Blogging Bayport Alameda

August 5, 2011

Stroke care applied with tenderness

Filed under: Alameda — Tags: — Lauren Do @ 6:06 am

The nice thing about the City Council being on August break is that I get to write about topics that often get shunted to the side because the City Council issues are always seem to suck my attention away.    And again, my attention turns toward the Alameda Hospital.   It is a subject I am fascinated by because I don’t really have a strong feeling about whether it should stay open or whether it should close.   Selfishly, the closure of the hospital and stopping the parcel tax would probably benefit me more since I don’t use the Hospital and probably won’t use the Hospital, but there are a lot of services and programs that I pay for with my tax dollars that I don’t get the use out of either.

So I’m taking this opportunity to discuss the puzzling opposition by Alameda Hospital detractors and one Board Member to Alameda Hospital getting certification as a stroke center.   Right now, Alameda Hospital is not currently certified by the Joint Commission, an accreditation organization, as a stroke center, but it is in the process of becoming accredited.  There is a fairly rigorous set of hoops that must be jumped in order to be accredited by the Joint Commission, aka they don’t give these away in boxes of cereal.

However, despite not being a certified stroke center Alameda Hospital can accept stroke patients.   Now we can argue about whether it is better to get to a hospital first or to be routed to a certified stroke center first, but that isn’t the point of this post.   The answer to that question, I imagine, is rather gray and fuzzy depending on which professionals you talk to.

Some hospital detractors, including one Hospital Board member, has explicitly stated that he believes that Alameda Hospital working toward stroke certification through the Joint Commission is a mistake.  In a question and answer on In Alameda, the question was specifically asked about Alameda Hospital’s attempt to get certified by the Joint Commission, the answer Elliott Gorelick gave:

The problem with acute stroke care at Alameda Hospital is that there are larger and more well-equipped hospitals close by. Because these alternative hospitals are so close there is no evidence in the literature that the relatively small time differential in reaching them is likely to have any negative effect on patient outcomes, but there is evidence that the additional services, resources, and expertise are likely to have beneficial effect.

Many studies show that larger volume of cases means better outcomes, not just for stroke but for a whole host of conditions. There are also several studies that show that even after stroke certification is obtained, reported outcomes follow the trend of outcomes prior to stroke certification — subpar hospitals have subpar outcomes even with PSC (Primary Stroke Certificaton).

Finally based on what I have read, I believe acute stroke care is a dynamically changing landscape that requires resources that Alameda Hospital does not have nor can afford.

If I put this all together, I draw the conclusion that the limited volumes and interventions that Alameda Hospital will have available to them (which will lead to poorer patient outcomes) does not compensate for the additional training and documentation associated with PSC (which should lead to better patient outcomes). Since PSC will drive patients to Alameda Hospital and away from the likely better alternative hospitals close by (but farther than Alameda), the net result will be “worse health outcomes for [Alamedans].”

So it’s not that Alameda Hospital doesn’t provide perfectly good or even perfectly adequate stroke care, it’s that someone else can do it better because they are bigger.  Unless of course, Boardmember Elliott Gorelick is accusing Alameda Hospital of being a “subpar hospital” thereby providing “subpar outcomes.” But of course how Alameda Hospital is “subpar” is never explained other than it just being small.

For me, it appears the opposition to Alameda Hospital being certified as a stroke center is to keep it from being competitive with surrounding hospitals.   The biggie is that Alameda County Emergency Services protocol does not allow ambulances to route stroke patients to hospitals without this stroke center designation.   Keeping potential patients away from Alameda Hospital is one way to ensure that it cannot raise any revenue beyond the parcel tax and thereby make the argument that the Hospital must be closed down.

I did find this one blog which recounted a debate at the International Stroke Conference in February this year which examined the question of whether the “Stroke Care” label improves outcomes.   On one side one doctor:

…cited lots of evidence over many years showing higher rates of using clot-busting drugs, lower death rates, and less need for institutionalization when patients were treated in stroke units compared with other hospital care.

But the blogger notes than many of these studies were conducted before the Joint Commission began certifying stroke centers.   On the other hand another doctor:

…agreed that care is better at Primary Stroke Centers, but argued that these were the centers that already were excelling at stroke care and working hard to improve stroke care, and so they applied for and earned the Primary Stroke Center labels. There’s no evidence that the label itself improved outcomes at those centers.

Essentially, if a Hospital is good enough to get the certification, then it’s probably doing a damn fine job already.

For me, it seems pretty obvious that it’s just good practice to get stroke center certified, regardless of whether the Hospital closes in 1 year or 100 years from now, there doesn’t appear to be anything negative for current and existing patients if Alameda Hospital achieves this benchmark.

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37 Comments

  1. Lauren: what a disservice you do to this discussion. The facts are far more complex that what you describe here. And the discussion is far broader one than of whether residents should turn their brains off and rather than think too hard, simply feel good about have our very own stroke center.

    The rate of change in stroke care technologies and disease expertise is so great that there is no way Alameda Hospital can 1. catch up and 2. keep up. Financially speaking. And medically speaking. To afford a neurologist 24/7 and specialized teams & radiologist on site as well as a cath lab with up to date equipment (significant) is a silly target for a hospital that has in the last 11 years, and with $60M of free money, been unable to even smell solvency, let alone get near it. And then you add in the condition of the facility, the earthquake retrofit problem, and you can see that this is a failing endgame no matter how you slice it.

    In 2001, the overall rate for occurrence of total stroke (first-ever and recurrent) was 269 per 100,000 population (age- and sex-adjusted to 1996 US population). This rate drops every year due to increased access to the most specialized stroke systems with increasingly new capabilities and technologies. With approximately 74,000 residents in the city of Alameda, this means we have fewer than 200 stroke cases per year. I’d guess that in order for a primary stroke center to financially break even, it needs more than one stroke case per day, wouldn’t you? Add to the fact that we have world class stroke centers minutes away that can immediately address every kind of stroke (Alameda Hospital won’t be able to), and statistics show that if taken directly into one of the highly specialized stroke centers from the get-go, that survival rates spike. There’s not one good reason to have a way-station here in Alameda in order to ship stroke victims over to Eden or Alta Bates.

    Comment by Denise Lai — August 5, 2011 @ 8:19 am

  2. “But of course how Alameda Hospital is “subpar” is never explained other than it just being small.”

    Doesn’t need explaining. The fact that it’s “just being small” makes it subpar, since the par treatment is defined by the treatment afforded to the majority of victims, which is different than that afforded by Alameda Hospital.

    “…agreed that care is better at Primary Stroke centers,”

    Subpar Definition: A lower standard than customary or traditionally accepted norms, but not entirely unacceptable.

    Comment by Jack Richard — August 5, 2011 @ 8:42 am

  3. Estimated cost of effort ? Show me the money!

    Comment by Denise Shelton — August 5, 2011 @ 9:03 am

  4. Denise Lai — devastating response! Point, game, match. Although what do the supporters say about the economics of this whole thing?

    Comment by Monty — August 5, 2011 @ 9:16 am

  5. i’m in agreement with Denise Lai. There are some things that larger hospitals do better b/c they have the financial revenue to do it. Alameda Hospital NEEDED a parcel tax to stay solvent, getting certified for stroke care will cost money as you’d need to have the standard equipment that comes along with the certification.
    Unless you’re banking on most seniors and the parents/children of Alameda to have strokes daily, how would you justify the cost of maintaining the program? Alameda Hospital currently doesn’t have enough “business” as it is. That’s crass, but in the end it’s true… I don’t think it sees enough patients. Just adding a certification doesn’t make that go away.

    I’m not debating whether the hospital should stay open or not, but I don’t see any advantage other than the hospital being able to treat stroke victims… but if the few minutes to the bigger and better hospital is true, I’d choose the better one. Also, can the hospital cope with the cost of running this program?

    Comment by hobnob — August 5, 2011 @ 9:55 am

  6. Monty: clearly you have not attended an Alameda Healthcare District board meeting. Decisions are made from anecdotal stories. The decision to become a stroke center was based upon Dr. Deutsch’s experience with his aged father for crissake. Apparently, they don’t need no stinkin’ economics: their fiduciary irresponsibilities are mitigated each year by the $6M parcel tax, hospital’s free money/revenue. The CFO just resigned, which is really, really interesting…

    Fighting for discussions and decisions founded upon evidence, facts, statistical trends and norms, disease systems knowledge, etc., is absent. What isn’t absent: 1., the vilification of Mr. Gorelick (AHD board member) because he insists on intelligent and informed discussions (Shoot the Messenger), 2., Alameda residents who believe whatever the AHD Board says despite obvious flaws in their logic, reasoning, and facts (epistemic closure is rife), and 3. would rather Shoot Peer Messengers who think critically (authentically so) than have a challenging, effective conversation because that conversation wouldn’t sound or feel nice, and because asking anyone to change their emotional value statement (belief system) about the hospital is verging on the demonic; it’s not an option, as the hospital is a sacred cow no matter what facts, corruption, or distortions are exposed.

    I expect those in charge of the healthcare district to optimize resources and services for Alameda residents (and not for themselves [read: more geriatric patients on-island translates into a larger patient pool for Dr. Deutsch, AHD board member]). And, as far as I can tell, they have never been focused upon us. Not since 2002 when the district was begun. Under Tam’s leadership, and under Bonta’s leadership, the District continued to manipulate the healthcare game in town to our disadvantage to ensure acute cases arrive at the ED door (manipulation begun in 1983 under Dr.Deutsch and other local physicians). It is corruption, but moreover, it’s really silly: the parcel tax is significant enough to address a population of 74K people with medical services that we all need and which would create abreak-even if not profitable business. They could have been by now both profitable and hugely loved for serving the very real day-to-day needs of residents. Clearly, focusing on acute cases—like has been done—is a faulty strategy: we just don’t have enough to support the ED and the hospital! But rather than focus on what would serve us (basic day to day healthcare), they’d rather focus on rarely needed specialized/elite services that feed their own egos, appear to gild their local network and positions of authority, and in Dr. Deutsch’s case, ensure the existence and, now with the wound care center, potentially enhance the magnitude of his medical practice.

    Comment by Denise Lai — August 5, 2011 @ 9:59 am

  7. hobnob:regardless of whether Alameda Hospital is stroke certified or not they still accept and treat stroke patients, from the Alameda County EMS press release:

    While the hospital seeks stroke center certification they will continue to treat stroke patients that are not transported via the EMS system as well as stroke patients that are not identified by EMS policies as patients that will benefit from stroke center care.

    Alameda Hospital’s relationship with Eden Medical Center’s stroke center and neurointerventionalist, Dr. Bonovich, allows it to effectively care for stroke patients presenting themselves to the emergency department. Alameda Hospital will continue to use the same protocols that have been developed at Eden Medical Center, which achieved stroke certification in August 2010.

    I would think that regardless of where anyone stands on the issue of closing Alameda Hospital ensuring that there is a standardized form of care that has been vetted through the appropriate certification entity would be something that people would support given that there has been no evidence — anecdotal or otherwise — that has been shown that Alameda Hospital does a poor job caring for existing or previous stroke patients.

    Comment by Lauren Do — August 5, 2011 @ 10:18 am

  8. For those who want a real financial discussion about the healthcare district and the hospital:

    $60M spent (parcel taxes)
    + $12M gone, evaporated (reduction of net assets)
    ———-
    = $72M (!) value given the healthcare district and squandered (we’re no closer to solvency)

    Now, if the hospital goes bankrupt— and they could, the decisions are so risky given the financial condition of the hospital combined with the recession and the earthquake retrofit requirements—Alamedans get left owning the hard debt:
    + $1.14M long-term debt
    + $5M in lease obligations, contracts for equipment and real estate
    + $500K obligation in severance to CEO Stebbins
    ———
    = $6.64M of hard debt obligations

    $7M+ that the healthcare district thinks it makes sense to obligate we-the-residents to. And we haven’t even seen the new *emergency* line of credit that the Bank of Alameda is giving them to spend on the Wound Care Center (what about that word emergency do they not get?!).

    Now look at the fixed assets of $8M; that’s an aged building that doesn’t meet state standards for acute care services, i.e., it’s not worth $8M. Total assets and total liabilities are overstated by about $6M, inflated from including the 2012 parcel tax (assets/other receivables; liabilities/deferred revenues). That’s just stupid accounting. It’d make sense to include next year’s parcel tax in a forward P&L, right? But in this year’s balance sheet? Shoot. No wonder the CFO quit. And the outsource firm in cahoots with the board for the bright new shiny egoistic strategies, is now doing the CFO’s work. No matter how you look at this, none of it is responsible or makes sense.

    The best way to keep apprised of this insanity is to bookmark and read Mr. Gorelick’s Notes: http://ahdboard-eg.blogspot.com/

    Comment by Denise Lai — August 5, 2011 @ 10:44 am

  9. 7 Lauren, would you choose the optimum care or the ‘appropriately certified’ care for your stroke victim?

    Comment by Jack Richard — August 5, 2011 @ 11:26 am

  10. Ooops, I stand corrected. My point is taking on the certification, can the hospital keep up with the certification financially. Paying for this financially from taking it out of the parcel tax is not justification in my opinion. You got that tax to keep the hospital running in the first place. Seismic retrofitting of the hospital will cost millions, which people are saying the parcel tax won’t cover, so where is this money coming from?

    I get the idea of having a hospital on the island when diaster happens. What about finding another building? Would cost more than to retrofit the current building? Not sure if anyone looked into that option. Or rebuilding the building?

    Comment by hobnob — August 5, 2011 @ 11:29 am

  11. Jack: Personally I would let the professionals transport my loved one to the facility they thought was best, if it’s the closest, so be it. If it’s the “best” regardless of distance, I’m not a medical professional and I wouldn’t second guess the people who are hired to be experts.

    Of course I have Kaiser, so I’m pretty sure I didn’t get the platinum “optimum” care when I delivered my two kids and neither did the husband when he shattered his ankle years ago, but did that mean that care was “subpar”? Not really, but it was just not “optimum” either.

    Comment by Lauren Do — August 5, 2011 @ 11:34 am

  12. I would like to see Alameda Hospital pursue the stroke care certification simply because it means they are and will be making an overall effort to improve patient care, which is one of the reasons I voted for the parcel tax.

    As to the earthquake retrofit issue, funding major construction and renovations as are required by the state standards is beyond the operating budget of most hospitals statewide, not just Alameda Hospital. Some form of state and/or local bond funding will most likely be required to bring the great majority of California’s hospitals into compliance with the 2030 standards, so I hope that our new redistricting process and other reforms will bring about some sound and reasonable proposals on this (and other) points in the Legislature.

    It would be a lot easier for me to read and consider Denise Lai’s reasons for opposing almost everything at Alameda Hospital if I did not feel like I was being shouted at all of the time. The emotionalism and obviously pre-sharpened editorial knives that she so readily pulls out make thoughtful consideration of whatever facts she presents difficult, which is a shame. I know she has done a lot of research into this but I don’t want to
    engage with someone – or the information she presents – when the editorial tone is so hysterical. (Not to mention the fact that hysteria is a good reason to suspect the accuracy of an information source…)

    Comment by Jon Spangler — August 5, 2011 @ 11:51 am

  13. Jon Spangler, you chauvinist pig! Hysteria…hysterectomy…from a Greek/Latin word meaning the womb. Don’t you know what a faux pas it is to call a woman hysterical? Some people are just PASSIONATE about the way they express themselves. If you don’t understand passion, well, i could say something about what you must be like in bed, but I won’t.
    Some of you are still missing the point: no amount of money can seismically retrofit AH to keep it open. And I sure hope nothing happens to Dr. Bonovich. A stroke program dependent on 1 doc…?

    Comment by vigi — August 5, 2011 @ 12:20 pm

  14. 11.
    We have Kaiser also and we used to have Aetna, long time ago which Alameda Hospital took it. One of our kids was born at Alameda Hospital and one at Kaiser Oakland.

    So in the interest of empirical evidence, I just went upstairs and asked my wife which of the two places she preferred. Alameda Hospital was the immediate answer. Why I queried. Because I had my own doctor there and I had never seen the one at Kaiser, was the answer.

    Well, that doesn’t answer the question about ‘optimum’ care. However, stroke care and childbirth care are slightly different and I think Kaiser probably has better stroke care than Alameda.

    Comment by Jack Richard — August 5, 2011 @ 12:28 pm

  15. 13: Vigi,

    The emotional extremism of your attack/ response is precisely what I was referring to in my original comment. Your emotional excess and personal attack do not contribute to a reasoned discussion of the issues Lauren raised.

    I used the term hysteria as defined here by Merriam-Webster and stand by it:

    hysteria – behavior exhibiting overwhelming or unmanageable fear or emotional excess

    Comment by Jon Spangler — August 5, 2011 @ 1:15 pm

  16. So, in the Journal today some guy who was suckered into voting for Hospital parcel tax was turned away from the joint because they don’t take Medical.

    Comment by Jack Richard — August 5, 2011 @ 1:37 pm

  17. Hysteria – Definition and More from the Free Merriam-Webster …
    http://www.merriam-webster.com/dictionary/hysteria – CachedSimilar
    Origin of HYSTERIA. New Latin, from English hysteric, adjective, from Latin hystericus, from Greek hysterikos, from hystera womb; from the Greek notion that …

    Comment by Jack Richard — August 5, 2011 @ 1:39 pm

  18. Mr. Spangler: thank you. You just confirmed my point #3 above: ” 3. would rather Shoot Peer Messengers who think critically (authentically so) than have a challenging, effective conversation because that conversation wouldn’t sound or feel nice”.

    Comment by Denise Lai — August 5, 2011 @ 1:42 pm

  19. Dr. Lai, Where did you go to medical school, complete you internship, residency, and in what specialty? I’ve seen many stroke victims who did not require a cardiac cath. What other capital equipment needs are required to maintain a PSC? What capital equipment does Alameda Hospital need to purchase to be awarded a PSC?

    Does a student pharmacist have medical knowledge that trumps physicians on the hospital board? A business education that trumps 30 years experience in healthcare business as has the Board President?

    How many other California hospitals lack the funds to retrofit for earthquake safety as required by CA law? Has our state closed down any facilities for being “unsafe” as defined by the current structural performance categories? Will earthquakes become stronger between 2013 and 2030 that causes the safety requirements to increase by 2030?

    Comment by Nancy Hird — August 5, 2011 @ 7:05 pm

  20. Yes, earthquakes will become stronger in the years ahead. Earthquake activity goes in predictable cycles, based on the time it takes for stress to build on a fault. It was well publicized in 2008 that the Hayward Fault had hit the end of its 140 year cycle, following on the last major quake of ~7.0 in 1868 (and numerous lesser quakes thereafter for many years).

    That 1868 quake was known locally as The Great Quake, until the 1906 earthquake, which had, incidentally, a displacement of 20 (twenty) feet at its epicenter in Marin. That took the stress off the whole fault system, and earthquake activity lessened considerably. Now we’re reaching the beginning of another period of activity. I suggest you take a look at the info and interactive earthquake maps on the ABAG site, or read Marc Reisner’s excellent book, “A Dangerous Place”, which describes in detail what a major quake on the Hayward Fault would look like.

    I’m among the people who would like to see hospital care remain here in Alameda, precisely because we’re very likely to be marooned on the island following the inevitable big quake to come, and because my opinion of Alameda Hospital is generally favorable, having seen the kind and humane care given to my elderly mother and my late stepfather (who passed away at 99). But with all that, I don’t doubt for a minute that it would be very difficult to effectively retrofit the hospital or any building in that location.

    The older brick building is hopeless, and I feel sorry for the people who work there, literally. The newer building must be better constructed, but they’re sitting on fill, obviously. I found a great study on the earthquake in Kobe, Japan, a place with a very similar geology to ours, and iwth many structures on fill. The ground level dropped literally 3 feet down from the foundation of buildings. I think that’s what they mean by “ground failure”.

    As a matter of common sense, I don’t see how a building could be retrofitted to withstand that. Let them take all that money from the AHD parcel tax and build a smaller facility somewhere else on the island, on solid ground and farther above sea level.

    Comment by dlm — August 5, 2011 @ 10:04 pm

  21. What’s with the vendetta against Dr Deutsch? Whatever did he do to make Ms Lai froth at the mouth? One would think he was the only person responsible for Alameda Hospital.

    It’s true that many hospitals in the area need retrofitting and can’t afford it. As I recall Alameda is actually better off than some, but I haven’t checked lately. While It’s true that plate movement, among other things, can cause pressure to build here and there along a fault line, and eventually the pressure will release, it’s a bit simplistic to suggest that earthquakes are cyclicly, uniformly getting stronger. The cycles are not regular, nor are any two earthquakes the same. Also, while land fill isn’t bedrock, properly compacted, engineered and aged land fill can stand up under quite a lot of pressure. There really are very few cases of liquefaction compared to the amount of fill put in since the early 1880’s in the Bay Area.

    While prudence suggests retrofitting or another alternative is a good idea, remember AH, unlike several of the big East Bay hospitals, is not sitting directly on a fault line and it is on old land. Historically, the city has had little damage due to earthquakes. There is no reason to assume this trend will change. But, prudence and State law are quite clear about our being cut off from Oakland. If there is an earthquake, at the least the tunnel and bridges will be closed until the State inspects and clears them. It is likely that all the other bridges and tunnels will be in the same fix, so I don’t think ours will be first on the list. I don’t think relying on volunteer small craft owners to ship very ill people to hospitals in Oakland makes much sense if we can provide for ourselves.

    I’d be interested in a discussion about what we can have and do to provide at least the equivalent of a field base hospital; why it is so expensive to get and keep this stroke certification if we already do strokes; if the buildings can’t be saved, why not trade property for, say, the old Del Monte and put all the health care in one spot? Can we do some positive thinking for awhile?

    Comment by Li_ — August 6, 2011 @ 12:54 am

  22. Jack R.: missed your #16 earlier, the letter seems strange because according to the Hospital’s website they take Medi-Cal and the financials in for the Hospital Board meeting (page 13ish) show that the hospital has been reimbursed by Medi-Cal for services rendered.

    Comment by Lauren Do — August 6, 2011 @ 7:54 am

  23. Yes, it does seem strange. I’m not familiar with medi-cal or medicare (don’t have either) but maybe there are restrictions on the type of maladies they cover at the AH.

    Ran across this while I was trying to research on the above (unsuccessfully).
    What Patients Say (About Alameda Hospital)

    Were you satisfied with your stay? Here’s what a sample of recent patients told this hospital when asked a series of questions. Almost 4,000 other hospitals now use the same survey, created by the federal government. Responses are posted on Best Hospitals and on the federal Hospital Compare page.

    Average
    How patients rated the hospital overall:
    Highest or very high
    49%
    State Average
    64%
    National Average
    67%

    Comment by Jack Richard — August 6, 2011 @ 9:27 am

  24. 21, 20. As far as I’m aware DLM is completely correct about the local seismic cycle and the fact that Hayward is due to bust and it will exceed 1906 quake in magnitude. The problem with 1880s quake is that there was so little development then that we have little to compare. A local contractor told me there were stories of liquifaction of muddy native shoreline. I’m sure Alta Bates will shake harder due to proximity to Hayward, but I hardly consider AH at a safer distance. The epicenter for Loma Prieta was far south of here but it knocked down the Cypress Structure. I know Kobe is very comparable and that Japan has generally built to heavier standards than even the Bay Area, but I’d like to know specifics of 3 foot soil recession, which on existing buildings in Alameda makes no sense. Buildings would be more likely to drop with the soil. As for prevention, Lum school was retrofitted with moment frames which sit on 75 foot deep concrete pilings which will at least survive the event even if the building isn’t immediately serviceable.

    DLM, I am perhaps one of few who shares your level of concern for seismic events and sea level rise. I wonder if you feel safe leaving your home or going to places like Park Street or how you rationalize remaining in such a dangerous environment. I’m personally trading mathematical risk of quake killing me for the weather. Now that kids are done with K-12 the sea level thing is wait and see. In this economy the problem is cashing out on property and having an alternative place to go.

    As for AH, a disaster is the one reason to fight to have our own hospital, but post quake I don’t expect the doors to stay open. Maybe some board members can offer a convincing scenario to the contrary?

    Comment by M.I. — August 6, 2011 @ 11:39 am

  25. #21 (Li)Here’s where you self-certified experts get into trouble: “Historically, the city has had little damage due to earthquakes” YOU have no gosh-darn idea! The back end of my 1902 Gold Coast home fell off in the 1989 Loma Prieta quake. Cost $100K to fix. So many chimneys toppled or were rendered unsafe on older homes, the owner found it cheaper to sell as-is than to fix ‘em (@$25K apiece). Li, your opinion, while you’re entitled to it, doesn’t contain any facts. So far, no one has taken me up on actually reading the State’s own docs on the seismic safety assessment of AH-except Nancy Hird, who evidently neither believes nor understands them. There aren’t higher future seismic standards, just more time to comply w/existing ones.

    “What’s with the vendetta against Dr Deutsch?” He does profit from a hospital-based practice. Since there are quite a few MDs living in Alameda, I for one find it strange that he’s the only one who has run for a Bd seat in recent memory. Which makes him a shoo-in for the voters not otherwise paying attention.

    Oh, & Denise Lai was correct about the Water Emergency Taxi Service having an arrangement w/the City of Alameda. U can read about it here: http://www.watertransit.org/aboutUs/aboutUs.aspx

    Thanks for the kind help, Mr. Richard. You are a true Renaissance man.

    Comment by vigi — August 6, 2011 @ 2:50 pm

  26. #25 – Dr. Jeptha Boone (prior to Dr. Deutsch), Dr. Stewart Chen (current board member)

    Comment by david burton — August 6, 2011 @ 4:40 pm

  27. Predicting earthquakes is not hard in the Bay Area. I predict we’ll have a few. Predicting when an 8+ will occur is a little more difficult. Predicting how it will affect Alameda is exceedingly dificult Preparing existing structures for an 8+ is a lot more difficult and a waste of money…unless you can float ‘em on the estuary.

    I don’t recall if the hospital parcel tax was promoted as a cure for earthquakes. I believe it was passed because of the subliminal fear Alamedans have leaving the Island. Any idea of the hospital as a savior during a catastrophic event is a hollow hope, it will most likely be unusable. Better to have a few medi-vac helicopters around (then the patients at least wouldn’t have to traverse Oakland’s streets).

    There have been fewer than 50 deaths by earthquakes in the US in the last 25 years. The big problem will be rebuilding structures, not humans.

    http://epirev.oxfordjournals.org/content/27/1/47.full.pdf+html

    Comment by Jack Richard — August 6, 2011 @ 5:14 pm

  28. 21, 1989 — compare damage in Alameda to damage in surrounding area, not so much here as there was there, and generally, not so extensive. If we take your house as definitive, then Alameda had extensive damage, if we take my house as definitive, then Alameda had no damage at all. Not helpful either way.

    Comment by Li_ — August 6, 2011 @ 6:56 pm

  29. 24: MI — as for staying here, it’s a long story. In some respects I’m also looking at the odds of being flat out killed (flattened), which aren’t that great. The odds for the city’s well-being tho aren’t good. I’m very aware of all the brick buildings on Park and Webster, which are in the majority in both commercial districts, many of which could collapse in a major quake (not to mention all the brick foundations). I really wish that the city had pursued some means of pumping sea water to fight fire — that’s something that Alameda really needs.

    The ground failure in Kobe does need more explaining — the areas of fill had a relatively stable strata not too far beneath the ground’s surface, that provided support for buildings build on piers. So it was possible for foundations to remain in place, even tho the ground dropped away beneath them. The lateral spreading of the fill did a huge amount of damage tho — it knocked everything sideways along the water front by several feet. A port similar to Oakland’s was largely destroyed. (And of course, around here it’s mud all the way down under the bay, for well over a hundred feet, with nothing solid to build on.)

    Comment by dlm — August 6, 2011 @ 8:26 pm

  30. 21: Li — here’s the explanation:

    http://en.wikipedia.org/wiki/Hayward_Fault_Zone

    “The last truly major earthquake in the region was the 1906 San Francisco Earthquake which occurred on the San Andreas fault. Many seismologists believe that the 1906 earthquake reduced the stress on many faults in the Bay Area including the Hayward fault, __creating an “earthquake shadow”: a quiescent period following a major earthquake.___ Since the 1906 San Andreas event there have been no moderately strong earthquakes on the Hayward fault as were seen before that earthquake. It also appears likely that this quiet period in the earthquake shadow is ending, as projected by the rate of plate motion and the stress state of other faults in the region.”

    So the stress on the fault zone was released in 1906 and consequently there were no major quakes for some time. Now the stress is building up again, and eventually it will lead to another — major — quake. This doesn’t mean stronger than ever, it means stronger than what has occurred in more recent times, over the past century. It just happens that the population growth of this area took place in the absence of the major earthquakes, not that they’ve somehow stopped. They run in cycles — geologists dig trenches in the fault traces to determine when earlier quakes occurred, and they follow a predictable pattern.

    The older part of AH is built on shore of the historic island — that little rise on Willow St alongside the older building is the original embankment, not to mention that the original seawall is visible on the lagoons. The newer part tho is obviously on fill, with water on both sides, and that’s not going to be stable. Also remember that underground utilities built in fill are not going to fare well — it’s not clear to me how anybody would plan to deal with that, via retrofitting or anything else. A hospital without utilities doesn’t do much good.

    Comment by dlm — August 6, 2011 @ 8:31 pm

  31. 30, dlm, I was attempting to expand a little on what you said in 20, not contest it. I was concerned that someone would think that seismology had suddenly become an exact science, earthquakes regular as time and land fill the same everywhere. My command of the language is apparently lacking.

    I haven’t found a good site for the history of the 3 to 8 (?) buildings following the original 1925 structure. Do you have same, hopefully including a map? I was under the impression that there were gardens behind the hospital that are now the upper parking area, the now main entrance area was not on fill and that the fill was part of the lower parking area. Frankly, I haven’t paid much attention to the pieces of the hospital since it seemed to have a pretty good following. Now I’m curious. Admittedly, this is off topic, but perhaps germaine, in that it is foundation information.

    Comment by Li_ — August 7, 2011 @ 1:00 am

  32. 25 vigi,
    Reniassance…hardly, but I am more than middle age. Thanks anyway…

    Comment by Jack Richard — August 7, 2011 @ 7:13 am

  33. 31: Thanks for the explanation.

    I haven’t followed the hospital issue too closely either — it seems to have a pretty good constituency already. I’ve seen references to 3 buildings on the site, in my limited experience. To locate the fill tho, I think it’s sufficient to look at an early map of Alameda, such as the 1888 bird’s eye view, and see what was there originally. You could also look at the original seawalls, and get a sense of where they would have crossed the hospital property.

    Comment by dlm — August 7, 2011 @ 1:43 pm

  34. Okay, here’s an old map (1875), on a site that has a good selection of Alameda maps. This particular map doesn’t have all the streets on it, but the original coastline is clearly delineated. That strip beside Clinton where the old hospital now sits was quite narrow.

    http://www.alamedainfo.com/alameda_ca_map_1875.htm

    See the (very similar) maps on the left — click to expand.

    Comment by dlm — August 7, 2011 @ 2:13 pm

  35. Here’s another good map:

    http://www.alamedainfo.com/alameda_map_1908.htm

    Comment by dlm — August 7, 2011 @ 2:24 pm

  36. Burton=Not all Drs are MDs. Dr Stewart Chen is a chiropractor. While Dr. Boone is an MD, his license has been cancelled (retired from active practice when he served on the Board). Dr. Deutsch is in active practice NOW.
    28(Li)You may be limited to your own home. I speak for the Gold Coast & my experience on the Planning Board.

    There’s an interesting article in JAMA, 7/20/2011-Vol. 306, No. 3:Assessing Liability for Health Care Entities That Insufficiently Prepare for Catastrophic Emergencies (Hodge, Jr., & Brown; both JDs)=In Preston v Tenet Healthsystem Memorial Medical Center, Tenet recently settled on eve of trial. The class of plaintiffs (45 deaths) in New Orleans alleged that, during Hurricane Katrina, Tenet’s failure to prepare for a FORSEEABLE emergency caused their harms! The settlement for an unknown (but probably large enough to bankrupt Alameda) amount “implicates the increasing potential for health care entities to incur liability in future emergencies.” If you don’t get it, in previous times a hurricane was viewed as an Act of God. No more. Here, an earthquake is a forseeable emergency. People lying in bed in Alameda Hosp would likely be greatly harmed by one. Since the Health Care District is taxpayer-supported, wouldn’t the parcel taxpayers of Alameda be the defendants in a similar lawsuit?
    Think about it.

    Comment by vigi — August 7, 2011 @ 4:54 pm

  37. 36 vigi

    As I understand it, the case you cite was filed because the Tenet Healthcare System hospital in New Orleans had an insufficient emergency preparedness response plan. The Katrina flooding emergency was found to be foreseeable and the hospital knew it was vulnerable to flooding, plus the hospital was fully aware that the backup power switches and pumps were underground and susceptible to power outages. The main and backup pumps failed resulting in forty-five patient deaths.

    That the Alameda Hospital is vulnerable to earthquakes cannot be denied. The logical answer to the liability question is to close the Hospital or immediately rebuild it to meet new earthquake standards. Since the State will not require the Hospital to meet higher standards until sometime in the future, the question is, what and who has the liability responsibility between now and the time when the standards must be implemented.

    Comment by Jack Richard — August 7, 2011 @ 5:35 pm


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