Posted Date: 2/11/2008
Kaweah Delta Hospital could soon become the central San Joaquin Valley's second trauma center, providing a new destination for the most critically injured patients.
The Visalia hospital would fill a 110-mile gap between Community Regional Medical Center in Fresno and Kern Medical Center in Bakersfield, providing specialized trauma treatment and surgical services not available at ordinary hospitals.
"It's essential to Tulare and Kings counties to save lives and provide the best care possible" said Lindsay Mann, Kaweah Delta's chief executive.
The 490-bed hospital is applying for designation as a Level III trauma center by the Central California Emergency Medical Services Agency, which oversees emergency services policies, including ambulance and paramedic services in Tulare, Fresno, Kings and Madera counties.
Minutes and seconds are precious for victims with life-threatening injuries such as mangled or severed limbs, head wounds or internal injuries from automobile collisions, industrial accidents or gunshot or stab wounds. A trauma center in Visalia, Mann said, is crucial to shaving time from an ambulance or helicopter trip from the South Valley to either Fresno or Bakersfield.
Adding a hospital to the state's trauma network also would take some pressure off of those larger hospitals. Community Regional is the only Level I trauma center between Los Angeles and Sacramento. Kern Medical Center is a Level II trauma center.
But hospital administrators have some work ahead of them: Although trauma designation will bring in new revenue, it will add costs as well.
"It won't be profitable, but we're happy to invest the funding that comes with the trauma designation into supporting that system," Mann said.
And the hospital must recruit new specialists to meet standards set for trauma centers -- no simple task in an area chronically short of doctors.
Kaweah Delta's emergency room already sees more than 70,000 patients a year, many with serious injuries and ailments, Mann said. But victims of severe trauma require specialized skills and services from physicians, surgeons and nurses.
"They're already getting trauma patients down there who come in seriously injured, and they don't have the resources available," said Lynn Bennink, trauma director at Community Regional.
The term "trauma center" refers to the ability of the entire hospital to meet a trauma victim's needs from arrival to either transfer or discharge, Bennink said. "You need the surgeons, the orthopedic surgeons and operating rooms -- you need to have all the other pieces in place to care for a trauma patient."
To become a Level III trauma center, Kaweah Delta must meet requirements that include having a trained trauma team with surgeons specializing in general and orthopedic surgery and anesthesiologists available on short notice.
Mann said the hospital already has on-call agreements with general and orthopedic surgeons to be available 24 hours a day, seven days a week, 365 days a year.
But, he added, a trauma designation will call for greater depth of surgical expertise. The hospital will work with local orthopedic surgeons to recruit more orthopedic trauma specialists, Mann said.
Rules are stricter for Level I centers such as Community Regional and Level II centers like Kern Medical, where more specialized equipment and more surgical specialties, including neurosurgery, are required for more severe injuries.
Tulare County Fire Division Chief Joe Garcia said ambulance paramedics at a major accident or other emergency follow specific protocols to determine how urgent a patient's injuries are and which hospitals are capable of treating them.
"If Kaweah Delta was a trauma center, that might be the way to go by ambulance [if it's faster than] waiting for a helicopter to arrive and finding a place for it to land," Garcia said. "A lot of times, we'll have calls in the north part of the county and if the helicopter in Fresno is busy, the paramedics have to call for a helicopter from Bakersfield."
Bennink said she views Kaweah Delta's plans not as competition for patients in an increasingly harsh health-care business, but as a welcome development for Valley trauma care.
"We support Kaweah Delta 100% in this effort," Bennink said. "It's a good thing. ... We already have enough to keep us busy."
Bennink estimated that of the 2,800 trauma patients routed to Community Regional last year with life-threatening injuries, more than 250 -- about 10% -- came from Tulare County. "And they're not sending us all of them," she added. "Kaweah Delta is taking care of what they can."
Kaweah Delta is still analyzing the costs it will incur for more surgeons, Mann said -- a subsidy that will depend largely on the volume of uninsured patients treated. Currently, Mann added, the hospital pays about $1,100 per day for around-the-clock, on-call emergency coverage by general and orthopedic surgeons.
Mann said he believes Kaweah Delta's $136 million expansion -- a new six-story hospital tower and other improvements to open early next year -- meshes nicely with the trauma designation even though it was planned years before the application.
The new tower will add 87 beds to the hospital with two more floors for future expansion; six new treatment bays in the emergency room; up to 20 more intensive-care beds; and two new operating rooms.
The expansion is being paid by Measure M, a $51 million bond issue approved by voters in 2003 to be repaid over 30 years through property tax assessments within the hospital district; a $5 million pledge from the hospital's fundraising foundation; and bonds issued against future hospital revenues.
A helicopter landing pad is also in the works for what is now Kaweah Delta's east parking lot after the new hospital tower opens next year.
Landing new physicians and surgeons may be more complicated.
"There's a general shortage of these physicians and specialists around the country and in California, and then there's difficulty in attracting them to places like Central California," said Lynne Ashbeck, regional vice president for the Hospital Council of Northern and Central California.
Mann said Kaweah Delta's expansion -- with new surgical, intensive-care and emergency facilities and advanced equipment -- and the trauma designation will be key selling points.
"Recruiting physicians is literally Kaweah Delta's top priority at this time," Mann said. "We're very optimistic that, given our investment in facilities and technologies, doctors will want to practice here in Visalia."
Mann added that Kaweah Delta is in talks with the medical school at the University of California at Irvine to establish a medical residency program in Visalia: "We're working to nurture an environment not only to recruit, but to train physicians as well."
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