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America's Hospital Menus Getting Green Overhaul

Soon "hospital food" may no longer mean the worst American factory-farmed cuisine has to offer. A handful of hospitals around the country are starting to put hormone-free meats, rBGH-free milk, and organic veggies on their menus. For years, the best advice of health-care professionals hasn't been reflected in the typical hospital menu. But now, hospitals "are increasingly seeing food as a treatment issue and not necessarily as a cost center," according to Scott Exo, director of a group working with hospitals to green up their menus. Patients at the Good Shepherd Medical Center in rural Hermiston, Ore., for example, now get made-to-order meals featuring organic, sustainably grown meats and produce. Food waste is down, and people are even asking for the recipes. The trend is partially driven by baby boomers, who are spending more time in hospitals and want the meals to appeal to their restaurant-honed palates.

From New York Times

March 7, 2006 Being a Patient For Hospital Menus, Overdue Surgery By KIM SEVERSON

In her family, the Filipino dishes that Felipa Tobias cooked were the standard by which all others were judged. That made the food she encountered at the Elmhurst Hospital Center in Queens particularly hard to stomach.

Instead of chicken adobo or tamarind soup, Mrs. Tobias, 81, picked at a lukewarm chicken breast and rice pilaf dampened with sticky brown sauce.

Boiled carrot sticks and shredded iceberg lettuce with a packet of low-calorie French dressing filled out the tray. She said her fruit cocktail tasted as if someone had rinsed it in running water and squeezed it dry.

Mrs. Tobias's cholesterol-limiting, no-sodium supper was assembled to help her overcome liver and kidney ailments. But it only added to her irritation.

"All of it tastes like nothing, and it smells worse," she said to her granddaughter in Tagalog.

The presentation made it even more dreadful. It sometimes arrived when Mrs.

Tobias was undergoing tests or was asleep, going cold under plastic wrapping until she could eat.

Still, the nutrition chart her nurses kept showed that she choked down about three-quarters of the 1,800 calories that her doctor said she needed each day.

"You want to get better, so you try to eat it," Mrs. Tobias explained.

For the sick, nourishment is a lifeline to healing. But in American hospitals, food is often the top complaint of patients and their families.

In some facilities, more than a third of the food served on an average day goes untouched. Hospital food has become a national joke. Want to dismiss a bad dinner at a new restaurant? Just say you have had better food at a hospital.

In recent decades it has become even worse, medical experts and veterans of the hospital food service business say.

"A majority of hospitals have long ago abandoned their homegrown food service or have made very limited attempts to make the food experience at all palatable for patients," said Dr. George Blackburn, an associate professor of surgery and nutrition at the Harvard Medical School and the director of the Center for the Study of Nutrition Medicine at the Beth Israel Deaconess Medical Center in Boston.

But there is hope among the Jell-O cups. Dr. Blackburn and other nutritionists say the medical profession has begun to recognize that good-tasting, culturally correct food that is served at the proper temperature and when a patient is ready to eat can help people feel better faster, save on food costs and attract patients with good insurance plans.

As a result, some medical schools are renewing emphasis on nutrition, and hospital administrators are hiring culinary school graduates to run kitchens that are being retooled to let patients order food as if they were staying at a hotel.

In California and a handful of other states, patients may be offered wine with dinner. A hospital in Duluth, Minn., buys local and organic produce.

Hospital kitchens that used to stick to traditional cafeteria-style staples incorporate dishes to comfort increasingly diverse patients, like jook, a Chinese rice porridge; Native American foods like fish soup and bison; and for Muslims, halal meat.

Baby boomers, with their well-traveled, restaurant-honed palates, are driving the trend. They spend more time in hospitals as they age, and they want to eat well while there.

"They will not accept the traditional type hospital food service," said Sharon Cox, director of food and nutrition for the Memorial Sloan-Kettering Cancer Center in Manhattan.

In 2002, Sloan-Kettering became the first East Coast hospital to offer hotel-style room service. Patients can order from an extensive menu with restaurant-style entrees from morning to night and be assured of delivery in less than an hour.

Ms. Cox is president of the 2,000-member National Society for Healthcare Foodservice Management. A recent survey showed that as of last year, 17 percent of the hospital services operated by members of the group had changed to room service.

Rick Wade, a senior vice president of the American Hospital Association, estimated that 40 percent of the nearly 4,800 hospitals in the group had changed or planned to change exclusively to room-service-style food programs in five years.

The move, helped by a wave of reconstruction among hospitals built after World War II and remodeled in the late 1960's and 70's, is part of a shift to improved patient care, Mr. Wade said. "It's a whole different look at what the patient is experiencing psychologically and emotionally, and food is a big part of that," he said.

The decline in food quality is in part tied to the nature of hospital care.

Because more procedures are conducted outside the hospital and stays have become shorter, patients who do stay at the hospital are sicker than they used to be. That means they cannot eat or they have dietary restrictions that render meals less important.

A patient with kidney disease, for example, will have to eat foods low in salt, potassium and fluid. Carbohydrates must be controlled for diabetics.

Some diseases make it hard to chew, so puréed meals are needed.

Often, the special diets a doctor can order for a patient includes more than 80 variations. At Sloan-Kettering, about 40 percent of patients are on some modified or restricted diet. With such restrictions, trying to create food that is palatable and culturally appropriate is a challenge.

Some dietitians trace the slide in hospital food to the growth in fast- food restaurants and advances in food processing and kitchen technology in the late 1960's and 70's. By the early 80's, leaders of large urban hospitals began to hire outside companies to prepare industrial-size portions of ready-to-heat food.

The practice, called "cook-chill" or "cook-freeze," allows as much as two or three weeks of food to be cooked and delivered in one batch. Though most American hospitals continue to prepare their own meals, 20 percent in Ms.

Cox's food service group contract out for some food.

The New York City Health and Hospitals Corporation, which includes the Elmhurst Hospital Center where Mrs. Tobias was a patient, began this year to distribute food from a central kitchen.

Even if each dish was prepared by a top chef, hospital kitchens might never make patients happy. The hormones the body needs for healing activate a condition called the tumor necrosis factor. A side effect is the loss of appetite, Dr. Blackburn said. That is the main reason hardly anything tastes good when a person is sick.

Food is often the only thing in a hospital that people feel they can
control. They might not be able to discern whether their IV is correct or that their latest test was conducted properly, but they can usually say what is wrong with their meals.

From a psychological perspective, patients start off assuming that hospital food will be lousy, and that colors even the best meal. Better food may make a hospital more comfortable, but there is no definitive connection between fresher, better tasting food and healthier patients.

"I don't know that anybody has proven that room service improves health status," said Carol Porter, director of nutrition and food services at the University of California San Francisco Medical Center, where they peel their own potatoes and hand out 287,000 cups of apple juice a year. "The issues are a little more complex than that."

The hospital is experimenting with a modified restaurant-style food service and studying a new kitchen plan. In the meantime, its 1,500 meals a day are prepared in a 50's-era kitchen defined by oversized steam-heated kettles and hulking griddles. Meals are scooped out assembly-line style and taken on carts to the rooms all at once.

Because food orders are processed 24 hours ahead, patients who may have been forced to order from the liquids-only menu can be cleared for solid foods by their doctors one day but still face another day of broth. Floor workers have had to deal with thrown trays and tears when the doctors' orders did not match what was on the tray.

Even if a hospital solves that problem by switching to room service, what arrives on a tray still may not make a patient happy, because everyone has a different idea of what will make him feel better. "Odds are it is bland, easy to chew or swallow and, perhaps most importantly, a riff on what a parent or caretaker gave you when you were a kid," Ms. Porter said.

Such food can take many forms. Someone who grew up in the suburban Midwest might like soft-boiled eggs. An immigrant from Mexico might want a bowl of posole. Someone raised in Russia might want sour cream, dumplings and

Developing medically appropriate menus that also satisfy many different cultures can be daunting, although hospitals are increasingly playing to their populations. When patients enter the Alaska Native Medical Center in Anchorage, they can choose from Native foods like caribou stew, boiled fish and berries.

The foods made life much easier during a recent hospital stay for Rebecca Nelson, a Tlingit from southeastern Alaska. The fry bread was cold when it arrived at her room, but the flavor of the fish soup made up for it, said her daughter Jenny Bell.

At the 54-bed Chinese Hospital in San Francisco, dishes like egg noodles with steamed fish dumplings and bitter melon soup taste better than what is served in many Chinese restaurants. But the dishes are lower in fat and sodium, so patients complain.

"They say it doesn't taste right," said Salina Au, the dietitian who manages the dietary department. "If they are not eating, we encourage the family to bring food from home."

For cancer patients at hospitals like Sloan-Kettering, chemotherapy and radiation kill appetites and induce nausea just as the body needs extra nourishment. That was one reason administrators there began to think about changing the food. A study in 1998 showed that just 40 percent of patients consumed all of their food and that a third did not touch their food trays at all.

By 2002, the hospital, with 425 beds, developed a restaurant-style system that allowed patients to order food from 7 a.m. to 9 p.m. Entrees include Southern pecan-crusted rainbow trout and butternut squash ravioli. Each of the 21 menus is presented on a card with attractive fonts, so even the puréed kosher menu looks appealing. Now more than 80 percent of the patients eat half or more of their meals, Ms. Cox said.

The hospital uses a few other tricks to make people eat. Because intense aromas can bring on a bout of nausea, the covers are lifted before the tray is brought in the room. Portions are not overwhelming, and a special plate warming system keeps food at a palatable temperature.

But the real difference is a personal touch. A server greets a patient by name and positions the tray so the patient can eat comfortably. The server goes over the order with the patient before leaving and picks up the empty tray within the hour.

James Gardella, 43, who lives on Long Island, has been in and out of the hospital for chemotherapy since last fall. He had once considered attending culinary school, so he was quite concerned about what he was going to eat during his stay.

The food, it turned out, was one of the few bright spots. On his first day, the vegetables in his omelet had been nicely sautéed. The haddock he ordered for dinner was served on china and was so perfectly cooked that it flaked apart with a touch of his fork.

"These little things mean a lot for a person with cancer," Mr. Gardella said.

Copyright 2006The New York Times Company