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.”