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Health and Human Services Agency, Public Health Division, recommending the Board consider the following:
1) Approve and authorize the Chair to sign Memorandum of Understanding 268-M1510 with Barton Healthcare to designate Barton Healthcare as a Level III Trauma Center with a term that will begin upon final signature, end on October 10, 2020, with a potential maximum revenue of $10,000 during the term of the contract; and
2) Approve and authorize the Chair to execute further documents relating to Memorandum of Understanding 268-M1510, including amendments which do not increase the maximum dollar amount or term of the contract, and contingent upon approval by County Counsel and Risk Management.
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Fiscal Impact/Change to Net County Cost
There is no Net County Cost associated with this Agenda item. This Memorandum of Understanding (MOU) includes a provision for the County to bill Barton Healthcare for costs incurred for conferring and administering the Barton Level III Trauma Designation as well as for conferring and maintaining the County's trauma plan in an amount not to exceed $10,000 for the term of the MOU.
Background
Advanced life support (paramedic) programs were established as a county option in California in 1971 by the Wedworth-Townsend Pilot Paramedic Act (SB 772). The Emergency Medical Services (EMS) Systems and Prehospital Emergency Medical Care Personnel Act (CA Health and Safety Code §§ 1797 et seq.) created the Emergency Medical Services Authority in 1980, which authorizes each county to develop an EMS program and to designate a Local EMS Agency (LEMSA) to oversee the delivery of EMS services within that geographic area. This level of governance allows for local control of emergency medical services that is desirable in a state as large and diverse as California.
The County of El Dorado established an Emergency Medical Services program and the provision of Ambulance Services under a public utility model in the early 1970s. The program has evolved to include implementation of an Advanced Life Support (ALS) level of service as identified in the EL Dorado County EMS Plan and Trauma Plan. On March 19, 2013, pursuant to Health and Safety Code §§1798.163 and 1798.166, the County of El Dorado Board of Supervisors approved a revised EMS Plan and Trauma Plan.
In accordance with the California Health and Safety Code §1798.165 and California Code of Regulations, Title 22, Division 9, Chapter 7, the designation of "Trauma Center" to a health facility that is within a county's geographical borders is the responsibility of the LEMSA. However, verification is necessary to confirm that the proposed facility has the necessary resources to successfully treat trauma patients. In El Dorado County, Trauma Center verification includes an evaluation process performed by the American College of Surgeons (ACS), which inspects hospitals to verify the presence of the resources deemed necessary for each trauma level, (i.e., Level I, II, III, IV, or V). These trauma levels are as follows:
1. A Level 1 Trauma Center provides the highest level of surgical care to trauma patients. It has a full range of specialists and equipment available 24 hours a day and admits a minimum required annual volume of severely injured patients. A Level I Trauma Center is capable of providing total care for every aspect of injury - from prevention through rehabilitation.
2. A Level II Trauma Center works in collaboration with a Level I Center. Level II provides comprehensive trauma care and supplements the clinical expertise of a Level I institution, as well as 24-hour availability of all essential specialties, personnel, and equipment.
3. A Level III Trauma Center does not have the full availability of specialists, but does have resources for emergency resuscitation, surgery, and intensive care of most trauma patients. A Level III center has transfer agreements with Level I or Level II trauma centers that provide back-up resources for the care of exceptionally severe injuries.
4. A Level IV Trauma Center exists in cases where resources do not support a Level III Trauma Center. Level IV provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care.
5. A Level V Trauma Center provides initial evaluation, stabilization, diagnostic capabilities, and transfer to a higher level of care. A trauma-trained nurse is immediately available, and physicians are available upon patient arrival in the Emergency Department. If not open 24 hours daily, the facility must have an after-hours trauma response protocol.
In October 2014, Barton Healthcare applied to the County LEMSA for Level III Trauma designation. As part of the verification process, ACS performed an on-site review and verification, and notified Barton and LEMSA via a letter dated December 5, 2014 that Barton successfully completed their on-site review. In addition, ACS has issued a Certificate of Verification which is valid for three years ending October 10, 2017. To continue to be designated as a Level III Trauma Center, Barton will require re-verification from the ACS before the Certificate of Verification expires. Loss of vertification would automatically result in the termination of this MOU.
Reason for Recommendation
HHSA recommends approval of MOU 268-M1510 with Barton Healthcare for the provision of Level III Trauma Center services so that Barton may treat trauma patients who would otherwise be transported to a Trauma Center in Nevada, thereby causing delays in potentially life-saving treatment for these patients.
Clerk of the Board Follow Up Actions
1. Clerk of the Board to have the Chair sign two (2) originals of MOU 268-M1510.
2. Clerk of the Board to return one (1) fully signed original MOU to HHSA Contracts Unit at 3057 Briw Road, Suite A.
Contact
Don Ashton, M.P.A., Director
Concurrences
County Counsel and Risk Management