Are patients dying while hospitals battle over profits?
January 28, 2010 6:45 am
First in a series: Profit share versus patient care on the Central Coast
By KAREN VELIE
While San Luis Obispo County hospitals are devoting major marketing dollars to the battle over who is in the best position to treat trauma cases, people with major life-threatening injuries may not be getting the critical care they need, when they need it.
In most cases, patients transported by ambulance in SLO County are routed to the nearest hospital emergency room. Currently that includes trauma patients, and CalCoastNews has learned that, at least in some cases, delivering these severely injured patients to the nearest hospital has resulted in delays of critical treatment of anywhere from 90 minutes to up to 19 hours.
Meanwhile, hospitals are squabbling over which facility should see trauma patients first, and at least one hospital CEO is lobbying against the designation of any hospital as a trauma center in SLO County.
A recent retroactive study that looked at the ultimate destination of trauma patients in SLO County over the course of one year concluded that all of those critically-injured patients seen at any SLO County hospital, who were subsequently transferred to another hospital in the county, were all taken to Sierra Vista Regional Medical Center for critical care.
The recent case of a rider on a motorized scooter illustrates the growing concern over trauma care, according to some hospital insiders.
Late last year, a 50-year-old man died as the result of head trauma he received in a scooter-versus-vehicle accident. The California Highway Patrol said the San Luis Obispo man, who had been drinking, ran a red light near Edna Valley Road south of the San Luis Obispo city limits and was hit by a truck. He later died from his head injuries after he was taken to French Hospital Medical Center in San Luis Obispo.
Some hospital personnel have told CalCoastNews that his chances of survival would have increased dramatically if he had been sent to Sierra Vista, because they have a neurosurgery department.
French does not.
“After a couple of hours of trying to help and stabilize him to transport to Sierra Vista, he died,” said a French Hospital nurse who asked to remain unnamed to protect her position. “Had he been sent to Sierra Vista with (its) neuro team, he would have had a good chance of surviving. So it would have been a couple of extra minutes in an ambulance is all.
“The good side, we will probably be able to bill $10,000 to $20,000 to the family insurance, so that is the price of a life,” she concluded.
Lag time between a severe injury and treatment can mean the difference not only between life and death, but can also determine whether a patient will be permanently disabled.
To prevent delays, the designation of a trauma center would create a system in which emergency personnel transport trauma patients directly to a trauma unit that would summon the appropriate surgical and support staff.
But which facility gets that designation has political implications.
Rick Castro, president and chief executive officer of Arroyo Grande Community Hospital, asked the Arroyo Grande City Council to back his hospital’s opposition to creating a regional trauma center in San Luis Obispo. He believes the designation could result in a shortage of surgical doctors available to provide care at the South County’s only hospital.
In addition, sources tell CalCoastNews that Catholic Healthcare West, which owns the Arroyo Grande hospital, is considering morphing it into a rehabilitation hospital and that designating another hospital to receive trauma patients could reduce income to the hospital.
Castro and representatives for Catholic Healthcare West did not return requests for comment.
“It is our belief that Arroyo Grande’s motivation has less to do with Arroyo Grande wanting to be a trauma center than stopping Sierra Vista from becoming a trauma center,” said Ron Yukelson, associate administrator at Sierra Vista Regional Medical Center.
While personnel from both Catholic Healthcare West’s non-profit hospitals, French and Arroyo Grande, initially indicated interest in being designated level-three trauma units — a step down from a level-two unit — only Sierra Vista has indicated interest in becoming a level-two trauma unit.
A consultant hired by the San Luis Obispo County Emergency Medical Services Agency (EMSA) concluded that multiple level-three facilities would have higher fixed and regulatory costs, while providing a lower level of care than a single level-two or level-three trauma unit.
A trauma center designation would likely result in brain-injured patients being transported directly to a trauma center.
Last week the EMSA, which includes representatives from local ambulance providers, physicians, emergency room personnel, law enforcement, fire and government agencies, recommended a trauma system design to the County Health Agency. The plan calls for the designation of one centrally-located trauma center for San Luis Obispo County.
The trauma system plan will likely go before the County Board of Supervisors as early as next month for approval, then on to the state Emergency Medical Services Authority for final approval.
At that point, the county would issue a request for proposals from any county hospital meeting the criteria that was interested in designation as a trauma center.
Given the topography of our county it doesn’t seem to me that just one trauma center would do. What about the folks in Paso or San Miguel? Are they supposed to hang on until they get over the Cuesta Grade to receive care at SVH? What’s that, a 30-minute ambulance ride? How much would that cost?
And what about all the people injured at the Pismo Dunes? Will they have to be taken all the way to SLO to get treated?
I like the idea of bringing all the hospitals up to standards (or at least improve their capabilities). That seems to be the best situation for us regular folk.
And all this talk about Alexander’s qualifications is moot. EMSA does not treat patients. As I understand it, her role is to oversee the organization and enact the wishes of her board. She’s an administrator and office manager, not a doctor.
And they don’t have any real power anyway, just the power to make recommendations.
Take your concerns to the Supervisors. That’s where the decisions are made.
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Currently, the only emergency room able to deal with trauma is Sierra Vista. Yes, it would be nice if they all could, but it’s not financially feasible. Trauma, the way it is used in trauma designation, is not a broken leg or a gash, it is blunt force trauma. There are about 30 a year in our county.
I do agree that we need Arroyo Grande Hospital and Twin Cities strong and healthy. However, if I had a serious head injury, I would want to go directly where I could be treated and not just were I could be stabilized and transferred.
The problem is not that we do not need a group of successful hospitals, but that the infighting over money is lowering the quality of care.
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Mr. Congalton,
Asking about someone’s qualifications is hardly “smearing their reputation”. Save the theatrics for your radio show.
If you want to see how to smear one’s reputation, check out the article on Dr. Rees – it is a textbook case.
Thank you for providing her education and work history. It’s too bad it wasn’t included in the original article; it is certainly germane to this discussion.
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DeepBlue: Your arguements are very weak and in one of your posts you indicate you are a retired Banker, presumably to bolster your credibility.
So let me pose a weak arguement to you …
“Our disasterous economy is due to crooked bankers, hence all bankers are crooked.
Get my drift DeepBlue?
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TacomaRose your right and I think he’s more like what Zapho said,”Narcissistic Authoritarian.”
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Interesting article. I wish, however, there were some quotes from actual doctors who are on staff at both hospitals rather than some (obviously disgruntled) unnamed ER employee whose expertise we cannot validate.
More interestingly though is the lack of transparency that Ms. Velie expects from others.
Did you know the local SLO County EMSA Director has no medical education or experience? Did you know she is also a writer for this website? Did you know her husband is a local talk-show host and also one of the editors of this website?
That’s right … none other than Dave Congalton’s wife, Charlotte Alexander. Why is she not mentioned in the article when she and her spouse are so heavily involved in this issue?
Charlotte and Karen – you can’t have it both ways.
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The study that wants a single level 2 trauma center was ordered before Ms, Alexander became director as a mater of fact the Chairman of the EMSA board at the time the study was ordered was Frenche’s medical director he chose the consultant to do the study.
Ms Alexander as director of the EMSA does not have a vote on the Trauma center and her husband does not have a vote.
The board approved the the trauma proposal a board made up of all parties involved.
Everyone know that Arroyo Grande hospital will be turned into a rehab facility with no emergency room ect. Catholic Healthcare West thinks that it can make more money sending the AG patients to French and Marion.
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A very typical response if you are not able to challenge the facts attack the people.
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For the record, only George Ramos and Karen Velie worked on this story–no other CCN staff member was involved. Ms. Alexander, a theater major in college, has contributed some theater reviews to the site.
So “Deep Blue” — what exactly is your point?
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Dave (I assume Congalton) – I am a retired banker and someone who unfortunately suffered 2 serious car accidents, was treated at both Arroyo Grande and Sierra Vista and received great care at both facilities. My wife is a retired Nurse Practitioner. As you like to say, “I have no dog in this hunt”.
My points are:
1. Don’t attack my anonymity by using “quotes” – CCN is a sites that lives by unnamed and anonymous sources. To suggest otherwise is hypocritical.
2. As a tax payer of this county I can question the educational and professional background of anyone, especially the high-level positions like EMSA Director. That fact she was a theater major doesn’t make me sleep better at night, unless Ibsen wrote about trauma care in the 21st century.
3. The Santa Maria Times wrote 2 recent articles in which Ms. Alexander was the go-to impartial expert on this subject and yet her name or relationship with you and CCN is not mentioned at all – go figure.
4. Do you really expect me to believe that Karen and George came up with this by themselves without any contact from Ms. Alexander either directly or indirectly through you? That’s complete BS and you know it.
I mostly enjoy your radio show, but don’t let your narcissism cloud your objectivity.
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Dear Deep Blue:
I appreciate your repeated attempts to detract from the issues raised by Karen Velie’s reporting (None of which you care to respond to) and instead try to focus on the qualifications of Ms. Alexander. And I especially enjoy being lectured on ethics by a “retired banker” (By the way, what makes YOU so qualified to comment on emergency care? Just curious.
Allow me to respond:
(1) The Santa Maria Times article actually is a Times Press Recorder article that was reprinted in SMT. Ms. Alexander also gave an interview to Atascadero News and I believe KSBY on this issue. She is indeed a go-to person on this subject.
(2) However, we at CCN attempt to hold ourselves to high ethical standards, since we thrive on those suffering apparent ethical lapses. George and Karen researched and wrote the article on their own. They did not consult Ms. Alexander. Neither one of us saw the article before it ran. we wanted to avoid any possible conflict of interest since Ms. Alexander has recently started doing theater reviews for us. Whether she is interviewed for the rest of the series is up to Karen and George.
(3) You’re obviously new to the area or grossly misinformed. Charlotte Alexander is recognized throughout the county as a top nonprofit executive. yes, she was a theater major in college, graduating from DePauw University, one of the top liberal arts schools in the nation. If it makes you feel any better, she also has a graduate degree in business. She was executive director at United way for five years and has served as president of both the Central Coast Natural History Association and the North County Humane Society. She consults for community colleges through California. Jack O’Connell selected her as the Woman of the Year for his entire Senate District in 1998.
The EMSA recruited Ms. Alexander (that’s right Deep Blue — they came to her) and asked for help in turning around a troubled nonprofit. Ask the county. Ask her staff. Ask her board. She’s getting the job done.
So, if you want to smear someone’s reputation put your name on your opinion from here on out. Otherwise, go play somewhere else. I’m done with you.
Dave Congalton
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I am a retired banker
Prosecuting Attorney
Judge
Prophet Seer And Revelator
Narcissistic Authoritarian
Paranoid Objectivist
would of been my guess,
judging by the size of derail you attempted .
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I reiterate, I ask that DeepBlueSLo answer,
This isn’t about hearsay. Sierra Vista is clearly and by far the #1 trauma center in this county. That’s a fact. So why all the contention from other hospitals about making it official? It’s all about the money and the hell with saving lives. The fact that a nurse or two threw in their 2 cents doesn’t make a bit of difference. The FACT is that Sierra Vista is the #1 trauma center with the staff to save lives and that’s why all trauma patients end up going there after the other hospitals get their (what they consider) fair share of services.
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Okay this is new what in the hell would be wrong with two top notch trauma centers? Non-profit and conventional not that I believe there is any difference, I just believe if you want to fight about something go to Irac, if you want to help people, work together and get the job done what ever it takes!
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cheseburger – The problem with two trauma centers is that one of them isn’t really a trauma center and will have to send patients to Sierre Vista after they have wasted time providing their less than adequate services to trauma patients.
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Dear Nancy I know were on the same side, What I mean is upgrade both hospitals to top notch trauma centers, wait till we have a terrorist attack or a natural disaster, or should we wait?
“if you want to help people, work together and get the job done what ever it takes!” What ever it takes meant upgrading both hospitals! Volunteering rich retired doctors would love to help, and it is proven that people who continue to do some work after retiring live longer.
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The county needs to wake up, French and AG hospitals may be non-profit but they exist for the benefit of their management. See the old story from Uncovered SLO about the one million dollar salary for the head of French hospital.
See the tribune article about the amount of uncompensated care last year, the 2 non-profit hospitals account for 28% of the care while the for profits hospitals account for 72%
I am amazed that someone has not sued French and the county for blocking the trauma program as people have died or ended up disabled due to the delay in service.
Read the consultants that is on the EMSA website this is a no brainer.
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“Lag time between a severe injury and treatment can mean the difference not only between life and death,”
Catholic Health-care West, is a non-profit hospital?, The only time they did not want to profit from me was when they were facing a lawsuit for a vicious attack on a new born baby when an over worked nurse had a melt down and because she wouldn’t allow me to get up and help her change my baby in my underwear, and my wife was recovering from a C-section and my mother in law witnessed this in horror, unable to move because of knee surgery. In the mourning when a new nurse came in I informed her that no one from this hospital was touching our child again, I touched on this in a previous blog on a previous article. Something is evil at CHC, and I think it’s the Money,non-profit my *ss. Dr. Arron Kromhout lied to my face and as far as I know still works there, he lacks honesty and has yet to learn integrity.
Arron was it really to be your first solo operation, like Karen Traft told me, six months after you told me you had performed 100-200 C-sections, prior to my wife, who I saved from your dull knife! Doctor you should know better then to lie to someone who just might check.
In closing I have to say money is the problem here and wet behind the ears people, I am determinately leaning towards Sierra Vista because of my past experiences with both hospitals.
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Cheseburger – A nurse at French Hospital was abusive to your new born baby? What?
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Nancy you better believe it, on Oct. 22, 2004, the day after the C-section done by doctor Monroy after I fired Kromhout right out of his greens, they all hated us, called us difficult patients, anyway this grey haired creepy nurse, busts in and wakes us all up a midnight and screams nobodies even changed this baby yet, first of all we changed her at ten, I had been pouring concrete since five that mourning, unlike the nurse who worked nights, I love my baby Alice and wanted to get up to change her, I asked the nurse if I could get up in my underwear,”No absolutely not, put your close on!” she stated firmly, well for 2,000 dollars a nigh I figured at that point she could handle it, wrong, she wiped my pore babies privates so hard with cold water and abrasive towels it gave her a yeast infection, this was diagnosable by a nurse from the health department soon after we left the hospital, that the hospital had sicked on me for my bad attitude, two years she came to my house and we became good friends. Thanks CHW for the free medical and post natal care, good call.
Seems if you rock the boat there’s always something wrong with you, fox smelled it’s own hole in this case.
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Adding to this confusion, ask the county about their convoluted helicopter policy and see how much it differs from most counties in California. I would imagine there will be some lawsuits in the future and the people drafting our policies will be held accountable.
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The city council just approved a heliport for Sierra Vista. I hope the county does not get sued for taking years to approve the Trauma center by some one whose loved one died. Read the consultants report it is on the EMSA website. How many will die or be disabled while we play politics in this county.
The report gives an estimate of the number of live that will be saved, read the report then make a comment.
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I can’t believe you are basing this story on the word of a nurse and unnamed hospital personel. Did the nurse actually work on the patient? How about the unnamed personel. What did the doctors have to say? The cynical quote by the nurse, “The good side, we will probably be able to bill $10,000 to $20,000 to the family insurance, so that is the price of a life,” indicates that she already has a negative view of the hospital. Perhaps you should do some more investigating before publishing an inflamatory article based on bias and hearsay.
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I am amazed at the timing of this report. A family member of mine was hit by a car Wednesday night at 9:00pm in SLO. He was first taken to French, we were notified at 11:15pm by the time we got to French, he was gone. They told us he had been transferred by amulance to Sierra Vista. When we got there he was in critical condition with a sever head injury and they were not sure he would make it through the night. It was a very stressful night, thankfully he made it through and is improving and will be out of ICU soon, However I questioned why he was not taken directly to Sierra Vista, why the delay? Why could French not take care of him? It just makes sense to me that if you are transporting a patient with a head injury that you would take the patient to the hospital neuro staff available???
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Shelby, The fact is that the local hospitals want their piece of the action. If they are the nearest hospital then they don’t want to lose their piece of the pie. They couldn’t care about the magic hour where trauma is concerned. It’s all about the $$$ and not about what’s best for the patient. It’s disgusting that French Hospital aka Catholic Healthcare West would fight this. It’s not the first time that they have been embroiled in $$ vs best health practices.
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This isn’t about hearsay. Sierra Vista is clearly and by far the #1 trauma center in this county. That’s a fact. So why all the contention from other hospitals about making it official? It’s all about the money and the hell with saving lives. The fact that a nurse or two threw in their 2 cents doesn’t make a bit of difference. The FACT is that Sierra Vista is the #1 trauma center with the staff to save lives and that’s why all trauma patients end up going there after the other hospitals get their (what they consider) fair share of services.
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I was replying to bslo. Sorry I ended up in the wrong slot.
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Unfortunately, with the lack of Cardiac services at SVH they cannot TRULY be considered a trauma center much less #1. Thanks to French Hospital, they made sure they wouldn’t have one. Someone ask Alan where the transfer agreement is allowing Sierra Vista to at least perform emergency cardiac procedures………….
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FACT – The cardiac services in this county are the worst of the worst. If I had a cardiac problem I would transfer out of here. Rush me anywhere but here in this county. SLO county is a dangerous place to suffer severe heart problems. I won’t go into the why’s or reasons that I know. Keep reading, this is but the beginning of a series of articles regarding local health care.
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Trust me, I am no friend of French. And I am extremely aware of what is happening with our cardiac services here. Neither are capable of trauma designation because neither provide adequate care; also considering the clowns at Coastal Cardiology are holding French’s “cardiac unit” down.
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Sorry for your unfounded opinions. I suffered a heart attack and upon walking into the emergency room at TCH I can only remember about 10 to 12 people immediately treating me and within minutes I was being treated for the attack. I honestly would have to say they reacted faster than a NASCAR pit crew. I was transferred to SVH where a blot clot was removed from my heart. Upon my arrival at the hospital there was a cardiac doctor and 3 assistants awaiting my arrival and tthere was NO delay in my treatment. I’m usually a critic but i have to admit that my cardiac care was superb.
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Cardiac services are not a part of Trauma. In a level 2 trauma center we are mostly talking about accidents not heart problems.
Alan has to try to keep his 1 million dollar salary so French need all the income it can get. No-profit my a–.
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SLOhealth, get your facts straight. Cardiac care has NOTHING to do with trauma. Check the trauma criteria from the American College of Surgeons. Trauma is about surgery and getting a person to the most APPROPRIATE hospital in the SHORTEST amount of time. Heart attacks and cardiac episodes are never mentioned in the context of trauma.
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Actually, Cardiac services are extremely important for trauma status, which is why STEMI designation is also a hot button with the EMSA at this time. Regardless of what the ACS says, cardiology is an integral part of any hospital system and reaches far beyond just echocardiograms and heart caths. Consider the trauma patient suffering a perioperative infarct during surgery. At this point if this happens at Sierra Vista, you are pretty much SOL as there is no reliable cardiac team onsite. The point is to create 1 center of excellence in our town that has all services available and adequate. The need for two major hospitals and trauma centers is just not feasible for our small population.
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The need for two major hospitals and trauma centers is just not feasible for our small population. This is still one of the fastest growing comunitiies in california, so I would have to disagree, there is a need, some just want a monopoly.
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bslo, I was there Oct. 21-24, 2004, this crazy nurse made a bloody pin cushion out of my wife and said all kinds of mean nasty things to her, then an angel walked by, I begged her to intervene and she popped that needle in on the first try in the elbow, two minutes later the crazy nurse with the fetish for probing came bake in with a whole tray of new needles stating profusely that she could not give birth with an IV in her elbow, this is when the crap hit the fan, I made them make a cardboard splint and she was able to have a C-section with the IV in her arm after the same nut case nurse came back a shoved a giant wooden thing up her, breaking her water a 3.5 centimeters, thus causing (nine lb four ounce Alice to get stuck in the birthing canal and thus force an emergency C-section which the hospital swore was not an emergency, because according to Dr. Monroy (an excellent surgeon and a kind man) would have been able to tie my wife tubes during the C-section, stupid hospital said no, I bluffed and said, “well since it’s not an emergency why don’t we sedate her and wait the 6 remaining hours”, the staff’s reaction was, “you would do that to her”, I said “no”. Monroy did the C-section and the hospital payed him to come back and do the tubalzation cutting through the first scare.
In closing you can tell five years later I am still angry at the CHW hospital for putting their religious views on my family, Quote,”you should have your tubes tied she could want more babies later!” Putting their views in front of our lives, I guess I’m pro Sierra Vista now.
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Opps that one went in the wrong place sorry, I know why you took away my delete button but why can’t I vote, give me back my thumbs.
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You can only vote on other’s comments, not your own, repost your comment where you want it , the moderator deletes doubles, leaving the most recent.
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zaphod, wrong, I don’t want to vote on my comments, I can’t vote period. And I’m not even a felon, where’s my thumbs moderator. Is there something wrong with my computer? Or am I back in China. There are no thumbs and I am dumb enough to think you took them away.
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It is your
browser
firewall
router
cookie
settings
preferences
Email the Admin re site issues.
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It’s really very plain and simple. It’s all about the $$$$$$$$$. The conversations are mostly about costs and profits and very little about care.
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What is shameful is that this person’s death is being used as a leveraging chip in this political battle. Even if the patient had been sent to Sierra Vista first, he would have had to have been stabilized prior to surgery, which is exactly what French Hospital was trying to do. Being unable to stabilize the patient at Sierra Vista would have resulted in the same fate.
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Very true, and there is a magic hour for ALL trauma be it neuro, cardiac, stroke….The hospital that receives designation MUST BE fully staffed and ready for anything. With the two fighting over market share and bragging rights I’m afraid we may be dealing with this for some time.
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This is shameful. Its a well know fact that there is a so called “magic hour” after a serious head trauma. The sooner a person receives proper medical treatment the better their chances for a full recovery. Maybe we should all put notes in our wallets that say, if I require medical treatment for head trauma, take me to Sierra Vista.
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