House Calls Alive And Well In South Jersey

BY JERRY CAREY

On a hot summer afternoon that’s thick with the threat of thunderstorms, John Bertagnolli, DO, climbs behind the wheel of a truck outside his Hammonton office. Staff nurse Lee-Ann Linden, medical student Patricia Eugene and resident Samantha Uriguen, DO, pile in through the other doors.

They’re not heading out to get a round of water ices to help beat the heat. They’re off on a 40-mile trek to see some of the more than 100 house call patients that “Dr. B,” assistant professor of family medicine at UMDNJ–School of Osteopathic Medicine (SOM), visits each month.

Every Tuesday afternoon and all day on Thursday, they check on patients in small towns like Buena, Sweetwater and Blue Anchor that are tucked away amid the farms and scrub forests of the Atlantic County Pinelands. In fact, one of Bertagnolli’s former patients didn’t live in a town at all.

“She lived in a place called The Unexpected Wildlife Preserve,” Bertagnolli explains. “To get there, we drove down a road until the pavement stopped. Then we took a dirt road that got so narrow we had to pull in the side mirrors to keep from hitting the trees.”

“The first thing I saw when we got there was the outhouse,” Linden adds. “I looked at Dr. B and said, ‘You’re kidding, right?’”

“On the phone, the patient had said to ignore the dog but to watch out for the goose,” Bertagnolli recalls. “She wasn’t kidding! No matter how many times I went out there, that ‘attack goose’ would always chase us. It would run right up and bite the tires on the truck!”

The second patient Bertagnolli saw in March 1998, when he opened the Hammonton office, was a house call. Today, most of his current house call patients are elderly, but about 20 percent are younger patients, with conditions like multiple sclerosis, muscular dystrophy or spinal cord injuries.

Above, left to right: Carmen Pratts of Hammonton, Dr. Bertagnolli, Lee-Ann Linden, Dr. Samantha Uriguen, third-year medical student Patricia Eugene. Right: Patricia Eugene and Dr. Bertagnolli

“Before I got here, some of them hadn’t seen a doctor in years because they couldn’t get out of their house,” he says.

A few years ago, Jacquelyn Torpey, of Blue Anchor, called Bertagnolli’s office to ask if he could come out to see her mother-in-law who was home-bound with Alzheimer’s disease.

“Trying to take my mother-in-law in the car was unbelievable,” Torpey recalls. “It would take hours to get her ready and she would become very upset and start to have seizures.”

Finding a physician who would come to the house made a huge difference. “She’d get excited when she knew Dr. B was coming for a visit,” Torpey says. “It made her feel special and lifted both our spirits.”

On this day—as if on cue—rain crashes down just as Bertagnolli pulls up to a small blue frame house for the afternoon’s first house call. Inside, 27-year-old David Pratts and his brother Anthony, 30, are waiting. Both young men have muscular dystrophy and two years ago their mother, Carmen, brought them to Bertagnolli’s office for an initial visit. That was the last time she took them there.

“When he saw my sons he said that from then on he would come out to the house,” she recalls. Since then, Bertagnolli has been stopping by the Pratts’ house every four to six weeks. “These are pretty much wellness visits,” Linden explains while Bertagnolli examined David in the Pratts’ living room. “But we also arrange for any other medical needs they have.”

Linden says they carry a portable EKG machine with them and have a network of providers they can call to make home visits for laboratory services, occupational and physical therapy, radiology, and podiatric and wound care.

Seeing patients in their homes helps them to feel more comfortable, but it also gives Bertagnolli a first-hand look at their day-to-day lives.

“I can make sure the family members are doing okay, too, and not feeling overwhelmed,” he says, explaining that he often helps families arrange free county services such as having wheelchair-accessible ramps installed at their homes.

Bertagnolli believes that house calls help keep patients out of hospitals and nursing homes. People who are home-bound will often put off seeking medical care until they become very sick, requiring ambulance and emergency room services.

“If patients know that I’m coming to see them, they’ll put off going to the emergency room,” Bertagnolli explains. “They know that the reason I’m coming out is to keep them out of the hospital.”

The popularity of the house call program led to a visit from a local administrator a few years ago.

“The CEO of an area hospital stopped by to see what I was doing because their ER business had decreased so much,” Bertagnolli says with a grin slowly spreading across his face.

Christine Foster, DO, and her husband, Walter Koscienski, DO, are both SOM grads. They operate Rolling Hills Medical Center in Monticello, Kentucky, an underserved area of rural America. Foster spent two months of her residency working with Bertagnolli and now makes house calls part of her private practice.

“I learned an incredible amount in those two months,” Foster says. “I’ll never forget how patients’ faces would just light up when Dr. Bertagnolli went to see them, as if an old friend had come to visit. Just his presence was very therapeutic for them.”

Back in his overcrowded office after completing the afternoon’s visits, Bertagnolli takes a few minutes to talk about why he makes house calls.

“It’s fun and it’s tough too. A lot of these patients are very ill, so we have weeks where we see a lot of death and it’s hard not to feel burned out. But we also help people make incredible changes. We have one patient, a typical ‘biker guy.’ He has a permanent spinal cord injury and when I first saw him he was depressed and overmedicated. Now, he’s quit smoking and makes violins as a hobby.

“The other day, another doctor said to me, ‘You’re actually doing what you went to medical school for.’ He’s right. And I wouldn’t want to be doing anything else.”