Bill Ryan/The Gazette
"If you buy what's in season, you can get great prices," says Marcea Cotter, food service director at Carroll Hospital Center in Westminster.
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To anyone who has tried to chow down on the soggy vegetables, canned fruit and dry meat that's stereotypically served to patients, staff and visitors, the phrase "hospital food" may sound like an oxymoron.
But a national initiative taking root in Maryland is trying to change all that, to the benefit of hospitals, patients and the farmers who are supplying fresh, local fruits and vegetables, grown without synthetic pesticides or petroleum-derived fertilizer.
Seven Maryland hospitals have signed on: Sinai Hospital and Mercy Medical Center, both in Baltimore; Baltimore Washington Medical Center in Glen Burnie; Carroll Hospital Center in Westminster; Anne Arundel Medical Center in Annapolis; Shady Grove Adventist in Rockville; and Washington Adventist in Takoma Park.
"Food produced in an environmentally sound way has a number of benefits," explained Louise Mitchell, sustainable foods coordinator for the University of Maryland School of Nursing, which administers the program. "Food from a local farmer is fresher. It's traveled fewer miles. It also has fewer pesticide residues, and it keeps dollars in local communities, supporting the local economy."
Hospitals have a special part to play in promoting healthful food, and also are crucial in the food distribution system due to their size and credibility, Mitchell said. For hospitals, buying local and organic food is "a big signal you send to the marketplace," she said.
According to the National Society for Health Care Food Service Management, about $12 billion is spent annually on food and beverages by the U.S. health care industry. Food Service Director Magazine said in a 2005 issue that while patient food receives considerable attention in the media, "it is cafeteria and catered food that make up the largest percentage of food in the budget, accounting for approximately 55 percent to 70 percent of hospital volume."
Statewide, Nancy Fiedler, spokeswoman for the Maryland Hospital Association, said about 7,200 beds are occupied in Maryland hospitals on any given day. Figuring at least three meals a day served for each patient, more than 21,000 meals are served in state hospitals daily — and that's just to patients. Thousands more meals are served to employees — the state has 89,000 hospital employees, says Fiedler — and visitors.
‘Really look at
what people are eating'
Carroll Hospital Center has been one of the major forces in the initiative. In April 2007, it became the second Maryland hospital to sign on, after Sinai Hospital.
Moving toward sustainable food is in sync with larger health and wellness trends. "There has certainly been a push nationally to really look at what people are eating," particularly given problems with "obesity and diabetes" said Marcea Cotter, food service director at Carroll Hospital Center.
The Westminster hospital has greatly increased its use of local fruits and vegetables. Of a $700,000 annual food budget, Cotter estimates that 25 percent now goes to locally grown food. The per-patient cost is low: about $1.56 per meal, not including labor and other service costs.
The Sinai program is even more extensive, as "45 [percent] to 50 percent of their produce comes from local and regional farms," Mitchell said. Sinai spent almost $9,000 on locally grown produce from June 1 to Sept. 13.
Meat is also part of the initiative. Carroll Hospital Center is "currently purchasing local beef products from a local farmer, Bullock's Meats, free of unnecessary hormones and antibiotics," Cotter said. The hospital previously bought from Bullock's, but its purchases increased after joining the sustainable foods initiative.
In Montgomery County, Shady Grove Adventist and Washington Adventist have a religious and historical connection to serving healthful food. For Seventh Day Adventists, "healthy lifestyle, healthy eating is at the root of the culture," said Diana M. Brande, director of food and nutrition services.
Over the past four months, Brande and Carol Chandler, a registered nurse at Shady Grove Adventist, have worked with Healthy Food in Health Care, bringing in produce from local farmers.
While the two hospitals initially delayed signing the Healthy Food in Health Care pledge, fearing they would be unable to meet its provisions, they joined in August.
The week of Sept. 8-15 kicked off the hospitals' local food awareness programs, Brande said. They served staff side dishes with local produce at every meal, with an option to purchase more. They also provided recipes and a list of local farmers whose products they use.
Still, only a small portion of the Adventist hospitals' food is locally produced, as it's difficult to attain a dependable source for large quantities. Exact figures are not available yet.
"What we can do is supplement our produce order with local produce, and so if it's summer, and they've got lots of yellow and green squash, we can buy it in the local market" Brande said.
Furthermore, as the Healthy Food in Health Care program continues, hospitals will "find ways to extend the season," Mitchell said. Such methods as cold storage for apples, squash, potatoes and onions, plus canning and other preservation techniques, could provide local food throughout the year.
The Clinical Center at the National Institutes of Health in Bethesda also works in conjunction with Healthy Food in Health Care, according to David Folio, chief of nutritional services.
The program serves milk free of synthetic growth hormones, has switched to reusable cups and has begun recycling grease. In addition, the kitchen uses a number of innovative, energy-saving devices, such as a TurboChef oven that works up to 10 times faster than conventional ovens and plastic airstrip curtains that prevent loss of refrigerator and freezer air.
The Clinical Center has not, however, shifted to locally grown foods because of concerns about patients' diets.
"We have to be very careful about who we buy from. Some patients are immune compromised," Folio said.
In an unaffiliated program, NIH offers local produce at 10 locations on its campus.
Other hospitals
exploring program
Several other hospitals, including Montgomery General in Olney, Suburban Hospital in Bethesda, Doctors Community Hospital in Lanham, Frederick Memorial Hospital Center, Holy Cross Hospital in Silver Spring and Laurel Regional Hospital have expressed interest in Healthy Food in Health Care and are beginning to take the next steps.
"Montgomery General is very much a proponent of recycling and environmental programs," said Kisha Stafford, food service director at the hospital, which provides milk free of synthetic hormones.
Using local and organic food might seem prohibitively expensive, but hospitals report otherwise.
For the Adventist hospitals, "so far it's been budget neutral," said Brande, explaining that buying in season and not having to transport goods thousands of miles keep prices down.
"If you buy what's in season, you can get great prices," said Cotter, at Carroll Hospital Center.
The switch does change the hospitals' purchasing habits. They have to "shift menus to accommodate seasonality," Chandler said. Still, "from the hospital's perspective, it's easy to work with farmers on the cafeteria side."
Nevertheless, on the patient side, hospitals have "fixed menus based on calories and nutrition," Chandler said. Local produce can therefore account for only a portion of the total menu.
That portion could grow, she said. "As more and more farmers are able to provide, there'll be choice."
Small, medium
and large farms
Hospitals purchase most of their food through distributors, which in turn purchase from farmers. Hearn Kirkwood of Hanover is a major distributor working with Maryland's Healthy Food in Health Care, providing all manner of fresh produce.
"We work with small, medium and large farms," said Ed Hunter, director of purchasing for Hearn Kirkwood.
The company has been involved with the hospital program since its inception, as the program fit with its practices.
"As far as buying local products, we've always been doing that," Hunter said. He estimates that Hearn Kirkwood has doubled its purchases of local products for hospitals since joining the program, to some 5 percent to 10 percent of the produce it provides them.
As for organic products, however, "we don't do a heck of a lot," Hunter said. Some hospitals, however, work directly with small farms, which deliver organic produce themselves.
‘Getting started
and starting carefully'
Joan Norman is one such farmer. Her One Straw Farm has been providing food to Sinai Hospital and Mercy Medical Center since the start of the program. The farm makes its own compost and doesn't use synthetic pesticides or fertilizers.
One Straw Farm's contribution "has not been huge yet," Norman acknowledged.
"We're getting started and starting carefully," she said. "I don't have a contract with anyone. How can I guarantee 50 cases of tomatoes, if we might not have them" due to hail or other unforeseen conditions?
Mark Israel at Query Mill Hill, a 1-acre Montgomery County farm, said he also would like to work with the program. However, he worries that "with a little farm like mine, I can't contract for any crop." Still, he sees potential benefits in selling to hospitals, particularly as it would provide a guaranteed market.
The food program dovetails with the participating hospitals' other environmental programs, such as recycling and energy conservation.
The Adventist hospitals, for example, have long sold their used oil to Valley Proteins, which reuses it in animal feed and biofuel. "People don't realize that there can be great cost savings associated with being more resourceful and minimizing waste," Chandler said.
The food and other eco-friendly programs are about "having a very heightened awareness of the impact that our resource consumption and our waste disposal have on the community so you can do it with minimal impact," Brande said.
"It's just thinking about what you're doing, really critically thinking about purchases and alternatives," Cotter said. "It's all so new, we're all learning together."
