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Gifford’s doc tells Washington to support rehab
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Gifford’s doc tells Washington to support rehab

  • From left, Rep. Jim Langevin, D-R.I., Peter Thomas of the Consortium for Citizens with Disabilities Task Force, and Dr. Gerard Francisco appeared in support of funding for medical rehabilitation.
    Cristina Rayas/Cronkite News ServiceFrom left, Rep. Jim Langevin, D-R.I., Peter Thomas of the Consortium for Citizens with Disabilities Task Force, and Dr. Gerard Francisco appeared in support of funding for medical rehabilitation.

WASHINGTON - Rep. Gabrielle Gifford's attending physician called the Arizona congresswoman's recovery "ideal" and "typical for those who have the ability and access to the right resources" to recuperate from a debilitating injury.

But not everyone has those resources, said Dr. Gerard Francisco during a congressional briefing in Washington on Thursday to support rehabilitation in America's health care system.

Giffords spent four months in his hospital but, "Not everyone can stay that long because of payer limitations," said Francisco, who was backed by advocates for rehabilitative medicine and a member of Congress' Bipartisan Disabilities Caucus.

Giffords was transferred to the Institute for Rehabilitation and Research Memorial Hermann Hospital in Houston, where Francisco is chief medical officer, about three weeks after she was shot in the head at a Jan. 8 at a Tucson political event. She was moved last week to her husband's home in Texas, where she has started outpatient therapy.

Some have said Giffords' treatment is an exception to the rule, Francisco said, saying she only got four months of hospital treatment because she is a public figure. But he said, "Four months is nothing."

"Many people now do not have the appreciation for how brain injury rehabilitation has to be done," Francisco said. "Unfortunately, we have had to take a lot of shortcuts in the past decade, when patients stay for under a month."

He said the average length of stay at his hospital is 28 days, longer than most facilities.

Physical medicine and rehabilitation, or physiatry, is a specialization that is relatively young, and has evolved greatly since its beginnings treating people with polio in the 1940s, Francisco said.

He said the strategy for rehabilitation in cases like Giffords' is not multidisciplinary, but interdisciplinary: Her team of doctors and nurses all met once a week to make small goals for the congresswoman's path to recovery.

"When she would recover more than expected, we would have to change the goals and upgrade them. So it's a continuous review of the person's progress," Francisco said.

He and Giffords' speech pathologist used YouTube videos of the congresswoman from before the shooting in order to study her speech and "to correct things as we could in order to bring her back as close as possible to where she was."

"But the program we designed for her is pretty typical," Francisco said. He noted that some patients do stay at TIRR Hermann longer, but only if their payers support treatment.

When patients get specialized services early on, he said, extra surgeries, antibiotics and therapies can be avoided, saving time. He used other dramatic examples of patients with brain traumas who were able to return home for active lives after their rehabilitation.

"There are many patients in these kinds of situations," Francisco said of those cases. "This is not unique to our facility, not in our city, not in our state. This is not unique all across the country."

The best treatment is uninterrupted, he said, but coverage limitations sometimes make that impossible.

"Ideally, traumatic brain injury rehabilitation starts with coma and doesn't end until the person is fully reintegrated into the community."

Francisco said "quality comes at a price." But instead of using the word "value" when talking about patient care, Francisco suggests using the term "reasonable," to balance value and cost of rehabilitation treatment.

He suggests the best way to move forward is through partnership and education in the delivery of healthcare.

"I think the best outcomes are when everyone is working together and that goes beyond the healthcare system," he said.

As for Giffords, he said, her perseverance has made a difference in her recovery.

"I'm sure you've seen her picture in the newspaper, she looked good," Francisco said. "She's a hard worker, that's one of the reasons that she's accomplished so much in those four months.

"It was managing the media that was most challenging," he said. "Managing the patients themselves were a delight."

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