No Maternity Wing or Trauma Unit Any Time Soon, But Florida Hospital Flagler Thrives On

If you’ve had occasion to speak about the surgeons at Florida Hospital Flagler or to be under their knives, you have almost certainly heard about Steven Bower, the general surgeon with superstar status locally. JoAnne King, the hospital’s chief operating officer—“I don’t operate on anybody,” the witty COO said, noting that she’s “grossed out by all medical stuff”—gave the audience at a Chamber of Commerce Common Ground breakfast this morning an idea why Bower elicits so much appreciation.

A man was in the hospital recently for surgery. It went well, and afterward Bower came in to his room to check on him. The patient’s wife was visiting, and it was time for her to go. Bower actually walked her to her car. It was a small gesture, and maybe it’s not much—why, after all, should it be more impressive to be walked to one’s car by a surgeon as opposed to by a nurse or a schoolteacher?–but the gesture spoke loads: “That’s not in a surgeon’s job description, but that’s going above and beyond,” King said, underscoring her point: “The healing happens with people.”

That was only one of a couple of illustrations she wanted to convey. She recalled a cancer patient coming in for what, to any cancer patient, is inherently an extremely difficult time. Afterward, the patient wrote her reaction, which King read from an email off her iPhone: “The team was formidable they were my shoulder to cry on my therapists my counselors, and more than anything they were my guardian angels, they were with me every step of the way.”

The chamber’s very popular, periodic Common Ground breakfasts are a sort of infomercial featuring the region’s key leaders in business or government who appear in the relaxed setting of a morning meal to give insights into their particular sector and take a few questions. The breakfasts don’t necessarily make news so much as provide nuggets of inside information, connect dots, demystify people with fancy titles and put faces to names. (The breakfasts are sponsored by a Palm Coast law firm whose Vincent Lyon said recently had a name change as one of its partners left and others were elevated to the masthead, so it’s now Chiumento Dwyer Hertel and Grant.)

King was one of several speakers this morning at Grand Haven’s River Club from Florida Hospital Flagler’s “C-suite,” as John Subers described the CEO, CFO, COO and the rest of them who addressed an audience of about 80 local government and business officials on the state of the hospital, the county’s largest employer after the school district, and its single-largest private-sector employer, with over 1,000 employees. (Subers is the executive director of the hospital’s foundation.)

CEO Ron Jimenez summed up the recent past—how the hospital weathered two hurricanes in two years—but did not unveil new projects ahead, only some tantalizing possibilities in answer to the most pointed question of the day (from Gretchen Smith, the chamber’s host for the event): “Are women ever going to be able to have babies here?”

“In the future we will have it. When we’ll have it, I just don’t know,” Jimenez said, providing two qualifiers. First, the population of the area would have to increase substantially to warrant the new wing. “If you’re a low volume delivery facility, it’s very difficult to maintain high quality,” he said—not because the 99 percent of deliveries require that much extraordinary skill, but because of that 1 percent that does, the complications, the cases that go “very poorly” and that require “extreme depth of resources.” That’s what makes such wings expensive.

The other reason is more demographic. While it’s true, he said in answer to Smith’s projections of considerable population increases ahead, that the population base could justify the wing, “the growth I think we’re expecting is in an age group that doesn’t have babies anymore,” Jimenez said. As for a trauma center, where people who suffer critical injuries from such things as gunshot wounds or vehicle crashes, that’s “not really on our radar any time soon.”

The hospital, Jimenez said, evacuated all patients in 2016 ahead of Hurricane Matthew but did not have to do so ahead of Irma for a couple of reasons. Between the two hurricanes the hospital’s new 32-bed wing opened, a wing built to resist Category-4 hurricane winds. So what the hospital did instead was reduce its in-patient population to 50 with discharges and some transfer, and shift its remaining patients to the new wing for the duration of the storm. Within two days of Hurricane Irma’s passing, the hospital was back up to 115 patients.

There was a question about the future of Florida Hospital’s Oceanside facility in Ormond Beach, which has a rehabilitation and transitional care facilities and “did not fare well” during Irma, Jimenez said. “There was intrusion of water, there were sevaral leaks to where they were evaluating that facility,” and whether it could be restored structurally. “It’s not going to be quick, there’s probably a long-term solution in there. There are five majpor plans that have been whittled down to try to figure out what’s the best thing to do with that facility.” That includes starting from scratch to fixing it to moving it. The “significant” decision is still pending but should be settled in the next month, depending on what the state Agency for Health Care Administration, the regulatory agency, will allow Florida Hospital. “So the impact here will not be significant because in the interim what’s happening is that unit has been moved into Florida Hospital Memorial Medical Center,” Jimenez said. “When we have patients that need rehab we can transfer them to that unit, and it’ll be the same as transferring them to Florida Hospital Oceanside, same physicians, same nursing staff.”

Within the hospitals the changes are more subtle, as with the move toward “hospitalists,” as Mark Kilman described the two to seven such physicians working at any given times. They are intended to step in where individual patient’s general practitioners or family doctors do not or cannot, as it is becoming difficult for physicians to juggle their own practice and doing rounds at the hospital. Hospitalists are trained to fill the role, relying on the patients or contact with their doctors to fill in the blanks of personal histories.

What that also means is that one’s persona physician’s bedside visits are going the way of house calls as health care and hospitals evolve. Another such evolution: the growth of telemedicine, or physicians who consult, or are hooked in to patients, through remote connections. The hospital—whose emergency room alone sees 40,000 patients a year–has a number of those physicians, including psychiatrists and psychologists.  “We’re incredibly proud of telemedicine,” says Robert Davis, the hospital’s chief nursing officer.

He summed up Florida Hospital Flagler with the pithiness of an ad’s jingle, minus the music (Davis happens to be the face of the hospital on some of its marketing cutouts): “We are the community’s hospital, your once-in-a-lifetime illness is our everyday.”