The Coastal Post - May 1999

Some Thoughts About Trauma Care

By Norman Carrig, M.D.

Periodically the local daily carries a story about someone injured a short ambulance trip from Marin General who is taken to John Muir Hospital, Walnut Creek, by helicopter. The Walnut Creek hospital is a Level II trauma center. No hospital in Marin comes close to offering that level of care. Marin has a problem. We cannot always transport by helicopter. Bad weather equals no helicopter service. So it's imperative that Marin has care equivalent to that which is offered by John Muir.

Logically, a trauma center should be at Marin General, the hospital owned by the people of the Marin Healthcare District (all of Marin except Novato). Long before MGH took in its first patient in 1952, the promoters promised around-the-clock emergency care in order to get the bond issue passed which made possible hospital construction. Level II trauma care is the logical extension of that promise. It means, among other things, that a trauma surgeon and an anesthesiologist always be on site.

Television coverage of the terrifying events at the Littleton, Colorado high school the afternoon of April 20 probably had little effect on the Board of Supervisors as they sat listening to the pros and cons of a trauma plan presented and championed by the county's new director of Health and Human Services, Nancy Rubin. The Rubin plan asks that doctors be within 30 minutes of the hospital (MGH?). The Rubin plan, which I consider a hoax, appealed to the supervisors, who voted 5-0 to accept it. Obviously, they did not consider a Littleton-type disaster.

We have a long way to go. MGH is now under the control of Sacramento-based Sutter Health. Until the community regains control of the district hospital, we may have less than optimal trauma care.

There is hope for Marin in spite of the bleak picture I have painted. The hospital lease, with Sutter as lessee, may be voided if the lawsuit by the Marin Healthcare District now on appeal in Sacramento is successful. Then the elected board will have the power and the authority to upgrade trauma care. If the elected board's suit to regain hospital control is a success, the money siphoning will come to an end and outrageous administrative remuneration will be but history. Millions of dollars will be available to be plowed back into the hospital's operation, including trauma care. * * * Trauma Plan Not Adequate By William Rothman, M.D.

Tuesday, March 20, the Marin County Board of Supervisors adopted a Trauma Plan which will not provide Marin residents with a full-time surgeon or anesthesiologist at any Marin Hospital. If the Supervisors had the chosen Level II trauma care, at least one Marin hospital, almost certainly Marin General, would have arranged for those specialists to be present at all times to treat life-threatening injuries. The Supervisors chose, instead, compromised Level III care, which does not require either a surgeon or anesthesiologist to be at the hospital.

The Board heard from 50 speakers who were approximately equally divided between those who urged the improved care that would be available at a Level II facility and those who felt Marin residents could get by with compromised Level III care. The notable difference between the two groups was that almost all who believed Marin should be satisfied with less good care were financially connected to Sutter Corporation. Their "enthusiasm" for poor quality was not surprising. Sutter, which operates both Marin General Hospital and Novato Community Hospital has fought tooth and nail to avoid paying to have trauma specialists at either of their Marin hospitals.

The refusal of the Board of Supervisors to demand excellent care may at first seem puzzling, but is connected to its reluctance to become involved in matters which involved Marin General Hospital, now the subject of a lawsuit by the Healthcare District to place the facility back under community control. It appears that the Supervisors, although they recognized the need for improved trauma care at Marin General, did not want to solidly back the excellent care that a Level II facility would provide, for fear of bucking, in their own elections, the big bucks of Sutter. The Supervisors did, however, put into the trauma plan the very important provision that the County will henceforth routinely review the care received by seriously injured patients to assure that all are treated by a surgeon within 30 minutes of arrival at the hospital. This is vital, because it has recently been revealed that some surgeons, supposedly immediately available for emergency call at Marin General, have actually been as far away as Santa Rosa. The new time requirement, although not nearly as likely to allow the saving of lives as having surgeons actually at Marin General, will eliminate the additional danger of time "fudging" by Sutter/MGH management.

It would, of course, have been preferable for the Supervisors to have required the full time presence of a surgeon and an anesthesiologist, but now at least the worst and most dangerous aspects of Sutter/MGH management's irresponsibility will be open to public scrutiny and correction by the Board of Supervisors.

Furthermore, the Supervisors also include a provision allowing them to upgrade care to Level II in the future. It is almost certain that Sutter will continue its efforts to maximize profit by minimizing to dangerous levels all aspects of its care, including trauma care. If that occurs, it won't be very long before the Board of Supervisors realize that they were wrong to allow Sutter to get away with Level III trauma care and will insist on the better Level II standard.

Now that the Board of Supervisors have begun to show a significant interest in the quality of care received at MGH, it is vital that all who have experience with the hospital keep their Board or Supervisors' representative informed about the quality of care they and their loved ones receive.

Yes, it is troubling that the Supervisors did not vote for the best level of trauma care, but the fact that public oversight has been increased is definitely a positive development. Perhaps the best barometer of what took place could be read in the facial expressions of those Sutter/MGH executives who attended the hearing. They were not smiling!

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