Harris Health’s new CEO explains why COVID-19 stress isn’t new for the safety-net system

NOTE: An abbreviated version of this story was posted on June 15, 2020 to chronicle the escalating COVID-19 crisis in Houston. The full interview was printed in the July 2020 issue of TMC Pulse. Both versions are represented below.

Harris Health System President and CEO Esmaeil Porsa, M.D., MPH, MBA

PULSE | Why were you interested in the CEO job at Harris Health?

PORSA | My entire life has been devoted to public health and, even more than that, population health. It was just the right fit at the right time. In my interviews, when they asked me why I wanted to come to Harris Health, the honest answer then and now is: I think I can help.

PULSE | You’ve spent some time professionally in Houston before. Tell me about that.

PORSA | I did my training in internal medicine at The University of Texas Health Science Center at Houston. I actually spent most of my training at LBJ Hospital. After that, I worked for one year as an ER attending at LBJ and, in 1998, I started working as UT faculty inside the Harris County Jail. I provided primary care inside the jail and also ran their infirmary for several years while I was teaching epidemiology and statistics at McGovern Medical School.

PULSE | Why did you leave Houston?

PORSA | In 2007, I was recruited to Parkland Hospital in Dallas to become the medical director for the Dallas County Jail. I did that for about six years and then I was promoted to senior vice president for medical affairs. During the move to the new Parkland Hospital, I became the interim chief medical officer to ensure the successful transition. About four years ago, I became the chief strategy and integration officer for Parkland Hospital and held that title until I came back to Houston.

PULSE | What’s your analysis of the elevated importance of public health amid COVID-19?

PORSA | The impact of COVID-19 on the segment of the population that the Harris Health System cares for is so much more significant. The percentage of the patients in my hospitals who are COVID-19-positive is more than twice the proportion of patients who are COVID-19-positive in any other hospital in this area. Think about this segment of the population: They are racial minorities, they are underinsured, they are uninsured. They are those who have chronically suffered from not just social disparities but also health disparities—and they are now being more severely impacted by COVID-19. I think COVID-19 is shedding a light on the impact of a pandemic on a community that has chronically had a lack of access to adequate care.

PULSE | Can you elaborate on the inequities, the special purpose of Harris Health and, respectfully, the greater burden?

PORSA | It is a burden. I was talking to another reporter the other day who asked if we were suffering a higher burden because of the number of patients. The answer is no. While the rest of the hospitals in this area have basically been empty until recently when they opened their doors again to elective procedures, the hospitals in Harris Health have been full. Several weeks ago, one of my hospitals was over 100 percent capacity. We were basically creating rooms in the emergency room to take care of our ICU patients. The proportion of ICU patients with COVID-19 has come up to 14 to 15 percent across the TMC, but 44 per- cent of ICU patients at LBJ Hospital are COVID-19-positive [as of early June]. That’s almost half of all ICU patients at LBJ. The percentage is less at Ben Taub just because it’s a larger facility. The burden is not so much the number. The burden is the fact that a much higher proportion of the patients are COVID- 19-positive and they are just more difficult to care for in a regular inpatient or ICU bed.

PULSE | How do you approach your job under these inequities in the era of COVID-19?

PORSA | I am relying on my education and training in public health. My hospitals have been full, they will continue to be full and that is just a constant struggle. It is our mission to care for the segment of the population who don’t have access to care otherwise. That’s who we are. That’s what we do. We will never use that as an excuse to provide anything less than the highest quality care for our patients, because they deserve it. As we do that, we should also be cognizant of the fact that if we are going to fulfill our mission to improve the health of the community, we also have to pay special attention to not just managing disease and treating patients, but think upstream to do what we can in disease prevention and health promotion. Why are our patients so sick? That goes back to the chronic lack of access to health care and the social disparities that exist. We have to address those things.

PULSE | Are you able to work on prevention during this pandemic?

PORSA | We are doing probably 2 percent of what really needs to happen. All hands are on deck trying to address COVID-19. We started testing the homeless for COVID-19 because that could become the next hot spot if we have homeless people in close proximity who are chronically ill or in poor health.

PULSE | If Harris Health System is doing well with population health and health promotion, what does that look like?

PORSA | We prevent disease onset. It would be ideal if we could prevent hypertension and diabetes, but what if we could do something to postpone the onset of hypertension and diabetes by five years, by a decade, by two decades? Both the financial impact and the health impact of that on our community would be immeasurable. Those are the types of things I’m excited about and what I want Harris Health to become known for.

PULSE | Finally, can you provide more details about the conversion of Quentin Mease, the former hospital in Third Ward that is transitioning to an outpatient facility focused on dialysis and HIV care?

PORSA | Dialysis is one of my passions. It’s going to expand our dialysis program with a focus on peritoneal dialysis [blood purification during a process in the lining of a person’s abdomen] and not so much hemodialysis [blood pumped and purified through an artificial kidney machine], even though that program is going to expand. I want to be well known in this community and nationally for doing peritoneal dialysis well. The difference in overall costs and mortality is huge. There’s less mortality and morbidity—infections and things of that sort—with peritoneal dialysis, as well as the ability to perform the dialysis at home and to travel and to work. But how do we treat the diabetes and hypertension that cause people to end up in end stage renal disease? The best thing would be to never get to the point of end stage renal disease and that goes back to upstream thinking and prevention.

Harris Health System President and CEO Esmaeil Porsa, M.D., MPH, MBA, was interviewed by Pulse assistant editor Cindy George. This interview has been edited for clarity and length.

Harris Health System President and CEO Esmaeil Porsa, M.D., MPH, MBA

Abbreviated version published online | June 15, 2020

Esmaeil Porsa, M.D., MPH, MBA, began his tenure leading Harris Health System in March after the retirement of George Masi and in the early days of COVID-19.

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While the uptick in Houston-area hospitalizations related to the novel coronavirus made headlines last week, Porsa’s public safety-net organization has been treating a disproportionate number of virus-stricken patients for months.

New widespread concern began to percolate last week when the Houston-based SouthEast Texas Regional Advisory Council (SETRAC), which covers 25 counties, showed an area-wide increase on its COVID-19 tracker.

June 7 to June 13 became the first seven-day period in which Houston-region COVID hospitalizations exceeded 1,000 patients daily, according to SETRAC. The total went beyond 1,200 patients on Saturday, June 13, 2020—with 840 patients in general hospital beds and 390 in intensive care unit (ICU) beds.

Porsa explains how the pandemic places a heavier burden on the public health system and how the ICUs at Harris Health’s Ben Taub Hospital in the Texas Medical Center and Lyndon B. Johnson Hospital in north Houston were shouldering COVID-19 stress before everyone else felt the pain.

PULSE | What’s your analysis of the newly elevated importance of public health amid COVID-19?

PORSA | The impact of COVID-19 on the segment of the population that the Harris Health System cares for is so much more significant. The percentage of the patients in my hospitals who are COVID-19-positive is more than twice the proportion of patients who are COVID-19-positive in any other hospital in this area. Think about this segment of the population: They are racial minorities, they are underinsured, they are uninsured. They are those who have chronically suffered from not just social disparities but also health disparities—and they are now being more severely impacted by COVID-19. I think COVID-19 is shedding a light on the impact of a pandemic on a community that has chronically had a lack of access to adequate care. We are seeing the results very clearly in my hospitals.

PULSE | Can you elaborate on the inequities, the special purpose of Harris Health and, respectfully, the greater burden?

PORSA | It is a burden. I was talking to another reporter the other day who asked if we were suffering a higher burden because of the number of patients. The answer is no. While the rest of the hospitals in this area have basically been empty until recently when they opened their doors again to elective procedures, the hospitals in Harris Health have been full. Several weeks ago, one of my hospitals was over 100 percent capacity. We were basically creating rooms in the emergency room to take care of our ICU patients. The proportion of ICU patients with COVID-19 has come up to 14 to 15 percent across the TMC, but 44 percent of ICU patients at LBJ Hospital are COVID-19-positive (as of early June). That’s almost half of all ICU patients at LBJ. The percentage is less at Ben Taub just because it’s a larger facility. The burden is not so much the number. The burden is the fact that a much higher proportion of the patients are COVID-19-positive and they are just more difficult to care for in a regular inpatient or ICU bed. It’s just more challenging and demanding.

Harris Health System President and CEO Esmaeil Porsa, M.D., MPH, MBA (brown suit) observes as U.S. Rep. Al Green speaks during a City of Houston news conference with Texas Medical Center chief executives early in the COVID-19 pandemic on March 20, 2020. Porsa had been leading the public safety-net organization for less than three weeks.

PULSE | How do you approach your job under these inequities in the era of COVID-19?

PORSA | I am relying on my education and training in public health. My hospitals have been full, they will continue to be full and that is just a constant struggle. It is our mission to care for the segment of the population who don’t have access to care otherwise. That’s who we are. That’s what we do. We will never use that as an excuse to provide anything less than the highest quality care for our patients, because they deserve it. As we do that, we should also be cognizant of the fact that if we are going to fulfill our mission to improve the health of the community, we also have to pay special attention to not just managing disease and treating patients, but think upstream to do what we can in disease prevention and health promotion. Why are our patients so sick? That goes back to the chronic lack of access to health care and the social disparities that exist. We have to address those things.

PULSE | Are you able to work on prevention during this pandemic?

PORSA | We are doing probably 2 percent of what really needs to happen. Right now, all hands are on deck trying to address COVID-19. We started testing the homeless for COVID-19 because that could become the next hot spot if we have homeless people in close proximity who are chronically ill or have poor health.

Harris Health System President and CEO Esmaeil Porsa, M.D., MPH, MBA, was interviewed by Pulse assistant editor Cindy George. This interview has been edited for clarity and length.