Calif. county orders emergency stroke patients sent off-island
Ambulance providers generally transport emergency stroke patients to the nearest hospital, like Alameda Hospital, which is not a certified stroke center
By Michele Ellson
Contra Costa Times
ALAMEDA, Calif. — Emergency stroke victims who call 911 for help now may be transported off-Island to designated stroke centers following a decision by county emergency services officials to revoke a county protocol that had ambulance drivers taking local patients to Alameda Hospital instead.
The county informed Alameda Hospital of the decision in a Nov. 24 letter, and the change went into effect Wednesday. The list of certified stroke centers in Alameda County includes Kaiser Permanente facilities in Oakland and Fremont, Alta Bates Summit Medical Centers in Oakland and Berkeley, Eden Medical Center in Castro Valley and Washington Hospital in Fremont.
Alameda County's emergency medical services director, Dale Fanning, said she believes the hospital is making good strides toward achieving its certification.
"We don't consider it unsafe there. They're providing good care," Fanning said. "We just wanted to make sure patients there get the same care they do in the rest of the county."
Denise Lai, a local resident who raised concerns about the protocol, called the change a great victory for patient care in Alameda. She said the protocol was inconsistent with accepted standards of care for stroke patients.
"I'm thrilled that these people will now get optimum emergency care," Lai said.
Alameda Hospital Chief Executive Officer Deborah Stebbins said she was disappointed with the county's decision, but she expects the hospital will have the certification it needs to accept those patients again within six months. She said the hospital will continue to accept other stroke patients, including those who aren't transported by ambulance and those who come in more than four hours after symptoms develop.
"We still feel we provide very responsible care for stroke patients," Stebbins said.
County protocol had required ambulance crews to transport stroke patients within four hours of the onset of symptoms to a certified stroke center — except in Alameda, where they would be taken to Alameda Hospital.
The county adopted new protocols in 2007 requiring ambulances to transport stroke patients to certified stroke centers but Alameda Hospital resisted, even threatening legal action if the new protocol were put in place, documents obtained by Lai show. Fanning, who wasn't running the county EMS agency at the time, said she believes the exemption may have been put in place to ease concerns about the hospital's viability should the stroke patients be sent elsewhere.
Lai said she had a bad care experience at the hospital and began looking at how she could be transported elsewhere if she suffered any other medical emergencies. She stumbled onto the exemption during her research.
The issue was raised at a Nov. 4 City Council meeting and the next day Fanning sent a letter to Stebbins questioning the exemption and the hospital's efforts toward obtaining stroke certification.
"The standard of care in Alameda County is for 911 ambulance providers to transport patients exhibiting stroke symptoms to the nearest stroke center. The exception to this policy, directing ambulances in Alameda to take these patients to Alameda Hospital, is not in the best interests of patient care," Fanning wrote.
Stebbins argued in a Nove. 19 letter to Fanning's boss, Alameda County Health Care Services Agency Director Alex Briscoe, that emergency stroke patients would be better served coming to Alameda Hospital because it's closer than any of the county's certified stroke centers, and that the hospital could more quickly administer health-saving drugs. She said the hospital was well on its way to obtaining stroke certification and she believed it could be in place by May 2011.
"Even a small difference in minutes matter when dealing with an acute brain attack," Stebbins wrote.
Stebbins said Alameda Hospital is working with a doctor at Eden Medical Center, which recently obtained its certification, in order to care for stroke patients and to obtain its own stroke certification.
Alameda Hospital is one of five hospitals in the county that don't have the certification.
She said the hospital cared for 375 stroke patients over the past two years.