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Trauma wars 

The surgical gloves are off over a contentious trauma system plan

Here’s what could happen that worries Dr. Clint Slaughter. A man has an accident while offroading at the Oceano Dunes. He has a chest injury, an aortic disruption, and is bleeding internally. Paramedics arrive and quickly assess they’re dealing with a trauma patient with multiple severe injuries. They load him into the ambulance, but instead of heading 3.5 miles and about seven minutes to Arroyo Grande Community Hospital, they hop on Hwy 101 and drive 15.4 miles—about 20 minutes—to SLO County’s only official trauma center: Sierra Vista Regional Medical Center in San Luis Obispo.

No one yet knows which option is better, or even whether Sierra Vista will become the designated trauma center. But in the coming months, local health professionals will determine whether a single, centrally located trauma center in SLO County would truly be the best way to treat trauma patients or whether Slaughter’s and others’ fears are justified. “We don’t know what’s going to happen,” Slaughter said.

Nearly every health professional you ask about the plan will likely note their first priority is patient care, but that’s not to say money isn’t a consideration. Even Slaughter, who works at the Arroyo Grande hospital, admits no one in the debate has no more in mind than simple altruistic passion for patient care.

“Everybody’s trying to figure out the right thing to do,” he said. “But also, everyone’s kind of biased because it affects their business.”

According to the California Emergency Medical Services Authority, a state agency, there are reimbursement funds to offset the costs of upgrading a hospital to meet trauma-center criteria. And treatment for trauma patients results in higher charges than for other patients who receive emergency care, according to local health officials and an EMSA spokeswoman.

There’s been criticism of the people behind the plan. “Sierra Vista essentially runs the EMSA board,” Slaughter remarked to county health commissioners on April 12. Thomas Ronay is the SLO EMSA Medical Director, essentially the top local official who reports to the state EMSA. Ronay also practices emergency medicine at Sierra Vista. Ronay couldn’t be reached for comment.

For two years local emergency room doctors, hospital administrators, County Public Health officials, paramedics, and a slew of other professionals have been hammering out the San Luis Obispo County Trauma System Plan. Opinions differ, to say the least, particularly over a key piece of the plan that designates just one hospital as a trauma center. The plan, which included that contentious element, was recently shipped to the state EMSA for approval.

“There has been an ongoing difference of opinion voiced by a few individuals who have come to the meetings as to what the negative consequences could be related to designation of a single trauma center in our county,” Public Health Officer Penny Borenstein said.

The county’s four hospitals are owned by two healthcare providers: Sierra Vista and Twin Cities Community Hospital by Tenet Healthcare; Arroyo Grande and French Hospital Medical Center by Catholic Healthcare West.

At a recent Health Commission meeting it was easy to see where biases lay. A collection of ER docs
who spoke against the plan worked
for Arroyo Grande and French Hospital. On the other hand, representatives from Sierra Vista tended to speak in favor.

As written, SLO County’s plan calls for just one centrally located trauma center, leaving just Sierra Vista and French. But it’s not difficult to interpret that Sierra Vista is the top contender and may be the only applicant.

“We’ve been serving this capacity for many, many years; we’d like the official recognition,” said Ron Yukelson, a spokesman for Sierra Vista.

French Hospital CEO Alan Iftiniuk said the hospital is considering applying for the designation, but wouldn’t say for certain.

“If French can support its mission of meeting the needs of the community, we would consider applying for that designation of level three,” he said. What’s a level three designation? According to some doctors, not much.

Trauma centers range from level one at the highest, to level four at the lowest for care. But there’s a big drop off in effectiveness after level two, some say. According to local doctors, a level-three center hasn’t proven to be any better than an undesignated hospital. Other health officials acknowledge there have been very few studies on level-three centers.

Furthermore, Twin Cities and Arroyo Grande—the only hospitals that can’t be trauma centers under the plan—have the top two rates of ER visits in the county, respectively, according to the trauma plan. Sierra Vista has the third highest ER traffic.

Why would a hospital want to be trauma center?

Aside from gaining some outside funding, any local hospital designated as the trauma center would receive most, if not every, trauma patient in the county. Statistics on local trauma patients are fuzzy because without an official trauma center there technically aren’t “trauma” patients. But according to the best guess of the consultants who compiled local data, there are between 200 and 300 trauma patients in the county each year, who historically have gone to the closest hospital and were later transferred after being stabilized if they needed further specialized care.

The relatively small patient population (about one patient per 1,000 residents) is the limiting factor for a local trauma center. “Trauma system care is a very specialized care and in order to remain a trauma center, a trauma center has to have enough volume … they have to maintain their proficiency,” SLO EMSA Executive Director Charlotte Alexander said. In other words, practice makes perfect for trauma specialists, and filtering patients to multiple trauma centers would mean less practice for specialists at each hospital.

Regarding critical patients on the verge of death, Alexander emphasized, “They’re going to the closest hospital.”

A patient’s ambulance bill could be more expensive. If, for instance, San Luis Ambulance—the county’s largest designated ambulance provider—picked up the patient at the Dunes and transported him to SLO instead of Arroyo Grande, the extra mileage would cost about $237 based on a rate of $19.85 per mile on top of the base rate of $1,867.35, according to the county’s service rate schedule. However, General Manager Chris Javine said some patients are currently transported to one hospital, then redirected to another to receive specialty care.

“So there could be a potential for, actually a savings [with a trauma center],” he said.

State EMSA officials still have to review the plan for approval, after which local officials will begin accepting applications and bids from Sierra Vista and possibly French Hospital to become the designated trauma center. Yet it’s unclear whether protests over the plan will stop.

“At the end of the day I think you’ve got intelligent people viewing the situation differently,” Borenstein said.

Staff Writer Colin Rigley can be reached at crigley@newtimesslo.com.

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