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Alameda County Seeks to Change EMS Preference for Alameda Hospital

The Emergency Medical Services Division of the Alameda County Health Care Services Agency Public Health Department is looking to review a three-old preference for Alameda Hospital in County Emergency Medical Services practice, as the current practice is “not in the best interests of patient care.”

The review comes after a series of exchanges in Action Alameda News and other local newspapers between an Alameda resident and Jordan Battani, President of the City of Alameda Health Care District Board, which oversees Alameda Hospital. After a negative experience with Alameda Hospital, Alameda resident Denise Lai began investigating the hospital’s practices, and learned that the Alameda County field manual for emergency medical services (EMS) directs paramedics to take stroke victims directly to a regional certified stroke center, except for patients in Alameda, which are to be taken to Alameda Hospital, which is not a certified stroke center. Ms. Lai asserted that this practice is not in the best interests of patient care, and serves to direct patients to Alameda Hospital to generate revenue, at the expense of patient well-being. Health Care District Board Member Robert Deutsch, M.D., has not yet responded to a written request for comment on this point.

Alameda County EMS Director Dale Fanning told Action Alameda News that the County policy directive to take stroke victims in the City of Alameda to Alameda Hospital was made at the behest of Alameda Hospital. “It was at the request of the Hospital,” she said, “I was not involved in the decision.” Ms. Fanning also said that she believes the request was made in July of 2007, but couldn’t remember who made the request – “It was probably in an e-mail which has long been deleted.” According to Fanning, at the time, Alameda County did not make the policy preference contingent on Alameda Hospital becoming a certified stroke center, “but the County encouraged it.”

Now, Fanning has sent a letter, obtained by Action Alameda News through a public records request, to Deborah Stebbins, CEO of Alameda Hospital, asking for a meeting to review this policy. In her letter, Fanning wrote, “It is my understanding that in July, 2007 members of our staff met with your leadership to provide information on the steps necessary to become a stroke center and request that your facility pursue stroke center designation. To my knowledge, Alameda Hospital has made no effort in this regard. The standard of care in Alameda County is for 911 ambulance providers to transport patients exhibiting stroke symptoms to the nearest stroke center. The exception to this policy, directing ambulances in Alameda to take these patients to Alameda Hospital is not in the best interests of patient care.”

Alameda Hospital CEO Deborah Stebbins, did not respond to a written request for comment about the Hospital’s request for the EMS policy preference. Nor did Alameda City Councilmember-elect, Rob Bonta, who is winding up a four-year roughly three-year term on the Health Care District Board. Bonta campaigned for his City Council seat on the basis of a financial turnaround at Alameda Hospital.

Denise Lai told Action Alameda News, “I’m thrilled to see that the County EMS director is addressing this very serious issue and that the removal of the variance seems imminent. This will protect lives and life quality for stroke victims in Alameda.”

At a September 21, 2010 Alameda City Council meeting, Council discussed potential changes to the emergency medical services model in Alameda; currently, the Alameda Fire Department provides EMS services in Alameda. In the staff report to Council, there was a letter from then-Assistant City Manager Robert Wonder, dated August 29, 1983, about the potential for the City of Alameda to join the County-wide paramedic program. In the discussion and analysis section of his letter, Mr. Wonder wrote, “Apart from that, the City must consider what impact a paramedic system might have vis-a-vis the Alameda Hospital. Local concerns have been raised that fewer acute medical cases being referred to Alameda Hospital could greatly impact, or even jeopardize, the hospital’s ability to retain its highly qualified medical staff. That is certainly an issue that needs to be explored and should be addressed to any of the local physicians who will be on hand.”

14 comments to Alameda County Seeks to Change EMS Preference for Alameda Hospital

  • […] This post was mentioned on Twitter by ActionAlameda and ActionAlameda, Alameda Buzz. Alameda Buzz said: Alameda County Seeks to Change EMS Preference for Alameda Hospital: The Emergency Medical Services Division of the… […]

  • I am relieved to see this long overdo review of EMS protocol and policy. During my last heart attack, I was taken to Alameda Hospital even after being stabilized on the ambulance, and although I am a Kaiser member. I was kept at Alameda Hospital for more than twelve hours, in the E.R., during which time a series if unnecessary tests and procedures were performed. As this was my seventh heart attack, I know the drill.

    Finally, I was transported to Kaiser S.F., where I was kept in the ICU in part to compensate for the long delay. Finally, I was implanted with a stent and released in good condition, but that detour to Alameda Hospital could have done me in. I’m too tough and ornery to die, but many Alamedans are not, and for their sake, I hope our town joins the civilized medical world where designated stroke and cardiac care centers exist for a reason!

  • […] On November 5th, County EMS Director Dale Fanning wrote a letter to  Alameda Hospital CEO Deborah Stebbins advising her that the variance to the county stroke transport protocol does not meet the standard of care in Alameda County and that it “is not in the best interests of patient care”.  Duh! And finally!  Fanning said that County EMS staff had met with hospital leadership (at the leadership’s request) in July 2007 to discuss stroke protocols.  The full story is here. […]

  • Thank God for Dale Fanning! The cronyism and rot in this town never fails to astonish. That Dennis Green was held for 12 hours without a stent, is horrifying; that a stroke patient’s care, which must occur with 60 minutes to prevent irreparable damage is nauseating. And this from Alameda Hospital who pretends to put our needs above theirs.

    Dennis, were you given thrombolytic therapy (clot-busting drugs) during your 12-hour detour at Alameda Hospital? Because that’s what hospitals who lack a cardiac catheter lab do. Problem is, a known and dangerous side effect of those drugs are…wait for it…stroke. That’s why there are also STEMI centers for treating wholly occluded cardiac arteries (what STEMI means).

    These STEMI centers have cardiac cath labs that can be activated in time to save valuable heart muscle by inserting a balloon into the artery and leaving behind a stent, all within 90 minutes and without the use of Thrombolytic therapies with their risk of stroke. Alameda Hospital isn’t s STEMI center and lacks a cardiac cath lab.

    I ask because this looks like another way Alameda Hospital has chosen revenue over patient care.

  • Barb

    Dale Fanning’s words “does not meet the standard of care in Alameda County and that it “is not in the best interests of patient care”, are two phrases that are pure melody to personal injury attorneys. Don’t think a jury would take to long to return verdicts for both actual and punitive damages. Especially if it were to be proven that the Alameda Hospital Board (several attorneys there) chose money over quality of care, when specifically advised people were going to be placed at higher risk to die or suffer permanent and irreversible damage, because of this choice.
    Is Alameda Hospital self-insured at this point? Or are the other hospitals that provide higher quality care going to be made to pay the price of Alameda Hospital’s lack of ability?

  • Betty

    After living in Alameda in the 50’s & 60’s and moving away for along time, I have returned to Alameda within the last 4 years.
    Why is this hospital open? It seems some sort of clinic and emergency center would be better. I know Kaiser did some surgery here, have they ever talked about taking over the hospital?
    It’s my understanding that the head of the hospital has a salary of 400,000. Is this true? What does she do?
    I know I am paying for this hospital on my property taxes but I haven’t been there since I was 7 and had my tonsils out.

  • I’ve been a patient at Alameda Hospital many times, both downstairs, (E.R.) and upstairs, (admitted/committed), and have seen the nursing care decline over the years. JCAH approval means very little, as it is so easy to scam. (I worked at Children’s Oakland for five years in administration and saw it happen.) Kaiser pulled out all its services, rumor has it, because of difficulties with management and medical staff. The Kaiser Alameda Clinic features primary docs, a lab, pharmacy, but no E.R.

    My quad bypass missed the fifth artery to my heart and I now have a “stent sandwich” there, since the first stent was uncoated and developed re-stenosis. While being held at Alameda Hospital, I was given “blood thinners” and didn’t stroke, probably because my carotid arteries are 40% occluded. Still, very risky business.

    I sincerely hope that EMS protocols are corrected, that we are taken by county ambulance directly to qualified stroke or cardiac centers if needed, and only to Alameda Hospital if specified by our insurance carrier, especially under life-threatening emergencies.

  • elliott.gorelick

    The stroke change is a no-brainer (pun originally not intended, but now I like it) but the ACS change will be a harder case because the AHA guidelines are not explicit about direct transport to a cardiac center except in cases of STEMI. I think that’s mainly a conservative approach so that they (the AHA) don’t get ahead of the evidence, but I would always want to go to a cardiac center because 1. some STEMI’s are subtle 2. NSTEMI can progress or lead to a secondary and 3. a cardiac center is going to have greater volume of cardiac cases and all else being equal research shows greater volume = better outcomes.

  • Anon

    Councilmember Elect Bonta is the one responsible for turning around the huge deficit at Alameda Hospital and making it “profitable”. He did this by paying the administrator $400,000 per year, cutting the quality of care to patients, and taxing landowners/taxpayers $300 per year in perpetuity. I can’t wait until we find out what he is going to do to the City of Alameda.

  • Bonta needs all the scrutiny he can get and we can give him. His methods are questionable at best, and his integrity much in doubt. That he benefitted from the SunCal onslaught against his opponents in our recent election, in spite of his supporters’ claims that it didn’t influence the more tone deaf Alameda voters, is bogus at best, disingenuous at most likely scenario.

    He, Gilmore and Tam will have to toe the anti-SunCal line, or we will launch the most aggressive recall movement ever seen in a community this size!

  • Barb

    The last recall was pretty great, bringing that Local Barber (some prefer Harvard lawyers) and Measure A into being.

  • Betty

    Recall.. I forgot about Recall.
    Maybe there is hope even with Tam moving up to 3rd.
    We’re stuck with her for 4 years instead of 2.

  • One of my biggest disappointments was losing the fight against the conversion of the “Bureau of Electricity” to “Alameda Power & Telecom,” by only 250 votes. I had seen the business plan, which ignored the fact that any nationwide cable company could undercut Alameda municipal prices on TV and broadband. Alameda lost $90 million on that fiasco, which hasn’t yet hit home, but will, and the voters of this town, easily mislead, have voted time and time again for the wrong candidates, the recycled old hacks, and silly propositions and parcel taxes, piling up one of the worst voting records in the East Bay. But every now and then they wise up, defeating Measures B & E, and making Chuck Corrica Mayor, so maybe there’s still some hope. For the time being, City Council doesn’t even count.

  • Betty

    So. please tell me what does this woman do for 400,000 a year?

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