A recent report by a coalition of trauma experts said the dwindling number of high-level trauma care units is reaching crisis proportions in California.
The report follows just days after Palomar Medical Center in Escondido, one of five adult trauma centers in San Diego County, said it may have to pull out of the trauma network unless it receives an infusion of state funds.
Last year, the Palomar Pomerado Health System lost $9.3 million in its operations budget and saw its credit rating downgraded.
Dr. Tom Velky, medical director at Palomar’s trauma unit, said there aren’t any other programs that can subsidize trauma care.
He said one major problem is that reimbursements from health plans, HMOs and government programs aren’t high enough to cover the costs of trauma treatment.
And some insurers refuse or delay payment, saying the center is outside the health plan’s network, according to the report.
Other problems include the high number of uninsured people who don’t pay for trauma care, and the high cost of staffing.
Each trauma unit is required by law to have a number of specialty doctors readily available.
Palomar’s trauma unit has at least four specialists on staff: A trauma surgeon, neurosurgeon, orthopedic surgeon and an anesthesiologist, Velky said.
Other specialty doctors are on call, he said.
The district pays certain specialists as much as $1,300 a day to be on call, regardless of whether they provide care, said Gerald Bracht, administrator at the Palomar Medical Center. It’s the trauma center’s biggest expenditure, he said.
Exacerbating the problem is the shortage of specialists in California. Some specialty doctors don’t want to be on call because they don’t get reimbursed enough, according to the report.
At Scripps Memorial Hospital’s trauma center, doctors frequently provide care for which they aren’t paid, said Dr. Brent Eastman, medical director of the La Jolla facility.
Studying Fair Pay
He added the problem has gotten to the point where Scripps initiated a study to find a payment solution that is “fair to physicians and affordable to the hospital.”
Velky said at Palomar, specialty doctors are paid “below the going rate.” He did not elaborate on what the going rate is.
Cutting back on staff to save money is not an option, he said. It’s also against the law.
Velky applauded the district for “aggressively renegotiating managed-care contracts” to get better compensation.
But without additional funding, Palomar’s financial struggle will not end.
Palomar’s unit is pivotal, because it serves a large and remote area, stretching to Palomar Mountain and the Anza-Borrego desert to the north and east.
If Palomar pulls out, Scripps Memorial in La Jolla and Sharp Memorial Hospital in Kearny Mesa would pick up most of the slack, Eastman and Velky said.
Palomar’s trauma center cares for some 1,200 patients every year, Velky said. About 12 percent of these patients are uninsured; 78 percent have some type of insurance, he said.
That compares to about 1,400 trauma patients seen at Scripps La Jolla every year, Eastman said. The majority of patients, or 80 percent, are victims of serious car accidents, he said.
Most people have traumatic injuries as a result of car accidents, construction accidents, falls, gunshot wounds or violent acts.
Most of them are under the age of 40 and thus, fall into the working poor adult category.
A third of all trauma victims that come to Scripps La Jolla can’t pay for treatment, Eastman said. The hospital needs to absorb the loss, and trauma care is the costliest of all care.
Losses On The Books
In the fiscal year ended Sept. 30, Scripps had $37 million in operating costs for both of its trauma units, a Scripps spokeswoman said.
Scripps Mercy Hospital in Hillcrest had a $2.9 million loss to provide emergency services in the fiscal 1999, according to published reports. That translates to an average loss of $64.45 per patient visit, it said.
“In general, emergency care is a losing proposition,” Eastman said, but added it’s critical.
In 1983, one year before San Diego’s trauma system was created, critically ill patients died from preventable deaths because they were mixed with emergency room patients, he said.
Since 1984, the preventable death rate in the county has dropped from 1 percent or 2 percent to zero, he said.
Gary Stephany, president and CEO of the Healthcare Association of San Diego and Imperial Counties, said legislation to improve trauma care is on the way, but may not come soon enough. He called on the state to boost funding.
