It’s been an interesting few weeks of ups and downs on the COVID-19 front. Our hospitalizations have stabilized somewhat from a high of 11 earlier this month, but positive test results in all three of our counties continue to climb.  

Sadly, we also experienced the first two deaths of Central Oregon residents from the virus, one in Crook County and one in Deschutes County. Our thoughts go out to the families and friends of these individuals and all those suffering due to impacts from the ongoing pandemic.

In addition, Deschutes County reported the first known outbreak in a local memory care facility. Our team was happy to provide testing and other support as part of the response effort and has been proud of how Mt. Bachelor Memory Care has handled the difficult situation. Again, we hold those dealing with these infections in our hearts.  

Explaining the numbers

As of this morning, we have seven patients hospitalized with COVID-19 and five of them are in the Intensive Care Unit. Since we started releasing this information to the public regularly, we have had a lot of questions that show we need to put the numbers into context.  

In order to best group and care for COVID-19 patients, we made the decision early on to treat all positive cases at the Bend hospital and we are continuing to follow this practice. We have 24 ICU beds in Bend and six in Redmond for a total of 30 throughout the health system. So, while having five COVID-19 patients in the ICU may seem like it’s not too big of a deal, it is important to remember that many patients need ICU care for other reasons like heart attacks, strokes or car accidents.

Today, 20 of our 30 ICU beds in the system are occupied.

When virus numbers climb, we do become concerned about the long-term impact on our patients, caregivers and community. This is where your actions continue to make a huge difference in our success. We appreciate all those of you who are doing your part to stay home when possible, wear a mask when in public, wash your hands frequently and physically distance from those not in your immediate households.

Just like you, we at St. Charles are learning how to live in this next phase of our reality. We must manage an ongoing response to the pandemic while also providing critical preventive care services, much-needed surgical services and more to our communities.

It is a never-ending balancing act – with the top priority being to keep our patients and caregivers safe.

Thank you for your ongoing support throughout this very difficult journey.  

Sincerely,  

Joe

Grand Rounds - July 17, 2020
"Telemedicine"

Speaker: Jesse Pines, M.D., MBA, MSCE, Director of the Center for Healthcare Innovation & Policy Research, Professor of Emergency Medicine and Health Policy, The George Washington University School of Medicine & Health Sciences

Objectives:

1. Describe the overall landscape of telemedicine and use cases
2. Analyze the shift that has occurred in the past few months with the Covid-19 pandemic
3. Explain what the future of telemedicine will look like in the short-run and long-run

Accreditation: St. Charles Health System is accredited by the Oregon Medical Association to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

Grand Rounds - July 10, 2020
"Ventilator Associated Pneumonia"

Speaker: Antonio Anzueto, M.D. Chief, Pulmonary Disease Section, The South Texas Veterans Health Care System Professor of Medicine University of Texas Health Sciences Center at San Antonio

Objectives:

1. Discuss the incidence, etiology and risk factors for ventilator-associated pneumonia

2. Describe symptoms, pathophysiology and diagnostic tests

3. Review effective strategies for prevention & treatment based on clinical guidelines

4. Recognize that preventing ventilator-associated pneumonia improves patient care outcomes & decreases healthcare costs

5. Appropriately care for patients with increased risk of VAP, such as the elderly patent and very young patient

Accreditation: St. Charles Health System is accredited by the Oregon Medical Association to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

What happens next in the COVID-19 pandemic is up to us. 

That was Gov. Kate Brown’s message yesterday to our news media here in Central Oregon, where the number of COVID-19 cases is on the rise.

At St. Charles, COVID-19 hospitalizations rose dramatically last week, nearly doubling from six to 11 in a 24-hour period. We have been preparing for such a surge for months and have capacity to treat many more COVID-19 patients while still caring for anyone who might come through our doors. But the concern is the exponential growth. Prior to this month, we saw at most 40 new cases in a week. In the most recent seven-day period, we saw 106—and there is no sign of it slowing.

We know we can curb the transmission of the virus by wearing face coverings, maintaining our physical distance from others and washing our hands. But this concerning rise in cases and indeed the number of COVID-positive patients in our Bend hospital tells us that too few people are heeding this public health advice. (You can now check our number of hospitalizations daily here.)

Some people believe that the dropping mortality rate of COVID-19 is evidence that the virus is not as serious as we once thought. The reality is the mortality rate now is lower than what we saw earlier in the pandemic because the most recent uptick in cases is among the very young and healthy—folks in that 20 to 40 age group. As the number of cases go up, however, there is reason to believe the virus will find headway into our more vulnerable populations. 

In an interview with The Bulletin Monday, the governor stressed that we are at a critical juncture in our response. If we don’t act now to minimize our risk of exposure, she’ll have no choice but to close businesses once again.

“Behavior needs to change,” she told the newspaper. “If it doesn’t change, it will overwhelm our health care system. My tools are limited. I can close businesses down. I can close medical and dental clinics. I don’t want to do that.

“If we can work together to slow the transmission, to slow the number of cases, I won’t have to take more restrictive action. It’s up to all of us.”

Let me say it, too: behavior needs to change, or we will look no different than Arizona or Texas where health systems are being overrun and COVID-19 is taking more lives.

In a video posted to our social media channels over the Fourth of July weekend, Dr. Nathan Ansbaugh, one of our Emergency Department physicians, issued an urgent plea to the community: “In the last several days in the Emergency Department, I’ve taken care of half a dozen or so of new diagnoses of COVID,” he said. “My goal is not to point fingers; my goal is not to scare everyone. But my goal is to communicate an honest, somewhat desperation about what’s happening here and to ask that everyone who lives in this community takes care of this community.” 

St. Charles makes COVID-19 inpatient data available on website

BEND, Ore. – To help keep the news media and public informed, St. Charles Health System is sharing its COVID-19 inpatient data on its website at stcharleshealthcare.org/covid-19.

The data, which will be updated daily Monday through Friday, include:

• Number of hospitalized patients with COVID-19
• Number of COVID-19 patients in the Intensive Care Unit (ICU)
• Number of COVID-19 patients on ventilators

St. Charles continues to remind the public to wear a mask, as well as practice physical distancing and good hand hygiene, as the number of the COVID-19 cases in Central Oregon continues to rise.

The health system has been preparing for a surge of COVID-19 patients since January, ensuring its hospitals and clinics remain a safe place for care of any kind. Individuals who experience a medical emergency should not hesitate to seek care.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, Madras, Prineville, Redmond and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,200 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

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With COVID-19 hospitalizations increasing, St. Charles Health System urges community to celebrate Fourth of July at home, limit interactions to a small group of people

BEND, Ore. – At St. Charles, COVID-19 hospitalizations have nearly doubled in the past 24 hours, and our data modeling shows that we are heading for a bigger surge than the one we experienced in April.

The bottom line is if behavior doesn’t change in our community, we will overwhelm our health system’s capacity in the coming weeks.

We know people are looking forward to celebrating the holiday weekend with family and friends. However, we are not in a position to celebrate in the ways we’re used to. After Memorial Day weekend gatherings, COVID-19 cases accelerated. This virus does not take holidays off, and our actions now will determine where we stand later in July.

To keep you, your loved ones and your community safe, we urge you to:

1. Stay home if you feel sick.
2. Think hard about your Fourth of July plans. Please strongly consider celebrating at home this year, and limiting your interactions to a very small group of people.
3. If you go out in public, it is absolutely vital that you wear a mask at all times.
4. Follow physical distancing guidelines.
5. Wash your hands. Wash your hands. Wash your hands.

St. Charles Health System has been preparing for a surge of COVID-19 patients since January, and our facilities remain a safe place for care of any kind. If you experience a medical emergency and need to seek care, please do not hesitate to visit a St. Charles hospital.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, Madras, Prineville, Redmond and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,200 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

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As a health system and the largest employer in Central Oregon, we want you to know we stand with our communities for equity and inclusion of all.

Our nation is hurting – and we know that many of you are hurting as well.

We can’t stay silent and simply watch the news of the past week. It is critical that you know we do not tolerate racism. We do not tolerate violence. We do not tolerate ignorance of these issues.

It is time to do better.

St. Charles has a more than 100-year legacy that started with a brave group of nuns declaring they would care for all or care for none. However, although we strive to provide health care to all those in need – we know disparities continue to exist for many of the populations we serve.

The global pandemic of COVID-19 has put a spotlight on this issue by disproportionately affecting communities of color throughout the nation. In Oregon, our African American, Hispanic and American Indian populations have been hit as well – we are not immune.

St. Charles should be a safe place for all regardless of race, religion, color, gender, sexual orientation or ability to pay. While we have taken some positive steps – including our cultural care programs in Madras and our sexual orientation and gender identity workgroup – we know it is just the beginning of an ongoing journey to learn and to improve upon our own understandings and practices.

We as a St. Charles leadership team vow to investigate where our organization may be falling short, to engage in conversations with our diverse populations, to listen, learn and improve. We also commit to educating ourselves to better understand these issues through diversity training and will continue to look for opportunities to better reflect our communities.

We owe it to the communities we serve — and ourselves — to do the important work of really understanding each other. Now is the time to see our differences from one another and not fear them, but instead embrace and learn from them.

We must do better.

Please, take this moment to check in with your fellow caregivers. Ask them how they are doing and what they are feeling. Connect with and support each other through these turbulent times.

Remember, when people are in pain, our job is to heal.

Sincerely,

St. Charles Executive Care Team

Joe Sluka, Chief Executive Officer
Jeff Absalon, Chief Physician Executive
Jenn Welander, Chief Financial Officer
Iman Simmons, Chief Operating Officer
Darren Binder, Chief Legal and Risk Officer
Rod Marchiando, SVP Improvement and Strategy
Jim Guyn, SVP Population Health
Pam Steinke, Chief Nursing Executive
Rebecca Berry, VP Human Resources

Grand Rounds - June 26, 2020
"Gut Health and Intestinal Hyperpermeability"

Speaker: Michelle Hirschy-Baker, FNP-C, Functional Medicine Nurse Practitioner

Objectives:

1) Explain the basic physiology of intestinal hyperpermeability

2) Explain how untreated intestinal hyperpermeability can lead to the development of autoimmune conditions

3) Demonstrate the basic recommendations to reverse intestinal hyperpermeability and when it may be appropriate to refer to a functional medicine provider for further evaluation

Accreditation: St. Charles Health System is accredited by the Oregon Medical Association to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at 541-706-4680, [email protected]. For CME or Clerkship questions, contact Sheila Jordan, MMGT, CHCP, Manager of Continuing Medical Education at 541-706-6780, [email protected].

Bend is a town that loves its beer, and the production and consumption of alcohol is a prominent part of the Central Oregon lifestyle.

Still, no one is immune to the dangers of alcohol misuse. That’s why St. Charles Health System has chosen alcohol misuse prevention as its community benefit focus for the 2020-2022 funding cycle.

“Our previous priority focus was suicide prevention, and we partnered with local organizations and individuals to provide QPR (Question, Persuade and Refer) suicide-prevention training to more than 2,500 people throughout Central Oregon over the past three years,” said Carlos Salcedo, manager of community partnerships for St. Charles. “Through that work we learned that engaging with the community is an effective way to help St. Charles meet its vision of creating America’s healthiest community, together.”

The American Academy of Family Physicians defines alcohol misuse as a spectrum of behavior, including risky (excessive) alcohol use, alcohol abuse or alcohol dependence. According to the 2018 Oregon Health Authority State of Health Assessment there has been a 38% increase in the overall rate of alcohol-related deaths in Oregon since 2001. Oregon also ranks third highest in the country for deaths related to alcohol.

“Alcohol misuse is a root cause of many chronic health and societal problems – liver disease, fetal alcohol syndrome, child abuse, domestic violence and the cause of many auto accidents that damage lives,” says Dr. Jeff Absalon, chief physician executive for St. Charles. “If we can reduce binge drinking, increase identification and interventions for alcoholism, and ensure that the norm for community gatherings that include alcohol is to drink responsibly, then Central Oregon will be healthier and safer.”

St. Charles leadership believes alcohol misuse prevention is a major health need in Central Oregon. As part of the Community Benefit program, the health system will partner with local organizations that are working to address this need in an effort to capitalize on the energy that surrounds the subject, and it will no longer sponsor events where alcohol is the primary focus, including fundraising events where alcohol is prominently featured in the title or promotional materials. “We hope that together with our community we can develop innovative ways to improve access to care where needed, increase educational and awareness offerings and reduce the negative impacts associated with alcohol misuse to the health of our communities,” says St. Charles’ 2020-2022 Regional Health Implementation Strategy.

The Community Benefit program will also provide financial support to groups that are trying to stem the tide of alcohol misuse in communities across the region. Exactly how that looks will be up to the individual communities, Salcedo said.

“Our hope is that each community will choose where to focus their time and energy around this issue. Maybe one will focus on teen drinking while another may want to focus on supporting parents who talk to their children about alcohol misuse,” he said. “St. Charles may find itself supporting communities in a variety of ways, such as offering financial assistance for projects identified by the community or providing medical experts and relevant research to enable community members to move forward in preventing the misuse of alcohol.”

Alcohol misuse prevention was identified as a priority based on the 2020-2022 Community Health Needs Assessment, which brought together population health data, input from community members, community survey results and analysis of available community resources to address health needs. St. Charles and the Central Oregon Health Council collaborated to conduct the research and develop the CHNAs.

As we navigate the turbulence of the past few months, I’ve been trying to keep an eye out for positive stories and progress to buoy my spirits.

It is important, of course, that we pay close attention to what’s happening across the country as the result of the COVID-19 pandemic, systemic racism and inequity, and that we try to understand it, learn from it and use it as fuel for self-improvement. In fact, it’s our moral duty.

It’s also OK to take a moment to celebrate the good things that happen, even if they often feel overshadowed by the tumult.

Earlier this month, the LGBTQ+ community (and its allies) had reason to celebrate when the U.S. Supreme Court issued a 6-3 decision holding that Title VII of the Civil Rights Act of 1964 prohibits an employer from firing an individual merely for being gay or transgender. The practical result of that decision is that it gives workers the right, no matter where they live, to be free to come to work as their true selves.

The decision reminded me that earlier this year, St. Charles applied to have all four of our hospitals listed on the 2020 Healthcare Equality Index, a nationwide guide to workplaces that promote LGBTQ+ health care equality. The results have not yet been announced, but based on our completion of the survey, we’re confident we will earn a score that will place us at the top level.

I’m very proud of our progress on this front, and I want you to know we didn’t get to this point by closing our eyes and wishing. It took a lot of hard work by many people – including our IDEA (Inclusion, Diversity, Equity, Acceptance) Council and our SOGI (Sexual Orientation Gender Identity) workgroup – who have helped St. Charles address LGBTQ+ health care disparities and provide an inclusive environment for LGBTQ+ patients and caregivers.

In response to the Supreme Court’s decision and in celebration of Pride month, St. Charles Senior Vice President and Chief Legal and Risk Officer Darren T. Binder wrote an essay about the significance of the ruling, our pursuit of health care equity and the changing legal landscape for the LGBTQ+ community over the past couple of decades. I really appreciate Darren’s expertise and perspective, and I would strongly encourage you to read it for yourself.

It would be a mistake to tout these accomplishments without also acknowledging that we can do better. St. Charles is responding to the events of recent weeks by embarking on a journey to learn, grow and understand issues related to diversity, inclusion and equity. While it’s not our first foray into this territory, I see and hear from many of our caregivers a renewed interest in pursuing progress in a deep and meaningful way. So we scheduled a moment of quiet reflection across the health system last week, we have encouraged our caregivers to share their thoughts on racism and social justice issues, and we’re using that information – confidentially, to be clear – to help plan a series of caregiver meetings in July. I can assure you that our leadership team is committed to investigating where we fall short in these areas, listening to our diverse populations, educating ourselves and looking for opportunities to better reflect our communities.

It’s not easy work but it is worth it. I believe it is an essential step in our journey toward truly caring for all.

Thank you for journeying with us.

Sincerely,
Joe