Betsy Ryan is president and CEO of the New Jersey Hospital Association. Her blog, Healthcare Matters, examines the many issues confronting New Jersey's hospitals and their patients. Readers are encouraged to join the discussion, because healthcare matters - to all of us.

Healthcare Heroes are Everywhere

Even on vacation, healthcare can’t be taken for granted. I was reminded of that on a recent beach weekend “down the Shore.”

My family and I had taken a long weekend in Cape May. I spent much of that Friday on the beach with my 10-year-old son. While reading is my preferred beach activity, I ended up in the ocean with my son, riding the waves and generally being spun around like I was inside a blender. The tide was very strong and we were swept down the beach often. To get back to our starting point we would leave the ocean and walk down the beach, back to where our umbrella was located. But once, as we left the water, I spotted a middle-aged man who was staggering. He sat down in a couple inches of surf, and I asked him if he needed help. At first he declined, but then when he tried to get up and couldn’t, he asked me to get his wife and told me her name. It was a scary moment, and I ran up and down the beaching yelling her name. Aside from a couple puzzled looks, no one responded, so I asked the lifeguard for help. It was only a matter of minutes, but by the time I returned to the stricken man, a good Samaritan was already at his side offering assistance. I’m not sure if that compassionate woman was a nurse or a physician, but she clearly was a healthcare professional with years of training backed by a strong commitment to service. I watched her as she took control of the situation, assessing the man’s vital signs and calmly reassuring the man and his wife (who by that point had been located, fortunately.) The lifeguard called an ambulance and the situation was well in hand. The crowd dissipated and my son pulled me back into the waves.

I don’t know who that caring person was who stepped up to help a stranger, but she could be any one of the thousands of dedicated healthcare professionals who work in New Jersey. And it’s not just physicians and nurses who care for our state. Our hospitals employ 145,000 individuals statewide – nurses and physicians, along with technicians, clerical workers, dietary staff, housekeepers and a much longer list of workers who keep our hospitals running 24/7/365. In my book, every one of those individuals are heroes, and I sure was glad one was on hand on the beach in Cape May.

Written by Betsy Ryan at 14:26

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N.J. Court Has Opportunity to Influence Compassionate End-of-Life Care

(This special edition of Healthcare Matters was co-authored by Betsy Ryan and Sister Patricia Codey, president of the Catholic HealthCare Partnership of New Jersey.) Modern medicine is amazing. We live in an age where life-saving organs can be transplanted, where intricate surgeries can be performed through an incision the size of a pinprick, where an implanted manmade device can do the body’s work. In short, we live in an age where medical marvels can and do occur.

But the unprecedented science and technology available to us today cannot change one fact of life: There comes a time when death is inevitable. Science may be able to force air into a dying person’s lungs or pump nutrients into the digestive system. In short, science can prolong the dying process. But is that really what we want from our healthcare system?

That’s a dilemma that is playing out in a New Jersey appellate court, where judges are being asked to determine whether physicians should be compelled to artificially sustain a dying person’s life. The legal drama stems from a case at Trinitas Regional Medical Center in Elizabeth where a team of physicians spent more than a year treating an unresponsive patient who was in a permanent vegetative state with multiple organ failure. The patient could not breathe on his own, eat on his own or respond to outside stimuli. He was being kept alive purely through science. Five different physicians agreed that there was no hope for his condition to improve and that the requested treatment – kidney dialysis – would not change that outcome. But the patient had not stated his end-of-life preferences ahead of time, and his family ordered the life-sustaining treatments to continue indefinitely.

It’s a gut-wrenching case, and our hearts go out to the family in this case and all families that endure the difficult process of a loved one’s death. The unsettling questions this case raises will only continue as our population ages and medical science advances. That’s why our organizations – the Catholic HealthCare Partnership of New Jersey and the New Jersey Hospital Association – have joined this case. Representing a faith-based organization and a secular healthcare association, we respect both the sanctity of life and the healthcare mission of healing and caring. The question our society must confront is: Should healthcare professionals be required to use technology to prolong a dying patient’s life when those interventions violate longstanding medical ethics and standards, while providing no relief or benefit to the patient?

New Jersey has a distinguished history in such legal debates. The landmark case involving Karen Quinlan, for example, set a precedent for the right of patients and their family members to stop life-sustaining treatments. That case involved a patient’s right to receive or refuse treatment within the medical standard of care. What sets this current case apart from prior situations is the fact that it is asking the legal system to compel doctors, nurses and hospitals to act in ways that go against the medical standard of care and continue treatment where it can do no good. It is uncharted territory and, quite frankly, it makes us uneasy.

Our organizations have been very involved with our state’s physicians and hospitals to address these very difficult issues in end-of-life care. Our goal is to provide the highest level of care that is medically necessary and appropriate, care that protects our patients from unnecessary pain and preserves their human dignity. In striving for the proper balance, we must ask ourselves some key questions: How much care is the right amount of care? When do healthcare interventions – in the form of machinery and technology – become inhumane rather than heroic? What, in fact, is a death with dignity?

These questions are deeply personal, and that’s why we will continue to urge all individuals to state their end-of-life wishes through an advance directive or a healthcare proxy. But these very personal decisions are now becoming a societal issue as well – one that will confront physicians and families again and again in the years to come. New Jersey once again is in a position to be a leader in setting legal precedent that clearly and compassionately establishes a process that respects the dignity of dying patients. It is a process that must include the input of patients and their loved ones. We urge the Court to accept this opportunity to set forth reasonable, responsible and compassionate procedures to be followed by physicians and hospitals when artificial healthcare interventions overrun the natural capacity of the human body and spirit.
Written by Betsy Ryan at 15:56

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Take Action Today to Become an Organ Donor

Thank you, Grace Sato; thank you, Kellye Miller; thank you to the Bottino Family. And thank you to the many selfless New Jersey residents who have made the life-giving decision to donate an organ or tissue.

Their personal stories are available on the Web site It’s a one-stop resource to learn about organ and tissue donation in our state and, most importantly, it offers a simple way to join the statewide registry of designated donors.

I can’t underscore how important the issue is to your friends and neighbors across the Garden State. There currently are 4,200 N.J. residents who face a very uncertain future without an organ donation. Nationwide, about 100,000 people are awaiting a life-saving organ transplant, and another name is added to the list every 12 seconds. And each day, about 18 Americans die, still waiting…

April is National Organ Donation Awareness Month. Make it a time to talk with your family about organ donation and then take the next steps to become a designated donor. Surveys show that 90 percent of Americans say they support donation, but only 30 percent know how to take the steps needed to become a donor. It couldn’t be much easier. The next time you renew your drivers license, say “yes” to organ donation. Or take action today by visiting and sign up for the online registry.

Written by Betsy Ryan at 20:00

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Project’s Goal: No Pressure Ulcers

Several years ago, my aging aunt developed a pressure ulcer – what most people would call a “bed sore.” Despite medical care, it took more than a year for the sore to finally heal, and I know that the skin loss from a pressure ulcer can never fully return. I saw firsthand the personal toll that pressure ulcers can have on a loved one. But as a healthcare executive, I also know that preventable conditions such as pressure ulcers have tremendous costs for our healthcare system as a whole. Nationwide, costs associated with pressure ulcer treatment exceed $1.3 billion.

With our population aging, NJHA made a commitment several years ago to address the issue of pressure ulcers. We brought together more than 125 hospitals, nursing homes and other healthcare facilities to work together in an intensive two-year quality “collaborative” to reduce the incidence of pressure ulcers. The results were astounding: Our participating facilities cut pressure ulcer incidence by 70 percent, and our project was featured in conferences from Oxford, England, to Toronto, Canada, to points all across the United States. We’ve since expanded the effort to many more facilities.

Now NJHA and its affiliate, Healthcare Business Solutions, has entered a new realm in our fight against pressure ulcers. We have teamed with industry experts Dr. Elizabeth Ayello, a consultant and past chair of the National Pressure Ulcer Advisory Panel, and Dr. Jeffrey Levine, a geriatric specialist at the St. Vincent Hospital Wound Care Center in Manhattan, to produce and publish the Pocket Guide to Pressure Ulcers. It’s a bedside reference tool to help healthcare providers classify and document pressure ulcers. We’re hoping it will go a long way in further reducing the occurrence of these preventable skin breakdowns. I invite you to visit our new Web site,, to learn more.

Last time I wrote in this space, I spoke about an effort many of our hospitals are involved in to reduce rising healthcare costs. This is another great example of hospitals and other healthcare facilities working hard to improve patient care and reduce costs all at the same time. Another win-win situation.

Written by Betsy Ryan at 13:56

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Snow-pocalypse? You Can Count on Hospitals and Wawa

This week I read an intriguing article about how Wawas are usually successful in staying open in the worst of weather conditions. Hospitals, nursing homes and rehabilitation facilities are like Wawas in that respect, except they have been doing it longer. (By the way, for my friends outside the region, Wawas are like 7-Elevens except they seem to be on every corner in central and southern New Jersey. Wawas are good for a good cup of coffee, a loaf of bread, milk, or if you are so inclined, a hoagie – or sub if you prefer.) You might say they provide comfort food. New Jersey’s healthcare facilities provide comfort to their patients. They have plans in place long before the big storm hits to ensure that they will have adequate staff, supplies and utilities to ensure that quality patient care continues…even if the rest of New Jersey is enjoying a snow day.

Written by Betsy Ryan at 19:05

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