Are patients dying while hospitals battle over profits?

January 28, 2010

First in a series: Profit share versus patient care on the Central Coast


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.

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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.

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.

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.

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?

TacomaRose your right and I think he’s more like what Zapho said,”Narcissistic Authoritarian.”

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.

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.

A very typical response if you are not able to challenge the facts attack the people.

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?

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.

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

I am a retired banker

Prosecuting Attorney


Prophet Seer And Revelator

Narcissistic Authoritarian

Paranoid Objectivist

would of been my guess,

judging by the size of derail you attempted .

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.

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!

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.

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.