Dr. Janet Bull’s Story

Since January 2000, Dr. Janet Bull has faithfully served patients at Four Seasons, both directly and indirectly, and has grown the services of Four Seasons to better serve our community. We are so grateful for Dr. Bull’s work at Four Seasons for over 20 years.

Read Dr. Bull’s story of how she came to work in hospice care, what patient care means to her, and how she helped to lead Four Seasons in innovative healthcare.

I was practicing medicine as an obstetrician-gynecologist in Atlanta when our office manager, a vibrant woman in her thirties, became critically ill. It was during that time that I realized that the medical system was so focused on treating her medical illness, that little if any attention was spent in helping her emotionally or spiritually or comforting her large family who was devastated by their impending loss. The day of her death, I did a visualization exercise and “journeyed her to her favorite beach.” I watched as her blood pressure and pulse normalized. The energy in the room shifted, a peace came over her, and soon after I left, she died peacefully. During the same time frame, Elizabeth Kubler- Ross came to Atlanta and talked about her work with dying children. She discussed the language of the dying, the need to bring meaning and resolution to life’s end, and I was taken with the authenticity and vulnerability of her work and the impact that it had on those she cared for. At the time, I was fully engaged in an obstetric-gynecology practice, but those two events were the catalyst that led me to volunteer with hospice and eventually change specialties.

In January 2000, I began my career at Four Seasons caring for patients at their homes and at the Elizabeth House. Most of our patients were being sent to hospice with less than 2 weeks to live. It became apparent to me that that palliative care was a solution to fill a needed gap in healthcare for patients with serious illnesses. Clinicians were often failing to have conversations about what mattered most to patients and families at the end of life, patients were suffering from pain and other symptoms, death was institutionalized, and families were often torn with making difficult medical decisions. It was a far cry from my previous life as an obstetrician. While birth also occurred in institutions, birthing rooms were the norm, families were included in the delivery process, and human touch abounded. Surely, there must be a better way. I find there are many similarities between obstetrics and hospice/palliative medicine as the birth of a child and the death of a loved one, are key sentinel events. The same elements surround both – intimacy, vulnerability, fear, angst, laughter, love, and wonder. Being a witness and often a facilitator to these events has been a great privilege.

In 2005, through the passion and vision of Dr. Bull, we formed our research department with the goal of exploring innovative methods to improve the care for those we serve. Since that time, we have participated in approximately 45 clinical trials; several of these have contributed to FDA approval of medications for patient use. During this time, we were awarded many grants to help with our work. We realized early on we needed to create a clinical database to demonstrate the impact of our patient care and the research work. We formed a relationship with Duke Medical Center in 2006 to create the Global Palliative Care Quality Alliance that led to the development of a national palliative care database and creation of the Quality Data Assessment Collection Tool (QDACT). This work has enabled us to join forces with 2 other highly revered registries to create the Palliative Care Quality Collaborative, a national clinical registry that launched in 2021 and is now available to all programs across the United States.

In 2013, Four Seasons received a CMS Innovations Grant to demonstrate the value of palliative care. We enrolled six thousand patients and were able to demonstrate value by completing advance care planning and increasing hospice utilization, while achieving very high satisfaction with care. Part of that project involved setting up a telehealth program that would allow the palliative care team to monitor patients remotely and respond to patient’s and caregiver needs as they arose. This program was widely accepted by palliative care patients and became a significant part of the palliative care delivery model at Four Seasons. In 2017, FS was chosen by the National Committee for Quality Assurance (NCQA) as one of eleven programs nationwide to participate in the Serious Illness Care Accountability Project, funded by the Gordon and Betty Moore Foundation to develop components of an accountability program for quality in serious-illness care. In 2017, we were funded by The Duke Endowment to conduct Project ECHO-Pal, a tele-mentoring and teaching modality in which FS experts held regular video conference sessions with palliative care providers who are predominantly advanced-practice providers from rural and underserved areas of the Carolinas.

In 2018, we were funded to conduct a clinical research trial with Tabula Rasa to study the feasibility, acceptability, usability, and outcomes of a new clinical decision support system for prescribers of opioid therapy in the context of specialist palliative care for serious illness. This system provided prescribers with a patient-specific genomic evaluation that was aimed at helping providers assess the potential impact of genomics on opioid responsiveness and multi-drug interactions. And, in 2020, we received a grant from the Cambia Health Foundation to partner with Providence Healthcare system in Washington state to expand the ECHO model for Hospice and Palliative Care providers throughout the Southeastern and Northwestern United States. These ECHO programs focused on topics that are relevant to delivery of care for the seriously ill, COVID-19, and resilience.

“Dr. Bull has been a pillar of innovation, creativity, and wisdom at Four Seasons for over 21 years. She has strengthened our mission, advanced our vision, and embodied our values. As a national leader in Hospice and Palliative Care as well as Research and Clinical Excellence, we are so thankful Janet has given so much time to us constantly helping our organization provide the most trusted care possible. We will forever be grateful for Janet and honor her legacy, thereby ensuring that all patients have access to the very best care as promptly as possible.” -Dr. Millicent Burke-Sinclair, Four Seasons President & CEO

Thank you, Dr. Bull, for over 20 years of knowledge, experience, and expertise at Four Seasons!

Chris Comeaux, Teleios Collaborative Network (TCN) President & CEO’s Speech Honoring Dr. Bull

There are many firsts in my life I can remember. When and where I met my wife. When I first saw my 5 children being born. All very important moments in my life.

Well, I can remember where I was when I first met Janet Bull. It was at the nurses’ desk at the Elizabeth House in March 2002 over 20 years ago. It was the end of a full day of interviewing at Four Seasons for the CEO role. Then I met this ball of energy and enthusiasm, Dr. Janet Hunter Bull. She told me you should consider joining us as we are going to do great things and make this one of the best hospice and palliative care programs in the country. I told myself,     I think I am going to do this just to work with this amazing person. I bet it might be a great journey. And man it has been a great journey and there is no way it would have been without Janet Bull.

My favorite movie in the world is It’s a Wonderful Life. We all know it and the great storyline where George Bailey gets to see what his community would be like if he had never been. If Janet ever met Clarence, you know the angel in It’s a Wonderful Life, I shudder to think of the countless patients and families Janet served in WNC who would not have gotten the care and compassion had there not been a Janet Hunter Bull at Four Seasons. I also shudder to think how less rich my life and career would have been without Janet in my life. I know many of you here tonight feel the same way. There are so many names over the years of patients, some of who really stick with you like: Dillon, Baby Samuel, Stryker the ex-NFL football player, and many, many more. All of whom were touched by Janet, their lives and the end of their lives would have been much different.

There have been so many triumphs and challenges over the years all impossible without Janet: palliative care, research and the many studies we were involved in which have furthered the field, countless grants furthering the service lines of Four Seasons, offerings, and the mission of FS, CMMI for palliative care, FS Center of Excellence where many other programs came and visited and Janet played a pivotal role in the training and best practices that were disseminated to programs from all over the country, palliative care immersion where 100’s of palliative care providers from all over the country have been trained and are now providing palliative care in hospitals and communities all over America, Four Seasons consulting group where Janet has added value to programs from all over the country and hopefully will continue to do so even in her retirement, our partnership with Zambia to further palliative care across an entire country on the continent of Africa, palliative care quality measures exist today in the US because of Janet, the FS physician model and really the physician model for hospices all over she did that too. FS twice won the Circle of Life award and no doubt a key part was due to Janet. Janet has won countless awards like the Cunniff Dixon Award, and the Josephina B Magno Distinguished Hospice Physician Award. With so many great accomplishments I could show you a picture I went and took on my phone just a week ago, there is this linen closet at the Elizabeth House that was Janet’s office for a large number of her years at Four Seasons. This shows the humility of Janet as well. Many of us knew, but many staff did not that there was a giant, a proverbial hospice and palliative care rock star in our midst who we got to work with and be challenged by on a daily basis.

Janet, I could go on. But I will leave everyone with this. When we did the ribbon cutting for the Elizabeth House expansion at the end of our Capital Campaign to build Greatrex Place and expand EH I was actually gone from FS working with the Studer Group but I was invited back for the ribbon cutting. I was not sure what I would say but on the plane ride I was reading something from the father of systems thinking Dr. Peter Senge and he said something that just struck me like lightning. Some of you might remember. He talked about Bell Laboratories having this grand vision of developing a tool that you could give to every child in the world and it would enable them to read. Well, Bell Labs never fully realized that vision but that vision produced what all of us use daily that you probably do not even realize but the graphical interface of icons on your computer and your smartphone find its origins in that bodacious project. The learning lesson in me paying forward that real story is, it is not what the vision is, it is what the vision does.

Janet, you shared with me in a moment in March 2002 a great vision when I met you literally in the first 10 mins of our very first conversation in March 2002. In many respects with so many here tonight together with you and in many respects in large part because of you, we have made great strides towards that vision of FS being one of the top hospice and palliative care organizations in the country, right here in the place you choose to call home Western North Carolina. That was crazy talk back in 2002. But you said it with such confidence. That conversation changed the trajectory of my life, my family’s life, my kids’ lives, and the lives of all of us here tonight in so many ways and I know many could stand up here and tell similar stories. It is not what the vision is it is what the vision does. And the most incredible thing which is the only reason why you can retire, is the vision you started will continue and will continue in ways we never imagined back in 2002. I love you, respect you, I thank you and I am going to miss you. We all will, but know you have given us a great vision that will live on and yours is a retirement well earned.