1. California Trauma System Summit II Improving Trauma Care through State Trauma System Development September 21, 2009

2. Measure B – Support for Trauma Services Cathy Chidester, Director Los Angeles County, Emergency Medical Services Agency Trauma Summit

3. LOS ANGELES COUNTY  4,082 Square Miles  Population > 10 Million  73 9-1-1 Receiving Centers  13 Trauma Centers  30 Public EMS 9-1-1 Providers  19,500 Trauma Patients Annually

7. GOVERNANCE  Board of Supervisors (BOS) - 5 Members  Department of Health Services - EMS Agency - 2002  V irginia Price Hastings, Director  EMS Commission – 17 Members Various constituent groups – 12 Members Appointed by the BOS – 5 Members

8. WHY OUR TRAUMA SYSTEM WAS VERGING ON COLLAPSE:  Increase in Trauma Patient Volumes  Poor Payor Mix  Drastic Cuts in Proposition 99 Tobacco Tax Funds

9. INCREASE IN TRAUMA PATIENT VOLUMES: YEARTRAUMA PATIENT VOLUME 199212,718 199312,423 199412,151 199512,619 199612,596 199714,303 199815,252 199915,653 200016,912 200118,837 200219,196

10. PRIVATE TRAUMA CENTERS PAYOR MIX: Fiscal Year 1997/98 (n = 6,745)

11. COUNTY TRAUMA CENTERS PAYOR MIX: Fiscal Year 1997/98 (n = 7,293)

12. DRASTIC CUTS IN TOBACCO TAX FUNDS: 1990/91 PHYSICIAN SERVICES $7,711,000 HOSPITAL SERVICES $9,209,000 2000/01$596,000$1,075,000 2001/02$394,000$998,000 Declined by 88%, while the indigent population for Los Angeles County steadily increased.

13. AS IF THAT WASN’T ENOUGH  Not only was LA facing the collapse of our Trauma System due to the Increase in Trauma Patient Volumes, Poor Payor Mix, and Drastic Cuts in Proposition 99 Tobacco Tax Funds  In addition, the County’s entire Medical Delivery System was verging on collapse due to the loss of Federal Medicaid "waiver" funding in two years.

14. BOARD OF SUPERVISORS HEARING JULY 30, 2002  Hearing to consider adoption of a resolution calling for voter approved special assessment  Supervisor Yaroslavsky “In less than 3 yrs, the County’s Section 1115 Medicaid Waiver will expire. In FY 05/06, we anticipate that the County will face a deficit of $710 million in the DHS budget…  “The projected decline in health funding will hurt County residents in many ways, but none so widespread as in the impact on trauma centers, EMS, and bioterrorism response.”

15. Board resolution providing for and giving notice of a special tax election  “While the County continues to press the State and Federal governments for relief, it should attempt to help itself by authorizing the raising of local revenues …”  “A charge of only 3 cents per sq foot of structural improvements…would raise approximately $168 million a year.”  “Preservation of Trauma Centers and EMS, Bioterrorism Response measure before the voters, does not come close to solving the County’s health funding crisis. However, it would go a long way toward the preservation of the most critically needed services provided by the County”

16. PURPOSE of MEASURE B  To avoid the life-threatening shutdown of Los Angeles County's trauma network,  To maintain and expand the trauma network Countywide, while ensuring more timely response to critical and urgent medical emergencies, and  To respond effectively to biological and chemical terrorism.

17. MEASURE B: November 5, 2002, Special Tax Election  Would Authorize the County of Los Angeles to levy a 3 cents per sq. ft. special tax on structural improvements to provide funding for the Countywide System of Trauma Centers, Emergency Medical Services and Bioterrorism Response.  Would require a 2/3 majority approval for passage from the voters.  Supervisors in favor of the measure 3:2

18. CAMPAIGN  Short time frame  Educate Voters (history of passing Prop 13)  Utilized Labor Union (SEIU)  Board of Supervisor’s Support  Retained Political Consultant – Dakota Communication

19. CAMPAIGN (continued)  Tenet Healthcare  Hospital Association  Endorsement by LA Times and Daily News  EMS providers  Free news coverage from local media  Funding through Labor Union and coalition of supporters

20. PROS versus CONS Argument in Favor of Measure B Preservation of our most critically needed services! Rebuttal to Argument for Measure B Stop your taxes from rising out of control!  Virginia Price Hastings, Director, EMS Agency  Michael Metro, Chief, Paramedic Services, LA Co Fire  League of Women Voters  Stephen J. Ryan, MD, Dean, Keck School of Medicine of USC  Michael D. Antonovich, Supervisor  Triso Del Junco, MD, Chief Medical Staff, ELA Star Community Hospital  Gary G. Hill, Chairman, Board of Directors, Antelope Valley Hospital  Jon Coupal, President, Howard Jarvis Taxpayers Association

21. TIMING IS EVERYTHING! November 3, 2002 (Approximately 190 vehicles were involved. Roughly forty people were hospitalized, nine reportedly in critical condition.)

22. VIRGINIA TRIUMPHS! MEASURE B WAS PASSED BY THE VOTERS ON NOVEMBER 5, 2002 AT AN UNBELIEVABLE RATE OF 73%

23. MEASURE B FUNDS FY 2007/08  County Hospitals -  County Departments -  Trauma Hospitals / physicians -  Grand Total - 140 million 9.8 million 44.6 million 197 million

24. DOWNFALLS OF MEASURE B  The passage of Measure B was no easy task  Measure B has not resulted in a complete fix  Not meeting expectations of:  EMS Providers  All hospitals  Underserved areas

25. REALITY OF MEASURE B  Saved our Trauma System  Protects the emergency departments  Makes a significant difference for bio-terrorism preparedness

26. CREATIVE FUNDING Thank you for listening to Los Angeles County’s creative solution to improving our Trauma System funding.