Trauma System in Critical

Angelenos in need of emergency care are facing the threat of longer journeys to fewer facilities. Faced with a projected deficit in excess of $700 million in 2005, the L.A. County Department of Health Services has proposed to shut down two of its hospitals, increasing the burden on remaining hospitals countywide.

To avoid this prospect, Los Angeles County Supervisor Zev Yaroslavsky proposed Measure B, a county ballot measure to generate funds for emergency and trauma care. Measure B would tax all residential and commercial buildings by 3 cents per square foot, effective July 1 of next year. For a 1,500-square-foot home, that would amount to $45 annually. The measure requires endorsement of at least two-thirds of voters in order to pass.

“If you’re a hospital and you have a trauma center or an emergency room, [by law] you must see anyone who’s wheeled through the door or walks through the door,” Yaroslavsky told The Journal. “If a hospital feels it can’t afford [to provide that kind of care], they have one of two choices: They either go broke or they close their trauma center or emergency room in order to salvage what’s left of the hospital.” Closure of a single trauma center or emergency room “will inundate the rest of the system,” he said.

Harbor-UCLA Medical Center in Torrance is one of the hospitals slated to close as part of the county’s cost-cutting measures. If that happens, the South Bay would lose its only trauma center. There are currently 13 trauma centers in Los Angeles County, hospitals equipped to deal with the most serious of injuries, such as car accidents and gunshot wounds. Unlike typical hospitals, trauma centers have specialized programs, equipment and staff (including a trauma surgeon) available at all times.

“If we lose one of these centers, it’s just going to critically stress all the rest of them,” said Dr. Daniel Marguiles, head of Cedars-Sinai Medical Center’s trauma service.

Nontrauma emergency care faces a similar, though slightly less urgent, strain on the system. Emergency care is costly, and the combination of uninsured patients and use of emergency departments for nonemergency conditions taxes the system. The majority of state emergency rooms operate at a loss according to Jan Emerson, vice president of external affairs for the California Healthcare Association. If county plans proceed, the Valley will have one less emergency room when Olive View-UCLA Medical Center in Sylmar is converted into an outpatient clinic.

The county’s deficit stems from a number of factors, including dramatically declining federal and state support, which exacerbates the challenge of providing health care to the 31 percent of the county’s residents who are uninsured. According to the California Department of Health Services, Los Angeles County trauma centers provide more than $57 million in unreimbursed trauma care annually. The county’s three trauma centers — L.A. County USC Medical Center, Martin Luther King/Charles Drew Medical Center and Harbor-UCLA Medical Center — together handle close to 55 percent of all countywide trauma cases.

Measure B would generate an estimated $168 million annually to preserve and maintain emergency medical services and the trauma system, and to bring trauma services to three areas — Pomona, the eastern San Gabriel Valley and the Antelope Valley — where none currently exist. The measure includes a bioterrorism response component to pay for medications, professional training and other related resources. Supporters include the League of Women Voters, the Hospital Association of Southern California, Rep. Jane Harman (D-Venice) and the director of the county’s Emergency Medical Services Agency.

Opponents say voters are already paying taxes that are supposed to support trauma care, that state budget mismanagement and federal immigration policy are to blame, and that the tax will “open the floodgates for additional taxes,” according to arguments in the sample ballot.

As an alternative to Measure B, Supervisor Michael Antonovich has proposed a voluntary system enabling property owners to contribute to the trauma system by means of a check-off box included on county property tax bills. “While the goal of a source of funding for trauma care is a worthy one, the means of burdening the homeowners with higher taxes is wrong,” Antonovich said of Measure B.

In addition to Antonovich, those listed on the sample ballot as opposed to Measure B include the president of the Howard Jarvis Taxpayers Association, the chair of the board of Antelope Valley Hospital and several businessmen.

Los Angeles County Trauma Centers

Los Angeles County currently has 13 trauma centers to serve a population of 10 million residents:

Cedars Sinai Medical Center – Los Angeles

Children’s Hospital of Los Angeles

(pediatric patients only) – Los Angeles

Harbor/UCLA Medical Center – Torrance

Henry Mayo Newhall

Memorial Hospital – Newhall

Huntington Memorial Hospital – Pasadena

L.A. County USC Medical Center – Los Angeles

Martin Luther King/Charles Drew

Medical Center – Los Angeles

Long Beach Memorial Medical Center –

Long Beach

Northridge Hospital Medical Center – Northridge

Providence Holy Cross Hospital – Mission Hills

St. Francis Medical Center – Lynwood

St. Mary Medical Center – Long Beach

UCLA Medical Center – Westwood