The S.C. Legislature passed the Stroke Prevention Act of 2011 in June that will establish a network of hospitals for stroke patients similar to the network that exists for trauma patients where all hospitals are rated based on their capabilities. The new law is expected to save lives and prevent permanent disabilities by getting stroke patients the most appropriate level of care in the shortest amount of time. The following are reactions from Edward Jauch, M.D., and Robert J. Adams, M.D., two influential advocates for the law.

MUSC Emergency Medicine and stroke researcher Dr. Edward Jauch, left, with state Sen. Darrell Jackson, center, and MUSC Stroke Center Director Dr. Robert Adams in Columbia.

What was your reaction to it finally getting passed?
Relief and appreciation for all the hard work so many people expended making this happen. Numerous members of the MUSC family contributed to the creation and passage of this bill, often behind the scenes. It is just the beginning of a long important process in changing the way stroke is prevented and cared for. It requires an incredible amount of effort to even begin to change the system. Soon people will be able to find out where to go for expert stroke care in our state.

What has the journey entailed getting to this point?
Three years of planning and working with numerous stakeholders throughout the state. It started as a multidisciplinary working group of stakeholders from across S.C. that led to the creation of the first stroke bill, which created the South Carolina Stroke Systems of Care Study Committee. It was critically important to add necessary direction and formality by placing the responsibility of success within the Department of Health so that we knew the frequent trips to Columbia would pay off.

This group worked aggressively for more than a year to identify the stroke needs of the state and create a statement of need for the legislature through the stroke bill.  After working to move the bill through subcommittees within the senate and house, and later through the full senate and house, and overriding the governor's veto, the bill became law on June 21.

What does this mean for S.C. residents?
This is the first step in organizing health care resources within the state to address the significant burden of stroke.  It will help build systems of care within regions to ensure EMS agencies are aware of hospital stroke capabilities within their region and that potential stroke patients are taken to the most appropriate hospital capable of treating acute stroke. 

Further, it will foster collaboration among hospitals in the state to provide the best stroke care for patients.  Additionally, the bill will fund a registry maintained by DHEC to better determine the occurrence of stroke within the state and provide guidance for future stroke intervention and prevention efforts. From a practical point of view, the bill increases chances that patients with stroke will be taken to the most appropriate stroke hospital as quickly as possible. It does not guarantee this will occur, but improves the chance. The bill also ensures that through DHEC we will continue to populate and update the map of South Carolina hospitals with stroke capable sites as the first step.

Why is it necessary to have a task force to maintain and track a stroke patient database, and is it worth the $500,000 price tag?
The cost came in part from additional staff that will be needed to deal with hospital certification issues. Granted registries are expensive and must be done correctly to be of any value. If done correctly, they can be a significant help in planning for service delivery and prevention. For instance, if Robert and I wanted to identify the counties with the greatest need for stroke education, improved access to tPA (a stroke drug), etc., we currently would not be able to obtain the necessary data. Most hospitalization data come from documents created for financial reasons and not medical reasons, so many important medical aspects are left out.

Why does our state rank among the highest with stroke and mortality rates?
South Carolina experiences a disproportionately high prevalence of major risk factors for stroke and cardiovascular disease—diabetes, hypertension, smoking, obesity, etc.  Lack of stroke resources at most hospitals in S.C. may also play a role. While this may explain the overall severity of the problem, what it doesn't describe is the disproportionate burden of stroke in younger patients, likely due to these risk factors occurring earlier in S.C .and not being treated as aggressively in S.C.

Why does our state have such a high stroke/mortality rate and what do you see MUSC's role in changing that for the future?
First, MUSC is clearly the fundamental medical biological resource for stroke in the state. While there are others, we need to be the leaders. We need to not only lead in the exploratory biology of stroke, but also in the application of the current knowledge, type 2 translational research, to ensure the best practices are carried out throughout the state and to export our good care, knowledge, and passion to improve care throughout the state. Examples of this are telemedicine efforts in stroke, sepsis and trauma. As a leading academic emergency department (ED) in the state, we also have the opportunity and obligation to improve the rapid triage and care for stroke patients in the ED and our coordination with EMS within the region.

What does the future hold?
We hope we are involved in the resulting stroke advisory council, a committee convened by DHEC to see this work implemented and extended to make a bigger difference with stroke.

Our MUSC lobbyists also worked hard and were key to making this happen even though MUSC has nothing to directly gain from the passage of this bill. The South Carolina Hospital Association (SCHA) also was crucially important, especially Rick Foster, M.D., because legislation like this cannot be passed or be effective unless the SCHA is on board. We are and will continue to make progress against stroke.