Our caring campus

For several years Community General Hospital and Van Duyn Home & Hospital have discussed the potential in our combined campus infrastructure for a "continuum of care."

Between the two organizations, we have 110 acres of suburban property dedicated to health care services. In the aerial photo, Community is to the left of the tree line.

Thanks to Upstate Medical University, the future of this caring campus has new potential. Upstate and Community General are planning to become a single hospital this year, and Upstate is in talks with Onondaga County, Van Duyn's owner.

Today's report in the Post-Standard offers a look into the caring campus, as envisioned by a grant application prepared last year by Van Duyn, Upstate, and Community.

LICH implications for Community?

A report in today's New York Times suggests that a takeover of Long Island College Hospital (LICH) by SUNY Downstate Medical Center might not happen. New York State is reportedly reconsidering its award of HEAL grant funds that were expected to be part of the overall financial transaction.

The Downstate-LICH transaction has some similarities to the proposed acquisition of Community General Hospital by SUNY Upstate Medical University. So a logical question is: does today's report about LICH have implications for Community?

Community recently finished a project involving a HEAL grant. Among other things, the grant funds made possible the Center for Orthopedics. The funds were awarded as part of the Berger Commission's recommendations for Community and Van Duyn Home & Hospital. They were not part of the proposed transaction with Upstate. The funds have mostly been expended (and reimbursed).

The Community-Upstate transaction is far smaller, as I understand it, and not as financially complex as Downstate-LICH.

Yesterday Dr. David Smith, President of Upstate Medical University, addressed the Upstate community on the overall subject of state budget cuts, university finances, and plans with Community General.

Dr. Smith reiterated Upstate plans for its acquisition of Community because doing so will help Upstate build capacity and will help “put the right patient in the right bed.”

Sign of progress

A sign of progress at Community this week is the construction crane outside the Emergency Department. The crane is working on the Center for Orthopedics, which is under construction on the sixth floor.

The new Center should be ready for its first patients in January 2010.

The project is made possible by a $7.6 million state grant, part of a larger award made for Community General Hospital and Van Duyn Home & Hospital in compliance with the recommendations of the Commission on Health Care Facilities in the 21st Century (the Berger Commission).

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.

Our Auxiliary gem

We see all around us the good they do, but we may not always recognize how varied are the works of the Auxiliary at our hospital and within our community. [1]

Last week the Healthcare Association of New York State (HANYS) shined a spotlight on the Auxiliary with its Advocacy Recognition Award.

HANYS recognized the Auxilians for all their work – the preventive health screening they conduct within the community, their health care scholarships, the car seat identification program, their support of hospital volunteers, the library cart for patients, as well as the financial assistance the Auxiliary provides to purchase equipment for patients. Last year, for example, the new waiting room furniture in the Emergency Department was purchased with funds donated by the Auxiliary.

A few years ago one of our doctors was at Van Duyn Home and Hospital, our campus neighbor. A nurse told him how grateful she was, these many years later, for the scholarship help the Auxiliary gave her to become a nurse.

One of the more visible parts of the Auxiliary is the main lobby gift shop which provides snacks, sundries, and gifts for patients.

Other examples of the Auxiliary at work? Auxilians maintain the flower beds that make the front of Community General Hospital so pleasant each spring and summer. They sponsor the Holiday Lights on the Hill program each year, helping families and friends honor and memorialize their loved ones during the holiday season. The Auxiliary holds an annual golf tournament, and it provides sales events throughout the year to help employees, volunteers, physicians, and visitors shop for books, toys, clothing, linens, flowers, and jewelry.

Auxilians are especially proud because their organization predates our hospital on Onondaga Hill. The first Auxilians went door-to-door in 1962, inviting friends and neighbors to join them. The then newly-formed Auxiliary led tours at Community for donors and community groups in the months leading up to our opening, January 1, 1963.

This is the second time HANYS has recognized the Auxiliary for its work on behalf of patients at Community General and within the greater Syracuse community. And just last year, the Community Genmeral Foundation saluted the Auxiliary for its 45-year service record at our hospital.

Please acknowledge Dottie DeSimone, Auxiliary President, along with the Auxiliary Board and all Auxilians for the time and energy and funds they contribute to make Community a better place for patients. Please thank Krtistin Dombroske, Director of Volunteers, and her staff for their work in support of the Auxilians. And thank you, HANYS, for shining your light on our Auxiliary gem.

[1] This posting includes some material about the Auxiliary from a previous posting.

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.

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.

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.

State funds will help compliance with Berger Commission

This morning’s Post Standard reports the allocation of $12.8 million of New York State HEAL NY funds for Community General Hospital and Van Duyn Home and Hospital. These funds will be used to comply with the requirements of the Berger Commission. I’ve written before about the Berger Commission.

The funds are necessary because the Berger Commission requires the affiliation of CGH and Van Duyn. These changes are part of a larger state plan affecting 74 institutions – the closure of nine hospitals and seven nursing homes, plus changes in the affiliations or bed configurations of another 48 hospitals and 14 nursing homes.

The state’s decision to fund changes at CGH and Van Duyn comes after many months of dialogue between CGH and Onondaga County, the operator of Van Duyn. County Executive Nick Pirro and his staff fought diligently for the affiliation scenario called “A,” under which the County would continue to own and operate Van Duyn. Scenario “B” would have involved the more complex and more costly process of transferring the ownership of Van Duyn to CGH. Both Onondaga County and the Civil Service Employees Association (CSEA) sued New York State to prevent such a change in ownership.

Our discussions with the County have been straightforward and cordial throughout this process. We have also had a number of discussions with the state, and these too have been helpful. The state remained noncommittal about scenarios “A” and “B” until about 5:00 p.m. last Friday, September 28, when it faxed the announcement of its grant allocation to the County and to CGH.

Although the state has not formally accepted scenario “A,” the funds it has allocated are based on the costs identified for “A” – so “A” appears to be the de facto decision of the state. Here is a summary of what the scenario “A” affiliation involves:

1. CGH and Onondaga County will create a new not-for-profit corporation, called the Onondaga Hill Corporation (OHC) to conduct strategic planning for CGH and Van Duyn. The OHC’s plans are intended to create operating efficiencies, to improve organizational effectiveness, and to develop a more integrated continuum of care on the CGH-Van Duyn medical campus.
2. Van Duyn will remain a county-owned facility, subject to OHC planning activity. CGH will remain a private, not-for-profit organization with its planning also subject to the OHC. Both CGH and Onondaga County will appoint OHC directors, with CGH designating the majority of them.
3. CGH and the County will decertify a total 63 long term care beds. Van Duyn will decertify 13 beds, and Community General will ultimately close its 50-bed skilled nursing facility, converting that space into fully renovated acute hospital capacity. After these changes, there will remain 513 long term care beds on the campus, all of them at Van Duyn. (The Berger Commission did not require any change in CGH’s licensed 306 acute care beds.)

The state funds will reimburse Onondaga County and CGH for the legal and planning costs incurred in complying with the Berger Commission. The funds will also cover the transition costs involved in closing CGH’s 50-bed long term care unit, they will fund the planning work of the OHC, and they will fund facility renovations at both CGH and Van Duyn that are consistent with the Berger Report.

Changes for nursing home residents can be disruptive and stressful. That means we need careful plans for the closure of CGH’s sixth floor skilled nursing unit. These plans have yet to be developed, and they too will be subject to approval by the State Health Department. We are committed to assuring that transitions for residents and their families are fair and respectful.

Of CGH’s 1,200 employees, about 50 will be affected by the closing of the sixth floor long term care beds. These employees may be eligible for positions elsewhere in the hospital, and we expect some may transition to Van Duyn or other community long-term care facilities. We will do our best to communicate fully with employees and to work with SEIU1199 in assuring fair and respectful transition opportunities.

You’ll notice I’ve used the word “allocation,” not “award,” in describing the HEAL NY funds. That’s because there are a number of steps to be completed before the state money is actually awarded and paid. These steps include state approval of a work plan and the sign-off by the Office of Comptroller, among other things.

The state’s decision to fund compliance comes 10 months after the Commission issued its report. It is a necessary step. It is a positive step. But it isn’t the end of the process – only the beginning.

"No secrets"

In an editorial today, the Post-Standard calls for more discussion about the grant application that Community General Hospital and Onondaga County submitted to the Department of Health to comply with the decision of the state’s Berger Commission. In the newspaper’s opinion:

Onondaga County residents have a compelling right and need to know exactly what is being proposed and exactly how much it will cost.

I discussed the application several weeks ago in a posting. See the newspaper’s website for the full text of its “No Secrets” editorial.

The flowers of summer

When the Central New York leaders planned Community General Hospital in 1957, they sought a location away from downtown in a place of “therapeutic green.” That concept sounds remarkably contemporary.

The planners suggested three “green” sites as possible locations for the hospital: Tecumseh Golf Course, Sunnycrest Park, and the Onondaga Hill site of the County Sanitarium (now, the Van Duyn Home and Hospital). The Onondaga Hill site included 42 acres of land that had been reforested in the 1930s under the Civilian Conservation Corps. (The CCC put to work young men from unemployed families during the Great Depression of the 1930’s.)

As we know, Onondaga Hill was selected and CGH opened here on January 1, 1963. The hospital has been known for this distinctive green and wooded campus ever since, thanks to the community planners. A circle of trees is the hospital’s logo.

If the campus is characterized by its trees, it is also known for its summer flowers.

And for this beauty we owe thanks, not to the community planners, but to Community General’s volunteers.

We are fortunate to have more than 300 women and men who volunteer their time and talent, helping in many ways to make us “more than medicine.” Among their helpful activities are the flower beds volunteers maintain in the park outside the hospital’s several entrances.

Vince and June Lawrence have been a big part of this beautification project for years. The photo of Vince and June, with their flowers, was taken yesterday. When not working in the gardens (as they did on a very hot Wednesday this week), you can find them helping elsewhere (such as assisting patients and visitors at the main desk on Friday). Other members of the flower team include Dottie DeSimone, Caroline Newell, Julie Newell, John Ronan, Bill Thorp and Carolyn Topalian.

Thanks to all who help make Community General Hospital, not only a place of therapeutic green, but a place of beauty.

What’s up with the Berger Commission?

There are two stacks of documents in my office, totaling nearly 21 inches in depth. These are my notes, letters, worksheets, reports, legal memoranda, and state documents, all of which relate to the Berger Commission.

The Berger Commission is the informal name of the Commission on Health Care Facilities in the 21st Century that last year recommended

“Van Duyn Home and Hospital and Community General Hospital’s (CGH’s) Skilled Nursing Facility be joined…under the control of Community General Hospital, and downsize their combined number of RHCF (residential health care facility) beds by approximately 75” (p.103).

I’ve written about the Berger Commission before. See the previous posts: What the Berger Commission said, I wrote about ‘right-sizing’ before the Berger Commission, and Q&A on CGH & Van Duyn.

The Berger Report is more than a recommendation. According to a 2005 state law, the Commission’s recommendations became law on January 1, 2007 because they were not reversed by the State Legislature in the prior year. Therefore, CGH and Onondaga County, Van Duyn’s sponsor, are legally required to comply.

On July 11, 2007 CGH and the County applied for New York State grant funds so we can comply. The state made $550 million in grant funds available this year to help organizations meet the Berger mandates. The Commission itself understood the need for such funds. Writing about CGH and Van Duyn, it said “The reconfiguration and change of ownership…will require capital support” (p. 103).

CGH’s grant application includes planning money, as well as estimated implementation costs. The estimated costs could change as a result of planning yet to be done.

Figuring out how, exactly, to comply with the Berger Commission has not been easy – despite seven months of discussion with the County and despite a number of Albany trips to meet with the New York State Health Department. As a result of these talks, we have identified two possible models for compliance, dubbed scenarios A and B.

Scenario A assumes the intent of the Berger Commission can be achieved by a cooperative planning structure that involves both CGH and Van Duyn without any change in Van Duyn ownership. Scenario B would involve the transfer of Van Duyn to CGH’s corporate structure as the Commission envisioned. The state has not taken a position on either scenario but has stated an interest in seeing the costs associated with both.

The County prefers scenario A. In fact, the County has filed a lawsuit against the state that would block the Berger Commission as it affects Van Duyn. The Civil Service Employees Association (CSEA), one of the unions representing Van Duyn employees, has also filed suit against the state to stop the impact of Berger on Van Duyn. Both lawsuits are pending.

CGH sees advantages and disadvantages in each scenario and believes the preferred plan will emerge as a result of further negotiations involving the County, CGH and the State.

CGH and the County have a long history of cooperation. In fact, the 43 acres on which CGH sits came from the County in a series of land transfers and purchases that go back to the 1950’s. And CGH’s discussions with the County have been positive and cooperative throughout this process.

We both agree that making either scenario work will require state funds. And whichever scenario is decided upon – or perhaps another scenario entirely – will require adequate time to plan and to implement.

The Berger Commission had a vision for the future of CGH and Van Duyn. “An integrated organization,” it wrote, “will reduce the duplication of services across the two facilities, reduce operating costs at Van Duyn, enable Van Duyn to receive a hospital-based reimbursement rate, and create an integrated continuum of care on the campus" (p. 102).

What are the prospects of receiving grant funds necessary to achieve this vision? It’s hard to say. According to a July 18, 2007 state news release, more than 60 hospitals and nursing homes have applied for the $550 million in available funds.

Stay tuned.

Q&A on CGH & Van Duyn

I have written two recent posts about the Berger Commission,[1] and I thought that was enough on the subject, at least for a while. But I am often asked about the Commission so here are my answers to frequent questions.

Is the Berger Commission really “the law?”
Yes. Its recommendations became law on January 1, 2007 because there was no vote to overturn them by the State Legislature in 2006.

What exactly did the Commission say about CGH?
The Commission had two requirements for CGH. The first was that the Van Duyn Home & Hospital (526 beds) and CGH's sixth floor skilled nursing facility (50 beds) should be “joined under a single unified governance structure under the control of Community General."[2] That means that CGH will become legally responsible for all long term care beds on this campus. The second requirement is that the size of the combined CGH-Van Duyn nursing facility become smaller by “approximately 75"[3] beds. In other words, the total number of nursing home beds on campus would go from 576 to about 500.

When does all this happen?
I don’t know. The Commission report says only that Onondaga County[4] and CGH have to develop an agreement by the end of 2007. And, as yet, there are no specific plans about how to accomplish it, how long it make take to do so, or how much it might cost to do so. What the Commission asked for is quite complicated and will require time and funds to accomplish.

Does the Berger Commission want CGH to become a nursing home?
No. The Commission recommended that we “create an integrated continuum of care on campus.”[5] That means developing a health care campus that encompasses various care alternatives – acute hospital care, nursing home care, and perhaps other care levels as well. The Berger Commission did not take away any or CGH’s certified hospital beds. It effectively added 500 nursing home beds to our 306 hospital beds.

How will this affect employees?
The Berger Commission gave us one year to develop a plan with Onondaga County, subject to the state’s approval. After the plan is developed, it will take some time to implement it. I believe that at the end of this process there will be more opportunities for CGH employees, not fewer opportunities.

Do you believe the Commission’s decisions will be implemented?
I believe they will be implemented, yes, but I am not sure how or when – and I don’t know if the state will permit changes in some of the Commission decisions.

At least seven hospitals have started lawsuits against the state to stop it from implementing the Commission’s decisions. The lawsuits object to the absence of Department of Health hearings on Commission decisions and to the Commission’s alleged failure to comply with the state’s open meeting law.

Also, we do not know exactly how the new Administration in Albany is going to implement the Commission’s decisions. The Administration has been busy filling top positions in the health department – these are the positions that will oversee implementation of the Berger report. A new Commissioner of Health was appointed by Governor Spitzer only two days ago.[6]

The state has identified funding sources for the institutional changes that are expected as a result of the Commission. These are HEAL funds, which come from the state, and FSHRP (“f-sharp”) funds, which come from the federal government. It is not known how or when these funds will become available for the organizations that need to make changes.

So the timing and ability to comply with the report’s recommendations may depend on the outcome of court cases, on Administration decisions yet-to-be-made, and on the future availability of funds.

So what is CGH doing about all this?
CGH and Onondaga County had met about ways to work together even before the Commission report. We met together with the Berger Commission last summer when it was considering its recommendations. Although we did not expect the changes that the Commission ultimately recommended, both CGH and Onondaga County support the goal of an integrated continuum of care campus. Since the Commission’s report, CGH and Onondaga County have prepared for discussions with the state. We hope to learn more about the timing and flexibility we have to achieve the goals of the Berger Commission. And we need to answer a very important question: how do we obtain the funding necessary to achieve these goals?



[1] The New York State Commission on Health Care Facilities in the 21st Century was chaired by Steven Berger – so it was called the “Berger Commission” as shorthand. On November 28, 2006, the Commission recommended the closing of nine hospitals across the state, most of them in New York City. It recommended the restructuring of 48 hospitals, closing about 4,200 staffed hospital beds in all. The Commission also proposed to close seven nursing homes and to restructure 14 others, leading to a reduction of some 3,100 nursing home beds statewide. The 2005 law that established the Commission was crafted so that its recommendation became law unless they were entirely reversed by the State Assembly and the State Senate before December 31, 2006.
[2] Commission on Health Care Facilities in the 21st Century, p. 101. To see the full report, go to http://www.nyhealthcarecommission.org/final_report.htm
[3] Commission, p. 101
[4] Onondaga County owns and operates Van Duyn, which has been a part of the County for 180 years. It began as the County Sanitarium 1827. In 1979 the Van Duyn Home & Hospital opened as newly-constructed 526-bed facility.
[5] Commission, p. 102.
[6] Richard F. Daines, M.D. was named to serve as State Commissioner of Health on January 18, 2006. Dr. Daines is the President and CEO of St. Luke's-Roosevelt Hospital Center in New York City.

What the Berger Commission said

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

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

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

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

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

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

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

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

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

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

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

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

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

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




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

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

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

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

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

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

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

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

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

My testimony before the State Senate Health Committee

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

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


Senator Hannon and the Members of the Senate Health Committee:

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

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

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

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

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

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

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

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

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

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

Thank you for hearing my testimony today.

Community's second employee

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

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

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

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

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

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

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

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

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

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

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

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

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

The quiet hand

We see the good they do all around us, but we may not recognize it as the quiet work of the Auxiliary to Community General Hospital. At the 42nd annual meeting of the Auxiliary last Thursday (October 27), Dr. David Simon, Medical Staff President, gave an example of their quiet deeds.

Dr. Simon had seen patients that morning at Van Duyn Home and Hospital, our campus neighbor across the tree line. In conversation with a head nurse at Van Duyn, he mentioned that he would be speaking with the Auxiliary later in the day. The head nurse told him gratefully that, years ago, the Auxiliary helped her become a nurse through its scholarship program. Each and every year Community's Auxilians volunteer interview candidates and make scholarship awards. Over the years they have helped many join the nursing profession.

How many of us use the Gift Shop for snacks, sundries, and gifts for patients? The Gift Shop is an Auxiliary project that requires many volunteer hours for ordering, inventorying, transporting, and staffing. At the annual meeting Carol Merritt, Auxiliary President, paid special tribute to Bob Easton, who has quietly run the gift shop for decades. She also acknowledged Walt and Vera Sassman, two Auxilians who have volunteered at Community – Vera for over 40 years, Walt for more than 35. Monday was their last day as volunteers. “But we are still members of the Auxiliary,” they hastened to tell me.

In his remarks to the Auxiliary, John Scala, Director of Volunteers, cited more examples of the Auxiliary’s quiet hand in the life of Community. He spoke of Auxilians’ work in maintaining the flower beds that make the front of Community General Hospital so pleasant; he spoke of the Light-a-Light program that decorates the campus and helps families and friends honor their loved ones during the holiday season; he spoke of the Auxiliary’s annual golf tournament, its fashion show (coming December 3), and the sales events throughout the year that help employees, volunteers, physicians, and visitors shop for books, toys, clothing, linens, flowers, and jewelry.

Auxiliary fund raisers contribute to the life of our hospital, and they generate funds the Auxiliary donates for hospital care. Last Thursday Carol Merritt presented the Community General Foundation with a very generous $45,000 check for Community's new Birth Center.

Here is something quite remarkable – the Auxiliary’s gifts to the Community General Foundation’s “Pay it Forward” capital campaign more than equal the gifts from hospital directors and employees. The Auxiliary has contributed $150,000 to “Pay it Forward,” and to date Community's board members, managers, and employees have pledged and contributed some $143,000. That shows just how busy – and just how generous – are the Auxilians.

If you're doing the math, you’ve noticed that the Auxiliary actually predates our hospital. The Auxiliary’s annual meeting was its 42nd. Community General Hospitalwill celebrate its 42nd anniversary on January 1st. Dr. Simon noted that the Auxiliary became active before Community opened when the first Auxilians went door-to-door, inviting others to join them. The newly-formed Auxiliary led tours of the hospital for community groups in the months leading up to Community's opening on January 1, 1963.

The Auxilians are a big part of our hospital’s past and, as is evident, a big part of our present. In my remarks to them, I thanked the Auxilians for their constancy, and I assured them that we who work for Community are grateful for all they do. I promised that, for our part, we will continue to value, care for, and respect each patient, every day.

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.

An old friend

We made a little history this week. The top management team from Van Duyn Home & Hospital sat down with senior management at CGH. It was a “first” for both administrations. None of us at the table could remember when the two administrations met as a group. We are not sure why we never met, but all agreed it’s a good thing to do.

Van Duyn traces its roots to 1827 when Onondaga County established a Poorhouse on Onondaga Hill. During the 1800s the county operated the “poorhouse,” an “insane asylum,” and “the county farm” on acreage that extended to the present Onondaga Community College (OCC) campus. In 1900 the sick residents were separated from the indigent residents, and the County Home and Hospital was established. In 1916 a sanatorium for tuberculosis patients was created on the site Community General Hospital now occupies. In 1959 New York State closed the sanatorium and transferred the buildings and 60-plus acres to Onondaga County (where Van Duyn now stands). The state also deeded the adjacent 42 acres to the Community Fund (for Community General Hospital). In 1954 the County Home and Hospital was renamed to honor Edward S. Van Duyn, MD, its respected medical director. In 1963 CGH opened its doors.

So CGH and Van Duyn have been neighbors on Onondaga Hill for 40 years. People often mistake Van Duyn’s large white façade, visible from Route 81, as Community General. And some visitors to Van Duyn find themselves in the CGH traffic circle wondering why there are no “Van Duyn” signs.

CGH purchased steam from Van Duyn until we built our own steam plant in 1999. Nursing staffs, social workers, and case managers talk frequently as they coordinate care for the many patients we have in common. This past summer Dale Parsons, Commissioner of Long Term Care, and I met several times to discuss road changes being planned for the CGH campus by the New York State Department of Transportation. Once we started talking about roads, we wondered why our management teams never actually sat down together.

The road conversation started because the New York State Department of Transportation (DOT) needs to eliminate the dangerous left turn at Seneca Turnpike as cars exit from the Van Duyn property and from our own “Woods Road.” The state will eventually ban left turns there. The state planned to require all city-bound traffic from Van Duyn to use a new road that would extend from Van Duyn property directly across CGH’s south “G” lot. This would have created a third intersection with CGH at Broad Road.

As you can imagine, our Broad Road neighbors were not very happy to learn of a third intersection with hospital property. That’s when Don Hamilton, a member of the Onondaga Town Council, asked CGH to consider an alternate route on our campus. Mr. Hamilton is also a neighbor. He lives on Elgin Drive and takes walks on the CGH and Van Duyn campus. Mr. Hamilton arranged for us to meet with County officials, and we agreed cars should use the existing traffic pattern, rather than cut a new intersection into Broad Road. As a result, Onondaga County arranged a big meeting with state DOT for officials from CGH, Van Duyn, and the Town of Onondaga. I am happy to say the state DOT accepted the change and has redrawn its plans. The new road will not cut across “G” lot. Instead, the new route will extend from Van Duyn road along the CGH tree line. It will intersect with the existing “G” lot driving lane and will use the existing intersection with CGH’s main road.

This will require DOT construction on our campus as the roads are upgraded to official standards. When construction is completed, the county will assume responsibility for the new route through CGH’s “G” lot and along part of our main road. For the most part, the new road will use the existing traffic pattern, but we will see changes in road construction, corners and signage next year.

As we discussed the road project, Mr. Parsons and I started talking about other things we might work on together. From there it was a short distance to “let’s get the management teams together.” So last Thursday the CGH vice presidents met with the Van Duyn administrative and medical leaders for coffee and cookies and interesting talk. How can we help our patients by facilitating communications about DNR or end-of-life issues? Can we learn from one another on ways to better manage certain costs? What about supply or energy savings? I’m not sure what will come from our talks, but we are actively interested in the things we might do together.

Sometimes you know a person for many years before you really open up to one another and build a friendship. It’s good to see CGH’s friendship growing with our nearest neighbor, Van Duyn.

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.