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Voices from the front lines: How nurses feel about Ebola

Dr. Kent Brantly is congratulated by Emory University Hospital nurses and staff as he is discharged after receiving treatment for Ebola.

Dr. Kent Brantly is congratulated by Emory University Hospital nurses and staff as he is discharged in August after receiving treatment for Ebola. Photo credit: Samaritan’s Purse

When the first Ebola patient to be treated in the United States was headed for Emory University Hospital this past summer, two of the hospital’s nurses canceled their vacations to be there.

That’s how registered nurse Barbara Ribner described the dedication of the Emory nurses who deal with Ebola. Her husband, Dr. Bruce Ribner, is the medical director of the Serious Communicable Diseases Unit, which has successfully cared for four patients with Ebola.

Nurses are on the front lines of treating such deadly diseases, and have been in the forefront of the news surrounding Ebola in the U.S. Two nurses in Texas contracted the disease from a Liberian man who eventually died, and an American nurse returning from West Africa was subject to a controversial quarantine in New Jersey and Maine.

GHN talked to several Georgia nurses — some who work at Emory and some who work elsewhere — about caring for Ebola patients. The viral disease, originally identified in West Africa in the 1970s, has killed more than 5,000 people there this year, and for the first time has turned up in a few places outside Africa.

Emory nurses who cared for the Ebola patients discussed the complexity of the medical procedures at a recent conference. And at the same time, they said it was rewarding beyond their expectations.

“It’s a different feeling, because there’s this barrier between you [the nurse] and the patient,” said one nurse who preferred not to be identified. “You cannot touch your patient” to support them or help them understand that the staff is doing everything possible, the nurse said.

President Obama hugs Dallas nurse Nina Pham after she underwent successful treatment for Ebola.

President Obama hugs Dallas nurse Nina Pham after she underwent successful treatment for Ebola.

People with Ebola symptoms are contagious, and the sicker they are, the more risk of contagion they pose to others.

There is no “one size fits all,” explained another infectious disease trained Emory nurse who preferred to remain anonymous. Putting on the personal protective gear took 38 steps, while removing it took 50. These highly specialized nurses counted each step while another trained nurse watched every move.

Day after day and week after week, they could not make a misstep even once during this demanding process.

“Not everyone who went through our rigorous training passed,” said one of the nurses. Each nurse working with Ebola patients had to be 100 percent detail-oriented by following the highly complex procedures every time one of them entered or left the patient’s room.

The fear came not from getting the infectious disease, explained one Emory nurse, but “we were more afraid of giving the virus to someone else.” And for that reason, each nurse was fastidious about every procedure.

The nursing education coordinator for Emory Healthcare, Kelly Shelby, said that depending on when they started nursing, “nurses were probably frightened by other types of infectious diseases as well.” For some it might have been polio, while others feared SARS and AIDS.


Taking the danger seriously


“I think there is fear [of Ebola] because it’s a scary disease,” said Lorine Spencer, a nurse and a  CDC public health adviser. Fear of the unknown is a problem.

CDC workers and prepare to enter an Ebola treatment unit in West Africa.

CDC workers and Doctors Without Borders personnel  prepare to enter an Ebola treatment unit in West Africa.

“We are getting evidence-based, accurate information out there,” Spencer said. “We continue to learn from those that have been to West Africa to treat patients and returned safely.”

Rebecca Wheeler, an RN and past president of the Georgia Nurses Association, told GHN that “we [nurses] must seek out the latest information and evidence-based practices to respond to any emergency or infectious disease outbreak.”

Communication, training and equipment are critical. The U.S. is not accustomed to managing Ebola, so information and strategies will evolve as more experience with the disease is gained, said Wheeler.

Valdosta nurse Jody Leonard added, “The public has a much greater risk of dying from influenza [than from Ebola], so please, just get your flu shot.” When discussing the Ebola problem with family members, Leonard reminded them that the risk of contracting Ebola in the U.S. is extremely low. Not so for the flu.


Fear and uncertainty



The scientific information about Ebola has not changed. Experts have long known that infected people are not contagious until they have developed symptoms. That means the disease, though it poses a serious risk to people who care for ill patients, is not easily spread in casual settings.

But public fears about the disease have waxed and waned, reaching a peak last month after several Ebola diagnoses in the United States in quick succession.

Dr. Kent Brantly appears with Emory physicians, nurses and staff as he speaks to the media.

Dr. Kent Brantly appears with Emory physicians, nurses and staff as he speaks to the media.

Americans are both divided and uncertain about the threat posed by the illness, according to a recent Washington Post article. A Washington Post-ABC poll showed that just 24 percent of Republicans believed the federal government was doing all it could reasonably do to stop the disease. In contrast, 50 percent of Democrats believed the government was doing enough. But even 50 percent is not a ringing vote of confidence.

“The key is for the front line [health care providers] to have accurate information from reliable sources like the CDC. But they also need training and appropriate equipment,” said Wheeler.

Nurses and other members of health care teams need to speak up when they feel they are getting the things they need, and they must be listened to, Wheeler said.

In early October, National Nurses United stepped up the call for U.S. hospitals to immediately upgrade emergency preparations for Ebola. NNU is calling for all hospitals to immediately implement a full emergency preparedness plan for Ebola or other disease outbreaks.

Georgia health officials have not yet revealed the hospitals that are being prepared to treat Ebola patients. But infectious disease training remains ongoing for nurses and other medical professionals, as it has for years.


Quarantining nurses: Is it realistic?


October was a scary month of Ebola headlines. Thomas Eric Duncan, recently arrived from Liberia, died of the disease in a Dallas hospital. Then two nurses who had treated him were found to be infected with the virus. Then a New York doctor who had recently treated Ebola patients in Africa was diagnosed with the disease, amid media reports that he had roamed all over the Big Apple just before falling ill.

All three of those health care professionals were successfully treated — one at Emory — and all fully recovered. But officials around the country began to talk about not just isolating Ebola patients, but quarantining people who might have the disease.

When nurse Kaci Hickox returned to the United States in October after treating Ebola patients in Sierra Leone, she was placed in quarantine by New Jersey and then by Maine.

Hickox, insisting she did not have Ebola, objected to the quarantines. In Maine, she took the matter to court. A judged ruled there were insufficient grounds for quarantine, saying Hickox should simply submit to direct active monitoring. She did, and eventually was confirmed as not infected with the virus.

An Ebola isolation tent in Newark, N.J., for Kaci Hickox

An Ebola isolation tent in Newark, N.J., set up for Kaci Hickox

After the court fight, Hickox said, “We’ll only win this battle as we continue this discussion, as we gain a better collective understanding about Ebola and public health, and as we overcome fear . . .”

The American Nurses Association opposes the mandatory quarantine of health care professionals who return to the United States from the Ebola-ravaged areas of West Africa.

On Oct. 27, Gov. Nathan Deal announced that Georgia plans to increase Ebola monitoring for all people arriving from affected countries. His directive also included the possibility of quarantines, but none have been implemented.

An open letter to Georgia’s nurses (co-authored by Public Health chief Dr. Brenda Fitzgerald and Carole Jakeway, a Public Health Department official), called for vigilance in recognizing early symptoms of Ebola. “As nurses, this is the type of situation we have been trained for,” the letter reads, while discussing the potential for anxiety and stress among Georgia’s nursing personnel.

Nurses are a good source of information about this potentially deadly disease, said Texas Nurses Association Executive Director Cindy Zolnierek.

“Also, I have advice for a concerned public: Talk to a nurse. Very likely, you have nurses in your own family or as friends,’’ she said in a statement.

“Nurses are a great resource for information and a calm voice of reason. We hope you care for nurses as much they work to care for you.”


Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.


Medicaid expansion: How it has worked in other Southern states

The University of Arkansas Medical Sciences Medical Center has seen its number of uninsured patients drop since the state expanded Medicaid.

The University of Arkansas for Medical Sciences Medical Center has seen its number of uninsured patients drop since the state expanded Medicaid.

The University of Kentucky’s Chandler Hospital has seen its inpatient numbers rise by 5 percent and its outpatient numbers rise by 10 percent since July. But its number of uninsured patients has dropped, from about 9 percent to 2.5 percent.

Prior to this year, says Chandler’s Dr. Michael Karpf, “we were getting paid 10 cents on the dollar” serving low-income patients. “Now we are getting 40 cents on the dollar, so the cost of care for these people isn’t totally covered, but there is a lot more reimbursement. It means we are having very strong bottom lines in the hospital.”

The financial transformation, he says, has been fueled by the state’s expansion of Medicaid.

Dr. Michael Karpf

Dr. Michael Karpf

Kentucky and Arkansas, unlike other Southern states, adopted the Affordable Care Act’s expansion of Medicaid, adding more people to the program. Although the two states took different approaches, hospital officials in both say it is working better than expected.

Besides extending insurance to millions of Americans, the ACA has brought increased reimbursements to hospitals for patients who were previously uninsured. Gradually, though, the health reform law will cut federal “disproportionate share’’ funds to hospitals that care for many indigent patients.

Georgia Health News contacted health care experts and officials in Arkansas and Kentucky to gauge the impact of Medicaid expansion thus far on hospitals, and found both states are experiencing significant benefits.

Kentucky, with a Democratic governor and Democratic-controlled House, chose to expand its Medicaid program as originally mandated by the ACA. Federal funding covers 100 percent of the expansion for three years and then drops to 95 percent after 2017 and to 90 percent by 2020.

A 2012 decision by the U.S. Supreme Court, while generally upholding the health care law, said states had the right to opt out of expanding Medicaid. That complicated the issue of expansion, which drafters of the new law had envisioned would be nationwide.

The expansion is designed to cover all individuals and families with incomes below 138 percent of the federal poverty level (FPL). Roughly half the states, including Georgia, have refused to expand Medicaid.

Arkansas, with a Democratic governor and Republican-controlled House and Senate, reached a compromise. It did not directly expand its Medicaid program, but received a waiver from the federal government to use expansion funds to create a “private option” alternative. The state is buying commercial health insurance for those low-income citizens on Arkansas’ health care exchange.

The federal funds pay the premiums for the insurance plans. The money also covers co-pays and out-of-pocket expenses for beneficiaries below 100 percent of the poverty level. Between 100 percent and 138 percent FPL, individuals and families are responsible for shared expenses up to 2 percent of their annual income.

“The impact has been remarkable,” said Joseph Thompson, director of the Arkansas Center for Health Improvement, a nonpartisan, independent health policy center. Of the state’s 250,000 uninsured low-income adults, 205,000, or 85 percent, are enrolled in the private option program.

Other data, Thompson said, show overall emergency room visits statewide were down 2 percent for the first four months of 2014, compared with the same time last year. Uninsured ER visits decreased by 24 percent, and uninsured hospital stays dropped 30 percent.

Dr. Roxane Townsend, CEO of the University of Arkansas for Medical Sciences Medical Center in Little Rock, says, “Our monthly uninsured patient rate has been consistently below 4 percent down from nearly 15 percent prior to insurance expansion.”

Roxane Townsend

Roxane Townsend

UAMS is in the process of evaluating the financial impact, but Townsend says the medical center already has seen improvement since the start of its fiscal year this past July 1.

She also notes, “The rates in the private option are nearly the same as our other commercial contracts. This is a higher rate than traditional Medicaid, and this has a positive impact on a hospital’s ability to cover all the costs of care.”

Several rural hospital CEOs reported a positive effect from expansion, according to an article in Arkansas Business this month.

Darren Caldwell, CEO of DeWitt Hospital and Nursing Home, a rural hospital in DeWitt, Ark., told Arkansas Business that the ACA and the private option have led to a decrease in his organization’s uncompensated care, an increase in insured patients and a decline in bad debt.

“We’ve seen really good numbers,” he said. “In talking with my counterparts in other hospitals in this region, they too have seen good numbers.”

The earliest impact for patients, Thompson says, was at pharmacies. People who had prescriptions for medicines but could not afford to purchase them were able to fill their prescriptions with their newly acquired commercial insurance.

Thompson also has heard from front-line providers at community health centers who say they have been able to connect low-income patients to hospital care more readily, including specialist care.


Other states showing interest


The Arkansas alternative to Medicaid expansion has drawn attention from other states such as Iowa, Michigan and Pennsylvania. Thompson notes it represents a hard-fought compromise made palatable to the GOP legislature by Gov. Mike Beebe’s support for a $100 million tax cut.

“From an impact perspective, the program is performing even better than originally expected because of the uptake,” Thompson says. “We didn’t think we could be at 85 percent in the first year. We thought it would take a little longer, but that’s because of the need that’s out there.”

Gov. Steve Beshear

Gov. Steve Beshear

In Kentucky, Democratic Gov. Steve Beshear used his executive authority to expand Medicaid under ACA and had enough support in the Legislature to defeat several Republican bills to stop it.

The state has experienced significantly greater enrollment than expected, according to Jill Midkiff, director of communications for the Cabinet for Health and Family Services (CHFS).

Of 640,000 uninsured Kentuckians, 521,000, or 81 percent, have acquired insurance under the ACA through the state’s health care exchange. Of those, more than 310,000 enrolled through the Medicaid expansion.

CHFS Secretary Audrey Haynes says, “More than 80 percent of those who qualified for the Medicaid expansion have used their benefits at least once this year, clearly demonstrating a need in this population who likely were not receiving the preventive care and treatment they required.”

She says Kentucky hospitals, pharmacies, physicians and dentists have received more than $591 million in Medicaid expansion reimbursements.

Other data reveal a significant decrease in hospitals’ uncompensated care costs. For the first six months of this year, those costs dropped by nearly 60 percent to $218 million from $511 million in the first half of 2013.

Another benefit has been an increase in jobs. The U.S. Bureau of Labor Statistics reported Kentucky added 3,000 health care jobs and 8,000 administrative and support services jobs from July 2013 to July 2014. The job growth, Midkiff says, “is a result of Kentucky fully embracing the ACA, including Medicaid expansion.”


Long-term concerns


Karpf, University of Kentucky executive vice president for health affairs and head of the school’s Chandler Hospital, agrees the Medicaid expansion is having a positive impact.

In the long term, however, Karpf predicts the current strong financial performance of hospitals fueled by the Medicaid expansion won’t last. After 2017, he said, Kentucky will be hard-pressed to pay its amount for the expansion.

University of Kentucky Chandler Hospital

University of Kentucky Chandler Hospital

“Kentucky is an overutilizer,” he explains. “Our hospital utilization is 120 percent or 125 percent of the national average. That is a problem, and that problem will get compounded when the state has to start picking up its share of the Medicaid costs.”

By 2020, he says, the state’s share of the costs for Kentucky’s newly eligible Medicaid patients will be substantial, in the hundreds of millions of dollars annually.

With a fixed budget for Medicaid, Karpf anticipates the state will push “for decreased utilization and for providers to take more risk and more responsibility for utilization.”

That means reducing inpatient care and supporting fewer hospitals, he added. In the long run, he predicted, some small rural hospitals may close as the state’s portion of Medicaid reimbursements fails to keep pace with the higher volume of patients.

Karpf favors Medicaid expansion, but says he would have delayed it until greater efficiencies in hospital utilization were in place.

The eventual state match for Medicaid expansion was a focal point of Gov. Nathan Deal’s refusal to support expanding Medicaid to up to 600,000 uninsured low income adults in Georgia. The state, Deal said, could not afford the expansion, which state officials have calculated at $2.5 billion over 10 years.

Deal is in a tight race for re-election with Democrat Jason Carter, a state senator, who has indicated his support for expansion.


A variety of challenges


Meanwhile, many Georgia hospital officials, especially those in rural areas, report facing financial challenges greater than ever before.

Regardless of who is governor, Medicaid expansion would have to be authorized by Georgia’s General Assembly. The Legislature is currently Republican-dominated and generally to hostile tot he ACA. In fact, it put considerable effort recently into blocking the state government from helping implement the health law.

Joseph Thompson

Joseph Thompson

In Arkansas, Thompson’s Center for Health Improvement is charged with evaluating the state’s private option experiment. The evaluation will determine if the program is cost-effective compared with conventional Medicaid expansion, such as in Kentucky.

In securing its waiver, Arkansas estimated the program would be revenue-neutral for the federal government after 10 years. The U.S. Government Accountability Office has projected the program will cost the federal government considerably more than conventional Medicaid expansion.

Thompson clearly hopes the evaluation supports the state’s experiment.

“There are 50 different Medicaid programs, and each one has been developed in its own unique way,” he says. “You overlay on top of that the political division that is present within our nation now between the two parties, and it becomes difficult for constructive policy to emerge.

“We found a way to craft a constructive and acceptable new way to provide health care to our lowest income individuals.”

A county’s difficult question: How to save its local hospital?

Elbert Memorial Hospital needs funding from the county in order to remain open.

Elbert Memorial Hospital needs funding from the county in order to remain open.

Elbert Memorial Hospital has served its northeast Georgia county for more than 60 years.

But the future of the hospital is now unclear. Its fate will hinge on the coming days and weeks.

Elbert County commissioners are holding public hearings this week and next on a proposed one-mill property tax increase for one year to raise about $500,000 to offset the Elberton hospital’s costs for indigent care.

Without the money, the 52-bed hospital will close, officials warn. That would eliminate more than 200 jobs, and residents would have to travel more than 30 miles to the nearest hospital. A closure would jolt the mostly rural county’s economy.

Elbert Memorial lost $1.5 million in its last fiscal year, CEO Jim Yarborough said Tuesday. “Our concern is that charity care and bad debt are trending upward,” he said. Yarborough calls the financial crunch facing many Georgia hospitals “a silent epidemic.”

The hospital’s predicament demonstrates how counties and hospitals depend on each other financially, and how revenue pressure on each is creating an unprecedented squeeze.

“Counties are in major turmoil deciding whether they want a hospital or pick up the garbage,’’ said Jimmy Lewis, CEO of HomeTown Health, an organization of rural hospitals in the state. Meanwhile, he added, “The general cash position in most rural hospitals is extremely dire.’’

Hospitals are facing lower reimbursements from government programs and private health insurers, along with high levels of uninsured and underinsured patients.

But another key issue is Georgia’s decision not to expand Medicaid, hospital execs say.

Gov. Nathan Deal and Georgia’s legislative leaders, citing costs, have decided not to expand Medicaid as outlined under the Affordable Care Act.

Expansion “would help significantly,’’ Yarborough said. “It would create a paying source” from uninsured low-income patients, he added.

The Elbert County predicament comes in the wake of five hospitals closing in Georgia in the past two years. Four were in rural areas. And several other hospitals around the state are struggling just to stay open.

Debra Nesbit

Debra Nesbit

“If this disturbing trend continues, we’ll have major access-to-care issues for hundreds of thousands of Georgians throughout the state,” Kevin Bloye of the Georgia Hospital Association told GHN recently. “It will also have devastating financial consequences to areas that lose their local hospital which serves as a major economic engine.”

Meanwhile, hospitals’ requests to counties for help are more urgent now, said Debra Nesbit of ACCG, which represents county governments in Georgia. “The counties are really struggling with that.”

“Hospitals are saying, ‘Give us money or we are going to shut the door,’ ’’ Nesbit added. But with property appraisals decreasing, she said, counties have financial problems of their own. “They may not have the resources, particularly in rural areas.”

Most counties are supporting their hospitals financially, Lewis said.

Reimbursement reductions for hospitals “translate into an unfunded mandate onto the county,” Lewis added. “Rural unemployment rates are so high there’s no millage capacity to support the unfunded mandate.”

Some counties are pursuing new avenues to keep their hospitals upright. Recently, Habersham County in the northeast Georgia mountains agreed in a deal with the
local hospital authority to make monthly bond payments on Habersham Medical Center’s $37 million debt. The county will eventually take over the assets of the facility.

Newton Medical Center

Newton Medical Center

In Newton County, east of Atlanta, 97-bed Newton Medical Center recently requested a property tax increase to offset indigent care costs. It would have resulted in about a $600,000 funding increase, said Troy Brooks, assistant administrator of fiscal services for the hospital. But he said the county has already set the budget and did not include the funding that the hospital requested.

The hospital isn’t in danger of closing, Brooks indicated. Last year the hospital posted its first positive margin since fiscal 2008, which Brooks attributed to the nearly $2 million in funds related to the Electronic Health Record initiative in the Affordable Care Act.


Rocky times in the rock hills


Elbert County takes pride in its granite industry, and Elberton calls itself “The Granite Capital of the World.”

But its overall economy is less solid.

About one in four residents has no health insurance, according to the 2014 County Health Rankings, produced by the Robert Wood Johnson Foundation and the University of Wisconsin. The report also shows the Elbert County unemployment rate is higher than the state average, and that about one in three children live in poverty.

Elbert County

Elbert County

As the Elbert County commissioners hold public hearings on the tax increase, Elbert Memorial’s website sums up the situation: “This financial relief is needed to keep our hospital from closing, which would result in a devastating economic loss to the community and leave Elbert County residents without local access to health care services.”

Yarborough said he’s “very hopeful and optimistic” about the financial help. Still, he noted that in the current hard times, “there is a portion of citizens that are not in favor of a property tax increase.”

Elbert Memorial has an affiliation and management agreement with AnMed Health in nearby South Carolina, which has helped the hospital. Nevertheless, the charity care and bad debt for Elbert Memorial Hospital grew to nearly $4 million in its last fiscal year.

The request to the county commissioners is for funding the charity care of Elbert County residents. “They don’t have a mechanism to pay,” Yarborough said. “The ER always has to take care of you.”

The county commissioners will take a final vote on the tax increase after the public hearings. Commission Chairman Tommy Lyon said if the hospital closes, the county will have to add another ambulance and crew to transport patients to hospitals in Athens or in Anderson, S.C. – a step that would cause the budget to be in deficit.

“We’re in a very dire situation,’’ Lyon said, according to an Elberton Star article.

A recent report by the Urban Institute said Georgia’s decision not to expand Medicaid will cost the state’s hospitals $12.8 billion in lost reimbursements over a 10-year period. Medicaid expansion – making more low-income people eligible for the program – would ensure some reimbursement for hospitals that treat these people.

Hospital executives aren’t saying expansion is a complete cure-all. In Georgia, said Yarborough, Medicaid pays only 85 percent of the cost of a covered patient’s medical services. “We lose 15 cents on every dollar,’’ he said.

Still, Yarborough noted that for a hospital, getting “85 cents on the dollar is much better than zero cents on the dollar.”

Brooks of Newton Medical Center said, “I am hearing that hospitals in those states that did expand Medicaid have seen noticeable improvement because of it.”

Nesbit of ACCG recognizes the political realities in Georgia. “Clearly, Medicaid expansion is off the table right now,” she said.

“We don’t have a position on Medicaid expansion,” Nesbit said, though she added, “We want all Georgians to have access to health care.”

“We are continuing to look at the situation, look at creative ways to expand some health care access.”

Elberton Georgia, Granite Capitol

Elberton, in northeast Georgia, takes pride in its famous granite industry.

Cancer care in Georgia marks milestone with MD Anderson affiliation

MD Anderson has a national reputation as a leading cancer center

MD Anderson has a national reputation as a leading cancer center

Greg Foster is looking forward to the end of his long medical commute.

Foster, who lives in Marietta, has been regularly shuttling back and forth to Texas for a couple of years.

He had brain cancer surgery in 2012 at MD Anderson Cancer Center in Houston. It’s renowned as the leading cancer facility in the country, and he says he went there after his personal research determined that it had the neuro-oncologist he was looking for.

And he returned to Houston every other month for a year for radiation therapy, and then every three months afterward.

Now Foster’s travel schedule looks a lot less complicated. That’s because Piedmont Healthcare in Atlanta, where he and his family already go for most care, announced Friday that it has joined the MD Anderson Cancer Network. The affiliation, first reported by the Atlanta Business Chronicle, means that many Georgians like Foster won’t have to travel to Houston to be treated.

Piedmont officials said Friday that more than 700 Georgians go to MD Anderson’s Center in Texas each year. “The hope is many patients will be able to be treated here at one of Piedmont’s hospitals,’’ said Dr. Eric Mininberg, an oncologist at Piedmont Atlanta Hospital.

Foster, who runs an Atlanta software company, said that now he will be able to have his regular imaging tests done under the MD Anderson guidelines at Piedmont Atlanta Hospital.

Greg Foster and his family

Greg Foster and his family

“It’s going to help me a ton,’’ said Foster, 41. He adds that all his doctors now will be coordinated. “With this, there is no loss in translation.”

Piedmont physicians in Atlanta will get access to MD Anderson’s expertise, and are adopting its cancer treatment regimens, Mininberg said.

The agreement is part of Piedmont’s push to buttress its position as a leading hospital-based systems in metro Atlanta. The affiliation is also expected to spark new competition among cancer centers in the area, including those run by Emory Healthcare, Northside Hospital and Cancer Treatment Centers of America.

MD Anderson’s best practices and protocols will be implemented at Piedmont Atlanta and Piedmont Fayette hospitals. Piedmont Henry and Piedmont Newnan hospitals, in southern metro Atlanta, are expected to become network members as well.

“We’re confident it will raise the bar even higher for cancer care in Georgia,” said Dr. Thomas Burke, executive vice president for the MD Anderson Cancer Network.

Piedmont will pay an undisclosed fee to MD Anderson for joining the network.


A national trend

MD Anderson isn’t the only nationally renowned health care organization expanding beyond its home territory. The Minnesota-based Mayo Clinic and the Ohio-based Cleveland Clinic are two others that have extended their reach nationally.

Mayo, in particular, has built a strong Georgia presence. Two years ago, it acquired a health system in Waycross that included a hospital and two nursing homes. And earlier this year, the dominant system in the northwest Atlanta suburbs, WellStar Health System, became the second Georgia health care organization to join the Mayo Clinic Care Network. St. Francis hospital in Columbus announced a similar agreement last year.

Piedmont Atlanta Hospital

Piedmont Atlanta Hospital

Such networking extends the brand of the national organization, said Craig Savage, a consultant with Durham, N.C.-based CMBC Advisors.

“The local hospital gets a bump from this national player,’’ which lends its protocols and ‘’best practices’’ to benefit patients, Savage said.

Under the MD Anderson deal, Atlanta cancer patients will have the opportunity to get the specialized care locally, thereby reducing travel costs and time out of their schedules, he said.

“It’s a good move for Piedmont,” Savage said. MD Anderson, along with Sloan Kettering in New York, is “the gold standard’’ in cancer care, he added.

The cancer network furthers MD Anderson’s mission to eliminate cancer, said Melanie Wong, an MD Anderson vice president. As part of the University of Texas, MD Anderson’s mission includes sharing knowledge, she said.

A goal of its cancer network is “to transfer knowledge so patients can stay at home,’’ Wong said, adding that patients with highly complex cases of cancer would still be able to go to Houston if necessary.

She said Piedmont approached MD Anderson on the affiliation possibility. Twelve other health systems are members of the network.

Foster noted that he won’t have to be away from his family for his care, and that his hotel and airline bills will disappear. Clear of cancer now, he will have to have imaging “for the rest of my life.’’

Now his care will all “be under one roof,’’ he said.

“This is a huge thing for the people of Atlanta,” Foster said.


Weather disasters and medical facilities: Why readiness is vital

Upturned car in front of Sumter Regional in 2007

Some of the damage from the 2007 tornado that hit Sumter Regional Hospital.

In the event of a natural disaster, resilience is a hospital’s prescription for success.

It’s all about bouncing back, recovering and then moving forward after a violent weather event. The proper response requires developing plans, then practice, practice, practice — and then putting those measures to work when the moment calls for action.

Whether our hospitals and medical facilities are safe and ready to help communities during and after weather events is a vital topic. Some areas are more prone to disasters than others, but it takes only one serious event to ravage a normally safe area.

Hurricanes, tornadoes and floods can cause casualties on a large scale, increasing the need for hospital readiness. But some disasters in recent years, such as Hurricane Katrina in 2005 and “Superstorm Sandy” in 2012, have inflicted damage on hospitals themselves.

Members of the American Meteorological Society (AMS) have recently added their concerns about hospital resilience in the aftermath of “high-impact” weather events throughout the country.

AMS suggestions include having medical centers look at their structural designs and, in some cases, relocate critical components to higher ground. When Katrina left large stretches of low-lying New Orleans submerged for weeks, it demonstrated the importance of having facilities that remain functional and accessible.

Health care’s critical problem in disasters is supply and demand. High-impact weather events create a pragmatic paradox, according to the AMS report. Supply decreases when health infrastructure is damaged, but the demand increases as the number of victims adds up.

Charity Hospital in New Orleans suffered severe flood damage during Hurricane Katrina.

Charity Hospital in New Orleans suffered severe flood damage during Hurricane Katrina.

What the American public needs to know is that “each hospital has the job of seeing how well they are prepared,” said Jim Blair, president of the Center for HealthCare Emergency Readiness, a consulting firm. “It’s a journey, not a destination.”

Blair questions whether hospitals are really ready to handle disasters when it’s been many years since their communities were struck. Institutional memories can fade, and a hospital’s vulnerabilities can become less obvious.

He refers to location intelligence when he’s working with health care clients. “Is there a dam nearby, or is the hospital close to an earthquake fault line?” asks Blair. “Where are the air conditioning, heating and ventilation power systems located?”

What about cesium-137, the most common radioactive material used in radiation therapy? Is it protected?

Sandy hit huge metropolitan areas of the Northeast in late October, leaving many communities in tatters and more vulnerable to the approaching cold weather. The storm did considerable damage to New York hospitals and other health care organizations.

Five acute-care hospitals in New York City alone were closed because of electrical and mechanical system failures, flooding and other storm-related issues. The closures were temporary, but all patients had to be evacuated.

Weeks after Sandy, four hospitals in the nation’s largest city remained closed for inpatients, leaving thousands of patients scrambling to find other medical centers.

Katrina was far worse for hospitals. According to a FEMA report, New Orleans hospitals suffered major interior damage such as collapsed ceilings, and emergency power generators became nonfunctional and shut down HVAC systems used to control temperature and humidity.

The bodies of 45 patients were found at Memorial Medical Center in New Orleans after the 2005 storm. Overall, more than 200 bodies ‘’were recovered from New Orleans hospitals and nursing homes as a result of the hurricane.

Blair says hospitals and health care facilities, in the midst of a disaster, must make the right decisions about sheltering in place or evacuating patients and staff.


It can happen here


History shows that Georgia hospitals are not immune to violent weather.

A communications tower dangles from the Grady Memorial Hospital roof after a tornado hit Downtown Atlanta.

A communications tower dangles from the Grady Memorial Hospital roof after a tornado hit Downtown Atlanta.


In March 2008, Grady Memorial Hospital, downtown Atlanta’s largest and most famous hospital, was damaged by a tornado that hit the heart of the city. According to claims reports, 15 buildings suffered significant damage, including the radiation/oncology center, Georgia Hall, Florida Hall, and the Hughes Spalding Medical Center of Children’s Healthcare of Atlanta.

Other health facilities have also met weather damage head on.

Seven years ago, severe thunderstorms moved across central Georgia, producing tornadoes that resulted in significant damage in several counties. Some of the heaviest destruction occurred at Sumter Regional Hospital in Americus.

That particular tornado’s path measured about 38 miles in length, with a maximum width of 1 mile, as it ripped through Americus. The hospital was evacuated after the tornado hit.

Fifty-five to 60 patients were in the building when it was hit. Three of them were in critical condition. All the patients were transferred to other hospitals.

Sumter Regional suffered major damage and later was demolished to make way for a new facility.

Dr. Thomas Frieden, the CDC director, recently reminded a Rockefeller Foundation audience that the first lesson is to build resilient systems that can be “scaled up” quickly.

In other words, know which systems are already in place that can be expanded on short notice to serve more people in a hurry.

“During the 2014 winter storms in Augusta, we lost power to several area nursing homes,” said Adrianne Feinberg, director of emergency preparedness at Georgia Hospital Association.

“A concerted effort among health care partners and emergency management agencies resulted in generators and other resources being allocated to the affected facilities,” Feinberg said. “Now we are working with a new federal program to help supply generators in the future — ensuring nursing home residents always have heat.”

Medical offices of all varieties and sizes are vulnerable to weather-related problems.

The same ice storm that brought Augusta to a halt also paralyzed Atlanta. There, in vitro fertilization (IVF) specialist Dr. Mark Perloe faced a time-critical challenge. “Retrieving eggs and caring for fertilized embryos are my first priority, no matter what the weather is doing in Atlanta,” he said.

All scheduled egg retrievals must occur as planned. IVF timing is critical for life. Because he and his staff planned ahead for access to the clinic (with some staff and patients staying in hotels close by), their backup system worked.

“You can close schools, banks and post offices, but when eggs are ready for their debut, we cannot let a little ice storm get in the way,” said Perloe.

Now that’s resilience.


Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.


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