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Martha’s Vineyard Hospital

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Dr. Gary Fudem, longtime plastic surgery specialist at Martha’s Vineyard Hospital (MVH), will leave the hospital and Island to become the associate director of the burn unit at the University of Washington Medical Center in Seattle, Wash.

“The burn unit at University of Washington is one of the top burn units in the country. They see over 900 major burn cases a year,” Dr. Fudem told The Times Wednesday. Dr. Fudem will also work with burn patients at the Veteran’s Administration hospital in Seattle.
“This is a career move,” he said. “I love living here and I love my patients, especially the 60-to-100 age group.”

Dr. Fudem’s last day at MVH is Tuesday, but he won’t be rushing off. A condition of his new contract is that he doesn’t have to leave the Island until Oct. 20, so he can fish the Derby, which ends Oct. 19. “The last three years I’ve really gotten into fishing. I learned so much and had so much fun fishing with Ed Amaral. I’ll miss him a lot,” he said. Dr. Fudem will take a 12-day break from the Derby to make a volunteer trip to Nicaragua.
Dr. Fudem handpicked his successor, Dr. Richard Montilla. “I was one of his attending physicians while he finished his residency six years ago,” Dr. Fudem said. “He’s a caring, skilled doctor, and a good family man. I was very happy that the hospital approved him.” Like Dr. Fudem, Dr. Montilla will work at MVH on a part-time basis. In addition to plastic surgery, Dr. Montilla also specializes in hand surgery.

Martha’s Vineyard Hospital donated a house that will be used to fill a critical gap in addiction and mental health treatment on the Island.

Community Services executive director Julie Fay and hospital chief executive officer Tim Walsh stand in front of the new home of the community crisis stabilization program.

In what health professionals describe as a major step forward in providing care for Islanders in crisis suffering from substance abuse and mental health issues, Martha’s Vineyard Community Services (MVCS), will establish an on-Island community crisis stabilization program (CCSP) on the grounds of the Martha’s Vineyard Hospital.

Tim Walsh, hospital chief executive officer, confirmed to The Times the hospital will donate  the “red house,” a former residential property located in front of the main hospital building that currently houses the billing department, to Community Services, the Island’s umbrella social services agency.

A CCSP treats patients in acute distress due to addiction or mental health issues for the first 24 to 48 hours of a crisis. It’s a less restrictive and voluntary alternative to inpatient psychiatric hospitalization. The goal of a CCSP is to stabilize the patient, to give clinicians time to chart an appropriate course of action, and to find the resources with which to implement it, according to treatment specialists.

“It’s going to be a huge resource for the Island,” Juliette Fay, Community Services executive director, told The Times. “When somebody is in crisis and needs evaluation, instead of going to the emergency department they’ll come to the red house. There will be individual therapy rooms, a group therapy room, crisis-stabilization beds, clinicians that are tied to emergency services, and also staff from our New Paths program.”
Currently when MVCS gets a call on the 24-hour hotline, a clinician is sent to the hospital emergency room to make an evaluation and determine if the person needs to go off-Island for inpatient care. Ms. Fay said the CCSP will spare people in crisis the cacophony and chaos of a busy emergency room.

“The emergency room staff has been wonderful, but a busy ER is not a good place to try to calm a situation down,” she said. “Consequently we have a very high rate of hospitalization. Right now, on the Island, 60 percent of the people we evaluate in the ER get hospitalized; off-Island it’s somewhere between 12 and 15 percent.”

A CCSP is not a detox facility, but the treatment it provides can potentially help an Islander avoid the onerous ordeal of going to an off-Island clinic.

“We don’t have to do an evaluation right away,” Ms. Fay said. “24 hours or 48 hours of crisis-intervention activity can forestall an evaluation and come up with a plan B, which is not going off-Island. Often when people are in the ER, that’s just the beginning of the ordeal. Our clinicians then have to start calling inpatient facilities, and finding an open bed is not easy. Once they find a bed they have to arrange an ambulance to the ferry, an ambulance on the ferry, and an ambulance to meet the ferry on the mainland to take the patient to the facility, which could be in Springfield or the Cape or Boston, you don’t know.”
A CCSP can also save valuable hospital resources. Currently, it’s not uncommon for a patient who could be treated in a CCSP setting to stay in the hospital ER for several days before a bed is found at an off-Island facility. During this time, patients who could be starting treatment in a CCSP are in a state of limbo, and often the patient requires 24-hour supervision from hospital staff or law enforcement personnel.

Collaboration pays off

Ms. Fay, Community Services staff, and board members began discussing the need for a CCSP about a year ago.

“We thought if we had access to a crisis-intervention program we could probably cut our hospitalization rate in the first year,” she said. “We thought if we could do it at the hospital, that would be ideal. About four months ago, Tim Walsh offered us the red house, and things really came together.”

“Initially, Community Services wanted to set up in the old hospital building, but that was problematic for the Medicare reimbursement process,” Mr. Walsh told The Times.

Mr. Walsh said the question was how to provide a venue that would work but be separate and accessible: “Having the red house where everything is separate, and where we can keep all the expenses separate, is a better solution for us.” Mr. Walsh invited MVCS representatives to inspect the red house at the beginning of the summer. “They thought it was a really good fit. With that, we started trying to accelerate our own renovations in the old hospital so we could get the billing department in there as soon as possible. We have a lot of balls in the air, like renovations to the dialysis unit, but we’re hoping that we can be out of there by December, January, so we can hand it over to Community Services and if they’re ready to start something, they can.”

Getting ready

MVCS will be ready, according to Ms. Fay. “We have a private donor who has made funds available to do the startup,” she said, adding that she has also met with commissioners from the Massachusetts Department of Public Health (DPH) and Department of Mental Health (DMH) to obtain additional funds and to navigate the bureaucratic maze.“We may have a volunteer architect, but we haven’t finalized that yet,” she said.

Estimated renovations will take two to three months, during which time MVCS staff will be trained in crisis-intervention stabilization. “It’s a very different model from what is used in emergency rooms,” Ms. Fay said. “You work proactively with individuals and family members about how to keep somebody safe in the community instead of going off-Island for inpatient care.”

The CCSP will be staffed on an as-needed basis. “We don’t think there will always be someone in the red house, but when someone is, we are committed to provide 24/7 staffing,” Ms. Fay said.

Contrary to the usual ebb and flow on the Island, the winter and spring will be the busiest time for the CCSP. “Our busiest time is January through May; that comports with a seasonal economy, the dark months,” she said.
If all goes as planned, the CCSP will be operational before the dark months on the Island have passed.

“You have to give all the accolades to Julie,” Mr. Walsh said. “I’ve been an advocate for a crisis-intervention center for years, but she really pulled it all together and made it happen.”

Ms. Fay said MVCS still needs funding to keep the momentum going for the CCSP. Donors can contact her at 508-693-7900.

Martha’s Vineyard Hospital announced that Rosemary Silvia, RN, MS has joined the hospital’s senior management team as chief quality and compliance officer.

Ms. Silvia has extensive experience in the field of quality and risk management, having served as director of quality, risk and medical staff offices at Sturdy Memorial Hospital in Attleboro, and as executive director of quality and risk at Westerly Hospital in Rhode Island, according to a press release.

Ms. Silvia received a bachelor of science in social and health services from Roger Williams University in Rhode Island and a master’s of science in healthcare risk management from Finch University in Chicago.

She began her career in healthcare as a staff nurse at the Methodist Hospital in Lubbock, Texas and quickly moved up to charge nurse and then head nurse where she supervised a 48-bed critical care unit.

Ms. Silvia will work with the entire hospital staff on quality improvement education and development. Her other responsibilities include acting as the hospital’s liaison with the Patient and Family Council and the Dukes County Health Council.