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Carmen captures hearts 3 Executive changes 7 Anchorage potluck 8 PERIODICAL RATE PUBLICATION

NOVEMBER 15, 2021 VOLUME 37, NUMBER 18

Graphite Health Pandemic compounds challenges for disaster planners invests to speed When Hurricane Ida was churning digital innovation across the Gulf of Mexico in late summer, Our Lady of the Lake Regional Medical in health sector Center in Baton Rouge, Louisiana, had to By LISA EISENHAUER

The new company follows Civica RX model of cooperative stewardship By JULIE MINDA

SSM Health, Intermountain Healthcare and Presbyterian Healthcare Services are teaming to create a “health care utility.” The startup nonprofit company, called Graphite Health, will tackle digital interoperability challenges that slow innovation uptake in health care. It will do this by establishing a common-language platform that the company’s members can use for operationalizing digital innovations. Graphite expects to attract Catholic, other nonprofit and for-profit health care systems and philanthropic organizations as members. All members will provide expertise and capital for developing the data platform and a marketplace of technology applications that members can use. As a condition of membership, all who join will subscribe to the IT equivalent of a Hippocratic oath that obligates them to protect patients and their data. Graphite is modeled after Civica RX, a nonprofit generic pharmaceutical company established three years ago to source or manufacture essential generic drugs. More than 50 U.S. health systems representing 1,350 hospitals, and major philanthropic organizations are part of the Civica RX Dredge collective. Carter Dredge, a board member of Civica RX and Graphite Health, has been deeply involved in the start-up of both companies. The senior vice president and lead futurist for SSM Health talked to Catholic Health World about Graphite Health. What learnings from the Civica RX start-up are applicable to Graphite Health? We have learned from our work on Civica that things can build fast. When we first launched Civica we thought it would take four to five years to get traction. But when you have a really compelling and noble mission and an environment hungering for a solution and the structure to benefit everyone and bring mindshare and financial capital together, you can make real progress fast. It’s been three years since we launched Civica and we have 50 products available. Four of Civica’s seven original founding health systems are Catholic. (In addition to SSM Health, they are Providence St. Joseph Health, Trinity Health and Catholic Health Initiatives, part of CommonSpirit Health.) We expect Graphite to have high representation from Catholic health care as well, and that is essential. This is a great opportunity for Catholic Continued on 6

In this disaster drill staged at Mercy Hospital St. Louis before the pandemic, a participant posing as a patient exposed to ebola is enclosed in a portable isolation chamber for transport.

brace for a disaster on top of a crisis. The medical center was in the middle of its worst surge in COVID-19 cases since the start of the pandemic. The patient load was so heavy that the hospital had halted elective surgeries and a team of military doctors and nurses was assisting its staff. Ida roared ashore just before Labor Day, causing 26 deaths in Louisiana and wreaking billions of dollars in havoc across its multistate path. At Our Lady of the Lake, damage was minimal and its patients and staffers unharmed, an outcome that Jeff Mosely, one of the disaster preparedness Continued on 5

Neurologist investigates how to address strokes’ unequal racial toll By LISA EISENHAUER

Even as the overall mortality rate from strokes has fallen, the racial disparity in the toll has remained what Dr. John McBurney calls stubbornly high. McBurney sees that disparity daily as medical director of the Bon Secours St. Francis Stroke Program. The program is based in Greenville, South Carolina, one of eight southeastern states identified by the Centers for Disease Control and Prevention and other health agencies as the Stroke Belt for their high incidence of strokes. “What we can see is that while there has been progress made for all racial and ethnic groups in the difference in the mortality rates — and that has been validated as a good proxy for the overall incidence of stroke — the disparity has not closed,” McBurney says. He has in recent years undertaken his own exploration of this lingering disparity and how to address it. His conclusions Continued on 4

Julius Hudson is flanked by his sister, Roberta Robinson, left, and wife, Amanda, outside of St. Francis Downtown hospital in Greenville, South Carolina, where he was recovering from a stroke. Hudson exercises and doesn’t smoke. His physician, Dr. John McBurney, is investigating the reasons for the higher than average incidence of stroke among African Americans.

MercyOne Dubuque promotes health equity for Pacific Islanders

After decades without insurance, many Marshallese regain Medicaid coverage By DALE SINGER

A diabetes education class hosted by the Pacific Islander Health Project in Dubuque, Iowa, is part of a community coalition’s health outreach efforts to a population that has higher than average rates of diabetes, cancer, hypertension and other chronic illness. MercyOne Dubuque Medical Center was instrumental in bringing the coalition together.

Natives of the Marshall Islands in the Pacific Ocean have reason to feel victimized by the U.S. government. Now, a coalition in Dubuque, Iowa, including MercyOne Dubuque Medical Center, part of Trinity Health, is building trust and trying to help make things right. After the United States gained control of the Marshall Islands from Japan in World War II, the U.S. tested biological weapons and detonated 67 nuclear bombs there between 1946 and 1958. According to the Los Angeles Times, bombs exploded “on, in and above” the islands leaving behind an “environmental catastrophe.” The nuclear contamination and the adverse health effects it caused remain a Continued on 7

CATHOLIC HEALTH WORLD November 15, 2021

Panelists say action is needed now to ward off eldercare crisis By JULIE MINDA

The number of Americans living with Alzheimer’s disease, the most common form of dementia, will more than double in the coming decades. Currently, about 5.8 million Americans ages 65 and up have Alzheimer’s disease. By 2050, that count may grow to 13.8 million, according to “2020 Alzheimer’s Facts and Figures,” a special report published in the March 10, 2020, edition of Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. Panelists in a mid-summer webinar joined the swelling chorus warning that the nation’s eldercare system is struggling now with staffing shortages and may be completely unprepared to meet the care needs of baby boomers as they enter advanced old age and develop debilitating diseases of cognition or the inability to perform essential tasks of daily living without assistance. The panelists said given the anticipated demand for care and assuming continuing difficulties attracting and retaining eldercare staff, they worry about care quality in the future for that vulnerable population of seniors unable to fully care for themselves. Charles Camosy, an associate professor of theological and social ethics at Fordham University, said the U.S. needs to make the financial commitment to prepare for the coming increase in demand for long-

term care, engaging the most creative minds in the country to address the challenge. Medicaid is the largest single payer for nursing Camosy home care. Camosy said advocates should promote increased Medicaid funding, including reimbursements for care provided in people’s homes and by family members. The July 26 webinar, “Dignity and Dementia: Mapping the Church’s Response to the Coming Crisis,” was sponsored by CHA; New City Press; National Review Institute; the archdioceses of Baltimore, New York, and San Francisco; and the diocese of Orange, California.

Harsh light The four panelists said the pandemic has laid bare and brought into public consciousness systemic problems including workforce shortages that had festered in some long-term care facilities years before 2020. Camosy said the staff shortages have led to substandard care in some facilities, with residents warehoused, isolated and medicated as a means of chemical restraint. Camosy warned that staffing shortages could grow more severe in the future in nursing homes, home care venues and dementia care units in the absence of policy

Psychologist offers advice for turning stress of pandemic into personal growth By LISA EISENHAUER

There is “no group more committed, creative, bright and compassionate than Catholic health care professionals,” according to Robert Wicks. Because of that devotion to their calling, Wicks said there’s a tendency among Catholic health care providers to deny, avoid or minimize the Wicks trauma they are experiencing due to the relentless demand for COVID-19 care. Societal expectations that health care professionals are able to easily shake off their bone-weariness and stress simply aren’t true, said Wicks, a clinical psychologist and professor emeritus of pastoral counseling at Loyola University Maryland. He’s also the author of dozens of books on topics such as resilience and self-care. Wicks shared his advice for how care providers can cope with the trauma of the pandemic and strengthen themselves mentally and spiritually during a webinar Sept. 8 titled “The Heart of Hope: Cultivating PostTraumatic Growth.” Wicks’ webinar was the first of two on the topic of post-traumatic growth in a series sponsored by CHA. Wicks said the chaos and stress of the pandemic will send many people down “spiritual and psychological dead ends.” But, he added, the crisis also is calling people to “be open to a sense of intrigue about how we live our lives. It’s amazing what can happen to us if we do that.” Openness can lead to a greater understanding of true friendship and an appreciation of how being compassionate spins a circle of grace that benefits the giver and receiver. Being open to new ways of evaluating and accepting experiences beyond one’s control can lead to a deeper relationship with someone or something greater than oneself, Wicks said. “Let’s face it, everyone copes. You cope. I cope,” Wicks said. “But the question is: How well do we cope? Do we deepen and grow in ways that would not have been possible had the stress of COVID-19 not happened in the first place?” His advice for how care providers can

find their way through the dark days of the pandemic covered nine themes. Among them: Recognize that resilience and posttraumatic growth are not just about you. Those attributes can help health care workers take better care of others. Appreciate that you can use stressful experiences to gain a greater understanding of yourself and others and a more meaningful life. Be aware of the constancy of change and cope with it by examining your habits. Those routines might need to be rethought or adjusted so as to better provide a sense of stability and personal security. Just as you would wash your hands after any potential contact with physical contagion, take time to reflect on your experiences so as to clear your head of any negative spiritual and psychological contagion. Accepting and acting on his themes, Wicks said, will help care providers to know their limits and not be distressed by the reality of them; to become more aware of their strengths and talents; to develop more flexibility; and to increase their emotional intelligence through healthy reflection. To put his advice into practice, Wicks offered a set of self-care tools that he calls ABLE: Assess the challenges — including the troubling emotions you are feeling and dysfunctional thoughts you may be having. Brainstorm possible solutions during your quiet time. Label the pros and cons including determining what you can control and what you can’t — time and energy are precious and limited, so don’t waste them on futile endeavors. Explore short-term and long-term goals that inspire but do not threaten you. “Please remember that on the most challenging days of your life, you can still be a blessing to others, and in the spirit of posttraumatic growth, may be blessed yourself in ways you don’t see at the moment,” Wicks said. A recording of Wicks’ webinar can be viewed on the CHA website at chausa.org/ online-learning/webinar-recordings. leisenhauer@chausa.org

changes that prioritize eldercare. “Health care providers aren’t technicians who have jobs that can be replicated by machines,” he said, acknowledging that amassing new resources for eldercare has proven to be an intractable challenge.

Lonely days Panelist Erin Younkins is an occupational therapist who directs the Office of Life, Justice and Peace Younkins for the Archdiocese of Baltimore. She said when COVID infection control protocols barred family visits to nursing home residents for much of last year, patients’ quality of life declined. Family members often pitch in to provide personal care for loved ones in nursing homes and they are a mainstay of emotional support and stimulation. “Nursing homes and assisted living facilities are not set up to provide optimal care when each resident is isolated” as was the case during much of 2020, Younkins said. “In my personal experience, family members frequently were the first to notice wounds, decline in appetite, or other concerning symptoms and report to nursing staff. Without those eyes on the residents, it would be very reasonable to assume a decline in timely care.” Befriend a senior Panelists explored what the Catholic Church can be doing to support the frail elderly — and particularly those with dementia — living in the community and in institutional settings. Panelist Bishop Kevin W. Vann oversees the Diocese of Orange, California. That diocese takes part Bishop Vann in the Whole Person Care Initiative, an effort by the Catholic Church in California to improve care to the seri-

ously ill. Bishop Vann said parishes around the nation could be organizing programs to teach parishioners how to care for the frail elderly, including those with dementia. California parishes have been doing this for several years. Panelist Sr. Constance Veit, LSP, is U.S. director of communications for the Little Sisters of the Poor, a congregation serving needy older persons Sr. Veit in the homes they run for the elderly. Sr. Veit said that with the medicalization of care in the U.S., many people believe that they are not qualified to aid in the care of the frail elderly. She said the church should dispel the fallacy that only medical providers can tend to the elderly. “There is so much that the average person can do to assist with basic self-care, household tasks and transportation, as well as providing companionship.” Younkins agreed, noting that many isolated seniors crave companionship. “Many of them just want human contact, and it does not take an educational degree to love someone.” Sr. Veit added it’s important for people to seek opportunities to draw senior adults out of isolation. She asked: Can you cook together? Can you watch a movie together and discuss it afterwards? Can you ask to learn something from the elder, such as knitting? Camosy noted that many young adults today are desperately lonely themselves, and spiritually hungry. By spending time with a senior, they could find companionship and broaden their perspective. “We need to expand how we think of family, neighborhood and community. We need all hands on deck.” “This is the spirit of new evangelization” of demonstrating Christ’s love through actions, Camosy said. jminda@chausa.org

THE LIGHT SHINES IN THE DARKNESS, AND THE DARKNESS HAS NOT OVERCOME IT. JOHN 1:5

CHA is pleased to offer a free booket and videos of weekly Advent reflections. Please order booklets for your associates, residents and others or download and share the videos.

Access them at chausa.org/advent

November 15, 2021 CATHOLIC HEALTH WORLD

Mercy nurse’s kindness draws spotlight to family’s COVID tragedy

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Eric Robison sits surrounded by some of the baby gifts donated by strangers. While his 22-year-old wife, Emily, was being treated for COVID-19 in the intensive care unit at Mercy Hospital Fort Smith in Arkansas, doctors delivered the Robisons’ daughter, Carmen. Emily died of COVID complications about a month after Carmen’s birth.

were snapped up. On Sept. 20, Emily Robison lost her battle with COVID. Schwartz said Eric Robison was reluctant to inform local media but she persuaded him. “I said, ‘I don’t want to pressure you, but I don’t think you realize how much support there is if you were to share that Emily has now passed,’” she said. The day after Fort Smith news outlets reported on Emily Robison’s death, “Good Morning America” contacted Schwartz and Robison. Soon other national outlets were on the story. As of late October, Schwartz still was getting calls and emails from news reporters and producers asking for interviews. Schwartz is eager to keep the Robisons in the spotlight. It has helped bring in assistance for a family with few resources. In addition to gift donations through the baby registries, a GoFundMe account that Schwartz set up had more than $25,000 in contributions on Nov. 3.

Ashlee Schwartz

An intensive care unit nurse in Arkansas has sparked a national outpouring of support since she started a baby registry for a young father whose wife was hospitalized with COVID-19. Ashlee Schwartz, an ICU nurse at Mercy Hospital Fort Smith, shared the family’s travails with local media. The story since has been picked up by “Good Morning America,” People, The Washington Post and other national news Schwartz outlets. “If you told me when I started this that it would have turned into this, I would have laughed and told you you were crazy,” Schwartz said about the media attention and deluge of donations. Schwartz met Eric Robison, 23, in August after his wife, Emily, was admitted to the hospital with complications from COVID. The hospital was seeing a surge in COVID patients at the time. Emily Robison stood out because she was only 22 and six months pregnant. The first time Schwartz saw Eric Robison he was sitting on a folding chair staring through a window into the ICU room where his wife was on a ventilator. “It literally broke my heart,” Schwartz said. On Aug. 25, with Emily Robison’s condition grave, doctors performed a Cesareansection. Baby Carmen, 2½ months premature and weighing less than 3 pounds, went immediately to the neonatal ICU. When Schwartz learned that the Robisons hadn’t had time to do much in the way of nursery planning, she coaxed some of her colleagues into going in on gifts for the newborn. Other than some baby clothes, the couple had nothing for Carmen. She asked Eric Robison if they had a baby registry. “He asked me ‘What is a baby registry?’” Schwartz recalled. Schwartz set up registries on three sites and spread the word on social media. When local news media reported the story of the young father whose wife and infant daughter were in ICUs, the items on the registries

Ashlee Schwartz

By LISA EISENHAUER

Carmen Robison was admitted to the neonatal intensive care unit at Mercy Hospital Fort Smith after doctors delivered the premature infant by emergency cesarean section.

Schwartz also wants the story of Emily Robison’s death to prompt pregnant women to get vaccinated for COVID. Emily Robison, an asthma sufferer, hadn’t gotten a shot. Her husband said in news interviews that he and his wife thought they were too young to be at risk. Schwartz said Robison has become like a little brother to her. She’s committed to continue helping him and Carmen find support. Tiny Carmen remained in the NICU in late October. The baby had been set for release when what Schwartz called reflux issues prompted doctors to extend her hospital stay. “I hope sharing this story will save some other lives somehow and maybe help people learn to be more mindful if they see someone in need to act and do something about it,” Schwartz said. leisenhauer@chausa.org

Upcoming Events from The Catholic Health Association Faith Community Nurse Networking Call Dec. 15 | 3 – 4 p.m. ET

2022 Long-Term Care Networking Zoom Call Jan. 11 | 3 – 4 p.m. ET

Global Health Networking Zoom Call Feb. 2 | Noon ET

Foundations of Catholic Health Care Leadership 2022: An Online Course for Formation and Development

Global Health Networking Zoom Call

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June 5 – 7

Feb. 3 | 1 – 3:30 p.m. ET

Feb. 25 | 1 – 2 p.m. ET

In-Person Meeting: Ecclesiology and Spiritual Renewal Program for Health Care Leaders Invitation Only May 1 – 6

May 4 | Noon ET

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United Against Human Trafficking Networking Zoom Call July 14 | Noon ET

A Passionate Voice for Compassionate Care®

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CATHOLIC HEALTH WORLD November 15, 2021

Stroke Death Rates, 2017 – 2019, Adults, Ages 35+ by County

Source: https://www.cdc.gov/dhdsp/ maps/national_maps/stroke_all.htm

Stroke disparities From page 1

include that while providing quality treatment for stroke victims is vital, the roots of stroke disparities are much deeper than what medical care can address. McBurney is strongly supportive of his system’s investments in programs that address the social determinants of health. And he is working with other organizations to provide early health-related interventions in the communities his program serves.

Lingering trauma Statistics cited by the CDC show ageadjusted death rates for stroke declined steadily and dramatically from 1950, when the rate was 88.8 per 100,000 Americans, to 1996, when the rate was 26.5. The rate has fluctuated in more recent years, as Americans have become more sedentary and overweight. In 2018, it was 37.1 per 100,000 people. Even as the overall picture has brightened in the last 70 years, the strikingly higher incidence of stroke deaths among Black Americans as compared to the population at large hasn’t changed. For non-Hispanic Black Americans, the rate in 2018 was 53 per 100,000, while for white Americans it was 36 and for Hispanic Americans it was 32. Those numbers translate to a likelihood of death by stroke almost 50% higher for Blacks than whites and about 65% higher for Blacks than Hispanics. McBurney points to studies that suggest the disparities are rooted in lingering trauma that goes back to slavery and has left its imprint on the genes of generations of Black Americans. For example, a study published in 1996 in The New England Journal of Medicine found Southern-born Black men and women both died from cardiovascular disease at a rate substantially higher than that of their counterparts born in the Northeast or in the Caribbean. “The observed differences in mortality from cardiovascular disease according to birthplace may be due to genetic or environmental influences” or both, the authors said. A study published in the journal Stroke in 2018 used county-level census data to compare stroke statistics between people of different races and birthplaces. It concluded that “a history of slavery may be a previously unacknowledged driver of current-day stroke mortality, particularly in blacks, and provide insights into the causes of presentday racial disparities seen in the Southeastern United States.” Stroke victim stunned One of McBurney’s patients is Julius Hudson, a 54-year-old Black resident of Green-

ville who is recovering from three strokes he suffered in late February and early March. He has a full-time corporate job and runs his own private security business on the side. He is long married with three adult children. When Hudson got into competitive bodybuilding at 19, he adopted a low-fat, high-protein diet that he has stayed with since. He thought his strict diet and workout regimen would keep him healthy. “My mind still can’t understand how this happened,” Hudson says. “One minute you

of a comprehensive stroke center, I look at where the problem is and it seems obvious that the biggest problem confronting the stroke care community is just the excess of stroke among African Americans,” he says. McBurney was in the middle of his career in 2012 when, he says, he “became increasingly convinced that as a neurologist, I was seeing disease too late, too far downstream.” He decided to do an integrative neurology fellowship at the University of Arizona. “This sparked a period of intense intellec-

Julius Hudson, left, is a patient in the Bon Secours St. Francis Stroke Program directed by Dr. John McBurney, right. Despite a rigidly healthy lifestyle, Hudson suffered a series of strokes in early 2021. McBurney is working with organizations to promote vigorous exercise in children and adolescents, establishing patterns that could reduce stroke risks later in life.

walk around thinking you’re Superman. The next minute you can barely lift a bottle of water. It comes out of nowhere.” By July, Hudson says he felt like “I’m probably a good 60% back, maybe a little bit higher.” Hudson’s care through the Bon Secours St. Francis Stroke Program has included medication to treat a constricted carotid artery in the back of his head that has restricted oxygen and blood flow to his brain and physical therapy to address the muscle weakness, particularly on his left side, from the strokes. McBurney points out that Hudson’s lifestyle does not include any of the known risk factors for cardiovascular disease or stroke, such as smoking and lack of exercise. “Julius lives an exemplary life,” McBurney says. “He certainly strives to be the best person he can be and he is inspirational in so many ways. And yet, here he is, in his early 50s, and he’s had a series of strokes.”

Looking upstream Patients such as Hudson inspire McBurney to find ways to address the underlying problems that are at the root of stroke’s unequal toll. “To me, as a medical director

tual growth,” he says. “I learned about diets, the effects of stress, the role of herbal medicine, and epigenetics, among many other topics.” In 2018, he came to Bon Secours St. Francis as medical director of its comprehensive stroke center. He stays up on studies and literature on stroke disparities. One of the texts that has been key in developing his interest is Health Disparities in the United States: Social Class, Race, Ethnicity, and the Social Determinants of Health by Dr. Donald A. Barr, a professor in the Stanford University School of Medicine. That book examines the limitations of medical care in addressing race-based disparities in health outcomes and it makes the case for the importance to overall health of social determinants of health including safe housing and economy security, McBurney says. “What we’re seeing, I think, is that access to care is only a part of this,” he says. “We fool ourselves when we focus exclusively on that and not the social determinants of health.”

Integrative approach McBurney’s observations so far in his studies of stroke patients at Bon Secours St.

Francis mirror what earlier and wider studies have shown about their harsher impact on people of color. For example, statistically, African-American patients in his program typically present with stroke 10 years younger than whites despite not being more obese or having more incidences of diabetes. In 2020, McBurney co-edited a textbook called Integrative Neurology that presents evidence-based integrative approaches to the prevention and treatment of neurological disease. McBurney advocates an integrative care strategy that takes account of the body, mind and spirit of patients as well as all aspects of their lifestyles. It relies on evidence-based therapies, both conventional and alternative, including medication, diet, exercise and acupuncture. In addition to providing integrative care to the patients in his program, McBurney is working with organizations on early intervention strategies. “We’re talking about problems that begin in childhood and then progress in adolescence and become symptomatic in young adulthood,” McBurney says. “So, whatever we do, we have to target programs and support that benefit children and adolescents.”

Lifestyle interventions The COVID-19 pandemic has slowed progress on some of his collaborations. One that he hopes to begin soon is with Momentum Bike Clubs, which works with youths aged 10 to 18 to promote vigorous exercise and healthy peer and mentor relationships. Another of his plans is to help bring the Hip Hop Stroke program to schools and churches in and around Greenville. The interactive program uses hip-hop music to teach fourth- through sixth-grade children about stroke including how to recognize symptoms and what to do. McBurney says he takes pride in the efforts his system, which is part of Bon Secours Mercy Health, is undertaking to address social issues that contribute to health. One of those efforts is to partner with the nonprofit Piedmont Health Foundation to improve nutrition programs in Greenville schools. Another is a program called Well Walkers in which the community is invited to make use of an indoor walking track and earn rewards such as T-shirts for meeting their distance goals. McBurney says he has hope that continued study and early interventions can change the trajectory for Black Americans when it comes to stroke prevention and outcomes. “I believe that we can make substantial inroads, but I think that what we have to really get down to is understanding the root causes,” he says. leisenhauer@chausa.org

November 15, 2021 CATHOLIC HEALTH WORLD

Disaster preparedness From page 1

planners for the hospital and its related facilities, credited to a combination of long-term planning and incident-specific flexibility. Emergency managers at some other Catholic health systems that have faced emergencies amid the lingering crisis of the pandemic say similar strategizing and agility have seen their systems safely through.

Decisions pay off Mosely can cite several examples of decisions that enabled Our Lady of the Lake to stay open and minimize COVID-related risks during Ida: As the storm hit, Our Lady of the Lake switched to the generator system Mosely fueled by natural gas it had invested in after an outage caused by Hurricane Gustav put the medical center on the brink of calamity in 2008. If not for the generators, the medical center would have lost power like much of Baton Rouge. The roofs of many of Our Lady of the Lake’s structures had been upgraded and storm-hardened in the last five years as part of a $4 million upgrade program. Only one structure, a medical office building, lost its roof membrane during Ida. Temporary sleeping areas for staff were spread out across more spaces in the hospital and with smaller groups in each to allow social distancing during the pandemic. As an added safeguard, Mosely bought about 100 one-person pop-up tents so staffers in the largest groups would have some personal space. With gas stations closed because of ongoing power outages, Mosely arranged to have gasoline brought in by tankers. The hospital distributed free fuel to staff for about four days. Like all other accredited hospitals, Our Lady of the Lake is subject to the Joint Commission’s requirements to activate or simulate the activation of an incident command to handle a disaster at least twice a year. In Mosely’s six-year tenure as the medical center’s vice president of construction and facilities, mock disaster drills have been unnecessary. “Since I’ve been in Louisiana, we haven’t had to do a simulated event because we’ve had more than two real ones a year,” he says. (In October, Mosely became system vice president for construction for Franciscan Missionaries of Our Lady Health System, Our Lady of the Lake’s parent system.) Prepping and stockpiling Jake Parmentier, emergency manager for Chesterfield, Missouri-based Mercy, says pandemic-related infection precau-

A worker at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, pushes his car after running out of gas while waiting in line for a free fillup. The hospital brought in the gasoline tanker in late August to help its workers after Hurricane Ida caused power outages that forced gas stations to close.

tions have prompted Mercy to take some of the drama out of emergency disaster drills conducted at its hospitals. There have been no mock victims from schools or community agencies it partners with in emergency planning.

A sign posted on a door at Mercy Hospital St. Louis alerts staff and visitors that a disaster drill is underway.

A crew with McKenzie Fire & Rescue Fire District gathers at the scene of a wildfire that came within a few miles of PeaceHealth Sacred Heart Medical Center at RiverBend in Springfield, Oregon, in September 2020. Charene Dehne, a nurse manager at PeaceHealth’s hospital in nearby Eugene, Oregon, captured this image. Dehne volunteers with the crew as an emergency medical technician.

Parmentier says one of the disaster scenarios that figures prominently into Mercy’s emergency planning is tornadoes, a high risk for the Midwestern system. Mercy continues to follow prac- Parmentier tices adopted after an F-5 twister made a direct hit on its hospital in Joplin, Missouri, in 2011. One is to keep a stash of “go bags” with the basics including water bottles, a flashlight and pens so co-workers could document things including care interventions or where they moved a patient to get them out of harm’s way. The Joplin tornado also made clear the need for backup communications capabilities. That prompted Mercy to partner with the Missouri Hospital Association to build a mobile emergency communications facility that can establish Internet, phone and two-way radio access in a disaster. “Essentially, we’re able to stand up an entire communications department inside of a trailer,” Parmentier says. Mercy is in the process of adding a second mobile facility that could be dispatched to a disaster area anywhere in the system’s catchment area, which, in addition to Missouri, includes the tornado alley states of Arkansas, Oklahoma and Kansas. In February, Mercy put its emergency processes in place when a fire forced the brief closure of its hospital in Cassville, Missouri. Parmentier says the system’s longterm preparation and training clicked and it adhered to pandemic modifications: All patients and staff safely evacuated from the hospital, and transporters and admitters followed COVID protocols as patients’ care was shifted to a nearby Mercy hospital and no subsequent safety issues arose. “You never want to have to exercise your emergency preparedness plans in true fashion, but when you do it’s nice to be able to see that they work, that all of your training and education didn’t go to waste and you’re actually able to complete the task at hand,” he says.

Northwest heats up Grant Finch, emergency management coordinator for the PeaceHealth Oregon network, says the effectiveness and Finch flexibility of his system’s disaster protocols have been put to the test on several occasions during the pandemic. In late summer 2020, PeaceHealth went into emergency operations mode as wild-

fires spread close enough that dense smoke could be seen from some facilities. At the time, the region’s acute care resources were maxed out by COVID. “We were already full at the hospitals as a state,” Finch recalls. He and other PeaceHealth emergency planners stayed in close contact with fire chiefs and emergency management officials and identified potential backup care sites. In the end, the fires never got so close that PeaceHealth had to close facilities or evacuate patients. The system assisted with housing for some of its care providers whose homes were either destroyed or threatened by the fires. This summer, when temperatures in the temperate Northwest reached all-time record highs, PeaceHealth prepared to activate its plan in the event excessive heat spiked demand so much that it knocked out power to those in hospice or home care settings. The plan includes working with emergency response partners to provide generators and transport patients to alternative care sites. “A lot of our patients on that service line are dependent on power, they have medical equipment, they need oxygen, but they are in their homes,” Finch says. The heat wave, while causing misery for many, didn’t spiral to the level that it required PeaceHealth to go into disaster response mode, Finch says.

Emerging threats He and disaster planners at the other systems say because of the heightened threats posed by global warming, weather emergencies like heat waves, fires and tornadoes are figuring more and more prominently into emergency planning. And they are not the only emerging threats. With modern health care highly dependent on technology, cyber failures and ransomware attacks also have moved to the top of the sector’s list of vulnerabilities. Another threat that has rocketed to the top is pandemics, spurred by COVID’s unexpected emergence and tragic toll. The evolving risks compound the challenges for disaster planners. “When you start stacking incidents and stacking emergencies on top of one another, they do start to interfere with one another and it becomes a more complicated situation,” Finch says. “You do have to be flexible in your planning and in your response because what you thought might happen and the way you thought you might get out of it isn’t going to work.” leisenhauer@chausa.org

CATHOLIC HEALTH WORLD November 15, 2021

Digital innovation

are such high stakes. So, the concept with Graphite is that we all can work as a collective to figure this out together.

health care, because we are deeply committed to engaging in digital innovation in a way that benefits the common good. If organizations are just in digital innovation for themselves and by themselves, they’re probably spending too much or going too slow. Graphite will need collective scale to make this approach work. If we are going to do digital innovation, we need to do it as a collective. And this will enable local providers to engage in national-scale cuttingedge innovation.

How will Graphite protect patient data? We know that to accomplish what we want to accomplish with Graphite, numerous organizations and people will have to work together. The health care data these organizations work with requires a high degree of privacy — a rock-solid foundation of trust. Graphite is not in the data selling business. Instead, it’s in the business of enabling health care data to work towards a more virtuous innovation cycle, whereby when you solve one problem, it allows solving another problem even quicker and more sustainably. Too much innovation in health care still happens in silos because the data is siloed. Our digital Hippocratic oath is about enabling scalable innovation with data, while still doing no harm to the patient. Especially as more organizations become involved with Graphite, it will be essential that we all agree to that oath because this all must be done in an environment of trust and with the patients’ best interest as the top priority. The value of this common platform is not about making money off of data assets. Patients are not products. They’re our beloved community and family members.

From page 1

Which types of technologies will Graphite enable first? Graphite is an interoperable data platform that can be used to create a marketplace made up of numerous outside applications. I’m not able to say exactly which applications we’d start with, but I can say we do not plan to start at the highest end of clinical complexity. When we have enough functionality, we will then continue to build out applications with aligned partners that have higher and higher direct clinical impact. Who at the member health systems will be doing the work? Graphite is an operating company. It’s a business with a management team and dedicated staff. Additionally, because it’s a member-generated business, we members can tap into a variety of teams in our organizations and use the collective wisdom of our systems in real time. The gap between the people building out the platform and the end users at the member organizations that will be using the platform actually will be quite small — the end users will be on the teams that are helping develop this. We’ll have a structure to engage departments such as IT and finance and the clinical areas. We will have a substantial operating core. What are the main problems that Graphite hopes to address? Speed to adoption of innovation is a problem. Health care is extremely complicated — with regulatory, financial, technological and data privacy complexities, to name a few. When we do something new, there are a lot of nuances in how we connect new technologies into the existing platform. For instance, if two organizations work together and try to connect, even if they both have an electronic medical record system from the same vendor, those systems may be used in different ways. So, there may be local differences, differences by clinical application. It is not uncommon to take 12, 18 or even 24 months to implement a new technology. It’s a steep hill to climb. Another key problem Graphite will be solving is that health care organizations and the vendors that work with them need a common digital language to conduct business. We want that language to be ubiquitously available so developers can create and scale technologies and create value with them. What is the main differentiator that will make Graphite’s efforts more successful than past efforts in this area? The main differentiator is that Graphite is a health care utility; it is a nonprofit entity. Since it is a collective, no one organization owns it. The members’ goal is to accomplish a common good. And as Graphite gets larger, it’s not just going to reduce costs and spread that benefit among members, it can also reduce the price of health care for patients. That is because no one owns this, so no one is trying to pull margin off of the business. We’re trying to streamline everything.

The Graphite marketplace will establish a single location for innovators to distribute digital tools to health systems across the country.

How will Graphite avoid the pitfalls in pursuit of interoperability? It’s the complexity of health care that is a main barrier when developing new solutions. In many sectors of the economy, innovation happens in an iterative way. It is hard to do something iteratively when there is the possibility of patient death or other harm. It takes a long time to get the right safeguards in place and make sure the data is secure. And so, the cost to switch tech-

nologies is so high. Innovation is timeand cost-prohibitive in health care, much more so than it is in other industries. Also, there is a lot of expertise needed when implementing new technologies in health care. External groups that try to come in to innovate underestimate the time and complexity and the important nuances of innovating. We need disruptive innovations in health care, but innovating is complicated when it comes to human health. There

jminda@chausa.org

November 15, 2021 CATHOLIC HEALTH WORLD

Health equity for Pacific Islanders From page 1

problem to this day for those living on the archipelago and those who moved to the U.S. Although the Compact of Free Association gives the Marshallese and other Pacific Islanders the right to live and work in the U.S. without a green card, legislation enacted 25 years ago ended the islanders’ Medicare and Medicaid eligibility. Malissa Sprenger, vice president of mission integration for MercyOne Eastern Iowa Region, said most of the Marshallese don’t earn enough to afford health care for themselves or their families. Additionally, they contend with language barriers, cultural differences and low health care literacy when they seek medical attention. Sprenger said Marshallese people have higher than average risks for cancer, hypertension, tuberculosis, diabetes and leprosy. Many of the estimated 800 Marshallese living in Dubuque were born in the islands and brought to the U.S. as young children. Experts say some of their serious health conditions result directly from radiation exposure or indirectly from a change in dietary preferences when, having poisoned the fishing atolls and farmland, the U.S. provided high-fat, high-calorie foods that supplanted a plant- and fish-based diet. The U.S. government sent surplus cheese and butter, Spam and canned corned beef, foods that are high in fat, said Neil MacNaughton, a professor of nursing at the University of Dubuque. MacNaughton “They became reliant on those foods, instead of their traditional diet, which was pretty darn healthy.” The convenience of processed foods won out, and that led to higher rates of obesity, diabetes and heart disease.

Right neighborly Kay Takes is president of the Eastern Iowa Region of MercyOne, including Takes MercyOne in Dubuque. She said that because the islanders have regularly used services such as obstetrics and the emergency room, the hospital’s diversity, equity and inclusion committee focused on how to do a better job of reaching out to them on a variety of health and

MercyOne Dubuque Medical Center took delivery of a mobile medical unit last month that will provide outreach care to Marshallese and other community members. Prior to a blessing ceremony, Kay Takes, president of the MercyOne Eastern Iowa Region, talks about the Winnebego’s customized exam rooms and furnishings with Pastor Stan Samson, a pillar of the Marshallese community.

wellness issues. Working with the University of Dubuque in 2014, the hospital invited MacNaughton, who had experience caring for Marshallese and other Pacific Island nationals, to conduct nursing grand rounds to increase the cultural knowledge of caregivers. It was an eye-opening session and one that spurred MercyOne Dubuque to bring stakeholders including Marshallese community leaders into the conversation about their needs, Takes said. “That was really the trigger for all the work that’s been done through the years, culminating today in a wonderful communitywide coalition,” Takes said. “The Marshallese folks are at the table, very actively engaged in how we can improve not just their health care situation but the life of the Marshallese people overall. We knew from the beginning that in order to be successful, they had to be active members of the team. We couldn’t impose on them. It came down to engaging them in the process, and that wasn’t as easy as you might think. It took the better part of a year to understand how to connect, share our vision and lay the foundation for a trusting relationship.” The coalition expanded to include community health center representatives, women religious, school system leaders, public health and city officials, local legislators and others. Takes said the coalition has influenced state and national legislation. The community coalition gave rise to the Pacific Islander Health Project. Centered at Crescent Community Health Center, it

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employs a community health worker, nurse and social worker to bridge the gap between health and human services access for Pacific Islanders. Staff salaries are funded in part by community benefit dollars from MercyOne Dubuque. The team coaches clients in lowering their body mass index, and, for clients living with diabetes, their A1c scores. A survey conducted at a community event helped identify other unmet needs, not only in terms of health but navigating across cultures and dealing with government red tape.

Why they came MacNaughton said several Marshallese nationals originally came to the city’s theological seminary and found the community to be welcoming and friendly. Others followed. Maitha Jolet immigrated in 1997, after visiting a sister who had arrived a few years earlier to attend a Bible study college in Dubuque. Jolet, now 62, said the attraction to live in the United States was clear: “a better living for my family.” “It was really hard for the Marshallese people to access medical help,” Jolet said. “Right now, I think we are doing much better. At least we have something,” she said of the Pacific Islander Health Project. Late last year as part of a COVID-19 relief bill, Congress restored Medicaid eligibility for Marshallese and other Pacific Islanders living in the U.S. “It’s a wonderful new development,” Sprenger said, adding that a large percentage of the Pacific Islanders in Dubuque have gotten their Medicaid benefit restored.

Adapting to cultural differences In dealing with the islanders’ legacy of health problems, leaders of the Pacific Islander Health Project had to learn to communicate in a culturally aware way, and they had to build trust. “Micronesians are very communal in what they do,” MacNaughton said. “Everything is done together. They like to be together, to learn together, to participate in things together. And they have a different response to authority. Anyone who is seen as in position of authority, they will acquiesce to. For many of them, that would be health care workers, teachers, and so on — those folks they would just agree with. “They may say yes when they really mean no, when it comes to scheduling appointments, for example,” MacNaughton said. “You ask, is it OK, can you come to this appointment at 3 o’clock on the 25th, and they say yes” but they may not be available at that time, or they may not have transportation to get to the appointment. “You have to help them understand they don’t have to say yes right away. That got better because they now understand they have the ability to let us know when they can’t make those meetings, and that kind of thing,” MacNaughton said. Rough waters Early on, the community health center began providing public health information translated into Marshallese, including educational videos and regular announcements on how to cope with the pandemic. But the Marshallese were nevertheless disproportionately affected by COVID-19, Takes said. “The way they live together in large households and in community with one another obviously played a role in the spread of COVID-19, especially in the very early days of the pandemic, when we had less knowledge and fewer tools to care for people with the virus.” The Pacific Islander Health Project has found traction. Takes and MacNaughton point to a 38% decline in ER visits since 2016, and a 60% drop in missed medical appointments. Now, MacNaughton said, the project is beginning to transition to a new phase, concentrating more on social determinants of health, including addressing food and housing insecurity. Jolet thinks American help is owed to the islanders. He puts it this way: “We want the United States to recognize what they have done to us, back in 1967. We suffered from the bomb, and a lot of people are dying. They should do whatever is necessary to pay the people of the Marshall Islands.”

KEEPING UP PRESIDENTS AND CEOS Janice G. Murphy to president and chief executive of the Sisters of Charity Health System of Cleveland effective Jan. 1. She was president and chief executive of St. Vincent Charity Medical Center, part of that health system. She will replace Thomas J. Strauss, who will step down effective Dec. 31. Succeeding Murphy as president of St. Vincent Charity Medical Center effective Jan. 1 is Dr. Adnan Tahir. He now is senior vice president/chief clinical and administrative officer for the hospital. CommonSpirit Health facilities have made these changes: Dr. Gary Kaplan will end his time as chief executive of Virginia Mason Franciscan Health. Since that health system’s January formation, Kaplan has worked alongside Ketul J. Patel as co-chief executives. Effective Jan. 1, Patel will be sole chief executive. For one year, Kaplan will remain as a special adviser to Patel and a senior vice president at CommonSpirit Health. Virginia Mason Franciscan was formed through the combination of Virginia Mason Health System and

CHI Franciscan Health. Chad Melton to president of Virginia Mason’s St. Michael Medical Center in Silverdale, Washington, effective Sept. 13. He was chief executive of Fauquier Health System/ LifePoint Health in Warrenton, Virginia. Jennifer Schomburg to president of Virginia Mason’s St. Joseph Medical Center in Tacoma, Washington, effective Sept. 7. She was system chief executive of Northwest Medical Center and Oro Valley Hospital in Tucson, Arizona. Linda Hunt plans to retire as president and chief executive of Dignity Health’s Southwest Division, effective in January. Bruce Peters plans to retire as president and chief executive of Dignity Health Mercy Hospitals Bakersfield, effective in January. He heads two Bakersfield campuses, Mercy Hospital Downtown and Mercy Hospital Southwest. Aristides “Ardy” Pallin to president and chief executive of Catholic Health Services of Lauderdale Lakes, Florida. He was chief operating officer. He replaces Joe Catania, who retired.

CATHOLIC HEALTH WORLD November 15 2021

Providence cooks concoct inventive potlucks for Anchorage shelters By PATRICIA CORRIGAN

Home cooks routinely pair ingredients that seem random to create new, nutritious dishes for their families. At Providence Alaska Medical Center in Anchorage cooks have done the same thing for over 35 years in order to feed individuals at two local shelters. “I love this program because through it, we are really living up to the mission of the Sisters of Providence, and it keeps us connected to the community,” said Amanda Barlow. A registered dietetic technician, she is production supervisor at the 401-bed hospital. Mother Emilie Gamelin, the French-Canadian social worker who founded the order, fed the hungry and the Sisters of Providence continued the practice in 1902 when they started the first hospital in Nome and provided social services during the Gold Rush. Today, the medical center dishes up 800 meals a day for patients and plates another 700–1,000 meals in its cafeteria. At the end of each day, unsold food items and extra ingredients from the cafeteria are set aside. Combined with fresh ingredients the next afternoon, the food is made into meals that are packaged and delivered to the shelters at a cost to the hospital of about $1.44 per meal. The hospital provides dinner seven days a week to Brother Francis Shelter and dinner once a month to Clare House. Both programs are run by Catholic Social Services. “The Sisters of Providence started by sharing soup, and we most often make that too,” Barlow said, “though sometimes the cooks come up with chili, red beans and rice, chicken gumbo or casseroles, such as macaroni and cheese Florentine.” Fifteen cooks are employed at the medical center, and the job of crafting the meals for the shelters rotates among five of them. “Last year, we had a primary cook, but now five

frozen meatballs and chicken. The cook preparing the meals for the shelter arrives at 11:30 a.m. and works plating patient trays until 1:30 p.m. Then it’s time to survey what’s available, put together the 60 to 80 meals that will be donated and package them for the delivery service. “The cooks enjoy being creative and they take pride in knowing they are making a difference by feeding someone a nutritious meal,” Barlow said.

Hearty helpings Brother Francis Shelter serves homeless women and men, refugees and individuals who are food insecure. The shelter provides overnight baggage storage, dinner, showers, laundry, basic medical care, medicine storage and a clothing room, plus programming and activities. COVID-19 has changed how much the emergency shelter can provide, said David Rittenberg, program manager. “This past year, we’ve served 450 individuals. In the past, that number would be closer to 2,500, but social distancing has reduced it.” The shelter went from 240 beds to just 72, concentrating on homeless seniors, elders and people with mobility issues. “The municipality has opened a 400-bed shelter in a hockey arena,” Rittenberg said, “and that changed everything significantly. There, you have to be able to go up and down stairs, so we stepped in to serve people who can’t.“

Cooks at Providence Alaska Medical Center use surplus food to whip up nutritious meals for clients of two Anchorage homeless shelters operated by Catholic Social Services. Recent menus have included the hearty chicken noodle soup below and the beef stir fry at right. Amanda Barlow, a registered dietician and production supervisor at the hospital, shows off her beef stir fry over rice.

individuals take turns, which gives them an opportunity to be creative.”

Name that dish Barlow’s instructions are brief. “Make what you want,” she tells the cooks, “and you get to name the dish, too.” Creations have included Three Bean Meatloaf Soup, Sausage and Spinach Pasta and Creamy Potato Steak Soup. Available ingredients might include cafeteria leftovers from the three madefrom-scratch entrees prepared each day plus side dishes such as rice, noodles or quinoa. The cafeteria production cook also makes a soup and a bean dish each day. Plus, fresh or frozen vegetables are available, as are cheese,

The meals Providence donates are much appreciated. “The food comes every day, like clockwork, and it’s a godsend for our program and our guests,” Rittenberg said. “The meals are so valuable to us, and they are essential to help us carry out our mission to meet basic needs.” Rittenberg described the dinners from the medical center as “hot, nutritious and filling.” Most often, he said, the meal is a hearty soup or stew served over rice, potatoes or spaghetti. At Thanksgiving, Providence sends over roasted turkeys with side dishes. At Christmas, ham or turkey may be on the menu. “Providence also supports our programs in lots of other ways, including donating money and providing volunteers,” he said. “They are great partners in this community.” The first Tuesday of each month, the medical center sends meals for 60 people to Clare House, a shelter for homeless women and children. During fiscal year 2020, the shelter hosted 229 women and children. Providence is part of Clare House’s “Meal Team,” local agencies that provide dinners for guests 365 days a year. “They also send us bread, fruit, cold cuts, cheese and juice once a week,” said Sharese Hughes, program director. “They’ve been helping us a long time.” Barlow, the production supervisor, has worked at Providence just two years, after moving from Las Vegas, where she worked in another Catholic hospital. “I found out about the meal donation program when I interviewed for the position here, and I was excited about it right away,” she said. “I’ve always been somebody who wanted to help.”

Military medical personnel answer Providence hospital’s call for help By LISA EISENHAUER

Reinforcements from the military arrived in mid-October to bolster the medical staff at Providence Sacred Heart Medical Center in Spokane, Washington. The contingent of 20 doctors, nurses and respiratory therapists was sent by the Department of Defense after the medical center requested assistance from the Washington State Department of Health in August, when the number of COVID-19 patients threatened to overwhelm the hospital’s resources. Dr. Daniel Getz, chief medical officer, said Sacred Heart had a surge in COVID patients and saw no end in sight. Despite the relentless stress on the staff, Getz said, clinicians’ dedication has not faltered. “I think when you walk through our halls the compassion is evident,” he said. “The way that our health care providers care for patients has been inspiring, to say the least.” With staff exhausted and the continuing influx of patients requiring high-acuity care for traumas, strokes and heart attacks, the hospital asked for backup. When the military team took up their posts in several hospital units on Oct. 17 the surge of COVID patients was easing. Getz said the military medical staff was nonetheless needed and appreciated. He said the medical center’s clinical staff has been working extra shifts and long hours since the beginning of the pandemic. The military team’s assistance means the hospital’s clinicians are getting “a chance to inhale a little bit and to get a little bit of a reprieve,” he said in late October. Sacred Heart is part of the Providence St. Joseph Health system. It was the 11th health care site in the nation to get pandemic assis-

A staffer with Providence Caregiver Health Services fits one of the military clinicians assisting at Providence Sacred Heart Medical Center for a respirator mask. A team of 20 military clinicians deployed to the Spokane, Washington, hospital in mid-October to help treat patients hospitalized for COVID-19.

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tance from military clinicians. The list of host hospitals includes Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, where a 20-member medical team arrived in August. Getz said that elective surgeries remained on hold at Sacred Heart in late October. But with the military clinicians’ assistance, the hospital was making headway on a backlog of “compelling procedures” that had been postponed. “While we’re nowhere near back to normal operations, the additional help from the Department of Defense team helps us get through that list of patients that we really need to serve much more quickly,” he said. The team is scheduled to remain at Sacred Heart for a month. However, Getz said the hospital would request an extension of their stay.