What I am thankful for

Each year a colleague of mine at another hospital[1] solicits words of thanksgiving from the workforce, and he publishes their statements of gratitude in a text called “the Thanksgiving quilt.” That patchwork of thoughts, reflections, and aspirations got me thinking about things I am thankful for at CGH. I am thankful for:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Happy Thanksgiving, everyone.


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

The Value of Life

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

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

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

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

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

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

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

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

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

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

[2] This quotation and the other facts and figures are taken from “The Value of Medical Spending,” cited above. You can find this article on the web at this address: http://content.nejm.org/cgi/content/full/355/9/920

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

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

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

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.

Respecting Diversity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sincerely,
Pam Johnson
VP Financial Services & CFO

As valuable as cash

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

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

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

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

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

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

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

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

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

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

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



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

Dr. Prior helps us remember

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

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

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

Within two hours of our arrival the little town [of Noville] had turned into a shooting gallery featuring small arms, machine gun, and tank fire on the main thoroughfare. The large front window of the pub was an early casualty and it was necessary to crawl on the floor to avoid being hit as we treated our increasing number of casualties.

Dr. Prior described the evacuation of casualties from Noville. When the half -track in which injured soldiers were riding burst into flames from tank fire, the wounded returned to the pub. Later soldiers removed the pub’s doors, strapped the wounded on the doors, and tied the doors to the US tanks heading for Bastogne. In the late afternoon, the American column was pinned down by enemy fire.

We treated the serious injuries in the ditches as we waited three hours for the column to move again. Lying in the ditch and having sniper fire chip away at a fence post beside me was a terrifying experience….Many of our enlisted men demonstrated great bravery on the road, pulling tankers from their blazing tanks, driving jeeps with the injured on the hood to our Aid Station.

Once in Bastogne Dr. Prior used a garage as the aid station, but that proved difficult to heat and too small for the growing casualties. So he relocated the aid station to a three-story home. Bastogne had no electricity, no water, no food, and no medical supplies. There were also no doctors so “the civilian population descended on our Aid Station as soon as the Red Cross flag was hoisted – I even did a delivery!” remembered Dr. Prior.

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

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

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

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

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

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

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



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

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

The importance of listening

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

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

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

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

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

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

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

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

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

I had no idea

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

Thank you, 95%

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

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

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

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

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

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

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

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



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

A tipping point

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

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

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

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

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

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

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

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

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

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

Farewell to a dear husband, father and friend.