By Lois Thomson

“We strive to keep our quality top-notch,” said Francis Afram-Gyening, CEO of Camillus Health Concern. CHC is a community health center whose purpose is to help people experiencing homelessness and indigent people with health care services, and the organization was recently awarded five Community Health Quality Recognition (CHQR) badges. There are 1,400 community health centers in the nation, and the badges recognize health center programs that have made notable quality improvement achievements in the areas of access, quality, health equity, and health information technology.

The five badges CHC received were: (1) Health Center Quality Leader, which recognizes health centers that improve quality of care and achieve best overall clinical quality measure performance. CHC was within the top 10%. (2) Access Enhancer, which recognizes health centers that increase the total number of patients they serve who receive at least one comprehensive service (e.g., mental health, vision, dental) by at least 5%. CHC showed an increase of nearly 6%. (3) Health Disparities Reducer, which recognizes centers that meet or exceed goals in the areas of low birth weight, hypertension, or uncontrolled diabetes for at least one minority group, and demonstrate at least a 10% improvement in those areas. CHC was one of 98 centers to achieve this, meaning it was in the top 1% of health centers in the nation in this category. (4) Patient-Centered Medical Home Recognition, which recognizes centers in one or more delivery sites. CHC was among about 75% of centers in this category, as this is a core element of all health centers’ missions. (5) COVID-19 Testing, for centers that tested more than 50% of their reported populations from April 2020 to July 2021, and had a response rate of at least 50% to a COVID-19 survey. CHC was among less than 22% of centers to receive this.

With the level of quality offered by CHC, Afram-Gyening shouldn’t have been caught off guard by the awards, but he was. “We were surprised to receive those five badges. We had received one or two before, but to be given all of those at once! I am particularly proud of the COVID-19 award – we really tested a lot of people with community partners, the sheltered and unsheltered, people experiencing homelessness. So to be recognized for that was very satisfying.”

Afram-Gyening said each of the health centers must submit a Uniform Data Set report every year that details a great deal of information. The Health Resources and Services Administration analyzes the data and determines if and how much the health centers have improved. He said that, in CHC’s case, for example, they served 5,700 new patients in 2019, but in 2020, the number increased by more than 5%, to 6,000. “Frankly, we should have seen a reduction in total patients during the pandemic because people were reluctant to come to clinics, with social distancing and masking and all of that. But for us, we grew during the pandemic. That alone was a significant achievement.”

He said word of mouth is the number one way new clients come to the center. “The population we serve – they move around, they are transient. They know where they have to go for their evening meal, and word spreads easily.” Afram-Gyening also said CHC works very closely with other homeless service providers, particularly the shelters, and when the clients stay with them, they are often referred to CHC.

Camillus Health Concern is located in Miami, and Afram-Gyening said, “Our sole mission is helping those experiencing homelessness and the indigent population. The Little Brothers of the Good Shepherd was established in 1960 when the Cubans were fleeing Cuba under Castro’s regime. We welcomed them when they came to Miami. We clothed them, we housed them, and fed them. So that was the original idea, to help these new refugees; and that gave birth, in 1988, to Camillus Health Concern.”

Of the many services offered by CHC, Afram-Gyening commented on what he considers to be the most significant: “The most important service is to wake up every morning, come to work, and see the success this population has when they come to the clinic for dental care or behavioral health or primary care. To see the smiles when they leave the clinic is what seems like the most important. It is so hard for this population to seek care because most of them are not working, and they might be experiencing mental health and financial challenges, they are sleeping under bridges, not in homes. Too often they are greeted with disrespect or disdain. So for them to get up and say, ‘Today I’m going to see a dentist, I’m going to see my counselor,’ it gives me joy to be able to provide those services with dignity and respect to these individuals who need them most.”

For more information, call (305) 374-1065 or visit www.Camillushealth.org



By Arthur E. Palamara, MD, FACS

In March or April, 1300, as he wandered through the underworld, Dante finds himself in a dark woods. Losing his way, he has to face monsters from classical mythology. As he wandered further into the underworld, he faces leopards, wolves, and a lion. He is driven back into a dark place into which the sun does not enter. Dante meets his guide, Virgil, the Latin epic poet who will lead him out. Dante hesitates. Virgil explains that he was sent by Beatrice, the symbol of divine love, Santa Lucia, the symbol of Grace, and Rachel, the symbol of contemplative life.

Dante then passes through the gates of hell which bears the inscription “abandon hope, ye who enter here.” Dante and his guide Virgil, hear the anguished screams of the uncommitted, the opportunists – who were out only for themselves, and the cowards. These miscreants wander around naked in pursuit of their own ever-changing self-interest.

Dante wrote this epic poem to describe the punishment for sins, immorality, and transgression of the people and politicians of 14th Century Florence. While no one would suggest that Covid-19 is a result of moral turpitude, what doctors and nurses face daily, is no less traumatic.

Walking into the ICU corridor, one is confronted with an imposing series of long, shiny, aluminum vent pipes that appear more suited to a factory than a hospital. They are intended to carry aerosolized viral particles to the outside where they will be diluted and neutralized by the sun. The pipes are immediately discordant and jarring, although, after a while, one becomes oblivious to them.

The doors of the individual units are closed, on which signs are hung that provide warning to the unbidden. Slowly opening the door, the nurse or physician enters a surreal world of gray, blue, and beige, soothing colors that do little to dispel the gloom. Gone is the incessant chatter of nurses, respiratory techs, doctors who formerly would be going about the business of recuperating patients in various stages of illness. The silence of oppressive. Oppressive because unlike previous ICU cases where the vast majority of patients would survive, few occupants will recover.

On one side, are the closed doors of cubicles. Holes have been cut into the doors through which pass various tubes connecting the patient to IV pumps and other paraphernalia, allowing adjustments without entering the patient rooms. This minimizes staff contact with patients and lowers their potential for contracting the virus. On a wall, seen only by staff, is a white board posting the names of the patients. Room 1 on top and 8 on the bottom. Next to their name are symbols. “V” stands for ventilator. “T” stands for tracheostomy. A red dot, “DNR” or do not resuscitate. The family or the patient has made the decision that if their heart stops, they will not receive cardiac massage and often futile measures ICU doctors use to preserve life.

Looking though the glass, the patient’s unmoving head and upper torso is seen. Their chest rising and falling with the mechanical rhythm of the ventilators. Others have an enhanced type of nasal cannula that are capable of delivering higher flows of precious oxygen. Their breathing is more spasmodic: they must work harder to supply their bodies with that essential ingredient necessary to maintain cellular activity. When it falls too low, a tube is placed in their windpipe and a machine takes over. Once this occurs, their chance for survival is around 10%. And even if they do survive, they likely will experience profound medical and emotional scars.

What is different from our experience a year ago is the color of the patients’ hair. A year ago, it was gray. Now it is brown. Many men sport beards and upper torsos that look formidable and robust. Except for the tubes protruding from their nose, mouth or neck, they look like they could pull out their IV, pack up their belongings and walk out of the hospital. It is unlikely that they will.

This past week, a nurse was observed to be crying softly. The day before, as her patient’s condition worsened, his family came in. They knew that they were probably saying good-by. The patient was alert and responsive enough to have personality and bonded with the nurse. She came in at 7:00 the following morning and learned that he had expired. Her humanity deserves respect in that she had continued to regard him as a human being. More often than not, the only way for healthcare professionals to survive is to depersonalize their charges and regard them as “cases.” To her credit and pain, she had not. Magnifying the loss was the patient’s widow and 3 young children. He was in his late 30s.

The scene was replayed the following day. This time a pregnant mother with severe COVID symptoms was flown in. Over the course of several days, her condition deteriorated. To try to preserve her life and that of her unborn child, a hysterectomy was performed. The child survived, but the mother did not.

She left behind several small children at home as well as her newborn child who will never enjoy her mother’s hugs or kisses. The emotional effect on her caregivers exceeds description.

What these cases have in common is the fact that neither of these patients were vaccinated. Nor are more than 99% of the other cases in the ICU.

At the end of Dante’s Inferno, his Purgatorio, is a passage from his female friend Casella: “As I once loved you in my mortal flesh, without it now, I love you still.” Why 700 years later should this be necessary? Why should the surviving wife or husband have to love only the memory of their lost spouse? Dante, in the end, was a poet of hope. As we have hope that our burden will soon end.

America has overcome 9/11, depressions, recessions, wars, and severe adversity. We will doubtlessly overcome this pandemic. Life will again one day become normal. But we need to lower the number of casualties. We have the ability. We stopped smoking. We use seat belts. We have the means to do so. Creation of the vaccine in less than a year is a miracle in itself!

There is only so much pain and suffering that the psyche of health givers can endure. And they (we) have given themselves selflessly for over a year and a half. While there is no Virgil to lead us out of hell, there are vaccines. There are masks. There is simple distancing. To those who deny the reality of the pandemic and its morbid consequences, I ask: please help us. Use those measures to keep yourself and others healthy.

Dr. Arthur E. Palamara is the Past President of the Broward County Medical Association and a vascular surgeon in Hollywood, FL.



By Daniel Casciato

In September, Steward Health Care named Marisela Marrero, M.D., as its first Regional President for the South Florida Region. In her new role, Dr. Marrero oversees the five hospitals Steward acquired from Tenet Healthcare Corporation last month, including North Shore Medical Center, Coral Gables Hospital, Hialeah Hospital, Palmetto General Hospital in Miami-Dade County, and Florida Medical Center in Broward County.

“The opportunity to become market president was a pivotal one, because it allows me to instill positive change in a community that I personally love and have ties to,” she says.

Dr. Marrero will also lead the hospitals’ efforts to respond to the recent surge in COVID-19 cases, as well as to expand high-quality, physician-led healthcare to the diverse communities of South Florida.

“My primary challenge has been the resurgence of COVID-19,” she says. “Hence, we are joining forces with all of the stakeholders in our community in an effort to educate the public on the importance of vaccination.”

In addition to her regional role, Dr. Marrero has served as the new President of Hialeah Hospital since August.

Prior to coming to Steward, Dr. Marrero, a Harvard-trained, board certified emergency room physician, was clinically practicing as an ED physician at North Shore Medical Center, which included Salem Hospital in Salem, MA and Union Hospital in Lynn MA. Both hospitals were part of Partners Healthcare which is now known as Mass General Brigham.

She also served as President of Good Samaritan Medical Center, one of Steward’s largest and most successful Massachusetts hospitals. Originally from Puerto Rico, Dr. Marrero has dedicated her career to engaging and partnering with Latino communities to provide vital health information and care, regularly appearing on Spanish-language television to provide expertise on many important healthcare topics.

Since she was a young girl, Dr. Marrero says that she always knew that she wanted to practice medicine.

“It was the perfect combination for someone who loved both science and people,” she says.

Based in Dallas, Steward currently operates 44 hospitals around the world, including 39 across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah, as well as five internationally within Malta and Colombia.

This past summer, Steward and Tenet Healthcare Corporation announced that they had signed a definitive agreement regarding the acquisition by Steward of Tenet’s five hospitals and related hospital operations in the Miami-Dade and Southern Broward counties.

“Steward acquired these hospitals for a variety of reasons,” explains Dr. Marrero. “For one, this is our chairman’s beloved home state. Second, Steward is a physician-led system, and as such, we have a unique way of partnering with our providers and our patients that unquestionably results in better care. Finally, we are fully engaged, on all fronts, and will work hand in hand with our community to address their needs.”

Dr. Marrero is excited about her new role and the challenges and opportunities that await her.

“My vision is to deliver the highest quality healthcare within all of our communities,” she notes. “The Steward Healthcare System will take this region to new heights and we will provide compassionate high quality care throughout the region.”

For more information, please visit www.steward.org.



Ayr Wellness Inc. announced the opening of Liberty Health Sciences (LHS) Port Richey, the Company’s 42nd operating dispensary in Florida.

The dispensary is located at 9314 US Highway 19, Port Richey within Pasco County, which is home to a population of 560,000 people, according to the 2020 U.S. Census. The store brings LHS to the Gulf Coast city, which attracts visitors from throughout Florida and the U.S. for its lush landscapes and well-known 8,300-acre wilderness park.

The new location features LHS’s expanded selection of flower strains, in addition to the Company’s recently launched Origyn concentrates, Big Pete’s Cookies and Secret Orchard vape cartridges.

Jonathan Sandelman, CEO of Ayr, said, “We appreciate the wonderful reception that we’ve received from the people of Port Richey and look forward to introducing them to our high-quality offerings. We now have 42 stores open in the state, thanks to the hard work from our Florida team which continues to find excellent locations to plant our flag.”



The U.S. House approved the Secure and Fair Enforcement (SAFE) Banking Act recently in a bipartisan 316-113 vote as part of the latest National Defense Authorization Act, a military spending bill. It’s the fifth time the legislation has been approved in the House as a standalone bill or an amendment as part of larger legislation. Since statewide cannabis reform has been enacted over the past four decades, cannabis businesses still are not fully tolerated, most evidently in federal restrictions, such as the way banking is restricted.

Representative Ed Perlmutter re-introduced the bill, as promised, saying that it would allow cannabis businesses to access the banking system—like any other industry—and would bring more money into the economy and offer the opportunity to create good-paying jobs. On September 21, the House Rules Committee approved the SAFE Banking Act as they sifted through over 800 amendments filed for the $778 billion FY2022 National Defense Authorization Act (NDAA) to determine which ones will get a floor vote. As Representative Perlmutter sits in the Rules Committee, the move suggests he has influence.