In addition to caring for terminally ill patients on a daily basis, hospice and palliative care physician Dr. Jay Peitzer of Trustbridge Hospice Care is the chief medical officer on a Disaster Medical Assistance Team (DMAT) for the U.S. Department of Homeland Security.
DMAT teams have been active nationwide during the COVID-19 pandemic, giving Peitzer a bird’s eye view into the health care system’s response to the crisis. These teams provide medical assistance during catastrophic events, such as hurricanes, tornadoes, floods or human-caused disasters like the 9/11 attacks.
He has participated in mass vaccination efforts, filled in at understaffed hospitals, and responded to emergencies such as the COVID outbreak on the Diamond Princess cruise ship as it docked in Japan.
Peitzer spoke with Hospice News to discuss the ways the field has changed since he entered in 1988, as well as the nation’s preparedness for pandemic-level events.
Earlier in your career, you were an ER physician. What drew you to hospice and palliative care?
I was an ER physician, and then I decided to go out and open my own urgent care center.
For the first year or two, it was tough to get a practice going. That was in the early days of urgent care centers. A rep came to me from hospice and said that I really seemed like a nice guy and asked if I would consider working for them.
I tried it on and it fit me very well. It’s just an emergency in a different setting, if you will.
You came to the hospice space around 1988. What are some of the things that you’ve seen change since you started working in the field?
Hospice has changed from what I would consider a cottage industry, with small mom-and-pop companies, to larger corporations, which I think became necessary because the way health care changed into big systems.
When we started, we were out talking to doctors. Now you almost have to talk to systems and case management groups, and all the different providers that are now involved in the marketplace.
How do you think that that may have changed or influenced the way care is delivered, or the way patients experience hospice?
I see it becoming squeezed, especially with management companies.
Now they’re starting to scrutinize the care that we’re giving to our patients, even for patients that I think are very appropriate. They’re asking why a certain patient is in hospice, where years ago, it never would have been a thought.
One of the things that seems to be coming down the road for hospice providers is value-based payments. Do you have thoughts on how that might ultimately impact patient care?
I can tell you that I’m an old guy with gray hair. In the days when I started in medicine, there was a chart. We would read the chart, and there would be subtleties. So a doctor would put notes in the charts, that breathing is better, or breathing is worse, and so on. And you would be able to see a trend.
When I go to the hospital now to do consults, everything is computer-transferred from one chart to the other. It really doesn’t give you much of a flavor of what’s going on with the patient. I find it very misleading. I actually go and talk to the patient and examine him, because I find a lot of people just aren’t even doing that anymore.
There’s a mindset among most of the providers. I see the young ones out there with a list of 30 hospital patients to see. How do you possibly do that and be a doctor? It’s totally beyond me, but that’s what they’re expected to do. And they just sort of kick the can down the road.
When you are onsite with your DMAT team, are you working in your capacity as a hospice and palliative care physician or are you providing more general medical care as needed?
When I started off with the team, I was providing more general medical care. However, as disasters go on we would get those patients that have terminal illnesses coming to us. I was very comfortable taking care of them, whereas a lot of the ER doctors and other clinicians are not comfortable taking care of those patients.
People really aren’t very well-trained in it, and they sort of do whatever they need to do.
Now, I’ve migrated to a position of really being a supervisor. I do less hands-on care. Although when anyone comes in that might have a terminal illness, they frequently will refer that to me.
What has your experience been like, working in a DMAT during a pandemic?
DMAT really has stepped up in all capacities to deal with this crisis.
My exposure to COVID with the team started in February of 2020. I was the chief medical officer for the rescue mission of the [cruise ship] Diamond Princess in Japan. I wasn’t scheduled to be on call but they were short on doctors, and my commander contacted me.
I left work and went to Japan, and I was one of four people that got sick after the mission. I was quarantined there for two weeks, then I came home.
Health care staff had been working very, very hard. We would go into hospitals to fill in for a lot of staffing deficiencies. Hospitals lost a lot of staff because of the COVID immunization requirement, so we responded to those types of things. We also provided mass vaccinations.
Are there any lessons learned from your experiences with DMAT that has come to inform your approach to providing day-to-day care?
I found that disasters or emergencies are equivalent to the same thing that people in hospice see every day, but the scale is different.
When you have a big disaster, like a hurricane, there’s going to be suffering. People very frequently consult with each other. Everybody had their house damaged. Everybody got flooded. Everybody’s low on food.
Hospice is a little bit different, but there’s sort of a camaraderie, especially in the inpatient unit, with the other families there and the staff that we have taken under wings in that capacity.
Do you think that there are aspects of the health care system that need to improve in terms of preparedness for pandemic-level events?
I think there are. When COVID was really raging about two years ago, I asked my commander, “We’ve responded to COVID. We’ve responded to hurricanes. Has anybody given any thought to how we respond to a major hurricane with COVID?”
And the response was, “No, I don’t think so.”
We were lucky that year. We didn’t have any bad hurricanes that hit the United States. But if we had something like a [Hurricane] Katrina or [Hurricane] Michael, things would have really been bad, with so many people in shelters.
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