REPORT TO THE BOARD OF DIRECTORS – May 2022

Mitchell H. Katz, MD
NYC HEALTH + HOSPITALS
PRESIDENT AND CHIEF EXECUTIVE OFFICER
REPORT TO THE BOARD OF DIRECTORS
May 26, 2022

CORONAVIRUS UPDATE

New York City raised the COVID-19 alert level from medium to high last week based on a steadily increasing number of cases and hospital admissions. However, the number of hospitalized patients with COVID-19 in NYC Health + Hospitals remains low and many of them are in the hospital due to other conditions. With the high alert, we have new guidance for the public:

We are strongly recommending the use of facemasks for all indoor settings. For people 65 years and older or those at increased risk for severe disease, masks are also recommended in crowded outdoor settings and they should avoid gatherings when possible.
COVID-19 tests, in particular home tests, are recommended for anyone with symptoms or before/after a gathering or travel.
Anyone who tests positive for COVID-19, should call their primary care doctor. Anyone who does not have one can call out hotline, 212-COVID-19, to connect with one of our doctors and find out if they are eligible for treatment, and if so, they can have Paxlovid delivered to their home.

Mask use remains the same for health care settings – everyone is required to wear a mask in all our workplaces.

Our NYC Test & Trace Corps team continues to provide testing at approximately 150 sites across New York City, at all NYC schools, and to distribute at-home tests through 192 libraries and cultural institutions and 850 community partners. Last week we announced plans to distribute an additional 16.5M home tests through community based organizations, houses of worship, libraries, and schools. We have already done about 2 million tests in NYC public schools. In fact, Dr Ted Long and others who led the surveillance and contact tracing work in the public schools, just authored a JAMA Open Network Journal published this week about how safe our schools have been. Here is the link to the journal article: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792541.

Our 212-COVID-19 hotline continues to serve as the one stop shop for resources and connects callers to our Virtual Express Care team for treatment – thousands of New Yorkers have received paxlovid through this service.

In addition, this week, the Centers for Disease Control reported that 1 in 5 adults who survived COVID-19 have “persistent symptoms,” or long COVID. Our COVID-19 Centers of Excellence in Tremont, Jackson Heights and Bushwick provide long-term care for those recovering from COVID-19 and we urge all New Yorkers who continue to suffer from symptoms to reach out and get the care they need. In addition to these specialized health centers, our Test and Trace Corps Take Care program offers direct connections to COVID-19 treatments, and quarantine and isolation resources, and our AfterCare program continues to provide outreach and referrals to New Yorkers suffering from Long COVID.

GUN VIOLENCE: AN EPIDEMIC WE MUST CONFRONT

How is it possible that here we are again? Just last week I sent a message to our staff, stunned by the horrible shooting spree in Buffalo, so soon after the subway shooting in Brooklyn. I never would have imagined that in such a short time we would experience another shooting, this one taking the lives of 19 children and 2 adults, in an elementary school no less. Adding to this pain, the gunman was also a young person of 18.

The headline in today’s New York Times reads, “The Stupefying Tally of American Gun Violence” and I thought stupefying was the perfect word. It means to be made stupid or groggy but also astonished and astounded. I feel all of those things, as I’m sure so many New Yorkers do too. The article quoted a statistic that is mind-boggling: according to the non-partisan Small Arms Survey there are now many more guns than residents in the United States.

As stewards of the public health, we should all be alert and alarmed. We are witnesses to a public health crisis as scary as COVID-19, and perhaps as lethal. The number of shootings both here in our backyard, and throughout the country is too long to list.

We must not let ourselves get numb to it. We must not forget what we stand for. Gun violence is an epidemic we must confront.

So, what’s next? We pause and grieve, not only for the long journey of mourning these families must now take, but also for this country. We take action: for some of us that may mean marching and protesting, volunteering and donating, and of course, voting. We support each other and we unite. If you know colleagues who are struggling and suffering, reach out. Direct them to the many excellent mental health support services we offer.

And finally, we keep on working. We continue to be the most committed public health system in this country, leading the way in providing safety, dignity and care to everyone we touch.

POSSIBLE MONKEYPOX CASE IN NEW YORK CITY

The City announced last week that it was investigating two possible cases of Monkeypox in New York City. One individual was treated at NYC Health + Hospitals/Bellevue and ultimately tested negative. Another NYC patient, however, is presumed-positive for Monkeypox and is isolating at home. Contacts of this individual who were considered high-risk have been referred to Bellevue Hospital for post-exposure prophylaxis with the FDA-approved Monkeypox vaccine, Jynneos. We are the first health system in the United States to receive supply of the vaccine from the CDC/National Stockpile. The vaccine is a subcutaneous injection that consists of two doses, four weeks apart. Monkeypox is uncommon in the U.S., but — in the rare circumstance where a positive case is identified — usually presents as a flu-like illness accompanied by swelling of the lymph nodes and followed by rash on the face and body.

PENDING SUPREME COURT ROE V. WADE DECISION

As the Supreme Court reportedly considers overturning the fundamental protections of Roe v. Wade, NYC Health + Hospitals will continue to provide access to safe, legal abortion services to all New Yorkers. We believe it is critical that New Yorkers have multiple ways to access vital reproductive health and pregnancy termination services, and we are proud to serve in a state that has codified these rights. As the procedure becomes unavailable in other states, we are prepared to scale up our services as needed to maintain this very important right and help women from other states. NYC Health + Hospitals offers a wide range of services, including primary care, family planning, abortion services, prenatal through delivery care, midwifery and doula services, breastfeeding/lactation services, nutrition, mental health support, preventative care, and much more. Our services are available to all New Yorkers without judgment and regardless of ability to pay or immigration status.

TWENTY-FOUR OUTSTANDING PHYSICIANS HONORED AT DOCTOR’S DAY CELEBRATION

We hosted a very moving celebration to recognize extraordinary patient care and 24 NYC Health + Hospitals physicians for their dedication throughout the pandemic and beyond. The event marked the first in-person Doctors’ Day since the COVID-19 pandemic emerged in New York City. Among the doctors we honored were primary care physicians, psychiatrists, ER physicians, pediatricians, correctional health providers and medical simulation experts.

While COVID-19 has been a monumental challenge for all our doctors, they responded heroically. We saw something we had never seen before and it hit us hard. But our physicians – not just the 24 we honored that day – but every doctor in the house — rose to the occasion the way that they have done throughout history – through 9/11, Ebola, HINI, Super storm Sandy — and we were happy to be able to recognize them for that. There are aspects of health care that make me a bit cynical, but the value of a doctor in a room with a patient has never been one of them. I have seen the magic that happens, the difference that good doctors make in the lives of people. It is amazing and we are so fortunate to have so many skilled, compassionate physicians dedicated to our mission and our patients.

The event was even more special as we had the opportunity to share a special video message from Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and the Chief Medical Advisor to the President. Dr. Fauci thanked all NYC Health + Hospitals doctors for their remarkable efforts during the pandemic, the lives they saved, the suffering they prevented, the comfort and caring they provided.

INVESTING IN PREGNANT PEOPLE AND BABIES

NYC Health + Hospitals this month launched three new programs that will enhance our labor and delivery services and make sure our obstetric teams receive the most advanced training available.

We are using new obstetrics virtual reality technology that will enable all obstetrics providers, from midwives to attending physicians, to experience simulated lifelike scenarios through a VR headset. The simulations will give teams the opportunity to sharpen their skills and anticipate situations that could be life threatening to the birthing person and baby. For example, one simulation recreates an obstetric hemorrhage and guides teams through all the correct protocols. The portability of the VR headsets allows providers to get a training session in while they are on their shifts, making it convenient and accessible to busy OB staff. Thankfully, serious and life-threatening conditions during childbirth, labor, and the postpartum period are uncommon. However, ensuring that our providers have the skills necessary to deal with these critical situations is essential.

We launched a new doula program at NYC Health + Hospitals/ Elmhurst and Queens. The two hospitals will provide community-based doula support, free-of-charge, to any pregnant person seeking care. Some 20 doulas will be available to pregnant people who plan to give birth at both hospitals over the next few months. The doulas are professional labor “assistants” who provide physical and emotional support to birthing people during pregnancy, childbirth and the postpartum period. Studies confirm that doula care contributes to better birth outcomes by reducing overall C-section rates, shortening the length of labor, and reducing the need for painkillers and hormones. Postpartum, doulas can identify and alert medical teams about post-partum depression. Patients will be referred for doula services and matched with a doula for the duration of their pregnancy and post-partum care. The goal is to match the pregnant patient with a doula who speaks the same language and shares the same cultural and religious background. This program is in partnership with project HoPE, a non-profit that advocates for birth equity, and is one of our many community-based collaborations.

NYC Health + Hospitals/Woodhull marked the official launch of the Family-Centered Cesarean Birth (FCCB) program, which places the family at the focal point of the birthing process during a cesarean birth. While we encourage virginal delivery, cesarean births are sometimes necessary. They take place in an operating room under sterile conditions and strict protocols, so they can be a disconcerting experience for the birthing patient and family. The new program at Woodhull helps parents undergoing a cesarean surgery to experience and celebrate the birth of their child by adding certain details like clear surgical drapes that allow the parents to witness the birth and even music selected by the birthing person. Midwives assist with all pre- and post- aspects of the birth, and patients can opt for a doula to support them during their birth. Our goal is to ensure that all our birthing patients can experience the joy of birth with baby and family.

INNOVATIVE DIGITAL THERAPEUTICS PROVIDE SUPPORT FOR PATIENTS WITH SUBSTANCE USE DISORDER

When the pandemic forced New Yorkers into isolation, Bronx resident Mary W. felt its toll almost immediately. She experienced deep loneliness, which led to heavy drinking and eventually alcoholism. After one particularly bad night last year where she drank excessively and felt depressed, she picked up the phone, and contacted the Comprehensive Addiction Treatment Center at NYC Health + Hospitals/Jacobi. Since then, Wilson has been working with one of our addiction counselors, who she meets with twice weekly for treatment. She also has a different and innovative kind of support at her fingertips: a smartphone application called reSET, which is prescribed by her care team.

Nearly 100 NYC Health + Hospitals patients have received a 12-week prescription to access a mobile app designed to help treat alcohol and substance use disorder. The innovative app, developed by Pear Therapeutics and provided to the health system at no charge, is the only FDA-authorized prescription digital therapeutics for the treatment of substance use disorder and opioid use disorder. The reSET app is available to patients who are currently enrolled in outpatient treatment under the supervision of a clinician and are used in conjunction with traditional treatments and not meant to replace in-person appointments.

With reSET, patients can track their recovery process by identifying their triggers, record recent cravings, and learn coping strategies. As patients progress through the various modules in the app, they are rewarded with gift cards ranging from $5 to $100 for recovery success. This is a highly effective treatment strategy known as contingency management, which involves giving patients tangible rewards to reinforce positive behaviors such as abstinence from drugs. For patients without smartphones, NYC Health + Hospitals has been able to provide five free devices and six months of cell data. A Spanish language version of the app is also available to our patients. Since September 2021, the health system has prescribed the app to patients at four of our hospitals: Jacobi, Bellevue, Kings County and Coney Island. It will soon be available to patients at Harlem and Queens hospitals later this summer.

STRIVING FOR NET ZERO

During a special visit to NYC Health + Hospitals/Lincoln on May 12, I joined the Assistant Secretary of Health, Admiral Rachel Levine, to launch a national program and pledge initiative aimed at reducing emissions across the health care sector. Our environmental challenges are particularly worrisome as climate change often magnifies health care disparities, and people in disadvantaged communities bear the brunt of extremes in increasingly unpredictable weather. Yet, according to government data, the health care sector contributes 8.5% of total U.S. carbon emissions: the greenhouse gases directly connected to climate change.

NYC Health + Hospitals is working hard to reverse this situation. Since 2006, our system has reduced carbon emissions by more than 30% and consumption of fuel oil by an incredible 96%. We are working to secure funding for a new ambulatory care center in the South Bronx which could be a beacon of a “net-zero” footprint; designed and built with the goal of zero carbon emissions that will use no on-site fossil fuels and will be 100% powered by on-site and/or off-site renewable energy. Now we are joining the Federal Government in a pledge to do even more.

I signed the pledge and committed our health system will aim to reduce emissions by 50% by 2030, and to net zero by 2050. We have agreed to publicly report our progress and develop climate resilience plans for our facilities and communities. The new pledge is in keeping with our public health system’s overall mission to reduce our carbon footprint and invest in state-of-the art, greener solutions.

In addition to reducing emissions and dependence on fuel, we have taken many other steps to conserve energy over the last few years. We have retrofitted thousands of fluorescent fixtures with LED bulbs, upgraded old and inefficient cooling towers with state-of-the-art equipment, and are modernizing air-handling units as well. Just a year ago, we received a reward of more than $1.4 million from Con Edison for our efforts to reduce energy consumption during days of extreme heat during the summer, and have reinvested those funds into continued conservation efforts.

NYC HEALTH + HOSPITALS/METROPOLITAN BREAKS GROUND ON NEW FLOOD WALL RESILIENCY PROJECT

I was pleased to join staff, our construction partners NYCEDC, and community members at the groundbreaking ceremony for a new flood protection system at NYC Health + Hospitals/Metropolitan that will mitigate the weakness exposed by heavy rains and flooding during Superstorm Sandy. The hospital’s critical electrical systems were damaged by contaminated floodwaters during Sandy. This new flood protection system around the hospital campus will minimize risk to public health by allowing us to continue serving our patients and the East Harlem community during and after future storms. The $120 million project, funded by FEMA, will feature a new perimeter floodwall, an upgraded storm water pumping system, and a beautiful public art project by a local artist that celebrates the community. This is an exciting moment for Metropolitan Hospital as we continue to protect our health care system from extreme weather events that are happening more and more frequently.

OFFICE OF FACILITIES DEVELOPMENT TRANSITION

Christine Flaherty, who has served NYC Health + Hospitals so well as the SVP of the Office of Facilities Development, is departing our health system for another opportunity closer to her family. Christine made major improvements in our capital program, our physical infrastructure, and helped build our Housing as Health team. While we will miss her greatly, we are excited that three of her outstanding deputies are stepping into larger roles to lead the team.

Manuel Saez, PhD., will be the director for the Office of Facilities Development reporting to me. Oscar Gonzalez will be Deputy Director of the Office and the Director for Capital Development. Mahendranath Indar will be the Chief Operating Officer for the Office. All three have done outstanding work for our health system and will continue to do so in these larger roles. To offer additional support for the transition, SVP Matt Siegler will serve as the executive sponsor of the Office. Leora Jontef and the Housing as Health team will join Matt’s organization while continuing to work closely with Office of Facilities Development.

EXTERNAL AFFAIRS UPDATE

City – We concluded our part of the City Council’s Executive Budget hearing on May 18 and appreciated the opportunity to discuss the forthcoming City budget with the Finance Committee and the Committee on Hospitals. We are grateful for the support and partnership of the City Council.

State – The State Department of Health concluded its public comment period for a new 1115 Waiver amendment that addresses health disparities and systemic health care delivery issues highlighted and intensified by the COVID-19 pandemic. We commend these efforts to close the equity gap, which is fundamental to our work as the essential safety net. We submitted comments to the State and continue to partner with our State colleagues on implementing these goals, particularly as we focus on comprehensive care for the special populations we are proud to serve.

This week the Governor swore in Representative Antonio Delgado as the new Lt. Governor and the State Legislature is expected to wrap up their session early next month. We are working up to the last minute to advance our responses to the final bills that are emerging.

Federal – Congress has yet to agree on a COVID-19 funding package, though it is expected that COVID Public Health Emergency will be extended through October. We have submitted FY2023 earmark requests to our Congressional Representatives. While the process will continue for another couple of months, we are optimistic that some of these projects will be funded. We had great success in this year’s earmark process, the first in years, and we thank our leaders in Washington DC for supporting our needs.

CONTRACTS

I want to summarize one continuing agreement to policy I approved for the Street Health Outreach and Wellness (SHOW) program during the last COVID-19 surge. In July 2021, I reported having approved an Exception to Policy amendment for nine months with Rapid Reliable Testing, LLC. This was for six mobile vans to be used on behalf on NYC for testing and vaccinations, and other needed medical assessments and treatments specifically for New York City’s unsheltered homeless population.

Given the success with these outreach services and the continuation of the pandemic, I subsequently authorized a four-month extension of the program through June 2022. The program now includes eight vans, with two of the vans dedicated to Mayor Adams’ “Subway Safety Plan” and are located at “End of Line” subway stations that are key components of that plan. The other six units are located at intersections selected in concert with the Department of Homeless Services, due to the large number of unsheltered homeless in need of our services at those locations.

The initial SHOW agreement was for a not-to-exceed $9M, and the additional agreement is for a not-to-exceed $7.5M. The cost of these services is covered by the City. While most of the staff provided by the vendor are W-2 employees and the vendor owns the vans being used, approximately 10% of their spend has been with diverse vendors, and continues through this period.

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