Sue Fitzsimons, RN, Ph.D.
Senior Vice President of Patient Services
Yale-New Haven Hospital
How Sue Fitzsimons helped set the bar higher for YNHH nursing
On May 24, 200 nurses assembled in a Yale-New Haven Hospital auditorium to listen to a live phone call from Craig Luzinski, director of the American Nurses Credentialing Center’s Magnet Recognition Program. They were about to learn whether five years of efforts to improve the status of nurses at the hospital would result in Magnet designation for high-quality nursing.
After Luzinski uttered the word “Congratulations,” screams and cheers drowned out the rest of his comments. Among those savoring the moment was Sue Fitzsimons, the hospital’s senior vice president of patient services –– and the driving force behind the extraordinary feat.
“Sue was the visionary leader who persuaded us to go for it,” says Yale New Haven Health System Executive Vice President and COO Richard D'Aquila. “Under her leadership the hospital, after a long and difficult process, was able to achieve what only about six percent of hospitals achieve.”
Just 391 hospitals in the world are Magnet designated. All but five are in the U.S.
Connecticut has two: YNNH and Middlesex Hospital.
The Magnet program “recognizes the quality of your nursing staff,” Fitzsimons says, “but the hospital is designated because the nurse can’t work in an environment where the hospital doesn’t support 88 standards across four domains.”
To achieve Magnet designation, the nursing staff must excel in areas including transformational leadership, exemplary professional practice, new knowledge, innovations and improvements and empirical quality outcomes.
The application form is daunting. “It is 15 volumes weighing over 40 pounds,” says
Fitzsimons, who grew up on Long Island and earned a BSN at Cornell in 1968 and a master’s in nursing at New York University in 1974. After working as a staff nurse at New York Hospital and Long Island Jewish Hospital and as an instructor of nursing at Queensboro Community College, she moved to Ohio, where she completed a Ph.D. in education at the University of Dayton in 1983.
Fitzsimons spent the next two decades in the Buckeye State, teaching nursing at two universities, honing her administrative skills as senior vice president of hospital operations at Miami Valley Hospital in Dayton and earning accolades and awards.
“I was recruited in 1997 to become the chief nursing officer and senior vice president for patient services at Yale-New Haven Hospital,” says Fitzsimons, who today oversees a nursing staff of some 2,800.
Fitzsimons already had some experience with the Magnet Recognition Program at Miami Valley Hospital, where she was seeking Magnet designation. “We were not fully there when I left Dayton,” she says. “When I came here I had multiple conversations about it with [YNNH President and CEO] Marna [Borgstrom], and the conversation continued with her and Rick D'Aquila.
“You don’t do this in a silo,” she adds. “The entire organization needed to be involved, and we actually hired a staff. I have a Magnet coordinator, who is a full-time nurse who spends her day thinking about this, a project coordinator and two consultants to ensure that our interpretation of the standards was correct.
“For five years, we looked at what’s the best way to do it and visited places that had been successful,” Fitzsimons says.
That’s not unusually long, according to Luzinski.
“We call it a journey, which results in the transformation of an organization into one that can address and meet all the criteria,” he says. “It takes time to innovate and change the culture and put infrastructure in place where nurses have a voice.”
The process, Luzinski adds, typically requires a leader with “the energy and tenacity” to succeed.
Even though Fitzsimons possesses those qualities, D’Aqulia says, he was “a little worried about Magnet.
“It was a great aspiration but it was a very heavy lift,” he says. “I had my doubts that we could meet the requirements, which were very stringent. My biggest fear is that we would get really close and not get it. And that would be demoralizing.”
One requirement, transformational leadership, dealt with “how the organization supports leadership, mentorship and successor planning for nurse leaders,” Fitzsimons explains. “We had to describe and demonstrate with data or examples over time that this organization had achieved this. Right from the beginning, I began an education of the organization and tempered the message for different employee groups to explain what transformational leadership is, why do you do it, why it is important and what will it take to get there.”
But once each group, including physicians and admitting staff, understood its role in supporting nurses, “The light bulb went off,” Fitzsimons says.
“When you start out, you’re a novice at it and the staff are not sophisticated,” she adds. “You work and evolve with them and become experts over time. Once you reach maturity you have a well-honed machine for staff engagement that results in staff who are committed, with less turnover.”
The process required continuous oversight and feedback.
“As we got close to document submission and knew we would get visited, it had to be a large educational effort involving the entire organization,” Fitzsimons says.
The hospital filed the Magnet application on August 2, 2010. As part of the review, examiners spent four days at YNNH, from March 29 to April 1, 2011, interviewing more than 300 nurses and meeting with other medical staff and community members.
Then began the waiting game.
“I’ve never been so anxious, and I’m usually pretty cool,” Fitzsimons says.
Relief came on May 24, 2011, with the confirmation of Magnet designation.
“I’ve had a long career and there are things I’m proud of but this is right up there,” Fitzsimons says. “I feel I have created a legacy, which is a really nice feeling, and it has improved patient outcomes, led to all sort of opportunities for nurses, and really elevates your nursing staff to get the recognition it deserves.”
Fitzsimons is not resting on her laurels.
“In four years we will apply for redesignation,” she says. “I brought the team together the day after [Luzinski’s phone call] and told them as challenging as it was to get to this point, redesignation is more challenging and now is the time to start planning.
“They were like, ‘We need a break.’
“And I said, ‘Well, that’s too bad.’”
Hospital of Saint Raphael
An HSR nurse at the forefront of a movement to make lifesaving defibrillators much more widely available
Working as a cardiac nurse has given Sherri Hopkins the chance to see a lot of miracles. But there’s also the other end of the spectrum.
“We see things sometimes when it’s too late,” says Hopkins of patients suffering from cardiac arrest who cannot be saved.
Hopkins, who works as a registered nurse at the Hospital of Saint Raphael, wants to increase such patients’ chances of surviving heart trauma. She has been on a crusade the past few years, educating patients and the public alike on the life-saving benefits of automatic external defibrillators (AEDs).
“For every minute that goes by without CPR [cardiopulmonary resuscitation] or the shock of an AED, your chances of survival goes down by ten percent,” Hopkins explains. “The faster you apply an AED, the better the chance of survival is.” She adds that even for survivors, the longer the time span between the onset of an attack and eventual resuscitation, the greater the chance that heart and/or brain damage will occur. “It’s irreversible — you can’t get that back,” says Hopkins.
An AED is an electronic device that assesses the immediate need of a person suffering from cardiac arrest and delivers a shock, or a series of shocks, as required. Instructive prompts guide the person administering the device on steps to take in using the device.
Immediate access is key, says Hopkins. “The goal is to get an AED on a person within the first three minutes.”
That’s why Hopkins has been advocating for installation on AEDs in public places, including offices and schools. A cofounder of the Connecticut chapter of the Sudden Cardiac Arrest Association (SCAA), she has testified before the state legislature in Hartford about public need for the devices.
“My inspiration is a 17-year-old I met [there] who had been saved by an AED,” says Hopkins. The teen inspired Hopkins to push even harder in her quest to make AEDs accessible in schools. With teens, previously undetected cardiac problems can become manifest during athletic practices and events, she adds.
Hopkins also wants to create a formal network of Connecticut-based cardiac arrest survivors, especially those who were resuscitated with AEDs. She believes not only that they can serve as an extended support system, but also help educate the public about the importance of AEDs.
Hopkins personally spends a lot of time doing just that.
“Now that I’m a nurse, my favorite thing to do is teaching patients. I believe that if patients are educated, that will help them stay out of the hospital,” she says.
Though sure about her mission now, Hopkins, 39, didn’t always know she was destined for a career in health care. She jokes that she settled on nursing by process of elimination.
“I went to Derby High School. One day my high school guidance counselor said, ‘What do you want to be?’” recalls Hopkins, a Derby native. She perused a list that included choices such as accounting, social work and psychology, as well as nursing. She made a mental note of the careers she did not want (accounting was definitely out) leaving the possibilities, nursing among them.
“I always wanted to help people,” she says, “and I enjoy the sciences.”
After making the decision, Hopkins prepared for a career in health care. She studied nursing at American International College in Springfield, Mass., and decided to specialize in cardiac nursing.
“I just find the heart fascinating,” she says, noting that the life-sustaining organ often is taken for granted. “We don’t think about it. We don’t think about how our hearts beat. I’m fascinated by the heart and what it does — the function of its muscles.”
She’s been at St. Raphael’s since 1993, working first as a CNA/student nurse. Two years later she joined the staff as an RN. Her dedication over the years has made her the most recent recipient of the hospital’s Nurse of the Year Award.
“I love the St. Raphael community,” Hopkins says. “I think they have something special there. It doesn’t feel corporate. It doesn’t have that sterile feel to it.”
Hopkins’ supervisor, Sharon Wood, RN, describes Hopkins as a “motivator.
“She just is a doer,” says Wood, who is HSR’s manager of nursing resources. “She was always the one to get everybody motivated, so it didn’t surprise me when she got involved with the school system” to encourage AED acquisition. What’s more, says Wood, “It doesn’t surprise me she is now getting this [BNH Healthcare Hero] honor. Whenever I need something done, she’s my go-to person. She’s wonderful, and has a lot of energy. She inspires me to do more.”
Wood adds that the BNH and other outside honors, along with the hospital’s own recognition of Hopkins, may well lead to even greater responsibility and leadership roles. “Some day she’ll make a wonderful [hospital] official,” predicts Wood.
Hopkins lives in Naugatuck with her husband Peter and their children, boys aged 12 and ten and nine-year-old twin girls. That brood provides an added incentive for speaking to parent groups about the importance of having AEDs in schools.
“Think of the time it could take for 911 to get there,” says Hopkins, adding that not all law-enforcement vehicles are equipped with AEDs in case of an emergency. Hopkins notes that Good Samaritan laws cover AEDs, releasing from liability anyone who might be reluctant to use the device for fear of being sued for inadvertent mishaps.
As Hopkins focuses, through SCAA, on enlisting others to discuss how an AED saved their lives, she’s intent on expanding the Connecticut chapter. “We’re searching for survivors and heroes,” she says, “or even if they’ve lost somebody to cardiac arrest. One woman in the chapter was instrumental in getting AEDs in airlines. Her husband died in-flight [after suffering from cardiac arrest]. They had nothing for him and he died. She wants to do something — she feels driven to do something about it.”
Whether in offices, schools or other public places, Hopkins plans to continue getting the word out about how important it is to have AEDs readily available on the premises to increase the chances of surviving cardiac arrest.
“It’s the leading cause of death; 300,000 people a year die from cardiac arrest,” says Hopkins. When [a person dies from cardiac arrest] there’s a chain reaction. Somebody’s life will get changed. When you really think about it, people’s lives are affected through education.
“I just feel like I have this information and I don’t want to keep it to myself.”
Both locally and nationally, the health care industry continues to evolve at a nearly revolutionary pace.
Earlier this year New Haven’s two major teaching hospitals — Yale-New Haven and the Hospital of Saint Raphael — reached an historic agreement to effect a merger. Elsewhere in New Haven County. Waterbury Hospital and St. Mary’s Hospital forged a similar deal.
In both cases the deals were hailed as landmark compacts that would buoy the two financially struggling Catholic hospitals, streamline service delivery in the Elm and Brass Cities, respectively, and eliminate costly duplication of services. In both cases, the rubber will truly meet the road for the first time in 2012, and the business and health-care communities will be observing with a keen eye.
In the Silver City (Meriden), officials at Protein Sciences say they are mere months from successfully completing trials on its game-changing flu vaccine. Closer to home, Quinnipiac University made great strides toward the opening of Connecticut fifth school of medicine, which hopes to welcome its first class in autumn 2013.
At a dynamic and exciting time in health care, Business New Haven for the fourth consecutive year celebrates the very best that the industry has to offer — from physicians and nurses to researchers and educators to administrators and volunteers. All of them have devoted their lives to caring for others in need.
They are an extraordinary group of individuals and organizations, with extraordinary stories to tell. We hope you enjoy their stories as much as we have enjoyed bringing them to you.
Harry H. Penner
Harry Penner’s footprints surround Connecticut’s bioscience industry
It’s not easy to find a New Haven bioscience company that doesn’t have Harry Penner’s name somehow connected with it. He has helped develop at least a dozen companies and is now focused on growing three more here in New Haven.
He believes he has all bases covered with one prescription drug company, one that specializes in diagnostics and one consumer-supplement business.
Affinimark Technologies is developing a test for the presence of cerebral spinal fluid, called Cerebrostrip, for used in trauma situations and surgery.
“There’s currently no test available — certainly not quickly and inexpensively — for this,” Penner explains. “It’s a very fun diagnostic opportunity."
Penner and Vincent Pieribone are Affinimark’s co-founders. The company was launched with funding from Connecticut Innovations Inc. (CII) and Launch Capital. “It’s an ‘all-Connecticut’ kind of thing,” he says. “Having the office on Temple Street very close to Yale helps.”
Penner also is developing New Haven Pharmaceuticals, a prescription drug company developed largely on the strength of intellectual property, pending patent applications, and, yes, technology out of Yale.
“The proximity to the scientists who are generating technology is not only convenient, but also extremely important to regular updating of that technology and communication with potential investors and partners,” Penner says.
New Haven Pharmaceuticals is at the final stage, pre-approval, of its lead product, something Penner calls a high-tech time-release aspirin product licensed from a firm in France.
“We very serendipitously found new uses for aspirin were being developed — one for liver injury and one for foreign body reaction — and what better product to use with that than a 24-hour controlled reach aspirin?” he asks rhetorically.
And as so often happens with science, one discovery leads to another. “As you know, aspirin can irritate the stomach and the scientists over at Yale learned that zinc, when used in a certain way, can help GI [gastrointestinal] irritation and so that can be combined to create even more products,” Penner explains. “The zinc product by itself is being developed to treat reflux disease. That has been the most unique and coincidental or serendipitous set of circumstances, all of that coming together to create this very neat suite of programs that are now getting funded.”
Penner’s third company, Prevention Pharmaceuticals, focuses on nutritional supplements developed by Yale scientists. “Our proximity to Yale is key,” he says. “It’s about networks. What’s interesting about the supplements, the consumer health products, is there are not only ties to Yale; it [also] involves some of the same people as New Haven Pharmaceutical — almost like sister companies.”
Other companies with which he’s had varying degrees of involvement over time are RxGN, a clinical research organization (CRO) headquartered in Hamden, and Neurogen, where Penner was CEO from 1993 to 2001. He also was co-founder of Rib-X Pharmaceuticals, on whose board of directors he continues to sit, and he serves as an advisor to MAK Scientific, which seeks to commercialize technology from the University of Connecticut. Penner was also involved with Ikonisys and Genaissance for a number of years. He co-founded Marinas and was CEO there until 2008.
“There’s clearly variety in my day,” he acknowledges. “Just look at these three companies: You have Affinimark, New Haven Pharma and Prevention. We cover the consumer-health end of the spectrum to prescription drugs to diagnostics. The intellectual stimulation that comes from dealing with all of these things is incredibly gratifying.”
Oddly, Penner’s academic training is in the law — not science.
“There wasn’t even a biotechnology industry” when he was in school, Penner jokes. He holds a BA from the University of Virginia, a JD from Fordham and an LLM in international law from New York University.
“I did practice law for a few years and I enjoyed it, but I got tired of the Long Island-to-Manhattan commute,” says Penner. So in 1978, he and his wife relocated to Connecticut where he took a position with Boehringer Ingelheim.
“That’s where I cut my teeth in the pharmaceutical industry, largely from the legal side,” Penner recounts. In 1981, he went to work for Novo (now Novo Nordisk), where he was offered the opportunity to relocate to Denmark.
“As luck would have it, I was chosen to become a member of the top management of the company, becoming executive vice president and general counsel to the parent company in Denmark,” he explains. “That was quite a trip — literally and figuratively.”
Three years later he returned to Connecticut and opened a North American headquarters for Novo in New York City’s Chrysler Building. Three years after that, he saw an opportunity with Neurogen, and so began his local pharmaceutical career.
Penner has since served as bioscience advisor to the governor, as co-chair of the bioscience industry group Connecticut United for Research Excellence (CURE) and as chairman of the state’s Board of Governors for Higher Education. He currently sits on the boards Rib-X, New Haven Pharmaceuticals, Prevention Pharmaceuticals and Affinimark.
“By virtue of the rich treasure trove of talented people that have over the course of their careers worked at Bayer, Pfizer and the like, we have a wonderful group of people who are literally right here at our doorstep in New Haven,” Penner says. “We don’t have to go to another state or run into problems with communication with people who are not close by.”
Penner says one of the things that’s been most rewarding throughout his career is working with highly talented people at his various companies.
“Sometimes people worry that New Haven can’t attract the kind of talent that you find in Boston or the [San Francisco] Bay area,” Penner says. “It is more difficult, but we’ve had wonderful founding people with a breadth of experience.
“What I’m most hopeful about is that the state continues down the track that I think it’s on of putting even more money to work at Connecticut Innovations to spark new companies,” Penner says. “New companies generate new employment opportunities and create a larger tax base and that works out well for everybody.”
Protein Sciences Corp.
Protein Sciences closes in on a revolutionary flu vaccine
One month after the September 11, 2001 terrorist attacks, Meriden's Protein Sciences Corp. (PSC) found itself on the front lines of the war against bioterrorism. The company makes proteins from cells derived from viruses and can grow them quickly and accurately.
In an interview with BNH published 30 days after the attacks, then-CEO (now Executive Chairman) Dan Adams revealed that the federal Centers for Disease Control (CDC) told the company that “We were the only ones who could make a vaccine to protect people against the pandemic flu in time to make a difference.”
In the interview Adams himself suggested that the deadliest threat might be not from bio-terrorism but rather a reprise of the “Spanish” flu pandemic that killed 50 million people worldwide immediately following World War I — more than three times the number killed in combat during what was to date the bloodiest conflict in human history.
Two years later that fear hit home nearly everywhere across the globe when the World Health Organization identified SARS as a new disease in 2003.
SARS spread rapidly and infected thousands of people around the world, including people in Asia, Australia, Europe, Africa as well as the Western Hemisphere..
SARS is caused by a member of the coronavirus family of viruses (the same family that can cause the common cold). It is now believed the 2003 epidemic started when the virus spread from small mammals in China, possibly initially infected by a bat.
By 2005 fear that another flu, Avian Flu virus (H5N1), would find its way to the U.S. Promising results by Protein Sciences in treating chickens against the flu convinced the FDA to put a PSC vaccine on the fast track.
It was a track that Adams had been hoping to move down since 1995. That’s when first contacted the board of Protein Sciences at a time when the Meriden bioscience company was struggling under the challenge of creating a vaccine for HIV/AIDS.
The company was short on funds and without a CEO when Adams, an experienced biotech entrepreneur, contacted the board. Adams had in 1976 founded and was CEO of drugmaker Biogen (now Biogen Idec, a $25 billion company) as well as three other biotechs.
The board told Adams they were seeking new capital and would look for a CEO after they raised the money. Adams responded that PSC would need a CEO first in order to raise money. Shortly thereafter Adams was named Protein Sciences’ new CEO.
Adams first decision was to jettison work on the HIV/AIDS vaccine. Although he believed the technology showed promise, the effort had been “mismanaged.”
While development of the AIDS vaccine was lost, the lessons learned in creating vaccines and growing proteins in a novel way were not.
Says Adams: “My philosophy was we’re going to patent around [the licenses, originally acquired from Texas A&M University], so when they expire we will own the field.”
In biotech to own something is to buy it first. And although the company's human trials for the FluBlok vaccine results were praised in scientific literature, the costs to the company were significant. According to current PSC CEO Manon Cox, “One clinical trial cost us $20 million alone.”
And while the reality that a truly deadly pandemic was possible and arising from “natural causes” was getting the attention of health officials, things were getting harder for PSC to fund operations and growth.
By 2007 the U.S. Department of Health & Human Services had committed $8.5 billion to address concerns of a pandemic flu through expanding existing vaccine facilities and funding new technologies.
However, much of that money continued to be directed to large pharmaceutical companies and much of that to traditional vaccine methods.
With a traditional vaccine a virus is grown and either killed or weakened so it won't transmit the disease. The body reacts to it and makes antibodies, which destroy the virus.
Cox says that traditional vaccine production is not up to the challenge of a true pandemic. “The process is long — it can sometimes take up to 12 months to identify and modify the viruses so that it will provide the correct immune response and can be grown in eggs,” she explains. Eggs are the traditional medium for creating vaccines and pose their own unique set of problems that can slow vaccine production.
The Protein Sciences approach is different. “It is pluck [a piece of genetic code from the virus] and play,” says Cox, and we use insect cells as production facility. Instead of giving people virus that has been killed we only give that part of the virus” that will generate antibodies in the human host.
In the event of pandemic Cox says it is much safer to work with as well. “Since we just use some genetic code which cannot cause disease, you don’t need to work with a [potentially] deadly virus that is pathogenic,” she says.
By starting with the known cause, Cox says PSC can literally have a workable vaccine in days not months.
Currently traditional vaccine manufacturing capacity would only meet a small fraction of worldwide demand for vaccine, and capacity for the Third World would be completely inadequate in the event of pandemic.
In 2008, Protein Sciences announced the sale of the company for $78 million as word of a major U.S. government contract surfaced.
The development would be funded and finished by the acquirer, Emergent BioSolutions of Rockville Md. Emergent provided immediate funding to shore up Protein Sciences, but the deal soon fell apart with acrimony and lawsuits a plenty.
In early 2009 H1N1 surfaced as a potential pandemic virus. Like many flus H1N1 started in birds and was transferred to pigs, which is why it was initially called swine flu. With pigs as hosts the flu became more suitable for transmission to humans.
Eventually more than 17,000 people worldwide would die, in part due to lack of supply of vaccines.
In 2009 PSC won a contract from the Biomedical Advanced Research and Development Authority of the U.S. Department of Health & Human Services for up to $150 million for the development, clinical testing and eventual manufacturing of its FluBlok vaccine. This June PSC received its second-round payment of $40 million.
As concerns of pandemic flu has spread globally, the company also received payments from its Japanese licensee, which recently signed a development deal with a Astellas, a major Japanese pharmaceutical company.
Adams says he’s been frustrated by the pace of final approval for the vaccine, but expects it within a few months.
It may come sooner if more folks see the current movie Contagion, featuring a deadly worldwide pandemic.
Physician Assistant Program
Quinnipiac’s physician assistant program grows to meet soaring demand
The demand for health care professionals is growing, and physician assistants are a hot commodity.
Quinnipiac University’s Physician Assistant Program is one of three such programs in the state, along with those at University of Bridgeport and Yale.
The physician assistant (PA) in years past may have had lower status compared to physicians, and some patients wonder why they spend more time with a PA at the doctor’s office than with the doctor.
Program director and Clinical Associate Professor of Physician Assistant Studies Cynthia Lord explains that PAs, physicians, and nurse practitioners are the only three medical providers licensed to practice medicine in the U.S.
“Physician assistants are medical providers who see patients from cradle to grave, and more and more people understand the role now,” Lord says. “We work with physicians, under their supervision, and it’s a collaborative relationship. We work together on the same team and the patient gets a much more holistic treatment.”
It’s the focus on outpatient procedures and especially preventative medicine that a PA is most charged with.
“We try to make it so that before [the patient’s medical condition] escalates into anything bigger, we’ve nipped it in the bud,” Lord says. “I wouldn’t treat your diabetes because I’ve helped you all the way through to not get diabetes. Or if you develop mild diabetes that is treated by your diet and not with 16 meds or needing your leg removed.”
Lord says the demand for more care providers throughout the health-care industry is huge, and as it is there aren’t enough PAs, physicians or nurses, so the more PAs in the system to handle the number of patients and the amount of time spent on each one, the better.
“When you’re 80 years old, your 15-minute visit isn’t 15 minutes any more” Lord says. “The time a patient needs from us is much more. PAs and nurse practitioners help expand and open up that practice.”
Danielle Tabaka, president of the Connecticut Academy of Physician Assistants and a 2005 graduate of the program, says there are approximately 1,600 licensed PAs in Connecticut, and they will be key to making health care more widely available as physicians become increasingly more occupied.
“There is a greater emphasis on preventative medicine, and we’re in a position to play a good role in that,” Tabaka says. “PAs will continue to fill the gaps as health-care reform takes shape. They will likely continue to be integral in taking care of patients.”
Lord graduated from the Yale School of Medicine’s Physician Associate Program in 1991 and was one of the first three faculty members hired for the PA program in 1994. She says the generalist training provided by QU’s program affords its graduates the flexibility to apply their skills across the health-care spectrum, adding that the average PA may work in two different specialties during his or her career, and one need not become re-certified or go back to school to make such a switch, either.
“For a lot of us, that flexibility is very appealing,” she says.
The program’s 54 new students each year undergo an intensive 27-month curriculum. For the 16 to 20 existing Quinnipiac students that enter the program from their undergrad years, the course starts the day after graduation.
Lord says Connecticut is an especially “PA-friendly” state in which to train and practice, thanks to legislation that gives physician assistants the ability to perform as broad an array of tasks as their MD delegates. The laws can be more restrictive in other states in such ways as limiting a PA’s ability to prescribe medicine.
Though she is currently on the administrative end, Lord still spends ten hours each week teaching in the classroom, and has been a clinically practicing PA in family medicine and primary care since 1991.
The program now boasts eight core faculty members, all of whom still practice professionally as PAs, with up to 30 adjuncts providing additional instruction.
And they must be doing something right: Lord says only nine students have failed the board exams in the past 17 years, but even they have since passed.
Most students probably shouldn’t worry about finding a job, either. With such a heavy demand for PAs, Lord says that within 16 weeks out of the program, 88 percent of the graduates land their first-choice job.
Each year, she says, about half the graduating class goes into surgery and surgical subspecialties (including critical care medicine), while 20 percent enter primary care and 23 percent pursuing emergency medicine. She credits the program’s solid faculty with providing instruction worthy of making Quinnipiac’s program nationally competitive.
“Not only do our students get good jobs and get them right away, but they’re getting non-entry-level positions,” Lord says. “To go into surgical ICU or the critical care unit is not something a new graduate typically does. We have a very good reputation in the state and across the country. They know what they get with a Qunnipiac PA, and they’re comfortable putting them in those positions.”
But it’s also the program’s extensive community outreach that Lord says distinguishes the program. She has a passion for promoting health literacy, especially in children. So all involved in the program provide books and offer fitness/health fairs and read several times a week to ACES students, and children at the Pediatric Outpatient Clinic at the Hospital of St. Raphael, even donating toys and books at the holidays. Lord also established ties with the National Kidney Foundation’s Kidney Early Evaluation Program (KEEP), where PA students are primary screeners for up to 100 people at the bi-monthly program.
Tabaka herself was involved in the KEEP program, and remained so after graduating. It even had an influence on her career path.
“I now work in the field; it intrigued me and I realized through that program that it was something I really enjoyed doing,” says Tabaka. “Quinnipiac is really committed to giving back to the community, and that’s one thing that really stands out.”
The students and faculty also give bagged dinners, clothing, cosmetics and toiletries to the homeless in New Haven. PA students also engage in a Migrant Farmers Clinic through the summer.
“Our service back to the community is important, and I’m very involved in our outreach,” Lord says. “You have to be a good model, a good mentor. You can’t just sit behind a desk and say, ‘You do this.’
“Our obligation to the community is real,” she adds. “We ‘practice’ medicine — and the students clearly practice in the community. And when you go out and work with people on their oral health and their health literacy, when you work with people who are homeless and who are migrant farmers, the students get that ‘Ah-ha’ moment: ‘I get it. This is why it’s important.’”
Edward Rippel, MD
Quinnipiac Internal Medicine, PC
A Hamden sole practitioner makes high-tech headway in primary care
At Quinnipiac Internal Medicine, what some see as the future of medicine is happening now.
Electronic medical records allow Edward Rippel, MD, the office’s primary-care physician, to communicate more efficiently with patients, track and monitor chronic conditions such as diabetes and heart disease and ultimately achieve better outcomes.
Moreover, Rippel says, using medical software technology has proven to be a better way to run his business.
Rippel drew attention earlier this year when he became the first sole practitioner in Connecticut to be as recognized as a Patient-Centered Medical Home by the National Committee for Quality Assurance (NCQA) at Level 3, the highest level.
The program “recognizes clinician practices functioning as medical ‘homes’ by using systematic, patient-centered and coordinated care management processes,” according to the NCQA.
“The basic principle is most of the care that a patient gets should be under the aegis of the primary care office, any care outside of office we coordinate, and we track those elements to completion,” says Rippel, who views the recognition as a reflection of his approach to medicine.
He says his “practice style has always been patient-centric with an emphasis on preventive care, guideline-based chronic disease management and coordination of care with specialists.” Moreover, his “practice philosophy” hinges on “personal individualized service, with superior availability and patient communication.”
A New York native, Rippel attended the Bronx High School of Science, where he discovered “a penchant for biological science.” He majored in biology at New York University, graduated from New York Medical College, interned at Montefiore Hospital in the Bronx and was a resident at Morristown (N.J.) Memorial Hospital. He then worked in a Colorado federal prison and a Spanish Harlem (N.Y.) community center to fulfill his obligation to the National Health Services Corps, which helped finance his medical education.
In 1993, Rippel joined a primary care group in Hamden. When the practice dissolved in 1999, he opened his own practice.
While working in Spanish Harlem, Rippel used a ruler and spreadsheet to track preventive care and disease management.
“You had a fairly good snapshot but could not do more,” he recalls. “In the 1990s, I heard about the advent of electronic medical records, and it seemed sort of a fantasy. The industry evolved fairly quickly but it really was a very expensive proposition, not feasible in primary care."
A decade later, the situation changed when insurance companies began implementing pay-for-performance models for achieving or exceeding certain health benchmarks.
“Now you had another source of revenue, and here’s this wonderful tool that could help me to realize my vision of chronic disease management and preventive care,” says Rippel, who speaks Spanish and Italian (he says 15 to 18 percent of his patients are Spanish-speaking). He began interviewing vendors. In summer 2006, he selected eClinicalWorks to set up an electronic medical record system, and set out to improve patient care.
“I thought I was doing a pretty good job, but there’s nothing like real data to sober you,” Rippel says. He found out around 40 percent of his patients had well controlled diabetes, which was “about the same as the national average.” By focusing on those patients with follow-up visits, the percentage “at goal” for diabetes control rose to 70 percent over the next several years.
In 2009, Rippel earned recognition from the NCQA for providing high-quality care to diabetes patients. The following year he earned NCQA recognition for providing high-quality care to patients with cardiac problems.
When Rippel became the first solo practice in Connecticut to achieve patient-centered medical home recognition this February, the NCQA dubbed him a “triple crown winner.”
“Practices that earn medical home recognition are really the leading edge of where health care needs to go, and that is a system that combines integration and technology to deliver better care at lower costs,” says NCQA spokesperson Andy Reynolds.
The ranks are swelling. As of September 30, there were 108 patient-centered medical homes in Connecticut recognized by the NCQA (105 at Level 3). Of those, 24 were sole practitioners.
Electronic medical record-keeping also has been good for Rippel’s business. With increased visits and other measures, including in-house rather than outsourced billing and pay-for-performance programs, Rippel has been able to enhance office productivity. He says his $50,000 investment in software technology “was recouped in just over two years.”
During office visits, Rippel takes notes on an tablet PC, which allows him to send a prescription directly to a drugstore or order a diagnostic test. “It’s not just data-capture,” he says. “It’s sharing of data.” Patients receive a printed summary of their visit and educational materials related to treatment.
They can submit questions, which he answers by e-mail, via a patient portal he launched four months ago. The system already has helped several patients, including a student who needed to quickly send his immunization records to a law school where he had been accepted for admission and a patient able to download his medical records from an emergency room in France.
The proactive approach suits Susan Rapini, executive vice president of the New Haven Chamber of Commerce
“The whole key with him is prevention before things become a problem,” says Rapini, who began seeing Rippel this spring. “You don’t leave the office without having your whole plan done and your appointments, and he’s so sincere and doesn’t rush you.
“You have your medical portal, where you can see all your lab results online,” Rapini adds. “You can e-mail him, and he’s meticulous about getting the right information and helping you manage your care.”
Rippel plans “to continue in the pursuit of realizing my vision of improving quality of health care at the level of the patient and helping to offset the cost for health care.
“If you look at performance measures and quality of care outcomes, the practices that are primary care-heavy are the ones that have the highest success rates and lower costs.”
Steve Glick, president of Chamber Insurance Trust, regards Rippel as “an innovator, visionary and example of how primary-care doctors should perform.
“He represents the future of primary care technology and personal communication, and in a way he’s like the old doctor Marcus Welby,” Glick says, referring to the 1970s TV series starring Robert Young, who embraced the role of general practitioner.
Make that Dr. Welby with a 21st-century twist.
Director, RN to BSN Program, Assistant Professor
Sacred Heart University Department of Nursing, College of Health Professions.
Helping those in greatest makes Strong true to her name
Linda Lee Strong defines herself, first and foremost, as a public health nurse — a “street nurse” in her own words — and has been since her graduation with a BSN from the University of Bridgeport College of Nursing in 1976. She went on to earn her MSN from the Catholic University of America, Community Health School of Nursing in 1980, and an Ed.D. degree in nursing education from Columbia University Teachers College in 1996.
“I fell in love with nursing in my senior year in college and have had a passionate love affair with public health nursing all my life,” says Strong. “Public health nursing cuts across all segments of society, whether it’s underserved populations or the man down the street. We protect the population’s health, work to prevent illness and premature death and promote healthy lifestyles in the community.”
To that end, she founded and co-directed the Sacred Heart University/St. Charles Health & Wellness Clinic in 2000, which has moved to a new location near the old one and operates today in the Hall Neighborhood House. The no-cost clinic, renamed the Center for Community Health and Wellness, serves thousands of patients from a diverse population of older residents as well as ethnic groups including Irish, Polish, Asian, Latino and African-American people. It serves as a training ground for learning, clinical practice and internship services for Sacred Heart University nursing students.
Strong also established the Aging With Grace seniors program in 2005 that specifically serves older adults. She has held blood pressure and flu clinics literally on the street, advising her nursing students that they will have their greatest impact when they work in the midst of the community.
“Wherever the people are is where we go to provide nursing — whether it’s in the home, at a grocery store or in a community clinic,” says Strong. “You talk to people to learn their perception of what is going on with their health. It’s all about communication.”
And with that communication comes a reward for her students that’s not part of the curriculum taught in the classroom, Strong explains.
“They get to talk to people face-to-face and they learn about more than just peoples’ health concerns,” she says. “They learn about their cultures, their families, what they like to cook and eat, where they like to travel.” About 20 of her students travel every year to Guatemala for a one-week stint in public health clinics in that Central American country, further expanding their experience in nursing, diversity and culture.
Closer to home, she found devastation and despair aplenty on her first visit to Mississippi one month after Hurricane Katrina ripped through the region, upending thousands of lives and wreaking havoc on families who could ill afford to repair the damage or restore order to their lives.
“I don’t even have to close my eyes and I can be there,” says Strong about the Katrina-stricken Lakeshore, Miss., region when she and her co-workers arrived. “We went into communities that looked all right on the outside but the interiors of the buildings were destroyed and the people fled elsewhere. What we saw wasn’t terror caused by people: it was terror caused by nature.”
She recognized that mobilizing the kind of response needed couldn’t happen quickly enough because of the scope of the damage. “It takes time to put these things in place,” Strong says. “But time is precious when you are hungry, when you’re wet, when your entire world has vanished – and you are very frustrated about the slow response.”
Strong and the Aging With Grace group that traveled to Mississippi with her began a project to hand sew rag dolls to bring to the people who had been driven from the neighborhoods.
“To see the look in peoples’ eyes when we brought them these rag dolls — it brought back memories to them of their own childhood that they could then give to their child or grandchild, and this gave them a sense of comfort, a sense that ‘Someone else made these for me, someone who cares about me,’” says Strong. The health-care system was thin or virtually non-existent so that her group became both the health-care providers as well as recorders of the history of what had occurred during and after the storm.
At Sacred Heart, Strong teaches online throughout the year and in the classroom for the fall and spring semesters, in addition to her administrative role as director of the RN to BSN program. When she finds time to relax, she reads history books (“We can learn a lot from our past mistakes”), gardening (“I’m not a professional gardener — I just tinker”) and travels. Ever conscious of her public health background and experiences with Katrina, Strong co-hosted a seminar with Sigma Theta Tau, the nurses’ professional sorority, titled “Preparedness: Radiological and Nuclear Emergencies: Medical and Public Health Response to Radiation Incidents” at SHU’s Cambridge Campus.
Strong acknowledges that challenges lie ahead. She cites diminishing resources, tight grant money and shrinking local and state budgets where money for expansion of public health programs has been reduced or eliminated. She hopes that private resources will provide what is missing and credits the Agency on Aging of South Central Connecticut with providing badly needed funding for elder residents.
“I am a public health nurse,” says Strong. “I believe what is global is local. Illness and disease doesn’t stop at a town’s borders. Sickness costs money but a superb health system equals a healthy population. The wealth of a country is measured by the good health of its citizens, so if I can make a difference in peoples’ lives as a public health nurse, then they will be stronger.”