Gifford ranks first in Vermont for energy efficiency among hospitals
Gifford electricians Stu Standish and Frank Landry, part of the Randolph hospital’s facilities team, replace 250-watt metal halide parking lot lights with 78-watt LEDs. Gifford is the most energy efficient hospital in Vermont and is striving to do even better by becoming the first Vermont hospital to earn the “Energy Star” label. (Provided: Robin Palmer)
Already the most energy efficient hospital in the state, Gifford Medical Center is striving to become the first hospital in Vermont to earn a national “Energy Star” rating by the end of 2014.
The Energy Star label is a program by the U.S. Environmental Protection Agency that benchmarks energy use. For hospitals that means looking at energy use per square foot and then taking into account factors such as number of hospital beds, number of employees and climates. Hospitals are then ranked nationwide.
No Vermont hospital has achieved the 75th percentile ranking required for the Energy Star rating. Gifford is currently at 65 percent and as such, the most energy efficient hospital in Vermont.
The Randolph medical center would have to reduce its energy usage by 6 percent to reach the 75th percentile. Despite Gifford’s record of energy efficiency, Tim Perrin at Efficiency Vermont and Gifford’s Director of Facilities Tyson Moulton say further reduction is attainable.
In fact, energy efficiency projects are already under way.
Last month, electricians at Gifford changed out parking lot lights from 250-watt metal halide bulbs to more efficient 78-watt LEDs.
Other projects planned include replacing a large kitchen stove hood with one that runs on demand using heat sensors rather than running more constantly. In addition to electricity savings, the hood would remove less air that has already been heated or cooled. Heating and ventilation systems in parts of the building are also being rebalanced to run more efficiently.
The projects, noted Moulton, are part of an ongoing energy efficiency plan at the hospital and relatively small in scale because of work that has already taken place.
“We have a history of energy efficiency,” Moulton said.
Moulton gives a couple of examples. A project in the 1980s focused on recapturing some exhaust heat from the medical center’s inpatient unit to reclaim energy. The building’s pumping system has been simplified to replace many smaller pumps added over time with fewer larger pumps, and domestic hot water and chilled water for coolant systems have also been converted to demand-based systems.
Gifford Director of Facilities Tyson Moulton, right, poses with his predecessor, Theron Manning, on the rooftop of the Randolph medical center. In the background are heating, ventilation and air conditioning units. Over decades of work, Manning set the stage for Gifford to become the state’s most energy efficient hospital. Working with Efficiency Vermont, Moulton is carrying on the tradition as Gifford now strives to earn an “Energy Star” rating. (Provided: Robin Palmer)
Moulton credits former facilities head Theron Manning with the decades-long work that has led to Gifford’s top energy efficiency rating.
The ranking, however, does not include buildings outside of the main medical center, namely older homes that have been converted into office space surrounding the medical center and Gifford’s eight outlying community health centers.
The benchmarking of Vermont hospitals is by Efficiency Vermont, which has been reaching out to medical centers to reduce energy usage. Efficiency Vermont helped Gifford audit and identify lower cost ways to reduce energy consumption last year when the medical center and other large Vermont employers participated in a voluntary “Energy Leadership Challenge.”
Gifford is also part of the national Healthier Hospitals Initiative. Vermont is the first state in the nation to have all hospitals join the initiative, which includes energy reduction.
Efficiency Vermont, Vermont hospitals and the Vermont Association of Hospitals and Health Systems worked collaboratively on the Healthier Hospitals Initiative.
“We have been very impressed with the work that Gifford has done to manage energy usage and promote sustainability,” Richard Donnelly of Efficiency Vermont said in announcing that all Vermont hospitals had signed on to the initiative.
“Energy efficiency is always part of projects,” Moulton said. “When we replace fixtures and equipment, we look at what we can do to be energy efficient.”
That look toward energy efficiency is done both from a costs’ perspective to save the non-profit, patient-focused medical center money and to reduce its impact on the environment, particularly when it comes to non-renewable energy.
“Both electricity and oil are very expensive,” said Moulton. “Most of Vermont’s electricity, however, is from a hydroelectric, which is renewable. Oil is a limited resource.”
Dr. Mark Jewett has been an internal medicine physician at Gifford Medical Center for his entire 36-year career. Originally from Pennsylvania, Dr. Jewett came to Randolph in 1976, where he has lived since with his wife, Gifford pediatrician Dr. Elizabeth Jewett. Together they have three grown children and one grandchild. In his free time, Dr. Jewett maintains a healthy lifestyle – hiking, biking, running, skiing, and sailing.
Except for a nine-month sailing trip in 2005, Dr. Jewett has worked at the Rochester Health Center. From 1976-2005, he also saw patients in Randolph.
Outpatient medicine is a passion for Dr. Jewett because it provides him an opportunity to interact with and help others. Sometimes that help comes in a cure. Sometimes it is with coping. Sometimes it is just to be understanding.
Below is his story as told in his own words, as featured in our 2012 Annual Report.
“Mitt Fowler and I were in residency together in Massachusetts when Gifford advertised for an internal medicine physician in the underserved Rochester area. We had come to Vermont to ski and liked the rural lifestyle. In fact, my role model as a child was an uncle who was a doctor in a town of 5,000 people, much like Randolph. That is what I envisioned for my life. So we convinced then hospital administrator Phil Levesque that it wasn’t one internal medicine physician that he needed, but two.
Milt and I opened the Rochester Health Center in 1976 and soon Dr. Lou DiNicola joined us. We were all fresh out of our residencies. A federal grant helped support the launch of the health center – called the Green Valley Health Center at that time – and its first three years of operations. While we “worked” for Gifford, as was the standard at the time, Milt, Lou, and I and the health center were a private practice. It wasn’t until about two decades later that we became employees of the medical center.
Drs. Mark Jewett, Lou DiNicola, and Milt Fowler in the early years shortly after coming to the Randolph area. The three physicians have spent the entirety of their careers providing medical care to the rural communities in central Vermont.
Initially I spent two days a week in Rochester, working in Randolph as well. In addition to Milt and Lou, other providers, including physician assistant Sue Burgos and family medicine provider Dr. Mark Seymour, rotated through Rochester throughout the years. But except for the nine months I took off in 2005 for my other passion – sailing – my trip from home in Randolph, over the mountain to Rochester, has been a constant for 36 years.
The road has changed over that time. In the early years when the top was a narrow dirt lane, I left a few mufflers behind. Since then it has been modernized, as has medicine. Initially as rural doctors, we took care of everything. There were far fewer specialists for referrals, we didn’t yet have CT scans or MRIs, and a radiologist’s availability to read X-rays was much more sporadic.
While I know today we’re taking better care of people thanks to these advances, I miss being able to do it all. I believe in the primary care medicine model where doctors know everything about their patients and coordinate all aspects of their care.
What’s nice about being in a community for 36 years is you get to see people over time. You see how people grow up in a community. You see how people grow old in a community. You see how people sometimes die in a community.
As an internal medicine physician, I see only adults. But even without youngsters in the mix, I still take care of up to four generations of the same family over time. To lose a patient – especially after decades of care – is painful for me as a doctor. It’s painful because of the relationships formed. Those relationships are what allow me to help families because I too am feeling the loss.
In a couple more years I will retire. While I won’t be driving over the mountain four days a week as I do now, I won’t stop caring – for the people of the Rochester area who have entrusted me with their care for so many years or for people in need of health care. While this area will always be with me in spirit, it’s my goal, if I’m still able, to sail my sailboat to the Caribbean and work in another underserved area, such as Haiti, providing care to new generations in need.”
~ Mark Jewett, M.D.
Rochester Health Center Internal Medicine Physician
Above left: Madison Fuller and Kristi Fuller of Granville and Carol McLoughlin of Rochester “examine” Dr. Mark Jewett. Dr. Jewett has been providing care at the Rochester Health Center for 36 years and cares for generations of area residents, including this fun-loving grandmother, mother, and daughter trio. Dr. Jewett also cared for Carol’s late mother, Lilla Clancy. Carol shares that her mother used to bring Dr. Jewett cookies in the early days because she thought he was too skinny. Above right: Dr. Jewett in 1979 a few years after joining Gifford.
A Randolph Center resident, husband, and father, Dr. Christopher Soares joined the Gifford Medical Staff in 1993, spending his entire career to date in Randolph. Initially a Dartmouth-Hitchcock Medical Center provider, Dr. Soares opened his own practice, Soares Ocular Surgery, in 2007. In addition to caring for adults, he is also a pediatric ophthalmologist.
An avid cyclist, he has biked more than 40,000 miles, including from Canada to both the Grand Canyon and Mexico along the Pacific Coast Highway. Dr. Soares also enjoys kayaking, water skiing, boogie boarding, cross country and downhill skiing, ice skating, and more. He is originally from Massachusetts.
Below is his story as told in his own words, as featured in our 2012 Annual Report.
Raising a family of three children has tremendous rewards. After 20 years my last child is finishing college and preparing to enter an exciting new phase in her life. My two boys are finished with college and have started careers. All three have expressed their gratitude for the opportunities they were given while growing up. All three realize my wife and I love them unconditionally and we gave our all raising them the best way we knew how.
Working as an ophthalmologist in Randolph for nearly 20 years has similar rewards. In the early years, just like parenting, you are learning and developing your skills. People are glad that you are in town and they do not have to travel a great distance to get eye care. You develop a friendship with the patients. This friendship grows with the years. As the years go by, your skill sets expand and more patients come for care. All the while, friendships continue to grow. As a doctor’s experience and confidence grows, so do the positive outcomes. Challenging cares are taken on and the outcomes are even more rewarding.
At left – Dr. Soares, dressed in scrubs, is often seen riding his bicycle through Randolph. Right – an updated portrait of Dr. Soares.
That is certainly true in the case of Nathan Wheeler.
Nathan is a young man who last year tripped, fell, and hit his head on a piece of furniture, severely injuring his left eye. He had torn an essential eye muscle in half. Nathan had already been seen by two ophthalmologists and an oculoplastic specialist after an emergency room visit, and was finally referred to my practice three days after the injury. I explained to him and his family the seriousness of the injury and that several surgeries might be required. The first surgery was performed that very night in a Gifford operating room. It lasted four hours. I’ll spare you the details, but I was able to locate the muscle stumps and sew them back together.
A month later, Nathan was seeing well but required one more surgery to align his vision when looking down. This second surgery was also a success. Nathan’s vision was restored and he was able to return to work with no restrictions.
In Vermont fashion, I had done the job before me, to the best of my ability, but when I came home after that first surgery, I was distraught. In fact, I was nearly in tears. I had been in that OR for hours and I wasn’t sure if I had even helped Nathan. At the time, I didn’t know what I had accomplished.
Later, I researched more on the procedure and found that what I had accomplished was rarely, if ever, done by others. My case was so unique that I was asked to present it to a group of pediatric and adult strabismus specialists at the Massachusetts Eye and Ear Hospital. Of the 50 doctors in the room, none had ever attempted to find a ruptured muscle and suture it back to the remaining muscle.
Needless to say, Nathan was thrilled with the results and has sent patients to me ever since, some looking for “miracles”. I can’t perform miracles, but every week I am blessed to receive the gratitude of at least one patient. This appreciation for what I do energizes me and keeps me committed to offering the best eye care possible.
~ Christopher Soares, M.D.
Soares Ocular Surgery ophthalmologist
Dr. Soares examines patient Nathan Wheeler, whose injured eye he restored through a series of tough and rarely attempted surgeries. And a grateful Nathan has been referring patients to Dr. Soares ever since.
The following was published in our 2012 Annual Report.
Above left – Robin Palmer, Tammy Hooker and Ashley Lincoln – the team lucky enough to be charged with coordinating the Last Mile Ride each August, post for a photo. Above right – Jack Cowdrey, Chair of the Development Committee and one of the chase-truck drivers for the Last Mile Ride.
In this year’s Annual Report, we are fortunate to read stories from our long-time providers. Gifford is also fortunate to have many long-term supporters. Many of their names follow, but it is hard not to pull out one group for its remarkably long-standing relationship. That group is the Gifford Medical Center Auxiliary.
In 2012, the now 106-year-old Auxiliary continued its support of Gifford programs and services, including “wish list” items awarded to individual hospital departments looking to improve care through new technology or training materials.
As these “wish list” gifts are distributed, there are often tears of thanks and happiness from the receiving department staff members. This speaks volumes to how much these gifts – and the Gifford Auxiliary – mean to the medical center and its patients.
Other major supporters in 2012 included those who gave to the Last Mile Ride. Now in its seventh year, this charity motorcycle ride raised a record $54,000 for end-of-life care and services. This year’s event brought a new run/walk and thus many new participants. Top among them was Todd Winslow and Lu Beaudry who raised more than $5,000 in memory of Todd’s mother, Joyce (read more about the Winslow family in our Donor Profile). The event was our largest individual fund-raiser to date.
The motorcycle ride is just one way to support Gifford. Many offer their community medical center financial support each year through an annual gift to the hospital or a special purpose fund. Others include Gifford in their will or trust, while still others choose a charitable gift annuity where they receive a predictable return on their investment.
Increasingly, community members are also expressing tremendous interest in our planned senior living community. That interest and enthusiasm has come in the form of financial support as well as interested residents. This project shows so much promise, and it is our utmost honor to be working to provide a solution to a serious problem in our region – a lack of local housing alternatives for those wanting to age in place, in their communities, rather than having to travel great distances.
As always, the Development Department is available by calling 728-2380 to discuss the many ways to support Gifford. Your investment truly makes a difference and the impact is far-reaching. Please don’t hesitate to ask us your questions or visit our website, www.giffordmed.org, to discover ways you can leave your legacy. New this year, we have included an option for online giving opportunities.
On behalf of Gifford, thank you. We appreciate your friendship.
Elaine Soule’s relationship with Gifford began at birth, and possibly before. Her mother graduated from the nursing school in 1923 and worked under hospital founder Dr. John P. Gifford. Elaine was born at the Randolph hospital in 1933.
Raised in Randolph Center, she attended local schools and married the summer following high school graduation. His career in the U.S. Air Force took them around the country and beyond. Elaine’s own six children were born on military bases in New York, Oklahoma, New Hampshire, Bermuda, Louisiana, and Maryland.
In 1971, after 20 years of military life, the family returned to Randolph. Before the families’ furniture had even arrived, Elaine had landed a job at Randolph National Bank. She started out typing signature cards and eventually became a branch manager of what was Randolph Savings and Loan, then Vermont Federal and finally Vermont National over her 28-year career.
Along the way, Elaine worked at Gifford on weekends from 1990-1995 in patient registration. After retiring from the bank in 1998, she came to work at Gifford in 2001 as the volunteer services coordinator.
“I have always felt close to Gifford,” says Elaine, who served on the hospital Board of Trustees for nine years in the 1990s.
So when Elaine retired in 2006 after five years as volunteer services coordinator to undergo cancer treatment, she knew she’d be back. “I knew I’d come back to volunteer, because I wanted to be part of this place,” says Elaine. “I just loved the Gift Shop. I’d loved volunteering. I thought it was a way to continue to be involved with Gifford after I retired.”
For months, Elaine came to Gifford as a patient for chemotherapy treatments. “My cancer treatments were wonderful,” Elaine says, calling the staff “so compassionate”. When her treatments ended in early 2007, Elaine continued her trips to Gifford – this time as a volunteer two days a week in the Gift Shop.
“Now I don’t have to be here, but I choose to be here,” she says from her post behind the desk of the boutique. “I think the volunteers at the Gift Shop are great. I hope we serve a purpose. I think we do.”
For Elaine, now 79, it is about staying active and connected in her community and at her community hospital. “I love it because it gets me out of the house to meet people and I feel that I am contributing to Gifford in a small way,” she says.
RANDOLPH – Gifford Medical Center’s Blueprint Community Health Team is offering a non-certification CPR course, called Family and Friends CPR.
The class is Wednesday, Nov. 20 from 6-8 p.m. in the Randolph hospital’s Conference Center.
The course will cover CPR for infants, children and adults and is designed to provide anyone with the basic skills needed to keep someone alive in the event that his or her breathing or heartbeat has stopped.
All are welcome to the course. There is a $5 fee. It is for the instructional booklet, which participants take home.
Attendance is limited to 12. Register by calling the Blueprint team at the Kingwood Health Center at (802) 728-7100, ext. 3.
The Gifford Conference Center is at the main medical center on Route 12 in Randolph. Park and look for the green awning marked “Conference Center.” For handicap accessibility, take the elevator from the main lobby to the first floor and follow signs.
Gifford Medical Center’s plans to create a senior living community in Randolph Center and renovate the Randolph hospital to have private inpatient rooms cleared a final permitting hurdle Thursday when it earned Certificate of Need approval from the Green Mountain Care Board.
The 5-0 decision was the final approval needed for the project to move forward.
“We’re ecstatic. This project has been years in the making and we’re excited to be moving forward. Our community is in dire need of more senior care and housing options and patients will benefit from the private room model, which is proven to enhance patient safety and satisfaction,” said Gifford Administrator Joseph Woodin, who was on hand in Montpelier Thursday to hear the board’s unanimous vote.
As part of the project, Gifford will move its 30-bed, award-winning nursing home, the Menig Extended Care Facility, to 30 stunning acres in Randolph Center. When the new nursing home is built, current nursing home rooms at the downtown medical center will be converted into private hospital rooms.
Independent and assisted living options will be added over time in Randolph Center to create a vibrant senior living community. Up to 150 total units are planned. The project’s first phase calls for the reconstruction of the 30-bed nursing home and a 40-unit independent living facility. Later phases, including 60 more independent living units and 20 assisted living units attached to the nursing home, are spread over 20 years.
Faced with facility constraints and a great number of inefficient older buildings in its downtown location, Gifford has been planning for this project for years. Many options were considered, including rebuilding the entire medical center. Looking at the most affordable, least disruptive option, the hospital finalized its plans in 2011 and filed for Act 250 approval under select criteria on Oct. 3, 2011.
Significant discussions on the use of “prime agricultural soils” for the development delayed discussions and approval on those criteria did not come until Jan. 3 of this year. Full Act 250 approval was sought on April 2, 2013, and awarded Aug. 13. Randolph Development Review Board approval also came earlier this year.
The hospital first filed its Certificate of Need application on Oct. 3, 2012. After the initial detailed review, Gifford resubmitted a revised application in May. A final hearing was held just last month on Sept. 26 and a verbal decision issued on Oct. 10.
A written decision was released late Monday. In it, the board finds the project has met all Certificate of Need criteria, including regarding cost, need, quality and access, and public good. “Gifford has demonstrated that the project serves the public good by enhancing services, improving quality of care and increasing customer satisfaction,” the five-member board wrote.
“We appreciate the Green Mountain Care Board’s thoughtful review and support of this project. The board clearly saw the need and the vision. Due to this decision, we will soon be able to better meet the needs of our community,” said Woodin, who also thanked community members for their support.
“It’s very exciting for all of us, for the staff, for the residents of Menig as well as those who will live in independent and assisted living. Thank you very much for the time, effort and all of the work folks have put into this.”
The hospital plans to begin construction on the Randolph Center nursing home in the spring.
The following was featured in our 2012 Annual Report.
Our effectiveness as a medical home has grown this year with the expansion of health care teams and our collaboration with the Vermont Blueprint for Health. But at the heart of these teams are Gifford’s long-established primary care practices. In each of our health team locations, we have providers and support staff whose relationships with the community run deep.
Take Starr Strong, for example. For 19 years, Starr has committed herself to the people of Chelsea – first under the mentorship of Dr. Brewster Martin and now as a mentor in her own right.
With humility and compassion, family physician Dr. Ken Borie has cared for the people of Randolph for 32 years. The humanity he brings to medicine is an example for all, including the many medical students who he guides through the family medicine portion of their clinical studies.
And Dr. Lou DiNicola, a local pediatrician for 36 years, has been among the foremost leaders in this state when it comes to children, advocating at every turn for their health, safety, and welfare.
Those of us enjoying long-standing relationships with Gifford and with our central Vermont community consider ourselves fortunate to know and work with these practitioners and their support teams. Such stability, and depth, builds our medical homes into more effective tools for helping our patients.
~ Marcus Coxon
Medical Staff President & family physician
The following article was published in our 2012 Annual Report.
Above left – One of Gifford’s newer providers, internal medicine physician Dr. Cristine Maloney, lives in Randolph and brings special training in palliative care to Gifford’s already robust advanced illness care program. Here she is pictured with patient David Wark of West Topsham. Above right – Emergency Department physician and clinical director Dr. Saul Nurok joined Gifford in 2010. Here he is shown with patient George Carr of Bethel.
Gifford is fortunate to have many long-serving health care providers, but the medical center would not be successful without the providers who have joined Gifford in more recent years.
Lured in part by the stability and quality provided by the very individuals highlighted in this year’s report, Gifford has welcomed new providers in almost every area of medicine.
For example, joining long-time pediatricians Dr. Lou DiNicola and Dr. Elizabeth Jewett, who have both been at Gifford for 36 years, are Dr. Joe Pelletier, now with Gifford for 10 years, and Dr. Pam Udomprasert, who joined more recently in 2011.
“Joe is now the cornerstone of pediatrics here,” says Dr. DiNicola.
At the Chelsea Health Center, long-time U.S. Navy family physician Dr. Brian Sargent joined physician assistant Starr Strong in practice in 2008. “I am especially appreciative of Brian,” Starr states, “and his commitment to the folks of this valley and the joy he takes in developing relationships in this unique place.”
In Bethel, family nurse practitioner and former emergency department nurse Emily LeVan joined long-time family physicians Dr. Mark Seymour and Dr. Terry Cantlin just this year. “Emily brings her wealth of emergency room experience and a firm commitment to primary care. She also has a strong tie to the area, working with her husband and family running a local farm,” Medicine Division Medical Director Dr. Josh Plavin says.
In the Emergency Department, Drs. Steven Fisher, Josh White, and Saul Nurok have filled the shoes of long-term physicians like Dr. Lucy Wollaeger, who retired from full-time work in 2012 after 21 years at Gifford.
“Often people’s first opinion of the hospital is through the emergency room, and Steve, Saul, and Josh are amazing,” Dr. Ken Borie, a family physician at Gifford for 32 years, says.
Anesthesiologist Dr. Dennis Henzig, a 20-year veteran of Gifford, has been joined by Drs. Jon-Richard Knoff in 2007 and Nazek Shabayek in 2012. Both of Gifford’s orthopedists, Dr. Stephanie Landvater and Dr. Bess Brackett, have come to Gifford within the last decade as Dr. Bill Minsinger prepared to retire.
Hospitalist medicine is a newer specialty. Consequently, it melds newer doctors and mid-level providers with experienced ones who have transitioned from another area of medicine, such as family care. Gifford’s certified nurse-midwifery team additionally melds newer and more experienced members. Ob/gyn physicians Dr. Anne Galante and Dr. Dina Levin have both joined Dr. Brent Burgee, a 27-year veteran of Gifford, and experienced gynecologist Dr. Ellamarie Russo-DeMara.
The most recent addition in the Randolph primary care office is family physician Dr. Barbara Lazar. “Barb brings a wealth of experience, particularly in geriatrics, and is an extremely competent and kind provider. She is an excellent long-term fit for our community-focused practice,” adds Dr. Plavin, who is also among those providers who have committed themselves to the community.
Most of Gifford’s newer providers – of which there are many more – are from the immediate area or have made it their home, raising children here and engrossing themselves in the community in a variety of ways.
Together – even as health care changes and recruitment, particularly of primary care physicians, becomes more and more challenging – they are carrying on the tradition of neighbors helping neighbors and of high-quality, accessible care in our communities.
Above left: Family physician Barbara Lazar joined Gifford in 2012, bringing a background in geriatric care. Above right – Certified nurse midwife Donna Butler, pictured here with a patient and her baby, only joined Gifford in 2010, but this Vermont native has more than 25 years of experience.
Blueprint Community Health Team now certified to offer American Heart Association courses
RANDOLPH – Gifford Medical Center’s Blueprint Community Health Team is offering a Heartsaver CPR certification course to the public for the first time.
The course will be held Oct. 15 from 6-8 p.m. in the Randolph hospital’s conference center. Register by Oct. 4 by calling Keith Marino at 728-2499.
Participants will receive hands on training in CPR for infants, children and adults and rescue breathing. The course is designed to provide anyone with the basic skills needed to keep someone alive in the event that his or her breathing or heartbeat has stopped.
“Knowledge is a very important part of being a concerned citizen,” says Marino, a member of Gifford’s Blueprint team, a certified American Heart Association CPR instructor and an emergency medical technician. “If you come upon someone having a heart attack or with a blocked airway, knowing CPR will assist you in saving that person’s life.”
All are welcome to the course. However, space is limited to 12 participants.
Gifford is on Route 12, or 44 South Main Street in Randolph. From South Main Street take Maple Street to the patient parking area. The Conference Center is marked with a green awning or for handicapped accessibility use the main entrance and take the elevator to the first floor.
Learn more online at www.giffordmed.org. Like Gifford on Facebook to receive notifications of classes like these.