I remember going [to work] Saturday morning and I said to my husband… “I’m going to go, but I am so afraid”….I thought I was the next one to get [SARS]….’cause all our nurses were falling down.[1]
Those are the words of a nurse from Ontario Province as quoted in a report by a Canadian Commission that has examined the SARS epidemic of 2003. It is a cautionary tale for hospitals and governments about controlling the spread of infection.
The report focuses on two Canadian cities, Vancouver, British Columbia, and Toronto, Ontario. At 4:55 p.m. on March 7, 2003, an ambulance brought a 55-year old man to Vancouver General Hospital. About three hours later, at 7:45 p.m., a 43-year-old man went to Scarborough Grace Hospital in Toronto. Both patients had Severe Acute Respiratory Syndrome (SARS), but the course of SARS contagion was very different in the two cities.
Because the Vancouver hospital followed strict precautions, there was no SARS epidemic in British Columbia. In Toronto precautions were inconsistently used. As a result, 44 people died in Ontario and 375 became sick with SARS. “Of the…people who contracted SARS in Ontario,” says the report, “72 percent were infected in a health care setting….[and] 45 percent were health care workers.”[2] In Vancouver only one health care worker contracted SARS.
This “tale of two cities” demonstrates the importance of proper infection control procedures, including the use of personal protection equipment. It was a “combination of a robust worker safety and infection control culture at Vancouver General….[that] ensured…B.C. (British Columbia) was spared the devastation that befell Ontario.”[3]
I was recently at an out-of-town hospital with a relative, and I saw a very casual use of precaution gowns and virtually no enforcement of gowns for visitors. I was at a meeting this week where a lay person, who had been recently cared for at another hospital, told me stories to me about inconsistent infection control practices there. We know that health care people do not always follow standard precautions, as they should.
Interestingly, the spread of SARS in Canada was mostly within hospitals and not within the community-at-large. The report credits “bold public health efforts and stringent quarantine measures”[4] with stopping the infection in the general community.
At one point, when the epidemic subsided, the Ontario government officially lifted the emergency measures that had been imposed. Here’s what the Commission said happened next:
As soon as the precautions were relaxed…the disease surged back and spread…to patients, staff, visitors, and their families.
Stringent infection control and worker safety precautions, so recently relaxed, were imposed once more. Health care workers donned their N95 respirators and gowns and gloves again. As soon as precautions were reinstated, the disease again subsided.[5]
The value of hospital standard precautions[6] has never been more clearly demonstrated. Vancouver’s precautions stopped an epidemic before it started. Ontario’s inconsistent prevention measures allowed an epidemic to get started and, even after it was brought under control, to start a second time.
Despite the infection control system failures in Ontario, SARS was ultimately stopped, and the report credits the heroism of health workers for this:
SARS was stopped by the front-line workers and the scientists and the specialists who stepped up and who were not afraid to take strong measures that worked in the end.[7]
The SARS report shows the need for a culture of safety, a culture where every hospital worker knows, respects, and follows standard precautions. SARS was not immediately recognized as a new and serious illness. We don’t know the diseases we might face on any given day.
That is why 100% compliance with standard precautions is the way we protect ourselves, our patients, and our families.
[1] Spring of Fear, Volume 1, Executive Summary, The Commission to Investigate the Introduction and Spread of SARS in Ontario. The nurse’s quote is from p. 9. All four volumes of the Commission’s report are available at this web address: http://www.sarscommission.ca/report/index.html
[2] Spring of Fear, Volume 1, p. 12.
[3] Spring of Fear, Volume 1, p. 4.
[4] Spring of Fear, Volume 1, p. 6.
[5] Spring of Fear, Volume 1, p. 6.
[6] Standard precautions are safety measures for all patients who receive care, regardless of a patient’s diagnosis or known infection status, such as hand washing, the use of gloves, masks, and eye protection, face shields, gowns, etc.
[7] Spring of Fear, Volume 1, p. 10
Saturday, January 13, 2007
Saturday, January 6, 2007
Why we have a hot line
In my greeting to each class of new employees, I spend a couple minutes talking about “corporate compliance.” That is the technical term for hospital business ethics.
This month a new federal law requires hospitals and other providers[1] to “teach their employees how to ferret out fraud and report it,” according to a New York Times report.[2]
Corporate compliance policies affect all of us who work at CGH. For example, the arrangements we make with vendors and providers must be ethical and legal. None of us can negotiate or manage a contract for the hospital in a way that benefits himself personally. We cannot steer business to favored parties or people with whom we might have a personal or business interest. Our corporate compliance policies mean none of us can accept a monetary gift for providing services,[3] we cannot disclose confidential information, and we cannot use hospital equipment or supplies for personal use.
Under the new law, it is important for CGH to make sure employees know there are specific laws against Medicare or Medicaid fraud and abuse. Employees have an obligation to report a suspected illegality to their employer or to the government, and they have rights when they do so – such as no retaliation for such reporting. People who report suspected fraud to the government are sometimes called “whistleblowers,” and they have specific rights, as well.
We already have a strong corporate compliance policy, and we are updating it to comply with the new law. There will be changes in the employee handbook , as well.
When new employees join us, I am not the only one talking about corporate compliance. Deb Kurtz also addresses the subject with employees. She is CGH’s corporate compliance officer. She is the person any employee can go to about a suspect activity. Deb Kurtz even operates a “hot line” number – 492-5965 – to make it easy to contact her, anonymously, if you wish. She reports directly to the Corporate Compliance Committee of the Board of Directors.
There is a copy of the corporate compliance policy is in your department. Ask your supervisor to see it, and feel free to ask questions of your supervisor or Deb Kurtz if you think something is not right. If you think something at CGH might not comply with the law or is of questionable ethics, please speak up. Tell your supervisor or report the matter to Deb Kurtz at extension 5965.
[1] “Other health care providers” includes physicians groups, health maintenance organizations, pharmacies, medical equipment suppliers, and home care agencies.
[2] “At Hospitals, Lessons in Detection of Fraud,” New York Times, December 24, 2006.
[3] Employees may not solicit gifts from patients or others, but the Corporate Compliance Policy does permit an employee to accept an unsolicited gift of nominal value, that is, $30.00 or less. See CGH the Corporate Compliance Program Handbook, p. 13.
This month a new federal law requires hospitals and other providers[1] to “teach their employees how to ferret out fraud and report it,” according to a New York Times report.[2]
Corporate compliance policies affect all of us who work at CGH. For example, the arrangements we make with vendors and providers must be ethical and legal. None of us can negotiate or manage a contract for the hospital in a way that benefits himself personally. We cannot steer business to favored parties or people with whom we might have a personal or business interest. Our corporate compliance policies mean none of us can accept a monetary gift for providing services,[3] we cannot disclose confidential information, and we cannot use hospital equipment or supplies for personal use.
Under the new law, it is important for CGH to make sure employees know there are specific laws against Medicare or Medicaid fraud and abuse. Employees have an obligation to report a suspected illegality to their employer or to the government, and they have rights when they do so – such as no retaliation for such reporting. People who report suspected fraud to the government are sometimes called “whistleblowers,” and they have specific rights, as well.
We already have a strong corporate compliance policy, and we are updating it to comply with the new law. There will be changes in the employee handbook , as well.
When new employees join us, I am not the only one talking about corporate compliance. Deb Kurtz also addresses the subject with employees. She is CGH’s corporate compliance officer. She is the person any employee can go to about a suspect activity. Deb Kurtz even operates a “hot line” number – 492-5965 – to make it easy to contact her, anonymously, if you wish. She reports directly to the Corporate Compliance Committee of the Board of Directors.
There is a copy of the corporate compliance policy is in your department. Ask your supervisor to see it, and feel free to ask questions of your supervisor or Deb Kurtz if you think something is not right. If you think something at CGH might not comply with the law or is of questionable ethics, please speak up. Tell your supervisor or report the matter to Deb Kurtz at extension 5965.
[1] “Other health care providers” includes physicians groups, health maintenance organizations, pharmacies, medical equipment suppliers, and home care agencies.
[2] “At Hospitals, Lessons in Detection of Fraud,” New York Times, December 24, 2006.
[3] Employees may not solicit gifts from patients or others, but the Corporate Compliance Policy does permit an employee to accept an unsolicited gift of nominal value, that is, $30.00 or less. See CGH the Corporate Compliance Program Handbook, p. 13.
Saturday, December 9, 2006
I wrote about "rightsizing" before the Berger Commission
In some ways an article I wrote for the Syracuse newspapers three years ago (“Right-Sizing Out Hospitals”) anticipated the work of the Berger Commission. [1]
On November 28 the New York State Commission on Health Care Facilities in the 21st Century, chaired by Steven Berger, recommended the closing of nine hospitals across the state, most of them in New York City – and more significantly, it recommended the restructuring of 48 hospitals – closing about 4,200 staffed hospital beds in all. The Commission also wants to close seven nursing homes and restructure 14 others, leading to a reduction of some 3,100 nursing home beds. All this activity will reportedly save $1.5 billion in health care costs annually.
In our area the Commission wants CGH’s nursing home beds to combine with those of Van Duyn for a total of about 500 nursing home beds. It also wants CGH to assume control of Van Duyn. The Commission did not change CGH’s licensed hospital capacity of 306 beds.
The Commission’s other decision involves Crouse Hospital and SUNY’s University Hospital. The Commission wants them to merge as a private hospital that is not a part of the SUNY system.
As I said in testimony submitted to the State Senate Health Committee on December 1, I support the work of the Commission, and I believe its recommendations are important. However, the devil, as they say, will be in the details of state oversight and assistance. How much money will the state provide and how much flexibility will the state permit as organizations go about implementing the Commission’s decisions? Without adequate funds to plan and invest, the Commission’s recommendations will be impossible to carry out. That is true for CGH and Onondaga County and, I believe, it is true for other institutions affected by the Commission’s decisions.
Most of the local news coverage has centered on the decision to combine Crouse Hospital and University at “approximately 500 to 600 inpatient beds.” [2] Today Crouse and University Hospitals have a combined total of 942 licensed beds, but their combined average daily census is actually 563, according to the CNY Regional Advisory Committee. [3] That is apparently how the Commission determined the 500-600 size.
You may remember that not too many years ago CGH and Crouse Hospital were affiliated under the Health Alliance of CNY. [4] During that time I served as Crouse’s Chief Operating Officer, and as such, I participated in the 2001 discussions regarding a possible merger of Crouse and University Hospitals. I had an opportunity to see first hand the positive potential of a Crouse-University merger, as well as some of the difficulties involved in bringing together these organizations.
After my return to CGH, I wrote an opinion article for the Post-Standard that reminded Syracuse that CGH came into being in the 1960’s as a result of community planning, and I expressed hope that through community planning a Crouse-University medical center might yet be achieved. Headlined “Right-Sizing Our Hospitals,” my article appeared on December 22, 2003.
In that article, I said
[1] The report of the Berger Commission is at this web address: http://www.nyhealthcarecommission.org/final_report.htm
Click on “Final report.”
[2] “Final Report of the Commission on Health Care Facilities of the 21st Century,” p. 91. The Commission’s report, which is 240 pages long, is available at http://www.nyhealthcarecommission.org/final_report.htm For the section on CGH and Van Duyn, see pages 101-103. To see the Crouse Hospital-SUNY section, go to pages 91-93.
[3] Regional Advisory Committees, or RACs, were established to advise the Commission. The Central New York RAC heard presentations by 123 individuals during February-March this year. The Commission also met with 50 providers in the CNY region, some of them more than once. To see the CNY RAC’s recommendations, go to http://www.nyhealthcarecommission.org/final_report.htm and click on “Central” under Appendix 2 - Regional Advisory.
[4] The Health Alliance of CNY (1999-2003) was the licensed parent corporation that appointed the boards of both CGH and Crouse Hospitals. Both hospitals shared a single management team, which was expected to bring about a more complete integration of CGH and Crouse over a period of years. The Health Alliance was derailed by several factors, not the least of which was Crouse’s bankruptcy in 2001. CGH officially resumed operations as a separately licensed hospital in May 2003.
On November 28 the New York State Commission on Health Care Facilities in the 21st Century, chaired by Steven Berger, recommended the closing of nine hospitals across the state, most of them in New York City – and more significantly, it recommended the restructuring of 48 hospitals – closing about 4,200 staffed hospital beds in all. The Commission also wants to close seven nursing homes and restructure 14 others, leading to a reduction of some 3,100 nursing home beds. All this activity will reportedly save $1.5 billion in health care costs annually.
In our area the Commission wants CGH’s nursing home beds to combine with those of Van Duyn for a total of about 500 nursing home beds. It also wants CGH to assume control of Van Duyn. The Commission did not change CGH’s licensed hospital capacity of 306 beds.
The Commission’s other decision involves Crouse Hospital and SUNY’s University Hospital. The Commission wants them to merge as a private hospital that is not a part of the SUNY system.
As I said in testimony submitted to the State Senate Health Committee on December 1, I support the work of the Commission, and I believe its recommendations are important. However, the devil, as they say, will be in the details of state oversight and assistance. How much money will the state provide and how much flexibility will the state permit as organizations go about implementing the Commission’s decisions? Without adequate funds to plan and invest, the Commission’s recommendations will be impossible to carry out. That is true for CGH and Onondaga County and, I believe, it is true for other institutions affected by the Commission’s decisions.
Most of the local news coverage has centered on the decision to combine Crouse Hospital and University at “approximately 500 to 600 inpatient beds.” [2] Today Crouse and University Hospitals have a combined total of 942 licensed beds, but their combined average daily census is actually 563, according to the CNY Regional Advisory Committee. [3] That is apparently how the Commission determined the 500-600 size.
You may remember that not too many years ago CGH and Crouse Hospital were affiliated under the Health Alliance of CNY. [4] During that time I served as Crouse’s Chief Operating Officer, and as such, I participated in the 2001 discussions regarding a possible merger of Crouse and University Hospitals. I had an opportunity to see first hand the positive potential of a Crouse-University merger, as well as some of the difficulties involved in bringing together these organizations.
After my return to CGH, I wrote an opinion article for the Post-Standard that reminded Syracuse that CGH came into being in the 1960’s as a result of community planning, and I expressed hope that through community planning a Crouse-University medical center might yet be achieved. Headlined “Right-Sizing Our Hospitals,” my article appeared on December 22, 2003.
In that article, I said
The much-discussed and much-delayed affiliation between University Hospital and Crouse Hospital makes sense, and a resumption of their collaborative discussions is to be welcomed. This does not minimize the complexities involved or the understandable interests of stakeholders such as unions, faculty, and private practitioners. But the ultimate stakeholders are the patients of Central New York and those who pay for their care.I also advocated that
such an academic affiliation [be] in the 500-bed range. That size approximates the combined effective occupancy of the two hospitals as they exist today, it fosters continued efficiency improvements, and it assures the best and highest use of all existing hospital assets.
[1] The report of the Berger Commission is at this web address: http://www.nyhealthcarecommission.org/final_report.htm
Click on “Final report.”
[2] “Final Report of the Commission on Health Care Facilities of the 21st Century,” p. 91. The Commission’s report, which is 240 pages long, is available at http://www.nyhealthcarecommission.org/final_report.htm For the section on CGH and Van Duyn, see pages 101-103. To see the Crouse Hospital-SUNY section, go to pages 91-93.
[3] Regional Advisory Committees, or RACs, were established to advise the Commission. The Central New York RAC heard presentations by 123 individuals during February-March this year. The Commission also met with 50 providers in the CNY region, some of them more than once. To see the CNY RAC’s recommendations, go to http://www.nyhealthcarecommission.org/final_report.htm and click on “Central” under Appendix 2 - Regional Advisory.
[4] The Health Alliance of CNY (1999-2003) was the licensed parent corporation that appointed the boards of both CGH and Crouse Hospitals. Both hospitals shared a single management team, which was expected to bring about a more complete integration of CGH and Crouse over a period of years. The Health Alliance was derailed by several factors, not the least of which was Crouse’s bankruptcy in 2001. CGH officially resumed operations as a separately licensed hospital in May 2003.
Saturday, December 2, 2006
What the Berger Commission said
The Berger Commission[1] released its report this week after months of confidential deliberations. It calls for the closure of nine hospitals across the state and the conversion, affiliation, or reconfiguration of another 48 hospitals. In all, about one quarter of all New York State hospitals are directly affected by the recommendations – and that includes Community General Hospital.[2]
The report recommends that CGH combine its 50-bed sixth floor, which operates under a skilled nursing facility license, with the 526-bed Van Duyn Home & Hospital.[3] It recommends that the combined entity be controlled by CGH – that is, Van Duyn should be transferred from Onondaga County. And it recommends that the size of a restructured Van Duyn be about 500 beds. Today Van Duyn is licensed for 526 beds, representing about 17% of all nursing home beds in Onondaga County.
The Commission did not recommend any changes in CGH’s licensed capacity of 306 acute care beds.
Van Duyn has been part of Onondaga County for 179 years.[4] In recent years, the County has incurred significant financial losses at Van Duyn. During its budget process last October, the County debated Van Duyn’s role and affirmed it would continue to be part of the government’s responsibility, including its safety net patient services. The Berger Commission wants to see the safety net responsibilities continue at Van Duyn under CGH sponsorship.
The Berger Commission recognizes CGH’s future needs for patient care, including the need for more private rooms. The Commission sees value in “an integrated continuum of care on the campus” involving CGH and Van Duyn and also sees potential reimbursement advantages in such a restructuring. All this, of course, “will require capital (investment) support,” in the Commission’s words.
During the review process, the Commission visited Syracuse several times, meeting with County Executive Nick Pirro and with me. The Commission also visited the campus and toured CGH and Van Duyn. With the encouragement of the Commission, CGH studied options available to the County and to CGH, and these preliminary study results were shared with the Commission and the County.
Onondaga County and CGH work well together. As I said yesterday in testimony for a special hearing of the State Senate Health Care Committee, “Onondaga County is among the best-managed county governments in the state, and its decision-making process is thoughtful and businesslike. Onondaga County has been committed to operating Van Duyn as a public, safety net institution, and Community General has supported that position.”[5]
Because of changes in state law made this year, Van Duyn is expected to return to break-even operations under County sponsorship over the next several years. With an end in sight to its losses, the County wants to keep operating Van Duyn. Both Onondaga County and CGH expected the Commission’s recommendations to require continued work together toward more coordinated care without a change in ownership or control.
However, the Berger Commission recommended changes that would effectively reduce government’s role as a health care provider. For example, it recommended privatizing the hospitals associated with the SUNY medical schools, including University Hospital of SUNY Upstate Medical University. It also recommended that Erie County Medical Center be privatized in Buffalo. In this context, the Commission’s recommendation that Van Duyn become private appears to be part of a philosophical change by state government.
The report raises a lot of questions which no one can answer today. Employees have asked what the report means for the location of sixth floor services, what it will mean if overall nursing home beds shrink by about 75, and what might be the potential impact on employment. It is too early to answer any of these questions, because the planning will take time. First, we have to see if the Commission’s report is rejected by the Legislature.[6] Next, we need to see how soon the state can provide the resources for the necessary business, legal, and financial planning. We also want to know how flexible the state will be in overseeing the complex planning we will have to undertake with Onondaga County and the State Health Department.
With a new Governor in 2007, we can expect many changes in the Health Department, starting with a new Commissioner of Health, yet to be named. It is clear the Governor-elect supports the report of the Berger Commission and has even suggested that the Commission recommendations do not go far enough.[7]
New York State does have funds available to assist institutions like CGH and Van Duyn in making changes. In 2005 New York has established the HEAL-NY program[8] with $1 billion in funds over four years to support hospital and nursing home restructurings, as well as health information technology. Two months ago, the federal government committed an additional $1.5 billion to New York to help close and restructure hospitals and nursing homes. [9]
The Berger Commission represents a significant change in state health care policy. In a short period of 18 months, the Commission studied the entire state, conducted hearings, visited numerous organizations and developed a wide-ranging roadmap for change. We have to give the process time to work, and we have to give the new Administration the opportunity to make changes in state government. For our part, CGH will work forthrightly with Onondaga County and with New York State in doing our best to achieve the ends recommended by the Commission.
As I said yesterday in my Health Committee testimony: “I…respect…the work of the Commission. The Commission members and staff accepted an enormous task. They completed their work in a thoughtful and timely fashion. The report is a positive step towards reform of the State’s health care system.”
[1] Popularly called the Berger Commission after its Chairman, Steven Berger, the Commission on Health Care Facilities in the 21st Century was created in the 2005 state budget process. It began its work in the summer 2005, and a tight deadline called for its final report by December 1, 2006. The report was released on November 28. Patterned after the federal Base Realignment and Closure Commission (BRAC), the state created the Berger Commission so that its recommendations become law unless they are rejected by the Governor before December 5, 2006 or by both houses of the New York State Legislature by December 31, 2006.
[2] Three of Syracuse’s hospitals are affected by the Berger report. In addition to CGH, the report calls for the merger of University Hospital and Crouse Hospital into a single institution in the 500-to-600-bed range. Today Crouse and University Hospitals have a combined total of 942 licensed beds.
[3] The full report of the Berger Commission is available on its website: http://www.nyhealthcarecommission.org/ Click on Download the final report. For the CGH-Van Duyn section, see pages 101-103.
[4] The County Sanitarium, which is now called Van Duyn Home & Hospital, has been part of Onondaga County since 1827. In 1957 Onondaga County deeded 42 acres of the Sanitarium’s property to CGH for the construction of the new hospital, which opened in 1963. In 1979 the Van Duyn Home & Hospital opened as newly constructed 526-bed facility on 65 acres.
[5] For a copy of my testimony before the Senate Health Committee on December 1, 2006, go to www.cgh.org. Click on CGH Family Letter.
[6] “Pataki and Spitzer Back Health Care Consolidation Plan,” New York Times, November 30, 2006: “Gov. George E. Pataki and Governor-elect Eliot Spitzer yesterday endorsed a plan to close or shrink dozens of hospitals and nursing homes across the state. Their support means that it will be up to the Legislature to decide whether to block the proposed downsizings.”
[7] “Berger, Spitzer see more health care cuts coming,” Journal News, December 1, 2006: “The plan to cut the state's health-care system proposed this week…represents merely a start on reductions that need to be made, the chairman of the commission that recommended the cuts said in an interview yesterday. Later, Gov.-elect Eliot Spitzer disclosed that the savings from the plan to state taxpayers from the proposed closings is likely to be minimal. He reiterated that the ‘bloated system’ needs to be further cut.”
[8] HEAL NY stands for the “Health Care Efficiency and Affordability Law for New Yorkers.”
[9] “In Move to Cut Hospitals, U.S. Will Pay New York $1.5 Billion,” New York Times, October 3, 2006: “The Bush administration has agreed to pay New York $1.5 billion over five years to help stabilize the state’s financially troubled hospital industry, state and federal officials said yesterday. In return, the state will move forward with shrinking that industry, cutting Medicaid costs, and sharply increasing the sums it recovers from Medicaid fraud.”
The report recommends that CGH combine its 50-bed sixth floor, which operates under a skilled nursing facility license, with the 526-bed Van Duyn Home & Hospital.[3] It recommends that the combined entity be controlled by CGH – that is, Van Duyn should be transferred from Onondaga County. And it recommends that the size of a restructured Van Duyn be about 500 beds. Today Van Duyn is licensed for 526 beds, representing about 17% of all nursing home beds in Onondaga County.
The Commission did not recommend any changes in CGH’s licensed capacity of 306 acute care beds.
Van Duyn has been part of Onondaga County for 179 years.[4] In recent years, the County has incurred significant financial losses at Van Duyn. During its budget process last October, the County debated Van Duyn’s role and affirmed it would continue to be part of the government’s responsibility, including its safety net patient services. The Berger Commission wants to see the safety net responsibilities continue at Van Duyn under CGH sponsorship.
The Berger Commission recognizes CGH’s future needs for patient care, including the need for more private rooms. The Commission sees value in “an integrated continuum of care on the campus” involving CGH and Van Duyn and also sees potential reimbursement advantages in such a restructuring. All this, of course, “will require capital (investment) support,” in the Commission’s words.
During the review process, the Commission visited Syracuse several times, meeting with County Executive Nick Pirro and with me. The Commission also visited the campus and toured CGH and Van Duyn. With the encouragement of the Commission, CGH studied options available to the County and to CGH, and these preliminary study results were shared with the Commission and the County.
Onondaga County and CGH work well together. As I said yesterday in testimony for a special hearing of the State Senate Health Care Committee, “Onondaga County is among the best-managed county governments in the state, and its decision-making process is thoughtful and businesslike. Onondaga County has been committed to operating Van Duyn as a public, safety net institution, and Community General has supported that position.”[5]
Because of changes in state law made this year, Van Duyn is expected to return to break-even operations under County sponsorship over the next several years. With an end in sight to its losses, the County wants to keep operating Van Duyn. Both Onondaga County and CGH expected the Commission’s recommendations to require continued work together toward more coordinated care without a change in ownership or control.
However, the Berger Commission recommended changes that would effectively reduce government’s role as a health care provider. For example, it recommended privatizing the hospitals associated with the SUNY medical schools, including University Hospital of SUNY Upstate Medical University. It also recommended that Erie County Medical Center be privatized in Buffalo. In this context, the Commission’s recommendation that Van Duyn become private appears to be part of a philosophical change by state government.
The report raises a lot of questions which no one can answer today. Employees have asked what the report means for the location of sixth floor services, what it will mean if overall nursing home beds shrink by about 75, and what might be the potential impact on employment. It is too early to answer any of these questions, because the planning will take time. First, we have to see if the Commission’s report is rejected by the Legislature.[6] Next, we need to see how soon the state can provide the resources for the necessary business, legal, and financial planning. We also want to know how flexible the state will be in overseeing the complex planning we will have to undertake with Onondaga County and the State Health Department.
With a new Governor in 2007, we can expect many changes in the Health Department, starting with a new Commissioner of Health, yet to be named. It is clear the Governor-elect supports the report of the Berger Commission and has even suggested that the Commission recommendations do not go far enough.[7]
New York State does have funds available to assist institutions like CGH and Van Duyn in making changes. In 2005 New York has established the HEAL-NY program[8] with $1 billion in funds over four years to support hospital and nursing home restructurings, as well as health information technology. Two months ago, the federal government committed an additional $1.5 billion to New York to help close and restructure hospitals and nursing homes. [9]
The Berger Commission represents a significant change in state health care policy. In a short period of 18 months, the Commission studied the entire state, conducted hearings, visited numerous organizations and developed a wide-ranging roadmap for change. We have to give the process time to work, and we have to give the new Administration the opportunity to make changes in state government. For our part, CGH will work forthrightly with Onondaga County and with New York State in doing our best to achieve the ends recommended by the Commission.
As I said yesterday in my Health Committee testimony: “I…respect…the work of the Commission. The Commission members and staff accepted an enormous task. They completed their work in a thoughtful and timely fashion. The report is a positive step towards reform of the State’s health care system.”
[1] Popularly called the Berger Commission after its Chairman, Steven Berger, the Commission on Health Care Facilities in the 21st Century was created in the 2005 state budget process. It began its work in the summer 2005, and a tight deadline called for its final report by December 1, 2006. The report was released on November 28. Patterned after the federal Base Realignment and Closure Commission (BRAC), the state created the Berger Commission so that its recommendations become law unless they are rejected by the Governor before December 5, 2006 or by both houses of the New York State Legislature by December 31, 2006.
[2] Three of Syracuse’s hospitals are affected by the Berger report. In addition to CGH, the report calls for the merger of University Hospital and Crouse Hospital into a single institution in the 500-to-600-bed range. Today Crouse and University Hospitals have a combined total of 942 licensed beds.
[3] The full report of the Berger Commission is available on its website: http://www.nyhealthcarecommission.org/ Click on Download the final report. For the CGH-Van Duyn section, see pages 101-103.
[4] The County Sanitarium, which is now called Van Duyn Home & Hospital, has been part of Onondaga County since 1827. In 1957 Onondaga County deeded 42 acres of the Sanitarium’s property to CGH for the construction of the new hospital, which opened in 1963. In 1979 the Van Duyn Home & Hospital opened as newly constructed 526-bed facility on 65 acres.
[5] For a copy of my testimony before the Senate Health Committee on December 1, 2006, go to www.cgh.org. Click on CGH Family Letter.
[6] “Pataki and Spitzer Back Health Care Consolidation Plan,” New York Times, November 30, 2006: “Gov. George E. Pataki and Governor-elect Eliot Spitzer yesterday endorsed a plan to close or shrink dozens of hospitals and nursing homes across the state. Their support means that it will be up to the Legislature to decide whether to block the proposed downsizings.”
[7] “Berger, Spitzer see more health care cuts coming,” Journal News, December 1, 2006: “The plan to cut the state's health-care system proposed this week…represents merely a start on reductions that need to be made, the chairman of the commission that recommended the cuts said in an interview yesterday. Later, Gov.-elect Eliot Spitzer disclosed that the savings from the plan to state taxpayers from the proposed closings is likely to be minimal. He reiterated that the ‘bloated system’ needs to be further cut.”
[8] HEAL NY stands for the “Health Care Efficiency and Affordability Law for New Yorkers.”
[9] “In Move to Cut Hospitals, U.S. Will Pay New York $1.5 Billion,” New York Times, October 3, 2006: “The Bush administration has agreed to pay New York $1.5 billion over five years to help stabilize the state’s financially troubled hospital industry, state and federal officials said yesterday. In return, the state will move forward with shrinking that industry, cutting Medicaid costs, and sharply increasing the sums it recovers from Medicaid fraud.”
Friday, December 1, 2006
My testimony before the State Senate Health Committee
Testimony of Thomas P. Quinn
President and Chief Executive Officer
Community General Hospital, Syracuse, New York
New York State Senate Health Committee
Albany, New York December 1, 2006
Senator Hannon and the Members of the Senate Health Committee:
Thank you for the opportunity to testify before you today. I am Thomas Quinn, President and CEO of Community General Hospital in Syracuse, New York. Community General is a 306 bed community hospital. We also operate an additional 50-bed skilled nursing facility (SNF), attached to the hospital.
Community General and the Van Duyn Nursing Home, a 526 bed SNF owned and operated by Onondaga County, sit on contiguous parcels of land. In the last few years Community General and Van Duyn have begun to take steps to treat those parcels as a common health care campus.
Before I comment on the particulars of the Commission’s report as they relate to Community General, I first want to state my respect for the work of the Commission. The Commission members and staff accepted an enormous task. They completed their work in a thoughtful and timely fashion. The report is a positive step towards reform of the State’s health care system.
The Commission’s report calls for the establishment of a unified governing structure between Community General Hospital’s SNF and Van Duyn Nursing Home, under the control of Community General Hospital, and for the reduction, between the two facilities, of about 75 SNF beds.
Because of our proximity, and ongoing joint efforts, Van Duyn and Community General have had exploratory discussions about the possibility of uniting in some form. We also have discussed other, less encompassing joint activities that would benefit both Community General and Van Duyn. In my own meetings with Commission staff, I discussed the possibility of affiliating with Van Duyn. We at Community General engaged a consultant to undertake an initial review of what affiliated operations would look like, either by close coordination of planning and investment of the two institutions or by combining institutions in some form. Community General also surveyed the legal issues that uniting could present. We did not conclude that a united operation was the best alternative at this time.
Our discussions with Onondaga County, both prior to and since the Commission’s meetings, have been open and productive. Onondaga County is among the best-managed county governments in the state, and its decision-making process is thoughtful and businesslike. Onondaga County has been committed to operating Van Duyn as a public, safety net institution, and Community General has supported that position. We have believed that close collaboration could accomplish the “integrated continuum of care” envisioned by the Commission.
I must tell you that the issues presented by joint control are daunting. They begin with the transfer of a publicly operated facility to private control. Bond covenants need to be respected. Labor contracts need to be examined. Governance and operational issues need to be addressed. But above and beyond all that, there is the issue of finance. Van Duyn has been operating at a substantial deficit over the last few years. My understanding is that Van Duyn expects to operate at a $5 million deficit in its upcoming fiscal year. Community General does not have the wherewithal to fund any deficit, much less a deficit of that magnitude, nor do we have ready access to funds for the technical, business planning, and legal services that would be necessary to address the changes recommended by the Commission.
Obviously, if Van Duyn were placed under the control of Community General, we would expect to introduce operational and programmatic changes to address the deficit. But to even begin that process requires funding. The Commission’s report was released on Tuesday. We have not had a sufficient opportunity to determine how much would be needed in planning and transitional funding. If the Legislature accepts the Commission’s report, Community General would need assurances of adequate state support for this process. Community General cannot allow itself to be weakened by a proposal that is intended to strengthen the delivery of health care.
I would also like to call the Committee’s attention to the special role that the Van Duyn Home has played in Onondaga County. Van Duyn has been the nursing home with a significant safety-net mission. That means that Van Duyn continues to admit a large number of residents on Medicaid-pending status. At best, that presents a significant cash flow problem for Van Duyn’s operation. The Commission’s report calls upon Community General to continue to fulfill that role. That is not an obligation a not-for-profit community hospital should be expected to bear by itself.
Community General Hospital shares a vision with Onondaga County to develop a health care campus from our contiguous sites. We see the advantage of the integrated campus concept endorsed by the Commission. We could foresee joint operations. But achieving this will require time, resources, and a public commitment to support the special role that Van Duyn plays in Onondaga County.
Thank you for hearing my testimony today.
President and Chief Executive Officer
Community General Hospital, Syracuse, New York
New York State Senate Health Committee
Albany, New York December 1, 2006
Senator Hannon and the Members of the Senate Health Committee:
Thank you for the opportunity to testify before you today. I am Thomas Quinn, President and CEO of Community General Hospital in Syracuse, New York. Community General is a 306 bed community hospital. We also operate an additional 50-bed skilled nursing facility (SNF), attached to the hospital.
Community General and the Van Duyn Nursing Home, a 526 bed SNF owned and operated by Onondaga County, sit on contiguous parcels of land. In the last few years Community General and Van Duyn have begun to take steps to treat those parcels as a common health care campus.
Before I comment on the particulars of the Commission’s report as they relate to Community General, I first want to state my respect for the work of the Commission. The Commission members and staff accepted an enormous task. They completed their work in a thoughtful and timely fashion. The report is a positive step towards reform of the State’s health care system.
The Commission’s report calls for the establishment of a unified governing structure between Community General Hospital’s SNF and Van Duyn Nursing Home, under the control of Community General Hospital, and for the reduction, between the two facilities, of about 75 SNF beds.
Because of our proximity, and ongoing joint efforts, Van Duyn and Community General have had exploratory discussions about the possibility of uniting in some form. We also have discussed other, less encompassing joint activities that would benefit both Community General and Van Duyn. In my own meetings with Commission staff, I discussed the possibility of affiliating with Van Duyn. We at Community General engaged a consultant to undertake an initial review of what affiliated operations would look like, either by close coordination of planning and investment of the two institutions or by combining institutions in some form. Community General also surveyed the legal issues that uniting could present. We did not conclude that a united operation was the best alternative at this time.
Our discussions with Onondaga County, both prior to and since the Commission’s meetings, have been open and productive. Onondaga County is among the best-managed county governments in the state, and its decision-making process is thoughtful and businesslike. Onondaga County has been committed to operating Van Duyn as a public, safety net institution, and Community General has supported that position. We have believed that close collaboration could accomplish the “integrated continuum of care” envisioned by the Commission.
I must tell you that the issues presented by joint control are daunting. They begin with the transfer of a publicly operated facility to private control. Bond covenants need to be respected. Labor contracts need to be examined. Governance and operational issues need to be addressed. But above and beyond all that, there is the issue of finance. Van Duyn has been operating at a substantial deficit over the last few years. My understanding is that Van Duyn expects to operate at a $5 million deficit in its upcoming fiscal year. Community General does not have the wherewithal to fund any deficit, much less a deficit of that magnitude, nor do we have ready access to funds for the technical, business planning, and legal services that would be necessary to address the changes recommended by the Commission.
Obviously, if Van Duyn were placed under the control of Community General, we would expect to introduce operational and programmatic changes to address the deficit. But to even begin that process requires funding. The Commission’s report was released on Tuesday. We have not had a sufficient opportunity to determine how much would be needed in planning and transitional funding. If the Legislature accepts the Commission’s report, Community General would need assurances of adequate state support for this process. Community General cannot allow itself to be weakened by a proposal that is intended to strengthen the delivery of health care.
I would also like to call the Committee’s attention to the special role that the Van Duyn Home has played in Onondaga County. Van Duyn has been the nursing home with a significant safety-net mission. That means that Van Duyn continues to admit a large number of residents on Medicaid-pending status. At best, that presents a significant cash flow problem for Van Duyn’s operation. The Commission’s report calls upon Community General to continue to fulfill that role. That is not an obligation a not-for-profit community hospital should be expected to bear by itself.
Community General Hospital shares a vision with Onondaga County to develop a health care campus from our contiguous sites. We see the advantage of the integrated campus concept endorsed by the Commission. We could foresee joint operations. But achieving this will require time, resources, and a public commitment to support the special role that Van Duyn plays in Onondaga County.
Thank you for hearing my testimony today.
Saturday, November 18, 2006
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:
[1] Peter McGinn, President & CEO at United Health Services, Binghamton, NY
• All who make our patients feel welcome, safe, and respected by their thoughtful actions and by the kindness in their voices.Happy Thanksgiving, everyone.
• 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.
[1] Peter McGinn, President & CEO at United Health Services, Binghamton, NY
Wednesday, September 6, 2006
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.
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.
Friday, August 4, 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.
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.
Saturday, July 22, 2006
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
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
Saturday, June 10, 2006
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.
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.
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