After spending five years overseeing the transition of a nonprofit group of 11 hospitals in Kansas City, Mo., to a for-profit division of the corporation, Rogers returned to Las Vegas in January to lead hospital and ambulatory centers in Nevada and California, including MountainView, Southern Hills and the adult and children's Sunrise hospitals.

Rogers spends the majority of his time in the Las Vegas area, where his division is based, but that could change if his company successfully acquires assets in the Golden State.

He joined the company in 1999 as president and chief executive of Riverside Community Hospital in California.

Rogers started his career as a respiratory therapist, later training as a physician's assistant. He has 14 years of experience with nonprofit hospitals and is a fellow of the Foundation of American College of Health Care Executives.

Rogers spoke with In Business Las Vegas about his company's role in the market, the effects of the economy and proposed cuts to Medicare reimbursements.

Bryan Rogers LEILA NAVIDI / STAFF PHOTOGRAPHER

Answer: HCA is an interesting company. It was founded about 40 years ago by two physicians. It is the largest for-profit hospital company in the world. We've got about 180 hospitals in, I think, around 28 states. We're also in Europe. It's a very exciting company to work for - a great company.

I came here from an acquisition that we did in Kansas City, and I was there for five years. This is a more mature division. Actually, I joined the company in 1999 and worked as a hospital CEO in this division. This is a larger division. It's about $2.5 billion of net revenue, and we're in two states: Nevada and California (with) about 10 hospitals. We are looking to grow and expand in this market and also in California.

Las Vegas is a unique market in that we have a lot of pair concentration (of insurance companies) here with Sierra (Health Services) that was recently acquired by (UnitedHealth Group), probably having close to half the market share. So that's unique. We're seeing more diversified markets in other regions. That's probably the principal difference. We've got 2 million people in this valley now, so it's a pretty critical mass. It's a large size, but a big pair concentration. That's unique.

Our surgery center division is currently looking at several surgery centers we might acquire - some in this market and some in California. Of course, in California there's a number of hospitals that are potentially for sale that we are interested in. No definitives yet, but we're hopeful that we'll be able to grow. Not only in this division, but the entire company over the next two years.

Our local teams work very closely. We have calls every week, have one-on-one meetings with all of our folks at least every month. It's a pretty close working relationship - ad hoc phone calls and meetings more or less every day. And then Nashville - I'm probably in Nashville a couple of days a month at most. We're a very decentralized company, which is probably why we have some of the best operators in the world. We know what we need to do, we hire good people, and we let them get their jobs done. That's one of the very positive things about the culture at HCA.

We're very strong. We probably have about 30-plus percent in Las Vegas. We share that large market share with Universal. CHW does an excellent job. Very good hospitals, slightly lower market share and more in the south and the Henderson region. Definitely a quality system.

Bryan Roders, president of Hospital Corp. of America's Far West division, speaks during an interview at the company's offices in Henderson. LEILA NAVIDI / STAFF PHOTOGRAPHER

There are portions of this market, such as the one you described, that are pretty dense relative to patient beds, but I think we've historically had such big population growth here as we've seen beds come on line up north and the like. I think you've seen the hospital operators try to keep bed capacity up with population growth. That dynamic has maybe slowed just a little bit as we watched the macroeconomics in the valley with gaming being down and all that.

We compete in a lot of different ways. We have technology that many others don't have. We have a very robust medical staff at all of our hospitals. We have ... the only children's hospital in the entire state that does very, very big and complex heart surgical repairs and the like. A lot of (emergency medical) transports. Again, we do a lot of tertiary and quaternary care, so we have patients that are helicoptered in every day. In fact, one day I was there, and the helicopters were waiting to land. There was so much activity at the Children's Hospital.

We've been here quite a long time, 50 years for Sunrise, and we're well-established here.

And lots of new things coming on line that we can talk about as well.

Something really exciting that we are doing, in fact, this entire space (at Green Valley Parkway and Interstate 215) that you're in is going to be converted, and we're going to move into new space across the (corporate complex). This will be the hub for our IT (information technology) operations. What we're putting up is our EHR (electronic health record) network. That will start next year. The IT part is very complicated. I'd love to explain it to you, except I couldn't because it's too complicated for me. But the essence of it is that we will be able to beam information from our network to physicians' hand-held devices. We have a software system company we use to do that. Clinically | we digitize all our radiographs and all of our lab data. If there's a panic lab value, we can literally beam that to the doctor, his PDA can vibrate, he can see the lab data, he can see a trend of that lab data over time, he can see previous admissions that the patient may have had, and it will actually call in the respective nurse on that unit to do an intervention. So, it allows us to decrease cycle time when we need to do interventions with patients. And it allows the physician to see trends and patterns that you often wouldn't see, which is one piece of lab evidence. Very exciting. It's complicated from an IT perspective. And again, this whole office will be full of IT folks who will help support all that, and we're pretty excited about that. And we're doing that across the country, that's not just in the Far West division.

Yes, it is. In fact eMar (electronic medication administration record) and all of our bar coding, and, again, I think HCA was the first company to do that, and it's a very rigorous effort to make sure we deliver the right drugs at the right time, and this is an extension of that. We're trying to use technology when we can. Technology is never a replacement for good patient care or intellect, but it helps us leverage up and extend physicians who are very busy. We have specialists who are busier than ever, and to help leverage them up and extend them, I think that's what you'll see from this technology. And it improves patient safety and patient outcomes.

One of the things that we've done a fair amount of in this valley is symbiotic-robotic surgery, which is with the da Vinci robot. We've done cardiac surgery with that, also some pediatric urologists are using that at the Children's Hospital.

I think you'll see more surgical robotics in the future. That's pretty much in its infancy, and of course we have a lot of microsurgery. All of the procedures that we used to do as open procedure, many of them are done through small portals. The recovery time is much quicker, and patient outcomes are very, very good. So, that's exciting.

Other than some surgery centers that we talked about, there's nothing.

Well, there are a lot of trends. We see very, very many new complex pharmaceuticals that are coming on the market, and many of these are now DNA-based, so we are starting to see that we will literally have customized medications for people, particularly around oncology and cancer treatment. That's very exciting, as they unwrap the human genome, and we figure out how all these enzyme systems work.

I think that we will see over the next 10 years just an explosion of biotechnology. That has not been pervasive in hospitals to this point. I think we're going to see that change.

Clearly, we've seen a shift from things that we did as inpatients to outpatients. That's not new, but it's accelerating. Our length of stays are shorter than they used to be. We can do a lot more in three days than we used to do in six. While that is probably good for the overall costs in our system, I think sometimes it's tough for patients. It's tough to be in and out in three days and feel like you're ready to go home because a lot of times you're not ready. Our technologies have probably accelerated ahead of what folks are ready for.

I read three newspapers this morning, and I can't remember where I read this, but one of the things - maybe it was yesterday's paper - but the nursing workforce is interesting. We have a lot of part-time workers, we have a lot of women who end up maybe going home and sort of retiring earlier than they might in a normal industry. Due to the sort of macroeconomics in the country right now, we see a flood of folks coming back as part-time workers. The number of refresher recertification courses at nursing schools is up, so if you think about the elasticity, it's all supply and demand, and we've talked a lot about nursing shortages, nursing schools have more applicants than ever. It's a great profession, it's a great job, it pays very well, and now we've also got folks working either part time and coming back to work full time, folks that were ready to retire deciding not to retire - many trends that you see and read in the business section of the newspaper.

Folks who were teed-up and ready for retirement look at their portfolio for retirement and say, "You know, I'm going to work for a few more years." So that is interesting as a national trend that may help us within our sanctuaries. We've done a lot of things to be creative with nurses in terms of special shifts: four-hour shifts, six-hour shifts, weekend-only options, and things like that to be as flexible as we can to allow people to work when they want to work, when it works for their family.

In California and Nevada, we cannot directly employ physicians. In most of the country, we can. In these two states, we mostly help other groups recruit, so we may have a core group of orthopedic or neurosurgeons that need to add partners, and we'll be involved in helping them recruit. There are lots of shortages across all specialties, primary care and otherwise.

One of the things that we do as a company is, we go out to physicians who are in their fellowship years and their subspecialty training, and we recruit at that level. We start a dialogue with them and have a relationship so that when they are done with their training, we offer them - you know, "We've got 180 places where you can work." So, that's one of the exciting things. That requires you get way ahead of the curve. These fellowships are anywhere from three to five or six years, so we like to meet them at a medical school, touch base while in residency and have a relationship during their fellowship years, and then recruit them into one of our hospitals. There's a lot of that going on across the country.

We have a lot of ongoing community outreach programs. You see some inside the town, but in a more diverse geographic way, particularly with our peds (pediatric) hospital. I think we had 3,500 transports to our three (adult) hospitals last year. That's a huge number of transports. When we look at Las Vegas, just being a dense 2 million people, that gets very undense as soon as you get outside the metro (area). Northern Arizona and Nevada, California, lots or tertiary transports, particularly with trauma center, with a full service pediatric hospital. We see lots of folks coming both (by) fixed wings, helicopter, ground ambulance and it's pretty extensive. Those are networks that we continue to grow, we're excited about relationships with other hospitals and emergency rooms. There's a lot of recreational activities around here that can be dangerous, and so we're a backstop for a lot of these community ERs that can't handle that level of complex care.

In certain states there's legislation (for) federally, free-standing ERs (emergency rooms). Free-standing ERs are connected by license to a hospital, are an extension of that hospital, and they require all the same rules and regulations that a regular ER would have. We're working on that in ... Nevada and California, because we believe there's many underserved areas where we could put a full-service ER that could take (incoming) medic runs. We would direct surgical trauma, obviously, away from there, but a full-service ER that we could put in spots where the patient need is. And it's more efficient obviously than building an entire hospital. But it's 24/7, just like any other ER. And it is our hope that we will be able to do that in this state and we're working on that. We think that is the right thing for patient care for different communities that don't have access or are geographically limited or traffic barriers or other barriers. The same for California. California's had an awful lot of hospital closures in the last 10 years, so we're looking at, where can we put these in California.

There aren't any of these in any of these states, so if we get this done, we'll be a pioneer in that area. It's dealing with state regulations and all that, but we think usually the right thing works out. There's a political reality to that, but we think the right thing will win out, and we'll be able to do that at the end of the day.

I think it will be less than five years. I really do believe in Nevada and California, we'll see that in, hopefully, the next year. We're hopeful.

Well, I think Sunrise Health, we think about our four hospitals in this market, three adult hospitals and a pediatric hospital. We have very, very good coordination of care. When we look at our backup here, our call panels, our specialists who rotate to all of the hospitals, our referral systems to make sure patients get to the appropriate place, from maybe a community hospital to Sunrise, where we deliver very, very complex care. If you've been through the trauma center there, we have the only dedicated pediatric ER. It's really neat to see.

Pediatric care is so much different from adult patient care. All community emergency rooms do a very good job with most pediatrics. They're also very smart to know when this is a really sick kid and this kid needs to move to a peds hospital. I would say it's really thorough coordination of care in making sure those networks are open, and we get our patients to the right place at the right time.

And, we've got great employees. When I make rounds at our hospitals in the valley they seem very happy and upbeat and well-aligned with what we're trying to do, and that's key.

At the end of the day, as our business school professor said, health care is a negative one. It's a very scary thing. Everybody wants good care, but no one gets up in the morning and says, "I want to go to the hospital today." You might want to go to Disneyland, you want to go on vacation, you don't get up in the morning and say, "I want to go to the hospital." We're necessary, but it's a scary thing to do. For patients, it's a scary thing to be in a doctor's office, so it's important that we have very focused and passionate employees. And I see that when I make rounds. Very notable in all of our hospitals, but particularly notable when you're in the pediatric ICU (intensive care unit) at Sunrise Children's and you see how our staff interacts with these kids. Families are living in the room and some of these kids are there for weeks and weeks and months, and it's neat to see (that family interaction).

We think it's important that while they're in the hospital, people have all the communications they can have. For folks that are used to being wired, whether it's your (Palm) Treo (hand-held device), laptop or cell phone, we think that's important. So we have wired up most of our facilities here and across the country, so that visitors, employees, patients can use their devices, their laptops and have Internet access. As part of a healing culture, the old traditions of a hospital we all kind of grew up with, don't really fit anymore. People want to be connected. People don't want to lay in bed and focus on "I'm sick." They want to lay in bed and focus on "I'm almost better. I'm going home." We think that's a positive thing for our patients. We have visitors who spend a lot of time in the room and there it is. Everything's a Wi-Fi zone.

Our primary retirement plan is a matching 401(k). It's a very complex HR (human resource) formula. This essentially allows people to get an even better match. It requires that they put their money in. So, if folks are going to invest in their retirement - we hope that they do, I think that is the right thing - then our match is even higher than it could have been. I see this as a pretty positive thing. I'm in the same plan. It's no different for me. So, we see it as a positive thing.

The SEIU contract goes through 2010, and so we've got quite a bit of time left. The relationship is pretty solid. Again, while I make rounds, the barometer for me is the employees, not the unions. Unions have their own rhetoric. You read about it a lot lately in this valley and everywhere else. They're in the business of delivering rhetoric. It's what they do. That is their business. We're in the business of patient care and keeping employees happy, whether they're unionized or not. It doesn't matter to me. They're taking care of our patients, and it's our job to take care of them. When I make rounds here I see engaged employees who seem focused and happy, and there's not a lot of noise or rhetoric. So, I think we're in good shape there.

Well, I would tell you that our focus is on quality throughout this company. We have a new president of our quality group in Nashville, Dr. Jon Perlin, who we recruited from the VA (Veterans Affairs) health system. He has been an instrumental leader - about a year on board with HCA - in redefining all of the perimeters of quality. Not only the things we measure, but how we're going to change and engage in that. Our Medicare core measures, that's a big focus. All hospitals are focusing on this across the country. That's a big focus for us, and we have some significant "best practices," not only in terms of how we get it done, but also hospitals that are scoring very, very well. That is something we look at, and the nice part about having a large portfolio, we can go to a hospital that's figured it out, and migrate that knowledge to our other hospitals. That's what we've done in the Far West region and inside the Western group and the whole company.

Those core measures are important. There's four of them now. It will expand year over year. It gets more and more complex. It's important we understand how to implement that in the hospital.

Our electronic health record, our portal, to tie our practitioners in with real-time data. In the old days, doctors would make rounds, they see lab data, they do an intervention, write some orders, go away for half a day or a day. That cycle time doesn't work anymore, so now we have more real-time exchange of data so we can change what we're doing with patients and accelerate their care. That sounds sort of obvious, but not all hospitals have that technology. I think we will be surely the first national system of any scope and scale of our large amount of hospitals to be able to pull that off. It will cost us a lot of money, well over a billion dollars to do that over at HCA, so it's not something we take lightly. When we invest a billion dollars, there's no direct financial return. That's truly qualitative. No one pays us to do that. Payers (insurance providers) don't pay us more because we have that technology. It's just the right thing to do, so we're pretty excited about that.

We also look at hospitals, and we measure patient satisfaction, employee satisfaction and physician satisfaction. We focus our management teams on those things and a good portion of how they get paid is related to how happy those independent groups are. So when we find a hospital's best practice, say for employee satisfaction, we'll go study that and roll that out to our other hospitals within the company, which is a pretty exciting thing. It lowers the learning curve for other hospitals and also helps us accelerate those agendas.

It seems like every year there's proposed Medicare cuts, because there are (laughs). We're always concerned about that. Medicare and Medicaid are very significant sources of funding for hospitals - our hospitals and all hospitals across the country. Care is getting more complex. It's more costly. Our employee shortages have driven up our average hourly rate, what we pay people in health care, it's much higher than people would guess. Any kind of cut in funding is pretty tragic to us in the hospital industry. We have lobbyists inside of our company, all of our CEOs are involved. We have a whole group in Washington, D.C., this week, doing what every other industry does, which is, get in front of our elected folks and say, "Hey, this is what we need. This is why. Here's what will happen if cuts ensue." So, we're very active politically. We think that's important. Jack Bovender, (chief executive and) the chairman of our board, is very much involved on Capitol Hill. It's another thing that I think HCA is a forerunner in. We're big enough and we have the scale to do it. We have the money to do those sort of things and put resources and people on it. It's important for the entire industry. It's bigger than HCA.

Yes. Yeah, we do. Like we see along the Strip, there's probably a building boom and the cycle time for building is quite a ways in advance of when the demand cycles up. So, I think you see in medical buildings around town, just as we see new developments on the Strip, some folks may have gotten a little ahead of the curve relative to the supply and demand cycle. But we absolutely work with developers. We have a lot of third-party medical office developers that we use within HCA, and it would be no mystery to anyone that our hospital campuses, if they're surrounded by medical office buildings, that's a very good thing. It's convenient, we like doctors close to our hospitals, we get to patients more quickly. There are certain specialties we need there very quickly. We like to have our doctors very proximate to our campuses.

Well, we have actually had very good growth in this valley. We're up about 6 percent quarter-over-quarter for admissions. So, we've not seen any decline in volume. What we do see sometimes in a recession is that employees have co-pays and deductibles and based on different insurance plans, they can be significant. Sometimes we will find that co-payment deductibles are hard for patients to come up with. Ultimately, that falls back on the hospital. We treat patients no matter what. We see them in the ER, and we admit them into the hospital. We have not seen that hit us yet, but if this is a prolonged recession, I think we could, and we have in prior recessions, seen employees have a harder time with their co-pays and deductibles. And, as you said, there's layoffs, companies that decide they don't want to insure employees anymore, so we're not immune to the economy. We have not seen great effect yet, but it's early and we would hope that the economy turns around rather quickly. If this goes on a year or so, I think we could see some negative effects.

(In 2006) $90 million for charity care, bad debt and the like. That's just here in the valley - pretty significant.

Well, we work harder at everything else we do. Almost all of our hospitals are full service with open ERs and again, we take care of everybody. It's a cost of doing business. You do all the things you can do to run your business right, but there's a certain percentage in every business that's going to be bad debt and charity care. We certainly in this company do our fair share of charity care. Sometimes there's a misnomer about a for-profit hospital system versus a nonprofit. We do our fair share. We also pay taxes. Having spent 15 years of my career as a not-for-profit CEO, we didn't pay taxes and we did charity care. Hospitals, I think, there's very little differentiation between for-profit and not-for-profit other than cap status. We take our responsibility seriously.

I think after the termination of the Sierra contract in this market, we had very, very solid backfill. We had a lot of pent up demand of physicians that wanted to use our hospitals. We were so impacted by that contract, so many patients, that they couldn't get in. We saw a very immediate backfill. That's a very, very positive number. In our business, if we can get a 1 1/2 percent or 2 percent year-over-year admissions growth, we consider that to be very good. Six percent was sort of stunning for this valley. Population growth is always a dynamic in Vegas, and I don't think it is running like it was in the past. We had pent-up demand, and we had physicians who wanted to use our hospitals and patients who wanted to use our hospitals. It's great. We see it as a very positive thing.

Going back to Southern Hills Hospital, I've heard rumors that it is struggling. I see billboards where you're advertising the ER - "Short ER waits." How does this hospital fare in comparison to the other three?

It is our newest hospital, having come on line in 2004. It definitely had some start-up pain. It is not our busiest hospital, and again, I think part of it is just geographically where it is, relative to the density of population. It's had a very exciting run over the last 24 months. Surgical volumes are huge, as are its occupancy and its earnings. It has done very well. I would say it came on late. I would say the first two or three years Southern Hills had to find its stride, but it's come along strong in the last 24 months.

Oh, yeah. Absolutely.

Very good. The margins that we make in Las Vegas are not as good as our other markets, I will tell you that. It's a complex market. It's not a very diverse group of payers, (insurance providers) but they (the hospitals) do very well. We're reinvesting in them. We just finished out last year $90 million in the Children's Hospital. Obviously, Southern Hills was a big investment at $120 million or so. We continue to reinvest in this market. We're looking at other things that we're going to do. Now, MountainView (Hospital) is very, very busy and impacted. We're going to have to do some things there to grow new patients' beds and its emergency services. So, it's exciting. We're continuing to grow, and I feel very good about this market.

Yes. Simple answer: Yes. I think pricing, it has been suppressed to some degree, due to one very large staff model group and we have a large group of union employees that get very, very fair global pricing. So, absolutely. Pricing in this market is not what we see in California or Denver or other large metros. It's not.

Usually, we will have an asset that is really struggling or one that's really performing (laughs). It could be either one. There's an occasional (situation where) we'll have a hospital that does very well in a market, but it's by itself. We try - again we have some hospitals that do very, very well - but for the most part you'll see us - like Kansas City, we wanted a significant presence, a big market share and a large metro. Kansas City is not known for its population growth, unlike Vegas. But it is a dense population, and we went into that market with 25 percent market share, the largest market share of the hospitals. We have that here. We have better growth dynamics, we have a third of the market, but in some areas, we will have one dominant hospital and no other HCA hospital around. On occasion, those hospitals, because someone else wants them, might sell at a very, very high multiple. That would be an occasion for the most part. There are assets that don't fit our portfolio, like we've done spins and maybe they're hospitals that are smaller or in non-metro areas. That has been my history in the last nine years. Those are the sort of hospitals I've seen us divest. We're not a hospital that buys and divests a lot. We're very cautious and careful, as our chairman said in that earnings report, if he could find another Kansas City, we'd do it in a heartbeat. They're not all over the place to be found, but clearly that was an exciting project for us and did very well for the company.

No. This market, I think (we) will definitely keep all our assets here and add to them. I think, probably, there will be some things to announce in the next six months or so, that we will be adding to this portfolio.

Nothing immediate. We look at our hospitals very frequently relative to staffing. We try to do what we call flex staffing, so our staff is used to flexing relative to the market. Clearly, if we have a prolonged period where we don't have a census that we budgeted for, then we absolutely do have the occasion to have layoffs. We don't like to do it. It comes up in our business, but again, we try to flex people. We have employees that are willing to do that. Most of our clinical folks know how hospitals do their staffing. We get up and see how many patients we have to care for, and we size our nursing staff in particular and other therapies regularly.

Well, one of the things that we did in Kansas City was we ended up having seven certified chest pain centers. We're going to do the same thing in this valley. I think that's really important. The neat part about doing this is we have very clear parameters and the key marker is during bloom time (opening the coronary artery by inflating a balloon attached to a needle pulled through the artery). Our goal is to open up that coronary artery in a very limited amount of time. Ninety minutes is kind of the medical standard. The quicker, the better. The difference being, just like with a stroke center, if we can open that up, we have a functioning person afterward, it's very much the same. We save cardiac (arrhythmia) and the left ventricle and people who might have an injection fraction, which is how we measure how that left ventricle contracts, that works properly or doesn't. And the whole difference is a whole change in a person's lifestyle, or someone living or dying. That's something that our team here is just rolling out. These centers will be chest pain certified, and you will probably see us market that so that people will know this is where to go, get there quick, and our cardiologists will revascularize them and open those coronary arteries up. It's very exciting, and it's important. And it's protocol driven, so we know exactly what we are doing. We're looking for particular elevations in EKG (electrocardiogram), we detect it in the field, then we now have what's called an ST (segment) elevation myocardial infarction. It's called a STEMI, it's an acronym, so sometimes you hear them being called STEMI centers. We activate a team, the cath lab (catheterization laboratory) team is ready. People move in real quick, and we do what we need to do. It's very exciting. There are some great stories from these chest centers across the country with folks who have heard about our centers and knew and got to the right place at the right time and our teams were waiting. So, you'll see that here in Vegas. You'll see it in California.

They'll be housed in hospitals. We like to have a very active cath lab. We have our heart surgery teams on standby, rarely needed but sometimes. And the key again is to get them into the cath lab and get that artery dilated or use a thrombocytic therapy that the cardiologist thinks is needed. Time is muscle, is how we think about that. People have to move quickly. Sometimes people end up in the wrong hospital and don't have a team ready, they're not waiting, not tuned in. We matrix this out and there's steps and we measure every piece of it. We roll out the charts. It's not sort of a plaque that we put up in the hospital. It's very focused and very data driven. So you will see those probably this year.

They do. It involves some pretty involved therapy inside the cath lab. This is stuff that our cardiologists are used to doing every day. We don't think it's all that advanced, but if we took you in there, you'd be pretty amazed at what they do and how quickly they are able to open coronary arteries up and how much we can do through a catheter, that 10 years ago we would have to do open heart surgery for, so that's pretty exciting.

We'll end up educating the public: These are the symptoms. We do the same thing for stroke centers. These are the symptoms, this is where you need to be.

You know, men are the very worst at putting these things off. You hear these stories and some of the stories end rather tragically. We have anecdotes of our own hospital employees. Husband says, "I got a call into the paramedics, get in a car and start driving to an ER." Somebody that's in arrest, that's not a good scenario. A lot of this will be community education. This is not drive yourself to the ER. This is call the paramedics, we can get an EKG on, we can tell very quickly if that is what's going on. If there's a problem, we've got defibrillators, we've got cardiac drugs in the field. If we do the right thing, most of these people can have a very, very good outcome. This is one where you want to do what you're told. Guys are the worst at that. Most of our messaging is to the men through the women (laughs). Make them do the right thing.

We had a whole women's cardiology program that we put together in the Midwest and that's a very good point. That often times we have a gender bias and it's the No. 1 killer of women as well. We've basically got to focus: These are the symptoms, get in and get there via paramedic. This is not a drive yourself episode.