Category Archives: County EMS Protocols

This November, remember…

Please see the recent blog post from Elliott Gorelick (AHD Board Member) addressing a recent and highly misguided letter in the Alameda Sun praising Alameda Hospital.

In case you’re uncertain as to whether to trust Mr. Gorelick’s opinion, please consider his CV:

  • Doctor of Pharmacy, UCSF (in progress or awarded, I’m not sure what stage he’s at)
  • Continued studies in Health Economics, UC Berkeley
  • M.S., Management Science and Engineering, Stanford University
  • B.A., Economics, Stanford University

His CV is impressive. Even if he didn’t have that CV, I’d agree with Mr. Gorelick: he’s the first, and often the only, voice of reason on the hospital board and publicly here in Alameda. But having that CV, well, maybe we should all wake up a little bit and pay attention to what he’s been saying and continues to say at Alameda Healthcare District board meetings and on his blog here.

Furthermore and in my opinion:

What we all need to understand is that today’s medical standards provide the following: diagnostics and treatment in specialized cardiac and stroke medical systems that begin in the field with the paramedics and continue uninterrupted on through to the readied (when you’re wheeled in, they are standing there ready to pounce) specialized cardiac or stroke team  that includes leading-edge imaging diagnostics, expert physicians and surgeons and highly-trained event-specific (cardiac or stroke) support teams.

Key here is the term ‘uninterrupted’ which correlates to improved outcomes, e.g., stroke victims with no damage or residual symptoms.  Any detour to Alameda Hospital, by definition, is an interruption that cannot help but correlate to worse outcomes.

The biggest risk to a healthy longevity while residing or visiting Alameda is due to the Emergency Medical System protocols (what the paramedics follow) that require these detours to Alameda Hospital. The fact that Alameda Hospital continues to provide low-capability but emergency and stroke cardiac care, that extracts patients out of the specialized cardiac and stroke care systems only to re-insert them back into it (i.e., sending them to the hospital a victim should have originally gone to), is a not only disservice to everyone but poses an enormous and unnecessary hazard for worse outcomes for those experiencing a heart attack or stroke.

We have a right to contemporary standards in our medical care.

Alameda Healthcare District Board Members Battani, McCormick, Chen, and Deutsch, Vice Mayor Bonta, and City Council Member Tam, have all been a part of the hospital business strategies that ensure substandard emergency medical care for Alamedans. Please remember this when you cast your vote in November.  

Understandably ill-informed

Elliott Gorelick, Alameda Healthcare District Board Member,

The following letter appeared in the Alameda Journal:

“Don’t skimp on funds for Alameda Hospital

On Aug. 2 with no pain — just shortness of breath — I left work at 8 a.m. and drove myself to the Alameda Hospital emergency room. I thought it was my asthma. I was in increasing distress.

The emergency staff immediately took me in, did an EKG, chest X-rays, started IVs and determined I was having a heart attack. This was a shock. I have no history in my family and never experienced chest pains.

The emergency room staff, with extraordinary professionalism, summoned Alameda Fire Department paramedics, who transported me with red lights and siren to Summit Cardiac Center Cath Lab for an emergency angioplasty and stent — all this before noon. Having my own HMO with its facilities in Oakland, I was one who hesitated to support the bond measure that would fund Alameda Hospital. I didn’t think I would be able to use it.

In my shortsightedness, I failed to grasp the fact that each citizen on Alameda island could have a life-threatening event at any moment, and the Alameda Hospital emergency room and fire department paramedics are all we have between life and, yes, death itself.

I am again, so grateful to live on Alameda.”

The letter writer displays an amazing ignorance.  I am certainly happy that this turned out well for him/her but driving themself to the ER, thinking that their time in the Alameda Hospital ER was anything but dangerous delay and concluding that they are safer because Alameda Hospital 1. delayed their treatment 2. charged them for that privilege  3. Did nothing really except summoned help is ignorant.

I understand that this person feels good about what happened, but they couldn’t be more wrong.  And this is why it is almost impossible to rid ourselves of the costly, health-destroying institution.  The ignorant fed by the politically ambitious (Rob Bonta, Mary Ezzy-Ashcraft, Lena Tam, Stewart Chen) and the dishonestly self-interested (Rob Deutsch and Debit Stebbins) have just so much more social capital. (Lauren Do, Jordan Battani,  and John Knox White when given a choice of standing with their friends or for the truth will choose their friends because that’s the civil way to go and, they are, just like this letter writer too ignorant to see the truth.)

I am still waiting for a knowledgeable person to articulate an argument for the Hospital that doesn’t distill down to the “voters approved it many years ago and you don’t have any smoking gun* that it kills people.”
*Actually, there is a smoking gun and the State fined the Hospital $50,000 for the inappropriate use of fentanyl patches.  The Hospital is appealing that fine (an appeal that I will be astonished if they win).

Thank God for Gorelick.

Do yourself a favor: click on Notes from the Hospital >>>>

Read Elliott Gorelick’s blog = critically important reading for all residents of the City of Alameda.

Don’t think so?  Think again:

Alameda County EMS has reinstated the transport protocol that allows ambulanced to take stroke victims to Alameda Hospital.  This is big, this is bad.

Stroke death rates vary per hospital. And you want to be taken to the best performing hospital when you have a stroke. Why? Significantly increase odds:

A. for survival at the time of the stroke and

B. for survival within 30 days of being discharged from the hospital.

The best hospitals for stroke around here are Summit and Kaiser (Eden’s statistics are not in yet). I cannot find any rates for stroke incidences, or I’d extrapolate how many deaths Alameda Hospital’s 12.5% stroke death rate adds up to, i.e., how many people didn’t need to die and wouldn’t have if they’d gone to Alta Bates Summit or Kaiser…

Did you know that over 50% of Alameda residents are Kaiser insured?  Why on earth would Kaiser patients then want to be taken to Alameda Hospital?!

So go to the right here>>>> click on Notes from the Hospital. Read.  Really. Go read.

Two for Two

Stroke transport protocol changed: check.

Illicit crude oil transfers stopped (along with the toxic fumes and oil spills): check.

So I’m pretty happy. It appears that when we take the time to report serious problems to the right people in the right agencies, they care and they do their job of protecting us, really well apparently.  And quickly.  In under two months for the stroke protocol. In under three months for the illicit crude oil transfers. Impressive.  Kudos (again, I can’t thank these people enough) to: … Continue reading

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 . . . Continue reading

Understanding the hospital issues better.

Elliot Gorelick’s (gor-REL-ick) answers to residents’ tough questions on ‘Officially Speaking’ (here) are a great first step towards understanding the hospital issues better. Mr. Gorelick goes a long ways here towards helping us understand the complexity of the issues rationally, without the usual Alamedan emotional component.  Read his statements here.  Keep up on his work on the hospital board in his new blog that he’s writing just for that purpose here.

He provides impressive discussion answers and it’s refreshing to see an elected official be so transparent, considerate and erudite in a public forum. . . . Continue reading

KQED’s Forum, 12/21/2011

Start listening at 47 minutes into the audio file:

Yes, that was I! (…on NPR this morning).

Despite my laryngitis, I managed to speak on Michael Krasny’s Forum this morning at 10:54 am and very briefly tell the story of discovering the substandard stroke protocol, writing an op-ed about it, having Mayor Johnson pick it up, then the change that brought the county EMS stroke protocols for the City of Alameda into line with federal, state, and county medical standards, and how, given our population size, 500+ annual stroke victims now benefit from being taken directly to a Certified Stroke Center. Woot!  Thank you for the Forum Mr. Krasny!!!!

Thursday’s Letter to the Editor

In the Alameda Sun, here.


Corrected version to the Sun’s version is below. They changed the crude oil spill date to 2009. In fact, the crude oil spill in our estuary took place on November 2, 2010, as I originally wrote.

Hospital board making the decision


Although I exposed the 2007 substandard Alameda County Emergency Medical Services (EMS) stroke transport protocol in an October op-ed in the Alameda Sun (Vote Medicrats Out,” Oct. 21), kudos go to Mayor Beverly Johnson, Interim City Manager Anne Marie Gallant and Alameda County EMS Director Dale Fanning who all worked quickly — overriding the hospital’s protest — to get this changed in under two months. As of Dec. 1, our ambulances transport stroke victims to certified stoke centers. Record time, I’d say!

The reason the stroke protocol was changed is because Alameda Hospital is not a stroke center, i.e., it’s not appropriate for ambulances to take stroke victims to Alameda Hospital. Federal and state stroke prevention and response standards dictate this, and it’s based upon the soundest of medical sciences.

People need to know that the recent statement made by Alameda Hospital CEO Deborah Stebbins explaining that “the hospital will still get other stroke patients … who are outside the four-hour window in which drugs that reduce the symptoms of stroke may be administered” makes no sense. Intravenous (IV) drug therapies are only effective the first four hours after a stroke. Interventions that work at or after four hours can only be found at a certified stroke center: intra-arterial tPA and mechanical embolectomies. Also, there are several kinds of strokes; for some types, IV drug therapies are not appropriate. This is why a comprehensive stroke center is so important for all stroke victims.

Now I don’t know which is worse, the fact that “island stroke victims caught in the middle” may have been seriously harmed during the last three years. Or the fact that the hospital leadership (CEO and board) knew of this protocol, created business strategies around it, and recently staunchly defended it in attempts to stop the county from removing it. Hospital board members are our elected officials, Stebbins is the CEO they hired.

This is a clear-cut case where our elected officials are not making decisions in our best interest. Alamedans need to wake up from their longtime, culturally ingrained and endemic hospital ticklefest: the Alameda Healthcare District should serve our best interests and not the survival of the hospital at any cost.

Lastly, I’d like to tip my hat to Liz Williams who is the maven of public records requests — she and I often work together on the 2009 FISC fire, the Nov. 2, 2010 crude oil spill and the Nov. 4, 2010 illicit crude oil transfer by the Marine Starlight company that filled our lungs with toxic air…

— Denise Lai

Hospital CEO continues to promote substandard emergency stroke care at Alameda Hospital.

Why does our hospital CEO continue to bloviate about what the Alameda Hospital will and can do for stroke victims?  Today’s medical standards dictate stroke victims go to Certified Stoke Centers….for good, sound, medical reasons! Period. Paragraph. END OF STORY.

Yet CEO Stebbins says that our hospital plans to receive stroke victims delivered by paramedics four-hours after stroke onset, i.e., after that four-hour window when IV tPA is no longer is effective.

WHAT is effective after that 4-hour window?  And can Alameda Hospital provide it?

NO. NO. And NO.

After the 4-hour window, highly specialized teams and technology are needed to provide intra-arterial tPA (they go up an artery and deliver the thrombylotic at the site of the blockage) or a mechanical embolectomy (they go up an artery and physically remove the blood clot, pulling it back out).  ALAMEDA HOSPITAL IS NEITHER CAPABLE, NOR HAS THE TECHNOLOGY, TO DO THESE THINGS.

So WHY has Ms. Stebbins said that—until it becomes a stroke center–Alameda Hospital will continue to receive stroke victims from paramedics after the 4-hour window and treat them?

I sure wish a hospital board member would comment here and explain the continued promotion of stroke care at Alameda Hospital.   They won’t, they can’t: there’s no medically sound reason for it.


Note to local papers

Get it right, please.  The Alameda Journal last week couldn’t bring themselves (Michele Ellson) to say that the reason the stroke protocol was changed post haste is because Alameda Hospital is NOT a stroke center and it’s not a medically appropriate place for ambulances to take stroke victims.  The Alameda Sun’s article today makes no sense—did Dennis Evanovsky not get the news that the stroke protocol was changed? He did not interview me. I sent him the docs; that’s all.  It’s true the hospital resisted the medically sound and important protocol change that brought the City of Alameda into line with the rest of the county on December 1, 2010.  His sub-headline “potential island stroke victims caught in the middle” was true for the last 3 years, but is no longer true.

Not sure why our local papers either don’t have time to write stories so they are accurate (the Sun, and typical of most papers these days in a dying industry) or have an agenda (the Journal, or maybe just Michele) and won’t state the facts without gliding over the real portent of them and ending with an illogical and anachronistic ticklefest about the hospital.

This was a very critical and important problem that the city and the county corrected in record time!  It would have behooved both papers to have taken the time to write something more accurate for their readers, for us, the future stroke victims or friends of future stroke victims.