Top trauma care at Fresno’s CRMC hospital in question as contract dispute persists
Critical contract negotiations remained at loggerheads Saturday between Fresno’s Community Regional Medical Center and the Central California Faculty Medical Group.
It remained unclear whether the hospital was providing Level I trauma care.
Six neurosurgical trauma surgeons with CCFMG have been without a contract since midnight Wednesday, and those trauma services weren’t available on Thursday and Friday. That meant anyone suffering major head trauma would be taken to another hospital hundreds of miles away from Fresno.
Craig Castro, CRMC’s president and CEO, said earlier this week the hospital planned to restore those trauma services sometime Friday through what he described as “alternate neurosurgery call coverage.”
However, on Saturday, it remained unclear whether those alternate services were in place.
CRMC spokesperson Mary Lisa Russell told The Bee she was looking into that question on Saturday.
Lauren Nickerson, a CCFMG spokesperson, confirmed the status of contract negotiations remained unchanged, and CCFMG’s surgeons were “not providing coverage” at CRMC on Saturday.
Nickerson said both sides were eager to solve the issue and described negotiations as “active” and “ongoing.” However, it wasn’t immediately clear whether the groups were actually in talks over the weekend.
What does this mean for Fresno patients?
CRMC was still treating almost all patients at the Fresno hospital. However, on Friday, people requiring neurosurgical trauma services, such as major head injuries, would be transferred to other hospitals across the state.
American Ambulance, which provides ambulance service in Fresno, continues to transport patients to CRMC, according to Edgar Escobedo, with the ambulance company.
“The policy to transport people to the trauma center has not changed,” Lynch told The Bee. “There’s no other facility to take a trauma patient to. CRMC is still the trauma center even though they lack that piece - the on-call piece of neurosurgical trauma - they are still the trauma center.
“Critically ill patients can still be transported to CRMC where they are stabilized, and they are considered for transfer to another facility if they need another level care,” he said.
At least one Fresno-area patient was flown to a Bay Area hospital on Thursday because CRMC couldn’t fully treat the patient, according to Fresno County Emergency Medical Services. It was unclear whether any additional patients were affected after Thursday.
Is CRMC’s Level I Trauma Center status in jeopardy?
A Level I Trauma Center means that all services related to trauma are immediately available, in-house, 24 hours a day, seven days a week.
The Fresno hospital is the only Level I center between Sacramento and Los Angeles.
As of Friday, CRMC’s elite status remained intact on paper. Castro has said the status isn’t in jeopardy
The county’s Emergency Medical Services agency is responsible for overseeing the Level I Trauma Center status of CRMC.
Dan Lynch, Fresno County’s EMS director, confirmed the crucial designation wasn’t immediately vulnerable on Friday.
“As long as they have a plan to correct this deficiency in a short period of time, we will try to work with them in maintaining their designation as a Level I,” he said. “We are waiting for an update... but I feel pretty good that they have a good plan to get the services back, we are not taking any action right now to remove their status.”
What is the hospital dispute about?
Castro on Thursday sent a letter for employees, and a copy was provided to The Bee. In the letter, he says, “one of the leadership qualities” he admires and tries to foster is “transparency,” so he wanted employees to know “the truth about CMC’s efforts to work in good faith” with CCFMG.
“Over the past couple of days, the misinformation conveyed through local media is shocking,” he wrote. “Through news media, CCFMG leaders began accusing CMC of jeopardizing patient access to key medical specialty programs including our Level I trauma services.”
Castro has said CCFMG neurosurgeons of “unilaterally terminated a call agreement” that interrupted services as of midnight on Wednesday.
Both sides say the dispute is not about money or control, but rather the funding model and a funding mechanism.
“CMC has been working on these complicated changes since May and from the beginning has sought to be transparent and to earn the full cooperation of CCFMG,” Castro wrote. “Though CMC has in earnest proposed solutions to every concern, the initial agreements we presented in July have yet to be completed as a result of CCFMG’s lack of full cooperation.”
CCFMG officials and doctors on Wednesday said the hospital’s first plan in July included a direct employment model, meaning doctors would no longer be employed by CCFMG and would no longer be allowed to teach at UCSF Fresno. On Wednesday, Dr. Yu-Hung Kuo, chief of neurosurgery at UCSF Fresno, said doctors had not seen a “mutually beneficial contract” they can sign.
Castro, in his letter, however, says CRMC has “proposed to CCFMG a detailed path forward that allows time for a smooth transition for patients, physicians, and medical education and training.”
“CMC invests more than $60 million annually for medical education, including funding UCSF faculty appointments through CCFMG,” he wrote. “In no way do we wish to jeopardize such a critical component of our mission.”
This story was originally published September 4, 2020 at 12:24 PM.
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