Catholic Health World - November 1, 2021

Heeding earth’s cry 2 ‘At Work’ with Rich Roth 3 Lloyd Dean to retire 7 PERIODICAL RATE PUBLICATION

NOVEMBER 1, 2021 VOLUME 37, NUMBER 17

Dr. Ira Byock makes an Through personal battles with COVID, clinicians gained empathy ethical and business Dr. Nadeem Qureshi was exhausted. case for investing in He’d just returned from teaching overseas and figured he needed a couple of days of rest to shake off the jet lag. As that next week palliative care of late March 2020 progressed, the fatigue

By LISA EISENHAUER

Practitioners strive to preserve the dignity and ‘fullness of life’ for patients facing chronic illness or death

Dr. Nadeem Qureshi, an emergency physician at SSM Health Cardinal Glennon Children’s Hospital in St. Louis, works with physical therapist Jill Roesch at his home in suburban St. Louis. Qureshi spent weeks in the hospital in spring 2020 fighting COVID-19 and is still overcoming lingering effects. His story is among those featured in “Behind the Mask,” a documentary that SSM Health produced about workers on the front line of the pandemic.

Continued on 5

Health facilities ease patients’ access to COVID-fighting treatment

By JULIE MINDA

The role of palliative care practitioners is to relieve the pain and suffering of people with serious illness and to improve their quality of life. Dr. Ira Byock says there has been a great and pressing need for such care throughout the pandemic.

Byock is a leading palliative care physician and founder and chief medical officer of the Institute for Human Caring at Providence St. Joseph Health. That institute aims to promote whole-person care, which it defines as care that is aligned with patients’ goals and based in relationships, and that recognizes each patient’s physical, emotional, social and spiritual needs.

Byock, who has authored or co-authored five books on palliative and end-of-life care, spoke with Catholic Health World about how palliative care is demonstrating its mettle during the pandemic.

Continued on 4

Clinicians emphasize: Monoclonal treatments are not a substitute for vaccines

By JULIE MINDA

For about a year, drugmakers have been rolling out a series of treatments at are helping reduce hospitalization and death in people infected with COVID-19. In recent months, health care facilities across the U.S. have been increasing their use of one such family of drugs, monoclonal antibodies, to improve patient outcomes.

A sampling of Catholic health ministry providers says they have been exploring how best to increase patient access to monoclonal antibody treatments. The drugs are not a fail-safe and providers warn there is a dangerous misperception among some unvaccinated people that monoclonal antibodies make vaccination Continued on 6

Associated Press/ AP Photo/Marta Lavandier

Dr. Ira Byock

A nurse enters a monoclonal antibody site in August at C.B. Smith Park in Pembroke Pines, Florida.

Numerous sites opened around the state to administer the drugmaker Regeneron’s treatment.

Pediatric disaster preparedness SSM Health Cardinal Glennon Children’s Hospital

lingered, a mild fever set in and his sense of taste diminished.

A pediatric emergency medicine physician at SSM Health Cardinal Glennon Children’s Hospital in St. Louis, Qureshi was aware that the World Health Organization had just declared COVID-19, the illness being spread by the novel coronavirus, a pandemic. One of the stopovers in his travels had been in Spain, already a hotspot for the virus.

Nevertheless, as a healthy 55-year-old who’d never spent a day hospitalized, he expected that even if he’d contracted the virus, after a week or two of rest and quarantine, he’d be back on his feet.

Instead, his bout with the virus resulted in a weeks-long hospital stay, much of it attached to a ventilator or extracorporeal

Beth Rhyne, a pediatric nurse practitioner, examines Jamierson Montgomery as he smiles at his mother, Jamie Montgomery, at SSM Health Cardinal Glennon Children’s Hospital in St. Louis.

The hospital is one of the hubs for the newly created Regional Pediatric Pandemic Network, a national effort to expand the number of hospitals capable of caring for children in disasters.

Story on Page 8.

SCL Health to merge with Intermountain Healthcare; SCL hospitals to remain Catholic

By LISA EISENHAUER

SCL Health has announced plans to merge its eight hospitals, 160 physician clinics and other facilities with those of Intermountain Healthcare to create a 33 hospital, 385 clinic system with more than 58,000 employees.

Lydia Jumonville, president and chief executive of SCL Health, said while the integrated system will be secular, the SCL Continued on 8

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CATHOLIC HEALTH WORLD November 1, 2021

Health systems commit to sustainability efforts for the long term Representatives of two of the country’s largest Catholic health systems that have pledged to reduce their environmental impacts say tying the efforts to their systems’ mission, making a long-term commitment, having the support of leadership and collecting data to verify that the efforts are on track are key aspects of the work.

“We know that this work is not instant work,” said Elizabeth Schenk, executive director of enviSchenk ronmental stewardship for Providence St. Joseph Health. “It takes time. It takes persistence. It takes not being intimidated by not finding easy answers because we’re trying to solve a very complex world problem.”

Schenk was one of three speakers who discussed how health care systems can take action to address climate change and environmental degradation during a CHA webinar Sept. 23. The online event marked the Feast of St. Francis, who is revered in part for his devotion to all creatures and called the patron saint of ecologists.

The event’s title was “Cry of the Earth, Cry of the Poor: Reducing Our Carbon Footprint.” Moderator Julie Trocchio, CHA’s senior director of Trocchio community benefit and continuing care, said: “Over the years our concern about climate change has turned to worry, and now it is very serious alarm.”

Trocchio pointed to the grim findings about global warming and its effects that were in recent reports from the United Nations’ Intergovernmental Panel on Climate Change and UNICEF. The UNICEF report, for example, noted that environmental change is putting 1 billion children across the globe at risk of climate-related disasters.

The webinar’s goal was to showcase concrete actions that health care organizations can take and are taking in response to the crisis, Trocchio said.

Pledging to lead Nick Ragone, executive vice president/ chief marketing and communications officer for Ascension, announced his system’s pledge to achieve net zero carbon emissions and waste by 2040.

He said Ascension hopes to set an example for other health care sysRagone tems and for society. “It’s not just making ourselves sustainable, which we will do, but advocating that writ large in our communities and beyond,” Ragone said.

The third speaker was Gary Cohen, president and founder of the nonprofit Health Care Without Harm, which works to transform the health care sector to be environmentally sustainable.

Cohen said the key to addressing climate change is to end the world’s reliance on carbon-emitting fossil fuels for energy, transportation, chemical manufacturing and other uses. He said analyses have shown that in the United States health care is responsible for as much as 10% of all carbon emissions.

“So, the U.S. health care sector has enormous responsibility and opportunity to address its climate footprint and to exercise leadership in our broader societal transformation,” Cohen said.

Global crisis becomes personal He pointed out that not so long ago climate issues were seen by most Americans as something that the world wouldn’t need to address for years. That has changed in

National Interagency Fire Center

By LISA EISENHAUER

A firefighter sprays water on a smoldering giant redwood in the Sequoia National Forest in California in mid-October. Scientists say climate change will lead to more wildfires like those that have ravaged the northwest this summer and fall and destroyed or damaged dozens of the iconic conifers, some of which are hundreds of years old.

recent years as hurricanes, flooding, wildfires and other extreme weather events tied to global warming have grown more common and devastating, he said.

“It’s become a much Cohen more personally felt experience for people on the planet and that creates both a lot of fear and concern but also an enormous amount of opportunity,” Cohen said.

Schenk noted that most of Providence St. Joseph Health’s ministries are in the western U.S., where wildfires and drought have become persistent threats. She said the system created a position of chief sustainability officer several years ago to focus on climate-related issues.

That position has morphed into hers.

She works across the system to engage its caregivers (the system’s term for all staff members) in reducing utility costs, energy use, and waste production and to build resilience in the communities served by Providence St. Joseph Health.

In 2020, Providence announced a pledge to become carbon negative by 2030. “This is an enormous goal,” Schenk said. “We know that because we’re moving ahead of, say, the government and other organizations that we would like to see move faster.”

Systemwide support Schenk said Providence’s pledge has the full support of Dr. Rod Hochman, the system’s president and chief executive. A leadership team called the transformation circle is charged with achieving the pledge’s goals. The team includes leaders from real estate, population health, supply chain and most other divisions of the system and liaisons from each of its seven regions.

In addition, all of the system’s employees are invited to participate in various groups and events related to promoting sustainability. One group, the Action Collaborative for Environmental Stewardship, comes up with ways to celebrate successes and tackle challenges.

Providence has created a framework for its environmental work called WEACT,

which is shorthand for focusing on waste, energy/water, agriculture/food, chemicals and transportation. The framework is used to organize data and projects and for discussion.

In addition, Schenk said Providence is developing a collection of environmentalrelated data that tracks its efforts and can be displayed on a dashboard. The dashboard will offer individual data about the system’s hospitals and facilities and be accessible to each of them.

Setting measurable goals Ragone said Ascension plans similar tracking using data and analytics of its progress toward its goals. “These have to be measurable goals, they can’t just be some feel-good platitudes that we put out in October of 2021 and then we forget about,” he said.

The Ascension effort has the full backing of Joseph Impicciche, president and chief executive, and is being led by Craig Cordola, executive vice president and chief operating officer, Ragone said.

Vice President Communications and Marketing Brian P. Reardon

Editor Judith VandeWater jvandewater@chausa.org 314-253-3410 Associate Editor Julie Minda jminda@chausa.org 314-253-3412 Associate Editor Lisa Eisenhauer leisenhauer@chausa.org 314-253-3437

It is based on three pillars — making use of energy efficiency and renewable energy in workplaces, creating an environmentally responsible supply chain and fostering healthy communities. A new environmental impact office will facilitate the work and oversee communications, data management, change management and governance.

Ragone said addressing climate issues aligns with Ascension’s Catholic mission to be a good environmental steward and to serve the poor and vulnerable.

He noted that the harsher toll of the COVID-19 pandemic on those who are poor and on people of color underscores that certain populations are at a disadvantage in crises. “It’s sort of further illuminated that schism with health inequity in our society,” Ragone said.

Each of the speakers discussed how the pandemic spotlighted health inequities that are also apparent in the disproportionate effects of global warming on the most vulnerable. Cohen noted that environmental activists and health equity champions who once worked separately on their issues are uniting around the health impacts of climate change.

“There’s this integrated vision coming forward now where people understand that COVID was a force multiplier for all those racial, economic and health inequities,” he said. “Climate is that as well — on steroids.”

Other initiatives Like Providence, Ragone said Ascension is counting on all of its associates to contribute to its environmental efforts and on seeing those efforts cascade and spur changes across the communities the system serves.

“We are so delighted to be able to help Catholic health care lead on this very important issue and I hope that leadership inspires the rest of health care to think about what their role is, what’s their responsibility to create longer-term sustainability,” Ragone said.

Trocchio noted that the majority of CHA’s members have committed to the association’s Confronting Racism by Achieving Health Equity initiative. She added that the fall issue of CHA’s journal Health Progress is devoted to environmental issues and features articles on the work being done by several systems.

She invited CHA members to take part in the Climate Action Collaborative that the National Academy of Medicine launched Sept. 28 and to sign onto a Climate Action Letter that the Catholic Climate Covenant plans to send to the Biden Administration and Congress this fall urging action on climate change. leisenhauer@chausa.org

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November 1, 2021 CATHOLIC HEALTH WORLD

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CommonSpirit’s Rich Roth embeds, sharpens and drives innovation Editor’s note: This story is part of an occasional series in which people talk about their jobs in the Catholic health ministry.

We invite readers to recommend themselves or colleagues for stories that will show the diversity of jobs, skills and people that make the ministry vibrant. To do so, send an email to jvandewater@chausa.org with “At Work” in the subject line.

administrative peers on how to move a project forward. Some are problem-solving sessions with financial or legal experts. Others involve reporting to community partners.

He also spends about 25% of his time as co-manager of CommonSpirit’s Strategic Investment Fund, which is invested exclusively in companies that partner with the health system to develop products and services. “Often, when we’re early in our relationship with companies we also invest in them. We recognize that it’s hard to work with early innovations and to scale them,” he says.

“In between that, I often have to pick up my kids, and take them to their sporting or club events. I have a regular family life. It’s super easy to be consumed. If you don’t take care of yourself, you risk everything breaking down.”

By KATHLEEN NELSON

Rich Roth knows “innovation” is an expansive term, one open to many definitions. So, as senior AT WORK vice president and chief strategic innovation officer for CommonSpirit Health, Roth has a crisp, elevator speech that encapsulates his team’s approach to innovation.

“This type of innovation is looking three to five years into the future to see what we think health care will be like, then to pull that future forward,” he says.

Roth and his team of six lead the system’s effort to create, test and scale three to five services, programs, partnerships or technologies a year that can reduce costs, improve quality and increase access to services. When their work is most successful, they share the results so other health systems and partners benefit as well.

Laying the groundwork After earning a master’s degree in health administration in 2004, Roth earned a fellowship with Catholic Healthcare West, which rebranded as Dignity Health in 2012 and aligned with CHI to form CommonSpirit in 2019. “I was stapling board packets and running to the copier,” he says. He was assigned a project focused on scaling community assets to address poor housing, unsafe streets, substandard education and a lack of job opportunities that keep people trapped in poverty and contribute to poor health and shorter life spans.

“We were looking at how to apply analytical discipline to community benefit” by making investments aimed at improving social determinants of health, he says.

The assessment tool and subsequent research he guided in partnership with IBM Watson Health revealed that residents

Concrete success Among the projects that Roth is most proud of is what he characterizes as the Rich Roth and his 14-year-old daughter, Lia, enjoy a vacation hike in Montana. Roth, the senior vice presifirst partnership in the country to prodent and chief strategic innovation officer for CommonSpirit Health, considers work-life balance essential duce a digital therapeutic device with GPS to his productivity and well-being. tracking. Working with Propeller Health, CommonSpirit developed a sensor that of communities with the greatest barriers area. You really need to get ownership from attaches to an asthma inhaler that records to health care achieved higher assessment operational leaders for the long term. If your where, when and how often the inhaler is scores and were twice as likely to be hos- goal is sustainability and greater impact, used and identifies triggers like air quality pitalized for such conditions as asthma, you have to bring people in early and bring and pollen count so that doctors have betpneumonia or congestive heart failure as them along.” ter data and can prescribe treatment more were residents of communities with the effectively. lowest scores for barriers to health care.

A typical day Originally designed for children with Catholic Healthcare West shared the Roth starts nearly every morning with a asthma, use of the device has expanded to tool, the Community Need Index, with workout and frequently walks to his office patients with cardio obstructive pulmonary almost 50 health systems and commu- in San Francisco, taking a disease, or COPD. nity organizations nationwide to identify phone meeting along the Just as important as “We realized that any health disparities, assess need and strate- way. He also sets aside the device and its utility gically allocate resources to improve peo- time each day for learn- employee can come up is the research structure ple’s lives. ing, poring over articles it. The clinical with an idea that can behind “That got me into innovation,” Roth says. in journals, browsing research trial in 2013 was “We realized that any employee can come Twitter and reading innobenefit not just their among the first in digital up with an idea that can benefit not just vation blogs from other health to include patients their department or system but health care industries or venture cap- department or system from a broad spectrum of as a whole.” ital websites. geographical and sociobut health care as After committing to this type of innovaThe rest is devoted to economic diversity. The tion, the system decided that rather than set meetings — sometimes 490 participants, from a whole.” up a separate innovation lab or facility, Roth trouble-shooting, some5 to 80 years old, saw a — Rich Roth and his staff would embed their innovation times advancing proj54% reduction in visits to efforts throughout operations. “At the end ects. Some meetings are the emergency departof the day, the innovation has to benefit the updates from his team on current projects. ment and improved outcomes. operation and cost benefit returns to their At others, he connects with clinical staff or “We managed to prove value, so that someone would pay for it and a clinician would believe in it,” Roth says. “The clinical trial was the largest piece of evidence on digital health in the country. It led to the next generation realizing that they had to do clinical research and that it needed to include a cross section of society.”

Upcoming Events from The Catholic Health Association Global Health Networking Zoom Call Nov. 3 | Noon ET

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31 flavors Roth gets excited about the possibilities of differentiating and personalizing care. “I use the 31 flavors analogy,” he says.

“A lot of times health care scoops a lot of vanilla to their patients and customers. It’s safe, but some people like butter brickle or cherry.” So, CommonSpirit is exploring the development of alternate pathways to care that meet people where they are, “differentiated models for seniors or women or ethnic groups that would have a different flavor than the standard choice.” For example, care for seniors might be more community focused than medically focused.

Care for women might be staffed and led by women.

As health care systems continue the shift from hospital-based care to disease prevention and wellness, Roth says, the model of care expands beyond health care “to something much more like the social services ecosystem. Catholic health systems have a leg up because they understand the person as a whole and because of the partnerships that we form with nonprofit entities. I think we have a better shot at caring for people in that model because that’s been our mission since the beginning.”

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CATHOLIC HEALTH WORLD November 1, 2021

Byock

expensive treatments, without pausing to consider if that is in their best interests — from their perspective.

In American medicine, the prevailing assumption is that more is better. But palliative care practitioners know that often that is not the case. An analytics team at the institute has been showing the real value in aligning what we do in terms of treatment with what people want. The work is also highlighting for senior leadership the important value of palliative care. It’s helping us to support the case of expanding palliative care teams. Another advantage of doing this is that expansion can help alleviate the burden on clinicians outside of palliative care teams.

From page 1

The conversation has been lightly edited for length.

What has the pandemic taught the U.S. about palliative care?

Never in the history of palliative care has the value of this skillset been highlighted as it has during the pandemic. The importance of examining our mortality has become paramount and it’s become clear that all of health care occurs against the backdrop of human mortality.

What are the main challenges of providing palliative care in a pandemic?

The main difficulty is that there are not enough palliative care providers to go around. The teams are incredibly strained and stretched, and they are showing obvious signs of wear and tear. A year ago, our palliative care teams were running on fumes and were exhausted emotionally and physically. By late 2020, the fumes were gone, and they were dragging themselves to work, and we were really worried by spring.

Then we had a break as vaccination spread and outbreaks went down. Palliative care providers were taking vacations and turning to focus on self-care.

But then the delta surge hit, and we’re again legitimately worried about their health and emotional well-being.

Has palliative care staffing been adequate, given demand?

It is important that we acknowledge that the pandemic showed us that there is a shortage of palliative care practitioners, including in Catholic health care. One can

This poster from Providence St. Joseph Health’s Institute for Human Caring can be affixed to a wall in a patient room. It prompts caregivers to get to know their patients as individuals. It’s also available in Spanish.

hardly exaggerate how stretched our clinical teams are, including our palliative care teams.

There has been, in the past, a tolerance for maintaining threadbare palliative care programs. For instance, there are so many palliative care programs that are just available during weekdays or are closed on holidays. Suffering does not take a holiday.

Now, with the pandemic, those deficiencies are very hard to ignore.

Within Providence, we’ve been calling attention to the need to expand palliative care staffing for a long time. Our data showed that there were significant numbers of patients with unmet needs for palliative care. Because of the pandemic, the consequences of not having expanded staffing are more obvious to all.

How are you making the case for increasing the number of palliative care practitioners?

We at the Institute for Human Caring and at our Palliative Practice Group have used this crisis to measure the impact of palliative care. We have shown how it improves the quality of the patient experience and is cost effective in terms of measures like bed use.

Can we improve quality while also diminishing the use of highly burdensome and nonbeneficial care? If so, this is another aspect of a business case for expanding palliative care resources. It’s worth looking at the best clinical protocols for situations in which health care resources are severely limited and patients are being given the most aggressive and

St. Joseph’s palliative care team ready for patient surges T

his January, the emergency department at Providence St. Joseph Hospital had a peak daily census of 267 COVID-19 patients — more than double the count during a July 2020 caseload spike.

Dr. Brian Boyd is program director for palliative care medicine at the Orange, California, hospital, medical director for the hospital’s home health services and the hospital’s chief of staff.

He says that while most emergency department clinicians at St. Joseph Boyd know that palliative care services are available to help patients articulate their goals of care, they have not always been able to prioritize linking people who are seriously ill with COVID to palliative care team members. This proved especially true amid onslaughts of patients early in the pandemic.

To help ensure COVID patients in the emergency room connect with palliative care providers during what Boyd calls the “golden time” — when they generally are lucid enough to communicate and before they are intubated — St. Joseph late last year established a Goals of Care Center. Boyd says it is especially important to have a palliative care staffer talk to patients and families when there is concern that the invasive intubation could be futile, when patients have low health literacy, or when there is a need to involve family not available at the bedside.

While that center was decommissioned 11 weeks after it opened because the surge of COVID patients had ended, Boyd says the approach worked well.

The palliative care service saw about 125 COVID patients in the ER during that period. Now, a palliative care social worker works five days a week in the ER. St. Joseph is prepared to reactivate the center if another spike occurs. And the center is serving as a model for other Providence emergency departments preparing for future surges.

Boyd says, “Our palliative care team has been revealed as the best kept secret in the hospital. There has been greater utilization of our team’s services (during

CHA offers resources on palliative care delivery

CHA offers palliative care tools including advocacy information, an advance care planning guide, spiritual care materials, social media infographics, programming development guides and articles at chausa.org/palliative/palliative-care.

Among the resources is “Living Well with Serious Illness,” a resource for patients. It is part of a series of publications that CHA created in collaboration with physicians, nurses, theologians and ethicists.

Palliative care teams will find resources including “Honoring the Spiritual Dimension of Palliative Care.”

It guides palliative care teams through conversations about integrating spiritual care into palliative care delivery. pandemic-related spikes) with our routine census roughly tripling.”

Immediate consult

The Goals of Care Center’s palliative care specialists — including doctors, nurse practitioners, nurses and social workers trained in palliative care — maintained an in-person or virtual presence in the emergency department during peak hours.

With the decommissioning of the team, these practitioners have returned to their regular duties at St. Joseph. Boyd says a dedicated palliative care chaplain will be part of the Goals of Care Center should it be pressed back into service.

During their initial run, team members met with the sickest COVID inpatients to discuss treatment options and prognosis so the patients could make informed decisions about invasive interventions and articulate their goals of care.

Palliative care specialists and emergency department staff members together identified patients who would benefit from goals of care consults. When possible, the palliative care specialists would bring into the conversation loved ones whom the patients wanted involved. Due to visitor prohibitions early in the pandemic, many times loved ones had to join the conversation via videoconference. Medical translators were

brought in by phone or videoconference.

Boyd says the conversations occurred with both the patients and, separately, their attending physicians and revolved around the realities of the patients’ condition, the interventions that might be used and the implications of different interventions. They talked about what the patients’ goals were, what interventions were acceptable to the patients, what palliative care measures such as additional pain control were desired and which loved ones should be making decisions if the patients are unable to make them.

The palliative care specialists assisted the patients in documenting decisions, particularly regarding advance directives and followed up with patients, loved ones and clinical team members.

Building the program

Boyd says he and his colleagues had been in conversation with Dr. Ira Byock and other Providence system palliative care experts before the hospital’s first COVID surge about how to improve the way palliative care practitioners provide services to emergency department patients at St. Joseph. Byock is founder and chief medical officer of the Institute for Human Caring at Providence.

Prior to 2020, specific clinicians in the emergency department were responsible for ordering palliative care consults. But, under this system, not all patients who could benefit from the consults received them. Also, referrals for consults were not always made at the best time.

Other Providence hospitals have found that embedding a palliative care social worker in the emergency department improves patient access to palliative care.

St. Joseph was preparing in early 2020 to put a social worker with hospice experience in the ER when its first COVID surge began.

Given the exigencies, Byock recommended that St. Joseph find a way to further increase its presence in the emergency department.

The Institute for Human Caring aided the St. Joseph palliative care department in creating the Goals of Care Center. The palliative care department initially had the equivalent of one and a half physicians, three nurse practitioners, half the time of one social worker and half the time of a per diem social worker. Leading up to the December 2020

What are some of the roles palliative care practitioners have had during the pandemic?

When it comes to palliative care, it is less about fancy new drug treatments and more about the basics: helping patients understand the treatments for their medical condition, updating them on the physiological aspects of what is happening, and helping the patients and families stay in touch and feel connected.

During the pandemic some of the most poignant roles of palliative care team members have been just holding an iPad so patients and family members can visit, given the visitation restrictions of infection control protocols. They have been part of patient and family meetings. These can be emotional and painful conversations.

It is worth noting that our palliative care teams provide just-in-time resources to guide our non-palliative care colleagues in having conversations about patients’ wishes, and we’ve been providing clinicians launch of the center, the department added two full-time social workers and two nurses.

The department also began to use videoconferencing to enable palliative care physicians and other specialists from sister Providence sites to provide consults.

Boyd said the video connection allowed practitioners to pick up on body language clues that could guide their conversations.

The “pop-up” center provided physical or virtual coverage in the St. Joseph emergency department weekdays between 6 p.m. and 10 p.m. In addition, the palliative care staff worked many other hours beyond those times, the hospital said.

Model

Boyd estimates only about 20% of patients who arrive in the emergency department have their advance care wishes documented in the hospital’s medical records system. He says that of the COVID-infected patients who come to the emergency department, about half are able to speak and have the mental cogency to have advance planning conversations. Another 25% or so can have such conversations but are challenged to do so because of their condition. The remainder are unable to have the conversation.

Boyd says it’s the rare patient who arrives in the ER with a full understanding of the implications of different interventions or of the likelihood of his or her survival.

He says that by having these difficult conversations with patients, and by documenting their wishes, he and his colleagues can ease the burden of decisionmaking for the families of patients who can no longer make the decisions themselves. Boyd says his team also is lifting a big burden from emergency department staff, as goals of care conversations are time consuming. Without advance directives, clinicians often have to make critical care choices in a vacuum.

Providence is expanding the Goals of Care team structure to respond to patient surges within its 51-hospital network.

Boyd says when he thinks of the value the center can add for patients, he thinks of Providence’s promise: “Know me, care for me, ease my way.”

— JULIE MINDA

November 1, 2021 CATHOLIC HEALTH WORLD

with tangible resources to facilitate communication as well as symptom management. It is important for frontline clinicians to have these resources.

In many ministries palliative care teams became involved in policy and protocol development to deal with critical issues such as visitation and the use of medical resources like personal protective equipment and ventilators. This invitation into operational leadership is occurring organically.

What are the main practical challenges to delivering on the promise of wholeperson care?

Personal protective equipment has been essential but is obviously a physical barrier to touching patients and to being seen as a person by our patients. We have been sorely aware of the lack of family at the bedside and the difficulties with visitation. Even now, visits are limited to one or two family members. Before the pandemic we encouraged families to visit, bring children, and spend extended time with seriously ill and dying patients. This has been the most difficult strain of this situation.

Families of lower socioeconomic means, who are among those underserved by American health care, have suffered a disproportionate share of COVID-related sickness. I’ve met multigenerational families living in a single household in which everyone in the home was infected with COVID19 and the matriarch and patriarch both died.

What have the limits of the pandemic meant for the delivery of palliative care?

It has been very hard to deliver on the full potential of palliative care to ease people’s way. The constellation of factors we’ve discussed — the intensity of the disease and its often-rapid progression, the physical and social barriers required for safety, and our staffing challenges — all inhibited our abilities to provide care to our highest aspirations.

The fullness of human caring involves not just saving and prolonging life, but also doing what patients would value even if a cure is unlikely or impossible. These poignant times offer a chance for them to complete their lives, say things that have been unsaid, express forgiveness and love, and achieve a sense of well-being. People are more than just bodies; we can love, feel loved and experience moments of joy before we die. With our families we can honor and celebrate life and relationships.

This is the fullness of life, that palliative care teams strive to preserve.

Now, we can’t put lipstick on this pandemic pig. I wish it were otherwise, but many patients are not getting this comprehensive level of care because of the impacts of this pandemic. Palliative care practi– tioners have had an unflagging commitment to delivering the fullness of human caring and we’ve tried to do it in an innovative way. In aiming high, even during these difficult times, we have still been able to give really good care.

How are people dying during the pandemic?

Often, not as well as we would wish. We don’t have the workforce to always hit the high mark we aim toward. But we’ve been doing the best we can. We have remained attentive to the dignity of our patients and their pain has been well treated.

Thankfully, we have not had to compromise on the fundamental elements of caring. There’s been no shortages of essential medications to alleviate physical suffering.

Patients are living and dying in clean, dry beds. We’ve been finding ways of connecting people within their families and of supporting those families in their emotional suffering and grief.

That is something we can be proud of, that we are continuing to honor their inherent human dignity and worth. jminda@chausa.org

Clinicians with COVID From page 1

membrane oxygenation machine.

“It’s been a long, challenging road,” says Qureshi, who a year and a half later continues to recover from effects of the virus.

No one is tracking the number of health care workers who have contracted the virus amid the ongoing pandemic, but a joint investigation by The Guardian and Kaiser Health News found that during its first year at least 3,600 U.S. medical workers died of COVID-19.

Octave LeDuff, a patient care technician at St. Joseph Mercy Oakland in Michigan, says that with outside visitors prohibited, visits from his colleagues helped him endure more than two months of hospitalization for COVID-19.

Qureshi considers his bout a brush with death. Octave LeDuff, a patient care technician at St. Joseph Mercy Oakland in Michigan, also considers himself fortunate to have survived after spending 71 days hospitalized with COVID complications. Another COVID patient, Dr. Edward Pyun, trauma medical director for Good Pyun Samaritan Medical Center in Lafayette, Colorado, endured a tough, though not life-threatening, ordeal with several days in the hospital.

All three say they came away from the experience with more compassion for patients.

From dehydration to intubation It was two other ER doctors — one his son and the other a good friend — who convinced Qureshi after several days of illness to go to the hospital to at least get treatment for dehydration.

He remembers the ambulance crew tried to convince him to stay home because he was strong enough to walk to the door to greet them and his symptoms seemed fairly mild. They warned him that he was risking exposure to the virus if he didn’t have it. He, his son and his friend prevailed.

At the hospital, tests showed that Qureshi’s oxygen saturation level was dangerously low. The doctors told him: “You’re not going to be going home.” They put him on hydration fluids and sent him to the intensive care unit for observation.

Within six hours, as his condition deteriorated, Qureshi was intubated.

Too early for conventional therapy He has little memory of the few weeks that followed. He was on a ventilator, and when his vital signs indicated that his heart and lungs were overwhelmed, he was hooked up to extracorporeal membrane oxygenation. He also suffered kidney failure, stroke and inflammatory response syndrome with markers that his doctors told him were off the charts.

It was so early in the pandemic, there was no conventional therapy. His doctors at an academic medical center con-

5

sulted with peers across the country about “I was so glad that I was at the hospitreatment options. Among the therapies tal where I worked because at that time they tried was a monoclonal antibody you couldn’t have visitors,” he recalls. “I drug, a treatment that the Food and Drug couldn’t have my kids, my wife, nobody Administration has come in. To see peosince given emer“I was so glad that I was ple that you know in gency approval for use the workplace made it at the hospital where I much better. It made in mild to moderate COVID cases. the ride much easier.” worked because at that After about 21 days LeDuff ’s illness in the ICU Qureshi was time you couldn’t have began with a fever in able to breathe withNovember 2020. When visitors.” out machines. He’s still his temperature spiked unsure of how he surto 102, his wife per— Octave LeDuff vived. “In a nutshell, suaded him that an they call me a miracle ambulance should be survivor, having multiple organs fail, the called. En route to the hospital, he began mortality was about 98, 99%,” Qureshi struggling to breathe. At the hospital, he says. was put on a continuous positive airway pressure, or CPAP, machine to force more Slowly recovering air into his lungs.

His hospital stay was followed by two When that didn’t raise the dangerously weeks at an inpatient rehab center rebuild- low level of oxygen in his blood, doctors ing his strength to walk and perform other sent LeDuff to the ICU. He spent a week basic activities. He then returned to his on a ventilator before recovering enough home in suburban St. Louis, where he lung capacity to breathe on his own. Still continued to get care from visiting nurses gravely ill, he was moved to a step-down and therapists for several months.

COVID unit, where he remained for two Late this summer, Qureshi was eas- months. Before he was released from the ing his way back to work, starting with hospital in January, he says he needed rehab to relearn how to walk and feed himself.

“I thank God that he let me pull through that situation,” LeDuff says.

He says his worst days of his illness are a blur. “I ask my wife and she says. ‘Maybe it’s best that you don’t remember,’” LeDuff says.

By late summer, he still felt out of breath occasionally, but he put his recovery at 90%. He was vaccinated and back on the job, screening patients and visitors in the ER for symptoms of COVID. He urges people to wash their hands, mask up and take whatever additional precautions they can to avoid the virus. “A lot of people don’t think COVID is real,” he says. “I’m a living testimony that COVID is real and COVID does kill, too.”

Fatigue, isolation Pyun came down with COVID in July 2020. More than a year Dr. Nadeem Qureshi is greeted by his son, Dr. Moiz Qureshi, as later, he still has occasional mild he leaves the hospital after a near-fatal bout of COVID-19. Both flu-like symptoms that he susmen are emergency physicians. Because of COVID protocols, pects might be lingering effects they had only been able to see each other by video for weeks. of the illness.

His symptoms started with a resuming some online teaching. In time, low fever and a cough the day after he got when he is able to return to his job as an back from a vacation. The Good SamariER doctor, he knows he will demonstrate tan Medical Center’s human resources a strengthened commitment to compas- department required him to get tested for sionate care.

COVID. When the test came back positive, “I was in a very difficult situation,” he thought he’d shake the virus in a few he recalls of his acute illness. “And at days. that point, each and every person who After a few days, he felt bad enough to extended their support to do something a admit himself to Good Samaritan. little extra to what their required response “I never want to go through that again, already was, it went a long way. It meant a the fatigue, fighting something that’s lot to me.” invisible,” he says. “There’s no quick treatWhen he chats with his caregivers or ment for this problem plus you’re isolated, speaks on professional panels at sympo- it still feels like you’re alone in the world.” siums, he urges clinicians to make those little extra efforts — asking patients if they Lesson in empathy need a drink of water, a readjustment in Pyun went home after five days. He their bed, an extra blanket — a regular still needed supplemental oxygen and his part of their rounds. balance was so off he feared he would fall “The medical care should not be lim- down the stairs at his home. Late in the ited, in my opinion, to just the medi- summer of 2020, after a month and a half cine, imaging, lab test aspect,” Qureshi of infection and not yet fully recovered, he says. “The patient should be treated in returned to work. a holistic manner, and his physiological He brought with him insight into the needs should be addressed. They are our experience of desperately ill patients. responsibility.”

“If you do any medical work at all, after a period of time you can get a little jaded, I In the care of colleagues guess would be the right word,” Pyun says.

LeDuff, 53, says one of the things that Knowing what it’s like to be very sick rallied him during his long hospitaliza- and vulnerable, Pyun says he remembers tion with COVID was visits and encour- to take a step back and try to understand agement from his colleagues. His career at what his patients are going through emoSt. Joseph Mercy Oakland spans 25 years. tionally and physically.

6

CATHOLIC HEALTH WORLD November 1, 2021

Monoclonal treatments From page 1

unnecessary.

Dr. Syed Raza calls that view “wacky, and a fundamental misunderstanding of public health.” Raza is vice president of medical operations for St. Luke’s Health-The Woodlands Hospital, a CommonSpirit Health hospital near Houston.

“The vaccines are being used as a preventive tool on a wide scale to change and improve public health and decrease the incidence of large-scale illness,” whereas the monoclonal treatments are an imperfect, reactive measure that must be administered within a tight time window and so carry a much higher risk of poor outcomes for patients than do the vaccines, he says.

He adds, “waiting to get COVID and expecting to rely on monoclonal antibody treatments to get better is like playing Russian roulette.”

All the ministry providers who spoke with Catholic Health World emphasize that vaccines remain the first line defense for COVID, and, while monoclonals have proven effective in reducing the severity of COVID infection, their limitations make them a far inferior protection from COVID than vaccines.

Dr. Steven Standaert, medical director for antimicrobial stewardship Standaert for Providence St. Joseph Health’s southwest region, says, “Given the complexity and risk associated with using monoclonals, there is a great misunderstanding among the general public about how they should be used. This is not equivalent to the vaccine. This is not the miracle cure.”

Emergency use According to the Food and Drug Administration, monoclonal antibodies “are laboratory-made proteins that mimic the immune system’s ability to fight off harmful pathogens such as viruses.” Over the past year, the FDA has granted emergency use authorizations for five different monoclonal antibody drugs, used either individually or in combination.

Providers have been switching among the different monoclonals, based on their availability and efficacy against a particular variant of the virus.

The monoclonals most in use currently, according to those who spoke to Catholic Health World, are REGEN-COV, which is a combination of the drugs casirivimab and imdevimab and can be delivered by subcutaneous injection or intravenously; and a cocktail made up of the drugs bamlanivimab and etesevimab, which only can be given intravenously. The REGEN-COV doses are given in four injections, three minutes apart; and the monoclonals given intravenously take an hour to infuse. An hour of observation is needed after any of these treatments.

Hospitalization reduction The drugs are optimally used within 10 days of COVID symptom onset for people at high risk of having serious complications from the virus and/or requiring hospitalization. The drugs also can be used prophylactically for people in high-risk categories who have been exposed to COVID but who have not tested positive. The drugs are approved on an emergency use basis for patients ages 12 and up.

Dr. Douglas Waite, Covenant Health senior vice president and chief medical officer, says research shows that when given early enough in the COVID disease progresWaite sion, monoclonals can reduce the risk of hospitalization and death by nearly 80% for those at higher risk of severe disease. He said most of Covenant’s patients who have taken monoclonals have

Dr. Syed Raza

seen their symptoms reduced and have avoided hospitalization.

While both vaccinated and unvaccinated people can take the monoclonals, the vast majority of people needing the drugs are those who cannot or will not be vaccinated, according to the clinicians who spoke to Catholic Health World. The federal government purchased monoclonal antibodies and so the drugs are available at no cost to patients. While Medicare and Medicaid pay for administration of the drugs, coverage under private insurance varies, according to the Department of Health and Human Services.

Patients need a prescription or an order from a medical provider to receive monoclonal treatment.

Seeking efficiencies Providence St. Joseph Health hospitals throughout the system’s five-state service area have been administering monoclonals, and some have set up clinics for this purpose.

Standaert says despite monoclonals’ effectiveness, the therapy can present challenges for providers. For instance, the administration process is staff-intensive, and there is a workforce shortage. Monoclonals at times have been in short supply.

Standaert says to gain efficiency and take the load off of swamped emergency departments, two Washington state hospitals teamed up to open an outpatient clinic to administer monoclonal antibody treatments that had been given in their ERs. PeaceHealth Chief Physician Officer Dr. Doug Koekkoek says that the northwestern U.S. health care system has been administering monocloKoekkoek nal therapy in the three states where it operates, with its largest hospitals setting up infusion centers and its rural critical access hospitals injecting or infusing the drugs in their emergency departments. He says while COVID surges have driven demand, the spikes have been manageable in most of the communities PeaceHealth serves.

With relatively high vaccination rates in many of those communities, the need for monoclonals has rarely outstripped PeaceHealth’s supply. In late summer, seven states with relatively low vaccination rates had dominated when it came to monoclonal orders, prompting the federal government to intervene by buying up monoclonal supplies and taking over distribution of those drugs. Most state health departments also play a role in distribution of monoclonal antibodies.

The Woodlands is among the CommonSpirit hospitals that opened infusion clinics when influxes of patients seeking monoclonals stressed already busy emergency departments during surges.

The Woodlands partnered with the Texas and Montgomery County health departments and HCA HoustonHealthcare

bial stewardship pharmacist, says COVID-positive patients are not infused in the same physical space as COVID-negative patients or cancer patients receiving immunotherapy drugs.

The hospital recommisioned an unused infusion room in its main building as its monoclonal clinic for COVID patients.

Amanda Kraus, the clinic’s director of operations, says the facility premixes the monoclonal cocktail to cut patients’ throughput time. And it has paired family members seeking treatment into one infusion bay to free up other bays for additional patients.

Waite says Covenant, which operates in six northeastern U.S. states, administers monoclonal drugs to outpatients in all its hospitals. In midJeannine Simonsen was among the first to be treated in a monocloOctober, Covenant’s Bannal antibody treatment clinic set up by PeaceHealth in Vancouver, gor, Maine, hospital, St. Washington. She and her mother both were COVID-positive and both Joseph Healthcare, set received treatment on the same day in September at the clinic. up a dedicated monoclonal infusion clinic on Conroe to convert a section of a shuttered its campus for outpatients. In its skilled hospital into an infusion center. The state nursing facilities, including on short-term and county and the two hospitals are pro- rehab units, the monoclonals have been viding staffing for the center. used in the care of individual residents who Raza says that site can infuse about qualify for the experimental treatment, or 150 patients per day, compared to a half when several staff or residents test positive dozen in the hospital’s emergency depart- for COVID, to reduce the risk of infection ment. The Woodlands deployed infusion spread to patients. teams on a mobile unit during the worst of Ascension Sacred Heart in Pensacola, the surges, to treat patients in their homes Florida, is among the Ascension hospitals when they could not travel to the clinic. with dedicated monoclonal antibody treatMercy Hospital Oklahoma City, part of ment clinics for COVID patients. Currently, the Chesterfield, Missouri-based Mercy Sacred Heart operates an antibody clinic for system, set up a monoclonal infusion clinic pregnant women — it is located in the hosamid high patient demand. As of mid-Octo- pital’s obstetric emergency department. ber, its clinic was still treating patients six days a week. jminda@chausa.org Eric Flaming, the hospital’s antimicro-

“In the diversity of peoples who experience the gift of God, each in accordance with its own culture, the Church expresses her genuine catholicity and shows forth the ‘beauty of her varied face.’”

POPE FRANCIS | Evangelii Gaudium (Joy of the Gospel), #116 | 2013

OVER THE PAST YEAR, OUR MINISTRY HAS COME TOGETHER AND PLEDGED TO CONFRONT RACISM BY ACHIEVING HEALTH EQUITY. WE INVITE MEMBERS WHO HAVE NOT YET SIGNED THE PLEDGE TO JOIN US.

Learn more at WeAreCalled.org

November 1, 2021 CATHOLIC HEALTH WORLD

7

Lloyd H. Dean to step down as CommonSpirit chief executive in 2022 Lloyd H. Dean, chief executive of CommonSpirit Health, plans to retire next summer after 22 years as a national leader in the Catholic health ministry.

He had a leading role in the February 2019 merger of Dignity Health and Catholic Health Initiatives that created CommonSpirit Health, the nation’s largest Catholic health system, and he continues to lead system integration. The Chicago-based system has 140 hospitals, 1,500 care sites, 150,000 employees and physicians across 21 states.

Dean, 71, had been chief executive of Dignity Health (previously Catholic Healthcare West) for 19 years before the merger.

Initially, he shared the chief executive responsibilities at CommonSpirit Health with Kevin E. Lofton, who had been chief executive of CHI. Dean has been CommonSpirit Health’s sole chief executive since

Lofton’s retirement in June 2020.

Tessie Guillermo, chair of CommonSpirit’s Board of Stewardship Trustees, said in the press release announcing Dean’s plans that he has been “one of our country’s leading voices for expanding access to quality health care.”

Guillermo added: “Lloyd steered our organization through one of the most important periods for health care in our country’s history, and we will forever be grateful for his leadership.”

Dean said in the press release that heading CommonSpirit has been “the job of my life and I cannot overstate how much I have enjoyed every moment of it nor how much I believe in the future of CommonSpirit Health.”

“I’m looking forward to the next year during which I plan to advance our strategic priorities, ensure our patients are receiv-

U.S. Postal Service STATEMENT OF OWNERSHIP, MANAGEMENT, AND CIRCULATION (Required by 39 U.S.C. 3685) 1. Publication title: Catholic Health World 2. Publication number: 8756-4068 3. Filing date: Nov. 1, 2021 4. Issue frequency: Semimonthly except monthly in January, April, July and October.

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editor, and managing editor: Catholic Health Association, publisher; Judith VandeWater, editor; Julie Minda and Lisa Eisenhauer, associate editors; 4455 Woodson Rd., St. Louis, MO 63134-3797 10. Owner: The Catholic Health Association of the United States, 4455 Woodson Rd., St. Louis, MO 63134-3797 11. Known bondholders, mortgagees, and other security holders: None.

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410 0

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1,389 14,094 354 14,448 90.14%

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I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material or information requested on the form may be subject to criminal sanctions and/or civil sanctions. Judith VandeWater, editor.

Share the joy of the season with a Christmas message to the ministry Include your organization’s Christmas message in the Dec. 15 issue of

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Lloyd H. Dean

ing the very best care possible, support our caregivers, do everything I can to help end this pandemic, and continue to advocate for health equity and social justice in this extraordinary country,” he said.

A crusader for health equity, Dean cites with pride CommonSpirit’s $100 million commitment to increase the number of black doctors and culturally competent clinicians in the U.S. through a partnership with Morehouse School of Medicine. Dean also has been a strong advocate for environmental stewardship. Earlier this year, he

joined the governor of Washington and the mayor of Charlotte, North Carolina, as cochair of America Is All In, a partnership of communities, businesses and institutions focused on addressing climate change.

Dean served on the CHA Board of Trustees from July 2002 to June 2010, and was chair of that body from July 2008 to June 2009 in the run-up to the passage of the Affordable Care Act. He was an outspoken advocate for the legislation, which expanded health insurance coverage to millions of uninsured Americans.

Sr. Mary Haddad, RSM, CHA’s president and chief executive officer, said: “Lloyd Dean’s retirement will mark the end of an era in Catholic health care. Starting with Catholic Health West to Dignity Health and now CommonSpirit Health, Lloyd has been a fearless leader advocating for accessible and affordable quality health care for all. His vision, commitment to mission and style of personal engagement are attributes that set him apart and contribute to his great success. He will be sorely missed throughout the ministry.”

In identifying candidates to succeed Dean, the executive search committee of the CommonSpirit board will be assisted by Russell Reynolds Associates.

Patricia Cahill, first president and chief executive of CHI, dies Patricia A. Cahill, founding president and chief executive of Catholic Health Initiatives, died Oct. 2 in East Sandwich, Massachusetts. She was 83.

Cahill led the consolidation of Catholic Health Corp. of Omaha, Nebraska, the Franciscan Health System of Aston, Pennsylvania, and the Sisters of Charity Health Care Systems of Cincinnati into the CHI health system in 1996. A year later, the Sisters of Charity of Nazareth Health System in Nazareth, Kentucky, joined. CHI had facilities in 20 states.

Cahill served as CHI’s president and chief executive until her retirement in 2003. CHI, based in suburban Denver, merged with Dignity Health in 2019 to form CommonSpirit Health, now the nation’s largest Catholic health system.

Before taking the helm of CHI, Cahill was the director of health and hospitals for the Archdiocese of New York. She developed the Alliance for Catholic Health and Human Services, an affiliation of 43 Catholic hospi-

tals with 15 religious sponsors that worked on collaborative programs. Her work also included a stint as CHA’s vice president of government affairs.

CHA named Cahill its Sister Concilia Moran Cahill Award recipient in 2006 for her pioneering work. The award honors visionary leaders in Catholic health care.

At the awards ceremony, Cahill was lauded by Kevin E. Lofton, her successor as president and chief executive of CHI and later a chief executive at CommonSpirit.

“Pat’s presence to CHI and other health care ministries inspired a group of leaders who followed her to the mountains of Colorado as spiritual pilgrims,” he said.

“Despite risks, despite obstacles, we knew, as Pat would often say, it was ‘something in the stars’ that made CHI come together and succeed.”

Steve Mackin is Mercy’s incoming president and chief executive Mercy health system of Chesterfield, Missouri, has named Steve Mackin president and chief executive, effective April 1.

Mercy also named him to its board of directors. He will succeed Lynn Britton, who has headed Mercy for 13 years.

Mackin joined Mercy in 2017 as a senior executive for business line development, focusing on cancer services and was soon Mackin named president of Mercy Hospital St. Louis and joined the senior leadership team of Mercy. Most recently he has worked as executive vice president, hospital president and president of Mercy’s east region.

Prior to his tenure at Mercy, Mackin worked at Cancer Treatment Centers of America for nearly 19 years, beginning as a management fellow and progressing to executive positions including chief operating officer and interim president.

According to a Mercy press release on the leadership transition, over the next six

months, Mackin will work alongside Britton until he assumes the helm. They will visit communities Mercy serves and listen to the input of co-workers, local boards and community members. The system has more than 40 acute care, managed and specialty hospitals as well as a network of other facilities throughout four Midwestern states.

When Mackin assumes leadership of the system, Britton will become executive chair of Mercy’s board of directors. Current chair David Pratt will remain on the board after the leadership transition is complete.

KEEPING UP PRESIDENT AND CEO Patricia Gathers to president and chief executive of the Carmelite System in Germantown, New York. She was chief operating officer. She replaces Paul MacGiffert, who has retired.

8

CATHOLIC HEALTH WORLD November 1, 2021

SSM Health hospital is hub for Regional Pediatric Pandemic Network Collaborators seek to grow the number of hospitals capable of caring for children in disasters SSM Health Cardinal Glennon Children’s Hospital in St. Louis has a major role in a new national network to improve and standardize the care of children, especially in disasters.

Cardinal Glennon is one of the five hub hospitals in the Regional Pediatric Pandemic Network. The Health Resources and Services Administration, part of the U.S. Department of Health and Human Services, established the network this summer and granted $48 million to cover operations for five years.

The other hubs are University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, UCSF Benioff Children’s Hospital in San Francisco, Norton Children’s hospital in Louisville, Kentucky, and Primary Children’s Hospital in Salt Lake City.

Primary Children’s is part of Intermountain Healthcare, which is the process of merging with SCL Health.

All of the hospitals are affiliated with universities, a requirement to take a lead role. Cardinal Glennon is affiliated with the Saint Louis University School of Medicine.

Dr. Rachel Charney, an emergency medicine pediatrician who is in Charney charge of emergency and disaster preparedness at Cardinal Glennon, is a primary investigator for the pediatric network. She will lead the hospital’s effort to create a pediatric disaster preparedness plan for the Midwest. The plan will include collaborations among hospitals and partnerships with other agencies that respond to disasters.

Charney says the plan will build on research she has done and practices she has developed in her work at Cardinal Glennon and as a professor of pediatrics at Saint

SSM Health Cardinal Glennon Children’s Hospital

By LISA EISENHAUER

Ashley Obrock-Mayer watches as Dr. Michael Smiley, a pulmonologist at SSM Health Cardinal Glennon Children’s Hospital, examines her son, Grayson. The hospital is one of five across the nation designated as a hub of the new Regional Pediatric Pandemic Network. Their charge is to improve care for young patients at hospitals nationwide.

Louis University School of Medicine.

“What tends to happen a lot in disaster preparedness is we function in silos,” Charney says. “One pediatric hospital may be developing reunification plans (to reunite unaccompanied children and their families), for instance, and another pediatric hospital is independently creating plans to do the same thing, but we often don’t have a process in place to really communicate that, so we’re duplicating efforts.”

Sharing knowledge, practices Charney defines a disaster as basically any event that overwhelms the resources of the area where it’s occurring. That can include a school bus crash with more casualties than a nearby hospital can accommodate, an environmental catastrophe in a region that lacks expertise and hazard-

The SSM Health Cardinal Glennon Children’s Hospital Incident Command team meets to collaborate on concerns related to the COVID-19 pandemic. As one of five hubs for the Regional Pediatric Pandemic Network, the St. Louis hospital will share best practices related to pediatric care in disasters.

SCL merger From page 1

Health hospitals will retain their Catholic names and identity. In a joint release issued Sept. 16, the systems said the merger would be a model for faith-based and secular health care systems to come together to deliver high-quality, affordable care.

SCL’s Catholic hospitals “will follow all of the Catholic directives and ERDs (Ethical and Religious Directives for Catholic Health Care Services) and all of the values of the Catholic hospitals will be there,” said Jumonville, a member of CHA’s Jumonville Board of Trustees.

She spoke at a virtual press conference to announce the merger alongside Dr. Marc Harrison, Intermountain Healthcare president and chief executive.

The pair said they have signed a letter of intent to merge their systems and expect the plans for the union to be finalized by the end of the year. They expect the merger to close early next year, pending Harrison regulatory approvals.

Based in the Denver suburb of Broomfield, Colorado, SCL is one of the nation’s largest Catholic health care systems. Most of its facilities are in Colorado and Montana but it also has a presence in Kansas.

Intermountain Healthcare is a nonprofit system based in Salt Lake City. Its facilities, which include 25 hospitals and 225 clinics, are primarily in Utah, Idaho and Nevada.

The system was formed in 1975 when the Church of Jesus Christ of Latter-Day Saints donated its hospitals to the communities where they were located.

“Since then, we’ve been a secular organization without any religious connection,”

ous materials remediation equipment to respond or a mass shooting where victims are transported to multiple hospitals for trauma or emergency care.

“When we look at disasters we try and do it through what’s called an all-hazards approach, so looking at what can we apply to any scenario and then more specifically what do we need to do for earthquakes, hurricanes, tornadoes,” Charney says.

The hub hospitals will focus on specific areas, called domains, in creating best practices and sharing learnings. Those domains include communications, equity, trauma, advocacy, telehealth and infectious disease. A domain of particular interest to Charney, a mother of three, is reunification of children with their families.

“We know that the faster we’re able to reunify kids the better the outcome is for them, both emotionally as well as physically because then we understand their medical history,” she says.

Prehospital is another domain and in that one Charney says Cardinal Glennon will share its Special Needs Tracking and Awareness Response System, known as STARS, as a best practice. The program, led by paramedic Patricia Casey, provides individualized training to hospitals and first responders in more than 30 counties so they can better care for children living in their district who have complex medical conditions, such as home ventilator dependence, congenital heart disease or severe neurological disorders.

Help for all hospitals The Regional Pediatric Pandemic Network charge extends well beyond keeping

Harrison said.

The merged health system will operate under the Intermountain Health brand and have its headquarters in Salt Lake City, with a regional office in Broomfield.

Harrison will be president and chief executive of the merged system. Jumonville will remain in her current role during a two-year transition period and serve on a new combined board of trustees. The other members of the integrated board and a new leadership team will be selected from both systems.

Jumonville said each system will bring particular strengths to the union. She cited Intermountain’s expertise in population health and “immense telehealth network.”

She said SCL adds expertise in governance and in building an integrated health care system across multiple states and highly competitive markets.

“I believe we’re going to have as much influence on best practices as they’re going to bring to us,” she said.

children safe when an illness is rampant, says Dr. Charles G. Macias. He is leading the network in his capacity as chief of pediatric emergency medicine and chief quality officer at UH Rainbow.

“The intent of all of this work is to really grow the number of hospitals that are capable of taking care of children in emergencies, in urgencies, in everyday needs, in the midst of global health threats,” he says.

Macias says the hub hospitals were selected because of the depth of their staffs’ expertise and because they are in regions of the country in need of better coordination and sharing of best practices and resources to improve pediatric care.

The network will build upon the work of the Eastern Great Lakes Pediatric Consortium for Disaster Response led by UH Rainbow and the Western Region Alliance for Pediatric Emergency Management led

by UCSF Benioff Children’s.

Those two programs were set up as pilots in 2019 through a federal grant.

Their mission, as stated in the funding announcement, is now the mission of the larger network: “define the delivery of pediatric clinical care when existing systems are stressed or overwhelmed by enhancing rapid sharing of expertise and assets.”

Filling the COVID gaps Macias says that while the regional pilot programs came before the COVID-19 pandemic, the gaps in preparedness spotlighted by that crisis have made clear the need for better coordination in the pediatric health sector and will inform the work of the larger network. For example, many hospitals had to develop their own guidelines for COVID care for children. Had the network been in place, it could have developed and shared those guidelines.

“As you think about all the learning that was having to happen on the fly or individually, or investments that had to be created for their own institutions, wouldn’t it have been lovely if all of that was consolidated and being done in a national network so that we simply went to that source and didn’t have to generate it?” he says.

Once the network is sharing practices and coordinating efforts, Charney expects it to raise the standard of care for children across the country.

“I think this grant is going to give us the resources we need to really see visible change in how we protect our children in disasters,” she says. “As both a pediatrician and disaster expert, and as a mom, I find that really exciting.” leisenhauer@chausa.org

Jumonville and Harrison said the merger was not driven by necessity on the part of either system. They stressed that both are financially sound. Harrison estimated their combined annual revenue at $14 billion.

What’s brought the systems together, the pair said, is a belief that they can provide better and less costly health care by joining forces.

“We feel strongly that American health care needs to evolve towards population health and value,” Harrison said. “This merger accelerates that movement regionally and nationally.”

He added: “We’ll bring together the best practices of both organizations, which are substantial and complementary, to provide even more clinical excellence to transform the patient experience and to help keep people healthy as well as take care of them when they’re sick.” leisenhauer@chausa.org