As the CEO of a major medical facility in Boca Raton, Florida, patient care is not only my top priority but also a top priority for the administration, physicians and staff at West Boca Medical Center. In today’s economic environment, one of the biggest challenges to face administrators in private healthcare facilities is providing care for an increasing number of uninsured or underinsured patient populations. This growing segment of our patient base challenges our resources and serves as a hidden form of taxation, resulting in higher healthcare costs for the insured and their employees.

At West Boca Medical Center, we have an interactive, strong and viable emergency service both for adults and pediatrics, which serves as the front line for treating patients who lack access to primary care physicians and specialists. The “readiness costs” associated with the myriad of issues that can occur in the emergency environment consume time, energy and resources from the management team and medical staff, making it difficult to continue to infuse more capital for modernization and staffing if the level of unfunded care continues to grow.

In Palm Beach County, our legislative leaders and representatives have been formant for years addressing under-funded, indigent care and associated medical legal issues surrounding tort reform. The present and upcoming debate on Healthcare Reform at a national level will clearly result in changes as to how healthcare is organized, delivered and provided.

Healthcare is a complex, multi-functional, multi-layered spectrum of services. Historically regulating one area – such as hospitals – and having lax oversight of the health insurance business or manufacturers of pharmaceuticals and implantable devices has lead to numerous inequities. Solving the problem of the uninsured and under-funded care requires insurance reform, tort reform, adequate supply of current and future medical practitioners, taxation increases to support growth in expenditures and bio-ethical discussions of appropriate rationing of care and how to deal with the needs of people experiencing a longer life cycle. This is a challenging but exciting time in healthcare – I look forward to participating to make healthcare services more widely available.



How can we convey both the true meaning of Thanksgiving and giving thanks all year long? As the holidays come closer, we should take time with our friends and families to find ways to answer this question. Let’s encourage each other to share our thoughts of thanks.

Thanksgiving is about all of our blessings and mercies. When we gather with our family and friends for a festive meal, we should remember to share our thoughts of thankfulness.

Season of Remembrance Tree

You may also want to take this time to share with others who do not have as much. You can find groups that offer meals for the homeless and the poor. You could possibly donate food or your time to prepare and serve meals or sit with a loved one who is lonely or ill.

Let’s continue the tradition of the pilgrims and recognize the gifts from God and thank him for all his blessing. We wish you a Happy Thanksgiving and look forward to coming together to make a difference this holiday season!

Since 1981, HospiceCare of Southeast Florida, Inc. has increased awareness of extended care and even a place for clients to reside through the end of life process. HospiceCare provides these services and locations for their clients and loved ones. The lush garden of the Bougainvilla, Forget Me not Center, Camp Coral, and the main patient care centers are just physical locations for their services. HospiceCare provides home care and counseling services for clients and loved ones to experience the life’s cycle in comfortable surroundings. Each location has something very different for clients and families, a wide variety of resources available to assist each of them through the transformation process. During this season we continue to share the HospiceCare message of peace, love and dignity.

Please join us Sunday, November 8 from 1-3 p.m. for Thanks for the Memories event at HospiceCare in Fort Lauderdale and the Dedication of Season of Remembrance, Tuesday, November 24 at 6 p.m. at the Galleria Mall for a beautiful tribute to all those we have loved and lost. For more information, contact the corporate office by calling 954-HOSPICE (467-7423) or toll free at 800-HOSPICE or visit www.hospicecareflorida.org.



“Mr. Public” returned to the hospital the other day. I met him 3 months earlier when he presented with a heart attack. I placed 3 coronary stents in 2 different arteries to restore blood flow to his severely damaged heart. He did not have health insurance and earned too much money to qualify for Medicaid. He returned in severe congestive heart failure because he couldn’t afford to see a doctor or pay for his medications. The hospital will likely absorb the $50,000 initial hospital bill and the cost of the second hospital stay and I probably won’t get paid. “Mr. Public” will miss additional work and risks bankruptcy.

This scenario is repeated continuously in my practice, in our hospital, and across our country daily. It seems to have worsened lately due to the down economy and job losses. Clearly something needs to be done. Whether or not you agree with the outcome, you have to give the President and Congress credit for finally taking action. Some version of reform is inevitable. Here is my best guess as to what it may include.

First, patients such as Mr. Public will obtain some form of health care. The most logical reform would include expanding the ranks of Medicaid and raising the income eligibility threshold so the “working poor”, who make up the majority of the uninsured, can qualify. Unfortunately government needs to be the safety net here. As much as I believe in free markets, and I do, the dark side of capitalism is that the poor, the underprivileged, and now the growing ranks of uninsured working Americans, are excluded. Society can’t afford this when it comes to health care, both literally and figuratively. State governments, already cash strapped and running deficits, won’t be able to afford this either. The Federal Government will need to subsidize a larger share of Medicaid than it does now, while allowing local and state governments to administer the program. The needs of a system in Florida are different than those in North Dakota. Healthcare systems need to be flexible enough to adapt to regional challenges. Second, we need to stem rising healthcare costs and further reductions in Medicare reimbursements are planned. Doctors are already struggling financially and such cuts will be catastrophic. Physicians will have to adapt. Likely the private practice model with solo or small groups will all but disappear, and more and more physicians will partner with, and likely be employed by, hospital systems. It is a natural partnership. We will need to work as a team and be competitors no more. Hospital administrators will need to balance budgets to keep the doors open while doctors should be more accountable for the healthcare dollars we spend. Most of us would rather leave the business side of medicine to others and just take care of patients anyway.

Increasingly, patients will be forced into hospital-based systems. Already, amendments to save home health care and hospice, services meant to keep patients out of hospitals, have been voted down. Government regulation of hospitals will continue to increase. Physician assistants, nurse practitioners and even pharmacists will provide more direct patient care in crowded hospitals and waiting rooms.

Finally, malpractice reform is a must. Defensive medicine, with its unnecessary testing, should cease. As physicians move to hospital based systems we will be covered in large insurance risk pools which have, historically, helped keep premiums down. Many of us will receive “coverage” under sovereign immunity as we basically become employees of the states which administer Medicaid. Physicians have been unable to successfully take on the trial lawyers. As employees of large healthcare systems or government run agencies we will at least have a shot.

Healthcare reform is difficult but necessary and will require sacrifice from everyone. We are Americans. No challenge is too great and our patients need our help.



Hurricane Frances came roaring into South Florida with copious rainfall and ferocious winds, but her astonishing power and endurance were no match for that of the dedicated and brave people who work in the region’s hospitals. Interviews with staff members at a number of South Florida health care facilities reveal a common thread of heroism and teamwork that enabled the health care professionals, administrators, support staff and volunteers to rise above the crisis and prevail, continuing to care for patients and for each other despite the daunting obstacles presented by Frances.


The aftermath of Frances at Columbia Hospital

Columbia Hospital in West Palm Beach remained open and functional throughout the storm, although the staff and physicians worked under conditions that challenged their problem-solving skills and tested their personal resources. Spokesperson Jean Wicken recalls, “The storm lasted longer than expected and there was a lot of uncertainty. The phones were down temporarily and the power failed, and although the generators kicked in, there was minimal air conditioning and it was hot and humid. But the staff was incredible! Many of the key staff, along with the physicians, brought their families and remained here throughout the storm and worked around the clock. The resilience and commitment of the staff was amazing to see.”

Wicken, Columbia’s Marketing Manager, says that the hospital prepared as much as possible, reviewing the disaster plans and holding drills in the days preceding the arrival of Frances. “We had adequate preparation time and that gave us the chance to set things up to support the staff and patients. Everyone brought in sleeping bags and air mattresses and we converted our gym into a shelter for the families of the staff. We provided child care and even pet care.” In addition to handling media calls, Wicken, along with the Human Resource director and Controller, took on the care of some of the 13 dogs and 6 cats that came to Columbia with their owners to wait out the storm. “We converted the Human Resources department into a kennel. We had 2 rooms of dogs and 1 room of cats – all in cages, of course. We fed them and walked them in the halls and on the grounds, and comforted them, too.”

Valerie Jackson, Columbia CEO, says “It was amazing to witness the incredible teamwork of the employees and medical staff who literally made the hospital their home for 4 or 5 days, working endless hours. Despite the limited air conditioning, few working elevators and reduced phone service, every crucial department such as the OR, the ER and dialysis units were operational. I am extraordinarily proud of our employees and members of the medical staff who pulled together under such stressful circumstances and provided excellent care through the entire disaster.”

South of West Palm Beach, in Boca Raton, there is a sense of pride in a job well done as the employees of Boca Raton Community Hospital look back on their experiences with Hurricane Frances. The 394-bed hospital was at full census when Frances arrived, and thanks to the willingness of the staff to do whatever necessary to conduct business as usual, patient care services continued in a nearly seamless fashion.

Hospital spokesperson D.B. Wienke reported no structural damage to the hospital and no loss of power, although there was a great deal of debris on the grounds. “We were fortunate in that we had electricity and were able to work closely with the police and the paramedics,” she says. “As a precaution, we closed our top two floors and we set up our meeting facilities as a hospitality center for the staff and their immediate families.”

The Emergency Department at Boca Raton Community Hospital has been designated as a “Best Practices” facility by the Agency for Health Care Administration, and the ED staff proved themselves worthy of that label as they confronted the storm and its complications. According to Wienke, “There were 37 nurses and 8 doctors who stayed in the Emergency Department from Friday morning to late Monday. They took shifts and slept in the offices. This was especially difficult because it was a large storm that lasted longer than anyone expected.”

The ED set up a “MASH”-like unit to care for people who sustained relatively minor injuries during and after the storm. They also dispensed free ice to people whose homes had no power and who needed to have medications refrigerated.

“We are so proud of everyone who volunteered to be here,” Wienke says. “People were upbeat without knowing if their own homes had been ravaged by the storms. They showed up wanting to help and everyone managed to come to work the next day. We honored our hometown heroes with a public thank you in the local daily papers and had huge pizza party.”

At Pinecrest Rehabilitation Hospital in Delray Beach, the Disaster Plan was implemented with great effectiveness and the 90-bed facility approached the storm with confidence and calm competence. Anna Cohen, Marketing Manager, says that the staff and the facility were extremely well prepared.

“We had Before and After Teams to deal with the preparation and the aftermath. We had good staffing because of the willingness of the staff to work around the clock. We had designated sleeping areas for them and for members of their immediate families,” she says. “But as prepared as the staff was, it was still very impressive to see their response. I think these people are local heroes. They went above and beyond, doing extraordinary things. The entire Pinecrest team is to be applauded for rising to the occasion and providing quality care under very stressful and uncertain circumstances.”

Pinecrest is planning to publish a special issue of their newsletter, spotlighting the many stories of heroism, resourcefulness and sacrifice that took place during the storm.

One of the hardest hit hospitals was Martin Memorial Medical Center, in Stuart, where Hurricane Frances literally blew the roof off the North Tower. The 7-story, 236-bed hospital had to cope with water pouring in through the exposed elevator shafts and was forced to temporarily reduce their bed capacity to just 50. Despite this trauma, the staff at MMMC dealt with things resourcefully, even forming human chains in the stairwells to pass supplies to the upper levels in the absence of the elevators. Melinda Glasco, hospital spokesperson, raves about the camaraderie and generosity of the employees.


Martin Memorial associates help clean up in front of the Cancer Center.

“There are amazing stories coming out about the teamwork and cooperation. Hurricane Frances actually brought us closer with a real sense of family. We all made new friends and learned that you can count on others when you need to. We saw people ‘out of context’ such as when the administrators were in their jeans and T-shirts, drilling alongside the facility staff. We saw everyone pitching in. I think we all have a greater appreciation of each other and of what a great workplace Martin Memorial Health System is,” Glasco says.


Hurricane Command Center staff at Boca Raton Community Hospital during the lockdown from Hurricane Frances.

The Federal Emergency Management Agency (FEMA) sent a mobile Disaster Medical Assistance Team from New Mexico to help out at Martin Memorial Hospital South. The crew of doctors, nurses, pharmacists and chaplain set up three tents and assisted the Emergency Department by caring for persons with storm-related injuries such as lacerations, while the more seriously ill and injured were seen inside. Martin Memorial Hospital South saw its Emergency Room utilization jump by more than 50% after the storm, so the assistance was needed and appreciated.

And in the midst of all the preparations, emergency plans, drills and long dark days and nights of this long, savage storm, there was one very bright spot for the staff at Martin Memorial – and that was the birth on Saturday, during the worst of the storm, of a baby girl whose mother was brought in by paramedics. Her parents had a name already chosen before her birth but, in consideration of the circumstances, changed their minds and named her – what else? – Frances.



Religious issues and spirituality are as much a part of the nation’s best hospice programs as are adequate pain control and home care visits.

Many think of end-of-life healthcare as a somewhat disconcerting departure from medicine’s traditional “fix-it” mentality. When a curative approach is no longer the best option, palliative care takes VITAS patients to a different place—both physically and spiritually.

At VITAS Innovative Hospice Care®, “a good death” is hardly an oxymoron. It is the ultimate goal we strive to meet for the almost 9,000 patients we serve every day. Our interdisciplinary teams of physicians, social workers, chaplains, nurses, home health aides, volunteers and bereavement specialists are as alert to a patient’s spiritual needs as they are to decubitus and diarrhea.

The common misconception is that hospice is about death. In fact, hospice is about life—some of the most important moments in life. In 20 Common Problems in End-of-Life Care (Barry M. Kinzbrunner, Neal J. Weinreb, Joel S. Policzer; 2002; McGraw-Hill), the end of life is embraced as an opportunity for growth by:

  • Moving through fear to peace
  • Moving through despair to hope
  • Moving from isolation to community
  • Moving from loss to closure

Any one of these can improve a hospice patient’s quality of life immeasurably. For that reason, every VITAS hospice team includes a social worker and chaplain with extensive training and experience in spiritual awareness, end-of-life issues and bereavement. Often they are the only spiritual advisors a patient sees, but they also can work with the patient’s physician and religious advisor to ensure a holistic prescription for quality of life.

Not every patient is open to spiritual care at the end of life, and those wishes must be respected. “Spirituality is an individual concept,” notes Thom McLeod, Bereavement Services Manager of VITAS’ Palm Beach County Program. “But patients who say they don’t need spiritual support to help them through the dying process are sometimes the very persons who need it the most.”

Paul Veliyathil, Home Care Chaplain for the Miami-Dade VITAS program, agrees. “There certainly is no formal religious aspect to our team members’ visits unless the patient and family specifically ask for it. But our training helps us gain acceptance from the patient and family, hear their concerns and offer non-judgmental support.”

When spiritual care is declined, VITAS hospice team members work together to find non-threatening, non-intrusive ways to include support and companionship in the patient’s care plan. Perhaps the chaplain accompanies the admitting nurse at the initial patient assessment. Or the social worker is introduced by the nurse as a member of the team who occasionally accompanies her on her rounds.

Whatever the method, the results are always worth the effort. “The level of intimacy achieved when we address the spiritual concerns of any patient,” Veliyathil has found, “opens the door to a vulnerability that can be rich with meaning.”

Spiritual support is so important in end-of-life care that it is legally mandated. “Psychosocial/spiritual support is a basic component of the Medicare Hospice Benefit,” notes Dian Backoff, General Manager of VITAS’ Broward program. “Here’s a case of the government doing the right thing, because the last days of life don’t need to be painful or lonely or confusing. With spiritual support, the last days of life can be an opportunity for growth, remembrance and closure.”

Professionals and lay people who would like to know more about providing spiritual care and companionship to the terminally ill should read Parting: A Handbook for Spiritual Care Near the End of Life by Jennifer Sutton Holder and Jann Aldredge-Clanton, published in 2004 by UNC Press in association with the Foundation for End-of-Life Care and the P.L. Dodge Foundation. It is available at bookstores or at www.uncpress.unc.edu.