Location, seismic upgrades named as reasons for the change
On Wednesday, June 12, Alameda and San Leandro nurses gathered in front of Alameda Hospital to protest the facility’s decision to get rid of the operating room. All decked out in red, they chanted “The nurses, united, will never be divided,” carrying signs that proclaimed “Some Cuts Don’t Heal” and “Nurses Care.”
Linda Strack, a circulating nurse at Alameda Hospital, told the Alameda Post that about two months ago the nurses received a memo that stated: “We’re giving you official notice that in 90 days, as of July 1, we are closing all surgical services, elective, and emergency cases.”
According to Strack, just three years ago there were talks to expand surgery at Alameda Hospital. “They started a surgical training program,” she said. “I believe we were 12 nurses across the system that were invited. These 12 nurses were going to be deployed across the health system because there was a need.”
In a statement to the Post, Alameda Health System (AHS) explained the decision to remove surgical services from Alameda Hospital:
“Alameda Health System (AHS) is relocating elective surgeries from Alameda Hospital to other AHS hospitals. Today, 95% of the surgery patients who are treated at Alameda Hospital are not city of Alameda residents. AHS is relocating those surgeries closer to the patients who are traveling to Alameda from the mainland for care.”
Another reason for the relocation is the need for seismic updates.
“The relocation of elective surgeries is not only in the best interest of patient safety and quality care, it is also one component of a larger plan to support the City of Alameda Health Care District’s seismic upgrade of Alameda Hospital.”
In response to the Northridge earthquake, California lawmakers passed a law that requires hospitals to seismically upgrade their existing buildings or replace them to ensure safety by 2030. Buildings that don’t meet the new earthquake standards must cease operations.
AB 2904, sponsored by Assemblymember Mia Bonta in 2022, would have extended the January 1, 2030 seismic safety requirement for Alameda Hospital until January 1, 2032. However, the legislation was vetoed by Governor Gavin Newsom, who stated that any consideration of an extension must be contemplated across all communities and across all types of facilities in a holistic manner, not just the Alameda Hospital.
The City of Alameda Health Care District owns Alameda Hospital’s buildings and is responsible for its structures, including the seismic update needed to continue operating. AHS is accountable for the delivery of quality health care services at Alameda Hospital.
“To support the District in meeting seismic upgrade requirements while ensuring that critical health care services continue to be available at Alameda Hospital, on January 10, 2024 the AHS Board of Trustees (BOT) agreed to divert the majority of the $6 million Alameda parcel tax dollars AHS received annually to the District,” AHS told the Post in another statement. “The District will utilize the funds to acquire a loan for the construction costs required to complete the seismic upgrade.”
According to AHS, its leaders and physicians are focusing on three areas to offset the financial loss of the parcel tax funds: improving efficiencies, expanding post-acute services and access for Medicare recipients, and relocating elective surgeries to other AHS facilities. In addition to the parcel tax, AHS is investing $42 million in infrastructure projects that support hospital operations.
Strack and the nurses at the protest on Monday are concerned for their patients. “Now people who need surgery will need to be transferred to San Leandro or Highland, which already have long wait times,” she said. “It’s not like ambulances are lined up like a taxi stand. Ambulances are already slotted for those high acuity transfers. Those are what those ambulances are needed for. You shouldn’t have to transfer someone out for something like an appendectomy because then you’re taking that ambulance away from someone else in a more critical condition. It’s a lose-lose situation. Plus, the surgery suite you arrive at, now you’ve bumped someone else who was gonna have surgery in that room.”
Strack is particularly worried about patients who require emergency surgery. “If we have someone with a bleed up in the critical care unit, we take our stuff into the elevator, go up, and do the procedure at the bedside,” she said. “People lose units of blood in an hour. The family is standing there watching the container fill. The family is horrified. Is the nurse gonna have to go tell that family, you need to wait for a transfer? Now they can say, the team is in the elevator, they’re coming up right now.”
David Sayen, President of the Board of Trustees of Alameda Health System, says “the number of emergency surgeries is quite small.” He told the Post surgery volume is 1,622 (four per day) with 271 (less than one per day) of those cases originating from the emergency department.
“The issue is this: Let’s say you have a patient there that now requires surgery right away, you can’t have a whole team of surgical people sitting around and be prepared for every type of surgery and maintain all the equipment for every type of possible surgery,” Sayen said. “If you have all the equipment, you’re ready to go, then what you do is call in the team to do the surgery. Now you need to bring in nurses, you need to bring in the right kind of physician, you need to bring in the other technicians, the different types of equipment required. It may be easier and faster for the patient to move to a place where all those people are sitting—for example at Highland, where they have a trauma center 24/7 waiting for someone to have a car accident. So we have more capacity there and that’s a big part of why this makes sense for us.”
Sayen assures these decisions were brought before leadership of the hospital — ”professionals who have some sense of what to do.” He said, “We think the greater good is to find a way to keep the hospital here providing services and consolidating surgery. The board certainly wasn’t happy about not having surgery at Alameda Hospital. But at the end of the day, without this plan, at the end of 2029 we would have had to close the doors of Alameda Hospital, which would be devastating for Alameda and also devastating for the system, which would have lost $10 million.”
Lisa Powers, who has worked in outpatient surgery for 21 years, attended Monday’s protest, hoping to raise awareness for the people of Alameda. “I’m not aware of any effort to inform the public of the change,” she said. “We were only notified by email a short time ago.”
Strack added, “The idea that they think the taxpayers of Alameda County aren’t going to notice? We pay taxes in Alameda for this hospital. And now they’re gonna get rid of surgery without telling anyone? When everyone is away for the summer?”
Sayen said elective surgery is scheduled to be removed at the end of June, but the timing of the removal of emergency surgery depends on a waiver that must be approved by the state.
“The federal definition of a hospital for the purpose of the Medicare and Medicaid program does not include surgery,” he said. “A hospital for federal purposes is a place where people sleep and get services to improve their health and a place that typically has an emergency department, which of course we do. The issue with eliminating the service entirely is that California does require hospitals to have surgical services. So we’re pursuing that waiver from the state.”
If the waiver is not approved, Alameda Hospital would continue doing emergency surgery and AHS would have to find the $1.6 million that the plan would have saved them from other sources.
“Maybe most importantly, we don’t have to ask the people of Alameda to make any more contributions to the hospital and that’s our goal,” said Sayen.
Kelsey Goeres is a contributing writer for the Alameda Post. Contact her via [email protected]. Her writing is collected at AlamedaPost.com/Kelsey-Goeres.
