TMC PULSE

t m c n e w s . o r g 10 B y C i n d y G e o r g e Baptism By Pandemic Harris Health System's new leader, Esmaeil Porsa, stepped into his role at the onset of the COVID-19 crisis I n early March, just as COVID-19 was emerging in Houston, Esmaeil Porsa, M.D., MPH, MBA, began his tenure as the first physician to lead Harris Health System. The former executive vice president and chief strategy and integration officer at Parkland Health and Hospital System in Dallas assumed his new post at the start of a global health emergency that has had a disproportionate impact on Harris Health's Ben Taub and Lyndon B. Johnson hospitals. Yet Porsa's decades-long experience serving patients in safety-net health care settings has energized his commitment to underserved populations during the global pandemic. 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 num- ber 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 pro- portion 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 manag- ing 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 hap- pen. 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 chron- ically 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, 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 pro- moted 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 pro- portion 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.

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