California Burn Center Bucks Trend to Downsize

Justin Strickland's badly burned left leg trembled as he struggled to hold it in the air.

The 19-year-old grimaced when his grandmother placed new bandages on his wounds during his final day at Arrowhead Regional Medical Center.

Strickland spent two weeks in the hospital's 14-bed burn center, the Inland region's only one and one of a shrinking number nationwide.

But as burn-unit beds across the country decrease, Arrowhead officials say they have no plans to scale back, despite the financial cost and toll it takes on doctors and nurses who work there each day.

Patients such as Strickland and the nearly 500 others treated each year will continue to receive the care they need to recover, hospital officials say.

Strickland, who suffered third-degree burns on his left leg and burns to his thigh, arm and face after two cans of black powder exploded at his Mira Loma home, said he was grateful.

"It was probably harder on my family than it was on me," he said from his hospital room last month. "Don't play with gunpowder. I was burned to a crisp."

The nation had 3,000 burn-unit beds in the early 1970s and there has been a steady decline since then, said Dr. William B. Hughes, director of the Temple University Hospital Burn Center in Philadelphia.

Though the number of burn beds is in dispute, an analysis of American Burn Association data shows the number of burn centers in the United States has declined from 132 in 2004 to 127 this year and the number of beds dropped from 1,897 to 1,820 in that period. Federal health officials put the number at 1,500, with most filled on any given day.

Experts are concerned there are not enough beds to handle burn victims from a natural disaster or terrorist attack.

"If something happens and we need the beds for burn patients, it is going to be a real catastrophe," said Dr. Alan R. Dimick, past president of the American Burn Association.

NO DOWNSIZING

At Arrowhead Regional Medical Center, the burn unit is more than half filled on most days. It treated 474 patients last year and 452 through Oct. 15 of this year. The average stay last year was eight days.

The unit provides care for San Bernardino, Riverside, Mono and Inyo counties, serving more than 4 million people and 40,506 square miles, an area larger than 14 states. Other Inland hospitals with trauma centers rely on agreements with Arrowhead's burn center to treat their patients.

"For both the hospital and the county, it is extremely important," said Dr. Dev Gnanadev, Arrowhead's medical director. "We have no intention of downsizing.

"Our goal is to provide the best care to the county rather than make money," he said.

Caring for burn patients is expensive, often topping $10,000 a day for the most severely burned. Units require specialized beds and equipment, and individual rooms for patients who are vulnerable to infection.

The length of stay is often longer for burn victims, and doctors and nurses need more supplies to care for patients, Gnanadev said.

About half of the burn center's patients require some type of skin-grafting surgery, hospital officials said. Just a six-inch artificial skin graft can cost between $5,000 and $6,000, Gnanadev explained.

In addition, turnover among nurses is high, he said.

"It is hard to not only recruit but to keep," he said. "You can't see really badly burned patients day in and day out and not ... get stressed. It is a tough job."

Gnanadev said many burn patients in California are uninsured, which is a financial drain on the hospital.

"We provide (the care) to everyone," he said.

CLOSE PROXIMITY

In July 2005, San Bernardino County firefighter Josh Sprague was helping his oldest son change the fuel pump in his car. Somehow, he said, a spark ignited gasoline vapors, catching his Oak Hills garage on fire and burning his legs.

"I had third-degree burns on both lower legs," Sprague said. "My left leg got the worst of it - burned down into the fat on the back of my leg."