Grossmont District Hospital administrators will meet with state health officials today to discuss alleged deficiencies in the hospital's emergency services which were uncovered in a recent investigation prompted by the death of a trauma patient on Christmas Day.
A report released Wednesday by the California Department of Health Services listed 11 areas in which Grossmont's practices failed to meet state standards. Although the hospital provided the state with its plans for correction last week, Ernest Trujillo, district administrator for the agency, said Grossmont administrators had yet to satisfactorily resolve three of the deficiencies.
Most of the deficiencies centered on the hospital's treatment of Nickey Trevino, a gunshot victim who was admitted on the morning of Dec. 25. Although Grossmont was designated as one of the county's six trauma centers at the time, no surgeon was present to operate on Trevino. Even after the on-call surgeon was notified that the patient's life was in danger, he failed to respond in time. Trevino eventually was flown by helicopter to UC San Diego Medical Center, where he died.
Although Ron Dahlgren, the hospital's chief administrative officer, has emphasized that the Trevino case was an isolated incident, the state's report on Grossmont cited "other instances in which a surgeon was not available within 20 minutes after a call-back for a life-threatening situation."
At a news conference Wednesday, Dahlgren defended the hospital's emergency response record, noting that in half of the life-threatening situations it had handled, on-call surgeons had responded before the patient arrived, and that in 90% of the cases, the response time had been 15 minutes or less.
Dahlgren added that apart from the Trevino case--when the surgeon had taken 42 minutes to respond--the slowest response time had been 27 minutes, within the 30-minute requirement established by the Joint Commission on Accreditation of Hospitals (JCAH).
But in his report, Dr. Carlton J. Peterson, physician-consultant to the Health Services Department, said Grossmont was required to have surgeons available within 20 minutes as part of its commitment to provide basic emergency medical service. Trujillo said this requirement was imposed in a memorandum from the department's Sacramento headquarters, and that he could not compromise on it.
Dahlgren said hospital administrators have yet to receive written notification of the 20-minute requirement from state officials, adding that JCAH informed him March 21 that it still only mandates that surgeons be available within 30 minutes.
"We are not attempting to be confrontative with the implied interpretation by the state of 20 minutes, but due to the clarification received from JCAH . . . we shall perform under that (30-minute) criteria," Dahlgren stated in his reply to the state report.
Although he said the 20-minute response time might be difficult and costly for the hospital to implement, Dahlgren said the hospital would comply with whatever requirement was agreed upon today. The Health Services Department cannot fine hospitals to enforce compliance, but it can refuse to grant part of the hospital's license, Trujillo said.
Six of the other deficiencies cited in the state report stemmed from the hospital's loss of a tape of radio communications between hospital personnel and paramedics responding to the Trevino case. The loss of the tape, which Dahlgren said was probably stolen, impeded the hospital's investigation of the case.
In his response to the state's report, Dahlgren said the loss of the tape had prompted the hospital to "maintain stricter control over access and accountability of the tapes," which he said are now kept under lock and key.
The Trevino incident occurred during the final days of the Grossmont's status as one of the county's six trauma centers. The hospital's board of directors had voted Dec. 18 to abandon trauma center status Jan. 3, ostensibly because of excessive costs and insufficient patient use.
However, Grossmont's trauma unit had been criticized by county health officials who charged that surgeons were not always present when patients arrived, as stipulated under trauma center regulations. There were also rumors of morale problems among trauma unit surgeons, who were not compensated for the hours they spent on call.
Responding to questions about the Trevino case Wednesday, Dahlgren would not disclose what reason the surgeon had given for failing to respond immediately to his call on Christmas morning. Although he said the physician had been disciplined, he would not elaborate on the nature of the punishment, saying only that the doctor is still on the hospital's staff. Nevertheless, he said the chances of a similar incident occuring in the future were remote "because of the trauma we've gone through in this matter."
"For the loss of one surgeon coming in, some of our reputation was lost," Dahlgren said, though he continued to stress, "that was (only) one surgeon, one case."
The other two deficiencies to be discussed by Dahlgren and Trujillo today are not connected with the Trevino case, but were discovered by Peterson during his inspection of the hospital on Jan. 30.
One involved Grossmont's failure to establish adequate bylaws for each of its departments, while the other pointed out the hospital's lack of specific requirements for continuing medical education for its personnel.
Dahlgren said the hospital was not aware that these requirements were mandated by the state Administrative Code. Trujillo said he expected "no problems" in securing the hospital's compliance with these directives.