County OKs Funds for Trauma Network

The Board of Supervisors on Tuesday agreed to pay private hospitals up to $8.5 million by next July to temporarily shore up the county’s teetering trauma system, insisting nonetheless that the problem cries out for long-term statewide solutions.

The board also voted to accelerate payment of fees to physicians who provide trauma and emergency care.

The actions came in response to what health officials deemed a trauma funding crisis. Several of the 10 private hospitals in the county’s 13-hospital system warned recently that they would pull out unless they were better paid. Physicians complained of months-long delays in payment, which has discouraged an increasing number from signing up for on-call trauma and emergency duty.

Board members agreed to provide the additional money to the system only on the condition that health officials pursue a more stable source of funding for trauma programs through state legislation.

As it stands, counties bear responsibility for these costly programs in California and, in this tumultuous health care economy, many are scrambling to keep them afloat.

But nowhere is the problem more pronounced than in Los Angeles County, with its deficit-plagued health system, vast numbers of uninsured people, huge geographic spread and competitive health care marketplace.

“My continuing frustration is why [do] we continue to get stuck in the middle of this problem,” said Supervisor Don Knabe. “I would think [Sacramento] would recognize . . . the importance of a trauma system.”

“The long-term issue has to be addressed,” said Supervisor Zev Yaroslavsky, who has threatened to place state funding for trauma care on the ballot in 2002 unless legislators act. “We need a permanent, stable and dependable source of revenue.”

A decade ago, the county spent $9 million a year to help private hospitals pay for the care of the uninsured patients who make up 30% to 40% of those in the trauma system. But the money has declined steadily, and this year amounts to $1.5 million.

The immediate reason for this year’s crisis was a dramatic cut in money that the state passes along from its tobacco tax receipts. Private hospitals rely on those funds to pay for the care of uninsured trauma patients.

Faced with a 50% cut in that money this summer, the hospitals would agree only to month-to-month contracts with the county.

Although the county was prepared to offer the hospitals $17 million over two years, the hospitals decided to accept a one-year agreement for as much as $8.5 million so that a search for permanent funding would not be postponed.

But James Lott, executive vice president of the hospital trade group, the Healthcare Assn. of Southern California, said Tuesday that he is not optimistic about state action.

“I just don’t see the response we need from Sacramento,” he told the supervisors.

He explained in an interview that there is “a huge anti-Los Angeles sentiment” in the Legislature and that the governor’s office has offered no encouraging signs.

Doctors expressed dismay as well, as they predicted similar crises and last-minute bailouts in the future.

“This is just a temporary fix,” said Dr. Daniel Higgins, medical director for emergency services at St. Francis Medical Center in Lynwood. “There will be another crisis early next year.”