Saturday, July 8, 2017

[San Bernardino County] As bed delays persist, Grand Jury urges trauma center in High Desert

The momentum for such a hospital in the region, history has shown, has been slow-moving because of funding considerations.

Editor’s note: This is the latest in a series of stories that will detail Grand Jury findings. Later, the Daily Press will report on the jury’s broach of oversight at charter schools, site security at county facilities and more.
The San Bernardino County Civil Grand Jury recommends building a new county hospital with a trauma center in the High Desert — a facility to rival Arrowhead Regional Medical Center in Colton — in response to chronic problems with hospital bed delays and ambulance availability.
The recommendation was just one of six on the issue made by jurors in their annual report released Friday, but it stands out for the enormity of such an undertaking, which would certainly cost hundreds of millions of dollars.
On Monday, county Supervisor Chairman Robert Lovingood underscored that a hospital as described by the jury was “a priority,” but costs would be a major hurdle.
“I think it’s absolutely on. The critical issue is going to be funding,” he said by phone. “If you look into the future, the desert’s going to continue to grow and (a hospital is) going to be just one of the things to put on the board.”
The momentum for such a hospital in the region, history has shown, has been slow-moving because of funding considerations — a blend of federal, state, county and private dollars — and Lovingood said the impacts to funding caused by changes in national health care were unknown.
The need, however, persists as pointed out by the jury: “A shortage of (emergency department) beds and the lack of a trauma center exist in the High Desert. This shortage leads to hospital and emergency department overcrowding resulting in bed delays.”
The Grand Jury investigation comes after the Daily Press dug into problems with bed delays and ambulance response times in a series of stories in 2015 and earlier this year. The stories this year highlighted the discord between the San Bernardino County Fire Department’s union and ambulance company American Medical Response in whittling the issue to its core.
In its review, the jury summarized that hospital bed delay — the time between arrival of an ambulance at an emergency room and the ER receiving the patient — was a consequence of several other factors including the public’s misuse of emergency rooms and overuse of 9-1-1 calls for non-emergencies as well as a lack of interest from private hospitals in expanding or building new services.
As ambulances wait outside hospitals, they can’t respond to other emergencies. In 2016, AMR lost 72,000 personnel hours due to bed delay. This county’s 36,000 hours of delay tripled Riverside County’s figure.
The jury also found a lack of coordination between the three hospitals in the High Desert, AMR and County Fire regarding overcrowding and unnecessary communication problems between AMR and County Fire because they don’t operate on the same radio frequency.
The five other recommendations made by the jury include:
• 17-21: Implement the Inland Counties Emergency Medical Agency’s “Centralized Medical Control Proposal.”
• 17-22: Educate the general public for the correct use of the 9-1-1 system.
• 17-23: Implement and utilize enhanced 9-1-1 call screening of pre-hospital triage strategies. Include utilization of existing nurse advice lines designed to identify patients who do not require the traditional Emergency Medical Services response or an Emergency Department to provide care for the patient’s medical complaint.
• 17:24: Track dispatches between American Medical Response and the San Bernardino County Fire Department to determine the number of patients each hospital can serve based on the availability of beds to ease the number of bed delays.
• 17-25: Create a process to facilitate access to a common radio frequency between American Medical Response and the San Bernardino Fire Department that will aid in the real-time monitoring of their ambulances.
The recommendations are the responsibility of Inland Counties Emergency Medical Agency, the joint powers authority which oversees ambulance response time monitoring as part of its extensive list of obligations.
Tom Lynch, administrator for ICEMA, said he expected recommendations from the Grand Jury, but it was premature to respond until a formal response can maneuver through proper channels.
“I think certainly it is a serious and ongoing issue,” he said, ”... and any emphasis added by the Grand Jury will be taken into consideration by the county.”
Jim Grigoli, president of the county’s Professional Firefighters Union, or Local 935, which has been critical of AMR for, they say, frequently being unavailable to cover their response area, repeated the line of attack Monday.
“From a firefighter-working-the-street’s point of view, you expect an ambulance to be there. It’s not there,” he said, claiming that AMR provides no details of how many units are out on a given day and ICEMA won’t enforce it. “Right now, nobody’s interested in it.”
But Jason Sorrick, spokesman for AMR, essentially dismissed that narrative as politically charged, saying AMR was “working with all the stakeholders,” including ICEMA, County Fire and partner hospitals on a sustainable solution, even as he acknowledged it wouldn’t be an overnight fix.
“The report essentially confirms what we all knew was already an issue, that the county has a significant issue with bed delays,” he said, adding that AMR was open to address Grand Jury findings.
And the Grand Jury’s interest?
“I think it highlights the fact that everybody now is fully engaged,” he said, “which is what we’ve been seeking from everybody all along.”
July 3, 2017
Desert Dispatch
By Shea Johnson

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