August 2015 Cover Story: Health Care

Partnerships critical to continuum of care

Kammi Hernandez holds her 2-year old son,  Joseph, outside Gouverneur Hospital last month. Photo by Jason Hunter, NNY Business.

Kammi Hernandez holds her 2-year old son,
Joseph, outside Gouverneur Hospital last month. Photo by Jason Hunter, NNY Business.

North country hospitals align with Syracuse facilities to manage major trauma, specialty cases

By Norah Machia, NNY Business

When Kammi Hernandez received a phone call from her babysitter that her 2-year old son, Joseph, had burned his hands, she did not realize the extent of his injuries until she took him to the emergency room at Gouverneur Hospital.

The babysitter had opened an oven door and just as she turned, Joseph came in unexpectedly behind her and reached over and touched the inside door and a rack. The oven had been heated to more than 400 degrees.

“They evaluated Joseph right away in the emergency room and gave him medication for the pain,” Mrs. Hernandez said. “They wrapped his hands in saline dressing to help cool them.”

But the attending physician knew that her son would need more advanced treatment because of the severity of his burns, she said. He contacted Upstate Medical Center, Syracuse, for a consult on Joseph’s treatment.

“They decided once he was stabilized, they needed to transport him to the Syracuse hospital” which was arranged through the Gouverneur Volunteer Rescue Squad, Mrs. Hernandez said.

Gouverneur Hospital is certified for 25 beds, and is affiliated with Canton-Potsdam Hospital, under a parent organization, the St. Lawrence Health System.

Upstate Medical Center has a Level 1 Trauma Center that serves 14 counties stretching from Canada to the Pennsylvania border. The hospital is staffed 24 hours a day by in-house specialists and on-call physicians, who provide care for all types of severe trauma and life-threatening injuries, spokeswoman Doretta Royer said.

“Our regional trauma center contains sophisticated and current equipment to resuscitate, stabilize and support the most critically injured patient,” she said.

Mrs. Hernandez said, “they gave my son great care at the Gouverneur Hospital, but they also knew their limitations” for treating his severely burned hands.

Joseph was subsequently admitted to the Golisano Children’s Hospital at Upstate, where he was evaluated and treated by pediatric burn specialists.

“His fingers and palms were burned,” Mrs. Hernandez said. “They clipped off the damaged tissue so they could assess it. They gave him antibiotic cream, bandaged him again and gave him more pain medications.”

Joseph was discharged after a short stay at the hospital, but the road to recovery was just beginning. He needed enzyme cream applied to his hands and bandages changed daily, and the family traveled weekly to Syracuse for follow-up care.

He underwent two separate skin graft procedures, “where they took skin from his thighs to graft onto his palms and index fingers,” Mrs. Hernandez said.

The accident happened in October, but the family made trips to Syracuse through May for Joseph’s treatments and evaluations.

“He received wonderful care in Syracuse, from the doctors and the nurses,” Mrs. Hernandez said. “I feel fortunate that we had access to those resources.”

Upstate Golisano Children’s Hospital offers both primary and specialized medical care for pediatric patients, and operates the only pediatric intensive care unit in a 17-county referral area. The facility also has the only dedicated pediatric emergency department between Rochester and Vermont, Mrs. Royer said.

In cases of patients with severe burns, the adult burn victims are treated at the hospital’s Clark Burn Center, a six-bed adult intensive care unit, while children are treated by both burn and pediatrics teams at the Golisano Children’s Hospital. The Clark Burn Center is a regional referral center that serves more than 27 counties.

While the Syracuse hospital works closely with north country facilities for emergency transfers, many patients can still receive specialized care closer to home. Those options are continuing to expand with increased physician recruiting efforts and the advancement of telemedicine throughout the region.

In 2013, Samaritan Medical Center re-established its neurosurgical program, and since that time, there have been 196 of those surgeries performed at the Watertown hospital, spokeswoman Krista A. Kittle said.

“We invested approximately $2 million to bring the program back to Samaritan Medical Center,” she said. “This has been an excellent program with Dr. Kidwai and the Central New York Neurosurgical Group. We are actually hoping to expand the program with the addition of another neurosurgeon we are currently recruiting.”

Neurosurgeons affiliated with Upstate Medical Center can provide emergency surgery 24 hours a day at both Samaritan and Carthage Area Hospital. Their north county practice, which includes a physician assistant, is Neurosurgical Associates of Northern New York, 629 Washington St.

“The addition of the neurosurgery has absolutely helped in this area to keep people here,” Ms. Kittle said.

It’s important to note, however, that Samaritan had already been offering emergency neck and back surgeries performed by surgeons from the North Country Orthopaedic Group, 1571 Washington Street, she said.

“The orthopedic group had done these type of surgeries all along and continue to do so,” she said. “The neck and back surgery was not re-established, it was the brain and cranial work that was re-established.”

Although SMC is not a state-designated trauma center, “that does not mean that we don’t treat trauma. We treat it every day,” Ms. Kittle said.

Approximately 60 to 70 percent of trauma patients “stay here at SMC, and we treat a variety of traumatic injuries when we have the specialty or level of care that the patient’s injuries call for,” she said.

“Some trauma patients are stabilized here in order to be able to survive the transport to Syracuse,” she added. “And some are transported to Syracuse directly from the scene if they are stable enough to make the trip.”

The decision of whether to transport a patient to Syracuse or provide treatment at the Watertown hospital is “made on a case by case basis and in the best interest of the patient, and is determined by which level of care that patient needs in order to have the best outcome,” Ms. Kittle said.

“We just don’t have the volume of trauma in our region that larger cities have” in order to justify the expense of such a highly specialized service, she said.
In addition to transferring critically injured trauma patients to Upstate, the Watertown hospital has agreements with other facilities in Syracuse as well.

For example, “we no longer offer diagnostic cardiac catheterization. That’s another example of a specialty that didn’t have the volume of patients in the region to support the program,” Ms. Kittle said.

All cardiac patients requiring transfers are sent to St. Joseph’s Hospital Health Center in Syracuse, she said.

Samaritan Medical Center also has a transfer agreement with Crouse Hospital, which has a Level 3 Neonatal Care Intensive Unit. The babies who are born earlier than the 32 week gestation are typically transferred to the unit at Crouse. Once the babies reach the 32 week gestation level, they are transferred back to Samaritan Medical Center, which has a Level 2 NICU.

North country emergency medical responders also play a vital role in helping to coordinate the initial care of trauma patients, said Charles Brenon III, Jefferson County EMS coordinator.

“All the regional hospitals are part of a medical control system,” Mr. Brenon said. “Emergency medical providers in the field will contact physicians in the emergency rooms to help determine if a patient should be taken to a local hospital or transported directly to Syracuse.”

A hospital medical control system, “such as the one at Samaritan Medical Center, is a key part of the process,” he said.

“A field provider will call medical control before leaving the scene,” Mr. Brenon said. “They are not making the decision on their own, although they may tell medical control what they believe would be the best option for the patient, because they are right there.”

Local hospitals often help stabilize patients for transport to Syracuse, particularly if they have an “unmanaged airway,” Mr. Brenon said.

“In that case, the patient is taken to the closest facility to get the airway stabilized” before an attempt is made to transport the victim to Syracuse, he said.

An unmanaged airway could be the result of an obstruction, massive facial trauma, or a crushed trachea, he said.

“The quicker we get a critically injured victim to a Level One Trauma Center, the better the odds of survival,” Mr. Brenon said. “That’s why we worked so hard to get the helicopter service back, because seconds count.”

In 2007, Fort Drum’s Military Assistance to Safety and Traffic program, along with its medical emergency helicopter that had been serving the north country, was reassigned to Fort Lewis, Wash.

After that departure, the region had been served by helicopter units from outside Jefferson County.

In 2012, it was announced that Air Methods Corp., Englewood, Colo., would operate the emergency helicopters under the name LifeNet of New York. The company uses a fee-for-service model that requires no additional government or hospital funding.

The helicopter will respond to the scene of an accident, or a pre-established loading zone, and it can also land at Samaritan Medical Center’s helipad on top of the hospital’s parking garage. A trip between the Watertown hospital and Syracuse takes approximately 28 minutes.

Another factor that will help reduce the need for emergency transports to the Syracuse hospital is the expanding field of telemedicine, said Denise K. Young, executive director of the Fort Drum Regional Health Planning Organization.

“Many specialty services are available in our region and they are growing all the time,” she said. “Telemedicine capability is also growing. Each of the hospitals and many of the primary care clinics now have telemedicine capability.”

The growth in telemedicine has been the result of a large fiber network established through the Development Authority of the North Country. The field is expected to grow even faster as a result of state legislation that will go into effect Jan. 1, 2016, requiring private insurers to reimburse facilities for telemedicine services, she said.

“We expect to see a significant expansion in the availability and usage of telemedicine,” after Jan. 1, Mrs. Young said.

North country hospitals and health care facilities in Jefferson and Lewis counties have already been using telemedicine services for specialties such as psychiatry, psychology and pain management, said David C. Johnson, certified telehealth liaison with the FDRHPO.

The organization is “progressing quickly with a teletrauma project between Upstate Medical and the six regional hospitals around Fort Drum,” including SMC, Carthage Area Hospital, River Hospital, Alexandria Bay; Lewis County General, Lowville; Claxton-Hepburn Medical Center, Ogdensburg and Massena Memorial, he said.

“The teletrauma equipment is in place in all these hospitals, training has been completed on that equipment, and we are simply awaiting credentialing and various paperwork measures,” he said.

“We are hopeful that by the end of this year, patients will be well served through this project” that will allow video conferencing and examinations of trauma patients in the emergency departments between physicians at local hospitals and Upstate, Mr. Johnson said.

By using telemedicine to treat patient, “the geography goes away,” he said.

“This gives the patients access to care they normally would not have,” Mr. Johnson added.

Upstate Medical Center is also encouraging the practice of medicine in rural areas through its Rural Medical Education Program, referred to as RMED, said Mrs. Royer. The program is offered through Upstate’s Department of Family Medicine, and places third-year Upstate medical students to work and train in rural primary care settings.

Samaritan is a participant in the RMED program, which offers students a unique clinical education, “working side-by-side with local physicians in small communities,” said Ms. Kittle.

The Watertown hospital also offers third and fourth-year students at several other medical schools the opportunity to rotate in a variety of specialties, and a Graduate Medical Education Program with training options for new physicians in areas such as osteopathic family practice, she said.

Dr. Benjamin Rudd is a graduate of the RMED program and works in the Samaritan Family Health Center network. Although his primary location for training was Lewis County General Hospital, he was based at Samaritan for more specialized training in areas such as Ear, Nose and Throat, Ophthalmology and Urology.

“As I was finishing my residency in Illinois, I was looking to this area for a position because my family is here,” he said. “I looked at several area hospitals, but I was extremely interested in staying academically involved in medicine.”

“I believe that teaching is an integral part of the physician’s role: teaching our patients, community members and future health care practitioners,” said Dr. Rudd, who spends time each week supervising Samaritan’s resident clinic. “Samaritan allowed me to pursue this interest.”

Dr. Rudd added “I’ve been able to create a rewarding balance of supervising resident physicians, teaching medical students, and caring for patients.”

Other north country educational partnerships with Upstate include the Nurse Practitioner Master’s Programs at Jefferson Community College, offered through Upstate’s College of Nursing. Family Nurse Practitioner (FNP) and Family Psychiatric Mental Health Nurse Practitioner (FPMHNP) programs are also available, along with part-time education for working nurses with bachelors in science degrees, Mrs. Royer said.

A Physician Assistant Master’s program is offered through Upstate’s College of Health Professions, which has students commit to practice in rural areas and share clinical sites with Rural Medical Education students.

Respiratory therapy and medical technology education is also offered through special programs at Jefferson Community College, with participation by hospitals in the Fort Drum region, Mrs. Royer said.

Norah Machia is a freelance writer who lives in Watertown. She is a 20-year veteran journalist and former Watertown Daily Times reporter. Contact her at norahmachia@gmail.com.