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Clinton's program might breathe new life into local trauma centers

Los Angeles Business Journal, Oct 18, 1993 by Tim Deady

President Bill Clinton's proposed health care reform package could rescue Los Angeles County's hospital emergency rooms and trauma centers, according to many local industry experts.

But an almost equal number of hospital administrators and officials believe the proposal does not address some critical issues and offers only minimal help in meeting what has been called a crisis in emergency care in Los Angeles County.

Because of the expense of operation, 11 of the county's 23 hospital trauma centers and 10 of 96 emergency rooms have closed since 1985. A trauma center is a major medical unit that is staffed with a full-time surgical team and is equipped to handle all life-threatening emergencies. A traditional emergency room does not have a full-time surgical team and is generally just staffed with a minimum of one physician specializing in emergency room care.

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So far none of the local hospitals that closed emergency facilities has rushed forward with plans to reopen them. But there are several industry representatives and hospital administrators who fully expect that some will be reopened because of Clinton's reform package.

"It's our sense that many will reopen," said David Langness, a spokesman for the Hospital Council of Southern California, a Los Angeles-based trade group. "They closed because they had to treat uninsured patients and as a result they had multimillion-dollar losses. With universal access to health coverage, many more people will have insurance and that should be an incentive for some of these facilities to reopen."

Hospital trauma centers and emergency rooms are required to see all patients who come into the facility, regardless of the severity of their injury or illness or whether they have insurance.

If an uninsured person goes to an emergency facility with a nonemergency condition, the hospital can refer him or her to a public hospital. If the condition is life-threatening or requires immediate attention, the hospital, under state law, must treat the patient, regardless of whether he or she has insurance.

Among the emergency facilities that have closed, about 50 percent of their patients required medical attention but did not have insurance.

Because the emergency services to the uninsured were such a drain on the hospitals' finances, administrators over the past decade have closed the units.

Richard Brown, a professor of public health at USC and a member of First Lady Hillary Rodham Clinton's task force on health care reform, said the issue of hospital emergency care was addressed by the group.

"Emergency care is obviously something that is needed and is covered by the plan," he said. "It's difficult to say for sure but the plan should provide the revenues needed to sustain emergency room services. But what has to be done is a serious effort to locate these centers correctly. They should be a reasonable distance from each other -- not too far apart or not too close together."

A spokesman for the American Hospital Association, the Washington D.C.-based trade group that represents the nation's hospitals, said the reform package as proposed should help finance emergency units but such facilities would be unnecessary in every hospital.

"If the package works as it should, hospitals in an area would work as a unit to provide services, including emergency care. Not every hospital in a health care network would have to have emergency care," said William Erwin, the association's spokesman.

Under Clinton's health care reform package, coverage would be provided to individuals through large pools of medical facilities.

Erwin said he could not comment on whether closed emergency room facilities in Los Angeles County would likely reopen under Clinton's proposal.

Virginia Hastings, director of emergency medical services for the Los Angeles County Department of Health, said she was uncertain about emergency units reopening. However, she said the reform plan in its current version should improve hospitals' ability to deliver emergency care.

"More people are going to have insurance and that means they will be making fewer emergency room visits and using 911 (the emergency response system) less," she said. "With insurance, people will have access to forms of medical attention other than emergency rooms, which should free up some of those units and allow them to provide more extensive service."

Currently, many uninsured people use emergency rooms as their primary care facility, which means they will go to an emergency room for any medical problem.

A serious roadblock to any recovery of the county's emergency medical service is the number of illegal aliens in Southern California.

Under the Clinton plan, about $1 billion would be provided nationwide for the treatment of illegal aliens or undocumented residents. In Southern California alone, hospital emergency units spend about $2 billion a year treating illegal aliens or undocumented residents, according to Langness of the hospital council.

Business Services Industry

Clinton's program might breathe new life into local trauma centers

Los Angeles Business Journal, Oct 18, 1993 by Tim Deady

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