ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
September 28, 2006

Our critical care collaborative teams are continuing to apply evidence-based practices to avert some of the most preventable causes of patient mortality in critical care settings. And more and more of our facilities are reporting promising outcome data. As of June 2006, not a single case of ventilator acquired pneumonia (VAP) had been reported over the previous two months in six of HHC's intensive care units (ICU). Bellevue had not seen an instance of VAP in either its surgical ICU or its medical ICU in the previous seven months, and Woodhull's ICU had not had an instance of VAP in the previous 18 months. Additionally, as of June 2006, no central line infections have occurred at four HHC ICUs in the previous two months, with Bellevue going a full five consecutive months with no central line infections in its medical ICU. This is extraordinary work on the part of the critical care teams at these hospitals.

Our clinical teams working on chronic disease management have now begun working to spread their achievements to much broader cohorts of patients. As you know, we have developed an electronic disease registry as a key tool to help our clinicians with these improvement efforts. Corporate-wide, more than 90% of our adult diabetics – nearly 49,000 diabetic patients -- are now being tracked in our electronic registry. I have asked Dr. Louis Capponi to present to you a summary of our progress with the electronic registry and that presentation is on our agenda today.

Too many New Yorkers have life-threatening diseases and don't know it. Simple health tests for diabetes, high blood pressure, cholesterol, HIV and even cancer could prevent thousands of illnesses and disabilities this year and ultimately save lives. That's why next week HHC will launch our Take Care New York campaign and invite New Yorkers to seek low or no cost health screenings for children and adults at dozens of locations throughout the city every Tuesday in October - Oct. 3, 10, 17, 24, 31. Our screening events will also feature information and education on disease prevention and affordable health insurance. HHC Options counselors, MetroPlus, HealthFirst and other partnering agencies like the American Cancer Society, NYC Department of Health and the Office of Citywide Health Insurance Access will also participate. The screenings are available to all New Yorkers regardless of immigration status or ability to pay. An extensive local marketing and citywide public service campaign will help get the word out about the locations. New Yorkers will be able to dial 311 or visit HHC's web site at nyc.gov/hhc to find out the nearest screening location.

On September 21 I joined City Council Speaker Christine Quinn at HHC's Child Health Center at Melrose Houses to announce a public outreach campaign urging New York parents to bring their children to HHC child health centers, rather than relying on hospital emergency rooms for basic healthcare. Over the last year, the City Council has made nearly $1.8 million available to raise awareness about child health clinics that serve low-income communities. The campaign includes print, radio and subway ads in different languages, as well as collaborative outreach with various community-based organizations. City Council funding was also used to create more visible signage to make these sites more conspicuous in the community.

Through this campaign we hope to make New York families aware that pediatricians and nurse practitioners are available at our community-based sites to diagnose and treat all of the common illness that children experience. We are grateful to Speaker Quinn and the City Council for their commitment to children's health and their continued, unwavering support of HHC. The campaign was well received by the media and received news coverage from News 12, the New York Daily News, El Diario and Hoy.

On September 5, I joined the mayor and other city officials to announce the city's three-point initiative to strengthen New York City's response to emerging health issues related to the attack on 9/11. The plan includes the establishment of the WTC Environmental Health Center at Bellevue Hospital, which will be under the direction of Dr. Joan Reibman, a pulmonary expert at Bellevue who published one of the earliest research papers on the initial ground zero-related health impacts. The center will replace the WTC Health Impacts Treatment Program, which was initiated at Bellevue one year ago and has treated several hundred local residents and workers who were exposed to dust or fumes from the WTC disaster. The new center will have the resources to treat additional categories of people who were affected, including residents of Lower Manhattan and Western Brooklyn, City employees, and office workers, as well as volunteers and contract laborers involved in debris removal, clean-up or other essential services in the vicinity of Ground Zero.

The City will provide $16 million over five years to develop and support the new center and these funds will allow Bellevue to dramatically expand comprehensive medical and mental health evaluation and treatment services to approximately 6,000 New Yorkers. The Center is scheduled to open in January 2007. Services will be provided at little or no cost and will be available to all, regardless of ability to pay or immigration status.

The Generations Plus Northern Manhattan Health Network has received this year’s coveted Nicholas E. Davies Award from the Healthcare Information and Management Systems Society (HIMSS) for its successful development and innovative use of a electronic health record to improve healthcare delivery, including the implementation of electronic medication administration documentation. The award, which has been given to 22 hospitals nationwide during its 11-year history, honors organizations for excellence in healthcare information technology. Generations Plus is the second HHC network to win the prestigious award, following the Queens Health Network, which received the same recognition in 2002 for its computerized physician order entry system. Both networks are outstanding examples of HHC's commitment to improving patient care and safety through the skillful deployment and use of its advanced clinical information technology.

HHC's expertise in caring for patients from a rich variety of cultural backgrounds was again recognized when Coler-Goldwater Specialty Hospital recently received the national Hobart Jackson Cultural Diversity Award from the American Association of Homes and Services for the Aging (AAHSA). The nursing home was selected from among 5,300 facilities nationwide for effecting positive change through a strong commitment to culturally competent care and inclusion. Coler-Goldwater patients and residents currently speak 15 different languages and come from a broad spectrum of ethnic backgrounds and the staff reflects that same diversity. The many programs that were recognized by the award included medical interpreter certification training, Spanish classes for staff, advanced training on culturally sensitive care and medical glossaries in eight languages.

On September 13 the New York State Department of Health issued guidelines describing language services that hospitals are required to provide their patients with limited English proficiency. HHC has long provided services that exceed the requirements in the regulations and the announcement brought attention to our programs as models that other hospitals can follow to meet the new requirements. HHC has invested some $30 million over the last few years to develop multi-lingual signage, translate written patient communications into the 11 languages most commonly spoken in our facilities and provide medical interpretation in over 150 languages, either onsite or by telephone, to insure that patients can participate fully in their health care. Because of the strong media interest, HHC's services were featured in television stories on Channels 4, 41 and 47 and in articles in El Diario and Hoy.

As you know, this year the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) officially began its new process of conducting unannounced accreditation surveys. Coney Island Hospital was surveyed in the early summer. Sea View and Lincoln received their visits in August and Kings County was surveyed last week. Special thanks to Dr. Maese, Dr. Brown and Mrs. Bolus for participating in the Sea View, Lincoln and Kings Leadership interviews (respectively). Each facility received positive evaluations, full unqualified accreditation, and laudatory comments from the survey teams. Congratulations to Pete Wolf, José Sánchez, Jean Leon and their dedicated staffs for demonstrating that HHC facilities are, indeed, survey-ready at all times. In late October JCAHO Survey Team Leader, Betty Minassian will meet with the Board and senior HHC leadership to summarize HHC's survey performance over the past two years and provide comparative national performance data from other facilities surveyed in 2005 and 2006.

On Friday, September 22, HHC issued disciplinary action against 39 Woodhull Medical and Mental Health Center employees who inappropriately accessed the electronic medical records of a high profile patient previously treated at the hospital. HHC is seeking to impose 30- to 60-day suspensions without pay, pending each employee’s final disciplinary process. The employees receiving suspensions -- including doctors, nurses, technicians, and clerical staff -- also will be required to undergo additional training before they are permitted to return to work and have been warned that they will be subject to termination if involved in a second violation.

The violations were discovered after an internal hospital audit of electronic logs which record all access to any of our electronic medical records and identify the employees who view each record. At my direction, our internal audits division has now begun implementing periodic reviews of random patient records at each facility to ensure compliance with privacy policies. In addition, our networks will regularly monitor access to the medical records of high-profile patients, including patients who have attracted media attention.

Because of the large number of employees involved, we felt obliged to share information about our action with the news media. While we were careful not to disclose the patient's name, the media quickly deduced which high profile case was involved.

Recent incidents in other health care systems have demonstrated that high-profile patients can tempt curious staff to access their records even when they are not involved with the patient's care. Our action is calculated to make it crystal clear that HHC will honor every patient's medical privacy and will have zero tolerance for any such inappropriate accessing of patient records - regardless of how prominent or little-known the patient may be. New Yorkers who depend on our public hospital system for their care have a right to the full protection of their medical privacy. Any employee who accesses a patient's medical record without legitimate reason will be penalized.

In July 2005 I informed the Board of Directors that I had granted a deviation to Operating Procedure 100-5 in authorizing a contract award to the Staten Island Jewish Community Center ("SIJCC"). This was a 12-month contract at a cost not to exceed $120,000. Its purpose was to have SIJCC enroll uninsured Staten Island residents in public health insurance and the Staten Island Health Access ("SIHA") program. The program was initiated, with funds provided by the Mayor, to offer medical services to low-income Staten Island residents who did not qualify for other programs. These funds were used as grants to primary care doctors on Staten Island who wished to become providers in the SIHA program. Under this contract, SIJCC has successfully enrolled 140 people in public insurance programs and 1,799 individuals in SIHA. However, its work is not yet complete, so I have authorized a ten-month extension of the contract, effective August 1, 2006, at a cost not to exceed an additional $100,000, also provided by the Mayor.

It is worth noting that SIJCC's functions have evolved beyond providing SIHA enrollment services. The organization is also giving assistance to those who need help in navigating the complexities of the health care system, providing counseling and educational services to clients and helping many to receive preventive care and treatment of medical conditions which they might otherwise have failed to receive.

As many of our nurses approach retirement age, we are seeking creative ways to fill our nursing recruitment needs in the years ahead. Collaboration among Corporate Nursing, the HHC Foundation and Pace University has resulted in a Helene Fuld Trust grant of over $1.3 million to provide scholarships for accelerated degree nursing students who commit to work at one of our facilities for a minimum of four years. Another nursing workforce development program was announced on September 18, when the mayor revealed the City's plans to reduce poverty as recommended in a new report from the Commission for Economic Opportunity. As part of the plan HHC will develop new training programs to provide subsidized career ladder opportunities for workers and prepare them for well-paid nursing jobs.

On today's agenda, for your review and approval, is a two-year extension of the current Affiliation Agreement with State University of New York/Health Science Center at Brooklyn (SUNY/HSCB) for the provision of General Care and Behavioral Health Services at Kings County Hospital Center, from July 1, 2006 through June 30, 2008. This extension is proposed to allow the Corporation and SUNY/HSCB adequate time to conclude discussions for a new Affiliation Agreement, and to ensure that the rights of the Corporation are protected during negotiations. The total contract costs for the two-year period are projected to be $31.42 million.

The newly renovated “E” building at Kings County Hospital Center is now fully occupied, providing central Brooklyn residents with consolidated outpatient services that were previously located in five separate buildings throughout the hospital campus. The multidisciplinary care center provides a wide range of ambulatory services, including dental services, adult and pediatric primary care, geriatrics, and numerous specialties such as ophthalmology, podiatry, urology, ENT and speech and hearing. The new Ambulatory Care Pavilion can accommodate up to 500,000 visits per year. A ribbon cutting will be held later this fall.

At Queens Hospital Center, construction work on the new 142,000-square-foot, five-story ambulatory care pavilion is substantially complete. The $55 million project includes two enclosed bridges which connect it to the first floor of the new Queens Hospital building. The New York State Department of Health (NYSDOH) pre-occupancy survey is scheduled imminently, with occupancy to begin in October. The new pavilion houses an enhanced Diabetes Center of Excellence as well as outpatient services in Behavioral Health, Primary Care, Pediatrics, Psychiatry, Ophthalmology and Dentistry. A ribbon cutting is expected later this year.

On September 7, 2006, Bellevue Hospital Center held a ribbon-cutting to celebrate the completion of a new Thoracic Surgery Laboratory to predict cancers of the chest and to devise new treatments. The project was funded through an allocation from the Mayor’s office.

Earlier this month HHC responded to a request from the Senegal Consul General for humanitarian aid by providing used and surplus medical equipment and supplies. The donation included hydrotherapy tanks, stretchers and obsolete computers. We are pleased that our surplus hospital equipment will find a useful home with our international colleagues and welcome the opportunity to provide such assistance whenever possible.

This month HHC launched a new monthly electronic publication "HHC TODAY – Innovations from New York City's Transformed Public Hospital System." Electronic newsletters, distributed by email, are convenient and economical and give HHC an opportunity to bring attention to some of our most outstanding initiatives and top priorities. Your packet contains a printout of the first issue of the publication. Initial feedback has been positive and we hope that our colleagues, partners, community representatives and healthcare advocates will look forward to receiving it in the months ahead.

• Gouverneur Health Services has received two grants from the City Council totaling $405,000 for new preventive cardiac diagnostic testing equipment and for pediatric obesity prevention.
• Lincoln Medical and Mental Health Center has received a grant of $40,000 from the United Hospital Fund to implement a new health literacy program for its Diabetes Clinic. The new program, POWER/PODER (Patient Outreach With Education and Reinforcement/Pacientes Obteniendo Direccion, Educacion y Refuerzo), will enable Lincoln to recruit and train volunteers who will teach self-management and health literacy skills to patients with diabetes.
• New York State Crime Victims Board Grant has awarded a 3-year grant to Metropolitan Hospital for $202,746. The grant funds a fulltime clinical therapist for victims of domestic violence and sexual assault as well as emergency food and clothing assistance.

By now most of you are probably aware that Barbara Radin will be retiring at the end of the month as Executive Director of MetroPlus Health Plan. Her contributions to HHC have been extraordinary and she will be sorely missed. When Barbara joined MetroPlus in June of 1997, the plan had 40,000 enrollees, was losing money, had poor employee morale and troubled relationships with its provider network. Thanks to Barbara's outstanding leadership, MetroPlus has been completely turned around, with a six-fold increase in enrollment to over 240,000 members, three new product lines, a large increase in its provider network, greatly improved quality and outstanding customer satisfaction. Nothing speaks louder than the 2005 NYS Department of Health rating, which placed MetroPlus as the #1 Medicaid Managed Care plan in the City, on quality and customer satisfaction measures. Barbara will be a tough act to follow, but strong leaders build strong teams, and last week the MetroPlus Board of Directors appointed MetroPlus’s long-time Chief Medical Officer, Dr. Arnold Saperstein, as the new Executive Director of MetroPlus. I have no doubt that Dr. Saperstein will continue to build on the strong foundation that Barbara leaves behind.