Hospitals battle over market share

November 23, 2008

By KAREN VELIE

Care of San Luis Obispo County trauma patients takes a back seat while local physicians and hospital officials battle over lucrative patient dollars.

French Hospital Medical Center and Sierra Vista Regional Medical Center continue to scuffle over whether either hospital will receive a specialty care system designation of trauma and/or ST-Segment Elevation Myocardial Infarction (STEMI).

While French Hospital CEO Alan Iftiniuk and Arroyo Grande Hospital CEO Rick Castro asked SLO County Emergency Medical Services Agency (SLOEMSA) and county Health Agency Director Jeff Hamm to proceed cautiously in designating a trauma system, officials from both hospitals have asked SLOEMSA to fast track a French Hospital STEMI 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 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. A STEMI designation means ambulances would bypass other hospitals to take patients with heart attacks caused by blood clots to a STEMI center where pre-assembled medical staff would be on site.

A trauma center is required to have the equipment, staff, and resources on hand to deal with high levels of trauma such as life threatening head and neck injuries.

“Unlike Trauma centers, the state has no guidelines on STEMI,” said SLOEMSA Executive Director Charlotte Alexander. “While we are trailing other counties in trauma system development, most have not put in a STEMI system.”

On November 20, at a SLOEMSA board meeting, officials from French Hospital requested speedy approval of a STEMI center at French with the assertion the designation would save lives.

These same officials mounted a behind-the-scenes maneuver to torpedo Sierra Vista’s plans for a trauma designation only days after representatives of all four hospitals recommended that the county approve the development of a trauma system and the designation of a level-two trauma center.

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. A consultant hired by SLOEMSA 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.

In July, the SLOEMSA board unanimously voted to recommend the county approve a trauma system with a level two trauma center. A few days later, French Hospital’s emergency department director and SLOEMSA board member doctor Paul Christensen and Arroyo Grande’s emergency department director doctor Carsten Zieger sent letters to county health officials and three county supervisors voicing their opposition to a single level-two trauma center.

“Our goal is to get them [myocardial infarction patients] to French,” said French Hospital’s Christensen, who claims French provides a higher standard of care. “There are those that say it is immoral to wait a year when the results are proven.”

Officials from Sierra Vista argued that both French and Sierra Vista meet all national standards for a STEMI designation, the same group of cardiologist provide treatment at both hospitals, and that only Sierra Vista has signed on to become a level-two trauma center.

“The first issue is the lack of a trauma system,” said Sierra Vista hospital spokesman Ron Yukelson. “Our competition wants to muddle the issue by bringing in the unrelated and separate STEMI issue.”

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.

“Patients are being delayed in care,” Yukelson said. “Our belief is that French is less interested in being a trauma center and is more interested in Sierra Vista not being a trauma center and they are doing their best to obfuscate and deflect the issue.”

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 as Sierra Vista has the only neurology surgeons on staff. Most of those were first routed through other hospitals, resulting in delays ranging from 90 minutes to 19 hours. A trauma-two designation would result in brain injured patients being transported directly to a level two-trauma center.

Nonprofits v for profits

The showdowns between French and Sierra Vista are representative of a national debate over whether community nonprofit hospitals are serving the public.

Recent congressional hearings have focused on the financial practices of nonprofit hospitals. Controversy swirls around the question of whether these tax-exempt facilities are adhering to the obligation of providing a public benefit.

French and Arroyo Grande Hospitals are nonprofits and as such are required to serve the public good, enjoy a tax exempt status, and solicit donations.

“The truth is, it is all about turning a profit,” Yukelson said. “They [French] have cherry picked the highly profitable cancer and cardiology services to focus on.”

Sierra Vista operates the only high risk pregnancy unit in the county at a financial loss. In addition, they have the only pediatric, neo-natal, and neurological surgery units. Sierra Vista paid approximately $1.6 million in taxes last year.

“We consistently treat the highest number of indigent and Medical patients,” Yukelson added. “It is not a level playing field.”

Megan Maloney, communication director at French Hospital, declined comment on the issue.

Four local cardiologists spoke out in favor of a STEMI center and on the need to focus on the highest level of patient care and not market share.

“I suggest the board not allow this to degenerate into a turf war,” cardiologist Bob Doria said.

SLOEMSA President Rob Reid concluded that the process of designating one or more local hospitals as STEMI centers would “take time and funding.”

“What are we here for?” Reid asked. “It is to provide the best care of the patients.”

Meanwhile, SLOEMSA director Charlotte Alexander said SLOEMSA continues to move forward on the design of a trauma system including one or more trauma centers.