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A Traumatic Future for Hospitals

County medical centers need a tax transfusion to avoid being shut down.

June 14, 2002|GAIL V. ANDERSON Jr. | Dr. Gail V. Anderson Jr. is medical director of Harbor-UCLA Medical Center and assistant dean at the UCLA School of Medicine. The views expressed here are his own.

Last month, a 10-year-old girl riding her bike home from school landed in the hospital after she was struck by a car and dragged for a distance. After stabilizing her, the hospital transferred her to Harbor-UCLA Medical Center for special surgical care.

Last fall at a Carson construction site, the roof of a giant sewage tank collapsed, impaling two workers with steel rods and injuring nine others. Harbor trauma experts provided critical surgical care.

After a 1998 oil refinery explosion, more than 100 of the refinery's workers and neighbors who developed breathing problems from smoke exposure sought care at Harbor's emergency department.

These events illustrate the fact that all of us, resident or visitor, may at some time need acute life-saving services from the public teaching hospitals of the Los Angeles County Department of Health Services.

Harbor and its sister county hospitals are the backbone of the greater Los Angeles network for trauma, emergency and critical care. This network provides care to half the trauma victims in the county, regardless of the insurance status of those who need help.

As the aftermath of Sept. 11 has so clearly underscored, these hospitals also are an important part of our community's civil defense. A reduction in these services would be a great and dangerous loss to the community.

Today, county hospitals are threatened by a decline in federal and state funds that would result in a $688-million cumulative deficit by 2005, forcing the Department of Health Services to begin shrinking the public health-care system immediately.

We should take action to protect the system even if it means paying more taxes.

Our county teaching hospitals are ideally positioned to respond to community crises such as terrorism, earthquakes and other natural disasters for a number of reasons:

* They are strategically located near potential terrorist targets. Los Angeles County-USC Medical Center is just east of downtown's skyscrapers and federal buildings. King-Drew Medical Center is near the Coliseum and the Sports Arena. Harbor is between the ports of Los Angeles and Long Beach, the South Bay oil refineries and LAX.

* They can quickly mobilize many physicians. Greater numbers of physicians are on site 24 hours a day at teaching hospitals than at community hospitals. Unlike many community doctors, most resident and faculty physicians are not spread out in multiple patient settings.

* They are pre-existing sources of expertise and medical information. Besides being on the forefront of trauma, emergency and critical care, Department of Health Services staff members have training and education in biological and chemical hazard response.

* Paramedics, sheriff's deputies, police officers and firefighters know and trust them.

Budget-cutting proposals that are being considered include complete or partial closure of at least two hospitals and major reductions in trauma- and emergency-care capacity. Reducing the Department of Health Services trauma capacity could dangerously strain the fragile safety net at a time when non-public-sector trauma centers are struggling with the high cost of providing this service.

The enemy of the trauma patient--rich or poor--is time. Increased travel distance and longer waits for operating rooms because of fewer centers could mean the difference in survival from a car crash. Victims of other time-sensitive conditions, such as heart attacks and strokes, could face longer waits for care if emergency-care capacity is reduced.

So how do we ensure the system will be here when we or our loved ones need it?

Certainly the county should continue to aggressively seek financial support from Washington and Sacramento. But all of us--you, me, our neighbors, even our region's tourists--need to take responsibility for creating a sustainable source of local funding.

For example, a new sales tax could be earmarked to support our network for trauma, emergency and critical care. When their trauma system was threatened with collapse in 1992, Miami voters passed a dedicated half-cent sales-tax increase to preserve that crucial service. We deserve the same chance to save ours.

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