Request

Vote Health believes it is the duty of the county to continue providing care for the patients on the Neuro-Respiratory Unit, who are among the most vulnerable in the system. We strongly oppose the announced intention of the Medical Center to close this essential service to our community.

We ask the Board of Supervisors to pass a resolution committing the County to spending up to $2.5 million for FY 2001-2002 to keep the Neuro-Respiratory Unit open, making up for any funding shortfalls not covered by the State.

Background

Alameda County Medical Center has operated the 20-bed Neuro- Respiratory Unit on the Fairmont Campus for many decades. Patients admitted to the Neuro-Respiratory Unit must be ventilator dependent, (require mechanical assistance to breathe) as the result of a trauma or illness following an acute hospitalization. According to the ACMC Website, criteria for admission include:

• Patients requiring mechanical ventilator support twelve or more hours per day;
  


• Patients who have permanent tracheotomy tubes in place;
  


• Long-stay medically fragile patients whose medical needs are such that they cannot be placed in acute or sub-acute facilities.

Clearly the medically fragile patients on the Neuro-Respiratory Unit are the epitome of the "special populations" for which the County is responsible. Several years ago the State informed ACMC it would no longer reimburse care on this unit at acute rates. At the newly reduced level of reimbursement, ACMC anticipates losing more than $3 million a year to continue providing this service.

In recent months, ACMC looked for other facilities to which these patients could be transferred. It appeared for awhile that another facility in the community was prepared to receive them (St. Luke's) . However, community activists and family members of the Neuro-Respiratory patients have expressed grave concerns over the impact of the move, such as the reduced level of ongoing care available in other facilities. The families of the 16 Neuro-Respiratory patients at Fairmont also feared possible long distances to visit their relatives at new facilities.

When the owner/CEO of St. Luke's came under indictment in legal cases alleging fraud, this alternative placement became unsuitable. As reported at the May 2001 Board of Trustees meeting, the only other two facilities in the area that were willing or able to accept patients with these extensive care needs remain full and do not have capacity to accept the transfers.

Now the Medical Center is being left with the financial burden of maintaining this service, at a potential budgetary loss for FY 2001-2002 of $2 - $3 million. We strongly support any efforts made by ACMC or the County to obtain adequate State reimbursement for care of the Neuro-Respiratory patients. Since the State cannot place these patients in another facility, it should be willing to reimburse ACMC at a higher level for their care.

However, this is a clear case where the County and not ACMC is the provider of last resort. The patients cared for in the Neuro-Respiratory Unit are medically fragile patients who will die without receiving adequate nursing care. We have heard the view expressed that the County is not interested in spending its own money on this program which cares for so few patients. This is a very troubling "slippery slope" into health care rationing which Alameda County specifically rejected over a decade ago. Unless Alameda County is willing to declare certain lives as expendable it has an obligation to continue providing the medical treatment these patients require to stay alive.

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