New Jersey Health Commissioner Dr. Shereef Elnahal will take over as president and chief executive officer of University Hospital in Newark on July 22. He recently met with the NJBIZ editorial staff to discuss the state of health care in New Jersey and his new challenge leading a major inner-city hospital.
Infectious diseases, vaccine skepticism, the opioid epidemic and maternal and infant mortality all rank near the top of Dr. Shereef Elnahal’s list of the most important health care issues facing the state.
Although neighboring New York had hundreds of measles cases this year, fortunately, New Jersey only had 22. Nevertheless, Elnahal is concerned.
“This reflects a really disturbing trend that we are seeing, which is the traction that the anti-vaccination movement has been making in convincing more and more folks to not get basic preventive health care.”
Elnahal pointed out that vaccines lower health care costs and are effective in preventing disease and hospitalization as well as complications from diseases.
He said that when these diseases also seep into health care facilities they pose a major risk to health care workers.
Vaccine-preventable diseases, Elnahal said, can easily spread throughout health care facilities where many patients have compromised immune systems.
“There was a devastating outbreak at Wanaque that killed 11 children, dozens were sick and there was an outbreak at University Hospital and there are hundreds of outbreaks at long-term care facilities every year,” he said. “I’m excited about legislation that we’ve been working on directly with the Legislature, one of which that would require outbreak plans that would take care of ventilator patients.”
Elnahal said that doubling down on vaccination, making sure that not just nursing homes and long-term care facilities, but that all health care institutions are equipped with good plans for outbreaks and infection disease control were among the paramount issues for him as commissioner.
“It’s an emergency in New Jersey.” That’s how Elnahal described the opioid problem.
“We had over 3,000 deaths last year, we have over 800 deaths and counting this year. The attack that the Murphy administration is pushing forward on for this epidemic is really significant.”
In two years, the state committed to spend $100 million in fighting the epidemic. Elnahal said the critical weapons in that battle include access to evidence-based treatment and not just hospitalization and consulting, but actually using medicines to get people into recovery more quickly.
“We are doing that through as much provider education as possible,” he said.
Elnahal said that there is preliminary evidence showing that individuals on medical marijuana in conjunction with evidence-based therapy can get into recovery more quickly.
“We have added opioid use disorder to the list of conditions for medical marijuana. Folks have to be on one of the medical assisted treatment regimens in order to get medical marijuana,” he noted.
The outgoing commissioner said the Department of Health has been working with law enforcement, particularly the Attorney General’s office, on making sure that they are finding supplies of illegal opioids as quickly and effectively as possible and preventing them from coming into the state.
“Whenever there is a bad supply that has this really potent type of opioids – the attorney general calls me and we get the messaging out from a public health standpoint to all of our stakeholders as quickly as possible. That has been a really effective partnership.”
He said the department is seeing more and more heroin being cut with fentanyl.
“Fentanyl is the reason why even though we see a drastic reduction in prescriptions – 75 percent of those addicted start with a prescription – even though we are seeing that reduction – the deaths have not gone down.”
He said there is a higher rate of overdoses and deaths with fentanyl because it is hundreds of times more potent than heroin.
I think University Hospital will be an amazing place to take what I’ve learned and apply it to Newark. I have to fix the financial situation at the hospital. I wouldn’t be a responsible CEO if I didn’t.
– Dr. Shereef Elnahal
Another piece of the problem is addressing the social determinants, the factors that cause relapse more quickly for people who are on opioids.
“That means access to housing, access to employment opportunities. The Division of Mental Health and Addiction Services has really been the key in stemming the tide on that as well as the Department of Labor. We are bringing in agencies that haven’t been as invested, they are really invested now,” Elnahal said.
From the Department of Health’s standpoint Elnahal said harm reduction, making sure that folks who are using drugs are minimized in terms of public health risks, is vital.
“The risk of HIV transmission and Hep C exists when people re-use needles. There are places where people can go, seven now in New Jersey to exchange dirty needles with clean needles. They take back the dirty needles so they don’t end up on the street.”
Elnahal said that hospitals need more help in addressing the opioid crisis.
Hospital emergency rooms, for example, can be more prepared by bringing more medication assisted treatments (MAT) into the ER. MATs have a unique mechanism of action it binds to the same receptors as opioids – it blocks them and prevents withdrawal.
Elnahal said that he was pleased with two recent initiatives.
The first is when pharmacies around New Jersey recently gave out more than 16,000 free packs of Narcan/naloxone under a Department of Human Services program. The other was when paramedics were authorized by the Health Department to carry buprenorphine to treat acute withdrawal symptoms after patients have been revived from an opioid overdose with naloxone, the opioid overdose reversal drug.
In regard to medical marijuana, Elnahal said that the main way that medical marijuana can be helpful in the opioid epidemic is that it is an effective replacement for opioids when treating pain. He cited data from clinical trials indicating a statistically significant benefit in pain control compared to other options.
Maternal and infant health
“In terms of the rate of women dying within the first year after birth, maternal mortality, we rank 45 out of 50 in the wrong direction,” Elnahal noted. “Multiply that rate for the general population times five that is the rate that black women experience in New Jersey. Black infant mortality is four times the rate of general population.”
Elnahal said that the disparities are inexcusable and that First Lady Tammy Murphy has been leading efforts on this issue with campaign Nurture New Jersey that will release a strategic plan later in the summer.
When asked about how recent hospital mergers and consolidations affect patients Elnahal said patients benefit when care is coordinated and when a network of services that meets their clinical needs is available.
“The way you can accomplish that is through multiple avenues. Consolidation is one – bringing in all the services into one entity allows you to coordinate care better.”
But to do that Elnahal said health care facilities must operate in a system or through business arrangements; for instance, a standalone hospital with a partner.
He added that the key is effectively navigating through care quickly and having a suite of services available to patients under the same roof with a design that is patient-focused.
Health care report card
Despite the problems, Elnahal said, New Jersey has one of the best health care systems in the country.
“In terms of advanced care up to levels of advanced tertiary care – the most complex procedures and services, but also the quality of our health care teams and physicians in the upstream – more preventative types of care, all of that is stellar.”
Nonetheless, some shortcomings remain. “The issue is our health care system has had a trouble penetrating communities of low social economic status and communities of color. That is why we have seen the disparities that we have seen. That is why I have focused so much of my time knowing that that was the big gap that I noticed in trying to change that. That’s why our Healthy Women Healthy Families program comes in.”
What will Elnahal miss most about leaving his commissioner’s post?
“I’ll miss the clear front and center social mission. We are there, the state is there, the governor’s there. I have been there for the residents. That has been the one thing that guided my decision-making.”
He said he didn’t come into the job as health commissioner with loyalties of any kind to any stakeholder in New Jersey other than “the mission.”
“I think that’s one of the reasons why the governor chose me for the job. I am New Jersey raised. I’ll probably miss that the most.”
“I think University Hospital will be an amazing place to take what I’ve learned and apply it to Newark,” Elnahal said. “I have to fix the financial situation at the hospital. I wouldn’t be a responsible CEO if I didn’t.”
Elnahal said the key to doing that will be taking the population health needs and figuring out a way to deliver those services effectively. The result must include a new model of care.
“That means bringing people into preventive, outpatient-based care, working with payers to compensate the care that that city needs. It will be difficult but achievable.”
The staff at that hospital is on board with this approach, Elnahal said.
“They know that the model of care needs to change and evolve into a value based one and all stake holders need to be brought on board. I really can’t wait to do that.”