a more attractive place to work without it.

But while it may be good for doctors and patients at Fountain Valley to close the center, Sperling conceded that it will be “lousy for the community . . . . I think (the trauma network) will fall apart, and I think people are going to die, and that’s the part I don’t like.”