Guest column: State-of-the-art health care and the cancer center
October 3, 2014
I have never heard nor seen anything in this Hospital Board election that challenges the quality of care in any part of our health system — it's excellent, and has always been excellent. The only clinical issue is "affordability." The administrative issues of "accountability" and "transparency" are significant as they relate to affordability.
I have donated a considerable amount of time, effort, and support to the Tahoe Forest and the UC Davis Health Systems. I have no personal stake in our cancer center, although I was on the TFH Medical Staff and actively participated in the first stages of our cancer program's development.
I was, however, part of the UCD Cancer Program (actively practicing at the UCD Cancer Center) before coming to TFH. I was never salaried by our district but had an income guarantee to draw against if needed. I still have a professional stake in both health systems; and am a Clinical Professor of Surgery at UCD, with rural oriented research currently in progress. I'm qualified to speak.
I have repeatedly been to all the websites pertinent to the hospital and this election, and am actively involved in this campaign to give meaningful direction to the Hospital Board. There are valuable points to be made:
Campaign literature and postulates do not relate the actual contents of Measure C, which defines no administrative or spending specifics about cancer or any type of health care. The size of the bond issue and how the money is to be spent have been largely left to the board and administration to decide, and not submitted to voters for approval.
The highly touted and so-called "supermajority" is nothing more than the standard two-thirds majority routinely required to pass any bond measure. Again, the bond measure itself had little to say about the clinical uses of the money, and it didn't reflect any particular public desire or need for a cancer center, nor did it reflect the contrary. Cancer care is good. Cancer centers are good.
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The fact that local cancer patients go elsewhere for care because of cost means that our health system and cancer center really doesn't "see everyone" in our district. The health system sees only those who economically feel comfortable coming through the doors — and those doors are not only financially gated, but have aggressive financial gatekeepers.
The fact is, there are significant risks to supplying complete oncology services in a system that is not immediately prepared to deal with the acute life-threatening complications that may result. Our rural health system, excellent as it is, is simply unable to give the kind of comprehensive support that a fully functioning health system provides to a fully functioning cancer center. Anyone can give a dose of drugs, but it takes a prepared sophisticated system to deal with life-threatening complications that may result. This is why cancer centers are typically in large health systems.
The fact is, oncology services, as wonderful as they are, are not part of essential services for a public critical access hospital. Yet, the TFHS website lists six (6) oncologists in the Medical Specialty Clinic (at least 4 of whom are fully-salaried). Oncologists outnumber all other specialists in our health system. However, we have only 1 orthopedic surgeon and 2 general surgeons listed. There are no primary care specialists and no emergency specialists listed. Frankly, this is shocking when the treatment of physical trauma is of far greater clinical and economic importance to our rural critical access health system than is cancer care. Again, this does not belittle cancer care in general; it's simply a statement of fact.
By comparison, Aspen Valley Hospital (a private, 25-bed critical access hospital) with an extremely successful 501c3 Foundation in a wealthy community, provides excellent cancer care for Aspen with only one oncologist and a small in-house infusion center. The hospital also lists 10 emergency physicians, 9 orthopedic surgeons, and 8 primary care specialists on their website. All this essential care for a population even smaller than ours. Again, cancer care is wonderful, but when resources are limited, health care must be reasonably prioritized.
A final fact, there are knowledgeable consultants available that can help us make our health system benefit from the cancer center without cutting services. But the Hospital Board must direct the administration to make it happen; and it won't happen until a new patient and community oriented Board is in place. "State-of-the-art" does not have to mean "excessively expensive."
Shakespeare is wonderfully quotable. Here's one of my favorites: "This above all: to thine own self be true, And it must follow, as the night the day, Thou canst not then be false to any man."
It is simply "false" for the Hospital Board to allow the administration and a few members of the medical staff to frighten the public with the prospect of losing their cancer care.
Lawrence A. Danto, MD, has been a North Tahoe resident since 1978, has been a Clinical Professor of Surgery since 1974 and was a Tahoe Forest Hospital staff member from 2003-08.