Catholic Health World - February 15, 2020

Civica Rx is delivering drugs 2 Coronavirus arrives in US 3 Executive changes 7 PERIODICAL RATE PUBLICATION

FEBRUARY 15, 2020

VOLUME 36, NUMBER 3

Change in SNAP rules will mean more adults could go hungry

Podcast highlights the work of Catholic health during the AIDS epidemic

The operators of St. Francis House Food Pantry are bracing for a surge in demand when a federal rule change takes effect April 1 that will cut off food assistance to hundreds of thousands of adults.

The food bank in Anchorage, Alaska, provides fresh and canned food to more than 15,000 people a year, including many working age adults with no dependents who stand to be cut from the rolls of the federal Supplemental Nutrition Assistance Program, popularly known as SNAP. “We are expecting to see an increase and we’re worried,” said Lisa Aquino, executive director of Catholic Social Services in Anchorage. The agency runs the food pantry with help from several supporters. A major one is Providence Health & Services Alaska.

Aquino said the worry isn’t so much Continued on 6

Courtesy of Catholic Social Services

By LISA EISENHAUER

Patty Jacobus shops at the St. Francis House Food Pantry in Anchorage, Alaska. The pantry provides a three-day supply of food to anyone in need. The pantry is run by Catholic Social Services and gets funding from Providence Health & Services Alaska.

By MARY DELACH LEONARD

In an episode of the America Media podcast “Plague: Untold Stories of AIDS and the Catholic Church,” reporter Michael O’Loughlin visits a small memorial park at the former site of St. Vincent’s Hospital in New York’s Greenwich Village.

O’Loughlin relates how the hospital, which closed O’Loughlin in 2010, was on the front lines as the AIDS epidemic grew during the 1980s. The tiny park at St. Vincent’s Triangle was dedicated in 2016, to honor more than 100,000 New Yorkers who died of acquired immunodeficiency syndrome.

“The day we visited the park was like any other — people cutting through on their commutes, couples sitting on benches,” O’Loughlin tells listeners, adding that he thinks it’s possible that some people who use the park don’t realize it’s a memorial.

There are few visible remnants of St. Vincent’s amid the former hospital buildings that have been converted to condos, he Continued on 4

Hospitals rally to ensure patients can vote in elections

Process isn’t simple and the rules vary by state

By LISA EISENHAUER

Sue Rosenbluth, an advocacy and public policy project specialist for CHRISTUS Health, registers voters at the system’s headquarters in Irving, Texas, in January. Registration was open to staff and visitors.

Ensuring that patients hospitalized at Our Lady of the Lake Regional Medical Center can vote is no small task.

Several days before an election, notices about patients’ rights to cast an unplanned absentee ballot are broadcast by television in patient rooms and common areas of the hospital in Baton Rouge, Louisiana. To start the process, patients have to ask the hospital for forms requesting an “emergency ballot” and the hospital’s medical director has to submit written statements affirming that the patients can’t get to their polling places.

Hospital staff must fax that paperwork to elections officials at the parish where the voters are registered by 4 p.m. the night before the election.

Once the officials check the paperwork and send absentee ballots, hospital staff has to deliver those ballots to the patients so Continued on 5

Prisoners get mission-based care at rare locked unit in critical access hospital

By JULIE MINDA

reserved for patients who are doing hard time. Most reside in WAUPUN, Wis. — The high-security, SSM HEALTH one of the town’s three locked unit tucked away on the third floor prisons — two maximum and one miniof Waupun Memorial Hospital here is mum security state prison — or in the medium security state prison in nearby Fox Lake, Wisconsin.

Hospital and prison leaders say that they know of no other critical access hospital in the nation with an in-house, secured unit for penitentiary inmates.

The unit is one of only two such locked prison hospital wards in the state — the other is at a large academic medical center in Madison. But in Waupun, the six-bed locked ward comprises There are six patient rooms off the central corridor of the secured unit at Waupun Memorial Hospital in Waupun, Wisconsin, that house patients who are imprisoned in state about a sixth of the hospital’s penitentiaries. A security officer accompanies any staff member entering a room to treat a patient.

Continued on 8

2

CATHOLIC HEALTH WORLD February 15, 2020

Civica Rx starts 2020 with 18 drugs in its supply chain, and more to come Company helps prevent heparin supply disruption for members

By JULIE MINDA

About a year and a half since its launch, Civica Rx now has 18 generic drugs available to its member health systems and has plans to make 14 to 20 more available over the coming year. Within five years, the generic drug company says it expects to be offering 100-plus drugs to its members.

Civica Rx, a nonprofit, nonstock company, was formed in fall 2018 to stave off shortages and price spikes of essential drugs. It shipped its first product — an injectable drug for use with hospitalized patients — in September.

“We are very pleased with our collective progress,” said Debbi Ford, chief communications and public affairs officer for the Salt Lake City-based company. “The Civica model is working as planned and essential medications that have been in short supply in hospitals are, or soon will be, available at fair and sustainable prices.”

Mohammad “Mo” Kharbat is regional vice president of pharmacy services and health research for St. Louis-based SSM Health, a governing member of Civica Rx. He said the drugs that Civica Rx is making available are “super important clinically.” For instance, the Kharbat drug company is offering its members access to heparin, the preferred anticoagulant for many hospitalized patients. There currently is a threat of heparin supply disruption worldwide, and Civica Rx has helped to ensure supply continuity for its members.

Three-pronged strategy Civica Rx’s initial focus is on stabilizing the supply of crucial sterile injectable medicines used in hospitals. In addition to heparin, such pharmaceuticals include antibiotics, anesthetics, cardiac medications and pain management drugs. (See sidebar.)

The company is reducing chronic shortages of such drugs through a three-pronged strategy: It is working with multiple generic drug manufacturing partners to produce Civica Rx-labeled generic drugs, pursuing multiple applications with the U.S. Food and Drug Administration to expand the list of drugs it can produce and looking to acquire or build its own manufacturing facilities. According to information from Civica Rx, this could include buying production capacity in existing facilities.

Industry disruptor Dan Liljenquist, chief strategy officer for Intermountain Healthcare, chairs Civica Rx’s board.

He came up with, and developed the concept for, Civica Rx, envisioning it as a social welfare-type orgaLiljenquist nization in which there are no ownership stakes and thus no profit incentives.

When the company was first announced, Liljenquist explained to Catholic Health World that Civica Rx was needed because market inefficiencies were disrupting the supply and distorting the pricing of a number of essential drugs.

He said for some drugs that have been around for decades and are still widely used, there are not many incentives for new entrants to manufacture the drugs even in the face of supply shortages and price spikes. While one or two manufacturers often can fulfill the demand for a particular drug, having a small number of manufacturers leaves drug purchasers vulnerable to anything that could go wrong along those

manufacturers’ fragile and complex supply chains.

However, were a new producer to come online and increase supply, prices would decline for all makers, reducing the potential for profit. “So, we’re just not seeing private capital flow into competition in some of these markets,” said Liljenquist.

SSM Health’s Kharbat said when hospitals cannot secure a supply of vital generics, nonpreferred therapies may be used as substitutes, but these drugs may be less effective, and clinicians may not be as familiar with them. Also, the substitutes may be more expensive than the preferred drug, which can cause a financial burden for the patient, Kharbat said.

Membership model Currently Civica Rx has 48 member health systems representing more than 1,200 hospitals in 46 states. Of those systems, 10 are governing board members, including CommonSpirit Health, Providence, SSM Health and Trinity Health. Governing members oversee the organization, and each gets a seat on the board. More than a dozen systems are founding members, including Hospital Sisters Health System. Founding members get input on the prioritization of drugs for manufacturing.

Over 20 systems are partnering members, including SCL Health. Like founding members, partnering members can contract to purchase drugs from Civica Rx. Last month, Civica Rx, the Blue Cross Blue Shield Association as well as 18 independent and locally operated Blue Cross and Blue Shield companies said in a release that they will partner to create a new Civica Rx subsidiary “dedicated to lowering the cost of select generic drugs” dispensed to consumers.

Under the partnership, Blue Cross Blue Shield and its licensee companies are committing $55 million to the subsidiary. Civica Rx and the Blue Cross Association said in a release the subsidiary will acquire and develop abbreviated new drug applications for select high-cost generics and join with Civica Rx and manufacturing partners to inject competition intended to lower prices.

Generic medications will become available under this arrangement by early 2022.

Drugs currently available to Civica Rx members Bacitracin, an antibiotic that helps prevent bacterial infection Daptomycin, an antibiotic used to treat bacterial infection Dexamethasone sodium phosphate, a corticosteroid hormone used to treat allergic reactions, arthritis, blood diseases, breathing problems, certain cancers, eye diseases, intestinal disorders, skin diseases and other conditions Diazepam, a benzodiazepine that helps to treat anxiety, alcohol withdrawal, seizures and other ailments Fentanyl citrate, the citrate salt of a synthetic opioid with analgesic and anesthetic properties Glycopyrrolate, an anticholinergic used with other drugs to treat stomach and intestinal ulcers Heparin sodium, an anticoagulant that helps to prevent and treat blood clots and blood clotting disorders Ketamine hydrochloride, a general anesthetic Labetalol hydrochloride, an alpha blocker and beta blocker used to treat high blood pressure Lidocaine hydrochloride, a local anesthetic that causes temporary loss of feeling in the skin and mucous membranes Metoprolol tartrate, a beta blocker used to treat high blood pressure Midazolam, a benzodiazepine used in children before a procedure or anesthesia to cause drowsiness and decrease anxiety Morphine sulfate, an opioid analgesic that helps relieve pain Naloxone hydrochloride, an opioid antagonist that prevents or reverses the effects of opioids Neostigmine methylsulfate, a cholinesterase inhibitor that helps reverse the effects of certain neuromuscular blocking agents after surgery Ondansetron, a serotonin receptor antagonist that helps prevent nausea and vomiting caused by chemotherapy and radiation therapy Prochlorperazine edisylate, a phenothiazine antipsychotic used principally in the treatment of nausea, vomiting and vertigo Vancomycin hydrochloride, an antibiotic that helps treat infections

That drug is prescribed to treat or prevent blood clots. It is commonly prescribed for those receiving dialysis and those undergoing cardiac procedures, among other patients. According to information from the American Society of Health System Pharmacists as well as from Civica Rx, there is a threat of disruption to the supply of heparin because of a potential shortage of a raw ingredient. One manufacturer, Fresenius Kabi based in Germany, said the disruption is partly due to an outbreak of swine fever in China, which is a major global supplier of the active pharmaceutical ingredient in heparin — that ingredient is derived from

pigs. According to an August Bloomberg article, China has lost as many as 150 million to 200 million animals to the disease.

Since Civica Rx’s supplier of heparin, Hikma, sources its ingredients from the U.S., its supply was not disrupted.

Kharbat said of heparin and the other drugs now in the pipeline: “These drugs are used heavily, and there had been supply disruptions. But now we have these products available and affordable. We feel very good about what Civica Rx has accomplished. In 15 months, it has come a long way.” jminda@chausa.org

Managing to prevent shortage In December, Civica Rx began offering heparin to its member health systems.

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February 15, 2020 CATHOLIC HEALTH WORLD

3

Ministry hospitals care for the first coronavirus patients in the US

By DALE SINGER

the virus was considered low in the states.

When Dr. Amy Compton-Phillips explains how Providence Regional Medical Infectious disease protocols Center in Everett, Washington, treated the Providence Regional and other first patient in the U.S. to have been diag- U.S. hospitals train and prepare to nosed with the novel coro- safely care for patients with novel navirus, three words came and potentially deadly contagious up often: abundance of diseases. The experience gleaned from caution. a widespread outbreak of the Ebola As executive vice presi- virus in West Africa a few years ago had dent and chief clinical helped sharpen training and protocols officer of Providence, the for infection prevention and conhospital’s parent system, trol and safeguards in caring for Compton-Phillips Compton-Phillips took patients in a manner that minia crash course in the coronavirus in mid- mized risk of exposure to caregivJanuary when the hospital began treating ers and others. The CDC said 11 the man in his mid-30s who had developed patients were treated for Ebola in the symptoms after returning from a trip to U.S. during the 2014-2016 epidemic.

Wuhan in China’s Hubei province, the epi“We learned a lot from the Ebola center of the fast-moving outbreak. scare,” Compton-Phillips said.

The Centers for Disease Control and Pre- “We’ve been preparing for this. vention announced Jan. 21 that the patient If you had asked me about this in isolation at Providence Regional Medi- back in 2015, I wouldn’t have cal Center was the first person in the U.S. been able to answer it the way with a confirmed I can now. We 2019 novel coronalearned that we had “We learned a lot from virus diagnosis. (The to be prepared, because Associated Press it was just a matter of the Ebola scare. … We reported the patient time. was released home learned that we had to be “We developed the from the hospital in capacity to use elecprepared, because it was early February.) On tronic medical records Jan. 30, the World and to use protocols for just a matter of time.”

Health Organization isolation and infection — Dr. Amy Compton-Phillips declared a global protection, and we had health emergency drills to show we know as the outbreak of coronavirus accelerated how to use them. We tried to dot every I and and spread well beyond China, where thou- cross every T. So far, it seems to be working sands of cases had been confirmed. well. We can’t afford to be complacent.”

By Jan. 31, the CDC was screening travelers for symptoms of coronavirus First human-to-human at 20 U.S. airports. And by Feb. 3, Ameri- transmission in US cans who had spent time in China in the The second patient in the U.S. with a past two weeks were being funneled confirmed case of coronavirus, a woman through one of 11 U.S. airports to undergo in her 60s who had traveled to Wuhan, was enhanced health screenings. Americans hospitalized at AMITA Health St. Alexius who had been to Hubei province in the Medical Center in Hoffman Estates, Illinois, past 14 days faced the possibility of a fed- near Chicago last month. That hospital said erally authorized quarantine. At the time in a statement that “given the advanced 11 cases of coronavirus had been identi- information and training provided by the fied in the U.S. and the risk of contracting CDC, our staff was well-prepared to care for

this patient.”

The patient was being “monitored in isolation, in accordance with established infection control protocols,” the hospital statement said, and AMITA “has contacted the small number of patients and staff who may have come into contact with the patient.”

At a press conference Jan. 30, Dr. Allison Arwady, Chicago Department of Public Health Commissioner, announced the woman’s husband had shown symptoms of coronavirus and was being treated in isolation at St. Alexius Medical Center.

The man had not traveled to China, but had been in close contact with his wife before she entered the hospital. He is the first person in the U.S. known to have contracted the illness in human-to-human transmission.

ing patient communication and minimizing staff exposure to infectious agents, she said. “Every time you go in and out, there is a small risk, but you can never get it to zero.

“If you want to have a conversation with a patient,” Compton-Phillips explained, “you don’t have to do it with a nurse or a tech person in a full mask and gown and hood. The patient can communicate back and forth using a kind of FaceTime functionality.”

The hospital also can send personnel to a patient’s home for testing, to minimize public exposure before a diagnosis. At home, the patient can await test results, and self-quarantine until the outcome of the test is known.

“We use an abundance of caution simply because we don’t know how this disease is going to progress,” she said of coronavirus.

With the symptoms of the coronavirus similar to flu-like conditions that can be common in the winter months — cough, runny nose, sore throat, fever — anyone who suspects they have the virus should call Protective measures a doctor, she said. Many people in the SeatLimiting contact with other tle area have followed that course. patients and with health care per“They’ve traveled, they’re sick, they’re sonnel is a key in treating coronavirus and getting screened,” she said of those with the preventing its spread, highest risk. “That’s Compton-Phillips the right thing.”

“We use an abundance of said. Using specialized But with all equipment such as caution simply because we cases in the U.S. to negative pressure room date traced back ventilation systems, don’t know how this disease to China, Compand robots like the one ton-Phillips said, is going to progress.” seen here for compeople who have — Dr. Amy Compton-Phillips munication and other not traveled there tasks helps the hospital or been in conachieve that goal. Treating clinicians wear tact with someone who has need not be protective gear including helmets with a full alarmed. faceplate and a blower to force air through a She said that all of the common-sense particle filter for the wearer to breathe. techniques to avoid getting sick and spread“When you’re taking a swab from a ing illness still apply — things like washing patient’s throat or nose,” she said, “there is a one’s hands frequently, or avoiding others possibility for the virus to get into the atmo- when one is sick. Following standard advice sphere. We use negative pressure ventila- — get immunized for diseases one can help tion in rooms, so the air doesn’t whoosh out prevent and use good hygiene to avoid the when you’re opening the door. It comes in ones one can’t — remains the best path to instead. We use isolation chambers when follow. we are moving patients (with infectious dis“Whether it’s SARS or MERS or Ebola,” ease) through the hallways.”

Compton-Phillips said, “those ways to fight Robots are particularly good at facilitat- germs are incredibly good.”

Upcoming Events from The Catholic Health Association

Diversity and Disparities Networking Call

Ecclesiology and Spiritual Renewal Program for Health Care Leaders

2020 Catholic Health Assembly

Feb. 26 | 1 p.m. ET

April 26 – May 1 Rome and Assisi, Italy (Invitation only)

Theology and Ethics Colloquium

International Outreach Networking Call

June 9 – 11 | Atlanta

Feb. 19 | 1 p.m. ET

IRS Form 990, Schedule H: An Overview Webinar

March 11 – 13 | St. Louis (Invitation only)

Sponsor Formation Program for Catholic Health Care

April 29 | 3:30 p.m. ET

Faith Community Nurse Networking Call May 5 | 3 p.m. ET

June 7 – 9 | Atlanta

Catholic Health Association and The Task Force for Global Health Joint Global Summit Mission in Long-Term Care Networking Call June 25 | 3 p.m. ET

Human Trafficking Networking Call July 17 | Noon ET

Session Two: March 26 – 28 (Invitation only)

A Passionate Voice for Compassionate Care® chausa.org/calendar

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4

CATHOLIC HEALTH WORLD February 15, 2020

Catholics and the AIDS epidemic From page 1

Capturing personal histories For O’Loughlin, 34, the podcast is a personal journey of discovery, as well as a history of a crisis that began several years before he was born.

“As someone who is gay and Catholic, I wanted to learn how people before me have managed this sometimes difficult identity,” he says in the introduction. “No time in modern history has been more volatile for gay Catholics than the height of the AIDS epidemic.”

O’Loughlin has written about LGBT issues as part of his job as national correspondent for America magazine, a Jesuit publication. He began researching the AIDS crisis after talking with a priest who worked in HIV and AIDS pastoral care during the 1980s.

“I wasn’t really aware of the history of HIV and AIDS, when it came to the Catholic Church,” O’Loughlin said in a recent interview. “So, I started digging through archives and found that there were a lot of priests and sisters and laypeople who had been doing groundbreaking pastoral care when it came to LGBT people back then. And I just started reaching out and asking them for their stories.”

The podcast relates the experiences of gay Catholics who sought acceptance and hope in their church during the epidemic, despite its teachings on homosexuality.

Several episodes focus on how Catholic health care providers like St. Vincent’s responded to the crisis.

Many of the people O’Loughlin interviewed told him that no one had ever asked them about their experiences during the AIDS epidemic. These personal stories are in danger of being lost to time, he said.

“You know, people kind of moved on as the ’90s ended, and I think they have all this trauma that they locked away,” O’Loughlin said. “So, it was important to me to give people space to talk and tell their stories.”

Into the breach O’Loughlin weaves these interviews with his firsthand accounts to portray the complexities and tensions of the period.

In the episode on St. Vincent’s, he talks to gay activists and hospital staffers who describe tensions over policies. St. Vincent’s, which was founded by the Sisters of Charity in 1849, is remembered for opening the first AIDS ward on the East Coast. But it didn’t become a haven for AIDS patients overnight, O’Loughlin said.

Sr. Karen Helfenstein, SC, then a hospital vice president, describes how the sisters responded to activists who took over the emergency room and covered crucifixes with condoms. Instead of pressing charges, the sisters met with protesters to find out what they should be doing differently.

The hospital held sensitivity training for employees and worked to create a more welcoming environment for gay patients and their caregivers. Because of the Catholic Church’s ban on condoms, nurses and doctors couldn’t pass them out, but they could explain how condoms prevented the spread of AIDS. And they could refer patients to places that did distribute them.

The sisters’ willingness to listen and

Courtesy Carol Baltosiewich

notes. And yet he is struck by the thought of AIDS patients who spent their last days at the hospital more than three decades ago.

“This is where some of them ate their last meals. Nurses, family, friends and partners fed patients ice chips. Gave them sponge baths. Sometimes sang their favorite songs. Prayed with them,” he says.

“There weren’t that many institutions that were respectful or hospitable to sick gay men in the 1980s. And the fact that St. Vincent’s became a place where the LGBT community felt they could safely receive care — that moved me.”

Sr. Mary Ellen Rombach, OSF, left, and Sr. Carol Baltosiewich, OSF, co-founded Bethany Place, an AIDS services organization that grew to serve a 12 county area in Southern Illinois. Baltosiewich, who later left her order, spent about six months in the 1980s in New York City ministering to AIDS patients to learn about HIV and AIDS care.

adapt was key, O’Loughlin said.

“I think it’s easy to say that there was this clash between the gay community and St. Vincent’s because of church teaching, especially on condoms and homosexuality,” he said. “But church teaching is also the mission to serve the poor and those in need.

And that’s where St. Vincent’s really shines because it held true to that part of church

teaching. And it didn’t retreat when there were challenges.”

Acknowledging implicit prejudice The podcast also looks at how Catholic health care organizations stepped up to help people in small communities where there were no AIDS resources. In some cases, health care providers like Carol

Baltosiewich had to start by educating themselves.

Baltosiewich was a Hospital Sister of St. Francis when she began meeting AIDS patients at St. Elizabeth’s Hospital in Belleville, a small city in Southern Illinois.

(She later left the order.) To learn how to care for AIDS patients, she volunteered to spend six months working at Catholic hospitals in New York. Afterward, she returned to St. Elizabeth’s and opened a center to provide services for people with HIV and AIDS. “You can’t begin to talk about AIDS. You can’t begin to minister to AIDS. You can’t even deal with it until you face your own prejudices and biases,” says Baltosiewich.

Although the podcast is about the past, O’Loughlin hopes it will remind Catholics of the church’s ongoing mission to care for those in need. He sees that continuing today in advocacy for universal access to health care.

“I think the fact that Catholic hospitals and Catholic health care leaders are fighting for the poor to have access to health care is an inspiration,” he said.

The six-part podcast began airing on Dec. 1, Worlds AIDS Day, which remembers the 700,000 people who have died of the disease in the United States. Worldwide, 32 million have died of AIDS. “Plague: Untold Stories of AIDS and the Catholic Church” is available at Apple Podcasts, Google Play and Spotify.

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Hospitals turn out the patient vote they can cast their votes and the staff can fax the completed ballots to the elections offices by the deadline.

In total, Coletta Barrett, the hospital’s vice president of mission, estimates that she or other hospital staff members spend 4 to Barrett 4 1/2 hours for each vote.

In the most recent election, a statewide one, that was 15 votes.

Regardless of the time required, Barrett says the effort fits into Our Lady of the Lake’s social justice mission. “We talk, in our mission and our ministry, about justice and so we live out our core values when we do things like this,” she says of the medical center’s efforts to facilitate voting. The hospital is part of the Franciscan Missionaries of Our Lady Health System.

Local initiative Across the Catholic health care ministry, just how many institutions make special efforts to accommodate patient voting is unclear. Representatives of several systems say they prepare educational material about elections — such as registration deadlines and rules for voting absentee — and distribute it to executives at member hospitals. The system representatives say they don’t know whether or how far those institutions go to facilitate voting for patients.

State elections officials have told Barrett that no other health care institution in Louisiana has a formal process like the one at Our Lady of the Lake to educate hospitalized patients on their right to cast an emergency ballot and to accommodate the process.

In Minnesota, St. Gertrude’s Health & Rehabilitation Center in Shakopee makes a similar effort on behalf of patients in its long-term skilled nursing facility. Marcie Donnelly, St. Gertrude’s wellness director, says that work gets a big boost from local elections officials as well as from St. Gertrude’s staff.

Donnelly says staffers at the care center ask patients as part of the intake process if they want to vote in elections. If they do, she and other staffers will help the patients fill

Courtesy of Benedictine

From page 1

A Benedictine Health System associate assists a resident of one of the health system’s communities with voter registration. Benedictine says its communities strive to ensure all patients and residents have an opportunity to fulfill their right to vote.

out the necessary forms to register to vote or transfer their registration to their new residence. Within two weeks before an election, elections officials will set up a polling place at the care center. Those officials bring the absentee ballots — even delivering them to the rooms of nonambulatory patients — and collect the completed ballots afterward.

In the last election, 18 of St. Gertrude’s 40 long-term care residents voted.

Donnelly has been part of the process to help patients vote since the care center, a member of Benedictine, opened about 20 years ago. “It’s their right to vote and I want to give them that right and that’s just been my philosophy,” she says.

Avera Sister James Care Center in Yankton, South Dakota, has similar arrangements with local elections officials to ensure that patients can vote. Those officials even send out sample ballots in advance so patients at the Avera Heath skilled nursing facility know exactly what races and issues they will be helping to decide.

Those requirements and deadlines vary vastly among states. Dr. Kelly Wong, an emergency medicine resident at Brown University, found that out when she decided to set up a website to help hospitalized patients figure out how they can vote. Her website, patientvoting.com, offers state-bystate information on the laws for emergency voting.

Wong lives in Rhode Island, where she says the laws are friendly to patients. Absentee ballots can be requested by patients up to 4 p.m. on the day before an election. If patients need assistance filling out their absentee ballots, elections officials send someone to deliver the ballots and assist them. In other states, patients are mostly on their own throughout the process.

In some states, just tracking down the laws that cover emergency voting was a challenge. In Texas, Wong says, “it was easier for me to find out how to vote if you were on a space mission than in a hospital.”

Official assistance People who have experience setting up voting processes for hospital or nursing home patients say the key to making the processes work smoothly is to be in close contact with elections officials well before elections to make sure that the requirements and deadlines are met.

Sara Wojcicki Jimenez says that when she started in her post as director of marketing, communication and advocacy for the central Illinois division of Hospital Sisters Health System, the 2018 midterm

Get out the vote

Jimenez

Some doctors work to simplify voting process for hospitalized patients D r. Kelly Wong says she was surprised when patients told her during the run-up to the 2016 presidential election how concerned they were about missing the opportunity to vote because they were hospitalized.

“I didn’t really think about it again until the midterm elections in 2018,” says Wong, who is an emergency medicine resident at the Alpert Medical School at Brown University in Providence, Rhode Island. “Just before that I decided I was going to try and see what process was in place for hospitalized patients to vote” in Rhode Island.

Wong says her research “blew up from there” because the hospital where she was working had patients from other states and she quickly found out that each state’s laws on emergency absentee voting vary. She ended up creating a website called patientvoting.com. By clicking on the outline of a state in a map of the U.S., users can get details on applicable voting laws.

“I wanted the website to be a central access point with information for all of the states in a very simple format that’s easy for hospital patients to read while they’re in their hospital bed dealing with their health conditions,” Wong says.

In addition to creating the website, Wong helped educate care providers and patients at the hospitals affiliated with the Alpert Medical School on emergency voting laws. This year, Wong hopes to expand

Dr. Kelly Wong

that part of her initiative and recruit representatives at hospitals across the nation to run patient voting programs.

Dr. Jennifer Okwerekwu, a fourth-year resident in the adult psychiatry resident training program at the Cambridge Health Alliance, was part of a similar effort at the health system based in Cambridge, Massachusetts.

Okwerekwu was one Okwerekwu of the founders of the alliance’s social justice coalition. The coalition focused on patient voting in 2016. Its members studied the emergency provisions

for voting in Massachusetts, distributed educational material to care providers and patients at Cambridge Hospital, helped patients get the necessary paperwork to secure absentee ballots and even delivered some of those ballots to elections officials.

“When you think about the people who are most likely to be hospitalized, they often represent an intersection of many marginalized communities and so the fact that they are unable to vote just further compounds that disenfranchisement and it just further compounds the injustice,” Okwerekwu says.

The voting laws were so complicated and the process so rarely used that Okwerekwu says she and other members of the alliance sometimes had to educate local elections officials on what the voting rules were.

Undertaking the voting promotion was a learning process, Okwerekwu says, and even resulted in academic papers. One of those papers focused mainly on how voting can be particularly challenging for psychiatric patients, whose mental capacity can raise barriers. In the end, she says the big takeaway from that paper is that any institution that gets federal funding has a duty to accommodate patient voting.

“Hospitals really do have an obligation to be able to help people exercise their constitutional rights,” she says.

— LISA EISENHAUER

5

elections were just weeks away. She made a call early on to Sangamon County elections officials to find out what steps needed to be taken to provide absentee ballots to patients at the four hospitals in her division.

Jimenez, who is a former Illinois state representative, wasn’t surprised or intimidated by the complicated process and strict rules and deadlines. She says she understands that elections have to follow explicit procedures to prevent fraud. “It’s not exactly an easy process by design, I think,” she says.

The patient experience staff at the four hospitals help distribute the necessary paperwork to interested patients and return the forms to elections officials. That staff plans to do the same again for this year’s elections. “Some of the feedback that I received from the last time is that people were very grateful” to be able to cast their vote, Jimenez says.

Linda Townsend is vice president of advocacy and government affairs for CHRISTUS Health, which has hospitals and care centers in Texas, Louisiana, New Mexico and Townsend Arkansas. She says that a get-out-the-vote effort is one of her staff’s big projects. Those efforts, however, are largely focused on the system’s associates.

“We create material that we can then distribute to our regional ministries for them to use,” Townsend says. “It is tailored by state because all of our states have different information on their primaries and rules on early voting and things of that nature.”

Hospital directors often use the information to send out emails to staff and to post or broadcast messages to encourage voting.

“We have to be diligent as do other Catholic health care systems and nonprofit organizations to ensure any get-out-and-vote efforts are done in a nonpartisan way,” Townsend says. “So, we really focus on raising awareness, providing information, and encouraging people to register and vote.”

The system goes so far as to set up voter registration tables. At one in the main lobby of its headquarters in Irving, Texas, in January about 80 people registered to vote. The table was staffed by a CHRISTUS employee who had been deputized by elections officials. Registration was open to both CHRISTUS staff and visitors.

Providing resources Michael Richards, vice president of government affairs and public policy at St. Louis-based SSM Health, says his office provides information on how registered voters can cast emergency ballots at its hospitals in Missouri, Illinois, Wisconsin and RIchards Oklahoma.

“We’re providing resources so that if somebody is in the hospital and does want to vote, (hospital staff) know how to make those accommodations for those patients and visitors,” Richards says. SSM Health encourages the ministry leaders at all its facilities to do whatever is needed to accommodate voters, he said.

In Baton Rouge, Barrett says her staff’s efforts to secure emergency ballots have been repaid in gratitude from patients eager to exercise their constitutional rights. She recalls one patient who was on a ventilator but still wanted to vote. In that case, after hospital staff secured an absentee ballot and delivered it to the patient’s room, the patient’s husband read the ballot to her and she squeezed his hand to indicate who she wanted to vote for.

Officials at other Louisiana hospitals have contacted Barrett to express interest in copying the “standard operating procedure” for emergency voting used by Our Lady of the Lake. “It is our hope and desire that in the future we won’t be the only one doing this,” she says. leisenhauer@chausa.org

6

CATHOLIC HEALTH WORLD February 15, 2020

Changes in SNAP rules From page 1

688,000 off the rolls The rule change will end a waiver that has exempted Alaska and several other states with high unemployment rates or a lack of jobs from some of the rules on SNAP benefits for adults. The U.S. Department of Agriculture estimates that ending the waivers will cut an estimated 688,000 nondisabled people age 18-49 who have no dependents from the rolls of SNAP, which in 2018 supported an estimated 40.3 million people. This adult population will only be able to access benefits for three months in a 36-period unless they have worked, volunteered or attended job training for 80 hours a month or 20 hours per week.

In January, the District of Columbia, New York City and 14 states filed a lawsuit in Federal District Court in the District of Columbia aimed at blocking the rule change. Alaska is not among the plaintiffs.

In announcing the rule change in December, Agriculture Secretary Sonny Perdue said: “Government can be a powerful force for good, but government dependency has never been the American dream.

We need to encourage people by giving them a helping hand but not allowing it to become an indefinitely giving hand.”

Dwindling safety net Some social services advocates see the change as part of a pattern to undercut the nation’s safety net for the poor. They point to other restrictions advanced by the Trump administration, including one that would keep immigrants from being granted permanent legal resident status if they rely on public benefits like Medicaid and food stamps.

Julie Bodnar, a policy adviser with the Office of Domestic Social Development of the United States Conference of Catholic Bodnar Bishops, called the benefit cuts and disincentives “discouraging.”

The USCCB, joined by Catholic Charities USA and National Council of the United States Society of St. Vincent de Paul, weighed in against the SNAP waiver withdrawal affecting nondisabled adults.

Their public statement urged the administration to “keep in mind that most food programs already are unable to meet the ongoing need for assistance. In addition, without more investment and resources, requiring individuals to participate in often already underfunded and ineffective state education and training programs will result in individuals losing access to food and making little progress to attain self-sufficiency.”

Economic impact Bodnar said ending the waiver program is projected to take $5.5 billion out of the food program over five years. While touted by the Trump administration as a savings, she pointed out that the loss of benefits will have a wide impact.

“There’s an economic multiplier effect to SNAP because this money’s been directly going into local businesses and it’s going to farmers that are producing the food, so it’s sup-

Tyler Cornell, a nurse practitioner, talks with a patient at a downtown Baltimore clinic run by Health Care for the Homeless. Mercy Medical Center of Baltimore was a founding partner of the organization. The nonprofit’s services include an emergency food pantry.

porting those industries,” Bodnar said.

The rule change affecting adults plus two other changes that have been proposed are jointly expected to push millions of people out of the SNAP program and trim billions of dollars in benefits. (See sidebar.)

Bodnar said that while the dignity of work is a tenet of Catholic social teaching, tying food aid to work requirements won’t make it any easier for unemployed adults to land jobs.

“We need more work and training programs to help people fulfill this requirement, but this rule doesn’t require states to provide more of that, it doesn’t give them resources to provide more,” she said.

Trinity Health also submitted public comments opposing the proposed end of the waiver program. Tina M. Weatherwax Grant, vice president of public policy and advocacy, said the Livonia, Michigan-based health system is “deeply concerned that this new rule will negatively impact access to necessary food and nutrition assistance and that will result in poorer health outcomes and cause more chronic conditions.”

Weatherwax Grant pointed out that studies have shown that food insecurity among working-age adults is associated with poorer diet quality and multiple chronic conditions, including hypertension, coronary heart disease, diabetes, kidney disease and poorer general mental health.

Courtesy Health Care for the Homeless

about whether the food bank can meet the increased demand as it is about how people already struggling to meet their basic needs can go on without the federal assistance.

SNAP benefits cover much more than the threeday supply of food that the pantry offers once a month to anyone who stops in. The Aquino loss of the federal benefits, Aquino said, will have “a negative impact for a lot of people that are living really close to the poverty line.”

Changes to SNAP eligibility rules The U.S. Department of Agriculture has proposed several charges to the Supplemental Nutrition Assistance Program, including: End of waiver program that affected states with high unemployment or low numbers of available jobs. The exemption allowed nondisabled people age 18-49 with no dependents to keep their benefits even if they didn’t meet the requirement of working or volunteering at least 20 hours a week. Expected to cut 688,000 from rolls and reduce benefits by $5.5 billion over five years. Set to take effect April 1.

Revision in the methodology for calculating the standard utility allowance used to adjust the qualifying net income of households applying for SNAP benefits. Projected to mean an overall loss of $4.5 billion in benefits over five years. Proposed.

Change in the categorical eligibility rule, by which people receiving benefits from other specified low-income assistance programs automatically qualify for SNAP. Could mean 3 million people would lose benefits. Proposed.

executive of Health Care for the Homeless, a Baltimore program that was founded in part by Baltimore’s Mercy Medical Center and gets continued support from the medical center’s staffers to Lindamood meet the health care needs of the city’s homeless population.

Lindamood said that most of the adults who come to his nonprofit’s five sites for care are either working but making too little to cover the costs of necessities like food and shelter or searching for work and coming up short. Baltimore is in the part of Maryland that is covered by a waiver on the adult SNAP rules. Officials in Maryland have said they expect the rule change to push 30,000 residents off the program’s rolls. Maryland is part of the lawsuit chal-

lenging the rule change.

Policy changes that make it harder for people to get assistance with basic necessities “end up being counterproductive and keep the most vulnerable members of our community in a subsistence kind of existence and keep people from reintegrating into the broader community,” Lindamood said.

He fears that the SNAP change will land hardest on those already on society’s margins, such as foster children age 18 and up transitioning to life on their own as adults and disabled people who haven’t been able to meet the paperwork requirements to qualify for federal disability benefits.

Even as the rule change was weeks away from taking effect, operators of food banks Working but not getting by said they were unsure how hard the hit Kevin Lindamood is president and chief could be among their clients.

Lydia Kreil, manager of community health at St. John’s Regional Medical Center in Oxnard, California, said the food bank the hospital runs already serves Kreil many single adults. While she expects an upswing in demand among that population once the waiver program ends, Kreil said it is unclear how big the surge will be and whether the medical center, part of CommonSpirit Health’s Dignity Health, can get more support from its patchwork food supply that includes donations from businesses and government commodities.

“I’m really kind of anxious Source: Based on analysis of fiscal year 2017 quality control data by the research organization Mathematica in a project funded by the Robert Wood Johnson Foundation. to see how this is going to roll Note: States with a white background did not have waiver areas in fiscal year 2017. out,” Kreil said.

February 15, 2020 CATHOLIC HEALTH WORLD

7

KEEPING UP ADMINISTRATIVE CHANGES Livonia, Michigan-based Trinity Health and organizations within that system have made these changes: Ben Carter to chief operating officer and Julie Spencer Washington to senior vice president and chief marketing and communications officer, both of Trinity Health.

Timothy M. Carrigan to chief nursing officer of Loyola University Medical Center of Maywood, Illinois; and Manmeet S. “Mani” Taneja to vice president of finance for the academic division of Loyola Medicine of Maywood.

Dr. Nicholas Kreatsoulas to chief clinical officer and Jerry Mansfield to chief

Armour

Clark

nursing officer, both of Mount Carmel Health System of Grove City, Ohio.

Janet L. Ready to chief operating officer of St. Joseph’s Health of Syracuse, New York.

Help spread the word about the importance of responding to the 2020 Census Flyers and social media resources available at:

chausa.org/census

Cullen

Montalvo

Kurt MacDonald to senior vice president of operations for Mercy Health Saint Mary’s of Grand Rapids, Michigan.

Sisters of Charity Health System of Cleveland and two of its facilities have made these changes: James Armour to senior vice president of mission and ministry for the system; Michael J. Biscaro to the new post of chief clinical officer of behavioral health and addiction medicine at St. Vincent Charity Medical Center of Cleveland; and Beth Graham to executive director of Joseph’s Home, a Cleveland medical respite facility for homeless men.

Covenant Health of Tewksbury, Massachusetts, and one of its facilities have made these changes: Donald Clark to controller of the system; and Adrienne Cullen to director of mission integration and spiritual care supervisor for Mary Immaculate Health/Care Services of Lawrence, Massachusetts.

PeaceHealth of Vancouver, Washington, has made these changes: Darrin Montalvo to executive vice president and chief financial and growth officer of the system and Krista Touros to chief financial officer of the PeaceHealth Northwest network.

Organizations within Renton, Washingtonbased Providence have made these changes: Carolyn Helfenstein to executive director, strategy and business development, for Providence Health Care of eastern Washington; Kelly Buechler to chief philanthropy officer for Providence Foundations of Oregon.

GIFTS AND GRANTS An anonymous donor has given a $5 mil-

Helfenstein

Buechler

lion gift to Avera Health of Sioux Falls, South Dakota. At the giver’s request, Avera will use $1 million of the donation as a matching gift to support the Coordinated Care program, which helps patients overcome barriers to better health. The donation also will support security assessments and updates at facilities across the system, unification of philanthropic efforts across Avera, operation of the Farm and Rural Stress Hotline, investment in employee appreciation programs and investment in various projects that enhance the patient and employee experience.

St. Mary Medical Center of Apple Valley, California, and the Hesperia Unified School District of California have received a $560,000 grant from the Well Being Trust to improve care for students in trauma and with mental health needs. The goal is for the school district to establish systems that more quickly respond to student needs, especially when it comes to youth at risk of suicide. The Well Being Trust was founded

by St. Mary’s parent, Providence. The trust is now an independent organization.

HONOR Dr. David Barbe has been named president-elect of the World Medical Association.

He is a family physician with Mercy of Chesterfield, Missouri and has been in practice in Mountain Grove, Missouri, for 36 years. The World Medical Association, which has a relationship with the World Health Organization, is an international organization representing more than 9 million physicians.

Seeking VPs of Mission Mercy hospitals in Fort Smith and Joplin are each looking for a Vice President of Mission to promote and integrate the mission and values of Mercy and our Catholic identity into the leadership decisions and daily operations of those serving across the ministry: hospital, clinic, shared services, and leadership.

These senior level positions will interface with all leadership initiatives, oversee critical mission-specific areas including ethics, pastoral care, community health and Church relations, and be responsible for all formation.

Qualified candidates will have experience in organizational development, an MA in Theology (or willingness to pursue this degree), and five years of health care experience including senior management roles.

D

ownload Catholic Health USA, CHA’s monthly podcast that brings together thought leaders from across Catholic health to discuss ministry-related topics. Recent episodes: Global Health Housing and Transportation Ministry Formation

Please apply online at

www.mercy.net/VPMission

The Suicide Epidemic Immigrant Youth at Risk Genomics and Ethics

We invite you to subscribe to the podcast on your device store or download/listen to it using the player below. chausa.org/newsroom/podcast

Your life is our life’s work.

8

CATHOLIC HEALTH WORLD February 15, 2020

Health care for prisoners

Waupun Memorial Hospital has expanded services for prisoners

From page 1

Caring presence Keel and Van Den Bogart say they like the wide variety of nursing tasks they perform on the unit at Waupun Memorial Hospital. They often care for patients receiving treatment for hernias, bodily trauma and other conditions not commonly seen in the general population of the hospital.

Protocol demands they do not share personal information with prisoners nor ask the inmates personal questions, but both nurses say many of the prisoners will volunteer information about themselves. Van Den Bogart says working on the unit has taught her to be nonjudgmental. Keel says she’s met many people who “never stood a chance” in life and deserve compassion.

DeAnn Thurmer, Waupun Memorial Hospital president, says, “We’ve been able to help many people. We’ve showed them we care and that we want to help them.”

Keel says she’s found her own ways of offering the human connections many prisoners are longing for. She says when she’s providing medical care to a prisoner, she often will “purposefully spend a little extra time with them, so they can have my presence just a little bit longer.”

S Barry Adams/Wisconsin State Journal

25 licensed beds. (Two of the six beds are counted as outpatient swing beds.)

Waupun Memorial Hospital is part of Agnesian HealthCare, which is a member of SSM Health. .

Recovery hurdles Orthopedic surgeon Dr. Eric Nelson and nurse practitioner Andrea Smits, who practice at Agnesian HealthCare’s Fond du Lac Regional Clinic, count prisoners among their patients. Smits notes that this patient population is among the most vulnerable the hospital sees. She says that post-op care is complicated by the fact Nelson that discharged patients who return to prison do not always have ready access to even the most basic items that can be useful in recovery, such as ice packs and extra pillows.

Nelson adds there is an increased risk of infection once patients return to the prison environment after hospital discharge.

Dolores Keel and Shelly Van Den Bogart are among the Waupun Memorial Hospital nurses who staff the locked unit at the hospital. There is one Waupun Memorial Hospital nurse on the unit when patients are present, and two if there are surgical patients.

Providing clear patient Keel education upon discharge from the hospital is vital, Keel says, because patients who are recuperating in prison have limited access to the web to get answers to medical questions and they may be Van Den Bogart among hundreds seeking care from the prison clinic nurse.

Van Den Bogart says patients weakened by surgery could be further stressed because of the risk of aggression from other prisoners while they are physically vulnerable. Nelson notes that all these impediments to healing come on top of the fact that the prison population for the most part is much less healthy than the general population.

“Being incarcerated is just not good for one’s health,” he says. “We are not meant to live behind bars, and it is literally harmful to one’s health.” Many prisoners have unmet mental and physical health concerns prior to their incarceration — sometimes due to risky lifestyles or lack of funds to access preventive care or treatment.

Waupun is known as Prison City because it is home to three state prisons. This one, Waupun Correctional Institution, is a maximum-security facility. It is among the penitentiaries that send inmates to Waupun Memorial Hospital for inpatient and outpatient services when they require services beyond the capability of the prison’s health clinic.

‘Prison City’ The area’s state prisons, which have a combined capacity to house over 4,500 prisoners, have been a linchpin in the local economy for generations. A 2017 profile of the city in the Wisconsin State Journal said Waupun is informally known as “Prison City” and the four prisons combined employ over 1,000 security officers. (Waupun has a population of about 11,000). The article said the city’s mayor, Julie Nickel, moved to the area about 30 years ago to work as a prison security officer.

In fact, because of the many prisons in the area, says Van Den Bogart, Waupun area residents — including those who are patients or staff of the hospital — do not become alarmed when they see a patient who is a prisoner and in chains being escorted through the hospital.

Waupun Memorial Hospital had provided emergency care to inmates throughout the hospital’s 69-year history. Before the locked hospital unit opened in 2005, a prisoner requiring inpatient hospital care would be assigned to an available room anywhere in the hospital. The dispatching prison scheduled a member or members of its security staff to guard the patient roundthe-clock for the duration of the hospital stay. Prisoners deemed to be higher risk might be under the watch of multiple security officers at all times.

The system was expensive and a burden to taxpayers, says Thurmer, and Waupun Memorial Hospital approached the Wisconsin Department of Corrections to discuss the situation. The hospital learned the department wanted to regionalize health care for inmates in its facilities. Together the hospital and corrections department came up with the idea to build the dedicated unit.

The hospital paid the upfront construction costs, a percentage of which the state has paid back through its contract for services with the hospital. The unit is staffed

by the hospital’s clinicians and guarded by employees of the state department of corrections.

Dr. Ryan Holzmacher is a physician adviser for SSM Health’s Agnesian HealthCare in Fond du Lac, Wisconsin, and the former chief medical officer for the state corrections department. He says, “It was a big decision for a small hospital to do this — it’s a heavy lift up-front to build a unit like this. But it has benefits downstream, so Waupun Memorial Hospital built the unit and dedicated the time and space for it. They did this because they knew it would help the local community and provide the best possible care for that population” of inmates.

Equal care Everyone who enters the secure unit at Waupun Memorial Hospital must pass through a locked door and wait in a locked vestibule until a security officer on the unit confirms their identity and permits entry into the unit’s single corridor.

A nurses’ station, a holding cell for patients awaiting an outpatient clinic appointment, a security post and the patient rooms are accessed from that hall.

The patient rooms are used for inpatient and outpatient visits.

The unit provides nearly 2,000 medical visits annually, including inpatient, outpatient and telemedicine visits for patients who have returned to their prisons. Most of the patients come from the facilities in Waupun and Fox Lake. Although any of Wisconsin’s 36 prisons can send patients to Waupun Memorial Hospital, correctional facilities normally send inmates to the nearest hospital that can supply the needed treatment.

In the Waupun Memorial Hospital unit, inmates receive care from hospital staff, physicians and nurses. Thurmer says, “We set the tone from the start — everyone is to

Hospital’s locked unit is designed to safely confine patients

W

hen building out its locked unit for prisoners, Waupun Memorial Hospital in Waupun, Wisconsin, adhered to the standards and protocols of the Wisconsin Department of Corrections, to ensure the safety of the prisoners and the public, says Heidi Bailey, the hospital’s inpatient manager and liaison to the corrections department.

Bailey says the patient room walls are reinforced with more metal and thicker concrete than other patient rooms in the hospital.

Bailey There are no exposed cords or wires; oxygen, suction and other machines are locked away. A television is the only wall furnishing. There are no mirrors. The toilet and sink in each room is stainless steel and tamper-proof, just

like the ones in prison. Each room has a camera for continual monitoring by the on-site officers; and lights are always on in each room.

Dolores Keel and Shelly Van Den Bogart are among the Waupun Memorial Hospital nurses who staff the unit. They say delivering care on this unit is vastly different from doing so anywhere else in the hospital. An officer always accompanies them and all other clinicians entering a patient’s room. The clinical care would be immediately halted if any safety concerns were to arise — though unit leadership says there have been no such incidents since the unit opened.

The clinicians must always count their sharps and their pens to ensure none have been taken by a patient or left in the room.

Such items could be used as weapons.

—JULIE MINDA

ince it opened the secure unit for prisoners, Waupun Memorial Hospital in Waupun, Wisconsin, has worked with the state’s corrections department to improve the efficiency of the services offered to inmates and to expand the services available to them — both inside and outside of the prison walls.

Kyle Hunter, the hospital’s vice president of patient services and chief nursing officer, says the hospital added telemetry equipment to the locked unit for monitoring heart Hunter rhythms. The output can be read by clinicians outside of the unit.

The hospital’s Fond du Lac Regional Clinic, established a telemedicine connection so that its clinicians can provide follow-up care post-op to prisoners in seven prisons — saving the cost, hassle and danger of prisoner transport to Waupun Memorial Hospital.

The hospital also helped some prisons set up their own dialysis units. And it assisted some prisons in establishing hospice programs, including by using a “train-the-trainer” approach to establish a corps of prisoners who provide hospice services to fellow inmates. Such expansions have been particularly important given the aging popuGill lation of prisoners, notes Nicole Gill, the hospital’s inpatient services director.

—JULIE MINDA

treat them as no different from all the other patients.”

Prison officials, not the hospital’s admitting physicians, decide which patients need services that are not available through their prisons’ health clinics. Services prisoners commonly receive at Waupun Memorial Hospital include emergency care, select laboratory tests, inpatient and outpatient surgery, and specialty care including gastroenterology and orthopedics, according to information from Waupun Memorial Hospital.

Patients who require higher acuity interventions not available at Waupun Memorial Hospital including inpatient dialysis and cardiac catheterizations are sent to Agnesian HealthCare’s St. Agnes Hospital in Fond du Lac, about 20 miles from Waupun.

Most patients in the Waupun Memorial Hospital locked unit are male. Last year, the unit had 704 patient days and 403 surgical cases, and the average length of stay was 3.34 days. This compares to 2.9 days for the rest of the hospital.

With few exceptions, the patients are confined to their rooms in the locked unit until it is time to receive their treatments or procedures. The room doors are locked from the outside hallway. A unit security officer accompanies each patient to medical appointments outside the unit.

Dr. Paul Bekx, medical director for the Wisconsin Department of Corrections, says the partnership between the prison system and the hospital has helped ensure inmates get the excellent care they are entitled to, while also saving prisons money. Since the department operates the locked unit and employs the unit’s dedicated officers — there are a minimum of two officers on duty whenever a patient is in the unit — the individual prisons do not have the added labor cost of providing personnel to guard patients from their respective institutions. jminda@chausa.org