Rogelio Lopez, who has been hospitalized for more than a year, had just one birthday wish.
He wanted to see his four children, ages 6, 9, 11 and 13, in person.
So, last Thursday, after intensive planning by his team of caregivers, Lopez was placed on a portable ventilator and wheeled on a hospital bed from Tower 6 to the main entrance of UC Davis Medical Center. There he enjoyed a tearful reunion with his kids.
Roughly 15 additional family members joined in the festivity, including his siblings and nephews. And to add to the party atmosphere, a mariachi ensemble played celebratory songs in honor of Lopez, who turned 38.
“Rogelio smiled as his four kids caressed and hugged him, as it had been more than a year since they had seen their father, all together, in person,” said Yesenia Ramos, a UC Davis resident physician who serves on a team of doctors training to care for patients in urban, underserved aeras. “The doctors, nurses, respiratory therapists and others tearfully watched this touching reunion.”
Dayshift Assistant Nurse Manager Ashley Dotger, a go-between for the family and staff, called the celebration a gratifying experience for nurses.
“I think the nurses on Tower 6 med-surg take great pride in being able to give great care to those who have extended stays,” she said. “It is humbling to be a part of somebody’s life when they’re struggling.”
In video filmed by Ramos, Lopez appears on his bed with a colorful, striped blanket covering his legs, while being escorted outside by six staffers wearing face shields. They reunite him with his family where the assembled mariachis, heavy on trumpets, play “Las Mañanitas,” a popular birthday song. Lopez’ older family members surround the bed while children holding “Happy Birthday” balloons greet their dad, one by one.
Lopez has been unable to speak but his sister, Lourdes Lopez, who coordinated the event for the family, said her brother deeply appreciated the celebration.
“It was incredible and emotional to see him laugh,” she said. “The kids didn’t want to leave, the time seemed really short to them,” she added.
Lopez’s medical ordeal began in December 2020 when he returned from vacation in Mexico and showed up at the Sacramento County Health Centercomplaining of puffy legs, a swollen stomach and shortness of breath.
“He was hoping to get better with just medication,” recalled Lisandra Franco, a primary care doctor who also is an attending physician to the medical center’s residents in the TEACH program, or Transforming Education and Community Health.
She knew better.
Because Lopez had diabetes and worsening kidney problems, Franco sent him to the emergency room. Within days of being admitted, Lopez started dialysis. Then he contracted COVID-19 pneumonia requiring intubation, developed bacteremia, had heart valve surgery, suffered a heart attack, encountered lung problems, a gastrointestinal bleed and multiple other health issues that are not easy to solve.
“He’s definitely gone through a lot of challenges while he’s been in the hospital,” Franco said. “He’s still trying to get better every day for his children, and it’s really touching to see that.”
When caregivers met with Lopez over the summer to discuss his uncertain prognosis, they learned about how much he missed his children, who haven’t all been able to visit together due to COVID-19 restrictions. Lopez, who is estranged from his wife, told his care team that if he was still hospitalized on Dec. 30, he wanted to spend part of his birthday with his children.
Lourdes Lopez, who visits her brother’s bedside every evening, envisioned a birthday celebration. She shared her idea with her siblings, one of whom suggested they hire mariachis like Mexican families do for weddings and other life milestones. Unfortunately, the brother who suggested mariachis was unable to see his plan come to fruition – Lourdes Lopez said he died from COVID-19 not long after.
Pulling off the celebration was a well-orchestrated collaboration involving physicians, nurses, respiratory therapists, language interpreters, a transportation team, child life specialists, social workers and administrators.
“This simple transport outside takes a team approach, an attribute which UC Davis does exceptionally well,” explained Dotger in an email to other nurses and leaders before the event. “We are very excited to make this possibility for this long-term patient.”
Franco, the attending physician, said Lopez is the kind of patient that doctors and staff will never forget.
“It feels really good to be able to work at a place like UC Davis,” Franco said. “Obviously, medical treatment is one of the important aspects of patient care, but you can’t forget the human part of medicine, which is treating each patient with empathy and respect. UC Davis really focuses on that aspect of patient care.”
As
New York state climbs the steep face of its COVID-19 curve, Gov.
Andrew Cuomo (D) issued
an executive order vastly
widening the scope of practice for some healthcare providers and
absolving physicians of certain risks and responsibilities.
Among
the order’s provisions:
Eliminating physician supervision of physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthetists, and others
Enabling foreign medical graduates with at least a year of graduate medical education to care for patients
Allowing emergency medical services personnel to operate under the orders of NPs, PAs, and paramedics
Allowing medical students to practice without a clinical affiliation agreement, and lifting 80-hour weekly work limits for residents
Granting providers immunity from civil liability for injury or death
Suspending usual record-keeping requirements
Allowing several types of healthcare professionals — including NPs, PAs, nurses, respiratory therapists, and radiology techs — with licenses in other states to practice in New York. However, physicians were not specifically included in the order, as the Department of Health and Human Services has not yet issued the necessary regulation
Suspending or revoking hospitals’ operating certificates if they don’t halt elective surgeries
The
order, which remains in place through at least April 22, was met
mostly with applause, though with some hesitation around work-hour
limits.
C.
Michael Gibson, MD, of Harvard, called it “stunning in both the
breadth and depth of recommendations” on
Twitter.
Shariq
Shamim, MD, described it as a “great move,” with the
exception that trainee work hour limits shouldn’t be scrapped: “They
are already working equivalent to 2 [full-time employees] without
Chinese-style PPE. More hours = more risk of exposure,” he
tweeted.
Art
Gianelli, president of Mount Sinai Morningside hospital in New York
City, told MedPage
Today that
his team is “grateful to the governor for throwing the
regulations out the window right now. He’s encouraging us and
enabling us to do what we have to do to get through this. It’s the
right thing to do.”
John
Puskas, MD, chair of cardiovascular surgery at Mount Sinai
Morningside, agreed that the steps are the right ones given that New
York City “hasn’t flattened the curve adequately to avoid a big
wave crashing. We’re really going to feel it in the next 2 or 3
weeks.”
“If
simultaneously with that, we lost a meaningful number of healthcare
providers to home quarantine, then we’d have a shortage not just of
ventilators, but of people to run them and care for patients,”
Puskas said.
by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today
The Clemson University School of Nursing recently received a $5,000 scholarship from the CVS Health Foundation to assist students in their studies to become family nurse practitioners. CVS’s grant is part of the new Advance Practice Nurse and Physician Assistant Scholarship program which launched this year.
The program is aimed at reducing the nationwide shortage of family nurse practitioners and physician assistants by supporting these promising future health care professionals. Scholarships will be provided to accredited academic institutions around the nation to be distributed to family nurse practitioner and physician assistant students for covering costs of tuition, books, and other academic fees.
Clemson is thankful for the scholarship funds which will go towards helping deserving students become excellent family nurse practitioners. Eileen Howard Boone, president of the CVS Health Foundation, credits the scholarship as one of many steps that the foundation is taking to increase the number of qualified healthcare professionals in South Carolina and around the nation. Boone tells The Newsstand at Clemson.edu,
“We know how important having a strong pipeline of family nurse practitioners and physician assistants is to making high-quality, convenient and affordable health care services more accessible. We’re proud to support schools like the Clemson University School of Nursing who are providing quality education to students pursuing a career as a family nurse practitioner.”
The scholarship will be awarded to students in good academic standing who are pursuing advanced practice nursing master’s degrees, doctorate family nurse practitioner degrees, or master’s degrees as a physician’s assistant. Scholarship recipients are also required to intern or volunteer with an organization supporting underserved populations, and at least 25 percent of the scholarship funds will be awarded to bilingual students.
A recent proposal from the Obama administration seeks to lift a ban that prevents physician assistants (PAs) and nurse practitioners (NPs) from providing home care to Medicare patients. In anarticlefrom Forbes contributor Bruce Japsen,Japsen explains that the current ruling limits access to care provided by PAs and NPs, resulting in more expensive treatment in nursing facilities and other inpatient care centers. PAs and NPs are working hard to earn full practice authority within the scope of their education, including writing proposals that would allow them direct access to patients across all states and expanded roles within Veterans Affairs facilities. The Obama administration views PAs and NPs as a crucial part of expanding the number of primary care providers nationwide, especially in certain areas where primary care providers are in shorter supply.
Following the lead of the Obama administration, the Centers for Medicare & Medicaid Services (CMS) published aproposalto amend a rule from the Program of All InclusiveCare for the Elderly, a program called PACE, designed to help provide home care access to senior Medicare patients and poor Americans covered by Medicaid. If implemented, the proposal could allow Medicare reimbursement to primary care providers who treat Medicare/Medicaid patients within the year.
CMS wants to see the PACE program used to its full potential and suggests expanding reimbursement to NPs and PAs as a way to increase access and lower costs. According to theNew York Times, only 40,000 seniors were enrolled in PACE as of January 2016 and CMS wants to grow that number and expand the PACE program.
Due to population growth, aging, and expanded health insurance, demand for primary care is expected to continue rising. The Health Resources and Services Administration (HRSA) predicts there will be a primary care physician shortage of 20,400 by 2020. However, the Institute of Medicine (IOM) notes that this projection does not consider the potential that PAs and NPs have on increasing access to primary care.
According to Andy Slavitt who runs ablogon the CMS website, team-based models like PACE which put the individual in the center are a vital part of the fabric of our healthcare system. Since the Affordable Care Act was passed six years ago, CMS has been taking significant steps to care for more people with better and more affordable health care. However, in order for these models to be successful, every member of the health care team will have to work together to find and implement new approaches to care.
PAs and NPs are petitioning to be a part of PACE, arguing that providing care in the home benefits PAs and the country’s aging population. President of the American Academy of Physician Assistants (AAPA), Josanne Pagel, believes in the ability of the PACE program to provide comfortable and convenient high-quality healthcare to elderly patients in their homes at a lower cost than hospital stays and nursing homes.
The proposed rule from the Obama administration redefines the meaning of a primary care provider. Adding PAs and NPs under the blanket of primary care provider could allow for more cost-effective care, especially in rural zones and areas with high labor costs.
