This month, St. Charles Health System is submitting an application to have all four of its hospital campuses listed on the Healthcare Equality Index.

The HEI, managed by the Human Rights Campaign, is a national LGTBQ benchmarking tool that evaluates health care facilities’ policies and practices related to the equity and inclusion of their LGTBQ patients, visitors and employees.

For the past few years, St. Charles' Sexual Orientation and Gender Identity workgroup has been working on initiatives that would allow the health system to apply for the 2020 HEI. As an example of this work, St. Charles has confirmed or added “Sexual Orientation” and “Gender Identity and Expression” to its Patient Non-Discrimination, Equal Visitation and Employment Non-Discrimination policies.

Additionally, as a requirement to apply, several members of the system's executive and leadership teams had to complete a three-part training offered by the HEI titled “LGTBQ Patient-Centered Care: An Executive Briefing.” And St. Charles' Sexual Orientation and Gender Identity class has been wildly successful, with around 350 caregivers going through the course over the past year. 

Learn more about the HEI here.

This December marks my fifth anniversary as president and CEO of St. Charles Health System.

It’s amazing how five years can feel like a long time and an instant all at once.

When I reflect on that time, I’m so proud of the milestones we have achieved as a team. I didn’t know at first that replacing our electronic health record would be a necessity. Nor did I realize right away how desperately we would need to add space to our facilities to accommodate a rapidly growing community.

Together, we have achieved so much.

The implementation of Epic as our electronic health record – a project that touched every one of our 4,500 caregivers, has advanced our ability to provide the safest possible care. We constructed and opened a new patient tower in Bend, are currently expanding our Prineville campus and completed a remodel and addition in Madras as well.

We opened a clinic in La Pine to serve our southern Deschutes County residents and are working on plans to expand cancer services in Redmond.

During my time here, we celebrated an incredible 100 years of providing care for all.

These accomplishments are just the tip of the iceberg. Every day, St. Charles caregivers save lives inside and outside of our walls – because the reality is our greatest strength is in our people.

But we couldn’t do any of it without you. Quite simply, without the support and trust of the communities we serve, these many milestones would not have been possible to reach.

Thank you for being such an important part of the past five years. I’m looking forward to what we’ll accomplish together next.

Sincerely,

Joe Sluka
President and CEO
St. Charles Health System

(Above, Dr. Juan Tamariz of the St. Charles Pulmonary Clinic. Dr. Tamariz is one of three new permanent physicians at the clinic.)

A couple times each year, Ken Kloster gets up early, hops into his truck and begins the long journey to Central Oregon from his home west of Lakeview.

His destination? The Pulmonary Clinic at St. Charles Bend. At 82 years old, Kloster experiences shortness of breath and he was recently diagnosed with sleep apnea, so his oxygen levels drop at night. Plus, after a 46-year career as a pipefitter, he’s worried that exposure to asbestos will give him mesothelioma.

“I’ve had a couple friends die of that and it’s a horrible way to go,” he said. “So, I don’t mind coming here to keep an eye on things. This is the closest place to my home to do it, and they’ve always treated me well.”

Kloster isn’t the only one happy that St. Charles Pulmonary Clinic exists. After a tumultuous year of uncertainty and a near closure, the clinic has bounced all the way back to providing a full level of service.

“People had to trust us, because we’ve had a lot of ups and downs. It’s been a roller coaster,” said Jacob Espinoza, interim director of ambulatory specialties for St. Charles Medical Group. “Now we’re rolling at full speed and we’re ready to go.”

One of Espinoza’s primary jobs over the past several months has been to recruit new, permanent providers. Ultimately, the clinic will be staffed with four doctors and one nurse practitioner. Today, three new doctors are in Bend and seeing patients, with the fourth (and the nurse practitioner) set to join them next spring.

The three new physicians are:

• Dr. Gregory Blair, who joined the group in April and brings with him more than 30 years of pulmonary, sleep and critical care medicine experience.
• Dr. Ryan Nelson, who joined the group at the beginning of August after completing his fellowship in pulmonary and critical care medicine. Dr. Nelson will split time between working in the Pulmonary department and working in the Intensive Care Unit.
• Dr. Juan Tamariz, who joined the group at the end of August. His interests are thoracic oncology, COPD and pleural diseases, and he is excited to be part of a strong medical community in a town with amazing outdoor opportunities.

With the new providers on board, the clinic has reinstituted spirometry testing in the office, as well as cardio-pulmonary exercise tests and outreach to Redmond each week. The clinic also houses St. Charles Bend’s COPD coordinator and will start a smoking cessation program by the end of the year. (A full list of services and procedures offered can be found at the bottom of this article.)

Dr. Blair called the rebirth of the clinic “exciting” and said he and his fellow providers can offer the same pulmonary services available at Oregon Health & Science University in Portland, where he practiced for 30 years. He retired at the end of 2018, but was starting to feel restless when St. Charles called and offered him a job in Bend.

So far, his favorite thing about his new job is the diversity of ailments that show up in the clinic, which he attributes to St. Charles’ enormous service area that includes much of Eastern Oregon.

“I see people from Fossil to Burns, and they’re all just amazingly happy for anything you can do for them,” Blair said. “It just feels good to know that we’re at the point where we can offer the kinds of services that will save people a lot of time and trouble, while at the same time remaining a small, cohesive group that’s focused on taking care of patients.”

For administrative staffers who’ve been with the clinic for the past year or more, the opportunity to get off the roller coaster and get back to focusing on patients is very welcome, said Miriam Bueno, supervisor of clinical operations.

“I am super excited that we have a great team that goes above and beyond to provide excellent patient care,” she said. “Everyone works hard on a daily basis to make sure the clinic is running smoothly, and we’re so glad to be here serving our community like we have for so many years.”

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St. Charles Pulmonary Clinic treats the following lung conditions and diseases:

●     Asthma

●     Chronic Obstructive Pulmonary Disease (COPD)

●     Emphysema and chronic bronchitis

●     Pulmonary fibrosis

●     Pulmonary hypertension

●     Occupational lung diseases

●     Adult cystic fibrosis

●     Other infectious lung diseases

The clinic offers the following services and procedures:

●     Inpatient pulmonary consultations

●     Spirometry

●     Pulmonary function testing

●     Pulmonary stress testing

●     Pulmonary rehab

●     Diagnostic bronchoscopy

●     EBUS bronchoscopy

●     Asthma medication, treatment planning and education

●     Smoking cessation consultations

●     Alpha-1 treatment

When Marinus “Dick” Koning retired in 2008 after a 30-year career as a general surgeon in Redmond, he contemplated what might be the next chapter of his life’s work.

It didn’t take him long to figure it out.

Piqued by his interest in tropical diseases and disorders, Koning traveled to Ethiopia on a medical mission in 2009. Once there, he was struck by not only how many children were born with spina bifida and hydrocephalus (SBH), but also how few of them received the life-saving surgeries they needed. At the time, there was only one neurosurgeon for nearly 100 million people in the country.

Koning and his identical twin brother, Jan Koning, who is also a retired surgeon from the Nederlands, began performing operations on children with SBH at Korean Hospital in Addis Ababa. But only a small number were fortunate enough to reach the hospital in time to have the openings on their spines closed, or to have shunts placed to drain the water on their brains. Many more suffered and died.

That’s when Koning founded his nonprofit organization, ReachAnother, whose work is to expand the availability of pediatric neurosurgery in Ethiopia as well as develop a countrywide food fortification program. With the support of St. Charles Health System, which donates used surgical instruments, and many individuals in Central Oregon, ReachAnother has saved the lives of more than 5,000 babies through surgical intervention over the last decade.

“An instrument that is not acceptable here anymore because of a divot or tiny crack, in Ethiopia is worth its weight in gold,” he said. “We’ve taken thousands of dollars in instruments.”

In early November, Koning and his team traveled back to Ethiopia, where they’re now working with the government and a group of international public health experts to launch a clinical trial to fortify salt with folic acid.

In the United States, fewer than 2,000 children are born with SBH each year, according to the Centers for Disease Control and Prevention. That low number is in large part attributable to the folic acid that, since 1998, has been added to the country’s supply of enriched grain products such as bread, pasta, rice and cereal. In Ethiopia, where unfortified teff is the staple of most families’ diets, more than 40,000 children are born with the birth defect.

Folic acid prevents SBH. The problem, Koning said, is the birth defect develops before the mother is aware she’s pregnant, making it crucial that every woman have access to the vitamin.

“Salt is the only staple food that everybody uses,” he said. “I just learned from a new study that 70 percent of the world population doesn’t have access to wheat or rice or other staple food that can be fortified, so fortified salt has been one of the holy grails of nutrition science.”

But while it has been proven possible to fortify salt with folic acid, it has not yet been proven clinically effective, he said.

“Now we have to do three preliminary studies to show that it can be done and that it’s effective,” he said. “We have no question it will be effective, we just have to show it.”

Koning said the preliminary studies should be completed within the year, after which there will be a “feeding study” to determine whether women who eat folic acid see their folic acid blood levels rise to the desired level. The group will also be evaluating the country’s supply of salt and how it’s distributed to consumers, who “have to like and accept it. (Fortified salt) is a little bit differently colored.”

Koning is hopeful that within the next few years, fortified salt will be a proven method for the prevention of SBH.

“That’s not only good for Ethiopia, it’s also good for the rest of the world,” he said. “It’s amazing that people from Bend, Oregon, now have the eyes of the world focused on them to come up with this solution.”

A warming shelter for the homeless in La Pine will be open for more nights this winter than ever before thanks to a $5,000 grant from St. Charles Health System.

In the shelter’s first year of operation — the heavy snow year of 2016-17 — it opened on nights when the forecasted temperature was 10 degrees or lower. Last year, the shelter raised that threshold to 15 degrees and was open 58 nights — more than the previous two years combined.

“One of the nice things about the (St. Charles) money is that it didn’t have any strings attached to it. That gives us the flexibility to use it for whatever we need it for,” said Chad Carpenter, pastor at Calvary Chapel, home to the shelter. “When that came in, that’s when we decided to raise our threshold to 20 degrees. That was a deciding factor for us.”

The expanded program in La Pine is just one component of a region-wide effort to not only establish warming shelters in each of Central Oregon’s communities, but also keep them open every night throughout the coldest months of the year. This year, St. Charles awarded community benefit grants to six area shelters: $5,000 for La Pine, Sisters and Prineville and $10,000 each for Madras and Redmond. Depending on needs, money has been set aside for Bend, which just found a location for its shelter.

The effort has brought together churches, existing shelters, elected officials, volunteers from the community and local businesses, said Rick Russell, president of the Faith Based Network and pastor of two churches in Madras and Redmond.

“Redmond was doing it so well, we wondered if we could take the Redmond model and bring it to Jefferson County, and we were off and running,” he said. “There was literally a meeting at Mazatlan (in Madras) where we got the county commissioners and the chief of police and the city administrator and various pastors and other interested parties in the room and said, ‘Can we do this here?’ We walked out an hour later with a pretty strong commitment from everyone that we need to do this.

“That was in July or August,” Russell said. “By Nov. 1, we were open.”

The Redmond model Russell refers to looks like this: A shelter will be open and available to anyone who needs it from Nov. 15 to March 15. Right now, it’s at Highland Baptist Church. On Dec. 8, it will move to Mountain View Fellowship. And then Feb. 16, it will move to Redmond Christian Church. It’s run by Shepherd’s House Ministries, which operates shelters for men and women in Bend.

“Both communities have a 16-foot trailer full of mattresses and cots and a coffee maker and all the stuff they need to get going for the night,” Russell said.

In La Pine, the effort to open a shelter started on Facebook, said Chad Carpenter, the program, facilities and communications director for La Pine Park & Recreation District and president of the Board of Directors for NeighborImpact. Two days later, a shelter was open, he said.

“There was no plan,” Carpenter said. “The community was just compelled by the need. Along with Sisters, it’s a little bit colder in La Pine than the rest of the region. The snow’s a little bit deeper here. Everyone knows it’s a rough place to be homeless.”

Besides their unique locations and operations, each shelter welcomes a different population of people. In La Pine, where services are scarce, the shelter has taken in a mother and three children escaping domestic violence, Carpenter said. In Madras, they get lots of people who are just passing through town on U.S. Highway 97, Russell said.

On a recent Wednesday in Redmond, the gym at Highland Baptist Church was quiet, despite 20+ residents (including two families) who had arrived for the night. A warm dinner was served and the lights were dimmed at 9 p.m. as residents settled onto their mattresses for some sleep.

Russell said some Redmond regulars often gather in a corner of the gym for a game of “street Uno” and some camaraderie.

“If you walk into any of these environments, it will feel safe and warm and hospitable,” he said. “People are tired. They’re not looking to party, they’re looking to sleep. But somewhere there’ll be people getting to know each other, and that’s a very cool thing to see. It’s more than a shelter. There’s a sense of community.”

Supporting the shelters was an easy decision for St. Charles, said Carlos Salcedo, the health system's manager of community partnerships.

“Our vision is creating America’s healthiest community, together and this aligns perfectly with that vision,” he said. “Having a place to sleep is important, especially when it’s cold. And this whole thing is not just ‘us’ but also ‘them’ —these are all networks of people working together to try to address this problem.”

For Carpenter, the shelters are about more than just a safe, warm night of sleep. They’re about human dignity and helping others when they need help.

“I’ve done nonprofit work for a long time and you always want to give people a hand up as opposed to a handout — most people,” he said. “But I’ve come to realize that people need handouts, too. On an emergency basis, people need to come in from the cold and get warm, and that’s OK, too.”

Central Oregon’s community model for providing support services to children with traumatic brain injuries is going to be studied by the University of Oregon’s Center on Brain Injury Research and Training (CBIRT).

The center has received a four-year, $2.2 million grant from the Centers for Disease Control and Prevention (CDC) to compare the health, academic and social outcomes of Central Oregon children with traumatic brain injuries to those in school districts in Ohio and Washington without formal programs.

Children with traumatic brain injuries are at risk for disabilities that can affect their academic performance, according to CBIRT’s research proposal. Those with moderate to severe injuries can have cognitive, behavioral and social difficulties. Even children with mild brain injuries can experience learning and social impairments such that monitoring students through their recovery is equally important.

Since 2006, St. Charles Health System, The Center for Orthopedic and Neurological Research and the High Desert Education Service District have worked collaboratively to develop a community-wide concussion management program that will be the focus of this research. Dr. Sondra Marshall, a neuropsychologist at St. Charles, has been working with The Center since 2006, when she and then colleague Dr. Leah Schock traveled to the University of Pittsburg Medical Center for training with its concussion team. Over time, and with support and engagement from the medical and educational communities, the Central Oregon program has grown to include identification, screening and assessment, close tracking of a student’s progress and professional development for school and health care professionals.

“The focus of our work here in the community is not only getting kids back to playing sports safely, but also getting them back into the classroom successfully,” Marshall said. “We’re excited for the potential for our model to be replicated around the country, helping support more children who have been impacted by a traumatic brain injury.”

CBIRT Director Ann Glang, who is leading the study, said the research is unique “in that it allows us to evaluate an existing model of support for students with brain injuries rather than develop a new approach that may take years to translate into practice. This helps us close that research-practice gap.”

Dr. Viviane Ugalde, who serves as the concussion medical director for The Center Foundation and is a consultant on the CDC grant, said she will be educating health care providers about the study and recruiting people to participate.

“It’s exciting to have the ability to measure the work that we are doing and learn what kind of scientific impact we are having with concussion recovery – returning kids to normal life, school and playing sports,” she said.

Our friends in Warm Springs have been dealing with a water crisis for the past month, due to loss of pressure in the distribution system following a water main break. Most residents have no access to running water and have been on a boil water notice since May 30.

Three times in the past couple of weeks, St. Charles Foundation has donated 2,000 one-gallon jugs of water to Warm Springs to help ease the burden, with caregivers from St. Charles Madras helping to make the deliveries. Health system officials are currently working with the Confederated Tribes of Warm Springs to determine how St. Charles can provide meaningful assistance going forward.

St. Charles got involved after hearing of the problems from Shilo Tippett, a member of the Tribe who works as a clinical psychologist at St. Charles Family Care in Madras. Her initial suggestion was to provide water for the annual Pi-Ume-Sha health fair, but - thanks largely to the efforts of Carlos Salcedo, manager of community partnerships for St. Charles Foundation - that blossomed into 2,000 gallon jugs, according to Madras Family Care Clinic Operations Manager Randy Jasa.

“We learned about it on a Monday and we were able to meet that need by delivering a truckload of water by, I believe, Thursday,” Jasa said. “They told us at the time that they’d probably be through all that water by the middle of the afternoon.”

That revelation sent Jasa looking for more ways to help, and another truckload was delivered on June 17. A third was delivered on the morning of June 27.

For Jasa, responding to the crisis in Warm Springs is part of his job as a health care provider in Jefferson County, but it’s also simpler than that.

“The people of Warm Springs are our neighbors. Some of them are our patients, but all of them are our neighbors and we want to help our neighbors,” he said.

“It’s a small community and a small county, and too often we let 15 miles in between us seem like an eternity,” Jasa continued. “But they’re our friends and neighbors, and when somebody’s in trouble, everybody needs to step up and help out.”

Tippett echoed the sentiment that Madras and Warm Springs don’t “interface enough,” and said one silver lining of the water crisis is that it has brought the two communities together.

“The administrators and leaders in Warm Springs are working very hard to address the (issue) and are doing all they can to get water back to our people,” she said. “Many people are pitching in to help and that is a wonderful thing to see.”

Surgeons at St. Charles Redmond recently performed the first robotic surgery there—a ventral hernia repair with mesh—using a da Vinci Surgical System, which translates surgeons' hands into smaller, more precise movements.

Our surgeons love this technology because it not only increases their dexterity and meticulousness, but also it reduces the physical strain of performing surgery.

“I can’t turn my wrist 360 degrees, but with the robot I can twist the hand around to where I can reach into places that I would not be able to do (in open surgery) or laparoscopically,” said Dr. Ngocthuy Hughes, a general surgeon with St. Charles Surgical Specialists. “And also, it’s for the surgeons’ longevity. With laparoscopic surgery, sometimes getting to a certain angle or certain area of the body is a lot of work on the surgeon.”

For our patients, robotic surgery can mean a shorter hospital stay, less post-operative pain and a faster recovery time.

“Post-operative pain issues are significantly less,” said Dr. John Land, also a general surgeon with St. Charles Surgical Specialists. “I’ve decreased my narcotic prescription rate by 94 percent compared to when I used to do open (surgery).”

The surgeons said a common misconception that patients have is the robot performs procedures all on its own.

“When you talk to the patient, you really stress—and I guess assure them—you’re the surgeon, not the robot,” Hughes said. “A lot of time they get (the idea that) the robot is going to operate on me. And I have to explain to them, ‘No, it’s me operating the robot. The robot is my new tool versus the laparoscope.’ I tell them that the robot allows me to do things that I can’t do with my hands.”

The da Vinci Surgical System has been used successfully in hundreds of thousands of minimally invasive procedures over the past decade. St. Charles is excited to grow its robotics program to include the Redmond hospital.

Our world is changing at an incredible pace, and it’s no different in health care.

Across St. Charles Health System, we’re committed to leading our industry on several fronts. We’re using powerful technology and new techniques to improve the way we treat patients, while at the same time partnering with other organizations on training and education to ensure Central Oregonians receive uniformly excellent care.

We’ve implemented a number of initiatives to ensure the LGBTQ community feels comfortable coming to a St. Charles facility, and we’re helping respond to the water crisis in Warm Springs – not because we’re a health care provider, but because it’s the right thing to do for our friends and neighbors.

Here are a few other things worth knowing about St. Charles:

• Our hospitals and the jobs they create – both directly and indirectly – play a vital role in the region’s economic wellness.
• Last spring, we welcomed our first child life specialist, whose role is to help children cope with the challenges of their care.
• A team of surgeons at St. Charles Bend used a novel procedure to save the life of a 79-year-old patient who couldn’t tolerate a more conventional approach.
• St. Charles Redmond received a grade of “A” for patient safety from a national nonprofit group committed to improving health care quality and safety.

At St. Charles, we know that if we aren’t relentlessly focused on forward-thinking, innovative pathways of care, then we’re not doing our part to make Central Oregon America’s healthiest community. That’s our vision, and it stands at the heart of everything we do.

Joe Sluka
President and CEO
St. Charles Health System

Last week, paramedics from Redmond Fire & Rescue and caregivers from the St. Charles Redmond Emergency Department gathered together for joint training on precipitous baby deliveries – meaning the baby is born within three hours of the onset of regular contractions.

On an early Wednesday morning, four Redmond Fire paramedics worked in tandem around a “pregnant” mannequin, learning processes and procedures from Meggen Ditmore, an RN in the Redmond Family Birthing Center, and Candy Peplin, an RN and neonatal transport specialist at St. Charles Bend.

The two nurses would call out conditions for “mother” and “baby,” setting off a flurry of activity among the paramedics. As conditions changed, so did the response.

The hands-on simulation is the result of months of work by nurses from the Redmond Emergency Department and Family Birthing Center, Respiratory Therapy and the Clinical Practice Professional Development team, with guidance from their leadership, Redmond ED Nurse Manager Amy Leath and Redmond FBC Nurse Manager Melissa Smith, and in partnership with Doug Kelly, chief of Redmond Fire’s EMS division. The idea was twofold: To ensure practices are aligned across various agencies, and also to create a culture in which emergency responders in the community are learning and growing together, Leath said.

“With the closure of the Redmond FBC (on July 13), we wanted to make sure our community is safe and all taken care of, but we also wanted to align our care. So (Redmond Fire) is getting a large portion of the education that we’re providing to our ED nurses,” she said.

Kelly said Redmond Fire has trained with St. Charles in the past, usually to prepare for a mass casualty event. This was the first time the groups got together for something more medical in nature, he said, and the benefit goes far beyond just the paramedics in his department.

"It's a good thing for the community because we always want to be prepared to handle any kind of emergency, and now the likelihood of a precipitous delivery may increase with the closure," Kelly said. "So our people will be freshly trained on it, and that's really the goal whether it's childbirth or trauma or cardiac arrest. We want to be able to do the job safely, effectively and also efficiently." 

Plans for the joint training were in the works well before the FBC closure was announced, Leath said, because emergent deliveries are a possibility regardless of the status of nearby facilities.

“There’s always the potential (of this happening) in the field, in our parking lot, in our waiting room,” she said. “We want to prepare our nurses in case a delivery does happen in our ED, so this is really just providing the education on those high-level things they need to know, even to recognize that this is going to be a precipitous delivery.”

Going forward, agencies in Redmond plan to meet regularly to talk through various cases and situations, and also work toward training in other areas of care, as well, Leath said.

“This was our first big piece that we bit off,” she said. “Our vision is to start doing more of this and to support our community partners in helping to provide care to our patients.”