Closing the Critical Care Gap: Lawmakers Fail to Advance Stroke Care Bill

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DES MOINES, Iowa  --  Almost 10 years after a severe brain stem stroke, Jackie Petersen-Blake is almost fully recovered. The incident happened in July of 2009 as she and her husband were driving from their home in Elk Horn to visit family.

"Just as she's driving along the interstate, she said she couldn't see," her husband Ross says. "She said, 'you need to call an ambulance.'"

EMS responders took Jackie to the nearest county hospital, but released her a few hours later on what they thought was a migraine.

"They kept saying if I was having a stroke my blood pressure would be much higher," Jackie says. "I had CT scan and it showed that it was clear. It was perfectly fine. It didn't show any blockage, so they sent me home."

On that drive home, her symptoms worsened; Jackie began losing her speech. Her husband took her back to the county hospital where she was re-evaluated and then taken to Mercy Medical Center in Des Moines. Doctors there diagnosed her with a brain stem stoke. Jackie was only 29 years old.

She's a part of a nationwide trend. Strokes are up 44% nationwide in adults aged 25-44, according to a 2016 study from the University of Southern California. Iowa is seeing a similar trend, even though strokes overall are decreasing. Some say the state is lagging when it comes to getting patients the care they need in a timely manner.

"I cringe, yeah, I absolutely cringe. Because we have such little time," says Terri Hamm, the stroke care coordinator for Mercy Medical Center. She knows time is of the essence when it comes to treating strokes.

"We want to make sure that we have met all of the criteria for safely and aggressively treating patients as they come into the door, and it starts with recognition," she says.

Iowa lawmakers failed to recognize that during this legislative session. Lawmakers proposed a law that would require hospitals to be credentialed based on the level of stroke care they are able to provide. The bill did not advance.

"If you're in a small facility with a four or five bed E.R., the likelihood that you're going to be able to provide all levels of care that are needed to be a stroke center is very small."

There are 118 hospitals in the state, 18 of which are primary stroke care centers that offer a high level of stroke treatment. However, the majority of hospitals in the state are "stroke capable," meaning doctors there have some resources to start treatment but patients would have to be taken to a stroke center for continued care.

A stroke capable hospital must have an emergency room, CT scan, and tissue plasminogen activator, which is a drug used to break up blood clots. Hamm says many hospitals in the state are not within 30 minutes of a stroke center. The goal is to better educate stroke capable hospitals on stroke recognition and making sure doctors there have the capacity to at least start treatment.

Hamm says, "If we require hospitals to prove they can do all of that, we are kind of raising that bar for them and we are saying to the people they serve, 'you are in good hands no matter where you live.'"

The bill also would have required EMS responders to take patients to the best hospital--not the necessarily the closest one--based on the patients' immediate symptoms. This would help medics avoid trips to the wrong hospital, like what Jackie experienced.

Right now, there are no statewide protocols determining where EMS responders are supposed to take patients. The Iowa EMS Association says care for the patients wouldn't change, but admits the bill would have given them better guidance.

"To have a guideline to follow is easier than trying to figure out information and which is best at what time," says association president Mark McCulloch.

Organizations that supported the bill, like the American Heart Association, say they plan on backing similar legislation in the future. If passed, the Iowa Department of Public Health would monitor the hospitals' credential requirements. There is not yet a clear idea of how much hospitals would have to pay in order to be credentialed.


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