Report 2013-116 All Recommendation Responses
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 (Release Date: February 2014)
Recommendation #1 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.
Annual Follow-Up Agency Response From October 2019
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. Los Angeles County will not be engaging the College of Surgeons to perform a comprehensive assessment of the trauma system.
California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement
Annual Follow-Up Agency Response From September 2015
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 Annual Follow-Up Status: Will Not Implement
1-Year Agency Response
LA 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 Trauma Hospital Advisory Committee, the State EMS Authority, and the EMS Commission. Although the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system is reasonable, LA County is already taking the obvious steps needed to improve the trauma system for all County residents. Several of these steps are described in the response below.
- Response Date: February 2015
California State Auditor's Assessment of 1-Year Status: Will Not Implement
We stand by our recommendation that the board should use the College of Surgeons to assist the board in better defining and identifying underserved areas in Los Angeles to ensure that areas and at-risk populations in need of additional trauma services are appropriately identified.
6-Month Agency Response
LA 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 Trauma Hospital Advisory Committee, the State EMS Authority, and the EMS Commission. Although the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system is reasonable, LA County is already taking the obvious steps needed to improve the trauma system for all County residents. Several of these steps are described in the response to other recommendations.
- Response Date: August 2014
California State Auditor's Assessment of 6-Month Status: Will Not Implement
60-Day Agency Response
DHS will discuss and evaluate whether additional information could be gained from conducting a study with the American College of Surgeons (ACS). In DHSs evaluation of recent assessments conducted by ACS, such as the 2013 State of Florida review, the value of the study is questioned since ACS overall recommendation to Florida was that they should collaborate with their stake holders to seek a solution to system problems.
- Estimated Completion Date: TBD
- Response Date: April 2014
California State Auditor's Assessment of 60-Day Status: No Action Taken
Recommendation #2 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.
Annual Follow-Up Agency Response From October 2019
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.
Los Angeles County will not be engaging the College of Surgeons to perform an assessment of the trauma system.
California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement
Annual Follow-Up Agency Response From September 2015
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 Annual Follow-Up Status: Will Not Implement
1-Year Agency Response
LA 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 Trauma Hospital Advisory Committee, the State EMS Authority, and the EMS Commission. Although the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system is reasonable, LA County is already taking the obvious steps needed to improve the trauma system for all County residents.
- Response Date: February 2015
California State Auditor's Assessment of 1-Year Status: Will Not Implement
We stand by our recommendation that the board should use the College of Surgeons to review Measure B allocations to ensure that they are addressing the most pressing needs of at-risk populations in Los Angeles. As we reported, the director of EMS acknowledged that Los Angeles had not conducted an evaluation of its trauma system to demonstrate that it has fulfilled the intent of Measure B. Los Angeles has not provided us with any evidence to support that such an evaluation has been or will be performed.
6-Month Agency Response
LA 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 Trauma Hospital Advisory Committee, the State EMS Authority, and the EMS Commission. Although the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system is reasonable, LA County is already taking the obvious steps needed to improve the trauma system for all County residents. Several of these steps are described in the response to other recommendations.
- Estimated Completion Date:
- Response Date: August 2014
California State Auditor's Assessment of 6-Month Status: Will Not Implement
We stand by our recommendation that the board should use the College of Surgeons to review Measure B allocations to ensure that they are addressing the most pressing needs of at-risk populations in Los Angeles. As we reported, the director of EMS acknowledged that Los Angeles had not conducted an evaluation of its trauma system to demonstrate that it has fulfilled the intent of Measure B. Los Angeles has not provided us with any evidence to support that such an evaluation has been or will be performed.
60-Day Agency Response
The benefits of having ACS review the Measure B allocations are unclear.
- Estimated Completion Date: TBD
- Response Date: April 2014
California State Auditor's Assessment of 60-Day Status: No Action Taken
Recommendation #3 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.
Annual Follow-Up Agency Response From October 2019
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.
Los Angeles County will not be engaging the College of Surgeons to perform an assessment of the trauma system.
California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement
Annual Follow-Up Agency Response From October 2019
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.
Los Angeles County will not be engaging the College of Surgeons to perform an assessment of the trauma system.
California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement
Annual Follow-Up Agency Response From September 2015
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 Annual Follow-Up Status: Will Not Implement
1-Year Agency Response
LA 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 Trauma Hospital Advisory Committee, the State EMS Authority, and the EMS Commission. Although the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system is reasonable, LA County is already taking the obvious steps needed to improve the trauma system for all County residents.
- Response Date: February 2015
California State Auditor's Assessment of 1-Year Status: Will Not Implement
We stand by our recommendation that the board should use the College of Surgeons to assess the adequacy of helicopter services it provides in underserved areas. As we reported, Los Angeles' current monitoring efforts do not enable it to examine whether its trauma system serves residents, such as those in underserved areas and at-risk population groups, equitably. Additionally, we reported that EMS's efforts to review helicopter data were undocumented and not specific to underserved areas. Thus, EMS cannot demonstrate that underserved areas fare as well as other areas of the county in terms of transport times. We believe engaging the College of Surgeons to perform such an assessment would allow Los Angeles to ensure its trauma system is serving the needs of residents in underserved areas.
6-Month Agency Response
LA 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 Trauma Hospital Advisory Committee, the State EMS Authority, and the EMS Commission. Although the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system is reasonable, LA County is already taking the obvious steps needed to improve the trauma system for all County residents. Several of these steps are described in the response to other recommendations.
- Estimated Completion Date:
- Response Date: August 2014
California State Auditor's Assessment of 6-Month Status: Will Not Implement
We stand by our recommendation that the board should use the College of Surgeons to assess the adequacy of helicopter services it provides in underserved areas. As we reported, Los Angeles' current monitoring efforts do not enable it to examine whether its trauma system serves residents, such as those in underserved areas and at-risk population groups, equitably. Additionally, we reported that EMS's efforts to review helicopter data were undocumented and not specific to underserved areas. Thus, EMS cannot demonstrate that underserved areas fare as well as other areas of the county in terms of transport times. We believe engaging the College of Surgeons to perfrom such an assessment would allow Los Angeles to ensure its trauma system is serving the needs of residents in underserved areas.
60-Day Agency Response
The benefits of having ACS review the helicopter services are unclear.
- Estimated Completion Date: TBD
- Response Date: April 2014
California State Auditor's Assessment of 60-Day Status: No Action Taken
Recommendation #4 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.
Annual Follow-Up Agency Response From October 2019
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.
Los Angeles County will not be engaging the College of Surgeons to perform an assessment of the trauma system.
California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement
Annual Follow-Up Agency Response From September 2015
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 Annual Follow-Up Status: Will Not Implement
1-Year Agency Response
LA 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 Trauma Hospital Advisory Committee, the State EMS Authority, and the EMS Commission. Although the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system is reasonable, LA County is already taking the obvious steps needed to improve the trauma system for all County residents.
- Response Date: February 2015
California State Auditor's Assessment of 1-Year Status: Will Not Implement
We stand by our recommendation the the board should engage the College of Surgeons to analyze how EMS might better use the data it collects to evaluate, improve, and report continuously on its trauma system. As we reported, the director of EMS acknowledged that Los Angeles has not conducted an evaluation of its trauma system to demonstrate it has fulfilled the intent of Measure B. Further, we reported that Los Angeles' current monitoring efforts do not enable it to examine whether its trauma system serves residents, such as those in underserved areas and at-risk population groups, equitably. We believe the College of Surgeons can provide insights to EMS on how to use the data it collects to evaluate, improve, and report continuously on its trauma system.
6-Month Agency Response
LA 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 Trauma Hospital Advisory Committee, the State EMS Authority, and the EMS Commission. Although the suggestion to engage the American College of Surgeons (ACS) in an analysis of the trauma system is reasonable, LA County is already taking the obvious steps needed to improve the trauma system for all County residents. Several of these steps are described in the response to other recommendations.
- Estimated Completion Date:
- Response Date: August 2014
California State Auditor's Assessment of 6-Month Status: Will Not Implement
We stand by our recommendation the the board should engage the College of Surgeons to analyze how EMS might better use the data it collects to evaluate, improve, and report continuously on its trauma system. As we reported, the director of EMS acknowledged that Los Angeles has not conducted an evaluation of its trauma system to demonstrate it has fulfilled the intent of Measure B. Further, we reported that Los Angeles' current monitoring efforts do not enable it to examine whether its trauma system serves residents, such as those in underserved areas and at-risk population groups, equitably. We believe the College of Surgeons can provide insights to EMS on how to use the data it collects to evaluate, improve, and report continuously on its trauma system.
60-Day Agency Response
The benefits of having ACS analyze how EMS collects its data are unclear.
- Estimated Completion Date: TBD
- Response Date: April 2014
California State Auditor's Assessment of 60-Day Status: No Action Taken
Recommendation #5 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.
Annual Follow-Up Agency Response From October 2019
The LA County Board of Supervisors (Board) will continue to serve as the advisory and approval body with respect to the distribution of Measure B funds. The County will not implement the recommendation as written, but did establish a Measure B Advisory Board (MBAB) to make recommendations on potential projects that could be funded using unallocated Measure B funds.
On January 10, 2018, the first meeting of the MBAB was held. During this meeting the MBAB Bylaws and the mechanism to take requests for Measure B unallocated funds were discussed. Subsequently, a process, which includes the submission of funding proposals, was developed and implemented.
On Oct. 9, 2018, the MBAB reviewed and discussed 14 funding proposals. On Nov. 26, 2018, the MBAB met to prioritize the funding proposals. On March 12, 2019 a Board memo was filled recommending to the Board to fund 12 projects (2 of the originally submitted proposals were withdrawn by the entity who submitted them). These recommendations were approved on April 4, 2019 and have all been funded.
On April 15, 2019 the Measure B Proposal Process and Proposal Form for 2019 was distributed and posted on the EMS Agency website and the EMS Agency accepted proposals for consideration (http://file.lacounty.gov/SDSInter/dhs/1040988_MABA071018.pdf.
On September 16, 2019 the proposals were reviewed by the MBAB and a priority ranking was done. A Board Memo will be prepared with the MBAB recommendations for 2019 and be submitted to the Board later this year for their consideration.
The MBAB will continue to utilize this process to review and prioritize and make recommendations to the Board, as additional unallocated funds become available.
California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement
Annual Follow-Up Agency Response From November 2018
The LA County Board of Supervisors (Board) will continue to serve as the advisory and approval body with respect to the distribution of Measure B funds. The County will not implement the recommendation as written, but the following activities were undertaken in response to the audit and its findings.
On May 2, 2017, the Board directed the Chief Executive Office (CEO) to work with the Dept. of Health Services (DHS) to report on a) a countywide strategy for ensuring objective, needs-based allocation of future unallocated Measure B funds that will ensure the maximum impact on LA County residents; and b) the feasibility of establishing a County advisory body for future unallocated Measure B funds, which shall consist of, but not be limited to the CEO, DHS, Emergency Medical Services (EMS) Agency, Dept. of Public Health (DPH), and other external stakeholders at the discretion of the CEO.
On July 3, 2017, the CEO filed the report addressing the above, and recommended the County create a Measure B Advisory Body (MBAB).
On July 11, 2017, the Board approved a motion by Supervisors Kathryn Barger and Janice Hahn to adopt recommendations in the July 3, 2017 report and direct the CEO to implement the MBAB to advise the Board on options or recommendations for spending unallocated Measure B funds.
On January 10, 2018, the first meeting of the MBAB was held. During this meeting the MBAB Bylaws and the mechanism to take requests for Measure B unallocated funds were discussed. Subsequently, a process, which includes the submission of funding proposals, was developed and implemented.
On Oct. 9, 2018, the MBAB reviewed and discussed 14 funding proposals. On Nov. 26, 2018, the MBAB will meet to prioritize the funding proposals and then will make recommendations to the Board based on this prioritization. The MBAB will continue to utilize this process to review and prioritize and make recommendations to the Board as additional unallocated funds become available.
California State Auditor's Assessment of Annual Follow-Up Status: Partially Implemented
The Board's actions have partially addressed our concern because the advisory body provides options or recommendations for spending unallocated Measure B funds. However, the advisory body has not re-evaluated the Measure B allocation approach.
Annual Follow-Up Agency Response From October 2016
The Los Angeles County Board of Supervisors will continue to serve as the advisory and approval body with respect to distribution of Measure B funds.
As a follow-up to last year's response regarding distribution of funds to non-County trauma hospitals, Los Angeles County, through its Department of Health Services, has met regularly with hospital representatives to collaboratively share ideas and concepts for allocating available funds, including Measure B, to support the trauma network. The group has developed guiding principles centered around preserving and supporting the County-wide trauma network for the uninsured and underinsured population, providing assistance with covering fixed costs for trauma-related infrastructure, and taking into account patient acuity and managed care changes. The group feels it is necessary to maintain a stable allocation of funds to ensure the stability of the trauma network instead of trying to reallocate funds annually, which could serve to undermine long-term planning efforts for the trauma network participants. This group will continue to meet on an ongoing basis and will serve as an important voice in developing overall recommendations to the LA County Board of Supervisors.
California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement
Annual Follow-Up Agency Response From September 2015
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.
- Estimated Completion Date: December 2015
California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented
1-Year Agency Response
LA County Dept. of Health Services will discuss with the Board the preferred process for evaluating, establishing, and reporting on the Measure B allocation approach, including consideration of the impact of the Affordable Care Act (ACA) on such allocation.
- Estimated Completion Date: August 2015
- Response Date: February 2015
California State Auditor's Assessment of 1-Year Status: No Action Taken
6-Month Agency Response
DHS will discuss with the Board the preferred process for evaluating, establishing, and reporting on the Measure B allocation approach, including consideration of the impact of the Affordable Care Act on such allocation.
- Estimated Completion Date: November 2014
- Response Date: August 2014
California State Auditor's Assessment of 6-Month Status: No Action Taken
60-Day Agency Response
The County's Health Services Department will work with the Board to consider establishment of an Advisory Committee to evaluate and advise Measure B allocation, assess the impact of the Patient Protection and Affordable Care Act on the trauma care system, and prepare reports as requested by the Board.
- Estimated Completion Date: TBD
- Response Date: April 2014
California State Auditor's Assessment of 60-Day Status: No Action Taken
Recommendation #6 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 following: the number of flights flown by each provider to underserved areas
1-Year Agency Response
The EMS Agency 2014 Data Report was published in October 2014 (http://file.lacounty.gov/dhs/cms1_220127.pdf). The data in this report reflects calendar year 2013 activity. Included in this report is EMS Helicopter Transport data, which provides information on the number of helicopter transports by provider agency and by geographic location. The geographic location data is further broken down into whether the transport was for a medical or trauma emergency and mortality rates.
- Completion Date: October 2014
- Response Date: February 2015
California State Auditor's Assessment of 1-Year Status: Fully Implemented
6-Month Agency Response
The EMS Agency data report is currently being developed, which includes helicopter transport and trauma care data. EMS plans to complete and publish the report by December 2014.
- Estimated Completion Date: December 2014
- Response Date: August 2014
California State Auditor's Assessment of 6-Month Status: Pending
60-Day Agency Response
The County Department of Health Services Emergency Medical Services (EMS) Agency will analyze data, develop reports and publish annual reports on helicopter transport and care of trauma patients. Data collection methods and reporting formats will be redesigned and reviewed.
- Estimated Completion Date: December 2014
- Response Date: April 2014
California State Auditor's Assessment of 60-Day Status: Pending
Recommendation #7 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 following: the time it takes to transport each trauma patient.
1-Year Agency Response
The EMS Agency 2014 Data Report was published in October 2014 (http://file.lacounty.gov/dhs/cms1_220127.pdf). The data in this report reflects calendar year 2013 activity. Included in this report is Trauma patient mode of transport and transport time data. An analysis of this data shows that 4% of trauma patients are transported by helicopter from the scene. 95% of the trauma patients transported by helicopter lived and their mean transport time was 20 minutes, and the 5% of the trauma patients transported by helicopter that died had a mean transport time of 16 minutes.
- Completion Date: October 2014
- Response Date: February 2015
California State Auditor's Assessment of 1-Year Status: Fully Implemented
6-Month Agency Response
The EMS Agency data report is currently being developed, which includes helicopter transport and trauma care data. EMS plans to complete and publish the report by December 2014.
- Estimated Completion Date: December 2014
- Response Date: August 2014
California State Auditor's Assessment of 6-Month Status: Pending
60-Day Agency Response
The DHS Emergency Medical Services (EMS) Agency will analyze data, develop reports and publish annual reports on helicopter transport and care of trauma patients. Data collection methods and reporting formats will be redesigned and reviewed.
- Estimated Completion Date: December 2014
- Response Date: April 2014
California State Auditor's Assessment of 60-Day Status: Pending
Recommendation #8 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 following: the health outcomes, including mortality rates, of trauma patients transported by helicopter.
1-Year Agency Response
The EMS Agency 2014 Data Report was published in October 2014 (http://file.lacounty.gov/dhs/cms1_220127.pdf). The data in this report reflects calendar year 2013 activity. Included in this report is Trauma patient mode of transport and transport time data. An analysis of this data shows that 4% of trauma patients are transported by helicopter from the scene. 95% of the trauma patients transported by helicopter lived and their mean transport time was 20 minutes, and the 5% of the trauma patients transported by helicopter that died had a mean transport time of 16 minutes.
- Completion Date: October 2014
- Response Date: February 2015
California State Auditor's Assessment of 1-Year Status: Fully Implemented
6-Month Agency Response
The EMS Agency data report is currently being developed, which includes helicopter transport and trauma care data. EMS plans to complete and publish the report by December 2014.
- Estimated Completion Date: December 2014
- Response Date: August 2014
California State Auditor's Assessment of 6-Month Status: Pending
60-Day Agency Response
The DHS Emergency Medical Services (EMS) Agency will analyze data, develop reports and publish annual reports on helicopter transport and care of trauma patients. Data collection methods and reporting formats will be redesigned and reviewed.
- Estimated Completion Date: December 2014
- Response Date: April 2014
California State Auditor's Assessment of 60-Day Status: Pending
Recommendation #9 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.
Annual Follow-Up Agency Response From October 2016
The 2015 EMS System Report included information on the number of and rationale for cancelled flights and was published on November 1, 2015. The 2016 EMS System Report is currently being compiled and will include information on cancelled flights, method of transport, transport times and patient outcomes.
- Completion Date: October 2016
California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented
Annual Follow-Up Agency Response From September 2015
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.
- Estimated Completion Date: Year 2016 (Data Merger to be completed for CY 2015)
California State Auditor's Assessment of Annual Follow-Up Status: Not Fully Implemented
1-Year Agency Response
The EMS Agency collected this data for fiscal year 2013-14 and will continue monitoring all EMS helicopter flights that are cancelled.
- Completion Date: October 2014
- Response Date: February 2015
California State Auditor's Assessment of 1-Year Status: Partially Implemented
We believe EMS should report the information it collected regarding cancelled flights to clearly show the impact that cancelled helicopter flights have on its ability to transport trauma patients in a timely manner.
- Auditee did not address all aspects of the recommendation
6-Month Agency Response
The EMS Agency data report is currently being developed, which includes helicopter transport and trauma care data. EMS plans to complete and publish the report by December 2014.
- Estimated Completion Date: December 2014
- Response Date: August 2014
California State Auditor's Assessment of 6-Month Status: Pending
60-Day Agency Response
The DHS Emergency Medical Services (EMS) Agency will analyze data, develop reports and publish annual reports on helicopter transport and care of trauma patients. Data collection methods and reporting formats will be redesigned and reviewed.
- Estimated Completion Date: December 2014
- Response Date: April 2014
California State Auditor's Assessment of 60-Day Status: Pending
Recommendation #10 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.
Annual Follow-Up Agency Response From September 2015
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.
- Completion Date: August 2015
California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented
1-Year Agency Response
LA County Dept. of Health Services (DHS) is in the final stages of reviewing and selecting the applications received from the two hospitals that responded to the Request for Application (RFA) for Trauma Services. The RFA process was concluded in mid-February, and negotiations will be conducted with the qualified applicant and Board approval will be required to move to the next step of designation as a trauma center. Upon the Board's approval to designate the most qualified hospital in the San Gabriel Valley as a Trauma Center, DHS will implement the designation process. This process is estimated to take between 15-18 months and will be implemented to ensure that the hospital complies with all the California Code of Regulations building requirements and has all the necessary processes, staffing and equipment to provide optimum trauma care as set by the American College of Surgeons.
- Estimated Completion Date: June 2015
- Response Date: February 2015
California State Auditor's Assessment of 1-Year Status: Partially Implemented
6-Month Agency Response
At the request of two hospitals in the East San Gabriel Valley, the Request for Information (RFI) due date was extended from April 16, 2014 to the end of May 2014. By May 30, 2014, DHS received responses from Citrus Valley Medical Center-Queen of the Valley Campus and Pomona Valley Hospital Medical Center indicating interest in becoming a designated trauma center. DHS determined a competitive solicitation was necessary to elicit sufficient information from the RFI respondents to formally evaluate responses and select one entity to negotiate a contract. DHS anticipates issuing a Request for Applications (RFA) on or about August 27, 2014 with applications due on October 1, 2014. After an evaluation process, one entity is expected to be selected with contract negotiations commencing in early December 2014.
- Estimated Completion Date: December 2014
- Response Date: August 2014
California State Auditor's Assessment of 6-Month Status: Partially Implemented
60-Day Agency Response
On April 1, 2014, the County of Los Angeles Department of Health Services (DHS) released a Request for Information (RFI) for Trauma Service Center Candidates in the East San Gabriel Valley. The RFI was sent to Pomona Valley Hospital Medical Center, Kaiser Permanente, Citrus Valley Hospitals, Prime Health Care, and AHMC Health. The deadline for submitting the RFI was April 16, 2014. DHS will need to review and analyze the RFIs and further negotiations with hospitals will be required.
- Estimated Completion Date: December 2014
- Response Date: April 2014
California State Auditor's Assessment of 60-Day Status: Partially Implemented
All Recommendations in 2013-116
Agency responses received are posted verbatim.