January 2006

Medical Staff Bulletin

Message from the Chief of Staff

Happy New Year to all the Medical Staff of Yale-New Haven Hospital! I especially wish you good health. We have seen disease unexpectedly strike down several of our number in the last few months and we are repeatedly reminded by our patients of the fragile nature of health.

I wrote several times in the last year about the trials and tribulations of Yale-New Haven Hospital seeking approval to build a new Cancer Center. These matters have continued to command attention in the new year. On January 3, approximately 150 members of the Medical Staff quietly "demonstrated" their concern to our newly elected/re-elected New Haven Board of Aldermen. Serendipitously, we also had opportunity to communicate our concerns to Mayor DeStefano. Two members of the Medical Staff independently catalyzed this visit to the aldermanic chambers. About 40 physicians were expected to come, largely staff directly engaged in cancer care. The large number of physicians and other Medical Staff who attended was surprising, for physicians are generally reluctant to be politically active. I was reminded by one physician that it was our patients and not us who successfully lobbied for legislation to end drive-by births and mastectomies.

The Cancer Center was not on the agenda and Medical Staff members did not speak at the aldermanic meeting. The meeting was largely devoted to the election of a new aldermanic president, for whom support was very evenly divided between the current president, Jorge Perez (from the Hill area) and Carl Goldfield (from Beaver Hills and West Hills). Mr. Goldfield edged Mr. Perez by a narrow margin and expressed confidence that the aldermen will be able to effectively work together.

The next several months will determine if the Cancer Center project lives or dies and the aldermen will play a critical role. The project will die if the politicians, as a condition of approval, demand that the hospital agree to an alternate form of union organizing and recognition (outside of the NLRB-defined process). In a widely-touted incident in Chicago, the Service Employees International Union (SEIU) blocked construction of a small Advocate Health System hospital. However, their power will truly be validated if the Cancer Center is shelved. Academic medical centers in Boston and Houston are closely watching what happens here.

The interests of our community and patients may well be sacrificed to enhance the cause of unionizing health care workers across the country. Ironically, those who will be most disadvantaged by a failed project are the inner-city residents of New Haven who lack the resources to travel to Boston, New York or Houston for the best cancer care. This must be recognized by our aldermen.

Important changes to the Medical Staff Bylaws and Rules & Regulations

In October, the Medical Committee of the Board of Trustees approved a number of changes to the Medical Staff Bylaws and Rules & Regulations. Three significant changes included:

1. University- and community-based members of the Medical Staff are now required to notify the Department of Physician Services in writing of any change in practice location, 30 days before the anticipated practice change date. This should include a statement about new coverage arrangements, proof of malpractice insurance and any change needed in clinical privileges. Individuals who fail to notify Physician Services of their relocation within the required time frame will be automatically suspended pending receipt of the required information. (Eliminated is the requirement to reapply for Medical Staff membership when a University-based member enters practice in the community.)

2. Members of the Medical Staff must be appointed in a primary department/section and may, based upon training and education, have a secondary appointment in another department/section. Members with more than one appointment must fulfill the conference and meeting attendance requirements of their primary department. If the primary and secondary appointments are in sections of the same department, the applicant may fulfill the conference /meeting requirements in either section, with the approval of the chief.

3. For all patients, the attending physician, dentist or podiatrist is obligated to ensure that a daily progress note has been written by a member of the house staff, affiliated staff or other member of the Medical Staff. The attending physician must write progress notes with a frequency that reflects appropriate involvement – a minimum of every other day. When the patient is stable and disposition/placement is the only active issue, the attending must write a progress note at least once a week.

The full text of these changes and complete copies of the Bylaws and Rules & Regulations can be found on the Yale-New Haven Hospital website or by contacting the Department of Physician Services at 203 688-2615.

Performance management update

Below are Yale-New Haven Hospital August performance numbers for the set of measures we report to Medicare and JCAHO each month. You are now well aware of our goal to exceed the national 90 percentile for every measure. Last month, Medicare published our data, as well as the data for the nearly 3000 acute care hospitals that participate in this program, for the July-December 2004 time period on their Web site. How did we compare? All CT hospitals ranked in the upper 50th percentile and Yale-New Haven Hospital ranked above the 90th percentile, overall.

The data appearing below will be seen with next-year’s Medicare web-publish, as well as on other quality-reporting Web sites such as the Connecticut Hospital Association. We can be proud of our performance and many thanks for all the effort by the multitude of groups working to improve on these measures. If you have any questions, please call Dr. Tom Balcezak at 203 688-1343.

August Performance

Caution urged on prescribing medications for family members and friends

For many years, state and federal officials who regulate the prescription and handling of controlled substances have taken the position that physicians and other authorized prescribers may not prescribe for themselves, family or friends. The only exception for family and friends occurs when the prescriber actually has a physician-patient relationship with the family member or friend. Proof of this relationship must be documented in a standard medical record for the family member or friend in the same format as for other patients. Even this exception, however, does not permit a physician to prescribe outside the scope of his/her training and practice. Pharmacies have an obligation to report prescribing patterns that do not seem appropriate – particularly controlled substances both for pain or anxiety.

We bring this to your attention because the Board of Medical Examiners in this state has been regularly disciplining physicians who prescribe controlled substances for themselves, family members and friends. Fines have ranged from $1,000 to $5,000 and are accompanied by a settlement agreement, which appears in the National Practitioner Data Bank.

Refer items for the next issue of Medical Staff Bulletin via phone, fax, e-mail or mail to:
Peter N. Herbert, MD
1063 Clinic Building
P: (203) 688-2604, F: (203) 688-7152
herbertpn@ynhh.org
or
Katie Murphy
Marketing & Communications
GB 443
P: (203) 688-2492, F: (203) 688-2491
Katie.Murphy@ynhh.org

Back issues of the Medical Staff Bulletin:

• December 2005
• November 2005
• September 2005
• August 2005
• June 2005
• March 2005
• January 2005
• December 2004
• November 2004
• October 2004
• September 2004
• July 2004
• June 2004
• May 2004
• April 2004
• March 2004
• February 2004
• January 2004
• January/February 2003
• October/November 2002
• August/September 2002
• April/May 2002
• February/March 2002
• January 2002
• November 2001
• July/August 2001

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Last revised: December 8, 2005 (mv)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.