Taft Street Winery founder Mike Martini is one of those saved by the fast actions of Palm Drive Hospital’s newly certified stroke center.
Palm Drive is where Martini received the emergency care and miracle drug in time to dissolve the blood clot that threatened to kill him or cause severe brain damage—and Martini thanks his wife for that.
“It was my wife, Susan,” he says, finally. “She saved my life.”
Martini, a former city councilman and mayor of Santa Rosa, isn’t just practicing good family politics when he recalls that afternoon last March 3. He and Susan were waiting to order lunch at Mary’s Pizza Shack in Sebastopol.
“We were chatting. I looked out the window, looked back…and all of a sudden, my world went upside down,” he says.
“Are you all right?” Martini heard Susan ask, but he didn’t respond.
“You have 30 seconds to talk to me or I’m calling 911,” she said.
Martini was too busy to talk: “I was holding on for dear life.”
Susan called 911.
In about five minutes, an ambulance was taking Martini to Palm Drive. Martini carries Kaiser health insurance, but Palm Drive was the closest hospital, just 1.8 miles away.
There, he was diagnosed with having suffered an Ischemic stroke, the most common type of stroke, caused by a blood clot in an artery leading to the brain. By Martini’s estimation and based on what he’s been told, it took a little more than an hour for all the tests to be done at Palm Drive before the decision was made, in consultation with California Pacific Medical Center (CPMC) neurologists, to begin giving him tPA (tissue plasminogen activator), a clot-busting drug.
Several hours later, after Martini had been transferred to CPMC in San Francisco, the clot was gone. So were his symptoms.
“They put me to bed at Pacific Medical Center, and I was doing just fine. What’s all the fuss?” he says now.
Of course, it wasn’t all that simple. After more tests and an overnight stay in San Francisco, Martini was taken to Kaiser Santa Rosa where more tests found the cause—a previously undetected hole in his heart. Fixable.
After that, to hear Martini tell it, the story becomes almost routine. Home by Saturday. Back to work at Taft Street’s Sebastopol winery on Sunday. Kaiser plugged the hole in his heart about a month later.
Since then, it’s life back to normal including completing a half-mile swim in the Russian River, an 18-mile bicycle ride, and a 3.1-mile run—a private race and challenge hosted in August by Martini’s partner at Taft Street Winery.
Recovery reigns
Just as impressive as Martini’s recovery is, perhaps, the recovery of Palm Drive, that little West County hospital that was on the brink of financial collapse for more than a decade and given up for dead more than once.
But Martini is living proof that Palm Drive survives and is providing the level of medical care voters in West County were counting on when they supported two parcel taxes over the past 10 years to keep the public hospital afloat while it worked itself out of the financial and operational challenges many small hospitals face these days.
Palm Drive emerged from bankruptcy in May. It sold $11 million in bonds to pay off loans and creditors, and is now operating almost in the black, including cash reserves from the bond sale and a $2.7 million operating improvement over 2009. The hospital is also earning terrific patient satisfaction scores and a respectable track record for providing good clinical care to its public.
“We’re $2.5 million ahead of budget and expect a positive bottom line this coming year. Our cash collections have gone through the roof,” says Mike Lieb, Palm Drive’s interim CEO under a management contract with Brim Healthcare Inc., of Tennessee.
“Palm Drive has had 10 years of ups and downs, and through it all, our clinical care is remarkable,” says Lieb. “Our patient satisfaction scores are higher than larger hospitals in our region.”
He says Palm Drive has some cash for facility improvements and is working to expand the number of physicians who use the hospital to help fill Palm’s 37 beds. Currently, the average daily census shows 14 beds in use. Lieb would like that to increase by two or three beds.
“Once the doctors try us, they find out we do a good job. The trick now is how to overcome the mindset of doom and gloom,” he says.
Despite all the turmoil, Palm Drive hosts—and boasts—leading and innovative clinical services. It has a state-of-the-art intensive care unit and is the hub of a regional robotic telemedicine program that links small hospitals in Sonoma and Mendocino counties with specialists elsewhere in the world for virtual consultations and diagnoses.
Lieb says Palm has developed a new hip surgery program, and now it’s just one of two hospitals (Kaiser Santa Rosa is the other) in Sonoma County certified as a Primary Stroke Center by the American Stroke Association and the American Heart Association.
The Stroke Center designation, announced in May, means the level of care at Palm Drive for stroke patients exceeds the standards set by the Stroke and Heart associations, and that Palm Drive’s medical staff has received advanced training in clot-busting drugs; neurologists are accessible 24 hours a day, seven days a week; and a stroke patient can be examined, diagnosed and begin receiving treatment within one hour of arrival at the ER. The standard is three hours.
Palm Drive hadn’t yet received that Stroke Center certification when Martini had his stroke, but the training was already done and the procedures in place to provide him with the urgent medical care he needed.
Acting fast
Dr. Allan Bernstein, a leading Bay Area neurologist for more than 30 years, was part of the original team involved in building Kaiser’s stroke treatment program in Santa Rosa. He left Kaiser in January 2008—a retirement that lasted about four months before he joined Palm Drive, where he established and now directs a program for responding to “Code Stroke” ER situations.
Bernstein says time means everything if a stroke victim is to have a chance of survival or escaping serious brain damage. “The brain is a very soft structure with high blood flow,” he says. “When you cut off blood, brain tissues degenerate very quickly.”
A trained stroke team is essential and, when someone in the staff declares a Code Stroke, stroke patients go to the head of the line.
“The team has to work efficiently to get a good exam and a detailed history of the event. You need a stroke neurologist right away; you need to get a CAT scan and lab tests as fast as possible,” he says. “We have a drug [tPA] that helps dissolve blood clots, but it’s most effective when administered as close to the time of the stroke as is safe. The longer you wait, the less effective the drug.”
That’s the race against time that started when the EMTs wheeled in Mike Martini in March.
The 24/7 access to a neurologist is provided by the CPMC, whose stroke staff quickly connects to Palm Drive’s robotic telemedicine system to help determine the kind of stroke that’s occurred and what kind of treatment to begin.
“They get on the robot and examine our patient remotely from San Francisco, review the lab work and the CAT scan,” he says. “Then we can answer the acute question: Treat or don’t treat with tPA? Also, does the patient need to go to a tertiary center that has interventional radiology and neurosurgery available?”
Keeping the pace
For Mike Martini, the answer was, “Yes, treat,” and it came well within the standards for safe use of the tPA clot dissolver.
The happy ending has made Martini a poster child for prompt stroke treatment—and for betting on Palm Drive.
“I had a stroke, and my wife’s quick thinking to call 911 and the intervention at Palm Drive allowed me to continue a life and lifestyle that I cherish,” he says.
For Nancy Dobbs, president of the Palm Drive Hospital District Board of Directors, Mike Martini’s experience illustrates the simple logic for residents living between Laguna de Santa Rosa and the coast to keep a hospital like Palm Drive alive and running. “If someone like Mike can get that kind of stroke care at Palm Drive, that may be the half hour that makes all the difference,” she says.
According to Bernstein, Martini’s case wasn’t all that unusual. Reviewing Palm Drive ER admissions one recent week, he says: “We called five Code Strokes on Wednesday. Three were false alarms, but two were strokes. Those patients went home with minimal or no deficits two days later.”
