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Cape Cod Healthcare

REPRODUCTIVE HEALTH

Hospital Expansion Could Trigger Abortion Access Review

The Dept. of Public Health could put pressure on Cape Cod Healthcare

By Robert Kuttner Jul 20, 2022

HYANNIS — A proposed $137-million expansion of Cape Cod Hospital could potentially be held up or denied by the Mass. Dept. of Public Health (DPH) because the hospital’s parent organization, Cape Cod Healthcare, restricts access to abortion. The plan was posted on a state website earlier this month and reported by the Boston Business Journal.

The DPH is required to review all such plans and make a “determination of need.” The law under which DPH approves or denies expansion plans explicitly cites access and quality of care, and it invites community comment. It’s not clear, however, whether the DPH could literally condition approval of the hospital expansion on the provision of abortion services. DPH’s style seems to be to cajole rather than to issue orders.

As the Independent reported last week, the two major providers of medical care on the Lower and Outer Cape — Cape Cod Healthcare (CCHC) and Outer Cape Health Services (OCHS) — both refuse to offer most abortion services. CCHC, which runs both Cape Cod Hospital and Falmouth Hospital, provides abortions only in urgent situations. OCHS says that it cannot provide abortions because it is a federally qualified health center restricted by the Hyde Amendment.

(In a letter to the editor in this issue of the Independent, Dr. Ronald Gabel of Yarmouth Port, the former medical director of a surgery center that provided abortion services, argues that OCHS is not in fact prevented from providing abortion care by the Hyde Amendment, provided that federal funds are not used to pay for it.)

A third nonprofit medical group, Health Imperatives, which operates seven clinics in Southeastern Massachusetts including one in Hyannis, has so far resisted requests to add abortion services.

Women in Massachusetts have an unrestricted legal right to abortions up to 24 gestational weeks of pregnancy — assuming that they can find a provider.

“Southeastern Massachusetts is an abortion access desert,” Dr. Jennifer Childs-Roshak told the Independent this week. She is the president and CEO of the Planned Parenthood League of Massachusetts.

“Abortion is health care,” said Childs-Roshak, “and access should not be based on one’s zip code, identity, or income level. We are committed to working with existing reproductive health-care providers on the Cape and across Southeastern Mass. to establish and expand abortion services, because everyone deserves access to care close to home.”

Planned Parenthood operates four clinics in Massachusetts, but none on the Cape.

The state has some leverage to improve access to abortion, but it’s not clear how hard the DPH is pushing, despite Gov. Charlie Baker’s stated commitment to defend and expand reproductive rights.

Last year, DPH blocked a proposed $2.25-billion expansion by Mass General Brigham to build outpatient care centers in Woburn and Westborough on the grounds that it would raise costs by substituting a teaching hospital that bills at high rates for community hospitals and clinics that bill at lower rates.

Health Imperatives, which is funded by DPH, has clinics in Hyannis, Wareham, Plymouth, Nantucket, Martha’s Vineyard, New Bedford, and Brockton. The Independent has learned that the DPH has been urging Health Imperatives to provide medication abortions. Health Imperatives’ website displays a wide range of reproductive and health services, including testing and treatment of sexually transmitted infections, birth control, pregnancy testing, cancer screening, and “gender affirming hormone therapy for all genders” — in short, everything except abortion.

In spite of the discussions with DPH, Health Imperatives CEO Julia Kehoe says that will not change.

“Currently, Health Imperatives has no plans to provide abortion-related services to our clients,” Kehoe wrote in an email to the Independent. “Since the overturning of Roe v. Wade, we have had several discussions in our community and with advocacy groups about the lack of direct abortion-related services in the area and while it is concerning, we must allocate our limited resources where they are needed most.”

A DPH spokesperson was unwilling to say that the department would insist on abortion services. “All DPH-funded sexual and reproductive health programs are encouraged, but not required, to provide abortion services as a part of full spectrum of reproductive health care,” the spokesperson said by email. But there is high interest on Beacon Hill in protecting and expanding abortion rights, and pressures on both community facilities and state agencies like DPH are likely to intensify.

Massachusetts is one of 16 states whose Medicaid program (MassHealth) fully covers abortion services. This is permitted, even though Medicaid is a state-federal program, as long as the abortion services are paid with state funds. Advocates want the Biden administration to change the rules so that federally qualified health centers like OCHS can provide abortions services.

President Biden issued a general executive order on July 7 to defend abortion rights. He gave the Dept. of Health and Human Services 30 days to write specific rules.

Editor’s note: An earlier version of this article, published in print on July 21, incorrectly stated that Dr. Gabel was the director of a women’s health clinic. He was the medical director of an ambulatory surgery center that provided abortion services.

REPRODUCTIVE HEALTH

Abortion Access Is Unclear on Cape Cod

Nearest clinic with comprehensive care is 110 miles away

By Emma Madgic & Edward Miller Jul 13, 2022

HYANNIS — Relying on a June 28 statement from Cape Cod Healthcare (CCHC), the Independent reported two weeks ago that abortion services are not available anywhere on Cape Cod. That, it turns out, is not the whole story.

In response to requests from the Independent for additional information, CCHC, which owns the Cape’s two hospitals and most of its other medical facilities and practices, provided a new statement the next day confirming that it does, in fact, provide abortions in cases “where underlying medical issues and out of concern for the wellbeing of the mother, a higher level of care is required than could be achieved in a freestanding outpatient center.”

The nearest clinic to the Outer Cape that provides comprehensive abortion care is in Attleboro, 110 miles from Provincetown. Others are in Boston, at least 114 miles away.

Efforts by reporters and editors to get more information about the kinds of underlying medical issues that would qualify a patient for an abortion at Cape Cod Hospital were unsuccessful. Similarly, hospital sources would not explain how they arrive at those decisions.

In a July 6 email to the Independent, CCHC Senior Vice President Patrick Kane wrote, “That’s a clinical decision based on many factors — age, health condition, family history, term of pregnancy and dozens of other factors — and our docs are not going to comment on hypotheticals.”

Kane did not respond to a question asking whether Cape Cod Hospital has an ethics committee. Such committees often make decisions at hospitals on whether procedures are medically necessary.

Kane and Marketing Communications Manager Lisa Connors also did not respond to questions about whether CCHC doctors would prescribe the abortion medications mifepristone and misoprostol, which are effective in the first 10 weeks of pregnancy. Kane told a reporter to stop trying to contact CCHC doctors directly because, he said, “our corporate policy requires that all employees direct media calls to our office.”

A Letter to Baker

Meanwhile, in a reaction to the Supreme Court’s reversal of Roe v. Wade on June 24, the Eastham Select Board has spoken out forcefully in favor of abortion rights and, at its meeting on July 11, signed a letter to Gov. Charlie Baker supporting his commitment to protect reproductive rights in Massachusetts.

“The Eastham Select Board is proud of Massachusetts and its leaders for taking fast action and a critical stand during this trying time,” the letter read. “We, the Eastham Select Board, endorse the swift actions of Governor Baker and the State of Massachusetts and will stand by the Executive Order to protect access to reproductive health care services.”

Eastham Select Board member Aimee Eckman said the lack of abortion access on the Cape is a serious problem, especially for those on the Outer Cape.

“I’m shocked that hospitals don’t provide it,” Eckman said. “I don’t really understand why that is, especially when there are no services locally. The hospital is far enough from Provincetown as it is. [Abortion care] is health care, for god’s sake.”

Fellow board member Suzanne Bryan agreed. “Even in a state that is liberal, it’s still not easy to access,” she said. “It’s just one piece of the larger puzzle of not having robust health services on the Outer Cape for younger people.”

Access to Medication

There are two different methods of getting an abortion, according to Planned Parenthood: the abortion pill or an in-clinic or in-hospital abortion. Ninety-five percent of all abortions in 2017 took place in clinics, according to the Guttmacher Institute. In recent years, medication abortions, available from pharmacies by prescription, have become much more common early in pregnancy.

The abortion pill consists of two different drugs, mifepristone and misoprostol, which can be taken at home, and can cause side effects that resemble a heavy menstrual period. The process, according to Planned Parenthood, is similar to an early miscarriage. The medications can be taken up to 10 weeks into a pregnancy.

The Independent has not been able to confirm whether medication abortion is available from Cape Cod’s doctors.

Spokesman Gerry Desautels at Outer Cape Health Services said that its physicians do not prescribe abortion pills because OCHS is a federally qualified health center and therefore is prohibited from providing abortion services by the Hyde Amendment — legislation that bars the use of federal funds to pay for almost all abortions.

The Independent contacted 17 providers of obstetrical and gynecological care on Cape Cod who are not associated with OCHS. Those who were reached declined to say whether they will prescribe abortion medication, while others did not respond to messages.

The Washington Post reported in 2016 that doctors often face challenges from hospitals for speaking out about abortion services they provide. The Post noted that “hospitals comprise more than one third of the nation’s abortion providers” but that “most do this work quietly, compared to the more visible standalone clinics such as Planned Parenthood.”

Massachusetts law places no restriction on abortions up to 24 weeks into a pregnancy, and abortion services are not restricted to obstetricians and gynecologists: physicians, physician assistants, nurse practitioners, and nurse midwives all may perform abortions.

After 10 weeks of pregnancy, women can get an in-clinic abortion procedure. After 24 weeks, the law says that abortions may be performed only “to preserve the life of a patient,” “to preserve the patient’s physical or mental health,” or if there is “a lethal fetal anomaly or the fetus is incompatible with sustained life outside the uterus.”

On July 6, Mass General Brigham, one of the largest hospital organizations in the state, issued a statement affirming its commitment to providing comprehensive abortion services.

“The Supreme Court ruling does not change the right to an abortion for patients receiving care in Massachusetts,” the statement read. “Mass General Brigham will continue to provide high-quality care to all patients who come to us for care. We will do this no matter what state or country they come from. We respect the very personal, and sometimes very difficult, decisions that patients make together with their care teams.”

HEALTH CARE

Seasonal Urgent Care Clinic Opens in Orleans

Threat to Outer Cape Health Services feared

By K.C. Myers Jul 13, 2022

ORLEANS — Cape Cod Healthcare, the organization that owns both of Cape Cod’s hospitals and most of its medical offices, expanded its territory in the direction of the Outer Cape by opening a seasonal urgent care center in Orleans on July 2.

The Orleans Medical Center building at 42 Route 6A is close to Stop & Shop and right next to the Nauset Fish Market & Lobster Pool. (Photo by K.C. Myers)

The clinic will operate seven days a week from July through Columbus Day. And when it closes in the fall, Cape Cod Healthcare CEO Mike Lauf said, he plans to open a year-round primary-care office with “two or three providers” in the adjoining space. The building, now named the Orleans Medical Center, sits in what used to be the parking area of the Lobster Claw restaurant on Route 6A next to the Nauset Fish Market & Lobster Pool.

Urgent care is designed to treat complaints that do not require emergency services, such as strep throat, urinary tract infections, tick bites, cuts requiring stitches, sprains, and ear infections. There is walk-in Covid-19 rapid testing available at the center as well, said Lauf.

The growth of such facilities has exploded in Massachusetts, driven by a combination of forces, including a national shortage of primary-care doctors, which causes people to seek care in emergency rooms, which is expensive. Many health insurance policies require costly co-payments for emergency room visits. Co-payments for urgent care visits are often about one-third of those for emergency care visits, Lauf said.

In 2010, Massachusetts had 18 urgent care centers. By 2018, there were 145, according to State House News Service.

Cape Cod Healthcare’s urgent care center in Harwich was seeing 180 to 220 people per day, said Lauf, which showed that “the need is very evident” for the Orleans facility. “We anticipate it will serve the Lower and Outer Cape,” he said.

On July 5, the waiting time at the Harwich urgent care center to see a provider was one hour and 20 minutes, while it was 15 minutes at the Orleans center, according to the Cape Cod Healthcare website.

Lauf said he was working hard to hire primary-care doctors amid a national shortage, and that he hopes to have year-round doctors on board at the Orleans center by the fall.

The addition of urgent care and primary care in Orleans will have an unknown effect on Outer Cape Health Services (OCHS), the nonprofit federally qualified health center that has provided the only medical services from Provincetown to Orleans for years. OCHS operates three clinics, in Provincetown, Wellfleet, and Harwich.

Patricia Nadle, the CEO of OCHS, said she is not worried about urgent care coming to Orleans. But there is a concern that the new primary-care business could take clients and potential staff from Outer Cape Health.

The primary care office in Orleans “could introduce some level of competition, but we will wait to see what happens,” said Nadle. “The work force is a significant issue. The health-care community is not untouched by the staffing shortage, and now you add competing for the same talent pool. Sometimes competition is good, and sometimes it is not.”

OCHS pays its primary-care physicians $200,000 per year right out of medical school, she said. Cape Cod Healthcare’s compensation is similar, according to Nadle. But OCHS can offer the added incentive of loan forgiveness because the Outer Cape is medically underserved and OCHS is a federally qualified health center, she said.

“You can work here at that compensation and not have to pay your student loans,” she said.

Hours at the Orleans urgent care center are Monday through Friday from 8 a.m. to 6 p.m. and 8 a.m. to 4 p.m. on Saturdays and Sundays

HEALTH CARE

Need for Rooms at Cape Cod Hospital Exceeds Capacity

Patients face difficult choices about elective surgeries

By Jasmine Lu Dec 22, 2021

HYANNIS — Cape Cod Hospital has been dealing with a triple threat: a recent swell in incoming Covid-19 patients, a backlog of inpatient discharges, and a pandemic-driven staffing shortage.

The fact that these challenges are faced by hospitals across the state prompted the Mass. Dept. of Public Health (DPH) on Dec. 15 to advise facilities to cut back on nonessential elective procedures by half. But last week, when Cape Cod Hospital’s inpatient population swelled past its maximum capacity, officials here opted to cancel elective surgeries altogether on Dec. 16 and 17.

Over the weekend, patient volume dipped, said Patrick Kane, senior vice president of communications for Cape Cod Healthcare, which owns the hospital, in an email. “All cases are back on the books for this week,” he wrote on Monday, Dec. 20.

The next day, however, the statewide swell in Covid-19 cases pushed the DPH to update its strategy. Effective Dec. 27, “all hospitals are directed to postpone or cancel all nonessential elective procedures likely to result in inpatient admission in order to maintain and increase inpatient capacity,” said Gov. Charlie Baker at a Dec. 21 press conference.

The hospital on Tuesday would not confirm whether another round of cancelations was slated post-Dec. 27. Hospital officials were “digesting” the new state guidelines, according to Dr. William Agel, the chief medical officer. “But we’ve been dealing with this for 21 months,” he added. “We’ve gotten pretty good at adjusting our schedules accordingly.”

The hospital uses a scoring system that ranks cases based on the level of attention each one is likely to need from staff. Urgent procedures, like the removal of a diseased gall bladder or a cancer surgery, would fall in the “nonelective” category. Certain cosmetic procedures and joint replacements, by contrast, verge more on “elective” and so are more likely to be delayed.

In between, there are cases that don’t fit neatly into either category, such as neurosurgery procedures for chronic back pain.

“It depends on the level of discomfort and the level of disability the person has,” Agel told the Independent. In these cases, he said, patients and their physicians need to discuss whether alternatives to surgical intervention, like continuing physical therapy, could be appropriate in the interim.

“It’s hard to tell someone that their pain is ‘elective,’ ” Agel said. “It requires a frank and honest conversation between the surgeon and the patient. Some folks have been waiting a while to begin with, so they’re usually a little disappointed because they’ve made some preparations. But our patients understand we’re in the middle of a pandemic.”

Exceeding Capacity

The Cape Cod Times reported last Friday that Cape Cod hospital had admitted 20 patients more than the 259 beds prescribed by its license, placing these people in surge areas. Meanwhile, Falmouth Hospital, with 95 beds, was operating at 85 percent capacity.

While the surge in Covid-19 cases has added new patients to Cape Cod Hospital’s population — as of Tuesday, there were 33 Covid-19 patients in the hospital, two of whom were in the ICU —the facility has also been managing the care of numerous non-Covid-19 patients needing longer stays before being discharged.

“In terms of what kinds of illnesses we’ve been seeing, it’s been acutely exacerbated chronic diseases,” explained Agel. “These are people with heart disease who may have put things off. Or people with diabetes who maybe didn’t take care of themselves during the pandemic. And then, there’s also the consequences of prolonged social isolation, like depression.”

When discharges do occur, some patients need to be transferred to a skilled nursing facility — where they encounter another widespread problem: a health care staffing crisis, driven by the pandemic.

“With the current labor shortage, those nurses just aren’t available,” Agel said. “So, you have some patients who end up staying in the hospital, just waiting for those nursing facility beds.”

Mass. Health and Human Services Secretary Marylou Sudders in a Dec. 21 press conference put it this way: “There remains a critical staffing shortage in many jobs and many roles to meet the needs of our patients.”

With workers nationwide leaving health care, Cape Cod Hospital is grappling with staffing shortages of its own.

“These are people who don’t want to be exposed or get overrun by 40 or 50 sick patients, so they’ve said, ‘It’s too much. I’m going into another business,’ ” Agel told the Independent. “That’s really what’s hurting us.

“Last I checked, we were at about 500 openings,” he added, “which is about 10 percent of our workforce.”

The unfilled positions go beyond the roles of doctors, nurses, and technicians. Cape Cod Hospital has also been searching for people to clean patient rooms, deliver food, work in environmental services, and answer phones at the reception desk.

“We need everything,” Agel said.

In the Emergency Room

Most hospitals, when overwhelmed, go on diversion, directing ambulances to ferry patients to the next closest hospital. Cape Cod Hospital can’t fall back on that option.

“There’s really nowhere to divert to,” said Mary Johnson, who has served as the hospital’s associate vice president of nursing and emergency services since 2020. “We just use our triage process, and we’ve opened up other areas of the hospital to move admitted patients.”

Johnson aims to get patients who need inpatient care upstairs within four hours following an initial screening in the emergency room. On Monday, Dec. 20, the average wait was 6½ hours.

“Over the last few months, we definitely haven’t been able to move patients through the system as quickly,” Johnson said. “We’re having to use hallway spaces during peak times to see patients.”

For the E.R. staff, a busy hospital means double shifts in personal protective equipment, plus overtime. “Being a nurse, in particular, is not a job — it’s a calling,” Agel said. “The large majority of the staff has said, ‘You know, we’re the safety net hospital for this community.’ They’ve stepped up in ways that put their families’ lives in danger.”

In the midst of crisis, the E.R. has held steady. “We’re a really strong, great team,” Johnson said. “We’re like a family, so we support each other.” If family matters crop up, coworkers offer to pick up extra shifts. “Some registered nurses who moved to administration have come down to help in times of need,” Johnson added.

Looking Ahead

“There’s no question the next few weeks will be enormously difficult for our health care community,” Gov. Baker said at his Dec. 21 press conference.

To support health care workers amid the state’s recent rise in cases, Baker, as of that day, activated 500 members of the Mass. National Guard. Of these, 300 people will be deployed to 55 acute care hospitals and 12 ambulance service providers.

Some Guard members will drive ambulances and transfer patients between hospitals and nursing homes; others will commandeer wheelchairs and stretchers, ferrying patients between the E.R., X-ray rooms, and the inpatient floor. Other roles include providing security support, delivering meals, and observing patients who may pose a risk to themselves.

The remaining 200 Guard members will be providing Covid-19 testing support or administrative support for the deployment or standing by until needed.

This week, the Guard members are undergoing training, and by Monday, Dec. 27, they will be dispatched to their assigned locations. Cape Cod Hospital does not yet have plans to use National Guard troops at this time, according to Agel.

CLINICAL CARE

Health Care Giant Tackles Outer Cape

Cape Cod Healthcare plans urgent and primary care center in Orleans

By Christine Legere Jan 7, 2021

ORLEANS — The financial challenges that prompted Cape Cod Healthcare to temporarily shelve its $180-million hospital expansion plan last year and lay off more than 100 employees in late summer haven’t stopped the organization from continuing its steady eastward expansion toward the Outer Cape.

Local permitting is well under way for a $5.6-million urgent and primary care center on the site of the former Lobster Claw Restaurant on Route 6A in Orleans, just half a mile south of the Eastham town line. The project remains on track to open by spring 2022.

Cape Cod Healthcare operates the Cape’s two hospitals, the Visiting Nurse Association, and dozens of primary, outpatient, rehabilitation, laboratory, specialty, and urgent care centers from Orleans to Bourne and beyond. Its existing facilities in Orleans include the Nauset Family Practice, the Orleans Medical Center, and the Orleans Rehabilitation Center.

Michael Lauf, president and CEO of Cape Cod Healthcare, said the public has expressed a need for the company’s medical services.

“The plan is to ensure we have services in the Orleans community and surrounding communities if they choose to use us,” Lauf said in a Monday phone interview. “This is an opportunity to meet the people where they live.”

The project has been touted as serving both the Lower and Outer Cape, all the way to Provincetown.

Lauf said the facility will also support the organization’s effort to recruit new primary care physicians to Cape Cod.

“I think physicians want to practice in an environment that’s nice and warm and clean, and has amenities,” he said. By amenities, he referred to cutting-edge facilities and services. “We want to provide those, so they come to an incredible community like Orleans.”

Orleans officials have embraced the proposal, which calls for the demolition of the old restaurant and construction of a 6,800-square-foot building that will house urgent, specialty, and primary care services, as well as an onsite lab and X-ray facilities.

Cape Cod Healthcare is the largest medical provider on the Upper and Mid Cape. In addition to medical offices, Cape Cod Hospital in Hyannis, and Falmouth Hospital, the organization currently has urgent-care centers in Falmouth, Sandwich, Hyannis, and Harwich.

For the tax year ending September 2019, Cape Cod Healthcare reported total revenue of $987 million, and an operating surplus of $53 million. Lauf’s compensation for the year was more than $1.9 million, and at least five physicians working for the organization were paid over $1 million.

Outer Cape Health Services has historically been the main health care provider on the Outer Cape, with medical centers in Provincetown, Wellfleet, and Harwich Port.

Will Outer Cape Health Services feel the squeeze from Cape Cod Healthcare’s move onto their turf?

“The future impact of Cape Cod Healthcare in Orleans remains to be seen,” said Gerry Desautels, senior development and communications officer for Outer Cape Health Services.

Calling Outer Cape Health “the only medical provider from Eastham to Provincetown,” Desautels said the organization uses an integrated health care model, which he called “team-based wraparound care.” In addition to traditional health services, the Outer Cape Health centers provide behavioral health services, social services, and a food and nutrition program for women, infants, and children, all on site. Insurance enrollment counselors are there to help patients find plans and sign up for them.

“We have a lot under one roof,” Desautels said.

Andrew Jorgensen, chief medical officer for Outer Cape Health, said urgent care on the Outer Cape is nothing new — his organization provides urgent care at its Provincetown health center year-round.

“Certain clinicians are dedicated to that service,” he said. “We’ve had it for several years.”

The number of employees at the planned Orleans operation has not yet been determined, but Cape Cod Healthcare, in its permit filings, said that there will be four or five full-time physicians assigned there.

“We have a lot of respect for Outer Cape Health Services,” said Lauf, who characterized the two medical organizations as having a solid working relationship.

Asked whether a merger is in the works, Lauf said, “We’ve never had that discussion.”

Meanwhile, the project is navigating the town permitting process.

The plan secured approval before Christmas from the site plan review committee, which is made up of staff from various town departments. It will undergo architectural review this month and must secure a special permit from the zoning board of appeals for a change of use. The conservation commission will review wetlands issues, and the board of health, a Title 5 septic system.

“It sounds like a very good, positive project for Orleans and the area, and we are glad to have them present the proposal,” said Orleans Town Planner George Meservey.

IMMUNITY

‘Rollout’ of Vaccine Gets to Cape Cod

First responders set to receive Covid vaccine starting Monday

By Paul Benson Jan 7, 2021

PROVINCETOWN — The Outer Cape is getting vaccinated for Covid. Outer Cape Health Services has been inoculating its staff here and in Wellfleet with the Moderna vaccine. Seashore Point Wellness and Rehabilitation Center in Provincetown, the Outer Cape’s only nursing home, was to have offered the Pfizer vaccine to its residents and staff on Wednesday, Jan. 6. And beginning Monday, Jan. 11, first responders will be authorized to receive the vaccine at the county’s new drive-through site in Barnstable.

This is the beginning of a long process. On Monday, Gov. Charlie Baker called it “the largest, most significant, potentially lifesaving vaccine rollout in U.S. history,” and then he literally screamed the words “That can’t happen fast enough!” The need to dispense the vaccine both quickly and fairly has raised pressure on local leaders to organize a strategy and execute it.

According to the state’s vaccine timeline, health-care workers are the first priority, and Cape Cod’s first vaccine shipments — 9,450 doses — have gone directly to medical providers instead of town or county governments. Cape Cod Healthcare, which manages both of Cape Cod’s hospitals, is, by far, the largest medical organization here, with about 6,000 employees and an annual payroll of nearly half a billion dollars. Detailed breakdowns of where the vaccine shipments went are not yet available — but it’s clear from statewide data that nearly everyone who received the vaccine in December was connected to a hospital.

Community health centers and nursing homes are now a statewide focus. The state is participating in a federal plan for CVS and Walgreens to administer vaccines in nursing homes. The CVS plan to administer the first dose of the Pfizer vaccine to residents and staff of the nursing home at Seashore Point on Jan. 6 was confirmed by David Ball, a spokesman for the AdviniaCare group that owns Seashore Point and several other Mass. nursing homes. Ball could not confirm how many residents and staff would be inoculated.

State reports indicate there have been no deaths from Covid at Seashore Point. Since the first dose of vaccine is thought to offer significant protection, the arrival of vaccines this week holds out the hope that the facility might escape the pandemic with a record of no Covid deaths at all.

At Outer Cape Health Services, “all OCHS staff who have opted for the Moderna vaccine have either received the first dose or are scheduled for this week,” said communications officer Gerry Desautels. OCHS has a staff of 198, and it received a shipment of vaccine directly from the state.

Not every employee of a medical organization is considered by the state to be a vaccination priority. “Individuals who do not come into contact with patients are not prioritized in phase one,” according to the state’s vaccine timeline. But Gov. Baker made clear on Monday that he doesn’t want to see any vaccine wasted, either.

“I do know that a couple of community health centers did distribute doses to some of their local first responders” rather than let doses spoil, said Baker. “Our point of view is it’s important to use it.” Baker added that no loss or spoilage of vaccine had been reported so far.

Vaccines for First Responders

This week’s expansion of inoculations to police officers, firefighters, and EMS personnel is the first time that town and county governments will become involved. Barnstable County will be directly receiving a shipment of around 1,300 doses from the state, said Sean O’Brien, the county’s health director. Those will be for first responders from 10 Cape Cod towns: Yarmouth, Dennis, Brewster, Harwich, Chatham, Orleans, Eastham, Wellfleet, Truro, and Provincetown.

According to mass.gov, first responders from these 10 towns will be able to make appointments online and then head to a new drive-through location at the Barnstable County government campus on Main Street (Route 6A) in Barnstable. According to the state’s website, vaccinations there will be on Thursdays, Fridays, and Saturdays.

Later in January, phase one will expand to include people who live or work at congregate living sites, including homeless shelters and jails, as well as home health-care workers. After that, vaccination will expand to larger segments of the public, beginning with people over 75 and people with two or more health conditions that make them vulnerable to Covid, such as cancer, obesity, and diabetes. (The state’s full list of co-morbidities can be found at mass.gov/info-details/when-can-i-get-the-covid-19-vaccine).

The same sites used for first responder vaccinations are likely to be used for the broader public, said Gov. Baker. Additionally, the state is working on “mega-sites” that could vaccinate 2,000 people per day.

“When it comes to handling the general population, it will be between the state Dept. of Public Health and the local boards of health, as it should be,” said O’Brien. “Every town has an emergency dispensing site plan. If they want to set up their own vaccination clinics, they have plans to do it. We can provide resources through our nurses, our medical reserve corps. Whatever they need, we are here to help.”

It’s going to be an all-hands-on-deck effort. With a population of almost seven million, Massachusetts could be looking at six million vaccine candidates, and nearly 12 million individual doses. (People under 16 are not yet approved for Covid vaccines, and some vaccines may require only one dose.)

That’s a lot of inoculations. To get it all done in eight months would require around 50,000 shots per day. The numbers are less scary if you just look at Cape Cod, where 1,500 shots per day would work. That could be accomplished at one of Baker’s “mega-sites,” or 15 smaller efforts in the 15 towns in the county.

But no matter how the work is divvied up, it’s going to take a lot of shots to stop the pandemic from spreading.

VISITING THE SICK

Hospitals Can Be Flexible on No-Visit Policy

But sometimes you have to fight to get them to do it

By Tessera Knowles-Thompson Dec 17, 2020

Among all the challenges of the Covid-19 pandemic, perhaps the greatest is not being able to visit elderly loved ones. In some cases, Covid patients have died in health-care facilities without family members present.

“It has been one of the most difficult and heartbreaking consequences of the pandemic,” said Chris Hottle, director of the Provincetown Council on Aging.

But the issue of leaving loved ones at the front door of a facility goes far beyond end-of-life separation.

For people with cognitive impairment, for example, including a large population of dementia and Alzheimer’s disease patients, the no-visitor policy at hospitals means that patients lose their spokesperson at a time they need it most. There can be dire medical consequences.

In recent weeks, the number of hospitalized Covid-19 patients on Cape Cod has more than doubled. As of Dec. 13, Cape Cod and Falmouth hospitals reported 37 patients with Covid, eight of whom were in the I.C.U. Less than three weeks earlier, on Nov. 24, there were 15 cases in the two hospitals, and zero in the I.C.U.

For people living with dementia or Alzheimer’s, going to the hospital without a caregiver can be like sending someone to a place where they don’t speak the language, said Melanie Braverman, co-founder of the Alzheimer’s Family Support Center of Cape Cod.

Caregivers of dementia patients are not just visitors, said Alan Johnson, a Provincetown resident and an Alzheimer’s and dementia social worker with Cape Cod Healthcare. Without a caregiver, dementia patients are unable to explain their own medical history, how they feel, or their exact symptoms. Elderly patients often have many pre-existing conditions, making it hard for doctors to know their baseline, he said.

That is why, this spring, at the urging of patient advocates, Cape Cod Healthcare — which operates both Cape Cod Hospital in Hyannis and Falmouth Hospital — broadened its initial Covid-19 policy, which prohibited all visitors, to add special circumstances, including caregivers of patients with dementia or Alzheimer’s, Johnson said.

But now, as hospitals and other health care centers are locking down again, there is confusion about the shifting policies. Johnson said it’s critically important to advocate for your loved ones. Staff members of large medical complexes like nursing homes and hospitals are not always able to keep up with the rapidly changing rules.

Magic Word: ‘Lawyer’

Johnson runs a support group for dementia caregivers. One of his clients reported that she had recently been denied entrance into an emergency room in Brockton with her loved one. She demanded to talk to someone in charge, Johnson said. She was turned down by the first receptionist, but kept pushing, eventually dropping the word “lawyer,” and that made the difference, Johnson said. A higher-up was summoned and she made it in.

According to Cape Cod Healthcare’s printed policy, effective Nov. 30, visitors are prohibited at all of CCHC’s 17 facilities, including Cape Cod Hospital. But exceptions include cases when a caregiver is considered “of benefit to either the patient or the provider.” Under this policy, one caregiver is allowed to accompany a patient with cognitive impairment, memory impairment, or dementia.

Although the most recent policy includes some leeway for special cases, visits are not guaranteed. Clinical staff evaluate patient needs for accompaniment on a case-by-case basis, said CCHC spokesperson Christina Peaslee.

The Independent’s senior reporter, K.C. Myers of Wellfleet, experienced first-hand the confusion created by the policy when her mother, Cate, was admitted to the hospital two days before the Nov. 30 policy went into effect. Since Cate has dementia resulting from a stroke, Myers was concerned that, without a familiar voice and face in the room, her mother could get hospital-induced delirium — which had occurred in April when the hospital prohibited all visits.

Hospital-induced delirium is among the most common complications among older patients resulting from hospitalization, occurring at rates ranging from 26 to 94 percent. When it is not addressed, it can result in long-term health problems. People with dementia are more likely to develop delirium while hospitalized. Having a caregiver or family member close can help prevent it.

Before the ambulance arrived on Saturday, Nov. 28, Myers looked at the visitor policy on the CCHC website and called the hospital to make sure she could visit her mother. A nurse told her she would most likely get an exemption under the new policy. The following day, another nurse wouldn’t guarantee she could visit her mother, but told her to explain the situation to the shift supervisor.

On the day the policy went into effect, Myers spoke to the shift supervisor over the phone and was told that neither she nor another caregiver could visit her mother. The policy for accompaniment, she was told, was for patients coming into the hospital for procedures.

Eventually, Cape Cod Hospital staff made a special allowance and a caregiver was allowed to stay with Cate. The nurses were kind and supportive, said Myers, but she had to make multiple phone calls over the course of two hours to make it happen.

A Lack of Training

Johnson said it appears that Myers was a victim of the lack of hospital-wide training about dementia — something that every Massachusetts hospital is required to implement by 2023. According to the 2018 Act Relative to Alzheimer’s and Related Dementias in the Commonwealth, all hospitals are mandated to have an operational plan “for recognizing and managing individuals with dementia.”

“Imagine the number of encounters at Cape Cod Healthcare where people need lab work, or to use the E.R., or hip surgery,” said Johnson, “and every one of those departments is focused on hips or labs and they are not focused on dementia.”

Johnson said the hospital needs to do that training. And, in the meantime, people should know that he and a nurse run a program to help guide and support caregivers. The Cape Cod Healthcare Dementia & Alzheimer’s Caregiver Support Program offers group support session classes, telephone advice, referrals, respite care grants, and counseling sessions.

DOING GOOD

An Artistic Haven for Essential Workers’ Children

The Cape Conservatory fills an urgent need

By Saskia Maxwell Keller May 7, 2020

Among the institutions stepping up in the Covid-19 crisis, like hospitals, police and rescue squads, schools, and grocery stores, you might not think of a music conservatory.

But the Cape Conservatory has indeed stepped up. With its usual program of classes and workshops in music, dance, and art on two campuses in Barnstable and Falmouth suspended (or taught virtually) during the epidemic, the conservatory was approached by Christopher Lawson, chief development officer at Cape Cod Healthcare, who asked if it would serve as a child care provider for local health care workers. The answer, straightaway, was yes.

“We already had a relationship with Cape Cod Healthcare because of our close proximity,” says Anne Kullas, director of the conservatory’s Emergency Childcare Program. “We thought, absolutely, we are willing to open our doors to serve any children or families in the community in a time of crisis.”

Since then, the conservatory’s program has expanded from health care to all essential workers on Cape Cod. It offers drop-in child care at no charge from 6:30 a.m. to 5:30 p.m., for children aged 2.9 and up, at its Barnstable facility at 2235 Iyannough Road. Though the program currently serves six children, there are 39 spots available. (Contact Kullas to pre-register at 774-810-5571 or [email protected], though pre-registration is not required.)

“It’s almost like we’re our own little family here,” Kullas says. “We have a boy who is nine and has become a mentor to our youngest, who is four. He has almost become the big brother of the group.”

The Cape Conservatory (merged with the Cape Symphony in 2010) is usually home to the Conservatory Preschool, which teaches an arts-enriched curriculum and is meeting virtually during the crisis. The children in the Emergency Childcare Program likewise spend their days doing craft projects, having dance parties, and playing musical instruments. They also must do remote learning for the schools they were attending.

It can be challenging to juggle diverse ages and curricula in the same room. But, Kullas says, “When the parents are done working their eight-plus-hour shift, we want them to go home and relax and be with their kids, not feel the pressure of completing assignments.”

Lynn St. John, who works at Spaulding Rehabilitation Hospital Cape Cod in Sandwich and whose two grandchildren are in the program, says, “During these trying times, it is comforting to know that my grandchildren are in a safe, supportive environment that provides structure as well as fun.”

Fun aside, staff members follow strict health protocols, Kullas says. The classrooms are thoroughly sanitized morning and night, children wash their hands frequently, and plans are in place if anyone comes in contact with an infected person.

Despite the risks, teachers Alyson Anderson and Larry Smith have always been on board. “It’s the least we can do for our local community heroes,” Anderson says. They work 11-hour days, providing emergency child care as well as remote learning for the Conservatory Preschool.

Unlike some of their elders, the children in the program seem to have taken in stride the disruption to their lives. “They don’t seem worried or concerned, although we’d be ready to handle that if they did, as we’re trained in that area,” Kullas says.

In fact, some of the children like it so much, they don’t want to leave at the end of the day.

D.I.Y.

Homemade Face Masks: Sewing a Statement

Last-resort wear, better than nothing, makes a point about a broken system

By Molly Newman and Teresa Parker Apr 2, 2020

WELLFLEET — Deirdre Oringer hadn’t sewn in ages. But when her daughter, Alita Pedley, who is an emergency room nurse in Bellingham, Wash., posted a pattern for face masks created by nurses, for nurses, Oringer thought, “I can do that.” Using social media, Oringer rounded up fabric and sewing machines and got to work. She gave her first set to those serving meals at the Fox & Crow Café’s Common Table.

Deirdre Oringer adapted a pattern that calls for ties instead of elastic. She says they’re more adjustable and durable that way. (Photo Lisa Brown)

Even as she is making them, Oringer knows these masks are not what her daughter really needs. Medical professionals working closely with patients who have COVID-19 can be protected from tiny virus-carrying droplets by N95 respirators, made from special materials and designed to form a tight seal around the wearer’s mouth and nose. And the country is running low on them. That shortage is real at Cape Cod Healthcare, owner of the Cape’s two hospitals, according to a statement issued on Mar. 25 by Michael Lauf, the company’s CEO.

The pattern Alita posted was for a mask designed to cover the higher-grade N95 masks to help prolong their useful life, Oringer explained.

Last-Resort Wear

Lauf’s statement noted that while the hospitals would prefer donations of medical-grade masks, hand-sewn masks are being accepted as well.

Cloth masks “do not provide adequate protection for medical staff,” according to the Johns Hopkins School of Public Health website’s COVID-19 page. “Cloth masks should be used only as a last resort if medical grade masks are not available,” it advises.

The World Health Organization and the Centers for Disease Control and Prevention both say there’s no point in healthy people wearing any kind of mask unless they are taking care of someone who may be infected with COVID-19 — that is, for self-protection.

Studies of influenza pandemics have shown that when high-grade N95 masks are not available, even surgical masks protect people “only a bit more than not wearing masks at all,” according to a March 29 New York Times report.

At the same time, some doctors are suggesting that healthy people should begin to wear masks if they have to be in close proximity to others. The idea is that, even though masks are not as effective as hand-washing or social distancing, they may be better than nothing for situations where those precautions can’t be taken.

We Can Do It

Susan Jordan in her Orleans workshop. A sailboat print gives her masks a Cape Cod theme. (Photo Charles Jordan)

The real reason to make and wear the masks may not be medical. Some people hope homemade masks will stop ordinary citizens from hoarding masks that medical workers need more desperately.

For those who sew, making masks is an outlet for the desire to help. Susan Jordan’s Orleans custom sewing business, Susan’s Workroom, closed when Gov. Charlie Baker ordered nonessential businesses to cease operations. But she had industrial sewing machines and fabric on hand. A friend cut the patterns and, Susan said, “I just put myself into production mode.” Her masks are going to Fontaine Primary Care, part of Cape Cod Healthcare.

Mary DeAngelis heard from a friend who was making masks in Truro, but in need of elastic. That idea awakened a sense of purpose for DeAngelis, a fashion designer who lives in Provincetown. She envisioned a brigade of seamstresses in town forming a production line.

Mary DeAngelis knows how to make a statement. (Photo Marian Roth)

When social distancing requirements thwarted that idea, DeAngelis got out her scissors anyway. “I immediately thought of my flannel pajama bottoms, and how I could use their elastic waistbands, but also their bird, puppy, elephant, and flower patterns,” she said. She is working to make 25, the number of masks Seashore Point has requested. “I had quite a few pairs of pajamas, but now I’m onto a friend’s shabby chic couch cover and a neighbor’s denim dress from the 1940s.”

Jessica Nandino, the nurse who posted the pattern Oringer found on Instructables.com, accompanies her instructions with an acknowledgment that the evidence on the effectiveness of cloth masks is not encouraging.

Instead, she wrote, “I believe these masks may demonstrate our protest.” Her point is to show the power of community to spring into action where neither the free market nor the government are doing so.

“We will make a statement, when all across the country, medical professionals start showing up to work in fabric masks, sewed by members of their community, from of a hodgepodge of fabrics in every color,” Nandino wrote. “The act of wearing this mask could become a visual representation of the sacrifices we are making and our unwavering dedication to care for others in their time of need, regardless of the most recent constraints of the terribly broken system we work within.”

PANDEMIC

Health Center Funds Dwindle as Patients Stay Home

OCHS puts losses at $1 million per month

By K.C. Myers Apr 2, 2020

PROVINCETOWN — No clinical services to patients have been canceled since Outer Cape Health Services last week furloughed or laid off nearly half its staff because of lost revenue caused by the coronavirus pandemic.

Federally qualified health centers like OCHS are the “canaries in the coal mine” of the economic crisis caused by COVID-19, according to the Mass. League of Community Health Centers. Though it was not clear whether any other such centers in Massachusetts had announced staff reductions as of Monday, Atrius Health, the largest independent health care organization in the state, also made temporary cuts affecting about half its workforce on March 23.

In a conference call on Monday, Dr. Andrew Jorgensen, medical director of OCHS, said no clinicians have been furloughed or laid off. But many support staff at all three clinics, in Provincetown, Wellfleet, and Harwich, will be out of work, mostly temporarily, for an estimated four to six weeks, said CEO Pat Nadle.

“Today has truly been one of the hardest days in my entire career,” Nadle stated on March 25. “Making decisions that impact even one staff member’s life is very difficult.”

OCHS has furloughed about 70 of its 200 employees. They can return to their jobs when patient visits and revenues return to normal. In the meantime they can apply for unemployment benefits and health insurance through MassHealth, Nadle said. Others, including members of the management team, will work reduced hours, she said. There will be a small number of permanent layoffs — “enough to count on one hand,” she said.

Gynecology, behavioral health, radiology, and other services will continue for now, Nadle said. Dentistry and ophthalmology were suspended about two weeks ago at the recommendation of the governor, Nadle said.

Cape Cod Healthcare, which operates both Cape hospitals, had avoided staff reductions as of the Independent’s deadline. But in reaction to the lost revenue from canceled elective surgery, CEO Mike Lauf announced he would give up his salary for April ($78,000 according to the Cape Cod Times). The trustees of Cape Cod Healthcare said they would match that amount in a donation to the company’s foundation.

At Outer Cape Health, the reduction in patient visits is expected to create losses of $1 million a month, according to Nadle’s announcement.

The League of Community Health Centers announced on March 20 that clinics like OCHS (which get federal funding to serve poor and rural areas) are expected to see revenue drop by 50 to 70 percent during the pandemic.

Ironically, health care is taking a hit because, as people isolate, they postpone seeing their doctors. Community health clinic revenue comes mostly from patient visits. For hospitals, the top revenue streams are from elective surgery and cardiovascular surgery, followed by cardiology, neurosurgery, orthopedic surgery, and gastroenterology.

In order to adapt to the losses, OCHS is applying for grants, and should benefit from the recent federal stimulus bill, though Nadle said the amount of help was still not known.

Aside from the aid package, the government is beginning to help shift the immediate revenue picture. The federal government did recently allow Medicare to begin paying for telemedicine appointments. Private and state-funded insurance companies were ordered by Gov. Charlie Baker to reimburse immediately for telemedicine, Jorgensen said. But that did not happen quickly on the federal level.

Telemedicine, which now accounts for about 80 percent of appointments, could help stop the spread of the virus, and saves on personal protective equipment, which continues to be in short supply.

THE PANDEMIC

Cape Works to Meet Growing Need for Coronavirus Testing

The supply of tests remains scarce; hospital capacity is limited

By K.C. Myers Mar 19, 2020

Updated at 4 p.m. Tuesday, March 24.

PROVINCETOWN — Outer Cape Health Services will test patients for the coronavirus, but they must first call one of the OCHS health clinics to be screened by phone. If a test is deemed necessary, a staff member will come out to your car in full protective gear to administer it.