providence health: fall 2014

1 PROVIDENCE FALL 2014

Nurses Bridge the Generation Gap

Providing Healing to the End of Life

Choosing Wisely During Open Enrollment

THE PURSUIT OF WELLNESS IN SOUTHERN CALIFORNIA | PROVIDENCEHEALTHONLINE.ORG | FALL 2014

PINK POWER

Providence caregivers help a determined woman win her

battle with breast cancer


Across Providence Southern California, we strive not only to be the best in providing quality and compassionate care— we seek innovation. New ideas from our meeting rooms to our operating rooms drive our pledge of Creating Healthier Communities, Together.

In this edition of Providence magazine, you’ll learn about cardiothoracic surgeon Raymond Schaerf, MD, who was the first physician in the nation to implant a new MRI-compatible pacemaker in a patient. This patient later underwent full magnetic resonance imaging that included a detailed look at his heart. Previously that was too risky because of the potential complications from the magnetic force on the delicate leads that connect the pacemaker to the heart.

Innovation can be found on every floor of each of our Southern California hospitals, where recent nursing school graduates have landed those first hard-to-get jobs through our new Nurse Residency Program. These tech-savvy nurse grads helped veteran nurses master our new electronic health records system and, in return, learned bedside care from the experts.

You’ll also read about our leading-edge trauma simulation program. Our Providence Holy Cross trauma team members hone their skills on computerized, state-of-the-art mannequins, practicing lifesaving techniques to be at their best when faced with the real thing.

We are so proud to announce that Ira Byock, MD, one of the nation’s foremost experts in palliative care and a leading advocate for transforming care through the end of life, is joining Providence as chief medical officer of our new Institute for Human Caring.

Quality, compassion, innovation: We urge you to keep those ideas in mind as we enter the annual open enrollment period. Read inside how Providence provides the full spectrum of health care to residents from the San Fernando Valley and surrounding communities to the Westside and South Bay.

letterfrom the Chief Executive

Karl CarrierInterim Regional Chief Executive

OUR MISSION

Core ValuesCompassion

Caring for each person as part of our family.

JusticeWorking for a fair and equitable

society.

RespectAffirming the God-given dignity and

worth of each person.

ExcellenceContinually improving all that

we do.

StewardshipWisely caring for and sharing

human, environmental and financial resources held in trust.

As people of Providence, we reveal God’s love for all, especially the

poor and vulnerable, through our compassionate service.

Interim Regional Chief ExecutiveKarl Carrier

Providence Editor-in-ChiefNancy Franklin

58 11th Street, Hermosa Beach, CA 90254Tel 310-376-7800 Fax 310-376-0200

moontidemedia.com

VP, Branded Media, Emily S. Baker; Art Director, Ajay Peckham;Editor, Shari Roan; Copy Editor, Laura Watts;

Managing Partners, Charles C. Koones, Todd Klawin

Providence Managing Editors

Patricia AidemJennifer Fagnani

Connie MatthewsKirk McDonald

Robert Lehner Natasha ShowsAndrew Werts

ContributorsAnn BeurskensTiffany DeVallBrenda GoettemoellerKathryn Sprague

If you no longer wish to receive Providence Magazine, please let us know by calling 1-888-HEALING or writing to Providence Magazine, Attn: Marketing, 20555 Earl Street, Torrance, CA

90503. Please allow 4-6 weeks to honor this request.

contents

in good health 5 | Kids and Weight 6 | When to Use the ER 7 | Single-Incision Surgery 8 | Recipe: Cauliflower Casserole 9 | An MRI-Compatible

Pacemaker

features 14 | A Survivor Speaks

With many advances in treatment and support, breast cancer patients learn quickly they are not alone.

18 | It’s Your ChoiceFind answers to important health coverage questions during open enrollment.

24 | Completing Life in PeaceEnd-of-life care becomes a “vital service” at the Institute for Human Caring.

profiles 22 | Everyone’s a Teacher

Katherine Bullard, RN, encourages young and veteran nurses to learn from each other.

28 | Dress RehearsalHealth professionals sharpen their skills in the novel simulation lab.

departments 2 | Letter from the Interim

Chief Executive 10 | On the Horizon 30 | Happenings 34 | Shout Outs

ON THE COVERAt Providence, Ethel Smith

found the treatment and support she needed to fight

breast cancer.

FALL 2014 PROVIDENCE 3

28

6 8

At Providence, we know what it takes to care for even the smallest, most fragile of patients. You’ll also find that same dedication and caring in such vital areas as cancer and cardiology; women’s services; stroke care and neurosciences; rehabilitation and emergency services.

When you give to Providence, you’re helping create not only better medical facilities but also a better community — one person or one family at a time. You may not know them, but your generosity will change their lives for the better, forever. That’s the power of giving.

At 4, Kaylee Chiang picked up her first violin.

At 6, she played Carnegie Hall.

To make a donation or for more information about our Providence hospitals and hospice services, visit us online at providencepowerofgiving.org.

You’d never guess she spent her first 10 weeks

of life in a Providence neo-natal intensive care unit

funded by your generous donations.

california.providence.org 1-888-HEALING (432-5464)

Providence Holy Cross Medical Center | Mission Hills

Providence Little Company of Mary Medical Center | San Pedro

Providence Little Company of Mary Medical Center | Torrance

Providence Saint John’s Health Center | Santa Monica

Providence Saint Joseph Medical Center | Burbank

Providence Tarzana Medical Center | Tarzana

Providence TrinityCare Hospice

Providence Affiliated Medical Groups

in good health


About one-third of U.S. children are overweight, and about 17 percent of those kids are obese. A key public health goal is to promote weight loss and healthy weight maintenance, and in recent years some studies show the obesity epidemic among children and teens is leveling off or even declining.

However, a key obstacle in anti-obesity campaigns is kids’ own perceptions of normal weight. A recent study from the U.S. Centers for Disease Control and Prevention found that many kids ages 8 through 15 misperceive their own weight status—considering themselves either too fat or too thin. The survey of more than 6,100 kids found that 81 percent of overweight boys and 71 percent of

overweight girls believed that they were the right weight.

Almost half of obese boys and 36 percent of obese girls believe their weight is normal. The study is an eye-opener because efforts to help children and teens embrace a healthy weight is dependent on kids understanding what constitutes a healthy body weight, the authors noted. The study was published in the July issue of the National Center for Health Statistics Data Brief.

Find out your child’s body mass index by going online to Providence Health & Services’ website and using this simple calculator: california.providence.org/health-library/interactive-tools/calculators.

It’s a bit ironic that a vegetable is the em-blem for a night when kids (and plenty of adults) indulge in high-fat and high-sugar snacks. Before you relegate your pumpkin to the role of a mere jack-o’-lantern, how-ever, think about purchasing a pumpkin for its health benefits.

Pumpkin is considered a nutrient-dense food, meaning it contains lots of vita-mins and minerals even though it’s not a high-calorie food. According to the U.S. Department of Agriculture, one cup of

cooked pumpkin contains just 49 calories with only a fraction of fat and no choles-terol. A cup of cooked pumpkin contains 12 grams of carbohydrate, 5.1 grams of sugar and 2.7 grams of fiber.

The best reason to consume pumpkin is for its nutrients. Pumpkin is rich in vitamins A, C and E, riboflavin, potassium, copper and manganese. Of course, the nutrient beta-carotene gives pumpkin its vibrant orange color. Beta-carotene is a powerful antioxidant and, like vitamin C,

contributes to immune system health.Canned pumpkin puree can have added

sugar. But you can make your own puree and use it in a variety of recipes or as a substitute for oil or butter. For taste, smaller pie pumpkins or sweet pumpkins are better than large jack-o’-lantern pumpkins.

For a Healthy Halloween, Eat the Pumpkin

What’s a Normal Weight? Our Kids Don’t Know

PUREED PUMPKIN

• Preheat oven to 350º F.

• Cut the pumpkin in half and remove seeds and pulp.

• Bake flesh-side up on a baking sheet for one hour or until tender.

• While still warm, scrape pumpkin meat from shell halves.

• Puree in a blender or food processor.

ARE YOU A HEALTHY WEIGHT?

Kids have a hard time knowing if they are overweight, according to a new study.

These are the rates of kids who considered themselves to be about the right weight.

Source: NCHS Data Brief, No. 158, July 2014

87.4%

76.0%

41.9%

Normal weight youths who feel they are the right weight

Overweight youths who feel they are the right weight

Obese youths who feel they are the right weight

in good health


Your throat is sore, your temperature is high and you have no appetite for even Ben & Jerry’s ice cream. Influenza is a miserable condition, and during the throes of an infec-tion, it’s common to wonder if you will live to see another day.

However, before you set out for the nearest hospital emergency department (ED), think twice about whether that’s the best place to obtain care. In this era of high health care costs, professionals are urging patients with non-emergency illnesses to seek help at an urgent care center or their physician’s office.

In the ED, every patient is treated as a true emergency, which means a higher level of care, including tests and exams. Providing this level of service around the clock is costly for all hospitals. Urgent care can often be a better option for patients in non-emergency situations.

“Inappropriate use of the ED is not good for the community as a whole,” says Ben-jamin Yasharel, MD, medical director of Affiliates in Medical Specialties in West Hills. “If you’re occupying an emergency room for something that is not an emergency, then you may be delaying the care of someone who has a life-threatening condition.”

Using an emergency room for non-emer-gency conditions also is an expensive choice. According to estimates, inappropriate use of the ED is one the biggest contributors to wasteful health care spending.

“Inappropriate use of the emergency

department is an issue for everyone because the cost of health care continues to rise,” says Elizabeth Sander, MD, medical director of Axminster Medical Group, Inc., in Hawthorne.

It makes much more sense to seek non-emergency care at a doctor’s office or urgent care center, she says. One study found that a respiratory infection, such as bronchi-tis, treated at an ED will cost at least double than if treated at a doctor’s office.

“The care at an ED is more expensive be-cause the overhead is greater than an urgent care or doctor’s office,” Dr. Sander says. Even though some hospital EDs have “fast track” features designed to expedite the care of patients with less serious ailments, “those services are still billed at the ED rate,” Dr. Sander adds. “The reason they have a fast track is more for consumer convenience. It’s not a cost-cutting measure.”

People may assume they’ll get more thor-ough care, such as X-rays or blood tests, if they seek care at an ED. But Dr. Yasharel cau-tions: “Most consumers overestimate the care they need. An urgent care doctor can quickly assess whether you need emergency care.”

Sometimes, however, it’s hard to know when to use an ED. Unless it’s a life-threaten-ing issue, call your primary care physician’s office before going to the ED. You may be referred to an after-hours doctor or nurse who can advise you on what to do.

Another option is to go to an urgent care

center. Many urgent care centers have ex-tended evening and weekend hours for your convenience. Know where the nearest urgent care center is and whether it’s affiliated with your physician and hospital network.

“Urgent care centers are all over the place now, and Providence has many of them,” Dr. Yasharel explains. “One advantage Providence has is a system-wide electronic medical record. If you see any of our urgent care doctors or go to any Providence hospital, your studies will be available, online, to your primary care doctor and any Providence doctor you see. This ensures that your doctor has all the most up-to-date, correct information about your health and any special health care needs you may have, which helps provide better, more coordi-nated care.”

While every individual is different, in general you don’t need to go to an ED for influenza-type symptoms unless there is altered consciousness, such as passing out or confusion, or the risk of dehydration, Dr. Yasharel says. A fever, sore throat, headache, nausea and vomiting are symptoms that, typically, can be evaluated at an urgent care center or doctor’s office.

However, those younger than age 1, older than age 85 and people with chronic immune problems (such as individuals with HIV, active cancer or who have had organ transplants) should seek emergency care for flu-like symptoms, Dr. Sander says.

in good health

When to Use—or Not Use—the Emergency Room During Flu Season

in good health


Providence Students Embody the Organization’s Mission On the fourth Friday of every month, four young women from Providence High School get together. While that’s not unusual for teenagers, what they do together is. Marie Bardelli, Maggie Mannion, Sareen Khachatourian and Alex Movsesyan—all members of the class of 2016—can be found serving the homeless at Ascencia, a shelter in Glendale.

Recognizing that service to others is an integral part of Christian discipleship, Providence High School requires all students to give of their

time and talent to service projects during each of their four years. The students serve in organizations such as hospitals, retirement homes, schools, parish churches or various charity agencies.

“We don’t just do this for service hours; we do this because it makes us understand how lucky we are, and we’re helping people who are having a hard time,” says Mannion.

To discover all Providence High School has to offer, attend the annual open house from 1 to 4 p.m., Nov. 2. For more information, call 1-818-846-8141 or visit providencehigh.org.

Providence Holy Cross Medical Center has become the second Providence hos-pital in Southern California to implement the Welcome Baby program, an initia-tive created by First 5 LA to help give children the best possible start in life. The program also was implemented at Prov-idence Little Company of Mary Medical Center San Pedro.

Welcome Baby addresses the following First 5 LA goal areas: that babies are born healthy, that children are safe from abuse and neglect, that children maintain a healthy weight and that children are ready for kindergarten. Using “parent coaches,” Welcome Baby addresses prenatal testing,

home planning/safety, labor signs, breastfeeding, maternal depression screening, family nutrition, infant assessments and growth and development milestones.

First 5 LA issues grants to hospitals to hire professionally trained parent coaches who visit with families during the baby’s first nine months to provide support, information and education. Families resid-ing in specific neighborhoods surrounding the Welcome Baby hospitals are eligible for additional services, including prenatal visits with a parent coach.

Visiting parents in their own homes is important, says Brenda Hart Bailey, a Wel-

come Baby parent coach at Providence Holy Cross Medical Center in Mission Hills. “I enjoy the client-centered ap-proach of the program, which allows the client to determine what she wants to address during that visit,” she explains.

For more information, call 1-818-496-4173 (for Providence Holy Cross) or 1-310-514-5444 (for Providence Little Company of Mary Medical Center San Pedro).

Welcome Baby Program Now at Two Providence Hospitals

“As people of Providence, we reveal God’s love for all, especially the poor

and vulnerable, through our compassionate

service.”—Providence Health &

Services Mission statement

Marie Bardelli, Maggie Mannion, Joyce Mannion, Sareen Khachatourian and Alex Movsesyan with the brownies and

cornbread they made for the residents of Ascencia.

Gallbladder Removal Through a Single Incision Minimally invasive surgery offers many advantages compared to open surgery, including reduced recovery time and less pain with faster return to normal function. Now there’s even an improvement on minimally invasive surgery. Single-incision surgery has been approved by the U.S. Food and Drug Administration for gallbladder removal. The technique eventually may become available for other abdominal surgeries as well, says James E. Camel, MD, chief of surgery at Providence Little Company of Mary Medical Center Torrance.

In single-incision surgery, which is typically performed on an outpatient basis, surgeons use a robot and insert instruments through a small opening in the belly button, their maneuvers guided by clear imges on a computer screen. The gallbladder is removed through that same open-ing. The operation leaves no visible scar.

Dr. Camel and his colleagues, as well as physicians at Providence Saint Joseph Medical Center in Burbank, are among the first surgeons in the region to offer single-incision laparoscopy. “Our groups are probably among the few that do the single-incision surgery,” he says. “Providence has been at the forefront of this.”

in good health


Healthful Eating

Food is a central part of holiday events and parties. It can be challenging, however, when you are trying to lose weight, maintain a healthy weight or manage your blood sugar. A lower carbohydrate casserole is a great alternative to the traditional potato, yam, corn and pea dishes that often are served at holiday celebrations.

Recipe by Phyliss Flannigan, RD, Providence Little Company of Mary Medical Center San Pedro

Festive Tomato Cauliflower Casserole

1 cauliflower6 tomatoes ¼ cup olive oil pepper

Preheat oven to 375º F. Wash the cauliflower and separate into bite-sized pieces. Steam until tender. Peel, seed and chop the tomatoes. (Dip each tomato in boiling water for 30 seconds. Peel the skin. Cut in half. Squeeze out the juice and seeds. Chop coarsely). Put cauliflower in casserole dish. Layer the tomatoes on top and sprinkle with pepper to taste. Combine cheeses, breadcrumbs and parsley. Sprinkle evenly over casserole. Drizzle olive oil over the top and bake 30 minutes.

Nutritional values:One half-cup serving contains:114 calories4.7 grams protein7 grams carbohydrate8 grams fat127 milligrams sodium9.6 milligrams cholesterol

• Start a meal with a soup or salad to fill up a bit before the main dish and dessert.

• Enjoy your favorite foods but limit portion sizes.

• Use smaller plates.

• Trim the fat and skin on meats and poultry before serving.

• Try broth-based sauces such as those made with vinegar, salsa, lemon and herbs.

• For parties, make plates of bite-sized fruits and vegetables.

• When making pies, opt for a single crust instead of a double crust.

• Use olive or canola oil instead of butter and margarine.

• Use fat-free or low-fat dairy products.

• For beverages, select water, tea, coffee or diet drinks.

Source: National Institutes of Health

TIPS FOR AVOIDING HOLIDAY WEIGHT GAIN

½ cup breadcrumbs¾ cup shredded low-fat mozzarella cheese½ cup minced parsley½ cup Parmesan cheese

¾

in good health


What is an MRI-compatible pacemaker?

“It’s a pacemaker that has been specifically

manufactured and tested so that patients can go through MRI studies. The original devices that were MRI-compatible were limited as to what MRI studies could be done. For example, you could do an MRI of the legs or arms but not the chest or abdomen and not the neck or most of the spine. But the newest devices allow you to scan the entire body. This is called whole-body MRI compatible.”

What permits this device to be MRI-compatible?

“It’s not just the device that is compatible, but the electrodes. You can put a device in, but if the electrodes aren’t compatible you can’t do the MRI. For MRI-compatible devices, the manufacturer has reduced the amount of iron in the device, and they’ve worked very hard so that the circuitry is shielded from the MRI. In addition, MRI studies expose the patient to radiofrequen-cy and magnetic energy, which were also thought to be dangerous to patients with cardiac devices. The new, compatible devic-es allow us to address these issues safely.”

What were the risks to patients who had pacemakers that were not MRI-compatible?

“What happened in the past was anecdotal. We heard of patients who had very bad outcomes, including death, but these were not studies done in clinical trials. We also saw patients whose devices were severely damaged after an MRI

study. We had concerns that the device could suddenly stop working. If the patient had a defibrillator, the defibrillator could shock the patient, or the radiofrequency could burn a hole in the heart. We were part of a large study—more than 1,500 scans—however, and found there weren’t many risks. The basic stumbling blocks to having more patients involved in our study were fear and misinformation among both physicians and patients.”

Why is it important that pacemaker patients have access to MRI, if needed?

“There are certain conditions where you need an MRI to know what the exact problem is and how it can be most effectively and appropriately treated. The two biggest areas where you need MRI are orthopedics and neuroradiology. We’ve had people who may have had a stroke or a brain tumor and there is no way to know that unless you can do an MRI. But in the past we’ve actually had patients who have had the device removed, then had the MRI, and then had a new pacemaker and electrodes put in. That costs about $20,000.”

So there were lots of people who faced difficult decisions when an MRI was recommended?

“Yes, a lot of people have pacemakers. According to the last study that was done on this, 50 percent to 70 percent of patients with new pacemakers or defibrillators implanted may need MRI studies within three years. The new MRI-compatible devices now allow patients to safely undergo these MRI studies.”

Is the device still considered investigational?

“The total body MRI-compatible device is still investigational. But there are limited MRI-compatible devices that are FDA-approved. I also think that within the next year or two a host of other MRI-compatible devices will come out.”

How long have you been involved in MRI studies?

“For 15 years. I was always hounding the device manufacturers about why you couldn’t do MRIs. I just thought, ‘I have all these patients who need MRIs, particularly the patients who need an MRI of the brain, back or knee, and we couldn’t get it done.’ So we did the first scan in the world using this device as part of a Phase I Food and Drug Administration study. At Providence Saint Joseph Medical Center, we’ve been very fortunate to get many Phase I studies here over the years. Providence Saint Joseph Medical Center has truly been a major testing site for many important innovations.”

More than 2 million people have pacemakers or defibrillators. In the past, when such a patient needed an MRI, doctors were unable to perform the scan because they feared it could harm the device or the patient. However, pioneering studies, including those conducted by Raymond H. M. Schaerf, MD, showed these patients can be safely scanned. Now MRI-compatible pacemakers and defibrillators are becoming available. In April, Providence Saint Joseph Medical Center became the first hospital in the nation to conduct a cardiac MRI of a patient implanted with the new Accent MRI™ Pacemaker and Tendril MRI™ Lead. We asked Dr. Schaerf to describe the latest developments.

Pacemaker Progress: The Dawn of MRI Compatibilty

Raymond H.M. Schaerf, MD

ONGOINGLow-cost Heart ScreeningsProvidence Little Company of Mary Medical Center Torrance will offer valuable, low-cost heart screenings to the commu-nity. Screenings will be available during the week and weekends for your convenience. Getting screened today could help avoid problems in the future. >>Register online or at 1-888-HEALING.

Heart Valve ScreeningsHave you or a family member been diagnosed with a heart murmur or valvular heart dis-ease? Providence Saint Joseph Medical Center will offer low-cost heart valve screenings. Get-ting screened today could help avoid problems in the future. >>Register by calling 1-844-MY-MURMUR (1-844-696-8768).

Hip or Knee Pain ReferralsIf hip or knee pain has limited your mobility, you should know you have options. The board-certified orthopedic specialists at all Providence medical

centers can provide advanced treatments that can help you regain function, relieve pain and experience the life you deserve.>>For a free physician referral, call 1-888- HEALING (432-5464).

Bariatric Wellness CenterIf you (or a loved one) are struggling with weight issues, the nationally renowned experts at the Bariatric Wellness Center would love to help you find the right option for your successful weight loss. The board-certified specialists at Providence Saint Joseph Medical Center provide weight loss treatments, including minimally invasive options, that may be just right for you. >>To schedule a consulta-tion, call 1-888-HEALING (432-5464).

Farmers MarketSeveral farmers markets are affiliated with Providence hospitals.• Every Thursday, 9 a.m. to

2 p.m., in the west parking lot at Providence Little Company

of Mary Medical Center San Pedro, 1300 W. 7th St.

• Every Friday, 9 a.m. to 2 p.m., in the Atrium parking lot at Providence Little Company of Mary Medical Center Torrance, 4101 Torrance Blvd.

• The Burbank Certified Farmers Market is one of the few certified organic farmers markets in the San Fernando Valley area. Located behind Burbank Community Services Building, 150 N. Third St., in downtown Burbank, it’s held every Saturday, 8 a.m. to 12:30 p.m. (rain or shine). Parking is free. A portion of the proceeds benefits the Providence Saint Joseph Foundation.

OCTOBER 22Free Spanish-Language Lecture: Understanding Total Joint Replacement Surgery6 to 7:30 p.m.Providence Little Company of Mary Medical Center San PedroDe Mucci Center, 1300 W. 7th St., San Pedro

No matter what your age, you should be able to move with comfort and confidence. If you have been living with hip or knee pain, we can help you get back to doing the activities you love. Come to our free talk in Spanish with Juan Frisancho, MD, an expert in orthopedics, to learn about the latest treatment options for joint pain, including:• Surgical and non-surgical

treatments for reducing joint pain

• Total joint replacement and if it’s right for you

• Progressive techniques for faster recovery

>>For more information or for reservations: 1-888-HEALING (432-5464)

OCTOBER 22Lecture: Spine Health6 to 7:30 p.m.Providence Holy Cross Medical Center – North Building15031 Rinaldi St., Mission HillsIf you suffer from back pain or a spine condition, this free lecture is an opportunity to learn about your options for treatment from

on the horizon

Jump-start a healthy diet by shopping at one of the farmers markets affiliated with Providence Health & Services.

Providence hosts dozens of lectures, events and classes each week across the region. Here are some upcoming highlights. Check our website for more activities.


our expert, Justin Spooler, MD.>>For more information or for reservations: 1-888-HEALING

OCTOBER 22Lecture: Treatment for Breast Cancer Providence Little Company of Mary Medical Center Torrance Del Webb Center for Health Education6:30 to 8:30 p.m.Learn about the latest treatment options. Topics will include: new diagnostic imaging options for earlier detection, surgical advances and breast-sparing techniques, information on chemotherapy and radiation treatment .>>For more information: 1-888-HEALING (432-5464).

OCTOBER 23Power of PinkHouse of Blue, Sunset StripCelebrate an acoustic evening with P!NK and friends to benefit the Cancer Prevention Program at the Margie Petersen Breast

Center at Providence Saint John’s Health Center.>>For more information: powerofpinkevent.org

OCTOBER 25Caritas GalaBeverly Wilshire, Beverly Hills, CAThe annual Caritas Gala presented by the Saint John’s Health Center Foundation board of trustees and the Irene Dunne Guild is a black-tie evening of glamour and elegance. >>For more information, contact Tess Csiszar at [email protected].

NOVEMBER 1Providence Little Company of Mary Sellabration Gala 2014Terranea Resort, Palos VerdesProvidence Little Company of Mary will host its Sellabration Gala featuring hosted cocktails, silent and live auctions, dinner and dancing at the beautiful Terranea Resort in Palos Verdes. Sellabration Gala 2014 will honor American Honda

Motor Company, Inc., with the Providence Little Company of Mary Corporate Leadership Award. The event benefits the Cardiovascular Center of Excellence (Torrance campus) and Critical Patient Services (San Pedro campus). >>For more information: events.providencepower ofgiving.org or contact Kathryn Girardi at 1-310-303-5342 or [email protected]

NOVEMBER 11Lecture: Diabetes—Signs and Symptoms for the Whole Family Providence Little Company of Mary Medical Center Torrance Del Webb Center for Health Education6:30 to 8:30 p.m.Learn the signs, symptoms and risk factors for diabetes. This lecture will help you understand factors contributing to obesity (child and adult) and incorporate healthy meal planning and practical ways of getting enough physical activity for the family. Experts also will discuss the

latest treatment options and how to get support if you have the condition.>>For more information: 1-888-HEALING (432-5464).

JANUARY 29, 2015Diabetic Insulin Support GroupProvidence Tarzana Medical Center, North Conference Room, 7:30 p.m.Open to people with either type 1 or type 2 diabetes.

on the horizon

The Caritas Gala to benefit Providence Saint John’s Health Center will be held October 25.


VISIT US ONLINEFrom support groups to fitness classes, Providence provides the programs you need to live healthfully. View our many classes, events and screenings online at ProvidenceClasses.org or call 1-888-HEAL-ING (432-5464)


Breast Cancer WITH COURAGE

FACING

Ethel Smith relied on caring professionals and state-of-the-art treatment to conquer

a terrifying illness.

Written by Victoria Clayton

Photographed by Daniele Rose

Facing Breast Cancer With Courage


Smith, 52, is a lifelong San Fernando Valley resident. She married Curtis Smith, her high school sweetheart, in 1979, settled down in Lakeview Terrace and had two sons. For the past 20 years she’s been a full-time recruiter, often helping recruit people looking for work among her family and church friends at New Zion Christian Fellowship in San Fernando. Each Sunday she sang with New Zion’s praise team.

Despite being a determined and outgoing

woman, Smith says she was hiding something that a bout with cancer last year helped reveal. “Before, I was the cowardly lion, like in The Wizard of Oz,” she explains. “I was afraid of everything. With breast cancer, my fear had to go. I had to have faith. There would be no more hiding behind Dorothy.”

Instead, there were important decisions to make and an illness to confront. Smith found the resources she needed among the

health care professionals at Providence Health & Services, Southern California.

Patients like Smith benefit from emotional and practical support in addition to excellent medical care, says Nancy Kolanz, RN, a nurse navigator at Providence Little Company of Mary Medical Center Torrance. Kolanz and other breast cancer nurse navigators are usually the first medical professionals whom newly diagnosed patients see.

THERE ARE NOT MANY PEOPLE WHO HAVE GOOD THINGS TO SAY ABOUT CANCER. THEN AGAIN, THERE ARE NOT MANY PEOPLE LIKE ETHEL SMITH.



“There’s a certain anxiety that comes along with the word ‘cancer’—it can be overwhelming and paralyzing,” says Kolanz. “My job is to make sure nobody is confused and alone here.”

Kolanz spends time with patients and their families to answer questions and explain medical options. She also schedules necessary appointments with specialists, often streamlining the diagnosis-to-treatment process and trying to shorten the time spent waiting for care.

“When you’re getting medical treat-ment, it’s about having faith in your plan and the people providing service to you. I may help patients get to this place much faster,” she explains.

Smith, who was treated at Providence Holy Cross Medical Center in Mission Hills, agrees that Providence’s team approach instills confidence in patients. “Everybody who was a part of my team—the nurses, the anesthesiologist, the surgeons, even the receptionists—made a difference in my health. I needed what they offered: collaboration and unwavering support and encouragement.”

Of course leading-edge treatment also helped. Advances in breast cancer treatment have improved the outlook for many

patients, says Moshe Faynsod, MD, surgical oncologist at Providence Little Company of Mary Medical Center San Pedro.

“Targeted medications, better digital imaging and advances in surgical treatments have meant better outcomes in general, even for women with more aggressive cancer,” says Dr. Faynsod.

For example, hormonal therapy with selective estrogen receptor modulators (called SERMs) and aromatase inhibitors has become standard treatment for women with a type of cancer called estrogen receptor-positive breast cancer. These medications either interfere with tumor growth by preventing estrogen from binding to the estrogen receptor or block estrogen production in the body.

Surgically, Dr. Faynsod says breast-preserving techniques also are now standard. Incisions have become smaller and, in general, conservative approaches with less tissue removal are favored. “Digital imaging really has helped in this area. We now are able to get a much clearer, more comprehensive picture of the condition and what needs to be done,” he says.

Sometimes a newer strategy, neoadjuvant chemotherapy (chemo before surgery), is employed. “At times this reduces the tumor

enough so we can perform a breast-preserving lumpectomy instead of a mastectomy,” he explains. “Today the focus is on not only eradicating the cancer but also preserving the maximum amount of breast tissue when it’s appropriate and safe.”

Another surgical advance is referred to as a “direct-to-implant” procedure, a process that allows for complete reconstruction during the same surgery as a mastectomy.

“It’s not for everyone, but for some patients this is clearly a great option,” explains Maggie DiNome, MD, assistant professor of the John Wayne Cancer Institute and acting director of the Margie Petersen Breast Center at Providence Saint John’s Health Center in Santa Monica.

Traditionally a mastectomy is performed along with the first stage of the implant reconstruction—the

expander placement—in the first surgery. This is followed several months later by the second stage of reconstruction, the implant exchange.

Between the two surgeries, the balloon-like expander is gradually filled with saline to create the space for the implant. This requires multiple doctor visits, discomfort from the repeated expansion and a second surgery. With the direct-to-implant approach, the implant is placed directly in the space created behind the pectoral muscle immediately following the mastectomy.

“One drawback is that we’re limited by breast size and patient anatomy,” explains Dr. DiNome. Still, many patients are thrilled with the results and happy not to go

When you’re getting medical

treatment, it’s about having faith in your plan and the people providing service to you. I help patients

get to this place much faster.”

INVASIVE BREAST CANCER

Most breast cancers are invasive, which means they have broken through

the ductal or glandular walls where they originated and are growing into

surrounding breast tissue.Estimated number of female invasive

breast cancers per year in the United States:

So

urce

: Am

eric

an C

ance

r S

oci

ety

Ages 4

0 and yo

unger

Ages 50

and yo

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er20k

40k

60k

80k

100k

10,98048,910

84,21099,220

Nancy Kolanz



At least 10% of breast cancers are heredi-

tary; they arise because of alterations in

our genes that are passed down through

families and raise the risk of cancer. In

the era of personalized medicine, genetic

testing can empower individuals by giving

them the information they need to discover

hereditary risks and learn what they can do

to catch cancer early—or even stop it from

ever developing.

Genetic counseling and testing may be

of utmost value to individuals with breast

cancer in their families. For years genetic

testing for breast cancer has been focused

on mutations in genes called BRCA1 and

BRCA2, which account for about 5 percent

to 10 percent of all breast cancers as well

as increase the risk of ovarian, prostate,

pancreatic and other cancers.

Today that's not all that genetic testing

can identify. Recently genetic testing

options for such families have expanded

and now include testing for more than

a dozen genes implicated in hereditary

breast cancer risk in addition to BRCA1 and

BRCA2. This expanded testing is enabling

individuals with previously normal BRCA

testing to identify the causes of breast

cancer in their families, as well as to learn

about risks for other types of cancer.

Providence Health & Services, Southern

California, has two newly opened, state-

of-the-art centers to serve families with a

high risk for cancer or individuals who wish

to learn more about their cancer risks. The

Genetics Program at the Sheri and Roy P.

Disney Center for Integrative Medicine at

Providence Saint Joseph Medical Center in

Burbank and the Cancer Prevention Clinic

at the Margie Petersen Breast Center at

Providence Saint John’s Health Center

in Santa Monica both put the concept of

personalized medicine into practice.

Consultation in these centers helps

individuals identify risks in order to

establish individualized management.

Services in both centers include high-

risk surveillance (such as breast MRIs),

dietary and life-style modifications, stress

reduction and other integrative health

practices, and tailored use of medication

and surgery for cancer prevention.

“Genetics is the first line of prevention,”

says Ora Karp Gordon, MD, medical

director of medical genetics and integrative

medicine at the Roy and Patricia Disney

Family Cancer Center of Providence Saint

Joseph Medical Center, and a nationally

recognized expert in hereditary cancer. “We

can identify who is at extraordinary risk and

tailor their screening and management—and

unburden those who have been living in fear

but are found to not carry a mutation that

may have plagued their family.”

The Cancer Prevention Clinic at the

Margie Petersen Breast Center, Providence

Saint John’s Health Center, is directed by

Maggie DiNome, MD. Dr. DiNome also is

acting director of the breast center.

“There’s a whole population of patients

who don’t know they are at increased

or high risk, and we want to be able to

identify those patients so that we can

reduce their risks and enhance their

screenings so we can find cancer at a much

earlier and curable stage,” Dr. DiNome says.

Insurance typically covers appointments

for genetic risk assessment, as well as

genetic testing for those considered at

high risk of disease. Moreover, the Genetic

Information Nondiscrimination Act (GINA)

is a federal law that protects people from

health insurance discrimination based on

genetic test results.

For more information or to make an

appointment, contact the Genetics Program

at the Roy and Patricia Disney Family

Cancer Center, Providence Saint Joseph

Medical Center, at 1-818-748-4748, or the

Cancer Prevention Clinic at the Margie

Petersen Breast Center, Providence Saint

John’s Health Center, at 1-310-582-7100.

THE INFORMATION CONTAINED IN YOUR GENES

Source: American Cancer Society; Centers for Disease

Control and Prevention

BY THE NUMBERS

29%

67%

1 in 8

6189%

All newly diagnosed cancers among women that are breast cancers

Women 40 years of age and older who had a

mammogram within the past two years

Lifetime risk of being diagnosed with breast cancer

Median age of breast cancer diagnosis in U.S. women

Five-year survival rate for women with breast cancer



Ora Karp Gordon, MD, left, and Maggie DiNome, MD, help women assess their breast cancer risks.

through any additional medical procedures. Because the nipple and areola often are saved, Dr. DiNome says many direct-to-implant breast cancer patients leave surgery with a near-natural cosmetic result. “For the right candidate, this allows them to get back to a normal life more quickly.”

Ethel Smith initially had two lumpecto-mies on her right breast and six rounds of chemotherapy, but ultimately she required a mastectomy. Afterward she also endured radiation every day for seven weeks.

“Sometimes I really wanted to throw in the towel,” she admits. “I was weak, my skin and fingernails changed, everything

tasted horrible, I had sores in my mouth, I lost all of my hair.”

Instead of giving up, though, she used music to lift her spirits and as a form of meditation. She sang the inspiring church songs she loves. She even composed her own song of gratitude and had her nephew develop an instrumental beat to go with it. When she physically couldn’t sing, she used her iPod to listen to the music.

She repeatedly envisioned herself healthy and strong. And though she was struggling, she looked for opportunities to help other cancer patients she met. She offered encouragement, advice and once even went to the drugstore to buy the aloe vera and lotion that eased her skin discomfort so she could give it to another radiation patient who couldn’t afford it.

Most importantly, says Smith, she became absolutely fierce about her mental outlook. “I discovered something: The mind is an incredibly powerful resource. There were many days when I literally had conversations with myself. I would say, ‘Fear, you cannot come here. Depression, you can’t live here! Sorry, but I have nothing to wear to any pity party!’ I simply wouldn’t succumb mentally, and I think that has helped get me through this.”

Encouraged and supported by her family, including sons Curtis and Michael, she forced herself to eat well and exercise, even if it was sometimes only a 10-minute walk. The type

of strategies Smith embraced intuitively, says Dr. DiNome, are what Providence profes-sionals encourage in all patients.

“We know that when we combine top-notch treatment with truly healthy lifestyle choices and integrative strategies, we have the most powerful tools for healing,” says Dr. DiNome, who is embarking on a clinical trial using acupuncture to improve medication adherence and outcomes in certain types of breast cancer patients. Her center also has introduced yoga and nutritional counseling.

“Physically, emotionally, mentally, spiritually, cancer changed me,” says Smith. “That scared little lion? That’s not who I am today. I got my courage. But still, I always hope that other women will not have to go through what I did.”

As much as she appreciates silver linings, Dr. DiNome agrees. “We really are at the forefront here with breast cancer research, treatment and even innovative healing strategies. As we move forward, I see a future of far more community outreach and patient-oriented research. We’ll be working harder to get the message out that lifestyle changes such as regular exercise, diet and stress reduction make a difference in breast cancer risk. We believe in education and empowerment in women’s health, and if we can convey that and reduce an individual’s risk for cancer development, that’s exactly what we want.”

We know that when we combine

top-notch treatment with

truly healthy lifestyle choices and integrative

strategies, we have the most powerful tools for healing.”


electing health insurance isn’t as easy as buying a new sofa or purchasing a cell phone plan. But it’s getting better, thanks to the efforts by the government, insurance plans, insurance brokers and consumer advocacy groups to educate consumers on their choices.

The health insurance marketplace has experienced seismic changes in recent years due to health care reform and the advent of the federal Affordable Care Act. Moreover, the cost of health care is continuing to rise, many hospitals and physician groups are realigning, and Americans themselves are becoming wiser and more proactive about their health. This somewhat chaotic scenario means that most people need to put a little more time and effort into choosing health insurance plans during the open enrollment period

Open Enrollment YOUR DOCTOR, YOUR CHOICEA sea of changes in health care means consumers need to shop carefully for insurance.Written by SHARI ROAN


that typically occurs each fall. “Each year, everyone has to carefully

review their benefit options,” says Teresa David, chief operating officer of Facey Medical Foundation. “Look at the full range of benefits and make sure your physicians and hospitals are in the networks. Things change from year to year. It’s worth the time and effort to carefully review options and do the research ahead of time. In addition to written materials you may receive, don’t hesitate to go directly to the health plan website or call their member service line to obtain more information.”

Each health plan is required to send a notice of changes or evidence of coverage to its existing customers, says Martha Gonzales, a health insurance broker specializing in Medicare and individual/family health plans. Health insurance brokers can help you find a plan that meets your budget and physician preferences.

“A broker who is an independent agent is in a position of neutrality,” she explains. “We want to best serve our clients. We can let the patient navigate the decision

with all the tools and resources available to brokers.”

Now is the time to attend a lecture or contact a broker for assistance, says Bruce Johnston, a broker who specializes in assisting Medicare recipients. “People should start the process early. Get in touch with someone right after October 1. Find a broker to do an annual insurance review. It takes about an hour.”

Taking stock of your coverage What should you consider during open enrollment? According to the experts, one of the most common mistakes consumers make is to do nothing.

“Some people don’t check their drugs to see if the formularies have changed,” Johnston explains. “They don’t check out the benefits from one HMO to another. On paper, they all look the same. They should talk to a broker to understand the nuances.”

Even consumers selecting insurance through an employer-based system may not realize that those plans can change each

“If you do nothing, nothing

changes. But there can be significant changes in plans from year to year. Your individual situation may have changed. The plan from last year may not be the best for this year.”

Autumn: Time for Open Enrollment


October 2010 to 11:30 a.mProvidence Little Company of Mary Medical Center San Pedro

October 2110 to 11:30 a.mProvidence Little Company of Mary Medical Center Torrance

October 219 to 11:30 a.m.Grand Vista Hotel, 999 Enchanted Way, Simi ValleySpace is limited. Call 1-888-HEALING (432-5464) to RSVP.

October 2310 a.m. to noonProvidence Little Company of Mary Medical Center Torrance

October 2411 a.m. to 1 p.m.Providence Tarzana Medical Center, 18321 Clark St., Tarzana, North Conference Room 2, rear bungalows

October 2810 to 11:30 a.m.Providence Little Company of Mary Medical Center San Pedro

October 309 to 11 a.m. Pickwick Gardens, 1001 Riverside Dr., BurbankSpace is limited. Call 1-888-HEALING (432-5464) to RSVP.

November 310 to 11:30 a.m.Providence Little Company of Mary Medical Center San Pedro

November 52 to 4 p.m.Providence Tarzana Medical Center, 18321 Clark St., Tarzana, North Conference Room 2, rear bungalows

November 610 to 11:30 a.m.Providence Little Company of Mary Medical Center Torrance

November 134 to 6 p.m.Denny’s Canoga Park, 8330 Topanga Canyon Blvd., Canoga Park

November 1310 to 11:30 a.m.Providence Little Company of Mary Medical Center San Pedro

November 174 to 5:30 p.m.Providence Little Company of Mary Medical Center Torrance November 1810 a.m. to noonProvidence Tarzana Medical Center, 18321 Clark St., Tarzana, North Conference Room 2, rear bungalows

November 184 to 5:30 p.m.El Torito Grill, 21321 Hawthorne Blvd., Torrance (Village Lane Shopping Center)

November 204 to 5:30 p.m.Providence Little Company of Mary Medical Center Torrance

November 2510 to 11:30 a.m.Providence Little Company of Mary Medical Center Torrance

December 210 to 11:30 a.m.Providence Little Company of Mary Medical Center Torrance

December 22 to 4 p.m.Providence Tarzana Medical Center, 18321 Clark St., Tarzana, North Conference Room 2, rear bungalows

December 310 to 11:30 a.m.Providence Little Company of Mary Medical Center Torrance

December 410 to 11:30 a.m.Providence Little Company of Mary Medical Center San Pedro

INFORMATION ON MEDICAREThe Providence Medical Institute and Facey Medical Group are sponsoring

several seminars to help Medicare-eligible consumers understand their 2015

insurance options. Please join us at one of these forums. Check-in begins

30 minutes before the start of the seminar. Parking is free. Providence

Little Company of Mary Medical Center Torrance is located at 4101 Torrance

Boulevard, Torrance, and Providence Little Company of Mary Medical Center

San Pedro is located at 1300 West 7th Street, San Pedro. The addresses of

other seminars are listed below. Check providencemedicalinstitute.org to find a

listing of other seminars being held now through the end of the year.


Open Enrollment

year as well, David advises.“In many cases now, an employer may

offer a health plan that consists of a broad network of providers and also a product with a restricted network of providers,” she explains. “It’s to the employee’s advantage to review these. They have to be careful to see if their personal physician or preferred hospital is in the narrow network.”

Under the Affordable Care Act, Californians who are self-insured or who work for small companies can purchase insurance through an exchange called Covered California. Now heading into its second year, the exchange is growing and changing, with many more provider networks joining, including many Providence-affiliated providers.

Providence Health & Services continues to be a great choice for consumers, David notes. “We provide a full spectrum of services. Providence is an integrated delivery system where we promote coordinated care between physicians and hospitals. Providence has implemented a system-wide electronic medical record system, which allows physicians and hospitals to share data. That promotes better care and eliminates unnecessary testing. As a system, Providence treats each patient as a unique individual and is

attentive to his or her personal needs.”When selecting insurance, consumers

also should pay close attention to understanding prescription drug benefits. Drug benefits usually are organized by tiers. A formulary is the list of medications a health plan covers. Consumers should do an assessment of the medications they take and then calculate what their out-of-pocket costs for those medications will be under a particular health plan.

“With a medication assessment, you can anticipate the out-of-pocket costs you’ll have,” Gonzales explains. “The idea is to maximize coverage and minimize cost.”

Understanding Medicare and Medi-Cal OptionsConsumers with Medicare and Medi-Cal also need to re-examine their coverage each year, Johnston says. People who are eligible for Medicare for the first time should seek a consultation about the various Medicare services (parts A, B, C and D).

“If you do nothing, nothing changes. But there can be significant changes in plans from year to year. Your individual situation may have changed. The plan from last year may not be the best for this year,” he says.

On the surface, many Medicare plans look the same, Johnston notes. “But if you go down to the details, you see there are substantive differences.”

Medicare and Medi-Cal recipients may be eligible for one of two special programs. One is the Medicare Dual Demonstration Project, a new program for people who qualify for benefits under both Medicare and Medi-Cal programs. These people commonly are called “dual eligible beneficiaries” and must carry several insurance cards and know how to navigate two or three separate systems to receive care. But under the Cal MediConnect program, they can enroll in a coordinated care system.

Dual eligible recipients will receive packets of information about their health plan choices and should review the material carefully, Gonzales says. “They need to be able to reach out to somebody, because if they don’t make a selection, one will be made for them. That may mean a

relationship they value may not continue because they didn’t make that selection.”

Another program that may better serve some Medicare beneficiaries is the Medicare Chronic Special Needs Plan (C-SNP). This is for people with chronic health conditions, such as diabetes or cardiovascular disease, to help them manage their expenses.

“This type of plan gives people a select drug tier where a lot of the medications they’re taking can be a zero or low co-payment,” Gonzales says. “That is a big savings to a lot of people.”

One client switched from a regular Medicare plan to the Medicare Chronic Special Needs Plan and saw her medication copays drop from $70 per month to $10 per month. “For a senior on a fixed income that’s a big difference,” she says.

DATES TO REMEMBERMedicare or Medi-Cal:

Open enrollment for people

on Medicare is October 15

to December 7.

INDIVIDUAL COVERAGE: Individuals who purchase their

own insurance from exchanges

(such as Covered California)

or from brokers will have from

November 15 to February 15,

2015, to make their selections for

2015, according to rules under

the Affordable Care Act.

EMPLOYER-BASED COVERAGE: Most employers offer a period

of several weeks in the fall to

introduce their health insurance

offerings for the coming year

and give their employers an

opportunity to switch to a new

plan or stay with their existing

coverage. The open enrollment

period varies by company.

Study your insurance options carefully, says Teresa David, chief operating officer of Facey Medical Foundation. Don’t make the mistake of thinking your current plan hasn’t changed.

profiles in health


New Nurses Learn—and TeachWith 3,800 nurses in her charge, chief nursing officer Katherine Bullard has a knack for bringing out the best in everyone.Written by SANDI DRAPER

Photographed by REMY HAYNES

profiles in health


verybody lucks into a win-win situation occasionally. Only someone special can achieve a win-win-win-win. Katherine Bullard, RN, accomplished just that with

the rollout of the electronic medical record system in Providence’s Southern California region.

The electronic medical record system was developed by Epic Systems Corp. of Madison, Wisc., and is referred to as Epic. Nationwide the shift to electronic medical records has marked a massive and challenging transition for hospital personnel accustomed to the traditional, paper-packed medical charts. Electronic medical records, however, facilitate enhanced, real-time communication among health care providers and improve patient care and satisfaction.

“As we were preparing for the Epic rollout, we were on a pretty compressed schedule,” Bullard says. “We were extremely concerned about meeting the needs of our patients if we had to pull one out of every six of our nurses and train them to be Epic ‘super-users’ to support the staff. We could replace them with temporary labor, but that’s costly and not optimum for continuity of care.”

A wealth of workforce graduates in nursing led to win No. 1. “We were aware that 42 percent of the newly graduated and newly licensed registered nurses in the Los Angeles area were not employed in nursing,” Bullard says. “If we could tap into the wealth of new nurses, we could train them as Epic experts.”

What the new nurses lacked in clinical expertise they made up for by being “technology natives.” As Bullard puts it, “Computers are ubiquitous to this age group. They don’t remember a home without a computer. They are at ease with technology.”

Win No. 2 went to the veteran nurses—so-called “technology immigrants”—who had the technology native nurses to assist them. “We needed to get our more experienced nurses engaged in using Epic technology and ensure they felt supported,” Bullard says. “Each nursing unit had two types of ‘super-users’—experienced nurses specially trained to the role and newly graduated nurses serving as Epic Implementation Technicians (EITs). The new nurses were working side-by-side with experienced nurses, and they complemented each other perfectly.”

Win No. 3 went to Providence patients. By adding new nurses instead of temporary labor, patients got attention from Providence employees, and the Epic rollout came off with minimal disruption to patient care. And patient care is critically important to Bullard, the daughter of a physician and a nurse.

“Growing up, I learned what a sacred privilege it is to help people who are suffering and vulnerable,” she

says. “We are patients’ advocates. Nurses are the ones who are there when everybody else goes home.”

Win No. 4 was a victory of its own. The new nurses who had been hired as EITs became logical candidates for Providence’s nursing residency program, and Providence landed some new employees who were already familiar with its health care facilities.

“Experienced nurses sometimes find it burdensome to bring a nursing resident up to speed,” Bullard says. “But because the nursing residents had already been part of the Providence system as EITs, they came in familiar with the system and already knew some of the people. In fact some of our nurse managers were competing with each other to hire their favorite EITs to work in their units.”

The successful Epic rollout at five of the six Providence hospitals (Providence Saint John’s Health

Center will “go live” in November) is just a sample of the way Bullard approaches her responsibility to the 3,800 nurses she leads. Bullard was also the visionary behind Providence’s Nursing Institute, formed in 2012.

“It is a virtual institute versus a brick-and-mortar institute. The goal is to facilitate the exchange of ideas among various educational and clinical practice experts among Providence’s Southern California facilities,” she explains.

Among the program’s achievements are a regional standardized RN residency program, a common orientation program for nurses and common best practice guidelines. “Instead of each hospital’s team having to invent a wheel, we share the best of what Providence has to offer,” Bullard says.

Bullard, who is participating in a doctoral program for executive leadership in nursing practice, worked at medical facilities all over the country as she fol-lowed her husband’s 35-year Navy career. The Bullards raised two daughters and a son and have three grandchildren.

When she’s not working, travel and family visits are her priorities. When her husband retired as a rear admiral six years ago, the couple started a vineyard in Paso Robles.

“Who knows if we’ll ever see any grapes,” she jokes. But if the vineyard is half as successful as her work with Providence Health & Services, there will be grapes aplenty.

Computers are ubiquitous to this age group. They don’t remember

a home without a computer. They are at ease with technology.”

E


FINDING PEACE

Providence’s Institute for Human Caring is leading the way on redesigning health care for patients through the end of life.

Written by Sandi Draper

Photographed by Scott Gilbert

“The health care industry, as a whole, is hungry

for clear leadership and vision in caring for patients through the end of life. Providence has seized the opportunity.” —Dr. Ira Byock

Let’s face it: Regardless of advances in medicine, technology and treatment, we have not discovered the key to living forever. In recent years

that realization has launched a national dialogue on improving the care for patients who are approaching the end of life. And it’s why Providence Health & Services recently launched the Institute for Human Caring, which will enhance care and quality of life for patients and families across the five states with Providence facilities, as well as serving as a national resource for clinicians, researchers and policymakers.

Based at Providence TrinityCare Hospice in Torrance, the Institute will be led by Ira Byock, MD, as chief medical officer. “There really is a public health crisis in the way we die,” Dr. Byock says. “Simply put, many people die badly, being treated in ways they would not have wanted during the last days of life. When patients are faced with a life-threatening condition, the reflex is to bring medical treatment to bear without considering that there is a whole human being who has personal needs.”

Those needs include: support in making difficult decisions; expertly managing symptoms such as pain, constipation, fatigue; assessing the wellbeing or stress of the person’s family; educating and supporting caregivers; and extending spiritual care. “Medical advances are wonderful, but medicine still hasn’t made one person immortal,” Dr. Byock says.

through the end


Finding Peace Through The End

Central to the Providence Mission is “creating healthier communities, together.” The academic focus of the Institute

is on how to recognize and foster healthy community behaviors around the realities of illness, dying, caregiving and grief. Different cultures may value different things.

“We need to find out what’s important to this patient at this inherently difficult time,” Dr. Byock says. Treating the whole person doesn’t happen unless “we know who you are and what your cultural and personal values are. The best care has to be personalized for each individual.”

Care for people nearing the end of life should center on the concept of healing—arriving at a more peaceful place before the time of death, says Glen Komatsu, MD, chief medical officer of Providence TrinityCare Hospice and medical director of TrinityKids Care.

“We see people die badly when health care providers are singularly focused on curing, not healing,” says Dr. Komatsu. “People tend to use the terms interchangeably, but there is a difference between curing and healing. Patients want the injury fixed, the illness eradicated. Unfortunately, all diseases cannot be fixed. But healing, a much more transformative phenomena, is always possible. People who are dying can be healed even though they cannot be cured.”

Patients and families have the inner capacity to “heal” even at the far end of life, he suggests. “People heal themselves if caregivers provide the conditions for the healing to occur.”

Providing the conditions can be as simple as offering patients the full range of op-tions—not just the best disease treatments technology has to offer but also the option of palliative or hospice care.

“If we care for people in this way, caregiving is a more gratifying experience for us, the health care providers, as well as the patient,” he adds. “This mitigates against compassion fatigue, and we are more whole ourselves as caregivers.”

Before assuming his current role,

SERVICES AND RESOURCESPALLIATIVE CAREPalliative care is a relatively new medical specialty that strives to relieve suffering

and improve quality of life for people with serious illnesses. While Medicare and

other insurance limits hospice care to people who are dying, palliative care is

available to patients of all ages who are living with and being treated for serious,

life-threatening or chronic conditions. The Doak Center for Palliative Care is based

at Providence Little Company of Mary Medical Center in Torrance. For more

information see California.providence.org or call 1-310-303-6854.

HOSPICE CAREHospice care provides medical services, emotional support and spiritual resources

for people living with terminal illness and their loved ones. Hospice focuses on

maximizing patients’ comfort and quality of life. Hospice care also helps loved

ones manage the practical, spiritual and emotional challenges of care. Providence

TrinityCare Hospice, based in Torrance, provides care for adults in homes or

outpatient settings. Providence TrinityKids Care offers hospice-style care for

children with the differentiation that preventive medical care can continue. For more

information, see California.providence.org.

LIVING WILLS AND ADVANCE DIRECTIVESLiving wills and advance directives are written, legal instructions outlining a

person’s preferences for medical care if that person becomes unable to make

decisions. Advance directives are important for all adults—not just seniors—and

can guide choices for doctors and caregivers if a person becomes terminally ill,

seriously injured, comatose or is near the end of life. By spelling out wishes in

advance, a person can avoid unwanted medical intervention such as life support.

It also relieves loved ones of decision-making burdens. For more information, see

the Conversation Project at theconversationproject.org or the California Coalition

for Compassionate Care at coalitionccc.org.


Dr. Komatsu had been a neonatologist at Providence Little Company of Mary Medical Center Torrance. “I was drawn to that field because of the high stakes of that kind of medicine. But I began to realize that often treatment was being undertaken without any real regard for physical, psychological and spiritual pain.”

This interest in the relief of suffering as a fundamental goal of medicine led him to change fields, accepting a year-long fellowship at Harvard to study palliative care before returning to Torrance. “Interest in this type of care has exploded in medicine and the public in the past 10 years,” Dr. Komatsu says.

“Most medical centers, health plans, payers and health care reform advocates are very interested in palliative care,” he explains. “Providence, as a system, has embraced palliative care as a signature service that differentiates Providence from other health systems and brings our Mission to life.”

The need to improve care for patients we cannot cure also extends to pediatric services, says Terri Warren, executive director of Providence TrinityCare Hospice and TrinityKids Care, which opened in 2001 and is the largest pediatric hospice in California. “There are children living with terminal conditions,” Warren says. “They needed a version of hospice care tailored to their unique needs. We couldn’t walk away from that challenge.”

Unlike a traditional hospice program where lifesaving medical treatment is discontinued, at TrinityKids Care children can receive hospice-style care while continuing treatment. “There are a lot

of organizations that provide hospice care. But at Providence our core values of respect, justice, compassion, excellence and

stewardship, inspire all the work done—not just at the organizational level but at the human-caring level,” Warren says.

But it can be tough to promote “end-of-life care” as a vital medical service. “Doctors and other health care providers are human; we don’t want to see patients die,” Dr. Byock says. “The natural tenden-cy when treating a seriously ill patient is to ramp up the medical treatment. But it comes down to a length-of-life versus a quality-of-life issue.”

Part of the Institute for Human Caring’s mission will be to help the entire Providence system move more fully from talking the talk to walking the walk.

“We get there by paying attention to the patient and their family. Are they satisfied with treatment? Was the patient’s dignity preserved? Was their pain managed? Did somebody ask about their fears? Did somebody ask about their spiritual wellbeing?” Dr. Byock says.

Providence Little Company of Mary Medical Center in Torrance has been recognized for asking all the right questions. In April the center was surveyed by The Joint Commission and was awarded Advanced Certification for Palliative Care, the first program and health system in Southern California to be recognized.

“The health care industry, as a whole, is hungry for clear leadership and vision in caring for patients through the end of life,” Dr. Byock says. “Providence has seized the opportunity to redesign health care around the whole person and stands as a national example for what health care organizations can achieve.”

Dr. Byock is visiting programs across Providence’s five-state network to see what already is working well within Providence centers and programs, with an eye toward opportunities to extend innovative and effective approaches system-wide. He thinks of his research as listening to and learning from other caregivers and likens himself to Johnny Appleseed. “I’m collecting seeds to carry elsewhere.”The institute is in the process of hiring

researchers and program managers, and developing staff and infrastructure. “It will be a small staff with a synergy that makes the whole greater than the sum of its parts,” he explains.

He continues, “None of this is particularly expensive or esoteric. It’s the basics of human caring. With this approach, it’s more likely that people’s preferences for care will be known and respected, and that there will be fewer unwanted final days spent in an intensive care unit. Families will have the opportunity to spend precious remaining days together, completing their relationships. That’s entirely consistent with top-quality care.”

“Medical advances are wonderful, but

medicine still hasn’t made one person immortal.”

Ira Byock, MD, is the chief medical officer of the Institute for Human

Caring. He is a palliative care physician and a professor at Dartmouth’s Geisel School of

Medicine. He has been recognized as a Visionary by the Academy of Hospice and Palliative Medicine and has received the Academy’s

Lifetime Achievement Award. Dr. Byock is the author of three

books: Dying Well, The Four Things That Matter Most and The

Best Care Possible.

Finding Peace Through The End

profiles in health


nter the control center of Providence Little Company of Mary Medical Center’s

Torrance-based simulation lab, and you might just think you’ve walked onto the set of Grey’s Anatomy. There are high-tech hospital beds, IVs, an electrocardiographic heart monitor and (fake) blood, bodily fluids and medications. There’s even a food tray with a forlorn piece of French toast and a glass of milk.

Alas, however, there’s no Dr. McDreamy. But there is the $85,000 Laerdal SimMan 3G. SimMan is an eerily believable mannequin patient.

“He blinks, he sweats, he cries. He has a heart rate and blood pressure. We can even program him to have a seizure or a stroke,” says Heidi Traxler, RN, MSN, nurse educator and the clinical simulation program manager.

So what’s the point of all this? The state-of-the-art lab, as well as a similar one at Providence Little Company of Mary Medical Center San Pedro, runs training exercises for Providence health care teams four days a week. The lab was launched in 2008 as a collaboration between Providence Health & Services, Providence Little Company of Mary Medical Center Torrance and El Camino College nursing school.

UniHealth Foundation, a Los Angeles-based foundation that supports innovative health activities, awarded Providence Southern California South Bay Service Area a $1 million grant to support the simulation program for RNs and nursing assistants with a focus on quality and safety. Because the program was such a success, UniHealth then granted another $1

million in 2011 to expand inter-professional training with nurses, doctors and other medical professionals already working at Providence clinics and hospitals.

“I think we’ve been able to get this support because the simulation program has such a clear and vital purpose: to ultimately improve the safety and outcomes of all Providence patients,” says Ellen Gorbunoff, director of education and professional development.

The training sessions consist of no-nonsense drills dealing with real-life medical crises. Roughly 13 Providence doctors and nurses, trained as faculty, take turns sitting behind glass, much like television producers, as embedded cameras

and audio record every move. A scenario, developed by Traxler and

colleagues, is presented to a team of medical professionals who then manage the complex clinical situation using effective communication and team skills. The scenario is carried out as real-to-life as possible.

Whoever would normally be in the hospital in the given scenario is present: nurses, doctors, respiratory therapists, anesthesiologists, surgeons, medical technicians and others. There are even volunteer actors who pose as family members or the patients themselves.

“Sometimes it gets really intense,” says

Traxler. “It is so real. We could be dealing with a women’s health issue, a neonatal, gastrointestinal or intensive care scenario, but the atmosphere, whether we are doing simulation in the sim lab or in the actual patient care area, is always as if you were in the hospital and the medical emergency was truly happening.”

IVs are inserted. There’s intubation, hemorrhaging and resuscitation. In some cases, doctors even have end-of-life conversations with “family members.” This gives them the opportunity to work on their patient and family communication skills.

The sim program is also used to train volunteers for Providence’s No One Dies Alone program. “We use simulation to train

them to sit with people who are dying and may not have friends or family members around,” says Gorbunoff. “Volunteers have to know how best to respond to people at end-of-life stages. So we work on scenarios that help them recognize signs of pain or anxiety. We train the volunteers on how to best comfort the patient and when to get the attention of a nurse for help.”

After each training scenario, a debriefing session is held, and the team gets to review the recordings and discuss where they excelled and where there were gaps. The actor-family members are asked to give feedback to the medical team about how

Practice Makes Perfect The Providence simulation program trains health care workers on everything from intubation to holding the hand of a patient near death.

Written by VICTORIA CLAYTON

Photographed by VINCE TAROC

I think we’ve been able to get this support because the simulation program has such a

clear and vital purpose: to ultimately improve the safety and outcomes of all Providence patients.”

E

profiles in health


information was communicated to them.“It’s pretty phenomenal. The atmosphere

is as high-pressure as in a real scenario, but even veteran doctors love to come here. It just gives our health care teams a unique opportunity to evaluate the clinical

scenario, teamwork and communications and see where they could be improved, with the goal of our teams being able to provide the highest quality and safest care possible should that scenario occur with a patient in the hospital,” says Traxler.

And, of course, SimMan is an incredibly forgiving patient. “With a little clean-up, he’s quickly ready to have the next medical emergency,” says Gorbunoff. “So we practice on him and save the perfection for our real patients.”

Heidi Traxler, clinical simulation program manager, poses as a patient during a simulation.

happenings


TRAUMA 30TH ANNIVERSARY CELEBRATION

Former trauma patients and local community leaders attended the 30-year anniversary celebration of the trauma program at Providence Holy Cross Medical Center on June 11. Events included a live demonstration with the emergency and trauma teams and the computer-controlled, state-of-the-art mannequins used today to train doctors and nurses in lifesaving procedures and protocols when time is critical. Since the trauma program started in 1984, Providence Holy Cross has become one of the busiest and most highly regarded trauma programs in Los Angeles County, treating more than 1,300 patients a year.

A NIGHT OF MAGIC

Providence Little Company of Mary Medical Center Torrance and the Cancer Support Community–Redondo Beach joined in celebrating National Cancer Survivors Day with “A Night of Magic” held at the Del E. Webb Center for Health Education. More than 140 cancer survivors, their families and friends enjoyed a buffet dinner with artfully decorated, themed food stations that included Italian, Mexican, American and Asian cuisines. Guests were also treated to caricature portraits, a magical photo booth and the magical powers of “Fantastic Fig”—an award-winning magician.

happenings


MIDSUMMER NIGHT’S DREAM GALA

Providence Tarzana Medical Center celebrated its staff, friends, supporters and many successes at the Midsummer Night’s Dream Gala on July 17 at the Four Seasons Hotel in Westlake Village. The event raised more than $150,000 for the medical center, including specialized equipment for the vascular program. Zahi Nassoura, MD, was presented with the Providence Tarzana Foundation Humanitarian Award for his leadership, dedication and service to this medical institution. This award is given to individuals who exemplify the core values of Providence Tarzana Medical Center: respect, compassion, justice, excellence and stewardship.

REOPENING OF THE WARNER BROS. PERSONAL APPEARANCE CENTER

A ribbon-cutting ceremony was held on July 31 to mark the reopening of the newly designed Warner Bros. Personal Appearance Center at Providence Saint Joseph Medical Center. The redesign was the vision of Sheri Disney, who helped fund the project. She and her husband Roy P. Disney have contributed to the cancer center since it opened in 2010, continuing decades of support from the Disney family. The center stocks scarves, hats and wigs to cover hair loss from chemotherapy as well as prosthetic bras and gifts.

1. Master of Ceremonies CBS2/KCAL 9 news and weather reporter Josh Rubenstein; honoree Zahi Nassoura, MD; chief of staff Alina Lopo, MD; PTMC chief executive Dale Surowitz 2. Gala committee chair Donna Stillo; vice chief of staff Jeffery Work, MD; Providence Tarzana supporter Brenda Kitchen 3. Providence Tarzana Foundation board of governors chair Bruce Ferguson; Providence Tarzana Foundation executive director Patty Williams; master of ceremonies Josh Rubenstein 4. Zahi Nassoura, MD, with his wife, Lydia, and two daughters, Lana & Tala

1

2 3 4

Above: Michael Rembis, chief executive, Providence Saint Joseph Medical Center; Sheri Disney; Ed Romano, executive vice president and chief financial officer, Warner Bros. Entertainment, Inc., and Michelle Laskey-Nielson of Dwell Floor Five in Studio City cut the ribbon at the reopening of the Warner Bros. Appearance Center, located inside the Disney Family Cancer.

happenings


AVON WALK FOR BREAST CANCER

The annual Avon Walk for Breast Cancer, a 29-mile trek along the Santa Barbara coast and Santa Ynez Mountains, was held Sept. 6 and 7. The John Wayne Cancer Institute, at Providence Saint John’s Health Center, served as a partner and medical sponsor and is a beneficiary of the event, which raises funds for breast cancer programs. Delphine J. Lee, MD, PhD, director of translational immunology in the Dirks/Dougherty Laboratory for Cancer Research, received funding from the Avon Foundation for research that will investigate how microbes influence the development of cancer in breast ducts.

FARMERS MARKET

Providence Little Company of Mary Medical Center Torrance, in partnership with Cal Poly Pomona, held a farmers market on July 18 on the hospital campus. The farmers market is held weekly and is open to the public. It features locally grown fruits and vegetables, jams, breads, nuts and much more. Dates and times will be promoted on Facebook. Please follow us.

RELAY FOR LIFE OF BEACH CITIES

The Providence Little Company of Mary Medical Center Torrance’s team—called The Healers—participated in the Relay for Life of Beach Cities on July 19 and 20 to support the American Cancer Society. The event is a 24-hour relay with teams supporting a walker on the track at all times for 24 hours. There were 16 teams and 320 participants who raised $89,674. The Providence team of more than 65 individuals raised $2,590 for the American Cancer Society.

happenings


STRIKE OUT STROKE

Staff members from Providence Little Company of Mary Medical Center San Pedro attended the Strike Out Stroke event at Dodger Stadium on Aug. 24. Pictured are Deborah Buntin and Darcie Fitzgerald.

CORRECTION

The name of Ed Fountain (far left) was misspelled in the Summer 2014 issue of Providence magazine. We regret the error.

PROVIDENCE FOUNDATIONS ANNUAL BOARD RETREAT

Providence Foundations, Southern California, convened at the Hyatt Park Aviara Resort in Carlsbad, Sept. 12 to 14, for its annual board retreat. This year’s theme was “Philanthropy: Creating Healthier Communities, Together.” Board members heard guest speakers and attended breakout sessions.

A panel discussed the physician’s role in donor philanthropy. From left: moderator Bernie Klein, MD, chief executive, Providence Holy Cross Medical Center; John Robertson, MD, cardiothoracic surgeon, Providence Saint John’s Health Center; Raul Mena, MD, hematologist and oncologist, Providence Saint Joseph Medical Center; John Armato, MD, internist, Providence Little Company of Mary Medical Center Torrance.

Ira Byock, MD, chief medical officer of Providence Institute for Human Caring, addressed attendees on the subject “Grow-ing Healthier Together; Clinical and Cultural Leadership in the 21st Century.”

Rod Hochman, MD, president and chief executive officer of Providence Health & Services, discussed how Providence is committed to creating healthier communities.

shout outs


We value feedback from our patients and visitors and strive to ensure that every individual entering Providence Health & Services is treated with kindness and respect. We are proud to share some of the wonderful comments we’ve received in the past few months. We invite you to share your story with us at providence.org/share or join us on Facebook at facebook.com/Providencecalifornia.

“I’ve been a nurse for Providence Holy Cross for more than 13 years, and my experience as a family member of a patient made me so proud to be a part of this facility. My mother was brought in by the paramedics to Holy Cross after suffering from a stroke at home. She was admitted to the ER, then to the ICU, then to Comfort Care where she passed away. She received such excellent, excellent care. All the nurses, doctors and ancillary staff gave her loving, caring, respectful and compassionate care.” — Annie Paz

I spent one of the hardest weeks of my life by my mother’s side while she recuperated at Providence Holy Cross Medical Center. It was also one of the best experiences of my life at a

hospital. I had never been at one where there was so much deep and genuine care for the patient. I expected the worst but was deeply humbled and warmed by the kindness and beautiful humanity

of your nursing staff and doctors. You have created something amazing there. Thank you.”

— Raciel Çapuling Fernández

During my stay at Providence Saint Joseph Medical Center, I was helped by some 20 or more people—skilled, courteous, efficient. I was

very well treated by your wonderful staff in

every department. Your people were dedicated and enjoyed their work—I couldn’t ask for more. After three weeks I feel much better and am resum-ing most of my normal activities. Thank you VERY MUCH!” – J. Finkelstein

“Providence Saint John’s Health Center’s nursing team is top-notch.

They helped make my stay so easy, and I truly appreciate that. I tried to tell everyone thanks

for all their help, but please let them know again how they all made my stay so easy.”

– Grateful Caritas patient

“My family and I are grateful for the outstanding treatment offered to us at Providence Little Company of Mary Medical Center Torrance. We’ve had to visit your hospital a few times, and every time we are treated with a great deal of respect and care. You have a great group of people on staff, and we certainly appreciate their work.” — Renee Campau Campisi

“After two years of pain and concern, I finally located my Providence Little Company of Mary San Pedro surgeon. What a terrific choice. He has been the most concerned, most involved and most competent doctor ever seen during my long life to date. My confidence in him led me to have my surgery at Providence Little Company of Mary Medical Center San Pedro, and that was an even better choice. The staff at the hospital—from doctors to nurses in pre-op, surgery, post-op, on the floor to assistants, to volunteers, to housekeeping, to lab staff and on down the line—were SUPERB! Even the folks who didn’t know me and met me in the halls during rehab walks were friendly, interested and just plain NICE. These are wonderful folks, and I highly recommend them to any-one who needs hospitalization. As managers, you have my recognition for choosing the right people, giving them the tools they need to properly operate and managing them to promote such a wonderful family atmo-sphere at your hospital. Well done!!!” — Bob Fenster

“My nurse at Providence Tarzana Medical Center gave me caring customer service. She kept making sure I was feeling alright in the recovery room and comfortable. She also brought me cranberry juice and crackers to help settle my stomach after my procedure. Very courteous and caring. I give her five stars.” — Harry Pattison

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BurbankNorthHollywood

San Pedro

MissionHills

Santa Monica

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If you have an annual health plan selection to make, choosing the right health care providers for you and your family has never been more important. Whether you get insurance through your employer, are enrolled in a Medicare plan or pay for your own insurance through a Covered California Exchange plan, the choices you make during this open enrollment period can impact your out-of-pocket costs, the services you receive and the doctors or hospitals you’re able to use.

At Providence, we can help you understand your choices. We are the second largest provider of health care services in Los Angeles County and California’s fi rst and only health system to have all our eligible hospitals recognized with the Healthgrades’ 2014 “Distinguished Hospital Award for Clinical Excellence.”*

We’re contracted with most health plans including Medicare Advantage, Cal Medi-Connect, Covered California and many commercial PPO and HMO products.

Affi liated Medical Groups• Affi liates in Medical Specialties• Axminster Medical Group• Facey Medical Group• Doctors of Saint John’s• Providence Care Network• Providence Medical Group• Providence Medical Institute

Contracted Medical Groups• HealthCare Partners Medical Group• Lakeside Community Healthcare• Regal Medical Group

Th is year during open enrollment, choose Providence and get the right care from the right providers when and where you need it. With Providence, we’re everywhere you need care.

You can fi nd the complete list of plans we accept at california.providence.org.

Choose Providence. We’re everywhere you need care.

1-888-HEALING (432-5464)california.providence.org*Based on risk-adjusted, in-hospital data. Providence Little Company of Mary Medical Center San Pedro

was not eligible for consideration for this award. Not all medical groups/clinics are contracted with all plans. Please check with your doctor to fi nd out if your clinic/physician accepts your plan.

FREE Medicare Educational SeminarsFree Medicare seminars are being held now. Learn about your Medicare options and our Providence network of services. Visit us online at california.providence.org or call 1-888-HEALING (432-5464) for more information or to reserve your spot at a seminar.

6 Hospitals10 Urgent Care Locations

3,500 Physicians 46 Clinics

CA14-35230_AD_Open Enrollment_ProvHealthMag.indd 1 10/3/2014 2:08:26 PM

Providence Health & ServicesSouthern CaliforniaAdministrative Offices20555 Earl StreetTorrance, CA 90503

providencehealthonline.org

NONPROFIT ORGANIZATIONU.S. POSTAGE

PAIDTorrance, CAPermit No. 89

Nursing TeamworkAn innovative program pairs young and veteran nurses to learn from each other.

Practice Makes Perfect A simulation lab helps health care professionals prepare for real life.

Focus on Hospice

The Institue for Human Caring embraces peace and dignity at the end of life.

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providence health: fall 2014

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