Our living dinosaur: Alameda Hospital Emergency Department.

The Alameda Hospital Emergency Department should be obsolete.  Why isn’t it?  Oh, right: something yawl voted on in 2002 that gives them the free money (tax revenue) to stay in business whether it makes sense for the city or not.  And the Alameda Healthcare District Board has proven (read up on the business strategies they enacted in 2010) that the very survival of the hospital is more important than providing services that actually fit the medical needs of the community that supports them with free millions of dollars per year.  What a business model!  Never ending millions each year for free! No expenses incurred to gain the millions. No debt.  Just free! Wow. I guess if my business had that, I wouldn’t have to align my services with my customer segment either.  So wrong.  So SO wrong.

In February 2011, out of the 267 people arriving by ambulance at Alameda hospital, 168 (62%) arrived via an AFD ambulance (source).  All AFD buses are ALS (advanced life support) ambulances, you know, the kind that have more capability than the Emergency Department (ED) at Alameda Hospital?  Yeah, that kind.

168 people were taken by an ALS ambulance to Alameda Hospital.  That makes no sense.  … A bus with more sophisticated equipment than the ED takes the patient to a less sophisticated facility?!  EDs are meant to be used when your life is in danger. Folks, if you truly need an ambulance, then you need to be taken off-island.  Or are there that many Alamedans with chest pain, fearing a heart attack, calling 911, then showing no heart event in the field, and have just been having a panic attack?! (<< get it?  the patient has no need for intake by a specialized system.)

Life-threatening cases—cardiac, stroke, trauma—get plucked by paramedics directly into a specialized care system that starts with their work in the field and continues in the ALS ambulance (communicating with the receiving hospital) and on through to delivery into the specialized teams and facilities off-island, only 3 to 5 miles away.

There were a total of 1,337 Emergency Room visits in February.  That means 1,070 people drove there and walked in. Which means most just needed urgent care. Typically, ambulatory cases are not life threatening events.

Would far more *affordable* Urgent Care Center (UCC) have been more appropriate for most of these cases?  It looks like at least 75%, but probably more, of ED visits could be handled by urgent care.

Urgent Care cases are minor traumas and ambulatory care, the kind we most often get: cuts, sprains, eye injuries, flu, fever, insect bites, simple fractures, chronic illnesses, medication problems, etc.  UCCs have all the cool tools and equipment and trained teams to diagnose and treat most conditions: MDs, digital radiology, blood tests, pharmacies, etc.  And they cost A LOT less than an ED. And A LOT less than Alameda Hospital’s ED. I know, I went there last year AND went to Alta Bates (to survive what Alameda Hospital did to me) all in the same day for the same medical event. Alameda’s ED was twice as expensive than Alta Bates. For 4 hours and one CT Scan, Alameda Hospital the bill was over $10,000.  See the story of my Nightmare on Clinton Avenue here.

If acute cases don’t belong at Alameda Hospital, if they get taken off island to the nearby world class EDs, why do we even have an emergency department at Alameda Hospital?  Isn’t an Urgent Care Center what is needed most?!

Considering the costs to us to maintain an ED (our parcel taxes) AND the exorbitant costs to visit an ED, and the statistics that indicate urgent care is primarily what is provided at the Alameda Hospital ED, then it’s ridiculous to keep the ED and not redirect our resources to what residents obviously and most often need: a UCC.

I’m going to backtrack here for a minute… Since the early 2000s, our wonderful <sarcasm> Alameda Healthcare District Board Members thought it made sense to jimmy the ambulance protocols so that the paramedics would have to bring the acute cases that, medically speaking, should go to a specialized system off-island.  Every other city adhered to county protocols that ensure each 911 victim is taken to the best hospital for the event. No matter what. Even if that means going out of county. So why would our elected board members go against medical standards like this? Why would anyone create business strategies to make money redirecting acute cases from optimal medical care as determined by medical/scientific standards?! They literally ensured ambulances would bring acute cases to the hospital so that they could drive revenue and keep themselves in business.  And THAT is some kind of political and sociopathic cruelty. You can thank Dr. Deutsch who has been crafting these kinds of policies since the 1980s and Rob Bonta who, in his short tenure on the AHD board, jumped on board with this and perfected the marcom about the tremendous financial turn-around these heinous policies brought.

Note to Alameda Healthcare District (AHD) Board:

1. the federal healthcare program is going to increase demand on doctor appointments: there won’t be enough doctors to meet the needs of the increased number of insured patients. Urgent care centers are needed to handle the overflow.

2. UCCs are WAY more affordable for the patient to use, and WAY more affordable for the healthcare district to provide.

3. UCCs are WAY more appropriate than an ED for most urgent medical issues

4. The nearest UCCs are in Hayward and San Mateo, i.e., there are none in Alameda, Oakland, or San Leandro.

5. We don’t need a Wound Care Center. <duh>  Only 3.5% of the geriatric (65+) population have chronic wounds. We’ve got approximately 9,600 age-65+ seniors in Alameda. SO, with our tax dollars, you think it makes sense to build a wound care center for exactly 336 residents?!?! WTF?  100% of the resident population of Alameda would use an urgent care center.

Ya think it might be a good business strategy to open one or two UCCs that would better serve the 70K Alamedans and address the massive market in adjacent cities?!  Gee, you could make money while adhering to medical standards of care AND be aligned with the best interests of your patient population! What a thought!  It’s not rocket science: cities that are not behind the times like Alameda, have already put UCCs in place to solve for the ED dilemma (why treat a hangnail in an ED?!) and the upcoming patient demand from the federal insurance program.  All you have to do is look at what other cities are doing, and why, and copy them.  All you have to do is look at what is most needed by the population of Alameda. Rather than working from some high fallutin’ image of yourselves on par with nearby world class medical facitilies, your strategies should be provide something they don’t!  Be grounded in the realities of what you can best provide that is most needed within our city borders. Alameda Hospital will never be able to compete with, let alone keep up with, nearby hospitals as disease expertise and technology continues to soar. What medical care can you provide that best serves us on a day to day basis? What services will best ensure our health over time and fix us when we have minor accidents and illnesses? What is specific to our city? Are you looking at disease statistics unique for our city, and their causes, and solutions?

Something went terribly wrong with your thinking when you chose to compromise our medical standards of care in order to make money.  Something’s gone terribly wrong in your thinking when you concoct a business strategy focused on serving less than 4% of the population.

Like businesses that have to live and die by their bottom line, its way past time to redirect your strategies to serve the residents of Alameda.  After all, and after the very generous $50M+, that’s the least we deserve.


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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