Federal Award Supports Increased Substance Abuse Services

This article was published in our Spring 2016 Update.

federal funding

Gifford was one of four Vermont health centers to receive Affordable Care Act funding in March for programs that will help address an escalating national heroin epidemic. The Department of Health and Human Services award will be used to expand substance abuse services, especially those for people addicted to opioids.

Chief Medical Officer Dr. Martin Johns said Gifford is collaborating with the Clara Martin Center to support a SBIRT (screening, brief intervention, referral to treatment) model of care. The award will primarily fund additional staff for the program (a primary care provider with training in substance abuse treatment, a
social worker, and supporting staff).

“We are thrilled to have this opportunity to expand services for alcohol and drug dependence and misuse in our community,” said Johns. “These funds will allow us to increase patient access and to collaborate with other community organizations to provide seamless, all-encompassing treatment for those seeking help.”

Nationwide $94 million in Affordable Care Act funding was awarded to 271 health centers in 45 states. The other three organizations in Vermont that received funding were the Community Health Centers of Burlington, Community Health Centers of the Rutland Region, and Northern Counties Health Care in St. Johnsbury.

Personalizing High Tech: Keeping core values while opening to change

This article was published in our 2015 Annual Report.

Gifford laboratory

Lab technicians Susie Curtis and Matt Clayton

Gifford’s laboratory, tucked into the heart of the hospital, provides essential services that touch all areas of patient care. Open 24 hours, the lab performs chemistry, hematology, blood bank, and microbiology tests so providers can diagnose and treat their patients.

The expertise and quality of our lab is well-recognized: when Centers for Medicare and Medicaid Services inspectors spent two days looking at the competency of staff, equipment, and all analytic processes (from blood drawing, testing, and delivery of results to providers), Gifford’s final score was “100 percent.”

“I’m amazed by the number of tests we perform here now,” says Laboratory Technician Susie Curtis, who has witnessed many changes in her more than 40 years in the lab.

She’s seen many “best practices” evolve. People no longer smoke in the lab or use their mouth to pipette, and now everyone always wears gloves. But she says one thing has remained the same: at Gifford the patient is the #1 concern.

“We always try to accommodate special situations—for example, a courier can bring specimens to the lab from a community clinic if a patient is unable to travel to Randolph.”

There have been major lab renovations and equipment upgrades, but Curtis says the biggest change has been in technology she uses every day.

“When I first started, the glucose testing machine was huge and it took forever to get results,” she said. “Now a machine half the size does 20-30 tests at a time.”

Over the years Curtis was mentored by several colleagues who had spent most of their careers here. They provided a sense of continuity, and passed on the importance of preserving Gifford’s core values while embracing change. Today she finds herself in that role, and enjoys working with new lab technicians like Matt Clayton.

“Matt is fresh out of school and has innovative ideas—we talk about them,” she said. “I explain why we do certain things the way we do, and together we come up with an approach that is best for the patients.”

Sophisticated Equipment, Less Travel, Compassionate Care

This article was published in our 2015 Annual Report.

Gifford mammography

Gifford’s Lead Mammographer Terri Hodgdon

When Lead Mammographer Terri Hodgdon came to Gifford in 1991, the Radiology Department had four full-time employees and she took medical images in just two areas. Now patients come for mammography, ultrasound, X-rays, MRIs, and interventional radiology treatment. The darkrooms are gone (images are digital now), and the department is staffed by nearly a dozen people, including technologists at the Sharon and Berlin clinics.

This growth responded to a need for local radiology services, so patients could avoid travelling for care. Hodgdon sees primarily sports-related injuries when working in Sharon, but in Randolph she helps patients with mammograms, cardiac and lung issues. The newest procedures use interventional radiology (using medical imaging for breast biopsies, to place PICC lines, or to find and drain abscesses), which are less invasive than surgery.

“In radiology you have to be a perfectionist—it’s really important that everything is lined up perfectly,” said Hodgdon. “Still, easing people’s anxiety is a big part of my job. We’ve expanded. We have the newest technology, but helping the patient through the process still comes first. That’s stayed the same over the years.”

In-House Imaging Expertise for Faster Reports

This article was published in our 2015 Annual Report.

Gifford’s radiologists Drs. Alan Ericksen and Jeffrey Bath

Gifford’s radiologists Drs. Alan Ericksen and Jeffrey Bath

For many, “Radiology” brings to mind a room filled with intimidating X-ray, CT, MRI, ultrasound, or mammogram machines. Few think about the people behind the cutting-edge equipment, specially trained physicians who translate images into accurately diagnosed diseases or injuries. These specialists work closely with providers to troubleshoot and find the most effective treatments for patients.

Last spring Gifford hired two new radiologists, Dr. Jeffrey Bath and Dr. Alan Ericksen, to create our first employee-staffed Radiology Department (radiology services were previously contracted through outside private practices).

This change strengthens our personalized patient-care focus by providing seamless physician collaboration and shorter reporting times. Using new voice recognition software, the radiologists can read images and dictate their findings right into the digital storage system –often within just a few hours.

“With radiologists in-house the whole process is streamlined —I don’t have to wait for technicians to send images out as I’ve had to do in larger hospitals,” said Pediatrician Dr. Christina DiNicola. “In an emergency I could have a report within 20 minutes, the time it takes a patient to cross the street to radiology, have the procedure, and return to my office to discuss treatment!”

The Best Beginnings: Personalized, 24-Hour Support for Moms and Newborns

This article was published in our 2015 Annual Report.

Gifford's Birthing Center

(L to R): Bonnie Hervieux-Woodbury, Ronda
Flagherty, Karin Olson, Kim Summers, Mary Borie, Bonnie
Solley, Jennifer Davis

For more than 35 years women have traveled from all over to have their babies at Gifford. Our nurses are famous for their loving care — many have helped welcome multiple siblings to a family.

“Our certified nurse midwives and Birthing Center nurses provide compassionate, personalized labor support for low-intervention births,” said Director of Women’s Health Bonnie Hervieux-Woodbury. “Women are attracted to Gifford because we offer a variety of choices, including epidurals and the back-up support of three ob/gyn physicians.”

Partnering to Improve Patient Access to Care

This article was published in our 2015 Annual Report.

Physician assistants and nurse practitioners are partnering with medical doctors to help patients get the care they need, when they need it. These health professionals have been specially trained to provide primary care and help patients learn how to make the lifestyle changes that will help them stay healthy.

Physician Assistants Certified (PA-C)

Physician assistants, under the supervision of a physician, are primary health care professionals who are trained to diagnose and treat acute illness and injury, assist in surgery, and manage chronic disease. Following a medical model, they use preventive medicine to promote healthy lifestyles and provide a broad range of healthcare services.

Education: Physician assistants graduate from a Master of Physician Assistant Studies program.

Certification: Physician assistants are certified by the National Commission on Certification of Physician Assistants and, like physicians, licensed by the state Board of Medical Practice.

Nurse Practitioners (NP), also known as Advance Practice Registered Nurses (APRN)

Nurse practitioners train to specialize in a specific area (including primary care). The core philosophy of the nurse practitioner field is individualized care, preventing illness, promoting wellness, and patient education.

Education: Nurse practitioners are registered nurses who have completed a minimum of a master’s degree and received training in the diagnosis and management of
common medical conditions, including chronic illnesses.

Certification: Nurse practitioners are certified through the American Nurses Credentialing Center or American Academy of Nurse Practitioners in specialized areas and are licensed by the state and overseen by the Vermont State Board of Nursing.

Rebecca Savidge, Chelsea Health Center PA-C

Rebecca Savidge Chelsea Health Center PA-C

Rebecca Savidge, Chelsea Health Center PA-C

“When I was growing up, I came to the Chelsea Health Center to see Starr Strong. The way she practiced medicine influenced my choice to become a PA.

Living close to those I care for is important to me. Now I see generations of patients in the same family. When I started, Starr passed her patient’s history on to me, as it had been passed on to her when she started. It’s like the passing of a community torch.”

Tammy Gerdes, Bethel/Rochester Health Center PA-C

Tammy Gerdes, Bethel/Rochester Health Center PA-C

Tammy Gerdes, Bethel/Rochester Health Center PA-C

“Patients want to be heard—when they feel heard, healing can happen. I wanted to be in a small clinic setting where I could give unique and individualized care because I treat every patient as if they were a member of my extended family.

Practicing medicine is a fine art. I have found that I am both a teacher and a student, asking questions on my medical journey. Gifford’s focus is on the patient, so I knew this setting would allow my practice style to flourish.”

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!”

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.”