Bristol Hospital Annual Report 2005

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Taking a closer look at Bristol Hospital

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Bristol THospitail

a SAINT FRANCIS Care Partner

Sincc 1919. Bristol Hos;rital has plor,iclccl quality health calc to thc (ircatct' Bristol conrnrunity. Its chicl' rcsl-ronsibility is prcsc'rving lil'c ancl caring lbr thc' sicli. To oLrr stafl. no nrission is nrolc critical.

OLrr.job is to culc lilr'patients n'ith highll' udr uncccl cclLripnrcnt aucl thc nrost soplristicatcd lucilitics in thc lulca. Our' 1-rrioritics rcnrain clcar:

pulicnts lncl liuriIics. cnrplol'ccs. plry'siciuus.'l'ltat husn't chltngctl. )rrr soul is to hur c []r'istol Flospitll \liln(l ()trl ltr lr lit'sl-elrtss rtrrlttlltttlil-r

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lrospitul lrnrl nothing clsc. Ttr lcleh this goltl. ric arc constalrllv cr altratirrg thc clrrality o1'our scrviccs lroru u clinicll pcrspcctir c in closc i:ool.lcnrlion ri ith thc urcclical stall'. lntl lionr thc conrnrunity's pcrspcclir c throrrgh our' paticnt ancl conrnrtrnitl, sLll\

cvs. []r'istol llospital continr,rcs to

bc u lcarlcr in hcalth carc, continually strir ing to irlplove ancl crpancl our' sclviccs to llrcct the rteecls ol'otrt conrnr rrn itr'.

PnESTDENT,S MTSSAGE

Foundation n-let or exceeded their fiscal goals. Only the hospital underperformed. Despite these struggles we retain a healthy balance sheet with promises of better days ahead.

Already, we have begun to climb

Thomu.s D. Kennecly,

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t would be a pleasure for all of us if I were able to inform everyone that the adverse fiscal experience

that we reported a year ago was a one time anomaly and that Bristol Hospital & Healthcare Group had returned to its long tradition of net operating gains. That pleasurable experience will have to wait. Fiscal year 2005 was as economically troublesome as 2004. Several of last year's culprits were tamed. while others continued to vex us. Of course. there were new ones to cornplicate our situation as well. In summary, we confronted Medicare rate changes of only a fraction of luh. we faced another doubling of our pension expense, and we experienced nursing shortages that constrained our growth. These three items account for almost all of the operating loss for the year. The only real source of fiscal relief for hospitals across America, and ours in particular, is patient volume, but even this source of assistance was absent in 2005. In a positive vein, the nursing home, the practices and the Development

back towards profitability. The nursing recruitment efforts for the past six months have made up for all of last year's attrition and more. Since July 2005 more than 20 registered nurses have joined our ranks, including several returns to the family. We are committed to shaking off the sense of concern tl-rat has haunted our workforce wliile we retooled for budgetary reasorls and have initiated the new programs of connectivity between the organization and it employees that has made us one of the best employers in the State in the recent past. The workforce of tl-ris century demands a voice in the conduct ofbusiness and we are engaged in that effort. At this l'r'lonlent, the employees are poised to do their part. We also have dissected our various lines of business down to the most finite of levels to target our growth towards the sectors with the best value to our operations. These opportunities are being promoted to our broad referral base ofphysicians and our community. Lastly, we have committed ourselves to elevate the relationship between tl-re r-r-redical community and the hospital to a superior level and to assist our physicians with the responsibility of managing clinical outcomes and length of stay. There is no indication that anything will be easy, but the path is clearly marked.

It is critical however that no one stop reading here. Because, although strong fiscal perfonrauce is imporlanl. it must never detract from tl-re mission of any not-for-profit organization, especially one dedicated to healthcare services. It is, after all. the sole reason that we exist. We are always all about patients and their needs. So often we allow ourselves to be corrsumed by the work of the accountants who focus our attention on the business of hospitals, not the work we do. George Lynn, the retiring Chairman of the American Hospital Association, drilled this notion into the audience that gathered for his induction into that office last spring. In our community it is about Dr. Suzanne Powell, one of our pediatric hospitalists, clinibing into our arnbulance and managing the ventilations of a frightening ill child being raced to Hartford; it is abor"rt Sopliie Whitlock, R.N., one of our home care nurses. valiantly managiug a patient resuscitation in a home while the EMS crew raced to the scene; it is about Mark Rouleau, RN, one of our nurses from TeleNr-rrse, who, following his shift, drove to a patient's home after his last call of the evening to relieve his pain from a plugged catheter. It is about thousands of acts of compassion, professionalism, and skill that happen around the clock at your community's hospital. As our local United Way taught us several years ago, "That's what matters," and I think they are right.

There are a few things that rnust be mentioned. This annual report introduces the renovated approach to

paticnt carc quality oversight ancl review tlrat has tal<en holcl over tlre

All of us wlro hacl a hancl in crafiing this answcr arc proucl of its ncrv bc_r:innings ancl carly sllcccss.

Wc carnccl or"rl tlrircl national awalcl in the past sir years as finalist for thc Monloe E, Tror-rt Prenrier Cales Awarcl.

Daniel Scoppetta. M.D., c'rur Chief of Stal'l- l-ol tlrc pirst trvclrc yclrls. is stcpping dorvu ancl rvc applaucl all of his acconrplishr.ncnts in this mlc. Dan rvas in this rolc throu-9hout thc vcly best yeals of the Blistol Hos;lital expast year.

perience.

And to closc. aflcr cightccn ancl thrcc quartcr ycars. this is my frnal contlibution the Bristol Hospital & Hc'althcarc ()rou1-r cxpcricncc. I anr leaving rvitlr the absolute celtainty that

this cournrunity ancl this ht'rspital are vastly bcttcr- off bccausc of thc worl< of thosc rvhon.r I havc lccl ancl lovccl firr so long. To all of those who havc laborecl besicle nrc in pursuit of thc clreanr of a llrst class conrnrunity hospitaI" cougratuIations. you havc' one.

llri,:tttl Ilo,::ltilttl wu.t tttttttt,t/ ottt' of ottl.t .si.t tttrtiortul .lirrulist,t /itr tltc l-l't' .lrttttttl lllortnta E. Tntrrt Prt'nriL'r'('urt'.t.luurul fitr iLt Breu.sl Haullh uul ('olott ('uut at' Pnt jatl.s ul lltc ltt't'tttit't' (.ut't"s (iot t't'ttuttta Edtttttlitttt (' t f i' rL' rt t t' i rt P lt r tt' i.r i u,lu rt u rr I ( )( ) 5. t

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CHruRMAN'S MESSAGE move to its new, 9,000 square foot clinical space last fall will allow this CARF-accredited program to accommodate its continuing growth.

Tlre Connecticut Gastroenterology Institute. under the clirection of Dr. Salam Zakko, continues to do cutting-edge research in the field of gastroenterology. We are extrernely proud of the arrival of the new state-

of-the-art. wide-bore MRI. which was brought in-house in early 2005.

We will contirrue to make the best

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community's qLrality of life can be judged by r-nar-ry features - schools, libraries, recreation, transportation, and healthcare services. Our community shor"rld be quite proud of the luxury of havirrg arr outstauding coururuuily hospital such as Bristol Hospital. The results ofa recent attitude survey helped reinforce the community's

commitrnent to Bristol Hospital as its prirnary source for health care needs. This vote ofconfidence will ensure our slrccess as we look to the future. Bristol Hospital's first-class reputation, supported by an exceptional group oftalented physicians, a dedicated and comrritted clinical staff and strong liospital management, should reassure the community that no one needs to leave the area to receive quality care.

Despite some of the finar-rcial challenges that were f-aced this year, the Board of Directors witnessed a number ofgreat successes. The Connecticut Spine and Pain Center's

strategic investr-nents as we advance our clinical technology in the future.

We must stay focused on keeping pace with an ever-growing number of new technologies that provide faster, urore accurate diagnoses and save lives.

Plans for the upcoming year will iuclude the remodeling and expanding of our emergency department to better serve the more than 36,000 patient visits each year. We are excited to anrlounce the expansion and relocation of our Oncology Department to the

main floor of the liospital, which

will begin in early 2006. The investments in these areas will better accommodate the quality of care that our patients need and expect from us.

Our partnership with Saint Francis Hospital and Medical Center has matured over the years and continues to provide additional clinical strength in a number of key areas, including oncology, advanced cardiac care, diabetes and rheumatology.

Bristol Hospital operates within a complex relationship between trustees, physicians, employees, payers,

patients. vendors, the community. and otlier health care organizations. But, there is no doubt tl-rat relationships with physiciaus are central to ollr success. We need to cortlintre to strengthen the focus ol.r ollr partnersl-rip with physicians by taking deliberate steps to build these strong relatiorrslr ips. ident i lyinq conllron ground and cultivating a spirit of partnership. The success of this partnership with physicians will also have a powerful effect on our ability to retain the talented staffof employees who interact with these physicians daily.

The future will be challenging.

However, with the cooperative efforts of our physicians, the clinical staff, employees and management tean1, Bristol Hospital will continue to be the outstanding community hospital that it is today. Responsible health care costs, qLrality health care services and patient satisfaction are the hallmark of onr cor-nrnitment.

CHIEF OF STNTT COMMENTS

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Duniel J. Scoppettu, M.D. s ury tenure as Cliief of Staff coures to an end, I can't help br-rt look back with trer.nendous pride at the accomplishr-nents that Bristol Hospital and the medical staff have made over the last twelve years.

One of the largest accomplishments that I have witnessed during my tenure is, witliout question, the opening of the Perioperative Center. It has helped r-rs corrtinue to recruit outstanding nredical lalenl to our organization.

And, our 9Stlr percentile ambulatory surgery patient satisfaction scores tell us that the comrnunity is delighted with the Center, as well. Aside from the rnany technological improvements and efficiencies that this new building provides, the positive irnpact that the new Center has had on the physicians, the clinical staff, and more importantly, the patients, cannot be underestimated. The completion of this project has allowed us to support the growth demands and keeping pace with medical advancements.

I ani delighted to report that our Hospitalist prograrn has matured to where it is today. At a time when rapid response is so important, our in-house physicians ale able to provide 24-hour, 7-day-a-week response as a service to cornmunity physicians and their patients. And" the addition of our Pediatric Hospitalist progranl ensures thal otrl youngesl palients carr rer.nair.r close to home for inpatient medical treatn-leut. I comltrend our community pediatricians, obstetricians and anesthesiologists for their tremendous collaborative efforts in supporting these vital programs. We believe tl-rese prograrrs are improving the quality of care, bringing increased efficiency to reduce the tir-r-re a patient spends waiting for testing, results and specialist visits, this increasir-rg both patient and staff satisfaction.

each day. We are working hard to develop a culture of safety at Bristol Hospital, such that our processes are focused on improving the reliability artd salety of care lor orrr palients.

Strong leadership on the part ofour medical staff, hospital manager.nent and our Board urust dernolrstrate this organizational goal. We have made tremendous strides in irnpler-nenting safety guidelines that target the prevention of medical el'rors, as well as setting quality iltrproveurent goals that measure the care of patients with specific conditions, such as heart failure. I r-r-rr-rst comurend Dr. Jim Sayre and his colleagues who serve on tlie Medical Staff Quality Review Committee whose efforts are highlighted on page 9 of this report.

Medicine, Internal Medicine.

Pediatrics and our Pediatric Hospitalist

I would like to recognize Drs. Carlos Badiola and Larry Levine for their support in their leadership positions on the Medical Staff's Executive Comntittee. I would like to congratulate and welcome Dr. Valerie Vitale on her recent election as the new Cliief of Staff. I pledge to provide whatever support she may need in her role to continue advancing the vital work of our medical staff.

prograrn, Rheurnatology, and Pain Management. We must also recognize the significant contributions of three of our distinguished physicians, Carl Bomar, Jose Mendoza, and Vittorio

I am grateful for the trust and the confidence that you have placed in me during my years as Chief of Staff. I leave this role knowing that, despite

I am amazed at the caliber of ruredical talent that continues 1o join our medical staff. The medical staff expanded tliis past year witlt the addition of a number of new physicians, enhancing the specialties of Anesthesiology, Emergency

Mirabelli, who retired this past year.

The medical staFf continues to improve the delivery of high quality, patient focused care, despite the challenges that we face in our industry

the challenges that we have faced over the years, the medical staff has remained sleadfast in ils commitnrent to providing the best possible care to our community. I can assure you that

this commitment will not change.

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OuR CoMMITMENT To AALITY for our patients ^-\, uality of careettort.

Lnanges I 1,, u .onrrunt ctlnrcal tecnnology and rn \rr

tr"uiht ,t, mean

that we must have

methods to continually review our processes, look for trends and share best practices with others. Long before outside organizations began requiring hospitals to submit reports related to quality, Bristol Hospital's medical staff and hospital leadership led the quality effort with our own initiatives for detecting, tracking and

eliminating medical errors. Just as our focus with customer service is to be

- this same culture of excellence applies to our clinical skills.

the best we can be

At Bristol Hospital quality data is shared and reviewed as a regular

discipline. Numerous staff members and committees, including the Quality Assurance Committee of the Board of Directors, the Quality Assurance and Compliance Departments, and the Medical Peer Review Committee, have been assigned responsibilities for gathering and assessing information about our processes. We believe that

a rigorous performance improvement program will have a dramatic affect on

the healthcare of our community, and our organization is committed to the highest levels of performance.

Bristol Hospital participates in a number leading-edge voluntary efforts regarding quality in itiatives.

We are particularly proud of our decision to participate in the Institute for Healthcare Improvement's (IHI) 100,000 Lives Campaign, which is an initiative to engage U.S. hospitals in a commitment to implement changes in care proven to improve patient care and prevent avoidable deaths.

Initially launched in December 2004,the 100,000 Lives Campaign is the first-ever national campaign to promote saving a specified number of lives in hospitals through the implementation of proven, evidencebased practices and procedures.

These include deploying rapidresponse teams at the first sign

of patient decline; which we are doing under the direction of our hospitalists, delivering evidence-

based care for patients with acute

myocardial infarction; implementing medication reconciliation - listing and evaluating all of a patient's drugs to prevent adverse events; and using science-based methods to prevent central line infections, ventilatorassociated pneumonia and surgical site

infections.

Bristol Hospital measures results with monthly mortality data reported on a quarterly basis and made available on IHI's website. Our commitment to this important initiative demonstrates that we are implementing important changes in health care delivery by attacking the problem in the best of ways -- by focusing on system improvements based on evidence.

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r MnDtcAL Srnr-r Qtnlrry

RrvrEW CoMMtrrrE

arly in 2005 the Medical Staff Quatity Review Committee was

'organized and endorsed by the Executive Committee of the Medical Staff and Board of Directors. The function of the Medical Staff Quality Review Committee is threefold:

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To assist the individual physician in assessing the quality of their function.

This allows the physician to identify opportunities for and obtain guidance to improve performance. It allows for documentation of quality care for scrutinizing entities.

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James Sayre, MD

Stephen Caminiti, MD

Armann Ciccarelli

Conmittee Chair

To assist the departments

in evaluating performance, organizing peer review, evaluating the effectiveness of peer review. evaluating the CQI and CME programs for the department, and

providing this necessary information for effective leadership

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To assist the institution in documenting the quality of care delivered at Bristol Hospital and evaluating some key aspects of the effectiveness of leadership of the

Howard Dubin, MD

Lawrence Levine, MD

Wendy Latshaw, MD

Medical Staff As a standing committee of the Medical Staff, the Medical Staff Quality Review Committee is responsible to and reports to the Executive Committee of the Medical Staff and to the Quality Assurance Cornmittee. The ultimate goal

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and vision of this committee is

to demonstrate superior care and continued quality improvement by Bristol Hospital physicians.

Suzanne Powell, MD

Antonio Scappaticci, MD

ChristopherWakem, MD

As Bristol Hospital continues to face the growing challenges of balancing our mission and our services with the need to make ends meet, we still have a strong commitment to our mission services. We believe that they are part of being a community

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hospital. A full-service community hospital serves as the health care safety net, providing basic health care services for those in need. No matter what, or when, we are there.

During these challenging times. we must do everything well, but a few areas are clearly ofhighest importance. We must continue to be successful at growth in these key areas, programs which we hold with great pride and strive to earn the support of our community and our local physicians. Our key areas for growth include the oncology program, the pain management program, orthopaedic surgery, gastroenterology services, diagnostic imaging, maternity and gynecology surgery services.

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2005 Plroc r{AM H rc; r{ Lre i{TS Pediatric Hospitalist Program In 2005 Bristol Hospital was one of the only community hospitals in Connecticut to launch a 24 hourll day a week pediatric hospitalist program for our young patients. This program was developed through a collaborative effort between Bristol Hospital's Pediatric, OBiGYN and Anesthesiology Departrnents.

Our pediatric hospitalists are all Board-certifi ed pediatricians with advanced training in neonatal resuscitation, advanced pediatric life support, and lactation consultation.

They uranage pediatric patienls in all inpatient areas of the hospital, especially in Bristol Hospital's Farnilies Are First unit, where they can provide imniediate care for newborns.

They also provide Emergency Department consultations and oversee pediatric diagnostic procedures. This prograrn provides convenient access to high quality pediatric care in our community and allows children to remain close to home for inpatient medical treatment.

Connecticut Gastroenterology Institute

psychologist who specializes in the treatment of pain, a specially-trained

Since the Connecticut

physical therapist, and a staffof almost 30 employees to support this CARF-accredited program.

Gastroenterology Institute at Bristol Hospital opened in 2003, Dr. Salam Zakko and his team of medical researchers continue to thrive in the environment the hospital has provided.

Groundbreaking clinical research is being conducted in the field of gastroenterology and patients are being provided with access to stateof-the art diagnostics and therapeutics long before such treatments are available for general use. For example, we were the first hospital in the area to offer PillCam ESO, the camera-in-a pill that allows doctors to evaluate and diagnose diseases of the esophagus, including GERD or chronic heartburn, esophagitis and Barrett's esophagus, a pre-cancerous condition.

The Bristol Hospital Center for Diabetes 2005 saw the opening ofthe new location for the Bristol Hospital Center for Diabetes from the Bristol Hospital Wellness Center to 102 North Street, Bristol. This Saint Francis Care Center of Excellence offers the latest in medical care and comprehensive self-management education and training for people with diabetes and their farnilies.

This program holds the coveted and prestigious American Diabetes Association (ADA) Education

Recognition Certificate for a quality The Connecticut Spine and Pain Center at Bristol Hospital We proudly celebrated the relocation of the Connecticut Spine and Pain Center to its new, 9,000 square foot location on Level D in Fall 2005. The program has grown to six pain management specialists, a

diabetes self-management for its individual, group and gestational education programs.

Rehab Dynamics For nearly twenty years, Rehab Dynamics has been a leader in providing cornprehensive, full service

rehabilitative services. Recently, the decision was made to changc thc mauagelrent of Rehab Dynamics fi-orn HealthSouth to Bristol Hospital.

The focus has shifted frorr that of a large, corporate-run business to a corrrururrity-hascd olgarrizatiorr with thc goal of providing the best local rchabilitative care available.

Rehab Dynamics is a full-service. hospital-baseci, mu Iti -faceted -9roup of nine physicaltherapists, five occupational therapists. an athletic trainer, two massage therapists ancl a speech therapist. alon-u with a physical therapy assistant and various other integral support staff. As a service of Bristol Hospital. Rehab Dyuamics is accrcclited by thc.loint Commission on the Accreclitation of Health Care Organizatior.rs (.lCAHO ).

This certification ensures a level of competency anc'l high standards not

found at all rehabilitation and sports medicine centers and sets us apart fi-orn othel outpatieut practices.

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MRIArrives at Bristol Hospital Bristol Hospital saw the arrival in February 2005 of its new, state-ofthe-art magnetic resonance imaging

door to new imaging applications that will improve the diagnosis of disease throughout the human body.

(MRI) scanner that is described as a breakthrough tool for the diagnosis of

IDX Goes Live Bristol Hospital underwent a technological transition in documentation with the first phase of the IDX CaTeLINK system in January 2005. Lab results and transcribed reports, such as History and Physicals,

disease.

The Signa@ Infinity with EXCITETM systeln is capable olacquiring diagnostic information signifi cantly faster than other MR systems. It enables physicians to irlprove the diagnosis of a wide range of conditions, including cardiac and vascular disease; stroke; abdominal and brain disorders; and musculoskeletal conditions in the knee, shoulder and other joints. This scanner also reduces the length of MRI exams and will make exams rnore cornlortable for patients. especially those who have difficulty holding their breath during certain procedures.

This new MRI replaced Bristol Hospital's mobile unit and provides much more convenience for patients and families. This system opens the

Discharge Summaries, Operative Reports, and Diagnostic Imaging and Cardiology reports, are now available in CaTeLINK to be viewed by physicians on-line. These reports come directly from the Lanier system and can be signed by a physician's E-Signature. Nurses are documenting medication administration, allergies and heights and weights and all orders are being entered into CaTeLINK by nursing and ancillary staff. The next step will be to implement a Computerized Physician Order Entry (CPOE) system. The future prospect of CPOE is an exciting one for Bristol Hospital by allowing us to move forward technologically, with a primary focus on patient safety.

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HealthStream@ E-Learning Bristol Hospital's Learning Center (formerly Education and HRD Department) began working on introducing the HealthStream@ E-Learning Systern to Bristol Hospital's workforce during Fall 2005. HealthStream@ E-Learning System is web-base4 self-paced computer software covering most JCAHO and OSHA mandatory courses that employees are required maintain compliance on an annual basis. Staff can meet many of their annual mandatory cornpetencies by completing these courses online by access through a personal password. Healthstream allows us to better address the learning needs of a diverse, geographically dispersed staff. meet compliance requirements through real-time adm i nistration. improve courseware offering that is automatically updated, and use Internet-based technologies.

BRrsroL HosprrA1,, TNCSRp9RATED .f,rfiffif-t, Hospital Services

FiscalYear Medical/surgical

Births

FiscalYear

admissions

Medical/surgicalinpatientdays Outpatient

CENTRAL CONNECTICUT MEDICAL MANAGEMENT

visit

2004

2005 5,367 823 27,522

27,531

173,420

178,005

Surgical and endoscopy procedures 9,942 Emergency Room visits 37,540

5,658 819

10,058 36,657

200s

Visits

Physician Office

61.437

Admissions Patient days Average daily

328 45,051 123

census

:

Net revenues from services to patients Bequests, contribution and donor restricted gifts Other revenue including investments

Expenses: Salaries, wages and fees Supplies and other expenses Bad debts Depreciation and amortization

Interest

Excess ofrevenue and contributions over expenses

Fiscal year ending September 30

61,743

INGRAHAM MAN9R'i"'"fr'1)

BRISTOL HOSPITAL AND HEALTH CARE GROUP COMBINED STATEMENT OF OPERATIONS Financial Performance

2004

122,104,250 583,254 6,838,259

119,598,391

$130,125,763

$126,223,r55

65,428943 5r,801,r17 7,565,058 6,739,799 1,829,239 sr33,364,216

65,535,555 48,663,459 6,905,791 6,834,948 r,593,278 $129,533,037

($3,238,453)

384,510 6,240,264

($3,309,882)

189

45,504

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LInnERSHIP MEDICAL STAFF

HOSPITAL SERVICES Lawlcncc

OFFICERS Danicl J. Scoppcttr. MD ('lticl ol Srull

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Lcvinc. MD C ltu

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.losiah H. C'hild. MD .lcnnil-cr M. Dugan, MD .lcnnil-cr M. Gcorgc, MD Blyan D. Goldbcrg. MD Michacl B. Gutman. MD

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Lar'r'rcncc P Lcvinc. MD S I f f R c1 t t't'.t t' t t I I i t't' t r

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EMERGENCY MEDICINE

f lrlos M. tsrdiola. MD .1.s.s i.t I tt rr

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EXECUTIVE COMMITTEE OF TTIE MEDICAL STAFF Danicl .1. Scoppctta. MD

Ilor,i"arcl

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Ronalcl S. (lrcc'n. MD Molly Haycs. Esq. Thonras D. Kcnncdy. III

A.E. Hcrtzlcl Knox, MD Tcn:sa Kukolja. RN. MPA.

Suzannc Millcr. MD Scott W. Organ. MD

Karcn W Poolc, Esq. .loscph J. Roblcs, MD Stuart E. Roscnbclg Dcbolah A. Sculco. MD Thomas E. Verdone, MD Edward Wcingardcn, MD Michael L. Whaley. MD Richard M. Zweig. MD

DEPARTMENTS AND SECTIONS DIAGNOSTIC IMAGING Dennis D. Ferguson, MD Depu rtttte I C ltu i rntu n Carlos M. Badiola. MD Stewart E. Bober, MD David E. Kayc. MD Chlistophcr.l. Lcary. MD Lawrence N. Rappaport, MD Folco Scappaticci, MD John M. Walkcr. MD

MD

FAMILY MEDICINE Sac t i ott C lt u i t'uttt rt Lca M. Bailcy. MD Conlad D. Collins. MD

.krnathan

CASTROENTEROLOGY

Hungchih Lcc. MD Eugcnc R. Lucicr, MD Anncttc K. Macannuco. MD Rowcna B. Mariano, MD

Ronald S. Grccn. MD Set'tiort Chuirntun Kcnncth l. Klasner'. MD Danicl N. Smilcy, MD Salam F. Zakko. MD

CNAA

Lawlcncc P Lcvinc. MD Nachiyappan Manoharan, M D Larry M. Marcus. MD

En-rmarrucl C. Javicr.

Michacl J. Liftman. MD Balry C. McNcil, MD .lonathan H. Roscn. MD H. Andrcw Sclingcr'. MD

PAIN MANACEMENT A. Kost. MD

.lctlicy R. Coltlbcrg. MD

Yong-Sung Chyun. MD

OCCUPATIONAL HEALTH

DLrbin. MD

Dcnnis D. Fcrguson, MD

ENDOCRINOLOGY AND METABOLISM

Jcflicy R. Goldbcrg. MD

tsrian E. C'onrstock. MD Russcll L. Tuvclson. MD

Nasima Bancrjcc, MD

INTERNAL MEDICINE Jack H. Adlcr. MD

.lcl'licy t'. LaFlancc. MD C'lilIbrd \I'. Wagncr'. MD Mark (i. Wipflcr. MD

('lt u i rrrr tt rt

Michacl V Adanrs. C'PA C'allos M. Badiola. MD

DERMATOLOGY Timothy K. Charticr. MD Glenn S. Gart. MD

MEDICAL SERVICES Richard M. Zrvcig. MD Dapu rt

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ADDICTION MEDICINE Kalcn

S. Guaclagnini,

MD

ALLERGY Brucc E. Englandcr. MD

CARDIOLOGY Michael L. Whaley, MD Secliott Cltuirnrun Artr,rro E. Baltazar, MD Robcrt DeBiase. MD Olivcl B. Diaz. MD John A. Frazicr. MD .loscph E. Malakovits. MD Paul L. Mastlopolo. MD

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CRITICAL CARE Stephen P. Caminiti, MD Sec'tiort Cltuirntun

Howald C. Dubin. MD

Doris L. Althcn'. MD Nadecm S. Bch.ict. MD Yong-Sr-rng Chyun, MD Howard G. Dubin. MD .losc

A. Estcla. MD

P. Gallaghcr. MD Kalcn S. Guadagnini, MD Richard P Cucn'iclc. MD .lack H. Katz. MD Stcphcn .l. Kayc, MD .lonathan T. KrLrmcich. MD

Janrcs

.1. Licata. DO Gary Millcr. MD

Charles

Aistc Norbcr-q. MD Antonio Scappaticci. MD Phil Watsky. MD Stcphcn E. Zcbrowski, MD Richald M. Zwcig. MD

PATHOLOGY Nasirla

Michclc

HEMATOLOGY/ ONCOLOGY Dcbolah A. Sculco. MD Seclion Cltuirntan Alessia C. Donadio. MD Christopher J. Wakem, MD Saycdur Rahman, MD

Virginia M. lan-Wettstein. MD

INFECTIOUS DISEASES Richard M. Zweig. MD

INPATIENT MEDICINE (Hospitulists) Howard G. Dubin. MD Section Chuirnrun Brock Drapkin, MD Timothy M. Pratt, DO

Mark S. Safalow MD Naeern Sarfraz, MD Brian A. Timko. MD Jocl L. Wilken, DO

Banelc- jc-e, M D

DepurlnteuI Chuirntuu Matthcw J. Cr.rrlan. MD Lcslic S. Kish. MD P.

Norrrandin. MD

PEDIATRICS A.E. Hertzler Knox. MD Scclion Chuirntun Susan A. Adeyinka. MD

Arthur T. Blun-rer. MD William .l. Brownstein. MD Carolyn A. Clark, MD Linda Dyel Ertl. MD .1. Cleen-Wrzesinski. MD Delbert H. Hodder. MD Bryan R. Holland. MD Nancy B. Holyst, MD Ruth A. Loomis. MD Ranjit S. Pandit. MD Alpa R. Patcl, MD Suzanne M. Powell. MD .lulie E. Schiff. MD Thomas G. Ward. MD

Tarrrlrlr

PHYSICAL MEDICINE & REHABILITATION Angela L. Aldam, MD William J. Pesce. DO

OTOLARYNGOLOGY AND HEADAND NECK

Ronald C. Bezahler, MD

Joseph J. Robles, MD

Section Chairman

SURGERY

Susarr F. Burroughs,

Jeune G. Bae. MD

Paul J. Ceplenski, MD

Larry M. Malcus, MD J. Vitale. MD

Joseph T. Cherneski,

GENERAL SURGERY

Ara D. Bagdasarian, MD Rainer

PULMONARY DISEASES Nelson A. Bondhus, MD Stephen P. Carniniti, MD Pacifico G. Flores, Jr., MD Yin Fei Hung, MD

Michael S. Ptaszynski, MD

PSYCHIAIRY Nachiyappan Manoharan, MD Secliotr Chairman Kenneth F. Bean. MD Frederick O. Reindel. MD Diedre A. Reynolds, MD Enrique J. Tello, MD

W

Bagdasarian,

MD

Kenneth G. Benoit. MD Ovleto W. Ciccarelli. MD

Chlistian W Ertl, MD James T. Sayre,

MD

Daniel J. Scoppetta, MD

HAND SURGERY Armann O. Ciccarelli, MD Michael T. LeGeyt, MD

NEUROSURGERY Joseph Afelzon, MD

Arny S. Breakstone, MD

Departnrcnt Cltuirnton

ANESTHESIOLOGY Edward Weingalden. MD Section Chuirnran

Kalvin H. Block. MD Ra.jendra M. Bobba, MD Nazmul Chowdhuly, MD Victor C. Eanniello. MD Terence K. Gray, DO

PLASTIC AND HAND SURGERY Armann O. Ciccarelli, MD

Larry M. Marcus, MD Valerie J. Vitale. MD

Section Clttrirntan Sharon Adler'. MD Victoria R. Biondi, MD

Lalry M. Marcus, MD

Ara D. Bagdasariarr, MD Kenneth G. Benoit, MD Christian W Ertl. MD James T. Sayre, MD Daniel J. Scoppetta, MD

PLASTIC SURGERY FACIAL

Kathy E. Dennis-Yawingu, MD Christopher K. Manning. MD Thomas J. Terenzi. DO

SURGICAL SERVICES

PEDIATRIC SURGERY

GYNECOLOGY Suzarrne Miller, MD

Robert M. Chmieleski, PhD MD Jayne C. Cluett,

MD

Wendy M. Latshaw, MD Cannelina Luongo, MD Iacob Marcovici, MD Kenneth K. Rhee. MD

OPTHALMOLOGY Steven R. Hunter, MD Section Cltuirntan Robert J. Ouellette, Jr., MD Charles R. Robinson. MD

Yair Grinberg, MD

PODIATRIC SURGERY Paul F. Dobies. DPM

Richard E. Ehle, DPM Gary P Jolly, DPM Jeffrey M. Tencer', DPM Joseph R. Treadwell, DPM George P. Zuk, DPM

THORACIC SURGERY Ovleto W. Ciccarelli, MD Christian W Ertl. MD Joseph J. Robles. MD James T. Sayre, MD

Daniel J. Scoppetta. MD

UROLOGY

Keith Lipsitz, MD

ORALAND MAXILLOFACIAL

Chelian Santosh Oon-unen, MD Glen S. Rosenfeld MD Joseph A. Scaniffe, MD Allan Sutin. MD Scott K. Switzer. DO Thomas E. Verdone. MD Shue W. Wong, MD

SURGERY Ronald B. Herliott. DMD

Michael A. Fischrnan, MD Sectiotr Chqirntun Petel F. D'Addalio. MD

ORTHOPAEDICS Scott W Organ, MD

VASCULAR SURGERY

COLON-RECTAL Saumitra R. Banerjee, MD Steven H. Brown, MD David Cherry, MD Christina Czyrko, MD

Williarn

P.

Pennoyer, MD

David L. Walters, MD

Sec'tion Chuirnrtttt

Chang S. Choi, MD Michael E. Cucka, MD Vipul Dua, MD Michael T. LeGeyt, MD Tirnothy P. Mclaughlin, MD

Rainel W. Bagdasarian, MD Kenneth G. Benoit. MD Chlistian W. Ertl. MD James T. Sayre,

MD

Daniel J. Scoppetta, MD

LIMITEDACTIVE AFFILIATE James D. Affenito, DMD

Abdel

F.

Allam, MD

Corlis L. Archer-Goode, MD Robert A.J. Ave'Lal lernant,

MD William Begg, III, MD George Barrows,

MD MD

Raphael M. Cooper, MD

Valerie

OBSTETRICS/

RHEUMATOLOGY

Syed F. Bilgrarni, MD

MD

Richard S. Cutler. DPM David J. Domenichini. MD

Richald L. Edwards. MD Ronald L. Falit. MD Andrew G. Gabow. MD Sherman M. Hawkins..h.. MD Keith A. Kaplan, MD Craig M. Kaufr.r.ran, DPM Allan R. Mayer, DO Beth E. Nelson. MD Tanrlata H. Parikh, MD Susarr Rabinowe. MD Zia U. Rahman. MD Joelg Rathrlarrrr, MD Challes W. Scott. DPM Jonathan R. Sporn, MD Pavel Straznicky, MD Teresa M. Szajda, MD Peter'.1. Tutschka, MD Raphael S. Wurzcl. MD

CONSULTANT STAFF Jcffi'ey A. Bash, MD Steven G. Beck, MD Jeffi'ey A. Bittern.ran. MD Nicholas B. Forrnica. MD

Adarl M. Goldstcin. MD Charles W. Glaeber. MD Susan E. Halley, MD Er.nmanuel C. Javier. MD

Mark P. Kawalick. MD AlexanderA. Komm. MD Robelt A. Lapkin, MD Andre Lerer. MD Bernard Percalpio, MD Joseph Ravalese. lll, MD Alnold J. Rossi. MD Falid Shafik. MD Balry G. Spass. MD

ADJUNCT STAFF Thomas J. Balga, PA-C Charles F. Barnicoat. PA-C Mary B. Bcland, RNFA Cathy A. Belanger, RNFA Blian S. Bullard. CRNA Jill R. Cristo. LMFT Mary Fiorello, APRN William Frick, CRNA Mary Greene, APRN Robert A. Guyon, PA-C Tracy L. Houle, APRN Elizabeth R. Jensen, CNM