HELP FOR TRAUMA PA­TIENTS County seeks to add a fa­cil­ity in the eastern San Gabriel Val­ley

Los Angeles Times - - CALIFORNIA - By Soumya Kar­la­mangla

When Sam Pe­droza col­lided with a truck four years ago while rid­ing his bi­cy­cle, he was air­lifted from Clare­mont to the near­est trauma cen­ter — 30 miles away.

In­stead of be­ing f lown to Los An­ge­les County-USC Med­i­cal Cen­ter in Boyle Heights, Pe­droza wanted to go to Pomona Val­ley Hos­pi­tal Med­i­cal Cen­ter, a few blocks from the site of the ac­ci­dent and from his house.

“Are we that re­mote that we need to get an air­ship to take us to get the care that we need?” asked Pe­droza, a Clare­mont city coun­cil­man who broke sev­eral bones but has since re­cov­ered.

Trav­el­ing long dis­tances for the most dire med­i­cal care has been a long­time com­plaint of San Gabriel Val­ley res­i­dents. For more than two decades, the eastern county re­gion has lacked a trauma cen­ter — a spe­cial emer­gency room equipped to treat se­ri­ous in­juries, in­clud­ing those from car crashes and gun­shots.

That could soon change. Los An­ge­les County of­fi­cials are draft­ing a con­tract to help fi­nance a unit at Pomona Val­ley, which would be­come the county’s first new trauma cen­ter in a decade.

Los An­ge­les County Su­per­vi­sor Hilda So­lis, who rep­re­sents the re­gion, scored a po­lit­i­cal vic­tory in push­ing for the cen­ter, which she de­scribed as a “win-win” that would help pa­tients with­out strain­ing

the hos­pi­tal. She and other su­per­vi­sors say that they want to con­tinue ex­pand­ing the county’s cur­rent 14-hos­pi­tal trauma sys­tem.

But the new cen­ter isn’t nec­es­sar­ily a sign of hope for other ar­eas of the county that may feel un­der­served. There are no state or na­tional stan­dards that dic­tate where trauma cen­ters should be placed, so the cre­ation of new ones tend to fall to po­lit­i­cal and eco­nomic forces.

“There are ar­eas where they need trauma cen­ters, and they’re not open­ing up there,” said Jen­nifer Ward, pres­i­dent of the Trauma Cen­ter Assn. of Amer­ica. “For sure, we need them in some of the more ru­ral, des­o­late ar­eas.”

At its peak in 1985, Los An­ge­les County had a net­work of 22 trauma cen­ters — in­clud­ing one at Pomona Val­ley.

The vi­sion was to spread them strate­gi­cally so that when calamity struck, no pa­tient would be more than 20 min­utes away from a fa­cil­ity.

Soon af­ter, how­ever, Pomona Val­ley and sev­eral oth­ers grad­u­ally with­drew: given the high cost of staffing a cen­ter with spe­cial­ized doc­tors around the clock, they couldn’t af­ford to treat so many pa­tients who lacked in­sur­ance to pay the bills.

That eco­nomic re­al­ity was not a lo­cal phe­nom­e­non: More than 300 of the 1,125 trauma cen­ters na­tion­wide shut their doors be­tween 1990 and 2005, com- pared with about 60 in the pre­vi­ous decade.

With the im­ple­men­ta­tion of the Af­ford­able Care Act, there are now fewer unin­sured pa­tients for whom hos­pi­tals have to pick up the tab, and trauma cen­ters are open­ing at a record pace.

A state au­dit last year iden­ti­fied Mal­ibu, large swaths of the de­vel­op­ing An­te­lope Val­ley and the eastern San Gabriel Val­ley as un­der­served re­gions, and called on Los An­ge­les County of­fi­cials to con­sider ex­pand­ing trauma cen­ters in those ar­eas.

Su­per­vi­sor Mark Ri­d­ley-- Thomas has said he wants to add one in South Los An­ge­les, which is served by St. Fran­cis Med­i­cal Cen­ter, whose fu­ture is in limbo due to un­re­lated fi­nan­cial pres­sures.

So though prompted partly by the au­dit, the de­ci­sion to open Pomona Val­ley was largely due to So­lis’ inf lu­ence and the hos­pi­tal’s belief that it would be good busi­ness to re­join the net­work — un­der­scor­ing just how much trauma cen­ters re­main at the mercy of lo­cal pol­i­tics and hos­pi­tal f inances.

The Amer­i­can Col­lege of Sur­geons re­leased a state­ment this year call­ing for trauma cen­ter guide­lines that would be based on a com­mu­nity’s needs.

“When chang­ing eco­nomic for­tunes de­ter­mine the de­sir­abil­ity of trauma cen­ter des­ig­na­tion ... the re­sources avail­able for the care of in­jured pa­tients change with the eco­nomic tide,” the state­ment said.

In Chicago, for ex­am­ple, that tide shifted in 1988, when fi­nan­cial pres­sures prompted the Univer­sity of Chicago to close its adult trauma cen­ter.

As a re­sult, none of Chi- cago’s six high-level trauma cen­ters are in the city’s South Side, which ex­pe­ri­ences a dis­pro­por­tion­ate num­ber of shoot­ings.

Dr. Ron­ald Stewart, chair of the Amer­i­can Col­lege of Sur­geons’ com­mit­tee on trauma, said there haven’t been laws reg­u­lat­ing trauma cen­ters be­cause it’s not clear how in­de­pen­dent the net­work should be. There’s an un­re­solved ques­tion at the cen­ter of this de­bate, he said: “Is it mainly a busi­ness, or is the trauma sys­tem more like po­lice and fire,” which are public safety ser­vices?

He said the as­so­ci­a­tion plans to con­vene a work­ing group this year to de­velop trauma stan­dards.

The as­so­ci­a­tion rec­om­mends one or two trauma cen­ters per mil­lion peo­ple, which puts Los An­ge­les County well within that range.

Stewart said it’s im­por­tant not to have too many trauma cen­ters; re­search has shown that doc­tors and staff need a steady f low of pa­tients to main­tain their ex­per­tise.

When the trauma cen­ter at the for­mer King/Drew hos­pi­tal closed sev­eral years ago, the prob­a­bil­ity of death for trauma pa­tients at nearby Har­bor-UCLA de­creased by 31% — even though Har­bor treated 55% more trauma pa­tients be­cause of trans­fers, ac­cord­ing to re­searchers from the Los An­ge­les Bio­med­i­cal Re­search In­sti­tute at Har­bor-UCLA.

“It’s com­mon sense, if you think about it. The more of some­thing you do, you tend to be bet­ter at it,” Stewart said.

In gen­eral, trauma cen­ter lo­ca­tions should de­pend on a va­ri­ety of fac­tors, in­clud­ing pop­u­la­tion, in­jury rate and ge­og­ra­phy, Stewart said.

A re­cent UC San Fran­cisco study found that Cal­i­for­nia pa­tients were 21% more likely to die af­ter a trauma cen­ter clo­sure if they had a longer driv­ing dis­tance, com­pared with those who did not have a longer driv­ing dis­tance.

In 2003, with no new trauma cen­ters on the hori­zon, Los An­ge­les County of­fi­cials in­tro­duced a he­li­copter sys­tem to trans­port pa­tients if drive times would have ex­ceeded 30 min­utes.

Cathy Chidester, di­rec­tor of the county’s Emer­gency Med­i­cal Ser­vices Agency, said that sys­tem has helped the county main­tain a safe trans­port time.

And Dr. Re­nee Hsia, the UC San Fran­cisco study’s lead au­thor, agreed with that logic, say­ing that time, not dis­tance, is key.

“If the times are com­pa­ra­ble, it shouldn’t make that much of a dif­fer­ence for the pa­tient,” Hsia said.

How­ever, the au­dit re­leased last year noted that county of­fi­cials hadn’t col­lected enough data on the he­li­copter trans­ports to show that the sys­tem re­ally is ef­fec­tively serv­ing pa­tients.

Robert Gau­thier Los An­ge­les Times

A CAR CRASH vic­tim is wheeled from a he­li­copter, a trans­porta­tion sys­tem in­tro­duced in 2003 for drive times that would have ex­ceeded 30 min­utes.

Mark Boster Los An­ge­les Times

SU­PER­VI­SOR Hilda So­lis wants a fa­cil­ity at Pomona Val­ley Hos­pi­tal Med­i­cal Cen­ter, which she says would help pa­tients with­out strain­ing the hos­pi­tal.

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