A new and technologically savvy medical service is set to be offered in Tehachapi as early as May 2014.
The Tehachapi Valley Healthcare District board of directors authorized the proposed agreement for telemedicine consulting and acute dialysis renal care services with Sanderling Healthcare LLC at its meeting Aug. 21.
The contract did not pass easily. The board considered the proposal over several meetings and instructed TVHD Chief Executive Officer Alan Burgess and other staff members to negotiate certain terms with Sanderling.
The item of primary concern to the board was the exclusivity clause in the five-year contract. Sanderling originally asked the board to agree to only use its renal care services through that period and decline to work with any other potential organizations wanting to bring similar services to the area.
Instead, Burgess arranged with Sanderling CEO Dr. Jerome Tannenbaum a one-year exclusive contract, with the option to extend it for another year or two at the end of its term. Adjusting fees to reflect inflation rates will also be a point of negotiation at the contract's end.
According to its website, Sanderling Healthcare was founded in 2009 by Tannenbaum to "further one of his personal missions for healthcare -- to lower the cost, and speed the construction, of healthcare facilities." As a nephrologist, Tannenbaum especially seeks to offer dialysis services to rural communities whose residents must otherwise drive a significant distance to receive that care, he said at Wednesday's meeting.
Through his more than 25 years of experience as a nephrologist, Tannenbaum said he learned that one reason smaller communities have no dialysis centers is because specialists like himself are in short supply. As a result, he developed a consulting system using wireless technology where patient information can be transmitted to the doctor instantly and the doctor can even have face-to-face time with the patient using programs like Apple's FaceTime. This setup is becoming more common in the medical field, he said, and is known as telemedicine.
"We're using the advanced telemedicine to reduce or eliminate the need for the patient to travel a long distance to see the nephrologist," Tannenbaum said. "So between [iPads] and FaceTime and electronic medical records and digitized x-rays... and the ability to see laboratory [work] instantly over the network, as a nephrologist we can take care of our patients."
Tannenbaum said the doctors who would serve Tehachapi would all be board certified, licensed in California and on-call every day of the year at all hours of the day.
Accompanying the telemedicine service is a dialysis center staffed by nurses experienced in dialysis treatment and, Tannenbaum said, with nephrologists always on-call. In an emergency, dialysis could also be administered to patients admitted to the hospital by those nurses.
"If we're going to build the clinic here, it's critical to have a contract with the hospital to provide the acute dialysis because when patients come in at two in the morning, extremely short of breath from fluid overload, we have to be able to bring the nurse in, start the dialysis and get this patient treated," he said to the directors. "The other alternative for the patient is to be transported by ambulance, either land or air, and all this time they're suffering from what's called pulmonary edema, which is very uncomfortable and frankly, very dangerous for the patient."
Based on his research, Tannenbaum estimated that at least 30 people in the Tehachapi area must commute 30 miles or more to a dialysis center. In his experience, he said, those commutes place a great hardship on patients and their families.
"And what we find is in communities that don't have dialysis, most of the patients end up migrating to some other local city where dialysis is available, they leave your community, or they actually just go home and die," the nephrologist said.
With the board's approval, Tannenbaum said he expects to begin construction on the center by Dec. 1 and begin seeing patients in May. He credited the short construction time with the frequency with which his other facilities have been built, saying that the only change between buildings is the exterior design. The opening of the facility would coincide with the beginning of services at the hospital.
Chief of Staff Dr. Susan Hall represented hospital staff at the podium prior to the board's decision.
"Medical staff is strongly in favor, in general, in bringing dialysis to the community," she said. "It's been a real lack in the community. I have one patient who died recently because we didn't have dialysis in our community. And I know her family, it's too late for them, but there's other families that would be really grateful. So I urge you to approve this contract."
Community member William Nelson voiced opposition to the contract, recommending the board open a bidding process to other renal care service companies.
Having the hospital board's approval in his hand, Tannenbaum can now petition the city for the appropriate permits. He said the site they are considering is on Valley Boulevard, next to Dr. Mark Pesche's practice at 707 W. Valley Blvd.
Henry Schaeffer was the first of the board members to weigh in on the contract during the meeting.
"I'm happy that we've had the presentation," he said. "I'm happy that you're coming and it really sounds to me like we're going to save some lives."