Tri-City Suffers Rebuffs in Bid for Trauma Status

Tri-City Hospital of Oceanside was dealt a series of damaging setbacks Tuesday in its efforts to become part of San Diego County’s network of trauma care hospitals.

The Board of Supervisors voted 4-0 to keep Tri-City representatives off the key committee of doctors and county officials that monitors the fledgling network by reviewing each patient case brought to the six hospitals now in the system. Tri-City wants the knowledge that comes from sitting on the committee to enhance its chance for designation as a trauma hospital later this year.

The board also voted to have the six hospitals in the system meet with top county officials to explain why the facilities have threatened to shut the network down if Tri-City is added. Chief Administrative Officer Clifford Graves is to report to supervisors within two weeks on the substance of those talks.

The chief lobbyist for the hospitals expressed satisfaction Tuesday. “We heard encouraging things from the board members today,” said Ben Clay, whose clients have argued that an additional hospital will result in both economic problems for present members--all of whom are now losing money on their trauma units--and a reduced level of health care.

Tri-City officials acknowledged that the two votes--which they called politically motivated--could hurt their goal of gaining trauma center designation in six months when a special health committee reviews the hospital to see whether it has corrected deficiencies in Tri-City’s existing trauma care unit.

The board actions came just one week after supervisors had voted unanimously to reconsider Tri-City for trauma membership at the end of the six-month period. That vote had set off a harsh reaction from the current system members, who afterward implied they would not sign long-term contracts with the county if Tri-City was added. Contracts expire Tuesday, and Clay said his clients did not want to make expensive commitments until the number of trauma hospitals was decided by supervisors.

As a result, several supervisors Tuesday backed away from any commitment to a future designation of Tri-City, even if it passes muster in a future medical review.

“I want to make clear that all I said last week was that we would take a look at Tri-City again (in six months),” Supervisor Susan Golding said. “I certainly don’t believe at present that (an additional hospital) is good,” indicating support of Clay’s position.

Supervisor Brian Bilbray agreed with Golding that the maximum number of hospitals must be decided before any move to designate Tri-City.

Bilbray further asked county health officials whether Tri-City was taking trauma patients away from Scripps Memorial Hospital in La Jolla, now the designated center for the county’s north coastal area. Clay said after the meeting that his clients also “have an opinion” that Tri-City is violating county policy.

Tri-City has a contract to dispatch paramedics to accident scenes in North County. At the scene, paramedics take direction from Scripps. Tri-City has testified that it treats a substantial number of people suffering from trauma--major injuries such as those suffered in auto accidents, shootings and knifings--but said it does so at the direction of Scripps. Trauma victims in North County often cannot be helicoptered to Scripps because of bad weather or mechanical problems and are ordered by Scripps to be taken to Tri-City.

County health officials Tuesday could cite no instances in which they have warned Tri-City that the hospital was taking trauma patients away from the system. “We’ve had no formal complaints,” said Gail Cooper, the health official in charge of trauma planning.

The lack of substantiating data led Tri-City officials to call Tuesday’s moves politically motivated by the current trauma hospitals to protect themselves economically.

“It’s clear that they are trying to exercise their power and control to keep Tri-City out of the system,” attorney Gregory Garratt, the lobbyist representing Tri-City, said. “Whether they can force the supervisors to make that decision or whether the board will act on the basis of what’s best for North County residents, I don’t know.”

Tri-City argues that long distances to Scripps from North County make it desirable to designate Tri-City as a trauma facility.

The trauma hospitals, while encouraged Tuesday, still want a decision on the total number of centers made before the end of the six-month period set by the board last week, said Richard Keyser, president of Mercy Hospital Medical Center. Keyser, who was representing the trauma centers, said the contracts expiring Tuesday will probably be extended temporarily until the results of the talks with county officials are known.

“No one wants to shut the system down,” Keyser said. However, he said none of the six hospitals wants to sign a three-year contract without first knowing whether another facility is to be added later, diluting the number of patients, driving up costs and possibly resulting in poorer overall care.

In addition to Mercy and Scripps, the trauma centers include UC San Diego Medical Center, Sharp Memorial Hospital, Palomar Hospital in Escondido, and Children’s Hospital for victims 14 year and under.