Beaufort News

Area medical experts mixed on reaction to new stroke-prevention law

A pending state law that will send stroke patients to the hospital best-equipped to handle their care -- not necessarily the nearest one -- has evoked mixed reaction from local medical experts.

The legislature overturned the governor's veto Tuesday to pass the Stroke Prevention Act, which will establish a network of hospitals for stroke patients. All hospitals will be rated based upon their capabilities.

The law's intent is to save lives and prevent permanent disabilities by getting stroke patients the best, fastest care. Some medical professionals believe the law will do that, but others say stroke patients should go to the nearest hospital no matter the circumstances.

Dr. Paul Mazzeo, Beaufort Memorial Hospital's chief of staff, said he worries EMS personnel will bypass closer hospitals for those "deemed worthy" by the state of being stroke capable, even though many local hospitals can treat most stroke patients.

"The goal of the program, and codified into legislation, is diverting patients to certain university centers around the state to the exclusion of local hospitals," he said. "We have community hospitals providing good, quality care across multiple disciplines in South Carolina that are able to treat most stroke patients."

Beaufort Memorial, for example, has a neurologist on call and can deliver medication that breaks up blood clots that cause strokes, restoring blood flow, oxygen and nutrients to the brain. The faster the clot is broken, the better the chance for full recovery.

Beaufort Memorial, though, is not a certified stroke center, neither is Hilton Head Hospital. Coastal Carolina Hospital in Hardeeville is the state's only primary stroke center south of Charleston. The closest level-one stroke facility, where stroke-specific surgical intervention is always available, is the Medical University of South Carolina in Charleston.

But more than 85 percent of all strokes do not require surgery, and patients that do are already transferred to hospitals where surgery is available, Mazzeo said.

And, as with a heart attack, time trumps everything, he said.

"Every minute on the road in an ambulance or in flight in a helicopter, versus receiving treatment in a hospital, you're losing brain tissue," Mazzeo said. "The best thing, rather than centralizing care, is decentralizing care."

Sheila Traficante, stroke-program coordinator at Coastal Carolina Hospital, disagrees. Taking patients to a nearby, non-stroke-certified hospital delays delivery of the most appropriate level of care, she said.

"If a patient is unstable, they should always go to the nearest hospital to be stabilized. The thing with stroke patients is, treatment is time-sensitive," Traficante said. "There is a three-hour window from the onset of the symptoms for that medication to be effective. By the time they get to the stroke-ready facility -- after testing and figuring out where to send them -- you may have lost that window. You save 10 to 15 minutes initially, but you waste an hour to two hours to get the appropriate treatment."

Emergency medical personnel will determine where stroke patients should be treated, based on the severity of their conditions and how long they've had symptoms. The worst cases would likely bypass level-two stroke centers -- such as Coastal Carolina -- to get to MUSC, according to the plan. Patients more than an hour from Charleston would go to a local hospital as a stopover before being transferred quickly to MUSC.

South Carolina has among the highest rates of stroke and stroke mortality in the country.

Gov. Nikki Haley vetoed the bill, saying the state already funds efforts to enhance stroke prevention and treatment in rural areas.

The (Charleston) Post & Courier contributed to this report.

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