Saturday, December 29, 2007

Special memories

Today the census in Community General’s licensed nursing home is in the single digits. Our census was 48 just 90 days ago when New York State announced it would provide the funding to help Community comply with the Berger Commission.

With the funding, Community and Van Duyn Home and Hospital were able to go forward with plans to downsize our combined nursing home capacity. On November 5 I announced specific dates for the closure of Community’s 50 nursing home beds. Our census had already started to fall – it was 41. By December 15, when we formally reported the 30-day closure plan, the census was 13. Today we have just seven residents.

Community has cooperated with the Berger Commission decisions, both in negotiations with New York State and with Onondaga County, Van Duyn's owner. I have written much about the Berger Commission and its impact on Community and Van Duyn in previous posts.[1]

The Berger Commission has attracted nationally attention, and the current issue of Modern Healthcare, reports:

One year after becoming law, New York’s landmark experiment in mandated hospital closures, mergers, and restructuring is proceeding as planned. In fact the majority of affected hospitals and nursing homes are meeting or exceeding the June 30, 2008 deadline, according to state Health Commissioner Richard Daines.
With Van Duyn, Community's mandate is to downsize nursing home beds and to coordinate medical planning. In association with Onondaga County we have responded directly.

1. Community has transferred residents from our sixth floor nursing home to Van Duyn and to other area residential health care facilities. This has been done gradually and smoothly with respect for patients and their families. There has been no negative impact on the area's nursing homes which collectively operate at about 97% occupancy. In addition to the closure of Community's 50 nursing home beds, Van Duyn plans to decertify another 13 beds next year.

2. This week Community and Onondaga County signed an agreement to form a joint planning company that will oversee and coordinate planning on the Community-Van Duyn shared medical campus. This agreement was reported last evening on WTVH-TV in Syracuse with speculation as to what such coordinated planning might mean. There are no specific plans for shared “food, laundry or and nursing facilities,” as reported. But the joint planning company, when it becomes operational next year, will look to improve clinical specialization and coordination and will seek opportunities for cost savings and medical campus development.

3. Finally, New York State has committed some $12.8 million to Community and Van Duyn. These funds will be used for capital improvements in Community’s medical-surgical areas and in Van Dun’s long term care service areas, as recommended by the Berger Commission. They will also help the to-be-formed joint company begin its coordinated planning process.

Despite this good news, the fact remains that 48 residents have been (and are being) relocated from Community to other facilities. In addition, some 60 full-time and part-time employees will no longer have jobs on Community’s sixth floor.

The loss of jobs has been (and is) a source of concern and upset within the hospital, as evidenced by SEIU1199's requests for the hospital to maintain these positions, despite the loss of work. Unfortunately, Community cannot afford to do this, as I explained in a letter to the labor union's officers on December 3.

Special thanks are due to our sixth floor management and employees for the professional and sensitive ways they have worked with residents during this disruptive and sometimes heart-wrenching process.

Two weeks ago, sixth floor residents received holiday tree ornaments as mementos of the time they have lived at Community. Employees visited former residents who are now at other nursing homes to give them the ornaments. It was a sensitive gesture, illustrative of the care and purpose with which employees (who are themselves affected by the sixth floor closure) have addressed the transition with residents.

Congratulations to Maureen Cerniglia, Community’s Director of Continuing Care and licensed nursing home administrator. After closure, she will become the licensed nursing home administrator at Van Duyn under the administration of County Executive-elect Joanie Mahoney.

Special thanks, also, to Joseph T. Barry, MD. Dr. Barry was recently honored as a member of the medical staff with the STAR award for his demonstration of “star” qualities (sensitivity, thoughtfulness appreciation respect). He has served as our sixth floor medical director for 19 years.

[1]A positive side to Berger compliance,” November 9, 2007; “When our sixth floor will close,” November 5, 2007; “State funds will help compliance with Berger Commission,” October 2, 2007; “No secrets,” August 12, 2007; “Today's news about the Berger Commission,” August 14, 2007; “What's up with the Berger Commission,” July 28, 2007; “Q&A on CGH and Van Duyn,” January 20, 2007; “What the Berger Commission said,” December 2, 2006; and “My testimony before the Senate Health Committee,” December 1, 2006.

New York hospitals rank 49th

Here’s a revealing note from the Healthcare Association of New York State (HANYS), posted yesterday on its website.

A recent HANYS analysis of hospital financial data found that more than half of…[New York] state’s hospitals lost money or recorded margins of less than 1% in 2006. A separate national study by the American Hospital Association (AHA) found that the average operating margin of New York’s hospitals ranked 49th in the nation in 2006, second only to Hawaii...

Weak hospital margins and losses are primarily attributable to governmental and private insurance reimbursement rates that are artificially low and in some instances more than a decade out of date. Perennial federal and state funding cuts, along with workforce shortages and rising costs for everything from blood products to liability insurance also exacerbate ongoing revenue challenges…

See my posting of two weeks ago about the shortfall in payments to Community General Hospital by Medicare.

Saturday, December 22, 2007

A responsibility & a privilege

Three years ago, at Christmas time, I wrote a brief letter to employees, following my rounds that morning.

"It's a holiday," I said, "and our patients need us."

I also compared the hospital to Robert Frost's definition of home, "where, when you go there, / They have to take you in."

What a responsibility we have, working in the hospital. And what a privilege too.

Happy holidays, everyone.

Sunday, December 16, 2007

Our wrong-side surgery

Recent news reports about wrong-site surgery at a Rhode Island Hospital generated coverage around the country, including here in Syracuse. Today the Post-Standard reported about a wrong-side surgery that occurred at Community General Hospital in 2004.

How could such a thing happen?

It’s the question we asked ourselves, as you can imagine, in the agonizing minutes, hours, and weeks following that day in 2004 when a surgeon performed an arthroscopy on the wrong knee of a patient here.

I learned about this medical error the morning it happened. Later that day I participated in a root cause analysis intended to identify factors that contributed to the error. Participating in the analysis were the surgeon, the operating room personnel, as well as key administrative and quality department staff.

I promptly apologized to the patient for the medical error. I also apologized to the surgeon because our safety processes did not help prevent the error that day.

This wasn’t a willful act. It was a mistake by human beings who are highly capable and who had the best of intentions. The complexity of modern medicine allows us to do much good for patients, but that very complexity can also introduce risk. Hospitals have established internal processes that are designed to reduce the risk of error, but our process failed us – and failed our patient – one day in 2004.

Our first step that day was the root cause analysis. But there were many more steps in the succeeding days and months, each one intended to help us better understand the error and better prevent a recurrence.
- We promptly reported our error to the State Health Department, as required by law. We continued reporting to the state over many months. We acknowledged our error, and we paid a fine.

- I contacted a hospital administrator who had experience with a wrong-site surgery. She helpfully shared with Community General the lessons from that hospital’s experience, including other sources for us to contact and process improvements they made.

- We requested help from the Joint Commission. Specifically we asked for an on-site review of our processes, starting with patient registration and continuing through the process of surgery.

- We visited a local manufacturer and met with the plant manager and a quality engineer to learn more about how industrial processes can reduce the risk of error.

- We hired an operating room nurse consultant (someone with experience in wrong-site surgery cases), who reviewed and helped us improve our processes.

- We made changes in our Universal Protocol, and they were accepted by the Department of Health.

- We re-trained all staff in the safety procedures required by the Universal Protocol, not only in the Operating Room but throughout the hospital.

- Each member of the Medical Staff individually endorsed the Universal Protocol process and committed to follow it.

- We conducted ongoing reviews of compliance with the Universal Protocol, and we audit procedures throughout the hospital to assure proper processes are followed. This surveillance is ongoing.

- We reported all our actions to the Quality Committee and to the Board of Directors. This reporting continues (as recently as our last meeting of the Quality Committee and the last Board meeting).
Because health care involves human beings, mistakes, regrettably, are possible. That’s why we rely on standardized processes that are followed by each member of the care team in a coordinated fashion in each and every case. This safeguards patients from error. But we know that systems too can fail, and the process of improving systems is ongoing.

We have done many things to address the situation that allowed a wrong-side surgery in 2004. But we have not closed the chapter on it. It remains a fresh lesson for all of us who work together each day in the interests of patient safety.

Saturday, December 15, 2007

The Medicare shortfall

I got a call this week from the office of Congressman Jim Walsh (NY-25). What, I was asked, does it cost for Community General Hospital to care for a Medicare patient? And how much do we get paid for that care? It’s an interesting question – and an interesting answer.

The average cost of care for each Medicare patient at CGH is $8,767. For that we are paid an average $6,612. That means our hospital loses $2,155 for each patient. And we take care of a lot of Medicare patients, some 4,600 a year.

How does a hospital make up such a loss? There are really only two sources : the payments we receive from commercial insurance companies and the funds donors give to the Community General Foundation. That’s a reason employers find their health insurance premiums so high each year. Part of their health insurance premium represents the extra amount it takes to help make up for shortfalls by government payers. It also explains why hospitals rely on charitable contributions.

Holiday lights

Thank you, Auxiliary to Community General Hospital, for the beautiful lights that decorate the trees in the park across from the entrances to Community General Hospital. And thank you for the splendid Holiday Lights on the Hill tree-lighting ceremony on December 5.

Saturday, December 1, 2007

For the United Way & CGH Employee Fund - Thank you!

My thanks to all who contributed to the CGH Employee Fund/ United Way Campaign. The campaign exceeded the 2007 goal by 8%!

Some $45,755 was raised in cash and pledges from employees, with help from retirees and volunteers.

Congratulations to Nancy Thompson, who chaired this year’s campaign with the help of her able committee, the leadership of the 14-person CGH Employee Community Service Fund. That's Nancy in the photo, more or less in the center of the photo. Others representing the Fund are, from left, Kristin Dombroske, Dan Cameron, Ken Redmore, Nancy, Maria Damiano, and me.

Each year the Employee Fund helps the United Way of CNY and raises funds that help members of the CGH family who may face unexpected personal financial hardship during the year.

Great work, all.

Friday, November 30, 2007

Stylish, comfortable, functional

Congratulations to King and King Architects, LLP on the award by the American Society of Interior Design (ASID) for its design of the Jim and DeDe Walsh Family Birth Center. The Center was dedicated at Community General Hospital in December 2004.

The ASID award recognizes King and King for its space plan at CGH, as well as for combining warm earth tones with stylish comfort while meeting hospital standards for cleanliness and functionality.

Yesterday King and King architect David Johnson, partner, and interior/ architectural designer, Zoriana Dunham presented the award to CGH (they are at left in the photograph, above). Accepting the honor for the Labor & Delivery staff were Marianne Holcombe, RN, and me.
Thank you, King and King, for designing such a wonderful facility for our patients – and thank you, Huber Breuer Construction, for making the design a reality at CGH.

Click here for more pictures of the Walsh Family Birth Center.

Sunday, November 25, 2007

Dr. Prior

Dr. Prior's obituary appears this morning in the Post-Standard, providing a more complete list of his affiliations and accomplishments than my reminiscence yesterday. I wrote about his World War II experience and posted his 1972 article about Bastogne. For the record, Dr. Prior's

decorations include the Bronze Star, the Silver Star, the Legion of Merit, the Belgian Croix de Guerre and the medals of the cities of Bastogne and Metz.

Saturday, November 24, 2007

Farewell, Jack

Yesterday I received a brief e-mail message from Donald Dew, a former Board member of Community General Hospital: “Jack died this morning,” he wrote. “As you know, he was a great man. I was privileged to know him well…”

“Jack” was John T. Prior, MD, for many years the Chairman of Pathology at Community General Hospital. He set a high standard for medical practice, he played an active role on the staff, and was famous for his droll humor and sharp wit.

In the 1970s, when I was new to the hospital world, I asked Dr. Prior why autopsies are important. “Patients die for one of two reasons,” he said wryly, “patient failure or doctor failure. We ought to know which.”[1]

A few years ago, when I met Eliot Lazar, MD, Vice President & Chief Medical Officer of the New York - Presbyterian Health Care System, he immediately called to mind “Community General’s excellent reputation in pathology.” Because Dr. Lazar did his residency in Syracuse, he rotated through Community General, and he remembered Dr. Prior’s pathology lab.

Dr. Prior wrote eloquently about his World War II experience as Captain in the Medical Battalion of the 10th Armored Division. He was at Bastogne on December 24, 1944. He selected a three-story home as an aid station for the wounded and dying soldiers in his care. Twenty-eight years after the experience, he wrote about that Christmas Eve in Bastogne:
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.
By chance, Jack was not killed when the aid station was bombed, then strafed, by a German plane, an incident portrayed in an episode of Band of Brothers, a 2001 ten-part television series based on the book of the same name by Stephen Ambrose. Although Dr. Prior is not depicted in the television episode, Renee Lemaire, his nurse, is. She died in the bombing, and Dr. Prior later wrote:
It seems that Renee had been in the kitchen as the bomb came down and she either dashed into, or was pushed into the cellar before the bomb hit. Ironically enough, all those in the kitchen were blown outdoors since one wall was all glass….Before our unit left Bastogne we dissected the hospital rubble and identified the majority of the bodies, including Renee Lemaire. I brought her remains to her parent encased in the white parachute she so dearly wanted [she wanted the silk for a wedding dress]. I also wrote…[a] commendation for her and forwarded it to our Commanding General…
Forty years later, Dr. Prior returned to Bastogne and erected a plaque in memory of Renee Lemarie.

I have written about Jack Prior before in What makes a good doctor, and Dr. Prior helps us remember. In his memory I have posted, below, his memories of WWII, The Night Before Christmas – Bastogne, 1944. I suggest you take a couple minutes to read it.

Dr. Prior slowed down in recent years, but his mind remained active. He lamented his physical maladies, and he treasured the monthly meetings he attended, along with other past presidents of the Onondaga County Medical Society. Medical papers are read at the meetings, and as Jack explained to me, “Everyone is expected to make a comment or ask a question after the paper is finished. Apparently, that means I’m not supposed to doze off.”

Dr. Prior served as President of the Medical Staff of Community General Hospital, he served on the its Board of Directors, and chaired its planning committee. He was on the faculty of SUNY Upstate Medical Center (now, Upstate Medical University). I am sure I am omitting many affiliations and accomplishments.

I was supposed to have lunch with Jack and Don Dew last Tuesday. But Jack was ill, Don said, and we thought we would be able to reschedule after the Thanksgiving holiday.

Farewell, Jack. As Don said, it has been a privilege knowing you.

[1] I quoted this remark in an earlier posting, but without attribution. See “Hospital mortality rates.”

The Night Before Christmas – Bastogne, 1944 by Jack T. Prior, M.D.

"The Night Before Christmas - Bastogne, 1944" by Dr. Jack prior was first published in The Bulletin of the Onondaga County Medical Society in December 1972. Last year Dr. Prior gave me permission to reproduce it, and I distributed it to the CGH family during the holiday season.

Dr. Prior passed away yesterday. In his honor I post this World War II article in its entirety.

When my oldest son was a youngster he periodically posed the question, “Dad, what’s the most exciting thing that ever happened to you?” It was a question I never remember asking my Dad and I wonder today what his answer would have been – he did not serve in World War I. At any rate my answer to my son, John, was always the same; recounting episodes of the Battle of the Bulge with particular emphasis on Bastogne since I was “in resident” there from December 20, 1944 until January 17, 1945. I would often tell the children the depressing story of December 13, 1944, just after I had finished reading “the night before Christmas” to them on Christmas Eve, emphasizing that this particular Christmas was neither happy nor merry for many people. For a long time I had promised myself to put this Christmas story on paper and it is some 28 years later that it is occurring.

Much of the detail of this particular period remains surprisingly fresh in my mind and the dates and sequences I had recorded daily in my diary which I carefully kept (contrary to my army directives) and still possess. I have always chuckled over the years to see General after General (one being a past President) publish his memories which had to have had origin in a carefully kept record – maybe this rule did not apply to General officers!

I was a member of the Medical Battalion of the 10th Armored Division. This division left Georgia where it had trained too long and arrived in Cherbourg September 23, 1944. The Division first saw action in attacking the outer fortifications of Motz on November 14th and my assignment was to help operate a clearing station preparing patients for transit to the nearest evacuation hospital. Working in a safe climate, free of artillery and small arms fire, I was ill-prepared for the baptism that was soon to follow.

On December 14th I was detached to the 20th Armored Infantry Battalion as their surgeon to replace their regular officer who had been evacuated with pneumonia. I had assigned to me a dentist, and about 30 enlisted men who were trained as liter bearers and first aid men. Our detachment had armored half-track ambulances and two jeeps and was a well trained unit. The 20th Armored Infantry was part of a combat team, the latter composed of a tank battalion, an engineer platoon, and a reconnaissance squadron. This team, called “Team Desobry,” after its infantry commanding officer, moved through Luxembourg on December 17th on what we believed was an administrative march with eventual quartering of the unit in Luxembourg. I have always been impressed with how little information in the army filters down to personnel at my level from the Army and Corps Headquarters. Perhaps there was some virtue in this, for our assignment actually was to move into the town of Noville (seven kilometers northeast of Bastogne). Field Marshall Gerd von Rundstedt could have told us our assignment. As the West Front Commander, he had struck a blow in the Ardennes. He was on his way to override Belgium, Luxembourg, Northern France and penetrate to the channel coast. The little village of Bastogne was in his way since it was the hub of a network of seven spoke like highways and would need to be taken on the way to his capturing Antwerp, largest supply point for Allied troops on the West Front. Soldiers of the 9th Armored Division, 4th and 28th Infantry Divisions could also have made our assignment clear since their ninety-five mile sector was being overrun by the German onslaught at that moment.

Arriving in Noville at six a.m., December 19th, we found a sleepy little crossroads. My Aid Station was located in the pub. I found this type of building always best for our purposes since the large drinking area accommodated many litter patients. Within two hours of our arrival the little town 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. Someone had selected our backyard as the “ammo” dump and this did not boost our equanimity. Team Desobry was ordered to hold Noville at all cost and it was not until the Battalion Command Post was hit and Major Desobry was wounded that we were ordered to withdraw to Bastogne. Evacuation of the score of injured had been virtually impossible. We did load four patients into a half-track at one point and just as it lumbered off, it received a direct hit from a tank and burst into flames. The four patients were unloaded and returned to the Aid Station; this under the gaze of the German tank commander. Upon receipt of the withdrawal order we were given ten minutes to move out. Since I had no functioning vehicular transportation and no litters I decided I would stay and surrender my patients to the Germans. I asked for volunteers to stay with me but the silence was deafening! It looked as if only myself and the tavern owners (an old lady and her husband who said their rosaries aloud for two days in their cellar) would remain behind. At this point my first sergeant seized the initiative and ran into the street, shouting at the departing tanks to swing by the Aid Station. The tankers ran into our building after ripping off all the doors from the walls, strapped our patients to the doors, and tied them to their vehicles. The column then moved down the road to Bastogne where I assumed there was a hospital and fresh defenders! It was not until after the war that we learned that Team Desobry had stopped the entire Second German Panzer Division which had assumed it was opposing a much stronger force. Outnumbered by ten to one, the Noville defenders knocked out thirty-one enemy tanks in two days.

Even the trip back to Bastogne turned into another fire fight. In a later afternoon fog the column was stopped by the enemy who knocked out our tanks and harassed us with small arms fire from the flanks. We treated 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. I was head to head in the ditch with my dental officer. He did not wear a helmet with the bright red cross and suggested mine was a sniper target and should be shed – a suggestion I resisted. 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. Many of these air men were soldiers whose reputation in the unit would have given no clue to the fact that under stress they could meet this challenge. This observation was to be pounded home again, time after time, in the months ahead. I have never learned who to predict will be a hero! I have often thought I’d still be in that ditch on the Bastogne road if it had not been for the arrival of a Parachute Battalion from the 101st Air Borne Division. This division had been hastily summoned from a rest area and was rushed to Bastogne without sufficient weapons and suitable warm clothing. They were instrumental in getting the remnants of Team Desobry back to Bastogne on December 20th by routing the enemy.

Bastogne on this date was an intact but somewhat deserted city. The sight of the residents dragging their belongings with them on little carts, leaving as we entered, was recognized as a bad omen – “rats leaving the sinking ship.” Many of these people faced the difficult decision of whether to retain the American flag over their door or to put the Swastika back up. My Aid Station was initially in a garage on one of the main streets. Two days later I had to move into a larger area in a private three story home as the casualties increased and because I could not heat the garage adequately – the 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. It was a major decision whether to run up the street a block to the Battalion Command Post. We in Bastogne never had any idea of the importance of this battle, thinking it was just another town. Its importance did not dawn upon us until one day we hooked up a radio to a vehicular battery and heard the BBC in London paying tribute to the “Gallant defenders of Bastogne.” They compared this battle to Waterloo, Gettysburg, and Verdun. The news that we were surrounded also had a curious effect upon our men – such remarks were heard as: “they’ve got us surrounded, the poor bastards,” or “surrounded, good – now we can attack on all sides.” I can never remember considering that we were going to lose that fight or that help would not eventually arrive. German artillery fired propaganda leaflets into the town, urging us to surrender. These were regarded by the GIs as humorous and were collected and swapped like baseball cards. One of these had a photograph of a little girl and her letter to her daddy.

Dear Daddy,

Today I went to the birthday party of Jean, but I didn’t have a good time because I was worrying so about you. Last night Mummy cried and cried because we haven’t heard from you for so long. Jean got a letter from her Daddy. He is a prisoner of war. Jean says he will be sure to come back home now. Oh, Daddy, you just got to come home. We miss you so.

Loads of kisses,
Living in a city without electricity, water, food and medical supplies was a challenge. My men scrounged port steaks, ham and jam from the vegetable cellars of deserted homes. The combat units sent whatever food they found to the Aid Station and any medical supplies in deserted doctors’ offices found their way to us. Civilian physicians were always scarce in towns we took. I never remember seeing a civilian physician in all of Germany. The only explanation for this I can offer was that many physicians were members of the Nazi party and that they took to the road before we arrived. Jewish physicians had either left the country or were in concentration camps. This, of course, had serious implications in that the civilian population descended upon our Aid Station as soon as the Red Cross flag was hoisted – I even did a delivery! The water problem was serious – melted snow was some help but Champagne filled a big gap. Very few people have shaved and bathed in Champagne as I did! On December 22nd German Commander sent a major, captain and two enlisted men into the town with a while flag – it was quickly rumored that they had come to arrange our surrender. Many of our defenders took this lull to shave, wash, to visit the straddle trenches. What followed is well known – we were given two hours to surrender the garrison or face complete destruction. The German Commander, Lt. General von Luttwitz, listed one Artillery Corps and six heavy A.A. Battalions as ready to annihilate us. General McAuliffe’s reply of “nuts” posed a problem for their interpreters. The best they could do with the translation was: “Go to Hell.” We were advised that a heavy shelling would occur – it did but I can not recall it being any different from the usual.

Now, in regard to the care of the wounded in Bastogne, I have always believed and still do that this did not constitute a bright page in the history of the Army Medical Department. I operated the only Aid Station for the Armored Division Combat Command although there were at least three other Battalion Surgeons with the Armor. 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. The extremity wounds were irrigated with a preciously low supply of hydrogen peroxide in an attempt to prevent gas infection. I attempted to turn my litter bearers into bedside nursing personnel – they were assisted by the arrival at our station December 21st of two registered female civilian nurses. One of these nurses, Renee Lemaire, volunteered her services and the other girl was black, a native of the Belgian Congo. She was “willed” to me by her father and when we eventually left Bastogne he was most distraught with me for refusing to take her along. They played different roles among the dying – Renee shrank away from the fresh, gory trauma, while the Congo girl was always in the thick of the splinting, dressing, and hemorrhage control. Renee preferred to circulate among the litter patients, sponging, feeding them, and distributing the few medications we had (sulfa pills and plasma). The presence of these two girls was a morale factor of the highest order. This decaying medical situation was worsening – with no hope for the surgical candidates, and even the superficial wounds were beginning to develop gas infection. I never did see any tetanus develop during the entire siege. It was at this point that I visited the acting Division Surgeon of the 101St Air Borne Division and requested he make an effort to bring medical help to us.

I had not visited the Air Borne area up until this time, December 23rd. Their headquarters and hospital area was in a former Belgian barracks compound. Major Davison, their surgeon, listened as I detailed our hopeless situation, and he assured me it was impossible to bring a glider surgical team into the area because of the weather and because the Germans would knock down anything that tried to fly in. He also stressed the fact that his paratroopers were used to being cut off (Normandy and Holland), and this situation was the expected. He then brought me to a riding hall where I saw the unbelievable! There on the dirt riding floor were six hundred paratroop litter cases – I can not recall the number of walking wounded or psychiatric casualties. These patients were only being sustained as were mine. I did see a paratroop chaplain (armed with a pistol and shoulder holster) moving among the dying. While I was there someone announced that General Patton was only a few miles out and that the road in would be opened momentarily. This evoked loud cheers and whistles from all those in the riding hall. Gas gangrene was rampant there, aided and abetted, I’m sure, by the flora on the dirt floor. Major Davison did drive into the German lines later with a white flag in an attempt to arrange a truce for medical evacuation. He proposed to take out one German wounded to two American but this was refused by the ranking German medical officer.

I returned to my Aid Station very depressed – it is ironic but surgical help did arrive in the person of a Major Sorell on December 26th. He came in via a piper cub to care for sixty patients – a mistake in decoding from the Air Borne headquarters had occurred and the figure of six hundred surgical patients was interpreted as sixty. Major Sorrell had a basic instrument kit and a few cans of ether. When he saw the riding hall and the mass of patients needing surgery he was overwhelmed. His decision was to take care of the gas infected extremities first; feeling that he could save more lives this way, as against the time it would take to do one belly, one chest, or one head case. On December 23rd hundreds of C-47’s droned over Bastogne and multicolored parachutes fell to earth – each color representing a various category of supplies. Food, ammunition, blankets, medical items were eagerly gathered. There was no attempt at control collection and each unit corralled whatever fell in their vicinity. Many parachutes fell in German territory, and we later learned that they relished the famed “C” rations. Even the parachutes were utilized as bedding in our hospital. I can recall Renee Lemaire leaving her duties and rushing into the back yard to get a chute. She wanted the silk for a wedding dress. She invariably was beaten out by a soldier and always returned empty handed.

December 24th was another day of constant shelling. General McAuliffe sent his famous Christmas message to the troops asking them, “What’s merry about this Christmas?” He added that they were cold and hungry and not at home, but that they had stopped four Panzer divisions, two infantry divisions and one Parachute division. He concluded his message saying that we were giving our loved ones at home a Merry Christmas and that we were all privileged to take part in this gallant feat of arms. At 8:30 p.m. Christmas Eve, I was in a building next to my hospital preparing to go next door and write a letter for a young lieutenant to his wife. The lieutenant was dying of a chest wound. As I was about to step out the door for the hospital one of me men asked if I knew what day it was, pointing out that on Christmas Eve we should open a Champagne bottle. As the two of us filled our cups, the room, which was well blackened out, became as bright as an arc welders torch. Within a second or two we heard the screeching sound of the first bomb we had ever heard. Every bomb as it descends seems to be pointed right at you. We hit the floor as a terrible explosion next door rocked our building. I ran outside to discover that the three-story apartment serving as my hospital was a flaming pile of debris about six feet high. The night was brighter than day from the magnesium flares the German bomber pilot had dropped. 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. Our team headquarters about a block away also received a direct hit and was soon in flames. A large number of men soon joined us and we located a cellar window (they were marked by white arrows on most European buildings). Some men volunteered to be lowered into the smoking cellar on a rope and two or three injured were pulled out before the entire building fell into the cellar. I estimated that about twenty injured were killed in this bombing along with Renee Lemaire. It seems that Renee had been in the kitchen as the bomb came down and she either dashed into, or was pushed into the cellar before the bomb hit. Ironically enough, all those in the kitchen were blown outdoors since one wall was all glass. I gathered what patients I still had and transported them to the riding hall hospital of the Air Borne division. At about 2:00 a.m. Christmas morning the bomber returned and totally destroyed a vacant building next to the smoldering hospital. I have often wondered how the pilot picked this hospital as a target. There were no external marking but, as some of the men said, the bomb must have come down the chimney. Many tanks and half tracks were parked bumper to bumper in the street in front of the hospital so it seems probable he simply picked an area of high troop concentration. Before our unit left Bastogne we dissected the hospital rubble and identified the majority of the bodies, including Renee Lemaire. I brought her remains to her parent encased in the white parachute she so dearly wanted. I also wrote the following commendation for her and forwarded it to our Commanding General:

Medical Detachment
20th Armored Infantry Battalion
APO 260, US Army
1 January 1945

SUBJECT: Commendation for Renee Bernadette
Emilie Lemaire (deceased)
To: Commanding General
10th Armored Division
APO 260, US Army
(Attn: Division Surgeon)

Thru Channels:

As Battalion Surgeon, 20th Armored Infantry Battalion, I am commending a commendation for Renee Lemaire on the following evidence:

This girl, a registered nurse in the country of Belgium, volunteered her services at the aid station, 20th Armored Infantry Battalion in Bastogne, Belgium, 21 December, 1944. At this time the station was holding about 150 patients since the city was encircled by enemy forces and evacuation was impossible. Many of these patients were seriously injured and in great need of immediate nursing attention. This girl cheerfully accepted the herculean task and worked without adequate rest or food until the night of her untimely death on 24 December, 1944. She changed dressings, fed patients unable to feed themselves, gave out medications, bathed and made the patients more comfortable, and was of great assistance in the administration of plasma and other professional duties. Her very presence among those wounded men seemed to be an inspiration to those whose morale had declined from prolonged suffering. On the night of December 24 the building in which Renee Lemaire was working was scored with a direct hit by an enemy bomber. She, together with those whom she was caring for so diligently, were instantly killed.

It is on these grounds that I recommend the highest award possible to one, who though not a member of the armed forces of the United States, was of invaluable assistance to us.

Jack T. Prior
Captain, M.C.

Renee Bernadette Emilie Lemaire
Place du Carre 30
Bastogne, Belgium
I have never heard what action was taken on this commendation.

Lt. Col. Abrams (now General Abrams and awaiting confirmation as Army Chief of Staff) opened the road on December 26 and elements of the 4th Armored Division poured into Bastogne. I spent the next few days assisting Major Sorrell in surgery, and, on December 27th a Glider Surgical Team arrived. This was a highly organized unit and they worked as teams on the abdomen, chest, etc. It was their role to prepare as many casualties as possible for evacuation to the rear. The Germans continued to shell the town day and night and the bombers continued their activities several times a night until January 2nd. It was not until January 17th that Team Desobry left Bastogne.

The most spectacular battle of World War II was over. More than fifty-six thousand Americans were killed in this winter blitz. The Germans had thrown five hundred thousand crack troops and one thousand tanks into their last stand. They had used eight hundred Luftwaffe planes in the Ardennes battle. They are now reluctantly withdrew, battered and bleeding, and the wound of that fight never healed.

Sunday, November 18, 2007

What we are thankful for

The Thanksgiving Quilts are on display at Community General Hospital, representing thoughts from members of the hospital family. There were some 90 submissions. To do them justice, we created three quilt graphics. To read the comments on each quilt, move the cursor over the picture and click. The quilts are on rotating display on the first and ground floors, allowing everyone to share the tender, thoughtful, and appreciative comments of friends and colleagues. Thank you, all, who submitted thoughts at Thanksgiving time.

Here is what I am thankful for this week:

• All who make our patients feel welcome, safe, and respected by thoughtful actions and by kindness in their voices.

• All who demonstrate leadership through their knowledge and expertise, through their example, hard work, and 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 birthdays, take up collections, offer congratulations at coworkers' weddings and graduations, and who are ready to help when there is an accident, an illness, or a death in someone's family.

• All who volunteer their time, who donate their money, who share their stories, and who make time for others.

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

• All with good hearts, who see when another feels awkwardness or worry or pain – and who make an effort 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 colleagues every day.
Happy Thanksgiving, everyone.

Thank you, Tom and Sue Watson

I had the pleasure of meeting Tom and Sue Watson last week when the Community General Foundation dedicated a five-by-two foot photographic print in the waiting room on the fourth floor. Sue's mother, Marge Gifford, passed away at CGH earlier this year, and the Watsons donated the print, Hesperis Matronalis, in her memory.

I wrote about Tom's photography recently, and my posting contains links to his work.

Before the brief ceremony, Tom told me that members of his family "must have used this hospital 50 times in the last 20 years -- for emergencies, childbirth, operations, for many things. And every time we've had good care by caring people."

I said, "You've made my day with that observation."

That's Tom and Sue in the photo, above, during the dedication on Four North. We are grateful to the Watsons for their thoughtfulness.

Saturday, November 17, 2007

Will we get a health information exchange?

On Monday Community General Hospital, along with other Syracuse hospitals,[1] will be part of a grant application that asks New York State for several million dollars to start a health information exchange (HIE) in Onondaga County. This will be our third such state application in as many years – and so far, our success rate is 0-2.

The HIE application will be submitted by the Health Advancement Collaborative of Central New York (HACCNY)[2] in cooperation with the Southern Tier Health Link, an organization that did receive a grant from the state under an earlier application process. Its success rate is 1-1.

An HIE would make patient data available via the Internet, no matter which doctor, hospital, or testing center holds a patient’s past test results. That means, any physician could, with a few keystrokes, locate an individual patient’s recent (or past) x-ray and lab results, as well as prescription lists, no matter what time of day or night…even on weekends. That could improve care, it could reduce waiting times, and it could save money by avoiding duplicate tests.

Some people assume that such ready access to patient data already exists, and they can’t believe that all the computers in the health care world don’t really talk to one another. But health care is filled with stand-alone systems for radiology, lab results, and medications. Even when the systems are linked, they typically do not communicate beyond the walls of a doctor’s office or hospital.

The advantages of health information exchange are self-evident. Bill Gates writes:
For the last thirty years computers and software have helped industry after industry eliminate errors and inefficiencies and achieve new levels of productivity and success. Many of the same concepts and approaches…can be adapted to the particular requirements of health care.
Dr. David Brailer, the former National Coordinator for Health Information Technology for the Bush Administration, said recently that the problem of linking patient data in a system wide exchange
is numbingly complex, and simplistic solutions won’t work. In an ideal world, we would not have to create intermediate infrastructure like [the exchange that HACCNY is trying to build] but in an ideal world HIT (health information technology) would already be in use.
Besides computer systems that don’t communicate with one another, there are other obstacles to developing an HIE, including paying for it. In the health care world, the sector that pays for an HIE investment doesn’t necessarily realize the benefits of such investment.

A 2006 a HACCNY study[3] demonstrated that potentially significant savings could be achieved by a Central New York HIE if it is structured to eliminate duplicative and unnecessary tests, reduce medication errors, and increase generic prescriptions. But that same study showed virtually all the savings from an HIE would accrue to insurance companies and the third parties that administer employer self-insured claims, not to doctors and hospitals that would have to pay for it or incur costs in implementing it.

In our health care world incentives are often misaligned, even perverse. If one part of the system benefits, another part is often if penalized, even when the overall impact on society is a positive one.

Of a potential $20 million in annual savings for CNY, 94% would go to the insurance side of health care. Other parts of the health care system – namely hospitals and pharmacies – would have negative savings. In other words, the HIE would actually cost hospitals and pharmacies more, not less. This argues for HIE investment by the sectors that realize the return from it, i.e., by insurance companies, by governments, or both.

To its credit, New York State has the HEAL grant program, under which tens of millions of dollars become available for doctors and hospitals to link together their patient data systems. The state realizes such linkage is in the long term interests of patients, and therefore it is in the public interest to capitalize HIEs with public funds.

HACCNY’s first grant application was turned down by New York State on a technicality. HACCNY did not yet have approval from the IRS for its tax-exempt status. This year the state declined to award funds because, after all the applications were submitted, Governor Spitzer’s administration changed the criteria developed by Governor Pataki’s administration. HACCNY’s second HIE application, along with all the others submitted in state, was turned down.

Next week HACCNY makes its third run at HEAL funds, this time in combination with doctors and hospitals from the Southern Tier. Let’s hope the third time is, as they say, the charm.

But even a successful grant award will not assure the start of an HIE in Onondaga County. There’s another obstacle, the lack of sustainability.

If HACCNY is successful in getting the hardware and software grant needed for an HIE, there is as yet no workable financial plan to assure the new system can pay its operating costs year after year. HACCNY wants to develop a sustainability plan, and it intends to accept state funds only when it has a viable financial model in place.

Stay tuned.

[1] Community General Hospital, Crouse Hospital, St. Joseph’s Hospital Health Center, and University Hospital of SUNY Upstate Medical University.

[2] I am the secretary of HACCNY, which is composed of health care, business, and insurance representatives. HACCNY was developed by the efforts of the MDA (Metropolitan Development Association), MACNY (Manufacturer’s Association of CNY), Greater Syracuse Chamber of Commerce, the Hospital Executive Council (HEC), the Onondaga County Medical Society, and Excellus BlueCross BlueShield.

[3] The study, funded by HACCNY and Excellus of CNY, was conducted by Health Alliant.

Friday, November 16, 2007

Women's health symposium

My thanks to Lisa Bane and Michelle Berkey of the Wound Care Center at Community General Hospital for their coordination of (and participation in) the CNY Women’s Health Fair & Symposium, held last Saturday at Onondaga Community College.

The event was organized by Congressman Jim Walsh (NY-25) and featured an address by Dr. Julie Gerberding, Director of the Centers for Disease Control and Prevention. Dr. Gerberding gave us a high level view of the CDC. She also shared with us a scary story of her recent trip to Africa when she donned protective gear and entered a cave with CDC scientists. The CDC was seeking the source of Marburg virus, after several cases were identified in the area's population. Wow! That story was right out of Hot Zone by Richard Preston!

That’s Lisa Bane in the photo with Congressman Walsh, above, from last Saturday.

And that's the Congressman and Mrs. Walsh in the photo at left, as they help to cut the ribbon in December 2004 to open the Jim and DeDe Walsh Family Birth Center at CGH.

The center was made possible, in part, because of a $1 million federal grant secured by the Congressman. In appreciation for the grant, CGH named the center in honor of the Walsh family.

Friday, November 9, 2007

A positive side to Berger compliance

The Post-Standard today reports the closure of our sixth floor long term care unit on its website. Expect the news report to appear in tomorrow's paper.

Because this is a moment of change (and sadness), it's important to remind ourselves of the collaborative progress Community General Hospital has made with Onondaga County in complying with the terms of the Berger Commission.
1. The ownership of Van Duyn Home & Hospital will not change. That meets the County’s core requirement.

2. CGH and the County are in the process of forming a new corporation to coordinate campus development and plan clinical care capacity between the two organizations. CGH will have four members on the board of this company, and the County will have three members – this is consistent with the intention of the Berger Commission.

3. Another positive is the availability of some $12.8 million in state funds to help Van Duyn make improvements on its resident care units, to fund planning for the new corporation, and to retrofit CGH’s sixth floor for acute care patients. The sixth floor will be redesigned and reconstructed with advanced patient safety features and amenities for hospital patients.

Monday, November 5, 2007

When our sixth floor will close

This afternoon hospital managers met with residents (and then with staff) of the sixth floor, 50-bed skilled nursing unit at Community General Hospital. A representative of the Department of Health was present. They announced what everyone wanted to know (and dreaded to hear) – a closure date for the sixth floor.

CGH’s skilled nursing floor will close on January 15, 2008, conforming to the requirement of the Berger Commission.

On September 28, New York State announced its decision to allocate grant funds to close CGH’s sixth floor. It was part of an overall agreement negotiated by Community General Hospital and Onondaga County to comply with the Commission’s requirement for affiliation and downsizing. Understandably, the decision to fund the closing created uncertainty among residents and staff. It made the closure suddenly real.

As a result, some residents and some staff members began to make decisions about leaving the sixth floor, not wanting to wait for the planning process to unfold. Sixth floor occupancy has declined from a census of 48 (September 28) to 41 (today)…and this trend will continue.

As staff departs, more temporary personnel will be required, increasing variability and potentially affecting quality. As residents transfer, a lower census generates financial losses. Neither trend is tenable for an extended period of time. For these reasons, after management consulted with the State Department of Health, I made the decision to announce a specific closing date. This ends the period of uncertainty, it avoids a more protracted period of declining occupancy, and it allows residents and staff to start making their plans.

Consistent with state regulations, there will be a 30-day closing period, starting December 15. We announced this today so residents and staff have advance notice to start planning for the transition period.

Is the holiday season a good time to do this? No.

A compliance plan was required by the state by the end of September (thus, its funding announcement of September 28). It also requires an executed agreement between CGH and the County by December 31. Such time frames and the associated announcements affected both residents and staff, making the holiday impact inevitable.

Last Friday I wrote about the Thanksgiving quilt, a patchwork of thoughts, reflections, and aspirations being generated by members of the CGH family for display during Thanksgiving week. I share with you one of the thoughts just submitted:
I am thankful for the capable and compassionate staff who have taken care of my [parent] on the sixth floor….We will miss them when we are forced to move [my parent]. (Original emphasis.)
I sincerely regret the disruption, the upset, and the sadness occasioned by the closure of our skilled nursing unit.

Sunday, November 4, 2007

Life in the blogosphere

Last June 30, I converted the weekly CGH family letter into the More than Medicine blog. [1] For a number of months the content of the family letters continued to reflect the content of the blog, but gradually the blog postings have begun to diverge from the letters.

The blog now includes items that do not make it into my letters. These may be some quick thoughts, they may be references to contemporary events (such as the legal prosecution of health care people following Hurricane Katrina), or they may be comments on news articles (such as the Berger Commission or hospital infection risk) or references to other blogs that comment on More than Medicine.

A comparison of the last week’s activity – letter versus blog – shows I wrote two letters (one on flu, the other on the blogosphere) compared with eight postings on this blog (ranging from "medical arrogance" or "all fish swim in the same water").

The content of the blog and the letters are related – but they are hardly identical. This is interesting, and it is not what I expected. I expected the blog to be little more than an electronic version of the letter. As it turns out, the nature of blogging encourages shorter, more frequent, and more topical entries.

Blogging also invites more interaction. I’ve had 19 comments on blog postings since June – hardly an overwhelming number, but more frequent feedback than I had with the letters alone. And not all comments are from CGH employees. Some are from readers, known and unknown, in the blogosphere.

Unlike the family letter, anyone can subscribe to the blog. The blog also allows me to track the number of times people look at it each week. After Paul Levy, the hospital CEO who authors Running a Hospital, linked a past entry from More than Medicine to his blog last Tuesday, I had 128 “hits,” a new high for me.

Another blog advantage: each posting is accompanied by “key words” so you (and I) can look up every time I’ve discussed a topic, such as “Berger Commission” or “mortality rates.”

I am, of course, continuing my weekly letters at Community General Hospital, as I have since writing the first one on October 19, 2002 (about three weeks after the Board of Directors asked me to serve as CEO). But the letters are not the same as the more frequent, more interactive communications through the blog.

When I started blogging, I thought I was merely expanding the letter content with an new means of electronic distribution – what I actually did was to learn an entirely different communications tool.

Don’t hesitate to write and tell me what you think!

[1] You will notice a number of blog postings with dates earlier than June 30, 2007. That is because, as I have occasion to refer to past family letters, I covert them to blog postings with their original dates. This process gradually populates More than Medicine with the content of past letters and allows me to link similar topics.

Friday, November 2, 2007

The Thanksgiving quilt

A year ago I wrote about “the Thanksgiving quilt” that was compiled by Peter McGinn[1], who was the CEO of United Health Services (UHS) in Binghamton. It was patchwork of thoughts, reflections, and aspirations reflecting the spirit of the UHS workforce.

With thanks to Peter and his colleagues at UHS, we at CGH borrowed his quilt idea this year. Yesterday posters went up, showing how the Thanksgiving quilt will look and offering instructions on how to participate. The Thanksgiving quilt is also displayed on all CGH computer splash screens.

Through November 12, members of the CGH family may drop handwritten messages into boxes that are located next to the poster displays[2]. Or simply send a brief e-mail message to

Feel free to share thoughts about family, friends, and work. Share something that makes you smile, warms your heart, or helps you meet the challenges of life.

Your messages will fill the squares of CGH’s Thanksgiving quilt during Thanksgiving week.

[1] Matt Salanger is the current President and CEO of UHS.

After his retirement from UHS last year, Peter McGinn, PhD, founded Leadership Impact “to help leaders and organizations excel by bringing out the best in people and aligning their talents with the goals of the organization.”

[2] In CGH's main lobby, in the Diagnostic Center and outside the cafeteria.

Wednesday, October 31, 2007

If you read nothing else...

Today’s Post-Standard reports that more than 200 Central New Yorkers probably died as a result of hospital acquired infections in 2004. The number comes from Excellus BlueCross BlueSheild, which made the estimate “based on data from the federal Centers for Disease Control and Prevention and other sources.”

I have previously posted comments about hospitals and infections, including Community General Hospital’s own infection rates and recent efforts to improve hand hygiene compliance. See: All fish swim in the same water, Weird glowing substances, A tale of two cities.

If you read nothing else, A tipping point deserves your attention. It contains the obituary of a Canadian gentleman who died as the result of a hospital-acquired infection. Please read it all the way through.

All fish swim in the same water

Before I began the blog, I wrote weekly messages as short letters to the employees, physicians, volunteers, and auxilians of Community General Hospital – to all the members of the CGH family. Hand washing, infection control, and standard precautions have been consistent themes. Here are excepts of past letters that have not been posted as blog entries.

From “All fish swim in the same water,” March 5, 2005
“If you saw a co-worker or someone from another department fail to wash hands, what do you do? Be embarrassed for them? Bite your tongue and say nothing? I suggest that you say something, such as: ‘Excuse me, did you forget to wash your hands? You must have a lot on your mind – just trying to help.’

“The fact is, hand washing is often done privately. Most of the time there is no one to remind us, just a sign (on the wall)…and that little voice in our heads that tells us to do the right thing. All of us who work in health care share the responsibility for keeping our patients and our co-workers safe. That responsibility starts with hand washing….

“In the aquarium all fish swim in the same water. In our world, we breathe the same air and touch the same surfaces. We touch our patients. Hand washing is not something to take for granted.”

From “Why the obsession about hand washing?,” March 19, 2005
“Nationally, statistics show hospital personnel comply with hand washing requirements only 54% of the time. That is shocking. At CGH our compliance last year averaged 90%. That is almost twice the national rate, but it is not good enough. Even a single instance of noncompliance could put an employee or a patient at risk of infection.”

From “A culture of safety,” July 3, 2005
“Last month the State Legislature passed a bill that will require hospitals to report publicly infection rates for surgical wound infections and for bloodstream infections related to central lines in ICU patients…..

“This particular bill received a lot of attention statewide and across the nation, thanks to publicity generated by the Committee to Reduce Infection Deaths (‘RID’), a non-profit organization that has worked to require the public reporting of hospital infection rates. I wrote to RID earlier this year in support of its efforts…”

From “Not Halloween masks,” October 29, 2005
“As you can see, [hand hygiene] compliance in October is 95%. That sounds great, but consider this as you look around the cafeteria. Of the 99 other people there, who are the five who, on average, fail to wash their hands? When it comes to infection control, we cannot be satisfied with 95% – 100% has to be the goal.”

That's Mitchell Brodey, MD, Hospital Epidemiologist, in the photo, above. Actually, it's a photo of the life-size cutout of Dr. Brodey that makes its way around the hospital to remind everyone at CGH about the importance of hand washing. Dr. Brodey's doppelganger has been "on duty" since September, a companion to the life-size cutout of Sue Chamberlain, RN, CGH's Infection Control Program Director, who has "patrolling" the halls and departments since July.

Compelling hospital stories

Please check out Running a Hospital, the notable blog from Paul Levy, President & CEO of Beth Israel Deaconess Medical Center in Boston. Paul is the pioneer of hospital CEO bloggers, notable for the insights, the candor, and the sheer abundance of his entries.

Yesterday he hosted a "Grand Rounds" posting that linked commentaries on experiences at hospitals that changed someone’s behavior or beliefs. Many compelling stories there.

Sunday, October 28, 2007

Diamonds & Denim

Last Friday evening the Community General Foundation held its annual, informal gala at the OnCenter in Syracuse with the theme “Diamonds & Denim.” The nearly 600 in attendance contributed some $189,000 to the fundraiser.

In his opening remarks Gala Committee Co-chair Mark Re, Vice President & General Manager of Gallinger RealtyUSA, said:
The “denim” is a symbol of people who roll up their sleeves and work to make a difference. The “diamonds” symbolize people who sparkle with accomplishment.
Honors were awarded for special accomplishments to the medical profession, to the community, and to Community General Hospital. The photo shows, from left, Mark Re, Dr. Drew Merritt (one of those honored ), and me.

The proceeds from Diamonds & Denim will help CGH upgrade its medical technology, including:

▪ New high-definition video equipment to improve the ability of surgeons to peer inside the body as they operate with miniature surgical tools that reduce injury and speed patient recovery;

▪ An upgraded, multi-slice CT (computerized tomography) scanner that brings faster and new imaging tests to our patients; and

▪ A state-of-the-art computerized physician order entry (CPOE) system using patient safety features available at only about ten percent of the nation’s hospitals.

The multislice CT is already in use. The high-definition video will be in place before year-end, and physicians will begin to use the new CPOE system in 2008.

We do not take for granted the support of donors to the Foundation. Thank you for your support, which directly benefits the patients of Community General Hospital.

My special thanks to Steve Johnson, Chair of the Foundation; to Gala Committee Co-chairs, Mark Re and Kim Dynka; to the Auxiliary for organizing the charity auction – and to all the volunteers who made it a fun night!

Medical arrogance

My thanks to Dr. Paul Kronenberg, President and CEO of Crouse Hospital, for his op-ed piece on “medical arrogance” in today’s Post-Standard. Dr. Kronenberg writes:
Hospitals are run by people, and people make mistakes. We don't always listen as well as we should. And yes, we sometimes fail to live up to the expectations of our patients and their family members.

Effective communications between caregivers and patients (and among the caregivers themselves) are not just a matter of politeness. Poor communications raise the risk that something is misunderstood, that something is missed – this can foster medical errors.

Dr. Kronenberg is right to emphasize the importance of caregiver communications. For more on this, see these past postings – Stop me if I say something you don’t understand, The importance of listening, and Whatever became of bedside manner?

Saturday, October 27, 2007

The flu, "a patient safety issue"

A few days ago Dr. Richard Daines, the New York State Commissioner of Health, sent a “Dear Colleague” letter to health care providers across the state.

In it he emphasized the importance of flu shots for health care workers, saying it is "a patient safety issue":
Unvaccinated HCP (health care personnel) have been implicated in the spread of influenza and outbreaks in every type of health care setting. In fact, the failure to adequately immunize HCP is a patient safety issue in all health care facilities, including home care and ambulatory care settings. Low vaccination rates among HCP are associated with an increased number of outbreaks, poor patient outcomes, and increased employee absenteeism. Despite this, HCP vaccination rates remain low.
I recently wrote about the flu vaccination clinic for employees.

In addition to the clinic, Sue Chamberlain, Infection Control Program Director, will bring the vaccination cart to work sites throughout CGH during the week of November 4 – this will make it even easier for employees to receive the vaccine.

CGH will also hold a flu clinic for employees’ family members on Saturday, November 17. This exercise will help test out hospital’s organization for the prompt dispensing of shots, as may be needed in an emergency situation.

There are many reasons to get the flu vaccine: to protect ourselves, to protect our families, and to protect our patients.

Friday, October 26, 2007

That flu bug

A couple years ago Sue Chamberlain, CGH’s Infection Control Program Director, accompanied by a cart full of supplies, appeared at my office door.

“Did you get your flu shot?” she asked, knowing the answer. Then she admonished me: “You have to set an example.” So I signed the consent, rolled up my sleeve, and had the shot.

I have been, uh, setting an example ever since.

This fall Sue is again leading the charge to inoculate the maximum number of hospital staff, and this time she’s enlisted the help of Dan Cameron, graphic designer.

Dan created his own version of the flu bug, as displayed on posters around the hospital and on computer splash screens. He's even included that flu bug in the hospital’s logo. Gone is the disc fir trees, symbolic of our beautiful campus. That disc in the logo has been replaced by a flu bug in surrender!

The next time flu shots will be offered for CGH employees: 6:30 - 10:00 a.m., November 2, in the Employee Health Office.

Saturday, October 20, 2007

More on the doctor shortage

I recently wrote about the growing shortage of physicians.

Dr. David Duggan of SUNY Upstate Medical University has brought to my attention documentation about the physician workforce shortage at the website of the Association of American Medical Colleges (AAMC). From the website:
Given the extended time required to increase U.S. medical school capacity, and to educate and train physicians, the nation must begin now to increase medical school and GME [Graduate Medical Education] capacity to meet the needs of the nation in 2015 and beyond.
The AAMC website includes Recent Studies and Reports on Physician Shortages in the U.S., a 10-page paper that identifies studies across the nation that document the physician shortage – from Arizona (“Still far below the national average”) to Wisconsin (“Who will care for our patients?”).

Monday, October 15, 2007

Worthy honorees

In about two weeks the Community General Foundation will honor a number of people for service to Central New York: Dr. Drew Merritt, the Auxiliary to Community General Hospital, and Local #43 of the IBEW.

The honors will be given at the Foundation’s annual gala, October 26, at the OnCenter in Syracuse. The gala’s theme is “Diamonds and Denim,” which seems to have left many people wondering just exactly what to wear. Blue jeans are OK, and I’ve heard people will wear “washed black denim” too. Western gear is fine – as, of course, are diamonds or otherwise sparkly things. The bottom line: attendance at the gala does not require formal attire.

In fact, informality is a hallmark of the annual gala. And that means the evening’s presentations are mercifully short too. The emphasis is on raising money for a good cause by dining, dancing, and enjoying the company of friends. Tickets are still available. Just call 492- 5079.

For service to profession, Dr. Merritt
Dr. Merritt, pictured below, will be honored for his service to the medical profession. He is a past president of the Community General Hospital Medical Staff who recently served as interim Vice President of Medical Affairs and Chief Medical Officer.

Dr. Merritt is Vice-Chair of the Department of Family Practice, a member and past president of the New York State Chapter of the American Academy of Family Physicians (AAFP), a member and past president of the Onondaga County Medical Society, and a member of the Medical Society of the State of New York (MSSNY), where he serves as chair of MSSNY Committee on Health Care, is an alternate delegate to national AAFP, and serves on the AAFP Commission on Practice Enhancement.

Beyond his roles in medicine, Dr. Merritt has served the community as a member of several organizations affiliated with the Town of Marcellus and as a coach for youth sports. He and his wife, Carol (who is also being honored), have three daughters - all of whom were born at Community General Hospital.

For service to hospital, the Auxiliary
The Auxiliary will be honored for 45 years of service to CGH. An important part of the hospital, the Auxiliary helps raise funds and provides community services. Since inception, the Auxiliary has donated over $2 million to the hospital, designating funds to such items as renovations to the Surgery Center, the Jim and DeDe Walsh Family Birth Center, and medical equipment in various patient care services.

The Auxiliary provides blood pressure screenings throughout the community and advocates for health care issues in Albany.

The group photo shows members of the Auxiliary’s Executive Committee, from left: Ted Topalian; Mary Lascaris; Carol Merritt, outgoing President; Kay Cudworth; Dottie DeSimone, incoming President; and Claire Wightman. Not shown are committee members Bernie Schmidt and Donald White. CGH is a very family-oriented place, and isn’t it fitting that both Drew and Carol Merritt will be honored on the same evening?

For service to community, IBEW Local #43
Being honored for service to community is the International Brotherhood of Electrical Workers, IBEW Local #43. Chartered in 1896, the union represents some 1,200 members, including quality electricians in Central New York. In the photo are Don Morgan, Local #43’s President, and Bill Towsley, its Business Manger.
The local chapter contributes to the Community General Foundation’s capital campaign that provides funds for capital projects such as the physical medicine & rehabilitation unit, the Jim & DeDe Family Birth Center, and the cardiac catheterization lab. Local #43 also supports the Foundation’s annual pro-am golf tournament as “presenting sponsor” for the past five years. Beyond its support of CGH, Local #43 assists numerous charitable causes throughout Central New York, with members regularly taking part in local fund raisers and volunteer work.

These are good people who have accomplished much for good causes. Please join me in saluting these worthy honorees.

Saturday, October 13, 2007

An image of beauty and peace

Tom Watson is a photographer from Skaneateles, NY, who uses satellite image technology to take beautiful, sweeping panoramic photographs. A few months ago, he spent time in Community General Hospital when a loved one was hospitalized here, and he noticed a poster of an Ansel Adams photograph on Four North, across from room 456.

As Mr. Watson explained to me:

My wife, Sue, and I spent the afternoon at the beginning of my career with Ansel Adams and his wife, Virginia. His work has inspired me, his books have taught me and if he were alive today, I believe he would be working in the same (digital) technology that I do now.

Mr. Watson has donated one of his own digital photographs to the Four North waiting area, across from the public elevators. “I hope that it will also bring comfort to others attending their loved ones at CGH,” he said.

On my rounds this morning, I visited Four North and studied Mr. Watson’s five-by-two-foot print of Hesperis Matronalis,[1] shown above. When the illumination is complete and a plaque in place, we will have a small ceremony to acknowledge Mr. Watson’s generosity.

I am no expert on photography, but I know that Ansel Adams was remarkable as an artist, not just for his eye, which captured the grandeur of nature, but for his technique, which combined in a single photograph richly evocative shadows and brilliant highlights.

“We have digital image tools that Mr. Adams never imagined, but would wholeheartedly embrace. He was an artist and a technician,” explains Tom Watson in IATH Best Practices Guide to Digital Panoramic Photography[2]

Mr. Watson uses those digital tools to create his own detail-rich photos that capture the dynamics of light, dark, and color. When you are on Four North, take a moment to study the texture of the tree bark in Mr. Watson’s photograph. Then examine the colors of the lilacs, the sunlight on the tree leaves, and the shadows of the woods.

A smaller, signed print of Hesperis Matronalis is being offered as a premium gift to all who make donations of $250 or more in this fall’s Circle of Friends campaign, being conducted by the Community General Foundation. Other examples of Mr. Watson’s high-definition digital images may be seen in articles about him in Wired and AIArchitect.

Thank you, Tom Watson, for the gift of your art, which brings to our clinical world an image of beauty and peace.

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[1] Tom Watson explains: “This photograph, Hesperis Matronalis, represents 4 trips and 8 hours standing behind the camera waiting for the optimum conditions. I produced at least 20 different image files to then narrow my selection to this one image. This continuous panorama (no stitching) could only be produced with a view camera and a scanning, 144 mega pixel digital back.”

[2] In IATH Best Practices Guide to Digital Panoramic Photography, see section 2.5 and find the text written by Tom Watson. Go to Figure 6, a panoramic view of the Academical Village at the University of Virginia. By repeatedly clicking on the image, you zoom in to discover the many people present, each one very much an individual.