Medical Assistant Noreen Fordham practices evacuating a patient, Surgical Associates Manager Sherry Refino, down a flight of stairs.
The following is an excerpt from our 2011 Annual Report.
In a disaster, the local medical center is a needed resource. With rooms filled with bed-ridden patients spanning multiple floors, a medical center must also be prepared for an emergency within.
Last year, Gifford held one of its largest emergency preparedness training events in recent years. In intense trainings held over two days, a total of 80 employees learned firsthand how put out a fire, communicate via emergency radios, and evacuate patients. They studied the locations of exits, emergency phones and medical gas shut-off valves. They learned about decontaminating patients and personal protection, and dealing with aggressive people.
Environmental Services Manager Ruthie Adams learns to use a fire extinguisher.
Ruthie Adams, Environmental Services manager, was among those who went through the training.
“I think it benefits the entire organization to have folks who understand key and critical points, especially non-clinical staff, such as how to evacuate a patient using an Evacusled, how to communicate on a radio properly, and just being a key go-to person in the event of an emergency,” says Ruthie, who used a fire extinguisher for the first time and now uses radio communication in her job.
The training was just one way Gifford prepares for an emergency. Employees take annual courses and exams electronically on workplace safety, such as fire, electrical, disaster preparedness, and violent situations.
Staff practice securing a patient, played by Environmental Services Team Leader Ralph Herrick, in the new Evacusled, used to evacuate bed-ridden patients.
A 2010 grant supported a study, changes, and significant educational outreach on Gifford’s emergency codes. These codes are what employees hear called out as overhead pages during emergencies and include codes from fire to cardiac arrest to a violent situation.
Monthly fire drills are held regularly throughout all shifts and in varying areas of the hospital.
Physical therapist Patrice Conard and materials clerk Alice Whittington participate in a scavenger hunt utilizing their newly learned radio communication skills.
Director of Quality Management Sue Peterson defines an emergency as “anything that stretches the limits of our normal operations.”
Prior to October’s larger training, smaller emergency trainings were held with managers and facilities staff on radio use and responding to a “code amber,” which is a missing patient or person. Future drills on other codes are planned.
When mass casualty situations like a bus accident with multiple victims arise, which they occasionally do, follow-up meetings are held to discuss what went well and where staff needs to make improvements. An essential Emergency Operations Plan has been
painstakingly updated over the last year, detailing Gifford’s response to a variety of emergency circumstances. The plan continues to be updated so hospital staff can remain ready to address changing threats and adverse events.
“As a medical center committed to our community and as Vermonters with a can-do attitude, we do well,” says Sue. “But preparing for the diverse threats in today’s world is a huge task. Emergency preparedness planning is essential to ensuring that we as a caregiver keep our patients safe in a crisis.”
Say “Gifford” and locals no doubt think of Randolph’s long-standing hospital. Say “Dr. Gifford” and the hospital’s founder and namesake comes to mind for most. Except Priscilla Carpenter, that is. To Carpenter, “Dr. Gifford” was better known as “Uncle Pearl.”
John Pearl Gifford was the son of an East Randolph farmer who went on to Dartmouth College and then Dartmouth Medical School, graduating as valedictorian in 1897. A respected local physician, he purchased a South Main Street house in 1903 and with two nurses established the hospital there.
Thirty years later in 1933, he nicked a finger on his right hand while performing surgery on a patient with a then-deadly streptococcus infection and died several weeks later.
Nearly 80 years after this death, Gifford – the hospital – still remains at that South Main Street address, and Dr. Gifford remains entrenched in its name and history. In fact, an oversized photo and a biography adorn a wall at the hospital. And now beside it is a newly created Gifford family tree.
The genealogy was created thanks to the efforts of Gifford graphic designer Tammy Hooker; long-time hospital employee Marilyn Sargeant, a great niece of Dr. Gifford; and Sargeant’s sister, Carpenter.
Carpenter, 90, of Randolph, scoured records, relying chiefly on a genealogy created by a cousin and calling relatives to fill in the blanks of the family history that spans six generations. Carpenter relayed the details to Sargeant, who relayed them to Hooker, who created the family tree.
Sargeant, 76, of Randolph Center is too young to remember Uncle Pearl. She was born after his death. Carpenter was 10 when he died and remembers it well for she was suffering from chicken pox at the time. “I was bed-ridden when he died,” says Carpenter.
Uncle Pearl had visited a sick Carpenter at her home before he died. As the local doctor, “he took care of us,” Carpenter says. But in those days there was no such thing as annual exams and well-child visits. “You didn’t go to the doctor’s unless you were sick.”
Dr. Gifford sought treatment for his own hand infection at Deaconess Hospital in Boston. The recommendation, recalls Carpenter, was to amputate but Gifford’s wife, Eliza, refused to allow it because of what it would mean to Dr. Gifford’s surgical career.
Eliza and Dr. Gifford, as the family tree shows, never had children of their own. Eliza Gifford died in 1964.
Sargeant and Carpenter are the last surviving children of Dr. Gifford’s nephew Edson Gifford Sr.
Sargeant has worked at Gifford for more than 40 years. She is Medical Staff Services manager. Sargeant and Carpenter’s mother, Loeata, was also employed by Gifford as a nurse. She graduated from the hospital’s then-nursing school in 1917.
Carpenter remembers her parents visiting Uncle Pearl at the hospital and sitting on an oversized wooden lounge in Dr. Gifford’s office while she waited. That lounge is now in the hospital’s main lobby for use by patients and visitors.
Seeing these pieces of their past, the new family tree and their surname still so prominently displayed on the hospital is a remarkable tribute, the sisters say. “It’s a great honor.”
From left, sisters Priscilla Carpenter of Randolph and Marilyn Sargeant of Randolph Center pose with Gifford Medical Center graphic designer Tammy Hooker of Barre in front of a new family tree at the hospital. The graphic features hospital founder Dr. John Gifford’s genealogy. Dr. Gifford was Carpenter and Sargeant’s great uncle.
As a student at Mount Holyoke College in Massachusetts, Barbara Lazar worked in a nursing home as a nurse’s aide. She decided then that she wanted to spend her career caring for the elderly.
You could describe it as a calling, but what Lazar really discovered was that when it comes to older people, a little caring goes a long way, and that felt good.
After a stint doing Alzheimer’s research in a lab in Philadelphia, Lazar went on to earn her medical degree at the University of Pennsylvania School of Medicine. Following her internship and residency at Thomas Jefferson University Hospital in Philadelphia, Dr. Lazar launched a family medicine career that has focused on geriatrics.
She began her career in 1996 working for the Indian Health Service at Northern Navajo Medical Center in New Mexico. Moving to Vermont in 2003, she served as a medical director at Genesis Elder Care in Lebanon while a member of the department of family medicine at Dartmouth-Hitchcock Medical Center. She also worked at Brookside Nursing Home in White River Junction and most recently at PACE (the Program for All-inclusive Care of the Elderly) in Rutland.
She loved her work at PACE to help support older people’s ability to remain in their homes, she says, but was looking for a shorter commute to work. A Sharon resident, she looked north to Gifford and found a remarkable fit.
“As a provider it’s very attractive to come to a place that has its heart in the right place and that is committed to serving the community. It feels like a gift to have found a place like this,” says Dr. Lazar, who has started seeing patients at Gifford’s family medicine practice in Randolph.
A warm, caring and thoughtful doctor, it is Dr. Lazar’s goal to provide whole person and whole family care, considering a patient’s psycho-social needs as well as their medical needs. She’s also hoping to serve the area’s elderly and families struggling to meet an elderly loved one’s needs.
Board certified by the American Board of Family Practice, Dr. Lazar is a native of upstate New York. She makes her home in Vermont with her husband, Dr. Joel Lazar, a family physician at Dartmouth, and their two sons, ages 13 and 15. In her free time, Dr. Lazar enjoys hiking and music.
For complete family care, call Dr. Lazar at Gifford Family Medicine at (802) 728-2445 or learn more at www.giffordmed.org.
This photo shows one of Kari Meyer’s paintings now on display in the Gifford Medical Center art gallery. Called “Morning Meadow,” it is acrylic on canvas and painted on Beaver Meadow Road in Marshfield.
Montpelier painter Kari Meyer’s unique landscapes are in the Gifford Medical Center art gallery through Jan. 30.
Born and raised in the Northeast Kingdom, Meyer’s love of nature started at an early age. She spent much of her childhood playing in the woods and rivers near her rural home.
She attended high school at St. Johnsbury Academy. The school offered in-depth classes in art and Meyer says she fell in love with acrylic painting. She went on to earn an associate degree in multimedia and graphic design from Champlain College and then her bachelor’s degree in studio art from the University of Vermont.
Her knowledge of graphic design, she says, continues to be integrated into her artwork. Her studies at UVM also sparked an interest in sculpture. On close inspection, viewers of Meyer’s work can see her love of texture and three dimensions.
“As an artist I see art as a form of communication that has a power beyond that of words. Through imagery I attempt to portray ideas that words cannot, like the archetypal beauty that connects all things,” Meyer says. “I attempt to create a positive experience for the viewer, while also hoping to make a positive commentary on the world.”
Meyer works from photographs. She estimates a third of her time creating a painting is spent in the woods and walking the back roads of Vermont in search of the places that portray the magic and beauty of the landscape.
She works in digital photography, using a computer to alter colors, lighting and even composition of some of her images. By incorporating different textures and materials into her paintings, she creates an even more dynamic image that changes with lighting, casting its own shadows and creating a depth and mystery within each image.
Meyer says her imagery demonstrates an abstraction of nature, with her inspiration coming in part from the ideals of wabi-sabi, a prominent philosophy of Japanese aesthetics.
“For me wabi-sabi changes the worldview of Western civilization. Things we normally view as negative become beautiful. Loneliness, old age and death become beautiful because they are inevitable and represent the constant flux of the universe,” Meyer says. “I attempt to address this idea of the movement of eternity, of everything either coming from or returning to nothingness. My work urges the viewer to contemplate the relationship between oneself, nature and the universe.”
See Meyer’s work for yourself at Gifford. The show is free and open to the public. The gallery is just inside the main entrance of the medical center, located south of Randolph village. For directions and more information, visit www.giffordmed.org. Learn more about Meyer’s work online at www.karimeyer.com.
Married couple Elvira Dana and Jason Kass live and work in Armenia, a developing country once part of the Soviet Union. When it came time to have children, however, Dana and Kass looked outside of Armenia for care.
Elvira Dana and Jason Kass hold 3-year-old Gideon and newborn Natalie at a family home in Northfield. The married couple has come home to Vermont from Armenia – traveling for 36 hours – to have both their children at Gifford Medical Center.
They looked to Dana’s native Vermont, specifically Gifford Medical Center in Randolph.
For each of their child’s births – first Gideon three years ago and then Natalie late last month – the family flew back to Vermont.
“When Gideon came along we decided very quickly we needed to be back in the U.S. for the birth,” says Dana, who grew up in Northfield and was one of Gifford’s early Birthing Center patients nearly 35 years ago.
She got her prenatal care – such that it was – in Armenia and e-mailed test results and information to Gifford’s team of certified nurse-midwives. “They were willing to be flexible about some pretty strange pre-natal care,” says Dana, noting some documents sent had been translated from Russian and Armenian.
At 36 weeks of pregnancy (the latest point in a pregnancy that women are recommended to fly and often the latest point an airline will allow a pregnant woman in the air) Dana, with Kass at her side, traveled the 36 hours home. Gifford childbirth education and lactation consultant Nancy Clark provided the couple a crash course in birthing.
Gideon was born the morning after that final birthing class. He arrived two weeks early and just two-and-a-half hours after Dana made it to the hospital.
Hurricane Sandy this year delayed the family’s flight and Dana ended up flying – a bit nervously – at 37 weeks. But Natalie was patient, arriving on Nov. 26, one day after her due date and about an hour and forty-five minutes after the family made it to the hospital.
In both instances, says the couple, the atmosphere, low-intervention birth experience, and friendliness of staff were exactly what the family was seeking.
“Nobody was stressed. It was so calm. It was just us, a midwife and a nurse with no beeping noises. Everyone we interacted with was so kind, including the cleaning and food services staff,” Dana says.
Pediatrician Dr. Lou DiNicola – Dana’s pediatrician growing up – checked on both babies following their births. The children have both gotten their pediatric care at Gifford while they’re in the state. And in fact, they even called Gifford, reaching Dr. DiNicola as the on-call pediatrician, when Gideon spiked a high fever in Armenia and the couple didn’t know what to do, says Kass, 37 and formerly of Randolph Center.
It is the consistency of the care provided at Gifford, says Dana, that gives the couple the confidence to fly in and give birth with a midwife they may never have met or entrust their child’s care with a pediatrician who may not be a familiar face.
“Mostly we just feel so incredibly lucky,” says Dana, cradling her newborn.
Service through the Peace Corps first took Dana to Armenia in 2005. Putting her master’s degree in teaching English as a second language to work, she taught English and trained teachers. She then was hired as Armenia country director of American Councils, a non-profit that administers U.S. State Department and international educational programs, including student exchanges.
Jason joined her in Armenia in 2008, working in the scant Armenia job market and for meager Armenian wages as a head gardener at a renovated public park.
Presently staying with family in Northfield, the couple and their now two children will fly back to Armenia on Feb. 4. Natalie will need a passport before they can go. Bilingual young Gideon is on his second passport, having already filled one in his three years of life.
The family hopes to make Vermont their permanent home one day again soon – at least by the time Gideon will start school.
The Kass family plays together. They are in Vermont from Armenia to have their latest child, newborn Natalie, at Gifford Medical Center’s Birthing Center.
The following is an excerpt from our 2011 Annual Report.
Information Systems Director Sean Patrick sits amid the old way of keeping patient records – paper files – and the new way to come – electronic medical records updated by providers via new laptops or even iPads.
As lawmakers embark on an ambitious schedule to create a health care exchange required under the federal Patient Protection and Affordable Care Act by 2014 and a Vermont single-payer system by 2017, Gifford is mindful of its role as a community care provider.
The laws seek to bend the health care cost curve, in part through information technology, advanced primary care and payment reform.
Through the implementation of Vermont Blueprint for Health initiatives, Gifford is embarking on reform initiatives including care coordination for the chronically ill and recognition of Gifford’s five primary care practices as Patient-Centered Medical Homes.
The medical center has chosen an electronic medical record (EMR) vendor and is progressing toward both the installation of an EMR system and meeting federal requirements for “meaningful use” of electronic health records (EHRs). EMRs are internal electronic medical records. EHRs can be viewed by appropriate outside entities, including specialists and providers from other hospitals.
Gifford’s modest budget requests and responsible spending also align with reform, notes Trustee Paul Kendall, who actively follows reform legislation.
But the non-profit community medical center is by choice not at the forefront of reform efforts.
Gifford Administrator Joe Woodin likens health care reform to a passing ship. Where others might be quick to jump on – appropriately, the region’s larger health care providers – Gifford is waiting to ensure the medical center commits to the best choice for
Gifford’s size, patients and rural area.
“Gifford is more inclined to stay on the dock and wait for the boat to come around on health care reform,” Joe says. “It takes a lot of fortitude to humbly wait for the boat to make a reiteration.”
“We continue to be watchful of what’s going on and gradually position ourselves to do
what is right and appropriate,” agrees Paul, noting some initiatives like information
technology upgrades can require huge investments of time and financial resources.
Gifford also strives to be a voice in discussions leading up to reform legislation. Leadership is suggesting cost-saving ideas the state could pursue now. They continue to set a standard
for financial stability and maintaining strong relationships with other hospitals, state and federal lawmakers, and health care organizations, like Bi-State Primary Care and the Vermont Association (VAHHS).
VAHHS represents the state’s nonprofit hospitals before lawmakers and the Green Mountain Care Board, which was created by the Legislature in 2011 to oversee the creation of a single payer Vermont system. Bea Grause, VAHHS president and chief executive officer, sees small hospitals’ role in health care reform as one of preserving local access to high-quality care.
“Hospitals are seeking to create reform opportunities by working with the Green Mountain Care Board and federal lawmakers that will balance the need to contain costs with the need to ensure sufficient revenue that will help hospitals meet their local missions,” she says. “Issues such as recruitment and retention of physicians and other health professionals, improving quality, ensuring access and long-term financial sustainability are just a few of the challenges small hospitals will face as Vermont and the entire industry prepare for a decade of continued change on all levels.”
Gifford’s work with Bi-State Primary Care in part addresses the recruitment piece.
Bi-State Primary Care is a nonprofit membership organization of Vermont and New Hampshire rural health care providers working to support primary care practices in medically under-served areas. Its members represent more than 175,000 Vermonters. This equates to one in four residents, or 46 percent of Medicaid enrollees and 52 percent of the state’s uninsured.
The organization is working on Gifford and small, rural primary care practices’ behalf to improve access by recruiting providers to underserved areas. They are also working on health information exchanges and quality improvement initiatives.
The ultimate challenge the state – and likely hospitals by default – will face for successful health care reform, however, will be answering the question: “What can we afford?”
“There are a lot of uncomfortable issues with health care reform that we don’t talk about. The most common issue is ‘what can we afford,’” Joe says, hoping lawmakers will address that question. If they don’t, it will fall on hospitals, which will be given limited funds to provide care. They will have to make tough choices on what care they can afford to