Ringworm, MRSA & Broken Buckles: The PPE Problem Nobody's Talking About w/ Justin McKay

You put on a lead apron and assume it's keeping you safe. But what if it's carrying MRSA, ringworm, and nearly 10 times the bacteria of a gas station pump handle? Even worse, what if nobody's required to clean it?

Justin McKay, founder of RadCare Services, joins Dr. Adam Brown and Dr. Lara Zibners to share how a ringworm infection, a torn-up apron on his first day in the OR, and a year of quietly studying hospitals across the country led him to build something the healthcare industry didn't even know it needed: a full-service lead apron cleaning, repair, and compliance program.

In this episode, we dig into the disgusting (and dangerous) reality of radiation protection garments in U.S. hospitals from blood and fecal-stained aprons going right back on the rack, to a culture study that found MRSA on the majority of aprons tested. Justin shares the moment a skeptical surgical director called his pitch "snake oil," so he tested her busiest surgeon's apron on the spot. The results were jaw-dropping.

We also talk about the uphill battle of building a business around a problem no one is required to fix, why financial incentives in healthcare make or break innovation, and what gives Justin hope for the future of medicine.

In this episode:

• Why hospital lead aprons are virtually unregulated for cleanliness in the U.S.
• The ATP test that proved aprons are nearly 10x dirtier than gas pump handles
• How a 2017 lawsuit tied defective PPE to cancer deaths among OR staff
• The founder's journey: quitting a VP of sales job, two years without a paycheck, and bootstrapping a new business

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Transcript

SPEAKER_00 0:00

Unstable Vitals is the podcast that takes the pulse of American healthcare, and the prognosis is critical. Dr. Adam Brown and Dr. Laura Zibner, physicians turned entrepreneurs and business leaders. Expose why the system is unraveling before our eyes.

SPEAKER_03 0:17

Well, listen, I'm so excited to be here. This is another episode of Unstable Vitals, and I'm here with Justin McKay from Radcare Services. We're going to talk about him a little bit, but as we know, it's about Laura and me. So, you know, we're going to Justin, it's it's good to welcome you to our world, but we're talking about you in a second. Laura, what have you been doing in the last few days?

SPEAKER_04 0:34

Uh yeah, and I'm Laura Zibners. I'm the co-host of Unstable Vitals. Adam usually forgets to mention me. Not true. I'm doing great because I moved house last week, and there's nothing I enjoy more than moving house.

SPEAKER_03 0:51

Can I just call out for a moment? Justin, I we're Americans, right? And and Laura is this duly person living in like the US and Austria and London. Do you notice that move house? Do we really say that in the US? We don't say that. We say we're moving.

SPEAKER_04 1:07

Yeah, but if I'm moving, that could be it right there. I just moved.

SPEAKER_01 1:13

No. Now listen, when you're from the country like I am, okay, move house means sometimes you see someone's house andor trailer cruising.

SPEAKER_04 1:24

Okay, but Justin back in your corner because we haven't introduced you yet.

SPEAKER_02 1:27

Yeah, this is true.

SPEAKER_04 1:28

Okay, I moved house, and I'd like you to look at my new office because our new flat came with like a mother-in-law suite kind of thing. So now I have a place that the children don't even know where it is. They've never been in it, they don't have keys to it.

SPEAKER_03 1:44

I think that is the value prop right there. Kids.

SPEAKER_04 1:47

The number of times we have filmed with a child under the desk. Anyway, so I'm doing pretty good. And then I you know, the thing about unpacking is that you find things. So I got I found these glasses I bought. I don't know if you're not.

SPEAKER_03 2:00

I like the color.

SPEAKER_04 2:02

They're I think they're for really old people because they come around the back of your head and they snap right there.

SPEAKER_03 2:09

Okay.

SPEAKER_04 2:09

But I think they don't know. I don't think it's a anyway. You find a lot of shit.

SPEAKER_03 2:14

Yeah, you do when you move move house. When you move house.

SPEAKER_04 2:18

And I agree that I have been behind enough houses being moved in the great states of America.

SPEAKER_03 2:25

Yeah. Well, okay, enough about us. Um, yes, Laura. What are you doing?

SPEAKER_04 2:30

So that was all about moving. What are you up to?

SPEAKER_03 2:32

Oh, I'm I've got an epic travel schedule coming up in the next few weeks, a couple of conferences I'm excited about. We want to talk with Justin about one of his conferences that he just came back from. Um, but I've got a medtech conference in Dublin. I'm kind of excited about that. And then Tech Week in London is coming up, and then so like some really cool kind of innovator space stuff that's happening uh in the healthcare world that I'm very excited to learn more about. Oh, and I'm speaking at Cambridge University. Like, I who would have ever thought a kid from eastern North Carolina would be doing that. So it's kind of exciting stuff happening. So that's very exciting.

SPEAKER_04 3:06

Are you gonna drive it? Well, anyway, enough about us.

SPEAKER_03 3:08

Enough about us.

SPEAKER_04 3:09

Do you know are you gonna drive? Because you have to drive on the other side of the road.

SPEAKER_03 3:13

I'm not gonna drive. And I they have these things called trains that are well very well connected.

SPEAKER_04 3:18

They're way better. Yeah, Europe's awesome for trains.

SPEAKER_03 3:20

I'm gonna take a train. Well, listen, um, Unstable Vitals, you know, we're trying to solve some of the problems in healthcare, and we're talking about people that are trying to solve them through various different activities. And so some people are are policymakers, some people are doctors, nurses, hospital, uh, hospital CEOs and administrators, some people are producers of healthcare, those that are making new widgets and innovations and technologies, and some are in the insurance industry. So there's a lot of different people that are trying to affect healthcare in a positive way and also assist with making it less less unstable, which so making it more stable. So, one of those individuals I wanted to introduce today was my good friend Justin McKay from Radcare Services. He's a founder of Rad Care Services from the great state of Indiana. For those that don't know, that sits between the East Coast and the West Coast.

SPEAKER_04 4:10

And um next to Ohio, where I spent 10 years.

SPEAKER_03 4:14

Yeah, this is also true. This is true. So um, so we are so excited to have you on, Justin, to talk with you about what you're doing and what problems you're trying to solve.

SPEAKER_04 4:25

And I'm just gonna say, when Adam told me what you do, I was like, how come no one's done that before? And that is so nasty. Thank God for you.

SPEAKER_02 4:32

Yeah, so Justin, introduce yourself. Tell us a little bit of what who you are and what you're doing.

SPEAKER_01 4:37

Yeah, first, um, thanks so much for having me on this platform. Uh it's gonna be a lot of fun, it's gonna be a great conversation. And Laura, I promise this will not be boring. I'm high energy, and you may have to you may have to put me back in my corner a couple more times.

SPEAKER_04 4:50

Don't worry, I'm I'm an unhinged middle-aged woman. Don't worry.

SPEAKER_01 4:52

I love it. It's gonna be great.

SPEAKER_03 4:55

I would I would that's a validated statement.

SPEAKER_01 4:58

So thanks so much. Thanks so much for having me on. I appreciate both your consideration and uh and your support. And yeah, I'm Justin McKay, uh Laura, um Adam's friend, uh, and and and colleague, if you will, in some capacity. And uh yeah, hey, so you know, my my story or my background is hey, I love uh unstable vitals, the discussions you all are having about healthcare, current state of healthcare, where healthcare is going. And so for me, um, I'm outnumbered here, okay? Uh I can't keep up with the two doctors in the room. I'm not a physician or a provider. Um, but hey, I was one who was a supporter. Uh so I worked uh in the perioperative space uh with orthopedics, you know, as a sales rep. And so um you travel, you're covering ortho cases, you're covering trauma cases, and the dreaded vendor rack, you know, uh where you go in, you hey that vendor rack's here, let's go, chop, chop, we gotta move. Um and it always the the the garments always smelled like cologne, perfume. They were stained, they were decrepit, broken buckles, torn straps, and just um just disrepair, if you will. And so early on in my career, um, Adam, I should stop back. I should stop for a second. Am I going too too fast, too deep here, Adam?

SPEAKER_03 6:17

No, I I probably I think what will what I what I let me I probably should have introduced a little bit more about what rad care does, and rad care at a very high level takes lead aprons that we all have worn, whether the dentist or us as clinicians have worn it in the hospital or emergency physicians, you know, anytime they bring in radiology equipment to protect ourselves or protect patients from radiation, we put on these lead aprons.

SPEAKER_04 6:41

And um and then and they're heavy, and you put them over, you often put them over your like protective gown, so they're like the front line. And and when you start talking about, and they are they're always ratty, and there's always a broken strap, and some of the nobody ever thinks about what you're about to tell us.

SPEAKER_03 7:07

Yeah, so so take me. I think Justin, probably like if saying this, where you Laura and I are very much used to wearing these lead aprons. You were working in operating rooms as a sales rep, having to go in quickly, grab whatever available apron was available to you to protect yourself. And so take me back to that moment of when you're like, Houston, we have a problem. And what were you doing to try to what what what did you immediately kind of see?

SPEAKER_01 7:36

Well, uh man, right out of the jump, I was like, Houston, we have a problem. And what I mean there is, you know, you go through training, you know, when you're learning a product, if it's an implant, plates, screws, whatever you're going to be, whatever widget you're going to be representing, you go through intense training. I mean, hours and hours and quizzing and testing and so forth before you ever step foot into an OR for observation and training and so forth. I'll never ever forget my first time stepping into an OR, like as a you know, wet behind the ears, green horn, you know, in training, they wheel the CRM into the room and someone hands me an apron, and there's no strap, no buckle, this thing's torn off. I said, How do you how am I supposed to secure this or put this on? And this woman goes, dog, don't worry, sweetie, just hold it up in front of you and try to hide behind. Just try to hide behind it. Or you can just stand behind me. And I'm like, okay, wait a second. I'm in a very prestigious, well-known billboard university, and this is the kind of crap that's taking place behind the scenes. Give me a break, man.

SPEAKER_03 8:38

Yeah, I mean, like, I I certainly I have been in the trauma situation where there weren't enough aprons, or like a patient comes in and they're bringing in this C arm thing to kind of see like where is the bullet, where is you know, where is their air, where are their broken bones. And that same thing has happened where it's like the nurse, like, oh, just stand behind me really quickly.

SPEAKER_04 9:00

I've done that.

SPEAKER_03 9:01

Yeah.

SPEAKER_04 9:01

Or you jump like two feet away as if that's gonna make you feel better. You hide behind somebody, you step off like three inches to the left, because that'll protect you from reading.

SPEAKER_03 9:12

I mean, and okay, and maybe there's still slate protection, but the fact is, is it's still not truly fixed. And so, but then so Justin, that was kind of the environment you're working in sales rep, selling ortho equipment in an operating room. You're having to use these aprons, but then take me back to the moment where you really said, Okay, there's a bigger problem here. These things are nasty.

SPEAKER_01 9:36

Is this gonna make it? Absolutely, absolutely. There's a twofold, twofold uh answer there, Adam. So, one, you know, but that was my first initial impression of lead, like, come on, you got to be kidding me. And then so I traveled for about a year, and I would be in New York, I'd be in Texas, Florida, and so for about a year, I was quietly just uh uh observing or studying. And so if I was in a small rural standalone or a large academic, you know, level one trauma teaching, what wherever I went, whatever state I went to, I always asked the question. And I would find the periop director or I would find the radiology director. Oftentimes radiology might be who dictates the policy for these garments. So I would just track these folks down, and I was kind of doing some market research, and nobody anywhere had a protocol, a cleaning system, compliance, records. And I mean, as I she used the she Laura used the word ratty. I mean, these things are you know, pardon my language, they're they're a shit show, you know, across the US. And so I'll never forget, Adam, like when you know your question of hey, when did this really hit in that something needs to be done here? Um, you know, I got a ringworm on my neck. And you know, my business partner, he and I have been friends for 30 plus years, and so um I'm at the uh Walgreens waiting on my prescription. My neck is nasty and gross. And you know, he had a little fun with me. We've been buddies for a long time. They called in on a prescription for yeast infection medication for women. He had a blast with that, giving me a hard time about that. But I called, I said, dude, seriously, like every hospital we work in, they're disgusting. And you know, we've seen blood, vomit, fecal, stains, unknown stains, splatter, cologne perfume, just a potpourri of funk, you know?

SPEAKER_04 11:25

And I'm like, we're gonna have that on the back of a new t-shirt.

SPEAKER_03 11:29

I love that, a potpourri of funk. I think I think that's a that's a I I really like that a lot. Um, I love the potpourri of funk. Um, we really should think about that as a t-shirt.

SPEAKER_04 11:41

I'm thinking we need season two t-shirts and a potpourri of funk yeah, yeah. It's a great follow-up to a code brown.

unknown 11:49

Yeah, yeah.

SPEAKER_03 11:50

This is right, it's totally a code brown follow-up. I really, really like that a lot. So, so Justin, okay, so you're working the OR gross grody, as we used to use when I was in high school. You know, grody, grody um aprons, broken aprons, and then you get a yeast infection, ringworm, and it's like, okay.

SPEAKER_04 12:13

Those are not the same.

SPEAKER_03 12:14

I know, I know, I know.

SPEAKER_04 12:15

Tinia corporis is not Canada albacans. Like, get your fungus.

SPEAKER_03 12:20

They are all tiny, Laura.

SPEAKER_04 12:23

Yeah, but but that's let's just be clear.

SPEAKER_01 12:25

They are tinnia.

SPEAKER_03 12:26

Yeah, okay, clear, fine.

SPEAKER_04 12:28

But canadiasis is not a tinia, is it?

SPEAKER_03 12:30

Oh, no, it's not. That's right. What am I thinking about?

SPEAKER_04 12:36

You know, corporis, and can be a little bit more.

SPEAKER_03 12:38

Yeah, that's albicens, it's totally separate. Never mind.

SPEAKER_04 12:43

But same medication. But same medication. You had like uh a cheesy discharge coming out of your neck. No, no, no, it was more like a little round ring that itched and it was scaly.

SPEAKER_01 12:57

It was scaly, and it had it, it did have some fluid though. It was scaly with some fluid, and it was fairly gross.

SPEAKER_03 13:03

It could have been a mixed thing, Laura. Who knows? It could have been Canada, but I don't know. Point here is you got fungus, amonggous, and funk. Something you got a popyri of. Yeah. Boom. Boom.

SPEAKER_04 13:19

Boom.

SPEAKER_03 13:19

Boom. So now we're like, if I can get this infection, there's probably other funk that could be on these things.

SPEAKER_01 13:30

Yeah. I I met a provider from uh Michigan uh shortly after I got this, and he said, I've always thought that he was an IR provider. He said, I've always thought these things were gross. Um, I just cultured 25 of them at random. And I said, No, wait, man, tell me more. And he said, Well, um, 21 of the 25 were carrying staff A, um, three of which was later confirmed to be MRSA. And then 21 of the 25 were also carrying ringworm. And he said, You know, I find I thought that was pretty remarkable. And I'm like, Well, been there, done that, buddy. No s no shock here. I already got the t-shirt and the sticker.

SPEAKER_04 14:09

So, what what was the moment where you decided to leave the security of what you were doing? Because becoming a founder of a startup is the definition of an insanity. What was the moment where you decided you just had enough and this was such a problem you were going to throw your sanity out the window and do something about it?

SPEAKER_01 14:35

Yep. Um, and let me tell you, as a co-founder, I did about everything you can wrong. And we'll talk about that in a little bit, in terms of trying to start a family and a business at the same time, leaving a VP of sales job and going two years with no paycheck. Yeah, there's a lot of insanity there. Um, but the but the the moment that just told me flat out I'm jumping in head first, I'm resigning, I'm you know, we're gonna figure this out. Um I went, I was kind of uh moonlighting, okay? So I was working my day job and then I was taking some meetings and doing some research. And so I got invited to um uh a meeting or uh a surgical director took a meeting with me, and I showed up with my little first little PowerPoint, and and Laura, I use ATP testing as a part of my quality metric, and so I sit down, very well known, billboard, academic, you know, level one, the whole shooting match, and she says, I've been here 35 years. This sounds like snake oil to me. I've never heard this. Everyone knows they're dirty and everyone knows they're gross, uh, but no one's making me do this, and why should I pay money for this? And she's going through this whole litany of crap. And so I said, Fine, give me a bunny suit, let's go back in the OR together. I'm taking my ATP and let's find one of your busy docs or your lead tech, you know, someone who's in that led every day. And so we uh I said, let's go do an ATP test right now. And and little did she know, I had stopped at the gas station on the way, and the gas pump handle I thought was nasty. And so just for grins, I'm I ATP'd the gas pump handle, and I took photos of the, you know, and so it ran like a hundred thousand RLUs, and that's a relative light unit, and that's pretty gross. And so I took a photo of that, went down the road, and so she kind of irritated me. And so I said, Let's just go. And we walk back in there, I get a body suit, you know, we go to one of her providers, you know, right next to the pocket on a three-quarter frontal apron, ATP, 930,000. And so she's like, Well, is that bad? And so I just show her my phone, and I'm like, Well, here's a gas pump handle, you know, at the at a gas station, and it's a hundred thousand RLUs, and your one of your busiest ortho docs is nine hundred and thirty thousand RLUs. So we're like we're almost ten times dirtier than a gas pump handle. So, like, I don't care if you believe in the PowerPoint or not, like this stuff is nasty. And so uh uh six months later, she still wouldn't take a call, she didn't follow up with me, and she was blowing me off. And honestly, it lit a fire in my belly that hey, you know what, this is stupid. Like, if a hundred thousand people are dying of infection, hospital-acquired infections every year, and like we've seen the blood, we've seen the volume, we've seen the fecal, you know. Adam, you mentioned trauma cases. How about in a trauma case where hey, someone from the back chucks a thyroid collar up to the table and they cover someone's junk, if you will, yep, you know, and then all of a sudden it gets chucked back to that person, and I watch it go and I watch it go right back on the rack. Yep, it's totally true.

SPEAKER_04 17:47

Okay, but right now I just am thinking about your home life and how annoying it must be to have you walking around the house, like criticizing the cleanliness of the kitchen. Like, do you check dinner? Are you the one going around the bathroom like you have a mental illness?

SPEAKER_01 18:04

I've got a halo. Laura, we can get my wife cued in here. I've got a halo. I would never be hard to live with, okay?

SPEAKER_04 18:10

Okay, because I right now I'm like, you're the guy who's like white gloving the top of it.

SPEAKER_03 18:19

But I mean, that's just such a great thing. I mean, you're like, okay, think about the number of people that are touching the gas handles. And think about the people who are, I mean, people are coming from bathrooms, doing God knows what in their cars. They're like sitting out there, like birds pooping on like all kinds of schmutz and shit on like a gas station handle.

SPEAKER_04 18:46

And now let's go to gas stations for a minute because I was just thinking, I really don't like to use the toilet at a gas station. That said, when my children and I are have been road tripping across Europe, we tend to eat dinner most commonly at a gas station. A gas station. Yeah, and they've got like schnitzel and pizza.

SPEAKER_03 19:04

It's a thing. I I know. It's basically like a wawa or a sheets in the middle of Austria. What is the German word for it? I forgot.

SPEAKER_04 19:14

It's a Rast uh Rast, yeah, Rast Stop.

SPEAKER_03 19:18

Oh, okay. For rest.

SPEAKER_04 19:20

So you just change the E to an A and Rust stop becomes Rast.

SPEAKER_03 19:23

Yes, yes. So I mean, but think about this: like you're sitting there, gas stations are gross. I think most people know they're pretty damn gross, and then all of a sudden you're walking into a hospital and you're showing head nurse supervisor, hey, look, gas stations are cleaner than your lead aprons that are coming in contact with patients, doctors, in what is supposed to be the most sterile, clean environment of the hospital. Yeah. And the response was man.

SPEAKER_04 19:52

Okay, so I now I now believe there's a problem.

SPEAKER_03 19:55

Yes.

SPEAKER_04 19:56

Uh right. So that is the problem. Now what are we gonna do about it?

SPEAKER_03 20:02

Yeah, so that's kind of what I want to know. Is like, okay, so now there's the problem. You highlight it, then how do you fix it?

SPEAKER_01 20:10

Yeah, yeah, that's hilarious too. Because uh, I love the fact I can speak freely on this on this podcast, by the way. Yes, so so uh we spent uh my business partner and I, we spent the next probably six to eight months traveling to the uh the garment manufacturing companies. And so we wanted to try to learn some do's and don'ts, you know, if we were gonna try to build a cleaning program. And you know, you've never met a kookier, more strange bunch of folks, uh, you know, um, some of them kind of like the Sopranos, some of them, I'm not sure how you graduated high school, just an odd bunch, okay? And the the advice or the direction you would get from these people, you know, just was all over the map. You know, like you'd go into one manufacturing facility and they'd say, Don't use alcohol and don't use bleach. And they'd say, Oh, but you can buy this wipe that we market. Would you like to buy our wipe? And you read the label, guess what's in the frigging wipe? You know, and you know, you get other people, yeah.

SPEAKER_04 21:12

I was gonna say urine, urine steril.

SPEAKER_01 21:15

Right. Other people are like, Well, you know, um, you should use like palm olive, you know, and a small brush, and you need to have ample drying space. And I'm like, dude, you can't listen. And one guy specifically told me, very well-known manufacturing uh plant, his chief uh engineer said, Man, I don't know. Look, we make garments, okay? We're really good at making them, and we really like selling them. And so, me, I want to clean them, I want to repair them, I want to keep them in good condition. And so I wasn't trying to make them. And I think maybe at first it kind of irritated them that I wanted to prolong the life of them. I wanted to keep them in good condition. And really, it wasn't until I went to A O R N Um, you know, the surgical, you know, group to get some real direction on how to build a cleaning program and what a cleaning program would look like in terms of building best practices. So um, again, just a lot of bloody nose moments where you know um you're getting some direction and there's no one to copy from. And so think about the orthopedic world I grew up in. You know, I used to spend time behind closed doors where when we were gonna make uh whatever, well, here's the other 20 on the market, here's the actual product, here's the patent. So you got something to build from. And so when you're trying to do something that's never been done before, I mean, every piece of this has been, you know, from scratch, you know, and and I laugh. Uh uh Haley uh uh Adams, I said something to her the other day. I said, hey man, I said, I was guided by God. I said I was inspired, you know, I was um guided by God, inspired by Menards, you know, my local hardware store, and fueled by Miller Light.

SPEAKER_03 23:04

Uh very funny. I mean, and I think what's kind of interesting here is that like you identified the problem, it's gross, and then you really identified a secondary problem, and that is there's not really a standard um that people were following on something that that is touching so many critical people, patients and clinicians and support personnel, and of course, your case too, you know, salespersons, like that there was not a not a standard, but you also recognize because you said because you said something a minute ago, that like you're looking at the buckles, you're looking at the integrity of the lead apron itself. So it's not just is it dirty and gross, and is it going to make a patient sick? Is it gonna make a clinician or whomever's wearing it sick? But are they are they actually preventing radiation exposure? Like, are there cracks? Are there things? And so tell me a little bit more about that now.

SPEAKER_04 23:59

So you've got now one problem was that they're not just that they're gross, now they're gross and ineffective.

SPEAKER_01 24:07

There you go. Yes, you're hitting that right there. Yeah, you know, I spent my first, I don't know, our first several years in this business, Adam. You know, I was really we developed this obviously with ringworm. You know, we developed our process, we were our cornerstone was cleaning. And we developed that with hospital-acquired infections, surgical site infections, patient and staff safety in mind. And then, wow, um, the more I got into understanding just the gross negligence and the sheer neglect around these, you know, I really shifted from, I mean, don't get me wrong, it's wearing clean garments is still super important, you know, but the the uh integrity piece is huge. And, you know, there's no regulations here. You know, the E the EU has a completely different set of standards for these garments. And so there was a lawsuit in 2017 that I wasn't called into, but uh the attorney who was involved in this was spending a lot of time with me, was trying to learn from me, was trying to ask me questions. And long story short, there was like seven um seven staff members in a periop environment, five years got cancer. And uh their busiest ortho doc, 46 years old, four kids, uh cancer six months later, dead. And so the providers sued the healthcare network, and in the brief, it said, Hey, the PPE, the lead is a joke, man. It's decrepit, it's never scanned, it's dirty, we don't have enough of it, it's just a hot mess. And so when that attorney was visiting me every week, every other week, pumping me for information, I started studying and looking up the x-ray piece. And so in the United States, it's not a requirement to do what they call an annual x-ray inspection. That's a radiographic exam of those lead aprons to make sure there's no holes, there's no cracks, there's no tears. And they do um, they recommend what's called a palpation test or a feel test, and that's the three of us have gloves on, and we've got a thousand aprons to do on a Saturday, and we go through with gloves and we're trying to feel to look for cracks and holes. So, according to Joint Commission, DV, you know, the governing bodies, that's okay as long as you have a process in place to check the garments, and so that that really rubbed me the wrong way. And once again, Lara, with me being the doing everything the wrong way as a small business person growing small business, I bought an X-ray machine like the next week.

SPEAKER_04 26:43

Well, I want a home x-ray machine now that you speak of it, because I get FOMO. But no, so I was sitting here thinking as you were talking about this, the amount of paperwork and onerous little things that get put in because of reimbursement, right? You have to list five different systems and do a review of systems so that they can build a certain if there it's follow the money. So if they don't have to do it and there's no fine and there's no reimbursement for it, it doesn't matter if it's the right thing to do. And I bet nobody does that palpate your lead apron thing because it never even occurred to me. So, okay, so you realize this is horrible. Now you've you dive in, you figure out a way to address this. And when you're thinking this, were you thinking, I'm gonna build a company and exit it? I'm gonna build a company and save five lives. Like when you started this, other than just being totally disgusted, what did you see at the end?

SPEAKER_01 27:43

Yeah, I was pretty uh I started this really with a lot of fire in my belly, you know, uh, in in in a good way, you know, kind of like a righteous indignation type thing. Just because, you know, you all you both know this more better than I do. All the regulations, there's regulations for the kick bucket, there's regulations for this.

SPEAKER_00 28:01

Yeah.

SPEAKER_01 28:02

And and how this was just completely ignored, you know, just baffled me. And I didn't share this story earlier. Um, but really what my tipping point here was I was talking with a um uh 35-year tenured surgeon, and he told me exactly what you just said. He said, Hey man, we all know they're gross, we all know they're dirty. No one's making me do it. It's not a requirement, dude. No one's gonna pay for this. Don't quit your day job. He said, You're going to fail. Don't do this. And it really rubbed me the wrong way. And I thought, you know what? We'll see, buddy.

SPEAKER_03 28:41

That's like saying sick em, isn't it?

SPEAKER_04 28:43

You know, and then it makes you think you can't just build the product and build the service. You actually have to go all the way to the top and make this a regulation. You have to make it reimbursable. You have to because at the end of the day, healthcare is a business in the United States. And no matter where you are, whether it's a for-profit business or not, it comes down to taking a finite amount of money and figuring out how you're spending it. You know, I just um was listening to some something um where the head of Jefferson Hospital System, in which you would know, they were paying for GLP ones for their employees and insurance um members, and they've had to cut that way back because it was a third at least of their 180 million in losses they took last year. So, you know, even and the and the guy who's he's a cardiologist, he goes, Yes, of course, the long-term benefit, we'd save tons of money, but who's gonna pay for it today?

SPEAKER_01 29:43

The other piece with that, the other piece with that, uh, Laura, is you know, uh, I mentioned, hey, uh, yeah, I went almost two years with no paycheck. And so what you're saying here is spot on. You know, my business partner, yeah, he paid my mortgage a couple times. Like we I bought a house, had a baby coming, surprised, didn't know that was coming.

SPEAKER_04 30:03

You didn't have any clue that that could be happening. Well, it wasn't kind of a talk later anyway about how to do it. I work in the fertility space.

SPEAKER_01 30:11

So you work in that space. You can tell me how that works. All right, cool. And so um now I got sidetracked.

SPEAKER_04 30:19

Well, we're asking you.

SPEAKER_03 30:24

See, Laura's bringing the sidetracking. This is amazing.

SPEAKER_04 30:28

So I'm allowed to just like space out and stare at you like a goat, right? No, no, no, no, no, but we were saying financial. It's where who pays the bills today to help us with things that are gonna help in patients in the future.

SPEAKER_01 30:44

Thank you. Yeah, and and so what really kept the fuel kept the fire burning, though, was think about this from an economic standpoint. Just what you said. Hey, hospitals are a business, they're not gonna pay for it unless they're, you know, I hear that. And so what what we were doing though, like when we first got started, from a business standpoint, we would get, you know, a hospital's inventory of their total number of garments. We would write them, you know, uh a proposed service contract, okay? You know, high-touch objects, right? The door handles, the walls, floors, ceilings, all that stuff has to get deep cleaned quarterly. So we were writing like a quarterly proposal and then had like a semi-annual proposal as a backup. And so um, we would write proposals for I don't know, $30,000 or $40,000, you know, I don't know, 500 pieces twice a year. You know, we're not talking about this, isn't like even like the cost of capital equipment. And and yeah, I would see what spending was on other things, and it just infuriated me that, you know, and specifically the lawsuit I mentioned in that particular case, I had been working with that woman for six months. I had I had dropped her a proposal for almost $20,000 for the entire year, and she was calling me, I can't get this approved, I can't get this approved. And then look what happened. And so, you know, I had we laid we leased the space, we had a delivery van, we were buying x-ray machines, we were gung-ho. And we may have had the cart before the horse, or we may have got out ahead of our skis. And even 13 years in now, still today, I may have lost some hair along the way. But, you know, he'll say to me, Um, hey man, like along the way, did you ever think of quitting? And I was like, Hell no. The more people that told me no, the the deeper the fire burned.

SPEAKER_04 32:42

So you have opposition, yeah. I mean I think disorder is what it's oppositional defiant, yeah.

SPEAKER_03 32:48

But no, I I think what you're you you're hitting on several things, both of you are, is one around you know, the financial incentives in healthcare really drive a lot of behaviors. Um but also the financial penalties can also, which are a financial incentive as well, but that also drives behaviors. And you know, we would never say to a hospital, don't buy cleaning material because it's not required. We would want them to buy cleaning material to clean up afterwards. And so, you know, some of the penalties are in hospital-acquired infections, surgical site infections, readmissions, and so they're they're in other kind of more indirect ways. But if you know that you've got equipment that is riddled with infection, I mean, let's just take the infection, the hospital-acquired infection, length of stay time, surgical site infections, bounce backs, all of those sorts of things. While there is very clearly a need that we should try to be as clean as possible and sterile in an operating room environment, you've got a piece of equipment that's a personal protective equipment in a lead apron that could potentially be a vector for infection.

SPEAKER_04 34:00

And so it it's it's all the rest of it's disposable. So, okay, but on your on this thought, because carrot and stick, and now we're talking about sticks. Did you ever look at the economics of saving the hospital money because they don't have to replenish the the lead aprons as frequently because they stay in better condition? Because that would be a carrot. Like when you're thinking of as a business person, and this is what Adam and I, because we both um Adam was my professor in business school, so we pride ourselves on speaking both medicine and business. I don't know how clearly I speak either, but you know, you have to explain to doctors why it can't just be what's good for patients, and you have to explain to administrators why it can't just be financial.

SPEAKER_01 34:42

Yeah. Yeah, absolutely, Laura. Adam, you haven't seen this yet, but you'll see it soon because it was just released. So we have an inventory management platform that we've developed. So, really, the quick overview is we started with cleaning, we moved into doing complementary garment repairs, all those broken buckles and torn straps, we fix all that stuff. We do the annual x-ray inspection, we tag everything, we do all the compliance reporting, we have an inventory management platform. So, where I'm going with that question is a great question. We we just now are starting to record data for every facility. So you mentioned like Jefferson, right? So, like hypothetically, let's say we were working with them. We're not yet. But I know somebody knows somebody out there. So let's say we started with Jefferson. We do, they probably have, I don't know, 4,500 pieces, 5,000 throughout the network. Everything is going to be tagged by facility, by department, by location, camo apron number one, two, three. Here's a QR code. So with that piece, what we're now able to do is what you just said. Hey, you know, we fixed the buckles on this, we sewed the straps back up, that just saved you 600 bucks. The other piece, the other piece we're now doing for the network is to guide their future purchasing decisions. You know, I play nice in the sandbox with all the manufacturers as nice as I can. Um, and so what we're capturing, let's say I do a thousand pieces for Jefferson. Here's the 300 you bought from this company, here's the 300 you bought from that company, here's what year they were made, here's the core material on the inside, and so here's the age of the garment. So we're now giving them basically pivot tables with this data. So if I'm in supply chain or if I'm in procurement or where whoever, you can start to look at what you're spending money on and to help you make some more informed purchasing decisions moving forward.

SPEAKER_04 36:33

So I know we've been talking, we always say 30, 35 minutes, and then it's always like an hour later. What I'm hearing is really interesting because when Adam first said you were coming on, I was like, okay, this guy saw a problem that none of us even think about, even though it's right in front of our nose every single day at work, and it doesn't occur to you because there's so many other things you're thinking of that are life and death in the moment, right? But now what I'm hearing is you not only saw a problem, you had no model to follow. So you had to create that. And then you had to find a way to sad the sad truth is, unless there's a financial incentive, how do you get a healthcare system to adopt it? And so I think that's a really interesting arc from recognizing something grody to having to think 10 steps ahead to who's gonna pay for this and and and how are we gonna get people to adopt it? I mean, I think your story is amazing because yeah, it's an amazing story. I'm you're my hero.

SPEAKER_03 37:38

Yeah, and and Justin, just kind of give give the audience and and us kind of where you are today, because like you know, it's it's been a struggle, but you're you're successful. You're you're now having you are convincing people that they need to clean their lead aprons, that they need to scan their lead aprons, that this is an important kind of required piece of keeping patients safe and doctors and nurses and clinicians safe.

SPEAKER_01 38:05

Yeah, you know, the the garments in general, uh, again, because this is a fun platform, and I can say this to you garments are like a hemorrhoid for hospitals.

SPEAKER_04 38:14

You know, it's like they don't want to be a little bit more than a lot of people you don't want to deal with them, so you just keep tucking it back in there and using the preparation H.

SPEAKER_01 38:23

You got it, man. It's like they're everyone's favorite hot potato, you know. Like radiology directors are like, I don't know, you know, been surgery directors are like, well, let's blame radiology, you know, and and physicists are like, oh, I'm too cool for that, man. Like nobody wants to deal with them, you know, and so we've developed a full service platform to where, like Adam said, yes, today, you know, we're working in about 44 different states, and we're, you know, we can keep them clean and repaired and compliant for your audit needs, and they're in good working condition, and we do disposal and we represent manufacturers to sell you the new garments. And so, you know, really um along the way, you know, it's been a slow ride for us because we've sacked we've sacrificed kind of what you'd call like operational stability, uh uh or speed, excuse me. We sacrificed speed for operational stability, meaning in the early part of the business, we had to educate and educate and educate. And along the way, you know, you both know this, but um surgeons are surgeons are terrible businessmen andor business women for the most part. Um most doctors are yeah, you know, so we had people like me trained, like we can go get a business degree, but I used to do all my my budgeting and Word We had we had people come along that would want to put money in and want to speed this up and grow it quickly. And you know, I never we never really wanted to do that because we wanted to do it the right way. There was some stuff we still had to build out in terms of scale, um, but we wanted to bootstrap the business for as long as we can to keep the business debt free. And we've done a really good job of doing that. And so at present today, where we where we are today is we're moving forward um in different markets. And so we just secured some space in North Carolina. I think Texas will be soon to follow, and and the goal there will be to have you know more regional hubs, you know. We're doing a little bit in the northeast as I get you know more concentrated up there, we're gonna have an RCS hub up there. And so um it's what really started everyone, what you're like, hey, no one's gonna spend money on this. How's this thing gonna grow? We started doing free work, you know, demo work. And I can't believe I have to say this, still, you know, a decade later, but still today, you know, um, I can show someone 10 hospitals that everyone in America knows. Here's their before and after pictures. Here's, you know, they've been a customer for five years. Here's their name and number for reference. And then people will still say, I need you to do some of my garments. Because, you know, Adam's hospital is different than Lara's hospital. And so I'm like, all right, man, no problem. Send me five garments. I'm gonna clean them, I'm gonna photograph them, I'm gonna send it back. The light bulb's gonna go off, and now we're off to the races.

SPEAKER_03 41:22

Yeah. It's um, it's uh I I think that story arc is so important, is the identification of the problem, the grind, you know, of trying to assess the market, looking at a lot of the challenges, you know, to Laura's point about the financial incentives, but now to the point where you're working in 44 states doing the doing the work of something that is not overly sexy, but is so extraordinarily important, is that is making sure that garments are clean and that they're effective and you know, it's a critical piece of protective equipment. I mean, hell, we went through COVID really talking about how important these masks were and were they really protecting us. We need to start shifting to thinking about we're wearing these other garments that are supposed to be protective, and are they really protecting us?

SPEAKER_04 42:09

You know, and it's interesting because I, you know, I worked in the UK for the since and they don't wear ties, they don't wear white coats. Right, and you're actually not supposed to have clothing below the elbows, which everyone always thinks is funny because they actually don't mean you can't wear trousers and underwear. Okay, yeah, yeah, yeah. I was wondering is that sleeves because it's a germ thing.

SPEAKER_03 42:31

Yeah, yeah, exactly. But that is the reason why I never wore a white coat in the ER.

SPEAKER_04 42:36

I love my white coat. I wonder how many people I killed.

SPEAKER_03 42:41

Laura.

SPEAKER_04 42:43

I mean, not like in the immediate. I know that that I know that number.

SPEAKER_03 42:47

Well, but you do wonder like how much of nasty gross germs are on these things, you know, because you are walking patient to patient, patient. Well, anyway, listen, we have got just uh about two minutes left. And Justin, I wanted to this has been a fascinating conversation. Um, and who would have known? Like talking about gas station handles and lead aprons would be.

SPEAKER_04 43:07

I warned you coming in, you delivered. That was good.

SPEAKER_03 43:10

Yeah, you delivered with this. So I you we usually ask like our guests on here of like, you know, do you see healthcare as being unstable? And so I'm gonna ask that for like a one-word answer. But then the second piece of it is what gives you hope for the future of healthcare.

SPEAKER_01 43:27

Oh, uh good.

SPEAKER_03 43:28

Is it unstable?

SPEAKER_01 43:30

Is it a one-word answer?

unknown 43:32

Sure.

SPEAKER_01 43:32

I'll give I'll give you one word answer, but I have to give a quick clarifier. I I did uh a podcast um a couple months back where I said yes. And now I'm going to tell you no, it's not unstable. And I was really inspired by the show that I just came home from. And so my answer is healthcare unstable? Um no. And I'm gonna say I have a lot of hope right now because. Um, hey man, AI and we know robotic surgery and AI and tech and all this, it can't replace heart. And I just came from a show with like 4,000 clinicians, and the number of young people that were there, you know, half my age and then some, you know, who I just kept asking, how'd you get into this? What brought you here? Hey, what you know, and and and the resounding answer of caring for people, helping people, making a difference, like physically turning people's lives around. Like I have I was kind of wondering if the young people were shying away from healthcare. And man, I got my socks knocked off at this last conference, just with the amount of young people with with hearts to serve and hearts to love. And man, so so um my answer has changed on that, man. I'm I'm I'm riding that hopeful, that hopeful vibe right now.

SPEAKER_03 44:51

Well, no, I it's uh I think it's a a great, great um reminder that you know, so much of healthcare's future is of course dependent upon the people, but that there's some really amazing people going into what has been or is kind of a very, very challenging, challenging field. Well, well, listen, um uh Justin, this has been a great conversation. I really appreciate it. Laura, you know, feel free, close us out.

SPEAKER_04 45:18

Well, uh, I'm just gonna stare at the camera like a goat because I'm menopausal. No, I think that was a great conversation. I um am happy to talk to you later about where babies come from. And um, otherwise, I think your story is fascinating. I think um our job here is to make sure that we attack the other Ps so that those young and hopeful doctors stay young and hopeful in caring for patients. And I'm just really thankful for you getting like having oppositional defiant disorder and getting mad when you're told no. And thank you for what you're doing for the patients because as we get older, I'm gonna find myself on the other side more and more. So very, very thankful for that.

SPEAKER_03 46:02

Absolutely.

SPEAKER_04 46:02

And we're unstable, and so are we?

SPEAKER_03 46:06

Yeah, I I think it's not anymore, but we still are.

SPEAKER_04 46:08

Even if healthcare is not unstable anymore, we will remain.

SPEAKER_03 46:12

We are still slightly unstable. I'll say slightly. Well, anyway, that was a great episode. Thank you so much, Justin, and thank you, Laura. It's good to see everyone.

SPEAKER_00 46:19

Thank you, but thank you both so much for having me. Thanks for tuning into Unstable Vitals. If you enjoyed this episode, make sure to follow us for more unfiltered conversations on the pulse of healthcare. Connect with us on LinkedIn or visit us on unstablevitals.com to stay in the loop.