Making a Difference: When Work Becomes Community

This article was published in our 2015 Annual Report.

Drs. Lou DiNicola and Christina DiNicola

Drs. Lou DiNicola and Christina DiNicola

In 1976 Pediatrician Lou DiNicola came to Randolph for an interview shortly after completing his residency. The first provider he met wore jeans and a flannel shirt, and he knew right then he was at an unusual organization.

“I spent the night at the CEO’s house—it really was a community hospital!” he said. “I wanted to work in Vermont, and I wanted to care for kids, not just see them and send them on to a larger medical center. I took the position.”

Forty years later, DiNicola is still practicing in Randolph (he also saw families in the Rochester clinic until 1992), and he has become a passionate and respected advocate for children’s health, helping to shape state legislation on a range of issues.

The organization has grown (there are now six community health centers), and you see fewer flannel shirts, but the feel of a “real community hospital” remains. The local Rotary Club holds morning meetings in the cafeteria, where at lunch the staff mingles with neighbors who come for great locally-sourced food; there are no reserved spaces for VIPs in the parking lot; and the computerized staff email directory is still arranged alphabetically by an employee’s first name.

In a small community everyone’s lives are intertwined. We care for people who repair our cars, teach our children, attend our church, or manage the store where we buy groceries. The lines that separate hospital from community, caregiver from patient, and even family from co-worker are less distinct.

“Everything that happens in the community —a town fire, school events, Hurricane Irene—comes into our office as well. I have patients now who are the grandchildren of patients I saw years ago,” said Dr. Lou DiNicola. “I live less than three miles from work; clearly this is my home.”

For Dr. Lou DiNicola the connection goes even deeper: Pediatrician Dr. Christina DiNicola spent a summer jobshadowing him before heading off to Stanford University in fall of 1994. Today her former mentor is both a colleague and her father-in-law.

“I wanted to live in the same community I worked in, to have the same accountability to community as to family,” said Christina, who came from a larger practice in Philadelphia last spring. “People care about each other, and about life outside work. There’s a special kind of familiarity this way. The people I see in the office I also see in my community—just in different roles.”

Both Dr. DiNicolas say this blurred line between their work and community roles brings relevance to their work, and shapes the way they deliver care. When something they do has a positive impact, they can see how lives are changed.

“In previous positions I was part of a team of rotating doctors,” said Christina. “My work in the clinic here is especially satisfying to me because I can follow up directly with patients and build ongoing relationships with families.”

Dr. Lou DiNicola says the opportunity for connection and community still attracts new providers. Another draw also endures, something he recognized when he visited years ago, and that is Gifford’s focus on quality. This ensures that the technology and expertise needed for direct patient care is available locally—most patients aren’t sent elsewhere after diagnosis. We do everything we can to treat our patients in the community setting.

“Today medical students are most often trained to be specialists at larger medical centers. Those who want to do more personalized care, and to see a wide range of cases, come to rural medicine,” he said. “I value my ongoing relationships with people in the community, but I also take satisfaction in being there for people who have come a long way for care. People from all over choose to have their babies at Gifford and helping them with the birthing process, whether routine or complicated, has also always been a rewarding experience. We have the best of both worlds at Gifford!”

Bethel Artist Carla Hodgdon Exhibit at Gifford Gallery

“Fuchsia,” pen and ink drawing by Bethel artist Carla Lamberton Powers Hodgdon.

RANDOLPH – Work by Bethel artist Carla Lamberton Powers Hodgdon is on display through May 25, 2016, in the Gifford Medical Center Art Gallery.

The 36 pieces in this exhibit display work in a variety of mediums, including watercolor, pen and ink, pencil, mixed media, and counted and stamped cross stitch. While she has never taken art classes or received formal training, over the years Hodgdon has turned to
art as a way to relax, especially during the winter months when she is not in the garden. Her mother first introduced her to needlework when she was a child, which led to her interest in cross stitch.

A native Vermonter, Hodgdon has lived and worked in Vermont for all but ten years of her life. She trained as a registered nurse and worked as a public health administrator, retiring from the VT State Department of Health in 2003. While away from Vermont, she served in the Peace Corps, working at the National University of Honduras as an associate professor of Nursing. After returning to the States in 1969, she worked at the Yolo County Health Department just outside Sacramento, CA. She returned to Vermont in 1977, and moved back to her hometown of Bethel in 1983.

Since her retirement she has enjoyed having time to volunteer in community and church activities, to care for extensive perennial flowerbeds, and especially to create art and needlework.

Since her retirement she has enjoyed having time to volunteer in community and church
activities, to care for extensive perennial flowerbeds, and especially to create art and
needlework.

This exhibit is free and open to the public, and will be displayed through May 25, 2016.
The gallery is located just inside the hospital’s main entrance at 44 S, Main St. (Route 12)
in Randolph. Call Gifford at (802) 728-7000 for more information.

 

Gifford Welcomes Certified Nurse-Midwife Julia Cook

Certified nurse-midwife Julia Cook

RANDOLPH – Certified nurse-midwife Julia Cook has joined Gifford’s team of midwives, and is now seeing patients in our Randolph and Berlin clinics.

Cook received a Master of Science in Nursing from Frontier Nursing University in Hyden, KY. Her clinical interests include adolescent care, patient education, and helping women to be active participants in their ob/gyn care.

Born in rural Louisiana, she moved to a suburb of Atlanta while in High School, and went on to get an associate of Science in Nursing from Georgia Perimeter College. She was first attracted to ob/gyn care after the birth of her first child 16 years ago.

“The midwives who cared for me were amazing—they empowered me as a woman and as a new mother,” she said. “I was intrigued by what they did, and asked them what I needed to do to start on that career path.”

When Cook finished her training she began to look for work in a smaller community, and was drawn by the story of Gifford’s Birthing Center and its pioneering efforts in family centered birth. She also appreciates that her work will include opportunities for well-women and adolescent care.

“I feel that education is so important when it comes to women’s health,” she said. “I especially enjoy working with adolescents because they are at a time in life when information about how to be healthy is taken with them as they transition into adulthood.”

Cook says her husband and four children are also excited about moving to New England, and the family looks forward to living in a smaller community and exploring all the new things Vermont offers.

To schedule an appointment, or to learn more about Gifford’s Birthing Center, please call 802-728-2401.

The Transformative Power of a Small Gesture

This article was published in our 2015 Annual Report.

Dr. Lou DiNicola, Development Director Ashley Lincoln and Lincoln Clark

Dr. Lou DiNicola, Development Director Ashley Lincoln and Lincoln Clark

Gifford’s Vision for the Future began in 2008, with 31 acres in Randolph Center and a list of long-term facility and community needs. After years of community input and careful strategic planning, this year we watched the “vision” become real: the New Menig Nursing Home opened in May and 25 new private inpatient rooms opened in December. A new and modernized Birthing Center will open this coming spring.

For us, one of the most gratifying aspects of this past year has been seeing people experience firsthand the impact that their gift has on our community. Our Menig residents are enjoying a new home, filled with light and beautiful views of the surrounding mountains and meadows, and anyone visiting the hospital can see how new private rooms have improved the healing environment for patients.

The highlight of our year came in November, when the Gifford Auxiliary made a million dollar contribution to the campaign—the largest gift in Gifford’s history! This gift is especially impressive as the funds were raised primarily through small-dollar sales of “re-purposed” items at the Thrift Shop.

Who could imagine that the ripple created by a donated box of unused household clutter could extend so far?

It is humbling what dedication, persistence, and belief in a unified vision can do. The investment of the Auxiliary and so many other generous donors represents a powerful affirmation of what we do every day at Gifford. Each gift has contributed to an outpouring of support that will help us continue to provide quality local care for generations to come.

Your generosity, and your faith in Gifford’s mission, makes transformation possible. We can never say it enough: thank you!

Gifford Auxiliary

Ashley Lincoln
Development & Public Relations Director

Lincoln Clark & Dr. Lou DiNicola
Vision for the Future co-chairs

A New Model for Primary Care

This article was published in our 2015 Annual Report.

Dr. Milt Fowler and physician assistant Leslie Osterman

Dr. Milt Fowler and physician assistant Leslie Osterman

For Dr. Milt Fowler and physician assistant Leslie Osterman, teamwork is the key to continuity of care.

Dr. Milt Fowler had just completed his residency when he arrived at Gifford in 1976.

He and his wife were eager to leave the city and wanted to be part of a small community.

He’s still practicing at Gifford forty years later, and now he faces another major life transition: easing into retirement.

“I’m having a hard time cutting back. I’ve known some of my patients for 35 or 40 years,” he said. “There’s a deep richness and joy in practicing primary care in a small community. Once you’ve shut the door on the chaos and paperwork and sit to connect with a patient, the office is like a sacred space.”

Providers at Gifford often say that an ongoing patient relationship is the most satisfying part of their work. For family physicians, the bonds can grow especially strong: it is not unusual for long-time primary care physicians to have treated several generations in a single family.

“I see my role as being a positive influence, someone a patient can come to for help—not just with medicine, but with other issues as well,” said Dr. Ken Borie, who has been practicing family medicine at Gifford since 1980. “Family doctors can build trust in ways a specialist can’t. That’s what’s valuable about being a primary care physician—it’s one of the intangibles that you can’t put a price on.”

Across the country a shortage of primary care physicians is forcing rural community hospitals like Gifford to look for alternatives to this traditional model. As a generation of long-time physicians starts to retire, fewer new providers choose a career in primary care.

Many factors have contributed to this shortage: primary care pays less than other fields and many medical students, burdened with student debt, specialize in other areas. Those who do practice primary care are in demand, and are much more mobile than the providers who settled in Randolph years ago. Rural communities are especially hard hit, since salaries are much higher in urban areas.

To respond to this primary care recruitment challenge, Gifford has implemented a team model, often pairing a physician with a physician assistant or nurse practitioner. These healthcare professionals have been specially trained to diagnose and treat a variety of conditions, prescribe medication, order and interpret tests, counsel, and manage patient care.

Fowler works closely with Physician Assistant-Certified, Leslie Osterman. The arrangement shortens a patient’s waiting time for appointments, but also helps to make sure that patients have quality time with a provider during visits.

“There are not enough MD/DO’s to care for everybody—we have to find new models,” said Fowler. “Leslie and I work really well together. She’s taken over much of the acute care and the preventive and health maintenance visits like annual physicals and cancer screenings. I tend to manage care for patients with more complicated needs.”

Osterman previously worked as a respiratory therapist but found she wanted to be more involved in patient care. She saw that the physician assistants she worked with could focus on preventative medicine, and shared knowledge and decision-making as a team. She returned to school, received a Masters of Physician Assistant studies from Franklin Pierce University (she completed three of her nine rotations at Gifford), and came to practice at Gifford in 2015.

“Milt introduces me to his long-time patients and they see us working together. If their next appointment is with me, I won’t be some random person they haven’t seen before,” said Osterman. “Continuity of care is really important to people.”

The new team model increases patient access to primary care professionals while preserving a quality provider/patient relationship. Like the long-term providers they work with, physician assistants and nurse practitioners say they specifically chose their roles because they wanted to build ongoing connections with patients.

“I trained as a physician assistant because I had seen that many doctors weren’t able to spend extra time with patients discussing concerns or preventive care,” said Osterman. “Sometimes patients need extra time for education or explanations, and I wanted to help fill this need.”

Rochester Welcomes Dr. Erwin Lange to Community’s Health Center

Gifford Medical Center

Photo: Dr. Erwin Lange (right) with Rochester Health Center Office Manager Dawn Beriau (left) and Registered Nurse Gail Proctor.

Dr. Erwin Lange has joined Gifford’s Primary Care team and is seeing patients at the Rochester Health Center. He started in Rochester as a locum in November, 2015 and has now settled in full-time as the community’s primary care provider. Lange brings many years of medical experience to his patients. He received a BA from Dartmouth College, a MD from the Brown Alpert Medical School in Providence RI, and completed a three year residency in family practice at the St. Joseph Hospital Health Center in Syracuse, NY.

Board certified in Family Practice, he began his career as a family practitioner in a rural community in New York State before moving into practice as an emergency physician in several NH and Vermont hospitals. When he decided to return to family medicine he was looking for a rural community like Rochester, where he could care for a variety of conditions but also establish ongoing relationships with patients.

Office Manager Dawn Beriau and Registered Nurse Gail Proctor have worked at the clinic for more than 30 years and are introducing him to local families, many who have been receiving primary care at the Health Center for generations. Lange says he really has appreciated how welcoming the Rochester community has been during his first months here. “Rochester really is an amazing community,” he said. “Sometimes people have stopped in just to introduce themselves and visit, and that has been great!”

The Rochester Health Center opened in 1976 and provides family and internal (adult) medicine in a convenient location at 235 Main Street. Dr. Lange sees patients at the center from 8:30 a.m. to 4:30 p.m., Monday through Thursday, and Physician Assistant Tammy Gerdes sees patients on Fridays. Services include: annual physicals, blood work, sick visits, EKGs, chronic disease management, care coordination, and emergency procedures. To schedule an appointment call 802-767-3704.

Gifford Primary Care Team Welcomes Dr. Kasra Djalayer

Gifford Medica Center

Dr. Kasra Djalayer

Dr. Kasra Djalayer has joined Gifford Health Care’s primary care team and is now seeing patients in the Berlin and Randolph clinics. He also sees Gifford patients at the Rowan Court Nursing Home in Barre, where he is the Medical Director.

Board-certified in internal medicine, Dr. Djalayer received his license of Medicine and Surgery at the University of Complutenese (Madrid, Spain). He completed his residency at the Yale-Griffin Hospital Prevention Research Center and did post graduate training in Obesity at Harvard University and in Rheumatology and Clinical Immunology at the University of Vermont. His clinical interests include dementia-related behavioral disorders, geriatric medicine, and rheumatology.

Most recently he has worked at Franklin Regional Hospital (Franklin, NH) and as a hospitalist at the New London Hospital (New London, NH), and the Brattleboro Memorial Hospital (Brattleboro, VT).  “Dr. DJ,” as he is known to his patients, has received both the Patients Choice Award and the Compassionate Doctor recognition for five consecutive years (2000-2014).

“I like to use humor in my conversations, and find it energizing to build ongoing relationships with patients,” he said. “We talk about the details of their medical problem but also about their situation in general—any family issues or other concerns. It’s an important part of good care.”

When not working, Dr. Djalayer enjoys cycling, tennis, swimming, and reading to keep up with current events and new medical developments.

Gifford Celebrates Strong Foundation, Legacy of Outgoing Administrator

Joe Woodin

Administrator Joseph Woodin listens as Gifford staff and board members express appreciation for his 17 years of leadership. He will be leaving in late April.

More than 100 community members gathered for Gifford Medical Center’s 110th Annual Corporators Meeting Saturday night and heard that the Randolph-based organization is in great shape and positioned to move ahead smoothly during transition into new leadership.

Current Administrator Joseph Woodin, who will leave Gifford in late April to lead a hospital in Martha’s Vineyard, received a standing ovation for his service. Throughout the evening voices representing all areas of the organization and community shared stories and expressed heartfelt appreciation for his years of leadership.

“Joe is leaving after 17 years of extraordinary leadership, and he is leaving us in great shape,” Board of Trustee Chair Gus Meyer said. “Perhaps the most important thing he leaves us with is an exceptionally strong leadership team and staff who are able to continue on the many positive directions we have established during his tenure. His time with Gifford underscores our capacity to sustain the organizational stability, clinical excellence, creative growth, and flexible response to changes in the health care world that have come to make Gifford a uniquely strong health care system.”

The Gifford Board will appoint an interim administrator to work with the hospital’s senior management team and facilitate operations and ongoing projects at Gifford. They have begun what is anticipated to be a 4 to 6-month national search for Woodin’s replacement

In his final Administrator’s Report, Woodin, who is leaving for personal reasons, reflected on his time at Gifford. He described looking through 17 years of hospital annual reports and how moved he was as he read the stories of patients he has met and people he has worked with over the years.

“At the end of the day there are so many beautiful things that happen at Gifford, and we can forget about that,” he said. “We’re so lucky to have an organization like this!”

After a short presentation documenting the changes at Gifford during his tenure, he ended with the Morgan Orchards Senior Living Community in Randolph Center.

“I have never spent as much time or energy as I have at this organization and in this community and I have loved every minute of it,” he said in closing. “I will never be able to repeat this anywhere, and I’m hoping to retire up here in this independent living facility!”

A legacy of financial stability, vision, and growth

Highlights of Woodin’s tenure include the expansion of Gifford’s network of community health centers to include clinics in Berlin, White River Junction, Wilder, Kingwood, and Sharon; expanded patient services for all stages of life, from the creation of a hospitalist program in 2006 to provide local care for more serious illnesses, to the creation of the Palliative Care program; a new renovated ambulatory care center and expanded radiology and emergency departments; and the Morgan Orchards Senior Living Community in Randolph Center, which includes the Menig Nursing Home, independent living (construction scheduled to start in the spring), and a future assisted living facility; 25 new private inpatient rooms. A renovated and updated Birthing Center scheduled to open in the spring.

Gifford’s long-time focus on community primary care was strengthened with a Federally Qualified Health Center designation in 2013, and in 2014 it was named a top 100 Critical Access Hospital in the nation.

Long-term providers describe ongoing passion for mission and core values

Following the corporators meeting, three key long-term Gifford providers talked about what first brought them to Gifford and shared some of the changes they’ve witnessed over the years. General Surgeon Dr. Ovleto Ciccarelli, Pediatrician Dr. Lou DiNicola, and Podiatrist Dr. Robert Rinaldi each stressed that the core values that sustain Gifford’s mission are kept alive and passed on by the committed staff who work there.

Dr. Ciccarelli, noting that many long-time providers are reaching retirement age, said the qualities that brought those people to Gifford remain and continue to attract new staff. “While there are some changes, the essence of what attracted people like myself to Gifford resides here,” he said.

Dr. DiNicola said that he has stayed at Gifford for 40 years because of the community. “The people I work with, the people in the community and those I work with in the schools,” he said. “ This is my family and this is why I am here.”

Dr. Rinaldi remembered that in 2003 he was first attracted by the passion he saw in the “Gifford family.” He noted that the hallways are still filled with people who treat each other like family, and who have maintained their passion for the organization.

He concluded with a tribute to Woodin: “Joe saw these things, the family, and the passion, and the desire to be the best for each other and for every patient,” Rinaldi said. “He led us to understand our family, and to understand ourselves. He leaves knowing that he led us to success and that we will continue to be successful.”

Community scholarships and awards presented

Jeanelle Achee was awarded the Dr. Richard J. Barrett M.D. Scholarship, a $1,000 award for a Gifford employee or an employee’s child pursuing a health care education. Safeline, Inc. in Chelsea Vermont, received the $1,000 Philip D. Levesque Memorial Community Award, given annually in recognition of his personal commitment to the White River Valley.

The $25,000 William and Mary Markle Community Grant was given to community recreation departments (Bethel, Chelsea, Northfield, Randolph/Braintree/Brookfield, Rochester, Royalton, and Strafford) to support youth exercise and activity programs.

Board of trustees and directors elected and service recognized

During the business meeting, retiring members Linda Chugkowski (9 years) and Linda Morse (3 years) were recognized for their years of service.

The following slate of new community ambassadors were elected: Dr. Nick Benoit (South Royalton), Dr. Ovleto Ciccarelli (Wells), Dr. Robert Cochrane (Burlington), Dr. Marcus Coxon (Randolph Center), Christina Harlow, NP (Brookfield), Dr. Martin Johns (Lebanon), Dr. Peter Loescher (Etna, NH), Dr. Rob Rinaldi (Chelsea), Dr. Scott Rodi (Etna, NH), Dr. Ellamarie Russo-Demara (Sharon), Dr. Mark Seymour (Randolph Center), Rick & Rebecca Hauser (Randolph) and Peter & Karen Reed (Braintree).

The following were elected trustees: Bill Baumann (Randolph), Carol Bushey (Brookfield), Peter Reed (Braintree) Sue Sherman (Rochester) and Clay Westbrook (Randolph). Elected officers of the board of directors are: Gus Meyer, chair; Peter Nowlan, vice chair. Barbara Rochat, secretary. Matt Considine, treasurer.

Nurse Practitioner Elizabeth Saxton Joins Gifford Primary Care

Elizabeth Saxton

Elizabeth Saxton

Nurse practitioner Elizabeth Saxton, APRN-AGNP, has joined Gifford’s primary care team. She is now seeing patients at the Gifford Health Center at Berlin, and also Gifford patients who live in nursing homes in the area.

Saxton first came to Vermont as a student at UVM, fell in love with the state, and has lived here ever since. After receiving a BA in history, she went on to receive her MS in Nursing from UVM.

Board-certified by the American Academy of Nurse Practitioners, she is also a member of the American Association of Nurse Practitioners and the Vermont Nurse Practitioners Association. Her clinical interests include preventative health, eldercare, mood disorders, LGBQT support, and addiction treatment.

“I like to get to know my patients well, and to make sure they understand their diagnosis, how they will be treated, and how to get the most affordable medications,” she said. “Patient education is very important to me. I see myself as a collaborative and supportive resource for people.”

An outdoor enthusiast, she is an avid skier and enjoys biking, kayaking, hunting, and fishing when she us not working.

In Berlin, Saxton works with family nurse practitioner Jeff Lourie. Other providers at the Gifford Health Center at Berlin (located just off Airport Road) include specialists in Neurology, Orthopedics, Podiatry, Urology, and Midwifery. Call (802) 229-2325 for an appointment.

Oncologist Dr. Eswar Tipirneni Provides Cancer Care at Gifford

Dr. Eswar Tipirneni

Dr. Eswar Tipirneni

Oncologist Dr. Eswar Tipirneni has joined Gifford Medical Center’s Oncology Department and is now seeing patients in Randolph.

Gifford is one of only five hospitals in Vermont designated as an accredited cancer program by the national American College of Surgeons Commission on Cancer.

The Oncology Department includes a team of specially certified oncology nurses and provides compassionate cancer care and services (planning options for treatment following a diagnosis; outpatient chemotherapy; and some treatments for hematology conditions, such as anemia).

Board certified in both internal medicine and hematology/oncology, Dr. Tipirneni received his MBBS (Bachelor of Medicine and Bachelor of Surgery) at Kamineni Institute of Medical Sciences in Andhra Pradesh, India. He completed his internal medicine internship at St. Joseph Mercy Hospital in Ann Arbor, MI, his internal medicine residency at St. Vincent Hospital in Worcester, MA, and his hematology/oncology fellowship at the University of Massachusetts Medical School in Worcester, MA, where he was the chief fellow.

Also a provider in the UVM Health Network, Tipirneni brings the resources of an academic cancer research center to his care for patients at Gifford, including participation in multidisciplinary tumor boards and current clinical trials. He says he was drawn to cancer care during his first student rotations in outpatient oncology.

“I saw the deep attachment patients have with their oncologists, a person they often will see every other week during treatment, and I was interested in providing this continuity of care,” he said. “I learn a lot from my patients—their positive attitude in the sickest of times is a driving force for me.”

Dr. Tipirneni is married to Dr. Saranya Kodali, who is currently finishing her internal medicine residency at the University of Massachusetts Medical School in Worcester, MA and they have a three-year-old daughter. When not working he enjoys traveling, hiking and cricket.