County health officials are in delicate talks aimed at opening the first trauma center in nearly a decade, a move that is pivotal in the effort to close the trauma unit at Martin Luther King Jr./Drew Medical Center.
The proposed trauma center, at California Hospital Medical Center in downtown Los Angeles, would serve 1,000 of King/Drew's estimated 1,800 trauma patients in the coming year -- more than any other neighboring hospital.
Creating the unit would mark a rare reversal after decades of trauma centers and emergency rooms closing because of financial problems.
Since the 1980s, 10 trauma centers have shut down, leaving the county with only 13 to handle the most serious emergency situations like gunshot wounds and car accidents. During the same period, 18 emergency rooms have closed, the latest being Northridge Hospital Medical Center's Sherman Way campus on Monday. Emergency rooms handle less urgent medical cases, such as chest pains and cuts.
California Hospital, a cluster of red tile buildings just north of Grand Avenue and Venice Boulevard, would be an attractive location for a trauma center because it is near the Harbor and Santa Monica freeways.
The hospital's history with trauma care, however, offers a sobering look at the struggles to pay for emergency care, which often goes to the uninsured.
California Hospital Medical Center was part of the first network of trauma providers in Los Angeles in 1984. It was the first to pull out in December of that year, citing major financial losses because most of the patients didn't have insurance.
Earlier this year, the hospital was about to sign a contract with the county to care for 660 trauma cases a year for up to $1.6 million. But after complications ensued, the item was pulled from the county Board of Supervisors' July 13 agenda. County health officials worried whether the hospital would have enough doctors to cover calls. And California Hospital officials said they worried the number of patients was too small to compensate for the costs of running a trauma center.
Joining the trauma system requires a deep financial commitment. A trauma hospital must be able to tap a general surgeon immediately, 24 hours a day, and bring in a host of other surgeons, including neurological and vascular, within 30 minutes. They also require specially trained nurses and a helipad.
California Hospital lost $12.3 million in the 2002-03 fiscal year, including more than $2 million from patients unable to pay, according to state data.
The hospital has declined to answer numerous requests for details of finances and would not discuss its decision-making process, citing a desire not to upset negotiations with the county. But spokeswoman Katreena Salgado did say the hospital intended to announce a decision by early December.
The hospital's emergency room in particular has been struggling because of a rise in the number of uninsured patients. It also has treated severely injured patients even though emergency rooms are intended for less urgent injuries, Salgado said.
Many patients arrive at the emergency room in bad shape because they are dropped off in "homeboy ambulances," she said. The term refers to the common practice among gang members of driving wounded friends directly to hospitals instead of getting an ambulance.
As a result, Salgado said, "We tend to get the gray area between trauma and ER already."
Hospitals must care for all who arrive at their emergency rooms but often receive no payment from uninsured patients, said Jim Lott, a spokesman for the Hospital Assn. of Southern California. A typical trauma patient costs about $18,000 to treat, he said. In the past, the association has placed the average at $250,000 per patient. Lott said the higher figure is for the most severe cases.
One benefit of joining the county's trauma network is that the county would reimburse about 75% of a hospital's cost if the patient is classified as a trauma patient, he said. Private insurers, Medi-Cal and Medicare also would pay the hospital at a higher rate for trauma patients.
Still, Lott said the county reimbursement cannot offset the general fiscal losses of running an emergency room. And a hospital like California would also have to pay out of its own pocket to set up a trauma center.
To turn a basic emergency department into trauma center can cost as much as $4.5 million, said Glenn Melnick, a USC professor of healthcare economics. But if California Hospital is already equipped for some services that a trauma center provides, he said, the start-up cost may go down to about $2 million.
"My experience with that hospital is those people are pretty careful about their finances," he said. "I suspect that they've done the analysis and [a trauma center] will generate enough revenue from patients that have insurance, plus enough revenue from trauma subsidy to make a go of it."