ALAN D. AVILES
HHC PRESIDENT AND CHIEF EXECUTIVE
REPORT TO THE BOARD OF DIRECTORS
December 14, 2006

As part of HHC’s focus on patient safety, we are continuing the implementation of Rapid Response Teams (RRT) throughout our hospitals. As you know, RRTs are composed of critical care personnel who are called to give immediate extra attention to patients outside of the ICU at the first sign of decline that could lead to cardiac arrest. All HHC hospitals have now implemented rapid response teams, although not all have yet gone hospital-wide in their coverage. Each month, as care teams become more skilled at utilizing the RRTs, they respond to more calls.

The initial results continue to be extremely encouraging. At both Coney Island and North Central Bronx hospitals the number of heart attacks occurring outside of the ICU dropped by 50 percent in four months, and at Bellevue the rate dropped by more than 75 percent since January. As we continue to expand our implementation of this and other patient safety measures, we have seen a steady decline in our system-wide inpatient mortality rates from 1.7 percent in 2003 to 1.45 percent in January through September of the current year – rates that are significantly lower than relevant national and regional averages.

Recognizing that chronically ill patients suffer disproportionately from depression, HHC has taken strong steps over the past two years to help our primary care providers recognize and treat it. We have integrated depression screening tools into our electronic medical record to facilitate regular screening and have created collaborations between primary care and psychiatry providers to expedite timely treatment. Several of our facilities are now beginning to report promising results from these efforts.

Elmhurst’s Senior Care Clinic screened nearly all of their new patients between December and May and found 25 percent had scores that indicated depression, with 66 percent responding positively to treatment rendered. Bellevue found that primary care providers were able to achieve significant improvement with 41 percent of the patients who tested high on the depression scale. Many of the Bellevue patients who also suffered from diabetes experienced improvement in their blood sugar levels once their depression treatment was successful. Facilities are continuing to expand depression screening and we are focused particularly on assessing the effect of early treatment of depression on the management of diabetes and other chronic illness where active patient engagement is so critical.

I want to alert the Board to our launch of a significant, new corporate-wide clinical initiative. As you know, the HHC Foundation recently awarded a $217,000 grant to HHC to support the development of palliative care programs for patients who face life-threatening or terminal disease. These care options stress dignity and comfort in the context of a more holistic approach to a dying patient’s medical, psychological and even existential or spiritual needs.

Too often our healthcare system is driven by a conditioned response to treat every death – even one that it has become inevitable and imminent – as a failure to be staved off as long as possible and by any means necessary. While this may accord with some patients’ wishes, it sometimes magnifies, rather than mitigates, the suffering and anguish of patients and their families. Palliative care offers the alternative of dignified, comfort care in the presence of family in place of a futile onslaught of technology in the relative isolation of the ICU. Expert and comprehensive palliative care should be available to all patients and families facing end of life trauma.

On December 6, Bellevue Hospital hosted a conference of more than 100 administrative and medical leaders from HHC’s facilities to kick off the first year of our palliative care initiative, which seeks to develop palliative care services at each of our 9 acute care facilities without such programs. (Coney Island Hospital developed a palliative program some years ago and Bellevue has recently launched its program.) Conference speakers included two national experts who stressed that palliative care programs can have a dramatic positive impact on patients, family and staff and alleviate needless suffering. It was also noted that such programs can be self-funding because they generally reduce ICU and other costs for those patients who opt for palliative care.

This is the right and moral thing to do for our patients facing the end of life, and the presentations at the conference clearly struck a responsive chord with our staff in attendance. Because it will seek to empower and support patients and their families in choosing to mitigate some of the anguish and suffering associated with the automatic imposition of invasive end-of-life medical technology, I view palliative care as falling squarely within the four corners of our broad patient safety campaign. A newly chartered corporate-wide Palliative Care Council will help guide and support the development of Palliative Care services at our facilities in the coming months.

HHC’s aggressive campaign to fully automate the medication cycle in our facilities reached another milestone this month as Bellevue and Jacobi completed their implementation of inpatient medication administration. HHC facilities were among the earliest hospitals to make computerized physician order entry (CPOE) standard throughout our facilities. CPOE has been widely recognized by national organizations, such as the Institute of Medicine, as one of the most reliable means to prevent drug errors and enhance patient safety. Nine HHC facilities have now completely automated medication administration, which helps nurses at each patient’s bedside administer and document medication accurately and efficiently.

On the IT front, we also saw another milestone in the implementation of electronic procurement capability when the North Brooklyn network went live this month with the eCommerce system, increasing to four the number of networks who are currently ordering through the automated system. The Central Brooklyn network will be the next to come on line with the system, which allows HHC to track requisitions and orders more easily and monitor spending on supplies more effectively. The program can help facilities achieve cost savings through both “just-in-time” ordering, when procurement is closely integrated with inventory, as well as through bulk “requirements” contracts. Complete implementation of eCommerce is scheduled for the end of 2007.

A ribbon-cutting ceremony was held earlier today, to mark the completion of the new Bedford-Stuyvesant Alcoholism Treatment Center in Brooklyn. The Center has been in operation since 1972 and has been on the Kings County Hospital campus during the past three years, while the new building was under construction. The new facility contains a 24-bed residence program and an outpatient program to provide follow-up treatment for graduates of the resident program. It also provides community education and outreach services to the Bedford-Stuyvesant community for the prevention and treatment of chemical dependency.

As the nation observed World AIDS Day this December, Harlem Hospital’s ongoing contributions in the battle against the disease were honored on several fronts. The NY State Department of Health AIDS Institute announced that Dr. Elaine Abrams of Harlem Hospital Center was selected as one of the recipients of the 2006 Linda Laubenstein Award for excellence in HIV clinical care. The award honors those physicians who provide high quality clinical care and are significantly involved in the ongoing effort to achieve comprehensive care for persons with HIV/AIDS. CNN also did a television news story on location at Harlem, where the number of patients who have received HIV rapid tests has more than doubled in the past year to more than 5,000.

HHC facilities continue to receive professional recognition for medical excellence in the treatment of several serious diseases that disproportionately affect the communities we serve. On November 6, the American College of Surgery conducted a site visit at Lincoln Hospital and subsequently awarded the hospital Community Cancer Center accreditation, with multiple commendations. Only 25 percent of cancer centers nationwide have this accreditation and only 5 percent receive commendations. Also in November, 12 clinicians from Lincoln, Harlem and Metropolitan hospitals were recognized at the third annual Niños Saludablez award ceremony for their dedicated work with asthmatic pediatric patients.

HHC Auxiliaries outdid themselves recently in a spate of successful fundraising events. The Bellevue Auxiliary held its 100th Centennial Gala and raised $330,000 for patient care programs, including vocational rehabilitation, crime victims services, and art and music therapy. Woodhull’s Auxiliary celebrated its successful Artist Access program for uninsured artists at its annual gala, which raised a record $250,000 for patient care initiatives. Kings County’s Auxiliary honored the hospital’s 175th anniversary of serving the central Brooklyn community and raised approximately $115,000 for cancer care programs. Kudos to the community leaders of the auxiliaries at all of our hospitals who help us do so much more for our patients.

The United Hospital Fund (UHF) awarded a $70,000 grant to Bellevue for its part in the UHF multi-year Medicaid High-Cost Care Initiative to reduce Medicaid costs by developing more efficient models for treating high-cost patients. The program is closely aligned with Governor-Elect Spitzer’s goal of seeking creative ways to improve public health while reducing Medicaid costs.

It is with deep regret that we announce the passing of our colleague, Dr. Jeanne A. Smith, an internationally recognized expert in sickle cell anemia research, who practiced at Harlem Hospital for 34 years. Dr. Smith also consulted with physicians in West African nations, helping them understand the disease and develop appropriate treatment protocols. She was the first woman elected president of the Harlem Hospital Center medical board, where she served from 1984 to 1987. Her outstanding leadership was also appreciated in her community of Englewood, New Jersey, where she was president of the Board of Health in the 1980’s and president of the Board of Education in the 1970’s.

Dr. Smith will be sorely missed. Her legacy of service and excellence will benefit the Harlem community for generations to come.