Supervisors Look Into Shrinking of Trauma Net

Alarmed at the growing gaps in its highly touted trauma center network, the Los Angeles County Board of Supervisors on Tuesday ordered hearings into the reasons behind Daniel Freeman Memorial Hospital’s announced intention to pull out of the emergency-care program.

The hearings, set for April 28, followed warnings from one hospital industry official that unless the county acts quickly, Daniel Freeman will not be the last hospital to withdraw from the trauma center program.

Daniel Freeman officials said Monday that the Inglewood hospital, now operating the third-busiest trauma facility, will close its trauma center effective June 15, citing economic losses, including a $2-million shortfall in 1986.

Indigent Patients Blamed

The hospital blames the losses on the large number of indigent trauma patients treated at Daniel Freeman under the county system. Hospital officials contend that government reimbursement programs for treating indigent trauma patients, including Medi-Cal, fail to cover actual costs.

Daniel Freeman’s withdrawal will make it the fourth hospital in the county’s trauma care network to abandon the program since it was inaugurated in December, 1983, and the second in less than two months. The program is designed to treat the most seriously injured patients--such as those involved in major traffic accidents or shootings--at a trauma center within a 20-minute ambulance drive of the incident.

Two of the original 23 trauma care hospitals, Pomona Valley Community Hospital and California Hospital Medical Center in downtown Los Angeles, dropped out within the first 14 months. Hollywood Presbyterian Medical Center, citing economic losses similar to those mentioned by Daniel Freeman, withdrew from the trauma treatment program Feb. 23.

Once Daniel Freeman’s trauma facility closes, the 19 remaining in the county-sponsored system would presumably be expected to accept those patients that would have gone to the Inglewood hospital. Such a scenario has officials at other hard-pressed member hospitals worried that they will be next to face the question of whether to remain as part of the network.

The hospitals most affected will be Martin Luther King Jr. Medical Center, Harbor-UCLA Medical Center, UCLA Medical Center and Cedars-Sinai Medical Center.

Attorney James Ludlam, representing the Hospital Council of Southern California, told the supervisors that more money must flow into the trauma care system from state and federal sources if the program is to avoid collapse.

‘Deeply Concerned’

“We are deeply concerned because if there isn’t immediate action on this, you’re going to lose some very critical hospitals in this program,” Ludlam said.

Asked later to elaborate, Ludlam said he was not at liberty to disclose which of the remaining 19 hospitals might follow Daniel Freeman. But he said, “We know that several others have (closure) under serious consideration. The cost has moved up very rapidly during the last 12 months because of the character of the patients that the hospitals are getting and the fact they can’t transfer to the county (hospital).”

Ludlam said that not only are many of the trauma patients without money, once they are stabilized at a private hospital’s trauma center and well enough to be transfered to a county-run hospital, there are no beds available for them. Since care for trauma patients is among the most expensive, the lack of county beds “is forcing hospitals to the breaking point,” Ludlam asserted.

Planned Fee Boost Hit

Ludlam also complained that Los Angeles County is proposing a boost from $15,000 to up to $40,000 in the annual administrative fee that trauma network member hospitals must pay. Such a boost may further discourage hospitals from remaining in the program.

Supervisor Ed Edelman, who proposed the trauma center hearings, said officials from Presbyterian Intercommunity Hospital in Whittier have called for a relaxation of the requirement that an anesthesiologist be on the hospital premises at all times. Hospital officials, also noting that 75% of the trauma patients have alcohol-related injuries, suggested that taxes on alcohol be raised to help finance the trauma network program.