Officials at UCLA Medical Center and Daniel Freeman Memorial Hospital fear that their ability to serve the Westside as part of the county's prestigious trauma center system will be impaired if more hospitals are added to the program.
Brotman Medical Center and Santa Monica Hospital Medical Center, which are fighting to be named trauma centers, will take their appeal to the Board of Supervisors on Jan. 15.
Brotman and Santa Monica claim their services are needed in the Westside and say their participation would enhance the county's program of round-the-clock medical care for the critically ill and injured at designated trauma centers.
Opponents say the additional designations would take patients away from existing trauma centers, thereby depriving doctors of the opportunity to treat trauma victims. They say that would jeopardize the quality of care and the training of trauma physicians.
The opposition includes the existing trauma centers at UCLA and Daniel Freeman, the county Department of Health Services and the American College of Surgeons, whose guidelines were used in establishing the county's trauma center program in December, 1983.
Some observers say the crux of the dispute is money, not quality of care. They point out that a trauma center designation can be an effective marketing tool, although some hospitals have lost money on their trauma centers. In addition, some hospitals fear that new trauma centers will drain off some of their paying clients.
Dr. Albert Yellin, chairman of the American College of Surgeons' Southern California committee on trauma care, said that it has recommended that trauma centers be able to attract enough patients to keep medical teams practiced in trauma care.
The American College of Surgeons recommended that trauma centers see a minimum of 300 trauma patients a year, with an even higher volume of 500 at so-called Level 1 trauma centers. Level 1 centers must offer physician training and research and must have heliports; Level 2 centers offer the same 24-hour medical care as Level-1 centers, but are not required to have heliports or residency programs.
In the Westside, UCLA Medical Center and Cedars-Sinai Medical Center are designated Level 1 trauma centers; Daniel Freeman in Inglewood, which serves Culver City and West Los Angeles, is a Level 2 center; Santa Monica and Brotman are seeking Level 2 designations.
UCLA and Daniel Freeman would be more affected than Cedars by the addition of Santa Monica and Brotman as trauma centers, said Virginia Hastings, chief of the county's Trauma Hospital Project. Both Brotman and Santa Monica hospitals are within UCLA's designated area, and Brotman is in Daniel Freeman's area, she said.
Hastings said that the health department originally estimated that Cedars would receive about 500 patients; UCLA, about 400, and Daniel Freeman "well above" the county's minimum guideline of about 350.
She said that the county has estimated that if Brotman and Santa Monica were added as trauma centers, the UCLA-area caseload would be divided as follows: Brotman, about 160; Santa Monica, about 120; UCLA, under 100.
Yellin said that if either Brotman or Santa Monica were to be designated as a trauma center, it would have "a major impact in drawing patients away from Daniel Freeman and UCLA."
At UCLA, he said, this would have a "catastrophic impact." Marshall Morgan, director of UCLA's Emergency Medicine Center, said that although Brotman and Santa Monica are excellent hospitals, "to designate them would essentially destroy the system as we've planned it. . . . We would have three centers (in UCLA's territory) and each would receive fewer than half as many patients as it should to function as a bona fide trauma center."
He said that UCLA receives about 350 trauma patients a year, but if Brotman and Santa Monica were added, UCLA's patient load would drop to less than 150.
At that rate, Morgan said, the center would not be able to offer residents enough practice in the care of trauma victims, thus jeopardizing the quality of care and UCLA's ability to provide training for trauma surgeons, he said.
Officials said that Daniel Freeman would also be affected by the additional designations, but the impact would be primarily financial.
Hastings said that according to the county's estimates, Daniel Freeman's caseload would remain above the minimum guideline of 350 even if Brotman were added.
But she said that Brotman would draw away Daniel Freeman's primary source of paying patients from Culver City and West Los Angeles, leaving Daniel Freeman with a predominantly non-paying clientele.
Steven Goe, vice president of administration at Daniel Freeman, said adding Brotman as a trauma center would "work a severe hardship (on Freeman), and put in doubt whether we can continue to serve as a trauma center for this community."