The Challenges and Future Plans

for The William W. Backus Hospital

Department of Surgery
David Kalla, MD
Chief of the Department of Surgery

When considering the future of surgery at Backus Hospital it is important to start by assessing our services and
achievements. We provide surgical services in general surgery, orthopedic, urology, ENT, gynecology, breast surgery,
plastics, neur sur er an trauma, efittin a mi si e spital e ave a ne est enerati n Da inci sur ical r t
as well as a Mako robot for orthopedics. The American College of Surgeons (ACS) through its National Surgical
Improvement Project (NSQIP) recently recognized Backus as 1 of 61 hospitals (out of 615 NSQIP participants) for
its Meritorious Award for excellent surgical outcomes.

Our General Surgeons provide trauma expertise within
a recognized level 3 Trauma Center that has recently
received rave review from ACS examiners. We have
colorectal and breast specialists who provide state of
the art surgery. We have two active plastic surgeons and
are the only center in the Hartford HealthCare system
providing our breast cancer patients with deep inferior
epi astric per rat rs D ap reast rec nstructi n
Backus Hospital has a very active orthopedic service
with both generalists and fellowship trained hand, foot,
joint replacement, and spine sub-specialists. We have
the latest Mako robot for joint replacement and are in
the process of purchasing a robot for spine surgery.
In gynecology, Backus Hospital has an active service
that recently became a teaching site for third and
fourth year residents in the University of Connecticut’s
obstetrician and gynecology residency program. We
ave seven cre entiale r tic sur e ns n sta an
gynecologic oncologists from both Hartford Hospital
and Women and Infant’s Hospital who operate at
Backus Hospital.
Urology is a very busy service line. The urologists
perform robotic prostatectomies, partial and radical
cystectomies, partial and radical laparoscopic
nephrectomies, and radical orchiectomies in addition
to lithotripsy and other state of the art procedures.
A r tic evice specificall r c mple spine an
neurosurgery has been purchased.
Despite the breadth of services outlined above the
department has weaknesses and threats. First and
foremost is a loss of certain surgical specialties. Our
active bariatrics program had only one surgeon, and
when he decided to move his practice we did not have
a way to replace him quickly. Fortunately, Dr. Carissa
Webster-Lake will be joining our department in
October 2017 to resurrect the bariatric program.
Backus Hospital established a strong thoracic surgery
program with Dr. Juan Escalon, but unfortunately he
moved to Orlando, Florida. Dr. Mario Katigbak, the
chief of thoracic surgery, consults twice weekly and
participates in the Thoracic Tumor Board. He plans
to start operations at Backus Hospital soon, pending
additional recruitment of thoracic surgeons to the
HHC network.
e ave a a si nificant ut elective utpatient
surgeries being performed at independent ambulatory
surgical centers.
ese sur eries s ul e ne in t ese m re e cient
envir nments, ut it presents c allen es r sta n t e
operating rooms. Surgical cases lost to the ambulatory
centers are often younger, healthier and better insured
continued on page 9

-8- TH E O P E N JO URNAL • FALL 017

leaving older, sicker, and underinsured patients for the
hospital. The loss of revenue limits our capacity to
upgrade equipment and embark on new programs.
Attrition of surgeons is a particularly acute problem.
e tra iti nal private practice m el is financiall
challenged and unable to recruit or grow the practices,
especially with a shrinking pool of surgery graduates.
Recruitment and possible employment through
Hartford HealthCare, a larger and more robust group
of surgeons, is a logical avenue to ensure surgical
excellence in the future.
Our surgeons need and expect better support in
the operating room and on the wards. The Surgical
Physicians Assistant program was started in 2009 and
has provided skilled surgical assistants in the OR.
The PA service is steadily growing and has extended
daytime coverage to the wards, providing timelier
care. This has allowed our surgeons to practice more
e cientl an e ectivel e plan t e pan t e A
service line to 24/7 in-house coverage which will
provide better night coverage. Recruiting and training
a full-time PA service will take time, but the hospital
is committed to this goal. An important piece of
growing our PA service is Backus Hospital participating
as a teaching site for several of the PA schools in
Connecticut.
T HE O P E N J O UR NAL • F AL L 2017
So, the future looks bright. We have recruited a new
bariatric surgeon as mentioned above, and she will
enefit r m an e perience R an spital nursin
sta previ usl per rmin ariatric sur eries an
providing postoperative care.
We have credentialed a vascular surgeon, Dr. Akhilesh
Jain, who has already started to operate at Backus.
He will be part of the Hartford HealthCare Heart
and Vascular Institute which will provide support and
coverage from the vascular surgeons throughout the
system.
Other areas where I see opportunities for growth
involve bringing missing surgical subspecialists to
Backus. Examples include thoracic surgery and
urogynecology. As with bariatric and vascular surgery,
this is most likely to occur through our participation in
Hartford HealthCare. It is not clear whether a full-time
presence, as with bariatric and vascular surgery, or a
part time presence as we currently have with
gyn-oncology will be the best model.
Overall these are challenging times for the department
of surgery, but we are heading in the right direction.
Our administrative team with the support of our
hospital president, Bimal Patel, is planning to fortify
our surgical services at Backus Hospital with the goal
of becoming the referral center of choice throughout
the East Region. g
-9-