Callous

The idea that there is a relationship between higher volumes and better outcomes in healthcare is completely uncontroversial.  The exact nature of the relationship, thresholds, and areas where it is strongest is the reason that all these studies are published.  The Board majority and management don't care.  (I think I have seen this kind of thing before - someone sticking their fingers in their ears and chanting, "nah, nah, nah, I can't hear you.")

The problem is that Alameda discharges around 2500 patients per year.  Even a 0.1% difference in mortality is  2 to 3 unnecessary deaths.  The studies I have quoted have found relationships much stronger than that (they would not even have been able to detect something as small as 0.1%).  For every 1% difference in mortality, it is 25 additional deaths.  Real people dying because Alameda Hospital is a smaller volume hospital that the Board refuses to close and route those cases to larger hospitals (at least 5 of them within a 10 mile radius).

UPDATED:  The question that keeps getting asked by the Board majority is where is the DIRECT evidence that Alameda Hospital is inferior.  They don't seem to believe that the responsibility lies with them to justify the tens of millions of tax dollarsthat have been used to prop up this failing institution.  I will listen to that evidence as long as it doesn't consist merely of the endlessly repeated words, "I trust The Joint Commissision."