Lucy Lawrence was in school to become a Medical Assistant when she first worked at St. Charles' La Pine Family Care clinic as part of a practicum rotation. She quickly came to love the team, culture and patients of La Pine, as well as the rewarding experience of serving a rural community. When a job opening came up after graduation, she leapt at the opportunity.

“I knew that La Pine was going to be such a fantastic fit for me, and I loved working for St. Charles when I was a student, so I couldn’t say no,” said Lawrence. “I really do have the best team. The culture in La Pine is something special. We are very closely knit, and everyone is a team player. We have so much fun with each other and I look forward to seeing them every day. We are all very driven by the work that we are doing, and we love what we do.”

Lawrence also spends part of her time as an assistant instructor at Central Oregon Community College, teaching clinical skills to St. Charles Medical Assistant cohorts, a program that pays for tuition in exchange for employment within the health system. She has always enjoyed teaching and she loves being on the other side and being able to pass on the knowledge she has gained working in the field.

“It’s so rewarding to see the students' progression, from being super nervous on the first day of labs, when they’re just learning how to properly wash their hands," Lawrence said, "all the way to the very end when they graduate and are doing these really complex clinical skills, and they are confident and ready to go into the field.”

Though she loves her career as a Medical Assistant, her goal has always been to learn as much as she can about medicine and have the skill set to make the greatest impact possible. With that in mind, she will be starting medical school at OHSU this fall to become a physician.

Along with an appreciation for her team, seeing the difference that the La Pine clinic makes in the health of the community is the most rewarding part of her job, she said. For many of Lawrence’s patients, regular access to health care has been limited due to geographic location or financial limitations, and chronic health conditions are common.

“A person’s health impacts every aspect of their life,” she said. “Poor health limits what you’re able to do, so by helping people become healthier we are positively impacting every part of their life and their ability to do what they want to do, from participating in their community to earning a living and being able to be there for their families.”

Grand Rounds - March 8, 2024  
"Suicide: Losing a Patient or Colleague"

Speaker: Michael F. Myers, MD. Professor of Clinical Psychiatry, Department of Psychiatry & Behavioral Sciences, SUNY Downstate Medical Center.

Objectives

1. Delineate up-to-date facts about suicide in America.
2. Discuss common emotional and behavioral reactions after losing a patient or healthcare colleague to suicide.
3. Describe approaches to take in reaching out to grieving families and others.
4. Itemize steps and actions that are helpful to regain equilibrium and promote growth in the aftermath of suicide.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at cme@stcharleshealthcare.org.

Oher CME or Clerkship questions: also contact Continuing Medical Education at cme@stcharleshealthcare.org.

Enduring Materials - March 6, 2024
"ADHD in Primary Care"

Speaker: Eleasa Sokolski, MD.

Objectives

1. Review ADHD diagnostic criteria and differential diagnosis.
2. Compare treatment strategies with stimulants and non-stimulants medications based on patient risk factors and comorbidities.
3. Discuss Case examples of Adults with ADHD and treatment options.
4. Outline a monitoring strategy for patients on long term treatment with stimulant medications.

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of St. Charles Health System and Mosaic Community Health. St. Charles Health System is accredited by the ACCME to provide continuing medical education for physicians. St. Charles Health System designates this live virtual activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at cme@stcharleshealthcare.org. 

Enduring Materials - March 1, 2024      
"Addressing Firearm Safety with Patients at Risk of Suicide"

Speaker: Christopher Wolsko, PhD, Elizabeth Marino.

Access the Course Materials

Objectives

1. Recognize key elements of rural culture that impact conversations about firearms.
2. Identify communication skills to use when speaking with patients at risk of suicide about firearm safety.
3. Create a suicide prevention safety plan specific to firearms.
4. Identify skills specific to working with a patient who becomes defensive.
5. Identify actions steps when a patient becomes hostile and won’t engage with the provider.
6. Understanding the contributions to suicide risk.
7. Awareness of emerging trends in suicide risk and prevention.

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of St. Charles Health System and OSU. St. Charles Health System is accredited by the ACCME to provide continuing medical education for physicians. St. Charles Health System designates this live virtual activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at cme@stcharleshealthcare.org. 

Grand Rounds - March 1, 2024  
"Advances in Acute and Chronic DVT Management"

Speaker: Edward Boyle, MD. Inovia Vein Specialty Center, St. Charles Healthcare System.

Objectives

1. Understand risks for Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE).
2. Clinical presentation and diagnosis of DVT.
3. Discuss recommendations for using an evidence-based algorithm to diagnose DVT/PE, taking into account the stability of the patient.
4. Provide recommendations for prescribing appropriate anticoagulant agents, according to the most recent clinical guidelines, to treat and help prevent recurrence of thrombotic events in patients.
5. Provide strategies and resources for developing collaborative care plans with patients; emphasizing adherence to prescribed therapies, and monitoring with follow-up.
6. Understand the differences in approach between acute and chronic interventions.
7. Understand risks of and treatment options for Post thrombotic syndrome including chronic venous stasis and venous stasis ulceration.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at cme@stcharleshealthcare.org.

Oher CME or Clerkship questions: also contact Continuing Medical Education at cme@stcharleshealthcare.org.

St. Charles has relocated its high-risk breast cancer clinic into the St. Charles Cancer Center, a move caregivers believe will help them identify more people at increased risk for developing cancer and give those people the tools they need to reduce their risk.

The clinic – a partnership between St. Charles and Central Oregon Radiology Associates (CORA) since 2015 – was previously located in CORA’s facility on the east side of Bend. Last year, when the CORA-employed provider who staffed the clinic retired, the decision was made to move the clinic into the Cancer Center and staff it with a St. Charles-employed provider.

That provider, Stephanie Henderson, started working in January and the clinic is now seeing patients.

“Because we were already collaborating closely with CORA, it made sense for us to bring it in-house,” said Dr. Linyee Chang, senior medical director of Cancer Services for St. Charles. “It’s important for our cancer program to provide this service as it allows our comprehensive breast program to encompass the full spectrum of breast care.”

On the surface, the move simply means that patients of the clinic will go to a different location for their appointments – crossing Neff Road from CORA to the Cancer Center. But bringing the clinic into the Cancer Center and under health system administration will also improve the care provided, both now and in the future, Chang said.

In addition to enjoying streamlined policies and procedures, the provider will have more options in terms of ordering MRI scans or ultrasounds than they would at CORA because of rules against self-referral, Chang said. Also, the move will bring the clinic into closer alignment with St. Charles’ existing menu of high-risk assessment and risk-reduction strategies.

Women identified to have greater than a 20% lifetime risk for developing breast cancer are considered at high risk. If they visit the clinic, they’ll receive general education about breast cancer, learn how to reduce their risk, discuss potential treatments, develop a personalized plan for surveillance and complete a familial risk questionnaire to identify whether they may benefit from a comprehensive genetic assessment.

The Cancer Center’s genetic counselor, Brigitte Cronier, said she expects to see an uptick in patients who come to her from the high-risk breast clinic now that it’s at St. Charles.

“Genetic counseling is a big part of risk assessment, and many of the people we meet are going to be candidates for it,” she said. “At the same time, there will be plenty of people we follow for high risk because of some other factor and not because of a genetic test result. Ultimately, we just want to capture as many high-risk people as possible and make sure they know what they can do to try to stay healthy.”

Jessica Keegan is the prevention and high-risk coordinator for the Cancer Center. She said the comprehensive screening process is designed to guide people into the program that’s right for them.

“When people come to me, I’m going through and building out pedigrees with them to really look and see where they are going to be best served,” she said. “That may be genetic counseling or it may be a more frequent screening regimen. We’re looking to make sure we are giving them the best possible resources.”

Last but certainly not least, Chang and her team see the breast cancer clinic as a next step on the path to a more robust high-risk cancer program at St. Charles.

“This is just the start. We want to have high-risk lung care, high-risk prostate care, high-risk colorectal care – we’ll be identifying those and rolling out comparable programs to this one,” Chang said.

“This clinic will serve as a sort of model for how we take care of people who are at higher risk for cancer and empower them to take control of their risk and their health,” she continued. “We’re here not just to take care of people who have cancer, but to help them never develop cancer at all.”

For more information or to schedule a consultation with the high-risk breast cancer clinic, call Jessica Keegan at 541-706-6729.

Above: St. Charles caregiver Jake Fries stands in front of his new home in Bend.

In March 2023, Jake Fries was reading the news when he spotted an advertisement for a new housing community in Bend called Rooted at Poplar. The concept: Seven 1,300-square-foot homes on the south end of town, with four of them prioritized for local workers thanks to partnerships between a developer, Rooted Homes, and local employers and organizations.

A year later, nearly half of the Rooted at Poplar’s residents are St. Charles caregivers, including Fries, a 29-year-old surgical tech in the Bend operating room.

“I can finally afford to live in my own place,” Fries says. “It’s changed everything.”

Like many local workers, Fries had trouble finding affordable housing in Bend, where the median price of a single-family home reached $800,000 last summer. It’s an issue that has contributed to workforce shortages at St. Charles, which is why the health system partnered last year with Rooted Homes, a nonprofit whose mission is to make buying a home more affordable.

“At St. Charles, we not only care about our people, we also depend on them to care for the communities we serve. We need great people to be able to live and work in Central Oregon,” said Rebecca Berry, vice president and chief Human Resources officer for St. Charles. “We knew we had to find creative ways to help attract and retain great caregivers.”

Rooted Homes works with a consortium of partners to build high-quality, affordable housing and pay part of the cost for homebuyers. To fund its Poplar project, Rooted Homes tapped a number of local and state organizations, banks, charitable foundations, the City of Bend and the Bend Chamber of Commerce, which secured financial support from some of its members. St. Charles Foundation provided $7,500 to cover closing costs for the three caregivers now living in the community.

“It really was a team effort,” said Berry. “Everyone knows how important it is that Central Oregon remains a place where people can afford to live, and we appreciate the partnership of the Bend Chamber, Rooted Homes and all the other entities involved in making this happen.”

The process starts with an application that places potential buyers in a lottery system, where essential workers and employees of partner organizations (such as St. Charles) are given additional weight made possible through private funds raised by the Bend Chamber. From a pool of around 300 applicants, Fries ended up fifth on the waitlist for a home, eventually landing a spot after another applicant dropped out. From there, the process was similar to buying any other house: loans, escrow, keys, furniture shopping. Fries moved into his new home in February.

“Now I feel like I’m able to build myself and my future family a better future,” he said.

The typical monthly mortgage for the Poplar homes is around $1,650, about 40% lower than average rent prices in the area. And it’s not just the mortgage that’s low — monthly utilities hover around $12. Rooted Homes communities are built with sustainability in mind, featuring solar panels and a net-zero design, said Jackie Keogh, vice president of the company. Residents also receive a free electric bike.

“The goal was that these folks become more long-term residents and, therefore, longer-term employees because they are not impacted by the cost of housing,” Keogh said.

Thanks to continued community support, more homes are on the horizon, including 40 new houses on Bend’s west side.

“It's been a great partnership,” Keogh said, “and we hope to continue it with St. Charles.”

You may have seen recently that St. Charles has been positively recognized by S&P Global Ratings and Moody’s Investors Service, two large and influential credit rating agencies, for the health system’s operating performance turnaround.

As a nonprofit health care organization, we issue bonds to reinvest in our facilities and infrastructure to continue providing high quality, critical care to Central Oregon communities. The affirmed ratings and improved outlooks from the two agencies strengthen the health system’s capacity to borrow additional capital dollars in the future. And it’s nice that others have recognized the improvements we’ve made over the past 18 months, stabilizing our workforce and our finances.

I want to tell you about another sign of stabilization at St. Charles – one that will be more visible to our patients, visitors and caregivers than a credit rating.

Late last year, the St. Charles Board of Directors approved a $74 million plan to fund deferred maintenance, facility improvements, equipment upgrades, growth initiatives and other projects. The total includes $30 million in bond funds for development of the Redmond Cancer Center and $44 million from last year’s earnings for existing needs.

This is another really strong signal that the organization is stabilizing financially. It comes after three years of limited spending on this kind of work across the health system, at first as a cautionary move near the beginning of the COVID-19 pandemic, and then because we simply didn’t have the financial strength to fund a lot of projects.

Now, with an improved financial outlook, the 2024 plan covers a number of facility projects that will be noticeable to patients and the visiting public, as well as equipment and infrastructure upgrades that will make a positive day-to-day impact on St. Charles caregivers. All projects in the plan were prioritized and selected by operational leaders across the system as part of an in-depth planning process.

This is great news, not only for our bottom line and the caregivers who work in our facilities every day, but for the health of the organization as a whole and our ability to continue to provide Central Oregon with excellent care, far into the future.

As always, thanks for reading,
Steve

Postpartum Depression

Postpartum depression (PPD) is more than just the "baby blues." It's a serious mental health condition that affects mothers after childbirth, often characterized by feelings of extreme sadness, anxiety and exhaustion. Unlike the typical fluctuations in mood that many new mothers experience, PPD persists and can significantly interfere with daily life and bonding with the newborn. Symptoms may include overwhelming fatigue, changes in appetite, difficulty sleeping, intense irritability, and a sense of detachment from the baby. It's crucial to recognize that PPD is not a reflection of a mother's ability to care for her child, but rather a biological and psychological response to the immense hormonal changes and new responsibilities of motherhood. With support, understanding and appropriate treatment, mothers can navigate through PPD and emerge stronger, healthier and more connected with their babies.

At St. Charles, we are committed to supporting mothers through their journey into motherhood and recognize the significant and often overlooked challenges that PPD presents. If you feel you're experiencing the effects of postpartum depression, please reach out to your obstetrician or primary care provider for help.

Grand Rounds - February 16, 2024  
"Controlled Substance Prescribing Guidelines and Pain Management"

Speaker: Michael Bottros, MD. Chief Clinical Operations and Medical Director for Pain Services, Associate Professor of Anesthesiology, Department of Anesthesiology, Keck School of Medicine of USC.

Objectives

1. Review how the current epidemic of opioid abuse developed.
2. Consider current pain management guidelines and how well they are achieving the goal of reducing overdose deaths.
3. Discuss the various methods of diversion.
4. Recommend techniques to minimize non‐ medicinal medication use.
5. Review which socioeconomic groups are at higher risk of non‐medicinal opioid use.
6. Review local resources for non-medical pain management.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)^TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at cme@stcharleshealthcare.org.

Oher CME or Clerkship questions: also contact Continuing Medical Education at cme@stcharleshealthcare.org.