Local hospital provides state-of-the-art care

Most of us who call Globe-Miami home would agree that you don’t have have to live in a big city, or have a big house or even have a big bank account to live a good life. We value our small, rural life and the size of our community and most wouldn’t trade places with ‘the Valley” if you asked us. That is until it comes to healthcare. That’s when we have it in our head that bigger just might be better.

So I took a day to go behind the scenes and share some insights which might change the way you look at the healthcare you can get right here at home. I spoke with nursing, got a tour of the lab, observed a surgery, visited with the CEO and ended my day in ER. And while this is far from a complete look at the Center, it does show a hospital which is growing and looking towards the future.

My day begins with Rose Ann Garcia, who now serves as Chief Nursing Officer at the Center.

She came from one of those large, well-respected hospitals, where she spent a decade as Director of Patient Services at Tucson Medical Center. She speaks from experience when she says it is a complete myth to believe that this Center is not equal to what larger facilities offer. People she tours at the hospital are amazed at what they find here she tells me.

State of the Art Equipment

“Our equipment is truly state-of-the-art,” Garcia says. “Our staff is very good and we pay very competitive rates – similar to the Valley – to attract good people. And I tell my nurses they will have more opportunities to grow here than in a larger hospital where they will likely be pigeon-holed into one department.”

Garcia planned to retire when she left Tucson when she ran into one of her former nurses who talked her into considering Globe and Cobre Valley. She may have thought it would be a step towards retirement. Everyone thinks that when “downsizing” to a small community right? Instead she is putting in long days again as Chief Nursing Officer and is actively involved in long range planning for the hospital.

“We are a fairly flat organization, so we are given the ability to make decisions and move on them,” she says. One program she has helped to spearhead is the Center’s Nurse Residency program. This is a sizable commitment by the hospital, but with a big payoff according to Garcia. She credits CEO, Neal Jensen and CFO, Jim Childers for funding the program, estimated to cost a quarter of a million dollars, and for embracing its role in developing a solid core of nursing skills within the hospital.  The 15-month program which will provide extensive hands on training in multiple departments, is in stark contrast to the more traditional four to six weeks training with a preceptor common in most hospitals. Yet, the basics leave many new hires feeling overwhelmed and under qualified for the demands of the job and the national dropout rate for new nurses is high.

Compounding problems for new nurses is a saturated market of new grads where we are turning out twice as many graduates from nursing schools than we did ten years ago.

The job opportunities are fewer because older nurses are not retiring as expected thanks to the financial meltdown of 2008. Most hospitals will not hire nurses with less than two years experience, requiring new grads to seek on the job training at nursing homes or other healthcare facilities before finding a career path with a hospital.

Trish Wurl, who was working the floor the morning I was there, came to Globe as a registry nurse for a short term contract and later accepted a permanent position with CVRMC this year. She spent nearly ten years working in Behavioral Health, and after being laid off twice in one year decided to put her money into nursing school at Mesa Community College. She got her experience working for a corrections facility, but said she had applied everywhere in the state before finding that job. She is one of the lucky ones and her investment in nursing is beginning to pay off.

Lab Work is Everything

“You know,” Stewart deadpans,” some people might say that without the lab…docs are only guessing.”

She checks to see if I write that down. I did. She smiles. She shows me around the lab, which includes the blood bank, a chemistry lab, microbiology, coagulation and urinalysis. It’s pretty geeky stuff, but important. I get it. We find ourselves over in Alison Riddle’s section where most blood work is done. She runs forty to sixty tests per day and points out the newest piece of equipment which can process coagulation tests in three minutes instead of the fifteen minutes it used to take. At a cost of $50,000 I ask about the return on investment.  Stewart points out that quicker results mean less waiting.  I am reminded that having state-of-the-art equipment is not just a phrase, it’s about a patient waiting for blood work.

Stewart, who is a 24-year veteran of running labs for the military, retired last year from the Air Force and took the position here to head up our lab. She likes the warmer climate and small town atmosphere and she loves the job. The center’s lab has been CAP accredited since 2011, which puts it in an exclusive group that numbers just 7,000 worldwide. The process to get accredited is voluntary, but if one chooses to submit to the process it means you are inviting a rigorous litmus test to your operation. If you pass, it’s only right that you get to boast about it.

Taking A Good Look Inside

When I visit the Imaging Department, they are in the middle of installing a new piece of equipment, which is the definition of high tech. The capabilities of the new Digital Mammography machine has been described by one writer, this way:

“ The standard mammogram is like looking for a bird by standing on the edge of the forest looking in. Digital Mammography is like walking into that forest ten steps at a time and looking around you at each location.” The new machine shows more detail, uses less radiation and allows the radiologist to manipulate the images which is not possible on film. All serve to make mammograms more patient and staff friendly besides providing better diagnostics.

I asked Jensen, why replace a piece of equipment if the old one is still working?  While there are many considerations which go into an

Surgery Made Easy

Over in surgery, my hosts were kind enough to heed my request for a simple surgery to observe, ie; one with little blood or drama. Suiting up with the surgery crew I felt ready for a moon walk. And walking into the surgery bay made me think of NASA. A tad intimidating. Luckily I was scheduled with Dr.Jody Daggett, who has practiced here for over thirty years, and his patient, a charming Mrs. Smyers whose pluck and pleasantness lying in the hospital bed reminded me of my own mother who also had to put up with the inconveniences of fragile bones as she got older.

As a surgeon, Dr. Daggett has an uncanny knack with all of his patients, and if he ever operates on you once, you’ll want to bring your mother, son, daughter or cousin to him in the future.

He has operated on almost every member of the Smyer family at one time or other, and it’s not unusual to find three generations in one family who have been mended by the guy. I realize this is rare in bigger hospitals where people move through the system and don’t return. But here that’s the way it is more often than not.

The surgery to remove some pins in her ankle goes smoothly. Daggett talks to me about the new C-arm X-ray machine he uses which is one of those new purchases which use much less radiation. Surgeons and their staff can perform on average three to five surgeries a day here, so the radiation levels from these machines add up quickly.

Assisting with the surgery is Stuart Shellenberger, Certified Nurse Anesthetist who has known Mrs. Smyers since he was a boy. Due to the nature of this surgery, only a local anesthesia is used to to numb the leg and the patient is awake through the whole procedure. Stuart sits at her head monitoring the progress and swaps family stories with Mrs. Smyers thereby keeping her mind off the surgery. Soon, Daggett is wrapping up and they are wheeling her out of the room. She smiles up at the nurse and asks if they are really done. “Why that was so easy,” she says. “I don’t know why I was ever worried about it.”

My sentiments exactly.

Why Offer Five Meds When You Can Offer One?

My next stop is to the hospital’s pharmacy. I realize I’ve never been here before. Like many hospital pharmacies this one primarily exists to serve the staff and patients at the hospital, fulfilling over 1500 prescriptions a month. Here at the center they also maintain a Retail Pharmacy, which has traditionally served the needs of retired mine families whose healthcare coverage carried over when the mines turned the hospital over to the community decades ago. It is now expanding to reach all the people in need of pharmaceuticals in their service region.

In the pharmacy I get the sense that it is not so much about technology as it is efficiency, although when Jake Albin, the new director, took over in December of 2009, the first thing he did was install a new automated system of tracking, dispensing and charging for patient meds. But something else he did to improve his department, which is also paying off in a big way, was more low tech. He used common sense instead of a computer.

He developed a formulary. This is a list of drugs which a pharmacy agrees to carry. It helps to streamline inventory and reduce redundancies by drawing upon research to determine and rate comparable drugs. Take for instance medication for acid reflux. There are five medications which are often prescribed for this condition and the Pharmacy was stocking all five. With a formulary, you identify the one which makes the most sense to stock, and most times that is a generic if one is available.  Generics are saving both patients and pharmacies big money. Recently a well-known brand name drug went generic – going from thirteen dollars per pill to three cents per pill.

“We will save nearly $80,000 a year on that one drug alone,” Albin says. “Of course our biggest savings will come from the 340B program.”

The little known program to which he refers has been around since 1992, but wasn’t available to hospitals like ours until the Affordable Care Act went into effect in 2010, that’s when the federal government included hospitals which are the sole provider and safety net to those who would otherwise not have access to health care.

The program makes it possible for the hospital to save nearly twenty five to thirty percent on all drug purchases, which will translate into an eight hundred million dollars savings this year alone. 

The Changing Face of ER

It is late in the afternoon when I finally head over to the ER. Usually things are beginning to get busy about now, but it is a rare afternoon of quiet. The acting Director Linda Hart visits with me in the hallway. She is a veteran of ERs and hospital administration and has been brought in on a temporary assignment while the hospital searches for someone to fill the position permanently.

“I’ve been around so long that I remember when they used to call this the accident room,” she says.

We talk about the challenges of today’s ER. In 1986 Congress passed the Emergency Treatment and Labor Act which gives individuals the right to emergency care regardless of their ability to pay. An emergency is defined as something that, in the absence of immediate medical attention, could result in serious impairment or threat to life. While the purpose of the law was to create a safety net, it also served to create sort of a dumping ground.

Emergency Rooms across the country have become an amalgamation of the family physician, emergency response team and social service agency all rolled into one.

The ER docs here rotate on 12 hours shifts and within one rotation might be asked to treat everything from trauma cases to mental cases and the common cold to cardiac arrest.  Each case must be assessed and ‘stabilized.’  In larger urban areas, the waiting rooms overflow with cases each day and the nationally the average wait is between four and five hours. Here, the center handles about 15,000 cases a year and the average wait is about two hours.

It is now after five and time for me to head home from my ten hour day ‘behind the scenes’.

I think of the seven blind men trying to describe an elephant and know that any description will fall short of the whole animal. But what I take away is a sense that our hospital is big in the ways that matter in providing good healthcare; state-of-the-art equipment, progressive management and a solid vision for navigating the future. Yet small in the ways that matter to community; sharing history, family ties and a sense of connection. Collectively they blend together to make Cobre Valley Regional Medical Center one of our most important social and economic hubs, and one we can depend on to be here in the future.

Linda Gross

Writer, photographer. Passionate foodie, lover of good books and storytelling. Lives in Globe. Plays in the historic district. Travels when possible.