ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
April 27, 2006

SEXUAL ASSAULT RESPONSE TEAM PROGRAM SUCCESS LAUDED AND EXPANSION ANNOUNCED

On Tuesday, April 18, I joined Mayor Bloomberg at Elmhurst Hospital Center to announce the expansion of HHC's successful Sexual Assault Response Team (SART) programs to our public hospitals in Queens and Manhattan, after initial success with pilot programs in our Bronx hospitals for two years and our Brooklyn hospitals for one year.  The programs are designed to provide state-of-the-art forensic and counseling services to sexual assault victims within one hour of their arrival at any of our emergency departments.  More than half of those brutalized by rape in New York City seek treatment at HHC hospitals.  With these highly trained teams now in place across our system, we can attend expeditiously to the physical and psychological trauma of the victim while assuring that critical evidence needed to prosecute the attacker is expertly collected and preserved. 

PATIENT SAFETY A CORPORATE PRIORITY

As you know, we continue to make patient safety one of our highest priorities across all care settings.  Here are several recent examples of noteworthy activities on this front.

• Our second annual Best Patient Safety Practice Fair, hosted by Coler-Goldwater Specialty Hospital and Nursing Facility on Thursday, April 6 was a resounding success with over 500 participants and representatives from all HHC facilities.  Eighteen facilities, as well our Home Care agency, exhibited thirty projects showcasing outstanding patient safety practices.  Awards were presented in three categories.  Queens Hospital Center won the award for most effective hospital-based program with its project "Reducing Heart Failure Morbidity and Mortality" – a project that will be presented to the Board at the May meeting.  Sea View Hospital Rehabilitation Center and Home won for long term care services with its program to reduce the number of falls by residents.  Renaissance Health Care Network Diagnostic and Treatment Center won the award for community-based services for its successful campaign to increase flu vaccinations of its staff.  Honorable Mention awards went to Elmhurst Hospital for its program to reduce the use of restraints and seclusion and Dr. Susan Smith McKinney Nursing and Rehabilitation Center for its infection reduction program.  Collectively, the presentations were an impressive testament to the ingenuity and commitment of staff in moving forward many dimensions our patient safety agenda.  Special thanks to Board members Ms. Josephine Bolus and Commissioner Edwin Mendez-Santiago as well as MetroPlus Medical Director Dr. Arnold Saperstein for their hard work in reviewing and evaluating the entries.
  
  
• Lincoln Medical and Mental Health Center was recently recognized for its outstanding work in the prevention of surgical site infection and has been selected as the demonstration site for a national training video on this topic.  The video is being produced by the Hospital Association of New York State (HANYS), which is partnering with the Institute for Healthcare Improvement (IHI) to create a series of training videos which demonstrate effective implementation of the patient safety interventions that are being promoted by IHI's "100k Lives Campaign."  Lincoln's segment, which is scheduled to be filmed in May and distributed to trainees throughout the country in June, will draw national attention to HHC's leadership in reducing hospital-acquired infections.  We will share the video with Board members when it is available.
  
  
• The implementation of Rapid Response Teams (RRT) is one of six key patient safety interventions that serve as the foundation of IHI’s 100k Lives Campaign.  The goal of these teams is to get critical care expertise to an inpatient quickly, at the earliest signs of significant clinical decline.  Several large studies here and abroad have shown hospital-wide decreases in the number of cardiac arrests as well as overall hospital mortality through use of RRTs.  To launch HHC's corporate-wide focus on RRT implementation, over 110 participants representing every HHC facility attended a day-long learning session on April 11th.   With support from the HHC Foundation, we have engaged national experts on RRTs to work with us for the next eight months to help guide team development and implementation in our hospitals.  We will be closely following the results from this collaborative and report on them in the coming months.
  
  
• HHC's Critical Care Collaborative has recently entered its second year and our intensive care units are showing promising results in improved patient safety and outcomes.  Since the initiative started in February 2005, teams from every HHC hospital have attended five corporate-wide shared learning sessions focused principally on the implementation of best clinical practices to reduce central line infections and ventilator associated pneumonia.  Both central line and ventilator-related infections significantly increase mortality rates in ICU patients.  Reducing the incidence of infection and the associated mortalities in our ICU patients requires the consistent application of a defined “bundle” of clinical best practices in both areas.  In our Critical Care Collaborative, the eight teams that have implemented the central line infection prevention “bundle” have achieved full compliance in 93% of lines inserted.  The seven teams that have implemented the ventilator associated pneumonia prevention “bundle” have achieved full compliance with 97% of vented patients.  As a result of this excellent work, we are seeing a marked drop in the incidence of both types of hospital-acquired infections and I will share this promising data with you at a subsequent Board meeting.  The next focus of the critical care collaborative will be improving the survival rate of patients with sepsis, which typically results in mortality rates of roughly 50% nationally.  Our goal is to aggressively manage sepsis with protocols that have been shown to reduce mortality rates dramatically.  I will be reporting on the outcomes from this important aspect of the collaborative in the months ahead. 
  
  
• As part of our patient safety work, HHC participates in the CMS National Quality Improvement programs led by the Island Peer Review Organization (IPRO).  HHC's successful achievements in the most recent IPRO quality improvement project were reviewed at a well-attended event at Woodhull Medical and Mental Health Center on March 28.  The data presented showed that HHC facilities consistently outperform most other facilities in New York City and New York State in the application of evidence based measures for the treatment and prevention of acute myocardial infarction, heart failure and pneumonia, as well as effective antibiotic administration to prevent surgical site infection. We will continue to work with IPRO to identify and apply best practices and measure our results throughout our facilities.

ENSURING FINANCIAL HEALTH IN FISCAL YEAR 2007

On April 5 the City Council passed a modification to the FY 2007 City Budget to add $575 million for HHC, as requested by the Mayor.  The new funds will enable HHC to obtain matching federal Medicaid funds for a total of $1.15 billion.  The additional funding will assist us in meeting the costs of retroactive labor payments that have come due after collective bargaining agreements were reached, as well as significant increases in health insurance and pension payment expenses.

Unfortunately, on the state budget front, there is still uncertainty.  Commendably, earlier this month the State Assembly and Senate acted to reverse the Governor’s proposed health care cuts and to add much needed funding to cover the costs of running hospital emergency rooms and nursing homes.  In response, however, the Governor vetoed all of the restorations as well as the proposed new funding.  As of yesterday, both houses have voted to override the Governor’s vetoes. 

However, these actions do not provide closure on the state budget because the Governor is currently maintaining a position that many of the State Legislature's budget items were unconstitutional and that he will ignore their veto overrides.  Unless negotiations produce a revised budget, this matter appears likely to be headed to court.  There is much at stake for HHC in this fight.  If the Governor prevails, the total negative impact on HHC could be as much as $185 million.  We will continue to work closely with our allies in Albany, our union partners, and industry trade organizations like the Health Association of New York State (HANYS) and the Greater New York Hospital Association (GNYHA) to advocate for the full restoration of needed funding.  HHC Community Advisory Boards, who have been advocating vigorously for adequate healthcare funding, will also continue their extensive efforts to urge the support of their legislators.

NEW YORK CITY COUNCIL HOSPITAL CLOSING TASK FORCE

Last month I participated in a roundtable discussion held by the City Council Hospital Closing Task Force.  The Task Force is chaired by Council Member Helen Sears, who has been a strong advocate for HHC, and is charged with evaluating the specific health care needs of New York City.   I was joined by my colleagues from the New York City Department of Health and Mental Hygiene, Greater New York Hospital Association, Primary Care Development Corporation, the New York Academy of Medicine and the Community Service Society.  My presentation focused on who we are and what services we offer to our patients – including the critical role we play in serving vulnerable populations, our strategic direction, and the important economic contributions our facilities and employees make to each borough.

The Task Force will be developing recommendations to send to the New York City Regional Advisory Committee of the Commission on Healthcare Facilities in the 21st Century (otherwise known as the Berger Commission).  The Task Force is holding public hearings in every borough to hear from the public on the health care needs of their communities and representatives from HHC's facilities have testified at the hearings.  The remaining hearings will be on Staten Island on May 1 and in Queens on May 4.

TOP NATIONAL NURSING AWARD

On April 15, Bellevue Hospital Center’s 18 East Psychiatry Inpatient Unit was presented with the 2006 award for Best Nursing Unit in the NJ/NY metropolitan area by the national nursing magazine Advance for Nurses.  The occasion marked the first time the award was given to a public hospital or to a psychiatry unit.  The selection was made from a regional pool of applicants, and considered a broad range of factors, such as safety and satisfaction on the job, continuing education, departmental initiatives, performance improvement projects, and teamwork.  Kudos to the nurses on 18 East!

STRATEGIC REINVESTMENTS FOR 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 satisfactorily.
  
  
• Bellevue Hospital’s second Catheterization Lab opened on March 23, enabling the hospital to meet the growing demand for these services.  The new, larger lab includes additional code-compliant recovery space and upgrades in lighting, HVAC and other systems for Bellevue to meet the latest standards necessary to accommodate the range of catheterization procedures performed.
  
  
• Kings County Hospital held a ribbon cutting ceremony on March 21 for its state-of-the-art Diabetes Resource Center, designed to support greater participation by patients in their diabetes management.  Features include a demonstration kitchen, a computer resource room and a conference center.  Funds to construct the center were provided by a congressional budget allocation of $320,000 through the efforts of Congressman Ed Towns.

CHILD HEALTH SERVICES MARKETING CAMPAIGN

Pursuant to my authority under our operating procedures, I have granted a deviation to Operating Procedure 100-5 to amend HHC's contract with Princeton Partners, Inc., to add $250,000 to the funding for marketing services originally authorized by the Board.  The City Council has awarded this amount to HHC for an advertising campaign to promote HHC's Child Health Clinics and the funds must be expended and publicly released by the end of the current fiscal year.  Since the promulgation of an RFP for these services would not meet this deadline and would jeopardize this funding, I have authorized this amendment so that we may seek creative services from Princeton Partners, Inc., who are now under a competitively bid contract with HHC and are able to immediately provide the promotional services to be funded by this appropriation.

ASSURING ACCOUNTABILITY THROUGH CORPORATE COMPLIANCE

HHC's Office of Corporate Compliance is currently developing research compliance protocols in conjunction with the Office of Medical and Professional Affairs and the HHC Research Committee to ensure that the Corporation has accountability procedures in place as required for the receipt of research grants.

In another Corporate Compliance initiative, HHC’s participation in the Environmental Protection Agency’s (EPA) “voluntary audit agreement” has saved the Corporation over $272,000 to date in penalties which HHC would have been required to pay as a non-participant in the program.

HHC IN THE NEWS HIGHLIGHTS

• April 4-5 - The New York Sun, New York Daily News and New York Post reported on the Mayor’s budget modification to provide $575 million to ease deficits facing New York City’s public hospitals. 
  
  
• April 6 - The New York Times reporter Sewell Chan interviewed Marlene Zurack, HHC Senior Vice President of Finance on the financial challenges facing New York City’s public hospitals.   The New York City Council approved $2 billion in city budget modifications, including an additional $575 million that will allow HHC to receive a total $1.15 billion in Medicaid payments from the city, state and federal governments.
  
  
• April 19 - The New York Times, New York Daily News, Channel 7, El Diario and Hoy reported on Mayor Bloomberg’s announcement about the expansion of New York City’s Sexual Assault Response Team program to Manhattan and Queens.  The program, which now operates in all public hospitals provides forensic and counseling services for victims of sexual assault within one hour of their arrival at an HHC emergency room, 24 hours a day, 7 days a week.
  
  
• April 26,27 - Following a front page story in The New York Times about the high incidence of thyroid cancers among survivors of the Chernobyl nuclear reactor accident, public affairs staff at Coney Island Hospital secured various follow up stories to highlight the hospital’s expertise in caring for Chernobyl victims for thyroid related problems.  The story, featuring Coney Island Hospital Drs. Zhuravenko and Rao and a patient, aired on News 12 TV, was published in the New York Daily News and is expected to run in the Brooklyn View.
  
  
• April 27 - In response to the citywide statistics regarding childhood obesity among the poor, Lincoln Hospital public affairs staff secured various follow up stories that featured the hospital’s child obesity stats which were discussed by Dr. Magda Mendez and services to the South Bronx community.  The story, featuring Dr. Mendez’ work, appeared on NY 1 Noticias, will air on Telemundo Channel  47 and is expected to run next week in the Bronx Times, Bronx News and Medical Herald.