by JUDY HODGSON
LAST FRIDAY A 58-YEAR-OLD MAN WAS TAKEN
Memorial Hospital in Fortuna, suffering from a heart attack. He was given a drug to dissolve a blood clot blocking the main artery feeding the heart. Initially he responded well, but during the night the artery closed again and Dr. Robert Lock, a cardiologist, was called in to consult.
The patient was transferred to St. Joseph Hospital in Eureka where Lock performed angioplasty in the heart catheterization lab to reopen the artery. Working through a tube inserted into the groin, Lock also inserted three stents, tubes that look like miniature erector sets, to prop the artery open. Angioplasty is often enough to restore blood flow, but this time it wasn't. The patient was transferred again, this time down the hall for open-heart surgery where Dr. Timothy Trotter, a cardiac surgeon who heads a team of eight specialists, took over. Trotter opened the chest and replaced not one but three blocked or partially blocked arteries. The patient is recovering well and may be discharged as early as next week.
Dr. Timothy Trotter points to the intake of the bypass machine.
Dr. Denver Nelson, a neurosurgeon who is chief of surgery for both St. Joseph and General hospitals, said the heart program has been receiving very acceptable numbers and has passed several state inspections, the most recent in January.
"I believe St. Joseph has reached the volume needed by the state (150 or more per year), everything is working OK and the mortality rate is very acceptable," Nelson said.
St. Joseph officials are less restrained with their enthusiasm.
"We are very, very proud of our program. We are getting great numbers. This is a good news story. It's a big deal to have a cardiac surgery program here on the North Coast," said Ann Warner, assistant vice president for quality and physicians services.
The "numbers" Warner refers to is the mortality rate, the percentage of patients who die within one month following bypass surgery. Three of 94 patients have died, two after they were discharged and one in the hospital.
"The predicted mortality was 4.2 percent; our actual is 3.5 percent," said Trotter, who moved to Humboldt County to join the heart program in August. (Large-volume heart programs such as Redding Medical Center and Mercy Hospital in Redding boast of excellent bypass mortality rates of about 3 percent.)
So what is different about the St. Joseph program now, compared to 1997, when the Heart Institute opened for just three months and voluntarily closed following six deaths in 40 procedures? How significant are the new mortality rates? And, more importantly, what are the long-term prospects?
In May 1997 the institute opened with no affiliation with an established cardiac program. Its surgeon, Dr. Charles Dietl, had no back-up relief and because hospital officials were anxious to achieve the volume of patients needed for a successful program, no patients were turned away.
(In a 1998 interview with the Journal, Dietl said he was often operating on very ill, emergency patients because the lower-risk patients with more time to travel were having surgery out of the county. He said, "Mistakes were made, but not in the operating room." Dietl was terminated without cause following the 1997 closure, he filed a multimillion-dollar lawsuit against the hospital and a cardiologist who is no longer practicing in the area. Dietl prevailed; his case was settled out of court for an undisclosed amount.)
Today the Heart Institute is affiliated with a cardiac program at Santa Rosa Memorial Hospital. The program is headed by Dr. Marshall Marchbanks of Santa Rosa and he and other cardiac surgeons travel regularly to Humboldt to provide relief for Trotter.
The program was also restarted slowly in the fall of 1998 by accepting lower-risk patients until a full-time resident surgeon was recruited and on board.
On Sunday Trotter served as tour guide for a Journal reporter and photographer, all clad in hospital greens and booties, through the cath lab and the nearby cardiac operating room. He pulled out tiny wires used to measure artery size and wheeled out a heart bypass machine the size of a large truck engine.
"We don't do pediatric (heart surgery). It's truly a subspecialty. But we do pretty much everything else," he said.
Trotter, 39, a third-generation physician from Stillwater, Okla., said much of the credit for the program's smooth restart and successful early numbers goes to the cardiac team --two general surgeons, a cardiac nurse and circulating nurse or two, an anesthesiologist and a specialist who runs the bypass machine.
There have been only two patients, he said, who have been transferred to more specialized hospitals since he came on board -- a 71-year-old who was to undergo a risky third round of bypass surgery, and another patient who was a likely candidate for a heart transplant which very few facilities do.
But the long-term success of the program may well hinge on how the program is accepted by patients, their primary care physicians and the three area cardiologists -- especially in light of the heart program's rocky start in 1997.
Lock said so far he is pleased.
"The results are good. The mortality rate is much less. I'm sending quite a few patients there," he said.
Marchbanks, in a telephone interview from Santa Rosa, said he is more than pleased.
"We've been given the green light by the state. There are no red marks against us."
Trotter may have one speed bump yet in his path, however -- one that Dietl also faced during his brief tenure.
Humboldt County has a number of general surgeons, board certified by the American Board of Surgery, who practice thoracic and vascular surgery. (Thoracic surgery involves anything that occurs within the chest cavity, including diseases such as lung cancer.)
Some of those surgeons say that when the Heart Institute was first conceived in the early 1990s and the community began raising money for it -- $1.7 million -- they were assured by hospital administrators that the chief cardiac surgeon would stick to heart surgery.
"I was a general surgeon on the search committee at the time," said Dr. John VanSpeybroeck.
"Our real issue is lung surgery. This person does heart surgery. He is employed at a salary guaranteed by the hospital. We are in private practice. He has an exclusivity clause -- no one else will do hearts. Those are our differences. We were told one thing (by previous hospital administrators) and delivered another."
VanSpeybroeck denied rumors that were circulating last month of an informal boycott of St. Joseph by general surgeons.
"Not at this time. In the future? That's open," he said.
Trotter is not only certified by the American Board of Surgery, he has completed two years of residency at the University of Oklahoma in thoracic and cardiovascular surgery and is certified by the American Board of Thoracic Surgery. No other practicing surgeon on the North Coast has that additional certification.
Trotter said he was never told about any restrictions on types of surgery and he would not have accepted the position with such restrictions.
"Hearts are fun. I love doing them. But it's only about a third of what I do," he said. "Thoracic surgery is what I do. Thoracic surgery is who I am."
Get Ready to Vote
California voters received a small book in the mail last week to help them prepare for the March 7 election. The official Voter Information Guide presents the full text of 18 propositions along with arguments for and against, political party statements of purpose, a quick overview of state bond debt and other assorted data. It's 147 pages long and not easy to read.
Even in abbreviated form the propositions themselves can be confusing. They are followed by arguments written by proponents and opponents of the measures. Both sides intend to sway the voters with analysis that can leave you even more confused.
Since this is "California's first Primary Election of the new millennium!" the secretary of state has made an attempt at improvement. There is a pullout "Quick Reference Guide" with condensed versions of the same biased arguments. And there is a state website, www.ss.ca.gov.
The League of Women Voters is offering an alternative. The league organizes a series of forums presenting local candidates. And on Saturday, Feb. 19, from 9:45 a.m.-noon the chapter is presenting pros and cons on the ballot measures at the Humboldt County Library in Eureka.
The League also has a well-designed website, www.smartvoter.org, with easy-to-read nonpartisan information and impartial pros and cons of each proposition. The site also contains information about all candidates running for office, including campaign finance reports.
When you navigate to the county level you find all the local races with links to the candidate's websites. Those who don't have their own sites are offered free space by the league to create one. There's even a set of links to online media sources, including the Journal at www.northcoastjournal.com.
Sand Pointe on agenda
The California Coastal Commission was scheduled to meet in San Diego Feb. 16. On the agenda was a decision on revised findings related to local developer Steve Moser's proposed Sand Pointe subdivision in McKinleyville.
The meeting took place after the Journal went to press. However, commission staff is recommending approval.
"I've been to the Coastal Commission six times and they have always done something other than what the staff recommended. So there is still doubt in my mind," Moser said.
In 1995 Moser applied to the county for a planned unit development on the bluff at the west end of Murray Road. His original plan called for a gated community with the 26.5-acre parcel divided into 63 lots. The plan was approved by the Humboldt County Board of Supervisors despite neighbor objections.
Opponents formed Concerned Citizens and filed an appeal to the commission in conjunction with the Redwood Chapter of the Sierra Club and a group called Humboldt Coastal Coalition. They cited concerns about density, bluff setbacks, seismic hazards and community character, especially the concept of the locked gate.
In February 1997 the commission asked Moser to rework the project and a new plan was drawn. The gate was eliminated, number of units reduced to 37 and a 100-foot bluff set-back was included. An access easement to the Hammond trail was also included.
Pat Hassen of Concerned Citizens was also on her way to the hearing "to make sure they get it straightened out this time."
Assuming the project wins final commission approval, Moser must return to the county planning commission in March.
"The planning commission already approved a project much more dense and intense than the project that will be in front of them the next time, so there will be no rationale to reverse themselves," he said.
Moser said he has several other projects in the works and it is unlikely that he will break ground on Sand Pointe before 2001.
Under lengthy construction
For the next 30 months, Humboldt State University will be getting down to earth, so to speak.
The physical services department on campus has contracted with Mallcraft Inc. to complete the long-anticipated infrastructure improvements project.
The project is necessary to repair and replace aging utility systems on campus. One common trench will be dug throughout campus, into which will be installed a number of utility lines including natural gas, telecommunication cables, irrigation systems and storm drains. Some stairs and walkways will also be repaired and replaced.
The single trench will not appear all over campus at once, but will gradually find its way at every part of the campus at some point until the projected completion date of July 2002.
The Humboldt County Office of Education will break ground soon at 901 Myrtle Ave. in Eureka on a new center to benefit county teachers.
Thanks to a $1 million grant from the California's School Building Lease-Purchase Program, the new center will house instructional materials, videos, computers, software, textbook samples and a circulating school library collection. Teleconferencing equipment will also be available, which will enable school personnel to participate in live seminars via satellite or tape events for future viewing.
The Humboldt County Board of Education provides educational resources to county schools through the Humboldt Educational Resource Center, and with the growth of information available, along with improvement of the quality of instructional materials, the center has outgrown its quarters.
The grant requires a local match and the Humboldt Country Board of Education agreed to finance its share through the sale of certificates of participation. Ground will be broken in early March, and the project should be completed within nine months.