Are patients dying while hospitals battle over profits?

January 28, 2010

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.