"We're embedding into our electronic medical records a screening tool for
depression. By the end of 2008, we expect 80% of the primary care patients
to be
routinely screened using this tool.";
City Hospitals Chief Describes 'Activist Agenda'
BY ELIZABETH SOLOMONT - Special to the Sun
August 13, 2007
URL: http://www.nysun.com/article/60353
As a lawyer for the state of New York and the city's housing authority in
the
1980s and 1990s, Alan Aviles championed civil rights and affirmative action.
Now
the head of the city's public hospital system, Mr. Aviles directs a health
care
network that serves 1.3 million New Yorkers, including 400,000 uninsured
patients, guided by the same activist principles.
"I really think the issues of health care access are issues at the forefront
of
this generation's civil rights concerns," the president of the New York City
Health and Hospitals Corp. said recently.
"Some of my friends who have known me a long time, when I went over to
health
care, were sort of surprised by that" move, Mr. Aviles said. "From my
perspective, it's not really that strange or long a trip.";
Created in 1970 as a public benefit corporation, HHC is the country's
largest
public hospital system, with 7,407 operating beds throughout the five
boroughs.
HHC oversees 11 acute care hospitals, including Bellevue Hospital Center,
Coney
Island Hospital, Elmhurst Hospital, Harlem Hospital, Jacobi Medical Center,
Kings County Hospital, Lincoln Medical and Mental Health Center,
Metropolitan
Hospital Center, North Central Bronx Hospital, Queens Hospital, and Woodhull
Hospital. It also runs six diagnostic and treatment centers, four skilled
nursing facilities, and more than 80 community health clinics.
The $5.4 billion corporation employs 38,000 clinical and administrative
staff
members, and it operates a Medicaid managed care plan, MetroPlus, with more
than
250,000 enrollees. HHC officials said they treat more than 1 million
emergency
cases annually, a figure they estimate is one-third of all emergency visits
citywide.
Mr. Aviles, 56, joined HHC in 1997 as an executive at Elmhurst Hospital in
Queens. He was named president of HHC in 2005, and since then, has overseen
the
corporation's five-year, $1.3 billion capital plan to renovate HHC
facilities.
The initiative was launched in 2002 and is underwritten by city bonds.
This past fall, Queens Hospital Center opened its new ambulatory care
pavilion,
and Jacobi Medical Center began operating a new acute care facility, which
features a video telecommunications system in the hospital's operating
rooms. In
2008, three years of construction are scheduled to end with the completion
of a
new 300,000 square foot facility at Kings County Hospital.
Like many in the Bloomberg administration, Mr. Aviles is focused on
technological achievements, including the adoption of electronic health
records
throughout the HHC system. During a recent tour of Elmhurst Hospital, a
556-bed
facility in Queens, Mr. Aviles pointed out a pilot system for an electronic
"white board"; that monitors patient-staff interactions in the children's
department. He also toured the pharmacy department, which houses an
automated
prescription-dispensing machine. "I love this stuff, it's so cool,"; he said
to a
hospital employee.
As a lawyer, Mr. Aviles worked for the state attorney general between 1982
and
1992. In 1983, he was head of the civil rights bureau there when Attorney
General Robert Abrams and the Lambda Legal Defense and Education Fund filed
a
lawsuit against a Manhattan co-op board that was trying to evict an AIDS
doctor
from its West 12th Street building. The discrimination case, which named the
doctor and five patients as plaintiffs, was settled in 1984.
Later in his career, Mr. Aviles served as general counsel for the city's
Housing
Authority from 1992 to 1994. He recently sat for an interview with The New
York
Sun.
Q: Why should the city be in hospital business when we have plenty of good
non-profit hospitals?
A: At the end of the day, I think that many of us in the public hospital
system
would support a move to true universal health care, and at that point,
public
hospitals would have to compete with everybody else. And to some extent,
that's
a trajectory that I certainly feel I put us on. At the same time, it's our
fear
that all of the talk of universal health care coverage isn't truly
universal.
For example, undocumented immigrants generally are not included among those
for
whom universal healthcare coverage is sought. And in a city like New York,
where
40% of the residents are foreign born, and where there are an estimated
500,000
undocumented immigrants, we are the ultimate safety net for the immigrant
communities in New York; we have been since the day public hospitals in New
York
City started operating.
Is care at public hospitals on par with private hospital care?
In the past, quality has always been judged very subjectively, like who made
the
"Best Hospitals" list in Newsweek. Beginning about two years ago, the
federal
government began to actually require the submission of quality data to the
Centers for Medicare & Medicaid Services. If you look at that data for New
York
City, where we have more than 60 hospitals, five of the top 10 performers
are
HHC facilities. Over the course of the last decade, we have taken a system
that
certainly has been known for providing access to many patients who otherwise
might not have access to healthcare services, to one that provides access
that
is of a quality that is equal or better than you can get just about
anywhere.
That is a huge, huge change.
This month, HHC announced it would not distribute baby formula in gift bags
to
new moms in an effort to promote breastfeeding. What was the impetus for the
program, which some have criticized?
The evidence is just so clear that there are significant health benefits for
newborns if they're breastfed. I think there's been a little bit of
misperception that this is simply about removing the formula samples from
the
gift bags. For us, it has been about education and support. Obviously, for
those
moms who can't breastfeed or choose not to, we supply the formula while a
baby
is here and we certainly wouldn't let the mom leave the hospital without a
bottle of formula to take with her. But we really do think its part of our
role
to take an activist agenda, to promote healthy living. It's a mixed message
for
us to be promoting formula by including it in gift bags since hospitals get
free
supplies in exchange for doing this marketing for the formula companies.
The medical community in New York is grappling with a malpractice crisis in
the
form of rising insurance costs, a large number of suits, and high
settlements.
How has the crisis impacted the city's public hospitals?
A fundamental difference between us and many other hospitals is that the
city is
essentially self-funded for malpractice costs, so we don't actually pay
premiums
to cover our physicians or to cover the hospital's liability and potential
malpractice cases. Over the last few years, we have done a lot to change the
way
that we deal with malpractice lawsuits. It used to be handled for us by the
city's Law Department; [as of January] we've taken that in house. We've
brought
on board a professional claims manager that helps us in managing all the
malpractice claims that come in, and that includes investigating them very
quickly so that we know early on whether they're cases that we should try
and
settle or whether they're cases that we should defend to the hilt. So while
the
rest of industry has been under tremendous pressure because of the rising
malpractice premiums, we've managed to buck that trend. Also, our hospitals
have
refined a lot of the patient safety initiatives, and that has manifested
itself
in fewer notices of claims.
What areas has HHC invested in?
One of the things that we've done is to use our electronic records to drive
performance improvement, both in terms of consistent evidence-based medicine
and
in terms of enhancing patient safety. We're embedding into our electronic
medical records a screening tool for depression. By the end of 2008, we
expect
80% of the primary care patients to be routinely screened using this tool.
Something else that we've been able to do is to take the data that is in our
electronic medical records and download specific portions of it. .From that
data
warehouse we run an electronic disease registry. It helps us guide the care
for
diabetic patients. We are a very mission-driven organization, and part of
that
is pursuing an activist agenda, not sitting back passively and waiting for
sick
patients to come to our emergency department. A lot of healthcare is about
access to accurate data in a timely way and how you use it.
What philosophy guides you as head of this system?
I came to healthcare without having a life plan to land here. I went to the
Bronx High School of Science, and I originally assumed that I would be in
the
sciences. Then I went to [Columbia College], and I completely switched gears
and
became an American history major and ultimately wound up going to [Rutgers
School of Law]. I was drawn to law school largely as a kid who grew up in
the
South Bronx, who then went to an Ivy League college and sort of had a keen
appreciation for the inequities that are apparent to somebody who comes from
the
South Bronx and then mingles with kids from the most affluent strata of the
country. I was very interested in issues of social justice so that's what
took
me into the law and what took me into public advocacy. In healthcare, there
are
huge disparity issues that cut across race, ethnicity, and income. And HHC,
as
the largest public hospital system in the country, is sort of the next best
