County health officials started the clock Monday and issued a no-nonsense warning to Palomar Medical Center, giving the besieged facility 60 days to fix its doctor shortage or lose its trauma care credentials.
Though North County's only trauma center has been rocked by disputes since last June, county and hospital officials said they are optimistic that a solution can be reached so health officials won't have to strip the facility of its trauma care credentials.
"We hope they can resolve the issue and get back into the fold," said Dr. William Cox, director of the county Department of Health Services.
At Palomar, where the trauma center has been shut since Dec. 23, officials have struggled to woo more orthopedic surgeons to work at the facility--a process that has met with little success.
And, they also are trying to sweeten the deal for their own seven disgruntled orthopedic surgeons, which has resulted in only one signed contract by Monday afternoon, said hospital spokeswoman Amy De Noble.
"We're still optimistic. We feel Palomar Medical Center has a mission to serve the community and it's important that we remain a trauma center," De Noble said. "We're concerned and we're committed."
Others in the medical community expressed disappointment--though not surprise--that Palomar hadn't forged an agreement that would have preempted the county's warning.
"I had thought and hoped Palomar would have been able to resolve what amounts to no more than labor issues with specialist physicians in North County," said Jim Lott, president of the Hospital Council of San Diego and Imperial counties.
In a Feb. 14 letter sent to the striking orthopedic surgeons, Palomar's administrator, Victoria Penland, posed a financial solution and wrote: "Yes, I agree that there are problems and inequities within the system as it currently exists--but I would like us to work together to fix the system--not destroy it."
Penland did not return calls to her office on Monday.
In her letter, however, she asked the doctors to cooperate in signing a contract, an action that--if enough doctors had taken it--would have prevented the need for the county's warning.
"I am requesting your commitment in helping Palomar Medical Center come back on line as a full trauma center by Wednesday, Feb. 19," she wrote in a plea that went largely unheeded.
Under Penland's proposal, the orthopedic surgeons would be paid for the operations they performed, rather than the existing method of paying an on-call stipend of $520 for 24 hours. This way, according to her letter, the doctors would be guaranteed payment--a point of concern to the doctors who say they are frequently unpaid by trauma patients, 40% of whom lack health insurance.
Penland also suggested that Palomar take over the billing responsibilities for the doctors. With a specially trained staff, she wrote, the hospital might be able to improve collection rates.
At Palomar, the orthopedic surgeons have long maintained that they are burned out and inadequately paid for their 24-hour call duty. But Penland's solution drew few takers. As of Monday afternoon, only one doctor had signed a contract.
In re-establishing the trauma system, hospital officials had hoped to sign up nine doctors. But a $60,000 search for orthopedic surgeons, initiated in January, has yielded only four interested candidates and no signed contracts.
In the months since Palomar shut its center, about 60 patients have been dispatched to the county's other trauma facilities. But the increased workload has not been overwhelming for the other five centers.
"There have not been any hospitals overburdened by this," said one hospital official, who requested anonymity.
The apparent ease with which other hospitals picked up Palomar's trauma patients will come under scrutiny as a county task force re-examines the trauma system.
In the months ahead, the task force is expected to tackle key questions about the county's system, including the number of trauma centers needed to serve the community.