AHD Board decisions based upon anecdotal evidence. Huh?

Mr. Gorelick hasn’t posted notes yet from last night’s Alameda Healthcare District board meeting, but when he does (soon), you’ll find them here.

I went to the meeting to see their discussion about becoming a primary stroke center (PSC). What I saw should concern everyone.  Mr. Gorelick brought reasoned questions, facts, medical science, the probabilities about the direction of future stroke care as indicated by hospitals well ahead of ours, etc., etc., to the table in hopes of a meaningful discussion to optimize moving forward with or without becoming a primary stroke center (not to be confused with a ‘comprehensive stroke center’). He asked that decisions be based on evidence.  Not one other board member was interested.

Mr. Gorelick suggested repeatedly . . .that it would be useful to have a neurologist involved in the discussion to facilitate real understanding of contemporary medical stroke services, the issues, statistics, and so forth.  Ms. Battani shut him down, saying that that was—basically—ridiculous at this time in the decision-making process.  Huh?

Dr. Deutsch and Mr. McCormick both brought personal anecdotal stories/considerations to this discussion, as though their feelings about a personal event or outlook was good enough information upon which to base a hospital strategy and medical services decision. Huh?  CEO Stebbins said that critical minutes are saved by the fact that imaging is read within, on average, 10 minutes (I’ve been to the radiology dept. there; they screwed up every single imaging event and I wasn’t a critical case! So forgive me if this ‘fact’ doesn’t impress me and, worse, causes me great concern).  Ms. Battani’s primary reason for becoming a stroke center is because the county wants them to (I’m pretty sure that discussion is not that simplistic!).  Stewart Chen’s contribution to the discussion was this: if Alameda Hospital could provide a quality stroke center (big ‘if’), then he’d be okay with it because “the county is paying for it”.  Huh?

I asked how providing a primary stroke center could be feasible given the limited number of stroke patients in Alameda (revenue) relative to the significant costs of maintaining a 24/7 stroke center.  That question was never addressed; it wasn’t even of interest. Which is curious considering CEO Stebbin’s talk at City Council last September claiming they had so much success driving revenue from cardiac patients, that now they are going to do the same with stroke patients. When they were receiving stroke victims and didn’t qualify for that, they were concerned with the revenue; now that they are going to spend money to become a stroke center, to become qualified, a forecast of profit/loss is irrelevant?

How can a healthcare district make decisions about spending our money, their time and focus, on a new PSC without having a discussion about the facts? Does this even serve the community best, given the fact that we have comprehensive stroke centers minutes away?  Sadly, last night’s ADH board discussion was like watching Alice-in-Wonderland (Gorelick) have a conversation with several Mad Hatters.

To have this discussion, we need to understand the difference between a PSC and a comprehensive stroke center (CSC).   PSCs can only evaluate if clot-busting drugs can/should be administered and then treat  ischemic stroke patients with IV tPA in the first four hours after symptom onset.  A CSC can immediately address the needs of every kind of stroke victim and furthermore, they can treat ischemic strokes up to eight hours after symptom onset with both IV and inter-arterial interventions.

To have this discussion, the Alameda Healthcare District board members need to look at facts, medical science trends, outcomes, and whether this direction does in fact best serve the residents of Alameda–there are no cities adjacent to the hospital, so it will only serve Alamedans (unlike other hospitals that serve adjacent city and county populations increasing the financial feasibility).  I’ve heard Dr. Deutsch speak publicly twice now about why the hospital should receive stroke victims.  Neither time did he speak about facts. And last night, when Mr. Gorelick brought facts and statistics and trends to the discussion, Dr. Deutsch first questioned that the facts mentioned could even be true (he appeared to be so unfamiliar with contemporary emergency stroke care data and trends that he reacted to the facts as being highly implausible/unrealistic [no comment]). Then he pronounced opposition to Mr. Gorelicks line of thinking/concerns with an anecdotal story about his father’s stroke.  He presented his oft-repeated story as sufficient evidence that a PSC at Alameda Hospital makes sense.  Huh?

I don’t know about you, but I have grave concerns that our healthcare district is making leadership decisions from feel-good stories and generalizations about stroke care.  Board members should be looking at and discussing contemporary and future medical science, stroke care outcomes, patient populations, neighboring hospitals services to come up with a patient hospital/benefit comparison/analysis and a business cost-benefit analysis.

I want to know—before a decision is made—whether stroke victim outcomes are likely to be inferior, equal, or superior when being received first at Alameda Hospital instead of the very nearby Alta Bates Summit, Kaiser, Eden, etc.

I want to know—before a decision is made–that becoming a PSC is the best and highest use of the hospital asset, resources, and our tax dollars as that directly correlates to what is most needed by resident Alamedans.  Where’s the financial-cost/patient-population-benefit? Or is this feasible only because the healthcare district tax revenue never sunsets?

I would think that board members would want to know these things too.  Mr. Gorelick does.

The others?  They only want us to know is this: they feel good about it, so we should too. Huh?

Now for my mea culpa.  It’d be pretty hilarious if it weren’t so stupid: last night I mentioned how paramedics will soon be administering tPA in the field so that coming to Alameda Hospital would be a moot point. Of course, this is nonsense; for IV tPA to be administered to a stroke victim, imaging must be done first to identity the type of stroke.  My bad: Fire Chief Fisher told me that in his discussions with Alameda County EMS, that they are considering trials with paramedics administering IV tPA in the field…and I repeated it without thinking.  Chief Fisher probably did not have his facts wrong but it would not be for stroke; it would be for cardiac patients.  Carol Gottstein MD immediately schooled me from the public forum podium, as did several board members.  :^)


About Denise Lai

Alive. Swim (fly is the best). Walking with my dog (weims are the best). Life is good. Would prefer people understood negative externalities and prevented themselves from creating them. Feeling the love anyway. View all posts by Denise Lai

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