ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
January 26, 2006

HHC STAFF MEETS TRANSIT STRIKE CHALLENGE

Adversity is often the test of true commitment and last month’s citywide transit strike – the first such walkout in 25 years — served to once again highlight the dedication of HHC staff to our mission, our patients and to each other. I thank all HHC staff for their individual and collective determination, ingenuity and selflessness in getting to work, helping others to do so, and ultimately ensuring that our patients received the care that they needed.

Like New Yorkers everywhere, our staff endured great inconvenience and at times true hardship as the strike unfolded. Some waited in the frigid air for scheduled rides that were delayed for an hour or more or walked in the cold for very long distances. Others set their alarms for 3 a.m. to allow time to pick up co-workers while others went to their facility prepared to sleep over and did so. Many stayed for hours beyond the scheduled end of their shift to ensure that patient care needs were met until their replacements actually arrived.

Remarkably, on the very first day of the strike every HHC facility was able to report adequate staffing and all patient care units and clinics across the system were fully operational. On the second and third days of the strike, the staffing levels improved, with most facilities reporting near normal attendance and, in some instances, even higher than normal for the week before the December holidays. In fact, by the third day, one facility reported the lowest number of sick calls by staff for the entire year and a parking lot that was filled to capacity by 4 a.m. All New Yorkers should be very proud of how their public hospital system performed during this crisis.

NEW YORK CITY PUBLIC HOSPITALS LEAD IN STATE-WIDE HEALTHCARE QUALITY RANKINGS

Last week, the New York State Department of Health published a new website that provides the public access to composite quality rankings for all hospitals in New York State related to surgical site infection prevention as well as the treatment of heart attack, heart failure, and pneumonia.

I am very pleased to report that HHC facilities across the system ranked well above the state averages in all categories and performed extremely well when compared to the roughly 60 voluntary hospitals in New York City. With respect to surgical site infection prevention, five of the six highest ranked hospitals in the City are all HHC facilities, with Metropolitan in second place. With respect to heart failure treatment, four of the top five hospitals were HHC facilities, with Lincoln Hospital ranked number two in the City. With respect to overall pneumonia care, five of the top ten hospitals are HHC facilities, with Coney Island Hospital and Harlem Hospital ranking number one and two in the City, respectively. And with respect to overall heart attack care, five of the top ten hospitals are HHC facilities, with Coney Island Hospital ranking number one in the City.

These outstanding results are a powerful validation of our system-wide focus in recent years on the consistent use of evidence-based best practices in the treatment of our patients. It also is a confirmation that our collaborative team-based approach to reducing the incidence of hospital-acquired infections, including surgical site infections, has begun to move us toward the leading edge of the industry-wide movement to enhance patient safety.

My congratulations to our clinical leaders and front line staff across HHC who continue to focus on enhancing the quality of care in these four areas reflected in the recently posted comparable quality data, and in many other areas where comparative quality data has not yet been collected and made transparent to the public. In these four areas at least, we now have objective empirical evidence that the care being rendered in our public hospital system is among the best care available anywhere in our City.

AFFILIATION AGREEMENT

Our agenda today includes, for your review and approval, the renewal of an affiliation contract with the Mount Sinai School of Medicine for the provision of general care and behavioral health services at Elmhurst Hospital Center and Queens Hospital Center.

The proposed $441 million three-year contract, like all of our affiliation contracts in recent years, is largely performance and productivity based. The contract also features a series of pay for performance incentives linked to more effective management of patients with diabetes, asthma and other chronic disease and achieving excellence in targeted quality indicators tracked by the Centers of Medicare and Medicaid Services.

The proposed contract costs are $86 million in FY 2007 for Elmhurst Hospital Center and $58 million in FY 2007 for Queens Hospital Center; $88 million in FY 2008 for Elmhurst Hospital Center and $59 million in FY 2008 for Queens Hospital Center; and, $90 million in FY 2009 for Elmhurst Hospital Center and $60 million in FY 2009 for Queens Hospital Center. The total $441 million cost for the three year agreement represents an 8% increase in cost over the three year term. I urge the Board to approve this affiliation agreement.

STATEN ISLAND HEALTH INITIATIVE

As you know, HHC has staffed a planning and development effort on Staten Island directed to improving health care access for uninsured low-income adults – especially those who live on the Island’s North Shore. We have worked with many others to develop short and long-term initiatives, including our colleagues from the Mayor’s Office and the Department of Health and Mental Hygiene, and a steering committee comprised of more than 30 individuals representing health care consumers; human services, mental health and medical provider organizations; the Richmond County Medical Society; local community planning boards; and elected officials.

In mid-December, we rolled out the Staten Island Health Access Program – or SIHA – a program that provides grants to select community physicians to provide primary and specialty care, including services such as laboratory and diagnostic tests as well as medications, to low-income uninsured adults not eligible for any public insurance programs. An essential complement to this program is our contract with the Staten Island Jewish Community Center to help facilitate enrollment of eligible Staten Island residents into available government insurance programs and to ensure that low-income uninsured adults not eligible for such insurance options are made aware of the SIHA program. Nearly 100 uninsured individuals have been linked to the SIHA program in its first month of operation.

As I have previously reported to the Board, we also are actively engaged with community stakeholders in the development of a Federally Qualified Health Center (FQHC) on the North Shore of Staten Island to expand ambulatory care access. Last month, with HHC’s support, a new not-for-profit organization was created as an initial governing body for the planned FQHC and that organization submitted a certificate of need to the State Department of Health for the establishment of a new health center in Port Richmond, one of the neediest neighborhoods on the North Shore and in the City. The new health center is expected to receive state designation this spring and begin providing services in June 2006. An application for FQHC status will be submitted to the federal government shortly thereafter.

CRITICAL CARE COLLABORATIVE

On January 12^th, the 4^th Learning Session for our Critical Care Collaborative teams was held at Metropolitan Hospital. Teams representing critical care units at every one of our hospitals were present to share their work around improving patient safety in our ICUs through the use of evidence-based best practices. The data shared by a number of clinical teams reflect that their work is making a real difference to our fragile patients in intensive care, with notable reductions in the incidence of central line blood stream infections and ventilator-acquired pneumonia. I was particularly pleased to see nursing very well represented and often taking a leadership role in this most recent critical care learning session and to see as well that many of our senior administrators and medical directors were in attendance. This is extremely important work that goes to the heart of our commitment to patient safety.

I have urged our critical care teams to give serious consideration to the implementation of “rapid response teams,” that is, dedicated teams often consisting of an experienced ICU nurse and a respiratory therapist that are available at all times to consult expeditiously in connection with any patient anywhere in the hospital that shows the signs of possible deterioration. National studies show that nearly two-thirds of patients who go into cardiac arrest outside the ICU show some signs of abnormal change in their heart rate, blood pressure, respiration rate or other vital signs in the period six to eight hours before their arrest. Data emerging from the relatively few hospitals around the country who have implemented rapid response teams has begun to show dramatic results in reducing the number of cardiac arrests that occur outside the ICU, reducing the number of emergency transfers to the ICU, and ultimately reducing overall hospital mortality rates. Several of our hospitals are now planning to pilot rapid response teams and I look forward to following the progress of these efforts closely.

CHRONIC DISEASE MANAGEMENT: E-REGISTRIES

A recent series in the New York Times drove home the impact that the raging diabetes epidemic is having on our communities and the difficulties experienced to date throughout our healthcare system in sustaining more effective management of the disease. As the article pointed out, and as you all know, diabetes is the leading cause of adult blindness, end-stage renal disease and lower limb amputations. It also is a very significant contributor to heart disease and stroke.

In another of our significant system-wide clinical collaborative initiatives, we are moving forward with the use of disease registries as a key tool to help us better monitor our patients with diabetes and other chronic disease and to guide us in the development and more effective implementation of evidence-based treatment. We have now made available to all of our facilities across our system, including our Diagnostic and Treatment Centers, a web-based electronic disease registry and we already have entered thousands of our adult diabetic patients into that registry. I have set the goal of entering into our electronic registry by June 30^th 45,000 adult diabetic patients across our system, which would constitute about 90% of our estimated adult diabetic patient population under regular care.

Being able to track our diabetic patients’ care through a registry is only the beginning foundation for improving care and outcomes. However, our Queens Health Network, where all 7000 adult diabetics are now followed through the prototype electronic registry piloted there, has demonstrated that the consistent use of such a registry by primary care providers can substantially improve outcomes. Over the course of the last year, the number of diabetic patients in the Queens Network with low blood sugar levels has increased by more than 20%, with significant improvements as well in blood pressure levels and lipid levels. Although much more can be done – this is an encouraging beginning and the system-wide use of our electronic registry to help guide the care of all our adult diabetics should bring immediate improvements that if sustained and built upon will make a profound difference in the long term health of many of our diabetic patients.

2006 UNANNOUNCED JCAHO SURVEYS

Starting this year, JCAHO will begin its unannounced surveys at HHC facilities. Under this new approach, hospitals will receive no advance notice of survey dates and will need to be "survey ready" at all times. The four HHC facilities scheduled to be surveyed sometime in 2006 are: Coney Island, Sea View, Lincoln and Kings County.

CAPITAL IMPROVEMENTS

I am pleased to report that the Corporation’s major modernization projects at Kings County Hospital Center, Harlem Hospital Center, Queens Hospital Center, and Jacobi Medical Center, are continuing to progress significantly.

• Construction work to renovate the existing “E” Building for outpatient services at Kings County Hospital is proceeding towards completion. The new main lobby is partially open for patient access. The balance of the outpatient building renovation is scheduled for substantial completion in February 2006, with phased occupancy through the Spring.
• Foundation work has been completed for the new 300,000-square-foot, behavioral health care center at Kings County Hospital. Superstructure construction is now in progress. The new building will house behavioral health emergency care services, 230 inpatient beds and behavioral health ambulatory care services.
• Demolition of the existing Emergency Medical Station building at Harlem Hospital Center is complete, and the schematic design phase has started for the $243 million modernization of Harlem Hospital. The restoration of the existing historic WPA art murals is underway, and the demolition and temporary replacement of the EMS Station has been completed. This new project will renovate the existing Martin Luther King Pavilion and construct a new pavilion on Lenox Avenue to connect the Martin Luther King Inpatient Care Pavilion to the existing Ron Brown Ambulatory Care Pavilion. The new pavilion will include a new emergency department, operating rooms, diagnostic and treatment services, a critical care suite and a modern radiology center.
• At Queens Hospital Center, the 142,000-square-foot, five-story ambulatory care pavilion continues in construction. Installation of the exterior pre-cast panels and glass curtain wall is substantially complete. Bridge steel erection is substantially complete. Interior construction work is in progress on all floors. Linked to the existing hospital, the new facility will provide outpatient services for behavioral health, primary and specialty clinics and a diabetes center.
• Structural steel erection and metal decking continues at Jacobi Medical Center’s new 120,000-square-foot ambulatory care pavilion. Structural Steel is slated for February 2006, completion. The new four-story facility will provide outpatient services, including general medicine, surgical sub-specialties, pediatric care and women’s health care services.

AWARDS AND RECOGNITIONS

• Woodhull Medical and Mental Health Center's Asthma Program has been awarded a $900,000, five-year grant to partner with local schools and the North Brooklyn Asthma Action Alliance to implement the chronic disease management model for children with asthma in participating schools.
• Metropolitan Hospital Center made the Alliance for Quality Health Care honor roll for care of patients recovering from heart attacks and pneumonia. AQHC is a state-wide collaboration of healthcare providers, health insurance companies and employers committed to improving health outcomes by publishing performance statistics on healthcare indicators for providers across New York State. The honor roll consists of hospitals that have treated at least thirty cases and whose mortality rates are significantly lower than the state average.
• Gouverneur Healthcare Services received a new community outreach vehicle that was funded by a $200,000 NFL Charities Community Grant following 9/11. The vehicle will be operated by Gouverneur with MetroPlus to enroll new patients and help uninsured patients receive healthcare insurance coverage.
• Gouverneur Healthcare Services has also received a $97,772 check from the Entertainment Industry Foundation (EIF), representing its portion of the proceeds from the 2006 Revlon Run/Walk for Women. The funds are designated for patient education and to provide treatment to uninsured women who are diagnosed with cancer at Gouverneur.

HHC IN THE NEWS HIGHLIGHTS

• December 1^st- Queens Courier reporter Jessica Lyons interviewed Antonio Martin, Executive Director and Dr. Margaret Kemeny, Director of the Cancer Center of Excellence of Queens Hospital Center, about the facility’s expanded services for the community. Photos of Mr. Martin and Dr. Kemeny accompanied the article.
• December 17^th- Channel 2 TV reporter Serena Altschul interviewed Dr. Vincent Hutchinson, Associate Director of Pediatrics of Harlem Hospital Center about the Harlem Children’s Zone asthma initiative, a program designed to eliminate some of the contributing factors of asthma.
• December 18^th- The New York Times reporter Boris Fishman interviewed Alex Agroskin, Addiction Counselor, of Coney Island Hospital about a smoking cessation campaign for the city’s Russian community. The antismoking advertising campaign is a joint program between HHC and the NYC Department of Health and Mental Hygiene.
• December 18^th- Newsday interviewed Dr. Michael Freedman, Director of the Division of Geriatrics of Bellevue Hospital Center about his participation in a national public awareness campaign that educates older adults about the risks of mixing prescription and nonprescription drugs. The New York Daily News also ran the story.
• December 26^th- New York Post reporter Stephanie Gaskell reported about Mayor Bloomberg’s visit to meet with sick children at Lincoln Medical and Mental Health Center on Christmas Day.
• December 27^th-28^th- The New York Sun and New York Post reported on the NYC Department of Health and Mental Hygiene’s plans to outfit HHC hospitals with radiation detection devices in the event of a terrorist “dirty bomb” threat. The equipment, funded by federal grants, could help medical centers diagnose and treat patients with radiation injuries.
• January 1^st- Crain’s New York Business reported the MetroPlus Health Plan as one of the city’s top five largest health insurers and also reported Bellevue Hospital, Kings County Hospital, Elmhurst Hospital and Jacobi Medical Center as part of the top 25 New York area’s largest hospitals.
• January 2^nd- Newsday, New York Daily News, New York Post, and Hoy reported on the first baby born on the New Years’ Day at Coney Island Hospital.
• January 3^rd- Channel 11 reporter Dr. Mike Rosen interviewed Chris Constantino, Executive Director and Dr. Glenn Martin, Director of Informatics of Elmhurst Hospital Center regarding the Smart Card which contains pertinent patient medical information stored on a wallet-sized card. The initiative is being developed by Mount Sinai Hospital in collaboration with Siemens Communications and Elmhurst Hospital Center.
• January 3^rd - 4^th- The New York Times, Newsday, New York Post, New York Daily News, Staten Island Advance and Channels 2, 7 and 9 covered a press conference at Jacobi Medical Center about two rescued pilots whose plane crashed into the Hudson River and who were treated for hypothermia. Dr. Sheldon Teperman, Assistant Chief of Trauma Surgery and the two victims spoke about their miraculous recoveries.
• January 6^th- New York Daily News reporter Oren Yaniv interviewed Rebecca Carman, Forensic Exams Coordinator of Elmhurst Hospital Center about the increase of sexual assault victims in Queens.
• January 6^th- News 12 Bronx reporter Sheri Sagan interviewed Cindy Sizemore, Nutritionist at Jacobi Medical Center about a new requirement for trans fat listing on food labels and the effects of trans fat on the body. News 12 Brooklyn also aired the story.
• January 11^th- New York Daily News reporter Bill Egbert reported on the North Bronx Healthcare Network and Generations + Northern Manhattan Networks in the Bronx participation in the BREATHES program — a smoking cessation initiative funded by the NYS Department of Health and Mental Hygiene which helps smokers work on effective quitting strategies.
• January 14^th- Channel 4 interviewed Dr. Michael Touger of Jacobi Medical Center for a national segment on how to survive major winter storms. Dr. Touger discussed cold weather safety and health issues.
• January 17^th- Crain’s Health Pulse reported on HHC’s pilot program HealthMatics Emergency Department Information System, a system which automatically pages doctors when their patients’ lab results are abnormal.
• January 20^th- New York Post reporter Kenneth Lovett reported about the NYS Department of Health's new online hospital profile which highlights key hospital quality measures and treatments for specific patient conditions in hospitals statewide. Coney Island Hospital, Lincoln Medical and Mental Health Center and Metropolitan Hospital Center ranked in the top two in the areas of heart attack and heart failure care as well as surgical infection prevention. New York Daily News and Crain’s Health Pulse also covered the story.