At Tri-City Hospital : Death of Boy Triggers Probe of Trauma Care

The San Diego County Board of Supervisors on Wednesday ordered an investigation into the treatment of a 14-year-old boy at Oceanside’s Tri-City Hospital to determine if there were violations of the county’s trauma system procedures.

The boy, John William Dement of Carlsbad, died Feb. 23 of heart and lung failure resulting from head injuries suffered 15 days earlier. He was admitted to Tri-City Feb. 8 after a skateboard accident near his home, according to records at the county coroner’s office.

The board’s vote was initiated by Supervisor Brian Bilbray and came in response to an article about the incident Wednesday in The San Diego Union.

The furor is the latest dispute surrounding the question of whether Tri-City should be designated as a trauma hospital as part of the county’s special hospital network for treating critically injured people.

Tri-City has failed to qualify for that designation after evaluations by special out-of-county medical panels. Earlier this month, supervisors gave Tri-City six months to improve its trauma unit and undergo another evaluation. The action caused consternation among officials of the five hospitals in the system, who say the addition of Tri-City would financially hurt the system and reduce the level of medical care.

Gail Cooper, the county official in charge of overseeing the system said Wednesday that a review is already under way of the particular case, adding that the county reviews every death of a trauma victim. Cooper refused to say whether there would be any changes in county trauma policies and would not comment on the scope of the review.

A major dispute involving the case concerns why the victim was transported to Tri-City instead of to Scripps Memorial Hospital in La Jolla, which is the designated trauma center for the North Coastal region. Tri-City serves as a dispatch station for paramedics in North County, but once the paramedics arrive at an accident scene, they are supposed to take their direction from doctors at the nearest trauma center, in this case Scripps.

According to Dr. William Baxt, director of Life Flight helicopter operations for the trauma system, Scripps was never contacted by the paramedics, who were from the Carlsbad Fire Department. Baxt said that the paramedics requested that Life Flight, which had initially been asked to come to the accident scene, to meet them at Tri-City hospital. The patient remained at Tri-City.

But Chris Farris, assistant director of nursing at Tri-City, said Wednesday that paramedics contacted Scripps and were told that that Scripps was too busy to handle the call, and to contact Tri-City. “We have a tape of the paramedics telling us that Scripps had told them to call us,” Farris said.

Dr. A. Brent Eastman, Scripps trauma surgeon-in-charge denied Wednesday that paramedics called. “We’d never say we were too busy,” he said. If Scripps had had too many trauma patients the paramedics would have been directed to take the patient to the next closest trauma center, in this case Palomar Hospital in Escondido, Eastman said.

The paramedics could not be reached for comment Wednesday.

Farris said that partially as a result of the incident, Tri-City, at a meeting on March 5, asked Cooper and Paul Simms, her boss at the county, for clarification on county policies involving transport of trauma patients. Faris said that the hospital has yet to receive the clarification.

Farris also said that Tri-City believes the victim received the same level of care at Tri-City that he would have received at a designated trauma center.

Cooper would not comment on whether her investigation includes the quality of treatment. None of the doctors involved with the trauma system would comment Wednesday either on the record or off the record on whether any problems with patient transport caused later problems with treatment, saying that the responsibility for that study lies with county officials.

The deputy county coroner who handled the Dement case said Wednesday that he could draw no conclusions as to the adequacy of care.