Bleeding Red Ink, Trauma Centers Threaten to Close.

While L.A. county officials try to hammer out a $1 billion federal bailout to keep the public health system running, another potential health care crisis is looming.

The 10 private hospitals that operate L.A.'s trauma centers are threatening to shut down those centers if the county doesn't increase its reimbursement rate for treating uninsured patients.

Ever since the 1980s, Los Angeles has had a countywide web of trauma centers that treat severely injured victims whose lives hang in the balance after a car accident, shooting or other life-threatening disaster.

At one time there were 22 hospitals participating in the program, but over the years that has dwindled to 13: three county hospitals and 10 private hospitals.

The county's contracts with the 13 facilities all expire June 30. County officials have warned the hospitals that, with a tight public health budget this coming fiscal year, reimbursement rates will need to be chopped by 50 percent.

The medical centers are up in arms because those rates have not changed for 10 years. Not only should they not be cut in half, the rates need to be increased fivefold just to cover the expense of running the trauma centers, hospital officials insist.

"The situation is really horrible," said Jim Lott, executive vice president of the Southern California Healthcare Association, which represents local hospitals.

Private centers struggle

While the three public facilities -- Martin Luther King/Drew Medical Center, Harbor/UCLA Medical Center and County-USC Medical Center -- would undoubtedly keep their trauma centers operating even if reimbursements were cut in half, the 10 private facilities are not eager to remain open unless more money is forthcoming.

By law, the hospitals are not required to have a trauma center, but many facilities have looked upon it as a badge of honor to call themselves "designated trauma centers."

Hospitals with designated trauma centers are the first destination for victims of accidents. These centers must have a trauma doctor, trauma nurse and anesthesiologist present at all times, as well as a designated operating room. The centers are one grade above an emergency room and treat critically injured patients during the "golden hour" when they linger somewhere between life and death.

Only heavily populated areas in California have trauma centers, such as San Diego, San Francisco, Orange County and Los Angeles. Areas such as Ventura and Santa Barbara have no such facilities.

With L.A. County health officials still negotiating to extend their Medicare waiver, it is still uncertain how much money the Department of Health Services will have in its budget after July 1. As a result, the county plans to transition its soon-to-expire contracts with the trauma centers into month-to-month agreements, until the budgetary dust clears.

The county Board of Supervisors is scheduled to discuss the matter June 20. County officials did not return numerous phone calls for comment.

"Our concern is that, if there is not enough funding, can we continue to be a designated trauma center?" asked Stephen Ralph, president and CEO of Huntington Memorial Hospital in Pasadena.

Hospitals maintain that, due to the high expense of keeping the centers fully staffed, some facilities are losing millions of dollars every year.

While patients covered by health insurance pay most of a hospital's trauma costs, uninsured patients whose treatment is reimbursed by the county are draining hospital coffers.

"Our reimbursement hasn't increased, but the cost of doing trauma, like any health care, has gone up," Ralph said. "We lose about $2 million to $2.5 million a year. Trauma care is important and saves lives, but someone has to pay for it."

County not budging

Hospital executives have met with county officials over the last several months to discuss the new contract. But the two sides are worlds apart -- with government officials looking to slash reimbursement rates and hospitals pushing to get them dramatically hiked.

"There has been ongoing dialogue with the county but little or no resolution," said Byron Schweigert, chief executive at Long Beach Memorial Medical Center, which has a trauma center. "We know the outcomes are wonderful for patients cared for by the trauma centers. But to have the county continue to expect that we are going to do it and not cover our costs is ridiculous."

Henry Mayo Newhall Memorial Hospital in Valencia has a trauma center that services a 450-square-mile area in north Los Angeles County between two major highways -- the Golden State (5) and Antelope Valley (14) freeways. Last year, its trauma center treated 468 patients, 57 percent of whom were victims of motor vehicle accidents. "There has been no change in what we are reimbursed for years," said hospital spokeswoman Janice Newbold. "We were hoping there would be an increase this year."

Other Los Angeles hospitals with trauma centers are Cedars-Sinai Medical Center, Childrens Hospital of Los Angeles, Providence Holy Cross Medical Center in Mission Hills, Northridge Hospital Medical Center, St. Francis Medical Center in Lynwood, St. Mary's Medical Center in Long Beach, and UCLA Medical Center.

If the trauma centers shut down, severely injured victims would be taken to the nearest hospital with an emergency room. Emergency rooms have on-call specialists, rather than full-time specialists. There are 84 emergency room facilities in the county.