More Complete Notes

Agenda and materials

1.  Quality issues are only covered in Closed Session.  This is allowed by the Brown Act but certainly not required.  I have requested an agenda item for a public summary of Quality metrics that the Hospital reports and which ones are accessible to the public (and where).  This would also include a discussion of why the Hospital has chosen not to participate in the California Healthcare Foundation reporting. 

(February may be too full for this discussion.)

2.  Nothing of note in the consent calendar.

3.  I am the Secretary of the District which makes me Keeper of the Seal.

4.  The meeting dates were approved.

5.  I will be on the Board Quality Committee.  I won't be able to say much without running up the Hospital's legal bill by constantly asking Mr. Driscoll for clearance so I probably will choose to say almost nothing.  I find the current Quality reporting difficult to work with, but that might be my own limitation, newness to the Board, and the fact that more in depth analysis will happen within the Committee.  The Brown Act is so comprehensive that it is even hard for me to write that without being wary.

6.  The Primary Stroke Certification discussion was not pretty.  See my notes below and Denise Lai's summary.  Dr. Deutsch brought up his father again who at the Cardinal Point candidate's forum had had a stroke and at the Board meeting it seemed like it was just symptoms of a stroke.  I'm not sure anymore and I don't know what it has to do with the discussion.  I really mean that.  First, one incident is hardly a basis for a decision.  You don't ask the lottery winner if playing the lottery is  a good idea or (when mandatory seat belt laws were being debated everyone had a friend of a friend who this happened to ) the guy safely thrown free of a car wreck if he should have worn a seat belt.  Also, do you really think the quality of care, the diligence, the speed at which orders are written, labs done and imaging completed are going to be the same for your average Alamedan vs. Dr. Deutsch's father?  I'll say it again.  I think the evidence is lacking to consider Alameda Hospital a good choice for stroke care.  I think the logical inference of the studies I am aware of is that there are better alternatives even if they require a longer trip to get to (and the OSHPD mortality numbers would imply the same).

7.  Compensation survey.  Well, the Board is spending money to come to the conclusion that Debi Stebbins is underpaid, but that we simply can't afford to raise her compensation to the market rate so we will give her none or a nominal raise (and nominal here would still mean thousands of dollars).   That's why you hire consultants - to tell you what you want to hear - and the Board and Ms. Stebbins wants to hear that.  My answers when interviewed will probably be outliers.  I wonder if anyone of my fellow Board members will be clever enough to suggest that she should get MORE money because she has to deal with me.

8.  Electronic devices.  No outside communication on Board business and we should all pay rapt attention. When I am on the computer during the meeting, I am usually gathering data.  During the stroke discussion I was searching PubMed for articles relevant to the discussion, but noone actually wanted to discuss real evidence.

9.  CEO reported on how great the stroke certification process is and how careful the JC is in issuing stroke certification.  I will just excerpt something I wrote to someone who actually cares about healthcare outcomes, "Common sense suggests that if every organization is capable of meeting a standard then it is simply a minimum rather than any measure of quality."

10. More sick people = better financial performance.  The November interim results were plus 72,000 and the ytd loss of the hospital is only 189,000 although I think that is astill bout a half million below budget and, even in the best month so far this year, not enough to support  financing for the seismic retrofit.  I also want to see cahs flow numbers since the hospital is capitalizing retrofit work, but that still costs dollars.

11.  Too much money contributed to Debi Stebbins pension plan.  Hospital gets about 25k back to defer the negative actuarial balance currently in the plan and reduce the amount of future contributions.

12.  The Hospital is operating illegally.  Noone cares.  Other hospitals throughout the state are also in the same boat.  OSHPD has not responded to my request for more information on this issue.

In short, the Hospital is still a mess and the Board cannot conceive of the only rational course of action which is to plan for a radical change.