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COURAGE We are stronger together REPORT TO OUR COMMUNITY

Stronger. Together. Board of Trustees David Cohen Beach Fleischman PC Gayle Dean, M.D. Chief-of-Staff Donal Drayne TMC Foundation Board of Trustees Chair Westin La Paloma (retired) Stephen G. Eggen Compensation Committee Chair Finance Committee Chair Raytheon Co. (retired) Louise L. Francesconi Board of Trustees Chair Executive Committee & Governance Chair Raytheon Co. (retired) Jay A. Katz M.D. Tucson Orthopaedic Institute (retired) Adaline Klemmedson University Medical Center (retired) Judy Rich R.N. President and CEO TMC HealthCare Alan K. Rogers M.D. Arizona Community Physicians Ira H. Rosenberg Managed Care Resources Inc. Beckie Torrey Audit & Compliance Committee Chair Raytheon Co.(retired) Gay Tosch Board Quality & Care Committee Chair General Motors Co. (retired) Michelle Williams M.D. Chief of Staff-Elect Envision Physician Services Jon R. Young Board of Trustees Vice Chair Investment Subcommittee Chair Holdings & GLPIC Chair Oracle Capital Advisors LLC (retired)

It has been a year we will never forget. We have seen heroic actions inside our hospital and throughout our health care system. Words can never do justice to the things we witnessed this year: from the nurses and doctors who fought to help patients find their breath as COVID consumed their lungs or shut down their bodies to all the staff who consoled families of those who died because this indiscriminate disease took away so many, so quickly. We saw heroics and despair. Sometimes on the same shift. But what also moved us was the touching response from our community. Practically every day during the pandemic we could feel the support from Tucson. We felt it when the first responders organized a truck procession around our hospital to salute our employees. We were inspired by sidewalk chalk messages around the hospital showing support for our tireless front-line staff. And we were grateful for the countless meals that appreciative neighbors brought to our emergency department to help lift our spirits. We saw the best of Tucson when it felt like we were at the worst. This year’s Report to Our Community is a look back at 2020 and how our health care system – and our community – worked together to battle the pandemic. Our front and back covers are a symbolic visual of how we came together to be stronger. On the front cover is a representation of our hospital staff – all in different scrub colors – under the word “courage.” On the back cover, we honored our partners in the community who worked shoulder to shoulder with us. Inside, you will read more about what we did in 2020. Among the highlights: • • •

Innovation. When we had an opportunity to partner with the state and county to begin administering the COVID vaccine, we sprang to action and created a drive-through vaccine clinic in a matter of days. There, we provided more than 1,000 vaccines a day to our residents. Growth. Our health care system continued to grow in 2020 with the announcement of a new hospital on Tucson’s southeast side and the expansion of our primary care provider network, TMCOne, to the Catalina Foothills. Photos behind the scenes. You’ll get a glimpse of some of the photos our staff took over the last year – and even though they may be masked, you’ll still be able to feel those smiles behind the masks.

One theme you’ll notice throughout our annual report is that all these stories are about community. You may have recently seen our new slogan “Together. Stronger” on billboards and on television – that’s never been truer than this year. It’s something we will never forget.

Judy Rich, R.N.

President and Chief Executive Officer

Louise Francesconi

TMC HealthCare Chairwoman

From Chief Development Officer Jeffrey Lamie When I look back on this past year, I am reminded of advice Fred Rogers received from his mother about what to do when faced with disaster. “Look for the helpers. You will always find people who are helping.” In 2020, it wasn’t hard to spot those helping. It was comforting to know so many people were there for others when it was needed most. As COVID-19 spread and surged in Southern Arizona, helpers showed up in the form of health care workers tirelessly treating patients, high school students raising money for the hospital, local businesses working together to feed the front line, and individuals sending cards and notes of gratitude. COVID-19 forced the world to adapt to a new way of life – “from the way we visit loved ones to the way we shop to the way we help others.” Our hospital learned to adapt, too. We learned new ways to treat patients and new ways to reach out for help – the community (our helpers) still showed up for us. Rather than our traditional fundraising gala, we hosted a virtual talk show event. People from Southern Arizona and beyond joined us online and helped us exceed the fundraising goal. Our annual Radiothon was held virtually as well, and again, the community tuned in to show support. Gifts, large and small, from individuals, local businesses and corporations kept us going strong and helped us get through the darkest times. This spirit of helping each other and lifting each other up is what makes Tucson such an extraordinary place. As Tucson’s only community hospital, your support is paramount to what we do, and you have shown us time and again that you are here to help. I want to thank you for being the helpers for our hospital and thank you for looking to us when you need help. With our community behind us, we can accomplish anything. We truly are stronger together.

From Chief of Staff Dr. Clifford Martin Dr. Martin was the TMC Chief of Staff from 2018-2020

My last year as Chief of Staff for Tucson Medical Center was one that I can never forget. They say that hindsight is 20/20, which has never been more true! 2020 tested us beyond any conceivable prior expectation. For all of the healthcare workers at TMC - from physicians to housekeepers, nursing staff to office staff - there was not a single person affiliated with TMC who was not tested by the COVID-19 pandemic, asked to go beyond the call of duty. We learned to tap into our personal reserves of willpower and compassion while caring for our patients and our community, as well as caring for ourselves and our own personal loved ones. It was a hard year. Our patients and their loved ones faced equally difficult challenges. There was hardly a day when I did not shed a tear as I attended to patients who felt alone and scared. And yet the vast majority of you, in your time of sickness and vulnerability, were so grateful and forgiving. It gave me strength to be encouraged by you - patients, family and friends, community members and businesses. We wouldn’t have made it through without you. Willpower can be grown, just like a muscle, but it has its limits. As healthcare professionals, we are now beginning to deal with the realities of burnout, PTSD, compassion fatigue, and even exhaustion as we start to recover. I believe recovery has begun, but it is a process. As we move through recovery, I see a future of hope. We learned a lot from this experience. Vaccine science has grown exponentially. We learned our strengths and weaknesses as a healthcare system. We learned that compassion and resilience are stronger than a pandemic. We learned the importance of self care, of work-life balance, and of gratitude. At Tucson Medical Center, we truly were and are part of a larger family. Like every family, we have our similarities and our differences. We come from many different backgrounds, religions, ethnicities, political ideologies. But what binds us together now is a commitment to reinventing ourselves, TMC, and our community in a way that makes us stronger and better prepared for the future. I am thankful to be practicing medicine in Tucson right now and am thankful to be a part of this community. I am truly thankful for you all. 2

Labor of love Adversity doesn’t shape who we are, it reveals who we are. Not even a pandemic could stop the labor of love in our maternity services units. Babies continued to be welcomed into the TMC family even as a virus shut down the rest of world. From the long shadow of COVID-19, hope was born again every day in units. We helped women give birth 5,364 times, including 90 sets of twins. Despite the necessary visitation restrictions, our staff found new ways to connect new moms and their babies with their families. Our staff reached beyond the role of medical professional and into the role of primary support and tech wizard. More than a few babies made their screen debut via iPad while celebrating big milestones in the NICU, so that parents and families could be there with them. We maintained one of the lowest primary Cesarean-section rates in the nation, where just 15% of first-time moms had a c-section. 103 women successfully gave birth via vaginal birth after cesarean. As in-person childbirth classes across the globe shut down, our childbirth educators stepped up and offered live Zoom classes and support groups for expectant parents, and parents navigating breastfeeding and postpartum depression. While not a substitute for in-person childbirth education, our childbirth class videos and pregnancy and parenting videos were watched and appreciated around 2.5 million times by expectant parents and new parents. 3

5,364 DELIVERIES

90 SETS OF TWINS

15% PRIMARY C-SECTION RATE

103 VAGINAL BIRTHS AFTER C-SECTION

Improving the health of children improves the future for all of us Our Children’s Miracle Network corporate partners recognize this, too. Even during the height of the COVID-19 pandemic, Ace Hardware, Costco, Panda Express, Walmart, local credit unions and many other area businesses raised close to $1 million in support of pediatric services at TMC for Children, Southern Arizona’s only Children’s Miracle Network hospital. Our annual Mix Miracles Radiothon went virtual for the very first time due to COVID-19. Professionals from throughout the hospital, including doctors, nurses, human resources staff and others came together to answer phones as community members and corporate sponsors across Southern Arizona helped to raise more than $136,000 for CMN. Bittersweet beginnings These funds support children like Josue, who was born at 24 weeks after his mother, Frances, had a fall. He spent 86 days in the Newborn Intensive Care Unit and underwent laser surgery on his eyes as well as surgery on his tiny heart. Josue had a twin sister, but after about a week fighting for her life, their mother had to make the decision to take her off the ventilator and say goodbye. The NICU staff made sure Frances was able to hold her baby without any tubes or wires before she took her last breath. “Having a baby is supposed to be the best time in your life, but there was so much heartache,”

Frances said. “But, the doctors and nurses were really good in the NICU. They always talked to me and told me what they were going to do and how the babies were doing, and they always listened to what I had to say.” Part of the family now Through it all, and through the years that have followed, TMC has been this family’s hospital of choice. “I only take my kids to TMC,” Frances said. “They were born there and we go there for everything. We were recently there because one of my kids just broke his arm driving a go-cart. We have always gotten really good service there.” Some of the nurses have even become part of their family. “We still talk to Josue’s head nurse,” Frances said. “She was the No. 1 person here for us. She would know if we were freaking out, and she would calm us down. … When we got out of the hospital, we would go back to see her. She even came to Josue’s confirmation.” Providing comfort, treatment and hope Gifts from CMN campaigns have made this level of care possible by funding education for staff, purchasing leading-edge technology and supporting programs such as Child Life. Sixty-two children enter a Children’s Miracle Network hospital for treatment every minute. Whether they suffer from common childhood afflictions like asthma and broken bones, or fight bigger challenges like birth defects, CMN provides comfort, treatment and hope to millions of sick kids. In fact, Children’s Miracle Network hospitals treat one in 10 children in North America each year.

Window, virtual visits bring loved ones together Connecting with loved ones plays a major role in the healing process, both physically and mentally. With this in mind, TMC found ways to provide those connections even when COVID-19 forced the hospital to implement visitor restrictions. • Since most patient rooms have windows to outdoor courtyards and patios, families could visit patients through the window while talking on the phone.

Carol Urich & Rosa Valencia, EVS associates In order to safely clean the rooms of COVID-19 patients, Environmental Services staff must don full personal protective equipment before entering the room. They clean, disinfect and empty trash all while cheerfully talking to the patients. When they leave a room, they doff the PPE, and do it all over again for the next room. During the peak of the pandemic, there were nearly 200 rooms occupied by COVID patients. “You have to have compassion,” said Rosa Valencia, EVS associate. “I talk to the patients because they don’t have anybody to talk to and it makes them feel good. These people need someone to talk to and it feels good to help someone else. I’m not scared. I have my PPE.” “This is my second year on this unit (Intensive Care Unit),” said Carol Urich, EVS associate. “I was scared when it first turned to COVID. I wasn’t sure if I would get sick, but if you follow the proper protocol, you’ll be fine. Plus, when you see patients suffer, it’s hard to turn away. Even before the pandemic, any little thing I can do to help a patient feel better was great.” 5

• Virtual visits were also facilitated by TMC staff, allowing friends and loved ones to see and talk to patients using FaceTime on a hospital iPad. “We are so thrilled we have been able to provide a way for patients to connect with their loved ones,” said Mimi Coomler, Chief Operating Officer, TMC HealthCare. “Those connections are such an important part of the healing process.”

Physically distant, socially connected Keeping our community healthy has always been a priority for TMC HealthCare. TMC has a consistent slate of education, outreach and community service programs all designed to keep families healthy – and out of the hospital! Despite the challenges that 2020 demanded – closed locations, physical distancing and quarantining – TMC’s outreach programs found a way to thrive in 2020! TMC for Seniors, The Core at La Encantada, and Child and Family Outreach came together to introduce a variety of new ways to stay connected. We developed a robust online presence, including virtual fitness classes and health lectures, support programs for expectant moms, plus unique drive-through events to keep seniors socially engaged. With nearly 60,000 virtual views, we found new ways to keep our community connected in a physically distanced world.

Thanks to the generosity of donors in our community, TMC Pediatric Therapy has moved into a new, larger space that will allow more families to benefit from physical and occupational therapy, speech-language therapy and audiology services. The new digs, which are twice the size of the former space, were made with children and safety in mind. The lobby is spacious with dividers between seats to allow for physical distancing. Treatment areas have more room for larger specialty equipment such as customized frames for swings to support sensory play for children who need help with maintaining attention, and a body-weightsupported treadmill system that helps children learn to walk. The expansion includes an upstairs area just for teens and two double-walled sound booths for hearing tests. It also gives the feeding therapists space for adapted feeding utensils and specialized bottle systems. “Our team is made up of therapists and audiologists with highly specialized training in pediatric therapies and audiology, and the most exciting thing about the space is having a place that reflects the quality of service that we provide,” said Caryn Barman, manager of TMC Pediatric Therapy. This was made possible by the generosity of Alan and Jan Levin and family. 6

Smallhouse family helps TMC family face pandemic challenges early in the pandemic, keeping staff safe from COVID-19 while on the job. Part of their gift also went to the Marks Fund, created to provide financial support to TMC staff members facing extraordinary economic hardships. “With many staff members’ spouses, partners and families facing layoffs or reduced hours due to COVID-19, the Marks Fund was more important than ever,” said Jeffrey Lamie, chief development officer of the TMC Foundation. “This fund was a helping hand for those who needed it. To David and Sarah and the Brown Foundation, we say thank you – and also to everyone in our community who came to our assistance in our time of need.” This gift helped TMC staff pay the bills, providing some relief during stressful times. “This has helped me pay my rent. I am a single mom and my son is graduating high school this year. I am blessed to know there are people like you willing to assist. You are so appreciated. Big thank you,” said one employee.

David and Sarah Smallhouse and the Thomas R. Brown Foundation are givers – they show up. Whether it’s through personal service, such as volunteering at the COVID-19 vaccination clinic, serving on TMC boards, advocating for the hospital or making transformational financial gifts, they pitch in. They were by our side this year when we needed it most. David is a trustee with the TMC Foundation and also serves on the investment and finance committees of the TMC HealthCare board. Sarah is president of the Thomas R. Brown Foundation, which has made several major gifts over the years supporting leading-edge technology for surgical suites and for nursing education. David, Sarah and other members of the Brown Foundation’s board and staff volunteered at TMC’s vaccination clinic this spring. The Brown Foundation made a substantial emergency gift during this incredibly trying year. Because of this generosity, TMC was able to quickly purchase needed personal protective equipment 7

“We were honored to be in a position to help the staff at Tucson Medical Center,” Sarah said. “These people are there on the front lines every day. Providing them some relief under such stressful conditions was the right thing to do.” The couple said they enjoyed their experiences volunteering at Lot 29, Tucson’s drive-through COVID-19 vaccination clinic. “We ran into old friends, and made new ones. People in line were relieved to get their jabs. The weather was nice, and I was happy to be a part of the effort. It was a good scene all the way around,” Sarah reflected. “As a fifth-generation Arizonan with deep roots in this community, I was drawn to help out in any way I could,” David said. “This challenge to Tucson and Southern Arizona was just so profound, being there with Sarah and others from the community to be part of the solution was an incredible experience.”

Maria Rodriguez, Respiratory Therapy Clinical Lead

Local teen starts Art for Smiles to cheer up patients More than 30 graduates of St. Michael’s K-8 School created and donated beautiful pieces of artwork to patients at Tucson Medical Center. Ella Healy, 14, started the project, Art for Smiles, and got help recruiting students to participate from her former art teacher, Barbara Faltico.

the need to do something to help my community, so after talking to my parents, attending a volunteer event at TMC that Cox helped organize and gaining inspiration from the Tucson community, I came up with the Art for Smiles campaign.”

Though she’s not an artist herself, Healy has seen firsthand how art can impact a person in the hospital. She said when her grandmother was in the hospital, she sketched pictures to hang on the wall in her room to give her something to look at. It made her happy. Once the pandemic hit and visitor restrictions were put in place, Healy wanted to find a way to help patients heal.

Lauren Rabb, curator of TMC’s Healing Art program, said research shows that art in hospitals can help relieve stress and anxiety, leading to less need for pain meds and shorter hospital stays.

“Art can put smiles on people’s faces whether or not they have immense interest in art itself,” Healy said. “I felt

“Ella’s gesture is particularly meaningful because it’s from the heart,” Rabb said. “She and her schoolmates hope to brighten the spirits of patients stuck in the hospital right now – often without visitors – and show them that the outside world is thinking of them and truly cares.”

“Everyone is figuring out how to take care of our patients the best way possible. The pandemic has definitely helped shine a light on what Respiratory Therapy is and that is exciting. And at a hospital like TMC, we have a voice when it comes to how to treat these patients. There is a new level of teamwork and communication.” “You go from one rough situation to another rough situation to another rough situation… and you can’t get away and go to the store, go see your friends, go have some drinks. There is no reprieve. Our teammates are our therapy right now. When we share our struggles with each other, it can be really heavy, but it’s so necessary because we understand and we’ve been there too.” “It’s been an oddly exciting year professionally. I’ve never learned and done so much so quickly in one year. You read and research and figure out how to care for these patients. Friends from other hospitals, people I went to school with almost 10 years ago are connecting to ask how we are doing, and what techniques we are using and what’s working for us.” 8

2020 in photos: A year to remember From tragedies to triumphs, the year showed that anything is possible working together and that our staff is committed to our community, our patients and one another.

Photo credit: Arizona Daily Star

Josh Hogan Since the onset of COVID-19, Josh Hogan has been part of the Facilities team that converts units to negative pressure, which keeps the airflow of COVID rooms separate from the rest of the hospital. At the pandemic’s peak, 191 rooms were converted to negative pressure. “When coronavirus came down, I said I’m available to help anytime,” he said. “I want to be a part of this. It’s been a huge team effort, and I’m very proud of it.” “Josh has an awesome attitude, and doing this is a way for him to help people by making the hospital safer,” said Richard Parker, director of Facilities and Construction.

Innovation helps TMCOne stay ahead of the pack Last year, TMC’s primary and specialty care practice, TMCOne, looked to technology to keep patients safer during COVID-19. The practice, which has more than 75 providers in southeast, central and northwest Tucson, used innovative solutions for patient visits, pharmacy services and appointment check-ins. Virtual visits: By offering patients video telehealth visits, providers were able to offer care to patients within the comfort of their own homes. “There was no standing in line in a public lobby, no walking by countless other patients who may not be masked appropriately,” said Jonathan Leicht, TMCOne director of operations. “We realized rather quickly from our patient experience feedback—in both the scores and the patient comments—that our patients really appreciated this option.” Contactless check-in kiosks: At one of its newer office locations, TMCOne was able to

pilot a contactless check-in kiosk. “It allowed our patients to scan their insurance cards, pay any outstanding bills, sign off on registration forms, all without physical contact with another person,” Leicht said. “Even better, the kiosk selfcleans between every use.” Pharmacy kiosks: Two clinics partnered with SpotRx, a local full-service pharmacy, to provide services to patients at the Wyatt and Rincon locations. Patients could fill prescription medications and purchase overthe-counter drugs before leaving the clinics using the SpotRx kiosks in the lobbies. In addition, SpotRx also provided patients with next-day home delivery of prescriptions. “These services continue to give our patients peace of mind,” Leicht said. “They can feel safe getting the care they need and not have to forego it because of the risk of contracting COVID-19.”

Retired nurse repaying help by giving back to a grant and, later, financial assistance from TMC, she was able to begin a more than 30-year nursing career that she loved. “I went to nursing school in Illinois and had a grant that helped me get started,” she said. “I was a single mom at the time. Without financial assistance to get me started, I never would have been able to go into nursing, and nursing is always going to be an important profession.” Many roles as an RN Three years after earning her associate’s degree in Illinois, Malone traded snow shoes for sandals and moved to Arizona. She was hired in TMC’s Labor and Delivery department, where she ended up finishing her career in 2014.

What goes around comes around. For Sherry Malone, a retired Tucson Medical Center nurse, that means bestowing half of her estate to the TMC Foundation in order to provide financial help to future nursing hopefuls.

While working as a nurse, Malone went back to school to earn a bachelor’s degree with the help of financial aid from TMC. As an RN, she held several roles, from case management to systems analyst and back to bedside nurse. “I loved working with the moms,” she recalled. “A lot of people go into obstetrics because of the babies, but for me, it was the moms.”

Help getting started

Giving back

At one time, she was the one who needed help. As a young single mother getting started in life, she needed a career that would support her son and herself. Thanks

She retired in 2014, but started volunteering in the transportation department the same day. Now, she is spending her volunteer hours in Employee Health.

“I just have a sense of loyalty,” she said. “I’ve had quite a few opportunities there. I sort of bonded with the institution. You can’t help it when you spend that many years there and do so many different things.” Now, she wants to help others have those same experiences. She worked with her estate planner to ensure a portion of her assets would go to the hospital after she dies. “If I can help people get a foot up to get started in a career that is going to change their lives, I want to do that, because I never would have been able to do it myself without the help,” she said. “What comes around goes around, I guess. I’m glad to be fortunate enough to provide an opportunity for others.” “This legacy gift from one of our former employees is so special because she’s paying it forward for future generations of TMC employees,” said Julie Wolfe Beadle, executive director of development, TMC Foundation. “This is a testament to the culture of compassion and empathy our employees have for one another.” Sherry’s gift will have a lasting impact on TMC employees - and in turn, the Tucson community - for years to come. If you are inspired to leave a legacy and become part of TMC’s story in this way, please call (520) 324-3411.

TMC partners with state and county to vaccinate Tucson On Dec. 17, almost 9 months to the day of the first COVID-19 case at TMC, the end of the tunnel came into focus. It was that day that TMC became among the first hospitals in the state to begin distributing the Pfizer vaccine to healthcare workers.

Stacey Spink and David Cohen As COVID began to take its toll on the community and particularly front-line staff, David Cohen and Stacey Spink wanted to find a way to support the teams caring for those in the most critical areas of the hospital. As a small gesture of thanks they thought practically – nourish those on the frontlines. The pair had food delivered to the ICU and outfitted the ED with “angel” shirts to show their gratitude. “It was evident that TMC’s staff bore the brunt of the pandemic, treating patients who were scared by this new and unknown virus with an uncertain outcome. While the general public read stories of these struggles, it was very real to TMC, so our gifts represent a small gesture of appreciation for what they had endured on behalf of the Tucson community.” David is a current TMC HealthCare Board member and both are longtime “We are Champions” members. 13

We knew that vaccines were critical in stopping the pandemic and we worked with our partners in Pima County, the state of Arizona and countless volunteers to help administer the vaccines to health care workers first and then our community. It started in our conference room, where we had an employee clinic providing shots to the scores of front-line health care workers who were among the most vulnerable to catching the disease. There, we provided hope to nurses, doctors, EVS workers, and other medical professionals throughout Tucson. When Pima County and the state expanded the vaccine offerings to those with the most critical needs in our community – our seniors – again, TMC stepped up and was among the first to provide shots to our seniors.

We eventually moved our vaccine clinic to a drivethrough lot on the north side of our property and had it up and running in a matter of days. There, volunteers and staff were able to provide more than 1,000 shots a day to people looking to get back to normal. The vaccine clinic moved again in early 2021 to the Morris K. Udall Center, where vaccine aspirants could wait in the air conditioning while moving through the process. Either through our drive-in lot or walk-in clinic, thousands of people turned to TMC for their first step to normalcy. We are proud of our partnership with Pima County, the state of Arizona and the countless volunteers who helped us serve our community with the COVID vaccine. We are stronger together. DOSES GIVEN (through May 1, 2021): MODERNA: PFIZER: VOLUNTEERS:

128,939 90,311 38,629 2,399

Hope before the vaccine As COVID-19 cases started to rise in our community, the U.S. Department of Health and Human Services (HHS) teamed with Tucson Medical Center (TMC) to begin administering monoclonal antibody therapeutic treatments at a temporary COVID-19 infusion center in the hospital. The center was the second federally supported infusion center in the country to treat certain COVID-19 patients in order to prevent hospitalization and the severity of illness. Hundreds of patients were served by the TMC/HHS clinic – sparing nearly all of them a more severe case of COVID. It was the first therapeutic breakthrough in the pandemic prior to the vaccine.

Clinical research ramped up in 2020 TMC HealthCare kicked up its research efforts in 2020 when it hired a director of Clinical Research to oversee studies in medical devices, drugs, procedures and protocols. Areas of research last year included cardiovascular care, COVID-19 treatments, and screening for type 1 diabetes. “There are just so many opportunities coming up with research. We’re really focused on providing options for our community, including expanding leading-edge therapies for our patients,” said Natalia Elias Calles, director of Clinical Research. In 2020, the research team participated in the following studies: • In cardiovascular research, we are a leading site for global pivotal trials. The research program came to fruition in 2019 under the leadership and guidance of our Cardiovascular Research Medical Director, Dr. Thomas Waggoner. Drs. Thomas Waggoner and Neil Gheewala are the principal investigators spearheading international

protocols that are impacting guidelines in structural heart disease which heavily impacts our community. • For COVID, the clinical research program collaborated with Mayo Clinic, along with Drs. Robert Aaronson, Ives de Chazal, Lisa Valdivia and other investigators, in the COVID convalescent plasma expandedaccess program. Furthermore, Dr. Aaronson activated Mayo Clinic’s new drug trial CAMOSTAT. TMC held an influential role in providing crucial data for national public health surveillance in evaluating the monoclonal antibody treatment with Johns Hopkins University. • Principal Investigator Dr. Chetanbabu Patel offers type 1 diabetes (T1D) screening to evaluate a patient’s risk of developing disease. The screening Dr. Patel provides can identify the early stages of T1D years before any symptoms appear, truly assisting in preventative medicine.

Bethany Keenan, R.N. Unit 900 With more than 340 days, and counting, spent caring for COVID positive patients, nurse Bethany Keenan reflects on the teamwork that it takes to maintain the level of care these patients need. “The team has worked together in complete solidarity through all of this, and that includes everyone… bedside clinical staff, lab, environmental services, food services … we wouldn’t have survived this year without the teamwork that we have on this unit.”

Hats for Heroes Before she knew it, she and Romero together were working more than 40 hours a week on the project, Hats for Heroes Tucson. “This hat project has been more than a full-time job for me,” Galloway said. “Sewing, dropping off, calling people, making sure deliveries are done, counting, collecting, putting buttons on. My sisters have even been sewing on buttons on their days off. It’s definitely been a community and family effort.”

Program defrays $7 million in drug costs, allowing TMC to better help the sickest, poorest Last year, Tucson Medical Center saved an estimated $7 million as a result of the federal 340B program that provides discounted drugs to hospitals that care for high numbers of financially vulnerable patients. “With our serving some of the sickest and poorest members of our community, 340B helps us defray the full price of high-cost drugs, meaning we are better positioned to extend services to underserved and vulnerable populations,” said Claudia Koreny, director of Pharmacy.

In three weeks they completed approximately 800 hats to be delivered to area hospitals, including TMC. This project connected Galloway and Romero to amazing women in the community who, like them, just wanted to help in some way. A seemingly small gesture turned into a full-scale production that resulted in 800 handmade scrub hats created by 28 volunteers and then donated to Southern Arizona hospitals. As the COVID-19 pandemic started spreading throughout the country, Edie Galloway, a seasonal nurse at Tucson Medical Center and her sister, Ester Romero, a TMC nurse for more than 30 years, wanted to help. Since Galloway wasn’t working at the time and had heard from some of her friends that scrub hats had become a hot commodity, she dusted off her sewing machine to make a few for people she knew. Since she and her husband are connected with so many in the Tucson medical community, word got out quickly. When word spread, they figured they needed help. Galloway put out word on Nextdoor, an app that connects people to local neighborhoods, asking for help. That garnered her 28 volunteers and more health care professionals asking for hats.

“I had a retired nurse who donated what she called a lifetime collection of buttons,” Galloway recalled. “She’s like ‘this is full circle for me. I collected these during my years as a nurse, now I get to give them back to health care facilities.’” Romero said she is amazed at Galloway’s compassion and dedication. From Galloway’s perspective, her sister Ester is amazing – working full time, raising a family and still making time to help with the hat project. “Edie is an amazing, dedicated nurse and colleague who has brought the community together to meet the needs of our health care workers,” Romero said. For Galloway, she is just doing her part. “During this pandemic, I feel that we all have an important role with coming together and supporting each other and this is my way of doing this for my colleagues, family and friends,” Galloway said. “I’m so proud of them and what they are doing on the front lines.”

TMC HealthCare virtual community outreach recap TMC for Seniors, The Core at La Encantada & Child and Family Outreach

193 Virtual Classes

2,163 Drive-Through

Activity Kits Distributed

17,000 online &

direct mail subscribers

144 Virtual Support Groups 303 Health care

professionals earned continuing education hours

60,000 views

Community quotes “You are doing a world of happiness with your care and help for seniors. You are making Tucson a community that truly cares about seniors. Thank you for all that you do.” “I had no idea the yoga poses I learned in prenatal yoga would be so helpful during labor! The TMC classes leading up to the birth of my son at TMC were such an incredible resource, thank you TMC.” “It was so much fun to have something to look forward to each month with the drive-through kits at TMC for Seniors, they keep us tuned-in.” 16

Community Benefit 2020

TMC reports more than $60 million in community benefit and charity care for 2020, or about 9.7% of net revenues. In the previous year, TMC reported a community benefit of 10.4% of net revenues.

50%

Unpaid Costs for AHCCCS/Medicaid Patients $30,238,000

18%

Cost of Uncompensated Care (Charity Care & Bad Debt) $10,994,327

27%

Hospital Assessment $16,505,690

Outreach & Education $2,298,295

What makes up this number? Unpaid Costs for AHCCCS/Medicaid Patients: TMC provides services to patients covered by AHCCCS and other public programs for people with low incomes. This is the shortfall created when a facility receives payments that are less than the cost of caring for public-program beneficiaries. In 2020, Arizona passed a law establishing the Health Care Investment Fund, which, when matched with federal funds, begins to offset hospitals’ unpaid costs.

Total

$60,036,312 Percentage of net revenue: 9.7%

Uncompensated Cost of Care for Charity Care, Bad Debt & Discounts for the Uninsured: Charity care is free or discounted health services provided to people who can demonstrate that they do not have the means to pay the full cost of care and who meet the organization’s financial-assistance policy criteria. Bad debt consists of services for which the hospital anticipated but did not receive payment. Recognizing that self-pay patients who do not have health insurance are not in the same position as insurance companies to negotiate reduced rates, TMC discounts these patients’ bills by 69 percent; and, depending on a patient’s income, other discounts may apply as part of TMC’s Community Care program.

Community Benefit Trends

$64

$63

$64

$59

MILLION

2016 11.6%

2017 11.9%

2018 10.7%

2019 10.4%

MILLION

$60

MILLION

For purposes of community benefit reporting, charity care, bad debt and uninsured discounts are reported in terms of costs, not charges. For more information about TMC’s charity care policy, visit: tmcaz.com/community-care. Hospital Assessment: Since 2014, Arizona hospitals have paid an assessment to the state of Arizona to help fund the cost of expanding AHCCCS services to low-income residents. In 2020, the assessment covered 510,000 residents, and TMC’s portion of the hospital assessment was $16.5 million. Outreach & Education: This figure includes community benefit programs and activities that provide treatment or promote health and healing as a response to identified community needs. These programs and activities help improve access to health care services, enhance the health of the community and advance medical knowledge. 17

(% of net revenue)

2020 9.7%

2020 HOSPITAL DATA Licensed Beds Unit Mom/Baby

NICU

Pediatric

PICU

Medical-Surgical

TMC Mega Raffle funds training, equipment and services Here are three ways Mega Raffle funds were used to serve our patients in 2020: Labor and Delivery Simulation Center Mega Raffle funds enabled the purchase of a life-like baby to join “Lacie,” a birthing simulator to provide hands-on training exercises that help prepare our staff for any situation in the delivery room. Fluoroscopy Equipment

In 2020, the TMC Mega Raffle raised $1.8 million to support patient care services at Tucson Medical Center. So far, this annual raffle has raised about $9 million. These funds allow TMC to continue to invest in services and programs that improve the health of our community.

TMC bought state-of-the-art fluoroscopy equipment, giving physicians access to the latest technology for capturing moving images of the body to diagnose patients and determine the need for surgery. Cardiac Rehabilitation Mega Raffle monies support important programs such as the TMC CardioVascular Center, which is one of the most active cardiac rehabilitation centers in Arizona.

Beds

404

ICU

Geropsychiatric

Inpatient Hospice

Total

628

2020 VOLUMES Emergency Visits Adult

55,591

Pediatric

16,581

Total

72,172

Inpatient Admissions Adult Pediatric Total

28,530 1,672 30,202

Babies Delivered 5,364 Surgeries Inpatient Adult Pediatric

8,462 8,107 355

Outpatient

12,133

Adult

10,319

Pediatric Total

1,814 20,595 18

TMC Auxiliary

TMC Hospice

Since its founding in 1949, the TMC Auxiliary has been an integral part of the hospital, supporting clinical staff and assisting with charitable fundraising. Volunteers encompass a wide range of talent, including former employees, recent retirees, college students, and those looking for an opportunity to give back. Because of the pandemic in 2020 and to help keep our volunteers safe, we reduced the number of volunteers in the hospital substantially last year. However, they found other ways to help us and we are forever grateful for their support.

TMC Hospice cares for people with a life-limiting illness, after the patient, physician and family have decided that medical care to cure the underlying disease is no longer the best path. Hospice involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support that fits the patient’s needs and wishes. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the support they need to allow us to do so. At TMC Hospice, we consider life a sacred journey of transformation, personal growth and discovery. Our mission is to help those with life-limiting illnesses walk their path of life and receive compassion, dignity and love. In 2020, our TMC Hospice program had: • 1183 total patients admitted to TMC Hospice • 569 patients admitted to the home care program • 614 patients admitted to Peppi’s House or Benson Hospital as inpatient stays • The average daily census for IPU was 9

2020 Volunteers

• The average daily census for home hospice was 99

Active Volunteers 500 College Student Volunteers 40 Pet Therapy Teams (Handler & Pet) 30 Pet Therapy Visits 1,000 Number of Service Areas 62 Total Hours Volunteered 21,257 FTE Equivalent 11 Salary Savings to TMC $575,000

TMC Hospice Volunteers play an integral role in hospice services. They provide helping hands, listening ears, companionship and support to hospice patients, families and hospice staff. • We had 55 volunteers who gave of their time to help hospice families and patients. • Our volunteers contributed 4,540 hours, valued at an estimated $124,000 cost savings. • 3,126 of those hours were for direct patient services. • Medicare requires hospices to count their volunteer hours, which must equal a minimum of 5% of total patient care hours of all paid hospice employees. Our average is 12.5%, well over the 5% minimum.

Fiber Arts Donations Heart Pillows Walker Bags Bolsters Bereavement Blankets Pediatric Quilts Veteran Pillowcases

2020 Volunteer Program:

750 250 25 10 75 75

• 258 veterans were admitted to Hospice with 118 receiving an appreciation commemoration of their services by veteran program volunteers. Veteran patients also received patriotic pillowcases made by various generous individuals and groups throughout the Tucson community including our very own TMC volunteer sewing group. In 2020, Care Calls was started to help hospice patients, loved ones and bereaved families who are feeling isolated due to the pandemic. Many of these people are not able to visit with their families and friends and this program gives them some companionship along their journey. Volunteers call at least once a week to check in and provide companionship. The program has been most successful with our bereaved families, who feel especially alone during these times of staying home and social distancing.

A special thank you to the TMC Foundation Board:

TMC Foundation Funding Sources 2020

Donal Drayne TMC Foundation Board of Trustees Chairman Westin La Paloma (retired) Christine Aronoff Wells Fargo Wealth Management Group Jodi A. Bain The Bain Law Firm PLLC Elizabeth Brewer Community Volunteer Tammy Caillet-Falbaum Community Volunteer Jeffrey J. Cesare Broadway Realty & Trust Inc. Palmer C. Evans M.D. Life Trustee Louise L. Francesconi TMC HealthCare Board of Trustees Chairwoman Christopher Kemmerly Miramonte Homes John D. Levin Levin Funding Group

Donor-Designated Funds

Patricia Lohse Director, 12 private foundations

40%

Children’s

25%

General Women’s

10% 17%

Hospice Other

Judith F. Rich R.N. TMC HealthCare President & CEO Steven Siwik M.D. Radiology Ltd. David Smallhouse Miramar Ventures Arlene Webster Life Trustee Sandra Wong TMC Auxiliary President Jim Zarling Life Trustee Nicole Zuckerman-Morris Community Volunteer

Stronger. Together. For our front and back covers we brought together our staff and community members to show the power of community. On the front, a group of TMC HealthCare employees in different color scrubs representing a variety of departments. On the back we have members of our community who supported TMC during the COVID pandemic: (from L-R) James Ogden and his dog Bandit Jeff Lamie Vice President and Chief Development Officer for the TMC Foundation Michael Goodwin Pantano Christian Church Luis Canchola TMC nurse Ila Miller Girl Scout Adelita S. Grijalva Pima County Board of Supervisors Greg Wakefield 94.9 MIXfm Cam Callahan Cox Communications David Smallhouse TMC Board Member and donor Tucson Police Officer Donal Drayne TMC Foundation Board Sarah Smallhouse TMC donor Dr. Theresa Cullen Pima County Health Department Roger Canchola TMC donor

Tucson Firefighter

TMC continues to grow, making our healthcare system more accessible and more convenient In 2020, there was big news about growth in Tucson’s southeast region. TMC HealthCare announced an expansion of the Rincon campus with a new hospital and expanded medical and surgery services.

gynecology, obstetrics, neurology, orthopedics, respiratory and urology. The 150,000-square-foot hospital facility will cost $80 million and is the third hospital in the TMC HealthCare system.

TMC HealthCare Rincon Campus

Benson Hospital

TMC HealthCare (TMC) is expanding its Rincon campus, providing additional medical and surgical services at the 10350 Drexel Road location in southeast Tucson. TMC partnered with MedCraft Healthcare Real Estate, a national health care real estate expert, in the expansion and future development of the campus. MedCraft acquired the 44,000-square-foot two-story medical office building and has added new medical groups to establish full-time offices to better serve the local community.

Benson Hospital announced plans for a new state-of-the-art imaging suite in 2020. The unit represents an addition to the hospital that will enhance care for patients across Cochise County and Southern Arizona. When the new unit is completed in the fall of 2021, not only will patients be able to remain in the hospital for scans, the new CT scanner will be a GE scanner, the first one of its type installed in Arizona.

Located along a rapidly growing section of Houghton Road, the expanded campus will further integrate primary and specialty care, including cardiology, family medicine, imaging, lab, orthopedics, rehabilitation, urgent care, as well as a planned state-of-the-art Ambulatory Surgery Center (ASC). The Ambulatory Surgery Center will provide a convenient and affordable option for routine surgeries and procedures. TMC HealthCare also announced plans to build a new 60bed hospital at the TMC Rincon Health Campus. The new hospital will serve residents in the growing southeast area of our city and reaffirms TMC’s commitment to providing safe and reliable medical care to Tucsonans. The new facility, slated to open in 2023, will include medical/surgical, telemetry and maternity beds along with four operating rooms. The hospital will have service lines including cardiology, general medicine, general surgery,

The imaging suite is the next step of the hospital’s renovation and expansion, which has included bringing in the newest in laboratory diagnostic equipment, ultravioletlight room-sterilization equipment, and other changes to enhance patient care and services. The new suite upgrades and expands diagnostic services, to include CT scans, X-rays, ultrasound and DEXA scans. Professional radiology services are provided to Benson Hospital by Tucson-based Radiology Ltd. TMCOne TMCOne, TMC HealthCare’s primary and specialty care provider group, continues to grow – making it one of the largest groups in the region with over 70 providers. In 2020, TMCOne opened near Skyline and Campbell to serve patients in the Foothills area. The new clinic features an in-house lab and an on-site SpotRx pharmacy kiosk so patients can get prescriptions and over-the-counter medications filled on site.

Our Locations

Ina

Sk yl

For 75 year’s TMC Healthcare has been Tucson’s health care leader. With our vast system of TMCOne clinics, to TMCNow virtual visits, to our hospitals, Tucson Medical Center and Benson Hospital, we are here for you and all your health care needs. 1

8 9

15 16 17 18 19 20

Tanque Verde

16 17

Broadway

22nd

10 20

Benson

Houghton

Harrison

Speedway

Ocotillo

7 14 18

Kolb

Wilmot

Grant

Sabino Canyon

6 13

Craycroft

Swan

Glenn

Alvernon

Sunrise

Campbell

River

Oracle

Tucson Medical Center 5301 E Grant Road TMC Urgent Care 2424 N. Wyatt Drive, #140 TMC Urgent Care 10350 E. Drexel Road The Core Health & Wellness Center 2905 E. Skyline Drive, #277 TMC for Seniors at El Dorado Health Campus 1400 N. Wilmot Road TMCOne: Wyatt 2424 N. Wyatt Drive, #100 TMCOne: Ferguson #100 and #104 2380 N. Ferguson Ave., #104 TMCOne: Harrison 70 N. Harrison Road TMCOne: Oracle Road 7510 N. Oracle Road, #100 TMCOne: Rincon 10350 E. Drexel Road, #110 TMCOne: Rita Road #100 and #180 9356 E. Rita Road, #100 and #180 TMCOne: Pulmonary Associates 1951 N Wilmot Road (Bldg 4) TMCOne: Erickson 5300 E. Erickson Drive, #100 TMCOne: Beverly 2141 N. Beverly Ave., #101 TMCOne: Skyline 2840 E. Skyline, #230 TMCOne Wilmot Pediatrics 1500 N Wilmot Road (B250) TMC Medical Network: Southwest Premier Urology 1100 E. El Dorado Place TMC Medical Network: TMC Integrative Pain Clinic 5355 E. Erickson Road TMC Medical Network: TMCObstetrics 5301 E. Grant Road (on the east end of the TMC campus) Benson Hospital 450 S. Ocotillo Ave., Benson

Drexel Valencia

Annual Report 2020 | Published June 2021 5301 E. Grant Road, Tucson, AZ 85712 tmcaz.com • (520) 324-5461