Unaffordable child care, skyrocketing student loan debt and high overall costs of living are driving a shortage of health care workers in Vermont, according to leaders in the sector. 

At a panel Wednesday, hosted by the Green Mountain Care Board in Montpelier, health professionals from around the state discussed the factors exacerbating a shortage of workers, and mulled potential solutions. 

This trend has already created problems in Vermont’s health care systems. Residents are experiencing longer wait times for certain procedures. In some cases, patients have to wait up to 100 or 200 days to see certain specialists. 

Data collected by the Vermont Department of Health shows the ratio of physicians to the general population has declined over the last decade. In 2006, there were 80 full-time physicians for every 100,000 residents. In 2016, there were 75 per 100,000 residents. 

A lack of health workers is a national struggle. The United States should expect a shortage of up to 122,000 doctors by 2032, according to the Association of American Medical Colleges. 

In order to address Vermont’s high cost of living and compete with hospitals in neighboring states, like those in Massachusetts that are easy for southern Vermonters to travel to, hospitals have been giving out large sign-on bonuses and raising pay. President of Brattleboro Memorial Hospital Steve Gordon said his hospital recently raised the minimum pay for nurses to $30 an hour. 

“When I mentioned that at a recent hospital board meeting there were a lot of gasps,” Gordon said. 

Some panelists also spoke about the stifling burden of student debt that plagues medical school graduates. In 2016, the average medical school debt was $190,000, the American Medical Student Association found. 

Trey Dobson, chief medical officer of the Southwestern Vermont Medical Center, said he was recently interviewing a surgeon for a position who said she had about $250,000 in debt at a 7% interest rate. So while the need for incentivizing loan repayment programs came up frequently in the panelists conversations, Dobson recommended the creation of repayment programs that are innovative enough to grapple with such large amounts of debt. 

Joyce Judy, president of the Community College of Vermont, spoke about the transfer partnerships her institution has with UVM, which can save a student thousands of dollars if they chose to transfer into medical programs later in their academic careers. She also said community colleges have a unique ability to make careers in the health care sector more accessible by offering apprenticeship programs, so students can earn a paycheck while gaining a new degree.

“People cannot stop work and continue their education,” Judy said. “So how can you help them earn and learn at the same time?” 

For example, CCV entered into an apprenticeship partnership this fall semester with CVS to train pharmacists. In the program, students are able to work and earn their degree simultaneously. She said these programs are specifically helpful for people from low-income families or who are first generation college students. 

Vermont does have an advantage in the nation’s race to attract and retain health care workers because it is home to universities that are training future physicians. However panelist Melissa Davidson, associate dean for Graduate Medical Education at UVM, said only 25% of its residents from UVM’s Medical Center get jobs in Vermont after graduation. Davidson said the university does not yet know why but that it is pursuing research on this topic. 

However, she said UVM has insights into why more medical student residents aren’t choosing to attend UVM’s residency programs. The number one reason people don’t attend is because there are no jobs for their spouses or partners in the Vermont area. Other top reasons were a lack of affordable child care in the state and a lack of diversity. 

And while universities in the state are creating various forms of partnerships and programs that can help address Vermont’s health care worker shortage, Gordon of Brattleboro Memorial Hospital recommended that hospitals and universities partner in a more formal way, possibly through a commission, to share solutions to this statewide shortage. 

“We’ve got to get our act together,” Gordon said. “So that everyone in Vermont knows about these programs, and so that we can standardize these programs.”

Read the story on VTDigger here: Vermont health care employers seek solutions to workforce shortage.

This story was updated at 5:10 p.m. on Sunday.

A patient at a hospital in Bennington is the first person in Vermont to test positive for the new coronavirus.

The patient, described by hospital officials as an older adult male from the Bennington area, is receiving treatment at Southwestern Vermont Medical Center. 

The individual arrived at the emergency department of the hospital late on Thursday with a fever and a cough. Test results came back within 48 hours showing that it was a case of COVID-19, according to Dr. Trey Dobson, the hospital’s chief medical officer.

As of midday Sunday, Dobson said the patient was in stable condition and undergoing treatment in the intensive care unit.

State officials announced the coronavirus development Saturday night. At a press conference in Waterbury Sunday morning, Gov. Phil Scott and Health Commissioner Dr. Mark Levine provided information on the case and an update on the state’s response. 

“The patient is hospitalized in an airborne infection isolation unit,” Levine said. “That means the patient is on the serious end of the [COVID-19] spectrum. The individual is receiving high-quality, compassionate care.” 

Levine could offer no information about the patient’s background, travel history, possible contacts with members of the public or health care providers, or the progression of his illness. 

“It’s not believed to be travel-related as of yet, but we are trying to obtain complete comprehensive information,” Levine said. “We are tracing anyone who came into close contact with the individual. We are talking to medical staff to ensure they are cared for. It’s the hard work of protecting public health.” 

While the health department is taking the lead on investigating the patient’s history of travel and interactions, Dobson said it’s believed the patient had traveled out of the country within the past three weeks, but not to the countries with the most known cases of COVID-19. He also said the patient’s public exposure appears to be limited.

“My understanding, I will tell you, is he has had limited contact with individuals,” Dobson said.

In a statement, the hospital said it is now offering drive-up testing for patients who are referred by their primary care doctors for testing. The service, in which patients wait for hospital personnel to come out to meet them in their cars to complete the swab, intends to minimize the exposure of other patients to the virus. Neither the hospital nor the state is charging for the test.

Dobson said any patient who arrives with symptoms of respiratory infection is given a face mask. The hospital is prepped for the new virus with strategies like using eye protection and proper hand-washing. Hospital staff immediately considered the new coronavirus to be a potential diagnosis, along with other options like pneumonia, Dobson said.

“It certainly does raise the anxiety level of the community and the staff, but we continue to refine these processes,” Dobson said.

Levine stressed that the primary symptoms of COVID-19 are somewhat different than those of a common cold or flu. The key signs, he said, are fever and a persistent cough. In more advanced cases, patients may experience shortness of breath. Sinus congestion is not usually a symptom of the disease. 

The Bennington case is “presumptive” pending confirmation by the U.S. Centers for Disease Control and Prevention, which should come within 48 hours. 

“We fully expected COVID-19 cases in Vermont,” Scott said Sunday. “The news is concerning, but put it in context. We can do much to avoid the spread. The very best thing for each of us to do is to follow the guidance we’ve been giving.”

That includes, Scott said, washing your hands with soap and water, avoiding contact with people who are sick, staying home if you become ill, and sneezing or coughing into your elbow or sleeve.

Levine said that people who have traveled to the five countries with the highest exposure risk  should go straight home from the airport, “self-isolate for 14 days,” and report to the state health department. China, Iran, South Korea, Italy and Japan have had high occurrences of the virus.

According to the CDC, the risk of serious illness or death from COVID-19 is highest among the elderly and those with certain pre-existing conditions, including heart, lung, and kidney disease, cancer, diabetes and any immunosuppressive illness. 

“With our older populations being most vulnerable to this virus, we’ve specifically strengthened protections for them,” Scott said. “We’re putting in place a screening process that will keep those at risk for carrying COVID-19 or any cold or flu from entering any facilities that care for older Vermonters.” 

Levine said that in-state testing has just begun in the past week. So far, he said, 23 people have been tested; all were negative for coronavirus. Five other Vermonters were tested in New Hampshire, and all were negative. A total of 224 Vermonters are being monitored; “that number will obviously increase,” Levine noted. 

New Hampshire officials announced two new presumptive cases, including one linked to an interaction at a West Lebanon church, over the weekend, the Valley News reported.

Levine said that Vermont is not suffering a shortage of test kits. “It’s increasing all the time,” he said. “Currently we’re fine. We’re running tests every day of the week.” Scott added that no Vermonter should have to pay out of pocket for coronavirus testing. 

When asked if the state was taking any action to close public gatherings such as sporting events or concerts, Scott said no. “It’s premature at this time, but this changes from day to day,” Scott said. “We’re ready to take action when needed.” 

Levine expressed confidence that employers will be generous in allowing sick workers to stay home. “I think we’re in a time in our society now where employers look at that very differently than they did before,” he said. “Employers do not want to be viewed as the place that was the vector for numerous people getting sick.”

Scott turned away a question about whether this situation is an argument for a statewide paid family and medical leave program. 

“I don’t think it’s the time for that argument,” Scott said. “But I would add that the bill that was passed and that I vetoed didn’t include medical. And it wouldn’t have taken effect for a year or two. So it wouldn’t have had an effect on this situation right now.”

Levine said the health department’s website is being updated daily with the latest information. Scott promised to continue informing Vermonters by all possible means as the situation continues to develop.

Elizabeth Hewitt contributed reporting.

Read the story on VTDigger here: UPDATED: Bennington patient Vermont’s first ‘presumptive positive’ coronavirus case.

VTDigger posts regular coronavirus updates on this page. You can also subscribe here for daily coronavirus news. Please send your Covid-19 questions to coronavirus@vtdigger.org

Some 650 Manchester area residents swarmed two Covid-19 pop-up test sites Wednesday as the region awaits state verification of a suspected coronavirus outbreak.

“We anticipate that confirmed positive cases will increase substantially over the next several days,” said Trey Dobson, chief medical officer of Bennington’s Southwestern Vermont Medical Center, which operates an outpost in Manchester.

The hospital set up dozens of state-approved test kits outside the nearby Riley Rink, only to face a nearly half-mile line of 100 vehicles — some holding entire families — upon the site’s 9 a.m. opening.

“It’s a record for us,” hospital spokesman Ray Smith said. “Usually we test around 400 in a week’s time. Here we’re approaching 400 in a single day.”

The Manchester site and a Vermont Health Department location that drew 250 people to Londonderry’s Flood Brook School came after the state acknowledged about 60 of what it considers to be “presumptive positive” diagnoses in the last several days.

“The cases are regional in nature and not isolated to one community,” the Town of Manchester added in a Facebook post. “More than half of the cases reported are from mountain communities along Route 11 and Route 30.”

Manchester Medical Center, a private urgent care practice whose doctors include town health officer Thomas Sterling, started to see a potential problem over the weekend. By Tuesday it reported about 40 positive antigen rapid-detection test results. On Wednesday it added another 21.

“This outbreak is a serious situation that requires prompt action,” Dobson said at Southwestern Vermont Medical Center.

The state, however, doesn’t include antigen rapid-detection tests in its official counts but instead requires the more time-consuming polymerase chain reaction (PCR) tests administered Wednesday at the two pop-up sites.

“We are working hard to ensure the most accurate test is available for patients,” Dobson said. “We need all of the information we can get and everyone’s cooperation to limit the impact.”

Although many area businesses are open this week, several others — from the Northshire Bookstore to the Winhall Market adjacent to the access road for the Stratton Mountain Resort — have returned to curbside service only.

In Londonderry, town clerk and state Rep. Kelly Pajala usually can cast light on local matters large and small. But after receiving news that a municipal office visitor recently tested positive for Covid-19, she’s as in the dark about the suspected outbreak as everyone else.

“We really don’t know anything yet,” Pajala said after closing her quarters as a precautionary measure. “Now that a red flag has been raised, everyone has to take a deep breath and wait for more information.”

Although social media speculation is rampant, the state isn’t expected to report anything official until Friday at the earliest as it awaits test results and its next Covid-19 press conference.

“I really can’t give you what you’re asking for until I have these cases in front of me and can be very definitive about who’s involved and where they live,” Vermont Health Commissioner Mark Levine told reporters Tuesday at Gov. Phil Scott’s most recent media briefing.

The Manchester test site at Riley Rink will remain open for free drive-up visits from 9 a.m. to 3 p.m. daily until volume subsides, at which time it will move to the nearby SVMC Northshire Campus.

Doctors are asking anyone who believes they’ve been exposed to the virus to stay home and monitor their health for 14 days, and everyone else to wear a mask in public, stay at least 6 feet apart, wash and sanitize their hands often and limit travel.

“Easing up on these very important aspects of controlling the virus puts everyone at risk,” Dobson said. “The most important way to care for our communities right now is by behaving in ways that reduce the spread.”

📈 Get the latest statistics and live updates on our coronavirus page.
📫 Sign up for our coronavirus email list.
🗣️ Tell us your story or give feedback at coronavirus@vtdigger.org.
❓ Get answers to FAQs in our Covid-19 knowledge base.
🛒 See what’s open near you in our business directory.
🙏 Support our nonprofit journalism with a donation.

Read the story on VTDigger here: Manchester area swarms Covid-19 test sites amid suspected outbreak.

A growing Covid-19 outbreak in southern Vermont has swelled to 59 people, according to test results from the Manchester Medical Center. 

The cases have affected people primarily in Londonderry and Manchester, said town manager John O’Keefe. But seemingly contradictory reports between town and state officials about the surge of cases have sparked confusion among residents and a backlash against the state on social media. 

At a press conference on Thursday afternoon, Health Commissioner Mark Levine said his department had confirmed just two of those positive cases and didn’t have enough information to label the incident an “outbreak.” But “we do take this very seriously,” he said, urging those who live in the Manchester area to wear masks and maintain social distancing. “We need to allow the data and information to come out.”

The controversy has arisen around different Covid tests. The Manchester Medical Center, a small health clinic in Manchester Center, has been using antigen tests, a new Covid test that offers rapid results. The Department of Health, meanwhile, has not publicly reported those positive tests without the confirmation of positive diagnostic tests called PCR, or polymerase chain reaction tests. 

That’s led to uncertainty, conflicting theories, and “a lot of information flying around,” said Rep. Kelly Pajala, I-South Londonderry. “There definitely seems to be a lot of panic in the community.”

The antigen test was first approved by the Federal Drug Administration in May. The test requires a nose-swab test, but can be analyzed in minutes by identifying fragments of the coronavirus proteins in the sample. Tests that come back positive are typically accurate, But antigen tests have a high rate of false negatives, meaning that a person with a negative test result actually has the virus. 

According to Levine, the tests are ideal to screen people who have Covid-19 symptoms — but not to determine for sure whether they have the virus. The Department of Health requires a follow-up PCR test before posting the results of the tests on its website. Until then, the state considers a positive antigen test a “presumed positive.”

State officials still treat the presumed case as though it were confirmed, reaching out to the affected person to tell them to stay home and self-quarantine. The Department also conducts contact-tracing, Levine said. 

The antigen tests are one of three Covid tests available to Vermonters. The state focuses on providing the nose-swab PCR tests, which screen for active infection. Some clinics and hospitals also offer antibody testing, which measures whether a person has already recovered from Covid.

Manchester Medical Center is one of the first to offer the tests — but it isn’t the only facility to do so. In Burlington, Russ Scully has offered employees at his tech campus, “Hula,” antigen testing on a weekly basis.

Scully contracts with Garnet Transportation Medicine, an ambulance company that he helped finance, to do the testing. About 30 of his 50 employees are getting tested each week, he said. 

Levine has not embraced the tests for widespread use and encouraged everyone in Manchester to get a confirmation PCR test. Of the 59 positive antigen tests in the Manchester outbreak, the state had received PCR results from just seven. Five of those tested negative; two were positive. 

It’s unclear whether those who have a positive antigen test and a negative PCR are infected with Covid, according to Levine. The results of the PCR test could be affected by the time in between the test and whether a person has Covid symptoms, he said. “It’s really difficult at this point in time to understand how best to deal with these discordant results because they are truly breaking new ground.” 

Town officials said the state’s silence on the new cases pushed them to communicate the information they had. One of the owners of Manchester Medical Center, Dr. Thomas Sterling, is also the town’s health officer. 

On Monday, O’Keefe, the town manager, posted on Facebook that 35 people in Manchester and Londonderry had tested positive for the virus with antigen tests. O’Keefe said he’d rather alert people of a possible outbreak too early and be mistaken rather than wait for confirmation and allow the virus to spread unchecked. 

“If we have life-saving or life-changing information and you don’t share it with the public, that to me, is unethical,” he said in an interview. 

In response to the news, businesses closed voluntarily, including several restaurants and Northshire books, said O’Keefe. People stayed home, possibly preventing further spread. “I think people are doing the right thing,” he said.

Meanwhile, Manchester Medical Center went on the offensive on Facebook, defending its use of antigen tests and criticizing the Department of Health’s reporting system. “It is time for Vermont to step it up!” the medical center posted on Facebook. 

They also struck back at the nearby Southwestern Vermont Medical Center after it released a statement about antigen and PCR tests, calling the information “confusing and poorly delivered.”

Owners of the medical center didn’t respond to multiple requests for comment.

The posts have sparked conspiracy theories, confusion, and widespread distrust of the state’s efforts to combat Covid-19, said state Rep. Laura Sibilia, I-Dover. Some respondents posted on social media about the “deep state” and accused the department of “undermining [MCC’s] positive results.”

“It’s unfortunate that there was intentional efforts to sow distrust in our state testing system on social media by MMC,” said Sibilia. She praised Vermont’s response to the pandemic and urged residents to “work together and not engage in … divisive behaviors.” 

O’Keefe said local, not state, officials should take the lead when they have the capacity to do so, but praised the work of Levine and his department. “People should have the utmost confidence in the Department of Health,” he said. 

Since Monday, the Department of Health and Southwestern Medical Center have opened testing sites offering PCR tests in Londonderry and at an ice rink in Manchester. Hundreds of tests have been run, and testing will be available for as long as the public needs it. The state has started contact tracing, which will help determine the source of the outbreak. Levine said he expects more positive cases in the coming days. 

The high number of positive test results “is definitely not a false alarm,” he said. “There are going to be positive cases.”

Ellie French contributed reporting. 

Read the story on VTDigger here: Manchester health clinic reports 59 Covid cases in growing outbreak.

Editor’s note: This commentary is by Trey Dobson, M.D., the chief medical officer at Southwestern Vermont Medical Center. 

I have learned that people find it easiest to remember things when they come in groups of five or less. 

There are five primary methods for decreasing the risk of spreading Covid-19: (1) maintaining physical distancing, (2) frequently hand sanitizing, (3) wearing facemasks indoors or within 6 feet of others outdoors, (4) screening and testing for the disease, and (5) developing a supportive culture. 

There has been significant media coverage of the first four items. Number 5 deserves more attention.

A supportive culture is not typically punitive. A supportive culture encourages, motivates, and inspires others to follow the first four measures listed. No individual can reasonably be expected to adhere to all preventative actions all of the time. A supportive culture is one that follows the principal, “I have your back, and you have mine.” We help each other in achieving compliance with the measures. Communities that can maintain a supportive culture will have low numbers of Covid-19 cases and few outbreaks while working to establish widespread vaccination.

There are a few other concepts — five, as a matter of fact — that are important in minimizing spread of the virus, especially as the weather cools.

Risk of transmission increases as ventilation decreases. The virus is most easily transmitted indoors. The size of interior rooms can make it difficult to appropriately distance, and a critical mass of aerosolized particles can hang in the air without adequate ventilation and infect others. This is in contrast to being outdoors, where the particles readily disperse and are far less likely to make others sick. Even during the upcoming cold weather, maximize your time outdoors. Wear more clothing and use blankets. When visiting with friends, go on an outdoor walk together, even in the snow, rather than remaining indoors. Such efforts will help us avoid the increase in Covid-19 cases that are predicted to occur this winter.

Risk of transmission increases as time increases. We need to hold in-person work, school, and social events, as it is important for business productivity and emotional well-being. In order to do that safely, we must think differently this year than in the past. Recognize that in addition to distancing, hand cleansing, and the use of face masks, time is a significant factor in spread of Covid-19. The greater the time you spend in proximity to people, the greater the likelihood of infection. Minimize the amount of time you are with other individuals outside of those in your household, especially when indoors. If you normally hold one-hour business meetings, cut them down to 20 minutes, and schedule some of them to occur outdoors, by telephone, or by video.

Precautions are synergistic. No one precaution is enough to prevent the spread of Covid-19. The measures work together and build upon each other. Wearing your mask is most effective if you are following the other precautions, too, including distancing.

Aim for consistency. We are beginning to notice clusters and outbreaks of illness due to people relaxing precautions as their perception of the risk decreases. When there are few cases in a community, some individuals become complacent and relax precautions. Then the number of cases increases, and people begin adhering to the mitigation measures again. Thus, a regional cycle is established, and at some point, large outbreaks result. To keep cases low and prevent outbreaks, we need to aim for consistency in following precautions, regardless of our perception of the risk.

Have realistic expectations. Cases will happen even when individuals and communities are diligent in adhering to mitigation measures. Covid-19 is very contagious. We need to understand and accept that in order to participate in some in-person activities, there is risk. We cannot expect that experiences at school, work, and social endeavors will lead to the same standards as those before and after the pandemic. Yet, we do not need to accept mediocrity. We can work together to innovate and strive for similar outcomes.

As a final note, if you know someone who has become ill with Covid-19, do not judge or blame them. Covid-19 is truly something that can happen to most anyone, even those following all reasonably preventive measures. We will overcome the current discord that has engulfed our nation through a supportive culture to ensure the health of the community and discovery of joy in our existence.

Read the story on VTDigger here: Trey Dobson: Covid reminders as the cooler weather moves in.

Editor’s note: This commentary is by Trey Dobson, M.D., the chief medical officer at Southwestern Vermont Medical Center. 

Back in April, when the leading doctors made recommendations about how to handle Covid-19, they were sharing their best scientific guesses. By now, nearly every primary care and hospital medicine doctor in America has observed Covid-19 firsthand. Together with our nurse colleagues, we have seen patients contract the disease, fight it, and recover or, sadly, die. Although there are still some questions that we don’t have answers for, we are now operating on experience.

Public health experts and contact tracers have spoken with hundreds of families right here in Vermont. As we approach what might be the most difficult time of the pandemic so far, we are better prepared regarding how to handle it. What we know now comes, not from far-off experts or from research, but from our own experiences. That is going to help us, as cases increase. Here’s what I know:

Number 1: We can control this. By following all of the recommendations as best as we can, we can rein in this most recent spike of cases and keep it low. Even though we have all heard them a thousand times, I am going to repeat the complete list of mitigation steps here:

— Socialize outside or in well-ventilated areas.

— Stay 6 feet apart or more.

— Keep in-person visits short, 15 minutes or less, especially if you are visiting inside.

— Wear masks when in proximity to those you don’t live with.

— Avoid contact with others and wash your hands.

— Limit travel to only essential trips. (The dictionary definition of “essential” is “absolutely necessary or extremely important.” This rules out almost everything.)

— Wipe down frequently touched areas.

— Quarantine and get tested if you’ve done something risky.

— Isolate if you have symptoms.

While no one of these efforts will solve the problem entirely, all of them together will provide the best protection we can get. Cases will still happen, even among those who are careful. When they do, health care workers have been working hard to ensure (and continue to improve) the availability of testing and fast and easy results communication. Their goal is to keep isolated cases from turning into clusters and clusters from turning into outbreaks.

Number 2: But it’s not easy. Everything about this pandemic is hard to hear, hard to believe, and hard to endure. We are all in situations we could not have imagined before now. It is unsettling and unnerving. I have three pieces of advice that I have been sharing with my colleagues, family, friends:

— Let’s live in the middle ground between paralyzing fear and relaxed complacency. It’s certainly not a comfortable place to be, but it is manageable. If you feel yourself deviating too far to one extreme or the other, come back to that middle place. That middle place is one where you live cautiously. There’s equal emphasis on both words: live and cautiously.

— For me, and for others I have spoken with, it is helpful to look for the joy in everyday life, even in the face of adversity. For me, I find joy taking a run with my dogs. (Maybe it’s because they have no idea there’s a pandemic going on. They are still having just as much fun as ever, and that is so refreshing.)

— Let’s take comfort in the fact that pandemics end. They always have, and this one will end faster than most. Widespread vaccination will allow us to return to traveling and gathering in the ways we always have.

In short, stay with me Vermont. We are going to make it, if we can just hold on a little bit longer. 

Read the story on VTDigger here: Trey Dobson: A Covid pep talk.

Ski patrollers count as health care workers. That’s the message from state officials after residents have voiced outrage that members of ski patrol have been vaccinated in the first phase of the state’s distribution.

The state is currently distributing the Covid-19 vaccine to “health care workers likely to be exposed/treat Covid-19 patients” and “long-term care facility residents and staff who have patient contact,” according to state guidelines. 

But who qualifies under that definition has evolved, sparking questions and controversy.

A policy change this week has allowed police and firefighters to be considered part of this high-priority group, and law enforcement officers have started to receive messages from the state about scheduling vaccinations for sworn officers.

Since Dec. 15, the state has been vaccinating health care workers and Vermonters living and working in elder care facilities. So far, about 21,000 people have received the first dose; the remaining 40,000 health care workers are expected to receive the shot by the end of January.

Though officials say outbreaks haven’t been traced back to ski areas, cases of Covid-19 have recently increased in towns with ski areas, and residents of those towns have reported that out-of-state travelers aren’t always adhering to the state’s quarantine guidelines. 

Some residents have accused the state of using a limited vaccine supply to keep ski resorts open and economically viable rather than prioritizing public safety. Some have also suggested that other frontline workers, like law enforcement officers or teachers who are at school in person, should have been vaccinated ahead of ski patrollers. 

The Vermont-National Education Association issued a statement Friday morning detailing frustration about ski patrol’s prioritization over teachers. 

“The state’s largest union is seeking clarity about the state’s vaccination priorities now that members of ski patrols are being vaccinated ahead of in-school educators and other front-line workers,” the statement says. 

Don Tinney, a high school English teacher and president of Vermont-NEA, said he’s hoping for clear answers about when teachers, who are required to work in-person, will be vaccinated.

“As the governor seeks to return to full in-school learning, the vaccination of school employees will be essential for the health and safety of students, educators, and the community,” Tinney said. “And at a time when the state hasn’t even finished vaccinating the most vulnerable, as apparently was a top priority just the other day, we and all Vermonters need clarity around when school employees will begin to receive the vaccine.”

Several hospitals near Vermont ski areas confirmed they have vaccinated members of ski patrol, and say they’re often health care workers or members of other local emergency response groups. State officials say ski patrollers can receive the vaccine regardless of whether they’re a health care worker with another organization.

“They still fit the category of being a first responder who’s directly in contact with a human being who is often in a vulnerable situation, and for a long time, because of the nature of the work they do,” said Mark Levine, commissioner of the Vermont Department of Health. 

Many in charge of distributing vaccines agree that, given the fact that mountains are open, it’s important for patrollers who have extended contact with patients to be protected. Hospital representatives also say many ski patrollers also serve with Emergency Medical Services, and that their top priority rests mainly with vaccinating as many qualified people as possible with the available supply. 

Trey Dobson, chief medical officer at Southern Vermont Medical Center in Bennington, said the hospital has vaccinated members of ski patrol from nearby mountains like Stratton, Bromley and Mount Snow. They’ve also begun vaccinating members of local law enforcement. 

Dobson said the hospital is now vaccinating more than 200 people a day, and his goal is to work quickly to vaccinate as many members of the community as possible. 

“We’ve been lucky,” he said. “We’ve gotten enough vaccine that we are open to all health care workers, law enforcement and first responders. And we want to continue to support that.”

Ry Young, public relations manager for Mad River Glen, a co-op style ski resort in Fayston known for attracting locals, said ski patrollers have been vaccinated according to the needs of patrollers, some of whom are elderly or have underlying conditions. Many, he said, also work on local rescue squads. 

“In the event that something happens on the hill and they need to tend to a patient, not knowing whether they’re infected or not — it’s just another line of defense,” he said. 

Gerianne Smart, spokesperson with Rutland Regional Medical Center, said the hospital began vaccinating ski patrollers from Killington last week. 

“We have vaccinated them because they deal with patients and people who are injured,” she said. “These are people, a lot of times, from out of state, and then they would end up coming to the hospital. So there’s a lot involved.”

Killington Fire and Rescue Chief Gary Roth confirmed that EMS workers in Killington have already been vaccinated, and Rutland City Police Chief Brian Kilcullen said the department is now working with the state to organize vaccinations for officers. 

“Just yesterday, we received notice that first responders who have some responsibility in caring for or transporting those who require medical attention are in the mix for the vaccination,” Kilcullen said. “We’re in the process of compiling our roster to send it to the state.”

Kilcullen, a member of the National Ski Patrol, said he understands why patrollers fit under the definition of health care workers, and also understands why police officers should get the vaccine because of their contact with the community, including patients. 

“Ski patrol are called to respond to assist with the care or transport of injured persons, as are police officers,” he said. “I see the merits for both groups.”

Updated guidance

On Tuesday, the Vaccine Implementation Advisory Committee released its updated guidance on who will be prioritized for a vaccine, adding details to the plan previously outlined by the Department of Health. The updates placed new emphasis on providing the vaccine to frontline workers and to Vermonters of color.

Under the plan, the state will prioritize Vermonters age 75 or older, followed by people age 65-74, and residents age 40-64 with underlying health conditions. 

Next in line will be frontline essential workers — the employees in regular contact with the public who are unable to work remotely or to social distance.

In the third group, the state will prioritize people of color, and people with limited English proficiency, as well as other frontline workers, high-risk Vermonters between age 16 and 39 and residents and staff in group homes.

The vaccine advisory group noted that the guidance is not binding and will require flexibility as the number of doses shift and scientific research advances. “This is the largest vaccine effort ever undertaken,” the group wrote, calling the challenges involved “enormous.”

“While the phases outlined in the criteria reflect the order of allocation, they are not exclusive,” they said. 

For Dobson, with Southwestern Vermont Medical Center, the largest focus is distributing the vaccine as quickly as the hospital receives it. While prioritization of certain groups is important to keep high-risk workers safe, the process is challenging, and can even slow down vaccination. Dobson said he works closely with the state, speaking with officials several times a week, to determine how to handle supply. 

He said the criteria for who is able to be vaccinated will vary from hospital to hospital, depending on supply and circumstances that affect the community. 

“If we got low on vaccine again, we may have to be a little bit more careful about when and how we sign people up so that we make sure we get the right people vaccinated,” he said. 

Dobson emphasized the benefits of the hospital’s ability to vaccinate a broad definition of health care workers under the state’s policy. Bennington has experienced a spike in the number of Covid-19 cases in recent weeks, and though this upswing was expected after the holidays, Dobson said it’s increasingly important to vaccinate as many people as possible. 

“The cases are higher than we want them to be, and we have the new strain that’s apparently more contagious,” he said. “At the same time, we’ve got this vaccine, and that’s caused a lot of anxiety, not only in the public, it’s caused anxiety in us,” he said. “We’ve got to get this going. We’ve got to pull ourselves out of this pandemic.”

Dobson is optimistic — he said he’s confident that the vaccine supply will increase in the coming weeks, and thinks most Vermonters will be able to access the vaccine by early summer. 

Anne Galloway contributed reporting.

This story has been updated to include the latest guidance on vaccine distribution and a statement from the Vermont-NEA about its concern that ski patrol members are receiving priority over teachers.

Read the story on VTDigger here: First wave of vaccination includes ski patrol, law enforcement, firefighters.

Editor’s note: This commentary is by Trey Dobson, M.D., the chief medical officer at Southwestern Vermont Medical Center. 

Within days of Vermont receiving its first shipment of the Covid-19 vaccine three weeks ago, concerns emerged regarding vaccine distribution, prioritization, and administration. The concerns were justifiable, given the incredibly high stakes we all face. With any initiative of this magnitude, opportunities for improvement undoubtedly emerge. And when we look at what has been learned and already accomplished in a very short amount of time, the vaccine program in Vermont is actually going quite well, and it is becoming more effective each day.

The Department of Health is working hard to coordinate vaccine deliveries from federal supplies and follow through with distribution to area health systems. All of the Vermont hospitals have put non-critical projects on hold in order to devote staff and resources to safe vaccine administration. The number one priority for all of us in health care in Vermont is to make the vaccine readily available to everyone and quickly pull ourselves out of this pandemic.

Vermont is currently in what is called Phase 1a, focusing on health care workers, first responders, long-term care facilities, and those in residential living arrangements. In Southern Vermont, over 1,500 individuals in these categories have received their first dose of vaccine at Southwestern Vermont Medical Center, and vaccination continues at a pace of over 200 people daily. Similar numbers are occurring at other hospitals throughout the state.

The next group to be vaccinated will include those 75 years and older, followed later by younger age groups in a stepwise fashion dubbed “age bands.” The state is also working to include those individuals with certain high-risk medical conditions regardless of age.

The most significant barrier right now is vaccine supply. We are confident that the amount of vaccine will rise substantially within a few weeks. Vaccination of the public can then begin at large capacity sites being planned in a collaboration among the Vermont Department of Health, hospitals, pharmacies, and other entities, similar to the pop-up testing sites that have been so successful in our state.

To reach immunity in the population, we need to vaccinate a lot of people, and we need to do so quickly. We cannot have vaccine sitting idle. Vaccine must be given whenever it is available and not reserved for certain populations. It does little good to vaccinate only a small portion of the population or drag the process out over a long period of time. We cannot tolerate the death rate, hospitalizations, school closures, and economic devastation brought onto us by Covid-19. None of us wants to continue wearing masks, remain under travel restrictions, and be separated from our family and friends.

Fortunately, vaccine supply will soon increase substantially, and Vermont has the people and processes in place to get the job done. Capable organizations and individuals at both state and community levels are working incredibly hard on this initiative above everything else. By early summer, vaccination for all Vermonters will be readily available. Continue to wear masks and avoid gatherings. Encourage your friends and family to get vaccinated as it becomes available. Simply put, we can pull ourselves out of this mess. Stay positive, Vermont.

Read the story on VTDigger here: Trey Dobson: Vaccinations are No. 1 priority.

Vermont is now getting 22% more vaccine doses per week from the federal government than its previous allocation, Gov. Phil Scott announced Tuesday.

Scott learned in a call with other governors that morning that doses would increase another 5%, on top of an 8% increase announced last week by the Biden administration, which is working to boost the number of doses sent to states. Compounded, Scott said, the increase works out to 22%.

That means Vermont will get about 10,800 doses a week for at least the next three weeks, a time frame that Scott said will aid greatly in planning ahead for administering the vaccine.

“This is just preliminary information — hot off the press, so to speak — and we’ll have more details in the days to come, but suffice it to say this is good news for us here in Vermont and throughout the country,” he said.

The federal government would also provide two other sources of help to increase doses: Providing the tools to Vermont to get the extra dose out of Pfizer vaccine vials, and providing some vaccines directly to pharmacies in a pilot project.

“I appreciate the collaboration with the White House, and look forward to receiving more doses so we can vaccinate others as fast as possible, and start getting back to whatever normal is,” Scott said.

So far, over 55,000 Vermonters have been vaccinated — 35,500 first doses and 19,500 second doses. 

Scott also learned on the call that Vermont would get millions from the Federal Emergency Management Agency as retroactive reimbursement for National Guard operations in 2020.

Previously, Vermont had been expected to provide 25% of the Guard’s funding, but that requirement has now been eliminated and the state will be refunded what it spent last year, which could mean millions of dollars per month, Scott said.

“We don’t know all the details and we’ll look into that and hopefully be able to update you on what that could mean, but safely say it’s millions of dollars that will be coming back to Vermont in some respects,” Scott said.

The Guard was used last year to staff the state’s medical surge sites. Mike Smith, head of the Agency of Human Services, said the National Guard could also be deployed to assist with vaccine distribution if the allocation rose past the state’s capacity under its original plan. 

About 9.7% of Vermont residents age 16 and over have received at least one dose of the vaccine, the Department of Health reported Tuesday. Smith said 34,000 Vermonters have registered to receive the vaccine under the latest Phase 2 plan, which includes all Vermonters age 75 and over.

Check out the Department of Health website to register for the vaccine or check out frequently asked questions in this VTDigger article. 

Cases up in Bennington County 

Covid cases in Vermont dropped for the third week in a row, but cases in Bennington County remain high, driving up hospitalizations statewide, officials said Tuesday.

The state reported 868 Covid cases in the past week, a 29% decline from the peak of a mid-January surge, according to a report from the Department of Financial Regulation. National cases are down 42% from their peak and regional cases are down 37%.

At the same time, Bennington County has been setting records in its case counts, including its highest-ever total of 40 cases in a day on Jan. 30.  Department of Financial Regulation data shows that, if Bennington County hospitalizations were excluded, the total number of people hospitalized in Vermont would be declining, but that county’s numbers are driving the statewide total up.

The Bennington hospital, Southwestern Vermont Medical Center, is “coping well” with the new clinical load, said Dr. Mark Levine, head of the Department of Health.

He said the latest rise in Bennington County numbers could be attributed to several potential issues: Several multihousehold gatherings prior to the holidays led to outbreaks, and out-of-state skiers could have passed along the virus to workers in the community, although the skiers themselves would not be counted in the data.

“There have been, not only on the site of a ski resort, but in the communities that are part of the ski resorts, cases that show up in worksites and in restaurants, to the point where in one or two times, several of those had to close due to staffing issues,” he said.

Some New York residents who work or receive medical care in Vermont may also be driving up the county’s numbers, Levine said. 

In addition, college cases have been an issue as students return to the state for the spring semester. Vermont reported 39 student cases this week compared to 118 last week, but the latest numbers did not include any reports from the University of Vermont.

Norwich University’s outbreak among students rose to 94 cases this week, Levine said. The health department is working with Norwich to refine its testing protocol, along with testing a variety of college samples to see if any of them could be one of the Covid variants circulating elsewhere in the country.

Long-term care case progress

The number of high-risk cases in Vermont is declining, likely driving a decrease in deaths.

The state had 27 deaths in January compared to 71 in December, according to the state report. The number of cases among Vermonters 65 and over has also declined in recent weeks as conditions improve statewide.

Levine said there have been fewer cases in long-term care facilities as well. 

Smith said people at all 37 skilled nursing facilities, the highest-risk facilities, have received both doses of the vaccine. About 87% at residential care facilities and 94% at assisted living facilities have received at least the first dose. 

In total, 85% of long-term care residents have elected to receive the first dose of the vaccine, Smith said.

Levine said it was difficult to say whether the decline in cases could be the result of the vaccinations. “I would love to say that what we’re seeing in the long-term cares is related to the vaccine, but that would be a little guesswork and a little premature,” he said.

The state has convened a working group to discuss opening up new activities for long-term care residents, such as social gatherings and events to allow people to socialize within the facility.

“Seniors have been isolated for far too long,” Smith said.

Levine said the initial discussion hasn’t included family visits, but it’s not out of the realm of possibility. The state briefly resumed family visits at a low point of the virus last year.

“There’ll be plenty [of family members] that will not have yet received their vaccine,” he said. “But that doesn’t mean we can’t improve the lives of those, those facilities with the activities and social arrangements that can be made within the facility.”

Read the story on VTDigger here: Vaccine shipments to Vermont on the rise; 55,000 vaccinated so far.

Bennington resident Carrie Percey called out of work on Jan. 28, as soon as she realized she couldn’t smell the strong odor of her nail polish. 

“I kind of thought I had dodged the bullet, but then the bullet hit,” she said. 

She tested positive for Covid-19 the next day. Since then, both of her 71-year-old parents, her daughter and her niece, who all live in Bennington, have contracted the virus after helping transport each other to doctor’s appointments unrelated to Covid-19. 

Percey, one of the first in the family to test positive, isn’t sure how she picked it up. It could have been at the restaurant in town where she works, or at Southwestern Vermont Medical Center, where she recently had an MRI. Her positive test results prompted a call from Vermont’s Department of Health, but officials there couldn’t pinpoint it, either. 

“They really didn’t know where I got it,” Percey said. 

The same quiet Covid surge that infected the Percey family has led Bennington County to have the highest per capita case count of almost anywhere in the Northeastern United States. 

Officials attribute the spread to a combination of family gatherings and regular travel across state borders with Massachusetts and New York. The county peaked at 312 cases in the past two weeks of the surge. On Sunday, Southwestern Vermont Medical Center reached capacity — the first hospital in Vermont to do so since the start of the pandemic. 

State and local officials say the coming days and weeks will be a turning point in whether Bennington County residents can tamp down the spread. 

The current rate of infection “is not sustainable for the long haul,” said Trey Dobson, chief medical officer and emergency room doctor at the hospital, which reported 25 Covid patients last weekend. 

Staff hurried to retrofit outpatient facilities as inpatient Covid units, Dobson said. Officials got on the phone with other hospitals, including Dartmouth-Hitchcock Medical Center and the University of Vermont Medical Center, to establish a plan to transfer any additional Covid patients who needed care. The Bennington hospital scheduled additional workers to make time for the constant donning and shedding of personal protective gear.

“The hospital system can’t keep expanding the number of patients with Covid,” Dobson said. “It’s very important that the community understands that.” 

Seeking a source

Local officials also hope to tamp down the rumors about how, exactly, the county with early mask mandates is reporting such high Covid numbers. 

“Most people here feel like they’ve done a good job” with masking and social distancing, said Manchester Town Manager John O’Keefe. The question they’re left with is, “Why do we have a surge here if we’ve done a good job in the past?” he said.

Confusion about the source of the outbreak is compounded by Bennington’s geographical position in the state. The New York border is a seven-minute drive west of Bennington’s town center, and the Massachusetts state line is a 15-minute drive south. The cases in the town reflect the case totals in the counties in nearby states more than they do Vermont’s totals, Levine said last week. 

That’s inevitable, said Rep. Laura Sibilia, I-Dover. When it comes to grocery shopping, doctor’s appointments and job commutes, the state borders are “porous,” she said. “It’s back and forth. There’s no hard line there.”

But the spread of Covid through travel has also led to pushback from locals, who worry that out-of-staters are bringing the virus into Vermont. 

Bennington Town Manager Stu Hurd said he’s received calls from residents expressing concern after noticing out-of-state license plates at local grocery stores. 

Some residents, particularly in comments on social media, have questioned whether the case counts are coming from visitors, many of whom drive through Vermont’s southern border towns on their way to ski resorts like Stratton, Mount Snow, Killington, Okemo and Bromley. 

Jessica Berg, a nurse at a school in Londonderry, said her entire family recently tested positive for Covid-19. Her partner works at a restaurant in Stratton and often serves skiers from out of state. Many restaurants near the resort have transitioned to takeout or curbside pickup after a number of local employees tested positive for the virus. 

Berg hopes the state will begin tracking high-risk activities at ski resorts, such as indoor dining, more closely. 

“There was just no discussion that, possibly, [the Covid surge] could have been from people who are not quarantining from out of state, which we know is happening,” she said. 

‘A little less careful’

But officials, particularly in towns that aren’t adjacent to ski resorts, point to local gatherings, not tourist visits, as the main cause for the prolonged community spread.

Hurd said several Bennington restaurants in town are not exercising enough caution, and some may be violating the governor’s orders. Conversations with state officials have led him to believe that’s part of the problem. 

“The folks from the Health Department just believe that it happens to be that we are perhaps a little less careful than our counterparts elsewhere,” Hurd said. 

In Stamford, about 30 minutes southeast from Bennington, town officials tried to terminate Gov. Phil Scott’s executive order, which outlines guidelines intended to prevent the spread of Covid-19. Officials retracted their statements after Attorney General TJ Donovan sent them a letter debunking their legal argument.  

Seven people have tested positive in Stamford in the last four weeks, the first cases in the town, according to the Department of Health’s town-by-town numbers.

Refusing to wear masks “certainly doesn’t help,” O’Keefe said of the area’s efforts to mitigate spread.

Meanwhile, local businesses and town officials are trying to keep cases down until the worst of the outbreak has subsided. 

“It might feel a little like we are playing whack-a-mole these days,” said Burr and Burton Academy Headmaster Mark Tashjian in a note to parents last week that warned of yet another Covid case. But, he assured them, their efforts were working. “What’s important to note, however, is that in each case, thanks to the responsible actions of those directly involved, we are containing the spread.”

The trend line does seem to be going down.

After a peak of 40 new cases in Bennington County on Jan. 30, Covid totals have started to decline, said state Health Commissioner Mark Levine. Southwestern Medical Center was down to 17 Covid patients on Friday, according to spokesperson Ray Smith; it was the first time in three days that there were no new Covid inpatients. 

Cases in nearby Massachusetts and New York counties have also decreased, giving cause for optimism that Vermont cases will also stay down. 

But it’s too soon to celebrate, said Health Department spokesperson Ben Truman.

“A couple days doesn’t make a trend,” Truman warned. 

Case totals in Rutland County have also started to rise, as the virus spreads north from Bennington.

Cases in southwestern Vermont still make up a significant portion of the state’s total cases. To help mitigate the spread, the Department of Health has offered staffing support to the medical center and plans to set up additional testing sites in the northern part of the county. 

The Department of Health has also asked the Carlos Otis Clinic at Stratton Mountain Resort to offer more testing for skiers, local residents and resort employees, according to the clinic’s executive director Seth Boyd. Levine vowed Friday to continue “watching [the county’s cases] very closely.” 

In the meantime, Manchester residents are staying home, O’Keefe said. 

“That’s our hope, that we’ve seen the spike,” he said. “Everyone’s still doing the right stuff.”

Read the story on VTDigger here: Bennington County surge slows down, but residents remain on high alert.

BENNINGTON — Patricia Johnson hears the dings and whistles of the emergency room when she falls asleep, sometimes in the early morning hours after a night shift.

Johnson alternates between the day and the night shift as an emergency room nurse at Southwestern Vermont Medical Center. Before her night shifts, she drops the kids at her parents’ house, then leaves work at 6:30 a.m., and often heads straight to her second job at Recovery House, Inc., an hour away in Wallingford, where she’s the nurse manager. 

Then she tries to catch a few hours of sleep, and when she wakes up, she’ll take her three kids to sports practice or help them with virtual school. One week in mid-February, she was focused on helping her youngest son sign into his online classroom. Bennington County’s rate of Covid-19 cases led New England until recently, and her youngest son’s school had temporarily pivoted to all-remote.

Johnson, a single mother, switched careers four years ago and considers nursing a dream job, an ideal match for her skills, even though it often leaves her exhausted. 

Before she became a nurse, she worked no fewer than two — and often three — different jobs, drawing on her degrees in criminal justice and leadership management. Several odd jobs in between paid the bills, lifeguarding and waitressing, for example. 

“I mean, name it,” she said. “Blockbuster.”

Some of this work, like a post in the Department of Corrections, exposed Johnson to flaws in the system that kept families from accessing the help they needed. Friends suggested that Johnson might have more impact in a career as a nurse. She gave it some thought, then asked her parents for help — she hadn’t yet paid off her existing student loans — and enrolled in nursing school. 

“I’ve always had a strong presence of mentorship in my life, people who took me under their wing, saw potential in me and knew that I deserved better and that my kiddos deserve better,” she said. 

Four years into her career, Johnson said nursing has given her many opportunities. It has brought her financial stability and, comparatively, more time with her kids. Still, the pandemic has generated stressors she didn’t see coming. 

She sees trauma regularly, she said, and patients are looking for reassurance that she can’t always give. The emotional byproduct trickles into the rest of her life. 

“You’re just so burnt out from giving so much to others that it’s difficult for you to give when you’re at home,” she said.

Johnson’s identity as an African American heightens her vigilance when caring for marginalized patients. She’s acutely aware of how Covid-19 disproportionately affects people of color, people living in poverty and people with disabilities. 

Nationally, the death rate of Black Americans who contract Covid-19 is almost twice that of white Americans. For Hispanic Americans, that number increases to 2.3 times the death rate of white Americans, and Native Americans have an even higher death rate of 2.5 times white Americans. 

When Covid-19 first hit the state, Black Vermonters tested positive at a rate higher than any other racial group. Data reported in December showed that Vermonters who are Black, Indigenous or people of color represent a total of 6% of the state’s population, but 18% of Covid-19 cases. 

Johnson has tried to connect with people of color and marginalized groups on Facebook, asking whether they’ve signed up for the vaccine, if they are getting adequate healthcare, and if they have access to clinicians who are people of color. 

“I overcompensate,” she said. “It’s exhausting.”

That burden keeps Johnson up at night. She’s found that she isn’t the only one who feels it — she’s joined a group of other nurses of color across the state who provide mentorship and who she helps to mentor. 

She said marginalized groups are often aware of the ways they’re still stigmatized in the healthcare industry. Someone with a substance abuse problem, for example, may not come in for treatment until an infection has progressed because they fear judgment.

“I don’t want to let them down,” she said. “I want to let them know, ‘I’m here for you. And I’m going to give you the care that you deserve and the care that you’re entitled to.’ And that’s equal care.”

Johnson said the responsibility adds another layer of pressure and anxiety.

“I know that I have to lead by example,” she said. “I’m up for that challenge.”

Read the story on VTDigger here: Virus in Vermont: ER nurse advocates for marginalized patients.

BENNINGTON — About seven years ago, the leadership team at Southwestern Vermont Medical Center realized, because of dwindling numbers of people being admitted as patients, they were going to need to rethink the hospital’s staffing system.

Inpatient care, a main source of revenue for many hospitals at the time, have been declining for years. SVMC flipped from 80% inpatient and 20% outpatient in 2000 to 79% outpatient and 21% inpatient in 2014. 

The downturn could have spurred the hospital to cut staff, but instead, it redeployed nurses who previously cared for patients in the hospital to new programs. 

Those initiatives have helped SVMC reduce unnecessary hospitalizations by more than half.

SVMC also won recognition: The hospital is the state’s highest-rated hospital on the Lown Institute Hospital Index and recently won the Rural Leadership Award from the American Hospital Association. 

The Bennington hospital was the only recipient of the award, chosen from several dozen applicants in a crowded field. The top reason for the award, a member of the American Hospital Association said, is a nursing team dedicated entirely to transitional care. 

Ironically, successful advanced medical treatment was to blame for the downward trend in inpatient demand. Patients no longer need to stay in the hospital for stretches of time. A patient who undergoes surgery can now go home on the same day. 

At the time, SVMC employed a number of advanced practice nurses with master’s or doctoral degrees, all of whom were focused on inpatient services.

“It’s very unusual for a hospital this size to have one clinical nurse specialist,” said Barbara Richardson, who won the Magnet Nurse of the Year Award in 2016 for her work as a transitional care nurse at the hospital. “We had five, and we have for the entire 20 years that I’ve been working here. The organization valued us, or they would not have kept us, because we were a pretty expensive resource.”

As the system moved from mostly inpatient to mostly outpatient, the fee-for-service health care model — in which hospitals and doctors are paid for the amount of care they deliver, instead of the quality — began to deteriorate.

That market switch could have severely affected SVMC, which serves Bennington and surrounding communities. The same dynamic contributed to the demise of many other hospitals, particularly in rural areas. Nationwide, 135 rural hospitals have shuttered since 2010. 

Transitional care: wave of the future?

“The state was looking at health reform for the future, and payment reform. I think we all came to the conclusion that there has to be a better way,” said Thomas Dee, CEO of SVMC.

But as the hospital transitioned, OneCare Vermont, a company also working to switch the state’s health care model to “value over volume,” came into play. SVMC saw an optimal window for a transition. 

“That was kind of the underpinnings for us to go down this road of creating some new programs that really were, at the time, pretty cutting-edge, especially for smaller rural hospitals,” Dee said.

Dee said the change gave them an opportunity to think deeply about the needs of the community.

“Vermont oftentimes is rated the most healthy state in the country,” he said. “That’s really driven a lot by the Burlington region. We have an area that is very rural, has access issues and has health status problems.”

SVMC’s advanced practice nurses, led by Billie Lynn Allard, started to review work by Mary Naylor, an expert nurse at the University of Pennsylvania. Naylor designed a system in which nurse specialists partner with other community organizations to help at-risk patients, many of whom frequently visited the hospital.

Transitional care nursing — a broad term that defines several different models of care — takes place when nurses provide care as patients shift from one physical setting to another, like a hospital to a home, or from one provider to another. All of the models are designed to provide continuity of services so that at-risk patients don’t slip through the cracks. 

Richardson remembers hearing about some of Naylor’s work at a conference when the hospital started to make staff changes.  

“I remember thinking at the time, ‘Oh my God, that’s my ideal job,’” Richardson said. “It was just so exciting and innovative, what she was doing. But it was not anything anybody around here was doing.” 

Nurses at SVMC got together for a retreat, then began to outline how a transitional care model might look at the hospital. As they began to provide free care to at-risk patients in the community, unnecessary hospitalizations at SVMC decreased by 55%. 

That number is what sets SVMC apart, according to John Supplitt, senior director for rural health services at the American Hospital Association, who gave the hospital its Rural Leadership Award this year. He said transitional care, as a concept, isn’t new, but the fact that a rural health care center reduced hospitalizations to such an extreme extent makes SVMC an outlier.

“I think the model helps Southwestern Vermont organize and focus on their approach toward transitional caregiving in a very deliberate way, which brought very measurable results,” he said. 

Supplitt said he hopes that, in the same way SVMC took Naylor’s model and retrofitted it for a rural facility, other hospitals around the country might be able to learn from SVMC. 

“It is something that can be replicated in other communities, if you’re willing to commit the time and energy and some resources to the strategy behind transitional nursing,” he said.

Closing the gap in health care  

In her role as a transitional care nurse, Richardson said her day typically starts with interdisciplinary rounds, where nurses survey the patients in the hospital. Along with other transitional care nurses, she finds out who needs extra care, and who their primary physicians are. 

If a patient doesn’t have another plan to transition out of the hospital, a nurse will introduce the program. Typically, the nurses carry a panel of between 15 and 25 patients, and most of these patients don’t qualify for other long-term care programs.

“For the most part, people who are coming to the hospital are usually so sick that they will meet our criteria for having some follow-up when they leave the hospital,” Richardson said. 

When patients leave the hospital, nurses help them understand how to take their medications, how to follow their doctors’ instructions and how to obtain other social services. They’ll connect with patients’ primary care providers, too. Nurses typically make home visits, but during Covid-19, these visits take place remotely.

“(Primary care physicians) call us and say, ‘Can you go see what’s going on?’ And if we can solve the issue, or collaboratively work with (the patients) to manage it, we might be able to prevent an admission into the hospital,” Richardson said. “Our goal is to find those little gaps in health care.”

The program, which is free, can serve anyone, but Richardson sees many elderly people and people living in poverty. 

“What we found very quickly was that people who don’t know if they’re going to be able to afford food at the end of the month, or buy their prescription, or have fuel oil to heat their home next month,” Richardson said, “they can’t think about, ‘How do I manage my chronic disease?’” 

“We didn’t know, initially, just how much those social barriers impact health,” she said. “But we found that out very quickly.”

Nurses will continue to see a patient until both the patient and the nurses agree that the patient is ready to end the service. Because the service is free — insurance isn’t involved — that decision rests entirely between the nurse and the patient. 

Nothing is off the table

The creation of the transitional care nursing program sprouted other programs that are now helping the hospital decrease hospitalizations and improve the health of the community. 

Allard said that, when the program began, it gave nurses a front-row seat to some of the multifaceted problems that patients faced. The team members held weekly meetings to compile what they were seeing. 

“Suddenly, we had a gap list of all these things that needed to be different,” Allard said. “Some of them were quick and easy, that we could fix. But some of them took years for us to figure out — was there a cost-effective way to create a new program, or to partner?”

One program that came out of the brainstorming session is the “community care team,” which presents the cases of patients who, for example, have mental health or substance use disorders to a roundtable of social service providers in Bennington. 

The program has connected patients to social services that help with addiction and housing, for example. It’s geared toward people who come to the emergency room seeking help, but don’t need to be hospitalized, and it’s decreased unnecessary, expensive hospital visits for this population by 30%. 

“Nothing is off the table, pretty much, with this program,” said Kim Warren, a health promotion advocate in the emergency department. 

Warren said she served between 250 and 300 patients in 2020. 

Another program, which has focused on diabetes education, has measurably reduced A1C hemoglobin levels by an average of 11%, and hospitalizations for people with diabetes have decreased by 20%. 

“I think improving the social aspect of it definitely helps the health aspect,” Warren said. “And people in general will have better outcomes.”

Now, the hospital is looking toward another problem in the community: ensuring that all patients receive the same access to care. 

While the hospital has been recognized nationally for its care model, and the Lown Institute Hospital Index rated SVMC first in the state, that same index also gave the hospital a “C” for civic leadership, and it ranks last out of 10 hospitals in the state for inclusivity. The inclusivity rating “measures the extent to which patients being served are demographically similar to those in the surrounding community.”

Paula Seaman, the hospital’s director of quality, safety and value, said the rating will help staff improve. She pointed to the hospital’s Diversity and Inclusion Committee, whose job is to create programs that specifically address the needs of marginalized populations, and measure the hospital’s progress. 

Patricia Johnson, a Black emergency room nurse at the hospital, serves on the committee, and has helped marginalized patients learn about the Covid-19 vaccine. She said the hospital is making progress.  

“We’re looking at a few different models currently to implement into our hiring process, and how to evaluate our (current) policies to make sure that they don’t create boundaries for that risk population,” she said. 

Loss and gain

Allard, who led the first team of transitional care nurses, said the program initially lost money for the hospital.

“My success with this program was causing decreased revenue for the hospital,” Allard said. “Those were some interesting phone calls with the CFO.”

A more patient-centered model was a leap of faith in the beginning, Dee said, particularly in a fee-for-service market. 

“You have two canoes, and one leg in one canoe, and another leg in another canoe,” he said. “Both are different systems, and you’re trying to navigate those canoes.”

Still with one leg in that fee-for-service model, managing the budget requires creativity. The facility relies in part on philanthropy, and is part of a broader company, Southern Vermont Health Care, that provides a number of services to southwestern Vermont.

SVMC is moving ahead: The emergency department will soon undergo a $26 million renovation that will double its square footage. The department was designed to serve between 12,000 and 13,000 patients per year, but now has twice that. The hospital will pay for it with $6.9 million carried over from a former project that didn’t go through, $14.5 million in fundraising and $4.3 million in net debt financing. 

SVHC, the hospital’s parent company, also recently purchased the former Southern Vermont College campus. The hospital announced on Thursday that, through a fund drive, it received $566,000 in donations to the Grateful Bennington Fund, which will be used to repurpose the campus. The group is collaborating with other community partners on a long-term plan for the property that will be rolled out throughout 2021. 

Watching the hospital’s progression over the last decade, Allard said she hopes officials at other health care centers will feel emboldened to take on the patient-centered model.

“I think one of my goals right now is to get the message across the country that more places need to do this,” she said, “because this is the right thing to do for communities, and for patients, and for health care.”

Read the story on VTDigger here: Bennington hospital doubles down on nursing care; fewer patients admitted.

This commentary is by Trey Dobson, M.D., chief medical officer of Southwestern Vermont Medical Center in Bennington.

 As you are likely aware from media coverage and medical publications, we are at a stage of the pandemic where the rate of coronavirus mutations is inversely related to the rate of immunity in the population, largely achieved through vaccination efforts. 

On one side, we have a virus that keeps changing, as we would expect. On the other, there are vaccines that largely prevent the virus from infecting cells and having the chance to change. 

Understanding the virus’s capacity to adapt is a great way to reinforce the importance of vaccination. The faster and more completely we get a large percentage of the population vaccinated, the fewer mutations will occur that allow variants to emerge. Here’s why:

Variants are viruses that have mutated from their original form to express new and different properties, typically consisting of a change in the outer protein structure. The mutations are chance occurrences due to errors in replication. In other words, the cells of a person infected by the virus (host cells) create millions of copies of the virus, and there are mistakes that occur when building the new virus copies.

The mistakes make a virus with a protein that “looks” different. Its outer proteins are angled differently, or they are longer or shorter than those on the original version. These mistakes most often make the new virus not work well, so the virus does not infect cells or replicate in high numbers. 

Rarely, however, the mistake produces a virus with a structural advantage over the original form. This is the start of a new variant. 

In a basic sense, there are two types of pressures that lead to mutations that allow the virus to proliferate at a rate greater than its predecessor. Sometimes these advantages lead to the emergence of a new dominant strain throughout a population.

• The first one is the pressure to infect. A mutation occurs that allows the virus to more reliably enter a host cell. In other words, the outer protein structure has changed to better attach and go through a channel in the cell membrane. This type of mutation may be the predominant mechanism that allows certain strains to spread more easily.
• The second is the pressure to evade. A mutation occurs that allows the virus to dodge the host immune system, a person’s own immune system fighting the virus. This type of mutation gives rise to strains that can make the person more sick and a vaccine less effective.

Variants are expected, and vaccination reduces the number of variants.

• When most people are vaccinated (including kids), the prevalence of the virus and the amount of viral replication is relatively low, leading to fewer total mutations and variants.
• When most people are not vaccinated, the prevalence of the virus and the amount of viral replication is relatively high, leading to greater total mutations and variants that can keep us on the run for a long time.

Beyond the obvious reasons to get vaccinated — such as not getting sick, causing others to become sick, and the desire to shed our masks — vaccination of most everyone is needed to prevent variants from forming and to allow the population to safely return to unrestricted socialization. 

Read the story on VTDigger here: Trey Dobson: The more we vaccinate, the fewer variants that can emerge.

BENNINGTON — To illustrate people’s struggles with returning to normal life amid the pandemic, the Guilford Community Church is preparing an Advent display featuring three doors. The wooden doors, of different colors, sizes and designs, are being repurposed from various buildings. 

One comes from a bathroom stall of a Bennington hospital building.

“You would never know it’s a bathroom stall door, except it’s short,” said Dwayne Johnson, a Guilford Community Church member, who was drawn to the door’s five panels. “It’s really unusual.”

Johnson bought the door from Deconstruction Works, a local company that salvages building materials otherwise headed for the landfill. The company recently worked with Southwestern Vermont Medical Center to strip attic insulation, floorboards, bathroom fixtures and other reusable lumber in the demolition of a circa-1925 hospital building.

The demolition is part of a two-year, $28 million project to expand and upgrade the Bennington hospital’s emergency department.

The renovation is the department’s first since 1974, when it was designed to accommodate 14,000 patients a year, at what was then Putnam Memorial Hospital. The emergency department now sees nearly 25,000 patients a year, according to hospital officials. The construction work would double the department’s size. 

“A lot has changed over that period of time,” said Jill Maynard, director of nursing for the hospital’s emergency department and intensive care unit. She spoke to VTDigger along with Ray Zimmerman, the director of engineering, and Ray Smith, public information officer.

Smith pointed to a variety of factors for the increase in emergency department patients, including the downsizing of another emergency department in a neighboring Massachusetts county and a reduction in local primary care providers. The rapid aging of Vermont’s population is also a factor.

The renovation aims to enlarge existing rooms to meet evolving industry standards, as well as upgrade facilities and equipment. The project, which started this month, is expected to be completed in mid-2024.

The $28 million project cost will be funded through a combination of a fundraising, equity contribution and debt financing, the hospital said.

Planned expansion, upgrades

The plan includes creating more spacious, private exam rooms, which would do away with curtains that currently separate some spaces. Waiting rooms would also be larger, where patients with injuries can be segregated from those who are sick, such as people running a fever or who have a cough.

An area will be added for patients whose conditions are not life-threatening, such as sprains or lacerations. Four patient chairs will be dedicated to them, where Maynard said the treatment process is quicker.

The existing Emergency Crisis Area, designated for people experiencing mental health distress, will be expanded from three to five beds. That section of the hospital — which is quieter, safer and more private than the bustling emergency department — is where patients stay until they’re moved to an inpatient psychiatric facility.

After technology upgrades, the entire emergency department will be able to be transformed into a negative pressure space. That would prevent potentially contaminated air or other dangerous particles from flowing into other areas.

“Something that we learned throughout the pandemic,” Maynard said, “is that dealing with Covid patients is ideally done in negative pressure areas.”

In the expanded emergency department, all 14 exam rooms would be equipped with telehealth, operated in partnership with Dartmouth-Hitchcock Medical Center in New Hampshire. The service enables emergency room patients and care providers to speak with doctors or nurses at Dartmouth-Hitchcock through a video link.

Telehealth can be activated so that remote care providers can start seeing patients if their counterparts in Bennington are busy, Maynard said. It can also be used for consultations, recommendations and support among care providers. Now, only two of the emergency department’s exam rooms in Bennington offer telehealth.

A pneumatic tube system would also be installed to speed up the transportation of specimens to the lab and medication from the hospital pharmacy.

The new additions to the emergency department are scheduled to be unveiled in June 2023, said Zimmerman. Afterward, the existing department spaces would be renovated.

He described “a tough balance” of running the construction work along with maintaining the daily emergency department operations.

“If it seems like it might even be a little extended or protracted, that’s why,” Zimmerman said. “We have our fundamental responsibility to our community and our patients to keep our doors open.”

The medical center’s patients hail from Bennington County and surrounding counties, Smith said. These include Windham County in Vermont, Rensselaer County in eastern New York and Berkshire County in western Massachusetts. 

Read the story on VTDigger here: Bennington emergency department undergoing $28 million renovation.

Calling more than 20 larger hospitals trying to find an open bed.

Transferring patients as far away as Connecticut or Pennsylvania.

Families grappling with whether to send their loved ones hours away or to choose palliative care.

As Vermont’s intensive care units become overwhelmed, including a record-setting 31 Covid patients reported in ICUs on Tuesday, medical staff at the state’s smaller hospitals say they’ve faced an escalating crisis in recent weeks. Strained capacity affects what kinds of care they can offer, they say, in part because it’s become increasingly difficult to transfer patients to larger hospitals. 

While some patients in the state’s hospitals are suffering from Covid-19 — the vast majority of them unvaccinated — most are not Covid patients. They may be facing anything from kidney failure to a heart attack. Many got sicker while they waited for care because of the pandemic.

Dr. Joshua White, an emergency department doctor and chief medical officer at Gifford Medical Center in Randolph, said current capacity levels are dangerous because they can prevent patients from getting standard-of-care procedures.

If doctors can’t quickly transfer a patient from Gifford to a larger hospital for a complex treatment, then they might have to find another solution. 

“You don’t know if that procedure was going to save that patient or not. They may have died anyways, because there’s nothing that works all the time,” White said. “But I know that there are people in Vermont, that the intent was to transfer, they didn’t get that service and they did not survive.”

He used treatment for heart attacks as one example: The best treatment is often a stent, White said, where an interventional cardiologist threads a wire in the artery and opens it up. No more than 90 minutes after a heart attack patient arrives at Gifford’s emergency department, doctors want that person transferred to Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, to undergo the procedure.

But over the past few months, “now there has been more than one instance when our providers have called Dartmouth, and Dartmouth has said no,” White said. 

They just didn’t have the space. 

“Then we start trying to decide well, how many other places do we call? Do we now start thinking about clot-busting drugs, which are demonstrated to be not as good?” White said. “You end up going down this whole other pathway that you weren’t really supposed to be going down.” 

Cassidy Smith, a spokesperson for Dartmouth-Hitchcock, said in an email that the medical center “has never been closed to ALL transfers.”

“However, depending on the circumstances of each day’s, and prior day’s, regional pressures and demands we are occasionally unable to accommodate certain transfer requests,” she said. “That is always the case and always has been the case. The current surge of Covid-19 in both New Hampshire and Vermont has only increased the demands and thereby further diminished the resources for our processes.” 

In New Hampshire, more than 95% of the state’s ICU beds were full as of Dec. 3, when the state last updated its Covid data.  

In Vermont on Tuesday, a total of 90 people were hospitalized with Covid, according to the state Department of Health, including the 31 patients in ICUs. The ICU headcount surpassed the record set the day prior, when there were 25 patients in Vermont ICUs.

At Northeastern Vermont Regional Hospital in St. Johnsbury, providers have called as many as 25 other hospitals trying to transfer a patient to a bigger hospital, said Chief Medical Officer Dr. Michael Rousse. 

“We’re delaying what would be standard care,” Rousse said. “We’re taking care of people that are on pressors or on a ventilator longer than we’re typically comfortable with. We can do it, we’re just playing the odds to a certain extent.”

Rousse estimated that people sick with Covid make up less than 10% of their patients. However, these cases turn up the pressure in an already stressed system that’s working with limited staff and EMS transport services. Transferring a patient to Connecticut takes an ambulance out of local service for most of the day.

These challenges aren’t unique to Vermont hospitals, said Jeff Tieman, president and CEO of the Vermont Association of Hospitals and Health Systems. Providers in New Hampshire and Maine are all struggling to transfer patients who need specialized care. 

White said Gifford’s record of 24 calls — the most hospitals they’ve had to call to secure a transfer — would be an “easy day” for some of his peers working in Massachusetts emergency departments. 

Over Thanksgiving break last week, Rousse said, they had to transfer a patient to Hartford, Connecticut, which took longer than three hours by ambulance. 

“In my 30 years, I've never been in a situation where we just aren’t able to get patients the care they need when they need it. It’s sort of been the American norm that we can get patients to where they need to go, and there’s always availability and somebody at the other end of the line that says, ‘Yeah sure, we can help you,’” Rousse said.

“And now we’re finding that there isn’t anybody at the other end of the line that says they can help us, because they’re overwhelmed themselves. It’s tearing everybody up.” 

Some patients decide they don’t want to endure hours-long transfers to hospitals out of state, Rousse said, and instead choose palliative care. 

“We had an instance where we tried 23 different hospitals, there was a bed available in Albany, New York, and the family weighed the pros and cons and said, ‘We’re just not going to transfer, we’re gonna see what happens here,’ and the patient died,” he said. 

The backlog isn’t just for patients needing critical care beds, but also at long-term care facilities and rehab, said Dr. Trey Dobson, chief medical officer at Southwestern Vermont Medical Center in Bennington. 

He estimated there’s about 10 to 15 additional patients each day who need to be transferred out, both to larger hospitals, and to long-term care facilities. Patients who need to go to long-term care, assisted living or rehab are sometimes waiting days in the hospital, when they might normally just wait a few hours, Dobson said. 

“When we get up to numbers like that, it compounds, and that’s the problem,” Dobson said. 

State agencies have added more long-term care beds in recent weeks to help ease hospital bottlenecks.

In the first phase this October, the state added 80 beds across three facilities in St. Albans, Rutland and Burlington, Will Fritch, a spokesperson for the Department of Disabilities, Aging, and Independent Living, wrote in an email. By Nov. 11, 80 patients had been admitted to those beds. 

Since then, the state has since agreed to open 39 additional beds across three other facilities, Fritch wrote. Of those, 18 have opened and the rest are waiting on traveling medical staff to arrive and get oriented. 

Dartmouth-Hitchcock is working to expand their telehealth capacity, ICU staff and bed capacity, said Smith, the Dartmouth-Hitchcock spokesperson. 

UVM Medical Center announced it would open five additional ICU beds, and 10 additional Covid beds in Burlington this week, to help ease some of the pressure. But that comes at a cost too, as they had to reschedule elective procedures to preserve staffing capacity. 

White is concerned that delays to routine care could compound down the line. 

“When they say elective procedures ... it's a misleading term. Your routine colonoscopy is quote-unquote an elective procedure,” White said. “If you miss a routine colonoscopy and you end up with colon cancer, there’s nothing elective about that.”

Philadelphia is the farthest a Southwestern Vermont Medical Center patient has had to be transferred, Dobson said. Southwestern’s ICU was full Monday, and has hovered near capacity for the past month. Transfers that would normally take two to three hours can now commonly take 12 to 24 hours, Dobson said. 

Still, he said, they’re managing. All 10 ICU beds are set up with telehealth connections to Dartmouth-Hitchcock, so they can access that additional support even when they don’t transfer a patient. But the strain in the larger health care systems takes a toll on hospital staff, Dobson said, and more time spent making calls to other hospitals means less time at a patient’s bedside.

Dobson worries that the problem could become worse, especially if the numbers of Covid patients needing hospitalization continue to rise. He estimates that 50 to 70% of their ICU patients, on average, are there to be treated for Covid, and most of these ICU patients are unvaccinated.

“We just can’t sustain these additional patients in our healthcare system, and it’s really weighing on our staff,” Dobson said. “And it’s really not fair to those in the community that are vaccinated and trying to seek other types of care.” 

Read the story on VTDigger here: Calling for help: Rural hospitals struggle with overwhelmed ICUs, finding beds.

A Bennington health care group plans to build a child care center at the former Southern Vermont College campus with the help of $827,000 in congressional funding.

Southwestern Vermont Health Care, which operates Southwestern Vermont Medical Center in Bennington, plans to increase its child care slots by constructing a facility that can accommodate up to 125 children. That is twice the capacity of its existing day care, Learning Tree Child Care, which is licensed for 59 children from 6 weeks to 5 years old.

Learning Tree is struggling to cope with demand, fielding calls from prospective clients almost every day, said Kevin Dailey, the health care group’s vice president of administration and chief human resources officer.

And leaders know the organization’s sustainability is related to its ability to offer child care — especially amid a child care crunch statewide. 

“It ties directly to our ability to recruit and retain our own workforce,” Dailey said.

Vermont currently lacks regulated child care for an estimated 8,750 infants, toddlers and preschoolers around the state — children between 6 weeks and 4 years old, according to a February report from Let’s Grow Kids. The nonprofit organization’s work includes providing grants and technical assistance to Vermont child care programs in an effort to increase their availability and quality.

In Bennington County specifically, the data shows that 586 child care spaces are needed to meet the local demand.

“Right now, three out of five of Vermont’s youngest children don’t have access to the care they need,” said Aly Richards, CEO of Let’s Grow Kids. “When families can find child care, it is unaffordable for too many. Our early childhood educators are also struggling to make ends meet.” 

Though Southwestern Vermont Health Care’s proposed child care center will prioritize the group’s employees, as does Learning Tree, it also would serve other families.

“By doubling the size of the facility,” Dailey said, “the thinking is, not only will it give us a better ability to serve our own employees, but there'll be additional capacity for the community.”

It plans to build the new day care at the former Southern Vermont College campus, which closed in the spring of 2019 after financial pressures cost the school its accreditation. The health care group acquired the property for $4.65 million at a U.S. Bankruptcy Court auction in December 2019.

Organization leaders said they’re still in the initial stages of planning the child care center, which they hope would open in a couple of years.

Dailey said they’ve already retained an engineering firm and architectural firm, and envision a building that could be expanded to meet higher demand down the road.

There’s no cost estimate for the center yet, but it got a boost from the 2022 federal budget bill, which President Joe Biden signed into law last Tuesday.

The $1.5 trillion in appropriations include $200 million for various Vermont projects; among them the proposed Bennington child care center. The project has been earmarked $750,000 through Sen. Patrick Leahy’s funding requests and $77,000 through those of Sen. Bernie Sanders.

In order to solve Vermont’s child care crisis, said Richards of Let’s Grow Kids, society needs to continue working toward long-term public investments in a strong and stable child care system.

The new child care center could be the first building Southwestern Vermont Health Care puts on the former college campus, which its medical center has been using for Covid-19 testing and vaccination since the pandemic began. The organization is still discussing its overall development plan for the property.

Southwestern Vermont Health Care operates the hospital in Bennington, located across the street from the former college campus, along with other primary and specialty care practices in New York and Massachusetts. 

Read the story on VTDigger here: Health care group plans to build day care for 125 children at former Bennington college campus.

Some months ago, when Vermont hospital executives began planning their budgets for the next fiscal year, the pandemic was in retreat. Cases were declining and so were hospitalizations and deaths.

Vaccines for younger children, toddlers and babies were on the horizon. The novel virus that radically altered every aspect of life in the Green Mountain State was slowly becoming the norm, not an emergency.

It was with that optimism that Stephen D. Majetich, chief financial officer at Southwestern Vermont Medical Center in Bennington, built the hospital’s budget proposal for fiscal year 2023. Executives built a budget to deal with the challenges they knew about — rising personnel costs and inflation.

Leaders at the 99-bed hospital in Bennington made very few allocations to handle another Covid-19 wave. Majetich is a money and numbers guy and none of the experts at the hospital could predict what the pandemic would do in the fall, he said. So he budgeted for little to no Covid-19 interruptions. 

But in recent weeks, top experts at the U.S. Centers for Disease Control and Prevention and at the Vermont Department of Health have said that new, more contagious versions of the Omicron variant could sicken 30% of Americans, as many as 100 million, this winter. A wave that big could have significant implications for hospitals — and their finances.

“When (hospitals) construct their budgets, they use all the information they have available to project what they’ll need next year,” said Michael Del Trecco, interim president of the Vermont Association of Hospitals and Health Systems. “When you throw Covid into anything, let’s face it, everything is really fluid and it’s very hard to predict.”

The Bennington hospital is not alone in building a no-surge assumption into its budget. Officials at North Country Hospital in rural Orleans County told Green Mountain Care Board regulators that Covid-19 “does not have” direct effects on their budget proposal for fiscal year 2023 beyond the lasting financial implications of previous coronavirus waves. 

Wendy Franklin, a North Country Hospital spokesperson, said on Thursday the hospital “isn’t planning for a significant Covid surge” and instead is focusing on “stabilizing” and investing in infrastructure. 

Other hospitals, including Brattleboro Memorial, took a more precautionary approach and built Covid-19 response into their budgets, according to their submissions. Hospital spokesperson Gina Pattison said on Thursday that while the hospital budgeted for some Covid response, a surge that’s large enough to “significantly impact staffing, force the cancellation of elective procedures and require closure of our operating rooms would adversely impact” hospital finances, requiring “relief funds of some kind.”

Executives at the 61-bed hospital built in expenses such as expanding the infection prevention program, continuing to fund screening personnel and maintaining a seven-bed negative pressure unit for Covid-19 patients at the hospital. 

Even without another surge, the fiscal year, which runs from Oct. 1, 2022, to Sept. 30, 2023, would have its challenges.

At Southwestern, inflation and staffing costs were largely responsible for increasing estimated operating costs by about $15 million, an 8.5% increase, for fiscal year 2023. Hospital leaders prepared to ask the Green Mountain Care Board to approve a 9.5% increase in charges to commercial insurers and their enrollees, which would amount to $8.2 million. 

Brattleboro Memorial is asking for a 14.9% rate hike, roughly $32 million. 

North Country is asking for a 12% increase, amounting to an additional $8.6 million in charges.

If regulators approve these increases in full, Vermonters with commercial insurance could face rising premiums next year. 

For now, it appears that hospitals would have to ride out a potential surge on their own, which makes this year’s budget review with the Green Mountain Care Board especially important.

Sen. Ginny Lyons, D-Chittenden, who heads the Senate Health and Welfare Committee, said it would be hard to offer state aid to hospitals unless Vermont gets additional federal support. 

“I am very concerned that another surge will overwhelm (small hospitals),” Lyons said. “But at the same time, we have so many outstanding needs in our state, it's gonna be really tough to find general fund dollars. It really will be.”

If the CDC’s projections hold true in Vermont, hospitals could contend with a wave of mild infections that sideline health care workers and worsen personnel challenges at hospitals, as was the case last winter. 

Those costly disruptions could push some hospitals in the state to the brink, according to Del Trecco.

“We are in a space of stabilization,” he said. “Every one of our hospitals and providers are challenged around workforce. Their Fiscal Year 22 projections are not favorable and moving into this 2023 budget cycle, the (Green Mountain Care Board’s) mindset has to be to stabilize this provider community.”

Read the story on VTDigger here: Covid wave this fall could derail next year’s hospital budgets.

This commentary is by Don Keelan of Arlington, a retired certified public accountant.

If not daily, certainly weekly, we hear the news (Rutland Herald) of the 50 million people nationwide, including 85,000 Vermonters, who experience food insecurity or, in some cases, no food. Why?

I believe the increase in food insecurity, at least in recent years, is linked to the impact of Covid-19 and exacerbated by the double-digit inflation attached to almost every food group. 

The rise in the number of folks who make up the food insecurity statistic parallels the homelessness statistic: about 1,000 Vermonters before the pandemic, and currently, close to 3,000. Again, why?

There is plenty of food throughout Vermont, especially at this time of year.  The fact that food is plentiful does not mean it is inexpensive or evenly distributed. 

How to get food to those in desperate need was the subject of a round-table discussion at the Arlington (Vt.) Common on Sept. 22, sponsored by Green Mountain Academy of Lifelong Learning.

The panelists were from the Hildene farm, Burr and Burton Academy faculty, the Manchester Food Cupboard, an East Dorset long-term farmer/grower, and  moderated by the managing editor of Edible Vermont. The panel gathered at the Arlington Common’s Performance Hall and addressed an audience of 60. Due to the agenda’s seriousness, more should have attended. 

It was clear to me, and I hope it can come to fruition, that the panelists believe there should be greater collaboration among the county’s organizations that grow, prepare and distribute food. This writer has been advocating such a goal for years, and still, the nonprofit organizations involved in food distribution are of one mind: protect their turf. 

Why (aside from inflation and Covid) do we have such a vast number of Vermonters with food insecurity when the employment rate is so low, businesses beg for employees, and the governor noted there are over 20,000 jobs in the state waiting to be filled? 

Not everyone wishes to admit it, but one community segment seeking food is closely connected to the opioid epidemic that has rocked Vermont, especially Bennington County, in recent years and only worsening.

If someone with $100 to spend is afflicted with addiction, and their choice is between buying food or illegal drugs, it is not difficult to imagine where the $100 will be spent. 

Our area is desperate for a significant addiction/recovery center. Such a center could provide medical treatment, counseling, housing, food, job training and family support. 

There is only one organization in our area that could be enlisted to provide these comprehensive services: Southwestern Vermont Medical Center. 

The medical center now owns the former Southern Vermont College campus that could be repurposed to provide such services. The medical center has the expertise to recruit the needed professionals. It also has the skills to operate a multiservice complex. 

What is needed is the medical center’s leaders’ willingness to commit to a costly multiyear challenge that will have little to no financial return. 

Our area’s farmers' markets, local farms, and food distribution centers can only do so much. The recent increased demand for their products will soon overwhelm them. 

It has been said that we will not arrest our way out of the illegal drug crisis, and we will certainly not address the underlying causes of food insecurity by giving away free food to those families/individuals battling addiction. 

A half-dozen years ago, a drug/methadone hub center was promised to Bennington County but has not materialized. Now, we have an even greater need and opportunity to make it happen. What is missing? The willingness to do so.  

Read the story on VTDigger here: Don Keelan: Why the recent increase in food insecurity? And what to do?.

Dartmouth Health network’s already large influence in the Vermont health care market is likely to grow next year with the addition of Southwestern Vermont Health Care.

The board of trustees of the smaller network, which includes a hospital in Bennington and medical clinics in Manchester, Pownal and Wilmington, approved an “integration agreement” in late November that would allow it to become a member of Dartmouth Health, according to an email to staff from SVHC’s president and chief operating officer first reported by the Bennington Banner.

“Over the next 90 days, both organizations will be meeting with state officials and regulators, so we can officially close on the agreement,” the email said. 

Dartmouth Health is the parent organization of Dartmouth Hitchcock Clinic and Mary Hitchcock Memorial Hospital, which form Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, and more than two dozen other nonprofit and for-profit entities. Those include Mt. Ascutney Hospital in Windsor and other smaller hospitals in New Hampshire in Lebanon, New London and Keene, all of which have become affiliated over the last 15 years.

Dartmouth Health network is roughly the same size as UVM Health Network in terms of employees and patients served, but roughly three-quarters of Dartmouth’s patients come from New Hampshire. It serves a much smaller percentage of patients from Vermont than the UVM network, but that may be changing.

Southwestern Vermont Health Care has been working closely with Dartmouth Hitchcock Medical Center for a decade. Its clinics in Manchester and Wilmington already are branded as Dartmouth Health clinics. Its cancer center and several other medical departments are already jointly operated by the medical center and physicians across the region are all affiliated with Dartmouth Hitchcock, an academic medical center with ties to the Geisel School of Medicine at Dartmouth College.

Southwestern Vermont Health Center’s greater “integration” into the Dartmouth Health network would provide several additional benefits to its 75,000 patients, according to statements from both organizations. Patients largely come from Bennington and Windham counties in Vermont and eastern New York’s Rensselaer County and Berkshire County in northwestern Massachusetts.

In particular, becoming a member of Dartmouth Health would allow Southwestern Vermont Medical Center to become a “regional referring hospital” and to integrate with Dartmouth’s electronic medical record platform. The move would allow SVHC to “participate in numerous initiatives such as joint purchasing, expansion of telemedicine services, education and research to name a few,” SVHC’s statement said.

Although the Green Mountain Care Board regulates hospitals, it does not have oversight of 

affiliations. The primary regulatory hurdle to the integration agreement appears to potentially be a review by the Vermont Attorney General’s Office’s Public Protection Division. 

Because SVMC is a nonprofit corporation, such a review would be triggered if the agreement involves the transfer of “all, or substantially all,” of its assets to another organization, said Lauren Jandl, the Attorney General’s Office’s chief of staff. The review would look only at whether the transfer is consistent with the original nonprofit's mission and any restrictions on the assets. 

SVMC staff declined to answer how the affiliation would impact its governance and debt structure. Southern Vermont Medical Center is midway through a $28 million expansion and upgrade of its emergency department.

New Hampshire law allows its Attorney General’s Office’s Charitable Trust Unit to conduct a more stringent review of transfers between health care nonprofits, including consideration of whether the transaction is in the best interest of the community being served. It was under that standard that the office denied an agreement that would have allowed an affiliation between Manchester’s Catholic Medical Center and Dartmouth Health earlier this year, finding that the affiliation would “adversely impact competition.”

Recent research has consistently shown that consolidation among health care providers is linked to increased costs charged to insurers. Americans spend roughly twice as much on health care on a per capita basis as other similarly developed countries.

Read the story on VTDigger here: Southwestern Vermont Health Care moves to join Dartmouth network.

Gov. Phil Scott’s midyear budget proposal would shift $283 million in state spending towards broadband, health care staffing, rural infrastructure assistance and more. 

The administration unveiled the plan, which is paid for mostly through federal funding and Medicaid savings, to lawmakers on Friday. Scott’s proposal would return about $1.3 million in savings to the state’s general fund. 

The plan’s one-time expenditures are primarily “coming from state dollars that are available because of more generous federal funding — predominantly, but not exclusively, health care,” said Adam Greshin, the state’s commissioner of finance and management, after a presentation to state lawmakers Friday. 

The annual budget adjustment act is a midyear true-up of the current budget. (The state fiscal year begins in July.) The administration’s proposal mainly serves to outline the governor’s short-term spending priorities. Over the next few weeks, lawmakers will develop their own plan. 

In pre-pandemic years, the budget adjustment altered state spending by approximately $10 million to $30 million, according to Doug Farnham, deputy secretary of the Agency of Administration. Big-ticket spending had generally been reserved for the annual budget bill, known in state government as “the big bill.”

But last year, with the influx of federal pandemic aid, the budget adjustment became a $367 million spending package that guided a range of policy decisions on state programs. It allowed lawmakers to continue tuition relief at the Vermont State Colleges, extend the state’s emergency housing program and fund retention bonuses for workers in child care, corrections and human services. 

Scott’s proposal for this year’s budget adjustment again includes multimillion-dollar line items, as inflation and increased usage of some government programs drive up costs. 

“The BAA is normally important, but we definitely don’t normally have the scope of money that we’re looking at in this BAA,” Farnham said. “It’s definitely above, significantly above, average.” 

Among the administration’s requests is an additional $11.2 million for traveling nurse contracts for the Department of Mental Health, as well as more than $20 million in additional funding to the Brattleboro Retreat. The Vermont Veterans’ Home requested an additional $5.8 million to put toward staffing and utility costs. The proposal also includes $3.3 million for the Vermont State Police to fulfill an 8% pay increase won by troopers in a collective bargaining agreement after lawmakers finalized the budget last year. 

The proposal also asks lawmakers to make several one-time appropriations, including $3 million for a new Rural Infrastructure Assistance Program, which would help small towns apply for and administer grants so they don’t leave federal pandemic relief money on the table. Scott previewed this program in his inaugural address last week. 

“The basics, like water, sewer and stormwater, housing, and high-speed internet — those are the sparks that ignite revitalization,” Scott said. “But we need to follow through to give more communities what they need, so those sparks don’t burn out.”

According to an administration memo explaining the proposal, the assistance program would help smaller communities, many of which rely on volunteer administrators, to “identify priority projects, submit applications, and then actively manage projects and corresponding reporting, should funding be awarded.”

Scott also requested $9.2 million to help Southwestern Vermont Medical Center fast-track construction on a new inpatient psychiatric facility for youth. The Bennington hospital plans to retrofit an existing space to create about a dozen beds for 12- to 18-year-olds, Greshin told lawmakers on Friday. The hospital hopes to open those beds by January 2024, he said, on “a pretty aggressive schedule.” 

The administration’s proposal also includes $30 million in one-time funding toward a competitive federal broadband grant. The grant, which Vermont applied for midway through the fiscal year in October 2022, requires the state to put up its own funds to access an additional $67 million in federal dollars. Private companies — including Consolidated Communications, Waitsfield and Champlain Valley Telecom, VTel and First Light — have pledged an additional $16 million toward the project. The grant would fund “middle mile” infrastructure — lines that are expensive to install, and crucial to expanding broadband access, but not profitable for telecommunications companies. 

The proposed new spending would be offset primarily by federal funding, Greshin said, mostly via the state’s Medicaid program. With the onset of the Covid-19 pandemic, the federal government picked up a larger-than-usual portion of Medicaid costs, saving the state millions of dollars. When state lawmakers crafted the budget last year, Greshin said, they didn’t expect those Medicaid savings to continue for as long as they have.

State agencies are also returning an unusually large amount to the general fund this year, said Farnham. According to the governor’s proposal, state agencies would return $10 million in unused money back to the general fund, to be reappropriated elsewhere. More than half of that is unused rebates meant for renters and homeowners.

Read the story on VTDigger here: Gov. Phil Scott asks lawmakers to move $283 million into spending plans for this fiscal year.

The midyear administrative budget adjustment that absorbs the first weeks of every Vermont legislative session usually involves requests to transfer money between already existing programs. And normally a hospital will take several years to launch a new service.

This year those norms have been turned upside down. In the budget adjustment package released late last week, Gov. Phil Scott’s administration requested approval to reallocate $9.25 million from this year’s budget to support the rapid development of an inpatient youth psychiatric unit at Southwestern Vermont Medical Center. 

However, the Bennington hospital has not yet committed to the project. Administrators with the Vermont Department of Mental Health now say they would like to see the legislative language broadened to allow the funds to go elsewhere if SVMC leadership decides not to move forward.

“We know there is a need and we don’t have the capability right now,” Adam Greshin, commissioner of the Vermont Department of Finance and Management, told the House Committee on Appropriations on Friday. 

The project involves renovating an existing hospital wing at Southwestern Vermont Medical Center, so it could likely open faster than a project involving a new building, said Greshin, adding that the goal is to have beds available by Jan. 1, 2024. “This is in the budget adjustment to try to keep the momentum going,” he said.

Should lawmakers approve the request for funds as part of the budget adjustment, the money would be available to the hospital during the current fiscal year, before next year’s budget kicks in on July 1.

Legislators and even the hospital’s leaders are skeptical about the possibility of such a rapid roll-out. But no one is questioning the need. 

On an average day, a half-dozen children and their caregivers are in their second day of waiting in emergency departments around the state for access to inpatient mental health care. That number, from a weekly survey by the Vermont Association of Hospitals and Health Systems, has been consistent over the past two years. 

A broader study tracking the number of patients — adults and youths — in hospital emergency departments seeking mental health care is due to the Legislature next week. Last year’s version, looking at hospital discharges for the year prior to Sept. 30, 2021, found there were 1,438 youth cases during that period, with an average stay of two days. 

A big gap in the system right now specifically is the lack of inpatient beds for youth within a medical setting, Emily Hawes, commissioner of the Vermont Department of Mental Health, told the House Appropriations Committee on Tuesday. 

Currently, the Brattleboro Retreat is the only facility designated to provide emergency psychiatric care for youth, but it is not equipped to serve patients who “also have complex medical needs,” Hawes said. 

Complex medical needs might mean conditions such as pregnancy, type 1 diabetes, epilepsy or developmental disabilities, or acute problems such as wounds from self-harm or the severe dehydration that can accompany an eating disorder. Youth in a psychiatric crisis with additional medical needs like these currently stay inpatient at hospitals, often in emergency departments, a setting which makes it difficult to provide the needed mental health care.

The department has been actively seeking a partner in opening a facility since last February. The UVM Health Network initially showed interest in adding the service at its pediatric hospital in Burlington, but stepped back after it paused all new construction because of significant annual budget deficits. 

Southwestern Vermont Medical Center signaled its interest after the department issued a second request for proposals in June for up to 12 youth psychiatric beds, agreeing to study the feasibility of the new service, said Jim Trimarchi, director of planning for the Bennington hospital. 

“We’re excited about it, and we’re pleased that Gov. Scott recognized the challenge and that he is taking budgetary steps forward,” Trimarchi said. However, in terms of the project, “it’s actually pretty early days.”

United Counseling Service of Bennington County, the designated social and mental health service agency for the region, has discussed the project with leadership at the hospital, said Executive Director Lorna Mattern by email. The agency already works with hospital staff daily to meet the psychiatric needs of patients there and has agreed to collaborate on staffing an inpatient facility, she wrote. 

Trimarchi said the feasibility study should be completed in late March. The next steps would be approval of the project by the hospital’s board of directors as well as the Green Mountain Care Board, the state regulatory body for hospitals, through the issuing of a “certificate of need.”

A January 2024 opening might be achievable from a purely construction standpoint if there were no significant supply chain issues, he said, but “I don’t want to get ahead of our board and other regulators.” 

Regulatory issues were also on the mind of lawmakers. No application for a certificate of need is on file for the project, according to the care board website.

Clearing that hurdle in itself could push the project into the next budget cycle, Rep. Robin Scheu, D-Middlebury, told the committee during Greshin’s testimony. “We appreciate your expediency with it, but we’ll have to find out what is possible or if there is anything in the way,” she said.

Administrators plan to work with legislators to make the language for the appropriation less specific to the Southwestern Vermont Medical Center, said Nicole DiStasio, director of policy for the Vermont Department of Mental Health, in an email. If the hospital decides against the project, the department would likely reissue the RFP for a third time, she said.

But the department would still like to see funds from this year’s budget adjustment set aside for that purpose, DiStasio said. Federal American Rescue Plan Act funding has offset the need for a significant amount of state spending in this fiscal year and the previous one, offering an opportunity to invest in helping to bring a hospital-based youth inpatient psychiatric unit into service. 

“There is an ongoing need to be able to serve this population of youth in-state, especially those with co-occurring medical needs that would require a connection with a hospital setting,” DiStasio said.

Correction: An earlier version of this story misspelled Emily Hawes' name and the Southwestern Vermont Medical Center.

Read the story on VTDigger here: Need for youth psych beds prompts unusual budget request for Southwestern Vermont Medical Center.

Smacked in the face. Punched and choked. Kicked in the stomach so hard you throw up. 

Nurses, doctors and administrators from hospitals around Vermont provided those examples of violence — from just the past week — to lawmakers on Wednesday. One after another, in often tearful testimony, the direct care providers also described their most traumatizing experiences from the last few years. 

“I have been spit at, kicked, had my hair pulled, been sexually harassed, had my life threatened,” said Jill Maynard, director of emergency nursing at Southwestern Vermont Medical Center in Bennington. In one case, she said, the patient who threatened her began stalking her in the community and near her family’s home.

During a joint session of the Senate Judiciary and Health and Welfare committees, 10 witnesses organized by the Vermont Association of Hospitals and Health Systems urged legislators to support S.26. The new bill would add three clauses specific to health care workers and health care facilities to Rule 3 of the Vermont Rules of Criminal Procedure, which governs when law enforcement officers can arrest someone without a warrant. 

Health care workers experience the large majority of non-fatal illnesses and injuries from workplace violence nationwide — 73% in 2018, according to the U.S. Bureau of Labor Statistics. Many hospitals and other health care facilities in Vermont and across the country try to counter the risk by putting staff through de-escalation training, setting aside quiet spaces for decompression, and creating crisis response teams that include mental health workers and security personnel. 

But, all the witnesses said, in the past few years, the frequency of violent incidents and their intensity have gotten much worse. As hospitals, and long-term facilities that they discharge to, struggled with the Covid-19 pandemic and extreme staffing challenges, patients became frustrated waiting longer for care and institutional systems for coping began to fray. 

Currently, in many cases, police officers will come to a hospital in response to a report of violence, but will only issue a written citation, witnesses said. As a result, the person lashing out or making threats, who is sometimes a patient, other times a family member, often remains in the hospital after an incident. That sometimes leads to further violence.

In one case, a patient threw a urinal at a nurse over a nighttime shift, hitting her, and was cited, but not arrested, said Alison Davis, medical director of the emergency department at Rutland Regional Hospital. He continued to taunt and threaten staff throughout the following day and later punched a different staff member, breaking her nose so severely it required two surgeries to repair, she said.

“One of the most disheartening statements I hear from my staff when assaults happen is ‘no one is going to do anything,’” Davis said. “I hope that I can go back to them and say that our legislature is going to help.”

Will this change anything? 

Vermont law currently allows law enforcement officers to make arrests without warrants in the situations described on Wednesday, said several legal experts who testified Thursday morning before the Senate Judiciary Committee.

“It seems like it really is a matter of discretion on the ground for the officer of how he or she wishes to go forward after speaking to the parties, and perhaps the state’s attorney,” said Chief Superior Judge Thomas Zonay. 

Senate Judiciary Chair Sen. Dick Sears, D-Bennington, the bill’s primary sponsor, acknowledged that might be true. “Whether or not they can already do it, you probably are correct, but they aren’t doing it,” he said.

The goal of the legislation is to emphasize as a matter of policy the importance of responding to violence against health care workers, he said. Similar language in Rule 3 calls out cases of violences against family or household members and against vulnerable adults as particularly sensitive situations, and allows law enforcement to make an arrest quickly. 

Tim Lueders-Dumont, an attorney for the Vermont Department of State’s Attorneys and Sheriffs, agreed that the special language around domestic violence made a practical difference, if not a legal one. 

“These are typically fast-moving situations,” he said. “You don’t have to fuss through the facts too much to figure out how to help that law enforcement officer when they are asking, ‘what can I do right now.’”

However, he added, in most of the cases, the person arrested would likely not be held, but simply booked and released. 

“I am less concerned about the outcome of what happens,” Sears said. “It is about the removal from the emergency room of the person who is creating the disturbance.” 

More training for law enforcement on responding to these situations would be needed for the new bill to have any impact, said Defender General Matthew Valerio. Providing training about what is possible under current law would have the same effect, he suggested. 

“To me you are dealing with a law enforcement implementation issue by changing the law,” he said.

But, he said, “It’s not a legal problem at all. It’s a mental health issue, a drug abuse issue, a poverty issue, issues of despair and the like. That is not going to be dealt with with Rule 3.”

Sen. Tanya Vyhovsky, P/D Essex, agreed. “To me, this is a symptom of a need to invest in our communities,” she said. “I support anything we can do to keep our health care workers safe, of course, but I don’t think we are getting anywhere close to the root of this problem.”

A baby step

Those taking care of patients say that these more abstract issues mean less than just doing something to address a situation that is exacerbating staff departures and limiting recruiting.

Nursing staff are leaving at an alarming rate due to the increasing violence, said Danielle Boudro, a registered nurse and director of the progressive care unit at Northwestern Medical Center in St. Albans.

That concern was echoed by Ben Smith, a doctor and medical director of the emergency department at Central Vermont Medical Center in Berlin. “We are not a bottomless resource that can absorb all this forever,” he said.  

For caregivers, each violent episode has the potential to be career-ending and life-changing. 

Nurses from University of Vermont Medical Center in Burlington and Mount Ascutney Hospital in Windsor each described brutal physical attacks by patients in the emergency room in recent years. The grappling and punches left them with significant brain injuries, constant anxiety and, in the latter case, ongoing hearing loss.

Matthew Looft, a nurse at UVM Medical Center, is still on heightened alert 20 months later, he said. He is working with administrators in the network to increase mental health support for caregivers who have suffered trauma on the job. 

Mark Sacco, emergency department manager at Mount Ascutney Hospital, said that all or almost all of the providers on his night shift were seriously injured trying to subdue a teenager brought there by his parents. Three of the six no longer practice. He feels he probably should have retired. But after a torturous three-month recovery, he returned to assist his colleagues during the Covid-19 surge.

“Please take this baby step, I implore you,” Sacco said.

Read the story on VTDigger here: Health care providers seek legislative action to curb workplace violence.

Patients and employees at University of Vermont Health Network’s three Vermont hospitals will no longer be required to wear masks in public spaces beginning April 12, the organization announced Thursday.

The change will affect the University of Vermont Medical Center in Burlington, Central Vermont Medical Center in Berlin and Porter Medical Center in Middlebury. 

Dartmouth Health also announced a rollback of its masking requirements for patients, visitors and staff at all of its affiliated offices effective April 10. That includes Mt. Ascutney Hospital in Windsor and the network’s flagship hospital, Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire. 

Southwestern Vermont Medical Center in Bennington, which is joining Dartmouth Health, is also doing away with mask requirements as of April 10, except for people with cold or flu-like symptoms.

Last month, Rutland Regional Medical Center did the same.

UVM Health Network hospital employees will be required to wear masks in patient rooms, in exam rooms and while providing direct patient care. But patients and visitors are no longer required to wear masks in those situations, the network said in a press release.

The network also removed Covid-19 visiting restrictions for most locations that did not have pre-pandemic rules, it said, with the exception of some high-risk clinical units such as dialysis clinics. 

New York hospitals in the network will keep masking and visitation restrictions in place due to state regulations, according to the press release.

At a press conference, UVM Health Network President Dr. Stephen Leffler said the decision was made by a team of experts and clinicians based on scientific data and guidance. As Covid continues to evolve, he said, the network would continue to follow scientific recommendations. 

The decisions have been criticized by the Vermont Coalition for Disability Rights. In a press release, the organization said it opposed both networks’ loosening of Covid restrictions because of the potential for harm of Vermonters with disabilities, particularly people who are at high risk of severe complications from Covid.

“Institutions that choose to actively perpetuate harm to people with disabilities cannot claim a commitment to health equity, or that they value ending health disparities,” coalition President Sarah Launderville said in the release.

Wilda White, founder of mental health advocacy organization MadFreedom, said in the release that Vermont’s commitment to health equity was “nothing more than lip service” if facilities are allowed to abandon masking policies, “effectively deny(ing) equal access to healthcare for individuals who are vulnerable to infectious diseases such as Covid-19.”

Leffler said some protections remain in place for high-risk individuals, such as the mask mandate for staff providing patient care. He said that people who might be uncomfortable in waiting rooms without masking could wait in their car, and that staff who are exempt from the masking rules had been directed to wear a mask if a patient asks them to. 

Anne Sosin, a health equity researcher at Dartmouth College, said lifting masking threatens to make health care facilities less safe.

“Even if we believe that COVID-19 infections are inevitable and pose a much lower risk to most in the population now, timing them with hospitalizations, surgeries and other healthcare visits is suboptimal at best and catastrophic at worst,” she wrote in an email. 

She said some data suggests Covid infections acquired in health care settings have been common and have a higher mortality rate than ones acquired in the general community.

The coalition also pointed to the rate of long Covid — thousands of Vermonters, according to some estimates — as reason for protecting high-risk Vermonters.

Ylan Roy is a former early childhood educator who has been out of work for months due to long Covid. She described herself as a super athletic person and rower before she developed chest pain and other symptoms. 

“The only way I can describe it right now (is) it’s not a body I know anymore,” she said.

Roy said she was surprised by the health networks’ decisions and wanted to know more about what evidence it was based on.  

David Clauss, chief medical officer for the UVM Health Network, said at a press conference that the low rate of community transmission and less viral shed among people with prior Covid immunity contributed to the decision. He did not elaborate on the full decision-making process.

Roy said that she isn’t a proponent of masking for everyone in every situation, but it makes sense to her that people in medical centers are more likely to be ill or have Covid. 

“If I’m not able to see my granddaughter when she has a runny nose, how hard is it to wear a mask at the hospital?” she said.

She said her plea is that “when you’re going into a building that has sick people in it,” wear a mask. “I’m not going to be able to go back to work if I keep getting Covid,” she said.

Read the story on VTDigger here: Several Vermont hospitals loosen masking restrictions for patients and staff.

[B]ENNINGTON — Putnam Memorial Hospital, now known as Southwestern Vermont Medical Center, opened to patients on June 10, 1918. A century later, that 30-bed community hospital has grown significantly and is part of one of New England’s leading rural health care systems.

Built with money donated by Henry W. Putnam and Henry W. Putnam Jr., the original structure cost $85,000 to construct. Putnam Hospital became Southwestern Vermont Medical Center in 1984.

To celebrate the centennial year, the corporate parent, Southwestern Vermont Health Care, has announced a schedule of events for the whole community throughout 2018.

“A hundred years of caring for generation after generation in Bennington County and beyond is certainly a milestone worth celebrating,” said Thomas A. Dee, SVHC’s president and CEO. “Equally worthy of celebration is what SVHC is today — one of the best and most innovative community health care systems in the region — and how we are growing our services to meet the needs of the future.”

In February 2018, SVHC will release “A Century of Caring,” a commemorative book covering 100 years of hospital history, and open a historical exhibit in cooperation with The Bennington Museum.

The public is welcomed to view the exhibit and others at the Bennington Museum free of charge on Saturday, Feb. 3.

“All year we will be honoring our past but also turning our attention to the future,” Dee said. “We’ve inherited a tremendous legacy, and it’s our responsibility to extend it by achieving an even higher standard of excellence for many years to come.”

A Centennial Gala is scheduled for June 9 — on the eve of the hospital’s 100th anniversary — at the Hubbell Homestead at Colgate Park in Bennington.

Centennial Community Day will be a free event for all ages on June 10. The event will feature 1918-inspired games, activities for children, entertainment and a road race. The day will also include annual events like the Heart Hike, Cancer Survivors Day and the Cancer Center Community Crusaders Day of Celebration.

In October, clinical leaders from around the country will be invited to a telemedicine conference called Telemedicine Reverse Innovation. The conference will be hosted by Southwestern Vermont Health Care and Dartmouth-Hitchcock Health Care.

In addition, each of the SVHC Foundation’s annual events — Masters in the Mountains and The Jingle Bell — will be enhanced for the centennial.

In a release, Dee noted several recent achievements of the institution:

• Southwestern Vermont Medical Center has been designated four consecutive times as a Magnet Center for Nursing Excellence.

• SVMC’s transitional care nurse, Barbara Richardson, RN, was named the 2016 Magnet Nurse of the Year, and in 2017, the hospital won the Magnet Prize — given to only one hospital worldwide each year — for its Transitional Care Nursing program.

• SVHC is accredited by the Joint Commission and recognized as a top performer on key quality measures.

• The health system received workplace honors from both Vermont Business Magazine and Becker’s Hospital Review. This fall the Centers for Living and Rehabilitation earned the prestigious five-star rating from the Centers for Medicare and Medicaid services.

More information and updates can be found at svhealthcare.org/100.

Read the story on VTDigger here: Southwestern Vermont Medical Center to celebrate centennial.

[B]ENNINGTON — With a five-star rating from the federal government under its belt, the local hospital is now in the top tier of hospitals across the country.

Southwestern Vermont Medical Center has earned a five-star rating for Overall Hospital Quality in 2017 from the federal agency that runs the Medicare program; it is the only hospital in the state and one of only 6 percent across the U.S. to do so.

The recognition comes, in part, from a culture of patient-centered care the hospital has built, according to Thomas Dee, president and CEO of Southwestern Vermont Health Care.

“It doesn’t come from just one area, but a total team approach,” Dee said Thursday. “From the medical staff and nursing team, to housekeepers, and technology and support services. It comes from putting the quality of patient care first.”

The rating comes from the Centers for Medicare and Medicaid Services. The center rolled out the expanded program last year. The overall rating represents 57 “quality measures” on the center’s Hospital Compare website.

The ratings, according to CMS, help consumers make decisions about where they receive health care, and “encourages hospitals to improve the quality of care they provide.”

The 99-bed campus in Bennington receives a substantial amount of payments through Medicare, the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. Dee said medicare recipients make up over 65-percent of SVMC’s patients.

The patient’s experience score is calculated from a voluntary survey, the Hospital Consumer Assessment of Healthcare Providers and Systems. The survey covers topics such as how well doctors and nurses communicate with patients, how responsive hospital staff are to patient needs, how clean and quiet hospital environments are, and how well patients are prepared for post-hospital settings. The system also evaluates clinical measures in the areas of patient safety, mortality, readmissions, effectiveness of care, timeliness of care, and efficient use of medical imaging to assign the star rating. SVMC earned four stars in 2016.

The 2017 questionnaire results show that 81 percent of SVMC patients reported that doctors “always” communicated well, while 83 percent reported the same for nurses (above the national average of 80 percent). And 89 percent reported in the affirmative that they were given information about what to do during their recovery at home.

Of the 4,579 hospitals nationwide eligible to receive a Star Rating, only 260 received the top rating, according to CMS.

Ratings earned by other hospitals in the greater region: Brattleboro Memorial Hospital and Rutland Regional Medical Center each earned four stars, Berkshire Medical Center in Pittsfield, Mass. earned three stars, and Albany (N.Y.) Medical Center Hospital earned two stars.

Ed Damon can be reached at edamon@benningtonbanner.com, at @edamon_banner on Twitter and 802-447-7567, ext. 111.

Read the story on VTDigger here: Feds issue rare five-star rating to Southwestern Vermont Medical Center.

SVMC Dentistry is located in 1,890 square feet of renovated space on the first floor of the medical offices building. The project represents an investment of more than $1.2 million by Southwestern Vermont Health Care.

“Dental care truly is a component of primary care,” said Dr. Michael Brady, medical director of the new practice. “I am happy to contribute to the health system’s goal of expanding access to primary care in our region.”

Brady will be joined by Dr. Richard Barbierri, Dr. Russell O’Connell, dental hygienists and other staff members.

In seeking state certificate of need approval last year, SVHC cited data showing a need for more dental services in the area. It told state regulators that “a significant percentage of the population within SVMC’s service area is afflicted with dental decay” and that Bennington kindergartners “have the highest incidence of tooth decay among peers in Vermont.”

A state report also showed that access to dental services in the region was limited, especially for new patients with Medicaid insurance coverage. And many area dentists were said to be aging, according to the application, with more than 75 percent 50 or older and nearly half 60 or older.

Last week Brady said the practitioners expect about 70 percent of their patients initially to be on Medicaid, although that figure is expected to decline toward 60 percent over time. The dentists hope to work with primary care doctors to help meet a significant need for all primary medical services throughout the region, which includes communities north, south and east of Bennington in Vermont and in nearby New York state.

In addition to dental services by appointment, the facility will handle emergency dental care for patients who now would likely have to go initially to the SVMC ExpressCare facility — also located in the medical building — and then wait for follow-up dental care later when an appointment can be made.

“We can take some of that burden from ExpressCare,” Brady said.

Brady and Barbierri are relocating to SVMC from private practices in the area, and both have practiced in southwestern Vermont for more than 40 years. The staff from each of the practices will also join the SVMC team, according to a news release, and patients are being encouraged to follow the dentists to the new facility.

O’Connell worked in Wilmington and in Whitefield, New Hampshire, prior to joining the new practice.

“Proper dental care is essential to overall health, and there is a tremendous need for dental services in Bennington and the surrounding region,” said Trey Dobson, chief medical officer at SVMC and medical director of Dartmouth-Hitchcock Putnam Physicians.

He added: “This practice leverages the experience of our long-serving local dentists to draw new dentists to our area. This will provide much-needed access to dental care and sustain it for the future.”

Brady said the original plan for the facility called for four dental offices and related equipment, laboratory and office space. But a fifth dental office was added within the overall renovated space in the medical building.

The practice will offer a full range of services, including preventive cleanings and treatments, general dentistry, restoration, exams, crown and bridge, implants, and cosmetic dentistry. The practice also will provide dental surgery and emergency care. Patients will be accepted with or without dental coverage.

“I am excited about this, and I thank our forward-thinking board (of trustees),” said SVHC President and CEO Thomas Dee.

Brady and Dee said they expect the new practice, which opened last week, to be very busy right from the start.

The SVHC service area is described as Bennington County and western Windham County; eastern areas of Rensselaer and Washington counties in New York; and northern Berkshire County in Massachusetts.

Brady started his career as a dental officer in the Navy and has performed general dentistry in the Bennington area for 43 years, specializing in children’s dentistry at Molly Stark Elementary for the last 18 years. He has been a member of Southwestern Vermont Medical Center’s medical staff since 1974.

In addition to his dental degree, Barbierri completed postgraduate studies in craniofacial pain at the Craniofacial Pain Institute in Maryland. He worked at Arlington Family Dentistry for more than 40 years.

The cost of the project was estimated in the SVHC application at approximately $804,000 for the renovation work, equipment and dental practice computer software. According to the permit application, that includes $319,102 for renovation work, $235,123 for medical and office equipment, $169,563 for software and associated hardware, and $79,994 for X-ray and intraoral camera systems.

Dee said the project was within budget and the only change was in designing in a fifth dental office for the practice.

Read the story on VTDigger here: Bennington hospital opens dental facility meant to serve region.

BENNINGTON — The story of Bennington’s hospital, which is marking its centennial this year, can be traced to mid-1800s California, where a young entrepreneur named Henry Putnam started building his fortune by selling bottled drinking water to those who had journeyed west in search of gold.

With an expanding business empire based in New York City, Putnam quickly made himself known after moving to Bennington in 1864, building a home, maintaining manufacturing plants, winning a selectmen seat and eventually becoming the largest property owner in town.

In 1918, he opened the Putnam Memorial Hospital, an institution that despite many setbacks and financial struggles would steadily expand over the next century, becoming what is known today as Southwestern Vermont Medical Center. The hospital’s history, and the stories of the leaders who built it, has been told in two deeply researched volumes by Tyler Resch, the research librarian at the Bennington Museum.

His new book, “A Century of Caring,” covers the history of the institution from the founding to the present era as SVMC, while the first volume, “Deed of Gift: The Putnam Hospital Story,” coincided with the hospital’s 75th anniversary celebration and was published in 1991.

In an interview, Resch said a key factor in the hospital’s survival as others in the region have closed was the support of its original benefactors — Henry Putnam and his son, Henry Putnam Jr. — and those in the community who later stepped forward as board members to stabilize the organization during tough times.

Another key, he said, has been a line of strong and progressive — sometimes aggressive — hospital administrators.

The first, Mary D. Baker, was a registered nurse in New York City before making the move to Bennington. In the 1940s, Dr. Francis Bean pushed for new facilities, advanced equipment and specialists before resigning in frustration when the trustees failed to provide enough funding.

Bean “set the tone” for executives that followed, Resch said, even though he couldn’t convince the trustees to fund his plans during the lean financial period that followed the death of the younger Putnam in 1938, and then during the Great Depression and World War II.

“We don’t expect to see a second Mayo Clinic,” Bean said in his final report to the board in 1948, “but in a modest way we believe the hospital can do much more with its resources to serve this community than it is now doing.”

After what Resch describes as a period of difficult finances and relative stagnation through the 1950s, Robert D. Stout arrived as the administrator in 1961 and was joined by a dynamic board chairman, retired Union Carbide chemist Joseph G. Davidson. They oversaw a second period of growth for the institution and the transformation of Putnam Hospital into a regional medical facility.

Harvey M. Yorke was the next notable CEO, continuing an aggressive approach to regionwide care and advanced medical facilities and treatments, Resch said. However, Yorke’s tenure ended abruptly after nearly 18 years, when he and other top administrators were dismissed during the recession in 2009, amid surging operating deficits.

And the current CEO, Thomas Dee, has overseen expansion of satellite facilities in Pownal, the Northshire, Hoosick Falls, New York, and the Deerfield Valley, as well as far-reaching partnership agreements and collaborations with Dartmouth-Hitchcock Medical Center — bringing more advanced medical services, equipment, personnel and training to Bennington.

“Think I’d put a lot of stock in the CEOs,” Resch said of the hospital’s success. “I think it is a function of the executive pushing.”

The first half-century

The Putnam Memorial Hospital opened its doors on June 11, 1918, three years after Henry Putnam died, and nearly 20 years after he had retired to San Diego. Henry Putnam Jr. picked up where his father left off, providing $100,000 for construction of the hospital and $30,000 for equipment.

In his new book, Resch cites the “loyalty and persistence” of the younger Putnam in continuing to fund new buildings and wings to the hospital and covering annual operating deficits until his death in 1937, when his estate added $3 million to the endowment.

Even today, the Putnam legacy in Bennington remains strong, as the proposed redevelopment of the Hotel Putnam and the Old Courthouse building at the Four Corners, both built by Henry Sr., are at the heart of a major project local investors (including Southwestern Vermont Health Care) hope will revitalize the downtown.

Putnam Hospital opened during a period of rapid transition nationally for health care, particularly medical institutions, Resch writes in his 1991 book. There were approximately 178 hospital institutions listed in the US 1873, a number that number had soared to 4,359 by 1909.

Mary Baker was selected as superintendent two years before the hospital opened. During her 25 years at the helm, she oversaw five building expansions and struggled with financial difficulties, such as mounting “charity” cases as the Great Depression wore on, and a disastrous fire in 1932 that closed the hospital for a year.

Baker managed the hospital and the nurses, who lived on the campus and worked long hours, with famously close attention, also finding time to plant flowers and tend to a vegetable garden on the grounds. She made it a point to visit every patient every day, totaling up an estimated 26,612 personal visits from 1918 through 1943, Resch writes.

A new era of growth

Robert Stout, who took over during the first years of the Kennedy administration, captured the idealism of the time by ushering in what was considered “a golden era for hospital administration,” both in terms of physical expansion and equipment but also in rapid improvements in the quality and training of the hospital staff, attracting young physicians from elsewhere with the allure of Vermont’s lifestyle, Resch writes.

Among the numerous building projects during the expansion years from 1974-91 were an 85,000-square-foot West Wing project that doubled the size of Putnam Hospital, the first phase of a medical offices building adjacent the hospital and development of the SVHC Regional Cancer Center.

The next long-serving CEO, Harvey Yorke, began in late 1991 and “by 1993 his vision had expanded into a grand — some would say grandiose — ambition that Bean and Davidson surely would have applauded: ‘To make our communities the healthiest in the nation,'” Resch writes.

He formed what was called “The Vision” for the organization, which included universal access to a continuum of care; access to the system through a primary care provider; a centralized computer system to share information and measure outcomes; a network operated at the local level; financial accountability to members; and incentives and education to promote a healthy lifestyle.

Quality of care statistics showed improvement during this period, such as in a 1999 top ranking in a Press Ganey Associates Inc. survey of 454 hospitals nationwide in patient satisfaction, waiting times and communication with patients and families.

In 2000, the corporate entities of the entire health care organization were reformed as Southwestern Vermont Health Care. The medical center had received its current name in 1984.

The financial crisis that led to the ouster of Yorke and other top administrators in 2009 occurred during the Great Recession amid changes and new financial complexities in health care that led to deficits at a number of hospitals, including the former North Adams (Massachusetts) Regional Hospital.

Mark Novotny, the chief medical officer then serving as interim CEO, had to oversee a reduction in staff costs and take other steps to slash the deficit. A national search for a new CEO was launched, and Dee was chosen from among 300 candidates and six finalists.

The new administrator pursued several initiatives that helped stabilize the institution’s finances, including exploring an affiliation with another institution, establishing a hospital foundation board separate from the board of trustees to concentrate on fundraising, and expanding and reviving the SVHC board, Resch said.

SVHC’s reach also continued to expand through the county into other states, including expansion of a clinic in Wilmington, a new Pownal primary care office, enhanced facilities in the Northshire, and in a satellite clinic in Hoosick Falls, New York.

SVHC also now has a 2020 plan, which envisions partnerships and collaborations with organizations such as United Counseling Service and further affiliations with Dartmouth-Hitchcock.

Dee has said major investments in the health care system here are under consideration that would extend beyond 2020, including expanded or renovated facilities and technical improvements, including remote video consultation with physicians at Dartmouth-Hitchcock Medical Center and elsewhere.

Copies of the newly released book, “A Century of Caring – From Hospital to Heath System: The story of Southwestern Vermont Health Care,” are available for $50 at the Bennington Museum and at the medical center gift shop.

Read the story on VTDigger here: Bennington celebrates local hospital’s centennial.

[W]hen a dental clinic opened in January at Southwestern Vermont Medical Center, administrators had no trouble attracting clients.

The Bennington facility is on pace for 6,000 patient visits this year. That’s 20 percent more than expected.

A dentist at the clinic, Dr. Michael Brady, said the hospital “underestimated the demand.”

The need for dental services in the southwest region is emblematic of a statewide problem. Officials and experts say Vermonters are not getting the dental care they need, in part due to a lack of adequate insurance and a lack of access to preventative services in some areas.

There are some changes happening that could make a positive difference. But the pace of change is slow amid what some have called a “silent epidemic” of tooth decay.

“The dental access issue is a very complicated issue, and there are no easy or simple solutions,” said Vaughn Collins, executive director of the Vermont State Dental Society. “Most of the causes are structural and systemic and deal with ability to pay.”

There are some key statistics that tell a troubling story about dental care in Vermont, including:

• A newly released state health assessment says 96 percent of adults and 99 percent of children have health insurance, but only 57 percent of Vermonters maintain “dental insurance that covers routine care.”
• The situation is worse for certain age groups: The assessment says only 30 percent of Vermonters age 65 and older and just 50 percent of of the 25-34 age group has dental insurance.
• Even when Vermonters have dental insurance, many aren’t using it. The state Health Department says only 28 percent of Medicaid-enrolled adults age 21 and older received any dental services in 2017.
• There are big dental-care disparities based on income and educational attainment.

People who live under the federal poverty level have more tooth extractions and visit the dentist less frequently, according to the health assessment. And those who have no college education are more than twice as likely to have had a tooth pulled than those who have a college degree.

Dental care directly related to overall health

Advocates say dental health issues have not gotten the attention they deserve.

Borrowing a term from a 2000 U.S. surgeon general’s report, state Oral Health Director Robin Miller summed up the situation this way: “For so many years, we’ve referred to oral disease as a silent epidemic.”

The reasons behind the problem, Miller and others say, are varied.

On one level, it’s a cultural and social issue because dental health has been perceived as “separate from medical health,” Miller said.

That’s true even among health care policy experts. Elizabeth Cote, director of the Office of Primary Care and the Area Health Education Centers program at University of Vermont’s Larner College of Medicine, said no one discussed dental health, for example, at a recent Green Mountain Care Board meeting during a lengthy discussion about workforce problems.

“I’m concerned at the lack of attention that oral health and dental health gets in these conversations about primary health care. It’s so segmented,” Cote said.

Residents ignore dental care at their own peril, some say. The state health assessment says oral infections have been linked to development of diabetes, heart disease and stroke.

“I think a lot of Vermonters don’t know about the connection between oral health and medical health,” Miller said.

Lack of Medicaid, Medicare coverage exacerbates the problem

Even those who make that connection, however, may face insurance-related barriers to dental care.

Medicare, for example, does not cover any dental services.

And while Medicaid offers dental coverage, there are complications. There is a $510 annual cap on dental care for adults, and that doesn’t go very far if significant procedures are required.

“I’ve heard anecdotally that people will not go (for preventative care) because they want to save that $500 in case they’re in pain,” Miller said.

Dr. Cassandra Coakley, a Montpelier dentist and president-elect of the state dental society, has firsthand experience with that cap. She said there have been discussions about changing state policy so that tooth extractions don’t count against the Medicaid limit.

That “could move a patient out of the vicious cycle of pain and infection,” Coakley said.

The other problem with Medicaid is a low reimbursement rate: Dentists say Medicaid pays only about 50 percent of their costs, so they can’t afford to maintain a high number of Medicaid patients.

The issue is borne out in a 2017 census of Vermont dentists: While 96 percent of primary care dentists said they are accepting new patients, only 60 percent said they would take new Medicaid patients.

The same survey noted that 67 percent of Vermont dentists practice at single-site, privately owned clinics – meaning there is no larger organization to absorb the shortfall in Medicaid reimbursement.

“We’re independent small-business owners,” Coakley said.

Providers unevenly distributed in Vermont

Small business owners are unevenly spread throughout Vermont, leading to another factor in the dental-care debate: There is a lack of adequate dental services in some places.

The 2017 Health Department census found that Vermont has 381 dentists, of whom 313 offer primary care. Both numbers are up from a decade ago.

But the state health assessment shows big differences in where those dentists practice: Some places have more than 4.5 full-time-equivalent dentists per 10,000 people, while others have fewer than 1.5 full-time equivalents.

The “vast majority” of the state’s dentists are in Chittenden County, Miller said.

The dental workforce also is aging, which could exacerbate access issues in the near future. The 2017 census found that 35 percent of Vermont dentists are 60 or older – up from 26 percent in 2007.

Collins said Vermont dentists are the oldest, on average, in the nation. And Coakley, who’s been practicing for two decades, said the problem isn’t new.

“I’ve seen more dentists retire than I’ve seen new dentists come in to replace them,” she said.

The dental society has been working to combat that exodus with a state-supported recruiting effort. Vermont also has a loan-repayment program for dentists, and it emphasizes work in underserved areas.

“I need to bring in probably 10 to 15 dentists per year to maintain a level workforce,” Collins said. “And we’ve been keeping up with that pace.”

A successful recruiting effort is just one of the bright spots that officials point to when discussing the future of dental care in Vermont.

Other reasons for optimism include new funding. The state recently received $728,356 in federal grant money that, over two years, will primarily be invested in new dental-workforce initiatives at three federally qualified health centers – Little Rivers Health Care, Northern Tier Center for Health and Battenkill Valley Health Center.

Another potentially positive workforce development is the pending introduction of dental therapists in Vermont. Those “mid-level” providers, who would work under the general supervision of a dentist, were approved in a 2016 state statute.

While there remains some skepticism about dental therapists, the Health Department is optimistic. “It has potential to impact accessibility and the diversity of the dental care workforce,” Miller said.

At this point, it’s only potential because no dental therapists have been trained. Dr. Cheyanne Warren, who’s directing the dental therapy program for Vermont Technical College, is hoping the school can begin enrolling dental therapy students in 2020.

The big obstacles at this point are accreditation and funding. “The startup costs around dental education are expensive,” Warren said.

Once the program gets under way, there will be room for 10 students initially. It will be a three-year course of study, or 15 months for those who already are dental hygienists.

Dental-care advocates have been looking at other ways to expand services, often in ways that stretch beyond traditional dentist offices.

The expansion of school-based clinics — like the program offered by South Royalton-based HealthHUB — is one example.

The new Southwestern Vermont Medical Center clinic is another example. The facility is focused on an underserved population: So far, Brady said, Medicaid makes up about 65 percent of the clinic’s business.

“The demand comes across the mountain, even – from the Brattleboro area and from Wilmington,” Brady said. He added that, even with 40 years’ experience as a dentist, he “hadn’t understood the adult needs … especially young adults.”

“It was really forward-looking for the hospital to do this,” Brady said.

A short drive to the east, a group of partners including United Way of Windham County and Brattleboro Memorial Hospital are looking into whether they can start a dental clinic catering partly to the Medicaid population.

While nothing is certain, “our goal is by 2020 – let’s hope we can do it before then – to open up a dental center to provide care in Windham County,” said Carmen Derby, the United Way’s executive director.

Derby said the clinic could be located on the hospital’s campus. That would have operational advantages, but it also would underscore the link between dental care and general physical health.

“When we think about individuals having the health care that they need, it’s all-inclusive,” Derby said.

Read the story on VTDigger here: ‘Silent epidemic’ of tooth decay worsens.

This story by Christie Wisniewski was published by the Bennington Banner on Sept. 28.

[B]ENNINGTON — Bennington County has become the third Vermont county to take part in a pilot program that partners addiction treatment centers with local hospitals, to provide recovery coaches to those who arrive in the emergency room after an overdose or other drug-related event. The Peer Recovery Coaches in the Emergency Department Program sends recovery coaches from community recovery centers to the emergency departments of several of the state’s largest hospitals. In Bennington, this program involves the Turning Point Center of Bennington and Southwestern Vermont Medical Center.

People who come to the emergency room experiencing an overdose or another substance-related issue are quickly connected with a certified and trained recovery coach who helps them get on track to recovery. These coaches, who are on-call 24/7 on a rotating basis, are also in successful recovery from their own addiction-related challenges.

The program was introduced by the Department of Health in close collaboration with three of the state’s Turning Point Centers, hospitals, and the Vermont Recovery Network. A $643,000 grant from the federal Substance Abuse and Mental Health Administration kickstarted funding for this program.

“This innovative effort takes recovery intervention to a new level,” said Vermont Commissioner of Health Mark Levine, MD. “By being there when the moment of need is greatest, the recovery coaches play a critical role in helping individuals avoid another overdose and engage in treatment.”

While the current program runs through early 2019, health officials say that the early results of this program are promising, and they plan for it to continue. By mid-2019, the program is expected to expand into at least three additional Vermont communities.

In addition to Bennington County, Chittenden and Washington counties have been participating in this program since July 2018.

These coaches work with individuals both during the hospital visit and after they’ve been discharged by helping them find the best treatment services and recovery support for their situation. Additionally, the coaches provide guidance on obtaining and using naloxone and can also help the individual with finding housing and other needs.

“Recovery from substance use disorder is not a simple or straight path,” Levine said. “Access and support are key. These coaches can make the difference in people being able to begin, succeed, and maintain their recovery.”

Turning Point

Turning Point’s peer recovery coaches are not clinical doctors; they are people who have walked their own path of addiction in the past and strive to help others emerge from their struggles with substance abuse.

Turning Point currently has six recovery coaches, said its director Kenneth Sigsbury. These coaches have all received hours of training and education. Agencies that work alongside Turning Point are working on developing certain standards for this training, and Sigsbury hopes for a peer recovery coach certification to soon be developed.

“Peer recovery support — it has a tremendous value in our eyes,” Sigsbury said. “We’re starting to be recognized within Bennington County and even more so within the state now.”

Sigsbury, who is also in recovery, believes the benefits of peer recovery coaches are vast because it helps patients be more honest and feel more comfortable talking about their own struggles. When someone is dealing with an addiction, speaking to physicians can be daunting, Sigsbury said.

“If you’re talking to a peer you understand that person has walked that path,” Sigsbury continued. “We’ve all been involved in the addiction issue so we truly understand, and we can truly empathize. And that gives [the patient] a comfort level.”

Recovery Coach Supervisor Julea Larsen says the program is already saving lives and Turning Point is already receiving positive feedback for its involvement.

“My coworkers really are able to provide so many resources and hope and support for people that didn’t even realize it was there,” she said. “[This program] is an amazing opportunity to help so many people. I’ve seen people’s lives turn completely around.”

Larsen says she has seen multiple individuals who have gotten help who are past the 45-days-clean mark and are thrilled that their lives are coming back together.

“They’re beginning to realize this one trip to the emergency room has changed their life,” Larsen said.

In addition to Larsen, the local peer recovery coaches are Lindalee Hayden, Justine Fortune, Doug Davison, Tom Haley and Tracy Mattison.

Turning Point, which began in January 2017, offers a safe and welcoming environment for people in all stages of addiction recovery.

“When we first started … we had one grant we were working with, and now we have four,” Sigsbury said.

A unique aspect of this recovery center is that those who run it have also experienced their own journey through addiction. The center offers help with housing and can provide people with addiction various community resources to help them. One of Turning Point’s goals is to bring recovery housing to Bennington.

In addition to the Peer Recovery Coaches program, Turning Point offers other resources like an intensive driving rehabilitation program and the Pathways program, which collaborates with opiate treatment centers and physicians who provide help for people seeking medication-assisted addiction treatment.

Chittenden and Washington counties were chosen for the program last year, and after talks with Division of Alcohol and Drug Programs Deputy Commissioner Barbara Cimaglio, Bennington’s Turning Point made the cut to be the third host of the program in July 2017.

“It was slow-starting because it was new to everyone — kind of like building the airplane as we’ve been flying it,” Sigsbury said, describing the program’s inception.

However, it has worked out “very well,” and Turning Point has gotten compliments from SVMC as well as patients it has helped.

“In some cases, we’re able to get them treatment before they’re released from the hospital— which is great because in a lot of cases people are homeless and have no place to go,” Sigsbury said. “If they go back on the street, there’s a likelihood they get back into drugs and alcohol.”

Bennington Turning Point coaches met with 19 people in August, and Sigsbury believes September numbers are shaping up to be higher.

“We have not missed a single call,” Sigsbury said.

Southern Vermont Medical Center

As an emergency room physician, SVMC Medical Director and Chief Medical Officer Trey Dobson is one of the people responsible for contacting the recovery coaches when there is a patient in need.

Prior to this partnership, a patient in the ER may have asked for help with addiction, but Dobson says the resources were limited and it takes a long time to be admitted into a recovery program.

“It takes a lot of effort and continual phone calls and work to get these patients in a treatment center,” Dobson said.

After being contacted, a recovery coach will appear at the hospital within 15 or 20 minutes, said Dobson, and they will meet with the patient and figure out what resources are available and what course of action is best for the patient.

“It’s been amazing for people,” Dobson said. “It can take weeks to get a patient into a suboxone program, and that’s way too long. We need to get people in immediately.”

So far, Dobson has received favorable comments about the program. Patients who he normally would have had to send home with a list of treatment center phone numbers are now getting direct, instant help.

While Sigsbury is excited for Turning Point’s opportunity to build a relationship with SVMC, Dobson says the hospital is also happy to work more closely with community resources.

“[The program] benefits the hospital by going towards our mission and vision, which is to take care of the people we serve here,” Dobson said. “It certainly reduces [the patient’s] disease burden because addiction leads to so many medical issues. It’s all preventative.”

Read the story on VTDigger here: Bennington County joins addiction recovery pilot program.

The two insurance companies that offer health care plans through Vermont Health Connect to individuals and small employers will be able to increase premiums by double digits in 2024. 

However, regulators significantly cut back the rates that insurers had requested, based largely on the expectation of regulatory cuts in 2024 hospital budgets, for which hearings begin this week.

The Green Mountain Care Board, which oversees changes in the cost of and benefits provided by plans sold on the state’s health insurance marketplace, set premium rate increases for Blue Cross Blue Shield of Vermont and MVP Health Care in decisions released late Monday. Despite the scaling back, the increases will be among the highest annually since the first full year of the state marketplace in 2014. 

Vermont Legal Aid’s Office of the Health Care Advocate represents the state’s ratepayers in the quasi-judicial rate proceedings, which took place in July. Chief Advocate Mike Fisher said Tuesday that he appreciates the reductions forced by the Green Mountain Care Board, calling the avoided costs to consumers “real money.” 

But the increases will still make it harder for individuals and small businesses, nonprofits and municipalities to afford the plans they purchase on the exchange, he said.

“Before this double-digit rate increase that the board agreed to, Vermonters already were priced out of the ability to get the care they need,” Fisher said.

Those plans currently serve just over 68,000 Vermonters, roughly 11% of the state’s population. The number of people enrolled is expected to increase by several thousand over the coming year because the Department of Vermont Health Access is restarting its annual process of Medicaid eligibility checks and renewals, which was paused during the Covid-19 pandemic. 

Individual purchasers are able to receive federal subsidies based on their income for certain marketplace plans at least through 2025, when the expansion of subsidies that occurred during the pandemic would need to be renewed by Congress. Generally, people purchasing through a small group plan and those individuals purchasing directly from the insurer are not eligible for federal subsidies.

The 2024 increases in premium prices will vary across the range of plans each insurer offers. On average, Blue Cross Blue Shield individual plan premiums will be allowed to increase by 14% and the small group plans by 13.3%, the board concluded. In a parallel decision, the board allowed MVP Health plans to increase the cost of its plans by 11.4% for individuals and 11.5% for small groups. These increases are higher than those approved last year for Blue Cross Blue Shield, but lower than last year’s increase approved for MVP.

The approved rate increases “reflect the reality of providing high-quality care in the face of increasing costs in the healthcare industry,” said Everett Patterson, MVP Health Care’s head of commercial sales, in response to the board’s decision, in a written statement. “Factors such as rising pharmaceutical prices, hospital budgets and a surge in health care utilization rates contribute to these challenges.” 

The care board estimated in a press release that the decisions will result in average premium increases in 2024 of around $105 per month for an individual plan with Blue Cross Blue Shield and around $90 per month for one with MVP Health. For small group plan purchases, the average cost increase per member per month is estimated to be around $89 per month for Blue Cross Blue Shield and around $78 per month for MVP.

“While we were able to reduce these rate requests, we know that Vermonters will still struggle to pay for their health care,” said Owen Foster, the Green Mountain Care Board chair, in a written statement. He said the board would continue to “use every tool we have” to improve affordability and access to high-quality care. He pointed specifically to hospital budgets, calling them a “key driver in health care cost increases.”

Approved rates are ‘a ceiling, not a floor’

The Green Mountain Care Board focused on drawing the connection between the recent growth in the state’s hospital budgets and the increases in insurance premiums.

Using the same wording in both decisions, the board made clear that the commercial rate increases approved as part of the hospitals’ annual budget review are “a ceiling, not a floor,” and are “a cap, not a sword to be wielded in negotiations with insurers.”

“We do not condone any effort by Board-regulated entities to utilize approved rates as entitlement,” the decisions read. 

The board urged the two insurance companies to consider affordability, quality and access when negotiating rates on behalf of their members. 

The board’s decisions scaled back the average premium increases by around four percentage points, roughly one-quarter of the request. The legal opinions cited a variety of factors for that decision, but the largest is that regulators said insurers should assume health care costs in 2024 will be lower than the companies had projected. 

The board lowered expectations related to the usage of healthcare for Covid-19 infections, and reduced the anticipated growth in the cost of specialty pharmaceuticals. But the largest change in premium increases in both decisions came from reducing insurers’ projections related to 2024 Vermont hospital budgets and what hospitals would charge commercial insurance carriers for services as a result.

The Green Mountain Care Board also regulates the annual budgets for Vermont’s 14 non-federal hospitals, which range in size from the University of Vermont Medical Center, with more than 450 licensed patient beds, to Grace Cottage Hospital in Townshend, with 19 licensed beds. Hearings related to the hospitals’ 2024 budget requests will begin Wednesday morning and run through Aug. 25. 

“The Board promised increased scrutiny of hospital budgets, which will impact affordability for all Vermonters,” said Sara Teachout, who directs government and media relations for Blue Cross Blue Shield of Vermont, in a written statement. 

In earlier guidance, Green Mountain Care Board staff suggested to insurance companies that, in developing premiums, they should assume that the board will cut down whatever charges hospitals propose by 17%, which is a historic average.

But, in the decisions, the board stated that percentage cut was too conservative an assumption, given that many hospitals requested increases in patient revenue of more than 20% over the 2022 fiscal year. Because the prices paid by Medicare and Medicaid, federal and state public insurers, are already fixed, the large majority of any increase in patient revenue is borne by commercial insurers. 

Noting that the Vermont hospitals’ proposed price increases exceeded growth seen for similar services nationally, the board said in its decision, “we conclude that a 50 percent reduction is a more reasonable and appropriate assumption than 17 percent.”

Hospital representatives responded to the board’s conclusion around cuts during a press event Tuesday morning scheduled to precede the hospital budget review hearings. 

Mike Del Trecco, president of the Vermont Association of Hospitals and Health Systems, said a 50 percent cut would be “absolutely catastrophic to the care we deliver to our communities.”

Hospital leaders echoed his statement. 

“The budgets that every CEO submitted are the budgets that we really think we need to provide the health care that our communities deserve,” said Anna Tempesta Noonan, who heads Central Vermont Medical Center in Berlin, part of the University of Vermont Health Network . 

Trey Dobson, chief medical officer at Southwestern Vermont Medical Center based in Bennington, which recently completed its previously announced integration with the region’s other large health network, Dartmouth Health, was more blunt. 

“I don’t think you can reduce expenses any more without cutting services, point blank,” he said.

Read the story on VTDigger here: Vermont regulators trim health insurance premium increases.