Is Alameda at Risk of Losing its Hospital’s Emergency Room?

Health system officials aren’t talking publicly, but Alameda Hospital advocates say that signs suggest they may want to narrow the hospital’s mission.


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Photo by Paul Haggard

Last May, an Alameda Health System executive told city officials that the county’s health care provider values Alameda Hospital but questions its status as an acute-care hospital. Alameda’s demographics do not suggest that a full-service hospital is particularly necessary, Chief Operating Officer Luis Fonseca reportedly told members of the Alameda City Council and Alameda Health Care District Board of Trustees attending a hospital liaison meeting. Perhaps the hospital would best serve county residents as an ambulatory surgery center or urgent care clinic Fonseca mused, according to two people who attended the meeting.

The comments raised alarms for several people attending the meeting. Is Alameda at risk of losing its emergency room?

Alameda County Supervisor Wilma Chan is well aware of how the potential loss of a community hospital can galvanize residents of a city. She is often credited with saving nearby San Leandro Hospital from closure almost a decade ago under similar circumstances. The common denominator between each situation was a push by the Alameda Health System, then called Alameda County Medical Center, to close a full-service, seismically insufficient hospital and replace it with a facility lacking the emergency room services valued by residents. Given that Alameda is an island linked to the mainland by four bridges and a tunnel, such emergency room services could represent the difference between life and death in the case of an emergency such as an earthquake.

What’s clear is that if the Alameda Health System does not begin state-mandated seismic retrofitting at Alameda Hospital by April 1, 2020, the facility will lose its license as an acute care hospital with emergency room services. Despite calls for updates from the Alameda Health System regarding progress toward seismic upgrades to the hospital required by state law, city officials have come away unsatisfied with the system’s responses. The health system has had difficulty finding a contractor for the hospital’s $20 million partial retrofitting, and one contractor has already passed on the project. A second phase of seismic upgrades are also needed at Alameda Hospital, but those have a deadline of 2030.

Alameda Health System officials did not respond to requests for comments about the hospital’s status. Instead, they referenced a guest editorial published last June in the East Bay Times that described the health system’s finances as in dire need of additional funding.

Further complicating the finances in Alameda’s case is that city officials say the health system is contractually obliged to facilitate the 2020 retrofitting on its own. In 2014, when the hospital was absorbed by the health system, the city’s health care district pledged to turn over its annual proceeds from a $298 parcel tax to pay for earthquake retrofitting. The taxes were approved by Alameda voters in 2002 and revenues exceed $6 million a year.

Councilmember Jim Oddie said that if the health system does not move forward with plans to seismically upgrade the hospital by April 2020, “they are breaching the contract.” To Oddie, the hospital operator’s intransigence with just eight months to go before work is legally required to begin appears suspicious. “There’s some sense that they’re slow-walking this,” he said. “It looks a little sneaky.”

And Alameda officials have other reasons to be skeptical. In May, the Alameda Health System Board of Trustees, an eight-member body appointed by the board of supervisors, raised the possibility of deferring new capital improvement projects for its hospitals. The resolution laid out its budget priorities in advance of the next fiscal-year budget process. “Projects that do not support the critical clinical needs of the system will be deferred or cancelled,” according to the May 16 resolution.

The resolution also raised other hot-button issues such as the possibility of “wage freezes” and worker furloughs. Yet, the item was placed on the consent agenda, a move that could have resulted in the item avoiding a public discussion. It was later pulled from consent and debated. But concerns persisted about the system’s intentions.

Alameda Health Care District Trustee Tracy Jensen then began reaching out to Alameda councilmembers, who then in turn met with Assemblymember Rob Bonta and Alameda County Supervisor Wilma Chan. During a July 2 Alameda City Council meeting, at which councilmembers voted to join the California Nurses Association in amplifying pressure on the health system to resolve the matter at Alameda Hospital, Oddie was uncommonly blunt about Chan’s view of the growing ordeal with the facility. “She’s super pissed about this,” Oddie said.

In an interview, Chan said she is upset not only about the potential risk to the hospital, but also many instances of obfuscation by the operator. The Alameda Health System — which also operates Highland Hospital in Oakland, San Leandro Hospital, and several other East Bay facilities — has attracted the ire of Alameda County supervisors over the years for failing to keep down its costs and pay down its debts to the county in a timely manner. The Alameda Health System is a public hospital authority that receives much of its funding from Alameda County.

“Most public hospitals needs more money,” Chan said. “But the board of supervisors’ position is we want to make sure you did everything to capture all your revenues and cut waste. … They have not presented us with a budget so we can look at the numbers. There’s a certain amount of poor communication for where they’re finances are at.”

The board of supervisors recently gave the health system a two-month extension to provide it with a budget, which is expected in August. Chan said she was told by system officials that the seismic upgrades will be funded, although they raised the possibility of potential construction delays. “I’m feeling at this point, it will be funded, but I think that the community needs to press them about the contractor,” Chan said.

She should know. Although it took several, messy years, San Leandro Hospital and its 24-hour emergency room remain intact — although the cost of saving it may have contributed to the current financial challenges that the health system faces.

The civic outcry that helped Chan save San Leandro Hospital was unprecedented in the recent history of the city, whose electorate is far less politically active than that of Alameda. At least one public meeting attracted nearly 500 residents to the city’s main library. At the time, critics of the county’s plan for San Leandro said the loss of the hospital would put lives at risk. Now, Alameda officials are already voicing the exact same fears.

“If that emergency room is not there,” said Alameda Mayor Marilyn Ezzy Ashcraft, “there are 20,000 emergency patients who don’t just go away or stop having emergencies; they’re going to be burdens on other already-crowded emergency rooms.”

Almost two decades before Ashcraft became mayor, she was the leader of the parcel ballot measure that helped fortify, for the time being, Alameda Hospital’s flagging revenues. In addition, she said, the extra travel time required to transport, say, a heart-attack patient to another hospital in Oakland, San Leandro, or Castro Valley, could mean the difference between life and death. Of course, that’s if Alameda’s bridges and tunnel are in working order.

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