Local Health Care Policy Issues
By  Hilbert Morales, M.P.H.. EL OBSERVADOR                 

During the Board of Supervisors Meeting of Tuesday, Aug. 24, 2010, held at County Government Center, Board of Supervisors’ Chambers, 70 W. Hedding St., San Jose, CA 95110, several items pertaining to the health care services were considered.
First let us acknowledge the unreported action which was not on the agenda. Valley Medical Center’s Emergency Room and its related Trauma Center, centrally located in the County of Santa Clara, continues to be the only ER amongst the nine San Francisco Bay Area counties, with an ‘open door policy’. This policy ensures that a patient with urgent medical challenges, who is presented at this ER, will be stabilized and  medical services initiated prior to dealing with “the ability to pay” and “Are you insured?” matters. The community, especially the low income and uninsured, especially appreciate this approach to essential and urgent human need. The Board of Supervisors, the County Executive, and the leadership of VMC, especially Medical Director Alfonso Banuelos, M.D., must be told that the residents of this county appreciate this stance. The community holds the present ER open door policy sacrosanct.
A recommendation is that information be disseminated which enables the public to minimize the use of the VMC ER facility as a primary care clinic. The use of VMC’s ER and Trauma Center must continue to focus on practicing emergency medicine and those severe traumatic injuries which are life threatening.
REGARDING SUICIDES: A report from the Health and Hospital Committee relating to early identification and detection of potential suicide was accepted. Recommendations from the Social Services Agency, Santa Clara Valley Health and Hospital System, and Mental Health Department included the creation of a single 1-800 Suicide and Crisis Phone Line and the establishment of a part-time Suicide Prevention Coordinator position to be funded with MHSA (Mental Health Services Act) resources. This proposed coordinator must have access to multilingual capabilities (English, Chinese, Spanish, Vietnamese, and Tagalog). Since the impetus for this action was the recent suicides of several students, school districts must be encouraged to orient both staff and student bodies regarding early detection of stress and related mental health disorders.
REGARDING AMBULANCE SERVICES: Competition requires more than one provider of ambulance services. For nearly 80 years American Medical Response (AMR) has been the the provider. In response to a request for proposal (RFP) Rural/Metro Corporation’s (RMC) submittal scored higher than AMR. An administrative paper analysis is subjective and may be influenced by those having a conflict of interest. Let the competitive process play out. Give RMC an opportunity to perform.  The County Executive, Jeff Smith, M.D., is to be commended for encouraging competition which will favor the establishment of reasonable pricing for the required services. Undoubtedly, this whole process, if allowed to be extended, is subject to external lobbyists influences. So, consider steps that ensure the county staff involved continues to be impartial and objective. If AMR’s administration was not that sharp with their cost estimates and profit margins, it has now experienced that a competitor has been. So the Board of Supervisors and the County staff need to allow the competitive forces to determine the outcome. No doubt that AMR has stakeholders who are disappointed. The residents now know that another provider, who was initially qualified by staff, presented a ‘winning bid’ that ought to be assigned. Further study permits AMR’s friends to influence the original rational and objective evaluations.
Ethnic communities understand this process whereby a favored individual and/or company eventually gets the business that was originally ‘won’ by a new kid on the block. If the costs of ambulance services are to be reasonable, let the RFP process, mandated by California State law and regulation, determine the outcome.