No posts because nothing really changes.   Consistently wrong is the mantra of the Board and Management.  Political connections trumps facts.  Perception trumps reality.  The Hospital will just go on losing money and killing people no matter how many predictions of profitability prove false or no matter how many fines, surveys, or statistics suggest that people would be better off receiving their care elsewhere.

UPDATE:  Indeed the City Council is responsible if 60 days go by without the vacancy being filled whether due to gridlock or any other reason.  Apologies to Lauren Do.

Congratulations to Tracy Jensen the newest Board Trustee.

1.  From the Board meeting:

a.  The process of referring an item to the agenda for Board consideration was clarifies although I found the earlier dual process without conflict.  The basic outline is more formal than I desire, but still preserves the prerogative of 2 Board members to add an item that the Board President opposes.

b.  The District lost only $18000 last month.  The accrual reversal was 96,000 so, without that reversal, the loss would have been about what I had previously estimated.  113,000 remains of accruals that could be reversed at Management’s discretion.

c.  The District appears to have had a strong November.  I am skeptical that this will mean a positive bottom line although it is certainly possible – it’s only one month.  Clearly the Water’s Edge acquisition offers a positive contribution, but since it comes with multiple albatrosses, not the least of which, is a requirement to keep the acute care hospital open (or it loses the “distinct part” benefit), it was the wrong direction to go.

2.  The Ninth Circuit lifted the AB97 injunction which I had anticipated to be more likely than not.  The District reserve quite a bit for this circumstance (based on what the auditor reported).  Management will report at the next Board meeting how much additional has to be reserved for this change.  The California legislature is now controlled by Democrats with a super-majority so maybe legislative relief is possible – ask Rob Bonta.

3.  The application process for the Board seat vacated by Stewart Chen is ongoing.  Thursday, January 3 is the last day to apply so, if you were considering it, you may have to scramble.  Unfortunately, there is little chance that the Board majority would allow someone with the idea of closing the Hospital on, but perhaps you enjoy quixotic efforts.   Several times I have referred to the previous application process where the odious Williams was chosen where it was ridiculously obvious that she was the designated choice.   Unless you have been solicited to apply by one of the Board majority, don’t count on having a chance of actually serving.

2/3 Consent for changes to the pension plan and the SEIU-UHW West MOU.

4.  The Alameda Hospital Foundation is designated as the sole fundraising/charitable donation vehicle for the District.  The Foundation, just like the rest of the Board, is way too Hospital centric, but after a minor change to the MOU, the vote to approve was unanimous.

5.  September 2012 financials.  What can you say?  Management is always upbeat even when losing tens/hundreds of thousands of dollars.  The loss this month was 190k.  This does not bode well for the year.  The total loss so far this year is 672,229.  We can take a guess as to whether October will turn around this trend. 

First, add back in the Accucare fee of 16,000 and add another 14,000 just to be generous so that Wound Care in October would help make that number a loss of 160k.

Second, let’s add in the additional net census for Waters Edge + subacute (simplifying things here).  That works out to about 4.  We will assume that adds 50k to the bottom line by multiplying $400/day X 31 and assuming no net increase in expense (rounding up).  The loss is now at 110k.

Third, the acute care census was down but the case mix index was up.  Also surgeries were up so I will just assume that the September to October delta of dollars of this segment is flat.

Overall, the District still faces a deficit of 110k for October is my best guess.  The Orthopedic program opened October 22 and almost certainly lost money for that initial time period.  We can safely assume that October will be a negative result. 

We can furthermore assume that there is, at most, another 50k of monthly margin that can be squeezed out of Waters Edge and maybe another 20k out of the wound care.  This would still mean a baseline loss per month of 40k (and I think I am being somewhat optimistic here).  I think it would be unlikely for the new surgeons to hit their stride prior to January 1 with the holidays coming up.  So let’s assume that the cumulative loss as of December 31 is 670k (1st quarter) + 110k (October) + 80k (November + December).  That is a total of 860 thousand.  The Bank of Alameda is not going to be very happy about that unless the Orthopedic program is starting to show signs of generating large amounts of cash; it would have to generate over 210 thousand a month for the District to generate $1 of net income for the year.  I don’t recall the budget numbers for the ortho program, but that sounds high to me. 

So 2012/2013 is like every other year, unless a miracle occurs, the District loses money over and above the subsidy provided by the parcel tax.  And let’s not forget the non-economic cost the District incurs in the form of poor health outcomes.

6.  2011/2012 fiscal year audit.  The auditor would have to be hit over the head with a hammer to give anything but a “clear” opinion.  They know who butters their bread.  The major change was after a series of minor adjustments which made little difference in net income, grants and donations were reclassified to an income statement account rather than being driven directly to the balance sheet.  This made the loss less for the year, but did not change the underlying numbers or dynamic.

7.  Metrics plan was approved.  I think there may be some small chance of the participants getting the 25% for the seismic part of this plan, but I don’t see much chance of them reaching the thresholds for the other pieces.

8.  Election results remain the same as the previous post.  There will be an appointed Board seat available shortly. 

9-xx.  Not much more interesting to report.  Board packet and video available on the web.

2.  To people who dispute the above statement on the basis that I can’t possibly know that care at Alameda Hospital results in poorer outcomes, I point you to all those who were willing to attack Nate Silver for having the temerity to suggest that Obama would win the election.  You may not believe you are in synch with Karl Rove, but, in this small (?) way, you are very much related.
3.  XKCD has the best take on Nate Silver’s and Sam Wang’s war with the pundits:  MATH.

4.  Thank you Tracy Jensen for running.  It’s not clear to me why you ran, but, if it was to take a seat in case Stewart Chen moved to the City Council then I would say your relatively strong showing puts you in the lead for that seat should you apply.

5.  Congratulations to Stewart Chen who appears to be likely to move to the City Council taking the seat that is likely to be vacated by Rob Bonta of good resume, friendly demeanor, and good looks.

6.  Congratulations to Rob Bonta.  I didn’t vote for you because of your District Board service, but I think you are definitely worthy of the State Assembly.  I think you will do a fine job and my vote was a close call.  Take a stand once in a while.  Stand up to your backers or the conventional wisdom.  Don’t always take the easy route; I don’t think Cesar Chavez was trying to win any popularity contests.  Combine all the assets you have especially your gentle nature, your intelligence, your good looks with some courage and you will not only go far (which seems predestined), but you will have something to show for it.

7.    Congratulations to Jordan Battani and Michael McCormick.   Could someone explain the 3000 vote difference in you tallies?  I certainly know that you are different people who don’t always think alike, but I saw nothing in your campaigns that would distinguish you two to that degree.  Maybe your ballot statements?

8.  Thank your favorite higher power that Mary Hayashi went down to defeat.  Having a convicted thief replace an addict on the Alameda County Board of Supervisors would have been shameful.

9.  Disappointed that Swalwell defeated Pete Stark, the only atheist in Congress.  Yes, Pete was the lesser of two evils and should have stepped aside this cycle, but now I fear that we will be stuck with the slimy Swalwell for multiple terms.  Of course, I was proud to cast my vote for Barbara Lee.

10.  I’m happy that Obama won a second term and that the Senate was retained for the Democrats, but I expected that result.

11.  I am THRILLED that the State Assembly and State Senate have supermajorities.  Please don’t give away the store to the prison guards.  Please do raise taxes.  Please fund higher education, healthcare for all, schools, environmental regulation, etc., etc.

Enough.  Board Meeting tonight.  I will try to get back to regular summaries, but no promises.  Come visit us if you plan on applying for the open seat.

Because besides the fact that the District spends 5.7 million dollars of Alamedan’s tax money every year (plus losses that erode the balance sheet); the Hospital ends up causing death and illness that would not occur if we closed it down.

This is especially galling to me, someone who believes government has a positive role to play and should be the primary provider of basic needs.  (YES MITT, I believe those 47% have it exactly right when they think they are entitled to things like healthcare, education, subsistence food and shelter needs, etc.  100% are entitled to that, at a minimum, whether they pay taxes or not.)  When government wastes money, I don’t see it as a reason to shut government down because there is waste everywhere.  But we shouldn’t turn a blind eye to waste especially when it is hurting people and our civic leaders should not be BS’ing people about safety or financial responsibility.

“Nationally recognized experts” for one should be offering truth and leadership and not myths and conventional wisdom.  That’s what is so disappointing to me; that people who at least pay lip service to the same philosophy of government I believe in are willing to lie in order to protect the status quo.  I expect that of Republicans (whether they call themselves Tea Partiers, Liberterians, or traditional GOP), but I hope for better from Democrats.
P.S.  To end on a positive note, the Alameda Community Health Fair is this weekend and well worth it.  (Just don’t get your follow-up care at the Hospital if it involves any acute services.)

Nonetheless, I thought that perhaps this was just my bias against the Hospital so I went to PubMed and did a search on “transport”, “time”, and “mortality”.    1451 articles came up many of them having nothing to do with the subject I was interested in.  All of the ones that appeared to be relevant concluded that within a narrow range, that transport to resource rich hospitals bypassing local community hospitals either made no difference or resulted in better outcomes.  The one article abstract that said it best was on trauma (and, to be fair, EMS protocol, I believe already dictates that trauma patients NOT go to Alameda Hospital).  “Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer’s effect on mortality,” states in its conclusion, “Triaging severely injured patients to hospitals that are incapable of providing definitive care is associated with increased mortality.”  Without getting into specific details of all the studies (Lauren Do can go try to cherry pick or misunderstand those irrelevant, not-really-a-study sources available that contradicts the overwhelming evidence, but I’ll refrain from debating her.), the conclusion I come to is:

1.  Reducing transport time has a powerful conventional wisdom logic to it that is pretty much contradicted by the actual evidence.

2.  In most cases, the determinative timing factors are initial call to EMS (witnessed events), beginning of BLS (AEF’s, bystander assistance), and the start of ACLS (the arrival of the ambulance).  Again, transport time is a non-factor in the ranges we are talking about.

3.  Bypassing the local hospital for a more resourced, higher level of care alternative leads to better outcomes.

4.  Stops at local hospitals caused delay in treatment, introduced error, and resulted in increased mortality.

The results appear to be generalizable with specific studies showing this general result for cardio and trauma.

Now I don’t know whether this is related and demographics vary greatly but here are available the latest raw mortality numbers for each hospital in California.  The % for the latest period reported (7/1/11 to 12/31/11) is 3.7% for Alameda Hospital which seems considerably higher than other facilities in Alameda County that I spot-checked.

2.  The District needed an emergency loan from its claims processing vendor to keep the lights on.  If you are in that dire a situation (no reserves and tapped out at the bank), something is seriously wrong.

3.  Go read the report known as a 2567 for the $50,000 fine that the Hospital received from CDPH.   If you read the whole thing and think that the State will reverse the fine then you are quite the optimist.  Pay special attention to the description of patient 2 which starts at the bottom of page 4 and goes through page 9.  Note especially where, at the bottom of page 7,  when the state investigator documents his interview with the pulmonologist (MD #1), he expresses his disbelief of the MD’s explanation that the fentanyl patches were prescribed for “respiratory distress”.  After confirming that MD #1 is full of it with respect to any evidence that the prescription of fentanyl patches for respiratory distress is a good idea, the investigator then hammers his point home with subsequent interviews with 2 pharmacists and 2 RNs where he  makes the point that noone thought that these patches were for respiratory distress and noone knew of any reason to think that application of fentanyl patches to treat respiratory distress was a good idea.

4.  Paul Ryan is an easy liar who is confident he would not be challenged and that he could avoid the label of liar if he was challenged.  NOONE misremembers a 4 hour marathon time as sub-3 hour; perhaps, if they have dementia.

5.  The Institute of Medicine estimates that 750 billion dollars is wasted in healthcare expenditures in this country every year.  No surprise here.

6.  The immediate survival of the Hospital will likely be determined over the next 6 months.  There are few, if any, additional opportunities to stave off the inevitable.

7.  Even if the Hospital survives, the District would need to create a financing plan for seismic retrofit or the Hospital will end up missing the 2020 deadline.  I do not believe this deadline will be ignored the way earlier earthquake requirements have been ignored.

8.  It will be interesting to see what the impact of 2 brand new hospitals (Oakland and San Leandro Kaisers) will be when they are completed in the next year or so.

“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).

On a personal level, it’s a thankless job that pays nothing.  It costs money to run if you put a candidate’s statement in the voting information guide.   You need to devote time and energy to staying on top of the material.  And there is no benefit.

On a public level, if you are for keeping the Hospital open you are advocating a costly and unhealthy position based on the best available evidence.  If you are for closing the Hospital then you are scorned by many and are likely to be ineffective.  The ineffectiveness extends to both being elected or, if elected, making any meaningful difference in the face of stupidity, dishonesty, ignorance and arrogance (the four horsemen of those who want to keep the Hospital open).