Merger feasibility

Several weeks ago, I wrote to you about discussions between Community General Hospital and Crouse Hospital. I’d like to update you on these discussions.

The boards of directors of both hospitals have approved a joint memorandum of understanding (MOU) authorizing the hospitals to move forward in their discussions regarding a closer affiliation. Over the last several months, we have had preliminary discussions about working together, with the common goal to create a patient-centered, cost-efficient delivery system.

The MOU outlines a process the two hospitals will follow to evaluate the feasibility of a closer relationship. As part of this process, the hospitals have worked together to select health care consultants to help conduct a feasibility study. This study will include a detailed analysis of the two facilities, as well as a financial, operational, programmatic and regulatory review to identify opportunities for enhanced patient care and increased efficiencies. The feasibility study will begin in early January and be completed during the first half of 2010. The firms selected include Alvarez and Marsal Inc. as feasibility study consultant, and Nixon Peabody LLP as legal counsel. Both firms come highly recommended and have extensive experience within the health care environment.

As previously reported, our discussions continue to be exploratory in nature as we continue with normal business operations. As the consultants begin their work, members of the Community General family may be asked for information to assist them in their research, and I encourage participation. I will continue to keep you informed as discussions continue throughout the coming weeks and months.

Most importantly, I appreciate the dedicated service and commitment to Community General Hospital and to the patient care by all members of the Community General family. My best wishes for a safe, happy, and healthy holiday season and prosperous new year.

Christmas 65 years ago

In 1944 US. Brigadier General Anthony McAuliffe wrote his famous one word response to the German demand that he surrender. He said, "Nuts." The US went on to win the Battle of the Bulge, as it came to be called.

John T. Prior, MD was there, and his memoir "The Night Before Christmas - Bastogne 1944" is one of the more popular postings on this blog.

Dr. Jack Prior, who was the Chair of Pathology at Community for many years, gave me permission to post his memoir.

He was also a brave man. I didn't learn how brave until I read his obituary in November 2007 and learned that he received the Bronze Star, the Silver Star, the Legion of Merit, the Crois de Guerre, and medals from the cities of Bastogne and Metz.

The Battle of Bastogne took place 65 years ago. If you haven't already done so, I suggest you read Jack Prior's reminiscence about it here.

A note from Kristen

Here a nice note from Kristin Schofield, Director of Volunteer Services, to the Community employee family:

I wanted to take just a minute to reach out to those of you who were not able to make the Holiday Lights on the Hill – Light the Logo event. . . .

Our Holiday Lights on the Hill tradition was started in 1983 to give us an avenue to remember. It gave us a way to memorialize someone who was special to us in some way. Some of our lights are given in honor or thanks of a person or event and others as a memorial to someone’s life. Over the years there have been many life lights purchased - 420 of them to date.

Many of lights out there – as you might expect are memorial lights; a light given as a celebration of a person’s life. We have lights from people from all over the hospital. In 1991, Marsha Connor, who was a nurse with us then, bought a life light for her son Navy Lt. Patrick Connor who was killed in the Persian Gulf War and another for his comrade Lt. Commander Barry Cook who was MIA in the same incident. A lot of you, I am sure, remember when that happened. There is also a light for hospital administrator Mark Miller who died here at CGH. Many employees contributed to his light. There are other lights that were purchased for loved ones none of us ever knew. I spoke with an employee this morning and she shared with me that she sees her mom’s life light every time she leaves here at night and it makes her smile. Parents, children, friends and spouses all share a special place on our trees.

Another group of the lights have been given in honor of someone - like a favorite physician. You see lots of docs in the memorial book – Lockwood, Changlai, Watts, Neulander but also lights for their staff and hospital staff like our volunteers, John Carnowski and his security team, the unit secretaries on Maternity and yes, even Tom Quinn has a life light on the tree!

As you can tell, the tree lighting. . . did not start out as decorating for Christmas. It started as a way to remember. To remind us of what is important and to celebrate the people who have meaning in our lives. This year we have moved back to the basics. . . by lighting the two trees out front that are reminiscent of our logo. These two trees were planted for the purpose of accommodating the life lights of the people we cherish. So this holiday season - when we leave here at night – or for some of us that are getting here in the dark - we can take a look at the lights and be reminded of
what they represent. . . .

We continue to celebrate and remember those loved ones you have asked us to light a light for. May this season be happy and healthy for you. Make memories – they are important.

Lights honoring lives

Many of the trees on the campus of Community General Hospital date from the work of the Civilian Conservation Corps in the 1930s. Those trees appear in stylized version on the disc that is part of the hospital's logo.

This week the Auxiliary to Community General Hospital illuminates two of those trees as it holds its 26th annual holiday celebration on December 2.

Tree lights may be sponsored in honor or in memory of someone.

Sponsorships are at the sliver ($25), gold ($50), and life light ($150) levels.

Thanksgiving Quilt

Members of the Community family express their thanks this year for many things. At the top of the list are their families, their friends, their jobs, and their faith. There is much to be grateful for at Thanksgiving time, and the 2009 Thanksgiving Quilt is being displayed throughout the hospital. Click on the following images to enlarge them. Happy thanksgiving, everyone.

My thanks. . .

Two years ago, Community introduced the Thanksgiving Quilt, after I borrowed the idea from my friend Peter McGinn, who was then President and CEO at United Health System (UHS) in Binghamton, NY.

Here is my submission to this year's Quilt:

My thanks to Peter McGinn, who taught us lessons in life and lessons in death with dignity -- and for the gift of "the Thanksgiving Quilt."

Of smoke and fire

This week we began enforcing a new county law that bans smoking within 100 feet of hospitals. I recall when hospitals used to allow smoking within their walls, decades ago.

It was a different time. Smoking was common in hospitals among patients, among hospital staff, and even among doctors. You could see doctors puffing on cigarettes as they made notes in patient charts.

Hospitals (and society in general) treated social smoking almost as if it were a civil right. A doctor's order was needed to keep a patient from smoking.

I smoked. I sat at my hospital desk and puffed away, oblivious to the smoke in the work environment. I remember bumming a cigarette from my boss.

At hospital board meetings each place setting had its own ash tray. Those meetings were filled with cigarettes glowing and pipes flaring.

When the first patients' rights regulation came from Albany, it included the right to a smoke-free room. Imagine that.

When Community General restricted smoking in its cafeteria to a designated area, it was a major upheaval. It was common to hear grousing about smoker discrimination.

Community General was the first Syracuse hospital to ban smoking among patients, and I recall the event that prompted it: a patient set fire to herself.

It was about 6:00 a.m. one morning. A confused patient decided she wanted to smoke. She had no matches because the nurses had taken them in compliance with the doctor's no-smoking order. The patient removed the cannula from her nose and placed it on a blanket, creating an oxygen-rich pocket.

The patient borrowed a cigarette lighter from her roommate, and when she used the lighter, her bed clothes burst into flame. The patient screamed. The nurses responded promptly. They sounded the alarm, and they rescued the patient, using blankets to smother flames that shot from the bed and scorched the wall, all the way to the ceiling.

Hospital engineers in the fire brigade arrived quickly, making sure the fire was out and evacuating smoke from the room and hallway. The fire department complimented our nurses and engineers on their work that day. Their prompt and correct actions saved the patient and prevented harm to others.

That single episode clarified what was at stake --the increased risk of fire that smoking posed for patients and for all of us in hospital buildings.

Since then, of course, there has been broad recognition of the dangers of smoking. More than fire, those risks include ambient smoke.

Thanks to the new county law, smoking has now been pushed farther from hospital walkways and entrances. There are, however, still far too many smokers, including health care workers, and the evidence of that is just 100 feet down the sidewalk.

- - -

I used some of the information above in a somewhat different form in a letter to employees on October 4, 2003.

Enforcing the County law against smoking

Yesterday - "The Great American Smokeout" - was the first day Community General and other Syracuse hospitals began enforcing Onondaga County's new law that bans smoking within 100 feet of a hospital.

At Community the smoking ban extends across the 42-acre campus. Visitors are permitted to smoke only in a single designated area, located 100 feet from the Diagnostic Center building.

Remembering John McGraw

The editorial on hospital affiliation

Said The Post-Standard last week:

. . .[T]here is renewed talk of affiliation between Crouse and Community General, and such talk deserves to be encouraged. . . .

The two hospitals should be able to find ways to benefit from closer association, both in containing their costs and fulfilling their missions.

Here's the link to the newspaper's editorial.

Register online for "Wine & Wildlife"

There still time to sign up for the "Wine and Wildlife" party this Friday at the Rosamond Gifford Zoo at Burnet Park.

You can register online for this fund raiser by the Auxiliary to Community General Hospital. Tickets are $35 apiece in advance ($40 at the door).

Center for Orthopedics nears completion

There's been great progress on Community's Center for Orthopedics, now under construction as 36 private rooms on the hospital's sixth floor.

Sheet rock has been installed, room finishes are in progress, tile is on bathroom walls, and flooring and millwork is about to stat.

The design is by King & King Architects and the construction manager is Heuber Breuer Cosntruction.

With the work more than 60% complete, we are looking for patient occupancy as early as February 1.

HealthGrades rates Community the number one hospital for orthopedic surgery in New York State.

H1N1 and health worker vaccinations

I am pleased to say that 90% of the employees at Community General Hospital have been vaccinated against the seasonal flu. That's a high proportion, and it should help protect our patients.

Vaccinations against the H1N1 (swine) flu started several weeks after the seasonal flu vaccine arrived, and to date about 50% of Community's employees have received the H1N1 vaccine. The Infection Control and Employee Health Departments are following-up with employees, and we are hoping for a higher vaccination rate.

When the New York State Department Health mandated flu vaccine for heath care workers, there was a fair amount of controversy, resulting in a lawsuit and a temporary injunction. With H1N1 vaccine in short supply, the state has since rescinded its mandate but promised to introduce permanent regulations to require vaccinations for health care workers in the future.

Given the state controversy and the mass media stories about the vaccine safety, some people may have second thoughts about the H1N1 vaccine.

Yesterday the Washington Post reported that 98,000 people have been hospitalized so far with H1N1 flu, with more than one-third of them under age 17. Of the 3,900 deaths from the H1N1 flu, fully 75% have been in adults between the ages of 18 and 64. This is different from the experience of seasonal influenza, in which 90% of the deaths typically occur in those 65 years of age and older.

There are risks to every medical procedure, of course, but the Centers for Disease Control and the Food and Drug Administration report the H1N1 vaccine to be safe, and these agencies say the benefits of the H1N1 vaccine “will far outweigh the risks.” For a review of vaccine side effects, as well of the risks of the H1N1 flu itself, go to the CDC’s “General Questions and Answers on 2009 H1N1 Influenza Vaccine Safety.”

I urge everyone who is able to be vaccinated against the H1N1 virus.

Foundation gala raised $310,000

There were more than 600 guests at last week's "Jeans and Jewels" Gala at the Hotel Syracuse -- all in support of the Community General Foundation.

The Gala raised more than $310,000 for Community General Hospital, making it the most successful such event in the Foundation’s history. That amount includes the generous $50,000 gift from the Auxiliary to Community General Hospital.

That's Auxiliary President Dottie DeSimone dancing with husband Jeffrey DeSimone, MD, a general and bariatric surgeon.

My special thanks to the 2009 Gala Committee and its co-chairs Jim Barger, Key Bank senior vice president (at left, in photo), and Mark Re, vice president and general manager of Gallinger RealtyUSA (at right). Through their committee's hard work, more than 60 companies, event patrons and donors helped the Foundation achieve its record-setting results.

Leadership sponsors for the 2009 Gala included the Community General Hospital Medical Staff; the International Brotherhood of Electrical Workers Local #43; the Laboratory Alliance of Central New York; the Pepsi Bottling Group; Bond, Schoeneck & King, PLLC; and the Bristol-Myers Squibb Co.

Honored at the Gala were the FamilyCare Medical Group, PC; Burns Bros.; along with three former hospital board members: William Burrows, Donald Dew, and John Morrissey, Jr.

It was a great evening as guests, who combined evening attire with blue jeans, enjoyed Pascale’s Catering and three choices of bands: Prime Time, the DeSantis Band and Andrea Miceli Trio.

As one party-goer commented, "This event makes a prestigious affair feel like a fun of a night with friends."

New TV spot today

INFOMERCIAL Community General Hospital "Health Grades Awards" from Solon Quinn on Vimeo.

Here's the new television spot about Community General Hospital's HealthGrades awards. It premiers today during the Syracuse -Akron football game at 3:30 p.m.

Full disclosure: The spot is by 7053 Productions, the production company owned by Solon L. Quinn, my son.

Top honors in orthopedics, maternity & prostate surgery

For 2009/2010, HealthGrades has awarded Community General its Orthopedic Surgery Excellence Award, one of just two hospitals in New York State so designated.

HealthGrades gives its five-star honors to Community's total hip and total knee joint replacement surgery, to the back & neck surgery (for spinal fusion and for surgeries without fusion), and to our repair of hip fractures. Community has received the highest honors in orthopedics for five consecutive years – recognizing the excellence of our growing orthopedic service. A new Center for Orthopedics will open on Community's sixth floor early next year.

Community also gets HealthGrades' top honors in Maternity Care, one of 21 New York hospitals to receive its Maternity Service Excellence designation.

With the busiest robot-assisted surgery in Syracuse, Community is also the only Syracuse hospital five-star rated in prostate surgery.

My thanks and congratulations for these honors goes to Community's physicians and nurses, and to the supporting staff. Working together they have helped achieve (and increase the number of) high marks we receive.

Considering the changes ahead

Over the summer, Community General Hospital began working with FTI Consultants, a national firm, to assist with strategic planning to help us prepare for changes associated with health care reform. We have recently provided the results of FTI’s research to our Board of Directors and to the Medical Executive Committee. Our planning activity will continue this fall.

Among the options presented by our consultant is the development of a collaboration with another hospital, and Crouse Hospital has been identified as our leading potential partner.

Independent of our planning process, Crouse Hospital has worked with its own strategic planning consultant (a national firm called Sg2), and its planning has identified Community General as a potential partner. Consistent with these results, I have held preliminary discussions with Dr. Paul Kronenberg, President & CEO of Crouse Hospital, regarding the potential community benefits of working together.

The fact that Community and Crouse are talking again may seem surprising, given our past, unsuccessful relationship in the Health Alliance of CNY (1999-2002). However, the health care world is different today with new regulatory and financial pressures on hospitals and doctors, and there are important reasons for looking at ways we might work together, as well as important lessons to be learned from our past experience.

The progress each hospital has made since 2002 is noteworthy. For example, HealthGrades has awarded Community its five-star service designation for several years, while Crouse was named “Business of the Year” by the Greater Syracuse Chamber of Commerce and has been the recipient of a “Human Resources Excellence – Employer of Choice Award” from the Central New York Chapter of the Society for Human Resource Management. In addition, both Community and Crouse were named “Top 100” most improved hospitals by Thomson Reuters.

To date, our discussions have been exploratory, and both hospitals will continue with normal business operations. As discussions progress, recommendations will be developed for the Board of Directors, and we will involve physician and clinical leaders.

Community General's physicians, employees, and volunteers are dedicated to advance health care in Central New York that is high quality, safe, compassionate, and cost effective. That has not, and will not, change.

The limited vaccine supply

The photo is from the flu vaccine clinics at Community General Hospital.

To date, some 85% of Community’s employees have been vaccinated against seasonal flu. That’s a significant number, but we have not yet reached 100%, as required by the New York State Commissioner of Health.

Yesterday a State Supreme Court judge issued a temporary restraining order that bars the State Commissioner from mandating flu shots for hospital personnel. Stay tuned.

Although we received all the seasonal flu vaccine we ordered, our order was placed long before the Commissioner mandated 100% vaccinations. Because of the mandate, the vaccine use rate is greater than expected, and this has reduced the amount of vaccine we have available for the general community.

Each year Community General provides flu vaccinations for workers at dozens of local companies. Because of the higher vaccine rate this season, we will be far short of the supply needed for these companies.

In addition, other hospitals reportedly do not have enough vaccine even for their own staffs to meet the 100% directive.

Because the supplies of seasonal flu vaccine are limited, we notified the Onondaga County Health Commissioner that, after we comply with our flu plan and the state mandate, we will transfer the limited amount remaining to the County for its redistribution based on priority community needs.

We have also informed area companies about the vaccine supply problem. They are not happy, understandably so. The companies have a heightened awareness of influenza risk this year, and their employees have been counting on Community’s annual flu shots. I am sorry we will not have the vaccine for our company flu clinics, as planned.

With respect to H1N1 (“swine flu”), Community received a supply of the vaccine last week, and vaccinations for medical staff, employees, and volunteers begin October 22.

Flu vaccines for health care workers are a patient safety issue. By protecting ourselves, we confer a measure of protection on the vulnerable patients in our care.

Civil liberties v. mandatory flu shots

"I just don't like to have somebody tell me what to put in my body. . . .My biggest concern is my civil liberties."

That, according to The Post-Standard, is the opinion of a registered nurse who works at another Syracuse hospital. The nurse is referring to a new state policy requiring all hospital staff to have the flu vaccine. [1]

The mandate becomes effective November 30, when flu vaccinations are required for anyone working in a hospital ("paid or unpaid") with direct patient care responsibilities. The mandate also includes hospital personnel “whose activities are such that they pose a risk of transmission of influenza to patients or to those who provide direct care to patients.”

In an open letter to health care workers last month, Dr. Richard Daines, New York's health commissioner, said:

[T]he facts are very clear: the welfare of patients is, without any doubt, best served by the very high rates of staff immunity that can only be achieved with mandatory influenza vaccination – not the 40-50% rates of staff immunization historically achieved with even the most vigorous of voluntary programs.

Dr. Daines is referring to the phenomenon of herd immunity, about which I wrote last year. The "herd effect" is typically achieved at high levels of immunity, say, 80% or more. A source of justifiable pride: last year Community's employees achieved an 85% flu vaccination rate on a voluntary basis, possibly the highest number in the state.

What is the responsibility of a hospital employee to take all reasonable precautions to prevent the spread of infection among patients? Are a citizen's individual rights subordinate to the individual's responsibility, when working in a hospital, to minimize health risks for patients?

In the case of the influenza, Dr. Daines is squarely on the side caregiver responsibility: “We as health care workers need to put patients’ interests ahead of our own preferences,” he said, according to The Post-Standard.

A similar thought was expressed last month by a physician at Community's medical executive committee. Following a brief discussion about the state's vaccination requirement, the doctor observed: “The regulation…represents a game change," he said, "in which there is no right for a caregiver to expose a patient to additional risk.”

Flu shots are not the first such mandate for hospital staffs. New York has long required hospital workers to be immunized against measles and rubella as a condition of employment. The state also requires each of us in a hospital to have an annual tuberculosis test.

I am happy to report that, as of last week, 1,092 of Community's employees, physicians and volunteers have been vaccinated against the seasonal flu. More flu clinics for hospital staff are scheduled, as we willingly comply with the state's patient safety requirement.

My thanks, especially, to hospital volunteers, who are covered by the regulation, as they roll up their sleeves for the good of patients.

- - -

[1] In a letter dated August 26, 2009, the State Department of Health cited an “emergency regulation” of August 13, requiring vaccinations of all hospital personnel. The regulation applies to both seasonal flu and the H1N1 (swine) flu vaccines.

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).

Huddled masses

When hospitals restricted smoking some years ago, there was an unintended side effect.

Banning smoking on a hospital campus (such as at University Hospital) pushed smokers into huddled masses on public walkways just outside hospital jurisdiction. The result was a cloud of tobacco smoke - and an obstacle course - through which patients and visitors had to travel going to and from a hospital.

Thanks to a new county law, no smoking will be allowed within 100 feet of a hospital or its property. The bill was introduced by County Legislator Tom Buckle, passed by the legislature, and signed into law last week by County Executive Joanie Mahoney. Effective November 1, the law will be enforceable by a $50 fine.

With its large campus footprint, Community General has been able to keep smokers away from its entrances and adjacent walkways for years. The county law will allow the city hospitals to keep their walkways free of smokers, as well.

The honorees

The Community General Foundation will bestow special honors October 23 at its annual gala at the Hotel Syracuse.

Honored for its service to community will be Burns Brothers, represented by its President and CEO, David Burns (at left).

For medical service to community, the FamilyCare Medical Group, PC, will be honored, represented by its President & CEO, David Page, M.D. (at right).

Recognized for their service to Community General Hospital will be three past members of the Board: William Burrows, a retired partner from Bond Schoeneck & King, LLP (top photo, in the series, below) ; Donald Dew, Sr., past President & CEO of Diemolding Corporation (middle, series); and John "Jack" Morrissey, a retired partner from Mackenzie Hughes, LLP (bottom, series).

With corporate offices in Syracuse, Burns Brothers provides industrial piping services, including plumbing, heating, ventilation, and air conditioning systems throughout the northeast. The company was founded in 1901 as a family business, and today its companies include Burns Bros. Contractors, Inc. (mechanical construction), Burns Cascade (industrial supplier of pipe, valves, fittings, and control and instrumentation products), and Burns Bros. Fabrication/Modular Systems. Burns Brothers has been a generous donor to Community General Hospital.

Founded in 1994 as a merger of eight small practices, FamilyCare is today the largest primary care medical group in Central New York with some 60 physicians, plus mid-level practitioners, practicing throughout Central New York. Among its diversified services, Practices Resources, LLC, is the group's wholly-owned subsidiary, offering billing and management services to dozens of independent medical practices throughout Upstate New York.

The past hospital directors served during the 1970’s and 1980’s. Mr. Burrows was a hospital director from 1974 -1984, an officer from 1985 – 1998, and a director of an affiliated company from 1998- 2005. Mr. Dew completed three full terms as a director from 1987 - 1996. Mr. Morrissey served as a director from 1981-1987, was an officer in 1988-1989, and served additional terms as a director from 1989- 1997.

The three directors have a combined service to Community General Hospital of 56 years!

Congratulations to all.

It's a blog world, after all

I recently wrote about the blogs by hospital CEOs. Well, Nurseblogger has expanded my vision with its list of “top 50 hospital blogs.” CEOs, nurses, and physicians are blogging. Check out the list.

Claire Wightman,a volunteer for 36 years

Featured in CNY Magazine (below) is Claire Wightman, a volunteer at Community General Hospital for 36 years.

Yes, 36.

Claire has logged 17,166 hours of volunteer service at Community. If you’re counting, that is the equivalent of 8 ¼ years if she were a full-time employee. But she is not an employee. Claire volunteers her time and concern to help patients and employees. And in the process, she shares her interests and her energetic, engaged, and positive outlook with everyone.

Claire is also a long-standing member of the Auxiliary board of directors. She was honored last year by Community’s volunteers for her exemplary service.

It’s great so see you recognized, Claire, in the larger Central New York community.

'Test drive' the daVinci robot on Sep 28

With the American Cancer Society and Lance Armstrong's Livestrong Foundation, Community General Hospital will host a prostate cancer awareness event on Monday, September 28 at 5:00 p.m. in Suite 1D in the Physician’s Office Building-South.

The free event will feature Drs. Po Lam and Andres Madissoo, who diagnose and treat prostate cancer. Both surgeons are fully credentialed in use of the daVinci surgical robot.

Those attending the event will actually be able to "test drive" Community's daVinci robot. To attend, call the physician referral line at 315.492.5940.

Not all men with prostate cancer are candidates for surgery. There are other treatment options, including hormonal therapy, radiotherapy, and "watchful waiting." For those who are surgical candidates, the daVinci robot represents the state of the art for prostate surgery.

September is prostate cancer awareness month.

September 11

We mourn still. We mourn anew.

Community generosity

Congratulations to Dr. Tom Welch[1], the faculty, staff, and administration of the new Upstate Golisano Children’s Hospital – and to the hospital's donors. The new Children's Hospital is pictured below.

Today’s story in The Post-Standard reports on the generosity of the community in raising funds for the new hospital:

The children's hospital at SUNY Upstate Medical University opening Thursday may be named after its biggest benefactor, businessman B. Thomas Golisano, who donated $6 million. But the new facility is as much a testament to the generosity of more than 8,000 donors, many of whom conducted grassroots fundraising in their neighborhoods, schools and workplaces.

The grassroots donors gave $15 million, the largest community-based capital fundraising haul in Syracuse history.

In a letter to The Post-Standard today, Dr. Welch acknowledges the leadership of Mary Ann Shaw, who chaired the Children’s Hospital fund drive.

I was reminded of the role played by Leonard Markert, Sr. in another hospital fund campaign – it was conducted some fifty years ago, and it built Community Hospital on Onondaga Hill, shown under construction in the photo, above.

Like the Children's Hospital fund campaign, the one that built Community Hospital was broad-based, and it too surpassed the goal.

On June 6, 1958, the Syracuse Herald-Journal[2] reported the Community Hospital Fund exceeded the $6 million goal by nearly $1 million. The paper quoted Carl Maar[3], who commended Mr. Market for campaign leadership, calling him

a man in a hurry whenever there’s a job to be done for the good of his neighbors. Long since, he has earned the admiration and affection of his townsmen. In this enterprise, the most ambitious civic undertaking in the life of the community, he has earned new distinction as a truly great citizen.

Under Mr. Markert’s leadership, that Community Hospital Fund had 15,000 donors and raised $6,963,954, as of June 1958. In today’s dollars, that is the equivalent of $51,892,527![4]

As we salute the Central New York generosity in funding the Children’s Hospital, I recall the past generosity for Community Hospital. Thanks to Mary Ann Shaw and to the 8,000 donors who assisted her, and remember with gratitude Leonard Market, Sr., and the 15,000 donors who assisted him in 1958.

----

[1] Dr. Welch, a professor and chair of the Department of Pediatrics at SUNY Upstate Medical University, is the medical director at Children's Hospital.

[2] The Syracuse Herald-Journal has since merged with The Post-Standard.

[3] Carl Maar was Community Hospital’s first board chairman, 1957-1966.

[4] The current value of the Community Hospital's 1958 fund drive was estimated by the consumer price index (CPI) calculator from the Department of Labor.

More hospital CEOs in the blogosphere

A mention of this blog on Social Hospital alerted me to blogs by the CEOs of other hospitals and systems. Here is the list and the links:

Let's Talk Health Care Bruce Bullen, CEO of Harvard Pilgrim Health Care, Wellesley, MA;
Hospital Life by Marty Bonick, CEO of Jewish Hospital, Louisville, NY;
McLeod Health by Rob Colones, CEO of McLeod Health, Florence, SC;
SJMC World by Scott Kashman, CEO of St. Joseph Medical Center, Kansas City, MO;
Running a Hospital by Paul Levy, President and CEO of Beth Israel Deaconess Medical Center, Boston, MA;
Todd's Perspective by Todd Linden, CEO of Grinnell Regional Medical Center, Grinnell, IA; and
Roper on health by Bill Roper, CEO of Univ. of North Carolina Health Care System, Chapel Hill, NC.

It's great to see the expanding CEO presence in the blogosphere. A quick check suggests that Paul Levy is still the master in both quantity and quality of his posts, present company included.

I've added these CEO blogs to the "suggested links" list in the right panel.

"Please read – all the way through"

Some three years ago, Peter McGinn told his colleagues about a Canadian pilot who died from a hospital-acquired infection. He copied the man's obituary in an email sent to the management staff at United Health Services (UHS), where Peter was President and CEO.

“Someday,” Peter wrote, “we may look back at this (obituary) and say it represented a tipping point in public consciousness.” He advised his managers: “Please read this very carefully – all the way through.”

It was typical of Peter to stay in touch with his managers, to bring them relevant information that might help them understand or perform better, to bridge the human and the technical.

Last Monday Peter died at Massachusetts General Hospital from complications of amyloid disease. The disease had damaged his heart, and he was in Boston for a possible heart transplant.

On Saturday he wrote:

I learned yesterday that the amyloid disease has infiltrated my lungs. I cannot safely or successfully have a heart transplant.

In the meanwhile, I have been kept alive with high doses of heart medication and kidney dialysis. We are going to stop the treatment soon. After that, my heart is not likely to continue to work. . . .

My family is here. We’ve had a chance to talk with each other. I am at peace with what comes next. I have been so moved by the expressions of support and the outpouring of prayers that I cannot begin to convey the comfort that brings me as I go to my next step.

While in Boston, Peter kept in touch with family, friends, and colleagues using CaringBridge, a website for communications and support during illness. His first journal entry was February 21. When he died 178 days later, his journal had been visited some 9,000 times. That’s an indication of the people who were touched by his life and his leadership.

Peter was a PhD psychologist, and throughout his career at UHS and at Johns Hopkins University Hospital, he was always a teacher, a colleague, a coach, and a friend. When he retired from UHS two years ago, he formed Leadership Impact, a management consulting firm.

On Sunday his nurses organized a picnic for Peter and his family, a last time together in the sun. After returning to his room, Peter declined his medications and said goodbye to the doctors and nurses who had cared for him.

This is from the last entry in the journal, written by his wife and daughters on Monday:

When we remarked to him that we were touched by his generous spirit even now, he said the important part of being kind is to share specific, meaningful details about what people mean to you. It was one last lesson he was able to teach us.

Reforming the system

Suppose we want to reform the transportation system. Where would we start?

Would we begin with bridge repairs, fuel costs, or alternative energy? Would we consider incentives or taxes on rail, ship, airline or truck traffic? How would we reduce accident rates – by changing vehicle design or operator behavior? What about licensing criteria or insurance costs? Could we address the comparative value of different modes of transportation? What percentage of the nation's economy should be devoted to transportation?

The reform analogy, of course, applies to the "health care system." It sounds straightforward enough, but reforming the "health care" involves many different sectors – industries in themselves, really – sectors that function in technical ways and involve a web of risk, referral, production, regulation, and financing connections.

This is why the advocates (and opponents) of health care reform talk about so many different things. There are many things.

Consider:

▪ Extending insurance coverage to the uninsured ("access,” “universal health care,” and "the public option"),

▪ Aligning financial incentives involving doctors and hospitals ("quality improvement," "patient safety," and "efficiency"),

▪ Controlling the cost of government entitlements ("affordability"),

▪ Paying for additional coverage by taxing employer-paid health insurance benefits ("affordability"),

▪ Mandating insurers to cover preexisting conditions ("access"),

▪ Authorizing payments only for services proven to be clinically effective ("review board," "rationing" and "affordability"),

▪ Limiting the resources used by individuals in the final six months of life ("quality of life," "rationing," and "affordability"),

▪ Expecting lawmakers to use any public plan they create for others ("fairness" and "quality"),

▪ Increasing payments for primary care specialists ("access"), and

▪ Developing better ways to manage chronic conditions ("prevention" and "affordability").

The list goes on.

It's no wonder people are talking past one another. It is no wonder people are concerned about the feasibility of trying to do so much all at once.

All health care is local

Atul Gawande’s compelling article for the New Yorker, “The Cost Conundrum,” discussed variations in health care system performance throughout the country. Such variations are apparently related to differences in medical and hospital practices. Dr. Gawande’s point: using relatively more health care in one part of the country does not mean patients are necessarily receiving better care or experiencing better outcomes. In fact, the reverse may be true.

That’s good news if the health care legislation now being debated in Washington finds ways to improve care and costs in inefficient medical geographies without penalizing areas where medical care has already achieved greater efficiency and effectiveness.

For over two decades the Syracuse hospitals have worked together through the Hospital Executive Council (HEC) to help improve acute care services. That’s a message the CEOs of Syracuse hospitals delivered last week when we met with Rep. Dan Maffei to explain our relatively better performance within New York State.

We showed Congressman Maffei the Syracuse area's lower discharge rate. A low discharge rate means fewer patients are being cared for in hospitals – the most expensive place for care – in proportion to the overall population. The point is made by comparing the discharge rates per 1,000 population among New York metropolitan areas, based on 2007 data. [1]

You can see that Syracuse is among the more efficient medical markets, about one-fifth more efficient than top utilizing areas, New York City and Utica.

Discharged Patients per 1,000
Oneida County (Utica) – 113.3
New York City (New York) – 101.8
Erie County (Buffalo) – 99.3
Albany County (Albany) – 90.7
Monroe County (Rochester) – 82.5
Onondaga County (Syracuse) – 84.2

The Syracuse area has also done a better job in managing the time patients remain in hospitals. The mean length of stay among Syracuse hospitals -- at 5.37 days -- is about one-tenth below the highest area (New York).

Mean Length of Stay
New York City (New York) – 5.93
Erie County (Buffalo) – 5.68
Monroe County (Rochester) – 5.62
Albany County (Albany) – 5.56
Oneida County (Utica) – 5.42
Onondaga County (Syracuse) – 5.37

The combination of lower per capita utilization and lower lengths of stay gives Syracuse hospitals fewer patient days per 1,000 population. This means that aggregate hospital capacity is more efficiently utilized. By “aggregate capacity” I mean the productive resources acute care hospitals employ, such as the patient rooms, medical equipment, professional and support staffing, and medical-surgical supplies.

Compared with areas of higher capacity utilization, Syracuse hospitals are about one-quarter more efficient.

Patient Days per 1,000 Population
Oneida County (Utica) – 614.2
New York City (New York) – 603.7
Erie County (Buffalo) – 563.9
Albany County (Albany) – 504.4
Monroe County (Rochester) – 463.7
Onondaga County (Syracuse) – 452.4

Some may question with shorter hospital stays are Syracuse patients being readmitted more frequently? The answer is no.

Through the HEC, the hospitals are participating in a demonstration of new software (developed by the 3M Corporation) that examines all patient data to determine readmission rates for the portion of the patient population that is at risk of being readmitted. [2] Based on 2008 data, the readmission rate for Syracuse hospitals is one-quarter below the expected rate.

Former Speaker of the House Thomas “Tip” O’Neill famously said, “All politics is local.”

As it happens, so is health care.

-----

[1] Prepared by the Hospital Executive Council, the data include medical, surgical, pediatric, and neonatal discharges. Source material: the New York Statewide Planning and Research Cooperative System (SPARCS) for resident discharged patients and the New York Statistical Information System for the state population.

[2] According to the HEC, potentially preventable readmission (PPR) software from the 3M Corporation examines the numbers of patients with at least one return to hospitalization within 30 days for non-elective reasons. The readmissions are identified when they are clinically related to the initial hospital admission. The data are statistically adjusted for differences in severity among hospitals and regions.

Upcoming events

Jeans and Jewels Gala

The fall gala will be Friday, October 23, 2009 at the at Hotel Syracuse.

For more information, including ticket and sponsorship information, visit Community's website.

Auxiliary Wine and Wildlife

This new wine tasting event will be Friday, November 20, 2009 at Rosamond Gifford Zoo.

For more information, including ticket and sponsorship information, visit Community's website.

The r-word

The r-word is not “reform” as in health care “reform.” It’s health care “rationing.”

An argument for explicit rationing was made by Peter Singer in a recent New York Times Magazine (July 19). A Princeton professor and native Australian, Singer says the US should establish a treatment effectiveness review board to decide if Medicare (or any national payment system) should cover costs associated with specific medical tests and treatments.

On July 23 Peter Orszag, the White house budget director, was quoted in the New York Times as saying America needs “an independent commission that would measure the efficiency of specific medical providers and practices.”

Just the other day in the Wall Street Journal (July 30), there appeared an op-ed article by Myrna Ulfik, arguing against such a federal health review board. Ms. Ulfik, a cancer patient, said that to survive she must have “the freedom to choose my insurance, my doctors, and get the diagnostic scans and care I need.” Implicit in the freedom to choose, of course, is the ability to commit a government (or other third party) to paying the cost associated with such choice.

Ms. Ulfik argues that a government commission should not limit an individual's health care decision-making. Poignantly she says, "I am still here because my care was managed by doctors — not a government agency. My doctors do what the bureaucracy can’t: They see me as a human being.” By still "here" Ms. Ulfik means still "alive."

Ms. Ulfik's argument accords with that of the rabbi, as quoted by Dr. Singer: “if you put one human life on one side of a scale, and you put the rest of the world on the other side, the scale is balanced equally.”

"Patient-as-person will be a lost concept under the new health-care plan," writes Ms. Ulfik, "where treatments will be based not upon individual patient needs, but upon what's best for everyone."

Dr. Singer asserts that the government already weighs human life in economic terms. The Department of Transportation, he says, "sets a limit on how much it is willing to pay to save one human life. In 2008 that limit was $5.8 million." He cites a similar value set by the Consumer Products Safety Commission. I have written about the value of life in a previous post.

How does one balance the appraising decision-making of Dr. Singer against Ms. Ulfik's moral imperative? Interestingly, such decisions may depend upon the part of the brain that’s doing the thinking.

Josh Green, a Harvard professor, has studied how the brain “lights up” under MRI examinations when individuals consider specific moral questions, such as how to balance the good of many against an individual good.

Dr. Green says moral decisions apparently emanate from different brain regions. When the ethical choice is, in effect, an accounting exercise (the greater good for the greater number, as in Dr. Signer’s argument), the brain reaches its decision in the region “behind the eyebrows.” When the moral problem is resolved by asserting basic human values, the decision apparently comes from deep within the brain, involving older brain structures that we share with our primate cousins. Dr. Green talked about this in 2006 on a WNYC radio science show called Radio Lab.

Considered morally, an individual life may have infinite value. This is how the life is seen by the individual, by the family, and by caregivers. They know, and worry about, and care for the individual person. When considered from the viewpoint of the government, however, a single life may have a finite value.

The government's job is to achieve the best results from limited resources. That is why it can train and send soldiers in harm's way. That is why it can set limits on health care spending. What are those limits? That is what the debate about health care reform is all about.

Of interest this summer

Here are interesting notes for the summer.

First
The newest OB/ GYN physician on the medical staff at Community General Hospital was himself born at Community.

Last month Fadi Makhlouf, MD, joined the staff and the medical practice of Howard Weinstein, MD, and Edith Westphal, MD.

With offices in Liverpool and downtown Syracuse, the practice provides OB/ GYN services for women in Onondaga and Oswego counties. Dr. Makhlouf's medical degree is from St. George’s University School of Medicine, and his residency training in obstetrics and gynecology was at the University at Buffalo. Dr. Makhlouf is a junior fellow of the America College of Obstetrics and Gynecology. Before he returned to Syracuse, Dr. Makhlouf was with OB/GYN Associates of Ithaca, NY.

Second
Last week 10 college interns at Bristol-Myers Squibb delivered “positively pink” packages to the Wellspring Breast Center at Community General. The packages include educational and inspirational materials to help women combat breast cancer.

The students toured Wellspring and met with its staff to learn more about the services available at the Wellspring Breast Center.


Third
This month Community welcomed 38 junior volunteers who are with us during the summer, helping others.

These area high school students are volunteering more than 250 hours each week through early September. They are from Fabius-Pompey, West Genesee, Marcellus, Baldwinsville and Fayetteville-Manlius high schools.

As they assist others, the young people get to see first-hand the variety of health careers. They are volunteering in departments such as the diagnostic center, radiology, pharmacy, physical therapy and Wellspring Breast Center.

Welcome to all!

The memorial service

On June 24 more than 70 attended a memorial service for two employees: Wendy Ryan, who passed away on May 28, and Toni Long who passed away on May 30. Each died suddenly, and their colleagues at Community General Hospital were shocked and saddened at the double loss.

Wendy Ryan was a registered nurse on the orthopedic floor, a part of the Community family for 26 years. Toni served as a respiratory therapist for 33 years -- she was also a respiratory clinical instructor at Onondaga Community College for 18 years.

At the memorial service, fellow nurses and family members read scriptures and paused to remember and celebrate their lives spent helping others. The service was conducted by the Rev. James Carey, who has long been associated with the Roman Catholic Diocese chaplaincy program at Community General.

Douglas Smith of the Food Service Department wrote a poem to honor the memory of Toni Long. Doug asked me to read his poem in memory of both employees at the service.

She gave
Until she had nothing
Left to give.
Sharing her own;
To give knowledge and life.
Now in a better
Place.

- Douglas P. Smith
June 9 2009

200th robot-assisted surgery

At 7:45 a.m. on June 1 Myron Luthringer, MD, performed the 200th robot-assisted surgery at Community General Hospital.

This makes Community's robot surgery program the fastest growing -- and the largest -- in Syracuse NY.

This new surgery has been developed safely and effectively, thanks to the surgeons and the robot team. Community's director of robot-assisted surgery is Po Lam, MD. He has performed the most cases to date, followed by Dr. Luthringer. Jennifer Marsiale, MD (in the photo), and Andres Madissoo, MD, have also been credentialed for this type of surgery, and other surgeons are in the process of becoming so.

Congratulations to Community's surgeons and the robot team.

Today's photo on the blog

Part of the fun is the banter.

I bantered a lot yesterday on the first hole at the Shenendoah Golf Course at Turning Stone Resort during the 25th annual Pro-Am Golf Tournament of the Community General Foundation. It turned out to be the Foundation's most successful tourney ever, netting some $110,000.

That makes it one of the top charity golf events -- if not the top -- in Central New York. And in this tough economic environment, that's saying something.

The tourney's success comes from great supporters of Community General Hospital -- the doctors, the businesses, and the individuals. It comes from a great Foundation Board, chaired by Scott Matukas; from great team participants and professional golfers; and from a great staff lead by Community's John Zacharek, Vice President - External Affairs.

Each foursome was paired with a Central New York PGA member. That means the amateurs played alongside pros with the interplay adding real value for the players during their five or six hours on an excellent course.

So there I was at the first hole, thanking all the players, making sure they got a gift memento of the day, and watching as team photos were taken. The picture-taking, as you may imagine, generated a fair amount of good-natured ribbing. Some exaggerated their golf accomplishments, some teased about shots-gone-horribly-wrong, and a few playfully lied about their names to Dan Cameron, who was snapping the pictures.

When David Northrup of Team Merrill Lynch challenged me to put the photo in Community's main lobby, I told him I wouldn't promise the lobby but he shouldn't be surprised to find the team on the web Saturday morning.

That's David, on the left, with his teammates Frank Pfau, Richard Neal, and John Redmond. They finished 10 under par in best-ball competition. In the center is PGA member Rob Phelps of the Onondaga Golf & Country Club. At two under, he tied for second place among PGA players yesterday afternoon.

The CNY PGA site has results of the morning flight for amateurs and pros, as well as the afternoon amateur and pro scores.

Thank you, everyone, for supporting a great cause on a great day.

Testing surge capacity

Community General Hospital tested its emergency preparedness this week when 20 “accident victims” showed up in the emergency department for a first-of-the-kind state exercise.

"Victims" arriving at Community General Hospital

The Exercise Plan (ExPlan) tests a hospital's surge capacity (at least 20% above typical emergency patient volume).

The ExPlan will be required for New York State hospitals in 2010, and Community was the first hospital to test the exercise for the Department of Health (DOH).

A "mass casualty" victim entering the ED

That screaming in our ED came from some of the high school students who played "victims" of a mass casualty event, complete with moulage (makeup simulating wounds). Exercising their vocal chords was part of the verisimilitude.

The training scenario, developed by the State Department of Health, activates a hospital's incident command system, allowing the hospital to practice its its ability to triage victims, to treat them, and to prepare the entire hospital, including surgery, for the influx.

Triaging a "victim"

It was a learning experience for all of us, and we certainly appreciate the help of the DOH in developing the significant resources needed to prepare, conduct, and evaluate this exercise.

Community's incident command center