When 31-year-old Marcie Delia tested positive for a gene mutation that predisposed her to develop breast cancer, she immediately embarked on a regimen of regular screenings, but soon decided that wasn’t enough. In November, she underwent surgery to remove both breasts as a preventative measure.

“After about a year, I had enough,” the Columbus resident told Toledo Free Press via Facebook. “I’m a risk-averse person and my 50-80 percent odds of getting breast cancer were by no means reasonable or favorable. [I thought] ‘If I get cancer, I’ll have to have surgery anyway, so why not do it on my terms, minus the life-altering fear of a cancer diagnosis and months if not years of debilitating treatments and continual monitoring?’ It was not something I wanted to do, but felt I had to go forward with the surgery for my relative peace of mind. Anything else felt like waiting around to get cancer.”

Delia

Delia’s immediate family — especially her father, who was fighting terminal prostate cancer — was supportive of her decision, but many people didn’t understand.

“Any friend who had ever lost a loved one to cancer was immediately supportive and encouraging of my decision. Anyone who had not generally responded with, ‘That’s really drastic.’ Some people said, ‘Why not watch and wait?’” Delia said. “That was frustrating. They don’t realize that while that is an option, it’s a risky one. Mammography can only do so much. There’s no guarantee a cancer can be caught early. Others may be comfortable with that approach, but for me, that was too big of a gamble to live with.”

Angelina Jolie

On May 14, the topic was thrust to the forefront of international conversation when The New York Times published an op-ed column by actress Angelina Jolie in which she shared her recent decision to undergo a preventative double mastectomy after testing positive for the gene mutation BRCA1.

“Knowing that many other women have been through this helped for sure,” Delia said. “[But] what I appreciate is that she is sharing this information and bringing more awareness and discussion to the issue.”

Local reactions mixed

Jolie’s announcement has also reverberated — with mixed reactions — among local medical professionals.

Kelly Morse of ProMedica’s Hickman Cancer Center at Flower Hospital, Northwest Ohio’s only board-certified genetic counselor specializing in cancer, said she thinks Jolie will be a positive role model for local women.

“Some women are very attached to their natural breasts and see that as an important part of themselves as a woman and it’s very difficult emotionally to wrap their heads around losing them,” Morse said. “Other women are of the mindset that they will do anything to remove the risk and basically say, ‘How soon can we get this done?’ Every woman is just very, very different.

“[Jolie’s announcement] should at least allow women to start asking questions and if maybe they didn’t think surgery was right for them a few years ago, maybe they will revisit that and decide it’s the right thing for them now. Or if they were never tested but know it’s in their family, maybe they’ll think it’s the right time to come back in for testing.

“Just being in her position, as an actress, where physical appearance is obviously very important, that she was able to go ahead with that surgery, I think it’s really empowering,” Morse said.

However, that same awareness could be “a double-edged sword,” said Dr. Nasfat Shehadeh, medical director of Mercy Cancer Centers at St. Anne and St. Charles.

Preventative mastectomies have become more common during the past seven years as more people become aware of the option and as reconstructive methods improve, but it isn’t the best choice for all women, Shehadeh said.

Shehadeh

“It’s an extreme measure,” he said. “It might even be an extreme measure in patients with a mutation. I think what [Jolie] has done is very reasonable; it will decrease the risk of breast cancer without question. But a study done in Europe showed it didn’t have an impact on overall survival. It can also have a significant psychological effect on the patient and the spouse.

“We have to make sure the patient is really well-informed and understands the consequences. We have to understand that the vast majority of patients will do fine with just a lumpectomy if cancer is detected early. We are overdoing mastectomies and I hope we won’t see a second rise of mastectomies because of this story.”

One in eight women

One in every eight women, or 12 percent, will be diagnosed with breast cancer, but those with the BRCA1 or BRCA2 mutation are five times more likely to develop the disaese, said Shehadeh, adding that only about 5 to 7 percent of breast cancer cases are genetic.

The genetic test is called BRACAnalysis and is done by only one company, Myriad Genetics Inc. in Salt Lake City.

Not everyone is a candidate for BRACAnalysis and not every cancer patient is tested, Shehadeh said.

Younger patients and those with multiple diagnoses in their families are likely to qualify for insurance coverage, but there are many criteria, said Morse, who said she consults with about 10 people per week, typically with a doctor referral.

The initial test costs $4,040, Morse said.

Once a genetic mutation is identified, the test for family members can be set to hone in on that particular gene, making it less expensive, about $475, Morse said.

Delia underwent genetic testing after her father was diagnosed with stage IV prostate cancer in 2010. Both were found to be positive for the BRCA2 gene mutation.

Her father’s sister, also BRCA2 positive, had breast cancer, and three of her father’s aunts died of breast cancer, one at age 30, Delia said.

“When people hear about my surgery, even medical professionals, they always ask ‘Did your mom have cancer?’ No. ‘Your grandma?’ No,” Delia said. “Cancer on the father’s side of the family matters just as much as cancer on the mother’s side.”

Road to recovery

Although she trusts she made the right decision, Delia said the physical recovery process as well as the emotional and psychological process of adjusting to her new body will take time.

“All along, I fantasized about the relief I would have once my surgery was over. I thought my anxiety would lessen and this huge weight over me would finally disappear,” Delia said. “[Instead] I felt a lot of discomfort and sadness. I know I did the right thing, but to expect relief in the short term was short-sighted.”

She does count the timing of her surgery as a blessing as it allowed her to spend time with her father, who died in April, shortly after her second surgery.

“I spent the last two weeks of his life with him almost nonstop,” Delia said. “Had I postponed the surgery, I would have been at work. I believe I was meant to have the surgery when I did.”

Everyone copes with a cancer diagnosis or a positive BRCA test result differently, Morse said. National support organizations like Bright Pink and FORCE (Facing Our Risk of Cancer Empowered) help many people, she said.

“We can’t change or correct our genetics right now,” Morse said. “We have to cope and deal with whatever hand we’re dealt.

“That’s why I personally feel it’s important for these families to see the expertise of a genetic counselor, not just for medical but for emotional support.

“It’s a pretty personal choice.”

Tags: Angelina Jolie, BRACAnalysis, BRCA1, breast cancer, Flower Hospital, Hickman Cancer Center, Kelly Morse, Marcie Delia, Mercy Cancer Centers at St. Anne and St. Charles, Nasfat Shehadeh, ProMedica, The New York Times

This entry was posted on Thursday, May 16th, 2013 at 2:20 pm and is filed under Community, Health Care.
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The newest (and most controversial) idea to fight America’s growing obesity epidemic is to shame overweight people into getting thin.

The proposed strategy could include a social campaign that would pose difficult questions, one of them being, “Fair or not, do you know that many people look down upon those excessively overweight or obese, often in fact discriminating against them and making fun of them or calling them lazy and lacking in self-control?”

Bioethicist Daniel Callahan is the scholar behind the idea of putting social pressure on heavy people, which some are calling “fat shaming.”

He argues that it worked with smoking, and could inspire overweight people to commit to eating healthy, exercising regularly ?– and then sticking with it. Currently, obese people are oblivious to their problem because they look like everyone else, he said.

“As a smoker, I was at first criticized for my nasty habit and eventually, along with all the others, sent outside to smoke, and my cigarette taxes were constantly raised,” he wrote in the article, “Obesity: Chasing an Elusive Epidemic.” “The force of being shamed and beat upon socially was as persuasive for me to stop smoking as the threats to my health.”

Local health providers disagree, calling it unproductive.

“Most of my patients who are overweight or in the obese category are pretty well aware of their situation and it is not necessary to point out or individualize a person in that situation,” said Dr. Matt Roth, medical director of ProMedica Wellness.

Actually, the opposite is the best strategy. Instead of criticizing unhealthy behaviors, ProMedica employees are rewarded for healthy behaviors.  The idea is to engage them with an incentive and then hope they are inspired by intrinsic motivators to continue the lifestyle change.

“People are in different stages of readiness to make a change,” said Laura Ritzler, co-director of ProMedica Wellness. “Sometimes they need to move along slowly, and shaming them doesn’t move them along.”

Roth also said weight doesn’t determine overall health. Thin people who aren’t eating healthy or exercising regularly are in danger as well. He recommends small changes for all sizes because people can’t go from unhealthy to totally healthy in just a few days.

“I tell my people that the goal is 30 minutes of exercise every day, but if they could just start with 5-10 minutes every day,” Roth said.

Changes could include using the staircase instead of the elevator and parking farther away. As for adjusting one’s diet, even just cutting down to one soda per day would result in a caloric deficit, Roth said.

At ProMedica, Ritzler said employees participate in a challenge that allows them to get points for keeping a food diary and weighing themselves once per week, which are both actions that can lead to weight loss.

Some overweight people already have a poor self-image, and shaming them will make them feel worse and possibly lead to emotional overeating, Ritzler said. Also, a weight-loss program structured around the “biggest loser” concept could lead to people starving themselves and eventually returning to their old ways.

Ritzler said ProMedica is willing to bring this challenge into other workplaces. Work sites are great places for such initiatives because employers want their employees to be healthy and can provide incentives to jump-start the journey.

“People are a captive audience at a work site and have the social support of employees,” Ritzler said.

Plus, there’s no shame in trying to make it fun.

Email questions or comments to Toledo Free Press Community Ombudsman Brandi Barhite at bbarhite@toledofree press.com.

Tags: Brandi Barhite, Community Ombudsman, Fat Shaming, obesity, ProMedica

This entry was posted on Saturday, February 2nd, 2013 at 8:00 pm and is filed under Community, Community Ombudsman.
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Take me out to the hockey game?

Fans typically flock to Fifth Third Field to watch the Toledo Mud Hens play baseball, but in late 2014 that will not be the case.

The Toledo Walleye announced Oct. 11 that hockey will move from inside the Huntington Center to Fifth Third Field as part of Winterfest 2014.

The outdoor game, scheduled for Dec. 27, 2014, will be part of a 10-day Downtown festival, beginning Dec. 26, which will showcase an outdoor ice rink assembled on the field.

“The Toledo Walleye are thrilled to host this unprecedented outdoor event,” said Joe Napoli, president and general manager of the Walleye and Mud Hens at a press conference Oct. 11. “Our fans have been clamoring for an outdoor hockey game and the Toledo Walleye Winterfest is the perfect way to showcase old-school hockey while also featuring other winter sports and events.”

ProMedica is sponsoring the festival.

Kevin Webb, president of ProMedica’s Toledo Hospital, said Winterfest will be working with venues such as the Toledo Museum of Art, Imagination Station, The Toledo Zoo and the Toledo Symphony for the 10-day festival.

“The community can expect this to be one of the best events that Downtown Toledo has seen in years,” Webb said at the press conference.

While specifics are still being planned, there will be other winter and family-oriented events throughout Winterfest. In addition to hockey, Winterfest will feature an outdoor open-skate at Fifth Third Field or the Huntington Center as well as activities such as broomball, curling, live music, ice sculpture demonstrations and fireworks.

“This event is all about our community and our region,” said Randy Oostra, president and CEO of ProMedica. “We are extremely proud to be able to present a week of family-oriented holiday activities that will showcase our city and its finest attributes as well as generating a significant positive economic impact for our community.”

The concept of an outdoor hockey game is not new, as the game started on frozen ponds and rivers.

The first NCAA outdoor hockey game was on Oct. 6, 2001, between the Michigan State Spartans and the University of Michigan Wolverines. “The Cold War” ended in a 3-3 tie.

Since 2008, the NHL has hosted its annual Winter Classic on or around New Years Day. The first Winter Classic was held in Orchard Park, N.Y., between the Pittsburgh Penguins and Buffalo Sabres.

The 2013 game, which is in jeopardy due to the current NHL lockout, is scheduled to be at Michigan Stadium in Ann Arbor and will feature the Detroit Red Wings facing off against the Toronto Maple Leafs.

For more information, visit toledowalleye.com/winterfest.

An artist's rendering of the Winterfest Walleye hockey game planned for Fifth Third Field in December 2014. Illustration Courtesy Toledo Walleye

Tags: Fifth Third Field, hockey, ProMedica, Toledo Walleye, WinterFest

This entry was posted on Monday, October 15th, 2012 at 12:11 pm and is filed under Community, Sports, Walleye hockey.
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The United Way of Greater Toledo aims to raise $13.8 million during its 2012 campaign.

Geoffrey Canada, an education innovator and founder of the Harlem Children’s Zone, is set to speak at the campaign’s kickoff at 7:30 a.m. Sept. 11 at the Hilton Garden Inn in Perrysburg. The Harlem Children’s Zone emphasizes community and parental involvement, early childhood education and afterschool programming to support children from birth on.

“We have not had someone like that at our kickoff in eons. I really cannot remember. I’ve been at this United Way for more than 30 years and this is one of the more exciting kickoffs I can remember,” said Jane Moore, interim president and CEO.

Randy Oostra, president and CEO of ProMedica, will serve as chair of the campaign. The campaign sum will aid in supporting the United Way’s goal of helping children graduate. The organization, which helps support other groups and encourages volunteering, factors in how education, income and health affect graduation rates in Lucas, Wood and Ottawa counties. In Toledo Public Schools, the graduation rate was at 80.5 percent for 2009-10, according to the Ohio Department of Education.

“We’re looking at [graduation] in a very holistic way. Kids can’t learn if they’re hungry. Kids can’t learn if they don’t know where they’re sleeping. Kids can’t learn if their families aren’t healthy,” Moore said.

Last year, about $13.6 million was raised for the campaign, up 1.5 percent from 2010, but still short of the same $13.8 million goal. About 30,000 donors contributed in 2011.

Oostra said while he is aware that times are tough, “I’ve never done this before so I’m optimistic.”

One of the ways United Way could meet its goal is through its matching grants, Moore said. For the leadership matching grant, ProMedica and the United Way Board of Trustees, will match new gifts made at or increased to $1,000 (leadership level) or more for up to $100,000. They will also match the increased amount of existing leadership level gifts for up to $100,000, according to a news release.

For the education matching grant challenge, Medical Mutual of Ohio, The Blade and BP-Husky Refining, LLC will match designations of $100 or more to United Way’s education-focused area for up to $100,000.

For the health matching challenge grant, HCR ManorCare, Mercy, University of Toledo Medical Center and ProMedica will match designations of $100 or more to United Way’s health-focused area for up to $100,000.

For the income matching challenge grant, the Hylant Group, Findley Davies and Fifth Third Bank will match designations of $100 or more to United Way’s income-focused area for up to $50,000.

Oostra has worked with United Ways in different capacities for more than 30 years. “People have ideas sometimes of what United Way is, but it’s really radically changed over the last decade,” he said, adding that the organization focuses on very specific results.

The United Way’s second annual Week of Caring (up from the standard Day of Caring in the past) began Sept. 10. More than 1,400 people from 40 companies are slated to volunteer this week. Oostra said he expects to help out at a local school’s garden.

When he worked with a United Way for the first time more than 30 years ago, “My boss at the time told me it would be one of the best experiences of my life and it was,” he said.

“I can tell you, Randy has really thrown himself into this and has been an extremely visible and willing leader,” Moore said of the new campaign leader.

The Andersons, Inc., Consultants in Laboratory Medicine, Fifth Third Bank, Health Care REIT, Inc. and Owens-Illinois are sponsoring the 2012 United Way Fellow Program, so the organization can temporarily expand staffing during the campaign.

For more information, visit www.unitedwaytoledo.org. The majority of campaign donations will be wrapped up in November, but the final sum isn’t expected to be released until February.

Tags: BP-Husky Refining, Consultants in Laboratory Medicine, Fifth Third Bank, Geoffrey Canada, Health Care REIT, Medical Mutual of Ohio, Ohio Department of Education, Owens-Illinois, ProMedica, Randy Oostra, The Andersons, United Way

This entry was posted on Tuesday, September 11th, 2012 at 8:20 am and is filed under Community, Philanthropy.
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About 40 area teens have been learning about the health care industry this summer as part of ProMedica’s Summer Youth Employment Program.

At Mayor Mike Bell’s encouragement, ProMedica hired the teens for a variety of jobs in the eight-week program. Their jobs included tasks in groundskeeping, patient care, pediatrics, the neonatal intensive care unit (NICU), transportation and even the surgical area (sterilizing equipment). Seven of the teens were referred by The Source, a local employment service. The teens, almost all from metro Toledo, worked 24 hours a week and received minimum wage.

The teens, 16-19, were thoroughly screened and ProMedica received more than 120 applications, said Wendy Papenfuss, the director of workforce planning at ProMedica.

The program was celebrated Aug. 1 at Ottawa Park. The teens were fed CityBBQ and listened to remarks by Randy Oostra, CEO of ProMedica, and Bell. Many of the teens’ supervisors also attended.

“They’ve fallen in love with these kids. They don’t want them to leave,” Papenfuss said.

ProMedica CEO Randy Oostra at a barbecue for students in the Summer Youth Employment Program.

One of those supervisors is Connie Bahls, operations manager, who oversaw three teens, including Start High School student Caleb Self. Self is responsible for cleaning up the Renaissance Lobby this summer. He said the job, his first at Toledo Hospital, has taught him values like hard work and responsibility.

“[Visitors] say the place has never looked so good,” Bahls said.

Papenfuss and Oostra said they hope the summer program exposed the teens to the health care industry.

“It’s good for the youth as far as getting exposure to health care careers. I think it’s good as far as thinking about our future pipeline of employees. I think it’s a great thing to help support the city in these economic times,” Oostra said.

Jalyssa Parker and Saveenah Allen, both recent graduates of Horizon Science Academy Toledo, said the jobs have impacted their career goals.

“Honestly, we’re young so we wouldn’t really get a job in health care, so for us to like preview [health care jobs] is a great experience,” said Parker, who used to want to be a veterinarian and now wants to be a nurse.

Parker worked in the NICU. “I got to feed, hold, everything dealing with babies,” she said.

Both Allen and Parker said they formed bonds with patients and loved their experiences.

“When I would come back and they weren’t there, I’d be like, ‘Where’s so and so?’” Parker said, adding that she was happy when the patients were released, even if she missed them.

Allen, who will attend University of Toledo in the fall, worked in pediatrics. She had already been volunteering at ProMedica before she was hired for the summer.

When asked if she had a favorite moment in the program, she replied, “The whole thing, I just enjoyed it all.”

Papenfuss said the jobs also taught the teens some basic life skills. “What we’ve found is most of them didn’t have bank accounts so we’ve had to help them set up bank accounts so they’ve learned some very basic payroll and bank account skills,” she said.

She said ProMedica would definitely consider having the program again next summer and even expanding it. Papenfuss also said ProMedica is trying to hire 12 of the teens who already graduated.

Oostra said early jobs like these offer valuable lessons.

“We all look back on our experiences and those first jobs and the impact they’ve had on our lives. Having to get up and go to work every day, interact with people, dress appropriately, those are skills that if you don’t have that opportunity in life to be able to go to work and have those jobs and interact with people, you may not be able to learn those skills,” he said.

Tags: Horizon Science Academy Toledo, Mike Bell, ProMedica, Randy Oostra

This entry was posted on Thursday, August 2nd, 2012 at 1:47 pm and is filed under Community, Health Care, Toledo Business Link.
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Officials at Toledo hospitals say they were already seeking to improve areas criticized by a recent hospital safety ranking prior to the survey’s release.

Whether ranked worst in the state or mediocre in comparison, all local hospitals have room for improvement according to the report.

Consumer Reports, a nonprofit marketplace watchdog organization, released the rankings this month, which compared 1,100 hospitals across the country in six areas: infections, readmissions, communication, CT scanning, complications and mortality. The ratings were based on a 100 point scale, with the highest scoring hospital earning 72 points and the lowest receiving 25 points.

ProMedica’s Flower Hospital took the lead in Lucas County with 65 points and University of Toledo Medical Center ranked the lowest with 28 points. Mercy hospitals placed in between, with Mercy St. Vincent Medical System garnering 58 points and Mercy St. Anne Hospital collecting 56. In Maumee, St. Luke’s Hospital earned a 54.

ProMedica’s corporate director of quality, Linda Yielding, said the problem comes down to consistency.

“We can identify best practices but then everyone has to know about it and consistently apply it,” Yielding said. “There are certain things like a 15 second scrub of the hub before you inject the medication and yet sometimes people will not do that. It’s the consistent application of it that we’re trying to make sure happens every time — so that every patient gets the same practice. Every hospital struggles with that.”

ProMedica Toledo Hospital ranked on par or above average in most categories, such as avoiding surgical site infections. The hospital saw 10 such infections out of 2,453 surgeries performed between 2009 and 2010. Toledo Hospital also ranked well in appropriate use of CT scans, with only 5 percent of patients receiving double abdominal scans and 3 percent receiving double chest scans. Frequent CT scans are undesirable because of radiation’s link to cancer.

However, ProMedica ranked worse than the average hospital in communicating information about prescription drugs to patients. Confusion about prescriptions, which often leads to taking too little or too much, is the most common reason for unplanned re-admission, Yielding said.

But she pointed to one of the caveats of the Consumer Reports data: Much of the information reported covers numbers from 2010 or earlier. Check out ProMedica’s most recent policy about drug communication, she said, and you might find it merits a better ranking.

Patients at Toledo Hospital, for example, now go home with a comprehensive list of medications and dose changes. ProMedica is also working toward implementing a systemwide policy of “teaching back,” meaning that medical staff quiz patients before they leave not only on what they are taking but why, Yielding said.

‘Most recent data’

Dr. John Santa, director of the Consumer Reports Health Ratings Center, said he and his team worked with the most recent data available. He accumulated his information by combing state data, some of which is reported by health officials and some of which is taken in survey form by patients. His study could only include  a small percentage of America’s hospitals because 22 states have no laws requiring health institutions to report complications, errors and infections.

The Affordable Care Act changes this in a way by requiring hospitals being paid by Medicare to report central line infections to the government. But a full year’s worth of data won’t be available until 2013.

“One of the frustrating things here are that the hospitals are saying, ‘Well this isn’t current’ but it’s the most current information that they have agreed to release and if they would be quicker we would love to print more current data,” Santa said. “We’re used to other industries commonly trying to do as little as possible to provide any information about safety problems with their products. This is how industries deal with these issues. They don’t volunteer information about problems — but it’s disappointing that it turns out to be that way in the hospital.”

Ohio’s hospitals report infections acquired while in the hospital, surgical site infections during knee replacements, cesarean sections and open heart operations. Among other data, they also have to report figures on mortality during heart surgery and information about how their employees prevent infection, according to the Ohio Department of Health.

The Consumer Reports team has been collecting hospital safety data for four years now but this is the first publication that has ranked the hospitals. Santa said the Health Ratings Center will continue to add new information as hospitals report the latest figures to the government.

Scott Scarborough, senior vice president and executive director at the University of Toledo Medical Center (UTMC), said he is skeptical of the report’s fledgling nature. The medical center was ranked 18th in the state by US News & World Report Best Hospitals from 2012-13, with 53 percent of surveyed patients indicating they would definitely recommend the medical center to a friend.

Scarborough said the US News & World Report was “more time tested” and covered a larger sample size of hospitals. The magazine surveyed nearly 10,000 specialists and collected data on about 5,000 hospitals.

The Consumer Reports low ranking of UTMC surprised Scarborough because the system typically receives high marks, he said. Scarborough questioned the validity of the report’s data collection process, pointing out that some of the areas were not adjusted for risk.

Yielding had similar concerns about risk adjustment, but said ProMedica puts some “rather high stock” on Consumer Reports, particularly because it does not require hospitals to buy information or submit information directly.

“How can Cleveland Clinic be rated No. 1 in the state on US News & World Report and Consumer Reports ranks it seventh from the bottom?” Scarborough asked. “It causes us to suspect they didn’t get it quite right on this first attempt.”

Take risk into account

Scarborough would have preferred if the Consumer Reports numbers took risk into account, noting that UTMC takes in the sickest patients in the area. University medical centers take referrals from other institutions to treat more complicated conditions because of their teaching status and the specialists that are available, he said.

On average, UTMC patients are already taking 12 different medications before they even check in, Scarborough said.

The Consumer Reports survey put UTMC at worse than average in communication about drug information, room cleanliness, appropriate use of abdominal CT scans, avoiding surgical site infections, complications and re-admissions.

Avoiding infection can be as simple as creating a culture more observant of hand-washing. The medical center is still installing new machines that automatically wash your hands with soap and water when you place them before a sensor. Also, the hospital employs one and a half staff members whose job is solely to address the prevention of infection, Scarborough said.

The medical center has focused on effectively communicating drug information since 2010, improving the system by decentralizing the pharmacy department and moving pharmacists to the patient floors.

As for re-admissions, many are planned or are because the patient is elderly and his or her body is breaking down, Scarborough said.

And how about double CT scans? He said his doctors tell him that taking two scans, one with contrast and one without, often yields more comprehensive results because they can notice different issues with both methods.

The Consumer Reports overview lists excessive CT scans as a major problem in hospitals across the country. While some of the categories in the report are, in fact, adjusted for risk, CT scans are not. And because of the radiation, Santa said he doesn’t think they should be.

Some health officials argue that surveys should not adjust for risk at all because doing so makes it easier for hospitals not to take accountability for hospital-acquired infections and complications, he said.

Santa said he understands that university medical centers see the sickest patients.

“It’s not about arguing where the data came from and who’s got the sickest patients,” Santa said. “UT should call Baylor if they have concerns about the score.”

Baylor University Medical Center scored 67 out of 100. Texas does not require hospitals to report surgical site infections, but it does require bloodstream infection reports. Baylor logged four during 2010. Ohio does not require hospitals to report bloodstream infections. UTMC reported nine surgical-site infections out of 299 from 2009 to 2010 — 130 percent worse than national rates.

The Consumer Reports data took into account discrepancies in available types of data and differing numbers of types of treatments, Santa said.

Santa started with the Health Rankings Center four years ago, after 30 years as a doctor in the state of Oregon.

“I’m afraid I would have to admit, when I was practicing I was like many other physicians in that era and I didn’t know how preventable hospital infections were,” he said. “I’m sad to say that I told many patients that, ‘you know, these things just happen.’ But they don’t just happen.”

He said a patient, regardless of risk, should never get a punctured lung during a procedure or fall while in the hospital. But, he said, the areas in which hospitals tended to perform the worst were related to communication about drugs and hospital discharge.

Address root causes

Mercy hospitals scored both above average and worse than average on infections. Nine bloodstream infections were logged in and three surgical-site infections out of 171 surgical procedures between 2009 and 2010 at St. Anne Hospital.

Mercy St. Vincent Hospital earned higher scores in those departments.

Charla Ulrich, director of quality at Mercy St. Vincent Hospital, said it is important not to make health care choices based on one survey. She pointed out The Leapfrog Group as another type of health institution scoring system that Mercy inspects.

The survey’s most recent reports indicate that Mercy St. Anne Hospital has made “some progress” at reducing ICU infections. The hospital fully meets standards in reducing hospital injuries, its steps to avoid harm and preventing medication errors. But the hospital ranked low on “managing serious errors.”

Ulrich said the hospital system looks at all surveys and rankings that are relevant to Mercy.

“Does it drive changes? Somewhat … sometimes. But overall I can’t say that it is the strongest indicator of the quality of care hospitals provide,” Ulrich said.

Santa said the health community as a whole needs to become better at addressing the root cause of errors and complications and eliminating infections and falls.

“We would acknowledge that we have set the bar high,” he said. “But even the best hospitals are re-admitting 16 to 20 percent with heart attack or failure or pneumonia, and we don’t think that’s a winning score.”

Tags: Consumer Reports, Health Rankings Center, Mercy, Mercy St. Vincent Hospital, ProMedica, ProMedica Toledo Hospital, ProMedica’s Flower Hospital, University of Toledo Medical Center

This entry was posted on Thursday, July 19th, 2012 at 4:21 pm and is filed under Community, Health Care.
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A group trying to change the government structure in Lucas County has until June 29 to obtain the 13,500 valid signatures of registered voters needed to get their proposal on the November ballot. The group is proposing a county charter form of government, with “home rule” for Lucas County.

Five co-leaders have taken charge of the effort, which they have titled “Better Lucas County.” The effort is the product of many more citizens’ years of work, said one of the co-leaders, Robert Reinbolt, president and CEO of Reinbolt Consulting Group.

KeyBank, Fifth Third Bank, Mercy and ProMedica are some of the petition drive’s supporting organizations. The University of Toledo provided major research and facilities support for a study that spurred the proposal.

Reinbolt said there was a “citizens for effective government concept” that pushed for county reform two or three years ago. Dr. Richard Ruppert, another of the five co-leaders and former president of the Medical College of Ohio, said when that effort stalled, the county suggested a study be conducted.

“Sometime in early 2010, a former County Commissioner (Ben Konop) suggested that Cuyahoga County and their form of government might be worth looking into,” County Commissioner Carol Contrada said. “An independent group was constituted.”

Advisory group

Reinbolt and Ruppert were on the study committee that consisted of 35 members and met at least weekly for more than a year, Reinbolt said. There was also an advisory group that consisted of about 15-20 people, he said.

Contrada said Lucas County Commissioners Pete Gerken and Tina Skeldon Wozniak were briefed on the group’s findings in May 2011 and the study was released and published in June 2011. Reinbolt said the group met with all the cities’ and some township trustees, got their input and incorporated it into the charter that Neema Bell finalized. Bell is a co-leader and attorney and partner at Shumaker, Loop & Kendrick LLP.

“The advisory and study groups spent quite a bit of time leading up to where we finally got the report [and] recommendation, then it was decided earlier this year that we need to take it forward in terms of a petition drive,” Reinbolt said.

The other co-leaders are Scott Hamner, vice president-secretary and principal at Findley Davies, and Thomas Palmer, managing partner at Marshall & Melhorn, LLC. The co-leaders have been presenting and talking to different groups, Reinbolt said.

“All we’re saying is, here’s an idea that’s been through a lot of citizens and a lot of hours, and a lot of research [has been] done, so sign the petition, put it on the ballot, and let the voters decide,” Reinbolt said. “If we get enough signatures we’ll spend the summer making sure the voters know what it’s about.”

Ruppert said the reason for the proposed change isn’t that things in the county government aren’t going well, but that by adopting this charter, the government will improve.

The proposal

Currently, Lucas County citizens elect eight row officers — coroner,  auditor,  treasurer, prosecutor, engineer, recorder, clerk of courts and sheriff — and a three-member board of commissioners. The group is proposing a county charter in which citizens would instead elect a county executive, a nine-member county council and the county prosecutor. Six of the nine council members would represent six different districts in the county, which the group has divided based on population, and the remaining three positions will be at-large spots, open to representatives from any district.

The county executive would appoint the chief fiscal officer, medical examiner, engineer and sheriff, with confirmation from the council. The council would appoint an internal auditor, who would work with the chief fiscal officer, a position that combines the roles of recorder and treasurer.

“Look at how we do private industry, or public. We have a board; even in the public setting we have a chief executive, the mayor, and there’s a council,” Ruppert said.

“That’s what we’re doing now. We’re suggesting that form of government,” Ruppert said.

In the study, the group looked at the two other counties in Ohio that have a similar, charter form of government — Cuyahoga and Summit counties. Reinbolt said Delaware County has contacted him about pursuing a new form of government as well.

“In every case it looks like they were more efficient and more cost effective and they began to focus on countywide, ‘What can we do, collectively, to improve our situation?’” Ruppert said.

Summit County originally adopted a charter form of government in November 1979 but has acquired amendments and adoptions since then, according to ccao.org. Cuyahoga County citizens voted for their charter in November 2009 and it was fully operating in the county as of Jan. 1, 2011, according to charter.cuyahogacounty.us. Ruppert and Contrada said that Cuyahoga County adopted the charter because there was corruption within its county government.

Ruppert said on a per-capita basis, Summit County’s costs of public funding dollars are 20 percent lower than Lucas County’s. Ruppert said the group did not perform a study to discover why that was.

“The committee lacked the resources and time to perform an in-depth analysis of each office, department and agency to ascertain efficiencies that could be achieved by reorganization. These analyses can be left to other groups in the months ahead. However, the committee did draw high level comparisons between Lucas and Summit counties because of their general similarity,” stated the report available at lucascountystudy.org in reference to cost comparisons between Lucas and Summit counties.

Economic development

Reinbolt said that the main purpose for the reform is not to save money, although he said he believes that will happen if this new structure is implemented.

“I can’t really say any cost analysis was done,” Reinbolt said. “It will probably save around $200,000-$300,000 a year but it could very well save more as we consolidate positions. It’s not intended to be driven by saving money, as the main purpose is not to save money. The main purpose is to have a more responsive government.”

Bell said with the charter, there is “every likelihood of economic development countywide.” Bell said it’s an opportunity for job development and a way to keep talented youth in the Toledo area.

“As we have it now, we have row offices; we’ve got all elected officials, none of whom are responsible to anyone other than to the citizens. It doesn’t channel up. With this new form of government, there would be one go-to person with whom the buck stops, which makes it easier to coordinate efforts throughout the county with the various branches. It makes it more efficient for businesses who want to come do business with the county,” Bell said.

Contrada said the report acknowledged that from 2008-11, the county cut more than $20 million from its budget.

“Then [the report] says the ‘committee is not aware of commensurate decline of services,’” Contrada said. “They are making the case that the county has been able to institute efficiencies without the reform.”

Contrada said the group had one good recommendation that the county is already looking into, and that is the internal auditor position.

“You have a lot of different offices that deal with budget and fiscal matters. By having an internal auditor, it makes sure there is a standard, transparent, consistent methodology in use. It helps efficiency from one department to another,” Contrada said.

Skepticism

Sylvania City Councilman Doug Haynam said he is “very skeptical about the proposal,” which was presented to him in November. Haynam said he thinks the proposed structure will cripple political diversity and fair representation.

“One concern I have is the extreme centralization of power within a single executive,” Haynam said. “He is more likely to appoint friends and political buddies instead of qualified people. The executive would be more likely to appoint someone who has contributed to his campaign and would use the positions as political patronage. Trusting in the good faith of a single executive — most people with government experience understand that that would not be a reasonable place to put trust.”

Haynam said he is also wary about the home-rule aspect of the charter and the supposed cost-effectiveness of the change.

Reinbolt said townships, villages or cities that have home-rule capabilities now will not be superseded by the new governmental structure.

“The home-rule is a provision of state law that allows you to establish a law or rule that would supersede something the state or county has in place,” Reinbolt said. “Right now, the county has to go by the charter established for all counties in Ohio. With this [new charter], we could put different laws into place, once approved by the council and a referendum by voters.”

Haynam said the proposal is “change for change’s sake.”

“I don’t have anything to lose or gain [from this],” Haynam said. “It just really isn’t a good idea. The fact that they did it in Cleveland doesn’t mean it’s a good idea here. In Lucas County, we have a well-functioning county government. What we have going here works pretty well.”

Kevin Haddad, Sylvania Township Trustee and President of the Lucas County Township Association, said he wants change in the county government system, but not by way of the proposed structure. When he ran for county commissioner in 1996, Haddad said he and a township trustee created a plan to change the three-member board to a five-member one.

Haddad said he thinks that the three at-large spots of the proposed plan will most likely go to Toledo city representatives, unfairly excluding the other county districts.

“I’m not happy with the three board member [structure] right now, but if we’re going to change the county government, let’s look at something to be fair. With a nine-member board, it’s going to be Toledo City Council running it,” Haddad said.

On the web: visit www.betterlucascounty.com for more information.

Tags: Ben Konop, Carol Contrada, Doug Haynam, Fifth Third Bank, Kevin Haddad, KeyBank, Lucas County, Mercy, Neema Bell, Pete Gerken, ProMedica, Richard Ruppert, Robert Reinbolt, Scott Hamner, Thomas Palmer, Tina Skeldon Wozniak

This entry was posted on Friday, June 22nd, 2012 at 12:00 am and is filed under Community, Lucas County.
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DEFIANCE — Step inside Kaitlyn’s Cottage behind ProMedica’s Defiance campus and the high ceilings, granite countertops and rich wooden floors will wow you.

That is, if the front deck that winds around the wood and stone exterior of the building hasn’t already.

But here, tucked away from the hospital hustle and perched at the edge of a dark and tall forest, what truly matters is the space to roam those wooden floors and the messes that will soon pile up on those countertops.

Kaitlyn’s Cottage opens June 26 to serve as a respite center for 16-to-40 year olds who have intellectual and physical disabilities. Guests can visit for a few hours or stay overnight in one of the four bedrooms. Staff will work with guests on a one-on-one basis, offering two frequently changing scheduled activities daily, said Marsha Kott, the program manager.

The building cost $1.9 million, an amount partially subsidized by ProMedica Defiance Regional Hospital, funded by donors and mostly fueled by Sharon and Dan Farrell, a Defiance couple who has an 18-year-old granddaughter with a disability. Her name is Kaitlyn.

Kaitlyn Shock

The two also started an endowment fund, which has accumulated $1.5 million, to help families afford to send their relatives to Kaitlyn’s Cottage.

“This is an idea that I thought about years ago and it was because of our Kaitlyn, seeing a need for a place like this,” Sharon Farrell said. “When young people like Kaitlyn come out of school, there’s nothing left, there’s no place … nothing for them to do … there are no options.”

Filling the gap

Parents of children with disabilities often struggle to fill the gap during the period following high school graduation. They are faced with finding a new social outlet for their kids or new programs to challenge them, said Frances Diehl, director of respite services for those with disabilities at Kaitlyn’s Cottage.

She said her little brother had a disability and her family saw him regress as her parents searched for a new outlet for him once he graduated.

Kott said the chance to socialize becomes strained after graduation.

“As they exit the school setting, if they don’t have the option to go onto other workshop settings and things like that, they’re limited to as to their friendships and the people they can be with,” she said.

Parents also suddenly have less time for themselves — not that they had much before — and couples often struggle to find time for a simple dinner date. Farrell said Kaitlyn’s Cottage gives parents the opportunity for their own respite.

But it’s difficult for parents to feel comfortable leaving their offspring with strangers, sometimes even at respite centers, said Cris Shock, Kaitlyn’s mother. She, her spouse Josh and her three daughters are a unit, and they all know how to communicate with Kaitlyn, she said, whereas strangers might not.

Kaitlyn has Rett syndrome, a nervous system disorder that leads to development reversals particularly in language and hand usage. The disorder almost exclusively affects girls. Kaitlyn does not talk, has never walked and has limited function in her hands, but Shock said she always knows what Kaitlyn is thinking because of her expressive eyes.

The staff at Kaitlyn’s Cottage learned communication styles firsthand through more than 40 hours of training. Kott said she assigned each trainee a particular disability to prompt the individual to problem solve just like their future guests. Kott gave the group sparse help, pushing them to decipher which communication cues would work to get the attention of their caretakers. For example, Kott left one “non-ambulatory” and “non-verbal” trainee in the kitchen alone so she had to figure out how to alert Kott that she was left behind.

After the exercises, the group discussed how it felt to be excluded. The idea is that once the employees know how they communicated thoughts when saddled with a disability, they would be able to pick up on those same cues from their guests.

Freedom of choice

Communication enables one of the most important aspects of Kaitlyn’s Cottage: choices.

“I’ve had students who were growing up in an environment where they’re afraid to say no and the first time my one guy said ‘No,’ I was thrilled,” Kott said. “It’s that freedom of choice — making a purposeful, functional concrete decision.”

Scheduled activities for a day might include making pottery, baking cakes, making crafts, playing music or engaging in games. For guests who have limited control of their hands, the staff can use objects that are activated when the guest pushes a button, such as a pair of electric scissors that the employee holds but depends upon the guest to power them.

But Kott said staff will ask guests if they want to partake in the activities or do something else. If someone needs quiet time, a reflection room flanks the living area for some solitude. The guests who cannot communicate with words will use cards with icons. The trained staff can notice which icon the guest prefers based on the guest’s eye contact, Kott said.

Kaitlyn just graduated with her class from Defiance High School; she will continue attending school until she is 22-years-old. After that? Shock said she feels comforted knowing that Kaitlyn’s Cottage will be waiting.

Tags: Defiance, Kaitlyn’s Cottage, ProMedica

This entry was posted on Thursday, June 21st, 2012 at 3:30 pm and is filed under Community, Health Care.
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Mercy Health Partners recently opened two new surgical suites with amenities specifically for robotic surgical procedures.

The $2.5 million da Vinci Si will be used at St. Vincent Mercy Medical Center on Cherry Street along with one of Mercy’s older da Vinci models.

In 2002, Mercy was the first hospital in the area to acquire the da Vinci robotic surgical system and is now the only area hospital to use the Si, which Mercy acquired in 2009.

With the da Vinci Si, surgeons maneuver instruments at a console, while instruments at the patient-side cart perform movements in sync with the physician.

Director of Robotics Dr. Mirza Baig, who specializes in urology and pediatric urology, said the cutting-edge da Vinci Si is used for gynecology, urology, cardiovascular and some general surgical procedures.

“We’ve sort of collaborated all the specialties and took an integrated comprehensive approach to robotic surgery here,” Baig said. “When patients come, regardless of the specialty, regardless of the case, it’s a similar type of experience that they end up getting.”

Baig said this is done through a nurse navigator, who walks the patient and family through the entire process and is there before, during and after surgery. He said another is a full-time robotic supervisor who is constantly behind the scenes working with the technology and patient care.

Also, Mercy has implemented new ways for surgeons to track their results and increase their expertise.

Baig said the Si’s camera distinguishes the system in robotic surgery technology.

Director of Robotics Dr. Mirza Baig

“What’s unique about the Si is the visual acuity, the camera that it uses,” Baig said. “The optics are unmatched. It’s 3-dimensional, high definition and … it’s the clearest picture you can get.

“It’s also magnified by 10 times, so you can imagine the technology of magnification and precision you can get from these types of surgeries.”

One of the other differences between the da Vinci Si and its elder counterpart is that the da Vinci Si has two consoles, allowing two physicians to collaborate and use the system during surgery.

“We take training and medical education very seriously here,” Baig said. “I sort of equate it to driver’s education, where the teacher has the emergency brake. They’re able to switch controls back and forth.”

Baig said the No. 1 reason Mercy purchased the da Vinci Si was for its single-port technology.

“All of this is minimally invasive, all of this is through small tiny incisions, [and] now you can take it a step further and just do it through one incision,” Baig said. “Through a belly button incision you’ll get surgery without a scar, that’s the idea. That’s specific to this robot. We purchased this technology and we’ve performed the first single sight robotic surgery in town, and we’ve done several now and it’s gone well.”

Mercy is also using Firefly technology as part of the da Vinci Si. Firefly technology allows physicians to inject the patient with a dose of green dye. Normal organ tissue is colored green while tumor tissue isn’t. This allows surgeons to more precisely determine what to remove.

Baig said since the da Vinci’s implementation at Mercy almost 10 years ago, about 1,700 robotic surgeries have been performed.

“We have approximately 21-22 surgeons that are actively doing cases and others that have showed interest in learning robotic surgery, because the benefits are clear to the patients: smaller incisions, less blood loss, quicker recovery time, quicker return to work, all compared to open surgery,” Baig said.

Baig said measuring the success of the da Vinci can be misleading because of the common misconception that the robot is doing the surgery, not the surgeon. Baig is quick to clarify that the Si is a tool and cannot replace the surgeon.

“If the surgeon is capable and well trained, then the robotic surgery, compared to open surgery, is safer,” Baig said. “So the success sort of has different variables that affect it. There are many studies that were performed where the same surgeon has compared his open surgeries to his same robotic surgeries and the benefits and success have been clear.”

ProMedica acquired its first da Vinci in 2008, Director of Surgery and Endoscopy Michelle Ziegler said. ProMedica now has two da Vincis that are used for urology, gynecology and vascular surgeries.

“As we see that robotic surgery is increasing along with the need for it, we have a committee continuing to look at it and the options for the new technology,” Ziegler said.

Tags: da Vinci Si, Mercy Health Partners, ProMedica, St. Vincent Mercy Medical Center

This entry was posted on Thursday, May 31st, 2012 at 3:03 pm and is filed under Community, Health Care.
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“The Classic,” ProMedica Toledo Hospital’s only annual fundraiser, has supported its Breast Care Center for the past two years, but this year’s event has a new focus: Heart and Vascular Institutes.

“We wanted to do a fundraising golf event back in 2009,” said Mary Sabin, executive director of the Toledo Hospital Foundation. “But we wanted the event to have a twist. We will have ‘celebrity’ golfers from the hospital this year competing in a wacky nine-hole putting contest.”

2011 Classic

Every two years, ProMedica Toledo board members and event volunteers direct funds received from The Classic to a new branch of the hospital in order to meet the needs of the facility’s 11 clinical areas. Right now, the heart health of Lucas County is one of the most pressing medical issues.

“Heart and vascular health tends to stay in the background [of medical awareness],” Dr. James Bingle, president of ProMedica Heart and Vascular Institutes, said.  “The truth is, we in Northwest Ohio have a troubling pool of people in high risk of heart disease. As such, we take it upon ourselves to educate the area.”

Heart disease and stroke accounted for 34 percent of Lucas County deaths from 2006-08, according to the 2011 Lucas County, Ohio Health Assessment Project commissioned by Healthy Lucas County for the Hospital Council of Northwest Ohio. The report also stated that approximately 34 percent of Lucas County adults have been diagnosed with high blood pressure, 27 percent with high blood cholesterol and 35 percent were obese — three known risk factors for heart disease and stroke.

In 2011, 24 percent of Lucas County adults were reported as being current smokers — a rate that exceeds the smoking rate the United States. The American Cancer Society stated last year that tobacco use was the most preventable cause of disease and early death, but still accounts for approximately 5.4 million deaths each year.

“Those staggering statistics are why we are redirecting the fundraiser to the Heart and Vascular Institutes,” Sabin said. “This way, we can inform and help the members of the community take care of their hearts.”

ProMedica board members believe that despite the redirection of funds to the Heart and Vascular Institutes, The Classic’s success of the past two years will continue to grow.

The Classic raised nearly $200,000 for Breast Care Center during the course of two years. ProMedica was able to use that money to purchase a new ultrasound machine and a collection of blanket warmers for the clinic. The Breast Care Center’s stereotactic breast table also received a MultiCare Maximum Comfort Kit, which is a foam unit designed to enhance patient comfort during procedures.

“We’ve had extraordinary support from our community,” Sabin said. “About 50 to 60 sponsors, a mix of both corporations and individuals, are already involved for this year’s event. I expect us to make $200,000 this year alone.”

The money raised at the event will help the Heart and Vascular Institutes open new programs, increase research and raise further awareness through education. The clinic, created only a year ago, specializes in cardiology and both cardiac and vascular surgery.

“We are extremely happy to be the receiver of this event’s fundraising,” Bingle said. “The money will truly raise the quality of our care. Up-to-date research and education keeps everyone attentive to new solutions.”

The Classic event will include a dinner and a putting competition. Live entertainment and a reception area will be available for guests who are not competing. The top golfers on the leader board will have the chance to win multiple prizes, including two tickets to the 2013 Masters golf tournament practice round or the opportunity to “design a golf course” with Arthur Hills, a renowned course designer.

A live auction will also be held with several items up for grabs, such as a pair of Detroit Red Wings tickets and a week-long stay at a condo in Fort Myers, Fla.

Guests can also participate in the “Raise the Paddle” auction, where individuals can bid on various healthcare packages that will be donated to patients in need. The funds raised will go to help underinsured or uninsured patients pay for their prescription medicine and transportation to the hospital.

“Raise the Paddle” raised almost $20,000 last year and the money was used to fund mammograms for patients unable to afford them. Those funds helped 50 women receive mammograms who would have otherwise gone without the screenings, said ProMedica Toledo spokesperson Tedra White.

Businesses looking for another way to donate can register to be sponsors for The Classic. Sponsorship packets can be downloaded from ProMedica.org.

The third annual event will take place  at the Belmont Country Club in Perrysburg on May 30. Businesses and individuals who are interested in being a sponsor for the event or placing a donation can contact Sabin at (419) 291-7473 or mary.sabin@promedica.org.

Tags: Breast Care Center, ProMedica

This entry was posted on Thursday, May 24th, 2012 at 2:42 pm and is filed under Golf, Sports.
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