Report 2013-116 Recommendations and Responses in 2015-041

Report 2013-116: Los Angeles County: Lacking a Comprehensive Assessment of Its Trauma System, It Cannot Demonstrate That It Has Used Measure B Funds to Address the Most Pressing Trauma Needs

Department Number of Years Reported As Not Fully Implemented Total Recommendations to Department Not Implemented After One Year Not Implemented as of 2014-041 Response Not Implemented as of Most Recent Response
Los Angeles County 1 6 6 N/A 5
Los Angeles Emergency Medical Services Agency 1 4 1 N/A 1

Recommendation To: Los Angeles County

To determine whether its trauma system is appropriately designed and serving the needs of residents in underserved areas and the needs of the most at-risk populations, the board should use Measure B funds to engage the College of Surgeons by July 2014 to perform a comprehensive assessment of the trauma system and then make the results available to the public.To the extent the assessment identifies weaknesses in the trauma system, the board should develop strategies to address those weaknesses where feasible. Specifically, the board should ask the College of Surgeons to do the following: assist the board in better defining and identifying underserved areas in Los Angeles.

Response

Los Angeles County highly values objective, rigorous external input from knowledgeable experts with respect to continuous improvement of its trauma system. Such input is regularly obtained from the LA County Trauma Hospital Advisory Committee, the State EMS Authority, and the LA County EMS Commission. LA County acknowledges the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system. However, LA County is already taking a multitude of steps and will be working with the American College of Surgeons, as described in its response, to improve the trauma system for all County residents and visitors.

For example, LA County has been notified that the State EMS Authority, the preeminent subject matter expert in California trauma and emergency services planning, has scheduled a review of the State trauma system in March 2016. It should be noted that the EMS Authority has already contracted with the American College of Surgeons for this review. LA County plans to fully participate in this review. The results of the review and any recommendations or comments relevant to LA County will be thoroughly evaluated internally and through its committee process.

  • California State Auditor's Assessment of Status: Will Not Implement
  • Response Date: September 2015

Recommendation To: Los Angeles County

To determine whether its trauma system is appropriately designed and serving the needs of residents in underserved areas and the needs of the most at-risk populations, the board should use Measure B funds to engage the College of Surgeons by July 2014 to perform a comprehensive assessment of the trauma system and then make the results available to the public. To the extent the assessment identifies weaknesses in the trauma system, the board should develop strategies to address those weaknesses where feasible. Specifically, the board should ask the College of Surgeons to do the following: review Measure B allocations to ensure that they are addressing the most pressing needs of at-risk populations in Los Angeles.

Response

Los Angeles County highly values objective, rigorous external input from knowledgeable experts with respect to continuous improvement of its trauma system. Such input is regularly obtained from the LA County Trauma Hospital Advisory Committee, the State EMS Authority, and the LA County EMS Commission. LA County acknowledges the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system. However, LA County is already taking a multitude of steps and will be working with the American College of Surgeons, as described in its response, to improve the trauma system for all County residents and visitors.

For example, LA County has been notified that the State EMS Authority, the preeminent subject matter expert in California trauma and emergency services planning, has scheduled a review of the State trauma system in March 2016. It should be noted that the EMS Authority has already contracted with the American College of Surgeons for this review. LA County plans to fully participate in this review. The results of the review and any recommendations or comments relevant to LA County will be thoroughly evaluated internally and through its committee process.

  • California State Auditor's Assessment of Status: Will Not Implement
  • Response Date: September 2015

Recommendation To: Los Angeles County

To determine whether its trauma system is appropriately designed and serving the needs of residents in underserved areas and the needs of the most at-risk populations, the board should use Measure B funds to engage the College of Surgeons by July 2014 to perform a comprehensive assessment of the trauma system and then make the results available to the public. To the extent the assessment identifies weaknesses in the trauma system, the board should develop strategies to address those weaknesses where feasible. Specifically, the board should ask the College of Surgeons to do the following: assess the adequacy of helicopter services it provides in underserved areas.

Response

Los Angeles County highly values objective, rigorous external input from knowledgeable experts with respect to continuous improvement of its trauma system. Such input is regularly obtained from the LA County Trauma Hospital Advisory Committee, the State EMS Authority, and the LA County EMS Commission. LA County acknowledges the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system. However, LA County is already taking a multitude of steps and will be working with the American College of Surgeons, as described in its response, to improve the trauma system for all County residents and visitors.

For example, LA County has been notified that the State EMS Authority, the preeminent subject matter expert in California trauma and emergency services planning, has scheduled a review of the State trauma system in March 2016. It should be noted that the EMS Authority has already contracted with the American College of Surgeons for this review. LA County plans to fully participate in this review. The results of the review and any recommendations or comments relevant to LA County will be thoroughly evaluated internally and through its committee process.

  • California State Auditor's Assessment of Status: Will Not Implement
  • Response Date: September 2015

Recommendation To: Los Angeles County

To determine whether its trauma system is appropriately designed and serving the needs of residents in underserved areas and the needs of the most at-risk populations, the board should use Measure B funds to engage the College of Surgeons by July 2014 to perform a comprehensive assessment of the trauma system and then make the results available to the public. To the extent the assessment identifies weaknesses in the trauma system, the board should develop strategies to address those weaknesses where feasible. Specifically, the board should ask the College of Surgeons to do the following: analyze how EMS might better use the data it collects to evaluate, improve, and report continuously on its trauma system.

Response

Los Angeles County highly values objective, rigorous external input from knowledgeable experts with respect to continuous improvement of its trauma system. Such input is regularly obtained from the LA County Trauma Hospital Advisory Committee, the State EMS Authority, and the LA County EMS Commission. LA County acknowledges the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system. However, LA County is already taking a multitude of steps and will be working with the American College of Surgeons, as described in its response, to improve the trauma system for all County residents and visitors.

For example, LA County has been notified that the State EMS Authority, the preeminent subject matter expert in California trauma and emergency services planning, has scheduled a review of the State trauma system in March 2016. It should be noted that the EMS Authority has already contracted with the American College of Surgeons for this review. LA County plans to fully participate in this review. The results of the review and any recommendations or comments relevant to LA County will be thoroughly evaluated internally and through its committee process.

LA County, through its EMS Agency, has included trauma system data in the Annual EMS System Data Report which is available to the public. A more comprehensive report with the focus on the trauma system, including evaluation, improvement and specific areas of high risk is being developed and will be issued on an annual basis. This report will be the foundation to a more comprehensive and targeted trauma prevention program under development and for approval by LA County.

  • California State Auditor's Assessment of Status: Will Not Implement
  • Response Date: September 2015

Recommendation To: Los Angeles County

To ensure that it allocates Measure B funds to address the most significant needs of residents within its trauma system, the board should reinstate a Measure B oversight committee, with participation from departments with trauma, EMS, and bioterrorism preparedness expertise, as well as representatives of the public. The oversight committee should review trauma system and other county needs annually and advise the board on Measure B expenditures. As part of its responsibilities, the oversight committee should reevaluate the Measure B allocation approach, taking into consideration the results of Los Angeles's comprehensive assessment and the effects of the Act, and issue a report on its findings no later than December 2015.

Response

Los Angeles County - Department of Health Services is working with the Board regarding the preferred process for evaluating, establishing, and reporting on the Measure B allocation approach, including consideration of a proposed revised methodology to allocate Measure B dollars to non-County hospitals, and analysis of the impact of the new methodology on the trauma system.

The reason for not fully implementing the recommendation is that additional time is needed to collect and validate relevant data from trauma hospitals, complete the analysis of data submitted, discuss findings with trauma hospitals, and develop and present potential recommendations to the LA County Board of Supervisors.

  • California State Auditor's Assessment of Status: Not Fully Implemented
  • Completion Date: December 2015
  • Response Date: September 2015

Recommendation To: Los Angeles County

Los Angeles should undertake formal discussions with Pomona's management regarding the hospital becoming a trauma center. In doing so, Los Angeles should analyze its current Measure B allocations to determine whether financial opportunities exist that would meet the needs of Pomona and present the resulting analysis to Pomona. Further, it should document its efforts and the resulting outcome so that both voters and taxpayers are aware of the diligence Los Angeles has undertaken in fulfilling the spirit of Measure B.

Response

As a result of a competitive selection process, Pomona Valley Hospital Medical Center (PVHMC) was determined to be the most responsive bidder. Based on this determination, a pre-trauma center designation services agreement was entered by and between the County of Los Angeles and Pomona Valley Hospital Medical Center on August 1, 2015. This agreement outlines the requirements that must be implemented in order for PVHMC to meet the American College of Surgeons trauma verification standards. The agreement also provides $4.4 million in Measure B funding to PVHMC to cover the cost of personnel that are essential to establishing a trauma services as well as funding for specialized trauma equipment for the emergency department, operating room and intensive care unit.

  • California State Auditor's Assessment of Status: Fully Implemented
  • Completion Date: August 2015
  • Response Date: September 2015

Recommendation To: Los Angeles Emergency Medical Services Agency

To determine the adequacy and effectiveness of the helicopter services it provides to residents of underserved areas who suffer a trauma injury, EMS should collect, assess, and report accurate and complete data on the number of cancelled flights in each of these underserved areas, including the method of transportation used instead of helicopters and the transport times and trauma patient outcomes.

Response

Los Angeles County, through its EMS Agency, is in the process of developing a mechanism to reconcile the information of the cancelled flight to a specific trauma patient, and provide information on the actual method of transport, transport time and patient outcome. Its EMS Agency has reported the number, location, and mortality of patients transported by helicopter within the system in the 2013 and 2014 annual EMS System Data Report which is available to the public. The next annual data report for 2015 will have the added information on the number of and rationale for cancelled flights. The EMS Agency anticipates that it will have a mechanism in place to reconcile the information of the cancelled flight to a specific trauma patient and provide information on the actual method of transport, transport time and patient outcome ready for the 2016 EMS System Data Report.

  • California State Auditor's Assessment of Status: Not Fully Implemented
  • Completion Date: Year 2016 (Data Merger to be completed for CY 2015)
  • Response Date: September 2015

Current Status of Recommendations

All Recommendations in 2015-041