Early in the summer, 10-year-old JC Lacks of Bend looked at his mom, Lori, and dad, Jon, and told them he wanted to do something to help with the fight against COVID-19.

“This was not prompted at all,” said Lori, a school teacher. “I looked at him and said, ‘What do you mean?’”

Her son was already dreaming big.

“‘What about all the doctors? Maybe we can do something for them,’” JC remembers asking his parents. “‘Or maybe we could come up with a cure for COVID.’”

Lori can’t help but smile when she remembers the conversation.

“I told him, ‘Yes, that would be nice, but let’s keep thinking about this,’” she said.

With shortages of personal protective equipment making headlines earlier in the pandemic, the Lacks ultimately decided to try running a fundraiser, with a goal of donating money toward the purchase of gloves, masks and other gear for frontline caregivers. They called it the Outdoor-A-Thon St. Charles Frontline COVID Fundraiser.

“We wanted it to be purposeful for the kids, to get them outside and to encourage them to be active,” Lori Lacks said. “Rather than just asking people for money, we decided to have the kids do whatever they want outdoors -- hiking, biking walking -- and log the miles, and we asked people to make a donation in a lump sum or per mile.”

JC wrote a letter explaining the idea and sent it out to neighbors, friends and family. Lori created a Facebook group to organize the effort. Word of the fundraiser spread and JC’s buddies started joining in and clocking their miles and posting pictures of themselves on trails, atop bikes and even floating the river.

“It was great motivation to get us out and doing something as a family,” said Lori. “We’d be out somewhere and we’d say, ‘If we just go 10 more miles …’”

All told, a group of about 15 participants tallied more than 350 miles, with JC logging 135 on his own. They ended the fundraiser on Aug. 31, but money kept coming in until the total amount raised reached $1,155.

Earlier this week, JC and his friend Parker Sheppard, 10, got to present a check for that amount to Dr. Jeff Absalon, St. Charles’ chief physician executive, and Carlos Salcedo with the St. Charles Foundation.

“Do you know what you guys have in common with everyone who works here at St. Charles?” Absalon asked the boys. “They care about helping people, and you guys do, too. That’s a great quality to have.”

After making the donation, JC and Parker were beaming.

“This makes me so happy that we were able to raise all this money,” JC said. “And we had a lot of fun doing it.”

I’m sure many of you who are reading this are doing everything you can to avoid contracting or spreading COVID-19.

But are you doing what you can to avoid the twin-demic?

If “twin-demic” is a phrase that’s new to you, you’re not alone. Only in the past couple of months have I heard health experts and medical professionals use it to describe a looming concern on our collective horizon: the potential collision of two viruses – COVID-19 and the seasonal flu – that cause some of the same symptoms.

As you probably know, flu season typically runs from October through April, and every year, the flu sickens millions of people and kills tens of thousands more. That’s the bad news. The good news is the impact of the flu can be markedly reduced by getting a flu vaccine.

Let’s be clear: The flu vaccine is safe and effective. Getting it can cut the risk of catching the flu by up to 60%, and for people who do get sick, it can diminish the symptoms and shorten the illness. That’s why the Centers for Disease Control recommends that anyone older than 6 months of age get the flu vaccine by the end of October.

If you are a person who normally doesn’t think about getting a flu shot, this is the year to make it a priority. Jill Johnson, communicable disease supervisor for Deschutes County Health Services, explained why in The Bulletin recently:

“It’s especially important this year because of the COVID-19 pandemic,” she said. “The seasonal flu vaccine can reduce the spread of respiratory illnesses. The danger is even in a mild flu year, there could be hundreds of thousands of hospitalizations, coupled with COVID-19, that could overwhelm the hospital systems.”

In other words, by getting the flu vaccine, you’ll protect yourself and your loved ones from the flu, and you’ll be helping our team at St. Charles by not inundating our hospital beds with flu patients.

The threat of COVID-19 is still very real in our community, and over the next few months, it is absolutely critical that we all work together to try to minimize its impact and the impact of the flu on Central Oregon. You can do your part by washing your hands effectively and regularly, practicing appropriate physical distancing, wearing a mask over your mouth and nose and getting your flu shot.

And get it soon, because health officials say it takes two to four weeks to become fully effective.

One last time: Get your flu shot. It may just be the simplest way you can help us avoid a twin-demic.

Thank you for doing your part to keep this community healthy.

Sincerely,
Joe

Above, Dr. Katie Ruth looks over Lindsey Hutchinson of Klamath Falls during an office visit at the OHSU-Cascades East Family Medicine Center in Klamath Falls, 2019. Ruth performed her residency at Cascades East, a collaboration between OHSU and Sky Lakes Medical Center working to improve health access in rural Oregon. Credit: OHSU/Kristyna Wentz-Graff

Oregon Health & Science University is in the early stages of creating what is expected to be the first graduate medical education program primarily based in Central Oregon.

OHSU has received a $750,000 grant from the U.S. Department of Health and Human Services through the Health Resources & Service Administration’s Rural Residency Planning and Development Program. OHSU will use the grant to develop a new family medicine residency program in partnership with Bend-based St. Charles Health System. 

“Establishing a family medicine residency program in Central Oregon can help address health care gaps that occur too often in rural areas,” said Joe Skariah, D.O., M.P.H., M.B.A., who directs OHSU’s family medicine residency program and is leading the new program’s creation. “Knowing physicians often choose to stay and practice in the communities where they complete their residencies, this new program could also attract more skilled and compassionate health care providers to Central Oregon.”

Residents are new physicians who have recently completed medical school and receive advanced training in a specific medical field. This program will focus on family medicine, primary care that specializes in caring for the entire family.

After receiving accreditation, the program could welcome its first residents as early as July 2024. The program’s first year, known as an internship, would be based out of OHSU’s Portland campus. The program’s subsequent years would primarily bring residents to St. Charles Madras. Many of the program’s details are still being decided, including the number of residents involved.

The program will build on OHSU’s long-established rural medical education program. Every OHSU medical student completes at least one month of training in a rural setting, including in the Central Oregon communities of Warm Springs, Madras, Redmond, Prineville and Sisters. During OHSU’s last academic year, 42 medical students had clinical rotations with Central Oregon physicians, many of whom are associated with St. Charles Health System. Portland-based OHSU residents have also had rotations in Bend and Warm Springs. 

The new residency program is being organized through the OHSU School of Medicine’s Department of Family Medicine, which was recognized this year by U.S. News & World Report as the nation’s best family medicine program. OHSU is home to one of the oldest family medicine residency programs in the U.S., and the first family medicine residency program in Oregon.

“I am excited to grow our collaboration with OHSU and create an important avenue for medical education in Central Oregon,” said Robert Ross, M.D., director of provider academics research and clinical service at St. Charles Health System and a clinical associate professor of family medicine at OHSU. 

With the pandemic nearing the six-month mark and the start of the school year approaching, more and more parents are wondering how COVID-19 is affecting children and how to help their kids navigate this time of uncertainty and change.

In an effort to provide guidance and resources, local health care organizations have teamed up to host a live, interactive panel discussion among pediatric providers on Facebook Live at noon on Sept. 8. The panel of experts will feature:

• Licensed clinical social worker Regina Joshi-McGaw from Central Oregon Pediatric Associates (COPA)
• Pediatric neuropsychologist Dr. Daniel Kriz from the St. Charles PEDAL Clinic
• Licensed clinical social worker Lindsey Overstreet of Mosaic Medical

The agenda will include a presentation by the panelists as well as a time for Q&A with the virtual audience. The presentation – titled Parenting in a Pandemic – will cover a wide range of topics, including back-to-school challenges, caring for your child’s mental wellbeing, keeping your kids safe in their interactions with others (both virtually and in real life) and the importance of caring for yourself so you can care for others.

“Without a doubt, this is a challenging time for all of us. COVID-19, separation from loved ones, social unrest, intense images on TV -- there are a lot of things happening that could cause kids to ask questions or to feel stressed or scared,” said Joshi-McGaw.

“It’s important for parents to remember that kids are not adults,” she continued. “They receive and process information in their own way, and they really need the adults in their lives to talk with them and help them understand what’s going on and what it all means.”

The event will be broadcast on the St. Charles Facebook page and also shared on the COPA and Mosaic Medical Facebook pages.

In accordance with contact tracing guidelines from the Oregon Health Authority, door screeners are now collecting names and phone numbers of all visitors who enter any of St. Charles’ four hospitals.

The organization is committed to protecting the privacy of patients and visitors and will not use the information gathered at screenings unless it’s required for contact tracing.

Please note that this important new protocol could cause delays at visitor entrances.

The collection of contact info is a new addition to St. Charles’ visitor restriction policy as a result of COVID-19. Since March, door screeners have been following strict protocols to help keep St. Charles patients and caregivers safe and the health system functioning. These include:

• Requiring individuals to adequately sanitize their hands.
• Requiring all patients and visitors to wear a mask or face covering.

Read more about St. Charles' efforts to control access during the pandemic.

At St. Charles, we work hard every day in pursuit of our vision: creating America’s healthiest community, together.

That last word – together – is a key component of our work.

As Oregon’s leading health care organization east of the Cascades, St. Charles plays a major role in the health of the communities we serve. But we can’t do it alone. We need an engaged constituency made up of people who are interested in health issues – the kind of people who not only open an email from their local health system, but also read the latest update from the health system’s CEO. (Thank you for doing so, by the way.)

We also need dedicated, knowledgeable community partners who share our vision for a healthier Central Oregon.

St. Charles is fortunate to work with many local organizations that fit that description. One of those is Stroke Awareness Oregon (SAO), which is expanding stroke education across the state and improving outcomes for stroke survivors.

By relentlessly focusing on stroke awareness and education, SAO is giving Oregonians the tools they need to do their part for stroke victims. That’s because stroke care is highly dependent on people who know the signs of stroke and can alert emergency responders quickly. For stroke victims, if a friend, family member, coworker or even a stranger doesn’t spot the symptoms and seek help, doctors cannot provide treatment.

At St. Charles, we’re doing our part, too. Led by a group of caregivers who are exceedingly committed to improving stroke care in our service area, the health system's stroke program has made some incredible advances over the past few years:

Number one, we have significantly increased our usage of t-PA, the best available medication to dissolve blood clots. At all four of our hospitals, this change is improving outcomes for stroke patients.

Number two, we now have 24/7 coverage of our Bend hospital by physicians trained in interventional stroke care. Using cutting-edge technology, these doctors are able to provide life-saving treatment as soon as a stroke victim comes through the door.

Number three – and this is a big deal – we are launching a rural outreach program. This will make our exceptional stroke care available to people in rural areas throughout Central and Eastern Oregon and, we hope, reduce the number of stroke victims being transferred out of state.

With a stroke, a rapid response is absolutely critical. For every minute treatment is delayed, 2 million brain cells will die. Every hour of delay leads to at least a 20% drop in recovery rates.

A rapid response is complicated, however, by the fact that St. Charles serves a huge, sparsely populated area. So we’re doing everything we can to ensure rural hospitals know about our stroke care program and we’re working with emergency responders across the state to get people the care they need as quickly as possible, including automatic deployment to stroke victims in rural and remote locations.

We’re also reaching out to our colleagues in towns like John Day and Burns to ensure we’re all working from the same modern playbook when it comes to stroke care. We believe this new program can serve as a model for similar areas and will save many lives.

There are other initiatives underway, too, all focused on one thing: Improving long-term outcomes for stroke victims in Central and Eastern Oregon. That’s our ultimate goal at St. Charles, and we’re proud to work with Stroke Awareness Oregon to get there together.

If you want to make sure you know the signs of a stroke – easily remembered using the acronym F.A.S.T. – please check out SAO's website for more information.

On the eve of the COVID-19 pandemic, St. Charles Health System posed a question to the Redmond community: What should the future of your community hospital look like?

At a January visioning session, caregivers and community members began a dialogue about how to realize the greatest potential of St. Charles Redmond, a hospital that is chronically underused despite sitting smack dab in the middle of one of the fastest growing regions in the country. On average, the hospital is only 48% occupied. Three of the five operating rooms there are only utilized about half of the time, and the remaining two aren’t used as operating rooms at all.

But the challenge for St. Charles isn’t just how to use the hospital more—it’s also, how can it be used better? How does the health system give a hospital that has a warm, relaxed care setting with committed caregivers and an excellent record for quality of care a more defined role that better meets the community’s needs?

“This is a challenge we’ve been wrestling with for a while,” said Aaron Adams, president of the Redmond hospital. “But this is also an opportunity. If we get creative and work collaboratively with our community, we can make some exciting changes that will improve access to services, improve the quality of care and benefit the local economy.”

To start, the visioning session participants were given four options: 1) Don’t change a thing; 2) Create a new service line, like cancer; 3) Transition St. Charles Redmond to a surgical hospital with an associated medical office building or 4) Convert the campus into a post-acute care facility (for example, one with an inpatient rehabilitation focus.)

When it came time to rank them, 85% of the respondents indicated options two and four were their top choices while still retaining the hospital’s general acute care status.

Growing existing services to meet demand: surgery and inpatient rehabilitation

One possibility, Adams said, is growing general surgery at the hospital, where five general surgeons already practice. St. Charles Redmond—which also recently added robotic surgery to its campus—could serve up to 200 additional patients from cities like Madras and Prineville who are currently referred to Bend.

The health system is also contemplating a new orthopedic trauma service, which would mean moving some surgeries currently done at Redmond to Bend. This would allow a dedicated, on-call orthopedic surgeon access to an operating room that is reserved exclusively for these kinds of cases, making it so patients can get surgery faster. 

Yet another option is to move St. Charles’ inpatient rehabilitation program to Redmond, where this vital service could double its capacity to 24 beds and expand into an outdoor space, allowing patients to go on walks and get fresh air during their sessions.

Research tells us that people who are admitted to inpatient rehab after experiencing a stroke, spinal cord injuries, brain injuries, burns and other conditions have better clinical outcomes and a higher quality of life. They have shorter hospital stays, lower mortality rates, fewer Emergency Department visits and are less likely to be readmitted. 

But the number of patients needing this service already exceeds St. Charles’ capacity to provide it, and demand is only projected to grow. 

What’s more, relocating inpatient rehabilitation to St. Charles Redmond would increase the utilization of the hospital to 75% (from 48%), adding 18 to 24 patients per day to the hospital census. For Redmond, this translates into $26.5 million in net revenue.

Before any expansion of inpatient rehabilitation services can take place in Redmond, however, Adams and other hospital leaders realized they’d have to first make room for them. A schematic design is already underway with the intent of remodeling and bringing back into service 17 patient rooms. 

Creating new services: a comprehensive cancer program

Yet another project on the horizon is a new medical office building, which would house a comprehensive cancer program.

St. Charles currently provides chemotherapy and other cancer treatments at a clinic a few blocks from St. Charles Redmond. Radiation treatments would be provided in the new building, which would be built on the hospital campus as part of an expansion approved by the St. Charles board of directors. Medical oncology and other support services would then be moved to the new building.

“This would represent a critical addition of services to Redmond and Central Oregon, making it easier for patients in our northern communities to access cancer treatments,” Adams said. 

Bringing a comprehensive cancer program to Redmond would result in an estimated 1,300 office visits and 6,300 treatments annually, Adams said, resulting in another $10.1 million in net revenue for Redmond.

“To be clear, all of these options are just concepts right now. There’s much we still need to learn before decisions are made,” he said. “But one of the overarching messages that we hope everyone will hear is that we are committed to continuing to provide the very personalized, quality care that our community has come to expect from us.”

(Above, extra hospital beds sit in storage in the basement of St. Charles Bend's new patient tower.)

Earlier this year, in anticipation of COVID-19’s arrival to Central Oregon, St. Charles Health System set up a number of teams to prepare and support hospital operations for the possibility of a surge of sick patients at St. Charles Bend.

Under normal circumstances, the Bend hospital has 209 beds available for patient care, including 24 in the Intensive Care Unit, home to the most seriously ill. At the time, COVID-19 cases were spiking in Seattle and New York City, overwhelming hospitals in those areas.

So St. Charles' Incident Command team – a management structure used in times of crisis – tasked a group of caregivers with developing a “surge plan” to detail how the hospital could expand its patient capacity within the existing campus.

It was a monumental and multi-faceted effort that required collaboration and cooperation across the entire organization, said Jenn Clark, a manager on the health system's Value Improvement Practice team who was heavily involved in the work.

“The initial stage of the process was to assess our current resources so that we would be able to maximize our abilities in space, equipment, supplies, people and technology,” Clark said. “That assessment gave us a framework to design a surge plan in tiers, which would allow us to maintain a controlled execution of services.”

There are six tiers, from Tier 1 (normal operations) up to Tier 6, which projects capacity at 751 beds. More recently, better data and predictive analysis were used to create a special Tier 1.5, which would increase capacity to 283 beds (complete with privacy and infection control measures) and would be “easier” to launch if needed, Clark said.

The team increased the hospital’s capacity by doubling beds in rooms that are big enough to do so and combing the facility for areas where patients are not typically cared for, but they could be if needed.

“We looked at non-traditional care spaces such as family waiting rooms, conference rooms and office space and fabricated plans to transform them into viable places for patient care,” Clark said. “Our regulatory team helped draft these plans to propose for certification from Oregon Health Authority, and our workflows for patient care were redesigned to ensure functionality in this new environment.”

At the same time, Tony Arnold, manager of purchasing and strategic sourcing on St. Charles’ Supply Chain team, was working to secure the supplies needed to execute the surge plans, Clark said. When certain items became scarce because of competition, the team developed backup plans. All necessary resources are now on hand and triaged to allow the health system to serve a record number of patients.

“Some of the surge work you cannot see, such as the framework our IT team built, which allows us to leverage existing technology for patient safety measures,” said Julie Ostrom, senior director of perioperative and cardiovascular services, who was also involved in the planning. “The surge plans also outline when we would pull on state and national agencies for support if our system were to become overwhelmed.”

Ultimately, the surge planning process included all the key components that enable St. Charles to deliver safe and effective care, including food services and linens, demands on the health system’s laboratory and pharmacy, and, of course, staffing. Clark gave a special shout-out to Jessica Truson, a manager in the Information Technology department, for organizing the work to ensure all its moving parts worked together.

“The plan outlines specifics for each St. Charles hospital campus that will ease collaboration and benefit each of the communities we serve,” Clark said. “Education and cross-training were developed and executed to allow for blended nursing care models to support a potential surge.”

She continued: “We’re ready to turn this on if we need to.”

Even if they’re never needed, however, developing the surge plans was a “valuable exercise” for the organization, Clark said, and work to archive them for future reference is almost done.

“Through all this, I wanted to make sure our patients would feel like they were getting the same high-quality service and care that they would get on a normal day at St. Charles,” she said. “Our passion is our communities’ health, and it was inspiring to see our team come together to serve them in the face of an emergency.”

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