A New Virus to Confront

Over the last two weeks, there has been much media attention focused on the coronavirus outbreak in China. There have been five confirmed cases in the United States and the virus has spread to 14 total countries around the world.

What are coronaviruses?
Let me give you the World Health Organization’s (WHO) answer to that question. Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans — this is what we’re dealing with in the current outbreak.

Coronaviruses are zoonotic, meaning they are transmitted between animals and humans. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from Arabian one-humped camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. Scientists have already proven that this new coronavirus is spreading from human to human.

Common signs of infection include: respiratory symptoms, fever, cough, shortness of breath, and breathing difficulties. In more severe cases, infection can cause pneumonia, kidney failure, and even death.

Respiratory viruses, like influenza, infect everyone, but those with healthy immune systems and without chronic illness generally recover without any long-term effects. The frail and elderly, along with those with chronic disease or weakened immune systems are at the highest risk of serious illness and death.

We are fortunate in the United States to have the world’s foremost public health agency, the Centers for Disease Control and Prevention (CDC). The Chinese government has shared the entire genetic makeup of this virus with the CDC and the strains identified from the five cases in the U.S. match the Chinese strain. Scientists are already working to create an immunization to block the spread of this disease. It is still unclear exactly how dangerous the virus is. There are more than 58 million people in Wuhan, the city in China where the outbreak started. So far, there have been 170 deaths from the virus, all of which have occurred in China.

So, what should we do? We should follow the standard evidence-based respiratory illness precautions including regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs, and avoiding close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.

That being said, there is currently no cause for alarm. There have been no identified cases in Maryland or in the surrounding states. We will follow this situation closely and take our direction from the CDC and the Maryland Department of Health.

Let me take this opportunity to underline the importance of following scientific recommendations and not getting caught up in hysteria. As a society, we have made so much progress in public health that we often take our health for granted. Measles came close to being eliminated in our country until ‘vaccine hesitancy’ began with people who did not understand the facts.

All the cases of measles in the recent outbreak happened in those who had not been appropriately immunized. Some parents have delayed or not vaccinated their children because of misinformation spread via the internet and social media. And sadly, some elected officials and others who should know better have downplayed the importance of immunizations and have made pronouncements that don’t fit with the science. So, let’s give deference to expertise and support the experts at the CDC as they learn more about the coronavirus outbreak and roll out a plan to address it. For more information on the coronavirus I suggest you visit the CDC website here.

Congratulations Laurie Beyer!
I’d like to congratulate our Executive Vice President and Chief Financial Officer, Laurie R. Beyer, BS, MBA, CPA, who was named by Becker’s Hospital Review as one of 20+ women hospital and health system “CFOs to Know” for the third year in a row. The annual list is curated from CFOs nationwide who lead financial departments at health systems and community hospitals. Way to go Laurie!

The Need for Medical Malpractice Reform Legislation

In July 2019, a jury in Baltimore City awarded $229 million to a child born very prematurely at Johns Hopkins Bayview Medical Center. The judge reduced the award to $205 million because of the state cap on non-economic damages. The child, now about five years old, has significant developmental delays.

Though I was not involved in the case, it does not appear to me that this baby’s outcome is a result of the care provided by the hospital. What is clear is that the verdict amount does not reflect the true cost of caring for this child. The jury awarded five times more than what the Plaintiff’s experts estimated it would cost to care for the child throughout its lifetime. While attorneys generally take 30-40% of a settlement as commission, which is $70-$80 million in this case, this still leaves the Plaintiff with significantly more than what is needed.

I did not see this covered in the newspaper stories about this case. It also wasn’t reported that the baby’s medical costs are already being paid for by the taxpayers through Medicaid. This means that the true “economic damages” are far less than what was projected at trial. Johns Hopkins will continue to fight this case in court, but if the finding stands, news outlets have reported that it would be the largest payout in malpractice history.

We need a way to reimburse people and families who have been harmed by medical care. Although I don’t believe that the care at the hospital was the cause of the baby’s poor outcome, I do believe that society should cover the needs of the disabled.

That being said, this case should cause all citizens to be concerned. In the U.S., medical care is already very expensive. All hospitals have malpractice insurance and the cost of that insurance is passed on to the patient. The current insurance system provides coverage for the occasional need to pay claims at amounts much lower than that of this child’s case.

If these $200 million judgements stand, hospitals, even large hospital systems, won’t be able to afford medical malpractice insurance. No insurance or reinsurance company would accept risks of this magnitude and hospitals cannot put themselves at risk for claims like this without insurance. If this $205 million-dollar payout holds, hospitals may seriously consider closing their delivery rooms.

So, what is the solution? I believe that our next step in Maryland is to create rational “life care plans” where experts calculate the true expenses that a family will see over the projected life of their child. In a subsequent step, I believe we should limit the amount of money that attorneys can make from the settlements. The state of New York is already doing this. Click here to see the limits that have been implemented. 

Last week, I attended a meeting with Maryland state legislators, that was organized by the Maryland Hospital Association (MHA), where we discussed the need for malpractice reform in our state. Stay tuned.

Highlighting the Positives
On a lighter note, I recently took part in a segment of the podcast, Baltimore Positive, where I shared many of the great things that are going on in our HealthCare system. Our efforts in behavioral health and all the great things we’re doing for our community and the city of Baltimore are making a tangible difference in people’s lives. You can listen to it here. It was a conversation hosted by Nestor Aparicio (former sports writer and radio station owner) and former Baltimore County Executive Don Mohler (D). Brian Frazee, Vice President of Government Affairs for the MHA, was also on the broadcast.

Wonderful Accomplishments!
Congratulations to our Sandra and Malcolm Berman Cancer Institute for achieving QOPI® Re-Certification. Quality Oncology Practice Initiative (QOPI®) status reflects our ongoing commitment to quality of care that leads to fundamental changes in the clinical practice of oncology. This recognition reaffirms our work to move towards our vision in cancer care. QOPI®, a program of the American Society of Clinical Oncology, is a three-year certification for outpatient hematology-oncology practices. The initiative is intended to reduce the risk of errors when providing cancer patients with chemotherapy and to provide a framework for best practices in cancer care. QOPI® collects and analyzes data from certified practices, and compares the data using more than 160 evidence-based and consensus quality measures. The information is then provided to participating practices, which can compare their performance to data from across the country to help identify potential areas for continued quality improvement.

I also want to congratulate The Sandra and Malcolm Berman Cancer Institute for opening a satellite location in Owings Mills. The center provides medical oncology and is led by Ari Elman, MD, one of our board-certified hematologists and medical oncologists. The office has five infusion chairs staffed by the Berman Cancer Institute's oncology-certified infusion nurses. In addition, patients have access to clinical trials, oncology support services, and a connection to all the resources of the Institute and the GBMC HealthCare system.

Remembering Dr. Martin Luther King, Jr.
Yesterday, we hosted our 5th annual Martin Luther King, Jr. Day celebration, which commemorated Dr. King’s life and vision. This year’s program, titled More Than Meets the Eye, featured our keynote presenter, Father Joseph L. Muth, Jr., and live music from the Parkville High School Choir.

After Father Muth, Jr.’s speech, we presented the Spirit of King Award, which recognizes an individual who embodies the spirit and life's work of the late Rev. Dr. Martin Luther King, Jr. and who is dedicated to serving their local community. The winner of this year’s Spirit of King award was Meghan Shackelford, MSN, CRNP-AC, Director of Advanced Practitioners. Please join me in congratulating Meghan and all the nominees!

I am grateful to my colleagues on the Diversity and Inclusion Council for hosting this event and helping to make us a more inclusive organization. Thanks also to the Parkville High School Choir and our Black History Month committee for putting together such an outstanding celebration.

Moving Towards More Rational Drug Pricing

The U.S. healthcare system is facing many challenges — the aging population is putting new stresses on the system, poorly designed mental health systems are unable to meet the growing need for their services, and the opioid epidemic is affecting every aspect of healthcare. Notwithstanding these issues, perhaps our biggest challenge is the dramatic escalation in the price of pharmaceuticals. Drug companies are raising prices for medications that have been on the market, in some cases for decades, and new drugs are coming to the market with prices well above their cost of production. I’m not arguing that pharmaceutical companies shouldn’t make a profit, but experts have pointed out that the majority of the cost of research and development is funded by taxpayer dollars through National Institutes of Health (NIH) grant support. So, the question is: how much profit is enough for the pharmaceutical industry and its shareholders?

The federal government has shown no inclination to pass legislation addressing this issue, but the state of Maryland has. Last year, the Maryland Prescription Drug Affordability Board was created through legislation that passed in the General Assembly. The Board will study prescription drug pricing, and with the approval of the Legislative Policy Committee of the General Assembly, may begin to set upper price limits for drugs purchased by state, county, or local governments beginning in 2022. In December 2023, the Board will recommend whether the General Assembly should pass legislation to expand upper price controls to all prescription drugs sold in the state.

The Board held its first meeting this past Monday. Former Maryland Health Secretary, Van Mitchell, is the chair of the five-member panel, which also includes Dr. Joseph Levy, Dr. Eberechukwu Onukwugha, Dr. George Malouf, and Dr. Gerard Anderson.

I wish the Board well as they begin their deliberations.

A Disappointing Loss but a Great Season Nonetheless
Congratulations to Felicity Kirby, Oncology Nurse Coordinator, and Alyssa Bonney, Hospice Aide, who each won a pair of tickets for last week’s Ravens playoff game. Jessica Booth, Clinical Social Worker, won the Ravens themed basket courtesy of Karma Fashion Boutique.

Unfortunately, last Saturday’s game did not turn out like we hoped, but the Ravens had a great 2019 NFL season. The future is looking bright for this team and their leader, Lamar Jackson! They will learn from this fabulous season and I’m excited to see what improvements they make next year.

My deepest appreciation to all our employees and volunteers who participated by donating to the GBMC HealthCare System - GBMC, GBMC Health Partners, and Gilchrist! Because of your generosity, we collected approximately $4,000!

Rallying Around a Great Team in Charm City

I have been walking around the halls of GBMC with a Ravens lapel pin that my colleague and Environmental Services Associate, Sedrick Haire, gave me. Sedrick knows that I am a New York Giants fan (I grew up in New Jersey and have never changed my sports allegiances). He and many others find it humorous that I have jumped on the Ravens bandwagon and am now rooting for a Super Bowl win. You may ask, “why?”

Well, my family and I have lived in Baltimore for almost 10 years and have really enjoyed our time here. We’ve been embraced by so many wonderful people and have come to love the city. We live in the city and take advantage of the great parks, museums, restaurants, music venues, and the waterfront. There is no doubt that Baltimore has problems…but what place doesn’t have problems? I get upset when I hear people bad-mouthing Baltimore and ignoring its fabulous attributes. Baltimore deserves a big win to boost the city’s morale and to show the rest of the country that we are winners.

The other reason I am rooting for the Ravens is that I know a good team when I see one. I love the way that star quarterback, Lamar Jackson, has made believers out of the entire franchise. With the buzz around the city and throughout the GBMC HealthCare System, the “purple pride” is growing on our campus.

With the Ravens getting ready to host the Tennessee Titans in the AFC Divisional round of the playoffs, I just have one question to ask: “Who wants a chance to get their hands on tickets to this weekend’s Ravens playoff game?”

If you haven’t already donated your $4 for a chance to land two (2) tickets to the game this Saturday night (Jan. 11), you’re running out of time. All entries must be submitted by 11:59 p.m. TODAY (Thursday, Jan. 9). Your donations will help support GBMC HealthCare (GBMC, GBMC Health Partners, and Gilchrist).

Remember that you can enter as many times as you wish. Each entry costs $4. This is an internal raffle that is only open to GBMC HealthCare System employees and volunteers. You can buy the raffle tickets online or, if you would like to pay in cash, visit the Human Resources Department in suite 5360 in the hospital. The TWO lucky winners will be chosen and announced by 2 p.m. on Friday, January 10. Tickets must be picked up no later than 5 p.m. on Friday, Jan. 10.

Also, courtesy of our friends at Karma Fashion Boutique, you will have the chance for a Ravens raffle basket prize valued at $100. One lucky winner will be chosen to receive this amazing prize!

So, are you ready to enter? Click here! 

Good luck to all participants and go Ravens!

What Matters to (or for) her?

This past Saturday, I was doing Lean Daily Management (LDM) rounds and I became quite distressed when I entered Unit 36, our Integrative Care Unit (ICU). An elderly woman, wearing a hospital gown, approached and asked me for help. In an anguished voice, she told me that she did not belong on the unit and that she “had her own car.” At her side was a security guard, and a nurse. They were speaking to her by her name in a very gentle tone and it was clear to me that she was suffering from dementia. The speed at which she was moving around the hall made me curious about why she was on the unit. Patients with dementia become more anxious when they are in a new place and surrounded by people they have not seen before. I wondered if this was the best place for her to be.

I don’t think I could work on the ICU as I do not have the patience. What I saw in the actions of the staff there that day was profound — they were patient with her beyond belief. It was a display of kindness, caring, and dare I say it, love. I am so grateful to the nurses, techs, and security guards that work there every day.

But I needed to know: What was she doing on the unit? Were we really helping her? What was the “medical” reason that she was there for? Her nurse told me that we were treating a urinary tract infection. 

It is not my role to enter into the medical decision making concerning individual patients, but as a leader at GBMC, it is my role to make sure that we are living our vision phrase: to every patient, every time, we will provide the care we would want for our own loved ones. Is this the care I would want for an 85-year-old loved one of mine with dementia? 

Again, it is not my role to get involved in deciding what patient gets sent from an extended care facility to GBMC, and it is not my role to decide who gets admitted to the hospital, but it is my job to make sure that we are asking the right questions. What is the goal? What matters to the patient and her family? What are the risks inherent in our actions? Do the benefits to the patient outweigh the risks to the patient (and to the staff)?

I had to ask the nurse if she thought the patient would be better off in her usual place of residence with oral antibiotics. The nurse responded “yes.”

I left the unit asking myself what I could do to continue to reduce the number of times that the Emergency Department and the inpatient units of GBMC are used as the pathways of least resistance, and to continue to build a system of care that starts every interaction with the question: What really matters?