New York City Council
Oversight Hearing: Access to Mammography and
Other Health Services for Women With Disabilities
Committee on Health, Committee on Women’s Issues and
Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse
and Disability Services
Good morning Chairpersons Arroyo, Ferreras, Koppell and members of the Committee on Health, Committee on Women’s Issues and the Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse and Disability Services. I am Dr. Ross Wilson, Senior Vice President for Quality and Corporate Chief Medical Officer for the New York City Health and Hospitals Corporation (HHC). I am joined here this morning by two doctors from Woodhull Medical and Mental Health Center in Brooklyn. Dr. Paul Kastell is the Chief of Obstetrics and Gynecology and Dr. Patrina Phillip, who is an attending physician in the Obstetrics and Gynecology Department. Thank you for the opportunity to discuss access to mammography and other health services for women with disabilities.
For more than a decade, HHC has worked to expand preventive and primary care services, including women’s healthcare services, to New Yorkers. All HHC facilities offer these programs. HHC has focused on the early detection and treatment of breast cancer in our patients. HHC’s clinicians screen for breast cancer through providing clinical breast examinations and mammograms for women aged 40 years and older regardless of ability to pay. In 2011, HHC’s hospitals and diagnostic and treatment centers provided more than 100,000 mammograms.
HHC’s acute care hospitals and nearly all of our diagnostic and treatment centers use state-of-the-art digital mammography systems that produce digital breast images with detailed image resolution. These digital mammography systems are superior compared to older x-ray based systems. Not only can they produce vastly better imaging, they are also much more adjustable to meet the needs of our patients including those who use wheelchairs and mobility devices. I would like to thank members of the Council for providing capital funding for many of these digital mammography systems.
In most cases, our technicians are able to position the mammography machine on the patient while they are still in their wheelchair and obtain a suitable image. To some extent, this depends on the type of wheelchair. If a suitable image cannot be obtained, some patients may need to be transferred to a wheelchair that has removable arms to allow for optimal positioning of equipment.
HHC’s cancer screening efforts are not limited to breast cancer screening; we also perform more than 130,000 cervical cancer screenings per year. We are able to screen women with disabilities for cervical cancer. Our exam tables are adjustable and can be raised or lowered to accommodate our patients. Our facilities also have a range of equipment available to properly perform gynecological exams.
One of the key aspects of serving patients with mobility disabilities is not only ensuring that appropriate equipment is available but also that facilities are accessible. Our facilities have accessible examination rooms with features that make it possible for patients with mobility disabilities to receive appropriate medical care. This includes an accessible route to and through the room, an entry door with adequate clear width and adequate clear floor space inside the room for side transfers and for certain equipment.
As we have rebuilt our facilities over the past several years, we have worked to make our facilities more accessible. Additional handrails have been installed, rooms are larger, bathrooms have been designed to increase the turning radius and toilets are installed at appropriate heights. Building entrances and elevators are of appropriate width. The principles of a universal or inclusive design are being incorporated by healthcare providers more often now than previously but there is always room for improvement. This is an ongoing process as requirements under the Americans with Disabilities Act are periodically updated.
Design is important. So is the patient-provider relationship. I want to have Dr. Patrina Phillip highlight work that has been done in collaboration with the Independence Care System (ICS) to improve care for women with disabilities.
Dr. Patrina Phillip:
Thank you Dr. Wilson. I am Dr. Patrina Phillip and I am an attending physician in the Department of Obstetrics and Gynecology at Woodhull Medical and Mental Health Center in Brooklyn and the Morrisania Diagnostic and Treatment Center in the Bronx. Staff at ICS reached out to staff at Lincoln Medical and Mental Health Center to determine if a relationship could be established to facilitate access to mammography services for women with disabilities. Following this meeting, it was decided that the initiative should not be limited to mammograms but also for gynecological services and HHC’s Morrisania Diagnostic and Treatment Center would be best suited for this initiative. Staff at Morrisania, including providers, nurses, radiology and clerical staff were trained by ICS experts in aspects of cultural sensitivity as well as instructing them on technical skills so that they could provide the very best access and care for women with disabilities.
I want to thank Ms. Marilyn Saviola, Women's Health Access Program Director, and the clinical and administrative staff at ICS for making this partnership a mutually rewarding experience for the patients and staff. Staff from Morrisania and Woodhull recently visited ICS headquarters and were impressed by the scope of technical, clinical and cultural support for clients with disabilities.
We have expanded the work that was done with ICS in the Bronx to Woodhull Medical and Mental Health Center in Brooklyn. Some staff have already received training by ICS and they have performed mammograms on patients with disabilities. We hope to expand training and additional services later this year.
Dr. Ross Wilson:
Beyond the efforts with ICS and our own extensive preventive screening efforts, we have been at the forefront in efforts to improve the healthcare system with an emphasis on proactive care management that treats the whole patient and not just focus on a disability. These efforts benefit all of HHC’s patients including those who may have a disability. Similarly, state and federal governments are increasingly focused on expanding care coordination efforts. This will lead to improved quality, reduced cost and better patient outcomes.
Our work in this area has focused on the patient centered medical home (PCMH). The PCMH is an advanced primary care practice model that employs a physician-led, team-based approach to ensuring comprehensive primary and preventive care, continuity, ready access, coordination of care and a systems-based approach to quality, safety and chronic disease management. Each of our primary care sites developed the full capabilities of a PCMH. All 39 of HHC’s primary care sites – both hospital and community-based -- applied to the National Committee for Quality Assurance (NCQA) and New York State for PCMH certification and were certified at level three, the highest level. Any New Yorker, who does not have a primary care provider, can go to an HHC facility, register to become a patient and receive any services they may need with the knowledge that their needs will be addressed.
As part of the PCMH transformation of primary care, we are focusing on patient care that does not involve face-to-face contact. Our plans are underway and we are testing different methods using telephone visits, email visits, and secure electronic transmission of patient data followed up by telephone-based advice. This is happening for patients with diabetes and heart failure but could also be used for patients with hypertension. Concurrently, we are planning an initiative that would allow patients to review test results and have prescriptions renewed through an internet connection from their home or smart phone.
New York State has similarly sought to make proactive efforts to improve patients’ health and has established a “Health Home” program that is focused on better care coordination for Medicaid patients with two or more chronic illnesses or serious and persistent mental illness.< The goal is to have designated “Health Home” networks use multidisciplinary teams of medical, mental health, and chemical dependency providers, together with social workers, nurses, and others, to ensure that enrollees receive needed medical, behavioral, and social services in accordance with a single care plan. There is an expectation that the Health Home program will decrease unnecessary visits to our emergency rooms and trim long-term healthcare costs by preventing costly inpatient stays and/or eliminating the need for other expensive healthcare services that typically result from sub-optimal management of chronic disease. This would be achieved by assisting the patient in navigating the health care system in the most efficient way and strengthening the patient’s ability to manage their care.
I want to emphasize that HHC is committed to ensuring that a patient’s disability does not pose a barrier to accessing needed care. We look forward to working with the members of the City Council, the Mayor’s Office for People with Disabilities and advocates for persons with disabilities to increase access to health care as well as exploring ways improve the care delivery process. This concludes my written testimony. I now look forward to answering any questions you may have.