Choptank Community Health System has been recognized for its leadership during the COVID-19 pandemic with the Comptroller of Maryland’s 2020 William Donald Schaefer Helping People Award for Caroline County. Choptank Community Health received the recognition at a July 13 virtual presentation with Comptroller Peter Franchot.

The annual award recognizes individuals and organizations in each of the 23 counties and Baltimore City who best exemplify former Governor and Comptroller William Donald Schaefer’s unparalleled legacy of public service and selflessness, with awardees nominated by their peers.

Choptank Community Health CEO Sara Rich.

Choptank Health served as Caroline County’s primary testing center and was cited for the award as a valued partner in the battle to successfully contain the spread of COVID-19, while continuing to provide quality, integrated health care for residents in need.

“Choptank Health is a critical piece of the health care system,” says Choptank Community Health CEO Sara Rich. “We collaborate with hospitals, local and state governments, social, health, and business organizations in all our operations to improve health outcomes for medically vulnerable people.

Rich says Choptank Community Health’s mission of providing access to health care for all is at the heart of the nonprofit’s recent testing and vaccination clinics, where COVID-19 testing and vaccines were brought into our underserved, most at-risk communities through partnerships with local health and emergency response departments and other organizations.

Choptank Health worked with the Caroline County emergency operations center to actively share information and track the initial spread of COVID-19. They were the region’s first health care provider to offer drive-up and curbside COVID-19 testing for Choptank Health patients, and worked in partnership with County government and Caroline County Public Schools to provide community mass testing sites.

Choptank Health’s vaccination and testing outreach expanded into the region’s most hesitant and hard-to-reach communities, including those served by the Avalon Theatre’s Multi-Cultural Festival and through clinics with Dorchester County’s migrant seafood processing workers. Its outreach also brought vaccinations to other communities through events including those at Union United Methodist Church in St. Michaels, and Building African-American Minds in Easton, among others.

“We are grateful to work with Caroline County and all our partners throughout the pandemic,” said Choptank Community Health CEO Sara Rich. “We helped the County to develop detailed policies and response plans for things such as community-wide testing and how to handle exposures in vital government services like

Corrections, law enforcement, and EMS. We also expedited the delivery of health and safety guidance to our business community without having to wait for information from the CDC or State Department of Health.”

“Choptank Community Health truly embodies the qualities of service the William Donald Schaefer Helping People Award seeks to highlight,” said Caroline County Chief of Staff Sara Visintainer in her nomination of Choptank Health for the award. “The Choptank Health team dedicates every day to improving the communities in Caroline, Talbot, and Dorchester Counties. They provide high quality, affordable health and dental care to all. This is especially true for our most vulnerable populations because Choptank Health provides health and dental services regardless of a person’s ability to pay.”

Visintainer also said Choptank Health has created exceptionally valuable public-private partnerships with county governments, health departments, and school systems on the Mid-Shore to help better serve our communities.

Other Eastern Shore award recipients include Friends of Blackwater National Wildlife Refuge, St. Michaels Community Center’s Executive Director Emerita Trish Payne, Kent Center Chief Morale Officer Larry Wilson, Court Appointed Special Advocate and The Beauty of Being Black Founder Sharon Robinson, Crisfield Arts Syndicate’s Shawna Kearsley, Fenix Youth Project’s Amber Greene, and Jesse Klump Memorial Fund’s Kim Klump.

“These recipients have positively impacted the most vulnerable members of their communities by feeding the hungry, protecting our natural resources and redirecting children to healthier, more fulfilling lives, and so much more,” Comptroller Franchot said. “They are heroes dedicated to lifting up those who need a helping hand.”

Choptank Community Health is one of 17 health centers in Maryland serving more than 377,000 individuals, including those without insurance or an ability to pay. Health Centers serve more than 28 million people nationwide and provide affordable, high quality, comprehensive primary care to people from throughout the local communities, including those underserved and uninsured.

Choptank Community Health System provides medical, dental, pediatric, and behavioral health services in Caroline, Dorchester, and Talbot counties, with a vision is to improve the health and well-being of people in the communities served by providing outstanding care experiences while being an exceptional place to work and make a difference, with more at choptankhealth.org.

While Kent County has had good reasons to celebrate the recent news that the Shore Regional Health’s Chestertown hospital would remain a full-service facility with its new designation as a “critical care” health center, there was another bit of news about the same time that might have been overlooked with all that excitement.

About the same time that the State of Maryland re-classified the town’s hospital, it was also announced that Choptank Community Health System had joined in a partnership with Shore Health to serve the needs of Kent County. Choptank might be a new name for locals, but it has been a highly respected health provider for the Mid-Shore for almost four decades.

Originally launched by concerned nurses and doctors in Caroline County in 1978, Choptank’s mission was to establish comprehensive primary health care services to all residents, regardless of one’s ability to pay. And since that time, the nonprofit health provider has grown to establish centers in Cambridge, Denton, Easton, Federalsburg, Goldsboro, and St. Michaels. And now Chestertown will be added to this list starting in 2022.

Not only has Choptank grown in the territory they cover, but in the last several years, they have significantly expanded their mission to include dental care, in-school health centers, and now behavioral health as well.

The Spy sat down with Sara Rich, Choptank’s CEO and president, at the White Swan Tavern the other day to learn more about Choptank and what they will be bringing to Kent County.

This video is approximately seven minutes in length. For more information about the Choptank Community Health System please go here.

It may take months, if not years, to truly understand the impact of the COVID pandemic on Talbot County but there is little doubt that Talbot Hospice has been on the front line of this crisis since it started in March of last year.

With now forty years of experience in end-of-life management, Talbot Hospice took on a massive undertaking on not only supporting those directly impacted by the deadly virus but had to quickly pivot to safely provide for those in its care and continue its grief services.

Very few people would be surprised that Talbot Hospice met this challenge, least of all Sheila Monahan, its current board president. Nonetheless, as the organization begins celebrating four decades of service to the community, it seemed like a very good time to talk to Sheila about how Hospice has fared during this difficult time.

The Spy sat down with Sheila a few weeks ago about the current work of Hospice as well as early preparations for its 40th birthday party planned for October.

This video is approximately four minutes in length. For more information about Talbot Hospice and how to volunteer please go here.

Perhaps one of the more significant events in Chestertown’s long history is expected to take place in a few weeks. While there is no official celebration planned to mark this important moment, this is when it is anticipated that the Health Services Cost Review Commission (HSCRC) will give the final approval of the town’s hospital becoming designated as a critical access facility in the eyes of the State of Maryland.

That might sound a bit bureaucratic, but it’s a huge deal.

This label determines that the UM Shore Medical Center at Chestertown is so rural, so remote, that it can operate as a full-service hospital even if the costs of running the facility could be above current standards for similar medical facilities in Maryland.

The Spy spoke to Shore Regional Health’s CEO Ken Kozel last week about this remarkable moment. As someone who has played a leading role for more than a decade with Chestertown’s hospital and the debate on its future, Ken notes that this historic phase for health care that Chestertown, and more broadly, Kent County and northern Queen Anne’s County, will be entering. He also talks about the five-year process that this new designation kicks off, including intensive community engagement. All to help determine precisely what a critical access hospital does, since Chestertown will be the first of its kind in the State.

This video is approximately six minutes in length. For more information about Shore Regional Health please go here.

Many of a certain age might recall the limited health services that were available in schools back in the day and that all other health-related issues were in the hands of family physicians or local health centers outside the classroom environment.

But like the health field in general, there have been significant changes in how healthcare is provided nowadays to kids. In fact, there is a new partnership that has developed between the school nurse model and in-school health centers that would not be that dissimilar to what you might find in neighborhood urgent care clinics.

A leader on the mid- shore providing this change is Choptank Health with school programs in all five counties. From Kent to Dorchester, Choptank is working with every school district to provide a range of health services to students right at their school or in their communities, which for many kids might be the only way they receive medical or dental care in any given year.

The Spy sat down with Sara Rich, CEO of Choptank Health, and her colleague, Chrissy Bartz, who runs its community-based programs, last week on how essential healthcare is now more successfully reaching some of our community’s most needy children and their well-being.

This video is approximately five minutes in length. For more information about Choptank Health please go here.

There is a notion that “end of life” means imminent death. But for most of us, death does not happen abruptly. Whether related to age or disease, a person’s ability to maintain activities of daily living usually declines over time. This could happen over years, months, or weeks. Each time period requires adaptation of the new normal.

If a person hasn’t taken time to think about and discuss these changes, the reaction is often to deny the change and fight to regain the old normal. This sets them up for pain and suffering because they can’t go back to their previous state indefinitely. There are resources available to help make these adjustments easier. 

Doctors & Clergy Members

When planning to discuss health and major life decisions, many people reach out to their healthcare provider or religious/spiritual advisor. But these professionals may be ill-equipped to counsel on end of life. Healthcare providers work in a system devised to keep people healthy, to maintain optimal functioning. Although advances have been made, there is still a level of discomfort surrounding the discussion of death. Many providers don’t know how to guide patients through end of life.

Religious and spiritual advisors help direct people to live a good life, teaching them how to assure a place in heaven or receive some other reward. Sadly, for some, their education didn’t include training about how to help people find peace and satisfaction at the end of their life.

How much is too much?

With a lack of resources for a meaningful dialogue about an end of life plan, another issue arises: over-treatment.

Over-treatment in the United States has become the standard of care. In her book, Finish Strong, author Barbara Coombs Lee, healthcare clinician, policy maker, advocate and president of Compassion and Choices outlines six reasons for over-treatment.

1. Financial gain. The main reason for over-treatment in the US is the current fee-for-service model. Providers are paid to perform tests, procedures and surgeries, not to cure disease or maintain health. It is not a matter of greed or conspiracy on the part of the provider. It is the inevitable result of this type of system.
   
2. Providers are reluctant to deliver bad news. Providers may feel a personal sense of failure when explaining that treatments aren’t working. This often prompts them to suggest other treatments. These treatments often lead to a decrease in the person’s quality of life or may inadvertently shorten their life because of side effects. When more technology is introduced into patient care, hands-on medicine decreases. The farther away a provider gets from the patient, the less comfortable they are looking the person in the eye to tell them that their life is ending. Studies reveal that healthcare providers experience feelings of profound grief, sadness, self doubt, failure and powerlessness when treatments fail and death is inevitable.

3. Patient and family expectations. There is a notion that we can abuse our bodies for a lifetime with poor diet, dangerous behaviors, addictions, lack of exercise, and expect — almost demand — that our doctor fix us with a magic pill or a silver-lining procedure or surgery. These do not exist but that doesn’t stop patients and families from imploring providers to “do everything you can,” “try something else,” or “spare no expense.”

Providers are not magicians and they certainly are not God. There is a limit to what the body can tolerate. We all come with an expiration date. The sad part about “doing everything” is that the majority of the time, the intervention causes pain and suffering. It robs the patient of enjoyment and quality time to say important things while loving those around them. In trying to save them, the precious time they have left is stolen.

4. Technology. In our country, many people think that just because technology is available, it must be used. When a patient hears that there is another machine available to perform a different test or procedure, they want to use it. That is not an inherently bad thing. The problem arises when no one questions why it’s being used, what the potential outcome is going to be, and if it may lead to further tests and procedures. Every case is different but this should be discussed at a level that the patient and family can understand.

5. Fear of lawsuits. A national physicians survey conducted in 2010 by Jackson Healthcare found that 73% of doctors say they order more tests, procedures, and treatments than are medically necessary in an effort to prevent lawsuits. Providers would rather do more than be accused of not doing enough. They don’t want to risk a lawsuit and an accusation of malpractice. According to a 2014 Gallup poll of healthcare executives, the financial impact of defensive medicine is about $650 – $850B a year.

6. Palliative care/hospice care equals giving up. Our current system requires a patient to stop curative treatment in order to receive hospice care. The main focus in both palliative and hospice care is comfort. Palliative care (treatments aimed at providing comfort and quality of life) can co-exist with curative care but Medicare does not pay for it, at least not yet. Hospice care requires an end to most curative treatments with a few exceptions and Medicare pays for it. 

Studies prove the benefit of a dual approach to patient care. In a 2010 study, 151 cancer patients were randomly assigned to standard treatments alone or standard treatments with early access to comfort care. The group that was given both standard and palliative care as their disease progressed was less likely to choose aggressive treatment such as 3rd and 4th rounds of chemotherapy or admission to the ICU. They actually lived an average of three months longer than the standard group and they reported better quality of life.

Start the conversation with these documents.

There are resources available to help you have important conversations and create legal documents detailing your end of life wishes. You can find these documents online or obtain them from your local hospital or hospice provider.

Five Wishes. This is a legal document that helps people consider and document how they want to be cared for at the end of life. It states what life-sustaining treatment the person desires as well as what they don’t want. It names the person who will make decisions when they are no longer able. It also documents how and where they die. For example, they may wish to die at home with their favorite music playing and a special aromatherapy scent in the air. The document lists who you want to be present at the time of death. People may write their own obituary and dictate what their funeral or body disposition plans are. This form needs to be signed by two witnesses who are over 18 years old and will not benefit from the person’s death. 

MOLST: The Maryland Order of Life-Sustaining Treatment. This is a legal document and a physician’s order signed by a medical provider. Most people discuss this with their primary care provider and have them sign it, but it can be signed by any licensed provider. It details what life-sustaining treatment and procedures you want and those you don’t. It identifies your decision maker when you are no longer capable of making the decisions. This document is different because it is a signed order and it only addresses medical issues.

Keep the completed document in a safe place in your home. Some people keep it in the freezer in a Ziploc bag so that if you need transport by EMT to hospital, the document is there and first responders can be made aware of your wishes. Without a MOLST, by law, healthcare providers must do everything possible to keep you alive even if that isn’t what you want. 

Advanced Directive. This legal document states your end of life medical wishes and names your decision maker. There is a section for funeral and after-death body disposition plans. This document needs to be signed by two witnesses over 18 who will not benefit from your death.

Legal Documents Protect You

All of these resources are legal documents. Only the MOLST is a signed order by a medical provider and must be followed. It is the only document that EMT responders will adhere to because in most emergencies there is no time to debate the meaning of a statement. 

Make multiple copies and give them to your medical provider, your family members, your decision maker (healthcare proxy), hospital, nursing home, and back-up decision maker.

Update the documents periodically to reflect your current condition and your feelings about the types of intervention you desire. It’s important to remember that these documents ONLY come in to play when you are no longer capable of speaking for yourself. You can change your mind and submit a new document at any time. Make sure to give healthcare providers the updated version.

To learn more about end of life planning, check out The Conversation Project, Compassion and Choices and Respecting Choices. To talk with an experienced hospice nurse, contact me at Connecting the Dots in Healthcare at 443-786-0873 or email dorothyamayorga@gmail.com.

Dot Mayorga has been a nurse over 20 years serving the residents in Caroline, Dorchester, Talbot and Queen Aanes counties. She has worked as a medical- surgical nurse in Easton Memorial Hospital, a case manager Home Health, Hospice nurse with Shore Health, and Wound Care nurse with Shore Regional Health System. She currently is a triage nurse with Choptank Community Health Services.