Will the Other Shoe Drop at ACMC?

Following on the heels of the devastating closures of Central Health Center and Fairmont Ambulatory Care Clinics on June 27^th and 30^th respectively, ACMC's Board of Trustees deliberated on additional deep program cuts and access restrictions for Fiscal Year 03-04.

At the ACMC Finance Committee meeting of June 23^rd, CEO Ken Cohen explained that on top of the $12 million in cuts already implemented, an additional $45.7 million in reductions is needed. He said that the level of cuts required would "transform ACMC into a hospital-based, acute care facility with only minimal primary care and preventive outpatient services remaining."

Mr. Cohen outlined two tiers of reductions:
• $11.5 million in operational changes
• $34.2 million in program reductions and service closures

The Finance Committee and then the Board adopted the FY 03-04 budget but deferred action on the program and service reductions. The list which Mr. Cohen had floated as being required to meet the reduction level required included:
• Elimination of Women's Urgent Care, dental, and optometric services
• Closure of Newark, Winton, and Eastmont, the remaining freestanding health centers
• Closure of outpatient pharmacy
• Closure of the Fairmont Skilled Nursing Facility
• Defer the opening of the new building at Highland
• Elimination of trauma services

These draconian cuts are on hold until the accounting firm Price Waterhouse Coopers issues a report verifying the extent of ACMC's deficit. The Board of Trustees and Board of Supervisors met on June 25th in closed session and reported afterwards that both boards are committed to keeping the clinics and the trauma center "viable and available." Some funding options being considered include having the County finance some equipment purchases for the new Critical Care Building, which would otherwise require cash payments from ACMC; carrying over the current deficit over a multi-year period; or passing a March 2004 ballot measure committing significant funding for ACMC. Vote Health believes that, short of passage of SB921, only a ballot measure will stabilize the Medical Center's financial situation.

While we take heart in the postponement of a decision on the program closures, Vote Health is very worried about some of the items contained in the $11.5 million internal operational changes list. Some are necessary internal efficiencies such as improving eligibility and billing, or a percentage reduction in outside contracts/supplies. Others are severe policy changes which will have a devastating impact on patient access. The two most ominous are proposed policy patients' co-pays to the $20-$40 range; and
• deny non-emergency services to uninsured patients who are not CMSP.

These policy changes will affect working poor patients in this County as much as service closures since they will result in loss of access to desperately needed services. These policy changes are to be taken up at the BOT's July meeting (July 28 at Highland Hospital Auditorium-please come if you can). Vote Health is asking the BOT to remove these patient-impact items from the list of internal efficiencies and instead consider them in the same way as service reductions and closures.

Single Payer Update

Here are excerpts from a letter to supporters of SB921 from Senator Sheila Kuehl:

"I want to praise you and thank you so much for your incredible work on behalf of SB 921. Our success in moving through the Senate was due, in no small part, to your steadfast advocacy and passion. We have surpassed the expectations of many. We have 19 committed co-authors and 8 pages of organizations that support the bill. We have moved closer to Universal Health Care than ever before in California. SB 921 and your activism are inspiring a political movement which, I have no doubt, will achieve universal health coverage. I am fully committed to the bill's passage.

"I have made a strategic decision that I believe will improve the possibility of getting a 2/3 vote in favor of SB 921 on the Assembly floor. And I have recommendations about how we can all best spend our time on behalf of SB 921in the coming months.

"I have requested that SB 921 not be heard in Assembly Health Committee on July 8 or at any time during the current legislative sessionŠfor a number of reasons.

"...The time between now and [next legislative session] January must be used to build support for SB 921. It is critical that we return in January with even more support than we have now and that legislators are aware of that support. So, I am asking advocates to continue lobbying members of the Assembly; the interim presents an excellent opportunity for constituents to reach legislators who are in their districts for the break."

Vote Health's Single Payer Committee will be working on these next steps: Urging organizations that have endorsed SB 921 to actively work to pass the bill; expanding our outreach to obtain more letters of support, such as from union locals; and raising money for the Health Care for All Californians Campaign. Join us in this important work (box).

Join us at the June 23rd
Vote Health General Meeting, 7 - 9 pm, 2000 Franklin St., 2nd floor, in Downtown Oakland, one block from BART's
19th St. Station.
Marla James, SEIU 616
Political Intern, will speak on:

Already convinced? Budget Accountability Act Community Outreach Days-
Help Gather Voter Petitions

When: Every Saturday starting July 12 through August 16
Where: SEIU Local 790, 100 Oak Street, Embarcadero in Oakland
Time: 9:30 am Coffee/Training

Trauma Center versus Emergency Room: What's the Difference?

In the recent lists of proposed cuts for the Alameda County Medical Center, the most unthinkable on the list, and most likely the last service to go before the entire institution bleeds to death, is the nationally recognized Trauma Center, based at Highland Hospital. It is part of the county's Emergency Medical Services system and plan, and its existence would be more stable if the EMS parcel tax rate were raised through a ballot initiative, which Vote Health has been advocating. This is a brief overview of how and why the Trauma Center is important to all people who live, work, or travel through Alameda County.

By the early 1980s, local governments understood the necessity for coordinated planning of services to assure optimum preparation, response, and definitive care for severely injured individuals (motor vehicle accidents, gun shot and stab wounds, burn victims) as well as public health crises affecting many people at once, such as earthquakes, fire, and now, terrorism. During the Oakland Hills fires and the Loma Prieta Earthquake, Highland Hospital was the staging area for those with life-threatening conditions.

Some of the reasons for establishing designated centers that can provide expert, definitive, immediate treatment are: Studies have found 20-40% higher mortality rates in areas without an organized system of trauma care; highly specialized professionals such as neurosurgeons are key, but coverage is compromised when spread between all local hospitals; planning, implementing and overseeing protocols for trauma response are complicated, costly, and not necessary or effective for all hospitals to do; private hospitals sometimes delay care while figuring out whether a patient can pay or not.

As the plan evolved, Highland, Eden and Children's Hospitals became the "Designated Level II Emergency/Trauma Centers" for Alameda County, with Highland receiving approximately 46% of patients in this category. (Level I is reserved for a university-affiliated teaching hospital trauma center, for which Alameda County does not qualify.) The designation was given after establishing a detailed plan (133 pages long--see note below) which includes increasing skills by seeing a large number of qualifying patients per year by the staff; having a multidisciplinary medical team, all of whom have the rigorous Advanced Trauma Life Support (ATLS) certification; availability of several surgical specialists; an emergency department staffed with qualified specialists in emergency medicine who are immediately available, provisions for aircraft rescue and landing, etc.

Emergency medical personnel in the field use three criteria to identify whether the critically injured patient is appropriate for trauma center referral: Anatomical, physiological and mechanism of injury. An average of 65,000 patients are served by the Highland Emergency Department annually, while the Trauma Center sees 2,000 patients a year out of approximately 4,000 county-wide. The county, a full partner in devising the EMS plan, contributed $7,133,554 in subsidies to the three trauma centers in 2000.

ACMC's new Trauma Center and Emergency Department, in the Critical Care Building on the Highland Campus in Oakland, will be the Bay Area's newest and largest such facility. It has 27,500 square feet and state-of-the-art resuscitation and monitoring equipment. Tragically, the opening of the building could be indefinitely postponed as a result of the ACMC and county's deficits, making the need for the EMS parcel tax increase even greater.

Data taken from "Alameda County EMS Agency Trauma System Plan 2001.

Central and Fairmont Clinics Celebrated and Mourned

Vote Health activists joined with SEIU and health care workers to mark the closures of the Central and Fairmont Clinics in their final days. Wearing mourning black on June 27, we hosted a press conference highlighting patients and providers at Central Health Clinic, addressing the assembled media in several languages. Channel 5 presented footage the event that night, and KPFA and the Oakland Tribune ran stories the next day. A copy of the "memorial program" that was distributed is included in this mailing.

On June 30, SEIU sponsored a lively funeral march and rally at Highland Hospital, featuring a Dixieland band playing New Orleans-style funeral music and dozens of cardboard coffins representing the loss of services to the community. After hearing support statements from Vote Health and others, the rally proceeded to organize participants for the upcoming Budget Accountability Act petition campaign and the long-term effort to get a measure on the March ballot that would stabilize funding for ACMC. We then marched into the Board of Trustees meeting and made it clear that these cuts and those projected to defray the 2003-2004 deficit were totally unacceptable.

A Town Hall Meeting Hosted by Alameda County Supervisor Alice Lai-Bitker:

Speakers:
Senator Sheila Kuehl, Author of SB921 (confirmed)
Senator John Burton (or a representative from his office), Author of SB2
Contact Jean Fong at 272-6743 for more information

Driving directions: 880 S, take the I-238 exit toward I-580/ STOCKTON/ FRESNO, take the ramp toward WASHINGTON AVENUE, Turn LEFT onto BEATRICE ST., Turn SLIGHT RIGHT onto WASHINGTON AVE, Turn SLIGHT RIGHT onto LEWELLING BLVD, Turn RIGHT onto WICKS.

We appreciate Supervisor Lai-Bitker for dedicating staff time to organizing this important forum, from which people can learn more about how these two bills would affect access to health care in California. We believe it will be obvious why SB921 is a far more comprehensive and affordable solution to the tragedy of lack of access to health care and the financial ruin obtaining care often represents. For a country that leads the world in wealth, we fall very short in providing basic human needs.

Newsletter committee:
Nancy M. Friedman , Kay Eisenhower
Our thanks to CA Nurses Association for their help in producing this newsletter.