New procedures & improved outcomes are among the game-changing strides in robotic surgery. 

By Erik Slagle

The future ain’t what it used to be, as Yogi Berra famously said. No one has a flying car, entire meals don’t come in pill form, and teleportation’s still not an option. Robots? Well, that one we’ve got…especially in the medical profession. They may not look like the droids from Star Wars or even the Jetsons’ beloved Rosie, but new advanced robotic systems have drastically improved surgeons’ ability to deliver top-quality care in performing some of the world’s most intricate, complex procedures. 

Operations that used to involve significant incisions (and unsightly scars) can now be performed through smaller, single-site entries. Patient blood loss is reduced and discomfort is often minimized—and without any compromise in favorable outcomes. What’s not to like? 

Dr. Mark Preston, an Obstetrician-Gynecologist at Trinitas’ Center for Advanced Pelvic Surgery since 2016, is one of thousands of providers around the country using robotic and laparoscopic equipment in their practices. “Robotic systems like the Single-Site da Vinci system facilitate treating more complex cases in a minimally invasive fashion,” he says. “They’re especially beneficial on cases that require precise, fine dissection and laparoscopic suturing. Also, recovery times are faster versus open surgery with large incisions, and less blood is lost. For the surgeon, the procedures are less physically demanding—the ergonomics are much better, as I can sit in a comfortable position and not have to stand in one place for more than an hour at a time.”

Dr. Sergio Baerga, Director of Robotic Surgery at Trinitas (far right), prepares to perform a double hernia operation using the da Vinci system.

Less fatigue enables surgeons like Dr. Preston to expand their caseloads, meaning more patients can benefit from those faster recovery times and improved outcomes. Doctors can operate more aggressively as robotic systems allow better access within the surgical field. 

In the OB/GYN field, for example, the use of robotics has advanced how doctors treat conditions like endometriosis. The da Vinci system allows for unparalleled precision in identifying, lifting and excising lesions. In many cases, a one-time procedure with the da Vinci can clear a patient of all lesions and adhesions, saving their patient’s reproductive system. In the past, endometriosis treatments often meant a full or partial hysterectomy. 

Preserving organs and saving body functions are primary goals of systems such as the da Vinci. Providers in the fields of general surgery, cardiology, and endocrinology—to name just a few—are all making use of these new, advanced systems. Dr. Sergio Baerga, Director of Robotic Surgery at Trinitas, performs various kinds of surgery using the da Vinci system, such as the double hernia operation (above). “Laparoscopic surgery was an improvement, but there were limits that we are able to overcome using robotics,” Dr. Baerga said. 

For instance, in 2019, Trinitas-based ENT-Otolaryngologist Dr. Jonathan Cohen and his team performed their first radical tonsillectomy with Transoral Robotic Surgery (TORS), a minimally invasive procedure used to treat oropharynx cancers. TORS often eliminates the need for large incisions and division of the jaw bone that are sometimes required by traditional surgery. 

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Robots are now key players in helping surgeons tackle aggressive cancers of the bladder, uterus, prostate, throat and more. Dr. Clarissa Henson, Chair of Radiation Oncology at Trinitas, touts the benefits of robotics-assisted procedures in combatting these cancers and lessening potentially harmful side effects of follow-up treatments. 

“We aim to increase the cure rate and quality of life for patients who can greatly benefit from minimally invasive surgery and targeted radiation,” Dr. Henson says. “Procedures such as the one performed by Dr. Cohen and his team reduce the space for radiation toxicity in muscles of the head and neck—that type of radiation is often required by traditional modalities of treatment.” 

How It Works 

With trained, talented surgeons at the controls, these robots are driving modern medicine into the future. The Single-Site da Vinci system allows a surgeon seated at a console to manipulate four robotic “arms” that can be rotated a full 360 degrees. The controls maneuver a camera and direct those instrument-equipped arms in cutting, holding, cleaning and coagulating all through a single or multi-port precise abdominal incision. 

The system not only allows for greater dexterity but also great visibility—up to ten times stronger magnification —than do traditional surgical procedures. And if a second surgeon is needed, there’s no need for that doctor to “scrub in;” they can simply sit down at an adjoining console and assess the surgical field. Also, adds Dr. Preston, “when there isn’t a laparoscopically skilled resident available to assist, the robot makes it easier to perform these procedures.” 

But the “how” behind these medical marvels may not be as important to patients as the “why”—and just about any way you measure it, it’s easy to see why robotics-assisted procedures are becoming the preferred option across the surgical profession. Trinitas continues to keep pace with the latest innovations, bringing state-of-the-art equipment into its Operating Theaters. 

“Patients need to know that we are diligently scouring the science of medicine to provide care at the forefront of our fields,” says Dr. Cohen. “Trinitas is on board with elevating the gold standard of healthcare.”

When your adult child is dealing with opioid addiction, it’s no time to be their friend.

By Krystyna Vaccarelli, LCSW, LCADC Trinitas Regional Medical Center

When a public health issue becomes a crisis, and then goes from being a crisis to an epidemic, it is human nature to look for a “magic wand” solution. What switch, we wonder, can be flipped to turn back the clock, return the genie to the bottle, to make everything manageable again? If we are talking about the opioid epidemic, unfortunately, there is no magic wand. And no one is immune, either. 

As the Director of the Substance Abuse Services at Trinitas Regional Medical Center, I know that there is no way to characterize that next person coming through our doors. It could be a 19-year-old who grew up in an environment of drug use, or a soccer mom from Short Hills who rolls into Paterson to buy heroin because the addiction has consumed her and the cost of illegal prescription pills is beyond her means. Socioeconomics plays no favorites where addiction is concerned; we’ve seen plenty of both. In fact, I can say with a high degree of certainty someone you know very well—but might never suspect—is in this predicament right now. The horrible piece of opioid addiction is that it is really easy for people to medication once your prescription has run out. 

Everyone we see in the Substance Abuse program is somebody’s son or daughter. So what if that next person is your child? If you are concerned that your child might become addicted to medication—and really, every parent should be—there are some common-sense things you can do. For children who are minors, parents should accompany them into the examination room and be part of the conversation during any doctor’s visit. Ask what the minimum amount of medication is that will be needed to treat a condition—not just opioids, but anything that could have negative consequences down the road. Don’t just sit in the waiting area. If you are concerned about your adult child, remember that being an involved parent is important regardless of your child’s age. You may not be accompanying your kids to doctor’s appointments anymore, but they still need the structure, rules, expectations, and guidelines a parent provides. These are the foundational elements in setting them up as functioning adults. 

I think a miscalculation many parents make is wanting to be a child’s friend once they hit those difficult ’tween and teen years. No one wants to be the bad guy and have to say No all the time, but does saying Yeah, Sure, Okay mean you love your kids more? That doesn’t make sense.

There will be time later on to be their friend. 

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Once a child moves away from home, of course, the nature of your contact changes. However, you can still see or hear things no one else but an involved parent would. If you notice a change, you don’t have to be afraid of acting. The sooner a parent intervenes, the better the outcome will be. Go with your gut if something doesn’t seem right, or if you have some questions you feel you should ask. Believe it or not, particularly if you have been an involved parent, contributing to the medical decision-making process shouldn’t strike your son or daughter as unusual. So you shouldn’t be timid about saying, “Wow, 30 pills? Doesn’t that seem excessive? Did you question your doctor about this prescription? Please be careful. It’s easy to become addicted—don’t go outside the prescription.” I believe that is reinforcing an aspect of the relationship that has been there all along. Indeed, it’s a product of the good groundwork you started when they were small children: being educated and aware. Now you are passing that education and awareness to your children as they become adults. Even if you don’t have that type of relationship, you can still say, “Hey, don’t listen to me if you don’t want to, but please get a second opinion.” 

There is good research going on that is looking at people who might be more predisposed to becoming addicted to drugs than others—genetically predisposed, psychologically predisposed, perhaps a combination of both. That being said, we know quite a bit already from what we observe day-to-day in the Substance Abuse program. I cannot overstate how critical the family dynamic is in the big picture of the opioid epidemic—not just in recovery but also in the conditions that often surround addiction. 

We see generations of addicts in the same family come through the program. It may be a physiological predisposition, but it might also be the culture or environment of the family. That’s the interesting question: Is it one or the other, or both? Most people would say that it’s the environment. However, we sometimes treat members from the same large family that are dispersed—they don’t interact with one another on a regular basis. And yet all of them are receiving some form of treatment, typically for mental health or substance abuse. 

We also encounter a fair amount of fractured family situations in the patients we treat. That is why we offer family therapy, as well. A patient can come in and we will work with a parent or a spouse or a child as part of the program (everyone we treat must be at least 18, by the way). One of my frustrations is that we don’t get the level of involvement in this part of the program as I would like. Sometimes patients decline because they know that the family will provide a lot more information than they are willing to provide. Sometimes the family doesn’t want to come in. They have “compassion fatigue.” They are done emotionally, and maybe financially. The only upside is that maybe that’s a part of a patient’s rock-bottom, that they’ve lost everything and everyone, which means we can start building them up again. 

A significant part of what we do at Trinitas is relapse prevention. We counsel people on techniques for dealing with everyday stress, how to be able to function without drugs. We teach them how to work through it, but it’s always a work in progress. Does anybody learn how to deal with absolutely everything? No, of course not. And that’s something else we teach our patients: You have to work your way through life’s challenges to the best of your ability. When someone completes the Substance Abuse Program, they leave with a toolbox for coping with the stresses and triggers that result in a relapse. Their job is to take the tools we’ve given them, and then use them as they need them. 

The work we do here is face-to-face, both group and individual treatment. When you are talking to someone and looking them in the eye, it’s harder for them to walk away. You have a better ability to fully assess someone and pull all the information together. On the most basic level, say someone is sitting across from you and smells like alcohol. You’re going to know that. You wouldn’t know that if you were on the phone with them unless they were slurring badly. I do know that Trinitas is working on a telemedicine component. Is there a day coming when we will all be on screens in a circle talking to each other? Who knows? But human contact will always be vitally important. Our patients are vulnerable people looking for support. When someone is physically there for them, it means so much more. For that reason, we strongly advocate attending Alcoholics Anonymous and Narcotics Anonymous meetings, in addition to our program. AA and NA provide valuable support, too. 

We interact with as many as 800 people a week in the Substance Abuse program. If that sounds like a lot, then you are still not appreciating the size and scope of the addiction problem out there. One of our strengths, I believe, is that each person who walks through the door is assessed and evaluated as an individual; because there is no typical person who seeks drug abuse treatment. Some are here for the first time. We have people we have seen 10 times or more. Sometimes we are the last place people went for treatment and they come back to update us on how they are doing. We get young and old—again, as long as someone is 18 or older we can provide treatment. We’ve seen it all. I don’t think there is anything that would surprise us. 

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For me, the job of Director is one I take personally. I call the people who come through this program “my patients”—because they are. I meet almost all of them when they begin the program. I am very much involved in the front-desk area during their intakes. I am one of the constants in this unit as far as the patients are concerned. They know who I am and I know who they are. We do clinical team meetings, where I absorb a lot of information about them and I am involved in the team decisions regarding each patient’s care. I run groups when needed. My job is to keep the program running at a high level, so it is different every day. But my role is always to support the clinicians and the patients throughout the process. 

When I took this position at Trinitas, I felt in many respects that I was led here. I have worked in this field for many years and am very passionate about what I do. I believe that everybody deserves a fair chance and an opportunity. If you want it, we’re here for you.

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Addiction In Women 

Trinitas offers a Women’s Addiction Services Program, which is specific to women who have identified substance-abuse problems. In the program, patients learn how to deal with a wide range of women’s issues, as well as childhood trauma, anger management, and parenting challenges. The program has a small babysitting/childcare area with supervision for children 6 months to 12 years old, while their mothers are here seeking treatment. For more information, call (908) 994-7125.

Editor’s Note: Krystyna Vaccarelli, LCSW, LCADC has worked in the field of substance abuse and mental health for 20 years. She received a master’s degree in Social Work from Yeshiva University. Prior to coming to Trinitas, she was Director of Adult Outpatient Services and Addiction at Jersey City Medical Center. The Substance Abuse Program is located at the Trinitas New Point Campus at 655 East Jersey St. in Elizabeth. For more information on the program, visit trinitasrmc.org/a_nation_in_pain or call (809) 994-7090.

Yolanda Navarra Fleming

If you ask Sharnelle Hubbard, a 50-year-old Elizabeth resident, her life could be a cautionary tale about living on the street and trying to stay high. And when she says she’s spent too many years “running,” she’s not talking about marathons.

“My drug of choice started out as alcohol, and as time progressed, I dabbled with heroin,” she says. “My mother, who suffered from an addiction, introduced me to it when I was 16 years old. Towards the end of my addiction, I was doing alcohol, heroin, crack cocaine, and Suboxone.”

Sharnelle’s birth mother was a functional drug addict until she lost her job and her children. Sharnelle was then adopted by another woman, also a substance abuser, who made sure she had absolutely no chance of any kind of normal life.

In 2017, she hit a wall. “I was in a battered women’s shelter at the time,” she says. “I knew there was help out there, but I wasn’t willing or ready to accept the help yet. Before I knew it, I had been addicted for 20 years, and I just could not live like that anymore. I was a walking time bomb, but I got through all of that.”

She made a commitment to her sobriety by checking herself into a detox center before becoming an outpatient of Trinitas Regional Medical Center’s Behavioral Health program.

Substance Abuse Services (SAS) has been helping people get clean at Trinitas since the early 1990s, and now treats about 4,500 patients annually. Trinitas offers partial-day treatment, which was the route Sharnelle took. She spent Monday through Friday, from 8:30 a.m. to 2:30 p.m. at Trinitas, and then went home every day.

“What people don’t realize is that they need so much support, and that’s what they get here,” says Krystyna Vaccarelli, LCSW, LCADC, and Director of Substance Abuse Services at Trinitas. “During the entire course of the day, the patient is engaged in various groups that address substance use, relapse prevention, understanding triggers, what addiction is, and what addiction is in relation to mental illness. Those are just some of the topics covered when understanding substance abuse on an intensive level.”

Sharnelle had also been diagnosed with bipolar. To this day, the horror of her traumatic past poses an ongoing threat to her mental stability, though you’d never know it now from her clear speech, even temper, and thoughtfulness.

At one point, her counselor, Catherine Elias, LSW, credentialed Intern, noticed that Sharnelle was exhibiting some unusually manic behavior. “So we had an individual session and talked about it,” recalls Elias. “We discovered that there were some issues regarding her medications, and through teamwork with her APN, we got it situated and helped her feel stable.”

Sharnelle’s husband had begun his quest to get off drugs first, which in time motivated her to want to do the same. “I was willing to make a change in my life, and that’s when my process began,” she says. “I went to every session [at Trinitas], and I did everything that was offered to me and more. From 8:30 to 2:30 every day, I was there, and even when my time was up, I found excuses to stay in the program longer.”

At 50, Sharnelle is still trying to make sense of it all, especially now as a sober graduate of the Trinitas outpatient program.

“Going through this process I lost a lot of friends and my mother, worst of all,” she says. “I never thought I would reach the age of 50, not even in my wildest dreams…I am amazed that I am clean and sober.”

According to her former primary counselor at  Trinitas, Michelle Defino, LCSW, LCADC, Sharnelle has completed the program. Now, as she is studying to take the GED exam, she is determined never to go backward. She even mentors others who have also concluded that “running” is not a survival tactic, but rather a recipe for disaster. Her two most important sharing points are not to compare yourself or your recovery process to others as we’re all on our own journey, and to take it slow.

“Just don’t give up, there’s always someone there for you,” she promises. “Even when you think you’re alone, you’re not. This process does work.”

Even with her newly developed confidence, Defino confirms, “I do have the same amount of concern today as when Sharnelle first entered treatment. Addiction is a lifetime disease,  just waiting around the corner if a patient becomes complacent with her recovery process.”

Sharnelle believes it was the rapport she developed with her counselors, the director, and the entire staff as well as other patients that contributed to her successful outcome.

“When I was in my darkest days and wanted to give up, they always checked on me and called my house,” she says, “and that’s what you need when you’re first starting in recovery; you need people who care. I’ve been taking my medication as prescribed every day thanks to Andrea Krasno (APN), she’s wonderful, and she is amazing. She’s also a great part of this process, I can talk to her about anything regarding my medication; if I want it changed or lowered. I have never had anyone take the time to take care of me like that.”

Sharnelle is happy to add, “Right now I am in a beautiful place in my life. I am clean and sober for two years and I have my children back in my life, as well as my grandchildren. I own my own place, which I never thought I would accomplish. I am married and have a wonderful relationship with my husband. …I go to the meetings, which are great, and I have a sponsor, but I think Trinitas made my recovery whole.”

A dozen years in the making, Trinitas unveils the Institute for DBT and Allied Treatments.

Caleb MacLean

For some people, change is difficult. For others, self-acceptance is the long hill to climb. For individuals undergoing Dialectical Behavior Therapy  (DBT), positive outcomes are the

result of finding a comfortable middle ground between these seemingly contradictory and often uncomfortable life challenges. At the Trinitas Institute for DBT and Allied Treatments, outpatient clients—including those diagnosed with Borderline Personality Disorder and substance, eating, and mood disorders—learn behavioral skills that get them back, and keep them on track.

The Institute is new, but the work being done in this area has been going on at Trinitas for 12 years. “We’ve offered high-quality DBT treatment to adolescents and adults for years,” says Dr. James McCreath, the hospital’s VP of Psychiatry and Behavioral Health. “The DBT team has reached a level of  skill, experience, and competencies that we feel we are ready to train other clinicians who seek to provide high-fidelity DBT services.”

Truth be told, Trinitas has been working toward “institute status” for more than a decade.

“We already give presentations around the state and offer in-depth training as opposed to just outpatient therapy services,” explains Dr. Essie Larson, who has been with the program since its start and is co-director of the Institute along with Dr. Atara Hiller. “We train psychology and social work interns, psychology externs, as well as psychiatry residents. Our goal is to have trainees who come through really learn what the empirically-based DBT model looks like in practice.”

The Institute team has undergone intensive formal training with Behavioral Tech, an organization created by Dr. Marsha Linehan, the developer of Dialectical Behavior Therapy in the 1980s. The treatment provided is completely in line with Linehan’s original model and is considered the gold standard for treating emotional regulation issues. “We do it by the book,” Dr. Larson stresses. “Lots of consultation and training—even for those of us who have been doing it for a long time.”

DBT treatment has gained a reputation in some circles as a “treatment for the wealthy.” At Trinitas, however, the adult DBT outpatient program is one of only a handful in New Jersey that take clients who want to go through their insurance providers, while the adolescent DBT program is the only outpatient program of its kind that regularly takes insurance. “We are dedicated to providing this treatment for clients who would not be able to afford it otherwise,” Dr. Larson says. Moreover, the adolescent DBT program also offers Spanish multi-family skills groups.

“We also value helping families who cannot access evidence-based treatments because of language barriers. The Spanish Adolescent DBT program has been an incredible resource for teens and their Spanish- speaking family members, enabling them to get the clinical results they desperately needed but could not access,” Dr. Hiller says.

The Institute is focused on recovery-based outpatient treatment, so success is dependent on a high level of motivation. A doctor or insurer can suggest to a client or family that it is a good idea, but clients (or the family for an adolescent client) must make first contact themselves and put themselves on the waitlist. For adult DBT, the staff will do an initial phone contact to answer any questions and then send out a packet that explains in full detail what is involved in the program. The prospective client answers some questions about

themselves and returns the packet as an initial screening to determine fit within DBT. For the adolescent DBT program, the family must call directly. A phone screening is conducted to ensure that they meet the treatment criteria before being placed on the waitlist.

“Following that, when a spot in the program opens up, an in-person intake is completed to further assess the ‘fit’ with our DBT program. Then there are three pre-treatment sessions (four for the adolescent program) before fully joining the program,” says Dr. Hiller. “That’s when we discuss goals, obstacles, and start working to increase the client’s commitment. After the final pre-treatment session, clients and therapists sign a contract together, agreeing to work together for a specified amount of time.”

For adults, that amount of time is a minimum of one year, and with contract renewals, can run as long as 30 months. For adolescents, the program runs a minimum of 24 weeks for English-speaking families (4 pretreatment sessions and 20 treatment weeks) and

28 for Spanish-speaking families (4 pretreatment sessions and 24 treatment weeks).

For both the adult and adolescent DBT programs, treatment consists of a once-a-week individual session and a once-a-week two-hour skills group. In addition, clients (and their caretakers in adolescent DBT) have access to between-session phone coaching to help use the skills they learn in sessions out in the real world.

“While this may sound like very little therapy for individuals who are struggling so much in life, this is exactly what the empirically-based DBT model is based on. It is the quality and the specificity of the treatment, as well as the intense training and supervision of the clinicians, that makes it effective for these clients. Not the quantity of weekly sessions,” says Dr. Larson. Both programs also have Consultation Team meetings each week to ensure that clinicians are getting support themselves and are adhering to the DBT model.

The overarching goal of the Trinitas Institute for DBT and Allied Treatments is creating a strong foundation of skills to deal with daily life—building a “Life Worth Living”, DBT’s primary goal. That may sound simple, but it’s not. DBT clients tend to have an “exquisitely sensitive” emotional regulation system (they become upset more quickly, more intensely and take longer to cool down) and more than 90 percent come to the program with a significant history of trauma.

According to Dr. Larson, while DBT itself is not a trauma treatment, the staff at the Institute is also trained in empirically-based treatments like Prolonged Exposure (PE) to help clients overcome the often paralyzing symptoms of their traumas once they have learned skills to manage their suicidal, self-harming and other high-risk behaviors. “We recognize that building a Life Worth Living does not just mean stopping behaviors,” she says. “It also means treating the suffering that often drives the behaviors.”

“No one has taught them what to do with all these intense emotions,” laments Dr. Hiller. “So we see the clients trying to tolerate the emotions and problem- solve using behaviors that include self-harm, drugs, and eating disorders. They have often been unsuccessful in other types of treatment.”

Indeed, most individuals entering the DBT program see and respond to things in their world as black-and-white, which leads to less effective coping decisions. At the Trinitas Institute for DBT and Allied Treatments, therapists help clients see reality as a whole, not a collection of extremes.

“We spend a lot of time teaching that there is no absolute truth, that everything is a mixed bag,” says  Dr. Larson. “This is where the ‘dialectical’ part of DBT comes in. Simply put, it means that everything is composed of opposites. But that middle ground can be so uncomfortable for the people we treat. They do tend to gravitate towards the black or the white, the right or the wrong—just to have a clear answer. The statement ‘it depends‘ is very accurate when making decisions and it is also hard to tolerate for our clients.” 

Editor’s Note: The Trinitas Institute for DBT and Allied Treatments is located at 655 East Jersey Ave. in Elizabeth. For more information on its programs, visit www.dbtnj.org or call (908) 994-7378 for more information on the adolescent DBT program and  (908) 994-7087 for more information on the adult DBT program.

Trinitas OB/GYN Chair making Elizabeth campus his base of operations.

Erica Otersen

Dr. Abu S. Alam has delivered thousands of babies and provided quality care to countless families, both here and abroad, during a medical career that has stretched across more than four decades. After two-plus years commuting between Elizabeth and his practice in Summit, the Chairman of Obstetrics/Gynecology has decided to close the doors of his longtime office overlooking Springfield Avenue and devote himself entirely to Trinitas.

Born and raised in Bangladesh, Dr. Alam cites his father’s death as his inspiration for a career in healthcare: “Before my father passed, he asked that one of us become a doctor. At sixteen, I was the youngest of seven children and none of my siblings had pursued medicine. It was left to me to fulfill his wishes.”

He embarked on his medical education as a teenager and, in 1972, graduated from Dhaka Medical School. He interned at Louisiana State University, completed his residency in Obstetrics and Gynecology at St. Vincent’s Hospital and Medical Center in New York City, and moved to the New Jersey suburbs to build his practice.

Dr. Alam has trekked to Haiti more than 20 times over the years, performing charitable work in the impoverished island nation—often finding himself in clinics with no electricity. His arrival at Trinitas in 2017 gave him an opportunity to connect with the area’s Haitian population. He has also worked tirelessly to secure funds and equipment donations in order to open Nandina General Hospital, a non-profit medical facility in Bangladesh.

It is this dedication to caring that initially led Dr. Alam to Trinitas, which serves a diverse patient population. And, he says, it makes the difficult decision to leave Summit a little easier.

“It will also decrease my commute time and increase time for my patients,” he points out, adding that his first priority—whether in New Jersey or Haiti or Bangladesh—has always been to his patients.

“When I go to bed at night, I know that I’ve given my patients the best care I can.” 

Editor’s Note: Dr. Alam’s efforts have not gone unrecognized. In 2006, he was awarded the Ellis Island Medal of Honor, which is presented to immigrants who have made significant contributions to America’s heritage.

Moving Trintas forward is a 24/7 job. I wouldn’t have it any other way.

Gary S. Horan

Quite a bit has changed regarding the healthcare landscape in the decade since EDGE magazine began publication, but to me those  10 years only represent the “second half” of the Trinitas story. It was actually 20 years ago that the final touches were being put on the merger between Elizabeth General Medical Center and St. Elizabeth Hospital to create Trinitas Regional Medical Center, in January of 2000. I came aboard as CEO in the summer of 2001 and, thinking back, I am struck by how my duties and focus, and the hospital itself, have evolved over that time.

The merger was still fresh when I arrived. By that I mean we were still operating with two separate buildings and two separate organizations, and there was anxiety in Elizabeth—the state’s fourth-largest city— about the prospect of closing one institution down and assimilating it with the other. Would Trinitas have the capacity to serve the community?

That turned out to be a non-issue. The decision to merge proved to be a very appropriate and prescient one. The individuals involved had the insight and vision to see that the healthcare environment was changing. They understood that merging was the way to achieve economies of scale and avoid duplication of equipment and technology. And because of that, Trinitas was able to invest in renovations and expansions that have maximized the impact of the new technologies and protocols that have come along in the years since. The capacity was there because of new treatments and medications, which shorten patient stays or prevent them from having to be admitted at all— advances in healthcare that were developed specifically to reduce hospitalization. The 2000s have been a very dynamic, innovative time in healthcare and the merger enabled us to leverage all of these benefits. It also enabled Trinitas to be more nimble and responsive as times changed.

Now, mergers are fairly commonplace among hospitals. But the idea was new in 2000. And it was accomplished during an era of considerable uncertainty. We had all just “survived” Y2K, which sounds like a small deal, but it was a big one at the time. People were afraid that bank accounts would be erased, traffic lights would stop functioning and planes would fall out of the sky. Even though nothing happened, hospitals had to take these threats seriously. A lot of the time and energy and preparation went into “what-if” scenarios. Then, just a couple of months after I came to Trinitas, the terror attacks of 9/11 occurred. Details of that day are still very fresh in mind. From the top floor and rooftop of the medical center we had a clear view of the World Trade Center. To see it burn and see it fall was incredibly sobering to witness. But I also remember how quickly we were able to react: Our emergency services team assembled quickly and, in coordination with the county and the state, dispatched ambulances to Port Liberte in Jersey City to accept the patients who everyone anticipated coming by ferry from downtown. And there were no patients.  It was a sad thing. All of the professionals were there waiting and nobody came,

If there was any kind of silver lining to that terrible day, it was that we had done a great job fine-tuning our emergency preparedness—and that people took notice. Right after that, I believe we were one of the first hospitals in the state to participate in the biological warfare training exercise by the Department of Defense. That was quite an experience. We had decontamination tents and everybody had to gown up. It was reassuring to know that we would be prepared if that type of attack occurred.  Everybody rose to the occasion—Trinitas staff, the city, the state. The coordination was fantastic. It showed me that people really rise to the occasion in a crisis. And improving our preparedness is something we have continued to do ever since. It’s part of our team-building culture.

Of course, some things I knew would not change. Today, as in 2001, financial viability remains one of my top concerns and challenges. We are still serving a significant charity-care population, a large population of undocumented residents, and a large Medicaid population. And dealing with insurance companies hasn’t gotten easier or less complicated.

Insurance companies—and this goes beyond 20 years—have systematically ratcheted down reimbursement, not just for hospitals but also for doctors. Different plans have come into effect for the consumer during the Obamacare/Affordable Care Act era that were supposed to cover everybody. But as it’s played out, deductibles are very high and the quality of the insurance product is not as robust. People may have seen a reduction in premiums, yet with those savings came a very significant increase in deductibles—which means when they get ill, they can expect to receive big bills at the end of the day.

That forced a lot of doctors to go out of network, which is a very big problem. Two decades ago that was not the case. But in the last four or five years, I feel like I hear more frequently doctors say, “I’m not going to accept any insurance”—in some cases, including Medicare, because the reimbursements are so low. When they see patients out of network, they send them very large bills, and then the patients have to battle that out with their insurance carrier to see how much gets paid. More times than not, only a fraction gets paid and the consumer is left holding the bag for the rest. And then the hospital and the doctor have to deal with them when they struggle to pay.

As a hospital CEO and president, I feel the same anxiety and frustration about our relationship with insurance companies. It’s a difficult one. For instance, it’s increasingly prevalent for insurance companies to deny days to the hospital and deny payments—and the hospital has to go through the hammers of hell to appeal these cases. The thing about it is that, in our appeals, we have an approximately 65% or 70% success rate. That might lead one to believe that the denials are not really looked at from the standpoint of justifiable denials, but a strategy of denying something just to see what happens. It’s an accounting strategy, essentially.

For our part, it’s  wonderful to win a high percentage  of appeals. When we challenge a denial or expedite an approval, we are advocating for our patients and the best outcomes. However, what people don’t realize is that to appeal is very costly to Trinitas. The amount of money we have to set aside to counter and challenge insurance company denials is staggering. This also includes the work we have to do to get certifications and pre-certifications for certain tests and procedures. This delays treatment in many cases, which is very stressful for the patient…who in many cases blames us!

Returning to happier thoughts, I would say that I have seen remarkable strides in quality control over the past two decades. Patient safety has always been at the forefront for Trinitas and all healthcare institutions— making sure your policies, procedures and products are of the highest quality—and that is top-of-mind here every day. In the old days, hospitals tended to operate on a volume-based system. Now it’s a value-based system. The results and outcomes for patients is far more important in the running of a  hospital than it was 20 years ago. You see this reflected in the mergers and acquisitions in healthcare, which have increased dramatically since we did it. Trinitas was one of the first truly successful mergers in the state. And it has certainly stood the test of time from the standpoint of success.

That success has enabled Trinitas to impact the lives of patients far beyond our immediate area. For instance, we are in 80 different locations throughout the state and in every county when it comes to behavioral health. Our presence is well known and our reputation has grown dramatically—people don’t look at us as a single hospital, they look at us as a system. And we are our own system, in that regard. Our Centers of Excellenceextend our reach to a wide audience. We have the professional talent, we have the technology available, and we focus on these areas to ensure that they continue to be Centers of Excellence. Many draw patients from Union County and beyond because we provide services others don’t. And even where others do, we are known for our high-quality patient care and good outcomes.

Take our Wound Care Center, which has three hyperbaric chambers. We get patients from all over the state and the region with complex wounds—often as referrals from other wound centers, because they are having difficulty curing a wound. A few years ago, there was a story in this magazine about a patient who traveled here from Delaware every day for at least 10 weeks. He was originally told that he’d probably lose his leg, and we cured him.

These stories make the dull-but-necessary duties of a hospital CEO bearable. Peter Drucker, the legendary management guru, identified managing a medical center as the most difficult job in the world. You won’t get an argument from me. Trinitas is an incredibly complex organization. Healthcare is very complex. I can probably speak for my peers at other institutions when I say that I would like to spend fewer hours working on issues of regulation and bureaucracy and more time developing new ideas. There are so many new regulations, and often regulations change without much notice. So I often have to shuffle things in order to change quickly to meet those requirements. Obviously, I rely greatly on our compliance people. Compliance is one of the other things, by the way, that has changed over the last 20 years in our industry. It is increasingly a part of everything we do. Not that we have a diminished focus on items such as strategic planning, but with less regulation and bureaucracy, we would have more time to concentrate on more productive things.

If you’ve made it this far, you’re probably wondering what I enjoy most about my job.

I enjoy the planning process—coming up with new ideas, new concepts, new ways to make sure we are providing the community with what it needs (as opposed to what we need). When we develop initiatives, I try to be “risk-assertive,” which means I like to try new things—more so, perhaps, than many of my colleagues. I believe it is important to take a good risk when it is based on good information and, to certain risks like that to deliver good healthcare and have the community on your side.

I also enjoy seeing where new ideas come from. At Trinitas, they come from every corner of the hospital— doctors, nurses and employees in every department. Management and staff meet on a regular basis and a lot of ideas are generated by those interactions, especially where the work environment is concerned. The people who work here have so many ideas of how to be more productive. Our physicians bring us ideas about new technologies we should consider using. An example of that is electroconvulsive therapy. It’s been around a while but it was something we hadn’t done. Our physician staff has been talking a lot about ECT and I think it’s a program we’ll be going into in 2020. Many ideas come from the management team, of course, and also from the outside community.

My job is to keep things running smoothly at Trinitas because, when everything runs smoothly in a hospital, you can put new ideas into action. Some lead to small improvements, while others turn out to be game- changers. You never know when the next big thing will come across your desk. That’s why I listen to all ideas. No one is shut down.

The dynamic healthcare environment was certainly reflected in the announcement we made just as EDGE was going to press: that Trinitas took the first step toward becoming a part of the Robert Wood Johnson Barnabas Health network. Our respective Boards signed a Letter of Intent that provides a basic understanding of future governance and details will be determined over the next few months. Should this transaction go through, Trinitas will remain a full-service, Catholic medical center. I see our eventual move into the RWJBarnabas Health system as an extremely positive and exciting development for our institution— one that will give us the resources and opportunities to greatly enhance the already high level of care we provide to our community.