Friday, May 27, 2011

NYC Comptroller John Liu: Dangerous Delays in Women’s Health Care at Some City Hospitals

Audit Finds Women Wait Months for a Mammogram at Some Health and Hospitals Corporation (HHC) Facilities
City Comptroller John C. Liu uncovered dangerously long waits for women in need of mammograms at some City hospitals, according to an audit released today.
The audit examined the ability of nine HHC hospitals to provide two types of mammograms: screening and diagnostic. Screening mammograms are initial checks for cancer, usually for women age 40 and older. Diagnostic mammograms however are more urgent and are scheduled when a lump or other potential sign of cancer is found.

At some City hospitals women had to wait more than three weeks for the next available diagnostic mammogram appointment. At Elmhurst Hospital in Queens, patients faced a wait of 50 working days.

“For years, City policy has emphasized the need for women to get mammograms. Unfortunately, significant shortfalls and lapses at City hospitals have undercut that intent and worse yet placed women in jeopardy,” Comptroller Liu said. “The HHC has performed admirably in the wake of private hospital closures, and shrinking budgets and reimbursements. This audit nonetheless uncovers problems that require attention and resources so that women’s lives and health are not put at risk.”
50 working days
Elmhurst Hospital
28 working days
Woodhull Hospital
21 working days
Kings County Hospital
20 working days
Gouverneur Hospital
17 working days
Bellevue Hospital

“For a woman who is worried she might have breast cancer, a 50-day wait for a diagnostic mammogram can be agonizing and could delay urgently-needed treatment,” said Lois Uttley, co-founder of Raising Women’s Voices for the Health Care We Need, a national initiative based in Manhattan. “Many of the women who depend on HHC facilities are uninsured and cannot afford to go somewhere else for a mammogram.”

“The real danger and focus of greatest urgency needs to be on women who present with a suspicious finding and don't receive a diagnostic mammogram immediately. This is where lives can potentially be saved,” said Alice Yaker, Executive Director, of SHARE: Self-help for Women with Breast or Ovarian Cancer, a survivor-led 35-year-old breast and ovarian cancer organization. “While controversies about efficacy surround the screening of healthy women, there is no controversy about the need for a diagnostic mammogram in a woman who presents with a lump in her breast, for example. This requires our urgent attention, budget cuts and hospital closings notwithstanding."

The HHC currently has no guideline on how quickly a woman with potential breast cancer symptoms should receive a diagnostic mammogram appointment. It does have a guideline of 14 days for a screening mammogram. Nevertheless, patients at three HHC facilities had to wait more than one month for a screening mammogram appointment.
148 calendar days
Elmhurst Hospital
49 calendar days
Queens Hospital
41 calendar days
Woodhull Hospital

Breast cancer is the second leading cause of cancer death after lung cancer and in 94% of cases is diagnosed in women ages 40 years and older, according to the Centers for Disease Control and Prevention (CDC). Early detection through breast cancer screening saves lives, reducing the risk of death by 17 to 30 percent the CDC has determined.

Long waits for a mammogram carry an added patient risk because the longer the wait, the higher the odds they will miss their appointment, according to the National Institutes for Health. Auditors noted a high number of missed mammogram appointments at Elmhurst Hospital, where the waits were the longest.

Officials at Queens Hospital and Elmhurst Hospital said that several hospital closures in recent years and budget cuts have left them overwhelmed and unable to meet the HHC’s 14-day guideline. In addition to having the longest waits, Elmhurst Hospital also conducted the most mammograms: 11,425. Queens Hospital performed 10,544 mammograms, the second highest of HHC facilities.

The remainder of the nine HHC hospitals in the audit did offer prompt mammogram appointments during Fiscal Year 2009. The audit also determined that HHC radiologists read and interpreted mammogram exam results in a timely manner.

Audit Recommendations:
§ Create a guideline for the number of days in which women will receive diagnostic mammogram appointments
§ Ensure all facilities provide screening mammogram appointments within 14 days
§ Ensure all facilities send patients reminders of scheduled appointments

HHC Response:
§ HHC is reviewing the creation of a performance standard for offering diagnostic mammograms appointments with a target date of September 2011
§ HHC is currently reviewing its 14-day performance standard for offering screening mammogram appointments and seeking to improve the wait time where it is able
§ HHC facilities are individually reviewing their ability to place appointment reminder calls to patients with a target date of June 2011

Comptroller Liu credited Deputy Comptroller for Audit H. Tina Kim and the Audit Bureau for presenting the findings. The full report is available at