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Alameda Hospital Business Strategies are at Odds with our Right to Optimal Healthcare

Dear Editor,

Current Alameda Hospital District board members are telling us that they’ve overseen the greatest financial turnaround in the hospital’s history while elevating the best interest of Alamedans and preserving critical high quality healthcare. This cannot possibly be true.

Earlier this summer, I sustained a non-life-threatening medical event that any ER should be able to handle with proficiency. Yet, by Alameda Hospital management’s own assessment, every single team–physician, nurse, radiology, and even housekeeping (ick!)—failed to follow procedures and protocols including those for dispensing narcotics. But suffice it to say that they said they nearly killed me and would have were I not so healthy. I survived that day by being seen at Alta Bates. (My complete story is here.)

When every interdependent team fails simultaneously, it means the problem is systemic. The dysfunction filters down from the top of the hierarchy to the bottom and across all teams. It’s called organizational sociopathy, and it’s nearly impossible to create in a healthcare organization. How has our hospital gotten to this dangerous state? It’s the leadership.

Recently, Ms. Deborah Stebbins (CEO, Alameda Hospital) spoke about the great success they’ve had generating revenue from funneling emergency cardiac patients through Alameda Hospital and over to Alta Bates Summit (Berkeley, 3 to 5 miles), so much so that they intend to replicate this strategy for strokes: funneling emergency stroke victims through Alameda Hospital and over to Eden (Castro Valley, 14 to 17 miles). There was no mention of the benefits of these strategies on our lives. Maybe that’s because there aren’t any.

In the county of Alameda, emergency service protocols require heart attack and stroke victims be taken directly to the nearest certified cardiac and stroke centers such as Summit and Eden…EXCEPT in the City of Alameda. Here, the paramedic must take us to Alameda Hospital. We have no choice.

Unbelievable, right? But it’s written right into the 2010 Alameda County EMS (Emergency Medical Services) Manual. And I quote:

“Certified Stroke Centers: The following hospitals have been designated as certified stroke centers. Patients should be transported to one of the facilities if possible. Exception: patients in the City of Alameda should be transported to Alameda Hospital.”

You’ve got 60 to 90 minutes to get accurately diagnosed and treatment begun before brain cells or heart muscles start dying. When the right treatment is not begun within these time-windows, the probabilities for permanent damage and death spike.

This is taken from the California master plan for emergency cardiac and stroke treatment:

TIME IS HEART MUSCLE SAVED.

TIME IS BRAIN CELLS SAVED.

Every other city in Alameda County ensures that you will be seen immediately at one of the several certified centers–where a cardiologist, neurologist, trained cardiac and stroke teams, top diagnostic equipment, and a cath lab are alerted before you arrive and onsite 24/7. This is the standard of emergency care, for good reason. Every other city is agnostic about which center you get taken to just so long as you get into the nearest certified center. Even if the closest center is outside of the county!

WHY IS IT THEN THAT the Alameda Healthcare District board thinks it makes sense for you to spend the first 30 or more critical minutes of your emergency being routed through their facility?!

It does not! These strategies are appropriate for remote/rural towns. These strategies are not appropriate for cities within minutes of the best cardiac and neurological care systems in the world!

Why don’t we have the same emergency transport protocols as other cities in Alameda County?! Who thought putting us at increased risk for heart or brain damage and death made sense?! Who created this variance to the county protocols for the City of Alameda?

Follow the money. Is the hospital is the only organization the profits from these strategies?

The paramedics provide excellent emergency care. We don’t need a stopover at Alameda Hospital!

We have a right to optimal care. The current hospital board members have failed us. The board has focused on generating revenue, and tooting their own horns, all the while selling us a bill of goods.

I know these hospital strategies don’t make medical sense. And they sure as hell don’t make any sense for my pocketbook: who needs two ambulance rides and two hospital bills when one of each will do?

I got lucky once. I survived the substandard medical care that day and only had to pay one hospital bill: my husband drove me to Alta Bates to get the care I needed to survive and Alameda Hospital comped me their $10,000+ bill.

How do we fix this? For starters: on November 2nd, we cannot vote any incumbent medicrats—Bonta, Deutsch, and Williams—back onto the hospital board or onto city council. They do not deserve to represent us.

Fortunately, we have two excellent candidates running for the hospital board who will better represent our best interests. Stewart Chen and Elliott Gorelick.

Addendum

Last Saturday, I asked Dr. Deutsch (Alameda Healthcare District board member and incumbent candidate) about the new cardiac and stroke strategies. He dismissed me and the conversation I wanted to have with him as “too complex”. But before ending it, he said two very telling things:

1. He told me that if I had a heart attack or stroke right then and there on the steps of Cardinal Point, that I could tell the paramedics to take me to Summit and they would. I told him that this was not true. He repeatedly told me “You have your facts wrong”.

No, I don’t. Read the county EMS manual. Ask the local emergency responders—like I did–who confirm this and worse: even if you put it in writing that you are never to be taken to Alameda Hospital, if you’re “unstable”, the emergency responders HAVE to take you there; they have to follow their protocols over your stated hospital preference.

I find it very hard to believe that a hospital board member, particularly a doctor, would not know the EMS protocols as they relate to the strategies he himself has led at the hospital.

2. “The percentage of stroke victims that require that [a certified stroke center] is so small that most people don’t need that [to be delivered directly to a certified stroke center by the paramedics].”

Seriously?! Why, then, is being delivered—where possible–into an alerted certified stroke system for all stroke victims the standard of care in Alameda County and in the State of California?!

Either the hospital board members have known about the EMS protocols or they have not, or maybe they helped create the county variance for our city. We cannot yet know. Regardless, they’ve put us at a healthcare disadvantage in our own city in order to keep their hospital alive. It is opprobrious, and worse.

And as Gorelick points out, since 2002, taxpayers have funded the hospital $50 million dollars and the hospital’s balance sheet is significantly worse off now than in 2002! That’s almost impossible to do with ‘free’ money, i.e., money that has no debt or equity stakes posted against it.

–Denise Lai, Alameda

23 comments to Alameda Hospital Business Strategies are at Odds with our Right to Optimal Healthcare

  • What I have found fascinating as I sat next to Rob Bonta on daises during this campaign is his terminology of turning the deficit of the Hospital into a surplus. Like a programmed robot, it’s the only term he can use to express his alleged pride of accomplishment on the board.

    First of all, in business, we talk about earning a profit. A surplus is something that you have of something you don’t need. Money is something every organization needs, especially a community hospital.

    Second of all, if the hospital is earning a profit, why isn’t that money going to improve the quality of care for people like Denise Lai instead of towards massive $400k/year salaries for administrators?

    Third of all, the parcel tax that funds the hospital and has now made it “profitable,” has no sunset: we will continue to pay year after year for this hospital, whether it serves us well, badly or ceases to exist, unless another Measure is passed to end this tax.

    Ms Lai is not the only one to have horrendous experiences with the Alameda Hospital, and not the only one to point out that the funding and planning for it seems to have little benefit to our community.

    Lately the Health Care District Board has been a feeder to City Council, and after seeing the quality of leadership that has brought us (sharing confidential emails with SunCal) and wants to bring us (a SF City Attorney who is bankrolled with nearly $50K of outside Alameda contributions for a $1200/year part-time job) added to the quality and management the Hospital displays, I can see why Ms Lai and others fear any further migration between the boards!

  • DHL

    Adam: well said! I didn’t realize the parcel tax has no sunset. The norm for these things is 5 year terms with a sunset. We have to change this (using my gravest voice here).

  • Anon

    Not only does the parcel tax which pays for BONTA’s $400,000 administrator’s salary (plus 35% more in benefits?) have no sunset, it is far worse. Since this is a health care district approved by Alameda County LAFCO, if (when) the hospital closes, we will still pay the tax until allowed to terminate the district and tax!!! Thank you ROB BONTA, TAM and EZZY ASHCRAFT!!! We can look for more of the same if these people get a majority on the Council. They have no clue as to what competent management is, or how to run a real business. They live off the taxes we all pay, usurping our money and giving exasperated gasps in return. What has TAM ever done for EBMUD except tell us to save water, while she looks for more water for SUNCAL’s 5000 homes? What has BONTA done in the SF City Attorney’s office? What has he authored, what cases has he tried and won? EZZY ASHCRAFT claims to be a lowly paid arbitrator? What cases has she solved? Give me a break. They are just looking to cash in on their time in office to get a real job. But since thy have no real talents, or expertise, the best they can do is sit around and castigate those who have really tried hard, and accomplished a lot.

    And these people (in cahoots with SUNCAL) have the temerity to complain about paying a competent City Manager much less than the $400,000!!!! How much will BONTA and TAM want to pay a city manager that SUNCAL tells them is competent? As much as he can steal (Like Flint) or loses and forgets about or doesn’t put in writing (Like Kurita)?

    The issue of the hospital aside, to claim a turnaround while receiving $300 per parcel for a subsidy of millions of dollars shows that hese people don’t have a clue.

  • anon

    alameda voters can organize and work to repeal the hospital parcel tax. From the Howard Jarvis Taxpayers Association website:

    PURSUE A LOCAL INITIATIVE TO REDUCE OR REPEAL A PARCEL TAX

    In 1996, California voters overwhelmingly approved Proposition 218 (known as the “Right to Vote on Taxes Act”), an initiative constitutional amendment sponsored by the Howard Jarvis Taxpayers Association. Besides giving voters the constitutional right to vote on local government tax increases, Proposition 218 also included provisions (Section 3 of Article XIIIC of the California Constitution) allowing local voters to use the initiative process to reduce or repeal local government taxes. This includes local parcel taxes.

    Under Proposition 218, local tax initiatives are generally subject to a reduced signature gathering requirement which is set at 5% of the local votes for all candidates for Governor at the last gubernatorial election. This number is approximately equal to 3% of the registered voters.

    If a local parcel tax passes by a very close margin, or if local taxpayers are otherwise unhappy with an existing parcel tax, then a local tax reduction or repeal initiative can be pursued under the provisions of Proposition 218. Such local initiatives are generally the only tool taxpayers have to reduce the tax burden within their community since it is rare for local elected officials to voluntarily reduce or repeal taxes once they have been imposed.

    Local initiative procedures are generally set forth in the California Elections Code. Elections Code sections can be viewed online at the website of the California Legislature at: http://www.legislature.ca.gov. Charter cities often have their own separate procedures for the exercise of the local initiative power.

    The proponents of a tax reduction or repeal initiative must follow all procedures applicable to the exercise of the local initiative power without deviation. Failure to follow all procedures can result in a measure not being placed on the ballot, even if a sufficient number of signatures have been obtained. Once placed on the ballot, local tax reduction or repeal initiatives are subject to majority vote approval.

  • DHL

    I agree; this is what needs doing; repeal the tax. But we URGENTLY need to get the variance to the County EMS protocols removed!!!! We deserve preferential tranport protocols like every other city in Alameda County!

  • And I have always wondered why I, a Kaiser patient now for many years, am always transported to Alameda Hospital, no matter what. My wife now drives me to Kaiser E.R. In Oakland unless I’m seizing. What total and horrible bullshit this is! And the parcel tax without end has to be nixed. This is insane!

  • DHL

    It’s worse than you think: over 50% of insured City of Alameda residents belong to Kaiser.

  • Thanks for such an excellent and thorough article, Denise. The medical facts regarding the importance of fast treatment for stoke and cardiac care is no joke. When you lose heart muscle cells to a delay in treatment (the standard is greater than or equal to a 90 min door to balloon time, the balloon being what clears the artery), your likihood of dying from the next heart attack increases exponentially. What’s stunning is how difficult this is for hospitals to achieve when the ambulance does not make a time-wasting stop at the nearest under-equipped hospital so they can ring up a visit on their cash register. Hospitals struggle to meet this time frame when the patient comes to them straight-off. It’s similar for stroke patients: It’s a huge struggle for a single hospital to get the clot-busting drug you need injected within the treatment time that minimizes brain cell death. In the case of stroke, that time limit os shorter – only 60 minutes and, failure to meet that time limit is the difference between a short, simple recovery and a lifetime of limited motor and speech function requiring assistance and care. Not only is this hell on the patient and the patient’s family, it’s expensive.

    I want to recommend a book, written by a Wisconsin physician and his HR colleague. It details the efforts and successes of the hospitals in their system to address thee two issues. It’s a lively, fascinating read and it will make you blanch with terror at the thought of being forced to delay your treatment for either of these conditions. It’s called “On the Mend” and the authors are John Toussaint and Roger Gerard.

    And a nit: If you are stable and able to direct the Alameda EMTs, they will take you to whatever hospital you say. I know, because I made them take me to Summit this summer when I thought I was having a heart attack. It’s only when you are unstable – having a bona fide medical emergency – that they are obligated to take you to Alameda Hospital. In other words, when you really need to go to somewhere – anywhere – else quickly for life-saving care, the EMTs will take you to Alameda Hospital first.

    And one more thing: Why does everything that smells rotten in this town lead back to the firefighter’s union? They support the SunCal/Lennar slate of tricky Gilmore, psycho Tam and clueless Bonta, they transport us only to the Alameda Hospital, against what is best or even safe for us, they treated the FISC fire like a fun little wienie roast, coating us all in asbestos and toxic fuel vapors for 19 hours. The fact that the FISC fire was a gift to Catellus, who was spared having to pay for demoing that building, has crossed my mind too. The AFD would certainly benefit from lots of development at the Point and elsewhere, as it guarantees them jobs. Are they that dirty?

    As always: Follow the money.

  • Barb

    Simply eliminating the parcel tax will not work. One cannot do that until the Health Care District is allowed to be abolished, bureacratically of course, by the reverse procedures of the Alameda County Local Agency Formation entity. And a vote thereon. We studied this when it was first established, and a Health Care District in Northern California with a hospital that had been closed for months, even years, was still in place. Their parcel tax was required to be paid even though the hospital was long gone.
    So we will be paying Ezzy Ashcraft, Tam, and Bonta’s $400,000 administrator for many years to come. Thank you to the both of you. What will they offer the City Council but more of the same?

    Alameda Hospital does not qualify as truly an emergency facility as to so requires a neurosurgeon be there 24/7. Only Highland and Eden so qualify. Alameda Hospital no longer has obstetrics due to the malpractice that was covered up during the LAFCO formation, by the sponsoring doctors. (I believe they did a robo call for Bonta, Tam and Gilmore) A doctor too lazy to get out of bed to a high risk delivery for a mother who had already had one Cesarean, and was left waiting for him to show up for her for hours. Wasn’t that a 17 million dollar award to her and her child? Money can never make up for what Alameda Hospital and its doctors did to that family.

  • Good ole Wikipedia has a good entry on Door to balloon time. The current times, with a 1-hospital stop – are not good. Hospitals miss the 90-minute mark more often than they hit it. Here’s the first part of the entry:

    Door-to-balloon is a time measurement in emergency cardiac care (ECC), specifically in the treatment of ST segment elevation myocardial infarction (or STEMI). The interval starts with the patient’s arrival in the emergency department, and ends when a catheter guidewire crosses the culprit lesion in the cardiac cath lab. Because of the adage that “time is muscle”, meaning that delays in treating a myocardial infarction increase the likelihood and amount of cardiac muscle damage due to localised hypoxia,[1][2][3][4] ACC/AHA guidelines recommend a door-to-balloon interval of no more than 90 minutes.[5] Currently fewer than half of STEMI patients receive reperfusion with primary percutaneous coronary intervention within the guideline-recommended timeframe.[6] It has become a core quality measure for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).[7][8][9]

    It’s a core quality measure for the Joint Commission. Excellent! Because they should be very interested in what’s happening at Alameda Hospital…

  • DHL

    Alta Bates Summit has a certified stroke center which means it has a neurologist plus a trained stroke team, etc., etc., 24/7. There’s no reason for us to go all the way down to Eden. Tho’ Eden may be closer/quicker for Bay Farm residents if it were direct to Eden did not include a stopover at Alameda Hospital.

  • This is a link to the story on the obstetrics malpractice case:

    http://www.yourlawyer.com/articles/read/6029

  • Barb

    Thanks Action Alameda. We forget that the mistakes make by the doctors and Alameda Hospital have real names and faces. The correct amount awarded was $15 million. Everyone connected with this hospital, and the disitrict and its Board, Tam, Ezzy Ashcraft and Bonta, owes this family its deepest apologies. For the life stolen from this child and the daily price his family has to pay. This would not have happened at a proper medical hospital.

    “Collin suffers from cerebral palsy, does not have control of his limbs and will need care for the rest of his life.”

    Peace.

  • Barb, thank you so much for your closing, “Peace,” as we forget the real desire of healthcare. I worked at Children’s Hospital Oakland and saw the anguish of the families in the E.R. And I.C.U. And outside the Trauma Rooms. We cannot take this subject, and this need, too seriously. I care less about myself, a savvy self-advocate, as the many families who do not know when a member is getting the finest care or not!

  • elliott.gorelick

    Just a quick note to thank Denise in pointing out some things about Alameda Hospital that few people know or will acknowledge.

    I do want to point out that the parcel tax is not until the District is abolished. The formation of the District authorized the Board to assess the tax. Every year the Board votes to collect an amount up to the $298/parcel. If the Board chose to not collect the tax or voted to assess less than the full $298/parcel then that is what residents would pay. Back in 2002, at the first such vote, when the Hospital had over 11 million in liquid cash and short term investments on the balance sheet, I urged them as a member of the public to not collect the tax and see if they could live within their means. (The dire financial condition had been way overstated for purposes of passing the tax.) Instead, the Board imposed the full amount and then proceeded to burn through the parcel tax dollars and all of that cash.

  • Barb

    So Bonta Tam, and Ezzy Ashcraft have voted to tax the maximum for each parcel for each year they were on the Board when they didn’t have to? Good to know, that these three have a proven record of imposing the maximum authorized tax possible. You have earned my vote elliott for the Hospital Board.

  • elliott.gorelick

    Well, in fairness to them, I’m not sure, given the competence of the Board and management (David O’Neill was a horrible CEO.)if the Hospital could have stayed open without the maximum tax being imposed each year. Since the Board has never, ever considered that Alameda may be better off without the Hospital, it became necessary to always vote the maximum subsidy.

    I’ll say something nice about this Board; even though their philosophy is just as ill-conceived, their business and strategic competence far exceeds the original Board. Had the Hospital started with this Board, maybe things would not have progressed to such a terrible situation, but now it’s too late and the Hospital is essentially irredeemable.

  • Barb

    So how are the mandatory statutory earthquake retrofits going to be accomplished? As I understand it, the Hospital has until 2013 to retrofit to updated earthquake standards. What if that cannot be accomplished? Who pays for this? Any good business factors in needed improvements etc. as part of the cost in future years and puts away funds accordingly. Is shutting down the hospital an option? If so, when do the property owners get to stop paying the annual $298 stipend to keep the hospital from oozing so much blood?

    Claiming Bonta directed the turnaround of a $2.5 million deficit to a .5mil profit, while ignoring the 5.8 million per annum subsidy seems pretty fraudulent to me. That really means the hospital went from losing $8.3 million per year to what, losing only $5.55 mil? That was before Kaiser left. How much is the hospital expected to lose annually, now? Who can make sense of this?

    I encourage the TAXPAYER NETWORK’s plan to keep BONTA voting for responsible Hospital Budgets, by keeping him on the Hospital Board. Sounds like he can work magic on Hospital Boards. It appears he has figured out how to do this on paper at least, and while paying the administrator $400k (plus 35% benefits) per year.

  • elliott.gorelick

    There is one and only one option for Alameda Hospital. This is the government entity Cal-Mortgage Loan which the Hospital is preparing a package to borrow 16.2 million dollars from. They guarantee healthcare capital spending in California with the full faith and credit of the State. The Board is in the process of preparing a final application to this agency. My understanding is that once the Hospital obtains insurance, then they can obtain financing at prevailing rates from any number of banks. The mortgage would be a contract which the citizens of Alameda would be responsible for paying off regardless of whether the Hospital stays open or not. After a mortgage is executed then the District will continue to assess the parcel tax until the mortgage is paid off. If the Hospital were to close, figure that to be about 3 years of additional tax less a decrease in that liability due to whatever could be obtained by disposing of the Hospital’s assets plus an increase in that time due to the existing liabilities of the Hospital.

    At prevailing rates, the debt burden associated with 16.2 million in financing is likely to be unsustainable by the Hospital, but that is unlikely to deter the Board from moving forward since the Hospital would have to close or obtain special dispensation by 2013. On the other hand, I believe pressure is building on the legislature for a 3 year extension. In fact Schwarzenegger just vetoed a bill that would have done just that. It’s likely that there will be some give in the deadline.

  • elliott.gorelick

    P.S. I would, if elected, vote against the seismic retrofit mortgage as the situation currently stands.

  • elliott.gorelick

    P.P.S. I currently can’t imagine voting for the assessment of next year’s parcel tax, but that only makes the vote 4-1.

  • I appreciate this discussion, but the larger debate, and one that the Obama healthcare plan completely overlooks, is the corruption of the entire system. The cozy deal with tech companies making the imaging devices, the physician pay and perks, the incentives to order useless tests and procedures. And on and on. I’ve worked in/with healthcare for 35 years and know how bad it is. I remember when doctors made house calls and drove Buicks instead of Mercedes.

    Kaiser is the better model, where all the docs are on staff, work regular house and are paid not by the patient, but by the hour. Yet, we need a system where the docs don’t have to see one patient every fifteen minutes, where they can attend to the needs of family care givers too, and spend a little more time checking the side effects of the medications they prescribe. I just stopped taking one — Lasix, which was giving me “Severe Drowsiness,” that is, I was semi-comatose most of the time!

  • hobnob

    I cannot believe that the city of alameda would even allow the hospital to take out that seismic loan and have the city be on the hook to pay the bill in its entirety if the hospital folds. WHAT A CROCK!

    I am also with kaiser, but it’s b/c I’m fortunate enough to be healthy and do not require doctor’s visits. Maybe once a year… I go with the cheapest plan, but do like Kaiser’s model and isn’t it the best HMO available? When you don’t put $$$ before care, it works better.

    As to healthcare reform, although I support Universal Healthcare, his bill will fail and probably put Medicare into jeapardy. Why would I pay for my own insurance or any insurance for that matter if the penalty of not having it cost about 700/year. I pay about 1400+ a year for Kaiser. If no healthcare company can reject my application, then I’ll get it when I get sick. So fatally flawed, the only way it works is if the penalty for not having it equals the cost of having it. 2 tier system, Medicare/Medicaid is the base healthcare, all other health insurance is premium and up to the person to get.

    The system over overpaid people, imaging devices, etc has always been in America. Healthcare is a business in the US, so it’s always been about $$$. Sad to say, but one of the nations richest countries has abysmal healthcare for the average person.

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