february 2013

SombreroP i m a C o u n t y M e d i c a l S o c i e t y

Home Medical Society of the 17th United States Surgeon General

F e b r u a r y 2 0 1 3

Inside the new St. Mary’s Hospital:

Merging the heart & soul of Carondelet

Special Issue: Carondelet’s West Side story

2 SOMBRERO – February 2013

J O H N D . L E V I N , C L U 6 0 1 1 E . G R A N T R D . T U C S O N , A Z 8 5 7 1 2

5 2 0 . 7 5 1 . 2 0 0 0 J O H N @ W M S A S S O C I A T E S . C O M

W W W . W M S T R A T . C O M

D I S A B I L I T Y L I M I T S O N T H E R I S E YOU EXAMINE YOUR PATIENTS’ EVERY DAY, OFTEN DISCOVERING RISKS NOT OUTWARDLY APPARENT. BUT HOW OFTEN DO YOU EXAMINE YOUR OWN RISKS? IT MIGHT BE TIME TO TAKE A CLOSER LOOK.

P i m a C o u n t y M e d i c a l S o c i e t y a n d W e a l t h M a n a g e m e n t S t r a t e g i e s a r e p r o u d t o o ff e r m e m b e r s a n e w d i s a b i l i t y i n c o m e i n s u r a n c e p l a n . T h i s e x c i ti n g p l a n o ff e r s d e e p l y d i s c o u n t e d i n d i v i d u a l a n d b u s i n e s s d i s a b i l i t y p l a n s , a n d u n l i k e m a n y p l a n s , t h e s a m e l o w p r i c i n g a p p l i e s t o b o t h m e n a n d w o m e n . D e p e n d i n g o n y o u r n e e d s , y o u c a n c h o o s e a p l a n o r c o m b i n a ti o n o f p l a n s t h a t c a n h e l p y o u : � P r o t e c t y o u r i n c o m e i f y o u a r e u n a b l e t o w o r k , o r u n a b l e t o r e t u r n t o y o u r f u l l d u t i e s � C o n ti n u e r e ti r e m e n t c o n t r i b u ti o n s o n y o u r b e h a l f � C o v e r b u s i n e s s e x p e n s e s � P r o t e c t a n y b u s i n e s s p a r t n e r s � P r o t e c t y o u r r e v e n u e i f a k e y e m p l o y e e i s d i s a b l e d

Associates of Wealth Management Strategies offer securities through AXA Advisors, LLC (NY, NY 212-314-4600), member FINRA, SIPC. Investment advisory products and services offered through AXA Advisors, LLC, an investment advisor registered with the SEC. Annuity and insurance products offered though AXA Network, LLC. Wealth Management Strategies is not a registered investment advisor and is not owned or operated by AXA Advisors or AXA Network. AXA Advisors and AXA Network are not affiliated with Pima County Medical Society. PPG 69384 (07/12)

J O H N D . L E V I N , C L U 6 0 1 1 E . G R A N T R D . T U C S O N , A Z 8 5 7 1 2

5 2 0 . 7 5 1 . 2 0 0 0 J O H N @ W M S A S S O C I A T E S . C O M

W W W . W M S T R A T . C O M

D I S A B I L I T Y L I M I T S O N T H E R I S E YOU EXAMINE YOUR PATIENTS’ EVERY DAY, OFTEN DISCOVERING RISKS NOT OUTWARDLY APPARENT. BUT HOW OFTEN DO YOU EXAMINE YOUR OWN RISKS? IT MIGHT BE TIME TO TAKE A CLOSER LOOK.

P i m a C o u n t y M e d i c a l S o c i e t y a n d W e a l t h M a n a g e m e n t S t r a t e g i e s a r e p r o u d t o o ff e r m e m b e r s a n e w d i s a b i l i t y i n c o m e i n s u r a n c e p l a n . T h i s e x c i ti n g p l a n o ff e r s d e e p l y d i s c o u n t e d i n d i v i d u a l a n d b u s i n e s s d i s a b i l i t y p l a n s , a n d u n l i k e m a n y p l a n s , t h e s a m e l o w p r i c i n g a p p l i e s t o b o t h m e n a n d w o m e n . D e p e n d i n g o n y o u r n e e d s , y o u c a n c h o o s e a p l a n o r c o m b i n a ti o n o f p l a n s t h a t c a n h e l p y o u : � P r o t e c t y o u r i n c o m e i f y o u a r e u n a b l e t o w o r k , o r u n a b l e t o r e t u r n t o y o u r f u l l d u t i e s � C o n ti n u e r e ti r e m e n t c o n t r i b u ti o n s o n y o u r b e h a l f � C o v e r b u s i n e s s e x p e n s e s � P r o t e c t a n y b u s i n e s s p a r t n e r s � P r o t e c t y o u r r e v e n u e i f a k e y e m p l o y e e i s d i s a b l e d

Associates of Wealth Management Strategies offer securities through AXA Advisors, LLC (NY, NY 212-314-4600), member FINRA, SIPC. Investment advisory products and services offered through AXA Advisors, LLC, an investment advisor registered with the SEC. Annuity and insurance products offered though AXA Network, LLC. Wealth Management Strategies is not a registered investment advisor and is not owned or operated by AXA Advisors or AXA Network. AXA Advisors and AXA Network are not affiliated with Pima County Medical Society. PPG 69384 (07/12)

SOMBRERO – February 2013 3

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Inside V ol. 46, No. 2

5 Steve Nash: Ourexecutivedirectorexplainstherhymeandreasonbehindthisissue.

6 New Life of a Legacy: Arizona’slongestcontinuously-operatinghospitalgetsa$20millionupdate.

9 Amy Beiter M.D.: St.Mary’snewCEOisaphysician–andaPCMSmember. 10 CHVI Relocates: ContinuingalongtraditionofcardiovascularsurgeryinTucson,

St.Mary’snowhousestheCarondeletHeart&VascularInstitute. 12 Member Profile: ScottBerman,M.D.hasdedicatedhimselftoSt.Mary’spatients–

andyoucanlearnwhatthathasmeanttoSouthernArizona.14-15 Campus Map: ItishardtoknowthenewSt.Mary’swithoutascorecard,er,agood

maptofindwherethingsarenow. 17 Primary Stroke Center: Aquicklookattheteamthatknowstimelossisbrainloss. 18 The Breast Center: Ittookadreamandturneditintoaphysician-drivenvisionof

breastcare. 21 Wound Care: Itistuckedawayabitoffthemaincampusbutisdoingitspartto

halveamputations. 22 Emergency Center: There-imaginedemergencycenteraimstoseepatientswithin

30minutesofarrival. 23 A Look Back: St.Mary’shasservedTucsonwellsince1880buttherewereolder

hospitalsinArizona,includingonefoundedinPrescottbytheSistersofSt.JosephofCarondelet.

25 Awards: VeryquietlySt.Mary’shasbeenreceivingdata-drivenawardsandwelistsomeoftherecenthonors.

26 Dr. Charles Katzenberg: ThePCMSPresidentandPimaHeartAssociates co-founderdeliversaeulogyforthelateTucsonHeartHospital.

On the Cover The cover photo of Carondelet St. Mary’s and the vast majority of the photos in this issue were taken by Tom Spitz. He has been capturing real life with his camera for nearly 25 years. After earning a degree in photo communication from California State University, Fresno, he began his career at the Reno (Nev.) Gazette-Journal and then spent nearly a decade at the Orlando (Fla.) Sentinel.He struck out on his own in 1993, launching Tom Spitz Photography in Tucson, Arizona. Tom’s work has won national honors, has been shown in galleries across the country, and has been published in Time, TheNewYorkTimes,Reader’sDigestand the WashingtonPost. Tom specializes in photographing people and their lives, and has developed a reputa-tion for catching moments that reveal his subjects’ true essence. He can be reached by e-mail at [email protected].


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VALUED VENDOR FOR THEPIMA COUNTY MEDICAL SOCIETY

AZ MGMA MEMBER

LatelastsummeryourPimaCountyMedicalSocietyofficersbegan

meetingwithCEOsoflocalhealthorganizations.Theobjectwastwofold:1)tolearnwhatstrategiestheyareusingtocopewithchange,and2)tofindhowPCMScanhelpthe

organizationssucceed.Asaresultofthesemeetings,easylinesofcommunicationhavebeenestablished.

We’vefoundthat,facedwithloomingchange,notwoorganizationsareusingthesametactics.Eachhasvaliddata andideas;innovationandinventionarealiveinTucson.

RoughlytwomonthsaftermeetingwithCarondelet’sCEO,atourwasarrangedofCarondeletSt.Mary’sHospitalsoPCMScouldseethenewlocationofCarondeletHeart&VascularInstitute.

Ourtourevolvedintoamoregenerallookatthehospitalanditwasfilledwith“Ididn’tknowthat”moments.Attour’sendwedecidedPCMSneededtoreintroduceCarondeletSt.Mary’stothemedicalcommunity.

IntextcreatedbythePCMSstaffandCarondeletHealthNetworkExternalCommunications,youwillseesomeofthededicationandinnovationatthefacility,andyouwillfeelthecommitmentandinvestment.

“Wearenotpickingsides,”PCMSPastPresidentAlanRogerssaidafteronemeeting,“Wewantallourhospitalsystemstothrive.”

InMayorJune,SombrerowillprofileTucsonMedicalCenter’schangesandlookattheAccountableCareOrganization.Infutureissuesthisyear,wehopetoexamineUniversityofArizonaHealthNetworkandthetwoNorthwestHospitalsandalliedphysiciansandfacilities.

WehopeyouenjoythislookatthedeanofArizonahospitals. Ifyouaren’tamember,youcandownloadamembershipapplicationatpimemedicalsociety.org(orcallforanapplication,795.7985).First-yearduesareonly$100.

Asa108-year-oldorganizationwecontinuallystrivetoincreaseourinfluenceandoutreach.Todayisgooddaytocommit andbecomepartofourfamilyofphysicians. n

A word on this issue...BySteveNash

PCMSExecutiveDirector

SOMBRERO (ISSN 0279-909X) is published monthly except bimonthly June/July and August/September by the Pima County Medical Society, 5199 E. Farness, Tucson, Ariz. 85712. Annual subscription price is $30. Periodicals paid at Tucson, AZ. POSTMASTER: Send address changes to Pima County Medical Society, 5199 E. Farness Drive, Tucson, Arizona 85712-2134. Opinions expressed are those of the individuals and do not necessarily represent the opinions or policies of the publisher or the PCMS Board of Directors, Executive Officers or the members at large, nor does any product or service ad-vertised carry the endorsement of the society unless expressly stated. Paid advertisements are accepted subject to the ap-proval of the Board of Directors, which retains the right to reject any advertising submitted. Copyright © 2013, Pima County Medical Society. All rights reserved. Reproduction in whole or in part without permission is prohibited.


ST. MARY’S HOSPITAL

SomethingextraordinaryisafootwithinthewallsofCarondeletSt.Mary’s

Hospitalthesedays.Amidstthemorethan$20millioninexteriorandinteriorrenovations,youcansensethatnewlifehastakenholdatthisTucsonWestSidemedicalcenter.Thereiselectricityintheairandprideamongthenearly2,000physicians,associates,andvolunteersatthehospitalthatis,well,infectious.

Atfirstglance,youmightattributethisenthusiasmtotherecentlycompletedfaçadethathasgiventhehospitalamodernlook.Maybeit’srelocationofCarondeletHeart&VascularInstituteanditsspecializedcardiaccareteamstothehospital’scampusthispastNovember.Itcouldevenbethetechnologicalandprogrammaticstridesbeingmadethatwillplacethehospital’soncologyservicelineattheforefrontofcancercareinthisregion.

Alltheseareimportantingredientsinthisexcitingnextchapterforthislegacyhospital;however,itisthemedicalstaffinparticularthatgivesthehospitalitssenseofstrengthandlong-termvitality.

“Ourphysiciansarenotonlyincrediblydedicatedtoprovidingourpatientswiththehighestqualitycareinthesafestpossibleenvironment;theypourtheirheartsandsoulsintothesuccessofthishospitalyearinandyearout,”saysSt.Mary’sHospitalPresidentandCEOAmyBeiter,M.D.

Dr.Beiter,whotookthehelminNovemberafterservingasthehospital’schiefmedicalofficersince2008,noted:“Itwasourphysicians’unyieldinginterestinputtinganewfaceonthishospitalthatledtoexteriorrenovationsfundedbytheCenturionsandcompletedthispastsummer.

“Itisourmedicalstaff,workinginconcertwithourmorethan1,500associates,thathasplacedCarondeletSt.Mary’samongthetopfivepercentofhospitalsnationwideforqualityandsafety,anditisourspecialists—unitedintheirinteresttoprovideonlytheverybestcare—thathasledtorelocationofCarondeletHeart&VascularInstitutetoourcampus,andthe

New life of a legacy

introductionofinnovative,physician-drivenprogramsliketheBreastCenteratCarondeletSt.Mary’s.”

Providing nationally recognized quality careBeyondCarondeletSt.Mary’spremiercardiovascularandbreastcancerservicelineofferings—aboutwhichyouwilllearnmoreinthepagesthatfollow—thehospitalhasbeennamedaTopPerformerinQualityandSafetybytheJointCommission(2012)andaDistinguishedHospitalforClinicalExcellence threeyearsrunning(2011-2013)byHealthgrades®,withmulti-year,five-starratingsforitscareofheartattacks,heartfailure,stroke,respiratoryfailure,pneumoniaandsepsis.

Whenthesenationalawardswerefirstannounced,longtimeCarondeletSt.Mary’scardiologist,Dr.JohnBoulet,noted:“I’vebeenfortunatetoworkatSt.Mary’sforthepast28years.It’srewardingtoseethehospitalgrowintoatruecenterofexcellence.Ienjoyworkingwhereeveryoneisconstantlystrivingtoimprovepatientcare.”

“Thecareprovidedat[Carondelet]St.Mary’sHospitalcanbecharacterizedwithoneword—awesome,”saidDr.RoyFarrell,chiefmedicalofficeratCarondeletHolyCrossHospitalinNogales,Ariz.

FarrellwassocertainofthetremendouscareheartpatientscouldreceiveatCarondeletSt.Mary’sthattwoyearsago,he

Adorned with a donated cross and new color scheme, the entryway at Carondelet St. Mary’s Hospital continues to beckon patients, as it has since May 1, 1880.


embarkedonaninnovativeefforttointroducefield-to-balloontreatmentprotocolsforemergentcardiacpatientsalongtheI-19corridor.

Forinstance,insteadofaheartattackpatientinSantaCruzCountybeingtakentoanemergencydepartmentbyambulanceorhelicopterforadditionaltestingbeforetreatment,paramedics inthefieldcoordinatedirectlywiththeSt.Mary’scatheterization labcareteamforfield-to-balloonintervention.

“StudiesshowthatEKGstakeninapatient’sbedroombyEMTsarejustasaccurateasthosetakenintheED,”saidFarrell.“ThankstothecooperationandcoordinationofourEMTpartners,Lifeline,andthecardiacspecialistsandcareteamsatSt.Mary’s,ourfield-to-balloontreatmenttimesforpatientsasfarsouthasNogalescanbeasquickas74minutes.YoucangetfromaparamedicresponsealongtheU.S.bordertospecializedtreatmentinSt.Mary’scathlabasquicklyasifyouhadaheartattackattheTucsonMall.”

Legacy lives onSince1880,whentheSistersofSt.JosephofCarondeletopenedSt.Mary’s,thehospitalhasbeenavibranthubofhealthcareactivityandavitalproviderforthemedicalneedsofresidentsthroughoutSouthernArizona.

Whatstartedasan11-bedhospital,withonephysicianandtheSevenSistersservingasnurses,hasgrownintoanationallyrecognized,tertiarymedicalcenterwithamedicalstaffofmorethan300.In2012,CarondeletSt.Mary’shandledalmost50,500emergencyroomvisits,139,000outpatientvisits,8,000surgeriesand59,000patientdays.

Physicians’ viewpointsDr.A.J.Emami,anotolaryngologistandPCMSBoardmember,hasdedicated15yearsofhiscareertothecareofpatientsatSt.Mary’s.AsmedicaldirectoroftheCarondeletSleepCenterprogramandaformerSt.Mary’schiefofstaff(2007-2009),heknowsagreatdealaboutthehospital’srecenthistory.

“Betweenthenewtechnologies,renovations,physicianengagementandhospitalleadership,wehavemovedforwardexponentiallyoverthelastseveralyears.Iamveryexcitedaboutourpathforward,”hesaid.

Emamiisespeciallyproudofthebrandnewoutpatientsleeplabthatopenedonthehospital’sthirdfloorinDecember.

“ThisistheonlysleeplabavailabletopatientsontheSouthwestSideofTucson.Morethanthat,itisuniqueinourarea,offering

patientstheverybestexperiencepossible,withmoretechniciansperpatientperstudy,anextremelyquietandcomfortableenvironment,andtheleast-intrusivemonitoringdevicesavailable.It’sallstateoftheart.”

YougetthesameenthusiasticopinionofCarondeletSt.Mary’sservices,programs,andthecareitprovidesfromjustabouteveryphysicianyouask.

Dr.TobyFreebourn,medicaldirectorofInpatientRehabilitation,thefirstprogramofitskindestablishedinSouthernArizona:“Ourrehabilitationcareteamwasrecognizedlastyearamongthetop10percentnationwideinpatientoutcomesbyUniformDataSystems,anindependentorganizationthattracksrehabilitationprogramsacrossthecountry.Personally,Iamveryproudtobeapartofthisamazinggroupofcaregivers.”

Dr.BernardoRebeil,aradiologistspecializinginchemo-embolizationandradiofrequencyablation,hasworkedatCarondeletSt.Mary’sfor23years:“Thishospitalhascarriedastigmasimplybecauseofthestereotypesurroundingtheneighborhood,butthatisfinallychangingforboththehospitalandthisareaofthecity.”

“WehaveseenanincredibledreamrealizedwiththefinancialcommitmentmadebyCarondeletHealthNetworktothiscampus,evenintimesofeconomicuncertainty,”

Dr.Rebeilsaid.“Thenetworkhasinvestedmillionsinthemostadvancedtechnologiessopatientsonourcampusreceivetheverybesttreatmentaccessibletoday.”

Thehospitalnowhasamulti-disciplinarytumorboardthatmeetsweeklytobuildintegratedtreatmentplansforeachcancerpatientandensurewell-coordinatedcare.

“Thisintegratedteamapproachamongspecialistswhootherwiseworkinprivatepracticeistrulyacutabovewhatyoumightexpect,”Dr.Rebeilsaid.“Ourteamofpathologists,radiologistsandoncologistsareextremelyqualified,dedicatedandcompassionatephysicians.TucsonneedstoknowthatSt.Mary’sisthatgood.”

One patient’s experiencePatients,likeMikeDavis,feelthesame.Thephysicallyfit,athletic62-year-oldGreenValleymanwokeuponemorninginlateNovember,experiencingasevereischemicstroke.Withinminutes,thebloodclothadincapacitatedathirdofhisbrain,leavinghimincapableofspeechandvirtuallyparalyzed.

ParamedicsrushedhimtoCarondeletSt.Mary’sPrimaryStroke

Just about ready to give way to combustion power this horse-drawn ambulance is poised near the landmark Round Building, designed to give sunshine to TB patients and others. The Round Building was demolished in 1965 to make way for a wider St. Mary’s Road.


Center,wherehewasabletoreceiveinter-arterialtPA.Theprocedure,performedbyinterventionalradiologistDr.RajulShahandwiththeassistanceofDr.StellaKahn,certainlysavedDavis’slife.

Hiswife,Kathy,recentlytoldtheGreen Valley Newsthatjustfourdaysafterward,hewasdoingsowellthatsomeofthestaffthoughthewasavisitortoolingthehallways,notapatient.

Today,Mikeisbackhomeand“noworseforwear.”

TheDavisesfeltsostronglyaboutmakingsureothersintheircommunityknewaboutthetremendousstroketreatmentavailableatCarondeletSt.Mary’sthattheysoughtouttheeditoroftheirlocalnewspapertosharetheirstory.

ItappearsthemissionoftheSistersofSt.JosephofCarondelet132yearsago—toserveevery“dearneighbor”withdignityandrespect—isstillattheheartofthequalitycarebeingprovidedallthesegenerationslaterbythephysicians,nurses,administrators,andvolunteersofCarondeletSt.Mary’sHospital.

“Asithasfordecades,St.Mary’sispoisedtoaccomplishgreatthings,”saidCEODr.Beiter.“WehavetransformedfromacommunityhospitalservingtheWestDidetoaregionaltertiarymedicalcenterwiththecapabilitiesandcommitmenttoprovidesomeofthebestcareimaginabletotheresidentsofthisregion.Thatisbothourlegacyandourpromise.”

St. Mary’s Hospital is part of Carondelet Health Network, a Catholic, nonprofit healthcare system dedicated to responding to the health, prevention, education, and wellness needs of Southern Arizonans. Carondelet was founded by the Sisters of St. Joseph of Carondelet more than 132 years ago. Carondelet’s

family of services also include St. Joseph’s Hospital and Holy Cross Hospital in Nogales, Arizona; Carondelet Neurological Institute at St. Joseph’s; nearly two dozen primary and specialty care offices; an ambulatory surgery center; several imaging centers; Hospice and Palliative Care; and a variety of other outpatient services. Carondelet Health Network is a ministry of Ascension Health, the nation’s largest Catholic, not-for-profit healthcare system. In FY 2012, Carondelet provided nearly $66 million in Community Benefit to improve the health of our community and increase access to healthcare. More information about Carondelet Health Network is available at www.carondelet.org.

The original cornerstone for St. Mary’s is on display at the hospital. St. Mary’s was built during a “hospital-building frenzy” after the Civil War. You may read more about the hospital’s founding on pages 23-24.



Dr. Amy Beiter: Physician’s administratorEvenasastudent,Dr.AmyBeiter,F.A.C.P.andPCMSmember,hadaclearvisionofthephysicianshewanted tobe.Herinterestinbiologyandscienceledhertothefield;herdesiretocontributesomethinggreaterto hercommunitydrovehercommitment.

Now,afternearly25yearsasaclinician,Dr.BeiterisapplyinghervisionofhealthcaretohernewroleaspresidentandCEOatCarondeletSt.Mary’sHospital.

“MyvisionforSt.Mary’sistocontinuetoservethecommunitybutinanexpandedandmorevisiblemanner,”shesaid.“Theadditionofnewservicelines,includingCarondeletHeartandVascularInstitute(CHVI)andtheBreastCenter,willservetoheightentheawarenessoftheavailabilityandqualityofserviceswealreadyprovide,manyofwhicharehighlightedintheSombrerothismonth.”

Looking backDr.Beiter,anIndiananative,firstattendedveterinaryschoolbeforemakingtheleaptomedicineatIndianaUniversity’sSchoolofMedicine.DuringhersenioryearshetraveledtoLiberia,inWestAfrica,wheresheworkedforacouplemonthsatahospital.

Theexperience,thoughshort,groundedher,shesaid.“IthelpedformmyvisionofwhoIwantedtobeasaphysician—instillingthatdrivetomakethingsbetterforthecommunity.”

Upongraduatingfrommedicalschoolin1988,Dr.Beitermovedwest,optingtocompleteherresidencyinInternalMedicine/PediatricsatGoodSamaritanMedicalCenter/PhoenixChildren’sHospital.In1992,shemovedtoTucsontopracticeatElRioCommunityHealthCenter,wheresheservedaschiefofstaffanddevelopedandmanagedafreeclinicforteens.

Alsoin1992,Dr.BeiterjoinedthemedicalstaffatCarondelet St.Mary’sHospitalwhere,shesaid,“Iveryquicklybecamecomfortableandembracedthechallengesofcaringforcomplexpatients.IlovedthepatientsandphysicianswithwhomIworked.”

AfterleavingElRioin1999sheworkedasahospitalistatCarondeletHealthNetwork,andatTucsonMedicalCenterandUniversityMedicalCenter.Sevenyearslater,Dr.BeiterbecamethemedicaldirectorofutilizationmanagementatCarondeletSt.Mary’s,soonfollowedbyapositionaschiefmedicalofficerin2008.

“ItookthepositioninutilizationmanagementinpartsoIcouldspendtimewithmykids.IhadnoideaIwouldlikeitsomuch,”shesaid.

HerexperienceandleadershipatSt.Mary’sdidnotgounnoticed,andlastOctober,Dr.BeiterwaspromotedtoCEOofthehospital.

Moving forwardAsCEO,Dr.BeiterhashadasmoothtransitionfromherpriorpositionasCMO.She’sstilltaskedwithmakingrapiddecisionsincomplexsituations,askillthatshedevelopedoverhermanyyearsasaphysician.

“MytenureatSt.Mary’shasallowedmetobepartofmanyoftheoperationalaspects—there’sjustawholelotmoreofthatnow,”shesaid.“Ifeelveryathomeintherole.IenjoyseeinghealthcarefromaverydifferentperspectiveandIlikebeingabletospeakbothlanguages—clinicalandadministrative.”

SincefirstenteringthedoorsofSt.Mary’s20yearsago,she’shadauniqueperspectiveonthechangestakingplaceatthe132-yearoldhospital.Technologicaladvancesandarenewedfocusonsafetyandqualityhaveimprovedpatientcare.Theawards—bynationalrevieworganizationssuchastheJointCommission—reaffirmtheirsuccess.

“IbelieveSt.Mary’sispoisedtodogreatthingsforourentirecommunity.WehaveemergedfromacommunityhospitalservingtheWestSidetoafacilityprovidingtertiaryreferralcarefortheentirecommunityandsurroundingregion,”Dr.Beitersaid.“I’mjustreallyproudofthephysiciansandthestaffhereandwhatthey’vebuiltoverthepastseveralyears.It’snotme.It’stheteam.”

Dr. Amy Beiter is board-certified in internal medicine and pediatrics; a fellow of American College of Physician; member of the Society of Hospital Medicine; and a member of the American College of Physician Executives.

As a physician/CEO, Dr. Beiter joins a select group. Of the roughly 6,500 U.S. hospitals in 2010, only 235 had a physician at the helm. In 2009, physician-led hospitals more often than not ended up in the top 100 of USNews&WorldReport’s rankings in cancer, heart and heart surgery, and digestive disorders.

In Tucson Dr. Beiter joins a select group of physicians who have held the top position at local hospitals. Dr. Janis Johnson and Dr. Richard Carmona each had a term at Kino Community Hospital. Prior to that, physicians ran the county hospital on Sixth Avenue from the mid-1930s through the late-1960s.

From the turn of the last century through the 1920s, several Tucson hospitals were founded and operated by physicians, including Whitwell Hospital, Rogers Hospital, and the Desert Sanatorium, forerunner of Tucson Medical Center.



Carondelet Heart & Vascular Institute relocates to St. Mary’s campus

CarondeletHeart&VascularInstitute(CHVI),nowlocatedonthecampusofCarondeletSt.Mary’sHospital,offersnationallyrecognized,award-winning

careforthetreatmentofcardiacandvascularconditions.Initsnewhome,CHVIalsoofferspatientsmulti-disciplinarycareunderoneroof.

“Morethan50yearsago,doctorsatSt.Mary’swerepioneersincardiovascularsurgery,”observedJamesK.Beckmann,presidentandCEOofCarondeletHealthNetwork.“In1959,St.Mary’swasthefirsthospitalinArizonatoperformopenheartsurgeryandthefirstinSouthernArizonatouseaheart-lungmachine.Today,oursurgeonsaremodern-daypioneers,offeringthemosttechnologicallyadvancedandminimallyinvasiveoptionsavailabletopatientsfacingheartandvascularsurgery.”

“CHVIat[Carondelet]St.Mary’sHospitalissettingthepaceforcardiaccare,bringingsignificantvaluetothecommunityandtheregion,”saidCarolErenberger,Carondelet’scardiovascularservicelineexecutive.“Theskilledteamofproviders—surgeons,otherphysicians,nurses,andtherestofthepatientcareteam—hasadepthofexperienceandup-to-the-minuteknowledgeofcardiovascularcarethat’sonparwiththebestmedicalcareinthenation.”

Big changesCarondeletHealthNetworkhasinvestedmorethan$17millionintherelocationandphysicaltransformationofthenewCHVIonthecampusofCarondeletSt.Mary’sHospital.Thislocationofferspatientsthemostmoderncardiovascularfacility,withmanyadvantagesincludingeasyaccessfrombothInterstates10and19andusingtwohelicopterpadsforemergencies.

“St.Mary’shasthemoststate-of-the-artcenterforminimallyinvasiveproceduresanywhereinthecountry,”saidDr.DerekvonHaag,acardiothoracicspecialist.

CHVI’snewhomealsoallowsmorespaceforitscardiovascularandcardiothoracicsurgeryprogramstogrow.

ThespecializedcareteamrelocatedfromwhatwasoriginallyTucsonHeartHospitaltotheSt.Mary’scampusinNovember2012.RelocatingCarondelet’scardiovascularprogramtoatertiarymedicalcenterprovidesauniqueopportunitytoservethecomplexmedicalneedsofcardiacpatientsfromacrosstheregion

whooftenfaceamultitudeofproblemsbeyondcardiacandvascular.

What’smore,allemergencyroomcareisnowprovidedexclusivelybyboard-certifiedEmergencyDepartmentphysiciansatCarondeletSt.Mary’sHospital.

Physician education, tooInadditiontoalltheimprovementsforpatients,CHVI’ssurgeonswilltrainotherexperiencedphysiciansinthelatestproceduresandtreatmentsforcardiaccareusingstreamingA/Vcommunications.

“Wehavetwogoals,”explainedDr.MichaelHecht,chiefmedicalofficerofCarondeletSpecialistGroup.“First,toofferthemostmodern,multidisciplinarycaretopatientsforthebestpossibleoutcomesandexperiences,andsecond,toteachotherpracticingphysicians—notmedicalstudents—thelatestbestpracticesincardiovascularcare.”

Latest technologyOneofthefeaturesofthenewCHVIatSt.Mary’sHospitalisitsnewhybridoperatingroom,currentlyunderconstruction.It’strulyone-of-a-kind,builttoimprovesurgicalfunctionsandpatientsafety.

“Ourspecialtyisminimallyinvasivesurgeryforeverykindofprocedure,individuallytailoredtobemostappropriateforeachpatient,withthebestqualityandsafestresults,”Dr.vonHaagsaid.“Thisfocusandtheuseofthenewhybridoperatingsuitewilltrulyseparateusfromotherprogramsacrossthecountry.”

Alltheinnovationandchangesareaimedatbetterpatientoutcomes.

“Nowthereisbettercoordinationofcarethanwewereabletoprovidebefore.WiththeexpertiseoftherestoftheSt.Mary’s

Part of the $17 million CHVI transformation includes a very impressive new lobby.


staff,wehaveallspecialtiesreadilyavailableforpatientswithmultipleco-morbidities,”Dr.Hechtsaid.

A regional referral centerThenewCHVIatSt.Mary’sisadestinationforcardiaccarethroughouttheregion.Incorporatingthebestpracticesoftwoaward-winningfacilities,CHVIandSt.Mary’stogetherformateamthat’squalifiedtoreachnewlevelsofexcellenceinpatientcarewithstate-of-the-artsurgicaltechniques.

“WithSt.Mary’s’focusonthehighestqualitypatientcareanditseasyaccessibilitybytwofreewaysandhelicopters,wearetrulyaregionaldestinationforpatientsallovertheSouthwest,”Dr.vonHaagsaid.“We’vealreadyhadpatientsfromNewMexicoandFlagstaff.”

Beckmanputsitanotherway:“BringingCHVItoSt.Mary’sHospitalcombinesCarondelet’sheartandsoulinonelocation.”

IfyouwouldlikeacardiologistcaringforpatientsatCarondeletHeart&VascularInstitutetoseeoneofyourpatients,youcancontact:

Carondelet Specialist Group— Cardiology and Cardiothoracic Surgery:445N.SilverbellRd.,Suite201Tucson,Ariz.85745Phone:520.396.1370

Pima Heart Associates–West Office: 445N.SilverbellRd.,Suite200Tucson,Ariz.85745Phone:520.624.8935

IfyouwouldlikeavascularsurgeoncaringforpatientsatCarondeletHeart&VascularInstitutetoseeoneofyourpatients,youcancontact:

Tucson Vascular Specialists:1815W.St.Mary’sRd.Tucson,Ariz.85745Phone:520.628.1400

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Carondelet nurse Stacey Lansdowne cares for cardiac patient Solomon Tolentino, Jr., in the Carondelet Heart & Vascular Institute Progressive Care Unit.

CHVI improvements include a complete redesign of patient rooms.



Dr. Derek von Haag lives on the cutting edge

OriginallyfromCalifornia,

Dr.DerekW.vonHaagwantedtobeamarinebiologistuntilthedayinhighschoolthathesawavideoofopen-heartsurgery.

Hisplanschangedimmediately. Todayheserves asmedicaldirectorofcardiothoracicsurgeryatCarondelet Heart&VascularInstitute(CHVI).

Afterearningadualbachelor’sdegreeinbiologyandzoologyfromCaliforniaStatePolytechnicUniversity,heearnedhismedicaldegreefromtheUniversityof

California—Irvine.FollowinganinternshipandresidencyattheUniversityofCalifornia—DavisMedicalCenter,Dr.vonHaagheadedeastforhisresidencyincardiothoracicsurgeryatUniversityofPittsburghMedicalCenter.

Dr.vonHaagisaboard-certifiedheartandlungsurgeonwithspecialtytraininginminimallyinvasivesurgicalprocedures,includingclosed-chestaorticvalve;closed-chestmitralvalve;closed-chestcoronaryarterybypass;closed-chestatrialfibrillationablation;andclosed-chestroboticsurgery.

Dr.vonHaag’sprofessionalmembershipsincludetheInternationalSocietyforMinimallyInvasiveCardiacSurgery,SocietyofThoracicSurgery,AmericanCollegeofSurgeons,andtheAmericanMedicalAssociation.

Dr.vonHaagsayshelovestheexcitementofevolvingtechnologies:“Moderntechnologyandcontinuingadvancementsinminimallyinvasivesurgerybringmetremendouscareersatisfactioneveryday.”

Infact,Dr.vonHaagspecializesinawidevarietyofthemostmodernclosed-chestsurgeries.Havingallthelatesttoolsandtechniquesavailableallowshimtheflexibilitytocreateanindividualtreatmentplanofferingthebestandsafestoutcomesforeachpatient.

“It’sgreatbeingabletocustomizeatreatmentplanforeachperson’sparticularneedsandhealthsituation,makingsuretheygettheverybestcarepossible,”hesays.

Threeyearsago,Dr.vonHaagwasworkinginPhoenixwhenCarondeletHealthNetworkcalled.

“IthoughtTucsonwasagreatopportunity.Carondelet,inparticular,appealedtomebecauseeveryonehereissofocusedonthequalityofpatientcare,”hesaid.

Hehasn’tbeendisappointed.“Everydaytherearesomanyinterestingcases.Theopportunitytosavepeople’slives—togivealifebacktosomeonewhowasdying,isjustamazing,”hesaid.

WhatbringsDr.vonHaagthegreatestsatisfactionatwork?“Moderntechniques,collaboratingwithcolleagues,andworkingwithinCarondelet’steamapproachtotakingcareofpatients.”

AsCHVImedicaldirectorofcardiothoracicsurgery,Dr.vonHaaghasbeenintegralinthebehind-the-scenesdesignworktobuildthenewinstituteatCarondeletSt.Mary’sHospital.Ofparticularnoteisthecreationofastate-of-the-art,one-of-a-kindhybridoperatingsuite.

WorkingtodevelopCHVIatSt.Mary’sintoanestablishedreferralcenter,hesaysheisexcited“toseeitevolveintoamajordestinationforcardiaccare.We’vealreadyhadpatientsfromPhoenix,NorthernArizonaandNewMexico.”



Dr. Scott Berman brings new vascular techniques to Tucson

ScottBerman,M.D.,F.A.C.S.hasbeenattheforefrontofvascularsurgeryinSouthernArizonasincethemid-1990s.Hebeganthefirstminimallyinvasiveendovascularprogramin

thisarea,andhiscommitmenthasresultedinmanynewproceduresforpatientswithvasculardisease.Theseincludeminimallyinvasivetreatmentsforblockedlegarteries,blockedcarotidarteries,thoracicandthoraco-abdominalaneurysms,deepveinthrombosis,andvenousinsufficiency.

Dr.BermangrewupinPennsylvaniaandreceivedabachelor’sdegreeinchemicalengineeringfromPennStateUniversity.HeearnedhisM.D.fromHahnemannUniversityinPhiladelphiaandcompletedhisresidencyattheEasternVirginiaGraduateSchoolofMedicine.There,hecompletedafellowshipinsurgicalresearchandclinicalnutritionattheHamptonRoadsVAMedicalCenter.Afterward,BermancompletedafellowshipinvascularsurgeryattheUniversityofArizona.

In1994heopenedhisTucsonpracticedevotedentirelytothespecialtyofvascularsurgery,andin1997hefoundedTucsonVascularSurgery.In2010,TVSjoinedtheCarondeletHealthNetwork,establishingthevascularsurgerydivisionofCarondeletSpecialistGroup.

Dr.Bermanparticipatesinresearchwithaparticularinterestinvascularbiology,medicaldatabasedesign,andbioengineering.Hehaspublishedmorethan50peer-reviewedarticlesonmanytopicsinvascularsurgeryandatextbookonvascularaccesssurgery.

Board-certifiedinvascularsurgeryandcriticalcareand asaregisteredvasculartechnologist,Dr.Bermanisa memberofthefacultyoftheUniversityofArizonaCollegeofMedicinewithanappointmentinbiomedicalengineering.Heisamemberofanumberofregional,nationalandinternationalvascularsurgicalsocietiesandisafellowoftheAmericanCollegeofSurgeons.BermanisalsoamemberoftheSocietyforVascularSurgeryandhasbeenrecognizedbythatsocietyforhiscontributionstothespecialtybyhisselectionasaDistinguishedFellow.

InFebruary2000,Dr.Berman’spractice,TucsonVascularSurgery,andCarondeletSt.Mary’sHospitalusheredintheneweraforthetreatmentofaorticaneurysmdiseasebyperformingSouthernArizona’sfirstendovascularstentgraftforabdominalaorticaneurysmrepair(EVAR).

Then,inearly2006,heplacedthefirstendovascularstentgraftforthetreatmentofthoracicaneurysm(TEVAR)disease.Sincethen,hundredsofpatientshavebeensuccessfullytreatedusingthistechnology.Theimpactforpatientswithaneurysmdiseasehasbeenfar-reaching.

“Thereisnothingmoresatisfyingthanseeingapatientwalking,eatingaregulardiet,andbeingdischargedhomeonthefirstdayafteranEVARorTEVARprocedure,”Dr.Bermansaid.“Thisisinstarkcontrasttotraditionalopensurgerythatwould

requiredaysintheICU,aweekinthehospital,andmonthsforfullrecovery.”

ThisyearDr.BermancontinuestheadvancementofminimallyinvasivetreatmentsforpatientswithaorticaneurysmsbyofferingEVARforpatientswithjuxtarenalaneurysms.

Earlyin2012theFDAapprovedtheCookfenestratedandbranchedendovascularaneurysmrepairsystemthatwillexpandtheoptionofminimallyinvasivetreatmenttopatientspreviouslyexcludedfromEVARbasedupontheiranatomyattherenalarteries.WithDr.Berman’sextensiveexperienceandconsistentsuccesswithEVARandTEVAR,CarondeletHeartandVascularInstitute atSt.Mary’sHospitalwillbethefirstfacilityinSouthern Arizonatoofferthisinnovativetherapy.

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When timing matters: Carondelet St. Mary’s Certified Primary Stroke Center

It’sanintenseandconfusingtimewhensomeonehasastroke—andtimeisthemainelement.

Whenastrokeissuspected,thePrimaryStrokeCenteratCarondeletSt.Mary’sHospitalbeginstreatmentimmediately—oftenwithin60orfewerminutesofthepatientarriving—minimizingdamageandsavingbrainfunction.

CarondeletSt.Mary’sreceiveditsdistinctionasaPrimaryStrokeCenterbytheJointCommission,anationallyrecognizedrevieworganization,forprovingitsabilitytoprovideexcellentstrokecarethatincludescriticalelementsinachievinglong-termsuccessbyimprovingstrokeoutcomes.

“WecollaboratewiththeEmergencyCenterphysicians,neurologists,interventionalradiologists,andvascularandcardiacphysicians,aswellasafullBrainAttack

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Carondelet St. Mary’s Stroke Treatment Team (L-R): Teri Gilmore, ANP, Herbert McReynolds MD, Stella Kahn MD, Rajul Shah MD and Francisco Valdivia MD. CONTINUED ON PAGE 19



The Breast Center: A physician-driven vision of breast care

Breastcanceristerrifying.Whenapatientreceivesa

positivediagnosis,itraisesanumberofuncomfortablequestions,amongthem:“What’snext?”

TheBreastCenterteamatCarondeletSt.Mary’sHospitalisreadytoanswerthatquestionandremovetheuncertaintyandfearsurroundingbreastcancer.

AtTheBreastCenter, whatstartedasasuggestionthreeyears agohassolidifiedinto amultidisciplinary,integratedgroupofotherwiseindependentradiologists,pathologists,oncologists,andbreastandplasticsurgeonswhosefocusistheprevention,earlydetection,andprompttreatmentofbreastdisease.

Apatientnavigator,experiencedincancereducation,helpsguidepatientsthroughtheentireprocess.

“OurBreastCenterisdifferentinthatwe’renotjustacenter forimagingorasinglephysicianoffice,”saidDr.GerlindeTynan,medicaldirectorofTheBreastCenterandtheBreastHealthProgramatCarondeletSt.Mary’sHospital.“Weencompass thewholescopeofbreastdiseaseand,morespecifically,breastcancer.Everythingfromthescreeningmammogramthroughbiopsy,surgery,tochemotherapyandradiationtreatment,supportgroupsandeducationalresourcesishandledunder ourauspices.”

Streamlined, centralized, quality careTheBreastCenteropenedinJanuary2012,thesameyearthattheNationalCancerInstituteestimatedtherewere229,060newcasesofbreastcancerdiagnosedintheU.S.—3,400ofwhichwerewomeninArizona.

MostoftheprocedurestakeplaceatasinglefacilityontheCarondeletSt.Mary’sHospitalcampus,whileconsultationsaredone intheprivateoffices oftheCenter’sphysicianslocatednearby.Imagingservicesareoffered onsite,includingdigitalmammography,breastultrasound,bonedensitometry(DEXA scans),breastMRI,andinterventionalbreastprocedures—stereotactic,ultrasound,andMR-guidedbreastbiopsy.

TheBreastCenterisuniqueinSouthernArizonaforitsuseoftheimagingsoftware InvivoDynaCADwithONCAD,which“helpsclassifylesionsbasedontheirmorphology,”saidRadiologistDr.ChristopherReed,whojoinedThe

BreastCenterfollowingafellowshipattheUniversityofArizonaMedicalCenter’sBreastImagingCenter.Thespecializedsoftwareisinadditiontothestandardcomputer-aideddetectiontechnologythatdetectslesionsbasedontheirenhancementkinetics.

Physiciansalsoofferpatientsthelatesttechnologyintreatmentoptionsincludingfive-daycatheter-basedbrachytherapyradiation,genetictesting,immediatebreastreconstruction,cryoablationoffibroadenomasandparticipationinoncologicclinicaltrials.

TheBreastCenteratCarondeletSt.Mary’sisamemberoftheNationalConsortiumofBreastCentersandusestheNationalQualityMeasuresforBreastCenters(NQMBC)programtotrackandcomparedatanationallywithotherbreastcentersaroundthecountry.

Carondelet St. Mary’s Breast Center Treatment Team (Standing L-R): Maria Tirado, breast center patient navigator; Felicia Alicea, nuclear med tech; Bruce Porterfield MD, Christopher Gilles MD, Manuel Modiano MD, Steven Baughan MD and Robert Gin MD. (Seated L-R): Chris Reed MD, Gerlinde Tynan MD and Guillermo Gonzalez-Osete MD.


“Weareoneofthefewcomprehensivebreastcentersinthestatetogothisextramile,”Dr.Tynansaid.“Weareheldtohighstandardsandhavetoshowaccountability.”

FurthersettingTheBreastCenterapartistheeaseandspeedwithwhichpatientsproceedfrominitialscreeningtofollow-uptreatment—abenefittobothpatientandreferringphysician.

“Likeanymedicine,”saidDr.RobertGin,aradiationoncologist,“wehavepatientsasking,‘Areyougoingtotellthistomydoctor?’ThethingaboutTheBreastCenteristhatallyourdoctorsarealreadythere.Theradiologist,thepathologist,theoncologist—we’reallfamiliarwithyourrecords.It’sateamapproach.Everythingisintegrated.”

Whenanabnormalbiopsyresultisfound,anappointment withanyoneofthecenter’sphysiciansusuallycanbe scheduledwithintwotothreeworkingdays.Physician-to-physiciancallsandnoteshelpkeepreferringprovidersinformedoftheirpatient’sprogressthroughouttreatment.AlsohelpingtoprovideexcellentcontinuityofcareisPatientNavigatorMariaTirado.

“Thepatientnavigatorhelpsoverseetheprocessandverifiesthatthepatientisprogressingcorrectlythroughtheirtreatmentplan,”saidDr.Tynan.“It’sreassuringforthepatient,aswellasthereferringphysicianwhodoesn’thavetoremember,‘DidIrequestthoselabs?DidIwritethoseorders?’”

Tiradoexplainsthatit’sherjobnotonlytoensurethat patientsunderstandwhat’shappening,butthatthey’re awareoftheresources—financial,emotionalandeducational—availabletothem.“Whilethedoctorsandstaffdoanexcellentjobexplainingthetermsanddiagnosis,onthatfirstvisit, most[patients]areoverwhelmedwithalltheinformationthey’rereceiving.”

AddedDr.Tynan,“Eventhoughyou’vehearditalreadyfromoneofthephysiciansyousaw,it’salwaysnicetohavesomeonewho’salwaysavailablewhocantellyoumore,whocansetyouupwithcommunityresources,websites,andsupportgroups.”[Thenavigatoris]“thatpersonwho’snotthedoctor,butwhoknowsaheckofalotaboutwhatisgoingon.”

Tirado,whoisbilingual(Spanish/English)andbicultural,isespeciallyinterestedinworkingwithwomenfromruralormedicallyunder-servedareasofSouthernArizona.“Oneoftheadvantagesofhavingapatientnavigatorinaprogramlikethisisthatwearenotjustanadvocateforthem,butwefollowthemallthewayfromdiagnosistocompletionoftheirtreatment,”shesaid.

From ‘screening to survivorship’PerhapsthegreatestbenefitofTheBreastCenteristhecomfortofknowingthateveryfacetofapatient’scareisconsideredandmonitoredontheirbehalf.Eachnewcancercaseispresentedduringaweeklyconferenceamongthecenter’smultidisciplinaryteaminwhichapatient’shistory,riskfactors,andexamarediscussedandtheirpathologyslidesand

radiographicimagesarereviewedindividually.AcustomtreatmentplaniscreatedandadjustedbasedonNationalComprehensiveCancerNetwork(NCNN)andothernationalcancerguidelines,aswellaspatientpreference,forthebestpossibleoutcome.

“Whatwe’vedoneisformapartnershipwhereallofushaveagreedtomakesurethesethingshappeninastreamlinedfashion,”saidDr.Reed.“Oneofthebigthingsforthesepatientsisthattheyknowthenextstep.They’reneverinthedark.”

“Weasprimarycaredocsarethrilledwhenwecanmake onereferral,andnotonlythemedicalandsurgicalneedsof ourpatientsaremet,butalsokindness,educationandtheirsocialneedsareincorporated,”saidDr.TomGriffin,F.A.A.F.P.“BeingabletosendmypatientstoTheBreastCenterandknowingthatthey’llactivatethecompleteteamofcaring isanincrediblecomfort.”

Teamtoachieveexcellenceincareforstrokepatients,”saidDr.FranciscoValdivia,aneurologistatSt.Mary’sandmedicaldirectorofthePrimaryStrokeCenter.“Together,wewillhelppatientsandtheirfamiliesrebuildtheirlives.”

Recognizingtheteam’slevelofcommitment,theCarondeletSt.Mary’sstrokeprogramwashonoredbytheAmericanHeartAssociation/AmericanStrokeAssociationwiththeGetWithTheGuidelines®StrokeGold-PlusQualityAchievementAward.

TheprogramalsowasplacedonAHA/ASA’sTarget:StrokeHonorRollforprovingitsabilitytoprovideacuteischemicstrokepatientsIVt-PAtreatmentwithin60minutesofarrivalatleast50percentofthetime.

With strokes, timing is key“Mostpatientswithanacutestroketypicallygeta headCT,thoughassessingforanocclusiontypicallyrequiresaCTarteriogram(CTA),”saidDr.RichardLucio,aneuroradiologistatSt.Mary’s.“At[Carondelet]St.Mary’sHospital,everyacutestrokepatientgetsbothanimmediateheadCTandCTA.Intra-arterialtherapybyaneuroradiologistisofferedtothosepatientswhomaybenefit.

“Thesecasescanbechallenging,buttooptimizeagoodoutcome,therapymustbeinitiatedasquicklyaspossible.ThestroketeamandstaffatSt.Mary’sdoanoutstandingjobmakingthishappen.”

Formoreinformationorcommunityeducation,please contactJoyPipes,StrokeProgramCoordinator,at [email protected],orcall872.4344.

CONTINUED FROM PAGE 17


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Extraordinary healing: Wound care at St. Mary’s

ThehighincidenceofdiabetesinSouthernArizona,especiallyamongtheHispanicandNativeAmericanpopulations,createsauniquechallengeforthemedical

communityinourarea.TheCentersforDiseaseControlandPreventionsaysthesegroupsgetdiabetesatfourtimestherateofthegeneralpopulation.

CarondeletHealthNetworkhasbeencommittedtomeetingthischallengefordecadesthroughaggressivetreatmentofwounds.AtCarondeletSt.Mary’sHospital,woundcareisprovidedinbothinpatientandoutpatientsettings.JustwestofthehospitalonWestSt.Mary’sRoad,St.Mary’sWoundHealingCenteroffersadditionaloutpatientcareatitsHolyFamilyfacility.

Becausediabetesfrequentlyaffectsbloodcirculationtotheextremities—preventingwoundsfromhealingproperlyandleadingtoamputation—Carondeletemploysavarietyofnewtechnologiesusedbyastaffofhighlytrainedphysiciansandmedicalpersonnel.

“Iknowthatwe’rereallyworkinghardtoreducethenumberofamputations.Theclinic’samputationrateforthelastsixmonthsis1.5percent.Mostwoundclinicsarearoundthreepercent,”saidDr.HerbertMcReynolds,medicaldirectorofCarondeletSt.Mary’sEmergencyCenterandastaffphysicianattheWoundHealingCenter.

Engaging the wound care community and saving limbsDr.BarbaraAung,apodiatricphysicianandsurgeonandboard-certifiedwoundcarespecialist,isalsoontheoutpatientWoundHealingCenterstaff.ShehasreachedouttothecommunitybyworkingtoestablishalocalchapterofSaveaLeg,SaveaLife.

“Theideaistogetthepeoplewhoaredoingwoundcareandperipheral-vascularworkthroughoutthecommunity,suchasvascularsurgeonsandvascularspecialists,toeducateeachotheronhowwemightworktogethertosavelimbs,ratherthandoingamputations,”shesaid.

OnesuchtreatmentisahyperbaricchamberusedbyCarondeletthatdirectswound-healingoxygentotheaffectedarea.Medicalexpertsalsousebiotechnologyinwhichlayersofaproductgrownfromhumanskinareappliedtothewound.

“It’saculturedskinfromahumanputbackonthewound,”Dr.Aungsaid.“Thatactuallyhelpsdelivergrowthfactorsandcytokinesthatpromotethewoundhealingprocess.In

aboutthreetofourweeks,sometimesalittlebitlonger,thewoundishealed.“Thetimesthatweliveinareprettyamazing.”

“TheSt.Mary’sWoundHealingCenteroffersamultidisciplinarypanelofphysicianswhoprovideinitialpatientassessmentforthosewithchronicwounds,andwillimplementatreatmentcareplanbasedonanevidence-basedpathway,”addedDr.RhondaQuick,F.A.C.S.“Patientsdevelopanongoingrelationshipwithaphysicianastheyarebeingseenonaweeklybasis,andtheirplanofcareisadjustedasthewoundchangesovertime.Thiscomprehensiveapproachcontributestofastertimetohealandadecreaseinamputationrates.”

Positive reputation and pride among physiciansDr.KarlHekemianisalongtimesurgeonatCarondeletSt.Mary’sHospitalandservesasmedicaldirectoroftheinpatientwoundcareprogram,inwhichvascular,reconstructive,andpodiatrysurgeriesareallavailableinonelocation.HepointswithpridetothereputationwoundcareatSt.Mary’shasthroughoutthecommunity.“WoundcareatSt.Mary’shasbeenprovidinggreatcaretopatientsinthiscommunityfordecadesandhasa verygoodtrackrecord,”hesaid.“It’sawell-runfacility.”



When minutes matter: Refined emergency care

TheEmergencyCenter(EC)atCarondeletSt.Mary’sHospitaliscommittedtoseeingpatientswithin30minutesof

arrival.

Tostreamlinetheprocess,andshaveminutesoffwaittimes,everystepinthepatientcareprocesswasexamined.Amongthesesteps wasgettingpatientsdirectlytoabedinoneof44privateexamroomssoonafterarrival.CarondeletSt.Mary’sECworksdiligentlytohaveanemergencyphysicianatthepatient’sbedsideassoonaspossibleaftertheyarrive.

“Wewantthebestcareforourpatients,”saidDr.HerbertMcReynolds,medicaldirectorofEmergencyServices.“Theearlierweseethem,thesoonerwecandeterminewhat’swrongandbegintreatmentquickly.Henotedthe

importanceoftimeespeciallyforpatientspresentingwithstrokesymptomsorchestpains.

CarondeletSt.Mary’sECisdoublecovered24/7byboard-certifiedemergencyphysiciansandmidlevelpractitioners(whoaveragemorethan15yearsofexperience)aswellasbyspecializedemergencynurses.Theyteamtoprovidetheinitialassessmentandemergencycareforpatientspresentingtothehospital’sPrimaryStrokeCenterandChestPainCenter.

AidingintheEC’sabilitytoproviderapidcareistheuseofnewtechnology,suchaslimitedbedsideultrasound—usedbymanyoftheemergencyphysiciansat St.Mary’stodiagnosisconditions—andvideolaryngoscopytoaidinairwayemergencies.

The newly renovated nurses’ station at St. Mary’s Emergency Center will assist in meeting the hospital’s long-standing commitment to see EC patients in 30 minutes or less.



Carondelet St. Mary’s: Arizona’s longest continuously operating hospital

St.Mary’sHospitalopeneditsdoorsinMay1880.NowCarondeletSt.Mary’s,itnotonlybroughtsincerecaretoTucsonandgraduatedacadreofnursesfromitsnursing

school;italsobroughtthelatestequipmentandadvancesindiseasemanagementandsurgerytotheOldPueblo.

Frompoliocaretoopen-heartsurgery,St.Mary’siswellknownforits“firsts”inTucsonandtheSouthwest.Itmightnotbethefirst Arizonahospital,butSt.Mary’sistheoldestArizonahospitalstillinoperation.

Surprisingly,though,itisn’teventhefirstArizonahospitalfoundedbytheSistersofSt.JosephofCarondelet.

ThePCMSHistoryCommitteehasresearchedArizonahospitalsoff-and-onfor20years.IthasfoundnoevidenceofahospitalwithinthepresentboundariesofArizonaduringtheSpanishorMexicaneras;indeed,an1858reportstatesthattherewereonlythreeMexicanphysiciansintheentirestateofSonora.

ThecommitteedeterminedtherewasahospitalforAmericantroopsatFortBuchanan,foundednearpresent-daySonoitaonoraboutMarch7,1857.Sick-callreportsfromtheforthavebeenexaminedinthestatearchivesthatsaytrooperssufferedfromavarietyoffevers,pains,wounds,andbrokenlimbs.

Dr.BernardJohnDowlingIrwinwasassignedtothefort.Dr.Irwin,whopublishedmedical,naturalhistory,andpresidentialreportswhilestationedthere,wasawardedthefirst(inchronology)MedalofHonorforleadingareliefexpeditiontoApachePass.TheposthospitalclosedwhentheCivilWarbrokeoutandFortBuchananwasabandoned.

WhenArizonabecameaU.S.Territoryin1863,oneofthenewTerritory’sfirstlawswasanordertocountiestocarefortheindigentsick.Thelawwasn’teasytoliveuptointhesparselysettledTerritory,accordingtoPCMSHistoryCommitteeChairmanJamesB.Klein,M.D.,whoseencyclopedicmemoryshinesbackintomostaspectsofArizona’spast.

YavapaiandPimacountiesoftencontractedorsharedspacewithArmyhospitalstocarefortheindigentatFortWhipplenearPrescott,orCampLowellinTucson,bothofwhichwerefoundedin1864.

“CampLowellwassouthofBroadwayandeastofScott,butthehospitalwaslocatedoutsideofthecampinacivilianbuilding,”Dr.Kleinsaid.“A[nearly]TucsonmaplocatedthemilitaryhospitalattheblockborderedbyAlamedaandCourt.”

WhenFortLowellwasestablishedatitscurrentlocationin1873,ahospitalwasbuiltandcontinuedtooperateuntilthefortclosedin1891.YoustillcanseetheremainsoftheposthospitalunderthecanopyatFortLowellPark.

Apartfromthemilitary,Dr.KleinnotedthattheUnitedStateswasinahospitalbuildingfrenzyaftertheCivilWar.TucsonwasnotimmuneandneitherwasPrescott.

In1878,twoyearsbeforeSt.Mary’sopened,theSistersofSt.

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JosephofCarondeletopenedPrescott’sfirstcivilianhospital.Thathospitalcaredforpayingpatients,primarilyminers,aswellasfortheindigent.Mostsourcesindicatethehospitalclosedin1883despitebeingprofitableandwellattended.

Inearly1879,BishopJ.B.SalpointebeganraisingmoneyforahospitalfromTucson’sbusinessleaders.TheBenevolentAssociationofSt.Mary’sHospitalwasestablishedandDr.MarianoSamaniego,whoalsotriedtostartaPimaCountyMedicalSocietythatsummer,servedastheassociation’svice-president.

InJuly1879,accordingtoMedicine in Territorial Arizona,Tucson’sCountyPhysicianDr.JohnC.Handyproposedusingabuildingherentedfor$10amonthasaspacetoprovideindigentandprisonercarefor$1.50perday.Amonthlater,Dr.HandyannouncedplansforahospitalthreemilesfromtownonFt.LowellRoadintocareforindigentandpayingpatients.The

hospitaldoesnotseemtohavebeenbuilt,althoughadobeswerepreparedandawelldug.

Ninemonthslater,St.Mary’sHospitalwasdedicatedonApril24,1880,andopeneditsdoorstopatientsonMay1.Dr.Handyservedasthefirstdoctor,assistedbytheSistersofSt.JosephofCarondelet.St.Mary’schargedthecounty$1perdayforindigentcare.Therailroadward,addedatSt.Mary’sinApril1881,helpedoffsettheexpenseofcaringfortheindigent.Therewereapproximately20sickandinjuredrailroademployeeseachmonthby1882.

Otherhospitalsintheterritoryhadfinancialproblems.

“Catholicsistersappearedtobetheonlyorganizationsthatcouldoperatehospitalssuccessfully,”reportedMedicine in Territorial Arizona,“doubtlessduetotheirdevotionandattendancewithoutsalary.”

Seven Sisters of St. Joseph of Carondelet journeyed for a month from St. Louis to reach Tucson in May 1870. Several pictured here were involved with the founding of a hospital in Prescott and St. Mary’s. Standing (from left) Sister Emmerentia Bonnefoy, Sister Euprasia Suchet, Sister Monica Corrigan, Sister Hyacinthe Blanc. Seated (from left) Sister Ambrosia Arnichaud, Sister Martha Peters, Sister Maxine Croissant.



Carondelet St. Mary’s consideredamong best for quality and safety

We know Tucson. We are Tucson.

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We are Tucson’s homegrown law firm providinglegal services for Southern Arizona since 1969. We can assist with all legal needs, from Business and Real Estate, to Bankruptcy, Family Law, Estates and Trusts, and Personal Injury.

Barry Kirschner is recognized as an AVPreeminent® attorney by his peers for his 30years of legal work in Tucson including as a partner at Waterfall Economidis since 2003. As a member of the firm’s Litigation PracticeGroup, Barry represents disabled persons whoseclaims have been denied or terminated by disability insurance carriers. Successful verdicts,settlements and administrative appeals comefrom knowing how to approach the problemeffectively with clear, convincing and honest medical assessments by treating physicians.When an insurance company inappropriatelyrelies on a doctor who has never seen thepatient, Barry supports the treating physician to ensure his or her opinion is not over ridden by the insurer.

Barry practices law with the conviction of a manwho has dedicated his life to helping others.Passion like that cannot be duplicated and is part of what makes Barry a preeminent lawyer.

InrecentyearsCarondeletSt.Mary’sHospitalhasestablisheditselfasoneofthisnation’sleadinghealthcarefacilities,receivingavastarrayofnationalawardsandacknowledgements.

TheJointCommissionnamedSt.Mary’saTop Performerin2012.Inits“AnnualReportonQualityandSafety2012,”thehospitalwasrecognizedforachievementsinthetreatmentofheartattacks,heartfailure,pneumonia,andstrokeaswellasthequalityofitssurgicalcare.Inaddition,ithasbeendesignatedasaJointCommission-certifiedPrimaryStrokeCentersince2010.

TheAmericanHeart/AmericanStrokeAssociationalsoawardedthehospitalitsStroke Gold-Plus Quality AchievementandHeart Failure Gold Quality Achievement awardsineachofthelasttwoyears.

Byfar,oneofthehospital’smostsignificantawardscomesfromHealthgrades®,whichhasnamedthewestsidecampusaDistinguished Hospital for Clinical Excellencethreeyearsinarow(2011,2012,and2013).ThisplacesSt.Mary’samongthetopfivepercentofhospitalsnationwide.HealthgradesalsonamedSt.Mary’saDistinguished Hospital for Critical Carein2012.Thehospitalreceivedfive-starratingsfromHealthgradesinthecategoriesof:➢ Heartattacks➢ Heartfailure➢ Stroke➢ Sepsis➢ Pneumonia➢ Bowelobstructions

Other notable achievements and accreditations include:

➢ Inpatient Rehabilitation Unit named a 2012 Top Performer by Uniform Data System.

➢ Named Top Performing Hospital in the Midas+Platinum Quality Ward in 2011.

➢ Ranked tenth in Arizona for neurosciences (2012).

➢ Designation as a Chest Pain Center by the Society for Chest Pain Centers.

➢ Recognized as a Cardiac Arrest Center by the Arizona Department of Health Services, Bureau of EMS and Trauma Systems since 2009.


Tucson Heart Hospital 1997-2012: An obituaryByCharlesKatzenberg,M.D.

PCMSPresident

OnNov.7,2012,TucsonHeartHospitalpassedawayquietlyafteraprolongedboutofacommunityacquired,iatrogenic,self-inflicted,recurrent,andrelapsingillness.

1996:IaminaprivatejetwithseveralotherdocsandexecsfromMedCathCorp.headingforMcAllen,Texastotouroneofthecountry’sfirsthearthospitals.Thetrip’smissionwastosee,askquestionsandformulateideaswecouldincorporateintotheformativeTucsonHeartHospital.BythetimeTHHopenedwehadcollaboratedwithMedCathonphysicaldesign,cathlabequipment,monitors,andevenweighedinonthehospitalmenu.

October1997:THHopens,withmuchexcitementamongstaffandphysicians,inaconflictedTucson,whereexistinghospitalsalljoinedinthemantraof“Wedon’tneedmorehospitalbeds,”acontroversyreflectedinthismagazine’spagesandelsewhere.

Why was THH built?➢ Anentrepreneurialcompany,Charlotte,N.C.-basedMedCath

presentedagroupofTucsoncardiologistswithavisionofbuildingastate-of-the-art,60-bedfacilitydedicatedtopatient-focusedcardiovascularcare.

➢ Physicianswereofferedownership,partnership,andaplaceatthetablewheredecisionsweremadeonstaff,supplies,policies,andprocedures

➢ Tucson,withtheexceptionofUniversityMedicalCenter,wasexperiencingcardiacsurgerymortalityinexcessoftwicethenationalaverages.Fivehospitalsweredividingup1300casesperyear.

➢ MedCath’spro-formapredictedprofitabilitywithacensusofabout35patients.

THHopenedwithgreatfanfareandsometerror.Wehadplannedtodotwocasesondayone,oneatatime,sowecoulddebriefbetweencasesintheeventofproblems.Buttwosurgeonsinsistedondoingthefirstcase,sothefirsttwoTHHsurgeriesweredonesimultaneously,startingandfinishingwithinminutesofeachother.Everythingwentwell…whew…

Thenrealitysetin.THHopenedwithoutahelipad.Despitemuchplanningandlobbying,itnevergotahelipad.ThislimitedTHH’sabilitytodrawpatientsfromSouthernArizona.

Andpatients,theydidnotmiraculouslyappear.TheEDsupplied<15%ofadmits,andtheremaining85%weredirectedinbystaffphysicians.AnypatientcomingtoTHHrepresentedlossofmarketsharebyotherTucsonhospitalsandmanycardiologistswerecaughtintheconflictsofloyaltywiththeirprimaryinstitutions.Somehospitalslimitedcardiologist’sprivileges,somethreatenedinsurancecompanieswithhigherratesiftheycontractedwithTHH,andallhospitalsgrumbled.

Nevertheless,withintwoyearsofTHHopening,StMary’s,StJoseph’sandElDoradohadallretiredtheirheartsurgeryprograms.

By2001thingswerelookinggoodforTHH,butaswithmanyhospitals,THHexperiencedhighturnoveroftopmanagement.InthefirsteightyearswehadfiveCEOs,andthefirstdidnotevenmakeittoopeningday.Thisdidnotbodewell.

Themiddleyearssawprofitablemonthsinthewinterandlossesinthesummer.Right-sizedstaffingwasacontinualchallenge.Outcomesweregood,oftenbetterthannationalnorms.Patientsatisfactionwashigh.Physiciansenjoyedeaseofschedulingandappreciatedflexiblehoursfordoingprocedures.Administratorsofferedopen-doorpolicies.Thestaffwaswelltrainedandenjoyedthework.Caseloadsofbothcardiacandvascularsurgerywereincreasing.

In2004-2005,CarondeletHealthNetworkshowedinterestinTHH.OverseveralyearsCHNpurchasedownershipfromphysiciansandMedCath.In2007,THHbecamepartoftheCarondeletHealthNetwork.

TheCHNtakeoverdidnotoccurinavacuum.TMCcreatedaservicelineagreementwithcardiologists,whileNWHwashiringcardiologistsandacardiacsurgeon.CHNalsohiredcardiologistsandemployedseveralheartsurgeons.TheTHHcoreofcardiologysupporterswasshrinking.Thentherecessionhit,puttingadentinhospitalbusinessandincreasinguncompensatedcare.

In2009THHwasrenamedtheCarondeletHeartandVascularInstitute(CHVI)andalast-ditchattemptwasmadetopulltherabbitoutofthehat.TwelvecardiologistschosenbyCHNwereofferedavaguelyoutlinedco-managementopportunity.Therewasinterestonthepartofmostofthecardiologists,butCHNbackedawayfrompartneringwithcardiologists.

In2011CHNbroughtinanewCEOwhoraisedthequestionofCHVIviability.Aftersixmonthsofintensediscussion,CHN’sboardelectedtocloseCHVIandmoveittotheStMary’scampus.Thelastmonthwassadandemotional.OnNov.7,2012,thefacility’sdoorswereclosed.

Anautopsywasnotrequested,butpostmortemanalysisrevealsseverallessons:

➢ Itisdifficultforanorganization/institutiontobesuccessfulinthefaceofhighlevelsoftopmanagementturnover.

➢ Hospitals/organizationsworkingwithphysicianscancreatesomethingstrongerthantheindividualparts.

➢ Highqualityisessential,butnotsufficientforasuccessfulprogram.

➢ Relationship,trust,transparency,andcommunicationarecriticalingredientstosuccess.

TheLegacyoftheTucsonHeartHospitalisthatevenbeforeitopened,cardiaccareinTucsonwasimproving.THHmadeeveryonebetter.

RIP,THH1997-2012.THHissurvivedbytheCHVI,onthecampusofCarondeletStMary’sHospital.

Disclaimer:IwasTHH’smedicaldirector1997-2004. n

SOMBRERO – February 2013 27 YEARS OF CARE


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