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Ingenuity and courage of DHR Health physicians, nurses, and staff, along with vital community support, helped overcome “uncertainty” and “fear of the unknown”, during the beginning of COVID-19 in the Valley and nation, reflects a top medical leader - Titans of the Texas Legislature

Featured, from left: Maritza Padilla, Vice President, Rehabilitation Services, DHR Health; Saroja Viswamitra, MD, DHR Health Rehabilitation Hospital; and Robert D. Martínez, MD, Chief Medical Officer, Chief Physician Executive, DHR Health. This image was taken on Thursday, September 26, 2019, immediately following the news conference and grand opening for the DHR Health Aquatic Therapy Institute, located at 2001 South Cynthia Street, Suite E, McAllen.

Photograph Courtesy DHR HEALTH

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Ingenuity and courage of DHR Health physicians, nurses, and staff, along with vital community support, helped overcome “uncertainty” and “fear of the unknown”, during beginning of COVID-19 in the Valley and nation, reflects top medical leader

By DAVID A. DÍAZ
[email protected]

Ingenuity and courage of DHR Health physicians, nurses, and staff, along with vital community support, helped overcome “uncertainty” and “fear of the unknown”, during the beginning of the COVID-19 pandemic in the U.S., according to Robert David Martínez, MD, Chief Physician Executive and Chief Medical Officer for DHR Health.

Martínez, who is from Mission, also serves as Senior Executive Vice President of DHR Health.

“Looking back now, it’s been a couple of months since we’ve been preparing. I think we’re doing very well considering there was a lot of uncertainty to begin with, as everybody had. It’s just the fear of the unknown more of anything else,” said Martínez. “Our team has stepped up in a big way, in many more ways that I would have thought possible. I think we’re doing relatively well. I think there’s still some fear of the unknown, which is unpredictable, but you work on contingency plans and hope for the best.”

A disease can be declared an epidemic when it spreads over a wide area and many individuals are taken ill at the same time. If the spread escalates further, an epidemic can become a pandemic, which affects an even wider geographical area and a significant portion of the population becomes affected.

(https://www.merriam-webster.com/words-at-play/epidemic-vs-pandemic-difference)

Martínez, whose extensive credentials include his current service on the Texas Medical Board – a state agency whose responsibilities include regulating the practice of medicine – recently shared some of the key behind-the-scenes developments that took place early on at DHR Health as part of the hospital system’s responses to the COVID-19 pandemic. 

His perspectives were featured in a recent and detailed broadcast interview with Steve Taylor, Editor-in-Chief for the Rio Grande Guardian

The Rio Grande Guardian “is the first online newspaper to launch on the South Texas border, starting out in July, 2005. It is still the market leader, setting the pace and breaking news often before traditional media outlets,” according to its website.(https://riograndeguardian.com)

Martínez has previous experiences in dealing with the dangers of epidemics, such as emergency response situations involving Ebola Virus Disease and H1N1. 

Ebola Virus Disease is a rare but deadly virus that causes fever, body aches, and diarrhea, and sometimes bleeding inside and outside the body. H1N1 is a predominately respiratory illness which feels like regular flu, but few people have any immunity to it.

“What made this one (COVID-19) different was the fear of the unknown and the rapid onset of what was going on, and the scare people were having because we just didn’t know. With a lot of the other stuff, it followed some simple rules. We knew from other countries what was going on. This (COVID-19) was moving so quickly that we were ending up with a lot of people very, very sick, and we didn’t know exactly how it was transmitted.” he explained. 

“We thought we knew,” he said of the initial findings the world’s most advanced nations. “What we didn’t know, for instance, was we usually see people start to get sick, then they’re very infectious. With this disease, you saw normal people walking around, testing positive with the results four to five days before, without ever getting sick, and some of them not getting sick,” he added.  “That created a whole different vectorissue for us about who can spread this to who. That was a big problem for us.”

(In medicine, a vector is a carrier of disease or of medication. – https://www.medicinenet.com/script/main/art.asp?articlekey=5968)

Martínez provided other recollections on how DHR Health’s leadership and personnel first dealt with the pandemic here at home, including taking the following decisive actions:

• Overcameglobal misconceptions about COVID-19 caused by the lack of information and understanding worldwide during the beginning of the pandemic, which began to take a national profile in the U.S. in March 2020;

• Established emergency protocols (official procedures) to meet the requirements by local, state and national leaders, such as putting into action an Incident Command. An Incident Command is designed to manage emergencies of all sizes and types during catastrophic events;

• Set up a team of up to 20 physicians and specialists who met every morning to develop strategies and provide updates on possible and confirmed COVID-19 patients;

Created alternative plans for emergency rooms, such as setting up an off-site Serious Infectious Disease Unit, known as SIDU, to contain the spread of COVID-19. SIDU personnel separate patients suffering from COVID-19 while still providing them with specialized care;

According to a posting on DHR Health’s Facebook, first published on Friday, May 1, 2020, keeping patients and employees safe is the hospital system’s first priority. Among the key steps taken in this effort, DHR Health created an off-site Serious Infectious Disease Unit, known as SIDU, to contain the spread of COVID-19. SIDU personnel separate patients suffering from COVID-19 while still providing them with specialized care. In addition, DHR Health implements COVID-19 testing for all elective surgeries, including at its Women’s Hospital at Renaissance, where all patients are tested for COVID-19 infection when admitted for delivery or surgery;

• Anticipated the needs and established a PPE (personal protective equipment) Conservation Team to provide innovative methods to create and sustain adequate PPE in order to maintain a safe environment for their patients, workforce and community during COVID-19 pandemic. Personal Protective Equipment, or PPE, refers to protective clothing, helmets, gloves, face shields, goggles, face masks and/or respirators or other equipment designed to protect the user from injury or the spread of infection or illness. When used properly, PPE acts as a barrier between infectious materials such as viral and bacterial contaminants and an individual’s skin, mouth, nose, or eyes; and

• Established a “Mini-Mart” grocery store at three DHR Health sites for all employees so they could purchase – at the prices paid by the hospital system – key groceries and supplies, rather than have their workforce have to wait in long lines at area grocery stores.

So far, he said, the Rio Grande Valley has been more fortunate that other regions of Texas and the nation during the ongoing COVID-19 pandemic, noting that the nearest U.S. metropolitan centers – San Antonio and Houston – are hundreds of miles away.

“We were lucky. For the first time in a while, the physical separation between us and another big city helped us a little bit, delayed some of these issues. Let’s be smart about it, let’s continue with that posture,” Martínez said.

“We need to be as vigilant as ever right now, if anything,” he emphasized. “The state and the county governments also need to remind people that we need to be six feet apart. Social distancing needs to continue. You don’t need to be huddled up. Don’t be huddled up, take meetings over calls, and wear your masks and your gloves. Please continue with the safety precautions that we’ve got in place.”

On Sunday, May 24, 2020, DHR Health announced several key updates on its services and activities.

DHR Health is resuming elective surgeries. As a reminder, DHR Health Main Campus, Specialty Clinics and Hospitals, Emergency Rooms and Urgent Cares remain open. DHR Health officials are reminding patients and the general public of the following safety measures DHR Health has put in place to safeguard patients, visitors, and employees:

• Everyone inside DHR Health facilities is required to wear a face mask;

• DHR Health is following social distancing guidelines by having people stay six feet apart from one another as per the CDC (Centers for Disease Control and Prevention –https://www.cdc.gov);

• Surgical patients can be accompanied by one guest for consign purposes only, prior to their operation;

• DHR Health will provide COVID-19 testing to all surgical patients prior to their operation to ensure a safe environment of care is being maintained;

• Pediatric, laboring mothers, and specialty clinics are permitted one visitor per day. No other visitors will be allowed;

• All visitors will be screened for COVID-19 symptoms and asked about recent travel;

• All employees are screened daily and checked for symptoms of COVID-19;

• All healthcare workers are provide appropriate Personal Protective Equipment (PPE); 

• The Emergency Room Extension minimizes unnecessary exposure; and

• Positive COVID-19 patients are triaged and cared for at the Serious Infectious Disease Unit (SIDU), the separate off-site facility. (In the emergency department “triage” refers to the methods used to assess patients’ severity of injury or illness within a short time after their arrival, assign priorities, and transfer each patient to the appropriate place for treatment.)

Anchored in southwest Edinburg, with a growing presence in neighboring McAllen, DHR Health offers some of the most comprehensive medical care on the U.S. southern border, with more than 1,400 nurses and 600+ physicians providing care in 70+ specialties and sub-specialties.

DHR Health is the flagship teaching hospital for the UTRGV School of Medicine and encompasses a general acute hospital with the only dedicated women’s hospital South of San Antonio, a rehabilitation hospital, a behavioral hospital, more than 60 clinics Valley-wide, advanced cancer services, the only transplant program in the Rio Grande Valley – and the only functioning 24/7 Level 1 Trauma Center south of San Antonio.

DHR Health is headquartered on a 130-acre site, with most of the facilities in southwest Edinburg but with a growing South Campus immediately across Owassa Road in northwest McAllen.

Also according to the Texas Medical Board: 

Martínez is a member of the Texas Medical Association, American Medical Association, and multiple community organizations. He has served as Co-Chair of the Ryan Gibson Leukemia Advocate and Research Group, member of the Texas Alzheimer’s Association and the Texas Workforce Solutions Board of Directors. 

Martínez received a Bachelor of Arts in Psychology and Biology from the Southern Methodist University and a Doctor of Medicine from The University of Texas Medical Branch in Galveston, where he also completed his internal medicine residency.

The Texas Medical Board consists of 12 physician members and seven public members appointed for six-year terms by the governor and confirmed by the Senate. The full Board convenes five times a year. 

Typical Board business includes interviewing licensure candidates, considering disciplinary matters, and adopting substantive and procedural rules.

The Board has a variety of duties mandated by state statute, including: regulating the practice of medicine in Texas through registration of physicians; determining a physician’s eligibility for licensure; conducting investigations based on complaints filed against physicians; and exercising authority to cancel, revoke, suspend, or otherwise limit the license of any physician upon proof of violation of the Texas Occupations Code (the Medical Practice Act) and/or the Board’s rules.

The transcription of that video interview, featured by the Rio Grande Guardian and titled “Watch: How DHR Health has coped with COVID-19”, and which has been edited for grammar and content, follows:

Steve Taylor
Editor-In-Chief
Rio Grande Guardian

Welcome back, Rio Grande Guardian viewers. So pleased to have another in our Community Spotlight series. This time we are with Dr. Robert D. Martínez, who is the Chief Physician Executive and the Chief Medical Officer for DHR Health. Dr. Martínez, welcome.

Dr. Robert David Martínez: 

Thank you for having us here. Glad to be here.

Steve Taylor: I’m glad to have you, too. Obviously, the subject has to be COVID-19. I have some questions for you. But first of all, just as an overview, how has the hospital been coping at this time of crisis?

Dr. Robert David Martínez: Looking back now, it’s been a couple of months since we’ve been preparing. I think we’re doing very well considering there was a lot of uncertainty to begin with, as everybody had. It’s just the fear of the unknown more of anything else. Our team has stepped up in a big way, in many more ways that I would have thought possible. I think we’re doing relatively well. I think there’s still some fear of the unknown, which is unpredictable, but you work on contingency plans and hope for the best.

Steve Taylor: Let’s dive into the questions we’ve prepared. What is your primary role and responsibility with DHR Health, because I understand you are part of the COVID task force and the physician task force? So, your role in that task force?

Dr. Robert David Martínez: I oversee, under the CEO (Manish Singh, MD, FSCS), all of our chief medical officers for different service lines, including cardiology, cardiac services, women’s services, main hospital. That’s an overall role of the system, and I have a pretty big role with the clinics as well. The Renaissance Medical Foundation has a significant number of physicians, probably right now a little more than 200 specialty positions that I help oversee as well. Primarily during this time, as soon as we had to establish the emergencyprotocols (official procedures), at the national, state, and local levels, we also went into emergency mode, and established Incident Command, which I have been in charge from the beginning. I have been intricately involved with every second of everything here, probably for a few weeks before there was a state of emergency. So, we’ve been at it for a while, preparing as best we could, to try to be ready for what we didn’t know was coming.

Steve Taylor: You try to be ready, but I can only think that nobody could have imagined this. How can you prepare for something like this?

Dr. Robert David Martínez: You plan for worst-case scenario, with what you’ve got, and try to make contingency plans, and hopefully have the right people in place, which luckily I think we did, including some of the folks that you talked about – the physician task force, which included a good number of physicians in multiple specialties, including surgery, infectious disease, pulmonary critical care docs (doctors), and of course, community docs, to engage every day, multiple times a day, about:

“Should we change course?”
“This is what we’re seeing.”
“This is what we’re doing.”
“This is where we are going to put these patients, this is where we’re not.” 

Alternative plans for emergency rooms, our ability to flex, making sure the nursing staff was capable and felt capable, they had everything they needed, certainly, with the challenges with PPE (Personal Protective Equipment) in particular, with a lot of information that was going back and forth at the state and federal level, including the CDC. There was some learning curve there, no doubt. 

((Personal Protective Equipment, or PPE, refers to protective clothing, helmets, gloves, face shields, goggles, face masks and/or respirators or other equipment designed to protect the user from injury or the spread of infection or illness. When used properly, PPE acts as a barrier between infectious materials such as viral and bacterial contaminants and an individual’s skin, mouth, nose, or eyes.)

Some of our biggest struggles were making sure that everybody understood what was necessary and what was not, and that we were going to do everything possible to make sure they felt safe taking care of patients.

Steve Taylor: That was going to be one of my questions – PPE – because we’ve all heard about this national shortage. How did that impact you, what was DHR’s response there?

Dr. Robert David Martínez: It was significant. That was probably my biggest headache to begin with, because there was a lot of misconception at the beginning. As we were getting information on what we thought how this virus was spreading, how it was not, what the dangers were, or precautions that were necessary, and therefore what equipment was necessary to appropriately manage these patients. A lot of the confusion revolved around fear. 

People are used to thinking the more the merrier, and/or the bigger, better mask you have, the better you’re off, which was not necessarily the case. We learned some things here and there, but everybody in the country was learning at one time, together, about how these things were moving forward, especially because we didn’t have a lot of case reports in the United States about what was occurring. We started to learn some things about the way things were helping and not helping in Washington (State) and New York and Los Angeles. We started to learn some things about how to treat these cases a little better, how to prepare our staff and make them feel comfortable about taking care of some folks, and how to really keep everybody as safe as possible.

Steve Taylor: Something I’ve heard about at DHR Health is this PPE Conservation Team. Tell us about that. Why was it created, and what does it consist of?

(DHR Health anticipated the needs and established a PPE Conservation Team to provide innovative methods to create and sustain adequate PPE in order to maintain a safe environment for their patients, workforce and community during this pandemic. As of Thursday, April 30, 2020, the DHR Health PPE Conservation Team had innovatively developed the following: 16,500 surgical masks; 300 intubation drapes; and 275 face shields. – https://dhrhealth.com/patients-and-visitors/coronavirus-advisory)

Dr. Robert David Martínez: One of the most satisfying portions of my job has been is to see that through. If your staff or your people who work for you, including the physicians and providers, don’t feel comfortable, I can tell you – and it’s not just here, obviously – probably the last thing on their mind is going to be taking care of a patient. This is the way I approach my staff, to tell them how important it was to make sure our staff felt comfortable with PPE and everything else. If I come in as a patient, they are not going to be worried about me if they don’t feel safe, they are going to be worried about them being safe. It’s just natural and fear occurs. 

We quickly got teams together and discussed how we could do things. I told somebody it didn’t matter how much money you have, the federal government can buy supplies, and they couldn’t get them. Eighty percent of the raw goods were coming from China, and their factories were off-line. You weren’t getting anything, unless you had a store somewhere, a big store. You couldn’t buy it fast enough. We started two weeks before and got some, but still our allocations were months away. They were being taken away by the federal government, literally, at the ports. It didn’t matter what I ordered, if they (federal government) wanted it, they were being sent to the hot spots. My fear was the RGV is not going to become a hot spot ever because there will always going to be a bigger place that’s on fire more than it is here. 

Whether it’s testing or PPE, we needed to start making some noise, and we need to start looking at other alternatives. Some of the those alternatives included, “How about cloth?” People used to wear cloth in scrubs, whether is was dresses or whatever for females. So we started looking at those alternatives. 

Obviously, they need to have certain characteristics – be non-penetrable in the operating room. They need to be able to get a hold of fabric, and by the way, somebody needed to make those things. We also started looking at masks the same way. 

We had some very creative folks with a lot of good skill sets, including sewing and making things. As our volume (of patients) started to dry up here, and it occurred everywhere else, probably by 90 percent because non-emergent (not an emergency)cases were not being allowed forward. There were a lot of people and staff who were in danger of being displaced or didn’t have their regular job to do. We asked for volunteers who had particular skill sets, and there were a lot of folks who were able to help us with this. 

We created a team of people with skills to sew and put things together. We had meetings about what materials, what strength, barriers, for respiratory issues, and quickly also started to use some things in the operating room that were actually of higher grade, in some instances, or filters for face masks. It came together really quick, it was pretty amazing. This is one of the first masks that we made with filters in it. You can see they even put our (DHR Health) logo on it. I have the first mask they made. Filters from operating room materials. Every day they did better and better and better, and the output became 1,500 masks a day or something like that, with sewing machines. 

We’re really proud of our (Edinburg) Conference Center (at Renaissance).

(https://www.facebook.com/MeetYouHere/)

We shut it down and turned it into a storage department, and there were folks spaced apart, but we have a ton of sewing machines. I guess not a lot of people wanted sewing machines during this time, so we were able to get some sewing machines and go at it. We have a lot of people making this stuff every day that really allowed us to get to another level – at a level that was not being dependent on the problems around us. 

Steve Taylor: Having heard that, I think it’s fair to say we can now expect a new company – instead of DHR Health, we will now have “DHR Manufacturing”, yes?

Dr. Robert David Martínez: I think so, I think so. That’s probably well on its way. 

Steve Taylor: You’re now into the maquila industry.

(Maquila is short for maquiladora, which is a factory in Mexico – including several hundred maquilas immediately south of the Rio Grande Valley – that operates under preferential tariff programs established and administered by the United States and Mexico.)

Dr. Robert David Martínez: Yep. I think so. I think we’re probably more efficient than they are right now.

Steve Taylor: That’s right, and you don’t have to worry about getting stuff across the bridge.

Dr. Robert David Martínez: That was the other good thing. We have a lot of vendors locally that had fabrics and other things, (and) their business was slowed down, too. When we reached out to them to help us with these, they were really helpful in telling us about different grades, availability of different fabrics, stitching, and different things. So we were able to harness that local energy and ingenuity, and help the community as well. It was really a community effort, after it was thought about by some of our folks.

Steve Taylor: Was all of this brand new? Had you done any of this before, or you just hadn’t needed to, so it’s as just started?

Dr. Robert David Martínez: Emergency responses, I’ve been around for a lot of them, I’ve run a lot of them, including Ebola (https://www.cdc.gov/vhf/ebola/index.htmlandH1N1 (https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html)

What made this one different was the fear of the unknown and the rapid onset of what was going on, and the scare people were having because we just didn’t know. With a lot of the other stuff, it followed some simple rules. We knew from other countries what was going on. This (COVID-19) was moving so quickly that we were ending up with a lot of people very, very sick, and we didn’t know exactly how it was transmitted. We thought we knew. What we didn’t know, for instance, was, we usually see people start to get sick, then they’re very infectious. With this disease, you saw normal people walking around, testing positive with the results four to five days before, without ever getting sick, and some of them not getting sick. That created a whole different vector issue for us about who can spread this to who. That was a big problem for us. 

Then you start having to limit people coming in, you just don’t know, you can’t tell. Whereas before, most of the time, you can tell who’s got something and who doesn’t, or who might pose a risk – they’re coughing, they have a fever. This was completely different, and we were learning about it, and trying to make decisions about it, and everybody was just kind of scared. The scale at which we saw was significantly worse because for the first time in a long time, it came to our hospital. 

If you needed a mask, if you needed a gown, you just reached for it, and picked up 10 masks and take them. Nobody would notice, nobody cared. I put them under lock-and-key two weeks before. I said these masks can only be released by this particular person, it has to be documented who took it, who picked it up, and what were they using it for, literally to that level. We were down to 200 masks at one point – N95s – and for an operation as big as this, you can imagine that is a significant issue.(https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html)

Those kinds of problems we had never seen. People were just reaching into wherever they wanted, and getting all the supplies they needed. That was not the case in this situation, and that’s what made things very, very different. Spoiled in getting what we needed before, and now that scarcity really changed things. That’s what created the biggest fear.

Steve Taylor: You mentioned earlier there are obviously much hotter hot spots than the Rio Grande Valley for this pandemic. We have been very fortunate. We have had deaths, we have had some cases, but compared to other parts of the country, that hasn’t been the case. A lot of kudos (credit) are going to our elected officials, the leaders who locked down things very early. That said, what sort of volume have you had, how many cases of folks have come to you saying, “I fear I’ve got this disease”?

Dr. Robert David Martínez: I think early on we saw a lot of fear, bringing the cases into the emergency room, so much so that we had to establish an off-site emergency room to separate any patient with any respiratory symptom. 

Looking back, that was also much better, if not for the psyche of our group of physicians, nurses and caretakers, because at least they knew, as best possible, we were trying our best to separate those two groups. There was just a lot we didn’t know. 

The volume was pretty significant. We were probably seeing in that extended emergency room (Serious Infectious Disease Unit) 30 or 40 patients a day, which is a good amount when you consider our (main) Emergency Room can see anywhere from 120 to 160 patients a day. These were just patients who were coming in with non-life threatening respiratory illnesses. The patients who were still very sick and short of breath and with chest pains still went to the main ER as a precaution. But talking about flu-like symptoms, like fever, those kinds of things, up to 40 to 50 a day, at the extended ER (Infectious Disease Unit).

Early on, the testing was an issue also. Not everybody who came in got a test, by any means. I was on the phone with every test that went out, essentially. Many, many, many, many sleepless nights, because we were trying to screen, again, does this patient really pose a risk? Is there a reason to be testing this patient? Are we okay to send this patient home and isolate and monitor, and contact the (Hidalgo) County (Health Department)? This case is good enough that we need to worry about this patient, we need to test them, and we need to put them in here, or there, they are at risk of literally crashing? 

The other thing that made this especially scary, we were finding patients that within 12 hours, and we had one early on. A young patient, from what we knew initially, in her 30s, if not late 20s, relatively-well, a little bit of chronic illnesses as a child, just crash in front of us within a 10-hour period. Go from walking in, breathing a little heavy, maybe, to being intubated, non-responsive. I’m glad to say that young lady walked out of here, in a wheelchair but on her own full-power, about two-and-a-half to three weeks after. She was actually probably the first successfully-treated patient in the Valley who was intubated and in an ICU. Doing well. She was our first big one. She did well. She did well.

That kind of progression quickly doesn’t normally happen, and that was the other scary part. Different than the flu or something else where you can expect a certain timeline to play out, you didn’t know whether sending this patent home would mean they would die at home. So you have to be very careful about who you pick, who you didn’t pick. Multiple doctors it involved saying “Test.” “Not test.” “Watch carefully.” “I don’t think this is an issue.” “I think this patient is a significant risk.” I think our medical staff, including all our doctors, especially did a great job maneuvering that, but there was literally a test that went out was screened by, and okayed by me. 

Steve Taylor: How did you go about protecting your employees and other patients who don’t have COVID-19? It sounds as though you came up with a different location.

Dr. Robert David Martínez: Yes, early on, we said, again, the biggest fear is that the patients and the staff were nervous, the staff not knowing, and how can we minimize that, because looking at somebody, they don’t look ill. But they may be ill. Just taking every bit of information that we knew, saying, “That’s a possible, put them over there. That’s probably not possible, put them over here.” 

That little separation really did a lot of good in making us feel confident that we were doing everything possible. You knew that if you were separated over there, you had to be taking 150 percent precaution for those patients, and not that you were forgetting about the other subgroup, but these were way more likely. Just another area of focus. I think that helped staff focus and allay some fears early on. We did that at multiple levels, including in the ICUs (Intensive Care Units), when we had suspected cases. 

(Intensive care refers to the specialized treatment given to patients who are acutely unwell and require critical medical care. An intensive care unit (ICU) provides the critical care and life support for acutely ill and injured patients.https://pubmed.ncbi.nlm.nih.gov/27612678/)

We were waiting seven to 10 days for results to come back – put those patients somewhere they weren’t stable enough to go. We even took some of our ICUs out of circulation and made those cohorts (people treated as a group) of either patients under suspicion or positive COVID patients, and separated those again. It just minimizes when you do that, you cohort those patients, whichever one it may be. The nurses get to concentrate, and you’re also minimizing the number of people coming in. So you have a certain group of nurses who works in this spot that are always going to be coming back and forth, not a different group of nurses every day. That minimizes the chance of infection as well. So early on, cohort not only the patients, we cohort nurses, we cohort physicians, we did all of those things to really try to minimize exposure numbers.I think those thingshelped a lot to try to minimize those things.

(In general, a cohort is defined as a group of people banded together or treated as a group.)

Steve Taylor: So, God forbid, we get that second wave that everyone’s taking about, but it’s possible. People are saying it could flare up again in the Fall (2020) with the flu season as well, but all of these best practices you’ve put in place, you’ve learned as a hospital, as a health system, the new protocols for future emergencies.

Dr. Robert David Martínez: Invaluable lessons. Fear does a lot of things, it’s the best motivator, probably. In retrospect, we learned what we didn’t know, and what we did well, where we were right. I think a multi-collaborative effort was the most important thing for us. We met every day, in person, a group of private physicians, 7 o’clock in the morning, maybe 20 of us, discussing everything that happened the night before. Then we’d meet again throughout the day in the Incident Command, report every day. Things were changing by the hour. That helps, especially when we didn’t have the testing here and I wasn’t able to turn around that test result for seven to 10 days. That was what was going on most of the time. Thinking back, that was significant. We were making a lot of treatment decisions with a lot of call backs to patients to make sure they were okay. The (Hidalgo) County (Health Department) was involved in helping us with that also because that had to be coordinated with their resources. 

The other thing was when we started to get testing back within 48 hours, that helped a little bit. That also minimized our time involved, and actually helped our capacity. You can imagine if my beds are out of the rotation for seven to 10 days because I’m waiting for a test, that bogs me down really fast, when you consider the average length of stay is anywhere from three to four days, depending on the kind of patient. That was the other important information I tried to give to the federal authorities and the state authorities, and I said, “Listen, it’s one thing is that South Texas is separated from everyone else, but if I don’t get some tests down here because I’m never going to be a hot spot, you’re talking about my bed capacity going from whatever it is – 1,000 beds to 400 to 500 beds –  because I can’t move these patients. They’re sick enough, I don’t know they’re not safe to send out, and I’m waiting for a test. You can imagine where a two-hour rapid test versus a seven-day send-out test could make all the difference in a health system being overwhelmed quickly. 

I made that argument to multiple officials, who luckily helped to step in at some point. We also have good relationships with our vendors, but I think they didn’t see it from that perspective. You heard the governor  speak every day about capacity, capacity, capacity. I started to think, they’re worried about capacity, they better give me some tests. Seven to 10 days is not acceptable for capacity. Should we get in an overwhelming situation, you’re going to have real problems. That point got across eventually and helped us cope. Luckily, that mess never came. Hopefully, it won’t come. Certainly, those were learning experiences on testing and coordination, and making sure the people who needed them get them. We’re not a screening center. We take care of sick patients here, that’s what we want to know of. We keep people from dying. Screening is somebody else’s issue right now. We have to do with what we’ve got. Those lessons learned were significant.

Steve Taylor: Thank you for that. My last question for you is I heard you started a grocery Mini Mart on your premises. What was that about?

(According to a DHR Health news release on Wednesday, April 22, 2020, DHR Health opened up grocery Mini Marts around their campus in order for essential employees to get the items they need. Some of the items being offered at the mini marts include: egg; milk; butter; cold cuts; oatmeal; pancake mix; produce; paper towels; toilet paper; cereal; granola bars; peanut butter; grape jelly; bread; pasta; and bottled water. In addition to the items being offered, DHR Health Mini Marts are offering three Grocery Kits that include assorted items. The Mini Marts were set up at a few locations on the DHR Health campus in order for employees to get the groceries they need. The locations include: DHR Health Women’s Hospital Cafeteria; DHR Health Main Hospital Cafeteria; and Edinburg Conference Center at Renaissance. Employees can simply fill out a form to pre-order their groceries needed and have access to the items via pickup and at one location curbside by the next day. DHR Mini Marts are open on weekdays from 8 am – 8 pm and available to all DHR Health staff.)

Dr. Robert David Martínez: I don’t think I’ll be competing with H-E-B anytime soon. I think that was a great idea. We started to see our employees work tirelessly day-in, day-out, challenging enough to come to an environment like a hospital and deal with what you don’t know about, or what you do, or what could kill you. Different from what we had done before.  

Going to the grocery story was a chore. They weren’t open. They were out of supplies. People were tired, they wanted to get home. They didn’t want to go for two or three hours before work or after work. A couple of our executives, Susan Turley (President, DHR Health) and Marissa Castañeda(Senior Executive Vice President) came up with the fabulous idea. Why don’t we talk to some of our vendors, let’s try to do something for our employees here to make it easy for them to get what they need to feed their family, one less thing that they have to worry about. It was a hit from the beginning. The first day it was open, my phone was bombarded with when and why and how. They’ve done a really good job. Those little things have been probably some of the biggest help for our employees because it’s another thing they don’t have to worry about. We sell it to them at whatever the cost is, it’s easy for them to pick up, its curbside (service). We also learned some thing from H-E-B, and it was curbside. I have to take my hat off to a lot of the vendors, including H-E-B, and a lot of other local businesses –  Sweet and Tasty, one of my favorites. They went above and beyond, bringing food and supplies to our people, who were working day and night here. 

Our community stepped up before like I’ve never seen before. Being from the community, I was born and raised here, it was a big satisfaction point for me to see and interact with these people and just how giving they are at a time, it was so uncertain for everybody else, on a large scale, they helped with that.

Steve Taylor: That’s the Rio Grande Valley for you, though.

Dr. Robert David Martínez: It is. It is. It is. I agree. I agree.

Steve Taylor: Those are all the questions I have, Dr. Martínez. Is there anything else we’ve missed, anything else you’d like to get across to the viewers?

Dr. Robert David Martínez: Most important, and I’m not wearing one (face mask) now because we’re one-on-one (in separate locations), on the air. But people need to be vigilant, they need to continue vigilance.

Hospitals – we have policies here, telling people all the time, you need to be wearing masks, you need to be wearing gloves. Nothing has changed for us. Our posture has not changed. We need to be as vigilant as ever right now, if anything. The state and the county governments also need to remind people that we need to be six feet apart. Social distancing needs to continue. You don’t need to be huddled up. Don’t be huddled up, take meetings over calls, and wear your masks and your gloves. Please continue with the safety precautions that we’ve got in place.

The recommendation is, and the requirement still in this hospital is that you are wearing a mask when you are in close proximity to somebody else, that you are six feet apart. Those are some of my biggest things right now. Let’s continue that posture. Let’s be smart. We were lucky. For the first time in a while, the physical separation between us and another big city helped us a little bit, delayed some of these issues. Let’s be smart about it, let’s continue with that posture and smart thinking.

Steve Taylor: Really important points there to end with, for sure, Dr. Martínez, because none of us can let our guard down now. Thank you. I going to make that do for now because I know you’re super busy. Dr. Robert D. Martínez, Chief Physician Executive, Chief Medical Officer, DHR Health, thank you so much for today’s interview, and stay safe.

Dr. Robert David Martínez: Thank you, Appreciate it. Take care, Steve.

The Rio Grande Guardian’s video interview with Martínez, which first went online on Sunday, May 10, 2020, is available online at:

(https://riograndeguardian.com/watch-how-dhr-health-has-coped-with-covid-19/)
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R-Myna Evans contributed to this article. For more information, please contact Roberto Haddad, Vice President and Counsel for Government Affairs and Policy at DHR Health, or Jesse Ozuna, Government Affairs Officer at DHR Health, at 956/362-7165.  For more on this and other Texas legislative news stories that affect the Rio Grande Valley metropolitan region, please log on to Titans of the Texas Legislature  (TitansoftheTexasLegislature.com).

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