Palomar Doctors Ask Health District Board for Increased Staffing

Administrators for Palomar Pomerado Health district board should hire more operating-room staff at Palomar Medical Center in Escondido to prevent surgical delays, according to a petition signed by about 150 physicians and hospital employees that was presented to the center's board of directors on Monday, the San Diego Union-Tribune reports.

The petition states: "We believe Palomar (operating room) needs increased staffing to provide better patient care, safety, increased staff retention and improvement of hospital and medical staff morale."

According to several hospital officials, most facilities offering labor and delivery services have a dedicated obstetrical team and anesthesiologist on duty at all times. Palomar has a separate obstetrical anesthesiologist on duty from 7 a.m. to 7 p.m., Monday through Friday.

Dr. Paul Milling, a Palomar orthopedic surgeon who presented the petition to the Palomar Pomerado board, last month wrote in a letter to Palomar Pomerado's board and administrators that the high number of emergency procedures, including caesarean sections, at the hospital delay previously scheduled surgeries to late evening or early morning, when they must be performed by "tired doctors and staff."

"If they had resources, patients' (surgeries) wouldn't get bumped by c-sections and they wouldn't have to wait and wait and wait -- often in pain," Milling said.

Milling added in his letter that if the facility does not increase its staffing, "it is only a matter of time when one of these avoidable late-night and early-morning cases will turn into another nationally known, tragic surgical embarrassment for (the hospital)," such as an incident in 2000 when a Palomar surgeon operating late left a metal device in the stomach of a patient (Clark, San Diego Union-Tribune, 2/3).

Milling on Monday told the board that the current situation has put patients at risk and lowered the morale of hospital staff members who are affected by the policy, noting that Palomar is the only county hospital that does not have its own designated obstetrics staff.

Milling said that Pomerado Hospital runs a round-the-clock obstetrics department although the facility is smaller and makes less money than Palomar, its sister hospital. Milling also noted that Pomerado is often referred to by Palomar doctors as "the country club hospital" because it offers other amenities that are not available at Palomar.

"The poor cousins of [Palomar] shouldn't have to suffer because of the country club," Milling said, adding, "If (Palomar's staffing level) is good enough one-third of the time, why shouldn't it be good enough 100% of the time? Especially when it's good enough for our sister hospital, which is smaller than us?" (Moss, North County Times, 2/8). Milling said, "It's not fair to the public. It's not fair to the people that work here. It does not make sense" (Gustafson, San Diego Union-Tribune, 2/9).

PPH President and CEO Michael Covert said he wished Milling had discussed the matter with him directly rather than present it to the board and noted that there are "many, many issues at play" in the different staffing levels at the two facilities. Such issues include differing levels of activity and patient volume, space constraints and a general shortage of anesthesiologists and nurses, according to the Times.

Covert said hospital officials should study the matter, adding, "If we're really interested in the issues of quality as we say we are ... you gotta go back no matter who is saying it and listen" (North County Times, 2/8). Covert said that he is "obviously interested in the issue" but added that comparing Palomar to Pomerado "is truly inappropriate. They are different places and they have different volumes and kinds of activity and challenges associated with them."

Covert also noted that many of the physical differences between the two facilities will be addressed when the county completes construction in several years of a new 453-bed hospital to replace Palomar.

Covert said he plans to meet with Milling Feb. 22 (San Diego Union-Tribune, 2/9).

Gary Vilke, medical director for San Diego County's Emergency Medical Services and an emergency department doctor, said, "(The doctors) make plans, they have other cases, and it's upsetting." However, Vilke added, delays cited by Milling in his letter are not "outside the realm of what is normal for the (medical) community."

Tony Coletti, an administrator for the Department of Health Services, said that while state rules do not address hospital obstetrical units or delays in surgical scheduling, the issue "sounds interesting, and I feel we should take a look at it" (San Diego Union-Tribune, 2/3).