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Rising Costs Are Taxing Burn Centers : Health care: Uninsured patients, expensive treatment and hospital closures put a strain on the county's three remaining facilities.


The signs for Robert Martinez were not good when he arrived at the hospital four months ago. They rarely are when a body is stripped almost completely of the familiar insulating layer called skin.

With more than 80% of his body burned in a refinery steam explosion, his lungs horribly damaged by contaminants from the blast, Martinez could breathe only with the aid of a ventilator as he lay comatose in his specially equipped bed at Torrance Memorial Medical Center.

That he was covered nearly head to toe in bandages and splints provided dramatic visual evidence to only part of his plight. His body was so traumatized that all of his organs were failing. Infections were ravaging through his wounds. His eyelids were blistered shut. The fact that he was already severely deaf seemed almost trivial.

"Just think of the horror of the situation where he couldn't hear, he couldn't talk and he couldn't see, and all he could feel was indescribable pain," said his primary physician, Dr. William Davies. "It was the ultimate in bad trips."

But it wasn't Martinez's final trip. Last week, he went home, an achievement that stunned even the battle-weary crew that work at the hospital's prestigious burn center. That the 26-year-old construction worker is still alive is a testament to the strength of the human body and to the expertise of the specialized group that assembles at the burn unit to care for people traumatized beyond recognition, and often, beyond hope.

Despite recent advances in burn care, critical-care centers such as Torrance's have been disappearing in the past decade at an alarming rate, victims of soaring health-care costs that have led to the near-collapse of trauma care networks throughout the nation.

Nowhere is that more true than in Los Angeles, where nearly a dozen hospitals have pulled out of the once-prestigious critical-care network in recent years and the number of beds for acute burn victims has decreased by nearly 50%.

Burn centers have been hit especially hard by rising medical costs. There are few traumatic injuries more expensive to treat than burns, largely due to the intensive, round-the-clock care and multiple surgeries required for those patients. And a disproportionate share of burn patients are uninsured, according to medical experts, forcing hospitals to absorb the costs, which can easily exceed more than $500,000 for a single patient.

Brotman Medical Center in Culver City was forced to close its burn center five years ago, citing significant losses, due in part to a reduction in government reimbursements. The burn center received national attention after pop star Michael Jackson was treated there after the back of his head was burned during the filming of a Pepsi commercial.

Jackson later gave the hospital a large endowment for research into burn treatment and the singer reportedly was extremely angry when the center--which bore his name--shut its door with little notice.

Torrance hospital officials placed their burn center on the critical list a few years back, citing the growing number of uninsured patients that they were required to treat because the county burn beds were filled. In 1989, the hospital wrote off as charity almost $1 million--the amount it cost the hospital to treat six burn patients.

Hospital officials later went public with their problem, saying that unless the county emergency network could figure out how to place more burn victims in county hospital beds, the medical center would have to shut down the unit because it could no longer afford to care for so many uninsured patients.

So far that has not happened, but hospital officials say the problem remains unresolved. If there is a major disaster in the area, they say, it could force the county's three remaining burn centers back into intensive care.

"It's a constant struggle," said Ray Rahn, chief operating officer of Torrance Memorial Medical Center. "It's a big gamble for a medical institution. The exposure is always there and in a catastrophic case, where you would have dozens of burn victims, it could make the difference."

County health officials say the problem is compounded by limited reimbursement provided to the hospitals by the state. Health care officials estimate that an acute care patient costs the hospital $4,000 per day, which Medi-Cal reimburses at a rate of $1,600. Indeed, a single burn patient can easily use more than $100,000 worth of wound dressings during a typical stay.

"A patient with a 70% to 80% burn can be a tremendous financial burden," said Dr. A. Richard Grossman, director of the Sherman Oaks Community Hospital burn center. "And now that we can save those patients that we couldn't save years ago, it's a much more costly process than ever before. But who can put a dollar value on a child's life? When they come in, we just do what we do."

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