Alumni Spotlight Boston Hope and Other Disaster-Relief Pharmacy Services of Ray Mitrano
As Assistant Director of Pharmacy at Massachusetts General Hospital, MCPHS alum Erasmo (Ray) Mitrano, BSP ‘80, MS ’85, played a key role in setting up the pharmacy services of Boston Hope at a critical point in the COVID-19 pandemic.
Boston Hope Medical Center opened on April 10th, 2020, transforming the Boston Convention and Exhibition Center into a thousand-bed field hospital for recovering COVID-19 patients. In the late afternoon just three days before its opening, MCPHS alum Erasmo (Ray) Mitrano, BSP ’80, MS ’85, was asked by Dr. Christopher Fortier, Chief Pharmacy Officer at MGH, to set up the pharmacy services for Boston Hope. Ray was on site the very next day, and in three days had the pharmacy ready for its first patient when Boston Hope opened. “I was honored to be able to help out in any way that I could,” he said.
Among the challenges that Ray faced at Boston Hope were getting supplies, securing (locking up) those supplies, and being able to provide the proper medications across a diverse population of patients. Because most of the patients had previously been admitted to a hospital for COVID-19 symptoms, they had the means to bring a small stock of medications with them when they arrived at Boston Hope. “We instituted a policy that any patient, coming from whatever institution they were hospitalized, would bring a five-day supply of their own medications. This was instituted so we didn’t have to scramble to get them their meds right at admission,” Ray explained. Each patient’s own medication was secured in a locked file cabinet next to their bed, and the was key held by the nurses. This system enabled quick access, saving nurses time and trips across the vast convention center to the pharmacy, without sacrificing security of the drugs. The pharmacy itself was similar to a disaster treatment set-up, with a limited supply of controlled substances, pain relievers, antibiotics, and so on. For the ongoing treatment of patients, Ray says that Boston Hope’s pharmacy had a good process thanks to partners like CVS Pharmacy. Prescriptions were electronically submitted to CVS and delivered to Boston Hope twice a day. “CVS was tremendous in terms of billing and delivering medications in a timely manner,” he says.
Another obstacle of the early days of Boston Hope was a limited pharmacy staff. To work around the inability to initially provide 24/7 pharmacy service, Ray gave some nurses and anesthesiologists overnight access to supplies. Eventually, they were able to provide 24/7 service when the military sent Boston Hope a team of doctors, pharmacists, and nurses to assist their efforts. Ray reflects that setting up the services at Boston Hope resembled his experience with disaster-relief services: “The premise of disaster treatment is taking care of the patient’s immediate needs, stabilizing the patient, getting them to a place [where] either they could be moved on the road to recovery or to a place where they need to be sent.”
Mitrano has extensive experience in reacting quickly and efficiently to emergency situations. He has provided relief services for several disasters and worked in management for the Pharmacy Department of Massachusetts General Hospital (MGH) for over 40 years. He initially realized he wanted to work on the operational side of pharmacy just five years after getting his bachelor’s degree. He was drawn back to MCPHS to complete his Master of Science in Hospital Pharmacy Administration. “Many of the professors were leaders in their time, providing insight into the course,” he says. “And it was just a great opportunity to learn and to network with such distinguished leaders in the field.” Shortly after, Ray became involved with disaster-relief services at MGH because of a trauma surgeon by the name of Dr. Susan Briggs. She was instrumental in setting up and serving as commander of the Disaster Medical Assistance Team (DMAT) in Massachusetts. “This was a medical team made up of a series of personnel with the mission of setting up a field hospital in a disaster area and being able to treat patients,” Ray said. “This was self-serving; didn’t rely on any of the resources in the area. We were able to go and provide care and have everything that we needed.”
Although Ray did not join until 2003, his first experience with the DMAT was during the 9/11 attacks. As the Pharmacy Operations Manager, he was responsible for sending medications to aid the deployed responders. During the debrief upon their return, Ray learned that one of the challenges they faced was the organization of drugs on site. The DMAT had been storing drugs in the field tents with hanging shoe racks, but the fixed deep pockets (built to hold shoes) made it difficult for the responders to move medications around as needed. Ray took initiative to resolve this issue by meeting with an EMS manufacturer, Iron Duck in Chicopee, Massachusetts. He and others from MGH proposed a new design for a pharmacy system that could set up within twenty minutes. “It was a three by five sheet with Velcro backing,” he said. “We had these clear pockets—all different size pockets—that we could attach to that Velcro backing. We could adjust the pockets and easily move the meds around. If I needed to create a drug supply just for the OR, it was easy to do…it provided a lot of flexibility.” Their design is still used by the government for the medication transport of their trauma and critical care team medications.
According to Ray, Dr. Briggs was instrumental in creating the International Medical Surgical Response Team (IMSuRT), which was specialized in providing OR capabilities in addition to trauma/medical care. It is now called the Trauma and Critical Care Team (TCCT). Although he is no longer part of the team, Ray was deployed for historic events such as Hurricane Katrina in 2005, the inauguration of Barack Obama in 2009, and the earthquake in Haiti in 2010. During the 2010 earthquake in Haiti, Ray worked on a disaster-relief team of about 45 volunteers, managing two ORs for twelve hours each day. They did everything from unloaded trucks, changed linens, fixed broken bones, and stabilized patients in critical conditions to be sent to the military hospital stationed off the coast. Nurses, pharmacists, physicians, and administrative staff all shared tasks to get the job done in the most efficient manner. “In a disaster,” Ray says, “you’re working as a team and you do whatever you can to just help each other. Everyone had each other’s back and that was the key thing about it.”
If you are a health professional and interested in helping with disaster-relief services, learn more about joining the NDMS.