VENTURA COUNTY, Calif. -- Being named a trauma center - the goal driving three Ventura County hospitals into a race that will likely produce only two winners - doesn't come easily or, in most cases, cheaply.
In an era when some hospitals struggle to find on-call doctors, trauma teams and specialists must be available any time for a train collision, a sudden illness or head wounds from a gunshot. Hospitals may spend as much as $11,000 a day for that availability, though some administrators say their costs would be much less.
But trauma centers may also bring better mortality rates, elevated care, a star of quality that can separate one hospital from the next and more patients, according to healthcare experts. And in Ventura County, three hospitals are investing in improvements needed to win trauma designation - doctors, staff, equipment or all of the above - though one of them likely won't get it.
"They take a risk in preparing themselves for that level, which tells you how serious they are about it," said Gerry Arcuri, regional vice president for the Southern California Hospital Association.
Ventura County had long been only one of two counties in the state without a trauma system that sends people with severe injuries to specific hospitals with specially trained teams. That changed with last week's announcement of a state approval authorizing the county's plan to designate one trauma center in the west part of the county and one in the east.
Officials at Los Robles Hospital & Medical Center in Thousand Oaks say they'll try to win designation as the east county center. In the west, the Ventura County Medical Center in Ventura and St. John's Regional Medical Center in Oxnard will compete.
County officials are putting together a request for proposals, detailing the requirements of being a trauma center. After hospitals submit their plans, their facilities and staff will be evaluated by an independent committee of trauma experts.
That group will make a recommendation to county supervisors who will make the final decision in a vote that could come by the end of the year.
The biggest hurdle
Hospitals that want the designation need trauma surgeons who are either in the hospital around the clock or close enough so they can respond within 15 minutes. They need promptly available surgeons in areas ranging from neurology to urology along with a full allotment of specialists who will take on-call duties.
"The biggest problem is lack of commitment on the part of physicians," said Dr. Robert Coscia, an Idaho surgeon who reviews trauma centers for the American College of Surgeons. "Hospitals usually have adequate staff. They just often don't want to do it. They feel like it takes away from private practice."
In some cases, hospitals have to pay more in compensation.
"On a daily basis, trauma centers are spending in excess of $11,000 for call coverage," said Mike Williams, a consultant who has been working with trauma centers for 30 years and is currently helping St. John's prepare for its inspection.
Many experts say costs for hospitals pursuing trauma center designation vary greatly. Williams said startup costs mostly involve staffing and can range from $800,000 to $2 million.
Hospitals gearing up
Officials at Ventura County Medical Center said their staff costs will be minimal because they already have almost all of what they need, including surgeons specially trained in critical care and a full allotment of on-call doctors.
"We have what we need in place," said Dr. John Fankhauser, the hospital's medical director.
VCMC is adding equipment and staff for advanced imaging that can be used to treat internal bleeding and other injuries without surgery. The services are required for trauma centers but would have been added in any event, officials said.
At St. John's, Chief Executive Officer T. Michael Murray said the hospital has recently contracted with four trauma surgeons, giving them a staff of five.
As with many hospitals, St. John's has struggled at times to convince specialists to serve on-call. But the hospital will have all the required specialities available in order to meet trauma center requirements, Murray said.
"We'll have the full call," he said, noting that initial costs of gearing up aren't severe but that the annual price of operating a trauma center could be more than $2 million a year.
At Los Robles, officials are pursuing needed staff including a nursing coordinator. They are working with doctors on developing on-call schedules and calculating the exact costs of operating a trauma center. Like the other hospitals, Los Robles officials say they want to provide the best care possible. They also want to keep area patients from going elsewhere.
"I think the opportunity is to capture trauma volume that's not going to Los Robles," said Natalie Mussi, the hospital's interim CEO.
Some observers say trauma centers generate enough revenue to offset their costs but not much more. But Williams said hospitals can justify higher prices for trauma center care.
Sometimes, trauma centers in low-income areas generate more people with private insurance that pays at better rates than government programs, he said.
"It does tend to be a money maker," Williams said. "It's a long-held myth that trauma centers can't make money."
Patients see most benefits
Though the official competition hasn't begun, hospitals are beginning to make their case for trauma center designation. All three say they already serve as unofficial trauma centers.
Ventura County Medical Center officials cite records that show the hospital's trauma mortality rate is better than national averages for trauma centers.
St. John's officials cite their emergency room facilities and the hospital's central location, just off the freeway, where ambulances can quickly rush patients.
Officials at Los Robles say that not providing a trauma center would be like turning their back on the community.
Outside observers say the competition could be intense. They also said that whatever hospitals emerge as trauma centers could see their quality of care rise in and outside of the emergency room.
Coscia, who works with the American College of Surgeons, said the people who will benefit most are those in life and death situations who need care immediately.
"It affects outcomes tremendously," he said. "Patients do better in trauma centers."