Wednesday, December 31, 2008

Bill's place at Community

Bill Hopkins retired yesterday after nearly 28 years at Community General Hospital. You may not know him, but if you work at Community, you will likely recognize Bill as a mainstay of the Food Service Department. That's him, at right, in a photo taken with me yesterday in the hospital cafeteria.

Bill lives at Nob Hill apartments, and he has walked the 2.5 miles between Nob Hill and Community Hospital, going to work and returning from work every day -- including yesterday, his last day on the job.

Bill would begin his hike about 5 a.m., walking down Seneca Turnpike to the Valley, then up the long grade to Onondaga Hill. He did this in fair weather and foul, and he did it without interruption until "Monday, December 4, 2006."

That was when Bill was struck by a car shortly after he began the walk. He had a leg fracture, among other injuries. Until that day, Bill had never missed a day at the hospital.

Bill had surgery on "Thursday, December 7, 2006," and he spent time convalescing in Mercy Rehabilitation Center, Auburn, NY, where he was admitted on "Tuesday, December 12, 2006." When he left Mercy on "Wednesday, March 14, 2007," Bill continued to rehab at Community’s outpatient physical therapy service on Velasko Road until "Monday, April 23, 2007."

On "Tuesday, April 24, 2007," Bill learned his leg was again broken. He underwent a second surgery on "May 18, 2007."

Bill Hopkins eventually returned to work on a part-time basis on “Tuesday, November 20, 2007.” He resumed full-time work exactly one year ago, on “Tuesday, January 1, 2008.”

I have used quotation marks for all the dates to respect the precision of Bill’s memory. He is gifted at remembering numbers and dates and the facts associated with them.

Years ago Bill asked me when I began working at Community. When I told him November 5, 1973, he promptly informed me that was a Monday, that there was intermittent rain that day, and that Watergate and Vietnam were in the news.

I asked Bill to what he attributes his talent with numbers and facts. “It’s a gift from God,” Bill said. “I had nothing to do with it.”

Nearing retirement, Bill recently told me he was reluctant to stop working although he conceded, “It’s time.”

When he was on medical leave in 2007, Bill was concerned that that his otherwise perfect record of attendance had somehow been marred. He often asked Pauline Warboy, his manager, and me if there would always be a place for him at the hospital.

The answer is: "Yes, Bill, there is always a place for you at Community."

Tuesday, December 30, 2008

In praise of community hospitals

Sunday's article ("Are the elite academic hospitals always a patient's best choice?") quoted Dr. Donald Berwick, President and CEO of the Institute for Healthcare Improvement, in the Boston Globe. Dr. Berwick's perspective is interesting but not necessarily surprising.

Some thirty years ago, Dr. Robert Westlake, Sr., who was then the Vice President - Medical Services (predecessor of today's Chief Medical Officer) at Community General Hospital, used to say that academic medical centers were better than community hospitals "if you happen to be an interesting case."

Dr. Westlake (shown in a photo from 1979) passed away in 2003. During his career, he was a proponent of primary care by internists (he was one) and family practitioners. He called primary care doctors "the captains of the ship," and he argued that the primary care physician knows the patient best (clinically, as well as within a family and social system context) and is best equipped to refer and supervise ("to captain") medical and surgical subspecialists who become involved episodically in a patient's care.

He also maintained that a routine case ("uninteresting" to academics) could languish in an academic hospital where it was more likely to receive cursory or disinterested attention from a resident staff (doctors-in-training).

We've seen many changes in health care since Dr. Westlake's day. The technology and medical expertise has improved in both academic and community settings. Services and technology that were esoteric ten or twenty years ago are now routine at community hospitals. And expertise that was once limited to the hospital setting has moved to outpatient settings.

There is, of course, a touch of ego and turf-protection in broad pronouncements about academic and community hospitals. Is an academic medical center always preferable to a community hospital? Is a "brand name" residency program always preferable to residency at a state university hospital?

My own informed self-interest tends to agree with Dr. Berwick -- and with Dr. Westlake. The community hospital serves an important role.

Thursday, December 25, 2008

Appreciation at holiday time

This morning, as I approached the entrance near the cafeteria with Bill Hopkins of the Food Service Department, a doctor who was also just arriving turned to Bill and me and said, "Thank you for what you do for this hospital."

As we celebrate the holidays and prepare for the new year, I'd like to thank all who help care for patients at Community General Hospital.

First, I thank hospital employees who work each day and night, including holidays, to care for patients and to assure that patients have the supplies, the facilities, the medications, and the organizational support they need.

I appreciate our medical staff, the physicians who entrust to us the care of their patients.

I thank our volunteers who support this hospital with the gift of their time. I thank also the Auxilians who represent our hospital within the community and who raise funds to help our work.

Sincere appreciation goes to those who donate funds through the Community General Foundation.

I appreciate too the alumnae of the Community General School of Nursing and their ongoing good thoughts and wishes for our hospital.

I thank our Board of Directors, the representatives of our community who serve without pay and accept responsibility for our hospital through many hours of study and service.

Finally, I thank the families who allow us to care for those they love. There is no greater responsibility, and no greater compliment, than caring for another's loved one in time of need.

Happy holidays, and happy new year!

Wednesday, December 24, 2008

Unholy night

It’s December 24, and I recall the memoir of Dr. Jack Prior about Christmas Eve, 1944.

As Captain in the Medical Battalion of the US Army’s 10th Armored Division, Dr. Prior set up a battlefield hospital in Bastogne, Belgium. The building was destroyed in a bombing raid on December 24 with many killed or injured. Dr. Prior himself escaped only by an accident of timing.

As I’ve discussed elsewhere, I worked with Jack Prior for many years when he was Chairman of Pathology and a member of the Board at Community General Hospital in Syracuse, NY. We remained friends until his death, at the age of 90, on November 23 last year.

One of the most popular postings on this blog is Dr. Prior's compelling story, “The Night Before Christmas – Bastogne, 1944.”

Christmas Eve is a holy and festive time for many. Today I honor the memory of Dr. Prior for his brave service in the US military during a very unholy time 64 years ago.

Sunday, December 21, 2008

The big bucks

This morning’s Post-Standard includes my salary in its report "How CNY hospitals pay CEOs big bucks."

This is not the first time I’ve seen my pay reported in the local newspaper. About 15 years ago a story included my pay, and I remember feeling quite embarrassed by it at the time – especially in light of some comments that friends and co-workers felt obliged to make.

I am well paid for the work I do. I appreciate the confidence that has been shown in me by the Board of Directors, and I appreciate what the Board pays me.

The chart, below, shows how my pay last year compared with that of the CEOs at other Syracuse hospitals, according to today's newspaper.
CEO pay is public information for not-for-profit organizations such as hospitals. Each non-for-profit hospital is required to file an annual form with the IRS that documents its finances and includes the highest payments it makes to employees, officers, and vendors. Anyone can get a copy of IRS Form 990 by asking the organization for it or by consulting a service such as Guidestar.

About a year ago, Paul Levy, CEO of Beth Israel Deaconess Medical Center, reported on his blog about his own $1 million annual pay, commenting:
Americans are often ambivalent about high salaries for corporate executives: They often complain about them, but, at the same, time, everybody hopes that he or she can someday earn them!

Saturday, December 20, 2008

Patient and robot meet Carrie Lazarus

Dr. Myron Luthringer and patient Kelly Wheeler joined Carrie Lazarus on WSYR TV's "Bridge Street" Thursday to discuss Ms. Wheeler's robot-assisted surgery a week earlier.

Also appearing in the TV studio was the daVinci S Surgical robot itself. Carrie got to "test drive" the $1.65 million advanced technology under Dr. Luthringer's guidance.

Here's a link to the WSYR video.

Dr. Luthringer practices obstetrics and gynecology with Dr. Jennifer Marziale and certified nurse midwife Janice Beaman. Their offices are in Syracuse and Auburn, NY.

Cool Tools

David Rothman, who manages the medical library at Community General Hospital, also runs a highly popular blog about medical information. He informs and advises health care professionals about the sources and uses of medical information...and he does so in a cool way.

Now, with co-authors Melissa Rethlefsen and Daniel Mojon, David has written Internet Cool Tools for Physicians. The book is helpful, not just for physicians, but for anyone. It makes available the useful advice David provides daily as he helps us get the most out of the Internet.

David first encouraged, then helped, me to set up this blog about 18 months ago. The popularity of his own blog, Exploring Medical Librarianship and Web Geekery, far exceeds my own. As a result, he has been invited to speak at professional colloquia across the country. Click here for some of the praises David's blog has received from the medical information community.

David tells me "Cool Tools..." is now available in Europe and coming soon to the US. You may order it on line at Amazon or directly from Springer, one of the world’s largest publishers of journals in science, technology, and medicine.

Congratulations, David, to you and your fellow authors.

Thursday, December 11, 2008

Yesterday's 'round-the-clock meetings

Yesterday I held a series of employee meetings, starting at 7:00 a.m. and ending at 11:30 p.m. This was an opportunity to talk about current hospital issues and to hear what’s on the minds of employees. I thank all who were able to get away from their work stations for at least a few minutes to participate.

For those who could not attend, I offer this recap of the discussion.

I talked about the difficulties of 2008, the increasing numbers of uninsured and charity care patients, plus the changes this year in the OB medical staff. Obstetrician recruitment is a priority for us.

Last January, the sixth floor skilled nursing facility was closed as a result of the decisions of the Berger Commission. To comply with the Commission, Community formed a planning company for the campus we share with the Van Duyn Home and Hospital. Our planning company is called the Community Health Information and Planning Services, or CHIPS.

In September 2006, the state promised a $12.8 million grant to help Community and Van Duyn comply with the Commission. The grant contract has yet to be completed in Albany, although we are hopeful that final signatures will be forthcoming before year end. Completion of the grant contract will set the stage for the $7.6 million renovation of our sixth floor, starting in 2009. We will create a new, 40-bed acute care unit on that floor, with mostly private rooms. The Certificate of Need (CON) application for the sixth floor renovation was filed with the Department of Health this fall.

2008 was a year characterized by protracted labor negations. The collective bargaining agreement expired on April 30, but its renewal was not concluded until June 26, when the tentative agreement was reached. The contract was subsequently ratified by employees on July 2.

The summer was filled with the Legionella issue, as Community worked with County and State officials to address the risk factors immediately. This was successful, and our hospital continued to operate fully and safely throughout the summer weeks.

As a result of the above, 2008 has been a financially challenging year for Community. Nonetheless, we've made progress in many areas.

With the new daVinci S Surgical System, Community began robot-assisted surgeries in urology and gynecology during August. The start-up of robot surgery here was described as “astounding” by Po Lam, MD, Medical Director of Robotics, in a recent address to the Medical Staff. “It is pretty astounding," he said, "to establish a completely new robotic program without the glitches and the pitfalls typical of a start-up.” We have had a significant number of robot-assisted surgeries already, characterized by minimal blood loss, short stays, and good outcomes.

This year Community added a new pharmacy robot (photo, at left) in the completely renovated Pharmacy. After the Pharmacy open house, I asked what happened to the old pharmacy robot, and the answer surprised me. The manufacturer asked to keep some of the original parts for a museum display in its home office. A decade ago, Community’s robot was the first at a community hospital, and that old machine, it turns out, is of historical interest.

This summer Computerized Physician Order Entry (CPOE), a project in the planning for some time, went “live” on the first patient care unit, Four North (orthopedics). About ten percent of the nations’ hospitals have CPOE, which increases patient safety.

Community introduced digital mammography this year, replacing the old film equipment. Also, Medical Imaging converted to PACS (Picture Archival Communications System) for better storage and comparison of diagnostic images and for instant image availability to physicians over the Internet.

We introduced a new quality report card for our Board of Directors and made strides in improving patient satisfaction (especially in the Emergency Department). A national hospital rating company reaffirmed our preeminence in overall orthopedics, as well as spine and neck surgery, hip and joint replacement surgery. In addition, for the first time, we received the highest rating in maternity services from a national hospital rating firm. I encourage you to research Community General Hospital’s ratings by conducting your own Google search, and enter key words Hospital Ratings.
Also discussed were updates to the hospital’s strategic plan, including both strategic objectives and operational priorities. A key concept in strategic projects is the importance of services that are reimbursed as relatively higher levels in helping to subsidize those community services with lesser reimbursement.

There was a lot of discussion about the difficult economic environment generally. The closure of Syracuse China (in yesterday’s news) was on the minds of many employees. I raised the question of the difficult New York State budget and the impact on hospitals. I spoke about a recent editorial board meeting at the Post-Standard where I, along with other hospital CEOs, discussed the state’s proposed taxation of hospitals and its proposed Medicaid cutbacks. That news story prompted a response last Sunday by State Health Commissioner Richard Daines, MD, and further discussion just yesterday by the Hospital Executive Council.

It’s been a challenging year, 2008. And we face many challenges for 2009. Our attention is focused on the importance of disciplined daily operations, as well as our overall strategy.

Encore Performance at the White House!

Three colleagues from Community General Hospital are part of The Master’s Touch Chorale, which will perform a holiday concert at the White House on December 22.

They are Cherolyn Ottey (Labor and Delivery), Sue Ellen Maxfield (Physical Medicine and Rehabilitation), and Lynne Hickox (Certified Nurse Midwife). This will be the Chorale's third visit to the White House since 2002.

The Chorale has been directed for 16 years by Warren Ottey, who is the organist and choir director at Cazenovia Village Baptist Church.

You can hear the Chorale this Saturday, December 13, at 7:00 pm at St. Mary of the Assumption Church, Minoa, NY.

St. Ann’s acoustics are, according to Sue Ellen, “AWESOME,” and she tells me “everyone is welcome to hear the terrific one and a half hour lineup of contemporary and classic holiday music, including ‘Hallelujah’ from Handel’s Messiah.”

To learn more about the Chorale and its CD, visit it website.

What a great time of the year for a White House encore performance!

Sunday, December 7, 2008

Inspirational Medicine

Last Friday NPR’s “Day to Day” radio program broadcast a segment about low morale and disaffection among primary care doctors.

A lot of doctors said they would prefer to be in another profession. Furthermore, only about five percent of the doctors-in-training are choosing primary care because of the significant medical school debt they have to repay and because they are discouraged by the daily example of unhappy older doctors.

One of the physicians interviewed on the program told how she stopped participating in health insurance plans a few years back. Another doctor who left practice complained about insurance companies that “put profits over patients.”

A third physician lamented the loss of patient contact, as well as the decline in intellectual satisfaction. The physicians said that medical practices are succumbing to the time pressure of seeing many patients with little opportunity for attention to individual situations.

I've written before about the coming shortage in primary care physicians.

Training these physicians is a source of satisfaction and pride. Each quarter a new group of family practice residents rotates through the internal medicine service at Community General Hospital. These second-year residents are from the training program St. Joseph’s Hospital Health Center, and they provide a real service to patients as they learn from Community’s attending physicians.

Last week one of the residents was honored as a local hero by the American Red Cross. One morning in August Dr. Michael Loeb (photo) came across a bad accident at the New York State Fairgrounds on his way home after night duty at Community General Hospital. The exhausted resident did not hesitate to stop his car and help the injured family.

Dr. Loeb described the situation for a local television station:
"…[T]he day of the crash was the day after one of the most brutal calls I’d ever had,” he said. “It had just been a crazy night…My first reaction was ‘I need to get over there [to the accident site],’…and my second was ‘This isn’t going to be pretty.’”
Dr. Loeb got out of his car and crossed the lanes of traffic to provide assistance. The following morning, I saw Dr. Loeb in the emergency department when one of the attending physicians told me what he had done. I thanked him and said his example was inspirational.

Dr. Loeb reminds us why people choose medical careers, despite the demands, distortions, and pressures of the medical marketplace. People choose medicine because they care about patients, and they want the knowledge and training to be of help.

Thursday, November 27, 2008

Community's Thanksgiving Quilt

This week Community General’s Thanksgiving Quilt shows the appreciation felt by members of the hospital family.

The words on the quilt are simple and direct. They express a personal sense of gratitude for one’s family and specific family members; for one’s co-workers and one’s friends; for life and health and recovery; for work and for the ability to help others.

The Thanksgiving Quilt is in poster-size display cases at Community’s main entrance (across from the first floor information desk) and outside the cafeteria (basement floor). It is also on the splash screen of the hospital's intranet.

Click on the two quilts shown here for easy readability.

I appreciate all who submitted their thoughts to the Thanksgiving Quilt project. My own Thanksgiving thoughts are posted below.

Happy Thanksgiving!

I am thankful for:

• All who make our patients feel welcome, safe, and respected.

• All who who pay attention to the details of their work, who wash their hands consistently, and who follow the “red rules” of patient safety to assure safe practices.

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

• All who celebrate birthdays, take up collections, offer congratulations at coworkers' weddings and graduations, and who 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 have a ready smile, who are courteous, and who our patients first.

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

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

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

• All the physicians who rely on us for the care of their patients.

• All who see another's awkwardness or worry or pain and who make an effort to help.

• All our Board members and advisers who offer their time, their expertise, and their funds to make Community General a better place.

Wednesday, November 26, 2008

Good Manners & Good Medicine

Congratulations to Dr. Myron Luthringer, the latest recipient of the STAR award, presented to members of the Community General Hospital medical staff who demonstrate sensitivity, thoughtfulness, appreciation, and respect (“STAR”).

I have written before about our STAR doctors and how good medicine includes good manners:

Being kind and respectful is not merely good citizenship. These are the attributes of individuals who build positive relationships with other members of the caring team. This can aid communications at all levels. Better communications help reduce risks for patients – and reduced risks mean better patient safety.
According to his nomination, Dr. Luthringer of Advanced OB-GYN “always takes the extra step to make sure that his patients are comforted in the OR. He does this by staying in the room by the patient’s side with his hand resting on theirs until they are under anesthesia. He is also…willing to pitch in & help the OR staff & treats everyone in the OR with respect.”

That’s Dr. Luthringer in the photo above (at right) with Dr. Fred Goldberg, Vice President & Chief Medical Officer at Community General Hospital. For more about Dr. Luthringer, see the video in which he speaks about his experience with the daVinci surgical robot.

Dr. Luthringer joins other recent STAR doctors: Dr. Richard Zogby, a spine surgeon with Syracuse Orthopedic Specialists (below, left), and Dr. David Simon, an internist with FamilyCare Medical Group, PC (below, right with Dr. Goldberg).

An earlier posting discussed STAR doctors Joseph T. Barry, MD, an internist and geriatrician with Preservative Medicine Associates, PLLC; Daniel Dombroski, MD, a general surgeon, who practices in Physicians Office Building – North; and James Watts, MD, a pulmonologist with FamilyCare Medical Group, PC.

If you would like to recognize a STAR doctor at Community General Hospital, nomination forms are available in the Medical Affairs office (first floor, west wing) and on Community’s intranet.

Sunday, November 23, 2008

Action on pensions?

Earlier this month I wrote about the crisis in pension funding resulting from the intersection of the Pension Protection Act (PPA) of 2006 and the extraordinary market collapse of 2008.

I expressed a hope that, once the national elections were behind us, federal officials would consider legislation to “make it possible for companies to adequately fund their pension plans over longer periods of time” than are required by the PPA.

Last week the New York Times reported several senators have proposed such legislation. The report speculated that, if the bill was not addressed in the Congressional lame duck session, it would be considered in “a pension relief bill in January.”

Saturday, November 22, 2008

A sad & bitter time...November 22, 1963

Forty-five years ago in my high school classroom, I was shocked to hear an announcement on the address system that President Kennedy had been shot while traveling in Dallas, Texas. Only minutes later, it seemed, the school principal returned to the address system, reporting sadly that the President was dead.

My memory holds such images from November 1963: the horse-drawn caisson in the streets of Washington, DC; the dark, riderless horse with boots backwards in stirrups; President Kennedy's young son, saluting as he stands with his mother and sister; President Johnson, his hand on a Bible, taking the oath of office on Air Force One with Mrs. Kennedy beside him, her husband's blood stains visible on her skirt; the assassination of Lee Oswald by Jack Ruby, broadcast live on television.

Some 37 years later, John Fey, MD, a surgeon, and I set out on foot to find Dealey Plaza from our hotel in Dallas, where we were attending a conference on patient safety. What an experience to visit the place where the President's murder took place – to see the confined space of the sixth floor in the school book depository, now a museum, and to walk the surprisingly small area bordered by North Houston and Elm Streets, where the book depository was located. Dr. Fey and I were touched to be at Dealey Plaza, to view the artifacts of the assassination, and to refresh our memories and our emotions of that time.

What a sad, bitter, and angry time it was.

Congratulations, Doctors!

Congratulations to the physicians listed in last month’s CNY Magazine as “best doctors.” I want to acknowledge and congratulate all who practice at Community General Hospital, starting with our Medical Staff President, David Halleran, MD (photo, at left) of Colon Rectal Surgeons of Central New York, along with his partner John Nicholson, MD.

Others from the list include our intensivists Russell Acevedo, MD and Daniel Polacek, both of Critical Care Associates; John McCabe, MD, leader of the emergency medical group that provides services at Community General; James Tifft, MD, of Associated Gastroenterologists of Central New York; and John Gullo, MD, and Anthony Scalzo, MD, both of Hematology Oncology Associates of Central New York, which operates a cancer care and hematology center on the campus of Community General.

Congratulations, as well, to Francisco Gomez, MD, (photo, at right) of CNY Neurology; Leonard Levy, MD, Chair of the Department of Pediatrics; Robert Weber, MD, Medical Director of our Physical Medicine and Rehabilitation Service; Mark Levinsohn and David Thompson, MD, of the radiology group that provides services at Community General; as well as surgeon Robert Schwartz, MD, of Vascular Care.

It is a tribute, indeed, to be recognized by your peers!

Sunday, November 9, 2008

Why hospitals seek 'herd immunity'

"Herd immunity” occurs when a sufficiently large part of a population is immune to a disease. A large number of immune individuals effectively interrupts the chain of contagion from person to person. This can prevent an epidemic, and it can confer indirect protection against the disease for members of the population who are without individual immunity.

Herd immunity is why hospitals, consistent with advice of the CDC and the Joint Commission, work hard to get flu shots for their physicians, employees, and volunteers. A high level of flu vaccination within the "hospital herd” helps protect vulnerable patients – those who are older, those with multiple conditions, and those with weakened immune systems.

Richard Daines, MD, the New York State Commissioner of Health, says flu shots for physicians and hospital workers are a matter of patient safety:

[T]he failure to adequately immunize HCP (health care personnel) is a patient safety issue….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…
According to the National Foundation for Infectious Diseases, the percentage of health care workers getting flu shots was 42% in 2006. Dr. Daines has set a goal of 60% flu vaccinations for health care workers by 2010.

I’m pleased to observe that 74% of the employees at Community General Hospital received the flu vaccine last year. We're working for an even greater percentage this flu season.

The flu season is upon us, and the Department of Health tracks the flu, county by county. See the state map (above), which is updated weekly. Influenza was confirmed in six New York counties the week of November 1.

In recent weeks the infection control staff has given flu shots all over Community, including on weekends and evenings. Yesterday, nurse leaders conducted a flu clinic for employees and members of their families. My thanks to Employee Health and to Infection Control and Nursing Services for their special efforts to assure herd immunity at Community General this flu season.

Sunday, November 2, 2008

The coming crisis in pension funding

In a discussion last month with candidates for national office, I voiced a concern about the impact of the current economic crisis on pension plan funding. I spoke about the federal requirement that would make companies, including hospitals, pay significant amounts of cash to make up in one year the significant losses suffered by their defined pension pension plans in this year’s stock market.

The economic crisis is quite extraordinary. Stocks have tumbled 30% below their value last year at this time. It is unrealistic to expect companies to make up the shortfalls in their pension funds in a short amount of time.

Most pension plans have at least 50% of their funds invested in the stock market. On October 30 the Wall Street Journal reported that, of 361 defined benefit pension plans operated by companies on the Standard & Poors 500 list, stocks typically account for 50-70% of their investments. “Pension plan shortfalls,” the Journal reported, “will likely result next year in hits to earnings… and possibly [hits to] cash at a number of companies.” This could happen not only at the big, publicly traded corporations. It could happen at modest-sized, not-for-profit hospitals, as well.

The Pension Protection Action of 2006 (PPA) requires companies to achieve 94% of their target pension funding next year. The target level has been creeping up year-by-year and will reach 100% in a few years. Assuming the 30% decline in stock values continues through year-end, getting to the PPA’s target funding will require millions of dollars in cash from companies that are already strapped. This is the prospect unless there is a miracle stock market recovery equivalent in size to the disastrous performance seen since September.

I recently spoke about this looming problem to a member of the House Ways and Means Committee. I don't think he was being facetious when he told me Congress really shouldn’t pass laws about things it poorly understands, such as actuarial requirements and accounting rules. However, that is exactly what Congress does. It passes such laws, just as it did in 2006 when the PPA was enacted.

One candidate for office with whom I spoke speculated that a solution to pension underfunding might be to extend the pension plan coverage provided by the Pension Benefit Guarantee Corporation (PBGC). But that won’t work for a couple reasons.

First, the PBGC is itself under funded. In testimony last month before the House Committee on Education and Labor, Charles Millard, PBGC Director, acknowledged that “PBGC has been in a deficit position for most of its existence.” He said, "the single-employer program lacks the resources to fully satisfy its benefit obligations" See Mr. Millard's graph, below. As of 2007 the PBGC had an accumulated deficit of $14.1 billion.

Here's a second reason extending PBGC coverage won't work: to do so, the PBGC would have to increase its premiums to the companies whose plans are covered. That would mean additional out-of-pocket cash from the strapped companies.

The solution isn’t to prepare for more PBGC bailouts. The solution is to change the PPA rules for the extraordinary circumstance in which we find ourselves. Congress should make it possible for companies to adequately fund their pension plans over longer periods of time. Companies have to be able to meet their funding targets in a reasonable way – or they won’t meet them at all.

The American Benefits Council has started to talk about this, proposing last week to the Ways & Means Committee a ten-point plan to deal with “the [pension] funding requirements that were unanticipated just weeks ago.” The Council called upon Congress to enact changes that would avoid the huge cash calls that are now possible for organizations across the county as PPA requirements collide with the stock market's extraordinary losses.

With the national elections nearly behind us, dealing with the coming crisis in pension funding is an important (and apparently as yet unrecognized) responsibility of our elected leaders.

Friday, October 24, 2008

Gala showcases our own "ER"

Click on the video to see Community General Hospital's homage to the opening credits of the popular NBC television show ER. The homage is the attention-getting start of a short video that was shown last evening at the annual gala of the Community General Foundation. (The video is also available at this YouTube link.)

The video highlights advanced technology at Community, which is acquired with the help of charitable contributions. The video shows more than technology -- it shows the way technology affects individual lives. Two recent patients at Community describe their experiences. It's quite poignant. My thanks to Andrea and Vinny for allowing us to hear their stories.

Shown in the video are the daVinci S Surgical System for robot-assisted surgery, the "RxD2" pharmacy robot, Community's PACS (Picture Archival Communications System), and the new digital mammography equipment at the Wellspring Breast Center.

Thanks to those attending yesterday's gala, the Foundation raised $300,000!

The evening was a success because of the hard work of many people. I'd like to thank master-of-ceremonies Scott Matukas, Chair, and the entire Board of the Community General Foundation. Thanks especially to Board members (and Gala Committee Co-Chairs) Jim Barger of Key Bank and Mark Re of Gallinger Realty USA. I am grateful to Dottie DeSimone, Auxiliary President, and to the Board and members of the Auxiliary to Community General Hospital -- they sponsored the silent auction at the gala. I'd also like to acknowledge the hard work of John Zacharek and his team in Community's External Affairs Division for their organization, their attention to detail, and their follow-through.

One more word about the ER-like opening sequence. All the "stars" identified in the sequence are real physicians, stars in their professional lives at Community General Hospital.

Sunday, October 19, 2008

It will be fun

There are two things that distinguish the annual fund raiser to be held by the Community General Foundation next Friday, October 24, at the Hotel Syracuse. They are: it is a casual dress affair, and it is a darn good party.

That means you can wear jeans (the theme, after all, is “jeans and jewels”). It also means that any formalities will be short and sweet, allowing the evening to be enjoyed as a great party by all who attend.

There will be fine dining – the meals are catered by Pascale – and fine music, as provided by two Syracuse musical institutions: jazz vocalist Ronnie Leigh, along with R&B masters, the Blacklites. With talent like that, you know it will be fun! The photo shows the Blacklites at the 2007 gala - they will be back by popular demand.

The fun, of course, is for a very good cause. Proceeds from this year’s gala will help support Community General’s investment in state-of-the-art medical tools, such as the daVinci® System for robot-assisted surgeries, digital mammography at the Wellspring Breast Center, and the new pharmacy robot for virtually error-free medication dispensing.

The Foundation will take a moment to honor its three special guests:

Steve Infanti will be honored for his years of service service to Community General Hospital. A member of the Hospital Board of Directors since 1999, Steve has served as its Chair since 2002. Before joining the hospital, he was a director of the Community General Foundation, where he also served as Chair.

Being honored for service to community will be the State University of New York College of Environmental Science and Forestry (ESF). ESF is the nation’s oldest (and largest) college dedicated to the study of the environment, developing renewable technology and building a sustainable future. Under the leadership of Dr. Neil Murphy, ESF has been consistently ranked among the top American universities by US News & World Report.

For medical excellence, the Foundation will honor Syracuse Orthopedic Specialists (SOS), a group of 21 orthopedic surgeons who are leaders bone and joint care in Central New York. With seven locations throughout the Syracuse area, SOS surgeons are known for responsive, high quality medical care. At Community General, the Orthopedic Department has 100% SOS members – because of their quality and leadership, Community's orthopedic services are ranked among the best in the state.

The gala is close to sold-out, but there are some tickets remaining. If you want to support a great cause (and enjoy a great party), contact the Community General Foundation at 492-5079.

Sunday, September 28, 2008

Remembering Mrs. Brown

Ula Brown Maclachlan, who passed away Thursday, was the widow of John L. Brown, the founding President & CEO of Community General Hospital. Mr. Brown was hired in 1958 to design and build the new Community Hospital on Onondaga Hill in Syracuse, NY. He retired in 1982 and died in 1986.

Perhaps 15 years ago, Jerry L. Harris, Mr. Brown’s successor as CEO, gave me a file of personal papers that belonged to Mr. Brown – correspondence, personal notes, the agenda of his interviews for the CEO position, etc. Jerry found the papers in his files, and he asked me to review the documents, saving anything of importance to Community General. I made copies of several documents I thought were relevant for the hospital, but most of the papers were personal in nature. I packed them up and sent them to Mrs. Brown.

A while later, Mrs. Brown sent me the kindest note. To today’s sensibilities her note would seem somewhat dated, quaint, perhaps even politically incorrect. But I was touched by her thoughts.

Paraphrasing (from memory), this is what she said. Mrs. Brown thanked me for sending the documents, saying that she read them with interest and that many fond memories were recalled. She said the documents were especially interesting to their children, Bill and Christine. Mrs. Brown commented to the effect that “when a man is at his most productive, his children are too young, too unaware, or too uninterested to understand the significance of his accomplishments.” She said that Mr. Brown's personal papers provided an opportunity for their children to better understand what Mr. Brown had accomplished and what he meant to the community.

Today, I recall Mrs. Brown, her work at Community General as a founding member of the Auxiliary and as a Volunteer, her life in the community, and the love and support she gave to family and friends.

Saturday, September 20, 2008

More discussion on SEIU

Paul Levy referenced my recent post about the SEIU corporate campaign in his blog, Running a Hospital. Paul is the CEO of Beth Israel Deaconess Medical Center.

Paul's posting elicited some lively follow-up comments, including one that seemed to compare picketing my house to put pressure on contract negotiations at a nursing home with the civil rights protests of the 1960's! Another comment on Paul's blog said, "The hubris is takes to compare any modern day civil rights staggering." After reading the comments on Paul's blog, I added my own:

Captains-of-industry imagery and class-stereotypes are powerful tools for motivating and for bullying, and the SEIU is masterful at using these tools. Employing the signs and symbols of civil protest, however, does not automatically confer legitimacy on one’s point-of-view or actions.

The SEIU is an organization, like any other. It has no special status as somehow “more moral” or “more politically legitimate.” Because it alleges something does not make it true.

In the days since the SEIU picketed at my home, numerous SEIU members have told me they disapproved of the activity. Some have apologized. They have usually done so after briefly looking over a shoulder so as not to be overhead.

One local labor leader called me last weekend to express personal support and to take issue with the SEIU’s tactics. Significantly, this leader said he was not comfortable expressing such an opinion publicly.

To read Paul's post and the comments it prompted, go to Corporate Campaign in Upstate New York. See also the comments on my initial post, as well.

Wednesday, September 17, 2008

Wrong-side surgery

Today’s newspaper carries a story about a wrong-side surgery at St. Joseph’s Hospital Health Center. My thoughts go first to the patient – and then to the caregivers at St. Joe’s.

The story recalls a wrong-side surgery that took place at CGH in 2004, about which I wrote last year. I learned about our medical error the morning it happened, and we conducted a root cause analysis that same day. I promptly apologized to the patient for our medical error, and I apologized to the surgeon because our safety processes did not prevent the error.

Hospitals are complex places where modern medicine allows us to do much good for patients, but modern medicine is accompanied by risk. All hospitals rely upon internal processes to reduce the risk of error, but we didn’t follow our process – we failed our patient and we failed each other – one day in 2004.

Following the root cause analysis, we took many other actions to improve our safety processes. We reached out to another hospital administrator who had experienced a wrong-side surgery; she helped us learn from that experience. We invited the Joint Commission to conduct an on-site review, we visited a local company to learn about industrial safety processes, we hired an operating room consultant to help us improve, and we made changes in our Universal Protocol. We re-trained all staff, and each member of the Medical Staff committed to following the Universal Protocol.

Because health care involves human beings, mistakes, regrettably, are possible – not just in the Operating Room, but anywhere. That’s why standardized processes help fallible individuals safeguard patients .

Today's news story reminds us that the lessons from our own wrong-side surgery must remain fresh for all of us.

This posting appeared in a different form on December 16, 2007.

Friday, September 12, 2008

SEIU's corporate campaign

Yesterday members of SEIU 1199 picketed my home. Interestingly, the picketing was not intended to influence me at Community General Hospital, where I am CEO. Instead, SEIU seeks to use me to pressure one of Community’s employees who serves on the Board of Iroquois Nursing Home. I have declined to apply the pressure.

Earlier this year SEIU conducted an organizing campaign at Iroquois. Having won its election on March 7, 2008, SEIU is negotiating its first contract – a process that is not apparently proceeding to its liking, judging by the calls and personal visits I have received from Al Davidoff, SEIU Vice President.

SEIU has made Iroquois the object of a “corporate campaign” intended to pressure, to intimidate, and to publicly embarrass the organization. As a tactic, corporate campaigns have been used by SEIU with organizations across the country, including such notables as Beth Israel Deaconess Medical Center, Sutter Health Care, and even the California Nurses Association. Anyone interested in learning more about this tactic need only search the Internet for “SEIU corporate campaign” and read the links that appear.

Corporate campaigns employ the methods of community organizing, political action, and public relations, such as letter writing, telephone calls, picketing, and publicity. SEIU corporate campaigns target elected officials, as well as candidates for office, and they involve outside organizations in an effort to bring additional pressure on the Board and management of a target organization – in this case, Iroquois Nursing Home.

Along with St. Joseph’s Hospital Health Center and Crouse Hospital, Community General Hospital shares the responsibility to appoint Board members to Iroquois. We three hospitals established Iroquois to meet a community need some 15 years ago, under the auspices of Plaza Corporation, Inc. Plaza is the sole member of Iroquois Nursing Home and Rosewood Heights Nursing Home. Plaza's two nursing homes are independent, not-for-profit corporations, separately licensed by New York State, each with its own Board of Directors.

As the three members of Plaza, Crouse, St. Joseph’s, and Community have the responsibility to appoint qualified community representatives to the boards of both Iroquois and Rosewood. Community’s appointees to Iroquois have served as Directors there from four to 15 years each.

Board members have the legal responsibility for nursing home governance. They are fiduciaries – that means, the Directors have legal responsibilities to the residents of the nursing home and to the communities served by the nursing homes.

About a year ago, the Iroquois Board elected one of the Community-appointed Directors as it chairperson. SEIU thinks that makes Community responsible for decisions made by the Iroquois Board. Mr. Davidoff has asked me to intervene with the Community employee serving as Board chairperson. The intention is to bring pressure from Community General Hospital's management upon a hospital employee who has fiduciary responsibilities at Iroquois.

I have explained to Mr. Davidoff – as I did to his predecessor, Marshal Blake – that Community sees Board membership at Iroquois as a community service, not as a puppet of Community’s administration.

Mr. Davidoff has informed me that SEIU would seek to generate unfavorable publicity for Community General Hospital, unless I make an effort to interfere with the Board of an independent, not-for-profit facility. That apparently is the price one pays for doing the right thing in the face of an SEIU corporate campaign.

Thursday, September 11, 2008

Saturday, September 6, 2008

A hospital's characters and its stagecraft

It is commonplace to see the drama of the medical profession portrayed in the popular media. But Hospital, a new book by Julie Salamon, is remarkable for the way it captures the life of a hospital in all its confusing, infuriating and inspiring complexity.

For one year Ms. Salamon had virtually unlimited access to Maimonides Medical Center in Brooklyn, NY – its people and its facilities, day and night. Pam Brier, the President and CEO of Maimonides, knew Ms. Salamon was an experienced writer, the author of other books, whose journalism credits include the New York Times and Wall Street Journal. Nonetheless, it took courage for Pam to give a reporter carte blanche at her hospital.

Pam Brier ends up as one of the characters in Hospital. We see Pam on stage, and we sense her presence even off stage. She addresses the men in a mosque to discuss Maimonides’ cancer center. We see Pam in day and night staff meetings as she demands spending cuts. One night she rounds in the emergency department. We overhear her fretting about patient volume. One manager sulks, thinking he’s been ignored by Pam. A doctor thinks she plays favorites.

I serve with Pam Brier on the Board of the New York eHealth Collaborative, but I do not know her well. I was fascinated to see her, through Julie Salamon’s eyes: someone with personal courage, a bit eccentric, plenty of worries, fully engaged in the life of her hospital and its difficult relationships.

But Hospital is not just Pam Brier's story. There are 69 other characters in the book – doctors, nurses, residents, patients, social and community workers, environmental aides, executives. We see them as the author does, as complicated, interesting, flawed, and worthy individuals.

Hospitals are political environments, as are all places where human beings work together and compete for resources, satisfaction, and respect. “Political intrigue and turf wars,” writes Julie Salamon, “were not unique to Maimonides; struggles for space, equipment, staff, and money were part of the hospital life.”

Beyond the politics and the professional jealousies, the book tells something about a hospital's stagecraft. We see the importance of medical record coding, length of stay management, case mix, and health insurance contracts. There are neighborhood politics. There are donor politics. These are unseen forces that shape a hospital world, and they help give this book its fascinating reality.

Despite financial pressures, despite individuals who give or take offense, despite various ethnic tensions, an undercurrent of hope buoys Hospital. At one point Dr. Alan Astrow, Associate Director, Medical Oncology, reflects:
In the contemporary world, when we speak of an invisible hand that drives us, it is often assumed that we are referring to the marketplace and the invisible hand of economic self-interest. But most physicians and nurses, I think, want to see themselves as more than simply one party in a financial transaction. Why do we do what we do? What keeps us going? Not just that we ought to care but why? Faced with a suffering or demanding patient whom we might prefer to avoid, where do we find the strength to enter the patient’s room?
Here is the author herself, summing up:
Depending on the day or night, life in the hospital could seem full of exquisite promise or pointless despair…Yes, individual doctors and nurses behaved badly, sometimes inexcusably so. Clerks were rude to patients and to each other. People made mistakes. Yet I was constantly struck by the sense of urgency that accompanied desires for fairness, for compassionate medicine, for efficiency, for meaning – and yes, for cleaner rooms. Both Pam Brier and Margie Morales (a member of the environmental staff) struggled to sort the unwanted from the wanted, to make the hospital what it should be. They needed their lives to matter.
Thank you, Pam Brier, for giving Julie Salamon the ability to research and write Hospital. I'm not sure I would have been as brave.

Sunday, August 31, 2008

The pneumonia deaths

A recent news report cited Community General Hospital for pneumonia death rates above the national average. The story was based on mortality statistics published by the Centers for Medicare and Medicaid Services (CMS). The mortality rates were mathematically adjusted for differences in patients' medical conditions, but the rates did not adjust for differences in mortality due to patients’ own do-not-resuscitate (“DNR”) orders.

The Post-Standard reported that for Medicare-covered pneumonia patients “the national mortality rate was 11.4 percent. Community General Hospital… had a pneumonia death rate above the national rate 15.1 percent.” In paragraph eight, the story appropriately quoted Fred Goldberg, MD, Community’s Chief Medical Officer, explaining that “these report cards do not account for...end-of-life preferences."

The distinction may be too subtle for headline writers.

Last year I wrote about CMS’ plans to add pneumonia mortality rates to its Hospital Compare website. I discussed Community’s past investigations into pneumonia deaths with respect to patients’ DNR orders – and I quoted “Mortality as a Measure of Quality: Implications for Palliative and End-of-Life Care” from the Journal of the American Medical Association (JAMA):
Mortality is a good quality measure for individuals with acute illness who are not supposed to die…However, mortality is a poor quality measure for the majority of patients with multiple chronic diseases who are near the end of their life, and may be engaged in…decisions that result in an earlier (or less delayed) death.
Following the recent news story, I again looked up the JAMA article. It said:
Treatments provided to seriously ill patients are often inconsistent with patients' underlying preferences….[T]here is a 10-fold variation in the rates of early do-not-resuscitate (DNR) orders across hospitals and dramatic variation in the proportion of all intensive care unit deaths preceded by withdrawal of life support….Such decisions may be relatively more common in the 600,000 hospital deaths that occur each year (over 50% of all hospital deaths) in patients aged 75 years or older who are at increased risk for accumulating multiple chronic illnesses.
During the period of time reported in the CMS data, the average age of the pneumonia patients who died at Community General was 83. As Dr. Goldberg reported, 93% of them had do-not-resuscitate orders.

Sunday, August 3, 2008

Hospital patients who can't (or won't) leave

Immigrants Facing Deportation by U.S. Hospitals” reports today’s New York Times about the extraordinary efforts of one Florida hospital to find continuing care, both in this country and in the patient’s native Guatemala, for an illegal immigrant who had become a de facto ward of the hospital.

Last week the Wall Street Journal reported that a Los Angeles’ ordinance makes it illegal for city hospitals to discharge to “skid row” homeless people who no longer need to stay in the hospital – this is called “patient dumping.” See “L.A. Law May Keep Homeless in Hospitals.” According to the Journal, many homeless patients simply “refuse to leave” a hospital.

Hospital, a new book by Julie Salamon, which is highly recommended, recounts the efforts of discharge planners at Brooklyn's Maimonides Hospital to find a place for a Chinese immigrant who, dying of cancer, no longer needed hospital-level care but otherwise had nowhere to go.

Hospitals nationwide deal with such situations all the time. Once a hospital has successfully cared for an individual’s acute care needs, that person may end up with nowhere to go because of deficiencies and inconsistencies in health care and social service systems.

A family may drop off an elderly parent in the emergency room, then leave on vacation or refuse to take the parent home after discharge from the hospital. If no nursing home will accept the patient, that individual becomes a border in the hospital, sometimes indefinitely.

Hospitals often help patients and families with nursing home placements by assisting with the complex Medicaid application process. It is not unusual, however, to find an individual or a family unwilling to disclose financial assets – unwilling even to sign a Medicaid application. This often means a nursing home will not accept the patient, who then remains inappropriately in the hospital.

These are called placement, transfer, or discharge problems, and few know about or understand them. As a result, such problems generate no political consensus toward a solution.

As a humane society, how do we assure appropriate levels of care for the homeless, for illegal immigrants, for the mentally challenged, as well as for those who may be willfully irresponsible?

According to the Journal: “[A]bout half the hospital’s homeless patients won’t sign discharge consent forms. ‘We can’t force them,’” says the discharge planner at one California hospital.

The Times reported that the Florida hospital’s care amounted to $1.5 million for the Guatemalan patient, but when it came to paying for nursing home or rehabilitation care, the hospital declined “to take out…[its] checkbook.” Why was that expected to be a hospital responsibility? Hadn't the hospital already discharged its (uncompensated) responsibility for acute care? Where is the nursing home industry's responsibility for continuing care? Where is the US government’s responsibility? Where is the responsibility of Guatemala for one of its citizens?

Government rules and media scrutiny are inconsistent among the sectors of the health care system. Thanks to unaligned incentives and inconsistent requirements, our disjointed health care system yields paradoxical results, as reflected in these stories from the Times and the Journal.

Saturday, July 26, 2008

The test results

I am glad to say that test results received yesterday show no Legionella bacteria in the cooling tower of an office building on the campus on the Community General Hospital.

As reported in the news media (see "No more Legionella in cooling tower" on WSYR-TV), that tower has been the investigated by the hospital, along with the county and state health departments, in connection with Legionnaires’ disease. The hospital has also relied on independent experts, such Janet Stout, PhD, a national authority on Legionella and water systems.

To identify Legionella, a laboratory grows cultures of the organism from samples of water. To encourage the growth, the lab adds nutrients to a Petri dish containing the sample. The dish typically contains antimicrobial agents, as well, to inhibit the growth of other bacteria, thereby improving the chances of finding Legionella.

In the photo, above, the Petri dish on the left shows no growth of Legionella after seven days from a water sample obtained from the office building cooling tower. For comparison purposes, the lab provided me with a photo that shows what Legionella looks like (in the Petri dish, on the right) after four days of growth. The comparison sample was from a source not associated with Central New York. For a better look at the Petri dishes, click on the photo.

Wednesday, July 23, 2008

Behind the headlines

In the past two weeks, a number of people have asked me about Legionnaires’ disease as a result of news coverage about patients in Onondaga County, including some who visited the Community General Hospital campus.

The news media work hard to provide the facts, and the hospital has spent a fair amount of time running down answers to questions and assuring that reporters had accurate information. But Legionella is not an easy subject to pin down in a few short sentences – or in short headlines that can look somewhat alarming.

My most important message has been simple and direct: Community General Hospital has done – and will continue to do – everything possible to ensure the health and safety of our patients, visitors, employees, physicians, volunteers, and neighbors. This is our number one priority.

Our engineering staff, our clinical professionals, and our communications people have spent many, many hours in recent days assuring that we have done the right things and that we fully respond to all requests, whether from patients or staff, from the County and State Departments of Health – or from the news media.

There have been several frequently asked questions, which I answer below.

For those with individual concerns, Community General Hospital has a health info line at (315) 492-5253. Feel free to call us.

To learn more about Legionella, please visit the website of Janet Stout, PhD, and her colleagues, who are experts on the subject. Dr. Stout has worked with Community General during our investigation.

How do I know I won’t get Legionnaires’ disease on the Community General Hospital campus?

You are safe on the Community General Hospital campus. We have taken proactive measures with our physical plant and patient protocols to ensure the health and safety of everyone on our campus – and we will continue to take every step necessary to do so.

Right now the office building on our campus has one of the most studied, most tested, and most treated water cooling towers in upstate New York, if not in the entire northeast. The New York State Department of Health continues to monitor the situation and has said there is no information to suggest any ongoing exposure on the Community General campus. Our hospital continues to work collaboratively with both the Department of Health and the Onondaga County Health Department.

A member of my family – and I personally – have sought care at Community within the past several weeks.

News reports said that an office building cooling tower on the hospital campus tested positive for Legionella, even after a first disinfection. What are you doing about it?

For years Community General Hospital has proactively treated cooling towers using outside water treatment experts – and will continue to do so. From the very first signs of concern, the office building cooling tower was disinfected using a chemical shock treatment to eradicate the presence of Legionella. A second disinfection process, about ten days after the first, was undertaken before we received any test results from the first one. The second disinfection used a 48-hour treatment program recommended by independent Legionella experts and the Centers for Disease Control. We felt this was an important precautionary measure. Preliminary test results indicate that this treatment was effective, and we await final results.

Is the office building cooling tower the source of the outbreak?

Although the cooling tower has not been confirmed as a source of the Legionnaires’ outbreak, we have acted as if it were, taking all the steps necessary to increase treatment and to measure results. Health officials have told me they continue to investigate other possible sources within the county.

Have any patients or hospital employees contracted Legionnaires’ disease?

Our surveillance program for diagnosing Legionnaires’ is very aggressive. No patients or hospital employees have been known to have contracted the disease. We have gone back and identified with employees who were ill and asked them to take a test for Legionella. All results have been negative.

Of the 13 cases identified as having Legionella in Onondaga County, Community General Hospital has firsthand knowledge of six who were treated at the hospital or by members of the medical staff. None of them are believed to have contracted the illness while in the hospital.

Am I able to drink the water at Community General Hospital?
Yes. The water is safe to drink. Patients are reminded to follow physician and nurse instructions.

Where does Legionnaires’ disease come from?
Legionnaires’ disease is caused by the Legionella bacteria, which is found naturally in the environment, usually in water. Legionella is very common, and small traces of the bacteria can be found in most water systems.

How do people contract Legionnaires’ disease?
People contract Legionnaires' disease when they breathe in a mist or vapor (small droplets of water in the air) containing the bacteria. The disease is not spread from person to person, and is most commonly found in people who smoke, who are 50 years of age or older, and who have a chronic lung disease or immune deficiencies.

What are the signs and symptoms of Legionnaires’ disease?
Although most people exposed to the bacteria do not become ill, Legionnaires' disease can have symptoms similar to other forms of pneumonia. Signs of the disease can include a high fever, chills and a cough. Some people may also suffer from muscle aches and headaches. Should you experience any of these symptoms, please contact your health care provider.

Tuesday, July 8, 2008

Today's Legionella announcement

This afternoon Dr. Cynthia Morrow, the Onondaga County Health Commissioner, announced that seven cases of Legionnaires’ disease were reported in the county over the past ten days. This includes four unconfirmed cases that Community General Hospital reported last week.

Obviously, there's a fair amount of news coverage this evening, including The Post-Standard, and Central New York television stations WSYR, WTVH, WSTM, and News10Now.

The Department of Health’s preliminary investigation identified that all of the unconfirmed cases were on or near Onondaga Hill, including at Community General Hospital. The source of this cluster of cases has not yet been determined.

Last week Community supplied the Health Department with water samples from both the hospital and the physicians’ office building cooling towers. In addition, over the course of the past several days, Community has undertaken additional measures involving experts in water treatment to assure disinfection of the cooling towers. Keeping Legionella below detectable levels in cooling towers at all times is practically impossible due to the ubiquitous nature of the bacterium, according to the Association of Water Technologists.

Community has routinely tested the hospital’s cooling tower and water supply. Also, Community has for years been one of the relatively few hospitals that actively tests for Legionella all patients who have pneumonia.

The office building cooling tower did recently test positive for the bacterium. In cooperation with the Health Department, we completely disinfected and sanitized that tower to eliminate the bacterium (even before test results were received).

Dr. Mitchell Brodey, Community’s Infectious Disease Specialist, and Sue Chamberlain, RN,CIC, our Director of the Infection Control Program, have been fully engaged with surveillance and with communications with the Department of Health, as has Community's engineering staff. We are glad to work with the state and county health department professionals, and we will continue to do so.

Monday, June 30, 2008

Check out the news stories from last weekend about the newest daVinci robot at Community General Hospital.

The surgical robot, such as the one acquired by Community, was on display for two days last week at the Carousel Center, where Dr. Po Lam talked about the importance of the new technology. Dr. Lam, a member of Associated Medical Professional of CNY, PLLC, is a board-certified urologist who is fellowship-trained in endourology, laparoscopic...and robotic surgery.

Explaining the advantages of robot-assisted surgery, Dr. Lam said

Our wrists can only rotate so much… (because) our anatomy – our elbows and our shoulders and our wrists – is limited. The robot can spin around…and has more dexterity and precision than the human hands. In some ways the robot is better than a human…
To see the daVinci demonstration and hear Dr. Lam, click on the links to Community General unveils daVinci robot and High tech robot performs surgeries.

Sunday, June 22, 2008

A trusted collaborator

I've heard this from state officials, as well as from other hospital CEOs throughout the state: Syracuse hospitals are unique in that we communicate with one another and we actually work together on cooperative projects.

I was reminded of this last week at the annual meeting of Community General Hospital. One of the annual reports is the status of organizations in which Community is a partner with other health care providers. For example, Community is a partner with Crouse Hospital and St. Joseph’s Hospital Health Center in the Laboratory Alliance of CNY, LLC, Liverpool, NY.

Founded in 1997, the Lab Alliance provides clinical laboratory services to its member hospitals, as well as to physicians’ offices, nursing homes, and other hospitals. With more than 400 employees, last year the Lab Alliance performed 8.1 million tests. It is accredited by the Joint Commission, and it also performs device trials for the manufacturers of laboratory equipment.

Another area where Syracuse hospitals work together is the Plaza Corporation, which has Community, Crouse and St. Joseph’s as members. Plaza is the parent corporation for the 160-bed Iroquois Nursing Home in Jamesville, NY. With Loretto, Plaza is also the sponsor of Rosewood Heights Nursing Home, a 242-bed facility in Syracuse, NY. Combined, Iroquois and Rosewood account for about 14% of the total nursing home capacity in Onondaga County.

EPC, LLC (known as the Endoscopy Procedure Center) is an organization formed in 2005 by Community General Hospital with two medical practices, Associated Gastroenterologists of CNY and Colon Rectal Surgeons of CNY. Licensed as an ambulatory procedure center, EPC provides specialized endoscopy services for patients. It is accredited by the Accreditation Association for Ambulatory Health Care.

Community is also a member in the Hospital Executive Council (HEC), which dates from 1979 and involves Crouse, St. Joseph’s and University Hospitals. The HEC was actually the planning vehicle that helped form the Laboratory Alliance, and it provided the focus for bringing the hospitals together in the Plaza Corporation about two decades ago.

Under the leadership of Ron Lagoe, PhD, the HEC provides data collection, information analyses, and information exchange among its members. It distributes daily reports on Syracuse hospital services, as well as the function of emergency departments in the city. The HEC serves as the hospitals' liaison with the area’s long term care industry, and it is a resource for medical staff credentialing.

The HEC operates multi-year projects that have helped the Syracuse hospitals achieve lengths of stay that are the lowest in New York State, as well as utilization rates that are among the lowest. The HEC is a focus for information and projects that help improve hospital quality and the more effective use of community resources. Ron Lagoe has contributed to the health care literature, using his Syracuse research to publish journal articles on subjects such as provider cooperation, length of stay management, information exchange, hospital-nursing home coordination, and many more.

Part of Community General Hospital's vision is to serve as “a trusted collaborator with those who share its mission.” Through the HEC and the other organizations, we help achieve that goal.

Saturday, June 7, 2008

A change of heart

When the Civil Rights Act was passed in 1964, I had just graduated from high school. In the years leading to this landmark legislation, I remember an argument by those opposed to it – “you cannot legislate morality!”

It’s a curious argument. On one hand, it acknowledges that racial discrimination is a moral issue. On the other, the argument asserts that governmental action is impossible, apparently because no law can change what lies in a person’s mind or heart.

Well, the law did pass, and it outlawed segregation and discrimination on the basis of race, color, religion, sex or national origin, and it helped assure voters’ rights. In a previous posting, I talked about the Jim Crow laws that were enforced in some states as late as 1965.

The law also changed America’s heart.

Many of us see this change within our own families. Racial language and ethnic stereotyping that may have been tolerated at one time, at least within family circles, is no longer acceptable. Even the look of families is different – more families have welcomed spouses and partners and children from different races.

But we all know that prejudice has not gone away, and thankfully there are people who continue to work on the “mind and heart” problem.

Here in Syracuse is the longest-running program in America that focuses on dialogue to help end racism. It’s called the Community Wide Dialogue to End Racism (CWD) , and for several decades it has been bringing together people who might not otherwise meet so they can build understanding, tolerance, acceptance, and friendship.

Today there’s a fund raiser for CWD at Syracuse’s Inner Harbor, and people from Community General have been great in helping to support this whimsical event, called The Duck Race. I am not entirely certain of this, but I think the duck theme comes from the old saw, “If it walks like a duck and quacks like a duck, it is probably a duck.”

The Duck Race has a festive and multi-ethnic atmosphere with music and dancing and food – but the main event is the “race.” Model and toy ducks, sponsored by local companies and school children, waddle or float or paddle from Onondaga Creek into the Inner Harbor. There are a number of prizes for the sponsor of the winning ducks.

It is a light-hearted approach to a serious subject. And it’s good for our community.