Director of Health Services
Registrar-Recorder/County Clerk
Treasurer and Tax Collector

At its meeting held July 30, 2002, the Board took the following action:

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Hearing to consider the adoption of a resolution calling a special election for a voter-approved special tax within the County to provide funding for the Countywide System of Trauma Centers, Emergency Medical Services and Bioterrorism Response.

"In less than three years, the County's Section 1115 Medicaid Waiver will expire. In Fiscal Year 2005-06, we anticipate that the County will face a deficit of $710 million in the Department of Health Services budget. The Department of Health Services has proposed a radical restructuring of its operations beginning in the current fiscal year so as to reduce the gap between expenditures and expected post-Waiver revenues, and to ensure the ongoing fiscal viability of our system.

"The projected decline in health funding will hurt County residents in many ways, but none so widespread as in the impact on trauma centers, emergency medical services, and bioterrorism response.

TRAUMA

"The County maintains and helps to fund a system of thirteen trauma centers, including three at County hospitals and ten at private hospitals. Funding for this system comes from diminishing Federal sources and from the State, whose support has declined by 88% between 1991 and 2001, to the point at which several private hospitals have left the system and others threaten to do likewise. This diminution of the trauma system poses a direct threat to every County resident, as trauma centers are designated hospitals that maintain specialized equipment and panels of physician specialists, including trauma surgeons, who are available 24 hours a day, 7 days a week to treat trauma patients.

"Trauma is defined as an injury caused by a physical force, most often the consequences of motor vehicle crashes, falls, drowning, gun shots, fires and burns, stabbings, or blunt assaults. Trauma is the leading cause of death in the first four decades of life. The availability of trauma centers is of tremendous importance to every County resident because car accidents and other blunt force trauma incidents can happen anywhere. In cases of severe trauma, no amount of medical insurance may be able to help an injured person if there is no trauma center nearby.

"Unfortunately, our current system of trauma centers does not cover every corner of Los Angeles County. According to the Department of Health Services Director of Emergency Medical Services, an optimum trauma system would include three additional trauma centers, in the Pomona, Baldwin Park/West Covina, and Antelope Valley areas. Additional funds for trauma purposes could make the creation of trauma centers at private hospitals in the Pomona and Baldwin Park/West Covina areas possible; however, it may be difficult to sustain 24/7 coverage at any hospital in the Antelope Valley. If such funding was available, it would be possible to provide trauma service to the Antelope Valley via medical air transport.

"The Director of Health Services estimates that the unreimbursed cost to sustain the three County-run trauma centers is about $35 million a year. Expanding to three additional centers would add an extra $4.5 million a year in expense. The ten private trauma centers are currently providing $22.5 million of unreimbursed trauma care.

"Emergency medical services are available in four of the County's six hospitals and at 75 private hospitals Countywide. These, too, are threatened by the projected withdrawal of Federal and State funding from the County system. The loss of emergency medical services will have an impact on the County's ability to respond to many critical and urgent incidents that also affect all County residents. The unreimbursed cost to the County of providing critical and urgent emergency medical services is approximately $92 million a year.

BIOLOGICAL AND CHEMICAL TERRORISM

"Finally, in the months since September 11, 2001 the nation has grown increasingly aware of the dangers of biological and chemical terrorism. The cost of preparing for bio-terrorism assault is enormous. While the County has received some funding for this purpose from the Federal government, there is still much to be done. The Director of Health Services estimates a need for $20 million in one-time expense, and $19.6 million in annual on going expense, to prepare fully for bio- and chemical terrorism attack. Inasmuch as the Department of Health Services would be a pivotal first responder in the event of such an attack, the County must be prepared for any eventuality.

"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 to partially bridge the massive funding gap in health services and minimize reductions in those services that are the most critical. State law allows voters to approve a special parcel tax on property, the proceeds of which would be placed in a trust fund, to be used exclusively for a designated purpose. The Auditor-Controller would be required to file a report with the County Board of Supervisors by January 1 of each year, stating the amount of funds collected and expended pursuant to this measure.

"A charge of only 3 cents per square foot of structural improvements, excluding parking, would raise approximately $168 million a year. Three cents per square foot is $3.55 per month (or $42.66 per year) on the average-size single family home. It is a small price to pay to protect our trauma network and other critical emergency medical services.

"It must be emphasized that placing the "PRESERVATION OF TRAUMA CENTERS AND EMERGENCY MEDICAL SERVICES; 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 the County provides."

CENTERS AND EMERGENCY MEDICAL SERVICES; BIOTERRORISM RESPONSE" measure on the November 5, 2002 ballot, authorizing an annual tax on all improved
properties in the County of Los Angeles of three cents per square foot of structural improvements, excluding the square footage of improvements used
for parking.

"Trauma and critical emergency care are an essential public service that not only saves lives by providing immediate coordination of highly specialized care for the most life-threatening injuries, but it establishes the critical infrastructure to respond to disasters and potential terrorist attacks. This is an important priority for the Board of Supervisors.

"The County has the ability to identify revenue from property taxpayers with voluntary check-off of $45.00, which would be dedicated to the trauma and critical emergency care network throughout Los Angeles County. Property taxpayers would be more receptive to provide additional funding for Los Angeles County's critical emergency care and trauma system by adding a voluntary check-off box on tax bills.

"If every Los Angeles County property taxpayer had a choice to donate $45.00, it would assist our County's critical emergency care and trauma system network by $103.5 million. The key is to give Los Angeles County taxpayers the choice in aiding our County's healthcare system."

Rick Auerbach, Assessor and Mark Saladino, Treasurer and Tax Collector responded to questions posed by the Board relating to Supervisor Antonovich's motion.

August 6, 2002 on the following:

1. The feasibility of implementing a $45.00 "check off" box on all property tax bills that specify that the donated funds would be allocated for critical emergency care in County hospitals and to the trauma care network; and

2. The establishment of a Special Revenue Fund to be used exclusively for critical emergency care and the trauma network system in Los Angeles County for Fiscal Year 2002-03 tax statements.

04073002-71

Attachment

Copies distributed:

Each Supervisor
Chief Administrative Officer
Assessor
County Counsel
Auditor-Controller