Heatbeat, vol 51, no 2 summer 2013

heartbeat providence

Quality health care in the Inland Northwest SUMMER 2013

Playing with the Zags Providence ortho specialist is sports doc for GU

Pathway to Wellness Changing psychiatric care in the ER

Sisters Madeline and Anna both underwent cancer treatment. Today they’re thriving.

Kids Care

Sacred Heart Children’s Hospital celebrates 10 years and stories of healing

Urgent Care opening in July!

Easy access from I-90. Conveniently located at 5th & Division.

5th Avenue & Division

No appointment necessary Open 7 a.m. - 9 p.m. / 7 days a week

On-site lab & X-ray

Providence Medical Park – Spokane Valley

Opening in spring 2014!

Easy access from I-90. Two blocks east of Sullivan on Indiana.

127,000 sq. ft. of physician offices, diagnostic and treatment space: • Primary and urgent care • Cardiac care • Lab and imaging • Outpatient surgery • On-site pharmacy

heartbeat providence

Executive Editor Joe Robb

Managing Editor Kate Vanskike

Medical Editor Jeff Collins, MD

Senior Content Editor Kari Redfield

Art Director Monya Mollohan

Photographers Gary Matoso Steven Navratil

{ FROM THE HEART }

Making Health Care ‘Healthy’

Copyright 2013 © Providence Health Care.

Online at phc.org. Published three times a year by McMurry/TMG, LLC. Send comments to heartbeat@providence.org or Public Relations, PO Box 2555, Spokane, WA 99220.

Elaine Couture, Chief Executive

Board of Directors Mike Reilly, Chair Gary Livingston, PhD, Vice Chair Marian Durkin, Secretary-Treasurer LoriLei Bruggink Patricia Butterfield, PhD Ramon Canto, MD Dan Dionne, MD Susanne Hartung, SP Elaine Hoskin Keith Marton, MD Dean Martz, MD Rob McCann, PhD Sr. Judith Nilles, OP Paul Pimentel Curt Shoemaker Phil Stalp Jim Watts, MD Ron Wells Providence Health Care Eastern Washington (PHC) is the parent organization of a number of Catholic health care ministries sponsored by the Sisters of Providence and the Dominican Sisters in Spokane and Stevens counties. These ministries include:

Hospitals Providence Sacred Heart Medical Center Sacred Heart Children’s Hospital Providence Holy Family Hospital Providence Mount Carmel Hospital (Colville) Providence St. Joseph’s Hospital (Chewelah)

Other Health Services Pathology Associates Medical Laboratories Providence Adult Day Health Providence DominiCare (Chewelah) Providence Emilie Court Assisted Living Providence Medical Group Providence St. Joseph Care Center & Transitional Care Unit Providence VNA Home Health PHC is part of the Providence Health & Services health care system, which spans five states from Alaska to California and east to Montana.

For more details, visit phc.org.

Mission Statement As people of Providence, we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service.

Walter Cronkite once said, “The problem with the health care system is that it’s not healthy, they don’t care, and it’s not a system.”

I’m borrowing that from Andrew Boulet, MD, who shared it in the Cardiac Report (pages 12–13) and added to Cronkite’s sentiment, “We’re making a concentrated effort to change that.”

Dr. Boulet is right. Here at Providence Health Care, our hospitals and physician clinics, along with other Providence ministries and community partners, are committed to putting a new face on health care. Medical services need to be delivered in a cohesive system that’s healthy and caring.

You’ll find several examples of that inside this issue of Providence Heart Beat. Along with the story about changing the way we care for patients with chronic issues like heart failure, you can read about Providence’s ongoing commitment to mental health services and ensuring that those who are most vulnerable receive the evaluation and treatment they need for a stable

and fulfilling life. Our Community Benefit Report on pages 28–29 also demonstrates how we use our financial resources to fuel other important community programs that serve the Inland Northwest.

The two beautiful sisters on the cover are both survivors of cancer.

Read their story and those of two other patients who have “grown up” with Sacred Heart Children’s Hospital, which celebrates its 10th anniversary this summer. In one short decade, the Children’s Hospital has dramatically changed the way local families face childhood illnesses—enabling them to stay close to home rather than having to travel long distances for expert care in a family-centered environment.

It’s hard to imagine Spokane without the Children’s Hospital now, and we’re excited about what our pediatric specialists will envision in the future.

The Providence family is growing right alongside the budding communities of the Inland Northwest, and we’re here to serve you. If you haven’t connected with a Providence provider for your health care journey yet, I invite you to find one at phc.org.

Many blessings on you and your family!

Sincerely,

Elaine Couture Chief Executive Providence Health Care

The Providence Vision Together, we answer the call of every person we serve: Know me, care for me, ease my way.

Core Values Respect • Compassion • Justice Excellence • Stewardship

PHOTOGRAPH BY Diane Maehl

Summer 2013 Heart Beat ● 3

{contents } S u m m e r 2 0 1 3 , Vo lu m e 5 1 , N o. 2

On the cover: Sisters Madeline and Anna were treated for cancer and are thriving. Read stories from the 10 years Sacred Heart Children’s Hospital has been healing kids. See page 18. Photo by Gary Matoso.

3 From the Heart

Providence Health Care is putting a better face on health care.

5 Mailbag

Take a poll, get a free medication guide and hear how much one reader loves Heart Beat.

27

6 Insider

Taking care of our beloved elders, those in need of home infusion services and others in our community.

8

28

Healthy Living Learn more about chronic pain and save our recipe for delicious and nutritious carrot-ginger muffins.

10 ELECTRONIC RECORDS

Five ways Providence’s electronic medical record system benefits you.

12 Cardiac report

Helping people with chronic heart failure requires a partnership and patient dedication to simple healthy habits.

12 14

14 Playing with the Zags

Providence orthopedic specialist is Gonzaga sports teams’ doctor.

A Learn how he helps these star student athletes.

18 Cause for Celebration

honor of the 10th anniversary of Sacred Heart Children’s Hospital, In we look at some inspiring kids who have grown up with us.

24 Pathway to Wellness

ew psychiatric care in the hospital setting helps people start and N complete their treatment more quickly.

27 FOUNDATION

One couple is making a lasting difference by leaving a portion of their estate to the Providence Health Care Foundation, Eastern Washington.

30 8 24 4 ● Summer 2013 Heart Beat

28 COMMUNITY BENEFIT

See what Providence Health Care is doing in the community to help make quality health care accessible to everyone.

30 Ethics guru

Meet our new ethics guru and hear his take on end-of-life decision-making.

31 COMMUNITY CALENDAR

See what activities and classes you can join this summer.

32 Role Model

Mckenzi, a 3-year-old golden retriever, and other canine caregivers bring joy to patients at Providence Spokane hospitals and nursing facilities.

{ mailbag }

Inspired Living

Sound Off! You can contact us by email at heartbeat@ providence.org, by phone at 509-474-3081 or mail at 101 W. Eighth Ave., Spokane, WA 99204.

facebook.com/ProvidenceSacredHeart facebook.com/ProvidenceHolyFamilyHospital youtube.com/ProvidenceSpokane twitter.com/Providence_PHC

TAke A Poll

TELL US YOUR THOUGHTS What is “community benefit” and why do hospitals report on it every year?

A) I have no idea what it is!

B) I have heard of it but don’t know why it’s important.

C) It’s a way for hospitals to talk about the good they are doing for their communities.

D) Hospitals are required to report how they spend their revenue.

Dear Heart Beat, I am a big fan of your Providence Heart Beat publication and read each issue cover to cover. Thank you very much for your commitment toward the maximum health of community members! My family and I appreciate all Providence does. — Laurel S.

Tell us your response online at phc.org/heartbeat. Turn to page 28 to learn more about Community Benefit and the ways Providence is making a difference.

Thanks, Laurel! It’s always nice to receive such positive feedback! We love hearing from readers. Thank you for reading Heart Beat.

Voted Most Popular Providence Health Care released a new Heart Healthy Guide this spring, and once again, it has been a favorite item among Heart Beat readers. It’s never too late to get your copy! Our free Medication Guide is popular among readers, as well. This pocket-sized form helps you keep important prescription information handy. To request either— or both!—just call 509-474-3081 or email heartbeat@providence.org.

Want to receive Heart Beat via email?

It’s easy. Just email heartbeat@ providence.org with “e-magazine sign-up” as your subject line.

Summer 2013 Heart Beat ● 5

{INSIDER }

WE CAN HELP YOUR FAMILY Schedule a tour of Providence Adult Day Health to see if this service may help your family with the difficult task of providing 24-hour care.

Call 509-482-2475 or visit phc.org.

35 Years of Caring for Beloved Elders Caring for an elderly or disabled person can take its toll on loved ones. Trying to accomplish everyday tasks or simply run errands is hard for someone who is caring for a family member suffering the effects of a stroke or Alzheimer’s or Parkinson’s. And the individuals who endure those conditions have needs, too—such as opportunities to socialize and enjoy activities in a safe and nurturing environment.

Providence Health Care has been meeting these needs since 1978, when, at the urging of Mary Raschko, the first Providence Adult Day Health center opened. The model of care was

6 ● Summer 2013 Heart Beat

a win-win: The center would provide respite for caregivers while offering nursing, rehabilitation, case management and activities for the elderly and people with disabilities.

“At Providence Adult Day Health, participants are treated with compassion and respect while building new relationships and a stronger support system,” says Oscar Haupt, business manager.

More than 100 clients enjoy the programs at Adult Day Health every week.

After a cup of coffee or tea and socialization, the clients participate in many activities, including exercise or physical therapy, memory care and sensory

groups. Nursing staff monitors their health while social workers and case managers tend to other needs. After a nutritious lunch, clients participate in fun activities including bingo, games, crafts, music and reminiscing.

Dr. John Moyer (pictured above), one of the concerned community members who helped raise the money for the facility located by Holy Family Hospital, once told people that he was raising the money because someday we could all be using the program. Today, Dr. Moyer himself is a participant who is benefiting from the mission of Adult Day Health. top left PHOTOGRAPH BY kate vanskike

Home Infusion Services Available Providence has purchased Integrated Health Professionals Inc.’s home infusion business.

Now called Providence Infusion and Pharmacy Services, this program has helped patients in eastern Washington, Idaho and western Montana for more than 20 years as a trusted home infusion provider.

For patients with infusion therapy needs, experts at Providence Infusion are dedicated to providing individualized care in a relaxed, comfortable environment. Services available include chemotherapy, blood product transfusions, hydration, immune suppressants, antibiotics, port care and stem cell collection.

{ STEVENS COUNTY UPDATES }

Expert Care, 24/7 Providence Mount Carmel Hospital in Colville now has hospitalist coverage around the clock.

Hospitalists are primary care providers who care for patients only within the hospital setting, allowing family physicians to focus on outpatient care. Not only does this help the functions of clinics, and patients who need attention there, but it also greatly improves the access patients in the hospital have to a physician who will oversee their care.

“Nurses have better access to physicians, patient care is more timely and coordinated, and doctors can give more attention to patients in one setting rather than trying to be in multiple places,” explains Bob Campbell, chief executive of Mount Carmel. “It’s a win-win all the way around.”

Physician hospitalists at Mount Carmel are Barry Bacon, MD; Ramon Canto, MD; Michael Snook, MD; Samuel Artzis, MD; Raymond Hutson, DO; Tanuja Edvalson, MD; and Ashlee Weimer, MD.

Top 100!

Congratulations to Providence Mount Carmel Hospital in Colville for being named in the Top 100 2013 Critical Access Hospitals by iVantage Health Analytics. As a Top 100 Critical Access Hospital, Mount Carmel is one of the nation’s best rural safety-net institutions.

500

The number of online floral orders placed from all over the country with the Sacred Heart Gift Shop. Ordering a beautiful arrangement for your loved one is easy! Visit shmc.org or scan this image with your smartphone.

Welcome, ‘New’ Doctors!

Northeast Washington Medical Group (NEWMG)—the largest multispecialty medical group serving the tri-county region (Ferry, Pend Oreille and Stevens counties)—has joined Providence Health Care’s family of services.

The group’s new name is Providence Northeast Washington Medical Group. It includes 26 physicians and seven advanced practice providers as well as 118 support staff members who handle nearly 70,000 patient visits a year.

Summer 2013 Heart Beat ● 7

{HEALTHY LIVING}

Bringing the Market Home Like many communities, the Inland Northwest has experienced a surge in farmers markets in recent years, with new locations opening practically every year. Shopping at your neighborhood farmers market provides many benefits: • Buying local means you’re not paying for produce to be shipped across the country. You get your veggies picked fresh from the garden instead!

• Many participants grow their food organically. (If they’re not “certified organic” it may be because they simply can’t pay to complete the certification process.)

• Supporting area farmers gives you the chance to know the people who grow your food, which helps you rest assured you’re getting the very best in quality.

• Farmers markets often sell fresh bread, locally made honey, and eggs from cage-free chickens, as well as gorgeous flower bouquets.

Carrot-Ginger Muffins Muffins are a great single-serving snack during cancer treatment, says Jodi Weinstein, RD. The ginger in this recipe from her book, Tell Me What to Eat Before, During, and After Cancer Treatment: Nutritional Guidelines for Patients and Their Loved Ones, helps relieve nausea. These muffins are also tasty for those not undergoing treatment.

Ingredients 8-ounce jar baby food carrots 2 eggs ¾ cup sugar 1 cup flour ½ cup oil ½ teaspoon salt ½ teaspoon baking powder ½ teaspoon baking soda 1 teaspoon vanilla ½ teaspoon cinnamon ¼ teaspoon ground ginger Directions 1. Preheat oven to 350 degrees.

2. Grease 12 muffin tins with nonstick cooking spray.

8 ● Summer 2013 Heart Beat

3. In a large mixing bowl, combine all of the ingredients and mix until dry ingredients are moistened well.

If using an electric stand mixer, beat at medium speed until the batter is completely smooth.

4. Pour the batter into prepared tins.

Bake, uncovered, for 15 minutes or until a toothpick inserted into the center of one of the muffins comes out dry.

Yield: 12 muffins Nutritional Information Nutrition per serving (muffin): 186 calories, 2 g protein, 10 g fat, 22 g carbohydrates, 1 g fiber, 131 mg sodium, 35 mg cholesterol

We could all benefit from more fresh produce in our diets, and a farmers market is a great way to do it. In the Spokane area, check out markets in the following areas: Downtown, South Perry, Northside and Millwood.

Neighboring communities with markets include Cheney, Chewelah, Coeur d’Alene, Colville, Liberty Lake, Moscow and Sandpoint.

MAKE YOUR APPOINTMENT The newly expanded Providence Pain Management Clinic at Holy Family Hospital is open Monday through Friday.

To schedule an appointment, contact your primary care physician and request a referral. Then contact the appointment scheduler at 509-482-1859.

Pain, Pain Go Away Relief from chronic pain can be elusive, but not unattainable

By Jo Ostgarden

Enduring pain from an injury or a strain is bad enough. But what if you had to endure pain that seemingly had no cause at all? Chronic pain sufferers are often told that their condition is “all in their head,” but as those who live with it will tell you, it’s real and difficult.

Here, we answer four questions surrounding the mysterious condition and provide a cutting-edge resource for treating chronic pain.

What is chronic pain?

Chronic pain is prolonged and persistent. Typically, it lasts far beyond the

expected period of healing for illness or injury, according to the American Chronic Pain Association.

Is it treatable?

Conventional treatments focus on pain management and, for extremely debilitating pain, may include narcotics, antiseizure medications or muscle relaxers.

For less debilitating pain, therapies include chiropractic care, acupuncture, yoga, tai chi and massage.

These may also be used in conjunction with medications.

Another approach, one being successfully used at Providence Holy Family Hospital, is a combination of local anesthetics and steroids that treat the source of nerve-mediated pain. Two board-certified anesthesiologists, David Vanos, MD, and Jeff Welch, DO, staff the Providence Pain Management Clinic and treat pain by injecting affected nerves.

Their approach includes trigger point injections, epidural steroids and a variety of nerve blocks.

What is the pain clinic’s primary approach?

Rather than using opioid (narcotic) management, “we try to treat the source of the pain by reducing the inflammation around the affected nerves,” notes Kellie Durgan, RN, manager of the pain clinic at Holy Family.

Treatment may also include injecting pained body parts (the neck or spine, for example) and areas where pinched or trapped nerves cause pain (the lower back), explains Durgan. Where appropriate and necessary, the clinic also offers sedation and uses radiology assistance (fluoroscopy or ultrasound) to ensure effective placement of injections.

How does treatment at Providence Pain Management fit in with my other caregivers?

Using a team approach, the clinic works with referring physicians to help manage patient care, advising on medications and other interventions. Durgan says the goal is to make the pain more manageable in patients’ lives.

Summer 2013 Heart Beat ● 9

{ELECTRONIC RECORDS }

In the Driver’s Seat Discover how Providence’s electronic medical record system benefits you

By Stephanie Conner

It’s your health. Yet it can sometimes feel as if you’re missing the tools you need to effectively manage it. With a new electronic health record (EHR) system in place, Providence Health Care hopes to change that.

The new EHR system, called Epic, is being implemented at all Providence facilities across five states, including Sacred Heart and Holy Family in Spokane and Mount Carmel and St. Joseph’s in Stevens County this year. With Epic, patients enrolled at Providence clinics and hospitals can access their own health information through a tool called MyChart.

“What’s exciting about the system is that it is patientcentric and allows us to all be partners in our own health care,” says Tami Klein, Providence Epic deployment director.

Here are a few ways Epic and MyChart can help you manage your medical information:

10 ● Summer 2013 Heart Beat

1

Caring for Family Members.

“One of the most vulnerable populations is our seniors,” Klein says, noting that many older adults struggle to remember their medications or a doctor’s instructions.

If you care for a parent, proxy access allows you to view that parent’s chart so that you know what happened at a doctor’s appointment—even if you couldn’t be there.

Parents can have proxy access to children’s records, too. This can mean easier tracking of immunizations or the ability to reprint the results of a school sports physical without having to call the pediatrician’s office.

2

Seeing Lab-Work Results.

Perhaps you had your annual blood work. Or maybe a medication you take requires regular blood tests.

Within three days of the results being made available to your primary care doctor, they’ll be made available to you, too. If you see something in your results that concerns you, you can send an email to your doctor’s office and ask questions.

“It makes the patient a partner in their health care,” Klein says. “Before, they didn’t necessarily see those results. It increases accountability for both our care team and the patient.”

3

Connecting with Your Primary Care Doctor.

When you’re busy during the day, it can be hard to find the time to call your primary care doctor—even when you know it’s important.

MyChart allows you to schedule your own primary care appointments online.

“I can go into the system and see my doctor’s schedule and schedule myself in an open slot that works for me,” Klein says.

“It’s very convenient.”

You can also send emails to your primary care doctor, and other care team members, when you have questions.

4

5

Traveling to Other States.

If you’re traveling and you become ill, you may need to see a doctor. You can access your MyChart from a computer or even your smartphone and show the doctor your patient snapshot.

And if you happen to visit a hospital or a doctor’s office that also uses the Epic system, your new record and your Providence record can be merged.

This, Klein says, can help prevent duplication of testing, as well as allergic reactions, adverse medication interactions and more. It also means that when you return home, your medical record is as up to date as possible.

Communicating with Specialists.

If you need to see a specialist, such as an orthopedic surgeon or a cardiologist, having access to your own medical record can be a timesaver. No more requesting paper documents and driving to your doctor’s office to pick them up or asking someone else to fax them from one office to another. This way, the provider can have the most recent information available.

MyChart also offers the ability to track your goals and share your progress with your doctor. If your cardiologist assigns you a goal of walking 30 minutes a day three times a week, you can track your activity in MyChart. And if you notice problems—for example, if you find yourself short of breath or in pain—you can send a message that alerts your doctor.

Connect with MyChart Are you a patient at a Providence clinic? Ask your provider about setting up a MyChart account at your next appointment. Or, simply visit phc.org and click “MyChart” in the upper right corner. There’s an app for that, too! Look for the MyChart app in your mobile device’s app store/marketplace.

Summer 2013 Heart Beat ● 11

{cardiac report }

Gladys Evans, RN, is one of several cardiac rehabilitation nurses at Sacred Heart who provides education to patients in the hospital setting.

Simple Measures Providence is providing more affordable, accessible care for patients with heart failure

By Kate Vanskike

Can there be good news for a diagnosis that includes the word “failure”?

Yes, because with heart failure, the organ is still working—it just isn’t pumping sufficiently. The better news: While the diagnosis in the past was followed quickly by death, today people can live many years after its onset.

Despite advancements, congestive heart failure can lead to frequent doctor visits and hospitalizations. It’s one of the leading causes of patients being readmitted to a hospital shortly after returning home from the previous visit.

Simply put, “heart failure is ripe for better care,” says Andrew Boulet, MD. Bettering Patients’ Lives Dr. Boulet and his partners at Providence Spokane Cardiology are helping to develop a more coordinated approach to care. A pilot project has created a model for better patient outcomes. The project includes heart specialists, cardiac rehabilitation nurses at Providence Sacred Heart Medical Center, and clinics such as Providence Family Medicine-Manito and Providence Physicians Clinic of Spokane.

What’s the key to success? Lifestyle education—not more medications, flashy technology or a complicated routine. It requires that patients have a better understanding of how their daily choices impact their heart disease.

“We can’t control the environmental issues that affect a patient’s health—how a family member is cooking, what they’re buying to prepare meals,” says Bryan Fuhs, MD. “So we have to provide the education not only to the patient but to the one who is doing the grocery shopping.”

Gladys Evans, RN, is one of several cardiac rehabilitation nurses at Sacred Heart who provides education to patients in the hospital setting.

“I am excited to see the whole coordination of care start to unfold and to increase

12 ● Summer 2013 Heart Beat

the quality of life for this patient population,” Evans says. “This has been a longtime passion of mine.” In fact, Evans went through rigorous testing last year to become eastern Washington’s only certified heart failure nurse.

Evans and the others involved share a common goal: to start the education process early.

While still in the hospital, patients are quizzed on their understanding of these important lifestyle changes and offered clarifications before going home. Then once home, a nurse follows up to make sure they don’t have lingering questions.

Nutrition Matters Heart failure education centers on: •D id you take your medications? (You can’t “stretch” your medications and expect them to be effective.)

•D id you weigh yourself today and record your weight? (Gaining any weight in a short period can indicate problems.)

•A re you limiting your water? (Unlike other health conditions, heart failure doesn’t benefit from a patient drinking lots of water.)

•A re you eating right?

The last one is by far the biggest opportunity for learning.

“We have to change the idea that healthy food doesn’t taste good,” Dr. Boulet says. “We know that access to these fresh foods is limited for many people living on fixed incomes,” Dr. Fuhs adds. “Fortunately, our communities are seeing more locally run co-ops, and the food banks often receive supplies of produce to share with people in need. This is part of our education to patients.”

The other keys to nutritional success are learning to read food labels and looking at things like sodium content. Even more important is to understand that the “serving size” indicated on a label is often not the same amount of food that many people consider an appropriate portion.

PHOTOGRAPH BY GARY MATOSO

Avoiding Rehospitalization The goal of the heart failure program is to help patients comply with doctors’ orders and lessen the likelihood of readmission.

Statistics show that Sacred Heart already has fewer patients being readmitted for heart failure treatment than the national average. “It’s hard to improve on that,” says Andrew Boulet, MD. Still, Providence is committed to even more improvements. Part of this is having its research department and other specialists contribute to better coordination of care in all settings.

1

Here are some steps Providence is taking to reduce hospitalizations for chronic heart failure:

Identify a primary care physician to follow up with the patients within seven to 10 days of their leaving the hospital. If a patient doesn’t already have a physician, he or she is connected with a Providence doctor.

2

Assign a cardiologist for the patient to see within 21 to 28 days after going home.

3

Connect with the inpatient cardiac rehabilitation nurse.

4

Make arrangements with the appropriate clinic for follow-up at home.

Eating Tips Watch a video showing the essentials of nutrition at phc.org and search “caring for your heart.”

“Walter Cronkite once said, ‘The problem with the health care system is that it’s not healthy, they don’t care, and it’s not a system,’” Dr. Boulet says.

“We’re making a concentrated effort to change that.”

Summer 2013 Heart Beat ● 13

Arnold Peterson, MD, Providence Orthopedics, is a team doctor for Gonzaga University’s men and women Bulldogs.

“I feel lucky to work with such great professionals, from the university’s certified sports trainers to my colleagues throughout the medical field,” he says.

14 ● Summer 2013 Heart Beat

z

g za s with the

If you’ve watched a Gonzaga University

basketball game on television or in McCarthey Athletic Center, chances are you’ve seen his face. He’s been courtside with all the big names—Olynyk, Harris, Bouldin, Daye, Heytvelt, Pendergraft, Morrison—to name a few.

Although he’s never been counted on to make a shot, like any trusted team member, he’s an expert at what he does.

Arnold (“Arnie”) Peterson, MD, Providence Orthopedics, is one of the team doctors for Gonzaga University’s men and women Bulldogs. “When it comes to the health and well-being of our athletes, Arnie is our go-to person,” says Mike Roth, Gonzaga University’s athletic director.

You won’t see Dr. Peterson’s name on any of the team rosters, and he’s not on the university’s payroll. The reward for working with an NCAA Division 1 athletic program is personal.

“I just love working with these kids,” he says.

A Calling It all started more than 20 years ago when Dr. Peterson’s youngest child left home for college with the opportunity to play soccer, basketball and track at Middlebury College

PHOTOGRAPH BY torrey vail

Providence ortho specialist is team doctor for gonzaga university sports

By Liz DeRuyter

in Vermont. Having watched his children play sports while they were growing up, his daughter’s departure left a void in his life. So when Gonzaga’s director of athletic medicine, Steve DeLong, asked Dr. Peterson to take on the role of team doctor, he quickly accepted.

Since then, Dr. Peterson has cared for college athletes with all sorts of bone and joint injuries, from torn ligaments and ruptured tendons to shattered bones and dislocated joints. However, what keeps a student athlete from having peak performance on game day is more often the flu.

“Caring for them is truly a team approach,” Dr. Peterson says. He works alongside experts in family medicine, chiropractic medicine, podiatry, dentistry and ophthalmology, with additional specialists readily available when needed. “I feel lucky to work with such great professionals, from the university’s certified sports trainers to my colleagues throughout the medical field. These athletes are getting the best possible care.”

Having a diverse medical team has been a key component of the athletic program’s success. “With his tenure and seniority, Arnie takes the lead. He is our liaison with physicians throughout the Spokane community,” Roth says.

Summer 2013 Heart Beat ● 15

g za s with the

Top photos: Dr. Peterson working with student athletes. Bottom: Rachel Kane had knee injuries during her college sports career. “I hurt my knees a number of times throughout my career,” she says, “but was very fortunate to have Dr. Peterson as my doctor.”

Focusing on Athletes “Arnie has a great love for Gonzaga, a tremendous approach with the students and the mind-set to work with high-level athletes. He understands how they think and how they react to certain situations,” Roth says.

16 ● Summer 2013 Heart Beat

The job is made easy, Dr. Peterson says, because Gonzaga and Providence Health Care have the same goal.

“We want what is best for the athletes,” he says.

“When I’m in a room with a coach and an injured athlete, the discussion is not about what is best for the university—it is always about what is best for the student athlete, today and in the long term. It doesn’t mean the athletes aren’t in a hurry to get back in the game—they are—but our decision is always to do what is right for the student.”

Part of the job requires that Dr. Peterson or one of his colleagues be present at all high-impact conference competitions at home, and occasionally on the road. This includes all men’s and women’s basketball games and soccer matches. Dr. Peterson knows that when a player goes down, he or she could be injured, and that it might be much worse than anyone realizes. “I always watch the game with apprehension,” he says.

That apprehension extends well beyond his beloved Bulldogs. As a doctor on record with the NCAA, his responsibility includes providing care to visiting team members whenever needed.

In fact, he says, it is not unusual for him to miss substantial parts of a game, such as last December’s Battle in Seattle, in which a Kansas State University men’s basketball player was hurt.

clockwise from top left: PHOTOs by Torrey vail, steven navratil, Gonzaga Athletics/RAM Photo

What’s the most common sports injury?

The correct response: a concussion. While knee injuries are common, concussions are among the most worrisome and unpredictable sports-related injuries, according to Arnold Peterson, MD. “One reason concussions are so troubling is that athletes are not always forthcoming about their symptoms,” he says.

“They want to play their sport so badly that they sometimes withhold information. And it is an injury that can have long-term effects.”

What is a concussion?

A concussion is a disturbance in the

function of the brain caused by a direct or indirect force to the head. The Sport Concussion Assessment Tool, or SCAT, helps assess an athlete’s condition after a hit to the head.

What are the symptoms?

• Headache • Pressure in the head • Neck pain • Balance problems or dizziness • Nausea or vomiting • Vision or hearing problems • “Don’t feel right” • Feeling “dinged” or “dazed” • Fatigue or low energy • Irritability • Difficulty concentrating or remembering An athlete who is thought to have a concussion should be removed

Dr. Peterson spent much of that game caring for the injured Wildcat.

“It has become a high point of my career—to work with student athletes, coaches and a university that share the same values and commitment to excellence as Providence,” Dr. Peterson says.

“If you want to talk to dedicated individuals, talk to members of the GU crew team, who get up at O-dark-30 to train when it is 30 degrees on the water. These are amazing athletes—being the best they can be.”

A Success Story Rachel Kane is one of those dedicated athletes.

She arrived at Gonzaga University in 2003.

Though she had suffered a knee injury requiring reconstructive surgery while in high school in Hawaii, she was excited to play point guard for the women’s basketball team. Early in the season, she reinjured her right knee, tearing the anterior cruciate and medial collateral ligaments (commonly known as the ACL and the MCL).

Before graduating in 2008, Kane would suffer two more injuries.

“I was very fortunate to have a good doctor and a good trainer,” she says. “Dr. Peterson always explained the process and what to expect. I strengthened my knees and legs, and learned a lot.”

from play and seek medical evaluation immediately.

What are other signs?

Problems could arise during the first 24 to 48 hours. An athlete who may have a concussion should not be left alone and should go to hospital at once if the person: • Has a headache that gets worse • Is very drowsy or can’t be awakened • Can’t recognize people or places • Has repeated vomiting • Behaves unusually or seems confused • Has seizures • Has weak or numb arms or legs • Is unsteady on his or her feet or has slurred speech Remember, it is always better to be safe. Consult your doctor after a possible concussion.

When Kane reinjured her reconstructed knee, Dr. Peterson performed a revision ACL reconstruction in collaboration with Russ VanderWilde, MD. “She was a model patient and worked very hard with the trainers to restore function to the knee,” Dr. Peterson says. She returned to play as the starting point guard the next year. A few years later she tore the ACL in her other knee, and Dr. Peterson fixed that one as well.

“Statistically only 70 percent of Division 1 athletes return to their sports after an injury. At Gonzaga we are closer to 90 percent,” says Dr. Peterson, though he deflects credit. “This is primarily due to the skill of the athletic trainers under Steve’s leadership. These trainers are simply amazing.”

Despite the severity of her injuries, Kane not only played basketball through her senior year at Gonzaga, but today she enjoys an active lifestyle and healthy knees. “I play women’s league basketball, work out, run long distances, and my knees are holding up just fine.”

That’s no surprise to Roth. “Arnie is a deeply caring person. It’s not just what he provides as a physician, but what he provides as a person.

If I ever have a problem, whether it is regarding an athlete or personal, I pick up the phone and call Arnie. I trust him,” says Roth.

Schedule with Experts Providence Orthopedics surgeons are board-certified by the American Board of Orthopaedic Surgery and are subspecialty trained in knee surgery, shoulder procedures, trauma, revisions of the hip, total joint replacement, bone cancer and sports medicine.

You can see one of 10 orthopedic surgeons or five certified physician assistants at 820 S. McClellan St. in Spokane. Call for appointment: 509-838-7100.

Summer 2013 Heart Beat ● 17

Cause for Celebration In honor of the 10th anniversary of Sacred Heart Children’s Hospital, we look not only at our own growth but also some special kids who have grown up with us

Story by Kate Vanskike Photos by Gary Matoso

18 â—? Summer 2013 Heart Beat

Fourteen-year-old Dilan has cystic fibrosis, a chronic disease that affects his lungs and digestive system. He undergoes treatment for the chronic disease at Sacred Heart Children’s Hospital.

Ten years ago, Providence took a giant leap forward in pediatrics by opening Sacred Heart Children’s Hospital—a place designed for kids and focused on families, with physicians who believed that putting all the resources in one location improved care. The medical center needed to bring together all the experts in children’s cancer, neonatology, cardiology and surgery, along with amenities like clubhouses and teen rooms, family spaces and even a movie theater to help families through harrowing times that sometimes require long hospitalizations.

Since then, the staff at Sacred Heart Children’s Hospital has saved countless lives and helped families heal through some of the scariest illnesses. Here’s a look at a few inspiring and courageous kids.

14 Years and Counting Fourteen-year-old Dilan loves the band Kiss. He even drew a picture of the band and entered it in an art contest at school. Like many teens, he enjoys hanging out at the mall and listening to music. What sets Dilan apart from his peers is his cystic fibrosis, a chronic disease that affects his lungs and digestive system.

In the 1950s, few children with the condition lived to attend elementary school, but today, Dilan can expect to live well into adulthood. He was diagnosed at just 5 months old and, in recent years, has been in the hospital as frequently as every three or four months. His usual 14-day stay was called a “clean out” because he needed breathing treatments four or five times a day to clear his lungs.

“Dealing with what he has is hard on him and on the whole family,”

Dilan’s dad, Paul, says. “It’s like having part of the machine missing. …

It just doesn’t feel or work right. But he always has a smile on his face and thinks of the positive part of life.”

Indeed, Dilan has plenty of positive things to say, even about his many visits to the hospital.

“I like Eric, who is my nurse every once in a while; he makes me laugh and makes me forget that I’m at the hospital,” Dilan says. “I also like hanging out with John, the volunteer. We play cards and board games together.”

For Paul, the Children’s Hospital is great for different reasons. “The staff treats Dilan like he is their own child,” he says. “I couldn’t see going anywhere else to get help for my son, and always advise people that if they have any problems with their children, to take them to Providence.”

Summer 2013 Heart Beat ● 19

Sister Act When she was 3 years old—and bald from chemotherapy—little Anna appeared on a Heart Beat magazine cover. She was in treatment for acute lymphoblastic leukemia (ALL) at Sacred Heart’s Pediatric Oncology when her little sister, Madeline, was born and placed into the Neonatal Intensive Care Unit.

For a few days, parents Jenny and Brian split their time on opposite ends of the Children’s Hospital as both of their princesses received care. But even that wouldn’t prepare them for the agony to come.

Less than a year after Anna completed her treatment and life began to return to normal, Madeline was

20 ● Summer 2013 Heart Beat

diagnosed with cancer, too.

“We were just 10 days away from the first anniversary of Anna’s treatment being over,” says Jenny. “We wanted to celebrate the milestone, but we had to do so as we admitted Madeline to the hospital.”

Madeline’s cancer was the exact same kind as Anna’s—so Jenny and Brian already knew the treatment plan, understood the drugs and had reasonable expectations for how things would go. Even more important to the family: They also already knew all the staff at Sacred Heart’s Pediatric Oncology and trusted them completely.

“The first time, I was trusting my child with complete strangers,”

Jenny says. “This time, I knew we were dealing with competent, loving people, and I didn’t question if they knew what they were doing. Having those relationships in place, we found a groove much sooner than we did with Anna.”

The staff had seen and held Madeline since she was just a couple of weeks old; she grew up at the hospital as her big sister underwent treatment.

“In fact,” says Jenny, “I think her first sentence was ‘Hi, Judy!’ to Dr. Felgenhauer, our pediatric oncologist.”

Today, Anna is a straight-A student in third grade who plays soccer, runs fast, climbs trees, takes risks and is not afraid to try

Sisters Madeline and Anna were both treated for cancers at Sacred Heart Children’s Hospital and today are thriving.

Off the Charts

Throughout more than a century of caring, Providence Sacred Heart Medical Center has opened its doors to children. With every decade, we accomplished new feats in pediatrics, thanks to doctors who were among the first in the nation to achieve subspecialty training in areas like pediatric cardiology. Together, we learned to better address adult-sized complications in child-sized bodies.

Our most recent addition—the Children’s Emergency Center— completes the Children’s Hospital, which offers hope and healing to kids from throughout Washington, Idaho, Montana and even British Columbia.

SNAPSHOTS OF GROWTH

2003

2009

Grand Opening of the Children’s Hospital Pediatric Oncology added

Cystic Fibrosis Clinic Peds ER record number of emergency patients (21,000) A record number of “patient days” in all inpatient units (39,600)

2004 Peds Endocrinology & Gastroenterology clinics New, expanded Neonatal Intensive Care Unit Pediatric Surgery Center

2005 Peds Hospitalist Program anything new. Her mom says she “takes life by the horns and rolls with it.” Soon, she’ll reach her fifth anniversary of the end of treatment, and her checkups will be only once a year.

Madeline, a kindergartner, is much more cautious than her daredevil big sister. She wears elbow and knee pads when she rides her bike, and she’s not crazy about climbing trees. Instead, she is the family artist and does some pretty fantastic karaoke. She is now one year out from her completion of treatment, and the family is on the journey back to normalcy.

While Anna’s memories of her treatment are foggy now, she and

2006 Children’s Clubhouse Remodel for Children’s Psychiatry Unit Adolescent Medicine Clinic

2007

2011 Peds Echocardiography North Spokane Clinic Congenital Heart Disease Clinic

2012 Rypien Foundation Children’s Emergency Center Children’s Hospital lead agency for Safe Kids Spokane

2013 New Children’s Clubhouse NICU adds 16 more beds

Peds Nephrology Clinic

2008

Peds Pulmonary Clinic Remodel for BEST outpatient mental health program NICU record for highest number of “patient days” (15,626) Summer 2013 Heart Beat ● 21

“We had complete confidence our precious boy would be well cared for at Sacred Heart.”

Madeline both have the scars to show what they’ve been through, and they share a twinlike bond.

“They are very, very close,” Jenny says. “Half the time, when I go to wake them in the morning, they’re in the same bed, snuggled up together.”

Anna is so in tune with Madeline that she often senses things no one else can. Jenny tells of a night when Anna emphatically told her that something was wrong with Madeline.

“She was really adamant about it and I kept saying, ‘No she’s fine.’

But sure enough, Madeline ended up in the hospital that night,” Jenny remembers. “I’ll never forget the worry in Anna’s eyes … she knew.

That’s the bond they have. It comforts me to know that they have each other.”

A Heart for What’s Normal The day Kevin was born, doctors knew he had a heart problem. Its name was aortic valve stenosis—a condition that causes the heart to work extra hard and requires valve replacement surgery.

“It was a shocking way to enter parenthood,” his mom, Kristi, says.

He underwent his first of many surgeries at just 6 months old. Since then he has had two open-heart surgeries and multiple other procedures, all at Sacred Heart Children’s Hospital, 150 miles from their home in Richland, Wash.

“Taking Kevin into the cardiologist’s office for the first time was so scary. Now, when I am sitting in the waiting room with my big, healthy 17-year-old, and I see those parents with their newborn come in, I really feel for them,” says Kristi.

She remembers what it was like to take him to the cardiologist

22 ● Summer 2013 Heart Beat

every month for an ultrasound and an EKG and trying to decipher the images on the screen. She recalls coming to the hospital and handing over her chubby, healthy-acting baby to the nurses for surgery, and the long wait to see him again.

While Kristi says it was “the most emotionally painful experience we’ve ever been through as parents,” their experience in the hospital taught them that there was always someone dealing with something worse. Across the hall, a little boy with flesh-eating bacteria was having parts of his body amputated.

“We learned to be grateful for our own trials,” she says.

During that hospital stay, they also benefited from a nurse’s advice: No matter what, treat your son like a normal kid, or he will grow up to be miserable.

“I’ve always appreciated that advice,” Kristi says. “There were some limits because of his heart, but we’ve always tried to make sure Kevin had as normal a childhood as possible.”

In 2010, Kevin’s aortic valve was removed and his own existing pulmonary valve was put in its place.

Then a valve from an organ donor was transplanted into the place where his own pulmonary valve used to be. One year later, he underwent surgery to implant a Melody® heart valve through his femoral artery.

Mom is happy to report Kevin has been doing wonderfully ever since.

“Sacred Heart and the doctors at the Congenital Heart Clinic have been wonderful,” Kristi says.

“I remember nurse Beth Dullanty from the very first surgery, giving Kevin his heart bear and helping us prepare mentally for what to expect before and after surgery. She was

Kevin underwent his first heart surgery when he was just 6 months old.

Today he is doing great and is an Eagle Scout.

there for each surgery. I remember the feeling of familiarity when we would end up in the hospital after years of wellness and seeing faces from long ago, and knowing that we would get through it just like last time. We had complete confidence, knowing our precious boy would be well cared for.”

Initially scared of needles, Kevin got over that fear and soon became the patient who played tricks on the staff. As he got older, he noticed other things—like how cute one of his nurses was. Now a junior in high school, he attends

Take a Virtual Tour Go to shmcchildren.org to get a pediatric referral, watch videos about pediatric health conditions and learn more about our expert care for children.

a skill center in Kennewick and looks forward to working as a welder when he graduates.

“Kevin is an amazing kid,” his mom says. “I think his hospital experiences have made him more compassionate and more aware of the value of life and family.”

Kevin recently achieved the rank of Eagle Scout, and for his Eagle project, his Scout troop assembled 100 heart bears for pediatric patients undergoing heart surgery.

“It was his way of giving back to Sacred Heart for everything they’ve done for him,” his mom says.

Find a Providence Pediatrician General pediatric providers are available at Providence Medical Group locations throughout Spokane. Pediatric specialists in the following areas are located at Sacred Heart Children’s Hospital: Adolescent Medicine, Allergy & Asthma, Cardiology, Critical Care, Emergency Medicine, Endocrinology, Gastroenterology, Hematology, Neonatology, Nephrology, Neurology, Psychiatry, Pulmonology, Oncology and Surgery.

Visit shmcchildren.org to find a Providence pediatric specialist.

Summer 2013 Heart Beat ● 23

Pathway to Wellness Improving mental-health care in the hospital setting Story by Kate Vanskike Photos by Gary Matoso

We Can Help There is help. To get started, talk with a trained professional at First Call for Help: 509-838-4428.

For a listing of community mental-health programs, visit phc.org/heartbeat.

24 â—? Summer 2013 Heart Beat

Technology and science

have allowed medical marvels that help people overcome some of the most challenging hurdles. But one area of medicine is struggling to keep up: mental-health care. Public funding shrinks, a stigma about mental illness lingers, and treatments are still highly misunderstood.

The unfortunate consequence is that people who need help often don’t get it. At Providence Sacred Heart, mentalhealth care providers are actively trying to keep these patients from falling through the cracks. With a 48-bed adult psychiatric unit always full, the team is trying a new approach to help avoid unnecessary hospitalizations and get people back on the road to wellness. It starts in the ER— the community’s “safety net.”

s Deb Hjortedal, psychiatric triage coordinator, says she has never before seen such a dramatic response from both patients and staff as she has with this “new” mental-health care.

Calming the Crisis When people with depression or other mental-health concerns don’t receive treatment in the early stages, their problems can escalate to what seems a point of no return and leave them struggling to function at work and at home. The situation can spiral to dangerous lows where suicide, crime or violence seem like rational options. At this point, the likely next step is a trip to the emergency room for immediate psychiatry evaluation.

At Sacred Heart’s ER, eight psych triage coordinators (who collectively have more than 100 years’ experience) conduct an evaluation to determine what kind of care is needed. The coordinators connect with community partners to provide the right help to each patient, often going to great lengths to find an available bed in the appropriate facility.

More than 500 people every month come to Sacred Heart’s ER for mental-health evaluations. Since finding the best place for treatment for each person can be time-consuming, it’s important that patients receive care during this waiting period in a place that’s safe for them and their caregivers. That’s why a recent remodel in the Emergency Department added more psych triage rooms in an area that’s designed for psychiatry observation. This separate section is staffed 24 hours a day by psychiatry nurses and mental-health counselors.

Summer 2013 Heart Beat ● 25

Encouraging Results Deb Hjortedal, psych triage coordinator, has been doing mental-health assessments in the emergency setting for 20 years. Never before has she seen such a dramatic response from both patients and staff.

“Within a short time of the changes, we noticed patients appeared less agitated and calmer,” says Hjortedal. “ER staff felt better about the arrangement, too. You can be an excellent ER nurse and not feel comfortable responding to patients with extreme psychiatric needs,” she adds. The new setup allows ER nurses to focus on medical problems while psychiatry colleagues tend to the others.

Saj Ravasia, MD, medical director of Psychiatry Services, says a much more robust consultation service from psychiatrists has made an impact, too.

Community Connections We’re all in this together. Providence Health Care works closely with a number of community agencies offering mental-health services, such as: • Chemical dependency—Daybreak and Spark programs (for youth and adolescents) and New Vision at Providence Holy Family (for adults).

• Outpatient mental-health evaluation/crisis treatment—Frontier Behavioral Health (formerly Spokane Mental Health).

• Inpatient care for younger patients—Sacred Heart’s Psychiatric Center for Children and Adolescents has 24 beds for ages 12–18.

Kootenai Health in Coeur d’Alene cares for ages 5–11.

When to Seek Help • If someone is in danger of self-harm or of harming others, get the person to an ER or call 911.

• When someone can’t (or won’t) stop selfmedicating with alcohol or other drugs to deal with problems, it’s time to connect with a counselor or treatment facility.

• Anytime a person has prolonged periods of delusion, depression, severe mood swings, irrational behavior or a combination of any of these, he or she should undergo evaluation.

26 ● Summer 2013 Heart Beat

“We have a real presence in the ER now,” he says. “We’re starting patients’ stabilization process earlier, and they’re receiving the same level of care as if they were placed in the inpatient psych unit.”

Receiving this kind of specialized attention right there in the ER has improved the likelihood of patients being discharged to outpatient treatment rather than inpatient hospitalization.

Sacred Heart’s team is taking its Psychiatric Triage services one step further by working closely with other community services.

“Our goal is to keep people out of the hospital and share the limited resources that are available for mental-health care,” Dr. Ravasia says. “It’s important to foster good continuity of care for our patients. A lot of people don’t follow up for the care they need. If you’re not working closely with other partners, [patients] fall through the cracks. We’re doing everything we can to reduce that possibility.”

Saj Ravasia, MD, medical director of Psychiatry Services, says, “If you’re not working closely with other partners, [patients] fall through the cracks. We’re doing everything we can to reduce that possibility.”

{ Foundation } Rayna Lee and Bruce Walker will leave a portion of their estate to the Multiple Sclerosis Center at Providence Holy Family Hospital.

Making a Lasting Difference A Spokane couple is leaving part of their estate to combat MS When Bruce Walker left the Army in 1970, he wasn’t sure what his next move would be.

During Bruce’s welcome-home party, his father handed him a job application for Sacred Heart Hospital. Bruce, a licensed practical nurse, followed his dad’s advice and soon was hired at Sacred Heart.

Turns out father knows best.

During Bruce’s employee orientation he met his future wife, Rayna Lee. Shortly after their marriage, he graduated from the Sacred Heart School of Nursing. Bruce and Rayna Lee’s careers at Sacred Heart spanned more than 40 years, until they retired in 2011.

With their long history at Sacred Heart, it was only natural that Bruce

What’s Your Legacy?

PHOTOGRAPH BY KATE VANSKIKE

and Rayna Lee looked to the Providence Health Care Foundation, Eastern Washington, when it came time to redo their will. “We’d known about the foundation for years,” says Rayna Lee. They both had seen the benefits of the foundation firsthand in their day-to-day work at the hospital.

A Lasting Impact After thoughtful consideration and research, the Walkers decided to leave a portion of their estate to the Multiple Sclerosis Center at Providence Holy Family Hospital. Multiple sclerosis is a chronic disease of the central nervous system that affects the brain and spinal cord. For reasons that remain a

mystery, the Inland Northwest has one of the highest concentrations of MS in the world.

“MS had been a part of my life since high school,” shares Rayna Lee. She grew up in Odessa, Wash., knowing several people with the disease. “I toured the Holy Family center and was impressed.” And because Bruce was profoundly touched by the patients he cared for, the couple is also leaving a gift to the local Parkinson’s chapter.

The Walkers encourage anyone considering a planned gift to do their homework and follow their passion.

“There are many ways to make a difference and for us, a planned gift made perfect sense,” Rayna Lee says.

There are many ways you can make a planned gift to Providence Health Care Foundation—often with significant tax benefits. Some gifts can even pay you income. Plus, you can choose from a wide range of programs, from pediatric oncology and cardiac research to arts in healing and care for the poor. To learn how you can make a difference, call 509-474-4594 or visit phc.org/giving.

Summer 2013 Heart Beat ● 27

{ community benefit }

At Work in Your Community Providence Health Care is committed to helping make quality health care accessible to everyone, as demonstrated in 2012’s Community Benefit Report By Liz DeRuyter

“As People of Providence, we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service.”

This is the Mission of Providence Health Care, and it is carried out in a multitude of ways: through the care that our team members provide to patients, through our thoughtful planning of services for the community at large, and through the donations we make for the greater good. In this report, you’ll see how Providence has lived its Mission through community benefit contributions.

In 2012, Providence Health Care provided $16.6 million in free care

28 ● Summer 2013 Heart Beat

to patients in need as part of our total community benefit of more than $84.5 million.

How to best use these dollars is determined by community health assessments. In 2012, a collaborative effort with the Spokane Regional Health District, Empire Health Foundation and more than 70 community participants helped identify the county’s greatest health care needs. The group studied volumes of data: everything from emergency room reports and demographic trends to assessments of health measures on behavior, status and outcomes. Focus groups provided additional insights.

The three most pressing health issues that affect the greatest number

of community members, impact various aspects of life, and where, as a community, we have the greatest opportunity to make sustainable improvements are: 1. Care coordination and access to services. 2. Mental health and substance abuse. 3. Obesity and diabetes.

Over the coming years, Providence will focus its community benefit efforts on these primary areas, working with others to best use resources, improve communication and seek measurable changes that address the unmet needs of our community.

Here’s a look at some of the work being done in these areas now: Access to Care Access to health care is often determined by an individual’s health

insurance or ability to pay for care.

In Spokane County, the percentage of adults without health insurance is 15 percent; more than 20 percent of adults don’t have a primary care doctor. Those without insurance or a personal doctor tend to have poorer health, which results in higher costs to the community.

Home from the Hospital Far too often, those who come to our Emergency Department have nowhere to go when they leave.

Through collaboration with the House of Charity, a shelter for homeless men, and the Providence Health Care Foundation, a program now provides homeless people a place to continue healing after being discharged from the hospital, improving chances for a speedy recovery.

Good Medicine Taking prescription medicines when you need them not only lowers overall costs of health care but can improve your long-term health and well-being.

A partnership with Spokane Prescription Assistance Network to provide medication to those unable to afford needed prescriptions has expanded to Stevens County.

Fighting Hunger Sometimes the most basic needs, such as nutritional food, are unattainable for members of our community. Providence helped create the Northwest Washington Hunger Coalition, bringing together food banks throughout eastern Washington to address hunger in a coordinated approach.

Keeping locally grown food in the community, improving distribution, providing cooking classes and expanding knowledge of planning nutritional meals—these actions have already begun to reduce povertyrelated hunger.

These are only a few of the many programs supported by Providence that bring health-related services to underserved members of our community.

Providence Health Care’s 2012 Community Benefit funds $47.1 million Unreimbursed cost of government programs: Difference between the cost of care and reimbursement from Medicaid and other state and federal programs—does not include Medicare. $9.6 million Community health, grants and donations: Community health support includes free services such as patient education, health screenings, immunizations and support groups; cash gifts and grants to community partners; and other donations. $11.2 million Education and research programs: Subsidies for medical residency programs, nursing and other education, and medical research. $16.6 million Free medical care for patients in need: Financial assistance for those who have no insurance or are otherwise unable to pay for their health care. $84.5 million Total Community Benefit

$16.6 million $11.2 million

$9.6 million

Total $84.5 million

$47.1 million

$34.2 million PHC Tax Benefit $63.9 million PHC Taxes Paid $84.5 million PHC Community Benefit

Providence provided $50.3 million back to the community in excess of its tax exemption as a not-for-profit organization.

Community Benefit does not include expenses such as salaries, new construction, facility improvements, investments in advanced technology, bad debt or taxes that Providence Health Care pays in the course of normal operations.

Download the Report For more about how Providence Health Care supports the community, go to phc.org and click “Community Benefit Report.” Or simply scan the QR code with your smartphone.

Summer 2013 Heart Beat ● 29

{ ETHICS GURU }

End-of-Life Decision-Making

Giles R. Scofield, JD, MA

It’s easier said than done

they can trust and what to ask. They might also struggle with whether to take the dying patient home, whether to touch or hold him or her, and whether to be present before, during and after the patient dies.

Our Ethics Guru will weigh Finally, there is in on health ethics questions the medical decisionin future issues. Just email making process itself. us at heartbeat@ Just because health providence.org. care providers are no longer tongue-tied when it comes to end-of-life care, that doesn’t mean that we communicate well. What health care providers believe about end-of-life care affects the options they present to families, according to another recent study.

To the extent that informed consent is not simply about shared decisionmaking, but also about open, honest and transparent discussion, improvements need to be made.

Send us your questions

Given that it’s been almost 40 years since the New Jersey Supreme Court said it was OK for Karen Ann Quinlan to be taken off a respirator—and almost 25 years since the U.S. Supreme Court said the right to refuse treatment includes the right to forgo artificial nutrition—you might think that we’ve worked out the end-of-life decisionmaking bugs. Not true. It’s still hard to do, for several reasons: There’s always something new to decide about. In addition to ventilators, CPR and dialysis, there are pacemakers, implantable defibrillators and even mechanical hearts. Additionally, end-of-life decision-making is no longer limited to patients who are terminally ill or permanently unconscious but also includes the minimally conscious, the chronically ill and the disabled. Last, the ethics of artificially provided nutrition and hydration is still debated all these years later.

End-of-life decision-making also includes nonmedical issues. According to a recently published study, families aren’t just making decisions about whether to place a tracheotomy so their loved one can breathe. They’re also deciding whom

30 ● Summer 2013 Heart Beat

Discussions Matter All of this means that end-of-life decision-making is neither simple nor too complicated to handle. It’s complex, for reasons that have to do with what’s being decided and who the decisionmakers are, namely us—all of us. End-of-life decision-making is the quintessential tragic choice, the kind of choice that needs to be made but that nobody really wants to make.

That being the case, we shouldn’t be worried that there’s still work to be done (so long as we’re doing the work), or that it never gets easier, that we don’t always agree or that new challenges keep coming along. After all, that’s what comes of living in a diverse, democratic society, where there are no preconceived, one-size-fits-all solutions to these important decisions.

This is why it is still so important these conversations occur, difficult though they can be, and that they don’t take place in a vacuum. In addition to talking with family members and other loved ones, bring your physician and other members of the health care team in on the conversation so that they understand what you want and why you want it so that everyone is on the same page.

See More Events

{ Community cALENDAR }

Summer 2013 Classes, Events & Activities

Check out the full calendar of events, with more details and free informative sessions, at phc.org. Click “News & Events” then “Calendar.”

Mother-Baby Time Tuesdays • 1 p.m.

Holy Family Health Education Center Call 509-428-2229.

Wednesdays • 10 a.m.

Sacred Heart Women’s Health Center Call 509-474-2400.

Come with your new baby to make friends, find support and receive answers to your questions. A lactation consultant is always available to address infant health care issues and to weigh your baby.

Cancer Support Groups A cancer diagnosis creates all kinds of needs for patients—and their family members. To learn more about support groups available through the Providence Regional Cancer Center, call 509-474-5490.

Meditation and More Various classes and seminars related to spirituality and stress reduction are offered at the Providence Center for Faith and Healing, on the Sacred Heart Medical Center & Children’s Hospital campus.

Call 509-474-3008.

Free Car Seat Checks July 13 • South Hill Shopko 4515 South Regal August 17 • Liberty Lake Home Depot 21701 East Country Vista Drive, Liberty Lake September 21 • Dishman Dodge 7700 East Sprague

Recycle your old car seats!

Bring them to any car seat check-up and we’ll be happy to recycle them for you!

Sacred Heart Children’s Hospital is the Safe Kids Spokane Lead Agency.

Learn more at shmcchildren.org.

Summer 2013 Heart Beat ● 31

NON-PROFIT ORG us postage

pai d

heart beat

Providence Sacred Heart Medical Center & Children’s Hospital 101 W 8th Ave Spokane, WA 99204

{ role model }

Comforting Presence

Only certified pet therapy dogs and service animals are permitted in Providence hospitals.

Mckenzi, a 3-year-old golden retriever, was destined to be a therapy dog when she was adopted by the Conrad family. Kara Conrad had decided as a young child that someday she would be part of a pet therapy program at a hospital and made it a reality when she turned 16. Mckenzi was just the dog to make that dream come true.

Parvo, a life-threatening canine disease, left Mckenzi ill for a long time—but she never gave up. Today, she brings that same “overcomer” attitude to children who also have to fight for their lives.

Mckenzi is one of many specially trained dogs who bring joy to patients at Providence Spokane hospitals and nursing facilities. Their wagging tails and comforting presence are bright spots during rough times for thousands of patients every year.

Our Mission is to reveal God’s love for all, especially the poor and vulnerable, through our compassionate service. Our values are respect, compassion, justice, excellence and stewardship. If you have a story of an employee demonstrating these, please email heartbeat@providence.org.

PHOTOGRAPH BY GARY MATOSO