The Los Angeles Times from Los Angeles, California • 32

SAN DIEGO COUNTY Cos Angeles Simes Monday. October 3. 1988 LOCAL NEWS EDITORIALS LETTERS CCWartll County Trauma System Confronts a New Crisis: Scaling Back to Survive I Writer By LINDA ROACH MONROE. Timet Staff Four years into the system that it the gold standard for traumatic injury care around the country, doctors and administrators in San Diego County are beginning to wonder whether the next step is to refine the trauma network downward. This idea which would have been resoundingly rejected four years ago brings San Diego once again to the forefront of innovative thought in trauma systems, this time regarding the financial problems that have plagued such systems from Los Angeles to Miami.

I think we have evolved to the point that it may be time for some changes." said Dr. Steven R. Shackford, trauma director at UCSD Medical Center. "We in San Diego (are sort of in the vanguard of what's happening. We've done it now for almost five years.

We've met all the problems with, I think, innovative ways of coverage. And perhaps it's another step in the evolution of the model system here." Sagf eatieas Vary Wisely The suggestions for revising the system are so preliminary that they vary widely. They include ideas to: Downgrade some or all of the five Level 2 trauma centers to Level 3, which would turn them into well-equipped hospital emergency rooms. They would handle the majority of trauma victims, but have the ability and commitment to recognize major injuries that should be transferred to a higher-level trauma center, which likely would be at UCSD. This also could allow addition of more hospitals to the network, at Level 3 status.

county network has one Level 1 trauma center, at UCSD, and five Level 2 centers, at Sharp, Scripps-La Jolla. Children's, Palomar and Mercy hospitals. The major difference between the levels is UCSD's mission to train trauma doctors and conduct research on traumatic injury care. Move toward a "Level 2W category, in which hospitals could have a formal commitment to trauma care without the stringent staffing requirements that have proved difficult to meet at the Level 2 hospitals. Reconfigure the system so that designated trauma centers resemble medical "boutiques" rather than "supermarkets." This would resolve the shortage of specialty doctors at the trauma centers by routing, for instance, all neurosurgical cases to a single hospital.

These ideas share the common thread of trying to dilute the economic and resource commitment required of trauma centers without sacrificing patient care. But they present officials with a delicate balancing act between those two goals. Indeed, there is some concern those goals could not be reached without returning to the days when, doctors say, people were bleeding to death needlessly in hospital emergency rooms. "I feel like the system should be scaled down. I think it's a difficult thing to do." said Dr.

David Cloyd. chairman of trauma at Palomar Medical Center in Escondido. the center that has had the most difficulty meeting trauma staffing commitments. "If we start reducing our sensitivity to the level of injury, and send the patients that appear to be less seriously injured to other hospitals, we're going to make mistakes." Cloyd said. "You'd have to accept the fact that occasionally you're going to make a mistake evaluating them in the field." Such issues would have to be resolved before a trauma system revision could be accepted, and changes won't necessarily be adopted at all.

said Gail P. Cooper, emergency medical services chief for the county. "Those of us who are intimately involved in the trauma system are discussing all kinds of different ways that trauma care here and other places can be made better. Whether or not that leads us to reconfigure the system. I wouldn't go that far." Cooper said.

4 We're at the ground floor of this discussion. The elevator door hasn't even closed GaUF. Cooper Emergency medical services chief "We're at the ground floor of this discussion. The elevator door hasn't even closed yet," she said. Currently, San Diego has six trauma hospitals to which the victims of shootings, stabbings, traffic accidents and other traumatic events are routed even if the injuries occurred closer to another hospital.

The system treated 5,466 people in the 1986-87 fiscal year, and kept potentially preventable deaths to about two dozen cases, the county reports. Million la Losses But it also has resulted in a concentration of no-pay or low-pay indigent cases that have brought losses to as high as $2 million a year to individual hospitals. In other cities, such as Los Angeles, the underpayment problems have threatened to topple the trauma system as hospitals bailed out of it and emergency rooms faced closure. San Diego's problems haven't reached that point, but the crisis may be approaching, officials say. Trauma surgeons and specialists such as orthopedists and neurosurgeons are being paid as much as $800 per 24-hour shift in exchange for being on call for trauma hospitals.

The situation is most critical at Palomar, where more than $700,000 of the Jl.l-mil-lion trauma loss in the 1987-88 fiscal year was due to paying physician fees, said Tony Noronha, senior vice president for finance and business development Please see TRAUMA, Page 5 Phoua bj DAVID HcNEW Jennifer Pratt gets some help from Terezia Vitazko, a physical therapist at the Sharp Rehabilitation Center. Along, Slow Road to Recovery Assailants Silent as Teen Straggles Back From Tragedy By ERIC BAILEY, Timet Staff Writer The progress is coming. Slowly, painfully, but it is coming. Eighteen months ago, Jennifer Pratt was the shattered remnant of a terrible tragedy. While sitting on the back of her boyfriend's motorcycle at a stop light on a lonely stretch of road in Carlsbad late one night, she was hit in the head by a length of 2-by-4 tossed from a white pickup loaded with teen-agers.

She languished in a coma for three months. When the Encinitas teen-ager finally came around, the damage to her brain caused her body to knot into a fetal position. Her memory seemed a blank slate. Taking Her First Slept Today, Jennifer is up and taking her first steps since the incident Her fingers, once twisted into tight fists, have been straightened by therapy and are functioning almost perfectly. And her mind is healing.

The facts and concepts of yesteryear are beginning to creep back into her consciousness. But this is not the Jenny Pratt her friends and family once knew. That young woman, the San Dieguito High School sophomore, the one with the bouncing mane of blond hair, the one who dreamed of being a model, is probably lost forever, her doctors say. Adding to the frustration is the stalled effort to bring her assailants to justice. Aided by a private investigator, her parents feel certain they know the identities of the teens involved in the board-throwing incident, but police say they lack sufficient evidence to bring charges.

None of the youths involved has stepped forward to identify the culprit Instead, they've remained hidden behind an impenetrable code of silence, a twisted sort of teen-age loyalty. "I've just about given up," said Garry Strom, Jennifer's stepfather. "I just really can't see anything happening after a year and a half. The detectives, the police, they're all frustrated. Everything seems at a dead end." Sgt Jim Byler, the Carlsbad detective handling the case, agrees.

soon come to an end. In November, the family's insurance aid is scheduled to run out. and Jennifer may be forced to begin attending a less-intensive special education program at her old high school (Already her medical bills are approaching $800,000.) To make matters worse, Strom has been unable to find a steady job since leaving his position as an assistant vice president with a financial services firm about a year ago, after a run-in with his bosses over the hours he put in during Jennifer's recuperation. "We're just going along month by month right now," he said. "I would dig a ditch if I could pay my bills." It's Been Hell' Jennifer's mother, Diane Strom, puts the past 18 months in plain perspective: "It's been hell.

When you're with this day after day, you don't really notice the changes, the improvements. And it gets really, really depressing, even though she's getting better gradually." While Jennifer remembers nothing of the night she was hit, her long-term memory of other events seems to be recovering nicely. But her short-term memory remains impaired. She often can't remember what she had for lunch and occasionally repeats herself in conversation. Her physical condition, meanwhile, has improved.

Though confined to a wheel chair for months after the accident she now can walk, although her left leg is still painful, wrapped in a cast to straighten the foot. Her left arm is frozen at the elbow by a cement-like calcium deposit but a future operation should rectify that her parents say. As Jennifer slowly regains her cognitive abilities, the sad reality of her situation grows ever clearer to the young woman. Her moods often turn bitter. "She has greater insights into her disabilities, and that's been painful for her," said Dr.

Jerome Stenehjem, medical director for rehabilitation at Scripp's Hospital in Please see JENNIFER, Page 2 later released to the custody of an aunt in Huntington Beach, Robinson said. May was driven from Torrance to San Diego Sunday morning and was booked at Las Colinas Jail for women on suspicion of felony child abuse, child abandonment and failure to provide for a child, said a jail spokeswoman. Bail for May was set at $20,000, pending her arraignment Tuesday. Her 11 -year-old daughter has been positively identified as Tanya Tegerdine, Robinson said. The girl, who was found wandering in the May Co.

store in La Jolla Please see MOTHER, Page 2 'You know what? I'm trying hard to find a frog. A frog in the back yard to kiss and turn into a prince and get married and live in a Jennifer Pratt "It's been very Byler said. "We gave it our best shot, but some cases don't get solved easily. Some don't ever get solved. As long as it's been now, I'm certainly not optimistic we're going to be able to figure out who did it" In recent months, Jennifer's family has increasingly turned their focus away from the icy trail of her assailant Instead, the day-to-day effort of helping the 17-year-old begin to overcome her disabilities taps a sizable share of the family's energy.

She came home in late March after a year in the hospital. Her parents now drive her to San Diego each day to attend classes at the Sharp Rehabilitation Center. But those sessions, though valuable, may children, and had spent the last several months moving from place to place in Southern California in an attempt to conceal their whereabouts from her estranged husband. Tipped Off by Relative May's arrest was the result of a tip from her sister-in-law, whose identity was not disclosed. The sister-in-law contacted ar San Diego police detective Saturday to say the mother of the abandoned child was at her house, said San Diego police spokesman Bill Robinson.

May was found at the house with her 7-year-old son, Floyd, who was btj i i atji Proposition Is It Key to the County's Survival? By BARRY M. HORSTMAN, Times Staff Writer If Proposition A causes San Diego County voters to experience deja vu in November, it will not be because their minds are playing tricks on them. Opponents, though, might argue that the measure's backers are trying to play a nasty trick on voters. Only several months after voters narrowly defeated an identical proposal in last June's primary, San Diego County officials have launched a second attempt to temporarily increase county government's annual spending limit Convinced that the measure's defeat last spring stemmed more from voters' misunderstanding of its intent than opposition, proponents, armed with the same arguments but with a new aggressive strategy, hope to reverse the outcome this time by persuading voters that Proposition A is a painless way of alleviating the county's fiscal woes. It would not they emphasize, increase taxes, but rather would help the county to obtain its "fair share" of local tax dollars and state revenue.

Backlash Predicted But opponents, infuriated by the county supervisors' decision to place the measure back on the ballot after voters had rejected it, predict a backlash at the polls against what they characterize as an attempt to circumvent the public's will. From their viewpoint, the ballot measure represents simply another attempt to chip away at voter-approved government spending controls that despite being billed as a temporary step, could lead to long-range spiraling budget increases. "This unparalleled arrogance in ignoring voters' decision is a politician's version of, 'Let them eat said Dick Rider, vice chairman of the San Diego County Libertarian Party. "They're obviously going to keep hammering away until voters cave in. If it loses this time, they'll probably try again." "It's an imperial attitude that says to voters, 'Unless you agree with the rulers, you're added lawyer Jack Sanders, president of United Taxpayers of San Diego.

Insisting that county leaders "aren't trying to ram this down anyone's throat," Board of Supervisors Chairman George Bailey argues that, given the closeness of the vote in June, the board had no choice but to try again to win approval for the temporary spending limit waiver. When it appeared on the primary ballot as Proposition the proposal was defeated by a 51.1 margin, 214,938 votes to 205,891. "With it that close and with this meaning so much to so many people and Please see PROP. Page 2 Mother of Abandoned Mute Girl Arrested Woman Apparently 'at Wit's End' After a Year of Living on the Run By LESLIE WOLF, Times Staff Writer A woman suspected of abandoning her mute 11 -year-old daughter in a La Jolla department store was arrested in Torrance, police reported Sunday. Karen Amy May, 37, was taken into custody at about 7 p.m.

Saturday at her sister-in-law's house and was later booked into jail in San Diego on suspicion of child abuse and other related offenses. May had apparently been living a "life on the run" since the break-up of her marriage about a year ago, said Detective Dan Dennis of the San Diego Police Department. She is believed to have fled from her husband in Arizona, taking their two 1 1 i a i i set ei tfti i BThe Princess and the Jubilee Princess Christina of Sweden was the honored guest at a ball honoring the settlement of Swedes in the New World 350 years ago. VIEW, Page 1 BTough Day for Chargers BSaft in the Wound The Chargers' offense couldn't get anything started Expatriates from a failed San Diego against the Denver Broncos, as their record fell to ballet helped make Salt Lake City's 2-3 after a 12-0 defeat. Ballet West a success.

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