In 2013, a BHCHP study of the causes of patient mortality revealed that from 2003-2008, fatal overdose had outpaced HIV/AIDS and cancer as the leading cause of mortality among our patients. The study prompted a massive shift in BHCHP’s approach to substance use disorder (SUD).
Dr. Gaeta has been the primary architect of that transformation. Under her leadership, we have put harm reduction at the center of our SUD care model, dramatically increased our treatment services, and become a national leader in overdose prevention and primary care-integrated addiction treatment.
Supervised Place for Observation and Treatment
Dr. Gaeta conceived and operationalized a first-in-the-nation medical monitoring program for people who are over-sedated from drug use and at great risk for fatal overdose and other harms. The program, SPOT (Supportive Place for Observation and Treatment), is staffed by a nurse who monitors vital signs and a harm reduction specialist who works to build relationship and trust. Since its creation in 2015, SPOT has saved countless lives, helped hundreds of people access addiction treatment, and averted thousands of emergency room visits.
While SPOT has made an impact locally, it has also been looked to by organizations across the country as an effective model to stem the devastating impact of the overdose crisis for people not able to or not yet ready to seek treatment. Dr. Gaeta has led studies that evaluate its outcomes and reveal insights into the epidemic, its effects on the neighborhood where it’s located, and the physiological effects of the drug “cocktail” that our patients commonly ingest.
Under Dr. Gaeta’s guidance, BHCHP has more than tripled its addiction services, to the point where most doctors in our program are dually-boarded in addiction medicine and a primary care specialty, and treatment services are incorporated into every corner of our practice. She is also a medical provider on Community Care in Reach®, the mobile clinic launched by the Kraft Center for Community Health to bring health care, harm reduction, and treatment services to hotspots across Boston where large numbers of overdoses are occurring. And she has helped the Kraft Center launch additional vans as the needs have grown.
Dr. Gaeta has been one of the architects of BHCHP’s response to the “Mass/Cass” crisis. BHCHP hired and deployed many new staff members to care for individuals living and spending time there, and their work has included overdose reversal, harm reduction and treatment counseling, wound care, and treatment for a disturbing uptick in HIV cases with pre- and post-exposure prophylactic medication. Dr. Gaeta also has served as a liaison with many of the area’s stakeholders and been an important advisor to the city as it has devised its approach to the crisis. As people moved out of the area into low-threshold shelters, hotels and other locations, she has provided technical assistance and training to the facilities’ staff, as well as direct care to patients.
Her Advocacy Beginnings
Early in her career, Dr. Gaeta recognized the authority that the M.D. after her name granted her in the eyes of many and she decided to use that authority in the fight against homelessness. From 2005-2007, she did a physician advocacy fellowship at Columbia University and spent a lot of time trekking to the Massachusetts state house to inform policymakers about the connection between homelessness and health. During that time, she also co-founded Home & Healthy for Good’s (HHG) Housing First program, operating under the auspices of the Massachusetts Housing and Shelter Alliance, where she worked as a physician advocate.
A Covid-19 Care System More recently, Dr. Gaeta, collaborating with many stakeholders, led the creation of BHCHP’s COVID care system that protected and cared for the area’s unsheltered population. Like many brilliant ideas, this one began on the back of a napkin. During a Sunday in March 2020, she and an infectious disease specialist from Boston Medical Center sketched on the back of several napkins ideas for a tent hospital for quarantining and isolating patients, crumpling them up as they recognized problems with each drawing. Eventually, Dr. Gaeta texted an architect she had worked with years earlier. He immediately responded and within six days, a tent hospital had been designed by the MASS Design Group architect and erected by Suffolk Construction.
By early April 2020, it became clear that aggressive testing would be one of the key ways to contain the virus in congregate settings, so Dr. Gaeta designed a testing system and schedule for every Boston shelter, collaborating with numerous entities including the shelters themselves, laboratories, the city, and the National Guard to accomplish this. She and other BHCHP leaders established a command center to oversee testing, transportation, and bed assignment across four isolation facilities, and the dozens of other components of BHCHP’s COVID response. And she led from the trenches: in addition to being the principal architect of much of BHCHP’s COVID-19 response, she also relished the on-the-ground work. She assisted in the design of COVID-19 care at several sites, including the Boston Exhibition and Convention Center, where BHCHP was in charge of 500 beds, but she also worked as a physician there and helped train staff.
At the height of the pandemic, Dr. Gaeta even found time to co-author research papers about what BHCHP had learned about the coronavirus and its transmission in journals including the New England Journal of Medicine and Public Health Reports — the journal of the U.S. Surgeon General and the U.S. Public Health Service. Dr. Gaeta recognized BHCHP’s learnings had profound implications for public health.
A brilliant clinician, a public health leader, a tireless advocate, and a superb teacher and communicator, Dr. Gaeta is being recognized nationally for what everyone at BHCHP has known for decades: she is remarkable.