Remarks by Alan D. Aviles
President, NYC Health and Hospitals Corporation

Good evening. I am Alan Aviles, President of the New York City Health and Hospitals Corporation (HHC). Thank you for coming tonight. Thanks also to Mr. Mendez-Santiago and to HHC Board members Daniel Ricciardi and Cecilia Norat, who have joined us tonight. I also want to acknowledge with gratitude our host Iris Jimenez-Hernandez, Senior Vice President of the North Brooklyn Network, and Woodhull Medical and Mental Health Center.

Before Mr. Levy calls on tonight’s speakers, I would like to provide an overview of some of HHC’s accomplishments over the past year and more specifically, highlight a few of the accomplishments of our Brooklyn facilities.

HHC is the largest municipal health care system in the country. We serve 1.3 million New Yorkers, including nearly 400,000 uninsured individuals, and provide a broad array of medical, mental health and substance abuse services through our 11 acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers and more than 80 community based clinics. We also provide health services at home for many New Yorkers.

In Brooklyn we have three acute care hospitals, Coney Island, Kings County, and Woodhull, which this year celebrates 25 years of service to its community. We also have two large family health centers – formally known as the Cumberland and East New York Diagnostic and Treatment Centers -- as well as the Dr. Susan Smith McKinney Nursing and Rehabilitation Center.

Across our entire system, we are working to provide safer care that prevents unnecessary harm to our patients, to provide more effective care that better manages chronic disease, and to provide more preventive care that averts disease or that diagnoses disease at an early stage. Our success on these fronts – which has increasingly received both local and national recognition -- speaks to the commitment of our staff at all levels to our mission and to our patients.

In September, HHC became the first healthcare system in the state of New York to voluntarily disclose certain detailed quality and patient safety data to the public. The information we are sharing includes our mortality and hospital-acquired infection rates; how often we follow best clinical practices in treating heart attacks, pneumonia, and other medical conditions; and how well our nursing homes are doing in providing quality care. This data is available on our public website which is nyc.gov/hhc.

On the site, you can see that our hospitals and nursing homes compare well to state, regional, and national standards on a number of important quality measures. In Brooklyn, our acute care facilities have achieved particularly outstanding performance ratings in providing heart attack care, heart failure care, pneumonia care and the prevention of surgical infections, and McKinney is outperforming the majority of nursing homes in the state in effectively managing pain and in reducing the prevalence of falls.

Our commitment to transparency will help drive improvements throughout HHC, and the information on our site effectively provides a baseline from which the public and we ourselves can measure our performance and make crucial improvements. Openly sharing this information may leave us open to criticism in some areas but it helps to build trust and confidence in our commitment to the continual improvement of quality, safety, efficiency and patient-centered care.

Before the end of this year, we will release data on our efforts around prevention and early detection of disease, as well as data on how well we are doing in helping our patients manage their chronic diseases such as diabetes and asthma.

I have stated publicly that it is our goal to make HHC one of the safest healthcare systems in the nation by the year 2010. In recent years, critical care teams from across our system have taken steps to sharply reduce ventilator associated pneumonia and central line associated blood stream infections. Both types of infection increase the risk of death for fragile ICU patients. During the past year the majority of our hospitals went several months in a row without a case of ventilator-associated pneumonia or a central line infection in their ICUs.

Last year, Woodhull Hospital did not have a single instance of hospital associated pneumonia in its intensive care unit. Kings County Hospital went nine months without a single case of a central line infection in its surgical ICU last year and again had zero central line infections during the first six months of this year. And Coney Island decreased its rate of ventilator-associated pneumonia by more than 70% during 2006.

As important as it is to avert unnecessary physical harm to patients, it is equally important to prevent the unnecessary suffering and anguish that too often accompanies the last weeks and days of life for terminally ill patients in our ICUs. Many patients facing certain and imminent death want high-tech interventions continued to the very end, no matter how invasive or futile, and that is their right. Others, however, would choose differently if given the choice.

Over the past year, we have been expanding successful palliative care programs for terminally ill patients at Coney Island and Bellevue and creating new ones in our other nine acute care hospitals. As a result, HHC patients and their families who face the end of life will soon have access to expert comprehensive palliative care that includes effective pain control, psychological and emotional comfort and support, advanced care planning and the possibility of home hospice care. In every case, the paramount concern will be to offer patients the opportunity for lucid closure with family and friends.

Even as we serve those in the community who become ill, suffer injury, or are unable to take care of themselves at home due to disabilities or advanced age, we are very focused on expanding access to preventive and primary care services that keep Brooklyn communities healthy and its residents out of the hospital.

HHC Options

Prevention begins with access to comprehensive primary care services. HHC has long set the example of how all people, regardless of their ability to pay or their immigration status, should be served by our nation’s healthcare system. Our financial assistance program, HHC Options, assists eligible patients in obtaining public health insurance and ensures affordable discounted services to uninsured patients who are not eligible for any public insurance program. For example, a child in a family of four whose annual family income is between $51,000 and $62,000 can be seen at an HHC clinic or health center for a fee of $15 per visit.

The HHC Options program’s deeply discounted care allows access to affordable healthcare for many uninsured working families with modest incomes. In FY 2007, HHC Options linked approximately 100,000 uninsured patients to an HHC primary care provider. During the same period, our Medicaid managed care partners, MetroPlus and HealthFirst, enrolled nearly 25,000 uninsured children in Child Health Plus and 314,000 uninsured adults in government-sponsored insurance programs such as Medicaid and Family Health Plus. HHC’s own financial counselors also assisted more than 50,000 New Yorkers in Medicaid enrollment.

Child Health Clinics

Child Health Clinics, now in their 100th year, are another important way that we provide access to healthcare and are an essential component of the City's healthcare safety net for children, regardless of their immigration status or ability to pay.

For the third consecutive year, the New York City Council is providing support to HHC to promote pediatric health initiatives, which has included interior clinic enhancements and community based outreach. The Council is also supporting a highly visible ad campaign, launching this month that highlights the clinics as a much better alternative to a hospital emergency room.

Although our ability to treat ill patients is crucial, preventing people from becoming ill or detecting an illness in its early stage when it is easier to treat are equally important.

Take Care New York

October is the month for our annual Take Care New York campaign, when we provide thousands of New Yorkers with flu vaccinations and health education and screenings for diabetes, hypertension, depression, cancer, HIV infection and other serious diseases.

Although we offer screenings all year, the Take Care New York awareness activities allow us to communicate the importance of early detection and disease prevention and to help increase New Yorkers’ awareness of the importance of primary care to their health and well-being.

I encourage you to check out the many Take Care NY events in our Brooklyn facilities this month and to take advantage of the screenings offered. While you are at it, get a flu shot, which is especially important if you are over the age of 50 or if you have a chronic disease. A complete list of Take Care NY events is posted at nyc.gov/hhc.

Keeping Infants Healthy

This year we also began wide implementation of an aggressive breastfeeding education and support program to improve infant health for the nearly 22,000 babies born in our hospitals each year. We know breastfeeding can help reduce their risk of common childhood infections, asthma, diabetes and other conditions. In order to help promote breastfeeding, we now exclude free baby formula samples from gift bags to new mothers, ban formula promotion materials from labor and delivery units and provide the necessary support to encourage the start of breastfeeding in the baby’s first hour of life.

Cancer Care

Our cancer prevention, screening and early detection efforts are helping to narrow the gap of ethnic and racial healthcare disparities, and to diagnose significantly more cancers at an earlier stage when treatment is more effective and prognosis much more hopeful. In the past year, we stepped up our screening programs, performing more than 150,000 cervical cancer screenings, more than 90,000 mammograms and nearly 22,000 colonoscopies. At Coney Island, a new colonoscopy suite, with increased staffing and larger clinical space, will enable the hospital to increase screening colonoscopies this year. And HHC’s smoking cessation clinics and services have helped more than 70,000 smokers in the past four years to quit, reducing their risks of lung cancer.

HIV Testing

HIV/AIDS is still an epidemic in New York City. It is estimated that 100,000 New Yorkers are diagnosed with HIV or AIDS, and there were roughly 1500 AIDS-related deaths last year, with 85% of them among African-American and Hispanic New Yorkers. Because an estimated 20,000 New Yorkers are infected by the virus but don’t know it, we are making HIV testing part of routine patient care. This past fiscal year we provided nearly 134,000 HIV tests – more than twice the number tested just two years ago -- and we identified more than 1,600 patients who tested positive. As a result, we have gotten many more individuals into early treatment and have helped to reduce the transmission rate even as we lessen the stigma associated with HIV/AIDS.

Chronic disease continues to be a great threat to the health of our communities. For example, asthma and diabetes are epidemics of disproportionate magnitude in New York City. They also especially afflict the African-American and Hispanic communities. In some of our communities more than 8% of adults have asthma while more than 10% of adults have diabetes.

Asthma

Alarmingly, more than 18% of New York City’s children suffer from asthma, and the disease is the single greatest health-related cause for missed school days. New York City has almost twice the rate of childhood asthma hospitalizations as the rest of the nation, and in some neighborhoods, asthma hospitalization rates for children up to age 14 are nearly four times the national rate.

All our Brooklyn facilities are fully engaged in treating asthma by following best clinical treatment standards, as well as by engaging in education and outreach to the community. And while Brooklyn has the second highest rate of asthma-related hospitalizations for children and adults in the city -- with only the Bronx doing worse -- there is some good news: today, fewer children and adults are visiting our emergency rooms or being hospitalized for asthma in Brooklyn and throughout the city. In fact, our asthma-related pediatric emergency visits declined by 24% and our hospital admissions dropped by 30% during the past two years.

We are helping our asthmatic patients by ensuring that we provide every patient with an asthma action plan and by prescribing the most appropriate medications for patients with persistent asthma. In one example of effective outreach, Woodhull Hospital has been partnering with local schools and the North Brooklyn Asthma Action Alliance to introduce ways for children with asthma to better manage their debilitating disease.

Diabetes

Diabetes, another chronic disease that reflects deep healthcare disparities, is the leading cause of kidney failure, adult blindness, and lower extremity amputation, and it is a prime contributor to heart disease and stroke. Residents of Williamsburg-Bushwick are hospitalized for diabetes at 10 times the rate of people living on the Upper East Side. And residents in the areas most affected by diabetes die from their diabetes at seven times the rate of New Yorkers in the least affected neighborhoods. Overall, the percentage of New Yorkers with diabetes has more than doubled over the past ten years, and now roughly 8% of all New Yorkers have the disease.

HHC facilities are battling diabetes on many fronts and we are committed to doubling the number of our patients system-wide whose diabetes is well-controlled by the end of 2009. This would effectively mean bringing more than 10,000 additional diabetic patients under good control and lessening their risk of life-threatening complications.

In one example of our focus of diabetes management, Woodhull monitors closely its 5,000 diabetic patients through the efficient use of our electronic diabetes registry and helps them develop personal action plans, further engaging them in their own care. In another, the specially designed Diabetes Resource Center at Kings County Hospital stresses education about healthy diet – it even has a demonstration kitchen so patients can learn how to cook their favorite foods in ways that lower their salt and fat content.

Heart Disease

Heart disease remains a prime cause of premature death in our city and HHC provides some of the most sophisticated cardiology services in the city. Comprehensive cardiac care including diagnostic screenings, stress tests, cardiac catheterization, pace maker implantation, angioplasty, surgery and other services are available in HHC.

HHC hospitals also have developed unique prevention programs to reach out to new immigrant communities, some of whom are at greater risk of cardiovascular disease than the general population. I applaud Coney Island Hospital for aggressively reaching out to the Pakistani, Bangladeshi and Indian community with its Healthy Heart Program.

Depression

Over the past two years, HHC has acted to help our primary care providers recognize and treat another prevalent chronic disease -- depression. We screened nearly 55,000 patients for depression in our primary care clinics during the past year. With the help of the New York City Department of Health and Mental Hygiene, we have been training primary care providers to treat mild and moderate depression. During the next year we will treat more patients for depression than ever before, and treat many in primary care as we continue to take a more holistic clinical approach in that setting.

Last year, speakers expressed concern about patient satisfaction rates among hospitals in New York City and New York State. We believe our increasingly patient centered approach to care and our aggressive initiatives to redesign care delivery for patient convenience are responsive to some of these concerns. A prime example is our continuing work on ambulatory care redesign to keep our average primary care visit time down to our goal of 60 minutes or less and to make appointments more readily available when patients want them.

HHC Diagnostic and Treatment Centers in Brooklyn have seen consistent decreases in wait times and rates of patients who fail to keep their appointments since we began this work. Cumberland has achieved a 30% decrease in wait time over the past several years and a 31% decrease in no-show rates. East New York has achieved a 50% reduction in wait times over the same timeframe and a 25% reduction in no show rates in the last year alone. Even as we make these improvements, we also want patients to be able to see their chosen primary care physician because we know that builds a stronger doctor-patient partnership, fosters earlier detection of health issues, and helps involve patients and families in active and more effective management of chronic diseases.

Several speakers last year were also concerned about our facilities’ ability to recruit and retain nurses, in light of the nation-wide nursing shortage. I want to bring you up to date on the creative recruitment and retention efforts we have been making to face that challenge.

While as many as 1,400 nurses – 20% of the current HHC workforce – are expected to retire within the next five years, we have been able to attract nearly 600 new nurses during the past year. Creative career-ladder programs bring new talent into the profession as well as offer advancement to seasoned nursing leaders. One such program offers training to non-nursing HHC staff, encouraging them to move into the nursing field. More than 600 HHC employees currently participate in those programs and nearly 90 have already graduated and await their licenses as RNs and LPNs.

Now, with support from the City’s Center for Economic Opportunity, we will provide 300 scholarships to help low-income New Yorkers, as well as eligible HHC employees, attend a four-year program leading to a Bachelor’s of Science degree in Nursing (BSN) from Long Island University. Students will complete two years of undergraduate course work and then two years of classes and clinical practice at the nursing school at Kings County Hospital. The program will guarantee participants employment at an HHC facility, will expand the pool of nursing school slots, and will ultimately help us ensure that we can replace those nurses who will retire over the years ahead.

Our affiliations with academic centers continue to bring the brightest young physicians to public hospitals and community health centers. Our hospitals in Brooklyn in turn offer a unique experience to work in a diverse, challenging urban health environment and practice HHC’s mission-driven brand of health care delivery. This past year, we renewed our affiliation agreement between Kings County Hospital Center and the SUNY Downstate/Health Science Center, and signed a new affiliation contract between the New York University School of Medicine and Woodhull Hospital and Cumberland Diagnostic and Treatment Center. This new affiliation agreement extends the benefits of HHC's long-standing relationship with NYU School of Medicine to the patients and clinical staff of the North Brooklyn Health Network for the first time.

We continue to re-build our public system with the largest hospital capital construction and modernization in the city’s history. In Brooklyn, these capital projects are dramatically changing the architecture of care.

During the last fiscal year, we completed approximately $15.6 million worth of projects throughout Brooklyn, including the opening of the Bedford-Stuyvesant Alcoholism Treatment Center and new cardiac catheterization suite at Kings County and new diagnostic equipment, including 64-Slice Computer Tomography suites at Coney Island and Woodhull.

We expect to invest another $16.9 million during fiscal year 2008 for the purchase of new equipment, including a new digital mammography unit at Woodhull, and to upgrade the lobby and Pediatric Clinic at East New York Diagnostic and Treatment Center.

We have another $196 million worth of active projects throughout the borough, including the construction of the Behavioral Health Care Pavilion and a new cancer care center at Kings County, as well as upgrades to Coney Island and Woodhull. Finally, we have begun the design phase for another $47.3 million in projects for repairs to the exterior and the infrastructure of our Brooklyn facilities.

Although being able to serve our communities well is a reward in itself, our system has received a number of notable awards and recognitions over the past year. For example, we received the 2007 Public Health Community Award for outstanding contributions to outpatient psychiatric services and treatment.

The award, given to us by the Public Health Association of New York City, recognizes HHC’s Mental Health Peer Counseling and Case Management Services, which employs individuals who are at a point in recovery from their own mental illness where they can counsel others and serve as a role model.

HHC’s leading edge work in medical and information technology also received national recognition. On behalf of HHC, I accepted a national Information Technology Achievement Award from Modern Healthcare Magazine and the Healthcare Information and Management Systems Society for our use of advanced clinical information technology to render safe, effective, and efficient health care to HHC’s 1.3 million patients.

The award recognized our leadership in advancing strategic goals related to public health through the use of technology, including reducing medication errors and improving health outcomes for patients with diabetes, asthma and other chronic diseases. HHC is the only public hospital system to achieve this national distinction.

The achievements that I have mentioned this evening would not have been possible without the generous guidance and advocacy provided by our Community Advisory Boards, the contributions of our volunteers and auxiliaries, the steadfast support of our elected officials, and, of course, the hard work, commitment and creativity of the men and women who staff our community-based ambulatory care centers, nursing homes, and hospitals in this borough and throughout our city.

Thank you for your attention and your support of our public hospital system. I look forward to hearing your comments tonight.