ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
March 23, 2006

As I stated in my report to you in February, patient safety across all settings within our system is my highest priority. As we deepen our focus on the various dimensions of patient safety, we will provide training opportunities to better empower staff at all levels to engage actively in our campaign to build a true culture of safety within our organization. Last week, 14 of our senior managers participated in an intensive eight-day Patient Safety Officer Executive Development Program hosted by the Institute for Healthcare Improvement (IHI). A number of our Senior Vice Presidents and facility Executive Directors joined their senior manager colleagues for the last 2 days of the program. Many of those who participated in the IHI training program are members of our corporate-wide patient safety steering committee and they returned from the training with fresh ideas and insights that will inform our patient safety campaign going forward.

I will be working with our steering committee to forge a targeted action plan to begin to frame the patient safety work that we will do on many fronts, to develop performance measures by which to gauge our progress, and to clarify the ground rules under which we will pursue the development of a just culture around medical errors. A just culture is one that moves us away from the knee-jerk blame and shame approach that tends to impede the honest and thoughtful examination of medical errors. A just culture is one that acknowledges the responsibility that we all bear for improving our systems, communication and teamwork to reduce the probability of error. A just culture is one that moves us toward an active encouragement of the reporting and analysis of all significant medical errors – including “close calls” that do not cause actual patient harm – while balancing individual accountability for avoiding reckless conduct with a non-punitive, systems-focused approach to reducing medical errors. We have a lot of work to do to get there.

In the meantime, many of our facilities have worked to increase awareness about patient safety during National Patient Safety Awareness Week, March 5 – 11, with a variety of programs and activities. Going forward, we will use National Patient Safety Awareness Week each March as a time to assess our progress on meeting specific patient safety goals as well as our progress toward embedding patient safety awareness and action into the fabric of our organization as a daily, on-going imperative.

Along the way, I will bring to the Board’s attention patient safety initiatives that merit special recognition. And on that note, Queens Hospital Center (QHC) was recognized recently by the Healthcare Association of New York State (HANYS) for their work aimed at reducing central venous catheter bloodstream infections which was cited as a model for other hospitals across the state. The recognition received by QHC reflects strong critical care leadership and a very committed multidisciplinary ICU team that is dedicated to delivering safe, efficient, effective and patient-centered care.

To help highlight some of the other noteworthy patient safety initiatives under way across our system, the Office of Patient Safety, Accreditation and Regulatory Services will sponsor a corporate-wide Best Patient Safety Fair at Coler-Goldwater Specialty Hospital on April 6. The Fair will provide each HHC facility an opportunity to demonstrate a best practice that can be replicated across the system and be recognized as a model patient safety initiative. HHC Board Members Josephine Bolus and Edwin Mendez-Santiago, together with Dr. Arnold Saperstein, Medical Director of MetroPlus Health Plan, have graciously agreed to serve as judges.

I traveled to Albany on March 7 and met with state legislative leaders in the Senate and Assembly to discuss the proposed New York State Executive Budget and to advocate for the restoration of Medicaid funding proposals that would have resulted in more than $140 million in cuts to HHC facilities. My visit also focused on advocating for an increase in Medicaid reimbursements for emergency room care which have been frozen for more than 15 years. It was clear from my interactions with legislative leaders that the groundswell of advocacy efforts from our allies in labor, from our CABs and Auxiliaries, and from our patients had helped sway both legislative houses toward fighting the cuts and addressing the emergency room rates. As of today, the State Senate and Assembly have each produced budget bills that would eliminate virtually all of the Governor's proposed Medicaid cuts, include an increase in emergency room payments and an update to the nursing home reimbursement structure. But, there are significant areas that remain targeted for cuts. The Assembly is still considering proposed cuts for inpatient detoxification reimbursement and the Senate is still mandating co-payments for Family Health Plus recipients. We are hopeful that in the final approved budget these cuts will be restored and HHC's capacity to provide the level of service currently available to the City’s most vulnerable communities will not be compromised.

On March 13, I appeared before the New York City Council to present testimony regarding HHC's budget for Fiscal Year 2007 and to ask the Council to restore needed funding for essential programs. In that testimony, I described the critical safety net healthcare role that HHC plays and explained the financial challenges that we face in this year's budget from both state and federal funding cuts. In earlier testimony, Budget Director Mark Page also spoke of the financial challenges faced by HHC and commented on the $150 million in funding that the City has advanced to HHC to help the Corporation deal with a significant delay is State Medicaid payments. In the past, the Council has been supportive with restorations and additions to our budget for important health programs such as behavioral health programs, outpatient pharmacy fee waivers, child health clinics and family health clinics. We urged the Council to support these vital programs once again. A full copy of my testimony is available on our website.

Building linkages to our communities and leveraging community resources for the maximum benefit of our patients is a central part of both our mission and our strategic vision. Some of our networks have been working on building bridges to their community physicians for quite some time and our health plan, MetroPlus, has increasingly incorporated community physicians into its provider network. I have asked each of our hospitals, as one of their strategic priorities, to commit firmly to the task of developing their community physician networks. A true partnership with community physicians will help increase referrals to our facilities, grow our revenue through the global capitation arrangements made possible by our health plan, and improve patient care through a more collaborative approach in the shared care management of our patients who seek some aspect of their care from community physicians.

To provide corporate leadership and facilitate shared learning toward this goal, we have formed a Community Physician Network Task Force that is led by Chris Constantino, Executive Director of Elmhurst Hospital Center, and Barbara Radin, Executive Director of MetroPlus Health Plan. The Task Force had its first planning retreat on March 16 with 20 Queens Hospital Center Directors of Service. The retreat was co-hosted by the Queens Medical Board and the Task Force, and included presentations by Dr. Joseph Skarzynski, Medical Director of the North Bronx Health Network and Dr. Ram Raju, Medical Director of Coney Island Hospital, who discussed the successes and the challenges of the Community Physician outreach programs at their hospitals. The goal of the retreat was to develop ideas about how to develop mutually beneficial relationships with community physicians and to create action plans to put the ideas into action. The next retreat will be held on May 3 for Directors of Service at the North Bronx Health Network.

Today’s agenda contains an action item for development and operation of a campus parking facility for 428 cars located at Kings County Hospital on Clarkson Avenue. A Public Hearing regarding this lease development was conducted on February 28th and all 16 speakers unanimously supported the proposed sublease. A copy of the meeting transcript is included in your packages. We want to thank the Chair, Charlynn Goins, and Board members Josephine Bolus, Dr. Marcia Brown, and Dr. Dan Ricciardi, for attending the hearing.

As you know, Kings County has been implementing a campus-wide, multi-phase modernization plan since the 1990s and the construction of this parking facility has been required by the New York State Environmental Quality Review Act to resolve the subsequent loss of parking spaces throughout the campus. The resolution before you is based upon an employee parking rate of $140/month, which represents a 55% increase from the existing rate of approximately $90/month. This below-market rate helps the hospital to satisfy the growing demands for affordable, on-site, and safe employee and visitor parking, which also facilitates the recruitment and retention of key medical and other staff.

The proposed deal has been reviewed by Richard Donohue of Cushman & Wakefield, the Corporation’s Real Estate advisor, and the terms of the lease have been assessed to be fair and equitable and in the best interests of the Corporation and Kings County Hospital. A copy of Mr. Donohue’s recommendation is included in your package and he is here today to answer any questions. I strongly support approval of this resolution.

On your agenda today are two Affiliation contract renewals for your review and approval. The proposed Agreements have been negotiated with University Group Medical Associates (“UGMA”) for the provision of General Care and Behavioral Health Services at Coney Island Hospital, and with Roosevelt Island Medical Associates, P.C. (“RIMA”) for the provision of General Care at Coler-Goldwater Specialty Hospital and Nursing Facility, and Dental and Rehabilitation Therapy Services at Gouverneur Healthcare Services. The agreements are for three years, commencing on July 1, 2006.

The proposed Affiliation Agreement with UGMA, like the previous agreement, links compensation to performance and productivity, encouraging effective management of patient care, timely completion of billing documentation, and healthcare excellence as measured by core indicators.

Under the proposed agreement with RIMA, the services to be provided include: direct patient care services; administration of the provision of services; supervision of post-graduate trainees and students; administration and provision of rehabilitation therapy services; and technical services. The proposed agreement also includes facility specific “pay for performance indicators,” created jointly with RIMA, which will address patient safety and effective management in high volume and problem prone areas.

I am very pleased to announce that the Board of Directors of the HHC Foundation recently awarded two grants worth nearly $200,000 to support key strategic initiatives in the arena of patient safety.

Dr. Karen Scott Collins, our Deputy Chief Medical Officer, will manage one of the awards for $98,500 to support the implementation of Rapid Response Teams. These teams will be available to expeditiously assess patients outside the Intensive Care Units who show subtle signs of deterioration that are often precursors to imminent cardiac arrest, effectively allowing us to “rescue” these patients before they code. The grant will cover planning and training session costs.

The second grant, for $100,000, will be managed by Caroline Jacobs, Senior Assistant Vice President, Office of Patient Safety, Accreditation & Regulatory Services, to fund the development and implementation of a customized education and training curriculum on patient safety for various levels of HHC clinical and non-clinical staff.

HHC is grateful to the Foundation for its support of these important initiatives.

As you know, the HHC Options program is designed to assist eligible patients to obtain health insurance and provide discounted fees for services to uninsured patients whose incomes are less than 400% of the federal poverty level. Our HHC Options program is meant to provide clear guidance to our uninsured patients about our sliding fee scale for low income families while also offering financial counseling to those who may be eligible for one of the available government insurance programs. In Fiscal Year 2005, through the HHC Options program, nearly 68,000 patients were enrolled in the Medicaid and PCAP insurance programs. We appreciate the assistance of the Commission on the Public’s Health System in the publication of a patient brochure that explains our HHC Options program.

In a few minutes you will view a new video that has been developed as another means to inform our patients about the HHC Options program. WNBC news anchor Lynda Baquero, a well-known television personality for many of our patients, generously agreed to act as a spokesperson in the video, conveying the important HHC Options message in both English and Spanish. Portions of the video have also been translated into Haitian Creole, Mandarin, Russian and Urdu, to show our patients that we have counselors who speak their language available to assist them. The video will be shown in waiting areas in our emergency rooms and outpatient care settings.

In recognition of National Colon Cancer Awareness Month, the New York City Health and Hospitals Corporation launched a campaign to increase awareness about this preventable form of cancer and help increase the number of colon cancer screenings offered by our hospitals to men and women over 50 years old. The campaign directs the public to “Dial 311” for more information and to learn where they can get low or no cost screenings.

HHC's stepped up efforts to increase awareness and screening of colon cancer have resulted in a significant increase of colonoscopies across our system. Last year, HHC facilities performed nearly 20,000 colonoscopies, and in the last two years we have performed more than four times the number of screening colonoscopies performed in 2003. This year's colon cancer awareness campaign features:

• multi-language TV, radio and print advertisements that will appear through the month of March in various stations and ethnic publications across the city;
• educational materials, including a brochure that's available in English, Spanish and Chinese, as well as a flyer that's available in 11 “HHC” languages;
• radio van appearances at various facilities by WPAT, WADO, and WRKS radio stations;
• appearances by HHC experts in public affairs programs on WPAT, WADO and WRKS radio and on Telemundo Channel 41 TV; and
• an electronic and print birthday card that will be delivered to HHC employees and patients turning 50 this year to remind them that it's time to get a colon check.

To learn more about colon cancer prevention or to view the e-card or the media campaign, including the radio ad, you can visit HHC's web site at www.nyc.gov/hhc.

From February 10 to March 4, Community Advisory Boards (CABs) in most HHC facilities held well-attended legislative breakfasts to advocate with elected officials for restoration of healthcare funding in the proposed New York State Budget for Fiscal Year 2007. Events were hosted by CABs at Kings County Hospital Center, Harlem Hospital Center, Cumberland Diagnostic and Treatment Center, Renaissance Healthcare Network, Queens Hospital Center and North Central Bronx Hospital. Presentations included overviews of the services provided by HHC facilities, updates on community health status and special programs developed by HHC to respond to community needs. The presentations made it clear that the proposed cuts would pose a serious threat to HHC's ability to expand such services or even to continue to provide them at current levels. As part of the advocacy efforts, CAB officers and members from both Coler and Goldwater CABs also traveled to Albany on February 28 to oppose the spending cuts. Many CAB members from facilities throughout HHC traveled to Albany on Wednesday, March 8 to join state-wide advocacy efforts.

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 progressing.

Construction work to renovate the existing “E” Building for outpatient services at Kings County Hospital is proceeding towards completion. The renovation is scheduled for substantial completion imminently, with phased occupancy through the spring.

The seven-story superstructure is nearing completion for the new 300,000-square-foot, Behavioral Health Care Center at Kings County Hospital. Pre-cast panel installation will begin in mid-April 2006. The new building will house 230 inpatient beds, as well as behavioral health emergency care and ambulatory care services.

Schematic design development for the $243-million modernization project at Harlem Hospital Center is proceeding towards completion. Conservation work on the existing historic WPA art murals continues. 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. Installation of the exterior pre-cast panels and glass curtainwall, as well as bridge steel erection are 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.

Concrete slab preparation continues on Jacobi Medical Center’s new 125,000-square-foot Ambulatory Care Pavilion. Structural steel work was completed in February 2006. The new four-story facility will provide outpatient services, including general medicine, surgical sub-specialties, pediatric care and women’s health care services.

• HHC recently received a one-year $50,000 Health Care Improvement Grant from the United Hospital Fund to fund the Corporation's work to extend and sustain quality improvement efforts in critical care units. This grant underscores the efforts in our clinical collaboratives and implementation of evidence-based practices to improve patient outcomes. I would like to commend Drs. Van Dunn and Karen Scott Collins on their efforts to secure this funding.

• The Harlem Hospital Center for Victim Support received a grant for $70,000 from the Avon Foundation to fund the Center's program to teach its Therapeutic Family Model to clinical social workers in the community’s social service agencies. The Center collaborates with local shelters and other community business organizations to identify families who could benefit from therapy to move beyond the violence they have experienced.

• The Susan G. Komen Breast Cancer Foundation has awarded Lincoln Medical and Mental Health Center’s Viva Mujer Cancer Outreach Program a $75,000 grant to support Lincoln's goal of reducing late stage cancer diagnosis by improving timely screenings through aggressive community outreach, patient education, advocacy, and effective case management.

• Woodhull Medical and Mental Health Center received a $23,000 grant from the Starlight Children’s Foundation for a bedside computer education system for the hospital's pediatric patients.

• March 7-13 - New York Times reporter Sewell Chan reported on the funding shortage for the City’s public hospitals. City budget director Mark Page commented that the City is working closely with HHC to address delays in the processing of state Medicaid reimbursements. The mayor expressed concern that the proposed State budget would shortchange the City's public hospitals and praised the effective leadership at HHC.

• March 9 - New York Times reporter Mike McIntire reported on the first increase in medical malpractice claims against City hospitals in five years, as reported by the NYC Comptroller. The Times noted the corporation’s aggressive claims management program which handles claims more quickly and effectively and has reduced overall malpractice costs for three consecutive years.

• March 10 - Staten Island Advance reporter Maura Yates reported on the opening of Staten Island’s first community health center on the North Shore and quoted remarks from LaRay Brown, HHC Senior Vice President of Corporate Planning, Community Health & Intergovernmental Relations, who said that the City is investing more than $3 million to support the clinic, which is expected to open in June or July.

• March 12 - New York Daily News reported on Metropolitan Hospital Center’s designation by the NYS Department of Health as the first official stroke center in East Harlem.

• March 12 - El Diario reported on comments from HHC President Alan Aviles about HHC's colon cancer awareness outreach campaign. The number of screening colonoscopies performed at HHC facilities has more than doubled in the last two years, allowing for early cancer detection for more patients.

• March 19 - New York Daily News reporter Donald Bertrand interviewed Dr. Gina Villiani, Associate Director of the Queens Cancer Center of Queens Hospital about the importance of getting a colonoscopy to prevent colon cancer or detect it in its early stages. The story emphasized that testing is particularly important for African Americans, since the incidence of colon cancer is higher for them and that screenings are available for everyone, including the uninsured.