Saturday, December 9, 2006

I wrote about "rightsizing" before the Berger Commission

In some ways an article I wrote for the Syracuse newspapers three years ago (“Right-Sizing Out Hospitals”) anticipated the work of the Berger Commission. [1]

On November 28 the New York State Commission on Health Care Facilities in the 21st Century, chaired by Steven Berger, recommended the closing of nine hospitals across the state, most of them in New York City – and more significantly, it recommended the restructuring of 48 hospitals – closing about 4,200 staffed hospital beds in all. The Commission also wants to close seven nursing homes and restructure 14 others, leading to a reduction of some 3,100 nursing home beds. All this activity will reportedly save $1.5 billion in health care costs annually.

In our area the Commission wants CGH’s nursing home beds to combine with those of Van Duyn for a total of about 500 nursing home beds. It also wants CGH to assume control of Van Duyn. The Commission did not change CGH’s licensed hospital capacity of 306 beds.

The Commission’s other decision involves Crouse Hospital and SUNY’s University Hospital. The Commission wants them to merge as a private hospital that is not a part of the SUNY system.

As I said in testimony submitted to the State Senate Health Committee on December 1, I support the work of the Commission, and I believe its recommendations are important. However, the devil, as they say, will be in the details of state oversight and assistance. How much money will the state provide and how much flexibility will the state permit as organizations go about implementing the Commission’s decisions? Without adequate funds to plan and invest, the Commission’s recommendations will be impossible to carry out. That is true for CGH and Onondaga County and, I believe, it is true for other institutions affected by the Commission’s decisions.

Most of the local news coverage has centered on the decision to combine Crouse Hospital and University at “approximately 500 to 600 inpatient beds.” [2] Today Crouse and University Hospitals have a combined total of 942 licensed beds, but their combined average daily census is actually 563, according to the CNY Regional Advisory Committee. [3] That is apparently how the Commission determined the 500-600 size.

You may remember that not too many years ago CGH and Crouse Hospital were affiliated under the Health Alliance of CNY. [4] During that time I served as Crouse’s Chief Operating Officer, and as such, I participated in the 2001 discussions regarding a possible merger of Crouse and University Hospitals. I had an opportunity to see first hand the positive potential of a Crouse-University merger, as well as some of the difficulties involved in bringing together these organizations.

After my return to CGH, I wrote an opinion article for the Post-Standard that reminded Syracuse that CGH came into being in the 1960’s as a result of community planning, and I expressed hope that through community planning a Crouse-University medical center might yet be achieved. Headlined “Right-Sizing Our Hospitals,” my article appeared on December 22, 2003.

In that article, I said
The much-discussed and much-delayed affiliation between University Hospital and Crouse Hospital makes sense, and a resumption of their collaborative discussions is to be welcomed. This does not minimize the complexities involved or the understandable interests of stakeholders such as unions, faculty, and private practitioners. But the ultimate stakeholders are the patients of Central New York and those who pay for their care.
I also advocated that
such an academic affiliation [be] in the 500-bed range. That size approximates the combined effective occupancy of the two hospitals as they exist today, it fosters continued efficiency improvements, and it assures the best and highest use of all existing hospital assets.

[1] The report of the Berger Commission is at this web address:
Click on “Final report.”

“Final Report of the Commission on Health Care Facilities of the 21st Century,” p. 91. The Commission’s report, which is 240 pages long, is available at For the section on CGH and Van Duyn, see pages 101-103. To see the Crouse Hospital-SUNY section, go to pages 91-93.

[3] Regional Advisory Committees, or RACs, were established to advise the Commission. The Central New York RAC heard presentations by 123 individuals during February-March this year. The Commission also met with 50 providers in the CNY region, some of them more than once. To see the CNY RAC’s recommendations, go to and click on “Central” under Appendix 2 - Regional Advisory.

[4] The Health Alliance of CNY (1999-2003) was the licensed parent corporation that appointed the boards of both CGH and Crouse Hospitals. Both hospitals shared a single management team, which was expected to bring about a more complete integration of CGH and Crouse over a period of years. The Health Alliance was derailed by several factors, not the least of which was Crouse’s bankruptcy in 2001. CGH officially resumed operations as a separately licensed hospital in May 2003.

Saturday, December 2, 2006

What the Berger Commission said

The Berger Commission[1] released its report this week after months of confidential deliberations. It calls for the closure of nine hospitals across the state and the conversion, affiliation, or reconfiguration of another 48 hospitals. In all, about one quarter of all New York State hospitals are directly affected by the recommendations – and that includes Community General Hospital.[2]

The report recommends that CGH combine its 50-bed sixth floor, which operates under a skilled nursing facility license, with the 526-bed Van Duyn Home & Hospital.[3] It recommends that the combined entity be controlled by CGH – that is, Van Duyn should be transferred from Onondaga County. And it recommends that the size of a restructured Van Duyn be about 500 beds. Today Van Duyn is licensed for 526 beds, representing about 17% of all nursing home beds in Onondaga County.

The Commission did not recommend any changes in CGH’s licensed capacity of 306 acute care beds.

Van Duyn has been part of Onondaga County for 179 years.[4] In recent years, the County has incurred significant financial losses at Van Duyn. During its budget process last October, the County debated Van Duyn’s role and affirmed it would continue to be part of the government’s responsibility, including its safety net patient services. The Berger Commission wants to see the safety net responsibilities continue at Van Duyn under CGH sponsorship.

The Berger Commission recognizes CGH’s future needs for patient care, including the need for more private rooms. The Commission sees value in “an integrated continuum of care on the campus” involving CGH and Van Duyn and also sees potential reimbursement advantages in such a restructuring. All this, of course, “will require capital (investment) support,” in the Commission’s words.

During the review process, the Commission visited Syracuse several times, meeting with County Executive Nick Pirro and with me. The Commission also visited the campus and toured CGH and Van Duyn. With the encouragement of the Commission, CGH studied options available to the County and to CGH, and these preliminary study results were shared with the Commission and the County.

Onondaga County and CGH work well together. As I said yesterday in testimony for a special hearing of the State Senate Health Care Committee, “Onondaga County is among the best-managed county governments in the state, and its decision-making process is thoughtful and businesslike. Onondaga County has been committed to operating Van Duyn as a public, safety net institution, and Community General has supported that position.”[5]

Because of changes in state law made this year, Van Duyn is expected to return to break-even operations under County sponsorship over the next several years. With an end in sight to its losses, the County wants to keep operating Van Duyn. Both Onondaga County and CGH expected the Commission’s recommendations to require continued work together toward more coordinated care without a change in ownership or control.

However, the Berger Commission recommended changes that would effectively reduce government’s role as a health care provider. For example, it recommended privatizing the hospitals associated with the SUNY medical schools, including University Hospital of SUNY Upstate Medical University. It also recommended that Erie County Medical Center be privatized in Buffalo. In this context, the Commission’s recommendation that Van Duyn become private appears to be part of a philosophical change by state government.

The report raises a lot of questions which no one can answer today. Employees have asked what the report means for the location of sixth floor services, what it will mean if overall nursing home beds shrink by about 75, and what might be the potential impact on employment. It is too early to answer any of these questions, because the planning will take time. First, we have to see if the Commission’s report is rejected by the Legislature.[6] Next, we need to see how soon the state can provide the resources for the necessary business, legal, and financial planning. We also want to know how flexible the state will be in overseeing the complex planning we will have to undertake with Onondaga County and the State Health Department.

With a new Governor in 2007, we can expect many changes in the Health Department, starting with a new Commissioner of Health, yet to be named. It is clear the Governor-elect supports the report of the Berger Commission and has even suggested that the Commission recommendations do not go far enough.[7]

New York State does have funds available to assist institutions like CGH and Van Duyn in making changes. In 2005 New York has established the HEAL-NY program[8] with $1 billion in funds over four years to support hospital and nursing home restructurings, as well as health information technology. Two months ago, the federal government committed an additional $1.5 billion to New York to help close and restructure hospitals and nursing homes. [9]

The Berger Commission represents a significant change in state health care policy. In a short period of 18 months, the Commission studied the entire state, conducted hearings, visited numerous organizations and developed a wide-ranging roadmap for change. We have to give the process time to work, and we have to give the new Administration the opportunity to make changes in state government. For our part, CGH will work forthrightly with Onondaga County and with New York State in doing our best to achieve the ends recommended by the Commission.

As I said yesterday in my Health Committee testimony: “I…respect…the work of the Commission. The Commission members and staff accepted an enormous task. They completed their work in a thoughtful and timely fashion. The report is a positive step towards reform of the State’s health care system.”

[1] Popularly called the Berger Commission after its Chairman, Steven Berger, the Commission on Health Care Facilities in the 21st Century was created in the 2005 state budget process. It began its work in the summer 2005, and a tight deadline called for its final report by December 1, 2006. The report was released on November 28. Patterned after the federal Base Realignment and Closure Commission (BRAC), the state created the Berger Commission so that its recommendations become law unless they are rejected by the Governor before December 5, 2006 or by both houses of the New York State Legislature by December 31, 2006.

[2] Three of Syracuse’s hospitals are affected by the Berger report. In addition to CGH, the report calls for the merger of University Hospital and Crouse Hospital into a single institution in the 500-to-600-bed range. Today Crouse and University Hospitals have a combined total of 942 licensed beds.

[3] The full report of the Berger Commission is available on its website: Click on Download the final report. For the CGH-Van Duyn section, see pages 101-103.

[4] The County Sanitarium, which is now called Van Duyn Home & Hospital, has been part of Onondaga County since 1827. In 1957 Onondaga County deeded 42 acres of the Sanitarium’s property to CGH for the construction of the new hospital, which opened in 1963. In 1979 the Van Duyn Home & Hospital opened as newly constructed 526-bed facility on 65 acres.

[5] For a copy of my testimony before the Senate Health Committee on December 1, 2006, go to Click on CGH Family Letter.

[6]Pataki and Spitzer Back Health Care Consolidation Plan,” New York Times, November 30, 2006: “Gov.
George E. Pataki and Governor-elect Eliot Spitzer yesterday endorsed a plan to close or shrink dozens of hospitals and nursing homes across the state. Their support means that it will be up to the Legislature to decide whether to block the proposed downsizings.”

[7] “Berger, Spitzer see more health care cuts coming,” Journal News, December 1, 2006: “The plan to cut the state's health-care system proposed this week…represents merely a start on reductions that need to be made, the chairman of the commission that recommended the cuts said in an interview yesterday. Later, Gov.-elect Eliot Spitzer disclosed that the savings from the plan to state taxpayers from the proposed closings is likely to be minimal. He reiterated that the ‘bloated system’ needs to be further cut.”

[8] HEAL NY stands for the “Health Care Efficiency and Affordability Law for New Yorkers.”

[9] “In Move to Cut Hospitals, U.S. Will Pay New York $1.5 Billion,” New York Times, October 3, 2006: “The Bush administration has agreed to pay New York $1.5 billion over five years to help stabilize the state’s financially troubled hospital industry, state and federal officials said yesterday. In return, the state will move forward with shrinking that industry, cutting Medicaid costs, and sharply increasing the sums it recovers from Medicaid fraud.”

Friday, December 1, 2006

My testimony before the State Senate Health Committee

Testimony of Thomas P. Quinn
President and Chief Executive Officer
Community General Hospital, Syracuse, New York

New York State Senate Health Committee
Albany, New York December 1, 2006

Senator Hannon and the Members of the Senate Health Committee:

Thank you for the opportunity to testify before you today. I am Thomas Quinn, President and CEO of Community General Hospital in Syracuse, New York. Community General is a 306 bed community hospital. We also operate an additional 50-bed skilled nursing facility (SNF), attached to the hospital.

Community General and the Van Duyn Nursing Home, a 526 bed SNF owned and operated by Onondaga County, sit on contiguous parcels of land. In the last few years Community General and Van Duyn have begun to take steps to treat those parcels as a common health care campus.

Before I comment on the particulars of the Commission’s report as they relate to Community General, I first want to state my respect for the work of the Commission. The Commission members and staff accepted an enormous task. They completed their work in a thoughtful and timely fashion. The report is a positive step towards reform of the State’s health care system.

The Commission’s report calls for the establishment of a unified governing structure between Community General Hospital’s SNF and Van Duyn Nursing Home, under the control of Community General Hospital, and for the reduction, between the two facilities, of about 75 SNF beds.

Because of our proximity, and ongoing joint efforts, Van Duyn and Community General have had exploratory discussions about the possibility of uniting in some form. We also have discussed other, less encompassing joint activities that would benefit both Community General and Van Duyn. In my own meetings with Commission staff, I discussed the possibility of affiliating with Van Duyn. We at Community General engaged a consultant to undertake an initial review of what affiliated operations would look like, either by close coordination of planning and investment of the two institutions or by combining institutions in some form. Community General also surveyed the legal issues that uniting could present. We did not conclude that a united operation was the best alternative at this time.

Our discussions with Onondaga County, both prior to and since the Commission’s meetings, have been open and productive. Onondaga County is among the best-managed county governments in the state, and its decision-making process is thoughtful and businesslike. Onondaga County has been committed to operating Van Duyn as a public, safety net institution, and Community General has supported that position. We have believed that close collaboration could accomplish the “integrated continuum of care” envisioned by the Commission.

I must tell you that the issues presented by joint control are daunting. They begin with the transfer of a publicly operated facility to private control. Bond covenants need to be respected. Labor contracts need to be examined. Governance and operational issues need to be addressed. But above and beyond all that, there is the issue of finance. Van Duyn has been operating at a substantial deficit over the last few years. My understanding is that Van Duyn expects to operate at a $5 million deficit in its upcoming fiscal year. Community General does not have the wherewithal to fund any deficit, much less a deficit of that magnitude, nor do we have ready access to funds for the technical, business planning, and legal services that would be necessary to address the changes recommended by the Commission.

Obviously, if Van Duyn were placed under the control of Community General, we would expect to introduce operational and programmatic changes to address the deficit. But to even begin that process requires funding. The Commission’s report was released on Tuesday. We have not had a sufficient opportunity to determine how much would be needed in planning and transitional funding. If the Legislature accepts the Commission’s report, Community General would need assurances of adequate state support for this process. Community General cannot allow itself to be weakened by a proposal that is intended to strengthen the delivery of health care.

I would also like to call the Committee’s attention to the special role that the Van Duyn Home has played in Onondaga County. Van Duyn has been the nursing home with a significant safety-net mission. That means that Van Duyn continues to admit a large number of residents on Medicaid-pending status. At best, that presents a significant cash flow problem for Van Duyn’s operation. The Commission’s report calls upon Community General to continue to fulfill that role. That is not an obligation a not-for-profit community hospital should be expected to bear by itself.

Community General Hospital shares a vision with Onondaga County to develop a health care campus from our contiguous sites. We see the advantage of the integrated campus concept endorsed by the Commission. We could foresee joint operations. But achieving this will require time, resources, and a public commitment to support the special role that Van Duyn plays in Onondaga County.

Thank you for hearing my testimony today.

Saturday, November 18, 2006

What I am thankful for

Each year a colleague of mine at another hospital[1] solicits words of thanksgiving from the workforce, and he publishes their statements of gratitude in a text called “the Thanksgiving quilt.” That patchwork of thoughts, reflections, and aspirations got me thinking about things I am thankful for at CGH. I am thankful for:
• All who make our patients feel welcome, safe, and respected by their thoughtful actions and by the kindness in their voices.

• All who demonstrate leadership by their knowledge and expertise, by their example, by their hard work, and by their willingness to help with new ideas and new projects.

• All who show up on time every day, who pay attention to the details of everyday work, and who do their jobs to the best of their abilities.

• All who wash their hands consistently, who follow the “red rules” of patient safety, who assure safe practices.

• All who make new employees feel welcome, who teach proper procedure and who encourage employees to feel a part of the CGH family.

• All who celebrate the birthdays, take up collections, offer congratulations at the weddings and graduations of coworkers, and who are ready to help when there is an accident, illness, or death in another’s family.

• All those who volunteer their time, who donate their money, who share their stories, and who make time to listen to others.

• All those who say hello with a ready smile, who hold open doors, who are courteous, and who pick up after themselves (and others).

• All who return to school, continue their studies, and demonstrate progress within their jobs, their professions, and their careers.

• All who respect our doctors by showing their professionalism, responsiveness, and teamwork.

• All who forego gossip and comments that can be hurtful, unkind, or thoughtless.

• All the patients who entrust to us their safety and wellbeing.

• All the doctors who have confidence in our care for their patients.

• All who have good hearts, who can see when another feels awkwardness or worry or pain – and who make efforts to help.

• Our board of directors and board advisers who give their time, their expertise, and their personal funds solely for the purpose of making Community General Hospital a better place.

• For the opportunity to work hard, to solve problems, and to be of assistance to my colleagues every day.
Happy Thanksgiving, everyone.

[1] Peter McGinn, President & CEO at United Health Services, Binghamton, NY

Wednesday, September 6, 2006

The Value of Life

Forty years of increased health care spending have prompted many initiatives to cut costs – restricting expenses technologies through state licensing laws, stimulating the growth of HMO networks, and more recently, introducing market incentives to health care. “Yet,” according to a recent study by researchers at Harvard University and the University of Michigan, “one of the most important question remains unanswered: What is the value of this medical spending?”[1]

The new study notes that, adjusted for inflation, annual health care spending for each person in America grew from about $700 in 1960 to more than $6,000 in 2000. At least half of that higher cost was the result of more medical care, not just higher prices paid for the care.[2]

What is the value of a human life? “Priceless,” is what most people would say. Society expects hospitals to make care available to everyone regardless of cost. Laws require hospitals to provide services on an equal basis, irrespective of an individual’s ability to pay. Emergency Departments remain open 24 hours a day, caring for all who present themselves. The EMTALA law prevents hospitals from transferring patients for financial reasons – only for reasons related to appropriateness of care.[3]

Yet we all know that government and health insurance payers limit how much they pay for an individual’s emergency visit or hospital stay, even when that individual may need additional tests or services. There are many of examples of payers limiting health care spending. For example, the nation’s second largest health insurer recently announced it will no longer pay for a very popular acid-reflux medicine.[4] And a gubernatorial candidate has promised to cut New York State’s Medicaid spending, in part by closing or downsizing hospitals.[5]

So what is the value health care spending? Or, as the study asks, what is the value of each additional year you or I live as a result of increased medical spending?

Published in the New England Journal of Medicine, the study cites sources that estimate a value of $100,000 - $200,000 for one year of life, called a “statistical life.” The study reports that for each person born between 1960 and 2000 the average cost per year of life expectancy gained was $19,900. For those over 65 years of age, the average cost of each additional year was $84,700 in medical spending. “In general,” the study concludes, “treatments that extend a life for a cost below $100,000 per year are deemed acceptable.”

One unanswered question: how many of the “extra” years are the result of health care spending and how much added longevity is due to public health improvements (seat belts and air bags in autos) or lifestyle changes (fewer tobacco smokers in the overall population)? The researchers estimate that 50% of the additional years of life result from medical care alone. Based on that assumption, the authors assert that “the increased spending (on medical care) has, on average, been worth it.” They go on to say that “even if 25 percent of the gains in longevity were due to medical care, the value of medical care is reasonable.”

That may be reassuring from society’s perspective. But we all know there are many inefficiencies in the health care system. One part of the system ends up paying (or not paying, or over paying) for services that benefit another part of the system. So a good part of the debate about health care spending is really about shifting the cost of care to someone else – to the employer, the insurer, the provider, or the government.

Although it may be reassuring, the study comes with a caution. It reports increases in overall medical costs for the additional years of life expectancy in people over age 65. By the 1990’s each additional year of life cost $145,000 for someone over age 65. It appears that the value of additional medical spending may be approaching its limits.

[1] “The Value of Medical Spending in the United States, 1960–2000,” Cutler, et. al. , The New England Journal of Medicine, August 31, 2006,

[2] This quotation and the other facts and figures are taken from “The Value of Medical Spending,” cited above. You can find this article on the web at this address:

[3] In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. See the federal government website:

[4] “UnitedHealth Stops Paying for Nexium,” New York Times, September 7, 2006. The story reports that
the country's second-largest health insurer will save it about $150 million.

[5] “Spitzer Says He’s Willing to Close Hospitals to Trim Medical Costs,” New York Times, September 8, 2006.

Friday, August 4, 2006

Community's second employee

Two weeks ago, I had a guest for lunch – Community General Hospital's second employee. He is Charles Calagaris and he started work for the Community Hospital Fund on April 1, 1959, more than three years before we opened our doors for the first patient at midnight on January 1, 1963.[1]

Mr. Calagaris was hired by John L. Brown, Community's first employee.[2] There is a plaque in Mr. Brown's honor in the corridor of the main lobby, across from the Business Office. Mr. Brown, who was Community's first employee and administrator, retired in 1982. With Mr. Brown, Mr. Calagaris directed the design, construction, and operations of the new Community Hospital from its opening and well into its first decade. In today's terminology, Mr. Calagaris would have been called Community's “chief operating officer.”
Mr. Calagaris brought me a number of Kodachrome slides, showing the construction of Community Hospital in the early 1960’s. He talked about some of the decisions he and Mr. Brown made in those early years. For example, did you know that CGH was originally conceived in an X-shape rather than the T-shape that was actually constructed? The reason? Air conditioning.

The Carrier Corporation donated air conditioning equipment to the new Community Hospital. In 1963 that made Community the first Syracuse hospital with central air. In planning for that, Mr. Brown became concerned that an X-shape for the building would mean more exterior surfaces. More exterior surfaces would mean greater exposure to heat and cold, making Community's utility expenses higher. So the X-shape was abandoned, and the T-shape we have today was adopted. Community's east and west wings form the top of the “T” with the north wing its stem.

Patient rooms were designed in dormitory style (with beds against the walls), rather than a more conventional hospital-style (with the beds extending into the rooms). This had the effect of reducing the square footage of each room, saving construction costs and creating a less institutional feel. But the dormitory style was controversial at the time. While Community Hospital was still in the design phase, Mr. Calagaris recalls that two prototype rooms were constructed in the S-3 building at Van Duyn to demonstrate how the dormitory-style rooms would work. Doctors and nurses visited the rooms and tried them out before accepting the dormitory style. Beds and equipment of several manufacturers were tested by the original staff in those prototype rooms.

In the 1950’s an intensive care unit was a new concept for hospitals, and none of the local hospitals had specially-designed ICUs. In fact, Community's original plans were made without a dedicated ICU, but Messrs. Brown and Caligaris changed the plans before construction to include an ICU on the first floor, opposite the public elevators (in the area that is now occupied by the Surgery Waiting Room, OR offices, and the Meditation Room). That first ICU had a horseshoe-shaped nursing station with direct line-of sight to each patient from the central core. Community replaced the original ICU in 19851 when the current intensive care unit was constructed on the third floor, north wing with the help of a gift from the estate of Dr. and Mrs. Sorgues.[3]

The original design of the nursery was the result of an experience with a nursery infection in Binghamton. The nursery was designed with four ten-bassinet rooms to permit staged cleaning of each separate room, as the babies rotated through the series of rooms. Remember, the 1960’s were during the post-World War II “baby boom” and Community and all local hospitals were very busy in the baby business at the time.

Mr. Caligaris left CGH in 1970 to oversee the construction of the Plaza Nursing Home on Crouse Avenue (now, Rosewood Heights Nursing Home), where he served as its first administrator. After Plaza, Mr. Calagaris joined University Hospital as its administrator until his retirement. He is still active in health care as the chairman of the board of the Syracuse Home Association in Baldwinsville.[4]

I would be remiss if I did not also recognize the long history of Mrs. Calagaris with CGH. Rose Calagaris began her volunteer work at CGH in 1964, one year after we opened. She continues as an active volunteer today, serving on the main desk on Wednesdays. Over the years she has accumulated 3,636 volunteer service hours at CGH.

It was great to visit with Mr. Calagaris. Both he and Mrs. Calagaris are a big part of who we are and how far we have come.

[1] When I asked Human Resources this week to check Mr. Caligaris’ employment dates, they had to check the archives and found his employee number: 002.

[2] I have written about CGH history in a previous posting: “Where we came from,” November 16, 2002.

[3] When CGH planned the current ICU in the 1980’s, it constructed a mock-up room in Onondaga County’s H-3 building (on the corner of Velasko and Route 173). There doctors and nurses saw and tested different head wall configurations and they assured themselves about the adequacy of space and maneuverability within the ICU rooms.

[4] Mr. Calagaris returned to CGH for six months in 1975, serving as consultant when CGH opened the sixth floor, which was newly constructed and licensed as a skilled nursing facility.

Saturday, July 22, 2006

Respecting Diversity

The author of today’s posting is Pam Johnson. Pam has been Community General's chief financial officer since 2001. Before that she was a part of the Community General family, serving as hospital auditor and consultant.

Among her many projects, Pam prepared the first business plan for the Laboratory Alliance of CNY. She also helped CGH and physicians with business planning in the 1990s. Pam’s letter contains personal comments she shared with the Multicultural Awareness Council (MAC) at its first meeting last Tuesday.

You will hear more about the work of the MAC in coming months. It is an important group that will help make sure CGH welcomes diversity and respects all individuals.

Thank you, Pam, for sharing your personal story.
- TQ

I have been very fortunate to have grown up in a family that valued diversity.

Both sets of grandparents married outside their ethnic background and both married a person of another religion.

My parents were active in the civil rights movement in the 50s and 60s. I had a childhood of door-to-door voter registration drives, protest marches, and rallies. I grew up Catholic during the heady days of Vatican II when the doors flew open and respect for and acceptance of other religions was the focus.

I grew up around people of many colors and backgrounds who had a dream of a better world and were willing to work hard to make it happen.

My elementary school was Percy Hughes when it was over 50% kids with disabilities. Kids without a disability were the minority and the “odd ones”. When we did those nuclear bomb drills in grade school, each kid who could walk had a kid who could not as a buddy to make sure they got safely into the halls where I guess someone thought we would be safe! For me, multi-lingual meant Braille and sign language, both of which we were expected to be reasonable proficient at.

I grew up down the street from the Vincent Apartments where the Peace Corps volunteers were being trained and we would watch them in awe, practicing languages and commuting on their bicycles. They were my idols.

I also grew up understanding that all this made some people afraid.

My parents’ neighbors would not let their kids play with me in “protest” over my parents having people of color at our house. My father was badly beat up one night for his efforts in registering people to vote.

I went to Roosevelt Junior High and Central Tech in the late 60s when race relations deteriorated into riots which closed the schools on a regular basis. It was there that I participated in an early prototype of the Dialogue Circles now run by the Inter-religious Council.

I have chosen to live for the past 30 years in my city neighborhood specifically because of the diversity it offers. I have neighbors of all colors, religions, sexual orientations, and backgrounds.

As I have grown older, I have seen that intolerance is not just a problem just for white people or straight people but for all of us.

I have also seen that the best way to battle intolerance is with one-to-one interactions. I have seen people who I had thought of as bigots accept and befriend new neighbors who were people of color or gays or lesbians. It is hard to hate someone who you chat with over lunch in the cafeteria or while taking a break from mowing the lawn.

And so I am very excited that the MAC is starting here at CGH. I speak for all of administration when I say we are looking forward to working with you to further awareness and understanding among staff, volunteers and patients. Little things that we do to start conversations can have rippling effects throughout CGH and our whole community.

Thank you for volunteering to help foster and celebrate our diversity.

Pam Johnson
VP Financial Services & CFO

Saturday, June 10, 2006

As valuable as cash

About two weeks ago all users of the CGH computer system got a “privacy and security” e-mail reminder from Joe Huber (HIPAA[1] Security Officer) of the Information Systems Department. “Is it okay to write down your (computer) password,” he asked, “if you keep it somewhere out of sight, such as under your keyboard?”

The answer is “no,” of course. When you scrolled down to read Joe’s answer, he explained that “your password…must be kept in a secure location such as a wallet or a purse or locked cabinet.”

In his e-mail Joe reminded us that Information Systems had sent the same “privacy and security” message two times before. He said he mailed it a third time because someone found an employee’s username and password posted on a computer monitor last month. In other words, the contents of CGH’s information system that were available to a specific employee were potentially available to anyone who happened to stop by and write down that individual’s username and password. Anyone.

Consider what you would think if an employee of the credit union were as careless with her username and password. Any unauthorized person would be able to look up your financial information simply by copying that employee’s secret access codes.

It’s just as easy to imagine how patients or family members would feel if they knew their information at CGH was potentially available to a snoop – or worse. Actually, we don’t have to imagine. We have only to read the news.

For the past several weeks the nation’s news reporters and editorial writers have been full of outrage and ridicule involving the Veteran’s Administration because a VA employee took home a computer disk that continued identifying information on 26 million military veterans. While in was in the employee’s home, the VA disk was stolen. Where is it now? What could someone do with so much information about individual Americans, including those serving in the active military? “How could such a thing have happened?” complained the news outlets. “What kind of security does the VA have?”

I read those stories – and I read Joe’s e-mail – and I thought, “What if that happened to a hospital instead of the VA?” Is everyone at CGH safety conscious about their computer passwords and about the files they have access to? Obviously not. A username and password were posted in plain sight in violation of CGH policy.

In today’s information age we have to treat computer information as if it were cash. Like cash, if access to computer information is left lying around, someone will steal it. If you saw cash on someone’s desk, you’d understand the risk right away.

It may be harder to recognize the value of computer data or passwords that give access to data, but we should consider computer data access as valuable as cash.

Using computers gives us great power to see and use and move around large amounts of information. This is much more responsibility than we had in past years when we worked only with paper records.

Being careless with a single file is a serious matter. Being careless with computer data can be a thousand – or a hundred thousand or a million – times worse.

[1] The Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses national standards for electronic health care transactions involving the security and privacy of health data.

Saturday, May 27, 2006

Dr. Prior helps us remember

For Memorial Day 2006 I would like to pay tribute to those who have died in the service of our country by recalling the experience of Jack Prior, MD, who was for many years CGH’s Chairman of Pathology. Dr. Prior retired from CGH a number of years ago. He may have slowed down a bit since his CGH years, but his mind is keen, and he retains a dry sense of humor and the ability to tell a good story.

During World War II, Dr. Prior was an officer with the Medical Battalion of the US Army’s 10th Armored Division. On December 14, 1944 he was the physician responsible for an aid station that was located in a pub in Noville, Belgium – about four miles from Bastogne, site of the famous battle in what has become known as “the Battle of the Bulge.”

Twenty-eight years after those events, Dr. Prior wrote about them for the Onondaga County Medical Society: [1]

Within two hours of our arrival the little town [of Noville] had turned into a shooting gallery featuring small arms, machine gun, and tank fire on the main thoroughfare. The large front window of the pub was an early casualty and it was necessary to crawl on the floor to avoid being hit as we treated our increasing number of casualties.
Dr. Prior described the evacuation of casualties from Noville. When the half -track in which injured soldiers were riding burst into flames from tank fire, the wounded returned to the pub. Later soldiers removed the pub’s doors, strapped the wounded on the doors, and tied the doors to the US tanks heading for Bastogne. In the late afternoon, the American column was pinned down by enemy fire.
We treated the serious injuries in the ditches as we waited three hours for the column to move again. Lying in the ditch and having sniper fire chip away at a fence post beside me was a terrifying experience….Many of our enlisted men demonstrated great bravery on the road, pulling tankers from their blazing tanks, driving jeeps with the injured on the hood to our Aid Station.
Once in Bastogne Dr. Prior used a garage as the aid station, but that proved difficult to heat and too small for the growing casualties. So he relocated the aid station to a three-story home. Bastogne had no electricity, no water, no food, and no medical supplies. There were also no doctors so “the civilian population descended on our Aid Station as soon as the Red Cross flag was hoisted – I even did a delivery!” remembered Dr. Prior.

...[T]he weather was very cold and there was about a foot of snow on the ground. My diary indicates we worked twenty four hours a day in the Aid Station, that the plasma froze and would not run, that we had no medical supplies and that the town was continually shelled....

I was holding over one hundred patients, of whom about thirty were very seriously injured litter patients. The patients who had head, chest, and abdominal wounds could only face certain slow death since there was no chance of surgical procedures – we had no surgical talent among us and there was not so much as a can of ether or a scalpel to be had in the city.

On December 24, 1944 – Christmas eve – Brigadier General Anthony McAuliffe sent a now-famous Christmas message to the US troops who were surrounded by tanks, under constant fire, and without winter clothing or supplies:

“What’s merry about [this Christmas], you ask? We're fighting - it's cold - we aren't home. All true, but what has the proud Eagle Division accomplished….? Just this: we have stopped cold everything that has been thrown at us….The Germans actually did surround us. Their radios blared our doom. Their Commander demanded our surrender….We continue to hold Bastogne. By holding Bastogne we assure the success of the Allied Armies….We are giving our country and our loved ones at home a worthy Christmas present…[2]

At 8:30 p.m. on Christmas eve, Dr. Prior was in the building next to his make-shift hospital, preparing to write a letter to the wife of a young lieutenant who was dying of a chest wound. A bomb hit the three-story aid station leaving it “a flaming pile of debris about six feet high.”

My men and I raced to the top of the debris and began flinging burning timber aside looking for the wounded, some of whom were shrieking for help. At this juncture, the German bomber, seeing the action, dropped down to strafe us with his machine guns. We slid under some vehicles and he repeated this maneuver several times before leaving the area….A large number of men soon joined us….[A]nd two or three inured were pulled out before the entire building fell into the cellar. I estimated that about twenty injured (solders) were killed in this bombing…

It has been 61 years since the events Dr. Prior described in his reminiscence. His account of the experience of Bastogne gives a vivid picture of sacrifices made by those have died for our country. Monday, May 29, 2006 is Memorial Day, the day we remember – and honor – all of them .

[1] John T. Prior, MD, “The Night Before Christmas – Bastogne, 1944,” The Bulletin of the Onondaga County Medical Society, December, 1972. This article is the source of all Dr. Prior’s quotes, used above. If you would like a copy of the article, please send a request via e-mail.

[2] This Christmas message wasn’t the only famous quote from General McAuliffe during the Battle of Bastogne. His more famous quote came in response to the German commander’s demand that Allied troops surrender. “If this [surrender] proposal should be rejected,” the German commander wrote, “one German Artillery Corps and six heavy…Battalions are ready to annihilate the U. S. A. Troops in and near Bastogne.” General MCAuliffe
responded with the one-word reply: "Nuts!"

Saturday, April 29, 2006

The importance of listening

“When [going into] an examining room,” said Dr. David Ruben, Chief of Geriatrics at UCLA, “you’ve got to be ‘out there’ for the patient. It’s very much like going on stage. It’s not that it’s insincere, but you have to be optimistic for patients. You need to engage them completely with your attention and be observant of everything that’s going on with them.”

That comment is from a story broadcast recently by National Public Radio. “On stage” was the phase that struck me because, although we are not “acting,” we in health care certainly are at center stage for patients and family members. Patients and family members study us, as if we were performing at a recital, giving a reading at our place of worship, or making a speech in front of our social group.

They watch closely to discern clues about what’s going on with their care or with their loved ones. Are we excited about something? Are we confident? Distracted? Are we sensitive to the patient’s discomfort or anxiety? This is the way we human beings communicate, by closely watching others to see if actions match words. And the more important something is (such as hospital care), the more closely we observe.

This year the federal government will start observing us – through the eyes of our patients. Surveys will be mailed to the patients of CGH and all other hospitals across the country. This is called the HCAHPS survey (pronounced “h-caps” and meaning “Health Consumer Assessment of Healthcare Providers and Systems”). The results of these surveys will be reported publicly, starting in 2007, by the federal Centers for Medicare and Medicaid Services (CMS). Eventually CMS intends to use the hospital patient satisfaction scores to determine how much they pay us for the care of Medicare patients.

CGH will voluntarily participate in a test run of the new HCAHPS survey this summer. The official survey process begins this fall.

Press Ganey Associates, a professional polling organization that already surveys CGH patients, has worked with the HCAHPS survey to determine what patient values are most correlated with high hospital satisfaction. According to Press Ganey, patients who give hospitals high marks well feel they have been listened to by the nurses and other staff.

“You need to engage them completely with your attention and be observant of everything that’s going on…” is the way Dr. Ruben put it, an excellent definition of effective listening.

The experts say that how we perform our jobs is as valued by patients as what we do in the jobs. “Scoring highly (on patient surveys) does not require [hospital staff] perform any additional tasks or duties but simply conduct their existing activities in ways that build relationships with [patients and families],” according to the experts at Press Ganey. Examples? Greeting the patient by name, and asking for help to pronounce the name correctly. Making eye contact with the patient and family members when speaking with them. Asking about a patient’s comfort and helping make the patient comfortable. Explaining what you are doing – and why. Using those most-important words consistently: “excuse me,” “please,” and “thank you.” Before leaving the room, ask, “Is there anything else I can do for you?”

Health care workers are hardly actors in any theatrical sense, but we are clearly stars to our patients when we listen to their needs, when we show concern for their comfort, and when we demonstrate courtesy in the many things we do every day.

Saturday, April 22, 2006

I had no idea

Two months ago we heard shocking reports about several individuals who were arrested for illegally harvesting body tissue in New Jersey funeral homes. [1] The tissues were provided to a legitimate medical supply company where they were properly processed and distributed to hospitals around the country – including to Community General Hospital.[2] The investigation into these matters is continuing, most recently with a probe of a Philadelphia funeral home.

We saw an entirely different kind of story in our local paper recently. For the 26th consecutive year, students from SUNY Upstate Medical University gathered at Weiskotten Hall for a memorial service to honor individuals who donated their bodies to science.

All of us benefit directly or indirectly from the gifts of bodies and body parts from voluntary donors. For many years the New York State driver’s license has included a short form allowing each of us to “make an anatomical gift to be effective upon my death.” This prompts a story about anatomical harvesting at CGH several years ago.

A young adult died in our Emergency Department as the result of a neurological event, and the spouse agreed to organ harvesting. The couple had been married only a few years, and they had discussed with each other their willingness to donate their bodies “to help others if something should happen.” When the patient was pronounced dead, the spouse readily gave consent, and the deceased patient went to the OR for harvesting.

Six months later the surviving spouse called me one morning and asked to meet with members of the Emergency Department and OR teams who cared for the patient who had died. “I want to thank them,” the spouse said, “and I have some unanswered questions, some things I am wondering about that I would like to ask.”

I did not know what to make of this request. The spouse was certainly heartfelt, but what were the “unanswered questions?”

Working with the Nursing Division, I arranged for a small reception in the Personnel Lounge for the spouse at mid-morning one day. I invited those who had cared for the patient to stop and introduce themselves to the spouse. It was voluntary, and I told the spouse that CGH people were busy, and I could not be sure how many would be able to attend.

Many did. Employees shook hands with the spouse and introduced themselves. They said, “I cared for your [spouse] in the ED,” and “I was with [the patient] in the OR.” They said, “I am sorry for your loss.” The spouse said, “Thank you so much for all you did,” and “Thank you for coming this morning.”

One nurse from the OR had done homework. She arrived with a small piece of paper that had numbers written on it. “Let me tell you about some of the people who benefited from [the patient’s] gift,” she began. “There was a 15 year-old girl in [a Southern state] with bone cancer. She received your [spouse’s] long bones. There was a middle-aged man in St. Louis who received the heart. I was there when the harvest team arrived from St. Louis. A few hours later, as we continued to work on your [spouse], there was a phone call that was put over the OR speaker. The caller said, ‘The heart is in the patient, and it is beating.’ And we all cheered.”

The nurse continued, “I tried to count the number of patients who were helped by [the patient’s] gift – the eyes, the kidneys, the skin, the bones, the heart. There were more than 150 individuals who were helped by some part of your [spouse]. The harvesting took many hours, and at the end we were all exhausted. We all said a prayer for your [spouse] in the OR.”

I don’t think there was a dry eye in the room. “I had no idea,” the spouse said. “I had no idea that so many people were helped. Thank you for telling me this. You have no idea how much this means to me.”

This story has stayed with me all these years as a reminder of the good that we do – and how powerful it is when we explain what we do so others may share its meaning.

This CGH story – along with the annual memorial service at SUNY – are antidotes to the revulsion we feel at learning of the tissue scandal in New Jersey.

Please take out your driver’s license. Have you signed permission to be an anatomical donor “to help others if something should happen?”

[1] Two CNY patients got tissue linked to indicted supplier ,” Post-Standard, February 23, 2006
[2] “CGH opens info line on body tissue scare,” CGH Family Letter, February 25, 2006

Saturday, April 8, 2006

Thank you, 95%

Community General Hospital has seen an increase in the percentage of hospital people (that includes doctors and employees) who comply with proper hand hygiene. In the first three months this year, we are averaging 95% compliance, compared with a 90% average in the past two years.

Three weeks ago I quoted a newspaper obituary for David Williamson Milne, a man who died in Kingston, Ontario on October 30, 2005. “The surgery was successful,” read the obituary.

Dave’s recovery was preceding well, thanks to the care of the [hospital] staff. Unfortunately, a series of hospital-acquired infections set back his progress and ultimately caused his premature passing.[1]

According to the Hand Hygiene Resource Center, “two million people become ill each year as a result of a hospital-acquired infection,” at a cost of some $4.5 billion. This week the Wall Street Journal reported “the rising alarm” that 90,000 hospitals deaths occur each year from these infections.[2] That translates to about 250 patient deaths each day! To put that number in perspective, last year CGH had an average daily census of 192 patients.

A review of 34 studies shows that “hand washing adherence among health care workers…varied from 5% to 81%” – with the average “only 40%.” Yesterday Sue Chamberlain, CGH’s Infection Control Program Director, told me there is a 1999 study by the Centers for Disease Control (CDC) that shows an average 54% of health care workers wash their hands as required. From this I conclude that the average hospital’s compliance is in the 40-50% range.

“‘It is no longer tolerable to accept noncompliance rates of more than 50% when we are dealing with critically ill patients,’” according to Dr. Don Goldman of the Institute of Healthcare Improvement (IHI) who was quoted in the Journal article. Dr. Goldman noted that computer-chip makers have better hand-cleaning performance than some hospitals.

At CGH nothing we do is more important than keeping safe the patients entrusted to our care. So I thank you for the increased vigilance that has boosted our hand hygiene compliance to 95%. We are at the very top of nationwide performance, ]something we should be proud of – and something very important for patients.

I do have a nagging question about the remaining 5%. Who would fail to wash hands and raise the risk of a potentially life-threatening infection for a patient in the next room, a colleague in the cafeteria …or for that matter, a loved one at home?

[1] “A Tipping Point,” CGH Family Letter, March 18, 2006.
[2] “Hospitals Get Aggressive About Hand Washing,” Wall Street Journal, April 5, 2006

Saturday, March 18, 2006

A tipping point

“Some day, we may look back at this and say it represented a tipping point in public consciousness.”

That is a message I received yesterday from my colleague Peter McGinn, PhD, who is the President and CEO of United Health Services in Binghamton, NY. Peter copied me on an e-mail that he sent to his staff about an obituary that appeared in a Canadian newspaper five months ago.

In reprinting the obituary, I repeat Peter’s words to his staff: “Please read this very carefully – all the way through.”

On October 30, 2005, David Williamson Milne passed away at Kingston General Hospital after a battle with hospital-acquired infections. He was loved and is deeply missed by many.

David Milne was the kind of person that you got to know, and like, quickly. His friends were among society’s small and society’s great, and he treated each with equal respect and appreciation. His Scottish humor and laugh were infectious. Even in his last days he could make us laugh.

His family was the joy of his life and sustained him throughout. As the youngest of a large Manitoba farm family, he was his mother’s joy and primary recipient of her loving largess. He wedded his first love and childhood sweetheart, Catherine, who followed him from posting to posting, with one and then two children, Catherine Jr. and Jacqueline.

As a long-service pilot in the Canadian Armed Forces David Milne’s life was not without risk, but risk balanced in an equation with skill. His heart surgery was a risk, but it was balanced against the outstanding skill of Dr. Hamilton at Kingston General Hospital. The surgery was successful and Dave’s recovery was preceding well, thanks to the care of the KGH staff. Unfortunately, a series of hospital-acquired infections set back his progress and ultimately caused his premature passing.

Every year hospital-acquired infections cause or contribute to the death of more people than breast cancer, heart disease, and car accidents combined. Most of these infections are initiated by otherwise caring healthcare workers who forget or neglect to clean their hands.

And for each of those who, like our friend David, succumb to one of these unnecessary infections, there are many more who ache for their loss. These are not numbers on month-end reports. These are our fathers, our mothers, our children, and our dear friends, who are dying prematurely because of unclean hands. The little bit of extra time that it takes for healthcare workers to wash or to use an alcohol sanitizer is pittance compared to the waste of so many productive, loved and loving lives.

In honour and memory of David Williamson Milne a donation will be made in his name to the Community and Hospital Infection Control Association of Canada. His family and his extended group of friends openly urge those at Kingston General Hospital as well as healthcare workers everywhere to clean their hands before and after every patient contact. It is absolutely a matter of life and death.

Farewell to a dear husband, father and friend.

Saturday, January 28, 2006

Whatever became of bedside manner?

The New York Times ran a series of letters to the editor last month under the heading: “What ever became of bedside manner?” [1]

The nine letters were mostly from doctors, who offered their own advice for improving doctor-patient communications. The doctors recommended good manners, such as making eye contact, remaining seated while a patient recounts symptoms, washing hands in the presence of a patient, returning phones calls and accepting appointments promptly for established patients. [2]

Some letters also pointed out a patient’s responsibility for effective communications. “So often patients come to us without organized information or prior records,” one wrote. [3] Another physician noted that patients can waste time by speaking of irrelevant things. He wrote about a recent example where a patient recounted a lengthy medical experience from the Korean War. The physician said,
I listened patiently as the minutes ticked by, wondering what the story had to do with his eye condition or general medical history. It eventually became evident that it was simply an interesting anecdote that the patient felt like sharing…[4]
Several weeks after the first set of letters, the Times printed more letters on bedside manners. Several suggested that better communications training is (or should be) available for health care professionals. One writer suggested that health care workers “ask themselves, ‘Is this how I would want my family member to be cared for? Is this how I would want a family member to be addressed?’” [5]

I have been in the hospital field for over 30 years, and I am still amazed at how much we sometimes talk past each other. We must all have examples of people misunderstanding one another – not because they were not listening, but because they applied different frames of reference to what was being said.

Messages we think we are sending may not be the same messages the other is receiving. We have different training, different experiences. We cannot automatically assume that our own perspective is shared by another. Sometimes our different frame of reference may cause us to make assumptions about another’s motivation. We may not even know we’re making an assumption, but what we think about the other fellow can affect the way we listen to – and accept or dismiss – what is being said.

I can imagine, for example, that the gentleman who rambled on about his Korean War experience (in the example above) may have done so because he was nervous at seeing a doctor – and his nervousness prompted too much talking. Or perhaps his long-winded story was an attempt to establish a relationship with the doctor before he brought up an embarrassing problem or a scary health complaint.

The point is, we may not know what motivates the other party, but our communications can improve if we imagine reasons why the other party might say or do something that is otherwise inexplicable. Keeping an open mind about the other person can help get past distracting or annoying communications. How might the caregiver’s communication with the Korean veteran have changed if he had considered reasons for the patient’s story other than mindless prattle?

When communications prompt an emotional reaction in the caregiver or the patient the focus can move away from what is being done or what has to be learned. If we’re thinking “How rude!” or “Who knows what she meant by that!” we’ve already changed the focus of our attention. When the focus moves away from the communication process, we risk not hearing something, forgetting to say something, not paying attention to something.

Good manners in health care communications are not just the “extra” that we bring to the bedside. They are an important part of the caring that we do, facilitating unambiguous understanding and reducing the chance for a mistake.

[1] “What’s Become of Bedside Manner? (Nine Letters),” New York Times, December 4, 2005.
[2] “Some Simple Guidelines for (seeing) Patients,”, Sharon Lewin, MD, New York Times, December 4, 2005
[3] Allan B. Ettinger, MD & Deborah M. Wesibot, MD, New York Times, December 4, 2005
[4] Mark Melamed, MD, New York Times, December 4, 2005
[5] Judith A. Erlen, New York Times, January 17, 2006

Saturday, January 7, 2006

"A classic example”

Earlier this week an employee raised a concern about patient privacy after she saw a provider interviewing a patient about her health history in a way that could be overheard by others.

Yesterday John Conner, our HIPAA[1] Privacy Officer, sent an all-department e-mail to remind us how important it is to use only the minimum necessary information when communicating about patients.

He wrote about a situation involving a department that produces a list of patients to be treated each day. The list is used to check-off names as patients arrive for their appointments. Last week a patient reported being able to see information on the list, such as the diagnoses or treatments associated with other names.

John called the situation “a classic example” of not following the minimum necessary standard.[2] In other words, more information was included on the patient list than was necessary. A second problem was that the list was visible to others. Patient information must be protected from unauthorized access, including casual access by others.

“The event provides a valuable learning opportunity for us,” John wrote, and he asked employees to bring similar situations to the attention of their supervisors right away.

I responded to John with an e-mail, saying that his message reminded me of another situation that dates from pre-HIPAA days. The mother of a patient called me to complain about a lack of information privacy. Her son, who had been a patient the prior week, had left his blue jeans in the room when he was discharged. She called Security, which promptly contacted the nursing unit, and the lost jeans were found.

When the mother stopped at Security to pick up the clothing, she saw that they were stored in a clear plastic bag, marked “patient belongings.” The bag also contained the printed half-sheet with the patient’s name, address, age – and diagnosis.

“Why, Mr. Quinn,” the mother asked me, “did the security officer have to know that my son is HIV positive?” It was a good question, and as a result, CGH changed its then-policy of including the half-sheet to identify patient belongings.

I’d like to thank the employees who showed their interest in (and sensitivity to) patient privacy this week. Confidentiality is a subject we take very seriously, and – as is apparent – one we need to remind ourselves about constantly.[3]


[1] HIPAA refers to the Health Insurance Portability and Accountability Act of 1996, a federal law that limits how hospitals and other health care providers may use health information that identifies an individual patient. The rule does not restrict the ability of doctors, nurses and other providers to share the information necessary to treat patients.

[2] HIPAA requires providers to use or share only the minimum amount of protected information necessary for a particular purpose. Information on HIPAA is available on this federal website:

[3] For CGH policies on patient confidentiality, go to “Public Folders” on the CGH intranet, find “Manuals” and select “Hospital Policies.” “Hospital Policies” will take you to a number of headings. Select “09 Management of Information” and go to the subsection on “Confidentiality & Security.”