The agenda and materials are found on the the Alameda Hospital website.
1. Swearing in was done one at at time with Stewart Chen going first. I neither looked right nor left focusing on Mayor Beverly Johnson and trying to make sure I stumbled over the words as little as possible. It definitely was more solemn than the swearing in in my living room when I received the Board packet last Friday.
2. Special Recognition was delayed until Rob Bonta arrived since he was stuck in traffic. Leah Williams was "too busy with her new job" to attend and be recognized.
3. The District Board Orientation was boring. I hope they eliminate that part in the future. Luckily I had my laptop to do research and find additional information. Could not find the total number of SNF beds in Alameda, but will continue to look.
4. The consent agenda was approved unchanged with the exception that I asked for the October 2010 financial statements to be pulled out as a separate item because of the critically low cash on hand as of 10/31 which was only $72,000. The Hospital has a line of credit with Bank of Alameda which is large enough to cover any shortfall but it requires Board approval to draw down. That would have had to be an emergency meeting probably and, I imagine, the terms are egregious.
5. I voted against the resolution asking everyone to play nice. When I first saw it on the agenda I thought it was aimed at me, but the Association of California Health Care Districts sent it out to all Boards. ACHD is the lobbying arm for Districts in the state. I don't know what we pay to be a member, but it is probably nominal (thousands or tens of thousands) and still too much. Playing nice and supporting the Mission sounds nice until you realize that there are things you can't be civil about. (I was probably too civil during Stebbins stroke update last night. The Hospital is just wrong about seeking stroke certification and is clearly putting revenue over patient safety in my opinion.)
6. Lease terms and project build-out budget for the wound care center were deferred. There was an official motion and vote which I did not vote against, but all that vote was for was to tell management that the Board saw nothing wrong with management continuing to pursue this opportunity. My thoughts in no particularly articulate and organized manner.
a. Don't bring a letter of intent for a lease of over 10,000 sf of space when the wound care center needs only 4600 sf unless you state the discrepancy squarely up-front.
b. Explain your rent dollar numbers in your financials. Get them right. Know them inside and out. Don't use the absolute smallest number you think you can get away with.
c. Know what the insurance implications are for adding oxygen to a building.
d. Don't label something "contribtution margin" when that is not what it is. I'm sure that most people in the room thought Stebbins was right and I was wrong (I admit I was somewhat confused about the meaning because of how stupidly it was being used), but she was totally incorrect about the term AND the way it was used in that particular financial spreadsheet was seriously flawed.
7. President's and CEO Report - More sick people in November so probably didn't lose money. I feel sorry for the sick people who had to come to Alameda Hospital for more reasons than one. The effort to continue to treat stroke patients sub-optimally in order to retain revenue continues. IT apparently was a mess as far as Stebbins was concerned so she reorganized the team and now has them reporting directly to her.
8. Nothing more of note happened in the meeting that I can comment on.
Overall, fairly civil in my opinion. Nothing changed relative to my opinion of the Hospital although I continue to develop my opinions of the people involved.
Elliott Gorelick
Question: How many stroke victims does a Certified Stroke Center need to support itself? Does the City of Alameda itself provide that many per annum? If not, then this makes no sense as we have no bordering cities which would use a stroke center near the bay-edge of our city.
ReplyDeleteThey have 27 patient profiles documented now and need 30 to obtain certification according to the Director of Nursing. Don't know timeframe for these initial 27.
ReplyDeleteThey will apply for certification with JCAHO likely in January and then there is a 4 month window before JCAHO can actually do the assessment. Hospital believes can act as a stroke receiving center in that window per Eden Hospital's input at November meeting. I objected and management said they would check with County EMS.
I am disappointed that Hospital is pursuing stroke cert. so aggressively since I think it will lead to worse outcomes. I, unfortunately, did not state that for the record last night (12/13). I hope that a formal transfer protocol to a CSC will be required by County EMS for < 8 hour (from time of onset) arrivals if Alameda does end up being designated a PSC.
Elliott - Thank you for this blog. If I hadn't been out of town, I'd have been at the meetings. I'd like to support closing down this hospital and sunsetting the parcel tax as a means to that end.
ReplyDeleteWhat you report about Stebbins approach to the stroke protocols astonishes me. They do not have the capabilities to treat a stroke appropriately. Denise Lai has written an excellent letter to the editor about this that I hope is in tomorrow's Sun. It explains the treatments for stroke >4 hours after onset. That Alameda Hospital - and the county EMS Director believe they should be allowed to treat stroke patients>4 hours after onset is frightening. The treatments needed in that time frame are exactly the ones they lack. Maintaining them for 27 patients a month is absurd.
As for the numbers, with about 74,000 people in Alameda, 50% of whom are Kaiser members, I cannot believe that this hospital believes it can achieve stroke center certification without dodging key elements critical to good outcomes. I cannot believe it still exists as a hospital. We do not have the patient population to support quality care, period. Thank you for your work, and for being willing to sit on that board.
blogspot doesn't work that well. use wordpress, far better. I wrote a long bit, and blogspot wouldn't recognize my username, then ditched what I wrote.
ReplyDeleteOk. To Mosaicland: clarifications are needed which actually make the discussion more muddy. Sadly.
1. In the county ems protocol for strokes, they provide a CPSS (cincinatti prehospital stroke scale) chart that includes the fact that at/after 4 hours, IV tPA is no longer a hospital treatment option. It does not say that the paramedic is not to take the CVA to a CSC (Certified Stroke Center).
2. AFD Chief Fisher said that in the past 4 months, paramedics have taken all stroke victims to a CSC, off island.
3. CEO Stebbins has said:
A. Alameda Hospital has received CVA victims via paramedic, I don't recall the number, and
B. Alameda Hospital will continue to treat CVA victims after the 4-hour window
There is nothing in the county protocol to suggest that paramedics would take a CVA to Alameda Hospital. But every time Stebbins talks on this topic, she seems to be misleading the public; almost as though she's just trying to save face and sustain the brand, the marcom and image people have about the place. It's just plain bizarre, and IMHO, irresponsible. It's not like she's running an amusement park here! It's a hospital for crissake.
The fact that city and hospital 'facts' are contradicting themselves doesn't help either. Until we see the data ourselves, we will not know a thing..
oh AND we need to figure out WHY Alameda Hospital should even bother being a PSC (primary stroke center). Isn't that a necessary strategy for a rural hospital? Much of Alameda is nearly equidistant for emergencies going to Alameda or Alta Bates Summit, the latter of which has a world class CSC. This makes no sense. And it can't be something that will even break even. It goes against all fiduciary responsibilities that the hospital should be adhering to with our tax dollars.
ReplyDeleteOur poor little island city is scratching for purchase like everyone else. The hospital has potential beyond the traditional role it has held. I wish the Board could think outside the box. In fact, I'm still smarting from past years and comments made by board members who sat idly by while overpaid hospital administrators couldn't think beyond their retirement dates - - all the way to the bank. When Kaiser discontinued their back surgeries in town it was looking bleak; then there was the failed attempt @ providing high end plastic surgery. Alameda is the jewel in the Bay that gets stepped on by developers and political climbers. What will have to happen before people who claim to love our trees and neighborhoods will attend a council, hospital or school board meeting? It only takes one meeting or one letter to the editor before you realize you write better, have good ideas and know how to get things done than those sitting on the dais.
ReplyDelete