Patient needs at center of stroke care debate

Boston Statehouse

BOSTON (SHNS) – Ten years after her stroke, Janet Wronski said Monday she still thinks daily about the decision her son made when the ambulance arrived.

He asked the first responders to take her to a larger hospital, where her doctors were, rather than the closest one, she recalled during a Public Health Committee hearing.

Wronski believes she would have been transferred to the larger hospital eventually either way, but after first waiting in an emergency room and losing time that doctors would have needed to treat her effectively. Instead, she immediately went into a CAT scan, had a clot-busting drug administered and then underwent brain surgery and “ended up coming through,” she said.

“It was all because I got to the place where they were ready for me, and like I said, I think about it all the time,” Wronski said. “If I had gone to the wrong hospital, I don’t know where I’d be right now … Every day I think about what could have happened if my son didn’t make that quick decision he did. I don’t know if I would have been dancing with him at his wedding last weekend.”

Wronski was one of several speakers to testify in support of bills aimed at making sure stroke patients get the care they need in a timely manner.

Stroke specialist Dr. Lester Leung described strokes as “a race against time,” with irreversible damage occurring to brain cells as minutes pass. He said emergency treatments have advanced dramatically in recent years.

“In essence, this is our space age,” said Leung, who serves as director of both the Comprehensive Stroke Center at Tufts Medical Center and the director of stroke service at MetroWest Medical Center in Framingham. “As recently as a few years ago, people with devastating strokes causing them to be mute and paralyzed would nine times out of 10 be destined to live in a nursing home, forever dependent on 24/7 care. Now, more than half of those people literally walk out of hospital with minimal or no long-term disability from their strokes.”

Leung attributed that progress to “the arrival of an incredibly effective and proven surgical treatment called thrombectomy,” which he said is now the standard of care for severe strokes and can only be completed in comprehensive stroke centers with specially trained surgeons and the right infrastructure.

Allyson Perron Drag of the American Heart Association and American Stroke Association said at least 80 percent of stroke patients should be able to stay in their own community hospitals for treatment.

Perron Drag spoke in support of a bill (H 2253, S 1477) that she said seeks to “establish a system of care to address the whole stroke continuum.”

Filed by Rep. Mark Cusack and Sen. Mark Montigny, the bill would task the Department of Public Health with developing criteria for designating hospitals into a tiered system based on their ability to treat strokes at different severity levels.

“Once a tiered system of care was put in place, the Office of Emergency Services would establish, based on what’s best for the region, protocols for a point-of-entry plan that would include plans for triage and transport of acute stroke patients,” Perron Drag said. “Pre-hospital care protocols and routing currently exist and are in place for both trauma and heart attacks, and EMS would work to further determine how to triage a patient to the appropriate hospital based on the type of stroke.”

The Senate last year unanimously passed a version of the Montigny bill, but House leaders did not bring it to the floor for a vote and it died in the House Ways and Means Committee.

This session, a handful of different stroke care bills are before the Public Health Committee.

Sen. Jo Comerford, who chairs the committee with Rep. Marjorie Decker, asked Perron Drag if she thought it “would be useful for the committee to consider a package of the proposals that are more coordinated.”

In response, Perron Drag said the bills “have a lot of similarities.” She said bills from Rep. Thomas Golden and Sen. Michael Moore (H 2307, S 1497) focus on the emergency medical services piece, and bills from Sen. Brendan Crighton and Rep. John Lawn (S 1396, H 2345) address how the DPH would regulate a stroke-care system.

“I’m hopeful that — as you know, we’ve been working on this for a very long time, feels like my lifetime — and we could take those six bills and really come out with something that I’m hopeful that everyone can be supportive of and move forward,” she said.

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