People die in Sacramento County emergency rooms at higher rates than in almost any other county in California.

Emergency rooms here lost 27 out of every 10,000 patients during the last three years, compared with a statewide average of 17. That's a higher death rate than any California county except tiny Inyo County, according to a Bee analysis of data from the Office of Statewide Health Planning and Development.

On top of that, The Bee's analysis shows that inland counties tend to lose more emergency patients than coastal counties, with higher death rates clustering in pockets of the Central Valley and interior Southern California.

Emergency rooms are by nature a magnet for all manner of medical problems, from people in very critical condition to walk-ins with troubling aches and pains to those without insurance. The vast majority of people treated there do survive.

When they don't, questions linger about whether they could have been saved.

Earlier this month, Roland Banaga died after collapsing in the waiting area of Mercy San Juan's emergency room. Banaga, who worked taking inventory for a medical supply company, suffered from an aorta that was tearing. Such a tear usually happens in stages and can be treated if doctors spot it early.

"I need to know what's going on," his sister Florence Sampior said, adding she's unsatisfied with answers given so far by hospital officials.

Answers that can fully explain the Sacramento region's high emergency death rate also remain elusive.

Are Sacramentans sicker or frailer than the rest of the state?

Hospitals officials and others theorize Sacramento's population might be more prone to ills that can send someone to an emergency room.

Are ambulances taking more of the nearly dead to Sacramento hospitals, for a few minutes of care before the inevitable?

Are doctors or hospitals here falling short?

Or, are hospitals reporting deaths so haphazardly that no one can rely on the information, despite a 1998 state law that ordered its collection?

"We as a group have never looked at this this way," said Dr. Steve Tharratt, California's director of emergency medical services. "You've identified something interesting."

Tharratt, who teaches at UC Davis Medical School and is certified in five medical specialties, said he plans to ask top emergency doctors around the state to look at The Bee's preliminary analysis, to try to pinpoint what's going on.

Is it the care?

Two Sacramento-area hospitals leap out from the more than 325 in the state database.

Mercy San Juan Medical Center in Carmichael had the second-highest emergency room death rate in California in the last three years – 52.5 per 10,000 visits – trailing only one small facility in Inyo County.

UC Davis Medical Center had the 22nd highest death rate, losing 31.7 of every 10,000 emergency patients. Methodist and Sutter General followed close behind, ranking 26th and 27th.

Even among their peers, death rates at Mercy and Davis are high. Mercy San Juan far surpasses any other Level II trauma center in California, and UC Davis tops all other Level I trauma centers. Both levels see dangerously ill patients, but Level I centers have more specialists in-house instead of on call.

Doctors at UC Davis and Mercy San Juan say the state's data are too flawed for fair comparisons because some hospitals track deaths differently, failed to report, or see healthier people. The two hospitals also said their patients are sicker, so naturally more of them die.

"The patients who seek care at UC Davis are extraordinarily ill," said Dr. Doug Kirk, the medical center's vice chairman of emergency medicine. "We take care of patients who are going to die at a very high rate."

Still, at least one group of very ill people fared worse at Mercy and UC Davis than elsewhere in California. These are patients whose principal diagnosis, in the state database, indicated they were brought into emergency rooms already undergoing cardiopulmonary resuscitation.

Call The Bee's Carrie Peyton Dahlberg, (916) 321-1086.