Covert attack mounted on trauma center plan

July 12, 2008

By KAREN VELIE

Physicians and officials at French and Arroyo Grande hospitals have mounted a concerted but furtive effort to halt plans for an advanced (level-two) trauma center at Sierra Vista Hospital.

The behind-the-scenes maneuvering to torpedo Sierra Vista’s plan started only days after representatives of all three hospitals voted publicly to approve it. The proposed level-two trauma center is the centerpiece of a program prepared by a county consultant who contends the facility would save lives and attract more physicians to the county.

Last year, every trauma patient in the county (those with life-threatening injuries who were not transported to out-of-county trauma centers) ended up at Sierra Vista. Most of those were first routed through other hospitals, resulting in delays ranging from 90 minutes to 19 hours. Nevertheless, according to one French Hospital nurse, French and Arroyo Grande physicians and hospital officials do not want to forego the large fees collected for stabilizing those trauma patients before being transferred to Sierra Vista.

“We know for a fact it (a level-two trauma center) does save lives,” said the consultant, Diane Akers. “There is also a component that many permanent disabilities could be prevented by having a trauma designation.”

Lag time between a severe injury and treatment can mean the difference not only between life and death, but may be the factor determining if a patient will be permanently disabled.

To prevent delays, the designation of a level-two trauma center would create a system in which emergency personnel transport trauma patients directly to a trauma unit and summon the appropriate surgical and support staff.

In early 2008, the San Luis Obispo County Emergency Medical Services Agency (SLOEMSA) board voted to hire a trauma system consultant to provide an objective assessment of the county’s trauma system needs. Akers and her partner, Richard Narad, presented their assessment to the board in May.

While personnel from both Catholic Healthcare West’s (CHW) non-profit hospitals, French and Arroyo Grande, have shown interest in being designated level-three trauma units — a step down from a level-two unit — only Sierra Vista signed on to become a level-two trauma unit. The consultant 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 trauma unit.

During two board meetings, skeptics of the plan, all affiliates of French and Arroyo Grande hospitals, voiced concerns that Sierra Vista’s proposed designation might result in staffing shortages at their hospitals, and wondered if trauma centers improve mortality rates. Following discussions regarding those concerns, board members voted unanimously to recommend the county adopt the consultants’ recommendations.

Although representatives of CHW voted to approve the recommendation, French Hospital CEO Alan Iftiniuk and Arroyo Grande Hospital CEO Rick Castro immediately expressed concerns to Health Agency Director Jeff Hamm.

“Alan Iftiniuk and others have advised EMS to proceed cautiously and make sure a single level-two trauma center is the best for the county,” Hamm said. “If it pulls physicians away from their emergency rooms, it could have a negative impact. We are moving forward with our eyes open.”

Following his vote in favor of the consultant’s recommendation, French Hospital’s emergency department director and SLOEMSA board member Paul Christensen sent a letter to Hamm, with copies sent to three county supervisors, which articulates his opposition to a single level-two trauma center.

“My goal in writing this letter is to cut through the rhetoric and the politically charged arguments that develop when there are market share and financial issues on the table,” Christensen says in the July 2 letter.

Arroyo Grande’s emergency department director Carsten Zieger sent a letter to EMSA chairperson Rob Reid July 3 asking him to reject the level-two proposal.

“Should a plan for a single level-two trauma center be adopted by the SLO County Board of Supervisors, our ability to care for our patients will not only be eroded, but appropriate patients will be siphoned away from our facility for financial gain, regardless of the assurances of the EMSA medical director,” Zieger says in his letter.

Some proponents of the trauma unit claim those who oppose Sierra Vista’s plan are placing financial motivations above patient care.

“What the ER doctors do not want to give up is that without Sierra Vista receiving a level-two status, the patients go to the closest hospital, then are transferred to Sierra Vista, hence the emergency room docs and the CHW hospitals get to collect large fees to stabilize the patients,” said one French Hospital nurse who has asked to remain unnamed.

Representatives from French and Arroyo Grande hospitals did not return numerous requests for comment.

Christensen also asserted the consultants’ report is “largely misleading and out of date.” He claims that the number of patients who would benefit by the program, “167” per year, would be at the detriment of the remaining “99,833 patients.”

Selected by the board because of her qualifications, lack of conflicts of interest, and previous experience, Akers has created similar studies for eight other counties in California. Akers asserts she relied on current trauma theories while compiling her report.

“The bottom line is the current practices are from the American College of Surgeons’ most recent 2006 edition,” Akers said.

Akers’ report suggest the county investigate concerns that a level-two designation could negatively affecting area hospitals, though she says that she has “never seen that happen.”

“The ferocity of this is not commensurate with the issue,” Akers said. “It’s not that many patients.”

Akers added that health care is very complex, and that when hospitals focus on specialized care, patients ultimately benefit.

“Everyone can’t be everything,” Akers said. “When you see trauma again and again, you get experience and expertise.”


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13 Comments

  1. ccn_debate says:

    Member Opinions:
    By: Anonymous on 8/20/08
    This post is about to scroll off and Congalton's wife should have been investigated as well as Dan & karen not doing this to cover up for a "friend".
    This whole thing smells fishy. INVESTIGATE!
    By: Anonymous on 7/28/08
    Cover up for what? Trying to say an ad has something to do with Congalton claiming credit for this site makes no sence. If you have proof the the responcibility for the public cliam for the trauma center than the back room deniel was Andersons doing, show it. Otherwise get back to topic. You sound like the guy that trashes Congalton on every other blog. Off topic allegations of links to the blog, but no proof or allegations of fraud. I don't care if he was involved in the blog as long as they get the news out. And I don't claim to know if he is or not. Who cares.
    By: Anonymous on 7/28/08
    San Luis Obispo County’s only independent source of real news and opinion
    Our Mission:
    Truthful, bold, vital, cutting-edge reporting.

    If there is any truth to this cleverly crafted statement…answer the questions or be exposed! You can't cover up for your pals and expect us to believe the other work you do is fair.
    By: Anonymous on 7/27/08
    Not a peep from Dan or Karen. Proof something fishy is going on with congalton and possiblly his wife.
    When they ask for money they want it, but when we ask a question we are treated like red headed step children.
    Not cool…Not cool at all.
    The dedicated to the "truth" gig is up.
    By: Anonymous on 7/27/08
    No answer from Dan ro karen. I am blown away/ Two people committed to getting to the bottom of any story…but it seems the lien is drawn at them or those they colude with. hmmmmm…
    If you want money you gotta tell the truth.
    We are also waiting to hear why congalton's wife is covering this mess up and why you are protecting her.
    By: Anonymous on 7/25/08
    When the KVEC logo was placed on your site did any money change hands for the advertising you provided to the station.
    If not this is something that proves congalton was taking credit for the site.
    Let's see if we can get an answer to that question first.
    What say you Dan & Karen?
    By: Anonymous on 7/24/08
    Congalton has never taken credit for this site. He is a radio host and as such likes good radio. UNSLO's investigative stories provide great content for his show. Remember the Kelly Gearhart show? Congalton has all sorts of guests on his show, that does not mean he is vested in them. Get a reality check.

    Pulling Alexander into this is like saying if the Mayor gets caught cheating it is somehow the fault of the city manager for having a friend that knows a reporter. Get real.

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  2. ccn_debate says:

    By: Anonymous on 7/24/08
    Dr. Paul Christensen is the one who deserves examinaton in this story. He said one thing in a public meeting (supporting the trauma center) and then tried to gut it privately, covertly.

    He is the main player in this drama. I can assure you that there are many people in the local medical community who are very upset and concerned by Paul's actions.

    He used to be very respected. Not so much any more.
    By: Anonymous on 7/24/08
    We are just trying to keep it real. We need to refer to her as congalton's wife because even she has distanced herself from her husband by not taking his last name.
    Congalton has taken almost all the credit for this site and many feel they are indebted to Dave in a somewhat inappropriate way.
    To uncover the cover up it is vital that congalton's wife be fully vetted in this matter. Do you have a problem with that? The public deserves to know the real truth on who is protecting whom. We are paying her salary. She works for us…never forget that.
    All we want is the real un-spun truth.
    congalton's wife needs to step forward and be vetted or this cloud will not go away. Who better to do it than this site and it's readers?
    You think that if she goes on hubby's show he will ask the tough questions? Not a chance in hell!
    You may kneel and pray at the alter of Congalton but this is still a majority conservative county and he has gone so far left he makes Soros look like a boy scout.
    GO USLO GO!
    By: Anonymous on 7/23/08
    It seems pretty obvious from all these references to "Congalton's wife" that someone who doesn't like Dave is trying to suggest something inappropriate on the part of his wife.

    Of course, there's no proof, merely Anonymous attacks and suggestions.

    Anyone surprised?
    By: Anonymous on 7/23/08
    With all due respect they could get an Apple lle to that. Why is congalton's wife there? Seems fishy to me too.
    By: Anonymous on 7/23/08
    The board sets policy and the executive director puts that policy in force.
    It is like saying the county only needs the board of supervisors and no workers.
    Do you think the supervisors should be out fixing potholes, ooooops maybe that would not be such a bad idea we could actually get something useful out of them.
    By: Anonymous on 7/23/08
    Seems like congalton's wife is a powerless puppet. If she has no control then why is she there? To babysit?
    This is why government is trouble today. Way too much pork and waste.
    By: Anonymous on 7/23/08
    How in the world can you make the connection that Alexander and Congelton are hiding something just becuase the consultants report is on the EMSA website.
    The EMSA is a publicly funded agency and they are required to make these things public.
    Dr. Cristensen was in charge when they ordered the report and picked the consultant.
    The whole board voted to accept the plan and implement it.
    As much as French would like to hide the report Alexander had no choice as to whether to make the report available.
    Remember she is the chief administrative executive not the policy maker.
    French talking points are to attack the people not have a discussion of the facts.

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  3. ccn_debate says:

    By: Anonymous on 7/23/08
    Paul Christensen has lost his moral compass. That's the sad legacy of this story. Hope there's more to report.
    By: Anonymous on 7/22/08
    You may be onto something since dave's blog has been dead for 10 days. hmmmmm
    By: Anonymous on 7/22/08
    to LocalRN: Unfortunately, you are doing nothing but labeling "all doctors" as corrupt and uncaring. Frankly, that is a simplistic view to a very complex problem in the medical community. I am not a physician, nor am I a nurse, but I have worked in the medical field for nearly 35 years, here and in S. California. The changes have been enormous, and not all for the better. The physicians are paid handsomely in some places, not so much in others. The discrepancies in attitude are also as they are in all of humankind. You cannot label one group of people without labeling yourself. Try to understand that everyone is worried about their financial health, physicians included. Does this make the things right? No. Does it make your statement correct? No. The greed is in the wanting at all cost. Labeling only creates a sense of entitlement.
    By: Anonymous on 7/22/08
    If the consultants report it is on the EMSA website, then congalton's wife IS involved.
    I smell a cover up. Can Dan or Karen speak to this. Sounds way too fishy.
    By: Anonymous on 7/22/08
    Everyone should read the consultants report it is on the EMSA website.
    It is not about witch hospital should be the trauma center say one in the north and one in the south.
    There is only one hospital that has all the different things to qualify. It is S. V. or nothing not a choice of who.
    By: Anonymous on 7/22/08
    We want to know ALL the players and their role in this situation.
    Could it be that people do care about facts? Or do you just think everything is a conspiracy?
    What out for the lil black helicopters!
    By: Anonymous on 7/22/08
    French fall back on the old method of when the facts are not on your side you must attack the people.
    By: Anonymous on 7/21/08
    I do not know why someone is insisting on libeling Charlotte Alexander. I work at Cuesta and I know Charlotte quite well. Someone posting anonymously on this site is spreading totally false information.

    Charlotte served Cuesta well in the Public Information Office, but stepped aside after Dr. Mitchell retired in 2000. I have nothing but respect for this woman and whomever is posting the rumors is completely incorrect.

    But I also agree that someone seems intent on attacking people and diverting attention from the real issues raised in the article.

    Who benefits when the discussion shifts away from French? Thought so.
    By: Anonymous on 7/21/08
    The amazing thing is that French gets away with whatever it chooses to do and SLO just lays down and takes it. The CHW-TENET battle is not even at issue it is purely French against Sierra. They even said that a better solution is to provide trauma care in North and South counties where all the trauma takes place.

    IF YOU WANT SOMEONE TO BLAME… BLAME the greedy doctors who refuse to take call or work anywhere other then where they want to work. Its not that far for a doctor to drive anywhere in the county to take care of an injured person but they make the injured person come to them wherever they are. IT MAKES ME SICK. And all you people want to blame the hospitals. Look to your doctor and ask them if you would get the care you needed on a weekend night if you broke a bone or were in a car or boat accident. The answer would likely be NO.

    The doctors are the problem… NOT THE HOSPITALS.

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  4. ccn_debate says:

    By: Anonymous on 7/21/08
    Why would French want to come on obvious radical left talk show? It's rigged. The deck is stacked. Same lefty callers and guests all the time.
    If I were French I would stay away as well.
    Any show host that would lets SMBILL, code pink and Michele run his show is not something most folks are interested in.
    Sad but true. We have lost home town radio. Thank God for USLO!
    By: Anonymous on 7/21/08
    Lets clear up a few things.
    Ms. Alexander was the Executive Director of United Way and the non-profit community had great respect for the way she managed the
    United Way.
    When the EMSA job came up they were looking for some one with managment experience not medical experience health care experience. The EMSA was in a mess and she was able to turn things around.
    As Exec Director here job is not to make policy but to implement the policy of the
    board.
    The board voted when Dr. Cristensen was the head to hire the consultant, when the board reviewed the consultants report and all of them voted to move forward she had to follow the boards wishes.
    Some board members they went behind the boards back to to try to torpedo what they all voted in the public forum to do.
    Congelton is married to Alaxander.
    A number of months ago Congeltom had USLO on his show they reported a story about the million dollar salary of the French CEO and his other full time job. They were guests on his show he interviewed them and let them take calls.
    He did not make any comments.
    He offered French equal time and all they did was write a letter to him blasting him and USLO people personally and they did not refute any of comments made on the show.
    Congelton has lots of people on his show giving all sorts of opinion. I am sure French could come on any time, but they only choose to attack people.
    By: Anonymous on 7/21/08
    This appears to be French Hospital trying to change topic. This has nothing to do with Alexander or Congalton.

    French officials lied to the public and are now trying to change the focus.

    Back to topic.
    By: Anonymous on 7/21/08
    Congalton is not married?
    Now that great investigative reporting.
    All this time he has been lying to us.

    btw: For the record…she was fired. Being allowed to resign is a liberal way to let you off the hook. She backed to the wrong pony in a power struggle and was told to pack it up and get out. Just keeping the facts right.
    By: Anonymous on 7/20/08
    "congalton's wife was a advertising grunt for Cuesta and got fired. What the hell qualifies her to be the counties EMS director."

    First things first. The woman in question is not "Congalton's wife." She is, in fact, Charlotte Alexander. If nothing else, give the woman some respect.

    She was never an advertising grunt for Cuesta. Rather she was the Public Information Officer for nine years. She was not fired. She has never been fired from a job, certainly not Cuesta.

    If you ask anyone in the local media, which nonprofit person ranks high in integrity and respect, I bet you that Ms. Alexander would rank near the top.

    She was recruited by the EMSA to come in and clean house and organize what had been a tremendous mess.

    If you've got facts, put them on the table. Otherwise, put the focus back on the trauma center where it belongs.

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