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Prepare for the Unexpected

Jack Ferriter says it’s never too early to talk to an attorney

Jack Ferriter says it’s never too early to talk to an attorney about a healthcare proxy and living will.

Medical decisions aren’t always cut and dry. The way Jack Ferriter sees it, why entrust them to just anyone?

“A healthcare proxy is someone who stands in your shoes to make medical decisions for you, but only if you’re unable to make those decisions,” said Ferriter, who practices business and estate law at Ferriter Law in Holyoke.

The term ‘healthcare proxy’ also refers to the document that specifies who will make those critical decisions for an individual if they can’t make them on their own — for instance, in a medical emergency that has them unconscious or otherwise incapacitated.

For instance, Ferriter explained, “if a surgeon says, ‘do you want this operation?’ and you can shake your head to say ‘yes’ or ‘no,’ the doctor will go with your answer. But if you’re unable to make that decision — or even if you’re unwilling, if you say, ‘I don’t know; please ask my wife, who’s my healthcare proxy’ — then the surgeon would ask your healthcare proxy whether you should have the operation.”

A 2017 study in the journal Health Affairs revealed that one-third of Americans have a healthcare proxy, which is far too low, say estate-planning attorneys and doctors.

“When somebody comes in here and they’re asking for an estate plan, we will always include a will, a power of attorney, and a healthcare proxy and a living will,” Ferriter told BusinessWest. “Everyone should have them. It’s not just for people 65 and older. Anybody could get hit by the proverbial bus and need somebody else to make medical decisions with a healthcare proxy, or financial decisions with power of attorney.”

In a recent blog post, Springfield-based law firm Bulkley Richardson noted that it examined whom its own clients had named as their healthcare proxies, and found that, not surprisingly, a spouse was most common, followed by an adult child.

“Where a child was named, gender, birth order, and whether the child was the parent’s ‘unofficial favorite’ often did not seem to matter,” the firm noted. “Geographic proximity to the parent signing the document, emotional maturity, and perceived alignment with the parent’s preferences seemed to determine who was named.  If a child was in a medicine-related profession, that was often a major factor in the selection.”

“Anybody could get hit by the proverbial bus and need somebody else to make medical decisions with a healthcare proxy, or financial decisions with power of attorney.”

Ferriter recommends that clients name two people — a primary and secondary healthcare proxy — because the designation comes into play at urgent and unexpected times.

“If it’s 2 in the morning and the surgeon is trying to reach your healthcare proxy and doesn’t have the right number, or has a home number that’s going into a machine and needs an answer, or if somebody’s out of the country, it’s always good to have a secondary healthcare proxy so the surgeon can call the secondary one and say, ‘should we do this operation or not?’”

He recommends that cell-phone numbers are used, not landlines, but even then, ringers are sometimes turned off, or phones lose their charge, and no one wants the wrong person to make life-and-death decisions because of a dead battery.

Wishes Granted

In addition to the healthcare proxy, Ferriter recommends clients prepare a living will as well.

“You go down the list and check off or initial each line — you do not wish to be resuscitated, you do not wish to be artificially fed, you do not wish to be artificially kept alive,” he noted.

However, the living will in itself is not a binding legal document in Massachusetts (however, it is in Connecticut and some other states). So why prepare one? Perhaps its greatest value comes in the guidance it gives one’s doctors and healthcare proxy.

“I find it’s a good guide for your conversation with your healthcare proxy and with your family. You go down the list and say, ‘here’s what I want, here’s what I don’t want, and even though this is not legally binding in Massachusetts, I just want you to know so that, if you are making the decisions for me, you’ll have my answers ahead of time.’”

And for those who worry about the finality of the living will, Ferriter pointed out that language on the form states that the living will is to be followed only if there’s no reasonable chance of recovery.

“I know these questions are kind of scary. If you’re 55 years old and it says ‘do not resuscitate,’ you’re afraid that if you walk out my front door and have a heart attack, they’re not going to resuscitate you. But they would, because it says ‘only if there’s no reasonable chance of recovery.’ So if you’re 105 years old in a nursing home and your heart stops, they’re probably not going to paddle you. But if you’re 55 years old and you have a heart attack outside a lawyer’s office, I’m sure they would absolutely paddle you, and wouldn’t even ask anybody.”

A third document related to critical-care decisions that has emerged in recent years is the MOLST document, which stands for medical orders for life-sustaining treatment. And, unlike a living will, MOLST is absolutely a binding document.

“MOLST differs from the most common type of palliative-care planning — advanced directive orders, which usually include a living will or other expression of wishes. Those orders generally designate a surrogate decision maker, or healthcare proxy, to act on behalf of an incapacitated patient,” the Massachusetts Medical Society (MMS) notes.

“Living-will instructions — when presented by a healthcare proxy — are generally recognized as evidence of patient preferences, but are not recognized by Massachusetts law. In contrast, a completed MOLST form travels with the patient at all times, may be faxed or reproduced, and is an official part of a patient’s medical record.”

Ferriter noted that the MOLST isn’t technically a legal document, but a medical one.

“We don’t do them here in the office because the medical orders are done with a physician or a medical professional. Those are your orders, and those are binding in Massachusetts because you’ve had advice from a physician.”

But MOLST is not typically a document prepared absent an impending, planned event, like, say, open-heart surgery.

“Typically, they happen if you are going into the hospital for some kind of serious procedure. My experience is that physicians don’t offer to do medical orders with their patients, but if you ask for them, they’ll do them, and if you’re going in for a serious operation, they may bring it up at that point,” Ferriter said. “You can’t sit at home and fill out medical orders by yourself because you’re not making an informed decision. And it’s usually your primary-care doctor who does it — someone who knows you well — even though the surgeon is doing the surgery.”

MOLST covers resuscitation efforts, breathing tubes and ventilation, artificial nutrition and hydration, and dialysis, the MMS notes.

“MOLST has priority over the healthcare proxy, because it’s your actual wish, as if you had shaken your head ‘yes’ or ‘no’ at the time of the actual procedure,” Ferriter said.

Don’t Put It Off

While many people will never have need of a MOLST, he went on, it’s hard to argue that they won’t need the other documents at some point — and the sooner, the better.

“We tell clients that as soon as you get married or buy a house, have a child, or even graduate from college, it’s not that expensive to do a will, power of attorney, healthcare proxy, and living will,” he noted. “For a single person, it’s less than $300, and for a couple, it’s less than $500.

“A lot of times, older couples will come in upon retirement,” he went on. “Most of the time, they had a previous version of these documents, but things have changed. They had it done in their 30s and 40s, now they’re in their 60s, so we update those.”

Individuals or couples with children will also want to include guardianship documents and perhaps establish a trust in case neither is around to care for them.

“When I have people in their 30s and 40s come in, it’s usually because one of the parents has passed away, or maybe a grandparent has passed away. There’s usually something that pushes them to come in,” Ferriter said, adding that, in truth, it shouldn’t take a big life change to start thinking about who will make important decisions in case crisis strikes.

When folks come in to get their estate plan done, I tell them, ‘you should sit around a dining room table with your family and have a frank coversation about what you want. It can be a difficult conversation, but it’s always better to have it at the dining-room table than around a hospital bed.’”

Joseph Bednar can be reached at [email protected]

The Fourth Installment of BusinessWest’s Future Tense Lecture Series!
Future Tense – Power of the Pause
Thursday, November 8, 2018
8 a.m.-9:30 a.m.
Cost: $25 donation to Tech Foundry
Presenter: Susan O’Connor, Esq.: Health New England, Director & General Counsel

It’s not easy managing in today’s fast-paced, complex, dynamic work environments. Leaders are required to remain focused in the face of a myriad of commitments, to have clarity of mind, to ensure they are doing the right things (not just doing ‘things’), and maintain calm in the midst of daily storms. But what if we as leaders could hit the “pause” button during our day, step back, and meet challenges with a sense of space, clarity and focus? What if there was a way to not just “get things done,” but ensure that what does get done connects us with ourselves, with the people we work with and ultimately, with our organization’s deepest values? Mindfulness is a compelling tool for performance, teamwork and effectiveness as well as presence, kindness and balance. Moira Garvey, Senior Consultant and Facilitator with the Potential Project, will share why mindfulness is relevant in the workplace and why companies around the globe are incorporating mindfulness to support workplace performance and employee well-being.

In this session you will hear how Springfield-based Health New England brought mindfulness training to its Associates. In 2015, HNE ran a pilot to enhance their high performance culture – 30 leaders participated in a 4 month course. HNE leadership knows the key to success is the ability to work at a high level of mental effectiveness, while also remaining resilient in the face of stress. In many industries including health care, the velocity of change, competition and complexity are constant challenges. Since the successful 2015 pilot HNE has continued to invest in Mindfulness training as a way to fortify a culture of high performance that is focused and intentional. In 2017, 63% of the participants held leadership positions

In the foundational session Moira will provide an overview of the nature of the mind and attention, while sharing information on the most recent scientific findings regarding how the brain works and how it can be rewired to enable us to be more focused, calm and effective at work every single day. She will teach a basic mindfulness practice and offer a focus strategy for immediate application.

Presenters:
Moira Garvey, Senior Consultant and Facilitator, Potential Project
Susan O’Connor, Esq., Vice President and General Counsel, Health New England

Cover Story Healthcare Heroes

Scenes from the Healthcare Heroes 2018 Gala

Passion is the word that defines these heroes. And it was on clear display Oct. 25 at the Starting Gate at GreatHorse in Hampden, site of the Healthcare Heroes Gala.

This was the second such gala. The event was a huge success, not because of the venue (although that was a factor) or the views (although they certainly helped), but because of the accomplishments, the dedication, and, yes, the passion being relayed from the podium.

There are seven winners in all, in categories chosen to reflect the broad scope of the health and wellness sector in Western Mass., and the incredible work being done within it. Go HERE to view the  2018 Healthcare Heroes Program Guide

The Healthcare Heroes for 2018 are:

• Patient/Resident/Client Care Provider:

Mary Paquette, director of Health Services/nurse practitioner, American International College

• Health/Wellness Administrator/Administrator:

Celeste Surreira, assistant director of Nursing, the Soldiers’ Home in Holyoke

• Emerging Leader:

Peter DePergola II, director of Clinical Ethics, Baystate Health

• Community Health:

Dr. Matthew Sadof, pediatrician, Baystate Children’s Hospital

• Innovation in Health/Wellness:

TechSpring

• Collaboration in Health/Wellness:

The Consortium and the Opioid Task Force

• Lifetime Achievement:

Robert Fazzi, founder, Fazzi Associates.

American International College and Baystate Health/Health New England are presenting sponsors for Healthcare Heroes 2018. Additional sponsors are National Grid, partner sponsor, and Elms College MBA Program, Renew.Calm, Bay Path University, and Trinity Health Of New England/Mercy Medical Center as supporting sponsors.

HealthcareHeroesSponsors

Photography by Dani Fine Photography

Meet the Judges

There were more than 70 nominations across seven categories for the Healthcare Heroes Class of 2018. Scoring these nominations was a difficult task that fell to three individuals, including two members of the Class of 2017, with extensive backgrounds in health and wellness. They are:

Holly Chaffee

Holly Chaffee

Dexter Johnson

Dexter Johnson

Dr. Michael Willers:

Dr. Michael Willers:

Holly Chaffee, MSN, BSN, RN: Winner in the Healthcare Heroes Health/Wellness Administrator/Administration category in 2107, Chaffee is president and CEO of VNA Care, a subsidiary of Atrius Health. Formerly (and when she was named a Healthcare Hero) she was the president and CEO of Porchlight VNA/Homecare, based in Lee.

Dexter Johnson: A long-time administrator with the Greater Springfield YMCA, Johnson was named president and CEO of that Y, one of the oldest in the country, in the fall of 2017. He started his career at the Tampa Metropolitan Area YMCA, and, after a stint at YMCA of the USA, he came to the Springfield Y earlier this decade as senior vice president and chief operating officer.

Dr. Michael Willers: Winner in the Patient/Resident/Client-care Provider category in 2017, Willers is co-owner of the Children’s Heart Center of Western Mass. Formerly a pediatric cardiologist with Baystate Children’s Hospital, he founded the Children’s Heart Center of Western Mass. in 2012.
 

 

Health Care

Deep Dive

Stacey Kronenberg (right), operations manager at Achieve TMS East

Stacey Kronenberg (right), operations manager at Achieve TMS East, demonstrates the dTMS technique with technician Sara Pittman.

With data in hand showing that its signature treatment — known as deep transcranial magnetic stimulation — has a strong track record in battling depression, Achieve TMS East has seen significant growth in the region. Now it has further reason to be excited, with the technique showing great promise in treating OCD.

Margie Pierce understands the difficulty — and, yet, the importance — of tackling the problem of depression.

“It’s the leading cause of disability worldwide right now,” said Pierce, a licensed clinical social worker and director of operations at Achieve TMS East, a fast-growing chain of behavioral-health practices that employ an innovative approach to treating depression known as deep transcranial magnetic stimulation, or dTMS.

“We’ve had people who were chronically depressed for 20 years have a fabulous response to this, and we’ve had people chronically depressed who have not had a great response,” she told BusinessWest. “We can’t pigeonhole people when they come in, whether they’re going to respond or you’re not. It’s kind of hit or miss, just like with medications. Some people respond to certain medications, and others don’t.”

That said, however, dTMS has proven remarkably effective in most people who undergo it — in many cases, people who have tried a seemingly endless string of medications and therapies with little success. That explains why the organization has grown to 11 offices across Western Mass., with broader geographic expansion planned.

“We can’t pigeonhole people when they come in, whether they’re going to respond or you’re not. It’s kind of hit or miss, just like with medications. Some people respond to certain medications, and others don’t.”

Deep transcranial magnetic stimulation, or dTMS, is a non-invasive technique that applies a series of brief magnetic pulses to the brain, by passing high currents through an electromagnetic coil placed adjacent to a patient’s scalp. The pulses induce an electric field in the underlying brain tissue and activates underactive areas in the brain associated with depression.

Dr. John Zebrun, senior medical officer with Achieve TMS East, said transcranial magnetic stimulation (TMS) was developed in Europe in the 1990s, and the first machine to receive FDA approval in the U.S. was the Neurostar machine, in 2008, which reached two to three centimeters into the brain, unlike dTMS — developed by an Israeli company called BrainsWay — which reaches six to seven centimeters in, and earned FDA approval in 2013.

“It enables you to get deeper into the brain tissue, so the volume of brain tissue is larger,” Zebrun told BusinessWest. “We don’t miss the target, ever, and there’s more stimulation in that area.”

The developers of the original TMS technique, he explained, wanted to discover if there were circuits or networks in the brain tissue they could stimulate to ease clinical depression. They targeted the left prefrontal area, which imaging scans suggested were underactive in patients with depression.

“The thought was to stimulate that area first and get it closer to a normal activity level, and that would help with depression — and it did. And that still is the primary target,” he said, noting that the device produces a magnetic field, not an electric current. “It’s getting groups of neurons in the circuit to fire together. As they get used to firing together, they’re more connected to each other.”

After a standard treatment of 36 sessions, he went on, those neurons become trained to fire normally. Treatment statistics show that 51% of patients who undergo the entire protocol get all the way to remission, while 75% get at least halfway to their goal. About one-third will need repeat, ‘booster’ treatments down the road, while two-thirds don’t.

Dr. John Zebrun says deep transcranial magnetic stimulation gets deeper into the brain than traditional TMS

Dr. John Zebrun says deep transcranial magnetic stimulation gets deeper into the brain than traditional TMS — and shows great promise for OCD as well.

In short, those are great numbers for a depression treatment, Zebrun said, and that success explains why Achieve has grown so rapidly across the region — and promises to become a more widely known name across the Northeast.

Long Time Coming

The breakthrough in TMS occurred in 1995, Zebrun said; that was when researchers first demonstrated that a magnetic field could stimulate the right neurons and get a response.

“So it’s been around a long time,” he said. “It varies from machine to machine, but they’re all operating within a certain range and certain power level to get the antidepressant effects.”

FDA approval was only one key development, however; insurances companies still needed to pay for the treatment if doctors hoped to reach a wide market. Medicare accepted it in 2015, and other payers soon came on board.

The FDA originally approved TMS for patients who had failed to find relief with another antidepressant treatment. “But insurance companies added extra layers, expecting to see about four medication and psychotherapy trials before they give this approval,” Zebrun said. “But a lot of people out there have already been through years of treatment and tried several medications.”

Dr. Thomas Bombardier, an ophthalmologist turned businessman, was involved with launching a chain of Achieve TMS businesses in California, Pierce told BusinessWest, and when he saw the benefits and how patients were responding out west, he decided to bring the model to his Western Mass. stomping grounds, teaming with two other owners to open Achieve TMS East.

Patients are referred to Achieve by their primary-care doctors, therapists, and psychiatrists, and some self-refer after hearing about the practice through social media or friends or family members.

“We’re very open to however they can get into the door to get the help they need,” Pierce said, noting that, while the majority of people who seek out tDMS are good candidates for it, some aren’t, due to medical contraindications, recent seizures, or even metal in the head that could heat up during the treatment. Everyone also gets a psychiatric consult to see if the treatment will be appropriate.

Stacey Kronenberg, operations manager at Achieve TMS East, demonstrated the dTMS technique for BusinessWest on Sara Pittman, a technician with the practice, although at a very low power level. Pittman put on a soft cap followed by the dTMS helmet, and Kronenberg set the device to a single-pulse mode, moving centimeter by centimeter until she found the motor area for Pittman’s hand, which twitched. From this process of ‘mapping,’ she could locate the right area to target for treatment.

The power setting isn’t uniform for each patient, and can be altered by the thickness of the skull, how much sleep the patient got the night before, even how much coffee they drank that morning. The process involves 36 ‘taps’ in two seconds as the neurons are stimulated, followed by a 20-second break, then another 36 taps in two seconds, then a 20-second break — a cycle repeated 55 times, totaling just over 20 minutes.

Initial treatments are run at lower power than later treatments to desensitize the patient to the sensation, which Pittman described as more of an annoyance — like a woodpecker tapping at her head — than anything. “It’s a tolerable discomfort,” Zebrun added. “I wouldn’t say it’s a breeze, but it’s tolerable.”

Margie Pierce

Margie Pierce says some people have come in after battling depression for 20 years — and finally found relief through dTMS.

Some patients pass the time by chatting with the technician, while others choose something to watch on Netflix, on the big TV hung on the wall beside the treatment chair.

“A lot of people, at the end, are like, ‘oh, I’m done already?’ They’re enjoying their conversation or their show,” Kronenberg said. “I think we should work for Netflix. A lot of people come in and are like, ‘I want to get Netflix.’”

That’s because they’re at the office often enough to binge a lot of TV — five days a week for six weeks, in fact, which is how long it takes to train the brain. “A lot of patients don’t want to leave when it comes to the end of their treatment,” she said. They tell us, “I’m so used to coming and seeing you. Who can I talk to now?’”

Beyond Depression

For starters, they can talk to their loved ones, in most cases, about how effective the treatment was. And depression isn’t the only use for dTMS. The FDA recently approved it as a treatment for obsessive compulsive disorder. In fact, dTMS has been successful in trials for OCD in ways that traditional TMS cannot be, because the target area of the brain is deeper than for depression.

“The surface coils [of TMS] would need so much energy to get that deep, it would hurt. The surface area would get too much stimulation rather than area you’re targeting, and you’d risk a seizure. That wouldn’t happen with dTMS,” Zebrun explained.

He said he hopes to reach people who don’t find standard cognitive treatment for OCD effective. “It can devastate one’s life. You can get wound up into some of these compulsions, or your mind can be so caught up and obsessed with obsessive thinking that you can’t focus on anything else. You can’t get through a planned project because there’s too many interruptions from your loops of thought that come in. There’s a wide range of those obsessions and compulsions.”

Even milder symptoms of OCD can really bother people, he added. “They wish they could get rid of these images popping into their head that started from nowhere and have no relation to anything in their lives and are disturbing to them.”

“They’ll say, ‘why wouldn’t you try this? What do you have to lose, except maybe your depression?’ … For most people, it’s going to help.”

Kronenberg also hopes dTMS makes an impact on the lives of these patients, noting that OCD is one of the most thorny issues that therapists tackle. And, much like depression, she added, OCD can be a “hidden” disease because there’s some stigma and shame associated with it.

But there shouldn’t be, Zebrun said, especially when something like dTMS exists, with its strong track record and its minimal side effects, which may include facial muscle contractions and headaches, which are both temporary. Fewer than one patient in 1,000 may experience a seizure — a risk similar to that of taking an antidepressant medication at the maximum dose.

Because it’s tolerable, he added, patients can do it before or after work, or during their lunch break, and return to their normal activities.

And maybe a normal life.

“People who for 20 years were depressed say it’s life-changing for them,” said Anita Taylor, marketing director at Achieve TMS East. “When we hear those kind of stories, we’ll ask them, ‘what would you say to someone thinking about this?’ They’ll say, ‘why wouldn’t you try this? What do you have to lose, except maybe your depression?’ It’s worth it to give it a try, go in wholeheartedly, and, for most people, it’s going to help.” u

Joseph Bednar can be reached at [email protected]

Health Care

In Search of Empathy

Catherine Williamson

Catherine Williamson says empathy is at the heart of the dementia-friendly movement.

Empathy is a quality America can always use more of — and that’s especially true, Catherine Williamson said, when it comes to families struggling with dementia.

“What attracted me to the dementia-friendly movement is being able to help individuals adjust to what’s going on in their lives,” she recently told a group of business leaders, who met for lunch at the Student Prince in Springfield for a presentation by the Springfield Dementia Friendly Coalition.

“It’s about empathy, and some of us are not great at being empathetic,” she went on. “Our lives are fast-paced, and we’ve got a lot going on — kids, jobs, husbands and wives, volunteering. We’ve got so much going on that, sometimes, we forget to stop and think about someone else not being able to move as fast as we can, or understand things the way we can.”

Williamson, a certified dementia practitioner and gerontologist with SilverLife Care at Home, said a goal of the dementia-friendly movement is to educate the community, and even the loved ones of people with dementia, about how daily experiences differ for individuals with that condition — everything from going to the library to visiting a doctor; from having a financial-planning meeting with an attorney to simply eating out at a restaurant.

To demonstrate, she led the lunch attendees in a virtual ‘dementia experience,’ in which participants use common objects to block or hinder their eyesight, hearing, range of hand motion, and other faculties, then try to communicate with each other — again, as a way to create empathy and reinforce the need for dementia-friendly changes in society.

“People with functional limitations are dealing with this constantly,” she said. “Imagine how much this impacts their daily lives, their relationships, getting around, even wanting to be out in the community. If you felt like this all the time, in this impaired state, you’d probably want to stay home, too. We need to think about how to make our communities and businesses and public spaces a little easier to navigate.”

The business leaders at the lunch shared their professional and personal experiences with dementia and learned about what it would mean to make Springfield a dementia-friendly community — a designation that an increasing number of Massachusetts cities and towns have been pursuing, one in which businesses, municipal departments, and other entities make a collective effort that help people who are memory-challenged to function in the community and live independently for as long as possible.

“Sometimes, we forget to stop and think about someone else not being able to move as fast as we can, or understand things the way we can.”

“What can we do as a community to improve the quality of lives?” asked Anna Randall of Greater Springfield Senior Services, one of the coalition members. “Being dementia-friendly means different things to different communities, depending on their populations and what resources they already have. We’re here to ask businesses what we can do to help your clients and make this community dementia-friendly.”

At a Loss

Nearly 5.1 million Americans age 65 and older are living with Alzheimer’s disease, the most common form of dementia, and the number is expected to reach 7.1 million in the next decade. Nearly 60% of people with dementia live in their own communities, and one in seven live alone, creating an urgent need, dementia-friendly advocates say, for communities to support people with dementia and their caregivers. 

Attendees of the recent Springfield Dementia Friendly Coalition

Attendees of the recent Springfield Dementia Friendly Coalition lunch underwent a virtual ‘dementia experience’ to get a small taste of what’s it’s like to navigate the world with cognitive impairment.

Meghan Lemay, regional manager in the Springfield office of the Alzheimer’s Assoc., said Alzheimer’s disease is a true epidemic, currently the sixth-leading cause of death in the U.S. and the only major disease that has been increasing in incidence — by a 123% rate since 2000, in fact. At the same time, incidences of diseases like cancer and heart disease have been falling.

In addition, she noted, Alzheimer’s is the most expensive disease in America, expected to cost the healthcare system and caregivers some $277 billion in 2018 alone.

“It’s something we have to address on multiple fronts,” Lemay said. “We know it impacts families directly and has a significant emotional impact, but there’s also a significant financial impact for individuals and our communities.”

Springfield, in fact, is disproportionally affected, with a higher rate of dementia than other Massachusetts communities on average. Demographically, meanwhile, the condition affects African-Americans and Latinos at a higher rate than whites.

While individual communities seek the dementia-friendly designation, a state-level organization known as Dementia Friendly Massachusetts is supporting those efforts. On the community level, Randall noted, businesses who go through dementia-friendly training can then display that fact, “to say this company has gone the extra mile to show they care about their community and want to be more inclusive for people caring with dementia.”

“It’s something we have to address on multiple fronts. We know it impacts families directly and has a significant emotional impact, but there’s also a significant financial impact for individuals and our communities.”

Williamson noted that such steps by businesses could include modifying entryways, altering lighting, or changing the ways they interact with customers. And the changes don’t have to be dramatic. For example, a coffee shop in Boston became more dementia-friendly when it complemented its chalkboard menu with large-print menus at the register. “It’s little things like that — different types of things you can do.”

One attendee of the recent lunch in Springfield noted that some businesses have gone the opposite route, citing the increasing use of automated ordering kiosks at McDonald’s and the dominance of self-checkout lanes at Stop & Shop as two developments that can be problematic for certain individuals.

However, on the plus side, many restaurants have embraced the Purple Table training program designed to help visitors with dementia, autism, PTSD, hearing or vision impairment, or other conditions benefit from a more predictable environment and additional accommodations when dining out.

When families make a Purple Table reservation, participating restaurants provide accommodations that work best for that diner, along with extra patience and attention from staff who have been trained to understand different needs and how to best meet them. Those steps might differ depending on the visitor, but the underlying philosophy of empathy and understanding is the same.

Law and Order

The recent lunch gathering was funded by a dementia-friendly capacity-building grant from the Massachusetts Council on Aging under a service incentive grant from the Massachusetts Executive Office of Elder Affairs, allowing the coalition to hold focus-group meetings with local government and public officials, first responders, and members of the business community.

The goal is to make them aware of the issues facing individuals living with dementia, their friends, family, and care partners; to give an overview of the movement; and to elicit their thoughts and engagement in the initiative. In addition, the group will meet with those living with dementia and their care partners.

The coalition chair, Synthia Scott-Mitchell from Springfield Partners for Community Action, noted that “a dementia-friendly community is defined as one that is informed, safe, and respectful of individuals with dementia and their families, and provides supportive options for improved quality of life.”

But legislators can make a difference, too, and recently did, by passing a first-of-its-kind bill — subsequently signed into law by Gov. Charlie Baker — that aims to make life a little easier for individuals with dementia and their families, through a multi-pronged approach.

More than 130,000 people are currently living with Alzheimer’s disease in Massachusetts, and being cared for by more than 337,000 family and friends. According to the Alzheimer’s Assoc., in 2018, Massachusetts will spend more than $1.6 billion in Medicaid costs caring for people with Alzheimer’s.

“Alzheimer’s is the single largest unaddressed public health threat in the 21st century, and we remain on the front lines of this crisis every day here in the Commonwealth,” said Daniel Zotos, director of Public Policy & Advocacy of the Alzheimer’s Assoc., Massachusetts/New Hampshire Chapter. “This legislation follows in the tradition of Massachusetts being a national leader in healthcare, and we commend the governor and Legislature for ensuring everyone impacted by Alzheimer’s gets the quality care and support they deserve.”

Among its mandates, the bill:

• Establishes a comprehensive state plan to address Alzheimer’s disease within the Executive Office of Health and Human Services, while also establishing a permanent advisory council to help coordinate government efforts and ensure that public and private resources are maximized and leveraged;

• Requires curriculum content about Alzheimer’s and other dementias be incorporated into continuing-medical-education programs that are required for granting the renewal of licensure for physicians, physician assistants, registered nurses, and licensed nurse practitioners;

• Ensures proper notification of an Alzheimer’s or dementia diagnosis to the family or legal guardian and provides information on available resources to both the patient and family;

• Requires state hospitals to implement an operational plan for the recognition and management of patients with dementia or delirium; and

• Establishes minimum training standards for social workers in elder protective services, to ensure protection from abuse and exploitation for elders with Alzheimer’s and dementia.

Small Steps, Big Impact

When it comes to making communities more navigable and manageable for people with dementia, every effort helps, Williamson said, noting that the dementia-friendly movement also seeks to raise awareness — often through workplace presentations — of resources available to help families grapping with Alzheimer’s, when they’re not always willing to seek them out because of shame or stigma.

“If we go into your workplace and address your employees, we’re reaching folks that might need help,” she said. “It’s not just about doing the right thing for your customers, but also for your staff — folks who are taking care of their loved ones, but might not want to come forward.”

As the statistics show, those folks are legion. Increasingly, Williamson and her fellow coalition members hope, they are starting to find their communities a little friendlier, in some very important ways.

Joseph Bednar can be reached at [email protected]

Cover Story Healthcare Heroes

Healthcare Heroes to Be Saluted on Oct. 25

HealthcareHeroes18

Passion.

If one were challenged to describe the Healthcare Heroes for 2018 — or any year, for that matter — with just a single word, this would be the one.

It is a common character trait within any healthcare profession, but it is certainly necessary to rise above the tens of thousands of men and women in this field and earn that designation ‘hero.’

And it is certainly a common denominator in the remarkable and truly inspiring stories. The passion comes to the fore whether that story is about a career emergency-room nurse who shifted to work at college wellness centers and completely transformed the one at American International College, or about a nurse administrator at the Soldiers’ Home in Holyoke who is transforming care there while also serving as a mentor and role model for other team members. It’s the same when the story is about a large, multi-dimensional effort to battle opioid and heroin addiction in rural Franklin County, or about a pediatrician dedicated not only to the residents of a community, but to making that community a healthier place to live.

Fast Facts

What: The Healthcare Heroes Gala
When: Thursday, Oct. 25, 5:30-8:30 p.m.
Where: The Starting Gate at GreatHorse, Hampden
Tickets: $90 (tables of 10 available)
For more Information: Email [email protected]

That we said, passion is the word that defines these heroes. And it will be on clear display on Oct. 25 at the Starting Gate at GreatHorse in Hampden, site of the Healthcare Heroes Gala.

This will be the second such gala. The inaugural event was a huge success, not because of the venue (although that was a factor) or the views (although they certainly helped), but because of the accomplishments, the dedication, and, yes, the passion being relayed from the podium. It will be same in about seven weeks.

But first, the stories that begin on the facing page.

There are seven winners in all, in categories chosen to reflect the broad scope of the health and wellness sector in Western Mass., and the incredible work being done within it:

The Healthcare Heroes for 2018 are:

• Patient/Resident/Client Care Provider:

Mary Paquette, director of Health Services/nurse practitioner, American International College

• Health/Wellness Administrator/Administrator:

Celeste Surreira, assistant director of Nursing, the Soldiers’ Home in Holyoke

• Emerging Leader:

Peter DePergola II, director of Clinical Ethics, Baystate Health

• Community Health:

Dr. Matthew Sadof, pediatrician, Baystate Children’s Hospital

• Innovation in Health/Wellness:

TechSpring

• Collaboration in Health/Wellness:

The Consortium and the Opioid Task Force

• Lifetime Achievement:

Robert Fazzi, founder, Fazzi Associates.

American International College and Baystate Health/Health New England are presenting sponsors for Healthcare Heroes 2018. Additional sponsors are National Grid, partner sponsor, and Elms College MBA Program, Renew.Calm, Bay Path University, and Trinity Health Of New England/Mercy Medical Center as supporting sponsors.
HealthcareHeroesSponsors

Photography by Dani Fine Photography

Tickets to the Oct. 25 gala are $90 each, with tables of 10 available for purchase. For more information or to order tickets, call (413) 781-8600, or email [email protected]

 

Meet the Judges

There were more than 70 nominations across seven categories for the Healthcare Heroes Class of 2018. Scoring these nominations was a difficult task that fell to three individuals, including two members of the Class of 2017, with extensive backgrounds in health and wellness. They are:

Holly Chaffee

Holly Chaffee

Dexter Johnson

Dexter Johnson

Dr. Michael Willers:

Dr. Michael Willers:

Holly Chaffee, MSN, BSN, RN: Winner in the Healthcare Heroes Health/Wellness Administrator/Administration category in 2107, Chaffee is president and CEO of VNA Care, a subsidiary of Atrius Health. Formerly (and when she was named a Healthcare Hero) she was the president and CEO of Porchlight VNA/Homecare, based in Lee.

Dexter Johnson: A long-time administrator with the Greater Springfield YMCA, Johnson was named president and CEO of that Y, one of the oldest in the country, in the fall of 2017. He started his career at the Tampa Metropolitan Area YMCA, and, after a stint at YMCA of the USA, he came to the Springfield Y earlier this decade as senior vice president and chief operating officer.

Dr. Michael Willers: Winner in the Patient/Resident/Client-care Provider category in 2017, Willers is co-owner of the Children’s Heart Center of Western Mass. Formerly a pediatric cardiologist with Baystate Children’s Hospital, he founded the Children’s Heart Center of Western Mass. in 2012.
 

 

Healthcare Heroes

This Compassionate Leader Has Transformed Health and Wellness on the AIC Campus

Mary Paquette

Mary Paquette

‘Sex and Chocolates.’

Sounds like one of Hollywood’s late-summer releases. But instead, it’s one of the many intriguing new programs and initiatives launched by Mary Paquette, MS, FNP, in her role as director of Health Services at American International College.

And now that we have your attention — and we almost certainly do — we’ll tell you about it.

Not long after arriving at the college in 2012 to accept the challenge of resuscitating a moribund health-services facility that few students knew about or ventured to (for a host of reasons we’ll get into later), Paquette decided she needed to do some serious outreach.

And it would be undertaken with a number of goals — from introducing (or reintroducing) students to the health facility (known as the Dexter Center) to providing some education, to gaining some insight into the many issues and challenges confronting AIC’s diverse population, many of them first-generation college students.

“There were questions on everything from STD education to things you would think of with Dr. Ruth; I learned some things from these students, and it ended up being a lot of fun.”

So, as part of this outreach, Paquette and Millie Velazquez, office manager and medical assistant at the center, went into one of the female freshman dorms with a large fishbowl containing some questions they had already put in, some chocolates, and a thirst for more questions about sex from the students they greeted.

“If they were brave enough to ask a question, they got a chocolate,” said Paquette, who recalled, with a large dose of pride, that she and Velazquez left with considerably fewer treats than they arrived with. “There were questions on everything from STD education to things you would think of with Dr. Ruth; I learned some things from these students, and it ended up being a lot of fun.”

As noted, Sex and Chocolates is just one of many initiatives Paquette has introduced since arriving. Overall, she has taken the campus service that was traditionally ranked dead last in surveys of students and made it one of the more highly scored.

Far more importantly, she has taken health and wellness to a much higher plane on the AIC campus, providing not just Band-Aids and Tylenol — which is about all the ‘old’ center was known for — but also a welcoming, non-judgmental environment that has improved quality of life on the campus in myriad ways.

For all that, Paquette was named the Healthcare Hero in the category of Patient/Resident/Client Care Provider, which is among the most competitive, with nominees from across the broad spectrum of healthcare.

Mary Paquette and Millie Valazquez, office manager and medical assistant at the Dexter Center

Mary Paquette and Millie Valazquez, office manager and medical assistant at the Dexter Center, have changed attitudes about the center, and created a healthier campus community, through programs like ‘Sex and Chocolates.’

And it’s a category Paquette has essentially devoted her life to, with AIC being only the latest stop in a 35-year career that has seen her take on a variety of roles in a host of settings. These range from director of Nursing at Ludlow Hospital to per-diem hospitalist at in the GI Department of the Eastern Connecticut Health Network, to assistant director of Health Services at Western New England University — the job that became the springboard to her post at AIC.

And there is a huge amount of overlap when it comes to the lines on her résumé, which Paquette explained quickly and effectively.

“I have a lot of energy, and I like to keep busy,” she said in a classic bit of understatement.

Indeed, she does, and at AIC this energy has translated into profound and very positive change, which was summed up by Robert Cole, the college’s vice president of Marketing & Communications, as he nominated Paquette to be a Healthcare Hero.

“Since arriving in 2012, Mary has almost single-handedly transformed the capabilities and perception of AIC’s Dexter Center for Health and Counseling Services,” he wrote. “She has worked tirelessly and passionately to reach students through new, campus-wide health programming and healthy-living promotion; expanded the scope and availability of Dexter’s services; and routinely works off hours to meet the emergency needs of students, student-athletes, faculty, and staff. She has done all this with limited medical staff and budget, and unlimited dedication, compassion, and extraordinary patient care and customer service.”

With that summation as the backdrop, we’ll explain how this transformation took place and what it means for all those — and we mean all those — on the AIC campus.

Sweet Success

The large Victorian home on Wilbraham Road that houses the Dexter Center has enjoyed a long history at the college and filled a number of roles.

It was once the president’s home, for example, and it has housed classrooms, a photography lab, and other facilities.

But when Paquette first saw it in the summer of 2012, she simply couldn’t believe that its role at that time was home to health services.

“It was falling down, the floors were this awful purple tile, it was filthy … I told Mark, ‘I wouldn’t come here for healthcare,’” she recalled, referring to Mark Berman, then vice president of Administration, who has since passed away. The building was in such poor condition that it was almost a deal breaker when it came to the position she was being offered.

Berman was neck deep in getting the dormitories ready for fall, but he promised Paquette that by October, she would see radical improvement in the Dexter Center. He made good on that pledge, but Paquette spent every weekend her first month on the job cleaning it out herself.

“There were ACE wraps that were disintegrating because they sat on shelves for long,” she recalled, adding that dirt on the floor wasn’t the only thing she cleaned out. There was also the receptionist on duty at the time who was so unfriendly, students hated coming to the facility.

But tidying up the Dexter Center and making it a far more welcoming — and less purple — place were only the first steps in a multi-layered process, and only the latest chapter in a long and quite rewarding career in healthcare.

So before returning to Sex and Chocolates and other endeavors at AIC, let’s go back … to the former Ludlow Hospital.

That’s really where the story starts, because, well, Paquette was born there and grew up only a few blocks away. She worked there as a nurse’s aide when she was 18 and in the ER while in college, and, after earning her bachelor’s degree in nursing at Elms College and spending the first several years of her career in the Boston area, that’s where she returned to.

She would eventually become the last director of Nursing at the facility, which would close its doors in 1994. But Paquette has never forgotten the mentorship she received there or the many connections she made that continued to benefit her throughout her career.

Ludlow’s closing prompted her to go back to school and earn her master’s degree in the Family Nurse Practitioner program at UMass Amherst in 1999, and, as noted earlier, she would put it to use in a number of settings over her long career as a care provider. They include Noble Hospital in Westfield, the Johnson Occupational Medicine Center in Enfield, Johnson Memorial Hospital in Stafford Springs, Hartford Hospital, and Mercy Medical Center.

Starting in 1999, though, her main employer would not be a hospital or medical center (although she would continue to work for several of them), but an institution of higher learning.

Wilbraham Road that housed the Dexter Center

When Mary Paquette first saw the facility on Wilbraham Road that housed the Dexter Center, she couldn’t believe people came there for healthcare.

At Western New England University, she started as a provider — and there was only one at the health center at any given time. “So you just put the pedal to the metal,” he recalled. “But for me it was OK, because it was just like the ER atmosphere … you just go, go, go and see one patient after the other. The trick in that is being able to be efficient, but also make patients feel like you’re listening to them and not rushing them.”

Remember that thought later.

At WNEU, she was mentored by the director of Health Services there, Kathy Reid, who, Paquette said, “was open to anything and everything I wanted to do.”

That meant such things as adding IVs to the list of services, as well as suturing and other initiatives. “Over the course of 13 years, we built Western New England’s facility into an amazing clinic. And when they built the new Pharmacy building and they added a new health services [facility], we even had a little surgery suite … we took off more toenails in the fall from turf toe.”

Remember those thoughts as well.

Paquette said she loved her time at WNEU and had no desire to leave. But then, Brian O’Shaughnessy, then AIC’s dean of students and now vice president for Student Services, hired Reid as a consultant to evaluate an underperforming health-services department — what Paquette described as a glorified (maybe) “high-school nurse’s office” — and recommend changes.

In her report, Reid said, in essence, that the school needed to hire a director of Health Services. And she had the perfect candidate — her second in command — in mind.

Something to Chew on

As noted earlier, the Dexter Center simply wasn’t a popular, or busy, place before Paquette arrived. Summing up why, she said simply, “one, it wasn’t marketed, two, it didn’t offer much care beyond Band-Aids and Tylenol, and three, the it had a secretary who was a real grouch.”

So … she set about changing all that and more. One of the first things she did was hire Velazquez (a referral from her mentor, Reid) and broaden that position to one of office manager and medical assistant.

Through what Paquette described as “an over-the-top friendly personality,” Valezquez has changed the atmosphere in the center, making it more welcoming, more efficient, and far-more visitor-friendly.

Meanwhile, the two have together gone about greatly adding to its roster of services and doing that marketing that was a big missing piece.

With the former, they’ve added IVs and suturing, as happened at WNEU before, and also STD testing, safe-sex education, a bowl filled with condoms in the waiting room, counseling, ongoing education into how the healthcare system works, and, most importantly, no judgment.

Overall, Paquette said she wants to make students better healthcare consumers.

“I feel that a large part of my job is teaching students how to be good healthcare advocates,” she explained. “I want them to leave AIC with a better understanding of their own health and the tools they need to navigate the world of healthcare.”

Regarding the latter, Paquette knew it wouldn’t do any good to make all those other changes if students and other constituencies didn’t know about them. And she knew from her time at WNEU that the place to start was with the resident advisors in the dorms.

With their support, she went about creating what she called silly but also effective programs. Like Sex and Chocolates.

“When you’re doing a dorm program in the evening, you have to be entertaining,” she explained. “The healthcare piece of it … you slip that in when they’re not looking. It was more about them, the students, seeing Millie and I, and seeing that we’re friendly and we’re non-judgmental, but we also know what we’re doing.”

Paquette and Velazquez have initiated other programs with the same goals and underlying mindset, including ‘Cards Against Humanity; AIC Edition,’ a takeoff on the popular party game. Sprinkled in with the offensive, risqué, and politically incorrect ‘answer cards’ are several related to birth control, STDs, the Health Services department, and more.

“You sort of slide those questions in, the students get them, but they’re having fun, and they don’t realize that you’re educating them,” Paquette explained. “We’ve created lots of fun games like that.”

But there were other constituencies to connect with, she went on, starting with the athletes on campus. Each team has trainers, she noted, but there was a disconnect, if you will, between the students, trainers, and health services.

That’s ‘was,’ because Paquette set about improving communications and building bridges. And soon, athletes were finding the Dexter Center for suturing, screenings, and other services.

“I feel that a large part of my job is teaching students how to be good healthcare advocates. I want them to leave AIC with a better understanding of their own health and the tools they need to navigate the world of healthcare.”

“We have rugby here,” she noted. “In those first two years, I’d come in at least a dozen times at night, go to the athletic trainers’ room, throw some stitches in a kid’s head, and go home. My deal with the trainers was, they all had my cell phone, they could call, and as long as I wasn’t working one of my ER shifts, I’d come in; that’s how we won over athletics.”

Paquette and Velazquez have also won over commuting students, college employees, students who remain on the campus during the summer, and other constituencies. The health and wellness center that no one visited is now the facility everyone visits.

Stitch in Time

Paquette doesn’t just work at AIC; she has become, for lack of a better term, a huge booster.

On top of the cabinet in her office sit three large wooden block letters — ‘A,’ ‘I,’ and ‘C.’ And she has much more swag, as she called it, all bearing the school’s letters, logo (a muscular, mean-looking yellowjacket), and color — yellow (obviously).

The item she’s most proud of, though — perhaps even more than a full bowl of questions during a presentation of Sex and Chocolates — is a T-shirt given to her by the rugby team signed by all the players, many of whom had seen Paquette for some stitches.

Maybe more than anything else, that T-shirt shows just how much the health and wellness center has grown since Paquette arrived, and how it has ceased being a college service and instead become a powerful force on campus.

George O’Brien can be reached at [email protected]

Healthcare Heroes

At the Soldiers’ Home, She’s a Nurse, Leader, Mentor, and Role Model

Celeste Surreira

Celeste Surreira

Celeste Surreira was talking about her work, and, more specifically, the unique constituency she serves, when she abruptly stopped in mid-sentence.

Strains of “Anchors Away,” the fight song of the U.S. Naval Academy, had permeated the walls of her office, and she knew exactly what that meant: the Soldiers’ Home in Holyoke was giving a Navy veteran a ‘farewell.’

Rising from her seat quickly, she invited BusinessWest to follow her to what she promised would be a solemn and immensely powerful ceremony. That was an understatement.

In the front lobby of the Soldiers Home sat a casket covered by a quilt, patterned specifically for a Navy veteran, that was made by one of the facility’s nurses. Behind it stood many family members. To the sides were Soldiers’ Home staffers, who, in many respects, are also ‘family’ for this individual — and all other veterans who come there.

Collectively, they assembled, with hands over their hearts, and heard about his life — not just about his service in the Seabees (the U.S. Naval Construction Battalions) during World War II, but about his family (three sons, 13 grand-children, and “eight, soon to be nine” great-grandchildren); the decades he spent as a commercial painter (he and his father helped paint the Soldiers’ Home when it first opened in 1952); his love for Holyoke, his long-time home; his affection for golf; and more.

Then came “Taps.” And many tears.

Walking back to her office, Surreira put the ceremony in its proper context, and in so doing helped explain why she came to the Soldiers’ Home in 2014 and why she is so passionate about the many facets of her work that she was named the Healthcare Hero in arguably the most competitive category — Health/Wellness Adminstrator/Administration.

“They go out the same door they came in — it’s our honor to them,” she said of the servicemen and women being given a farewell. “And that’s very important. When I worked in the hospital, death was something we hid, like it was like a failure; they [deceased patients] went out the back door. Here, death is a celebration of life; there’s no shame. They go out the front door.”

“When I worked in the hospital, death was something we hid, like it was like a failure; they [deceased patients] went out the back door. Here, death is a celebration of life; there’s no shame. They go out the front door.”

Surreira would speak often about the veterans she now serves as she talked about her career and her current work, because the clientele, if you will (they simply call them ‘veterans’ here), is truly unique, and this is reflected in everything from how services are delivered to how these individuals are addressed.

“I thought this was a really interesting population to have the honor to work with,” she said, adding that the Soldiers’ Home, a 265-room, long-term-care facility (which also has outpatient services and a domiciliary), represents a significant career shift for her, with most of her 33 years in nursing having been spent in the emergency room. But in many ways, the issues and challenges facing veterans at the facility and the providers caring for them mirror those of society in general as the population ages and people live longer.

“This is where healthcare is going,” she told BusinessWest. “The population is living longer with chronic diseases. This is the population with which we’re really going to have to make an impact if we’re going to manage the needs of the overall population over the next 30 years.”

In her role as assistant director of Nursing, Surreira has a lengthy job description, and considers herself — and, more to the point, she’s considered by others — to be a care provider, leader, teacher, mentor, and role model.

And she takes each of those responsibilities very seriously, especially the leader and role-model parts.

“Leadership and management are two different things,” she told BusinessWest. “You can manage, which means doing payroll or doing a schedule or telling someone what to do. Or you can lead, which to me means inspiring people to become leaders.

“You can’t lead if you don’t have emotional intelligence,” she went on. “People are just going to see you as the boss. And no one really follows the boss; they’re not inspired by bosses. I’ve always said, if you have to tell someone what your title is in order for them to know you’re the leader, then you’re not really the leader — someone else in the room is the leader.”

One of Surreira’s working definitions of a leader is that of an individual who can work with others to achieve positive change and improve quality of life for those being served, and as we’ll see, there are many examples of how she’s been able to do just that, and thus become a true Healthcare Hero.

Walking the Walk

They call it the ‘Walk Across America.’

This is a walking track of sorts at the Soldiers’ Home, located just outside the facility’s rehab area; 22 laps equals a full mile. There’s a mural covering a few hallways depicting different places across the country, hence the name, said Surreira, and different administrators are actually assigned to certain veterans to walk with them across America on days the veterans choose themselves.

Celeste Surreira says the Walk Across America

Celeste Surreira says the Walk Across America (that’s the St. Louis panel within the mural behind her) is one of many initiatives aimed at improving the mobility of veterans at the Soldiers’ Home in Holyoke.

The track is one of several ‘places to move,’ as Surreira calls them, that have been created in recent years as part of a broad effort to enhance the mobility of the veterans at the Soldiers’ Home and thus improve quality of life and actually reduce the rate of falls.

As with most all initiatives at this facility, this was (and is, as such work is ongoing) a team effort — actually a team with several smaller teams within it, such as the one assigned the task of creating places to move, she told BusinessWest.

The Walk Across America is just one example of that positive change and improvement in quality of life mentioned earlier that Surreira has helped orchestrate since arriving at the Soldiers’ Home in 2014.

She had been working just outside Atlanta as an interim director of Emergency Services at Rockdale Medical Center, and was looking to return to Western Mass., where she spent much of her career.

Indeed, she started in the emergency department at Ludlow Hospital in 1985, then spent more than two decades at Mercy Medical Center, starting as an staff RN and eventually advancing to manager of the Emergency Department. Earlier this decade, there was a short stint as administrative director of Emergency Services at Cooley Dickinson Hospital.

“I was looking at different positions up here, and I received a call regarding an opportunity at the Soldiers’ Home,” she recalled. “They were looking for a leader, someone who could come in and do some mentoring on leadership, and it sounded very interesting; it was a real change of pace for me to go into long-term care as well as geriatrics, but given my interest in leadership and veteran healthcare, a chance to work clinically, and all those things coming together, I thought that it would be a good opportunity for a change.”

And to work with an older population (most of the veterans are in their 80s and 90s) that, as noted earlier, reflects some of the larger, more complex issues facing all those in healthcare — specifically, not only caring for older individuals, but also helping them maintain independence and a high quality of life.

“Our focus is truly on how to promote a good quality of life for these older veterans,” Surreira explained. “We have 94- and 95-year-olds living very well.”

With this broad goal in mind, Surreira has created, and serves on, a number of process-improvement teams working on such matters as reducing the use of anti-psychotic medications, lowering the rate of falls, improving mobility, medication safety, and many others.

And as these teams address each of these areas, they do so with quality of life in mind, she said, using reduction of falls as an example. This could easily be accomplished by reducing one’s mobility, so he or she doesn’t get into positions where they can fall, Surreira went on. But this doesn’t equate to a high quality of life.

“This is where healthcare is going. The population is living longer with chronic diseases. This is the population with which we’re really going to have to make an impact if we’re going to manage the needs of the overall population over the next 30 years.”

“What we don’t want to do is promote the use of things like restraints and alarms, because they don’t allow people to move and self-propel,” she explained. “So what we try to do is advise them of safety and encourage their mobility; we want people to move, we want to take them for walks, we want to do everything we can to promote mobility while also reducing the risk of getting hurt from that fall if you do fall.”

To accomplish all this, Surreira leads the so-called ‘enhancing mobility team,’ which consists of several departments, including nursing, rehab, social work, facilities, and pharmacy working collaboratively to implement evidence-based interventions that will enhance mobility and reduce falls. This team has implemented a series of policies and procedures, including the introduction of a daily ‘fall huddle,’ interdisciplinary rounding, quarterly mobility screens, individualized care plans that include mobility goals, and regular review of polypharmacy.

As a result, the Soldiers’ Home has seen a confirmed reduction in fall-related injuries and a noticeable increase in the mobility of its population.

Taking the Lead

As noted earlier, Surreira’s position comes with a lengthy job description and list of responsibilities. And only a portion of them actually apply to the veterans being served.

The rest have to do with those other functions (for lack of a better term) that she carries out, including that of being a leader, a mentor, and a role model. Her ability to be all those things is a big reason why she was hired — and her desire to continually build upon those skills and add new layers to already considerable amounts of experience explains why she took it.

As she talked about being a leader, for example, she equated it to parenting.

“You mess up a lot, and then you learn how to be a better parent; it’s the same with being a leader,” she explained. “I think I’m a different leader now than when I started this journey, because it’s very humbling.”

Elaborating, she noted that one of the things she’s learned over the years is the importance of active listening.

“In order to hear the person, you can’t be thinking about your response already,” she said, citing a mindset held by all successful leaders. “You have to be totally focused on what they’re trying to tell you.

“You also need emotional intelligence, which means taking the time to know where that person is coming from and be queued into what they’re trying to communicate to you,” she went on. “Often, I tell people, ‘it’s not what they’re saying, but what they’re not saying; it’s not the words they’re saying, necessarily, but how they’re saying them. They may be saying something, but that’s not what they’re meaning or even intending.”

Surreira said mentoring takes place in many ways and on several different levels in her work at the Soldiers’ Home, including the formal teaching she does on subjects ranging from leadership to role-modeling.

“Mentorship from a leadership perspective takes place in a number of ways,” she explained. “Sometimes it takes place in just day-to-day interactions where you have opportunities to have a conversation with someone, provide someone with feedback … it’s all part of relationship building with those folks. Other times, it is more formal, such as the teaching I do.

As for the role-modeling, well, that part of it can really only happen as one adds layers of hands-on experience to their résumé, learns from previous mistakes, and develops a high degree of that necessary ingredient known as emotional intelligence.

“Even though someone may be handling a situation in a certain way, you can role-model a different way — that’s probably the most powerful thing to do,” she explained.

As an example, she cited a situation where there’s conflict going on and the discussion among individuals is getting quite heated.

“Managing yourself is probably the most important thing in those situations,” she said. “You manage your own reactions — the louder other folks may get, the quieter you get; the faster they talk, the slower you speak.

“Overall, mentoring involves building relationships and inspiring trust,” she went on, adding that ‘leading by example’ isn’t a formal line on her job description, but it’s a duty she carries out every day.

Waves of Emotion

Walking back to her office from the Navy veteran’s farewell, Surreira said the Soldiers’ Home obviously conducts many of these ceremonies. “Sometimes there will be two or three a day, and sometimes we’ll go a week without one,” she said, adding that, like most staff members, she tries not to miss a single one.

That’s because, as she said, at this facility, death isn’t something to be ashamed of; it’s not a failure. It’s part of a life being celebrated.

And improving the overall quality of that life has become the focal point of each individual and each team at the Soldiers’ Home.

Surreira’s leadership, mentoring ability, and passion for being a positive role have not only played a pivotal role in all this, they’ve made her a Healthcare Hero in administration.

George O’Brien can be reached at [email protected]

Healthcare Heroes

In the Emerging Field of Bioethics, He’s a Leader and a Pioneer

Peter A. DePergola II

Peter A. DePergola II

Oddly, he doesn’t actually remember where or when he got it.

But Peter DePergola’s copy of Rembrandt’s renowned The Return of the Prodigal Son looms large in his small office (it takes up most of the back wall) and, far more importantly, in his life and his work.

The painting, as most know, depicts the moment in the Biblical parable when the prodigal son returns to his father after wasting his inheritance and falling into poverty and despair. He kneels before his father in repentance, wishing for forgiveness and a renewed place in the family.

DePergola, director of Clinical Ethics at Baystate Health, the first person to wear a name badge with that title on it and the only clinical bioethicist in the region, says the painting — and the story of the prodigal son — provides a constant reminder of the importance of not judging others and providing them with what they need, not what they deserve. And that serves him very well in his work.

“The story is about sins and forgiveness, but what it teaches me about healthcare is that we should never treat our patients based on what we think they deserve morally, but on what they need, and only what they need,” he explained. “We don’t get to say, ‘you’re a murderer,’ or ‘you’re an adulterer,’ or ‘you’re an alcoholic — if you really wanted to stop, you can.’

“We have to meet them in the middle of their chaos, to sort of run out to them,” he went on, “and to treat them based on what they need and who they are, not on what we think they deserve.”

“It’s not that they don’t understand that medicine has its limits — I think they do. But they’re living in this larger narrative of ‘who am I if I don’t do everything I can for the person I love most?’”

‘Meeting them in the middle of their chaos’ very often translates into a time when decisions have to be made — difficult decisions — about what can be done for a patient and what should be done; about what is proper and what is needed (there’s that word again).

“There are plenty of things we can do, but shouldn’t,” he went on, adding that such dilemmas are becoming ever more common as the population ages and modern science finds new and different ways to extend life.

The issue he confronts most often involves what kind of life is being extended — and whether that kind of life should be extended. And within that broad universe there are countless other matters to consider, discuss, and debate — and they involve everything from raw science to individuals’ base emotions and perceptions about what is right, wrong, and proper.

“Family members will say, ‘I know this isn’t going well, but am I a loving daughter if I say this is the end? How do I think through this?’” he told BusinessWest as he recounted the type of conversation he has most often. “It’s not that they don’t understand that medicine has its limits — I think they do. But they’re living in this larger narrative of ‘who am I if I don’t do everything I can for the person I love most?’”

Overall, his work in the broad realm of bioethics involves everything from these end-of-life issues to the use of animals in research to potential conflicts of interest and conflicts of commitment. DePergola summed it all up in intriguing fashion by saying “no one ever calls me when something good is happening.”

Despite this, and despite the difficulty of his work — not to mention the long hours and often unusual hours; he was recently called to Baystate at 1 a.m. — DePergola finds it rewarding on many levels.

He likes to say he helps people make sense of nonsense and not necessarily answer questions that can’t be answered, but enable people to cope with them.

“People will say, ‘I’ve lived a good life, and I’ve always done the right thing, and here I am, with six months to live. Why must I suffer? Why do I have to be in pain? Why do I have to be in the hospital?’” he noted. “And at the end of the day, I’d say, ‘I don’t know, it’s not fair, I don’t understand. But let’s not understand together.’

“You don’t have to go through not knowing alone,” he went on, hitting upon the best answer to the question of why his role now exists. “And that may be the only antidote to that question; I can’t tell them why bad things happen to good people, but I can be there with them when they’re asking that question and looking for answers and looking for compassion.”

For his multi-faceted efforts — many if not all of which fall into the category of pioneering — DePergola has, well, emerged, into not just a leader in his field, but a Healthcare Hero.

Work That Suits Him

There’s a white lab coat hanging on a hook just inside the door to DePergola’s office, and it’s there for a reason.

While not a medical doctor, DePergola is a member of a clinical team that interacts with patients and their families. The white coat isn’t required attire, and he didn’t wear it earlier on his career. But he does now, and the explanation as to why speaks volumes about the passion he brings to this unique job every day.

“When I used to come dressed in a suit to have these very important conversations with patients and families, I think it was intimidating in a way,” he explained. “I did it out of respect … you’re going to have the most intimate conversation a family’s ever had — what would you wear to that? You’d want to wear something that says, ‘I really care about this. and I care about you.’

“But it looked like I was a lawyer, and people couldn’t get past the outward appearance,” he went on. “Sometimes just a shirt and tie is too casual, but the combination of the lab coat and the tie seems to send the right message.”

There are other examples of this depth of his passion for this work, including his desire to understand the role religion plays in making those hard decisions described earlier.

“I knew that what I was getting into had a lot of value implications,” he explained, “and that the primary pathway into those values was religious commitments. So I got a master’s degree in theological bioethics so I could make sure that I understood what Hindus and Buddhists believed about end-of-life care the same as Orthodox Jews and Catholics, and what Muslims thought about autopsy, so I could meet them not just where they are clinically, but where they are biographically and in their values.”

As he talked about his career and what he was getting into, DePergola stated what must be considered the obvious — that he didn’t set out to be a bioethicist. That’s because this field hasn’t been around for very long — only since the early ’80s, by his estimates — and it’s especially new in the Western Mass. region. In essence, and to paraphrase many working in healthcare, the field chose him.

“Larger American cities — New York, Boston, Los Angeles — have had full-time clinical bioethicists since probably the end of the 1980s,” he explained, adding, again, that he’s the first in the 413. And in many respects, he helped create the position he’s in and write the lengthy job description.

To fully explain, we need to back up a bit.

After earning his bachelor’s degree in philosophy and religious studies at Elms College (early on, he thought he might join he priesthood, but settled on a different path), and then a master’s degree in ethics at Boston University and his Ph.D. in healthcare ethics at Duquesne University, DePergola completed a residency in neuroethics at University of Pittsburgh Medical School and then a fellowship in neuropsychiatric ethics at Baystate, then the western campus of Tufts Medical School, in 2016.

“The patient is always the priority. In risk management, it’s the hospital first, then the patient. With me, it’s the exact opposite; I make sure everyone’s voice is heard.”

While completing that fellowship, he took on some duties in the broad realm of research ethics, a large subset of this emerging field, but this work was eventually expanded into a new leadership position at Baystate — director of Clinical Ethics, a role he said he helped create in partnership with the health system.

“I did a lot of convincing, and I sort of sold the problem,” he said.

“Medicine tells us what we’re able to, and the law tells us what we’re allowed to do. But neither one tells us what’s good to do. And how we navigate the mean between extremes? If we did everything possible for our patients, we’d be deficient, and there are plenty of things we could do without breaking any laws, but that wouldn’t be in itself good for patients. So we needed someone to step into a leadership role.”

In creating the position and its job description, he and members of Baystate’s leadership team borrowed from models already in existence at similarly sized healthcare systems, especially those at Maine Health, the Carolinas Health System, and the Henry Ford Health System.

DePergola said there are four main categories, or pillars, to his work: clinical ethics, research ethics, organizational ethics, and academic ethics, or ethics education.

The primary domain, as one might expect, is clinical ethics, and in that role, he meets with patients, family members, and healthcare professionals “as they navigate the moral terrain of life-and-death decision making at the beginning, middle, and end of life,” he explained.

“I see everyone — from patients and their families in the Neonatal Intensive Care Unit to our geriatric patients, to everyone in between, whether it’s a patient in infectious diseases or genetics or ob/gyn.

And, as he said, no ever calls him when anything good is going on.

Questions and Answers

As he talked about his work in bioethics and many of the difficult conversations he becomes part of, DePergola summoned a quote from Aristotle that he’s undoubtedly already used countless times in his short career.

“He said, in essence, that something is good if its fulfills the purpose for which it was made, and bad if it doesn’t,” said DePergola, adding that such a benchmark, if one chooses to call it that, should be applied to all aspects of healthcare, including everything from a feeding tube to any other step that might be taken in an effort to prolong life.

“If it’s not going to fulfill the purpose, is it good? We need to think about the logic of what it would mean to provide a clinical treatment without a clinical reason,” he went on, adding that such questions loom large in his field of work and often bring him to another difficult discussion — the one juxtaposing quantity of life against quality of life.

Such thought patterns help DePergola as he goes about his various duties, during which — and he makes this point abundantly clear — he advocates for the patient first, not the health system that employs him.

And this distinguishes his work from that of those in the broad realm of risk management.

“The patient is always the priority,” he explained. “In risk management, it’s the hospital first, then the patient. With me, it’s the exact opposite; I make sure everyone’s voice is heard.”

And not only heard, but understood, he went on, adding that the cornerstone of success in this field (if one can even use that word within it) is establishing trust.

Wearing a white coat instead of a suit coat is part of it, but a bigger part is understanding exactly where someone is coming from. And this comes from taking the time to understand their situation, their religious beliefs, and much more.

Even then, the decisions don’t come easy, he went on, adding that his work often comes down to helping parties decide between the better of two bad options and coping with questions that, as he noted, can’t really be answered.

Such sentiments are reflected in DePergola’s thoughts on other aspects of his work, especially his teaching — he’s an assistant professor of Medical Humanics at Elms College, where, in the small-world department, had Erin Daley, director of the Emergency Department at Mercy Medical Center and the first Healthcare Hero in the Emerging Leader category, as one of his students.

“I always try to emphasize to my students that the big questions of medicine that patients are asking have little to do with medicine, that the big problems in medicine have little to do with medicine,” he told BusinessWest. “They’re questions of meaning, purpose, identity, and value.

“They don’t show up on X-rays, you can’t write prescriptions for them, and we can’t bill for that,” he went on. “Medicine is very good at addressing ‘how’ questions — as in ‘how does ammonia work?’ — but it’s very poor at addressing the ‘why’ questions. And I think that, when we fail to connect with our patients in medicine, it’s because we’re giving ‘how’ answers to ‘why’ questions.”

Framing the Question

Returning to Rembrandt’s Return of the Prodigal Son, DePergola said there’s another reason why that painting resonates with him.

It has to do with how many times he has the same conversations with different people, such as the one about miracles, and walking them through the argument that there’s no logical connection between believing in a miracle and concluding that life-sustaining medical treatment should continue.

“You don’t offer life-sustaining medical treatment for miracles to occur, and I often dread having another one of these conversations,” he said. “But then, I remember that every time I have any of these conversations, it might be the 12th one of the day, but it’s the first for these families. They deserve for me to treat it as the most important and the only conversation, not the 12th.

“Again, I give them what they need,” DePergola went on, expressing sentiments that clearly explain why he’s an emerging leader, a pioneer, and a Healthcare Hero.

George O’Brien can be reached at [email protected]

Healthcare Heroes

This Pediatrician and Coalition Builder Has Helped Create a Healthier Community

Dr. Matthew Sadof

Dr. Matthew Sadof

Most people who have been working professionally for nearly 40 years have had a number of desk chairs, especially as technology has advanced and the office has become more ergonomically correct.

Dr. Matthew Sadof has had exactly … one.

It was given to him upon completion of his residency at New York Hospital, and it’s been with him ever since. It’s a low, wooden chair with arms, and Sadof obviously likes how it looks and feels — for the most part, anyway. But the reason he keeps it is what’s written on the back: “Go and do thou likewise.”

That’s the school’s motto, but far more importantly, it’s Sadof’s approach to life and also his life’s work, as will be made clear as we explain why he is the Healthcare Hero in the Community Health category.

“One of the things that I’ve tried to practice my whole life is something called tikkun olam, which means to heal the world,” he told BusinessWest. “And that’s what I try to do. I’ve been sitting in this chair since I graduated. It’s my chair; I’ve had opportunities for other chairs, but I like this one.”

The Heroes award is only the latest of many to be bestowed upon Sadof, a pediatrician at Baystate Children’s Hospital, whose chair resides in a small office at the Baystate High Street Health Clinic, in the middle of one of Springfield’s poorest neighborhoods, as it has for the past 20 years.

“Dr. Sadof has demonstrated that a physician who is dedicated to improving the health and well-being of his patients must go beyond the office walls and work diligently to improve the health of the community.”

This office is, by his own admission, not at all asthma-healthy, with its carpeting, drop ceiling, and somewhat poor ventilation. Which is ironic, because he is perhaps best known for helping to lead an all-out battle against asthma in a city consistently ranked among the worst in the nation for asthma health.

His leadership role in the Community Asthma Coalition and related initiatives has dramatically improved the environment across Springfield and reduced hospitalizations dramatically, but he would be the first to note that, with the city’s poor housing stock, there is considerable work still to do.

However, there is more to Sadof’s story than helping children and families breathe easier, literally and figuratively. He has also been a passionate advocate for the underserved and the marginalized, working with medically fragile and technology-dependent children and their parents, who are often overwhelmed by their medical needs. Meanwhile, he has worked to address the social and medical difficulties faced by adolescents in Springfield, patients who often fall through the cracks as they age out of pediatrics and fail to connect with an adult-medicine provider.

As he sat down to talk with BusinessWest to talk about the many facets of his work — yes, in that chair from NYU — Sadof made it clear that, while he is honored to be named a Healthcare Hero, he stressed that whatever progress has been made in terms of making Springfield a healthier community has been a team effort, not the work of one man.

“I can’t over-emphasize that it’s not just me,” he said, referring not only to the asthma initiatives but a deep portfolio of projects he’s been involved with. “I work with lots of wonderful people; you need a whole community of people to really change a community.”

Still, Sadof has established himself as a clear leader in these efforts and a role model for the medical students and residents he teaches.

Dr. Laura Koenings, vice chair of the Education Department of Pediatrics at Baystate Children’s Hospital, who nominated Sadof for the Healthcare Heroes award, may have summed up his devotion to community — and his approach to achieving progress — best.

“Dr. Sadof has demonstrated that a physician who is dedicated to improving the health and well-being of his patients must go beyond the office walls and work diligently to improve the health of the community,” she wrote. “A role-model physician looks for gaps in the healthcare-delivery system and strives to bring better healthcare to the underserved, whether that is the infant with complex medical needs on a home ventilator and a gastronomy tube for feeding, or the teenager out on the streets without a medical home.”

Sadof continues to do all these things, and that explains why he’s a true Healthcare Hero.

Clearing the Air

Sadof said it wasn’t long after he arrived at the High Street Clinic that he began to realize the full extent of the asthma problem in Springfield.

“My very first week, there was a kid who came in who had really, really, really bad asthma,” he recalled. “So bad that I had to go on the ambulance and transport him to ICU. He needed a breathing machine — he needed to be intubated — and while I was there, I looked at his mother, and I couldn’t help but notice that she had a Band-Aid on her arm and a hospital bracelet on her wrist.

“I said, ‘what happened to you?’ he went on. “And her asthma was really bad. I asked her where she lived, and she went on to describe an apartment building that had cockroaches, rodents, leaky windows, and mold — all of which are very potent triggers for asthma.”

Dr. Matthew Sadof says he’s had one desk chair throughout his lengthy career

Dr. Matthew Sadof says he’s had one desk chair throughout his lengthy career and lives by what’s written on the back: ‘Go and do thou likewise.’

Thus began what might be called a crusade against asthma, as well as a pattern of not only treating patients but asking them where they live. And not only asking them where they live, but taking steps to do something about where they live and removing some of those triggers for asthma.

“We teach people how to clean with vinegar, baking soda, baking powder, and castile soap, and that’s made a huge difference,” he explained. “We also showed people how to store food properly and store garbage properly in a way that doesn’t promote the growth of rodents and insects.”

Before getting into more detail about his efforts to combat asthma and the many other aspects of his work, it’s necessary to explain how Sadof arrived at the High Street Clinic.

Our story starts back at medical school, where, by this third year, Sadof realized he wanted to spend his career working with young people.

“I knew that I liked to talk to people, and I knew I liked to work with young families,” he recalled. “And I knew I liked working with children because they’re growing, and there’s the possibility to make a real impact on the trajectory of someone’s life when you start early.”

He practiced in Pittsfield for 10 years, doing general pediatrics, before he and his family relocated to Philadelphia to “try something new,” as he put it. Things didn’t exactly work out there as he hoped, so the family decided to return to what they considered home.

A former colleague was working at the High Street Clinic at the time. Sadof asked her what the lay of the land was, and she mentioned that the clinic was looking for someone. And, long story short, Sadof became that someone.

“Something about this place just felt really good,” he told BusinessWest, noting that, 20 years later, he still feels the same way.

“There was a huge need for services,” he explained. “And there were bright students and residents that I could work with. And practicing and teaching medicine at the same time keeps you really sharp. They’re always asking you questions that you may not know the answers to, so we all look it up and learn it together.”

Finding answers to some of Springfield’s most vexing health problems has been Sadof’s M.O. since arriving on High Street, and, as noted, asthma soon become one of his top priorities.

But to address it, he knew the city needed to bring together a number of players to form a solid, united front against the disease. And it really started with that visit his first week on the job.

“That’s when I started thinking about how important it was for me to start to address some of the root causes of asthma, and about what I could do to build a bridge from the clinic to the community,” he recalled. “They weren’t calling it the ‘social determinants of health’ back then, but that’s really what we were doing.”

Within a year after arriving at High Street, Sadof became the medical director of the clinic, and around that same time, he was approached by a grant writer from what was then Partners for a Healthier Community (now the Public Health Institute of Western Mass.) to apply to be part of the National Collaborative Inner-city Asthma Study.

Fast-forwarding a little, the local group was awarded a grant, and a social worker was hired to be an asthma counselor, he went on, adding that parent groups were formed, individualized counseling was provided, and other steps were taken not only to treat people who were sick but to make homes more “asthma clean.”

In 2001, the Pioneer Valley Asthma Coalition was formed, and Sadof, who started in what he called an observer role, became its chair in 2004. In 2009, he help forged a partnership with Boston University whereby a stimulus grant from the national Institute of Environmental Health was secured to create something called the READY (Reducing and Eliminating Asthma Disparity in Youth) program.

“We trained community health workers to teach people how to keep their home asthma clean,” he explained, adding that there would be a series of five home visits in the course of six months. “And anecdotally, I could tell which families were in the program and which ones weren’t; we cut hospitalizations down dramatically and cut hospital days down dramatically.”

Care Package

But while Sadof is perhaps best known for his work to combat asthma, there are many other aspects to his practice, all of which relate directly to what’s written on the back of his chair.

Indeed, while recognizing a real problem with asthma, Sadof said he also quickly realized there was a large number of children with severe disabilities and families struggling to care for them. And he’s continuously looking for new and innovative ways to meet the many needs of both these children and their families.

“I have lots of children who are technologically dependent,” he explained. “These are children who are on ventilators at home, they have feeding tubes, they often require 24-hour care … they and their families require services, and they need help.

“From listening to these kids, I was always trying to figure out a better way to do things,” he went on, adding that he was approached in 2012 by officials at Boston University Medical School with the goal of developing a grant to help improve complex care.

Baystate and BU were eventually awarded a $6 million grant ($1 million each over three years) to develop something called the 4C program. That’s an acronym for Collaborative Consultative Care Coordination program, which was created to help parents and pediatricians coordinate care for the most medically complex children in Western Mass. Each word in that acronym is important, and collectively they explain what it is and how it works.

“We developed a couple of teams, with myself as the complex-care doctor, where we brought people in, took in all their data, and put it into a cloud-based care plan,” he explained. “These care plans lived on their phones, and they were accessible by any kind of electronic device and were accessible by their primary-care doctor and by the hospital and the families.

The consultative-care program created for each family consisted of a nurse care coordinator, a social worker, a so-called ‘family navigator,’ a nutritionist, and a psychologist, he went on.

“There’s been a huge influx of patients from Puerto Rico, people whose lives were blown away who are medically complicated and very fragile. People with heart defects, lung defects, neurological issues, and we’ve been working hard to keep them healthy. It’s great work and its very rewarding.”

“And we really improved the lives of lots of kids,” he said with a large dose of satisfaction evident in his voice. “We were able to decrease the cost of healthcare by a lot and improve the satisfaction of families. This was a consultative program where we worked with primary-care doctors to keep the care inside the patient’s medical home, close to where they lived; we worked with schools, we worked closely with housing to make sure we could make accommodations, we did home assessments and home visits. The idea was to try to support families through this work, and it was incredibly rewarding.”

He used the past tense because the grant funding ended at the close of 2017. The plan is to find a way to restore and continue the initiative through the new accountable-care program being created. Meanwhile, Sadof continues to care for children with complex needs, mostly without the same comprehensive teams made possible by the 4C program, and the number of patients in that category has swelled in the wake of Hurricane Maria, which devastated Puerto Rico almost exactly a year ago.

“There’s been a huge influx of patients from Puerto Rico, people whose lives were blown away who are medically complicated and very fragile,” he explained. “People with heart defects, lung defects, neurological issues, and we’ve been working hard to keep them healthy. It’s great work, and its very rewarding.”

There’s that phrase again. Sadof uses if often, and it speaks to the passion he brings to his work, which, by and large, involves a poor, very challenged constituency, and many of the sickest children in this region — and beyond it.

To explain that passion, Sadof related the story of his father, who had tuberculosis.

“I just have this vision of my grandmother bringing my father to a clinic, where his test came back positive,” he explained, noting that his father had two aunts who died from the disease. “I carry that picture of my father and my grandmother with me always … and I look at the mothers here, and I say, ‘100 years ago, this was my family.’

“And the test about what decisions I make is that ‘if this was my family, what would I want to do? What would I want done for my family?’” he went on. “It has to pass that test. And it’s not always the easiest answer, and it’s certainly not the fastest answer.”

It Sits Well with Him

For the last word on the honoree in the Community Health category, we return to Laura Koenings’ nomination:

“Dr. Sadof recognized early on that it takes a village, and not just the actions of a single physician, to improve the long-term health of the community,” she wrote. “This is why he has always been a coalition builder — helping to unify patients, families, community agencies, and government entities to work together for a healthier community. He also recognized that, in order to advocate for his patients and their families, he must understand their needs and bring their voices to the agencies and government entities that are part of his coalition.”

He has done all that, and that’s why, from the day he earned that chair, he’s been a Healthcare Hero. u

George O’Brien can be reached at [email protected]