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Hospital learns Covid lessons on the flyFree Access

Chief of staff says more face masks are needed; supplies remain short


Mimi Carter

Mimi Carter

Dr. Mimi Carter is first and foremost just that — a doctor.

Family medicine is her specialty.

But Carter is also the chief of staff at John C. Fremont Healthcare District, which also makes her an administrator.

That’s a role that was pretty much routine before Covid-19. Not that it isn’t important, but in medicine, there are certain routines which Carter says are good.

“We don’t want to miss something,” said Carter.

But the global pandemic has turned everything upside down and it has made the routines anything but, well, routine.

Carter, though, has adapted and credits the team at the hospital and clinic for also being flexible during uncertain times.

“We need to be more flexible,” said Carter.

In the beginning

“January.” That, says Carter, is when she realized things were happening around the world and the warning signs were flashing.

“I became more aware there could be a problem,” said Carter.

Carter said at that time, she was paying close attention to the news, to medical journals and various other sources of information.

And then came early March when a cruise ship docked in Oakland. It made worldwide headlines and brought the message home.

“This is right here,” said Carter, remembering her thoughts when the cruise ship docked.

That, she said, was a wake up call for all medical people, including those at John C. Fremont Healthcare District ( JCF).

Carter said the hospital has had some prior experience.

“We’ve had things we had to pay attention to before,” said Carter.

That included ebola as well as various rashes that were running rampant.

But she also knows Mariposa County and said one of her first thoughts after the cruise ship incident was “we have so many tour buses from San Francisco.”

Then came the statewide lockdown order from Gov. Gavin Newsom.

“That was instant,” said Carter.

It was then Carter knew protocols had to be put into place. She spoke with hospital district administrators and an incident command was established.

The priorities

The top priority, said Carter, was the Ewing Wing, which is the skilled nursing facility at JCF.

“It’s a lot of moving parts,” said Carter. “We had to reassess and see what people needed.”

Carter gives high praise to Katrina Anderson, the director of the Ewing Wing.

“She has been very diligent about staying on top of the recommendations,” said Carter.

Anderson used guidance from other, national entities as well as her own instincts to take decisive action for the patients — and staff — at the Ewing Wing.

It has been in lockdown since.

“The staff is amazing,” said Carter.

Carter said officials in the Ewing Wing have developed a system for visits from the garden area through windows in rooms as well as video and other forms of communications. From what she has heard, Carter said the patients and families seem pleased with the system and understand the need because Covid-19 has decimated skilled nursing facilities across the nation.

Working together

Carter said one of the biggest positives for her has been how everyone at JCF has come together in a time of uncertainty.

“JCF has really pulled it together,” said Carter.

Carter said one of the main pushes by the Newsom administration was to put in place restrictions in order to “give us all time to implement measures.”

That, she said, is one of the reasons officials at the hospital and clinic were able to get everything in order, from how to do screenings of patients to ordering everyone entering the buildings to wear a mask.

Carter said the employees have done “amazingly well” through the entire process.

She said employees were given the option to continue working or to be at home with their families.

That moment happened, she said, when there were 10 people who were sick at a clinic in Los Banos.

“It was another warning moment,” said Carter.

Carter said around the country, “a lot of primary clinics” have closed because of the pandemic. She believes by working with the administration, staff and others, that’s why the clinic at JCF has been able to continue to function for services not related to Covid-19.

Inside baseball

Carter, who has been at JCF for 10 years, said her medical training was in California and she still has many connections with doctors across the state.

She has been in contact with many of them since the outbreak of coronavirus to seek advice with how the large hospitals and clinics were dealing with the pandemic.

“They laid it out,” said Carter.

She took their advice and began applying some of those lessons at JCF, which she believes have paid off.

For instance, one of the big changes was for more telemedicine, something Carter admits many are skeptical of practicing.

Or were.

“We implemented it as soon as we could,” she said. “Everyone jumped on it with us.”

So much so, Carter said she conducted a Zoom meeting with a couple who are both 90 years old.

That, said Carter, showed her that telemedicine can be an effective tool.

“We may do more of it,” said Carter.

With the clinic back open, Carter said many other lessons are being learned. In fact, she said Clinic 2 opened this week for patients. That is the specialty clinic at JCF.

She said doctors there are staggering in-office visits and video visits at least through June.

For some things, Carter said doctors have to see patients in person. For others, they can use video.

The specialty clinic includes cardiology, neurology, rheumatology, dermatology and more.

They are working hard to make sure appointments are timed properly and “people aren’t waiting in their cars,” especially because the summer heat is upon this region.

In the main clinic, those same practices are happening with appointments appropriately timed.

Learning on the fly

As part of the preparation, once it was clear a pandemic was gripping the nation, Carter said she had to put on her administrator hat along with her white coat.

Though she knows administration, it wasn’t something that was front-and-center until it became clear protocols and procedures had to be established at JCF.

“I’m a family doctor in a small town,” said Carter.

And a good one, at that.

But as a family doctor in a small town, she is also the chief of staff and an integral part of the administrative team which was suddenly thrust into a pandemic.

Small things suddenly became big, said Carter.

For instance, she said the maintenance staff had to make sure the air conditioning was operating properly in certain waiting areas, something that had never been a focus in the past.

“They have been amazing and flexible,” said Carter of the JCF maintenance staff.

They also have made face shields, put up — and then repositioned — the screening tent and much more.

The staff also had to devise a way to do the X-ray process. The big X-ray machine, she said, takes an “epic” effort to clean so they could not take the risk of anyone having the virus using that machine.

For those people, she said, a portable machine is being used.

Now, said Carter, things are getting back to some semblance of normal at the clinic. She’s seen “a number of kids” for wellness checks, vaccinations and more. They are also doing more mammograms, blood work and screening for colonoscopies. Carter thinks these are critical steps in getting people back into the habit of routine health care, something that has been lacking during the crisis.

Lessons learned

For Carter, she said even doctors can learn lessons. In fact, it might make some people surprised that doctors get into routines, but it shouldn’t.

Carter said routines are crucial in medicine.

“Medicine is so routine,” said Carter. “There are patterns in medicine.”

That’s just one of the lessons, said Carter.

There are many more. Those include:

• Telemedicine is okay.

• Everyone works as a team.

• Efficiency is improved.

• Time management is improved.

• “We are still flexible.”

That last lesson, said Carter, is something she believes will continue to apply.

“We need to be more flexible,” said Carter.

Moving forward — cautiously

One of the biggest issues now facing Mariposa County is when Yosemite National Park will open. That remains a mystery and the signs coming out of the park are changing almost daily.

“I am very nervous,” said Carter.

She agrees with the initial plans coming out of the park where the number of visitors will be limited, but sees a drawback.

“What happens to people not going to the park?” said Carter. “Where are the people going to go?”

She fears many people may flock to this region thinking the park is open and when they find out they can’t get in, will most likely be in the Merced River Canyon, Mariposa and other communities around Yosemite.

Carter believes that could be a major issue if some of those people are positive for Covid-19.

Carter is also concerned about how the general attitudes of some local residents appear to have changed, at least somewhat, from the initial lockdown.

“People are taking it less seriously,” said Carter.

The biggest visible sign, she said, is the majority of residents in the county are not wearing masks while gathering in public, whether that be at a pharmacy, grocery store or other places.

Carter is a big believer in masks.

“That is me protecting other people,” said Carter, adding she believes that behavior should be “totally normal.”

But “complacency,” said Carter, is a big concern and she said it could lead to a much more serious outbreak of the virus.

For Carter, she said when the virus first surfaced and it became obvious officials at JCF were going to have to do something, “it felt like a tidal wave.”

Then, she said, when a serious wave did not come to this region, she felt “a little better,” noting residents were taking it seriously and officials were making sure rules were established.

Now, said Carter, with the real possibility of the park reopening coupled with the fact some people are not taking it seriously, she fears a “tidal wave” could come back.

In fact, Carter said officials at JCF are preparing for both a surge as well as an easing of cases throughout the state.

“We are prepared to take steps forward and back,” said Carter.

Wanted: masks

Another issue which has recently surfaced at JCF is the fact the hospital and clinic are running low on face masks.

Carter said because everyone who enters the buildings are required to wear a mask, it has meant the supply is dwindling.

Carter said part of it is because many local people aren’t wearing masks and when they come to the clinic or hospital, have to have them supplied.

“We will run out,” said Carter, if the trend continues.

With tight supply chains around the world, Carter said it remains unknown if JCF can get more masks.

“I don’t know,” said Carter.

Carter is inviting people to sew cloth masks to donate and urged anyone to contact Katrina Anderson at (209) 966-3631.

But even with a shortage, Carter said “everything is open” at the hospital and clinic and she urges people to call ahead and make appointments. That includes lab work, said Carter.

One response to “Hospital learns Covid lessons on the fly”

  1. Darlene Thomas says:

    Doctor Carter is a real home town hero!

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