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Kim Solberg, MD, Chair of the GBMC Department of Psychiatry, was awarded the GBMC’s 2010 Nancy J. Petrarca Compassionate Caregiver Award at this month’s Schwartz Center Rounds. “I am deeply honored to have been chosen for GBMC’s Compassionate Caregiver Award,” said Dr. Solberg. “The nominees are all the kind of care providers that anyone would be fortunate to have been cared for by. It is truly humbling to have been considered among them."
The Nancy J. Petrarca Compassionate Caregiver Award was established in 2008 as part of the Schwartz Center Rounds Program at GBMC as a way to honor those caregivers who display extraordinary compassion in caring for patients and their families.
“Everyone who has had the pleasure of caring for a patient with Dr. Solberg knows that she has endless compassion,” said colleague Hanita Sawhney, MD. “Whether caring for the patient, helping distressed family members cope with their loved one’s illness or helping staff care for a challenging patient, Dr. Solberg is able to give boundless time and energy to a situation.”
In a letter supporting Dr. Solberg’s nomination, colleague Kathy Tracey noted the patient safety efforts and staff support that that Dr. Solberg has championed at GBMC. “Dr. Solberg was instrumental in modifying four patient rooms to improve their safety for high risk MedPsych patients,” Tracey noted. “Patient care is extremely stressful and Dr. Solberg recognizes the need to care for the caregivers. She clearly represents GBMC’s mission of Health, Healing and Hope.”
Several colleagues commented on Dr. Solberg’s active role in interacting with all aspects of a patient’s care team - including nurses, case managers, social workers, and fellow physicians – along with family members – to ensure they have the best possible care and outcome.
The award was given by Dr. John Adams, Emeritus Chairman of the Department of Pathology and founder of the Schwartz Center Rounds at GBMC. He spoke fondly of Dr. Solberg and her instrumental role in implementing the Schwartz Center Rounds at GBMC three years ago.
The four GBMC staff members receiving Honorable Mention recognition in this year’s Nancy J. Petrarca Compassionate Caregiver Award are:
o Dottie Martin (NST Unit 36 MedPsych- 40-year GBMC employee)
o Kathy Ruane (Community Benefit Senior Outreach, 5- year GBMC employee)
o Brian McCagh (Berman Cancer Institute, 3- year GBMC employee)
o Lori Kantziper, RN (Clinical Partner Unit 25/26, 8- year GBMC employee)
About Schwartz Center Rounds
Started a decade ago at Massachusetts General Hospital in Boston, the Schwartz Center Rounds concept was formulated by a dying lung cancer patient, Kenneth B. Schwartz, who felt that fostering relationships between patients and caregivers provided hope to the patient and sustenance to those who are committed to the healing or dying process. Schwartz established an endowment to fund a regular forum for caregivers to exchange their feelings and thoughts around the empathetic engagement that is truly at the root of compassionate care. John Adams, MD, a retired chief of pathology at GBMC, brought the Schwartz Center Rounds concept to GBMC after losing a friend to cancer. His vision and philanthropy have created an endowment fund to underwrite the cost of administering the rounds concept at the hospital. The fund is named in honor of his friend, Nancy Petrarca. The first Schwartz Center Rounds, where caregivers from all disciplines discussed the difficult emotional and social issues that arise in caring for critically ill patients, was held at GBMC in June 2007. Now, every other month, a forum is held on a different topic, similar to other rounds that occur in more than 115 hospitals in 26 states across the country.
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Charles C. Fenwick, Jr., Chairman of the GBMC HealthCare Board of Directors, is very pleased to announce that, after a national search, the Board of Directors unanimously voted to appoint John B. Chessare, MD, MPH, FACHE the new President and Chief Executive Officer of GBMC HealthCare. Dr. Chessare will begin this role on June 14, 2010 and succeeds John R. Saunders, Jr., MD, who was interim President and Chief Executive Officer following the resignation of Laurence M. Merlis in January, 2010.
“We are very pleased that Dr. Chessare has accepted the position as President and Chief Executive Officer of GBMC HealthCare,” Mr. Fenwick states. “After a careful review of the candidates, the search committee concluded that Dr. Chessare’s experience and perspective on executive and physician leadership, as well as his vision for the future, aligned well with GBMC’s mission of Health, Healing and Hope.”
“I am thrilled to have been selected the next President and CEO of GBMC HealthCare which has a long established reputation for high quality care in a unique setting. I look forward to the challenge of leading the organization and toward positioning GBMC for continued success in a competitive market and a changing healthcare environment” says Dr. Chessare.
An active and visionary leader in the healthcare field for more than three decades, Dr. Chessare has a proven track record as both a strong leader and highly respected physician. As an executive leader, he has led the clinical and administrative team of organizations toward improvement in health outcomes, patient and staff satisfaction as well as reduced wait times and profit maximization. Clinically, Dr. Chessare began his medical career as a pediatrician. He has been instrumental in a number of quality and performance improvement initiatives, including the implementation of Computerized Provider Order Entry (CPOE) and oversight of system-wide clinical quality and patient safety measures.
Dr. Chessare served as president of Caritas Christi Health Care System’s Caritas Norwood Hospital, a 264-bed hospital located just outside of Boston, Mass. from September 2005 through October 2008. In addition to his duties at Norwood, he was the Senior Vice President for Quality and Patient Safety of the entire Caritas system and served as the system’s Interim President from May of 2006 until May of 2008.
In addition to his tenure at Caritas, Dr. Chessare has held several senior level leadership roles at Boston Medical Center and at the Boston University School of Medicine from 1998 to 2005; at Albany Medical Center from 1994 to 1998; and at the Medical College of Ohio from 1983 to 1994.
Most recently, Dr. Chessare has been a consultant working with healthcare organizations to make operational changes to improve patient flow and patient satisfaction while reducing costs. Additionally, he served as faculty for the Institute for Healthcare Improvement and the Institute for Healthcare Optimization in seminars on improving hospital operations.
Dr. Chessare earned his medical degree from the University of Rome in 1979, completed his pediatric residency at the University of Massachusetts Medical Center and attained his Masters of Public Health from the University of Michigan School of Public Health. He and his wife, Tracey, will be relocating to the Baltimore community. They have four children, Michael, Matthew, and twins Patrick and Caroline all of whom attend colleges on the east coast.
Thurgood Marshall Award Winners
Last month at the
Third Annual Awards of Excellence of the Thurgood Marshall College Fund, a present and a past member of the GBMC Board of Directors were honored.
Patricia J. Mitchell, vice chair of the GBMC Board of Directors and vice president of Global Sales Operations for IBM Global Technology and former board member,
Ackneil M. Muldrow II, CEO Parker Muldrow & Associates LLC, were honored on April 7, 2010. The event was held in Baltimore, the birthplace of Justice Marshall, at the Reginald F. Lewis Museum, named after one of the nation’s most prominent former executives and alumnus of member university, Virginia State University. The event was hosted by Howard T. Jessamy and Patricia Coats Jessamy and featured Tim Williams from WJC-TV as the master of ceremonies. The evening started with the Morgan State Jazz Combo and Choir.
John Marshall, Justice Marshall’s son, gave the evening’s keynote address. He eloquently discussed the work of the Thurgood Marshall College Fund’s critical charge to lead the production of our nation’s next leaders. To date, the TMCF has invested more than $100 million in scholarships, programmatic and capacity support and leadership development to the 47 public Historically Black Colleges and Universities (HBCUs) it serves.
The other honorees included the Honorable Brian G. Kim, Associate Justice, Maryland District Court, Ava E. Lias-Booker, Esq., Partner McGuireWoods LLP and Levi Watkins, Jr., M.D. Professor of Surgery and Associate Dean, Johns Hopkins School of Medicine. Stuart O. Simms, of the GBMC Board of Directors presented Judge Kim for his award.
As recipients of the TGCF came forward to tell the story of their journey, one couldn’t help be impressed with their personal vision and drive. Several recipients were the first members of their families to graduate from college. It was great to see so many members of the GBMC family participating in this event.
Top 100 Women of Maryland
On May 2, 2010 before a full house in the Meyerhoff Symphony Hall, the Daily Record's 15th Annual
Top 100 Women Awards was held. GBMC Board of Directors member,
Bonnie Stein of PNC Bank and
Lauren Schnaper, MD, Medical Director of the Sandra and Malcolm Berman Comprehensive Breast Center were named to this year’s honor. GBMC sponsored the Circle of Excellence winners. These were women who had been named to thte Top 100 Women three times.
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This morning I went by the family waiting desk in the General operating room on my way for my first surgical case of the day. As always I was greeted by Buddy and Linda two of our volunteers. Their last names are both Kaufman, fancy that. For surgeons they perform a vital job, caring for the family members during the time their loved ones are in surgery. You can imagine the stress that these families undergo. Will it turn out ok? Will the biopsy be benign? Will they get it all? In the OR time flies. In the family waiting area time is at dead slow. The clock barely moves. Our volunteers reassure the families throughout and when the operations end they escort the families into a private room where they can meet with the surgeon to discuss the outcome.
Years earlier I told someone in our administration that this job was one of the most important jobs in the medical center. I even said that it was too important to be left to volunteers. Boy was I wrong. This position takes caring and understanding. That’s something that’s hard to pay for, but comes naturally from a GBMC volunteer.
Last Friday, as I stood on the podium at the volunteer luncheon, I couldn’t help but marvel at the sight. The room was filled with over three hundred and fifty volunteers. My first thought was “I hope the hospital is ok, because everyone Is here”. GBMC Healthcare is blessed. At the hospital we have 466 active volunteers who gave 95,749 hours last year. That amounts to nearly two million value-added dollars. They work in 80 departments throughout the hospital and have raised millions of dollars over the years. At Gilchrist Hospice Care we have 325 volunteers who donated 17,858 hours, 6% of all patient care hours.
As we honored Mary Pat Marzullo, as she retires from her position as Director of Volunteer Services and Rodica Johnson, President of the Volunteer Auxiliary and Debbie Jones, Volunteer Services Manager of Gilchrist Hospice Care spoke, I couldn’t help but marvel. I know that nearly all hospitals have volunteers, but do they have this? I don’t think so. This is way beyond over the top.
I left the group with some quotes about volunteers and giving back, which I share with you now.
Those who can, do. Those who can do more, volunteer. ~Author Unknown
Wherever a man turns he can find someone who needs him. ~Albert Schweitzer
Volunteers don't get paid, not because they're worthless, but because they're priceless. ~Sherry Anderson It's easy to make a buck. It's a lot tougher to make a difference. ~Tom Brokaw
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olunteers do not necessarily have the time; they just have the heart. ~Elizabeth AndrewThe smallest act of kindness is worth more than the grandest intention. ~Oscar Wilde 
How far that little candle throws his beams!So shines a good deed in a weary world
David Seltzer for the 1971 film Willy Wonka and the Chocolate Factory (adapted from W. Shakespeare)
Kindness is the language which the deaf can hear and the blind can see. ~Mark Twain
How wonderful it is that nobody need wait a single moment before starting to improve the world. ~Anne FrankAct as if what you do makes a difference. It does. ~William James
Unless someone like you cares a whole awful lot, nothing is going to get better. It's not. ~Dr. Seuss I am only one, but I am one. I cannot do everything, but I can do something. And I will not let what I cannot do interfere with what I can do. ~Edward Everett Hale
Nobody can do everything, but everyone can do something. ~Author UnknownThe true meaning of life is to plant trees, under whose shade you do not expect to sit. ~Nelson Henderson
We make a living by what we get, but we make a life by what we give. ~Winston Churchill
God has not called us to see through each other, but to see each other through. ~Author Unknown
Things of the spirit differ from things material in that the more you give the more you have. ~Christopher Morley
You give but little when you give of your possessions. It is when you give of yourself that you
truly give. ~Kahlil Gibran
I've learned that you shouldn't go through life with a catchers mitt on both hands. You need
to be able to throw something back. ~Maya Angelou
Everybody can be great, because anybody can serve. You don't have to have a college degree to serve. You don't have to make your subject and your verb agree to serve.... You don't have to know the second theory of thermodynamics in physics to serve. You only need a heart full of grace. A soul generated by love. ~Martin Luther King, Jr.
Thank you volunteers!
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GBMC Celebrates Earth Day
The first Earth Day was celebrated on April 22, 1970. It was the brainchild of Wisconsin Senator Gaylord Nelson. In 1962 he convinced President Kennedy to go on a five-state environmental 
tour, which he took in 1963. There was not much press. In 1969, at the height of the Viet Nam war and numerous anti-war demonstrations, Nelson envisioned a “teach-in” on the environment. Approximately 20 million Americans participated on that first Earth Day on April 22, 1970. Groups that had been fighting against specific environmental issues now had a common voice and the environmental movement had begun. Today Earth Day is celebrated by nearly 500 million people all over the globe.
Although April 22 is the birthday of Lenin, it is also the birthday of Eddie Albert (Green Acres fame and dedicated environmentalist) who spoke at the first Earth Day.
GBMC’s Green Team is hosting our celebration of Earth Day 2010. Employees, volunteers and members of the community are all invited to attend the “Farmer’s Market” themed event on Thursday, April 22 from 10:00 a.m. – 1:00 p.m. in Civiletti Conference Center rooms B and C. Earth Day 2010 will feature:
Recycling stations – Bring in one or more of the following items for recycling and your name will be entered into a prize drawing!
Cell phones/accessories
Eyeglasses
Computer equipment from home (PCs, monitors, keyboards, speakers, etc.)
Household batteries
Giveaways – Sign GBMC’s pledge to be environmentally responsible and receive a FREE reusable cup! Each time you use the cup in the GBMC Café, you’ll receive an extra 10¢ discount off the cost of a 16oz. fountain drink or coffee.
Refreshments – Free popcorn and lemonade will be available!
It’s a Jeans Day! – Buy a sticker for $5 and wear jeans to work on Earth Day. Come to the dining room on April 15, April 16 and April 21 between 11:00 a.m. and 1:30 p.m. to buy a sticker to wear with your jeans on April 22. Proceeds benefit Herring Run Watershed Association. *Check with your manager to determine whether jeans are appropriate for your department.
Numerous “
farmer’s market stands” will be full of useful information such as
• The history of Earth Day
• Your carbon footprint
• Environmental benefits of a vegetarian/vegan diet
• “Greening” Maryland Hospitals
Find out what GBMC is doing to minimize its impact on the environment through its energy-conserving Peak Load Contribution (PLC) program, expanded recycling capabilities and plans for a new Farmer’s Market this summer. Some participants include Baltimore County Recycling, Herring Run Watershed Association and several of GBMC’s energy management partners.
Also in honor of Earth Day, GBMC’s Café will serve an assortment of fresh local foods like chicken, bison burgers and vegetables to encourage interest in eating healthy, sustainable foods while supporting Maryland farmers.
Please direct questions to Barbara Nagle Bodyk at ext. 2945. See you at the “farmer’s market!”
Some Earth Day links:
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Just two weeks after World Water Day, we had none. A fire knocked out power to a local reservoir pumping station causing water to stop flowing in the Towson area. Here we go again. Code Yellow.
We drink it. We bathe and swim in it. We cook with it. We take it for granted. We turn on the faucet and expect instant, clean water. But, have you thought about how much water is part of your daily life? When it’s not there you may start to think about the possibilities. How much water does a hospital use? Lots.
In the aftermath of hurricane Katrina, hospitals are better prepared to handle a variety of conditions that might arise. All hospitals are stocked to be self sufficient for 96 hours. That includes water.
As tankers brought extra water on site yesterday morning,
Tressa Springmann, VP and CIO, took command in the GBMC Command Center. With the emergency management team, she outlined the priorities. It was déjà vu. Only this time rather than two feet of snow outside it was sunny and nearly 90 degrees!
As the hospital’s water pressure dropped the team acted quickly. From prior experience we know which areas use the most water. The chillers providing HVAC to the adjoining office buildings were brought down. Outpatient appointments were cancelled. All operating rooms and patient care areas were kept open and running. All surgical sets for the next day’s 125 cases
were sterilized and ready. Bottled water was delivered to each patient’s bedside. Alcohol based hand cleaners became more plentiful. The kitchen switched to cold food preparation. Portable eye-wash stations were positioned in the laboratory. “Bucket-brigades” were formed to flush toilets, signs were posted and broadcasts issued.
When I asked Tressa what her biggest concern was, she quickly replied “fire”. There would be little support from the fire department. Fire rounds had started early in the day visiting all areas of the medical center and keeping a log.
Water Facts:
• Although a person can live without food for more than a month, a person can only live without water for approximately one week.
• Only 1% of the earth's water is suitable for drinking water.
• The average person in the United States uses 100-150 gallons of water each day, Europeans use an averageof 74 gallons, Africans use 17 gallons and the Chinese use about 23 gallons.
• About 70% of water is used for agriculture globally, while 20% is used for industry and 10% for residential use.
• Asia has significant water challenges with 36% of the world's water supply, yet 60% of the total population.
• Leaks are an enormous problem. In developing countries, nearly 40% of the water is lost before it reaches its destination.
• In the US, we pay about $.005 per gallon of water. Compared water to a gallon of milk at $3.50--700 times the cost of water.
How can hospitals save water? Here are two case studies from Massachusetts.
Case Study Example #1 Carney Hospital in Dorchester is installing flow control fixtures on all patient and exam room faucets at their facility. The existing flow rate of the faucets was measured at 5 gallons per minute (gpm). After retrofitting the faucets the flow was reduced by 3.5 gpm to 1.5 gpm. The average usage of sinks at the facility is estimated at 25 minutes per day. This results in a water savings of 88 gallons per day, or 32,000 gallons of heated water per year for a combined water and energy savings of approximately $280 annually per sink. The cost to retrofit one sink is estimated at $12 resulting in a payback of less than one month.
Install flow control fixtures on all faucets.
Install water saving shower heads.
Retrofit flushometer toilets and urinals with low consumption valve replacement kits.
Replace existing higher consumption toilets and urinals with Massachusetts Plumbing Code conforming Ultra Low Flush (ULF) toilets and urinals which use 1.6 gallons per flush (gpf) and 1.0 gpf respectively.
Case Study Example #2 New England Memorial Hospital in Stoneham has over 300 flushometer toilets in their facility which use approximately 4.5 gallons per flush. Replacing all the existing toilets with ULF toilets would save over 5 million gallons of water annually based on estimates of average daily population in the hospital and information on toilet use. The cost of this measure is estimated at $65,000 and the water and sewer savings of approximately $42,000 result in a payback of 18 months.
By 7:30 p.m. the water was restored. Water pressure in the hospital quickly rose. Toilet valves that stick when water flow is interrupted for a period of time, were all changed by 9:00 p.m. The hospital was back to normal. We could flush again.
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On July 5, 2006 obstetrical nurse Julie Thao gave Jasmine Gant, a 16-year-old scheduled for induction of labor, IV bupivacaine (Marcaine), an anesthetic intended for epidural administration instead of the IV penicillin that had been prescribed to treat a streptococcal infection. The patient suffered a cardiac arrest and 
couldn't be resuscitated. An infant son was delivered by cesarean section.
This is a clear case of an adverse event that in health care is classified as a sentinel event, a medical error leading to death of a patient. Who is to blame? Who is responsible?
For 16 years Julie Thao had been a good obstetrics nurse, one highly regarded by her peers at St. Mary's Hospital in Madison, Wisconsin. Over the July 4 holiday she volunteered to work an extra shift, after working an eight-hour day shift. She was scheduled for a 7 am shift on July 5; she slept at the hospital at the end of the two shifts. The error occurred during the second half of that July 5 shift.
Nurse Thao allegedly failed to follow the “five rights” of medication administration (right patient, right medication, right dose, right time, and right route). She failed to use the patient's ID wristband bar-coding system installed on the unit three weeks earlier. The medications looked alike and were brought to the patient room before orders were given. She was obviously fatigued from working 20 of the prior 28 hours. Was she distracted, rushed?
Health care providers generally come to work to do a good job not to harm patients. They are, for the most part, dedicated individuals who see their work as a calling to improve the lot of mankind. What do we do when they make a horrible mistake?
St. Mary’s Hospital fired Julie Thao. The Wisconsin state board of nursing suspended her license and the state brought criminal charges. St. Mary’s Hospital settled a $1.9 million malpractice suit with the patient’s family. Nurse Thao was despondent. "I felt my soul banging on the inside of my chest to be set free," she said. "It could not bear to be inside this body, this person who had done this."
Several years ago David Marx, an engineer developed what is called Just Culture. Given the premise that most adverse events are a result of a system failure, errors are rarely caused solely by the actions of an individual. Individual responsibility for an error arises from intentional or reckless behavior or actions performed under the influence of drugs or alcohol.
Just culture may be difficult to implement. A young, healthy patient is dead. An orphaned infant, a grieving family and an outraged press and community exert tremendous pressure. How does the hospital respond? They fire the nurse.
An organization that adopts a Just Culture as one of its cornerstone principles should have a different response. First, the reason to use a Just Culture is have an organization where patient safety issues and concerns can be brought up in an open and safe atmosphere. An organization that uses individual blame will find that there is a scarcity of voluntary reporting, no learning and a poor safety record. Second, the initialization of a Just Culture starts with the board of directors and senior leadership. A standardized approach that investigates all incidents using an algorithm is needed.
The UK National Health Service has an on-line program that allows for a step by step evaluation of an adverse event.
The first point on the decision tree is whether the action was intended. If so, were the consequences intended? If not, did substance abuse play a role? If not, were safe practices violated? If so, then were the procedures available, workable, intelligible, correct and routinely used? Would another individual act the same way in a similar circumstance? The answers to these questions guide the evaluation of expectations, systems, and training with the determination of a system failing or an individual behavior problem.
If St. Mary’s Hospital had a strong Just Culture would this event be handled in a different way or could it have been prevented? There are a number of areas to consider. First, Nurse Thao was working extra shifts at a rate the data shows promotes unsafe acts. There should have been a strong policy that prevents nurses from taking on unsafe extra hours of work. The medications looked alike and arrived without a proper order. The newly implemented wrist band bedside medication verification was not working properly and nurses routinely circumvented its use.
An institution with a Just Culture would have quickly followed a standard algorithm and determined that, neither the act nor the consequences were intentional. That substance abuse did not play a role. That despite the fact that clear policies were violated, the training and systems were faulty and that others would have made a similar mistake. Julie Thao’s error might have been a natural result of the institution’s failure to protect the patient with the proper policies and systems. The institutions must accept the blame, work to correct their policies and have a process that aids the involved staff through the period of intense personal guilt and remorse that inevitably follows.
We need to separate the act from the outcome. What if Jasmine Gant had a brief arrhythmia and mother and baby were fine? Would the response be the same? Nurse Thao’s actions would be identical in both circumstances. Would the investigation of the event proceed in a similar manner with the purpose of preventing future similar events?
Could this happen at GBMC? Do we have the systems and processes in place to prevent such an error?
I spoke with Jody Porter, our senior vice-president for patient care services and Sue Bowen, our administrative director of L&D. We reviewed our policies and procedures with regard to epidural medications
. Since this episode in Wisconsin, epidural catheter manufacturers have made their catheters a bright yellow. Unfortunately the ends where the medication lines are attached are the same for IV catheters and epidural catheters. Our medications for epidurals are premixed by the pharmacy. The drugs (fentanyl and bupicacaine) are highlighted in yellow and there is a hot pink label (like St. Mary’s) on the bag stating EPIDURAL use. Yellow stickers are placed on the epidural tubing stating “epidural use only”. I visited our labor and delivery suite and spoke to our nurses and one of the anesthesiologists. They showed me how they used the Omnicell for the medication and the special tubing. 
At our hospital it is the anesthesiologist who actually attaches the medication line to the patient. The antibiotics that are used in L&D are physically much different from the epidural medications as shown. The epidural mixture is on the left with the two antibiotics frequently used to the right. Ampicillin’s vial is attached to the bottom of the infusion saline and Cefazolin is in a foil container.
Nationally, a recommendation by the Institute of Medicine in 2004 to limit nurses' working hours has not been adopted. The institute, a nonprofit organization that advises Congress on health-care policy, said states should prohibit nurses from working more than 12 hours in a 24-hour period or more than 60 hours per week. "No real action has occurred," said Ann Rogers, a nursing professor at the University of Pennsylvania. Her studies have revealed an increase in fatigue and errors among nurses who work more than 12 hours in a row. Our practice is that nurses can only work a maximum of 16 hours in a 24 hour period. The lessons that we can learn are that medicine has the capacity to heal and cure, but also has a capacity to cause great harm. As healtcare providers we must be vigilant in following Hippocrates' first dictum: "first do no harm".
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On February 27, 2010 the colleagues and friends of
Dr. Sam Alvaran gathered to honor his career in Anesthesiology at GBMC. Sam has retired this year and continues his battle with cancer. The evening brought together the GBMC operating room family including the many physicians of
Physician Anesthesia Associates (PAA), nurse anesthetists, anesthesia technicians, OR nurses and technicians, PACU nurses, GBMC physicians and surgeons whose lives and careers were intertwined with Sam Alvaran. Evident throughout the evening were Sam’s love for everyone of GBMC and their love in return.
The evening was highlighted by songs by Ester Ousborne who sang The First Time Ever I Saw Your Face and Remember When and by Sam’s daughter, Terri Curtis, who sang Promise. Bob Cordes, Jose Dominguez and Jo Ann Loeliger put their creative talents together to produce a great video and John Bisker reenacted the Sam Alvaran Shogun era.
Sam Alvaran came to GBMC in 1972 from Johns Hopkins. Dr. Pedro Garcia, who later became the second chairman of the department of anesthesiology, brought Sam to the department to run the heart program that somehow evaded the medical center to end up close by. Pedro remarked on his over 50 year friendship with Sam Alvaran; how they would flip a coin to see who would be the first to go home after being on-call. “Sam always won. I don’t know to this day how he did it”. Pedro, not always intelligible but never at a loss for words, expressed his great friendship and affection for Sam.
Sam was a part of a premier group of anesthesiologists who made surgeons want to bring their patients to GBMC because they recognized that their patients would be attended with expert and safe care. This excellence made GBMC one of the busiest surgical hospital in the state. Al Nelson, Pedro Garcia and today, Harry Goll have gathered an outstanding cohort of talented individuals. Many, like Sam Alvaran, were trained at Johns Hopkins.
Sam’s colleagues noted his quiet competence. How he silenced Pedro Garcia by intubating a difficult patient after several others had been unsuccessful. How he stayed close as a young anesthesiologist rescued the airway of a critical patient. When asked why he was still there, he replied “I knew you were upset, I wanted to be here for you”. The respect and affection for Sam Alvaran was palpable that evening.
Other stories included an emergency in OB where a Japanese speaking patient was in active labor. Sam expertly calmed her in fluent Japanese (if only in intonation and gestures). I operated with Sam Alvaran for over 25 years and have no stories. Perhaps, as a surgeon, that’s what you want from your anesthesiologist, no stories, just quiet competence. That is Sam Alvaran.
Just as Lou Gehrig addressed his adoring fans at Yankee Stadium many years ago, Sam Alvaran took the podium to address his fans. Like Gehrig, he said “I feel that I am sitting on the top of the world because I am surrounded by people whom I love and people who love me”.
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As Black History Month draws to a close I would like to introduce you to one of my surgical heroes, LaSalle D. Leffall, Jr., MD. As surgical resident at Walter Reed in the 1970’s I had weekly grand rounds with visiting professors. The format was the presentation of interesting surgical cases followed by a discussion by the professor. It was at time of great education and great stress for us as residents as the professor would ask questions of medical students and residents on a certain disease process or surgical procedure that had been presented. We had several visiting professors who were chairmen of surgical programs from Washington, D.C., and Baltimore. The most outstanding was Dr. LaSalle Leffall from Howard University.
Following the case presentation Dr. Leffall would walk up to the podium, grasp it in both hands and ask “where are the 3rd year doctors?” (referring to the 3rd year medical students on their surgery rotation) Next he asked where are the 4th year doctors, and so on through the residency ranks. He would then dissect through the case and give us the important lessons by asking questions all around the room. I remember once when I was the chief resident that one of Dr. Leffall's quesions made it all the way around the room up to me. Luckily I knew the right answer and didn't disappoint Dr. Leffall.
One of his favorite sayings was “There are only two reasons that patients come to the doctor, pain and bleeding. Pain because it hurts them and bleeding because it scares them.” He would admonish us that “there are two diagnoses that you will never make.” Then he’d stop and look out over the conference room and restate “never make”. Then he would tell us in his precise diction, “The two diagnoses you will never make are the disease that you don’t know about, and the disease you don’t think about.”
Dr. Leffall also taught us how to say Johns Hopkins. He would say “the founder’s first name was Johns, not John. You wouldn’t say Pitt-burgh, it’s Pittsburgh”.
LaSalle Leffall was born in Tallahassee, Florida, on May 22, 1930, to LaSalle D. Leffall, Sr., who hailed from east Texas, and Martha Jordan Leffall, from northern Alabama. He grew up in the small town of Quincy, Florida. Both his parents were educators in the public school system of Florida. Dr. Leffall graduated as the valedictorian of his high school class, graduated summa cum laude from Florida A&M University, and was first in his class at Howard Medical School. He did his residency at Freedmen’s Hospital, now known as Howard University Hospital and completed a fellowship in surgical oncology at Memorial Sloan-Kettering Cancer Center.
Dr. Leffall performed his military service as Chief of General Surgery in the U.S. Army Hospital in Munich, Germany in 1960 and 1961. He then joined the faculty of Howard University College of Medicine. He was selected to be Chairman of the Department of Surgery in 1970. In 1992 he was named the Charles R. Drew Professor, occupying the first endowed Chair in the history of Howard's Department of Surgery.
During the course of his illustrative career, Dr. Leffall was awarded honorary degrees from nine universities and was the president of nine medical organizations. He was the first African-American to be elected President of the Society of Surgical Oncology, President of the American Cancer Society, both in 1978 and President of the American College of Surgeons in 1995.
He used his national positions to emphasize the problems of cancer in minorities. He held the first conference on cancer among black Americans in February of 1979. "I have tried to point out the problems of lack of access to care and the increased death rate”. In 1980, President Carter appointed him to a six-year term as a member of the National Cancer Advisory Board.
As much as he dedicated himself to the broader aspects of prevention, nutrition, and education as head of the American Cancer Society, Dr. Leffall continued to remind others that "the one thing we must never forget is that the object of our attention and affection is the cancer patient."
In 1987 M.D. Anderson Hospital established The Biennial LaSalle D. Leffall, Jr. Award. This award recognizes Dr. Leffall’s contributions to cancer prevention, treatment, and education in minority and economically disadvantaged communities. In 1989, the citizens of Quincy, Florida named a street, a path, and the surgical wing in the Gadsden Memorial Hospital in his honor. The LaSalle D. Leffall, Jr. Surgical Society was formed in March 1995; the Leffall Chair in Surgery at Howard University was established in February 1996. Dr. Leffall and his family established the Martha J. and LaSalle D. Leffall, Sr. Endowed Scholarship Fund and Endowed Professorship in Science at Florida A & M University in 1997 in honor of his mother and father. His memoirs entitled “Grace Notes—A Cancer Surgeon’s Odyssey,” was published by the Howard University Press in 2004.
In addition to his professorship at Howard University, was the chairman of the Susan G. Komen Breast Cancer Foundation; the President’s Cancer Panel; the Board of Directors of the National Dialogue on Cancer. Dr. Leffall and his wife Ruth have one son, LaSalle, III an honors graduate of Harvard College and the Harvard Law and Business Schools. He is the Executive Vice President and Chief Operating Officer of the National Housing Partnership Foundation in Washington, D.C.. Dr. Leffall is an avid tennis player and supporter of jazz music. Because of his long-standing and close relationship with Julian “Cannonball” Adderley, Dr. Leffall represents an important link with one of the most imposing figures in modern jazz.
Meet LaSalle D. Leffall, Jr., MD, FACS in this video clip from the Washington Post.
http://www.washingtonpost.com/wp-dyn/content/video/2006/08/29/VI2006082900628.html
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In thinking ways in which to provide the best care possible to our patients at GBMC, I came across one recently that looks promising.
If there was a new product on the market that could reduce the rate of major complications in patients undergoing surgical operations by 36% and mortality rates by 47% would it be worth the investment? With 30 OR’s and 32,000 surgical procedures per year and a NSQIP mortality rate of 0.68% and an HSMR rate of 0.65%, perhaps we don’t need this new product. With healthcare reform still somewhat in the works, this new product might not be cost effective. Besides we have other priorities, such as showing that our EMR meets all the meaningful use criteria set forth by the federal government, making sure we can provide access to the newly insured and keeping a strong bottom line. But, just what is this new product? Perhaps we should make this investment, but what will it cost?
It turns out, it costs almost nothing. It’s the World Health Organization’s Surgical Safety Checklist. Published just over a year ago in the New England Journal of Medicine why hasn’t the surgical world embraced a tool that has been shown in a world-wide study to reduce morbidity and mortality? The answer is probably, us, the surgeons. It’s just not our culture. After spending a recent Sunday afternoon reading Atul Gawande’s new book, The Checklist Manifesto, I was 
struck, not only by his usual engaging review of the origin and use of checklists in other industries, but by his personal journey from skeptic to advocate. From the B-17 flying fortress that was felt to be too complex to fly, to the construction of modern skyscrapers, to the operations of a restaurant’s kitchen, Gawande shows that complex tasks can be completed with ease when managed by the use of checklists. Checklists help us not to forget the important things. They need to be simple and embraced as important tools to perform complex activities, like landing a jetliner or performing surgery.
For the past six months I have been using the WHO Surgical Safety Checklist in my OR’s, just to try it out and see how it feels. It’s different from our usual “time-outs” in a couple of ways. First it is divided into three parts: before induction of anesthesia, before skin incision, and before the patient leaves the operating room. It is a structured communication tool. It fosters teamwork as each member of the team, stops and introduces himself or herself by name and states their role. We use first names, like the airlines. It allows for communication between the surgery and the anesthesiology teams that is all too frequently absent. Besides checking for the proper patient identification, verification of the site of the procedure and consent, we confirm the proper functioning of equipment, the risk of excessive bleeding, review the critical steps, anesthesia concerns, and confirm the administration of prophylactic antibiotics as well as thromboembolism prevention. This 19-step checklist process takes less than sixty seconds to complete.
In order to ensure lasting adoption of this tool we are working to develop a process that will emphasize the results that can be gained with its use and align the most resistant members of our surgical teams so that they can become checklist champions. We will also look for other areas in the hospital, both in patient care settings and in operations where checklists will allow us to, as Gawande says: “get the stupid stuff right”.
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GBMC is in to its sixth day of Yellow Alert (essential staff remains on site) facing back to back super storms. No sooner had the snow from the Super Bowl weekend storm been cleared, forecasters called for a second severe snowstorm to drop 1-2 feet with blizzard potential. The medical center has been fully operational throughout with full surgical schedules Monday and Tuesday. In anticipation of the second storm beginning last night over 200 staff stayed at the hospital. Many came packed for three or four days. Putting staff up in empty patient rooms was not an option since the house was full. As the supply of cots ran low the Maryland Emergency Management System was put to use.
Dan Tesch, GBMC's Emergency Management Director, uses the hospital's Ham radio system to talk with other members of the Baltimore County Radio Amateur Civil Emergency Service (RACES) group during the beginning of the second snowstorm. In short order 100 extra cots came from the Baltimore County Emergency Management Task Force supply at Towson University. The cots were quickly delivered to designated sleeping areas for staff.
Mike Forthman, VP of Facilities unloads the cots as Dan Tesch readies the cots for use.
Jody Porter, RN - Senior Vice President Patient Care Services and Chief Nursing Officer, and Jill Wheeler, RN - Nursing Administration, plan staff accommodations in GBMC's Hospital Command Center.
Our Civiletti Conference Center has been converted into a staff dorm, filled with cots. Staff that are staying for several nights are instructed to store their linen for the next night as the night shift comes in to get some rest.
Throughout, the GBMC Command Center remains on high alert. At 5 a.m. this morning George Bayless, VP of Finance, took over for overnight incident commander, Eric Melchior. Steve Cohen coordinates volunteer drivers and prioritizes staff pick-ups. Four staff handle phone calls as Dan Tesch, Michelle Tauson and Donita Dietz of Emergency Management, advise the Incident 
Commander.
The Command Center includes an information board with the roles of all important personnel outlined. The individuals fulfilling each role are place on the board with their contact and cell phone numbers. To the left of the board are pre-arranged binders that outline the duties of each position with an action plan set out for the first 96 hours of any emergency.
Incident Commander George Bayless surveys the storm from the Emergency Department entrance. Area weather reports are reporting blizzard like conditions with wind gusts between 40-60 mph. Six volunteer drivers are still out this morning and we will assess the conditions as they return. As conditions worsen we may have to stop transporting staff altogether. Physicians are rounding on our telemetry patients to see if any patients can move to med/surg beds to alleviate a back up in the ED.
Surgical cases from our three OR’s were consolidated in the general operating room. All of the first case patients were here and on time. Only four patients called to cancel. We will do 26 cases today and have 68 scheduled for tomorrow. Our pharmacy, laboratory and radiology departments have remained fully staffed. There is a great spirit of teamwork throughout the organization.
There will be plenty of lessons learned with these storms. Our Command Center keeps a running list of items to be discussed in an after-action session, so that we can be better prepared in the future.
Plow and the “Gator” in the front parking area. Same area twenty minutes later.
Kim Solberg, MD, Chair of the GBMC Department of Psychiatry, was awarded the GBMC’s 2010 Nancy J. Petrarca Compassionate Caregiver Award at this month’s Schwartz Center Rounds. “I am deeply honored to have been chosen for GBMC’s Compassionate Caregiver Award,” said Dr. Solberg. “The nominees are all the kind of care providers that anyone would be fortunate to have been cared for by. It is truly humbling to have been considered among them."
