Q&A: Stony Brook Southampton CEO on the lessons learned

With the number of COVID-19 patients falling, and a frantic and stressful two months of the pandemic seemingly coming slowly down from its peak, Robert Chaloner, chief administrative officer of Stony Brook Southampton Hospital, took time on Friday to take stock, and to begin looking ahead at the lessons learned from a difficult first half of 2020.

Q: How are things in general?

Actually, they’re going very well now. Our volume [of patients being treated for COVID-19] has dropped down into the teens, and things are very under control right now.

The big unknown is … it’s the Friday before Memorial Day, when we’re usually in high gear, thinking about the summer ahead. It’s the first wave of summer we usually see. So we’re all kind of curious, actually: Are we going to see the wave? Or not see the wave?

Q: In a statement this week, you noted that the hospital successfully discharged 117 COVID-19 patients since the start of the crisis. That number is probably significantly higher than the number of deaths due to the disease?

Absolutely. As of a couple of days ago, we had 150 total; I’ve lost track of how many people tested, came into the ER and went home, but we had 150 inpatients, and 117 discharges. We had 15 deaths. The rest are still in the hospital.

Q: That’s a pretty remarkable rate of recovery.

Our numbers — we don’t want to brag, because you don’t know exactly, but our numbers are really good. The number of people who’ve died here is low. What we’ve been seeing is, we’re as good as any of the good places.

But there’s a lot of factors. We’re a small hospital, so every patient was able to get a tremendous amount of attention. [Medical Director] Dr. [Fredric] Weinbaum keeps talking about the focus on the details. We did get access right away to all the medications. Nobody shared ventilators — everybody who needed a ventilator got one. We were able to adapt the protocols quickly. We stayed in touch with Stony Brook and anything new and experimental they were doing, we were able to put in place.

I haven’t had a chance to look at what other community hospitals our size, what their experience has been, but compared to the aggregate data, our data look very, very good, in terms of survival and recovery. And our ventilator data — the people who were put on ventilators and ultimately weaned and recovered after ventilators — the rates are extremely good, too.

But you never know. Could it be just the mix of patients we had? There could be a lot of factors. So I’m very hesitant to ever brag. You know, the next week, we could have three people die, and, given our small numbers, the rate could start to change in the wrong direction.

I guess what I would say officially is: We are very, very encouraged by our results so far.

Q: And the numbers continue to decline? This isn’t the end, but is the end in sight?

Well … My guess is, we’re going to continue to see cases. It’s just going to be something that’s going to keep coming. I don’t know how low it’s going to go. It popped up: At one point this week, it was down to 13, and we’re back up to, like, 17, so it’s kind of jumping up and down. But whereas previously it was jumping up and down in the 50s, the 40s, the 30s, the 20s, now it’s jumping up and down in the teens. My guess is, we’re probably going to continue to have some number of patients who are going to continue to be admitted.

How long? It’ll probably be out there … what everybody is saying, for as long as it takes to get a vaccine.

But, definitely, I think everything that’s been done to date, in terms of social distancing, and the precautions, and those things, have kept the numbers down. It did do exactly what they wanted — it stopped the rapid growth of cases, then reversed it. And we seem to be in pretty good shape. We’ll have to watch it over the couple of months of the summer.

You know, a lot of people are speculating, could it be a lot of other things, like the weather warming up? Who knows. But I don’t think it’s going to go away right away. I’m hoping we can get down into the single digits, in terms of the number of patients in the hospital.

Q: In talking with your staff and other experts, do you have an educated guess how long COVID-19 will be with us? Do you think it’s going to return in the fall? Do you think it’s a permanent part of the health landscape, like the flu? Or do you think there’s a chance we can wipe this out altogether?

I’ve been asking that question a lot, and all of the people I talk to, who are a lot smarter than I am, all believe — and have convinced me — that, yes, it’s going to be with us until we get an effective vaccine that we can get out into the population.

You know, it’s like … remember the childhood diseases? We all used to have measles and mumps, and chicken pox, and they were just with us. And until vaccines happened, every year there’d be a round of kids getting mumps or chicken pox, and there were seasons for these diseases. Polio — actually, it’s related, I understand: The coronavirus and the polio virus are, I’ve understood, related. And polio was just there until they found an effective vaccine for it.

… We all know about HIV in our generation. And HIV, despite overwhelming efforts to contain it, to educate, to use preventive measures, HIV has not been eradicated.

Q: But it’s under control.

Yeah, it’s under control from the perspective of, we’ve managed the spread. We figured out what it was, we figured out how it was being spread, and we implemented precautions. When people don’t take the precautions, it spreads.

And we saw that a few years ago, with young people feeling, oh, HIV is a thing of the past, and suddenly we started to see the numbers ticking up again, with HIV in younger people.

And I think it’s the same thing with this. As long as we take all the precautions and do the right things, we’ll keep it under control, until an immunization is found.

Q: You announced that elective surgeries and other testing will begin in June. Why is that important, both to patients and to the hospital?

Yeah, it’s important for a lot of reasons. I think, number one, the fact that we feel comfortable doing this is the surest sign of our confidence at the hospital, that we’ve got this managed at this point, and that we can divert our focus — not all of our attention, but our focus, which really had to be on the coronavirus — to other things.

And it’s important to the hospital because, economically, we don’t make money doing chronic care, and even the coronavirus. We’re going to lose money on most medical conditions. Surgery is just the way the reimbursement system works, which is where hospitals make their money, so hospitals across the country … I just saw, one of the reports said that April will be the worst economic month in history for American hospitals, because of the fact that we weren’t able to do these other procedures. It is devastating.

… “Elective” always makes it sound like, from the patient’s perspective, “Oh, it’s elective — I can decide to do this or not.” People think about the procedures someone might want to do just because they want to look better.

Elective isn’t really that. Elective means it is a real issue — it’s just elective in terms of when you have to do it. It isn’t life-threatening at that moment.

Hernia surgeries are a good example. Do I have to do my hernia surgery today? But do I want to live with a hernia for the rest of my life? Absolutely not. And at a certain point, a hernia can become life-threatening.

So it really does impact people’s quality of life. A hernia, the longer it’s not dealt with, the worse it can get. And that’s the case with all of these conditions.

We know from talking to our surgeons that the patients keep asking, because they’re tired of living with pain, or whatever issue that they’re dealing with, and they want to get it taken care of.

Q: Bottom line, can patients be sure they’re safe to come in for surgery and testing?

Absolutely. We are doing a number of important things to make sure that happens, and we have guidance that we’re giving out. Number one, we’re encouraging the doctors’ offices, and requiring the surgeons’ offices, to start talking to the patients and notify them 14 days prior to surgery, to make sure that they monitor any symptoms, that they keep themselves in a quarantine state for 14 days. Because we don’t want them to get exposed and then get sick in the interim. So we want to know, by the time they come to us, that we can be reasonably sure that they don’t have COVID-19.

We’re going to be testing them within three days of surgery, all patients who have elective surgery, and we’ll have those results in advance.

We’re going to take extreme precautions to clean our facilities — before, in between and after, constantly. [Operating rooms] are extremely clean places anyway. … But we’re going to be doing all of those procedures, and then monitoring every step along the way.

And also being very careful about even, like, who brings you to the hospital. You don’t want to expose yourself on the way to the hospital. … And we’re still going to be limiting visitation. …

We don’t want people walking out of the hospital with something they didn’t walk in with. That is overwhelmingly what drives us on everything.

Q: You said this week — and Peconic Bay Medical Center says the same — that no patient has contracted COVID-19 while in the hospital, from another patient or a member of staff. That’s remarkable, and it seems to offer some clear evidence that protective measures work — a message that could be crucial as the economy begins to reopen.

We started testing our own employees, for antibody testing, and we’ve done 800 or so of our 1,100 employees at this point, and of those employees who have been tested — and I’m one of them — less than 5 percent, at this point, have shown positive antibodies. Which is lower than our general population.

So, even though we’re in and out of the hospital every day, and coming in contact with all of the hospital surfaces, with the patients, our antibody testing among employees is showing extremely low exposure to the disease.

And that, to us, is the most potent indicator that we’ve been able to protect people and keep them safe. Because, our employees, some of these people are, every day, working with the patients. But we’ve been scrupulous in terms of the protective equipment, the cleaning, the techniques we’ve been using. And we’ve kept our employees safe — and we want to maintain that.

People keep asking me, “What should we do to reopen?” And I keep saying: Do what we’re doing. Practice the techniques we’re using. We’re not able to social distance, in the hospital with patients — the caregivers are right in the rooms with them. But, yet, they’re wearing the appropriate protection, they’re washing their hands, they’re monitoring their own health. And we’ve done a remarkably good job of keeping our employees healthy and safe.

… Of the [employees] who have tested positive [for the antibodies], the overwhelming majority of them were exposed to a spouse, or a caregiver, or somebody else. They didn’t get it at work. We do have a small number of employees who we believe got it at work. Many of those were early on, in a couple of cases where patients came in and we didn’t quite know what they had yet.

Q: The hospital is certainly a hot-spot where we know there is virus — and yet these protective measures have kept people safe. There’s a message there for the community, and the way it views this virus as it begins to open up …

Exactly right.

… We have everybody monitoring their temperature at the beginning of a shift and the end of a shift, practicing scrupulous protections during the day. … And then, if somebody shows any sign of illness, we immediately remove them, we send them home, and then we test them, and then if they’re sick, we quarantine them. That seems to work. It’s worked for 800 of our employees.

Q: What have we learned in this crisis that will be important to know moving forward — the next time there is a medical health crisis?

I think there are a number of important lessons. One of the best things about health care is that we’re pretty adaptable.

I remember in the early 1980s, pre-HIV, when doctors and nurses were doing procedures at the bedside and refused to wear gloves, because they didn’t think they were necessary. HIV changed that. We implemented universal precautions because of HIV — and now it’s second nature to wear all of this stuff.

I think we are much more aware of the need for [personal protective equipment]. This has convinced all of us. Where people might have thought, in the past, “Oh, putting on a silly mask, and a plastic gown, and a face shield — they’re hot and they’re uncomfortable, and I really don’t want to wear it,” I think we’ve proven the benefit of doing all of that.

I think we’ve learned a number of lessons in terms of how to rapidly mobilize. We were able to put all these beds together in two weeks. We did it by learning what it would take to suddenly stand up a unit — we had never had that experience. That’s something like Army field hospitals, and places like that, they have a sense of it. But we’ve never done it. We’re very regulation-bound, so we do things very slowly and methodically. We’ve learned we can do it.

Somebody said to me, “What if we have a surge in the fall?” I don’t want it to happen, but I feel like: We’ve got this. We can mobilize really, really quickly. And the community should know that we can mobilize quickly.

Another lesson we’ve learned: We’ve gotta think about some of the supply line issues. None of us expected the supply lines to be as difficult as they are, because we never thought about needing mass quantities of swabs, or mass quantities of masks. We’ve been very focused on the technology — and I think we’re much more aware now of making sure we have adequate stocks. The governor’s talking about a 90-day supply of everything, and I think that’s going to be a lesson that the hospitals are going to have to be prepared on.

I also think that, just, daily technique, we’ve really refined that. Not only the protective techniques but even some of the clinical techniques. The intensive care doctors, the pulmonologists, the respiratory therapists have learned tremendous lessons. They all keep talking about things like the advantages of “proning” — turning a patient facedown. Even different nursing techniques that they’ve adapted. I think these will be things that will continue for a long time.

I think the government might have learned — I’m kind of hopeful — to let us do our thing. Regulations exist to keep us all safe, and I’m actually a fan of the regulations. But to trust us to build our capacity, and to do the right thing. And I think the health industry has responded incredibly well. We can’t manage in a crisis if our hands are tied. And they did, in this case, at least in New York State, they freed us to do what we needed to do — the governor said that very emphatically. And I think that was a lesson of what we can do together.

We also learned how to work together really well, both locally and across the board. The levels of cooperation were amazing, and I think we’ve opened up new channels of communication. …

Thank God I’m part of Stony Brook — that’s been part of the lesson. Because we’ve had access to everything they know. And they’ve been very helpful, and they’ve said the same thing about us — there have been a number of things we’ve been able to trial on a smaller basis, that they’ve been adapting. So I think we’ve learned a lot of lessons like that.

Q: You were CEO of the hospital when it was an independent hospital. If you had to go through this crisis as an independent hospital, what would it have looked like?

I’m glad we didn’t go through it as an independent hospital. I was one of the strongest advocates for joining with Stony Brook. I think we would have struggled. … I think we would have done all right, because we were a good little hospital before. But I think we wouldn’t have had the advantage of all of these other colleagues, where we could say, “We want to try this,” or, “Have you tried this?” and we could share that information back and forth.

I’d also be very worried financially. I think being part of a bigger system, we’re going to have more clout financially.

The financial story on this is still not told. We’re gonna struggle — the financial hit to all the hospitals is pretty severe. And I’m worried about that, honestly. Not that we’re in imminent danger, but I feel more comfortable being part of a system in dealing with the financial issues than I would if I were a little community hospital.

Q: Are you concerned about the mental health of your staff moving forward? They’ve been through a few months of unimagined stress and probably a lot of exhaustion. What is the hospital doing to address that?

I am, and I think that’s something we’ve thought about. In the old days, in health care, the residents would be asked to work 24-hour shifts and just tough it out. A few years ago, the concept of medical staff burnout — not just doctors but all health staff and burnout — became a real issue. And I have been worried about that.

We’ve done a lot of things around the stress and burnout issues. Probably the most important thing we did was bring in lots of extra staffing resources: There were about 50, close to 60, agency nurses and respiratory therapists. We never ran out of staff, so that people were able to go home at the end of their shifts — nobody was mandated to work an extra shift. People got their weekends off, and we were able to make sure that we had enough hands to help out.

… We never ran out of PPE, and we made that abundantly clear to the staff: We will protect you, we will do whatever we need to do.

… We were extremely visible. Dr. Weinbaum has made rounds every single day, all the clinical rounds, and talked with the doctors and nurses about their patients. I’ve been out, not every day but many times every week, talking to the staff. And everyone else has been making sure they had support.

Our social workers formed a hotline so that people could call and talk things out — they did take advantage of it. Our palliative care staff did a program on support around death and dying. We had our mental health division, within Meeting House Lane, all of them mobilized, and we made them available to all the staff to talk to. We have an employee assistance program. Our massage therapists — they’ve been incredible. They’ve just been in the middle of all the units, helping, giving the staff massages and counseling. We’ve had a number of meditation sessions.

Oh, and the residency program created this whole wellness area. We turned one of our conference rooms into a decompression space for the staff, and a place to relax.

… I think we’ve done a really good job of that. … We’re still going to have to monitor this. Sometimes the effects of this, it’s like [Post-Traumatic Stress Disorder] — it happens afterward. So we’re going to keep monitoring and keep making all these resources available.

I’ll tell you, the community support was overwhelming. That was incredibly energizing: the horns honking, the parade around the hospital at night, all of the food that flew in here from all the restaurants, and the other products. Probably less than the benefit of a free meal, it was just knowing that the community knows what we’re doing and appreciates it. That made people feel really proud.

You didn’t have anyone balk at rushing into the front line — it was really good. And I think they did it because they could see the community support. It’s like, “Hey, my job really means something.”

I think, if anything, I’m hoping health care comes out as a field more people will consider. You feel very proud right now, being a health care worker. I think that’s been a good lesson for all of us.

Q: And now you just have summer to think about …

(Laughs.) And now we just have summer! We’ll get through it. We managed.

That’s one thing I do feel good about — we’re used to surges.

… My only plea to everybody is: Let’s not get complacent. Even though we’re looking at how we reopen things, we’re not reopening it in the same way. … Because it could happen again. And we don’t want that.

This article was published in conjunction with The Southampton Press.