Quality Improvement Initiatives

This article was published in our Cancer Program 2014 Annual Report.

Rebecca O'BerryBy Rebecca O’Berry, vice president of surgery and operations

In 2014 the Cancer Program has focused on improving our screening efforts for colorectal cancer, the one cancer that can be prevented. Our two quality improvement goals for 2014 were to improve the tracking process we use for hemoccult cards given to patients and to increase the number of people screened for colorectal cancer.

Historically, less than half of the hemoccult cards given to patients are returned to the physician’s office for testing. We implemented a follow-up plan to increase our return rate and modified the system we use to track these cards. Our efforts were successful, and we were encouraged to explore bringing in a different test that is easier for patients to perform at home. This new laboratory test will be part of our quality initiative for 2015.

Throughout the organization we worked to increase the number of patients who receive some kind of colorectal screening. In the target age group of 50-75, our screening numbers increased from 59 percent (in 2013) to 90 percent (in 2014). This is a significant improvement, and shows how effective a targeted educational effort on the benefits of some form of colorectal screening can be! Unfortunately a large number of our patients still refuse to undergo colorectal screening. In 2015 we will work to improve patient access to screening by increasing the variety of our testing methods.

In 2014 we also increased our social services support for patients undergoing cancer treatment. To ensure that everyone has the help they need while moving through treatment, our patients now have easy access to a social worker and our Blueprint team. We also created a binder to collect all the information needed by someone undergoing cancer treatment.

The MagView program implemented at the end of 2013 has helped our radiology department track screening mammography in a more systematic way. This program keeps all a patient’s information in one location, and allows a much faster turnaround time for notification of results. The time a patient must wait to receive a mammography result notification letter is now less than two days!

Our providers are excellent communicators and have put a lot of time and energy into community education about prevention, early detection, and treatment of cancer. We work closely with our local senior centers to provide education sessions that are open to the public. Topics covered in these community outreach efforts include: skin cancer screenings and education (in several locations); discussions on breast cancer, bladder and prostate cancer, and colorectal cancer. We will continue to provide this education in the upcoming year.

In 2014, 53 new cancer cases were identified, with breast cancer continuing to be the most prominent followed by lung, colon, and prostate. A total of 41 of those 53 cases were discussed at Tumor Board meetings.

2014 Gifford cancer statistics

Click here to read our full Cancer Program 2014 Annual Report.

Expertise, Personalized Care, and Comprehensive Support Close to Home

This article was published in our Cancer Program 2014 Annual Report.

Brenda CaswellWhen someone is given a cancer diagnosis, their world is turned upside down. Suddenly there is a lot of information to absorb, many tests to take, and hard decisions that have to be made quickly—all when people are feeling most vulnerable.

Travelling to receive treatment and follow-up cancer care can be expensive, exhausting, and complicated to organize. At Gifford patients with cancer have treatment options that can relieve these stresses.

Most cancers—especially breast, colon, prostate, and bladder cancers—can be treated here in our community hospital with caregivers that patients know and trust, close to the family and friends who will support them during treatment.

“Our goal is to make sure people know that they can receive the same quality of care offered at larger hospitals close to home, with a support network they know,” said Rebecca O’Berry, vice-president of Surgery and Operations at Gifford. “Battling a cancer diagnosis is hard enough—I’m thankful that we can provide quality cancer care locally and decrease our patient’s travel time during treatment.”

First accredited by the American College of Surgeons Commission on Cancer in 1965 (we received our most recent 3-year accreditation in December of 2014), our cancer program has been delivering quality cancer care to our community for nearly fifty years. Our oncology services include cancer care from an experienced oncologist, hospital specialists and surgeons, and specially certified oncology nurses; lab and diagnostic services; advanced diagnostic services, including stereotactic breast imaging; outpatient chemotherapy; preventive cancer screenings; and a strong palliative care program. Our multidisciplinary approach to each patient’s care includes identifying social service needs as well as appropriate medical expertise.

Experience, expertise, and compassionate care close to home

“With cancer, making the right diagnosis and getting the right treatment is key,” says Dr. Richard Graham, a Gifford urologist who treats prostate, bladder, and renal cancers. “Experience with specific cancers is also important. We have the expertise and technology to diagnose a lot of rare cancers, but we are small enough to see patients as individuals: You are not a number here.”

Graham notes that he saw an increase in patients whose small cancers were treated with cryosurgery and laparoscopic surgery in 2014.

Personalized support for the cancer care each patient chooses

When a patient chooses cancer treatment that is not offered here, our providers make referrals and collaborate with outside oncologists so things go smoothly. Patients have the option to receive post-operative care and chemo treatments close to home.

Brenda Caswell, a Randolph mother of five, regularly comes to Gifford for medical care and annual mammogram screenings. She missed three years of annual visits because of her pregnancy and the birth of her youngest child, and when she resumed her check-in’s her provider insisted that she get a mammogram.

“My provider didn’t let me out of the office without scheduling a mammogram,” Caswell says. “She knew me, knew that my mom had had breast cancer, and knew that regular screening was especially important for me.”

A small tumor was detected, and after a biopsy and two consultations with Dr. Ciccarelli, she decided to have mastectomy and reconstructive breast surgery through a program offered at a larger hospital. Dr. Ciccarelli’s team made referrals and helped her arrange treatment. When her cancer was found to be more invasive than originally thought, she had to plan for chemotherapy after surgery. Then, when post-operative complications required a week of inpatient care right before the holidays, she knew she wanted to be close to home and with her family.

“I was able to be at Gifford, just down the street from my home,” Caswell said. “The doctors were wonderful—they collaborated with the oncologists who were treating me, sharing blood counts and test results. It was a very smooth process.”

Click here to read our full Cancer Program 2014 Annual Report.

Gifford Cancer Program Overview

Gifford's cancer program

This article was published in our Cancer Program 2014 Annual Report.

Gifford cancer committeeEstablished in 1959, Gifford’s Cancer Program is accredited by the American College of Surgeons Commission on Cancer.

A dedicated cancer committee meets regularly to provide leadership for the program, including setting program goals and objectives, driving quality improvements and best outcomes for patients, and coordinating Gifford’s multidisciplinary approach to cancer treatment.

Operating out of our relaxing Ambulatory Care Unit, Gifford’s Oncology Department includes:

  • Cancer care from an experienced oncologist
  • Specially certified oncology nurses
  • Planning options for cancer treatment following a diagnosis
  • Outpatient chemotherapy
  • Treatments for some hematology conditions

The medical center is home to advanced diagnostic technology, including stereotactic breast biopsies; a breast care coordinator providing education and outreach; a patient care navigator; many surgical offerings; data management and quality oversight; and cancer prevention programs, including a “Prevention into Practice” model that works with patients and their health care providers to bring screenings to the forefront.

Click here to read our full Cancer Program 2014 Annual Report.

Gifford’s 2014 Highlights: October – December

The following article appeared in our 2014 Annual Report.


Gifford completes its upgrade to electronic medical records (EMR). Throughout the year, Gifford primary care and specialty care outpatient practices moved from paper to candidates' debateelectronic records as part of a federal initiative.

Gifford and the White River Valley Chamber of Commerce collaborate to hold the only local candidates’ debate for Senate and House of Representatives candidates.

Gifford's Woman to Woman FundGifford employee Teresa Bradley and her niece, Krista Warner, once again hold a bowling tournament in memory of Teresa’s mom and Krista’s grandmother, Ruth Brown. Money raised supports Gifford’s Woman to Woman Fund and brings awareness to the importance of mammograms.

Gifford announces it has met its state-approved operating margin for the 15th consecutive year.

Gifford meets operating margin


Major Melvin McLaughlin

Gifford loses one of the greatest heroes of our time, Major Melvin McLaughlin. Affectionately known as “the Major” and “Major Mac,” he spent the last 40 years volunteering at the hospital, encouraging staff and patients with words of love and friendship. He will be greatly missed, but never forgotten.

Hannaford gift certificate for Project IndependenceHannaford Supermarket in South Barre presented Project Independence with a gift certificate worth $1,500. The gift is used to offset the cost of groceries for the program which provides a daily breakfast, lunch, and snack for roughly 38 participants. When the store manager asked staff which nonprofit they should contribute to, the adult day program was at the top of their list.

Dr. Lou DiNicolaPediatrician Dr. Lou DiNicola receives the Green Mountain Pediatrician Award from the American Academy of Pediatrics Vermont Chapter. He was acknowledged for over 38 years of service as a Gifford pediatrician. Along with a plaque, Dr. DiNicola was presented a 7-foot-long handwritten scroll describing what makes him special.


Gifford once again invests $40,000 into the regional economy through the Gifford Gift Certificate program.

Bowling Tournament Raises Funds for Mammograms

bowling tournament for breast cancer awareness

Teresa Bradley of Braintree, left, and Krista Warner pose at the Valley Bowl in Randolph. The duo organized a fifth bowling tournament recently to bring awareness to breast cancer and raise money for mammograms at their local hospital, Gifford Medical Center. (Provided/Robin Palmer)

What started as a senior project has grown into an annual tradition.

Four years ago, Krista Warner, then a local high school senior, organized a bowling tournament to support Gifford’s Woman to Woman Fund with the help of her aunt, Teresa Bradley of Braintree.

Warner of Randolph is now long out of high school, but the duo continues to organize the tournament to support local mammograms in the name of Warner’s grandmother and Bradley’s mother, Ruth Brown. Brown had several forms of cancer, including breast cancer in 1993 and lung cancer, which ultimately took her life in 2011.

A mammogram diagnosed her breast cancer.

“If she hadn’t had it, we would have lost her back in 1993,” says Bradley with conviction. “That mammogram gave her another 18 years.”

Following her death, Warner and Bradley renamed their tournament the Ruth Brown Memorial Breast Cancer Awareness Tournament. This year’s tournament – their fifth – raised $857, which they recently gave to their local hospital.

The top fund-raiser in this year’s event was Patty Grueteke. Nate Olmstead won the tournament.

Bradley thanked Valley Bowl and Bob’s M & M for donating prizes as well as all of the bowlers all who participated. “It’s awesome that they come out and do it. They’re very enthusiastic,” Bradley said, adding, “It’s a good tournament. We have a good time, plus we’re raising money for people who are less fortunate.”

Gifford’s Woman to Woman Fund pays for mammograms for low-income women not covered by other programs, such as Ladies First, and buys soft pads that go on the mammography machine to make mammograms more comfortable for all women.

“We want to encourage women to have their annual mammograms. Providing a more comfortable and more affordable experience helps substantially. We are so appreciative of Krista and Teresa for working hard each year to support this shared cause, raise awareness and bring a fun event to our community,” Gifford Director of Development and Public Relations Ashley Lincoln said.

The Ruth Brown Memorial Breast Cancer Awareness Tournament is held at Valley Bowl in Randolph on the fourth Sunday in October during Breast Cancer Awareness Month each year. Bowlers of all abilities are welcome.

The tournament has raised $5,150 since its inception.

Year in Review – Part 4

Our 2012 Annual Report included a month-by-month “Year in Review” section. Here is the fourth quarter excerpt.


Food choices in the Gifford cafeteria get even healthier as the hospital transitions to a healthy breakfast bar; healthier, lower salt meats; less butter and heavy cream in foods; and more grains and legumes as starches.

Lt. Gov. Phil Scott stops at Gifford on his “Cycling Vermont’s 14″ 500-mile bicycle tour of the state’s 14 counties. He tours Menig as part of his stop.

Dr. Josh Plavin, a National Health Service Corps scholarship recipient, speaks out for the federal program supporting primary care providers on Corps Community Day on Oct. 11, and for the need for more primary care providers, especially in rural regions.

Two local women, Krista Warner and Teresa Bradley, organize a bowling tournament in support of Gifford’s Woman to Woman fund and raise $1,485 for breast cancer awareness.

The CT scanner is upgraded from a 40-slice model to a 64-slice model, offering patients faster service, clearer imaging, and less radiation.


A new system, a CAREpoint Workstation, for transmitting EKGs from ambulances in the field to the Gifford Emergency Department is brought online. The system, generously paid for by the Gifford Auxiliary, is for use with heart attack patients to determine if they should be brought to Gifford or directly to a cardiac catheterization lab at Dartmouth-Hitchcock Medical Center or Fletcher Allen Health Care.

Stuff a TruckMenig residents work with school children from the Baptist Fellowship of Randolph to create 100 boxes of gifts for children in Third World countries through Operation Christmas Child.

Working with Connor Contracting Inc., Gifford staff and community members Stuff a Truck for Hurricane Sandy survivors in the Rockaway neighborhood of Long Island, New York.

The first patient is seen in the Radiology Department’s new fluoroscopy room. The room is utilized for interventional radiology procedures, which have grown in number.

Great American Smoke OutAll Gifford grounds go smoke-free in concert with the Great American Smoke Out on Nov. 15.

Gifford’s Annual Craft Fair raises funds for the Adult Day Program.

Married couple Elvira Dana and Jason Kass travel 36 hours from their home in Armenia to give birth at Gifford, for a second time.

Visiting Nurse and Hospice of Vermont and New Hampshire, the Vermont Ethics Network, and Gifford’s Advanced Illness Care team join together to offer a community discussion around end-of-life care planning. Other talks on death and dying continue at Gifford in the months that follow.


Family physician Barbara Lazar joins Gifford, bringing a love of geriatrics to the Randolph team.

Chef Wendell Fowler leads a free talk on the pitfalls of the American diet. He suggests cutting the food additives, chemicals, hydrogenated oils, and high fructose corn syrup in favor of fresher, less-processed foods to improve our health.

Gifford once again supports the community through its holiday gift certificate program – a buy local program where employees receive “gift certificates” redeemable only at regional, locally-owned businesses.

Hilda Gray: A Mammogram Found Her Breast Cancer

Now she encourages others to have their annual exams

This article appeared in our Spring 2013 Update publication.

radiologist Dr. Scott Smith

Radiologist Dr. Scott Smith performed Hilda’s biopsy and shared her diagnosis with her extended family.

Hilda Gray is a strong proponent of mammograms. The South Royalton resident has had one every year at her community hospital, Gifford Medical Center.

Last year was the first time this active grandmother got some unsettling news, however.

A small lesion in her left breast was found and merited further study. Gifford Patient Care Navigator Brittany Kelton scheduled all of Hilda’s follow-up care and was at her side during each appointment.

A diagnostic mammogram and ultrasound were performed and then an ultrasound-guided biopsy was done right in the Radiology Department.

At first, Hilda didn’t want the biopsy. “I wasn’t too thrilled about that,” she says. Her family, however, was insistent. “‘Momma, you’re going to have the biopsy and that is all there is to it,’” Hilda recalls one of her daughters saying.

On the day radiologist Dr. Scott Smith delivered the news that the small mass was indeed breast cancer, three of Hilda’s children and her husband, Robert Gray Sr., were at her side.

General surgeon Dr. Maury Smith

General surgeon Dr. Maury Smith removed Hilda’s cancer.

Dr. Smith “took the whole family in the office and explained to everybody. He didn’t try to hurry you out. He wanted to make sure all of our questions were answered,” Robert recalls.

A lumpectomy, surgery to remove the mass, was the next step. This time, Hilda was fearless. “If its something that’s got to be done, it’s got to be done,” she recalls saying at the time.

She also had every confidence in the general surgeon who would operate – Dr. Maury Smith. “To Dr. Smith, you are a person, not just a patient,” says Robert.

This time with Robert, all four of her children and their spouses with her, Hilda returned to Gifford last fall for surgery to remove the cancer. A follow-up mammogram earlier this year found no additional lesions, says a happy, cancer-free Hilda.

“I feel like the hospital did wonderful by me,” she says, encouraging others to have their annual mammograms.

“Just do it,” she says. “If I hadn’t gone, I would never have known it was there. I really think it’s something women should do every year.”

BRCA Test Can Help Determine Risk for Breast, Ovarian Cancer

By Dr. Ellamarie Russo-DeMara, Gynecologist

Angelina Jolie’s courageous decision to undergo a double mastectomy to reduce her risk of developing hereditary breast cancer has brought to light an important test done regularly, and promoted, at Gifford.

The reason behind Jolie’s decision was a positive BRCA test. BRCA is a test for hereditary breast and ovarian cancers. It is as pain-free as a test gets; all you have to do is spit in a test tube.

In more scientific terms, the test is of your saliva or, buccal DNA, and is done right in the doctor’s office to check for an inherited mutation or alteration in the BRCA 1 or BRCA 2 gene.

While hereditary breast and ovarian cancer account for only 5 percent of these cancers, knowing your BRCA status can help you and your family make informed decisions and choices.

A woman with BRCA 1 or 2 mutations has a markedly elevated risk of developing breast and ovarian cancer, including:

  • Up to a 50 percent risk of developing breast cancer by age 50 (compared to 2 percent in the general population)
  • Up to an 87 percent risk of developing breast cancer by age 70 (compared to 8 percent in the general population)
  • Up to a 64 percent risk of developing a second breast cancer
  • Up to a 44 percent chance of developing ovarian cancer by age 70 (compared to less than 1 percent in the general population)

Knowing whether you have this mutation will enable you to have increased surveillance and/or treatment, which can potentially save your life and help your family members make informed decisions. Management strategies may include earlier breast cancer screening with mammography or MRI, risk reducing surgery such as ovary removal after childbearing is completed, and chemoprevention, such as tamoxifen or birth control pills.

Red flags for hereditary breast and ovarian cancers, include:

  • Breast cancer before age 50
  • Ovarian cancer at any age
  • Male breast cancer at any age
  • Ashkenazi Jewish heritage
  • Relatives of a BRCA carrier

If you or a loved one falls into one of these categories, contact your primary care or gynecologist’s office to inquire about testing.

Dr. Ellamarie Russo-DeMara is a gynecologist at Gifford’s Bethel Health Center and Twin River Health Center in White River Junction. She provides BRCA advice and testing. She is also a breast cancer survivor.

Bowling for Breast Cancer

For a third year, Teresa Bradley of Braintree and Krista Warner of Randolph have organized a bowling tournament at Valley Bowl to support Gifford Medical Center’s Woman to Woman fund.

Held each year on the fourth Sunday in October, the Ruth Brown Memorial Breast Cancer Awareness Tournament raised $1,485 and attracted 32 bowlers. The winning bowler was Shawn Corbett of Rochester. The top fund-raiser was Barre’s Diana Flood. Also recognized were Bob’s M&M, Patrick’s Place and Valley Bowl, all of Randolph, for donating the top three prizes at each annual tournament.

The tournament, which started in 2010 as Warner’s high school senior project, is named in memory of Bradley’s mother and Warner’s grandmother, who was diagnosed with breast cancer in 1993 following a mammogram. She beat the disease but later developed lung cancer, passing away in Gifford’s Garden Room last year. For Warner and Bradley, the tournament is a way to keep her memory alive and support a cause about which they feel strongly.

Gifford’s Woman to Woman fund helps provide mammograms to low-income women and funds soft pads placed on the mammography machine to make essential mammograms more comfortable for all.

bowling for breast cancer

Here Bradley, left, and Warner, middle, present the money they raised to Gifford Breast Care Coordinator Cheryl Jewkes in the Randolph hospital’s stereotactic breast biopsy room.

bowling for breast cancer

Here Bradley and Warner stand with Gifford Breast Care Coordinator Cheryl Jewkes by the Randolph hospital’s digital mammography machine.

bowling for breast cancer

Here Bradley, Warner and Gifford Breast Care Coordinator Cheryl Jewkes, standing in the Randolph hospital’s digital mammography room, feign surprise at the thick stack of money raised.

Breast cancer awareness talk slated for Oct. 22 at Gifford

Dr. Anne Galante

Dr. Scott Smith

RANDOLPH – Experts from Gifford Medical Center will lead a free breast cancer awareness talk on Oct. 22 from 6-7:30 p.m. in concert with Breast Cancer Awareness Month.

Ob/gyn Dr. Anne Galante and radiologist Dr. Scott Smith will discuss screening and prevention of breast cancer among women of all ages. Specific topics include breast exams, clinical breast exams, the importance and limitations of various methods of breast imaging, and genetic testing for hereditary breast and ovarian cancers.

Time will be provided for one-on-one questions with these local experts.

Michele Packard, Health Connections specialist, will also be on hand to enroll qualifying women ages 21 and up in Ladies First as well as explore other insurance options.

Breast cancer is the most common form of cancer in women in the United States and in Vermont. It’s also the nation’s leading single cause of death overall in women between the ages of 40 and 55.

According to the Vermont Department of Health, about 473 breast cancer cases are diagnosed among Vermont women each year. About 92 people each year die from the disease. Nationwide, there is a new diagnosis every three minutes and a death from breast cancer every 14 minutes.

While advances have been made in prevention, diagnosis, treatment and cure, early detection still affords the best opportunity for successful treatment.

“We hope to increase awareness of breast cancer risks, prevention, screening and insurance opportunities available to Vermont women,” Dr. Galante said. “Early diagnosis offers the best chance of surviving breast cancer, but if we don’t know about the disease, we can’t treat it.

“This is an opportunity for women of all ages, and whoever they want to bring with them, to learn more about breast health.”

The talk, titled “The Importance of Breast Cancer Screening,” will be held in the Gifford Conference Center at the medical center at 44 S. Main St. (Route 12) in Randolph.

The event is free and open to all. No registration is required.

For more information, call the hospital at 728-7000 or visit www.giffordmed.org.