Great Colorado Women

Patty's story is so important not only in the health care space But for the city of Denver, the state of Colorado, and for women leaders She had this Very strong loyalty to the vulnerable populations that exist in our city that she felt needed health care Denver Health wouldn't be what it is today without the leadership of Patty Gabow As strong and enduring as the Rocky Mountains, they stood beside, as visionary as the views of the grand plains they looked across.

The women inducted into the Colorado Women's Hall of fame are trailblazers, whose work has improved and enriched our lives.

They are teachers, scientists, ranchers, leaders in business, education, religion, and the arts.

Women who have been recognized for their many contributions to our state our country, and the world.

I'm Reynelda Muse, and these are the stories of Great Colorado Women.

In life, there are so many people that have done so many great things that we don't know.

Patty Gabow was a Credit to physicians.

She was a credit to women, and she was also a credit to those individuals that gave their career too city service She excelled as a clinician.

She excelled as a teacher.

She excelled as an investigator.

This is what we call a triple threat And to add to that, she excelled as an administrator The people I worked with at Denver Health, these were extraordinary people that were committed to doing good in the world the doctors we hired weren't there to make a fortune.

Neither were the nurses or the technicians We were all in this together.

We were one family trying to do good for this community.

Because she was a medical doctor, because she was the chief medical officer, she really understood all the component parts of effective care, and of caring care, and those things were very important to her.

many people Want serve the poor Serve everyone without regard to their income status or their immigration status or their age or their color or ethnicity She saw the plight of these vulnerable people, and she said, I'm going to improve that That's what Denver General Hospital is about Patty Gabow helped define the Denver General Hospital as a place to get good health care The biggest step she took us through, and this was huge, was reorganizing us out from under city government into a freestanding public health authority.

When she took over, they were $35 million in the hole She slowly chipped away at that, and we became Profitable she adopted these approaches to waste reduction as the management approach And showed that you could remove waste from health care and improve the circumstances of the people you're serving We showed that you can take care of poor people, be in the black, and do care that's better than the care that's given by academic health centers in the United States.

We did that.

I grew up in an Italian Catholic family in rural Pennsylvania My grandfather had a saying, he had many sayings But one of them was if you get an education in America, there isn't anything you can't do I loved learning the two schools that had the most impact on me were my college and my medical school Seton Hill College was a Catholic girls' school about 70 miles from where we lived At Seton Hill, I met a woman who really influenced my life in many ways One of the nuns on the faculty of Seton Hill, sister Florence Marie, had a PhD in biology, and would spend the summers doing research at Woods Hole in Massachusetts She took me to Woods Hole with her in the summers as her research assistant and watching this nun hike up her habits, they wore them back then, and wade into the water to collect specimens with all the men, showed me that you didn't have to change who you are to be successful, even a nun in a man's world could still be what she was and be successful.

And that was an important lesson that I learned early on Florence recommended that she go to the University of Pennsylvania Med School since it was so strong.

And that's how Patty wound up going there Penn was a very interesting place.

On one hand, it was very gracious.

On the other hand, you know, women were not totally embraced in that environment.

I was one of six women in a class of 125 at Penn and two dropped out in the first year I gravitated towards kidney disease or nephrology, really for several reasons.

One, it's very intellectually interesting The other was The only woman who I encountered was in renal, Dr.

Donna McCurdy, and she was a fabulous teacher, and I wanted to be just like her My advisor kept telling me that women had to go into anesthesia, pediatrics, or dermatology.

And I rotated through all of those and disliked every one of them And he said, well, you can't go into nephrology.

Women don't do that.

And I said, well, this woman is going to do it.

Penn had two services.

There was big open wards for the poor patients and suites that served tea at four o'clock for the rich patients.

And I always wanted to be on the wards with the poor patients I enjoyed being with them.

They had gratitude for anything you did.

for them And that experience really solidified for me that I wanted to be at a safety net institution for my career.

I really wanted to spend my career taking care of vulnerable people I think Patty was troubled by the inequities in the health care system in America She was troubled by many people not having access to care.

And as you know, Denver General and now Denver Health is considered a safety net hospital I always tell my mentees pick an institution that aligns with your values And Denver General aligned with my values.

They had an open door.

Anybody who needed them got admitted.

There were no barriers.

You could be poor.

You could not pay.

They would take care of you One of the prominent nephrologists She had been introduced to out in the West Coast Dr.

Robert Schreier was just in the process of starting the renal group at the University of Colorado.

So she applied to him to be part of the team And one day she showed up to Dr.

Schreirer's office and said that her husband got a job in Boulder, and she needed a job There was no opening available right away But he was a man of great vision And he thought, this is a special individual we should find her a place One of the reasons I was interested in the position at Denver General was not only because it was a safety net, but it was academic.

And I had a faculty appointment at the university that enabled me to continue to do research.

And I sort of got into an area of kidney research for a very unusual reason.

So there was this professor at the University of Colorado, Joe Holmes, who was the father of ultra sound This was very new science in In the 1970s.

His office was full of ultrasounds.

And the ultrasounds he looked at were of the kidney of patients with polycystic kidney disease it turns out it's the most common hereditary renal disease in the world.

12 to 15 million people have it Even though this was so common, it wasn't even mentioned in the textbooks of nephrology, not a word So she saw an opportunity to do something special.

she collected all those families studied the genetics studied their clinical manifestations And we, studying all these patients, determined that, gee, it wasn't just a kidney disease.

It affected the liver, the heart, the brain, the ovaries We identified the chromosome that the gene was on, so it made it easier to diagnose people We broke open a whole new field of nephrology that really cemented in many ways my academic reputation Renal is a very complex area.

And she just had a real proficiency in understanding it and then being able to teach about it And she taught at the medical school Students and residents rotate through various areas, like they spent some time in surgery, they spent some time in pediatrics, and they spent time in renal I would first teach them about a problem in nephrology, then I would find a real patient case that was an example of it and asked them to apply what they learned from the didactic session to how they would take care of the patient.

Well, this made this the most popular elective in the School of Medicine And I ended up turning it into my first book She actually has written over 160 articles that have been published across the world.

She's written three books.

She was so knowledgeable.

She was so committed to understanding the full component parts of healthcare Her performance was irrefutably excellent in everything that she touched.

And so the Bosses They recognized it and were always looking for talent And was ultimately promoted to the chief of Medicine Being Chief of medicine at a safety net hospital at that period of time was one of the best jobs in American medicine But The challenges were enormous because at the time Every purchase over $500 had to go through the city council.

Well, you can't buy anything in healthcare for $500.

I was trying to recruit a head of cardiology, and he wanted a $50,000 piece of equipment So I called the company and said, I need you to send this piece of equipment in $495 increments.

So they equipment arrives at the loading dock with this huge number of receipts on it from one box, and the administrator said something's fishy here and caught onto it, and Dr.

Zabarbro threatened to fire me for doing this, but he didn't.

And he went to City council and said, oh, well, this is a new chair.

She doesn't really understand the rules, but I don't advise people to do this kind of thing, but I got the head of cardiology and he was terrific Even when she was the chief of medicine, she continued to be active on the wards and attended for the residents and students and fellows Patty pushed everybody hard.

She did it with a degree of respect and connection Patty's expectations were high because, again, we're dealing with life and death.

We're dealing with critical illness, and there's no room for a casual approach, dismissive approach to that She expected you to be excellent and you to give 100%.

And so that intensity, in my opinion, is a large part of her success So after I was chief of medicine, an opportunity came up In the city's lingo, it was deputy manager of medical affairs This really meant a break from being able to teach and take care of patients and do research.

And I loved those things.

So that was hard.

But the big reason that made it hard was the CEO was someone who I shared absolutely no values with And I thought he was destroying Denver Health And so when he asked me to be his deputy That was very hard But I felt I needed to do it to help this great institution So I did it, and eventually he was dismissed At that time It was a Low point in Denver Department of Health and Hospitals history, I would say The Infrastructure was severely under capitalized.

Our information systems were very poor.

Just getting medical records in time for patient visits was a struggle for the system.

And Patty being Patty She wanted to take a leadership role in this and help turn things around Denver General was put up for sale in the Wall Street Journal in an ad Denver city government felt like we need to cut off this limb and stop the bleeding upon becoming mayor one of my first tasks was to try to bring the Denver General Budget in line because it ran a continual Deficit And I thought it was important that the hospital Continue to serve the people of Denver in order to have someone manage that, one, you have to have someone that has the respect of the medical staff.

You have to have someone that understands the financial issues associated with running a hospital, and then you have to have someone adept enough at working with a political body like the city council And it was clear that the person in charge of the healthcare functions was Dr.

Patty Gabow If you wanted excellence, you picked Patty Gabow, and I think that's why Mayor Webb built this partnership with Patty When I became CEO Denver health had a $30 million deficit The healthcare market was changing rapidly.

It was becoming competitive A lot of systems were going to managed care, HMO.

You had to have contracts with those organizations to provide care and get reimbursed under those systems.

Well, under the City and County of Denver, the contract system to get a contract signed could take up to 18 months And I just felt we couldn't succeed with all the constraints of city government like the $500 limit to go to city council like you couldn't do long-term contracts City, civil service thought a neurosurgeon should be paid the same as a pediatrician, well, try to hire a neurosurgeon for a salary of a pediatrician I told Mayor Webb Look, we can stay in the city with all these constraints, and we won't do a great job, or you can let us go and we'll be fabulous Patty and a couple of members of my staff came up with this ingenious idea that they wanted to sell me on.

It cost me some long term Friendships which is what happens when you're at the top of the ring.

Some people question your judgment or question whether this was the right direction I felt that it was.

And so we proceeded in going forward We spun a third of the budget off in order to save Denver General Hospital, create a new entity called Denver Health Authority that change alone was very, very material because the regulations and the bureaucracy of working within a city entity went away when it became A political subdivision, really, of the state.

They could be more entrepreneurial.

They could be more creative.

They could recruit different kinds of talent.

They could find different ways to raise money One of the first things we did was issue a bond.

We went to the bond market as a safety net hospital and I remember meeting with the bonds people in New York and explaining that, oh, yes, even though we took care of all these poor people and they didn't pay, we were a reliable enterprise One of the other great things about Patty Gabow was her ability to connect with political leaders and influencers across the state of Colorado really and the country So there was a federal funding stream called Disproportionate share funding, which was intended for hospitals who did a disproportionate share of care for the poor.

Well, I learned that states like Alabama were getting $100 million in that, and Colorado was getting a like 3 or 4 million She knew every senator.

She knew every congressperson.

She knew all the city council people.

She knew that she needed to go build relationships with them, to build trust with them, if they were going to help fund her and help fund the organization So we worked Through The state legislature to rewrite the states's disproportionate share funding Rules And that really helped turn us around putting Denver Health back into a healthy position financially and reputationally in the community was, of course, Patty's first job when she became chief executive, she did it brilliantly And She put the money where it mattered she put significant resources into the beautification of our clinics so they weren't ugly looking and dirty We built some new buildings.

We computerized our system.

We were one of the first systems in the country to link our medical records that existed in community health, with those that were in the emergency room, with those that were in the hospital She also recognized that managing expenses was a really big part of this, as you can imagine a hospital that size with a billion dollar budget.

There were years we'd be in the middle of the year and we'd be on track to lose $25 million a year and she would find efficient, effective ways to reduce cost within the organization.

One of the really cool things that she did is she went and found the Toyota lean manufacturing process.

And Toyota had this process where they would go through every component part of their business and they would take out waste Waste is disrespectful to patients because it asks them to endure processes with no value.

Waste is disrespectful to workers because it asks them to do work with no value.. And waste is disrespectful to taxpayers because it asks them to pay for things of no value And we trained all our mid-managers, many of our doctors, all our executive team as black belts in Toyota production system Patty took these scientific principles into the healthcare system to produce much better care at much lower cost And they were able to take out tens of millions of dollars by going through this Toyota lean process Denver Health is a place where you would want to be rich or poor.

But When I was there, 40% of our patients were uninsured We cared for a population that was often disenfranchised it was really meant to be a safety net for those vulnerable populations.

And it was such an important mission Patty knew that If there's no margin, there can be no mission, even if the mission is very sacred.

And so she understood that we need become a little entrepreneurial, and thus the poison center was a very wildly successful operation that generated profit for Denver Health, and she recognized the need to attract more of these types of programs that could support the mission of Denver Health and continue to make them viable We had so many different funding streams We started school-based clinics, so children could get care where they went to school The hospital has specialty care, dental care We have a hundred bed non- medical detox unit We were one of the first hospitals under leadership to have a AIDS clinic a pharmacy clinic for people with AIDS and a dental clinic for people with AIDS.

But one of the other cool things that Patty helped create was the Denver Health Foundation, a separate entity to raise money It was hugely successful She would create this gala, and every year, hundreds and hundreds of people come to this gala to raise money for the hospital authority through the foundation.

And it became the go to event of the year In every one of those galas, Patty would do a video and she would have patients come forward and tell their story.

And when people really saw this commitment to excellence and the way they touch these patients It made a huge difference So a commitment to high quality care, a commitment to innovation, a commitment to new parts of revenue, but efficient and effective management of expense.

And all those things came together to create this incredible organization that Patty really stewarded All of this helped to put us on very solid financial ground The final year that I was CEO, we gave $400 million of care to the uninsured.

400 million.

And the city's contribution had been been the same since 1992 at about 30 million.

So we were able To Give all this care without costing the city.

An extra dollar.

She became nationally recognized for having accomplished something that most people had not been able to do, to have a vital city based system.

that took care of the poor and yet was not bleeding The budget Patty was very sensitive to revenue and balance sheets, and, you know, managing money properly.

But, man, at the core of it was always, what, how is this going to help the people?

How is this going to help the patient There was an organization called University Health Consortiums, UHC, which we were a part of, but also in that group were Harvard and Yale and Stanford, and et cetera, et cetera.

the big boys and girls from academic medicine.

And I can tell you with 100% certainty that for many, many quarters, over many years, Denver Health had the lowest mortality rate of any of those institutions And so I think the country recognized our quality of care was terrific, often exceeding private institutions People came to visit us from all over the country, and they'd always say, this is incredible, but we don't have the political will to do it.

She felt that we needed to become the model for the country so that other safety net hospitals Would take a lesson from us and replicate our success in that regard And to achieve that, she became much more active politically And she established connections with many of the formidable organizations in Washington, DC that were interested in health So the first foray into that was the Institute of Medicine, which is now called the National Academy of Medicine, had a Committee to look at the viability of safety nets.

Could safety net hospitals really survive?

And I was appointed to that commission and Denver Health was an example that was used in the publication She published what she figured out, and she wrote papers on it, and she spoke all on the country about it, and she would share her knowledge with other institutions As a result of her efforts, other safety net hospitals started to thrive and learn from us and become more prominent in their communities, and therefore they could deliver more care I think safety net systems are always on the edge here.

Our country is not one, which has made a sufficient commitment to the care of the poor There is no doubt that if you don't have access to care Your health is going to be worse Estimates, I these days are there still 18, 20 million Americans that don't have access to care and are not insured and thus their health suffers It's clear that we can't continue on this path and be successful as a country.

And we can't have people in poor health and have a good workforce I think as a physician, the most satisfaction always comes from taking care of patients.

And initially, it was taking care of them personally.

But when I became CEO, it was creating a system that gave the highest quality of care to people that other systems turned away You actually can in America take care of everyone and be financially stable.

You don't have to turn patients away from your door because they can't pay.

And Showing that gave me a lot of satisfaction