Decision 2010: Four in hospital board race
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By Jan Greene
Alameda Hospital’s ability to invest in modern medical technology, get earthquake safe and stay afloat financially are being debated anew in the race to elect three new members to the hospital district board on November 2.
Two of the four candidates are incumbents – longtime hospital physician Robert Deutsch, M.D., and board newcomer Leah Williams, an attorney and small business owner who was appointed to a board spot in 2009. The others are chiropractor Stewart Chen and pharmacist-in-training Elliott Gorelick.
Gorelick has been a critic of the hospital and the $298 parcel tax that voters approved in 2002 during his several attempts to get on the board over several years. Gorelick argues that the hospital can’t afford to keep itself up-to-date on medical and information technology that allows for quality medical care. He also contends that the $5.5 million in yearly tax money keeping the hospital afloat is not a good investment.
The district board should be focusing on preventive care, outpatient services and planning for a community-wide disaster “instead of trying to figure out how to make sure the hospital doesn’t go out of business because it’s losing money,” Gorelick said at a candidates’ forum on October 16. “I don’t want to abolish the hospital, the board is doing some excellent things. But an emergency room to provide these services that can be better provided elsewhere at a lower cost doesn’t make sense.”
Deutsch, a longtime head of the hospital’s medical staff and a doctor there since 1980, stood to defend the institution. “I couldn’t disagree more that a community supporting its hospital to provide health care to its citizenry is a waste of money,” he said, clearly angered by the criticism. “Last time I checked, the police department doesn’t make money, the fire department doesn’t make money, but we need fire services, we need police services and we need health services.”
Gorelick also argued that Alameda Hospital is not a good place to go for a heart attack or stroke because of its size and financial condition. “Being 10 or 15 minutes closer (than bigger hospitals) doesn’t compensate for the fact that it’s a small community hospital, it doesn’t have the resources necessary to give the best treatment,” he said.
Deutsch, joined by candidates Williams and Chen, vehemently disagreed on the quality question. “I think the quality of care is excellent,” the physician contended. “When my father had a stroke he came to Alameda Hospital. It is the hospital of choice for my friends, my family, I recommend it highly.”
They also clashed about the financial condition of the hospital, which has been slowly improving after years of being deeply in debt. Gorelick, who has a bachelor’s degree in economics and a master’s in management science and engineering, both from Stanford, points to its continuing financial challenges, such the $14 million it must borrow to pay for seismic retrofitting on its buildings and the fact that it would be deeply in the red if not for the infusion of tax dollars. He said the hospital can’t both be tax-supported and competing for business with other area hospitals. “You can’t have it both ways,” he said.
Williams countered that the hospital’s current management has been innovative in finding new, long-term sources of revenue that other area hospitals aren’t pursuing, such as a new wound care outpatient service and expanding long-term care beds for the elderly, disabled and patients dependent on breathing devices. “The hospital is in the black,” she argued, and has been for the past year.
Williams, Deutsch and Chen said the parcel tax is a good investment to maintain full-service emergency, surgery, intensive care and acute medical care on the Island without crossing a bridge or tube.
“The idea of having to travel miles across bridges through traffic to get emergency care in a community of this size, of 70,000 people with some affluence, I think this is money well spent,” said Deutsch.
Williams agreed. “We are an Island,” she said. “I was reminded just last week when the Tube closed and it took me 45 minutes to get off the Island. I thought, ‘Thank God the hospital is here in case of an emergency.’”
While Gorelick argued Alameda’s $298 yearly tax on properties is the highest hospital district tax in the area, Chen said it was relatively little given what it buys. “That’s a month’s worth of lunch,” Chen said.
Asked if the hospital would be asking for more parcel tax money in the future, Deutsch, Williams and Gorelick said they would oppose a future tax, and Chen said he would look for other financing first.
A Closer Look
Some of the main issues raised about Alameda Hospital during the League of Women Voters’ candidates’ forum on October 16 (available on video here) and more information about them:
Importance of Emergency Care on an Island
The hospital board candidates debated how important it is to have very sick or injured people brought to Alameda Hospital rather than to Highland Hospital in Oakland (about four miles from Alameda City Hall, according to Google Maps) or Eden Medical Center in Castro Valley (about 12 miles from City Hall).
Currently, paramedics from Alameda’s Fire Department take trauma patients – those with a serious injury such as from a bad auto wreck – to the Level II Trauma Center at Highland Hospital. They also transport certain serious heart attack patients from Alameda to Highland, which has open heart surgery capability along with a catheterization lab, which allows clogged cardiac vessels to be diagnosed and/or opened without open heart surgery. Alameda Hospital does not have a cath lab.
Mike Jacobs, a prehospital care coordinator at Alameda County’s Emergency Medical Services agency, said in an interview that Alameda patients are routinely transported quickly and efficiently to Highland in those circumstances, and that traffic in the tubes and raised bridges have not been a significant problem in getting patients to the hospital in a timely manner. He estimated that about one in five patients who have been identified as having a heart attack by paramedics in the field (who are now equipped with modern 12-lead EKG machines) need to go to a higher-level hospital, and need to get there within 90 minutes. Some other heart attack patients may need catheterization to find or fix a blockage, but can wait until a cardiologist recommends the procedure in the next day or two, and can be treated at any hospital.
Kerry Easthope, associate administrator for Alameda Hospital, says the hospital gets an average of 231 ambulance visits each month, most of those through Alameda’s Fire Department. The hospital gets about 1,500 emergency room visits each month, with complaints including chest pain, stroke, pneumonia, falls, digestive problems and more.
Alameda Hospital’s Role in a Disaster
While hospital supporters argue that Alameda Hospital is most important in a serious disaster such as an earthquake, one skeptic – Gorelick – argues that the hospital could provide medical care in a disaster without maintaining its current full complement of services.
Gloria Williams, RN, disaster coordinator for the hospital, says its staff has done a lot of planning for a large scale emergency. Two large storage spaces on the hospital property contain tents and decontamination showers that were provided by the Department of Homeland Security, she said. The hospital could use the tents and about 100 cots to set up in the parking lot to care for large numbers of people. It also maintains a large cache of antibiotics in case of a communicable disease outbreak or bioterrorism, and maintains updated lists of medical and other staff who could be called in to help, along with national registries of other medical personnel.
Being an Island can be seen as either an advantage or disadvantage in a large-scale disaster, nurse Williams said. “They could shut down the Island if there was a terrorist attack and keep people from coming here,” she said. At the same time, being unable to leave the Island could complicate medical care in a disaster. The hospital staff works with county emergency officials to plan how such area resources as ferries and the Coast Guard could help in that circumstance, and it maintains agreements with other area hospitals to help one another in an emergency.
Investing in Modern Medical Technology
Now that a little more money is coming into hospital coffers, officials have been using some of it to catch up on medical and information technology that most modern hospitals maintain. These include:
*A PACS (picture archiving and communication system), which holds digital images from mammograms, X-rays, MRIs, CT scans and ultrasounds on a computer rather than hard copies stuffed in a film records room. The system should be running by spring 2011, Easthope said. According to a national survey, 93 percent of U.S. hospitals with at least 100 beds already have a PACS, and many are on their second or third generation of technology (Alameda Hospital has 135 beds).
*As part of the PACS project, the hospital is upgrading to a digital mammography system so that women don’t have to go to another hospital to get a more modern image after getting a film done at Alameda Hospital.
*The PACS is also part of a new electronic health record system to track patient records and help clinicians make care more efficient. Easthope said the system is being installed in stages, with the first part giving nurses the ability to take notes on patients on computers; that is to be online by June 2011. The hospital also plans to install systems for the operating rooms and emergency department over the next couple of years, and eventually offer computerized physician order entry, considered a key technology for making hospital care safer.
All U.S. hospitals participating in Medicare (Alameda Hospital relies on Medicare for a little more than half its income) must adopt specific electronic medical records technology by 2015 or face financial penalties; if they get them done earlier they may qualify for incentive payments. Easthope says the hospital expects to have the system done in time to get the extra dollars.
To comply with state law requiring hospitals to meet earthquake safety standards, Alameda Hospital must fix three main places on its aging buildings; the plans must be in place by 2013. Easthope says the architectural plans were drawn up and submitted to the state for approval in mid-September. The hospital will need about $10 million for the construction work, which involves moving a kitchen, and will seek about $4 million more for “other program development and growth.” The hospital has not yet found a lender, and is hoping to get assistance from a state program that helps hospitals that need to borrow large amounts of money.