Report recommends 'trauma director,' in-county center for serious injuries
By JULIA REYNOLDS
Herald Salinas Bureau
Posted: 01/11/2011 01:43:10 AM PST
Updated: 01/11/2011 08:33:18 AM PST
For the second year in a row, Monterey County is overdue in establishing its own regional trauma center, according to the county's 2010 civil grand jury report released Monday.
The makeup of the 14-member grand jury was heavily Peninsula-centric, with one member residing in Salinas, one in Gonzales and one in Royal Oaks.
The randomly selected jury received more than 40 complaints — more than half of those coming from the county's prisons and jails. Many were outside the group's jurisdiction, the report said.
"The issues we investigated are those we felt impacted our community as well as those where we felt our efforts may make a difference in the future," the jury's forewoman, Lisa L. Hyman, wrote in her introduction to the report.
But the last grand jury's recommendation to explore opening a trauma center in a county hospital was underscored in this year's report, which urged the county to appoint a "trauma director."
Currently, all Monterey County patients who qualify as major trauma victims are taken to out-of-county centers by helicopter, usually in San Jose or Fresno, at no cost to the county.
CalStar, which provides the medical helicopter service, is a nonprofit with a charitable mission to provide care to low-income patients, and it writes off 60percent of its charges, according to the grand jury's report.
Those costs are made up in insurance premiums and by patients with financial means, the report said.
Medicare only pays "33cents on the dollar," it said.
"Monterey County residents cannot be sure that they will continue to receive the same high-quality level of service they currently receive today," the report said.
Although it did not say that CalStar is struggling financially, the report recommended the county explore "alternative forms of funding" to help cover costs for patients who can't afford to pay.
Of course, helicopter flights aren't the only cost associated with trauma care.
In late 2005, The Herald found that the tab started at $250,000 for a patient "life-flighted" to a San Jose trauma center who underwent surgery and was kept in an intensive care unit for several days.
Regardless of cost, the grand jury found that "people receive better care and have better outcomes from trauma if there is a dedicated trauma center located near where they are injured."
The report summarized the current state of trauma care in the county:
Last year, CalStar flew 293 patients to San Jose or Fresno. About 40percent of the county's trauma patients are injured in car accidents. Assaults such as stabbings and shootings account for nearly 18percent. Salinas, the county's largest city, had the most cases, followed by cities on the Peninsula.
While a trauma center in either or both of these areas would provide "the most expedient care," helicopters would still be needed to transport patients from much of Monterey County's 3,325 square miles.
The grand jurors praised CalStar's professionalism and recommended that its current contract, dating from the early 1990s, be updated because it is "long overdue for review." No specifics on how the contract could be improved were included in the report.
As with last year's report, the 2010 recommendations did not explore or discuss the cost of establishing a trauma center, nor how it would be funded.
After the county's 2009 grand jury determined that Monterey County meets the requirements to have its own trauma center, the county Board of Supervisors responded by saying that the clinical and financial evaluation required "can only be conducted by a hospital that is interested in achieving trauma center designation." The board did not say if any local hospital was interested.
This year's report faulted the county's Emergency Medical Services Agency for not analyzing or reporting trauma data on a regular basis.
The 2010 grand jury recommended that the agency and county supervisors takes steps toward instituting a trauma center by appointing a county trauma director and updating the county's Trauma Care System Plan.
Julia Reynolds can be reached at 648-1187 or jreynolds@montereyherald.com.
http://www.montereyherald.com/local/ci_17063665?nclick_check=1
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