Monday, March 26, 2012

Supreme Court to consider not 1 but 4 Affordable Care Act issues palliative hpm

Thursday, February 16, 2012

What do the Super Bowl & profession​al health care chaplaincy have in common? Lots!

By Marian Betancourt

So, did you win or lose the Super Bowl pool? And once the euphoria or heartbreak subsided, what kind of Monday morning quarterbacking did you do? If only Patriots receiver Wes Welker hadn’t dropped that pass from Tom Brady! Or, what if Giants’ Mario Manningham’s footwork had been a tad less precise? And what if Ahmad Bradshaw didn’t sit down in the end zone?

During the Super Bowl madness team sports is on everybody’s mind. We admire the players, the coaches, and more than anything, the splendid teamwork. As Dan Hawkins, former coach at Boise State and Colorado, told a New York Times reporter, “This isn’t Football 101. This is like doctorate-level stuff.”In a recent KevinMD blog, Davis Liu, MD, a New England Patriots fan wrote, “There is much to be learned by doctors and others involved in health care from the successful teams and the way they are coached and the way they practice, and the results that become obvious in the way they win.” Liu continued, “Providing complex medical care is like leading a football team of 53 players of which only 11 are on the field at any given time to play offense, defense, or special teams. For success, each individual must do his job consistently and reliably every time.”

So, we asked some sports-loving board certified chaplains to talk with us about team leadership.

Chaplains as Team Players

The Rev. George Handzo, sports fan and senior consultant, chaplaincy care leadership and practice at HealthCare Chaplaincy, said chaplains are trained to be solo practitioners, but that in a code team, “Good chaplains will learn their ‘position’ on these teams including when to get involved and when and how to stay out of the way. Sometimes we get in the game from the beginning like when a family is viewing the code. We have to know our role and be ready to get in the game as needed.”

From Martial Arts to Trauma Team

Chaplain Fran Pultro, who holds Black Belts in all the martial arts, is a one-person pastoral care department and part of the multi-person level one trauma team at St. Christopher’s Children’s Hospital in North Philadelphia. A few weeks ago, he was paged at home late at night and rushed to the hospital when a shooting that began over an altercation on Facebook, took the lives of three 14-year-olds and a 16-year-old, two already dead when he arrived. “It’s my job to do pastoral intervention for the families,” said Pultro, describing the chaotic scene. The medical staff didn’t know about the families, as they were working to save the life of the third teen. There was information coming from every different angle,” he said, and as a result a great deal of misinformation. “I began making phone calls,” he said and making course corrections as he worked. “I became the clearing house for information.” Pultro also still teaches martial arts and said he still gets on the mat with his students, because “if they don’t think you can do it yourself, they won’t listen to you.”

From Quarter Back to ER Team

Chaplain Malcolm Marler directs a 20-person pastoral care department at the University of Alabama Medical Center in Birmingham. Born in Selma, Marler learned about teamwork as a defensive quarter back (corner back) for Clemson University and was team captain in his senior year. “I grew up wanting to play with Bear Bryant, like every kid in Alabama did,” he said about the legendary coach. But they didn’t give scholarships then to poor kids like me.” When he took over as director of the pastoral care department at UAB in 2009, Marler applied this kind of team training. Previously chaplains worked either the day or the night shift and those shifts never met. Marler changed it so that everybody worked some of both shifts. “This is a big place with 1,000 plus patients,” he said. “The ER is a huge operation and we have 12 ICUs.” His department includes eight staff chaplains and one CPE supervisor along with support staff.

From Swim Team to Pastoral Care Team

Chaplain Sara Hester, who works with Marler, and is assigned to several services including ED, Trauma, and Trauma Burns, said it was her years of experience on a swim team that taught her the importance of teamwork. She was the breast stroke person but you had to watch for the back stroker, and know when to dive in or get out of the way. “It’s important to have that good hand off.” Hester said her trauma team in ED has excellent doctors and nurses. “I go around and introduce myself; I make regular rounds.” She illustrated the effectiveness of the team with an incident involving the chief trauma doctor who is “a bit gruff” and had upset the patient’s family. That physician immediately called Hest er and asked her to go and appease them. “She knew she needed me,” Hester said. “It was a good handoff.”

This is a condensed version of a more comprehensive article that originally ran in HealthCare Chaplaincy’s PlainViews, the online professional journal for chaplains and other spiritual care providers. To read the entire article, go to

Marian Betancourt is the associate editor of PlainViews and the author of Playing Like a Girl: Transforming Our Lives with Team Sports published by McGraw-Hill in 2001 and brought back into print by iUniverse.

Saturday, February 4, 2012

Helping Grandparents to Be There for Their Twin Granddaughters

Helping Grandparents to Be There for Their Twin Granddaughters

By Rabbi Nathan Goldberg

At a local hospital the daughter of a patient undergoing acute dialysis came to me and said that her father was feeling down, and asked that I speak with him, which I did.I learned that his twin granddaughters were soon to become bat mitzvah, and the grandfather was distressed that neither grandparent could attend, because he was in the hospital and Grandmother was home-bound. We together composed a blessing for each granddaughter on the lines of the blessing that Jacob gave to his grandsons in the book of Genesis:


Jewish Tradition provides the perspective that healing is not merely about the physical body. Healing incorporates body and soul. June and Joan, (note: names changed to respect privacy) please allow me to thank you for allowing me the privilege to be part of your lives and to share this blessing.

The mere act of writing this has provided healing for Grandma’s and my spirits.

Please know that even though Grandma and I cannot be here with you with our physical presence, we are certainly with you in spirit. On that note, we would like to share our gratitude to your parents, our children. They loved and cared for you long before you could recognize them. Their vigilant and tender care for one-and-a-half pound “premie” twins began years ago. The fruits of their love are beginning to be experienced now as you begin your journey as young women.

Joan, I shall start with you. Your Hebrew name is Miriam. Like Miriam the prophetess, your kind, considerate creativity endears you to your family and friends. I am blessed by you and pray that you will continue to grow into the wonderful woman you are already becoming.

June, your Hebrew name is Devora. You, like Devora the judge, can see things clearly and achieve your goals. Your intensity is energizing and I cannot wait to see where you will go in the future.We are particularly proud that our two granddaughters are wonderful individuals who are not afraid to express who they are. At the same time, they are considerate of others- each of them emanates kindness. In this way, they are following in the footsteps of their family- in particular their mother and father who are dedicated to Tikun Olam, fixing the world, on a personal and professional basis.

I leave you with the blessing of Jacob for his children and grandchildren as well as the Aaronic blessing, traditionally given to children as well. In these blessings, I also include (other granddaughter, grandson Jesse, and great grandson.)May the angel who redeemed me from all evil bless the children in the name of the parents…May G-d bless you, and watch over you. May G-d make his face shine upon you, and be gracious unto you.May The L-RD lift up his presence to you, and give you peace.

Afterwards Grandpa wrote to me, “The words were read by one of our sons and through these words everyone at the celebration felt our presence and love for our granddaughters. The words were beautiful and very moving. You had finalized our thoughts so perfectly. Thank you for what you helped us say and for our ‘being there with everyone,’ especially our girls. It touched us and gave us the comfort we needed so very much at that time.”Grandpa’s letter was such a gift to me, to hear that I could bring him and Grandma closer to their family, to ease their burdens in difficult times, and to add to the joy of this milestone event for their family.

Orthodox Rabbi Nathan Goldberg, an Association for Clinical Pastoral Education Supervisor, is a member of the Clinical Faculty at HealthCare Chaplaincy.

Global Perspectives on Palliative Care

By Kathleen M. Foley, M.D., attending neurologist in the Pain & Palliative Care Service at Memorial Sloan-Kettering Cancer Center & HealthCare Chaplaincy Trustee

Five million people die of cancer or AIDS each year with untreated pain, most of them in low and middle-income countries. The Open Society Foundations’ International Palliative Care Initiative has been working since1995 to change this. The Initiative is funded at three million dollars a year to work globally to advance palliative care in regions where the Open Society, founded and chaired by George Soros, has supportive foundations, such as Central and Eastern Europe, Central Asia and Africa.

I had the pleasure of co-moderating a seminar on Global Perspectives on Palliative Care with my colleague at Memorial Sloan-Kettering Cancer Center (MSKCC), Dr. Paul Glare, Chief of Pain and Palliative Care, held at MSKCC.

Palliative Care Advances Around the World

We heard firsthand accounts from four international experts on efforts to advance palliative care globally. Professor Judith Hill, the chief executive officer of the Northern Ireland Hospice told us of her organization’s efforts in Belfast, Ireland, as well as internationally. With her colleague, Professor Max Watson of both Ulster University and the medical consultant to the Northern Ireland Hospice, they described palliative care educational efforts in India and Nepal including the development of an international diploma program and publication of a handbook on palliative care.

Dr. Joe Hartford, director of the Office of International Affairs of the U.S. National Cancer Institute (NCI) described the key elements of his strategy to make palliative care integral to cancer care in resource-limited countries, and he discussed NCI efforts in the Middle East and Ireland. The Middle East Cancer Consortium (MECC) was started in 1996 during one of President Clinton’s peace initiatives. The vision was to try to form partnerships and collaborative efforts on cancer care in the region. For example, Egypt has 10 times the population of Israel, but Israel has 10 times as many services in palliative care. By sharing experiences and educational efforts, the Consortium is working to improve cancer care and palliative care in eight countries.

Similarly, The All Ireland Cancer Consortium , started in 1999 directly out of George Mitchell’s negotiation of the Good Friday Peace Accords, began with cancer and cross border ambulance services as the areas of cooperation in health in these two regions of Ireland. This Consortium has also supported cross border efforts to improve palliative care.

The fourth speaker, Dr. Nessa Coyle, an advanced practice palliative care nurse at MSKCC, and co-author of the leading textbook in palliative care nursing, described her role as an educator in international programs to advance nurse training in palliative care in Central and Eastern Europe, Africa and Asia. As one of the international faculty of the End of Life Nursing Education Consortium (ELNEC) which is administered by the American Association of Colleges of Nursing in Washington, D.C. and the City of Hope in Los Angeles, this initiative has trained more than 14,000 American nurses as well as international nurses in more than 30 countries.

The good news is that palliative care initiatives are rapidly expanding around the world. As Dr. Hartford described the World Health Organization’s (WHO) guide on palliative care, it outlines a model approach for how countries can create palliative care cancer services in their countries. The WHO model to advance palliative care calls for a three-pronged approach: availability of essential medicines for palliative care; the education of health care professionals and the public; and policy change that integrates palliative care into national health strategies. The WHO has recognized that access to pain relief and palliative care are human rights issues.

Palliative Care and Human Rights

Using a human rights-based approach, there is an increase in advocacy efforts by several groups. Human Rights Watch has published a series of reports on the needless suffering of patients and families in countries that lack access to pain treatment and palliative care such as India, Kenya and Ukraine. These reports, coupled with new advocacy campaigns, call for improved access to pain relief and palliative care for dying patients. Stop Torture in Healthcare is an Open Society Foundation campaign to call attention to the under-treatment of pain and features the story of a young Ukrainian patient with terminal brain cancer whose treatment for pain is severely limited by Ukraine’s strict laws regulation the availability of pain-relieving medicines like morphine. A Treat the Pain campaign is supported by the International Union Against Cancer. Using short powerful videos of real patients to document the problem of lack access to pain relief and palliative care in resource-poor countries, these are very useful educational and advocacy narratives. In fact, Dr. Watson used these videos in his opening talk to describe the barriers to palliative care internationally.

Make it Political

Siddhartha Mukherjee in his Pulitzer Prize winning book, The Emperor of all Maladies, pointed out that the big change in cancer care in America came only when the politicians were mobilized to really make the difference. Is there lack of political will? You can say a dying person cannot vote, but their families sure can. Access to pain relief should be a human right for everyone.As we ended our seminar, Judith Hill reminded us of these lines from Clearances, a poem by Nobel Laureate Seamus Heaney, about his mother’s death:

In the last minutes he said more to her

almost than in their whole life together.“You’ll be in New Row on Monday night

And I’ll come up for you and you’ll be glad

When I walk in the door…Isn’t that right?”

His head was bent down to her propped-up head.

She could not hear but we were overjoyed.

He called her good and girl.

Then she was dead,

The searching for a pulse beat was abandoned

And we all knew one thing by being there.

The space we stood around had been emptied

Into us to keep, it penetrated

Clearances that suddenly stood open.

High cries were felled and a pure change happened.

Kathleen M. Foley, M.D., is one of the world’s leading authorities in cancer pain management and palliative care. She is an attending neurologist in the Pain & Palliative Care Service at Memorial Sloan-Kettering Cancer Center and holds the chair of the Society of Memorial Sloan-Kettering Cancer Center in Pain Research. Dr. Foley is professor of neurology, neuroscience, and clinical pharmacology at Weill Medical College of Cornell University. She was the founding director of Death In America, which funded initiatives to improve the care of the dying. Dr. Foley is the medical director of the international palliative care initiative of the public health program of the Open Society Institute, working to advance palliative care worldwide. She consults to the World Health Organization Cancer and Palliative Care Unit. Dr. Foley was elected to the Institute of Medicine of the National Academy of Sciences for her national and international efforts in the treatment of patients with cancer pain. She earned her medical degree at Cornell University Medical College and is a trustee of HealthCare Chaplaincy.

“Just Healing the Body is Not Enough"

“Just Healing the Body is Not Enough,” says HealthCare Chaplaincy in Top Magazine Modern Healthcare

A recent issue of Modern Healthcare, the top-ranked magazine in readership among health care executives, featured an article about the important topic of how to measure quality care in the clinical setting.

HealthCare Chaplaincy’s the Rev. George Handzo responded with a letter to the editor which was published.

He wrote:“(The article) makes some valuable points in defense of patient satisfaction as a quality indicator. There is no argument about whether everyone ought to be held to best practices in clinical care. That said, many of us have seen patients whose diseases are cured but who leave the health care system so dissatisfied that they hesitate to interact with the system the next time they really need to and/or leave with actual social, emotional or spiritual wounds that negatively impact their quality of life.Just healing the body is not enough. Patient satisfaction speaks to the concept that the system needs to attend to all dimensions of the patient’s experience.”

HealthCare Chaplaincy CEO Awarded National Ministry Network’s Highest Honor

At its annual convocation in January in Alexandria, Virginia, The Network on Ministry in Specialized Settings (the COMISS Network) honored HealthCare Chaplaincy’s president and CEO, the Rev. Dr. Walter J. Smith, S.J., with its highest honor—the 2012 COMISS Medal—in recognition of his contributions to the profession and to the international field of chaplaincy care.

COMISS is a national organization of chaplaincy, pastoral care and pastoral counseling professionals, and their religious endorsing officials. Its multifaith network includes organizations that provide, certify, accredit and endorse chaplaincy and other pastoral services to persons in health care facilities, correctional institutions, mental health settings, the armed forces, business settings and the Department of Veterans Affairs.

The COMISS Medal has been given only 6 times since its inception. Some previous recipients have included the noted Dutch writer and lecturer, the late Henri Nouwen, and the celebrated developmental psychologist and Pulitzer Prize winner, the late Professor Erik Erikson.

Fr. Smith’s address to the COMISS delegates will be published in late March issue of the Journal of Pastoral Care and Counseling and will be available on HealthCare Chaplaincy's website in April.

Making the case for palliative care

HealthCare Chaplaincy’s the Rev. George Handzo was a workshop presenter in November at the annual conference of the Center to Advance Palliative Care (CAPC) which attracts palliative care professionals from around the country. Most of the 650 people registered at this educational event were doctors and nurses, followed by administrators, social workers and chaplains.George’s topic was “Improving the Quality of Spiritual Care as a Dimension of Palliative Care,” emphasizing the important role that a professional chaplain plays on the palliative care team.A recurring theme that ran through the presentations was the need to educate and advocate for the value of palliative care to the public, policy makers, and the health care profession itself.

CAPC Director Diane Meier, MD emphasized these grim facts:

  • 5% of all insured patients account for two-thirds of insurance company costs

  • 10% of Medicare patients account for two-thirds of Medicare costs

  • 10% of patients in hospitals account for two-thirds of a hospital’s costs
Dr. Meier said that palliative care can reduce costs while improving patient outcomes, that key to effective palliative care is listening to the patient and family members, and that chaplains are experts at this. Dr. Meier made special mention of the fact that professional chaplaincy will have a certification process in palliative care within the year. This effort, which creates the first subspecialty certification for chaplains, is a result of a joint initiative of HealthCare Chaplaincy and the Association of Professional Chaplains, and is supported by grants from the Arthur Vining Davis Foundations and the Retirement Research Foundation.HCC began the pilot of the educational curriculum with a small group of chaplains on January 23rd, and will open the program to all interested chaplains in September.