T h e C e n t e r I s Y o u Annual Report Three months ago I had a heart attack

T h e C e n t e r I s Y o u Annual Report 2010 Three months ago I had a heart attack

... and the people at Cayuga Medical Center literally saved my life. C r e at i n g t h e C ay u g a H e a r t I n s t i t u t e

Saving R a n d y S ta r k On the morning of January 7, 2011, Randy Stark knew right away what was happening to him. He was cleaning snow off his car when the pain started. I had the classic symptoms, says the fifty-eight-year-old father of three. Pain in my back between the shoulder blades, in my left jaw, and down my left arm. I knew I was having a heart attack. Randy is a native Ithacan, married to his high-school sweetheart, Patty. When he retired in 2003 after twenty-seven years with the New York State Police, he was a senior investigator heading up the Narcotics Unit. Law enforcement officers are trained in emergency medical services so they can assist people in crisis situations. Randy s medical history included a cardiac work-up three years prior that had revealed some partial blockages in his coronary arteries. He also has diabetes, which is a major risk factor for cardiovascular disease. There was no doubt in his mind that he was in big trouble. The Starks live not far from Cayuga Medical Center so he asked Patty to drive him to the Emergency Department. When I got to the reception desk I told them I was having a heart attack, says Randy. Hilde Abruzzo, a nurse I ve know for over twenty years, immediately took me into the ED. A wonderful man, Dr. Richard Allen, was my attending physician. Dr. Allen told Randy his EKG showed minor differences from his previous one, and he ordered an echocardiogram. This ultrasound technology produces images of the pumping heart and is used to assess heart function and the presence of heart disease. Both Dr. Allen and Dr. Lynn Swisher, the cardiologist on call that morning, recommended that Randy undergo cardiac 2 Cayuga Medical Center Annual Report 2010

catheterization to take a closer look at his heart Dr. Swisher talked with Patty and me, reviewed my medical history, and encouraged me to have the angiogram, says Randy. The nurse who came to transport me to the cardiac cath lab was Sharey Selover. I ve known her since she was a kid. Randy says the continuing contact with friends and familiar faces helped to ease his anxiety. Interventional cardiologist Dr. Stephanie Goodwin was ready and waiting for Randy when he got to the Cayuga Heart Institute. She told me that she would perform cardiac catheterization and that if she found a blockage in my coronary artery, she d take care of it. Anatomy of a heart attack There are two kinds of heart attacks, explains Dr. Goodwin. The first occurs when there is a significant blockage in the artery but a trickle of blood is still getting through. The second type of heart attack, the more critical of the two, occurs when the blockage is complete and there is no blood flow at all to the affected area of the heart. Randy showed a critical blockage needing urgent treatment but it was not a complete blockage, says Dr. Goodwin. His cardiac enzymes were elevated and he was having symptoms so we quickly got him to the cath lab. Our team can assemble in a matter of minutes so we were ready when he arrived. Randy knew he had some partial blockages from a previous cardiac catheterization that were being treated medically. But he was anxious to know why his condition had changed, so we talked about that to help him understand, says Dr. Goodwin. Once a person has heart disease, they really need to modify their risk factors to prevent problems from getting worse. Yet, even when people do all they can, heart disease can still progress. There is no cure. During Randy s catheterization, Dr. Goodwin found two blockages in the same artery. She proceeded to perform percutaneous coronary intervention (PCI), placing stents in two different places in the artery to restore the blood flow to Randy s heart. I was apprehensive, says Randy, and I really wanted to know exactly what was going on. Dr. Goodwin talked to me throughout the procedure. She told me what she was going to do, what she found, and how she was going to fix it. She was very, very good. I ve been doing this for seventeen years, says Dr. Goodwin, and between my training and my practice, I ve done over a thousand of these procedures. My experience has helped me appreciate how important good communication is. It s a frightening experience to have a heart attack and undergo PCI. We move fast and the cath lab is dimly lit. We do everything we can to help the patient remain as relaxed as possible. As I talk to the nurses, I also talk to the patient. Randy recovered in the Intensive Cardiac Care Unit under the watchful care of his nurses. It was a real joy to have my family five minutes away, says Randy. Some of the guys I worked with came to visit. Having family and friends stopping in was really important to me. I think it s crucial to recovery. He went home two days later on Sunday morning. Prior to his heart attack, Randy had been seeing an out-of-town cardiologist. Dr. Amit Singh came to see me Sunday morning and I decided to transfer my care to him, says Randy. He has followed up appropriately with Dr. Singh, who is carefully monitoring Randy s medications and his progress. Three weeks after his heart attack Randy went to the Cayuga Center for Healthy Living to begin cardiac rehabilitation. I haven t been good about exercising even though I know it s good for me, he admits. Two months into cardiac rehab, Randy has lost ten pounds and has changed his eating habits. The cardiac rehab program is great! he says. The people there are diligent, friendly, wonderful people. I m feeling really good and I m sleeping better. A gem of a hospital Cayuga Medical Center is a real gem, says Randy. You have local people who really want to take care of you. You get more quality time with your physician here, which I really appreciate. I ve seen the care improve at this hospital over the past few years. Seeing these improvements is very, very encouraging and should make people feel good about coming here. It s especially nice to know that the cardiac care is outstanding and that I don t have to drive somewhere else. If you live anywhere in Tompkins County, you are within twenty minutes of excellent cardiac care. I feel that the people here literally saved my life. Something has happened to this hospital. I feel very comfortable now recommending Cayuga Medical Center to my family and friends and I didn t always feel this way. There s something magical going on up at our hospital and I m really happy to tell people about my experience. Cayuga Medical Center Annual Report 2010 3

Report to the Community Cayuga Medical Center is changing for the better. Take it from Randy Stark, a native Ithacan whose family has used our medical center over the course of his lifetime. As you can see from his story in this year s annual report, Randy has noticed a distinct transformation over the past few years. One of the clearest illustrations of Cayuga Medical Center s evolution is the Cayuga Heart Institute. Our ability to offer interventional care to heart attack patients like Randy is a game-changer for local cardiac patients; however, it also illustrates a new paradigm in health care. Not so long ago the mission of hospitals the size of Cayuga Medical Center was to provide basic services, which meant that patients with really serious problems like heart attacks and cancer needed to go elsewhere for their care. In today s health care paradigm, community medical centers like ours, with rigorous standards and excellent reputations, are establishing affiliations with tertiary care centers to enrich local health care services. Cayuga Medical Center s affiliations with the Rochester Heart Institute and Roswell Park Cancer Institute mean that patients in our area have access to very sophisticated care right here where they live. For Randy Stark, this meant he didn t have to travel out of town in the middle of a heart attack for percutaneous coronary intervention (PCI) to have the blockage in his coronary artery opened. Creating the Cayuga Heart Institute took years of planning. It took commitment, skill, financial resources, and the support of our community. As we developed PCI capability, caregivers at Cayuga Medical Center considered the entire spectrum of heart health care: prevention, education, diagnosis, acute care, intervention, and cardiovascular rehabilitation. We enhanced cardiac-related services across the organization from the Emergency Department and the Intensive Cardiac Care Unit to Imaging Services, the Pharmacy, and the Lab. We developed the Island Health Center and the Cayuga Center for Healthy Living. Each of these steps supported our goal to offer comprehensive cardiac care, including intervention, here in Tompkins County. Each step was part of the promise we made to our community to be the best cardiac care providers we could possibly be. We now have other important projects in the works, as well. We will begin construction of a new Laboratory this spring, to accommodate more efficiently upwards of half a million tests performed each year by our dedicated Laboratory staff. Upon completion of the lab, we will build a new unit for Maternal and Newborn Care, including Neonatal Intensive Care and we re working on plans for a new Pediatrics Department. In response to community input all of our new mothers rooms will be private. When necessary, we will have the capability to perform cesarean section deliveries in this new unit. Also, this fall, we plan to begin construction of new Operating Rooms and an Endoscopy Suite. Our surgeons, anesthesiologists, surgical nurses and OR techs will have more space in which to use their new technology. I will keep you posted as these projects unfold. In our 2010 Annual Report we d like to shine our light on the Cayuga Heart Institute and the introduction of PCI. We are very proud to introduce this critical new service to the community we serve. We couldn t have achieved this without your support and we couldn t be happier about being here for Randy Stark when his heart needed us. Rob Mackenzie, MD, President and CEO Cayuga Medical Center 4 Cayuga Medical Center Annual Report 2010

We spent eleven years getting ready for Randy Stark s heart attack. Step by careful step we laid the groundwork for local interventional cardiac care to help save the lives of people having heart attacks. It took expertise, commitment, and hard work. We re ready. C r e a t i n g t h e C a y u g a H e a r t I n s t i t u t e 2 0 0 0-2 0 1 0

2000-2001 Invasive cardiologist Dr. Malcolm Brand joins the medical staff as the medical director of the new Cardiac Catheterization Program at Cayuga Medical Center. He comes to Ithaca with advanced training in nuclear cardiology, echocardiology, and cardiac catheterization, following a three-year fellowship in cardiology, during which he served as chief fellow. Cardiac Catheterization Lab Cayuga Medical Center is selected to be the site of one of New York State s first freestanding cardiac catheterization laboratories, confirming the high quality of local cardiac services and the reputation the medical center enjoys at the state level. Historically, cardiac catheterization has been performed only in large hospitals offering cardiac surgery. When we started the Cardiac Catheterization Program at Cayuga Medical Center our priorities were to allow patients to have a definitive evaluation of their cardiac status and to establish a plan of treatment with their local cardiologist. This is especially important for patients being referred to another institution for interventional care not available in Ithaca. By having a definitive diagnosis and a treatment plan in place, we can easily resume care without a break in service when a patient returns home. Ours was one of the first freestanding cardiac catheterization labs established in New York State in the early 2000s. Not all of those labs survived. Our cardiac cath lab is here today due to our commitment to quality, the perseverance of our doctors, nurses,

The Cardiac Catheterization Program at Cayuga Medical Center is launched with the very latest technology, including the capability to send digital images to consulting cardiac surgeons at a regional tertiary care center. Most importantly, the cath lab allows our patients to have their cardiac angiography performed locally. This way they can discuss the test results with their own cardiologist, the caregiver who knows the most about their situation. Diabetes is one of the top three reasons people develop coronary artery disease.* and technicians, and the support of community physicians. We knew this was a very valuable service and we were committed to establishing a solid track record here. As a team, we sent a cohesive message to the community that this was a safe procedure in Ithaca, and that there were clear advantages of having it available here. We also knew when we started up the Cardiac Catheterization Program that interventional care (PCI) was a natural progression, and it s great that we now have it. I arrived here at the beginning of the cardiac catheterization service and it was my job to make sure the program progressed appropriately, but it was the work of others that got the ball rolling. Cardiologists Dr. Michael Goodfriend, Dr. Don Wilson, Dr. Jonathan Mauser, and Cayuga Medical Center s former president and CEO, Bonnie Howell, were the people who got approval from New York State for a freestanding cardiac cath lab before I arrived. The same is true for the development of our interventional program. We were approved to offer PCI through the hard work of our cardiologists and Dr. Rob Mackenzie, president and CEO. And now interventional cardiologists Dr. Paul Stefek and Dr. Stephanie Goodwin are implementing the plan expertly. Malcolm Brand, MD, FACC Medical Director, Cayuga Heart Institute *Heart Health Facts courtesy of the American Heart Association. Cayuga Medical Center Annual Report 2010 7

2002-2004 The Cardiac Care Program at Cayuga Medical Center turns thirty years old. We are providing the full range of non-interventional cardiac diagnostic and treatment services, including cardiac catheterization, nuclear cardiac stress testing, transesophageal echocardiography, heart rhythm monitoring, pacemaker implantation, and more. Symptoms of a heart attack may be significantly different in women than men. Invasive cardiologist Dr. Amit Singh joins the medical staff and Ithaca Cardiology Associates. He has specialized training in cardiac catheterization, nuclear cardiology, and transesophageal echocardiography. The attraction of practicing cardiology in a small city is that we see the spectrum of cardiovascular problems. The cardiologists in Ithaca see an especially broad range of cardiac problems given the colleges and the international community. My colleagues and I enjoy this challenge. This specialty requires excellent diagnostic skills and there are many different tools we use to diagnose cardiovascular disease. We listen carefully to our patients in determining the nature of the problem that brings them to us and we test theories about what the problem really is. Once we have a diagnosis, we often use a multi-pronged approach to treatment, which includes medication and lifestyle changes, and in some instances, procedures or surgery. We manage our

Cayuga Medical Center is committed to community education, joining with more than sixty hospitals across the nation to launch Woman s Heart Advantage, a collaborative program to raise awareness and knowledge among woman about the nature and risk of heart disease. This year s Red Dress Tea helped raise awareness about heart disease in women. The event was open to the public. Tom Hoebbel As estimated one in two women will die of heart disease or stroke, compared with one in 30 who die of breast cancer. patients treatment, provide education and reassurance, and help them live with their conditions, both medically and psychologically. Within our pool of local cardiologists, we have delved into cardiac cases that used to be transferred to larger institutions. I was among the first cardiologists here with training in pacemaker implantation, which meant these patients could have this procedure done here. When Dr. Brand arrived in 2001 and introduced cardiac catheterization, local patients requiring this diagnostic procedure no longer had to be transferred elsewhere. He then became certified to implant automated internal cardiac defibrillators (AICD), which expanded our local capabilities even more. To raise the accreditation of our echo lab, I became board certified in echocardiography. The commitment of our local cardiologists to become proficient in additional subspecialties has continued and we have several board certifications and specialty areas among our seven cardiologists including echocardiography, nuclear cardiology, pacing and defibrillation, and most recently, interventional cardiology. These subspecialty certifications raise the bar; they require us to stay current in our practice of cardiology, which ensures that we are providing stateof-the-art care to our community. Lynn Swisher, MD, FACC Cayuga Heart Institute Cayuga Medical Center Annual Report 2010 9

Heart disease is largely preventable and education is the key. To that end, the Cardiac Services Department sponsors community seminars and collaborates in community education programs with local partners, such as Lifelong and Kendal. 2005 With help from the Hospital Association of New York State (HANYS), Dr. Rob Mackenzie, president and CEO of Cayuga Medical Center, assembles a group of hospital CEOs from around the state to form the HANYS PCI Work Group. Their goal is to revise state regulations governing who can perform percutaneous coronary intervention and where it could be done. For someone in the throes of a heart attack, PCI can make the difference between life and death. In 2005, however, PCI is only available in tertiary care centers. Dr. Mackenzie and his colleagues believe that community hospitals with established track records of successful diagnostic cardiac catheterization can, and should, be able to provide PCI: there is clearly a need for this service in rural communities. Effective bystander CPR, provided immediately after sudden cardiac arrest, can double or triple a victim s chance of survival. If you think you are having a heart attack, don t wait more than five minutes to call 9-1-1 for help. Invasive cardiologist Dr. Qutaybeh Maghaydah, FACC, joins the medical staff and Cayuga Cardiology. He comes to us from the Rochester Heart Institute with experience in cardiac catheterization, transesophageal echocardiography, and nuclear cardiology. Ellen Dugan, vice president for service lines, joins Cayuga Medical Center s Senior Leadership Team. She oversees the Cardiac Services Department and works closely with our cardiologists to expand capabilities and to help position the medical center for the development of important new cardiac services. Cayuga Medical Center s Department of Cardiac Services receives the 2005 Clinical Site Excellence Award from ADHERE, which is the national registry for patients with acute decompensated heart failure. This patient data registry examines treatment and patient outcomes to determine the most effective protocols for managing acute heart failure. This has proven to be a very important national study, providing significant data, and is widely referenced. The cardiologists in Ithaca are committed to educating our community about risk factors for heart disease, the signs and symptoms of a heart attack, and the importance of seeing your doctor if you have suspicious symptoms. The fact that we now provide interventional care is wonderful; however, the success of our PCI program in saving lives depends on people being able to recognize a situation that needs immediate treatment. What happens between the beginning of a cardiac event and the patient s arrival at the hospital is extremely important; right now fifty percent of heart attack patients in this country die before they get medical attention. We believe that the more we educate people, the better able we are to help them survive a heart attack. We have also made it a priority to teach area residents about the symptoms of sudden cardiac death, how to recognize it, and the steps we can take to save the life of someone experiencing sudden cardiac death. It is important for everyone to know cardiopulmonary resuscitation (CPR) and where automated external defibrillators (AEDs) are located in the community. These are all links in the chain of survival. Perhaps the most important teaching we 12 Cayuga Medical Center Annual Report 2010

What s an AED? An automated external defibrillator (AED) is a selfcontained device available in public locations, to use when a person collapses due to cardiac rhythm problems. With the formation of our Clinical Assessment Team (CAT), an experienced critical-care team responds immediately with airway equipment and medication when a patient anywhere in the hospital is in rapid decline and a nurse requires more help. With the initiation of CAT, patient codes drop significantly. CAT is part of the 100,000 Lives Campaign launched by Voluntary Hospitals of American and the Institute for Healthcare Improvement to help hospitals improve patient care and prevent avoidable deaths. Studies have shown that children as young as nine years old can learn and retain CPR skills. u v w x y Time Is Muscle Symptoms can occur in the center of the chest from the bottom of the ribs to the neck, and may also involve the throat, arms, jaw, and back. The sensation can feel like pressure, heaviness, burning (similar to indigestion), an ache, or a feeling of tightness. Patients often describe these symptoms as discomfort, rather than severe pain. The symptoms don t go away, they are constant. The symptoms may be accompanied by shortness of breath, nausea, vomiting, and sweating. Anyone with any combination of these symptoms needs immediate care and should call 911. must do is with our children. Preventing heart disease begins before symptoms develop. At any age we need to establish healthier habits to reduce our risks. We have an epidemic of diabetes resulting from an epidemic of obesity, both of which have lead to an increase of heart disease at younger and younger ages. We have to reverse this trend by teaching our children at a young age about the importance of eating an excellent diet, being fit, and not smoking. We can t get this message out at too early an age. Jonathan Mauser, MD, FACC Cayuga Heart Institute

2006 In December we cut the ribbon on a 40,000 squarefoot addition housing our state-of-the-art Emergency Department and Intensive/ Cardiac Care Unit. This new criticalcare facility is built in accordance with Leadership in Energy and Environmental Design (LEED) guidelines. It has many special features and provides greater integration with regional EMS providers. In 2004 I was on the medical staff of the Rochester Heart Institute at Rochester General Hospital. It was a year rich in clinical cardiology experience for me at one of the most highly rated cardiac centers in the nation. I joined the medical staff at Cayuga Medical Center in 2005, just prior to its affiliation with the Rochester Heart Institute. This affiliation was a very important step in the development of local cardiac services and brought with it many clinical benefits in terms of patient care, education and training opportunities for our staff, quality assurance, continuing support for the growth of our program here, and the availability of 24-hour consultation for difficult patient cases. We are also

Cardiac arrest is reversible in most victims if it s treated within a few minutes. The Rochester Heart Institute at Rochester General Hospital selects Cayuga Medical Center as an affiliate hospital, pairing our medical center with one of the most highly rated cardiac surgery centers in the country that is also a heart surgery center for the Cleveland Clinic. The most effective rate for CPR chest compressions is greater than 100 compressions per minute; the same rhythm as the beat of the BeeGee s hit song, Stayin Alive. The Island Health Center opens, developed in collaboration with the Ciaschi family of Ithaca. A premier fitness, rehabilitation, and wellness center, Island Health incorporates a medical model for clinical rehabilitation to help people recovering from cardiac illness, surgery, and musculoskeletal injuries. Cardiologist Dr. Malcolm Brand, director of Cardiac Catheterization, is performing automated internal cardioverter defibrillation (AICD) implantation for patients suffering from dangerously abnormal heart rhythms. computer networked with Rochester for simultaneous viewing during procedures when needed. All of this has been instrumental in developing Cayuga Medical Center s cardiac care program. I was interested in coming to Ithaca because I believed my experience in cardiac catheterization would serve this community and help to further develop the program here, and that has come to pass. Additionally, my familiarity with the Rochester Heart Institute and my collegial relationships there provided a link between the two institutions, which helped us to establish a close working relationship and smooth transition of care, especially in the early weeks and months of the affiliation. It has also been very reassuring to my patients in need of bypass or valve replacement surgery to know that I have first-hand knowledge of the quality of care provided at the Rochester Heart Institute. Patients have appreciated this assurance when facing a difficult time in their lives. Qutaybeh Maghaydah, MD, FACC Cayuga Heart Institute Cayuga Medical Center Annual Report 2010 15

2007 Regular moderately intense physical activity can lower your risk of heart disease, heart attack, high blood pressure, high cholesterol, overweight, and diabetes. Cayuga Center for Healthy Living The Cayuga Center for Healthy Living (CCHL) opens its doors at the Island Health Center under the guidance of Dr. Geoffrey Moore, a nationally known lifestyle management and cardiovascular rehabilitation expert. CCHL provides medically necessary lifestyle modification programs that help people improve their quality of life by learning to manage chronic health problems, such as heart disease and diabetes; become more active; quit tobacco; learn healthy eating habits; and manage stress. People with excess body fat, especially if a lot of it is at the waist, are more likely to develop heart disease even if they have no other risk factors. Cardiovascular Disease Prevention and Rehabilitation is introduced at the Cayuga Center for Healthy Living, to help cardiac patients learn more about cardiovascular exercise, proper eating and stress management, and how they can manage their individual risk factors for heart disease. JON REIS PHOTOGRAPHY We developed a cardiovascular rehabilitation program at the Cayuga Center for Healthy Living because it is essential to the treatment and management of any atherosclerosis disease. Angioplasty and bypass surgeries are important interventions, but if patients don t do anything about the underlying process that created the need for cardiac surgery, they re just sweeping the problem under the rug. Lifestyle management and cardiovascular rehabilitation are both key components in the array of cardiac care services. Our goal in developing a cardiovascular disease prevention and rehabilitation program was that it would meet standards set by AACVPR (American Association of Cardio-Vascular Pulmonary Rehabilitation). This association is an academic body of specialists who have established benchmarks for long-term quality of care for cardiac patients. They set the bar high and we wanted to surpass their credentialing requirements. Our nurses have training in intensive and cardiac care, we have a certified exercise physiologist on staff, and we have the hardware and infrastructure to monitor patients during exercise. All of this is designed for patient safety. Our program attained the important AACVPR certification in 2010. In the words of Dr. Francis Peabody, a famous Harvard medical professor in the 1920s, The secret of the care of the patient is in caring for the patient. This approach to patient care is crucial in cardiac rehabilitation and lifestyle management. Our staff members care about how their patients survive and 16 Cayuga Medical Center Annual Report 2010

Healthy snack foods for under $1 include apples, bananas, baby carrots, oranges, pears, and low-fat yogurts. Stay away from palm oil, palm kernel oil, coconut oil, and cocoa butter because they are high in saturated fats. The Emergency Department welcomes new medical director, Dr. Drew Koch. He is board certified in emergency medicine, a Fellow of the American College of Osteopathic Emergency Physicians, and has eighteen years of emergency medicine experience. thrive; they are concerned about the quality of their patients lives, as well as their longevity. Every member of our CCHL team brings a holistic approach to working with people who are dealing with depression and anxiety following a heart attack. The humanity of our staff helps our patients thrive. Geoffrey Moore, MD, ACSM Lifestyle Management Specialist and Clinical Director Cayuga Center for Healthy Living Cayuga Medical Center Annual Report 2010 17

2008 Our premier affiliation with the Rochester Heart Institute brings many benefits to Cayuga Medical Center: direct consultation on complicated cardiac patients, medical education through teleconferencing and shared grand rounds, shared protocols developed at the Rochester Heart Institute, quality review to ensure the highest standards of care, and a smooth transition to the finest nearby cardiac center for our patients who require bypass surgery. Each day the average heart beats 100,000 times and pumps 2,000 gallons of blood. With generous support of area residents, businesses, and organizations, the Cayuga Medical Center Foundation successfully completes a $2 million capital campaign. The PCI Work Group continues to meet, working with the New York State Department of Health. The group authors two white papers, gives several presentations, and provides advice to the health department as they help rewrite the cardiac regulations pertaining to PCI. JON REIS PHOTOGRAPHY We provide highly specialized care for patients requiring interventional treatment. The patient s cardiologist consults with the interventional cardiologist to discuss the patient s medical history, symptoms, level of activity, and current treatment so that together we can decide on the right plan of action. Our primary goal in managing these patients is to maintain the stent in the coronary artery and keep it open. I tell patients that having PCI or bypass surgery is like unplugging a drain: they have to be very compliant with their medications, lifestyle

Construction is completed on a new serene, sun-lit lobby where patients and families feel truly welcomed and comfortable. This marks the completion of an extensive five-year renovation throughout the medical center expanding emergency and critical-care capabilities, Imaging Services, Pharmacy, and the relocation of key patient services to improve patient safety and access. Cayuga Medical Center is committed to community education, joining with more than sixty hospitals across the nation to launch Woman s Heart Advantage, a collaborative program to raise awareness and knowledge among women about the nature and risk of heart disease. Nuclear cardiology is certified at Cayuga Medical Center by the American College of Radiology. This diagnostic tool combines nuclear medicine studies and CT scanning to produce images that show blood perfusion in the heart under stress, which can be very useful in diagnosing chest pain. changes, cardiac rehabilitation, and smoking cessation to prevent the artery from clogging up again. Medication adherence is especially critical because stents can close up and cause a massive heart attack when people do not take their medicine as directed. We are very careful to monitor and assess medications especially cholesterol medications following cardiac interventions. By complying with national guidelines for cardiac care, our patients can gain the most benefit with the least amount of risk. We also make a point to follow up on any other lesions in the coronary arteries because when you have had a heart attack, there is usually more than one narrowing in the coronary arteries. We evaluate and try to strengthen the pumping function of the heart and we make a decision about whether the patient needs an AICD (automated internal cardiac defribrillator). The feedback from our patients is that they get a lot more personal, focused attention and individualized care here than they have in other places. I believe that the care we provide here is equal to or better than the cardiac evaluation, care, and management of any hospital in New York State. Amit Singh, MD, FACC Cayuga Heart Institute Cayuga Medical Center Annual Report 2010 21

With the leadership of Dr. Amit Singh, cardiologist, and Dr. Drew Koch, medical director of the Emergency Department, the Cayuga Medical Center STEMI Team is developed. This is a rapid response team focused on the immediate assessment and treatment of patients with myocardial infarction (MI or heart attack). I like to say that the nurses and cardiac techs at the Cayuga Heart Institute are the heart of Cayuga Medical Center: they have big hearts and they provide excellent care for people with heart disease. Everyone here works as a team, every step of the way. We share a vision as we take care of each patient, with experience and communication. This is enormously important when you are working quickly to open a blocked coronary artery. Good cardiac care nurses possess advanced training and knowledge of cardiovascular anatomy, the expertise to understand EKGs and what they indicate, excellent communication skills, and sound patient education skills. You must also have the ability to gain the trust of patients and families in times of extreme stress so you can do what you need to do to save the life of someone having a heart attack. The nurses here are excellent and have come to the Cayuga Heart Institute from diverse backgrounds in emergency medicine, cardiac care, and intensive care. Most of our staff members have between five and thirty years of experience and are certified in cardiac care. They love what they do and they give our patients a gift by being on call. This means that no matter the time of day, if someone has a heart attack, our experienced nurses will be on hand to help them through it. Sandra Fuller, RN Director of Cardiac Services Cayuga Medical Center Half of all people having a heart attack wait more than two hours before getting help because they fear it will be a false alarm or they are in denial. Dr. Mackenzie and the PCI Work Group complete their recommendations to change regulations and introduce life-saving PCI to rural hospitals and smaller communities. Under the direction of cardiologist Dr. Lynn Swisher, the Cayuga Medical Center Echocardiography Laboratory becomes accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL). Stent Repair of Blocked Coronary Artery Before 2009-2010 A major renovation and expansion of the Cardiac Services Department is completed. Blockage Decreased blood flow After Stent placed Normalized blood flow The interventional team can assemble here in a matter of minutes and EMS (Emergency Medical Services) is instrumental in starting the process. Our goal is to have a patient s coronary artery blockage open within ninety minutes of the time he or she enters our Emergency Department. The teamwork continues in our ED with our doctors and nurses. They call Cardiac Services to let us know a heart attack patient is on the way in. Part of our staff goes down to the ED to prepare the patient for transfer to the cardiac cath lab and part of our team begins setting up for the procedure. The same level of communication is essential between the cath lab and the Intensive Cardiac Care Unit, where the patient is 22 Cayuga Medical Center Annual Report 2010

Cayuga Medical Center becomes an Accredited Chest Pain Center, one of only six hospitals in upstate New York State to have earned this certification. Cardiac arrest is reversible in most victims if it s treated within a few minutes. The Cardiovascular Disease Prevention and Cardiac Rehabilitation Program at the Cayuga Center for Healthy Living receives program certification from the American Association of Cardiovascular and Pulmonary Rehabilitation. Cardiac Services introduces the Heart Lab, a state-of-the-art digital image reporting and storage system that links Cayuga Medical Center directly to Rochester Heart Institute. Cayuga Medical Center receives official approval from the New York State Department of Health to offer percutaneous coronary intervention (PCI). This is performed on an emergency basis during a heart attack to quickly open a blocked cardiac artery and restore blood flow to the heart. PCI is also used electively in treating patients with chest pain due to coronary artery blockages. With the arrival of interventional cardiologists Dr. Paul Stefek and Dr. Stephanie Goodwin in July, the cardiac care team begins final preparations for the initiation of PCI services at the Cayuga Heart Institute. With the pieces all carefully in place and with an experienced team of cardiologists and cardiac-care nurses, PCI services are now available at the Cayuga Heart Institute beginning in November 2010. cared for after undergoing PCI. The communication is key to good patient care. The fact that we can offer this service in Ithaca is truly beneficial to cardiac care here; keeping patients in their community is great for them and it s a big plus for families, as well. Our PCI program may be in its infancy but we ve had excellent outcomes, which is attributable to the outstanding commitment of our people. We are all enthusiastic, on point and thorough, and all of the members of our team are contributing to our success. Stephanie Goodwin, MD, FACC Cayuga Heart Institute

C r e at i n g t h e C ay u g a H e a r t I n s t i t u t e Bringing interventional cardiology to the Cayuga Heart Institute has advanced the level of local cardiac care in the spirit of the past decade of work by all of the people mentioned on these pages. This new program is truly a combined effort of many players from the Emergency Medical Services in our community, our Emergency Department, Cardiac Catheterization Program, Intensive Cardiac Care Unit, and Air Methods Corporation Helicopter Services. Working with all of these committed, enthusiastic colleagues to educate and prepare them for the launch of this program has been a wonderful experience. Our intervention success rate for opening coronary artery blockages is very high, both for acute heart attack patients and elective interventions. We ve also set up fast patient transfer methods to move people to other institutions when we determine their blockage is too complex for PCI. In accordance with our guidelines, if an elective or urgent intervention is too high risk, or if we discover the patient may be a candidate for cardiac bypass surgery, we transfer them quickly to our affiliate, the Rochester Heart Institute, or to another tertiary care institution at the family s request. Some of our very best help with acute heart attack patients comes from our wonderful local Emergency Medical Services (EMS). When an ambulance is called, the EMTs who arrive on the scene perform an EKG on the patient right away and fax it to us. They also quickly evaluate the situation and make a judgment call. With the help of information EMTs provide, we can quickly assemble our cardiac intervention team, sometimes while the patient is still in transit. When the patient rolls into our Emergency Department they are transported as quickly as possible to the Cardiac Cath Lab. Every minute counts. Paul Stefek, MD, FACC, FSCAI Director of Interventional Cardiology at the Cayuga Heart Institute

Highlights of 2010 The Physical Medicine Rehabilitation Unit (PMRU) is ranked in the 99th percentile in the country in 2010, among 827 such units in the United States. Under the leadership of Intensive Cardiac Care Unit (ICCU) medical director Dr. Peter Hannon, a new therapeutic hypothermia protocol is developed and adopted in ICCU to treat cardiac arrest patients. Less than 25 percent of the nation s hospitals have adopted this leading-edge treatment, which reduces the risk of brain damage in certain patients suffering sudden cardiac death. Dr. Joseph Mannino joins Orthopedic Services of CMA in June 2010 and brings new capabilities to the community, including arthroscopic rotator cuff repair and arthroscopic capsular shift surgery. He also has significant experience in orthopedic trauma. General and bariatric surgeon Dr. Brian Bollo joins the staff of Bariatric Services and Surgical Associates of Ithaca. In August Dr. Brett Young and Dr. Kim Carney Young join Orthopedic Services of CMA, bringing new capabilities in shoulder replacement surgery and hand surgery including injury repairs, tendon transfers, finger reconstruction, and the correction of congenital anomalies. They are also trained in orthopedic trauma. This brings our orthopedic team to seven specialists and helps to enhance our capabilities in sports medicine, fracture care, joint-replacement surgery, and orthopedic trauma. The Department of Radiation Medicine earns accreditation from the American Society of Radiation Oncology. The Department of Sports Medicine, Physical Therapy, and Athletic Performance receives the Outstanding Clinical Education Site Award from the New York/New Jersey Clinical Education Consortium Cayuga Medical Center, with the help of Dr. Lloyd Darlow, vice president for clinical integration, moves ahead in the creation of a locally integrated health care system. Dr. Kim Carney Young performs microsurgery on this patient s hand.

Riding on the Cayuga Medical Center team is John Rudd in the lead, on the Ride for Life, a one-day bike ride around Cayuga Lake to benefit the Southern Tier Aides Foundation. Photo: ARTSPACE www.uticaartspace.com

r e a c h i n g o u t t o t h e c o m m u n i t y Cayuga Medical Center serves a diverse, dynamic community. As members of this community, our staff and physicians are actively involved participants in the life of Tompkins and Cortland Counties. In 2010, Cayuga Medical Center reached out in many different ways to support and to connect with the people we serve. Shown here is a partial list of our 2010 community activities, through sponsorships, board membership, and program participation. Alzheimer s Association American Cancer Society American Heart Association American Red Cross Beechtree Care Center BOCES Advisory Board for Technology Education Cancer Resource Center of the Finger Lakes Cayuga Addiction Recovery Services Cayuga Medical Center Foundation Challenge Industries Community Foundation of Tompkins County Cortland and Ithaca Relay for Life Cortland Chamber of Commerce Business Showcase Excellus Regional Advisory Council Family and Children s Services Franziska Racker Centers Hangar Theatre History Center of Tompkins County Hospicare and Palliative Care Services Greater Ithaca Activities Center Iroquios Healthcare Association Ithaca Youth Hockey Kendal at Ithaca Leadership Tompkins Legacy Foundation Lifetime Healthcare Companies Medical Society of NYS NYS Cardiac Advisory Council Opportunities, Alternatives, and Resources of Tompkins County, Inc. Paleontological Research Institute Rotary Club Sciencenter Society for the Prevention of Cruelty to Animals Southern Tier Aids Ride for Life Taste of the Nation Tompkins Cortland Community College Tompkins County Air Services Tompkins County Chamber of Commerce Tompkins County Health Planning Council Tompkins County Public Health Tompkins County Public Library Tompkins County Workforce Development United Way of Tompkins County Visiting Nurse Service Women s Expo 2010

Cayuga Medical Center Statistical Report 2010 Years Ending December 31, 2010 and 2009 2010 2009 Total Patients Served (Inpatient and Outpatient) 194,621 195,757 Inpatient Discharges: Medical-Surgical (Adult and Pediatric) 4,040 4,418 obstetrical 807 873 Newborn 814 876 Psychiatric (Adult) 667 680 Psychiatric (Adolescent) 170 181 Medical Rehabilitation Unit 195 200 observation 1,760 1,587 Total Discharges 8,453 8,815 Surgical Cases Inpatient 1,243 1,299 outpatient 5,197 5,270 Total Surgical Cases 6,440 6,569 Outpatient Utilization Emergency Department Visits 30,031 29,995 Convenient Care Center Visits 44,175 44,638 Cayuga Center for Healthy Living Services 6,166 5,141 Sports Medicine and Athletic Performance Services 2,891 2,135 oncology & Other Outpatient Service Visits 2,612 2,462 Radiation Therapy Treatments 4,677 4,378 Pain Management Procedures 2,936 2,727 Sleep Studies 838 822 Sleep Office Visits 2,160 2,009 occupational Health Visits 894 931 obstetrical Outpatient Visits 679 673 Outpatient Ancillary Imaging Procedures 101,351 103,076 Laboratory Tests 623,644 632,133 Rehabilitation Treatments 84,070 85,295 Endoscopy Procedures 4,872 4,737 Wound Care Visits 3,905 4,509 Cardiac Cath Procedures - PCI 22 0 Cardiac Cath Procedures - Diagnostic 328 344 Cardiac Testing & Other Services 4,653 4,975 Respiratory Therapy Treatments 24,105 27,535 EKG 12,724 11,708 Neurology (EEG, EMG, other) 811 926 28 Cayuga Medical Center Annual Report 2010

Statement of Operations Years Ending December 31, 2010 and 2009 2010 2009 Operating Revenues Patient Service Revenue - Inpatient $ 42,993,174 $ 44,992,268 Patient Service Revenue - Outpatient 85,617,950 $ 81,196,644 Total Patient Service Revenue 128,611,124 126,188,912 Other Operating Revenue 2,908,233 2,974,854 Uncompensated Care (5,655,790) (5,976,488) Total Operating Revenues $ 125,863,567 $ 123,187,278 Operating Expenses Employee Related $ 66,164,881 $ 63,206,236 Supplies, Professional, & Contracted 37,536,432 35,656,601 Fixed & Other Direct 10,043,399 9,088,819 Depreciation & Amortization 8,952,618 9,407,275 Interest 695,264 613,305 NYS Fees Assessment 450,351 341,470 Total Operating Expenses $ 123,842,945 $ 118,313,706 Income from Operations $ 2,020,622 $ 4,873,572 Net Revenue by Service Net Revenue by Payer Expenses by Classification 33% Inpatient Service Revenue 18% Commercial 1% Self Pay 4% Other Govt. 30% Supplies, Professional, and Contracted 9% Fixed and Other Direct 7% Depreciation and Amortization 1% Interest 65% Outpatient Service Revenue. 2% Other Operating Revenue 41% Blue Cross 6% Medicaid 30% Medicare 53% Employee Related Cayuga Medical Center Annual Report 2010 29

Message from the Chairman of the Board of Directors Jeffrey Snedeker, MD One of the biggest national news stories of 2010 was the health care reform debate that has been occurring throughout our country. It s probably safe to assume that among your neighbors and friends, while many support the recent federal legislation that attempts to reshape our national approach to health care and many oppose it, many more are probably confused and overwhelmed by it. Yet virtually everyone agrees that health care should cost less and deliver more. Our national health care system is inefficient, hard to navigate, and rewards volume rather than quality of care. Whatever the outcome of the current national debate surrounding health care, if the health of our community is truly to improve, we must change the way health care is provided at the local level in ways that reduce cost, achieve better outcomes, and improve access for every member of our community. At Cayuga Medical Center, the physicians of our community and our hospital leadership have come together in a way that is both exciting and unprecedented, in a process called clinical integration. The concept of clinical integration is simple: by reducing duplication of services and rewarding efficiency, and by preventing costly complications and lessening the impact of chronic diseases, we can improve the overall health of our community, and also contain costs. Although the concept is simple, the challenges are many. Hospitals and physicians alike will have to make sacrifices in order to contain costs. We will need to make it easier for patients to have a medical home in which they receive high quality preventive care, and through which access to specialists and hospital care can be expedited when needed. We will need to find ways for the providers of our region to share information more seamlessly while respecting patient confidentiality, and empower patients to have access to their own critical health care information whenever they need it and wherever they go. What have we done so far? In 2010, we formed a council composed of community physicians and our hospital leadership team, which serves as a forum for focusing on the health care needs of our region and determining how we can work together in meeting them. We also formed a partnership of community physicians Cayuga Area Physicians Alliance that is committed to increasing access to high quality care and containing costs. We are exploring Our commitment is better care for you and a community that grows healthier. creative ways of sharing health information that will help physicians and other allied health professionals provide better continuity of care. We are collaborating in ways that are positive, proactive, self-initiated, and focused on our local community needs. The model we are building in our community is well ahead of the national curve and is already being looked to as an example by other communities like our own. We are not waiting for outside entities to tell us what we should do and how we should do it. Clinical integration is something that we can and must do for ourselves, and the time to do it is now. Your physicians and the leadership of your medical center are putting significant time, energy, and resources into clinical integration, with one core goal in mind: improving the health of our community. It s what we all deserve, and I m thrilled as a physician, as an employer, and as a member of the community to be a part of it. Dr. Snedeker is board certified in pediatrics and pediatric infectious disease and is in practice with Northeast Pediatrics and Adolescent Medicine. He is a long-standing member of the medical staff at Cayuga Medical Center and has served on the medical center s board of directors for nine years. 30 Cayuga Medical Center Annual Report 2010

Thank You to our Donors! The Cayuga Medical Center Foundation would like to extend a special thank you to the donors listed on the following pages, whose generous gifts have supported our important work. Thank you for giving! The foundation is a not-for-profit fundraising organization whose mission is to support Cayuga Medical Center s evolving needs for new program development, services, and facilities. In 2010, the foundation started raising funds to support a major renovation of the Surgical Services Department at Cayuga Medical Center. This pivotal capital project on the main campus includes new construction and an overall reconfiguration of the surgical suite to increase the number and size of operating rooms, enhance our technological capabilities, and improve operational efficiencies. We also received designated gifts for the Unrestricted Fund, which helps the medical center respond to emerging concerns, and for the Charity Care Fund to assist people in the community who cannot afford the cost of their care. Recognized on the following pages are contributors who made gifts to the Cayuga Medical Center Foundation, to the Gala Celebration, An Evening to Care, and directly to Cayuga Medical Center during the period of January 1, 2010 through January 31, 2011. $20,000 to $35,000 Cayuga Medical Center Auxiliary Estate of Ruth Foote Margaret I. Gibson $6,000 to $19,999 Cayuga Anesthesia Assoc. of Ithaca, LLP Dr. Donald Bluh Dr. Mattison Burt Dr. Joseph Bylebyl Dr. David G. Fellows Dr. Christina I. Klufas Dr. Stephen Meyer Dr. Robert Mitchell Dr. J. Russell Norton Dr. Anthony Sanito Dr. Thomas M. Toal Cayuga Medical Center Physicians Arthur Kuckes and Martha Wright LPGA Corning Classic Marvin and Annette Lee Foundation, Inc. $2,000 to $5,999 Robert Abrams Aetna Bridges Cornell Heights Buttermilk Falls Pediatrics Dr. Jessica Casey Dr. John Lambert III Dr. Janusz Sendek Dr. Amit Shrivastava Conway Construction Dale and Nellie Corson Eci Drs. David Evelyn and Jennifer Weinraub Excellus Health Plan, Inc. Gastroenterology Associates of Ithaca Dr. Peter Brennan Dr. Brent D. Lemberg Dr. Steven Rogers Dr. Carl West HOLT Architects, P.C. Grace N. Chiang Graham Gillespie Robert O Brien David Taube Dr. Kim Hwang and Debora Huber-Hwang Ithaca Cardiology Associates Dr. Malcolm Brand Dr. Amit Singh Dr. Paul Stefek Dr. Lynn Swisher Dr. Rob and Maggie Mackenzie Dr. Anthony and Amelia Massi Jon Minikes and Susan Backstrom Susan and Jim Nohelty Olver & Associates, Inc. Dorothy Rinaldo John Rudd and Beverly Chin James and Cecile Spero Dr. Robert Strominger and Karen Miller Helen and Kevin Talty Tompkins Trust Company Stephen and Barbara Walczyk Philip White $900 to $1,999 Phyllis Allen Anonymous David and Joy Barr James and Margaret Bramble Charles Brodhead James and Terry Byrnes Alice Colby-Hall The Collyer Charitable Fund of the Bank of America Communiqué Design & Marketing, Inc. The Computing Center Linda Crumb David Dier Donald and Iris Greenberg International Brotherhood of Electrical Workers Peter LePage and Deborah O Connor Dr. Jonathan and Ivy Mauser Dr. James and Susan McCutcheon Merrill Lynch The Miller Mayer Fund Margaret Munchmeyer Neil and Lisa Olver Orthopedic Surgery & Sports Medicine, P.C. Dr. Kimberly Carney Young Dr. Dirk H. Dugan Dr. Joseph A. Mannino Dr. Brett Young Patterson s Service Station of Ithaca Alan and Nancy Pedersen Physiatry & Rehabilitation Medicine, PC Dr. Andrew Morpurgo Dr. Melissa Thibault Precision Filters Frank and Rosa Rhodes Jean F. and Elizabeth E. Rowley Dr. and Mrs. Victor Sacchi Sciarabba Walker & Co., LLP Security Mutual Insurance Co. Arthur and Charlotte Shull Lauren and Julia Stiles Chuck Tauck and Frances Littin Bud and Priscilla Tennant John W. Turner Ari van Tienhoven Tony and Polly Votaw Charles and Jane Walcott William and Ruth Zikakis $500 to $899 The Baker Foundation Bangs Funeral Home Dr. and Mrs. Peter T. Brennan James and Karen Brown Anntoinette Burger Jill Burlington Cayuga Radio Group Chemung Canal Trust Company Alton and Donna Clark Tom and Loren Colbert J. Lewis and Judith Cooper Cornell Finger Lakes Credit Union G. Walton and Jean Cottrell Robert and Vanne Cowie Ellen and Patrick Dugan Dr. Charles and Linda Garbo Robert and Wilma Habel James Haight Janice and John Hertel Stephen and Adrienne Hopkins James and Barbara Hulbert Herbert and Ruth Israel Dr. Lucia Jander Michael Judd Michael and Carol Kammen Rick Kidwell Tom and Lisa LiVigne Terry Marcus Design Brian McAree and Kris Corda Dr. Hermogenes Mecenas Dr. Viola and Gerry Monaghan Cayuga Medical Center Annual Report 2010 31

MVP Health Plan, Inc. Physicians Reciprocal Insurers The Rachel J. Siegel Fund of the Community Foundation Loretta Ramstad Kenneth and Jean Robinson Elma Robinson Dr. Elliott and P.A. Rubinstein Andrew and Rosemary Sciarabba Dr. Jeffrey D. and Suzanne Snedeker Dr. Martin and Ami Stallone Robert and Pamela Swieringa Mr. and Mrs. William H. Toth Frost and Kate Travis Barbara Workman Milton and Marjorie Zaitlin Zimmer Upstate New York, Inc. $100 to $499 Molly and Barry Adams Karen Adams Pete Akins and Connie Ged John and Elaine Alexander Richard Allmendinger and Teresa Jordan Dean C. Arcangeli Melanie Armstrong Robert Aronson Neil and Judith Ashcroft Philip Aubin and Emily Mallar Audrey Edelman RealtyUSA Autoworks David and Lenore Bandler Kevin and Jacqueline Bangs Louanne Bangs Bangs Ambulance Service Richard and MaryAnne Banks George and Ann Bantuvanis Joyce Barney Eugene and Carolyn Bartell Larry and Trudy Baum Bernard and Linda Beins William and Nancy Bellamy Janine Benjamin-Kuehl Randa Best Rose Bethe James and Deborah Bilinski Brad and Elizabeth Bilinski Louis and Jeanne Billera Joyce and Marty Bleiweiss Arthur and Donna Bloom Sherman Bodner Drs. Brian Bollo and Melissa Dhundale Julia Bonney and Greg Bostwick Borg Warner Foundation Ronald and Linda Bors Courtney Boylan Dr. Patsy Brannon and George Buchanan The Brew Family Mary Brickey The Carman and Sandra Brink Hill Fund of the Community Foundation Kevin and Kara Britton Liese Bronfenbrenner Toni Brotz Brown & Michaels, P.C. Roxann Buck David Burns Susan Cary Cayuga Landscape Cayuga Medical Center Physician Recruiting Dr. Eric Chanko Tony and Roberta Chiesa Roy and Alma Coats Shaun Cobb Bonnie Cochrane Timothy Colbert and Mary Ann Knight-Colbert John Collett Eileen Cornwall Robert and Patricia Crowley Mary Ellen Cummings Lori Davis Reverend Tim Dean Noel and Janet Desch Bonnie DeSombre Dr. and Mrs. Satish Devapatla Kenneth and Ruth Devine Roy and Frances Dexheimer Rudiger and Christine Dieckmann Anne DiGiacomo DiMarco, Abius & Pascarella, CPA, PC Frank and Barbara DiSalvo Mary Pat Dolan and David Kerness Clover M. Drinkwater David and Barbara Dubow David and Peggy Dunlop Katherine D. Durant Clifford and Lisa Earle Ronald and Randy Ann Ehrenberg Tony and Juliana Eisenhut Jane and John Murray Elliot Meredith Ellis Elmira Savings Bank Engel Foundation, Inc. Ann-Marie Esposito Howard and Erica Evans David and Grace Evans Mary Berens and Paul Feeny Dr. Howard and Rosalind Feinstein Dr. David Feldshuh and Martha Frommelt Martha Ferger Tim Findling and Paula Kilts Finger Lakes Technology Group First National Bank of Dryden William Fischbach Megan Fisher Frank and Gail Flannery Kevin Flint Dr. James and Judith Fogel Fontana Apartments Connie Frank Craig and Nina Fuehrer Gregory and Betsy Galvin Kristina Gambitta Dr. Henry and Suokmee Gerson Graham Gillespie Global Supply Chain Organization Marion Gnadt Barbara Goodwin Dr. Stephanie Goodwin and Mark Hopson Kurt and Sorel Gottfried Daniel and Karen Governanti Charles and Margery Grace Duane Gray William Griffin Bradley and Juanita Griffin Brian Grimes David and Adriana Hall Dr. Cris Haltom Dr. Shern Hart Hart & Welsh DDS Gregory and Beverly Hartz Jerome and Joan Hass John and Karen Hays John and Holly Heitzman Robert and Imo Herrick Angelo Hickman Joy Hodges Eva B. Hoffmann Allison Hogue Rebecca Holland Terrance Holmes Mary Honcharik Joan Horn Allison Howe Ithaca Times Ithaca Oral Surgery, PLLC Ralph and Rhoda Janis Dawn and Robert Jewell Dale and Jennifer Johnson Patricia Johnson Andrew Jordan Ruth Kahn Drs. Fredric and Marsha Kardon Harry and Doraline Kesten Dr. Jud and Suzanne Kilgore Chung Kim Eris Kimble Christine Klotz and Charles Henderson Stevan Knapp Carol and Charles Korbel David Kraskow Paul Krol Carol LaBorie Judith Leavitt Angela Leonard Paul and Laurie Levesque Stuart and Ruthye Lewis Jack and Barbara Lewis Michael and Bonita Lindberg Laurie Linn David and Nancy Lippert David and Alexandra Lipsky Christopher Lockwood Lou LoVecchio Terri Sue MacCheyne Dr. L.A. and Beatrice Magre Maguire, Inc. Virginia Maloney Mancini-Ferrara & Sons, Inc. Dr. Joseph and Cynthia Mannino Randy and Terry Marcus Dr. Luminita Marinescu and Bret Lukezic Peter and Ann Martin Susan Marzolino Amy Mathews George McGonigal Leo and Mary Jean McGrattan Susan McKeon-Schaerr Daniel and Jean McPheeters Carolyn McPherson Dr. John-Paul Mead and Elizabeth Vancort Joseph and Emily Metz Drs. Robert and Margaret Meyer Edna Michael Susan Milewski Eileen Miller Charlene Miller Donald Mintz Hrair and Lucy Missirian MJK of Ithaca, Inc. Christina Morse James Morton and Kari Ryder-Morton John and Robin Moss Hinchcliff Edward and Marguerite Moy Gail Murphy Everett Nelson John and Carolyn Neuman Shawn Newvine James Niefer Carl and Marion Norberg Gail Norwood Carol and Peter Noyes Melinda and Brett Oakes Girard and Marty Oberrender Michael and Virginia Olsen Oral Maxillofacial Surgery Cal and Joan Organ Roy and Elizabeth Park Dr. H. J. Patrick and Patricia Patrick Eileen Paulson Jane S. Peck Lori Pendell Perrywinkle s Fine Jewelry Linda Petak Victoria Pierce Dr. Francis and Susan Piliero Dr. Joseph and Linda Piskorowski Ronald and Kathy Poole Lisa Proctor Pro-Lawn Lansdscaping & Excavating, Inc. Frank and Jean Proto Patricia Quinn Hunter and Elizabeth Rawlings Thomas Richardson Michael and Allison Riley Donald and Nancy Robbins Ernest and Alice Roberts Lori Linn Robertson Beverly Rollins Faust and Charline Rossi Mary Ellen Rossiter Thomas Ruane and Donna Augustine Anthony and Norma Russo Gordon and Jane Ryan Raymond Sammartino Patricia Schafer Carol Scheele George and Bobbie Schneider Robert and Marion Schneider Teresa Scholtisek H. Daniel and Mary Ellen Schreher Arnie Schwartz Dr. David and Rebecca Schwed Beatrice Schwoerer Michael and Janet Shay Sheldon Hill Vintage & Estate Jewelry Shopiro & Meyer Associates Michael and Karen Shuler Roger and Carole Sibley Deb Siegert Shannah Simkin Daniel and Carol Sisler Marjorie N. Smart 32 Cayuga Medical Center Annual Report 2010

Dr. Christopher and Lisa Smith Smith Marketing Services, LLC Carlynn Smith-Thomas Thomas and Donna Sokol Michelle Sperl Suzanne Spitz Bernard and Lara Stanton Dr. Paul and Patricia Stefek John and Nancy Sterling Marguerite Sterling John and Heather Stevens David Stinson Maurice and Shirlee Stith Robert and Jean Storandt Cushing and Jean Strout Cornelius Sullivan Patricia Sullivan Jan Suwinski Neil and Paula Tarallo Larry and Alice Thayer Joseph and Margaret Thomas Total Care Triphammer Wines & Spirits Travis and Kimmarie Turner Curtis and Amanda Ufford United Country Susan Updike Valley Manor, LLC Kandace and Don Van Gorder Henrietta VanDeWeert Robbert VanRenesse and Lesley Greene Dr. Jake and Becky Veigel Dr. Arthur Vercillo Herbert and Jean Voelcker Joyce Vonderlin Polly Votaw Sue Vrzal Kuo-King and Cindy Wang Bryan Warren Judith Warren Warren Real Estate of Ithaca Joseph and Betty Weneser Mary Wheaton Maurice and Steffi White Sean and Jennifer Whittaker Fred and Mary Widding Brian and Christine Wilbur Karen Wilkins Fred Williams Patricia Williams Dr. Donald D. Wilson Edward and Marlene Wolf George Wolga William and Ione Worth Madison and Mary Wright Kevin Wright Eugene and Jeanne Yarussi Bettie Yerka George Zavaski Joseph and Mary Zichettella Joel and Cathy Zumoff $99 and below Thomas Adams Budd and Nancy Adams Gregory Adams Lewis and Mary Adesso Karen Ames Richard and Patricia Angerer Mark Armstrong Steve Avery Rachel Ayers Ramona Ayres Ellen Backman Cristin S. Baker Pat Baker Jamie Balas Gladys L. Barber Brenda Barber Crystal Barkman Dale and Marie Bauman Walter and Marilyn Baurle Amy Bean Danielle Bean Carol Beard Teresa Bednar William and Louise Bement Todd Benjamin Scott and Marianne Benjamin Kathlene Bergen James Bernal Mary Besemer Patricia Borra Patricia Bowen Sabrina Bower Cinda Bowers Joyce Boyer Kimberlee Boylan Pamela Brewster Adam Brickey Dorothy Brooks Rosalie Brooks Sue Brower Cindy Brown Derek Brown Cindy M. Brown Raymond and Dorothy Buckley James and Maria Burdett Carl Burgess John Burkleo Mary Burley Rosanna Carpenter George and Patricia Casler Barbara Jean Caward Cayuga Medical Center Nutrition & Dining Tori Champion Jeanne Chapple Larry and Arlene Chase Stephen and Lorraine Chase Barbara A. Chase Wanda Clements Louise Clink Patricia Cloyes Mary Cochran Connie Cole Betsey Conner Noel Crass-Conners Donna Creswell Jennifer Crispell Pamela M. Cronk Shannon Curkendall Joseph D. Curran Jr. Eric Cyker and Teresa Cater-Cyker Erik Cymara Pearl Cytryn Duane Davis and Mary McKeegan Davis Dr. Andreia de Lima David Delchamps Richard and Nancy Dolge Tina Dorn Marilyn Downing Judith Dresser David Drew Mildred B. Drosdoff Robin Dupay James Durkee Dennis and Joann Dyer Jennifer Easter Tina Eastman Gary Edwards Deborah Edwards James and Karin Eisenberg Nancy Emerson and Roy Luft Jay and Carol Engels Milton and Janice Esman Bonnie Everts Marie S. Everts Tina Faulkner Christine Feely James and Joan Fenner Gary and Lisa Ferguson Karla Ferguson Terence Fernon Diane Ferretti Joseph and Mary Fetcho Rebecca Fiore David and Patricia Flaccus Christina Foltman Carolyn Foote Allyson Freelove Michelle Fullagar Dena Ganoung Nathan Gatch Abigail Gay Renee Gaylord Lori S. Gee Margaret Gerlach Drs. Andrew Getzin and Karen LaFace James and Rhonda Gilmore Laura Goodwin Anne Gorsky Raymond Gozzi and Barbara Logan Erin Graves Emily Green Erin Griffeth Julie Griffin Annette Griswold Lori Grover Belinda Hadamik Robert and Janet Haggerty Dayton Hall Leslie Hammond Margaret Hampson Martha Hannah Thomas Harris Kevin Harris Rita Louise Hartigan Helen Hartnett Howard Hartnett Mary-Kay Hasenjager Katherine Haus Kendall Hazelton Elizabeth Heath David Heck Gina Heffernan Andrea Heilig The Heman Family Marcia Herrick Annette Heverly Nancy Hicks William and Phyllis Highland Matthew Hill Megan Hinman Thomas Hirasuna and Jean Hunter Tom Hoebbel Marian E. Holt Brenda Sue Houde Jean A. Houghton Donald House Cathy Howell-Seeley Sondra Hull Timothy Hull Michelle Humphries Lorryann K. Hurd Rachael Hutchinson Paul and Elaine Hyams Lynn Ink Clair Irvin Robert Irvin Stewart Irvin and Janet Haggerty Teena Irvin Kathleen Jacklin Carol Jackson Mark Jackson David and Rachel Jacobsen Lacey Jacobsen Andre and Jean Jagendorf Marguerite Sue Jayne David Jensen Kathryn Johnson Ralph and Jane Jones Hilary Jones Jenny Jursick Just Give Victor Kadylak Marc and Phyllis Kaplan Sarah Karius Joan Kearney Kristin Keller Sharon Kellogg David A. Keyser Michael and Dawn Kimberly Deanna King Ruthann Knapp Scott Koszalka Jonathan LaChance Jeffrey Lamb Robert and Virginia Langhans Ralph and Audrey LaPadula Nancy Leach Steven Brian Learn Jewia Leckey Brian Lee Allan and Denise Lentini Carole Leonello Kathleen Lester Deborah Levin Kandice K. Linn Winifred Lisenby Mary Katherine Logan Caroline Louey Julianna Lower Laura MacCarald Brandy MacCheyne Deborah Mahoney Lois Mahoney Lorrie Mahoney Dorothy Makris Stephanie Maleski Emily Mallar J.A. and V.H. Mancini Timothy Manheim Sally Maragni Dale Marcy Cayuga Medical Center Annual Report 2010 33

Russell and Patricia Mason Trevor Mattera John Matuszak Bonnie Mauboussin Ann Mayer Mr. and Mrs. B.B. McCaa, Jr. Lynne McClure Susan McCormick Robert and Mary McGinnis Jessica McMillen Kimberly Meddaugh Marianne Mellinger Anne Meltzer Joseph and Samantha Melucci Amy Mendelsohn Wanda Millahn Karen Miller Mona Miller Patricia Miller Theresa Moody Aubin Mooney Dennis and Jeanmarie Moore Susan Morgan Franziska Morris Martha Moses Karl Mount Laurie Mras Robert and Elisabeth Mueller Kimberly Mulks Michael and Judy Murawski John and Angie Murphy Eugene and Dorothy Murphy Tina Murphy Steven Murtha Deborah Myers Matthew Nagle Holly Naughton Muna Ndulo Jane Newman Sharon Newton Northeast School, Sunshine Committee Patricia Oates T.B. O Brien Michelle O Connor Paul Olcott Stephanie Oplinger Sharon Parker Deborah Pitcher Parmalee Caitlin Parsons Michele Phillips Robert Pietila Cheryl Pike Ann Pinette Grace Poyer Richard Prokop Richard and Joyce Putnam Tina Rappleye Nicole Ray Rachel Ray Paula Raymond Mary Reekie Hieber Robert Renzetti Marcia Rice Judith Riley Chris and Tanya Roberts Lisa Robinson Jodi Mae Rognaldsen Ward Romer Linda A. Roorda James Rothenberg and Mariana Wolfner Linda Rozelle John and Doreen Rudan Thomas Rumsey Laura Runyan Constance Runyon Elaine Saunders Cheri Saylor Patricia Schaffer Nathan Scheer Buffie Scott Debra Scott Sarah Searles Dorothy Sellers Sharey Selover Linda Shaff Richard Shaff Melanie Sharp William and Mary Sherlach Albert and Irene Silverman Sheryl D. Sinkow Photography Donald Simons Steven Simons William and Martha Sitzman James and Debbie Sladish Robert Slocum Debra Sloughter Patricia Smith Lorraine Smith-Clark Brenda Soboleski Tammy Solveson Kelly Spaulding Gail E. Stage Autumn Starkweather Marianne Stebbins Vickie Stebbins Kelsey Stegeland Billie Stilwell Anonymous Robert and Virginia Sweet Thomas and Tamera Swink Michael Talarski Carolyn Tavares Ashley Teeter Dawn Thompson Ruth Thompson Abby Tompkins Chad Trimm Pendleton Turco Deborah Vandyke Tiffany Vanetten Laurie Velardo Kristen Verrill Eleanore Vollweiler Amy Vorhis Nicholas Vorhis Jeffrey Wagner Debra Walawender Michael Waldroop Brenda Walker Lisa Walters Jeffrey Wardlaw Sharon Washburn Robert and Marilyn Wasserman Renee Watkins James and Louise Watson Diana Weaver Robert Wehe Bonnie Wemmer Kelly Wendt Carrie Westlake Westmere Elementary School Donald and Nonie White Kathy Willett Curtis Williams Valerie Wilson Carolyn Wiltsie John Winslow Timothy Wood Kaitlin Woodard Michele Woods Jacqueline Woodworth Rachel Wright Sue Yaniello Bonnie Young Jacqueline Zavala Dionne Zona Kelly Zona Bernice Zupancic Rivalyn Zweig While we strive to ensure the accuracy of our donor list, it is possible that a name may have been inadvertently omitted or incorrectly listed. If you notice an error, please contact the foundation office at 607-274-4284 and we will correct the error. 34 Cayuga Medical Center Annual Report 2010

Medical and Dental Staff Allergy and Immunology Mariah Pieretti, M.D. Elliot Rubinstein, MD Donna R. Sandidge, MD Christopher A. Smith, MD Anatomical Pathology and Clinical Pathology Luminita Marinescu, MD Daniel Sudilovsky, MD James A. Terzian, MD Anesthesiology Donald Bluh, MD Mattison Burt, III, MD Joseph Bylebyl, MD David G. Fellows, MD Christina Klufas, MD Stephen Meyer, DO Robert Mitchell, MD J. Russell Norton, MD Anthony Sanito, MD Thomas M. Toal, MD Cardiology Malcolm Brand, MD Qutaybeh S. Maghaydah, MD Jonathan Mauser, MD Amit K. Singh, MD David J. Skorton, MD Lynn Swisher, MD Cardiology Interventional Gerald M. Gacioch, MD Stephanie L. Goodwin, DO Paul Stefek, MD Thomas P. Stuver, MD Critical Care Medicine Vanessa M. Alvarez, MD Peter Hannon, DO David M. Landsberg, MD Paul L. Marino, MD, PhD Nathaniel M. Pascual, MD Dermatology Robert Horn, MD Josephine Chu McAllister, MD Kimberly J. Silvers, MD Diagnostic Radiology William Carroll, MD, PhD Robert M. Domke, MD Kim Hwang, MD Marc Jouandet, MD, PhD Anthony F. Massi, MD Walter C. Silbert, MD Diagnostic Radiology - Telemedicine Laurie A. Abrams, MD Lesly Benodin, MD Jennifer E. Bryant, MD Lynn Clements-Northland, MD John E. Ditzenberger, MD Elizabeth Dubovsky, MD Ana Maria Echenique, MD Matthew J. Hoffman, DO David Jacobs, MD Kristen A. Lachance, MD Elizabeth H. Moseley, MD John C. Quintas, MD Gerald T. Riley, MD Fred VanNatta, MD Sara Zeb, MD Ear, Nose, and Throat Jonathan E. Cryer, MD Ashu Ruparelia, MD Robert N. Strominger, MD Emergency Medicine Richard Allen, MD John A. Alley, MD Donald James Baker, MD Michael F. Boyle, MD Jason Buchanan, MD Garrison F. Christian, MD James L. Darling, MD David Feldshuh, MD Aaron Garber, MD Antony Hsu, MD Marc Immerman, MD Raymond Anthony Jannetti, MD Tara C. Khan, DO Drew A. Koch, DO Vincent J. Leonti, MD Christine V. Lorenzo, MD Lynn E. Miller, MD Monica Van Every Morgan, MD Richard Murray, MD Laura J. Rendano, MD Renee A. Ryan, MD Wajeeh Sana, MD LouAnne Ten Kate, MD Justine W. Schaff, MD Christopher R. Scianna, DO William C. Shepherd, MD J. Esther Steinberg, MD Martin K. Weitzel, DO Endocrinology Adam Law, MD Family Medicine Suzanne Anderson, MD Wallace A. Baker, MD Michelle Blegen, MD Robert Breiman, MD Peter Clark, MD John Cooke, MD Lloyd A. Darlow, MD Valentina Galyanova, MD Erin M. Hall-Rhoades, MD Mary F. Howson, MD William A. Klepack, MD Bruce Kuntz, MD Karen Marie LaFace, MD Eric Lessinger, MD James Loehr, MD Maura McCauley, MD Ahmad Mehdi, MD Alan Midura, MD Viola Peachey Monaghan, MD Ralph Ortiz, DO Jessie Varghese Phillips, MD Ellyn Sellers Selin, MD Neil Shallish, MD Howard Silcoff, MD Elizabeth VonFelten, MD Jennifer F. Weinraub, MD David Wentzel, DO John W. Weston, DO Sharon L. Ziegler, MD Gastroenterology Peter Brennan, MD Brent D. Lemberg, MD Steven Alan Rogers, MD Carl G. West, MD General Surgery Brian Bollo, MD Guillermo E. Ferrer, MD Cora L. Foster, MD John A. Mecenas, MD David A. Schwed, MD Hematology/Oncology Timothy E. Bael, MD Charles Garbo, MD Internal Medicine Nisar Alvi, MD Timothy Cardina, MD Eric H. Chanko, MD Reilly W. Coch, MD Ann Costello, MD John E. Costello, MD Elizabeth M. Cotton, MD Ruth Crepet, MD Andreia delima, MD Mark J. Emerick, MD Matthew Estill, MD Magdalena D. Hohn, MD Parvez, Jafri, MD Lucia Jander, MD Cynthia B. Jones, MD Fredric M. Kardon, MD C. J. Kilgore, MD Edward Koppel, MD Heather MacAdam, MD James Macmillan, MD Walter E. Margie III, MD John-Paul D. Mead, MD Aliasghar Mohyuddin, MD Geoffrey E. Moore, MD Charbel Moussallem, MD Samson Pachikara, MD Victor Sacchi, MD Jacob Skezas, MD Martin Stallone, MD Radomir D. Stevanovic, MD Sandra Thananart, MD Tomas E. Vence, MD Muhammad A. Wattoo, MD Serena H. Yoon, MD Nephrology Robert A. Hesson, MD Neonatal-Perinatal Medicine Srisatish Devapatla, MD Emad A. Ghaly, MD Eileen M. Reardon, MD Michael N. Whitman, MD Neurology Susan Cowdery, MD James Gaffney, MD Justin T. Montanye, MD Jody Stackman, MD Neurophysiology George Lee, MD Meyer L Proler, MD Neurosurgery Barry J. Pollack, MD Gerald M. Zupruk, MD Obstetrics and Gynecology Pedro J. Cruz-Torres, MD Kathleen E. Gardner, MD Steven A. Gelber, MD Cayuga Medical Center Annual Report 2010 35

Marie Harkins, CNM Catherine Husa, MD Amie E. Kennedy, CNM Oo Kyong, MD Dvorah Milner, MD Mahrie A. Moore, CNM Kathryn Pierce, CNM Jose A. Torrado, MD Ophthalmology Robert J. Arleo, MD Philip Lempert, MD Peter S. Schwartz, MD Oral and Maxillo Facial Surgery and Facial Plastic Surgery Jeffrey S. Lewis, MD, DMD Oral Surgery Timothy Bonniwell, DMD Francis Piliero, MD, DDS Melissa Dhundale, MD John Y. Lambert, MD Rajaram Rao, MD Janusz Sendek, MD Amit Shrivastava, MD Jeffrey D. Snedeker, MD Andrea Torrado, MD Marguerite Uphoff, MD Melissa Woo, MD Pediatrics/Cardiology Nader H. Atallah-Yunes, MD Craig J. Byrum, MD Daniel A. Kveselis, MD Frank C. Smith, MD Physiatry Andrew Morpurgo, MD Melissa Thibault, MD Plastic Surgery David Monacelli, MD Psychology Matthew D Ortona, PsyD Kevin Field, PhD Robert Laurentz, PhD Jed H. Weitzen, PhD Pulmonary Medicine Robert Kaplan, MD Earl Robinson, MD Radiation Oncology David S. Cho, MD Jorge A. Gomez, MD Michael Kuettel, MD David M. Mattson, MD Kilian Salerno May, MD Dheerendra Prasad, MD Anurag K. Singh, MD Graham Warren, MD Rheumatology Lawrence Endo, MD Officers of the Medical Staff Srisatish Devapatla, MD President Amit K. Singh, MD President-Elect Timothy Bael, MD Second Vice President John-Paul Mead, MD Past President Joseph Bylebyl, MD Secretary and Treasurer Orthopedic Surgery Eldridge Anderson, MD Dirk H. Dugan, MD Bruce L. Greene, MD Joseph A. Maninno, MD Stephanie Roach, MD Brett Young. MD Kim Carney Young, MD Pediatrics John A. Bradshaw, MD Suzanne M. Bradshaw, MD Jessica Casey, DO Janet Corson-Rikert, MD Audrey DeSilva, MD Podiatry Jeffrey Kadlecik, DPM Joseph M. Quezada, DPM Mary Ellen Smoolca, DPM Victor E. Villagonzalo, DPM Psychiatry John Bezirganian, MD Anthony P. DiGiovanni, MD Millicent Dudley, MD Auguste Lytton Duplan, MD Veena Garyali, MD Henry D. Gerson, MD Robert Mendola, MD Mahfuzur Rahman, MD Garrick Volpin, MD Sleep Disorders Michael R. Slattery, MD Sports Medicine Andrew R. Getzin, MD Jake D. Veigel, MD Urology Sami T. Husseini, MD Sanjeev Vohra, MD Vascular Surgery Muhammad A. Khan, MD Senior Leadership Team Rob Mackenzie, MD President and CEO John Rudd Senior Vice President and Chief Financial Officer Lloyd Darlow, MD Vice President Clinical Integration Ellen Dugan Vice President Service Lines David Evelyn, MD Vice President Medical Affairs Susan Nohelty, RN Vice President Patient Services Alan Pedersen Vice President Human Resources John Turner Vice President Public Relations Tony Votaw Vice President and Chief Information Officer Board of Directors Jeffrey Snedeker, MD, Chair Thomas LiVigne, Vice Chair Carolyn Bartell, Secretary Jackie Bangs Peter Bardaglio, PhD James Brown Tommy Bruce Noel Desch Srisatish Devapatla, MD Tony Eisenhut Gary Ferguson Dammi Herath, PhD Sami Husseini, MD Rob Mackenzie, MD Brian McAree Jean McPheeters John Neuman Cayuga Medical Center Foundation Board of Trustees Larry Baum, President Brian McAree, Vice President John Conners, Secretary Thomas LiVigne, Treasurer Percy Browning Roy Dexheimer William Highland Bonita Lindberg Luminita Marinescu, MD Reverend Nathaniel Wright Ex-Officio Larry Baum Claudia Chappell Amit Singh, MD 36 Cayuga Medical Center Annual Report 2010

Published by the Office of Public Relations Cayuga Medical Center John Turner, Vice President Carol Grassi, Public Relations Specialist Elizabeth Heath, Public Relations Specialist Tanya Roberts, Administrative Assistant Writing and Project Management: Julia C. Bonney Photography: Dede Hatch Design: Terry Marcus Design