County in Talks for New Trauma Center

County health officials are in delicate talks aimed at opening the first trauma center in nearly a decade, a move that is pivotal in the effort to close the trauma unit at Martin Luther King Jr./Drew Medical Center.

The proposed trauma center, at California Hospital Medical Center in downtown Los Angeles, would serve 1,000 of King/Drew’s estimated 1,800 trauma patients in the coming year -- more than any other neighboring hospital.

Creating the unit would mark a rare reversal after decades of trauma centers and emergency rooms closing because of financial problems.

Since the 1980s, 10 trauma centers have shut down, leaving the county with only 13 to handle the most serious emergency situations like gunshot wounds and car accidents. During the same period, 18 emergency rooms have closed, the latest being Northridge Hospital Medical Center’s Sherman Way campus on Monday. Emergency rooms handle less urgent medical cases, such as chest pains and cuts.

California Hospital, a cluster of red tile buildings just north of Grand Avenue and Venice Boulevard, would be an attractive location for a trauma center because it is near the Harbor and Santa Monica freeways.

The hospital’s history with trauma care, however, offers a sobering look at the struggles to pay for emergency care, which often goes to the uninsured.

California Hospital Medical Center was part of the first network of trauma providers in Los Angeles in 1984. It was the first to pull out in December of that year, citing major financial losses because most of the patients didn’t have insurance.

Earlier this year, the hospital was about to sign a contract with the county to care for 660 trauma cases a year for up to $1.6 million. But after complications ensued, the item was pulled from the county Board of Supervisors’ July 13 agenda. County health officials worried whether the hospital would have enough doctors to cover calls. And California Hospital officials said they worried the number of patients was too small to compensate for the costs of running a trauma center.

Joining the trauma system requires a deep financial commitment. A trauma hospital must be able to tap a general surgeon immediately, 24 hours a day, and bring in a host of other surgeons, including neurological and vascular, within 30 minutes. They also require specially trained nurses and a helipad.

California Hospital lost $12.3 million in the 2002-03 fiscal year, including more than $2 million from patients unable to pay, according to state data.

The hospital has declined to answer numerous requests for details of finances and would not discuss its decision-making process, citing a desire not to upset negotiations with the county. But spokeswoman Katreena Salgado did say the hospital intended to announce a decision by early December.

The hospital’s emergency room in particular has been struggling because of a rise in the number of uninsured patients. It also has treated severely injured patients even though emergency rooms are intended for less urgent injuries, Salgado said.

Many patients arrive at the emergency room in bad shape because they are dropped off in “homeboy ambulances,” she said. The term refers to the common practice among gang members of driving wounded friends directly to hospitals instead of getting an ambulance.

As a result, Salgado said, “We tend to get the gray area between trauma and ER already.”

Hospitals must care for all who arrive at their emergency rooms but often receive no payment from uninsured patients, said Jim Lott, a spokesman for the Hospital Assn. of Southern California. A typical trauma patient costs about $18,000 to treat, he said. In the past, the association has placed the average at $250,000 per patient. Lott said the higher figure is for the most severe cases.

One benefit of joining the county’s trauma network is that the county would reimburse about 75% of a hospital’s cost if the patient is classified as a trauma patient, he said. Private insurers, Medi-Cal and Medicare also would pay the hospital at a higher rate for trauma patients.

Still, Lott said the county reimbursement cannot offset the general fiscal losses of running an emergency room. And a hospital like California would also have to pay out of its own pocket to set up a trauma center.

To turn a basic emergency department into trauma center can cost as much as $4.5 million, said Glenn Melnick, a USC professor of healthcare economics. But if California Hospital is already equipped for some services that a trauma center provides, he said, the start-up cost may go down to about $2 million.

“My experience with that hospital is those people are pretty careful about their finances,” he said. “I suspect that they’ve done the analysis and [a trauma center] will generate enough revenue from patients that have insurance, plus enough revenue from trauma subsidy to make a go of it.”

County officials announced last month their intention to close King/Drew’s trauma unit before securing a plan to redistribute the 1,800 trauma patients that are treated there annually.

Other hospitals nearby, including St. Francis Medical Center in Lynwood and Harbor-UCLA Medical Center near Torrance, have said they could pick up some of the slack but they needed additional resources.

County officials believe that closing the King/Drew trauma unit is the only way to save the rest of the hospital. Shutting down such a complex unit at King/Drew, they say, will allow healthcare officials to reallocate resources to other crucial hospital functions and to reorganize the institution.

Troubled for decades, King/Drew has been reeling in the last year from a series of lapses in patient care, including several that contributed to patient deaths, according to regulators. Adding to the problems, accreditors have ordered the private university that trains doctors at King/Drew to close three of its programs, including surgery. Under the plan, King/Drew’s emergency room would remain open.

But the trauma center at King/Drew -- located in Willowbrook, just south of Watts -- is highly regarded by many in the surrounding community, which includes some of Los Angeles’ most violence-plagued police divisions. Many local activists and politicians worry that the added time to transport gunshot or stabbing victims to the next closest facility could lead to deaths.

County health officials have said that California Hospital is their first choice to pick up King/Drew’s former trauma patients, partly because of its location at the southern end of downtown. But Carol Meyer, who heads the county’s emergency services agency, says some King/Drew patients would have to travel farther north. “If we could select exactly where we want a trauma center to go, it wouldn’t be California at the corner of Grand” and Venice, Meyer said. A better location, she said, would be several miles south.

Catholic Healthcare West, which owns California Hospital Medical Center, already runs one of the county’s private trauma hospitals, St. Mary Medical Center in Long Beach. But Meyer said she had some worries about how many patients California Hospital could absorb and the stability of its emergency room. When the county and the hospital were negotiating earlier this year, California medical center wanted to take 1,000 patients a year, she said. The county wanted it to take about 300 fewer.

“They wanted to jump in the mix with a very large volume,” Meyer said. “We told California as it went on, we’d very likely add patients. We didn’t want them to get bombarded and end up dropping out because they couldn’t handle it.”

But now that King/Drew looks as if it might close down, Meyer said, the game has changed and the county has a greater need for California to take more patients.

“We’re waiting to hear from them,” she said.

County Health Director Thomas Garthwaite said California Hospital’s trauma center was important to the county’s plans with King/Drew. But even if California doesn’t join, he still believes the King/Drew trauma unit should be closed.

“It will put more stress if California doesn’t come on,” said Garthwaite. “We have to save [King/Drew] regardless of whether California comes on or not.”