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We will be here for you As president and CEO of Tucson Medical Center, I am pleased to present you with our 2008 Report to the Community.

Judith F. Rich President and Chief Executive Officer

“We are confident that we have taken steps to help

I am also delighted that we have so much good news to share with you – news of new programs at TMC, and of continuing partnerships with community organizations that share our vision of a healthy and vibrant community.

And I am especially glad to report that in spite of serious economic issues confronting our nation and our community, TMC is financially stronger than it has been in years. We are watching our spending and take nothing for granted. We are confident that we have taken steps to help us remain financially sound even in the challenging months and years ahead.

us remain financially sound even in the challenging months and years ahead.”

What does this mean to you and your family? It means, simply, that if and when you need us, we are going to be here. And our doors will be open to you.

TMC is one of about 3,000 nonprofit hospitals in the United States, and all of us who work here are deeply committed to meeting the needs of our community—needs that may not always come to mind when you think of the kinds of care a great hospital provides.

As you may know, TMC offers a complete continuum of services for heart patients – an acute cardiac care team, a five-room cath lab suite, one of the state’s most active cardiothoracic surgery programs and a cardiac rehabilitation program. In our newly opened Stereotaxis Electrophysiology Suite, cardiologists work as a team with registered nurses and technologists to perform diagnostic and therapeutic cardiac procedures.

We also have one of the busiest emergency rooms in our community – busier in recent months as people lose their jobs and their health insurance, and go without needed primary care. Our emergency room is their safety net.

And we provide a long list of services at no cost to you and your family. One example is free tutoring for children who have to be in TMC for more than a few days. You’ve probably heard of the free car seats and bicycle helmets we give away.

But did you know we give tours to children to show them what our hospital is like, so they will feel less anxious if they ever need to come here?

If you are a woman with breast cancer and no health insurance, we are able to provide you with care through our collaboration with the Southern Arizona affiliate of Susan G. Komen for the Cure.

And if you’re retirement age or older, you might want to check out TMC Senior Services at our El Dorado Health Campus. We offer no-cost counseling and support groups for caregivers of loved ones with Alzheimer’s disease. Our Legs for Life program provides free screenings for legvein problems. We offer assistance with Medicare decision-making, help with taxes and more.

Those are just some of the community benefits TMC offers to individuals and families – benefits that help people at all stages of life live safer, healthier, happier lives.

I hope you enjoy reading through this report.

And remember: If you need us, we will be here.

And our doors will be open to you.

“I’m a true believer in the steps TMC is taking to improve the quality of the care we provide. But I think what matters to me most is the personal side of what we do”

A Commitment to Quality I’ve been a member of the TMC HealthCare Board of Trustees and its Quality Committee for a number of years. I used to sit and watch as people put up charts on mortality rates, falls, infections, all those sorts of things that hospitals keep track of, and it never really made much of an impact on me personally.

Then, last December, the hospital convinced me to go to a national meeting of the Institute for Healthcare Improvement. At first I said no, I’m too busy, but people kept urging me to go and I have to say in hindsight it’s one of the best decisions I ever made.

I was one of 6,500 people from across the country talking about health care quality initiatives and how to make patient care be the best possible. Candidly, it just opened my eyes.

Our nation spends 16 percent of its gross national product on health care, and that is not something we can continue. One of the best ways to reduce health care costs – for the patient, and for the doctors and hospitals providing the care – is to do everything possible to avoid mistakes and complications that can easily be prevented.

There are things we can all do without spending a lot of money. It’s as simple as washing your hands.

At my request, we now have a box of hand sanitizer by the door going into the board meeting room.

I open the door and hit the hand sanitizer. We all do. Here’s another example: the scrubs that so many of our staff wear to work every day don’t go home anymore. We found out we can do a better job of laundering them here at TMC. Quality improvement isn’t all this simple or inexpensive. We are expending a major amount of resources to set up a new system of electronic patient charts. Never again will nurses have trouble reading a doctor’s handwriting. Information about each patient will be legible and accessible to those who need it.

I’m a true believer in the steps TMC is taking to improve the quality of the care we provide. But I think what matters to me most is the personal side of what we do: We save people’s lives so they can go home and continue to be a part of their children’s lives and the life of their family.

Henry Boice TMC HealthCare Board of Trustees Chairman, Quality Care Committee

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A Continuing Focus on Improving Care Together, doctors and hospitals save lives every day, but we never take that for granted.

The physicians on staff at Tucson Medical Center – and there are about 800 of us – are in partnership with the hospital’s staff and administrators, working harder than ever to improve the quality of care we provide you, our patients.

Improving patient safety and quality of care has become a goal of hospitals nationwide, and TMC fully embraces it. As a physician who has been working at TMC for nearly 20 years, it is especially gratifying to me that under the hospital’s current administrative leadership, physicians have been given a stronger role than I’ve previously witnessed in making sure our patients get the best possible care.

I am one of five physicians serving on the TMC HealthCare Board of Trustees. There used to be just one. I’m also a part of a new committee of 14 physicians who are taking a critical look at how physicians can continuously evaluate and measure the care they provide, appropriately following “best practices” to ensure quality care.

Doctors also are involved in a new process for communicating to each other about the work we do. It used to be that doctors only got feedback when they made a mistake. Now we

will get reports every six months, telling us what we’ve done well, how we can improve and when we’ve provided excellent care.

Quality and safety are not abstract concepts.

They are actual things we can measure. And we feel good about focusing on them. After all, we all got into medicine to take care of people, and we want to do a good job.

People are always going to get sick and they are always going to need TMC. We have a duty to monitor the way we do things and make improvements along the way, and we aim to make changes based on evidence and proven best practices. No matter what happens – from tackling a tough economy or a nursing shortage – we are always going to provide the highest quality and safest care possible. That is something we can all feel good about!

As Always, the Best Care I believe one of our very top priorities, as a community and as a nation, is to make sure we are able to provide quality health care for everyone.

I am honored to serve on the Board of Trustees of Tucson Medical Center, and I am glad to be able to assure you that TMC’s commitment today, as always, is to provide the best quality care for you and your family.

For more than 60 years, Tucson Medical Center has provided outstanding care to patients at all stages of life – starting at birth. We deliver more babies at TMC than any other hospital in Southern Arizona – 6,190 babies in 2008. We have incredibly skilled and dedicated doctors and nurses who provide state-of-the-art care for those born before they are fully ready. In our newborn intensive care unit, babies get the care they need to grow up strong and healthy.

Like many hospitals across the country, TMC has faced serious economic challenges. We have had to make tough decisions. But thanks to the outstanding leadership of Tucson Medical Center’s administrative

Matthew Atlas, M.D. TMC HealthCare Board of Trustees Chief of Staff-Elect

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team, and the commitment of our doctors, our nurses and our entire hospital staff, TMC is in solid financial health today. This allows us to look strategically into the future, to be sure we will be here with the kind of high-quality patient care and services our community will need.

There are so many reasons why Tucson Medical Center is a great hospital.

But I think the most exciting thing, which continues to impress me over and over again, is the fantastic people who work here – the doctors, the nurses and all the employees – and their commitment to quality care and improvement in our hospital and our community. I thank them, and I thank you for the trust you place in Tucson Medical Center.

Louise Francesconi Chairwoman, TMC HealthCare Board of Trustees

A Heart Valve replacement at 26 Doesn’t Slow D Young, active and healthy, with a softball pitch clocked at 72 miles an hour – Liz Berry hardly fit the profile of a person with serious heart disease.

But that changed four years ago when Liz began to experience shortness of breath and chest pain when she exercised.

An EKG showed a serious aortic-valve defect that impaired normal blood flow from her heart to the rest of her body. She was 26.

A cardiologist prescribed medication, but it failed to control her abnormal heart function. One evening, in the middle of her shift as unit clerk in the TMC Cardiac Care Unit, she fainted.

Weeks later, in early October 2005, she arrived at work short of breath, sweaty and pale. She saw a heart surgeon the following day, and on October 13 – her “lucky day” – she underwent a successful six-hour surgery to replace her defective valve.

“People look at me and say, ‘You’re too young. How could you go through something like that?’” Liz said. “But heart disease is more common than they think – even in young women.”

“He’s our miracle baby,” Liz said.

“We have so much to be thankful for.”

Liz’s story became even more remarkable early in 2006. She and her husband, Kevin, who works in Central Supply at TMC, intended to follow her doctors’ orders that she not get pregnant for at least three years. But four months following her heart operation, baby Kyle was on his way. Medtronic, the company that manufactured Liz’s artificial heart valve, had no record of any woman being pregnant with her type of valve.

Kyle was born a month early, in September 2006, and today is a bright, happy, rambunctious toddler who loves nothing more than playing outdoors with his mom.

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“He’s our miracle baby,” Liz said. “We have so much to be thankful for.”

Liz focuses as much of her time as possible on activities that educate others about heart disease. In March, she was a speaker at the Tucson Heart Ball, an annual event of the Tucson chapter of the American Heart Association, for which TMC is the presenting sponsor. TMC and its employees also support the association’s annual Go Red for Women luncheon and Tucson Heart Walk.

“We truly do value our relationship with Tucson Medical Center,” said Diana Cannon, executive director of the Tucson chapter of the American Heart Association. “They are an exceptional community partner.”

And so is Liz, Cannon said. “She does everything she can to help educate others about cardiovascular disease by talking about her own experiences, and she does it in such a positive, caring way. She’s so appreciative of TMC and all they did for her, and she appreciates the research that is funded by the American Heart Association to help others live a healthier life.”

For now, Liz is enjoying every moment of her life as a stay-athome mom. But she has big plans for the future: When Kyle is a little older, she wants to go to medical school and become a cardiologist.

“I want to be able to help people,” she said. “I want to give back.”

w Down This Mom High-tech Care for Hearts & Brains

...safer and more precise treatment of abnormalities of the heart and brain TMC has invested more than $6.4 million in purchasing and installing two new high-tech systems that will enable safer and more precise treatment of abnormalities of the heart and brain.

The second new system has an equally hightech name and function. Called “biplane angiography,” the system makes it possible for doctors to view a brain aneurysm or arterial blockage from two angles at once.

TMC’s new cardiac electrophysiology – or cardiac EP for short – system is the first of its kind in Arizona. It allows doctors to more easily locate and treat abnormal heart rhythms, including atrial fibrillation and ventricular tachycardia.

As with traditional angiography, biplane angiography involves inserting a catheter into an artery, then injecting a dye into the catheter to “highlight” the section of the brain where an aneurysm or blockage is located.

Most often such abnormalities can be repaired in the same procedure room or with surgery.

The system provides three-dimensional images of the heart to show doctors the precise point of origin of an abnormal heartbeat. A magnetic navigation system allows doctors to safely guide a treatment tool called an ablation catheter to a small area of damaged heart tissue that is causing the abnormal heart rhythm. A tiny electrical impulse delivered through the catheter to the damaged tissue “knocks out” the arrhythmia and prevents its recurrence.

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Living with

Alzheimer’s

At TMC Senior Services on the El Dorado Health Campus, families affected by Alzheimer’s disease receive encouragement, compassion and practical advice.

gests consulting a specialist in elder law to help the patient grasp the concepts.

The source is Jessie Pergrin, RN, PhD, director of TMC’s Alzheimer’s and Related Dementias Project. One of Tucson’s leading experts on these most-feared diseases, she’s been providing education and support since 1980. Grateful husbands, wives, children and others turn to her to learn how to cope with the disease that is taking away their loved ones, a day at a time.

“Ask simple questions such as ‘Do you want to be tube fed if you’re very ill?’ and ‘Do you want to go to a hospital and have CPR?’” Pergrin advises. Then she adds a note of caution: “But will she remember it when she gets home?”

The Alzheimer’s project is based at Senior Services and staffed daily by volunteers who help families navigate the care for loved ones with Alzheimer’s or other dementias. Lectures, support groups and other information are offered free of charge, thanks to a grant from the TMC Foundation.

On one recent morning, Pergrin was leading a caregiver support group for families who are navigating the care of a loved one with Alzheimer’s.

Just down the hall, the loved ones are having their meeting for support and socialization.

Within the caregiver support group, there is a richness of shared experience. Questions are raised, and answers provided. The caregivers understand one another as no one else can.

Pergrin answers each question with clarity and caring.

A group member said he’s having problems getting his wife to understand the concept of having a Living Will and Power of Attorney. Pergrin sug-

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The high cost of Alzheimer’s drugs is a major concern for many in the support group. Pergrin provides the names and phone numbers of people who can help steer caregivers through the morass of prescription drug plans.

She also reminds caregivers that monitoring medications means watching your loved one actually taking the meds, not just leaving them on the tray or bedside.

Another hot topic at this support group meeting is the loss of decision-making ability. One man said, “She doesn’t want to, or can’t, make decisions.” Pergrin’s answer is firm: “Avoid having the patient make decisions as much as possible.

When you ask him or her to make a choice, you’re reminding them they can’t make decisions. Make statements instead.”

Jessie Pergrin offered a final bit of encouragement as the session drew to a close. “We’re all caregivers,” she told the group. “We’re all experts.”

Breast Health Programs A Life Saver When Patty LeCompte was diagnosed with breast cancer in 2007, she knew where to turn. For years, she had been getting regular mammograms through the TMC Breast Health program. Her fibrocystic breast disease and a family history of cancer put her at increased risk, and she had two biopsies that were benign before she developed cancer.

She wanted to be sure that if she ever developed breast cancer she would catch it early.

Patty’s vigilance paid off when her mammogram detected a small lump that was diagnosed as breast cancer in May 2007. She underwent a lumpectomy, followed over the next several months by chemotherapy and radiation treatments. Today she is healthy, feels great and is continuing to enjoy life as a hairstylist, wife and mother of 17-year-old daughter, Sara.

Patty first turned to TMC eight years ago, when her family did not have health insurance. Her primary care doctor told her she could get a free mammogram and breast exam at TMC, thanks to the hospital’s collaborations with the Southern Arizona affiliate of Susan G. Komen for the Cure and the Avon Foundation Breast Care Fund. Both provide funding to TMC’s Breast Health program to cover the costs of screening and treatment of breast cancer for women without health care coverage.

The program “was life-saving for me, even though by the time I was diagnosed with breast cancer, we had health insurance again,” Patty says. “But when we didn’t have insurance, I was able to get mammograms

and biopsies when I needed them and I didn’t have to pay for them. It’s wonderful and necessary that women have this option available to them.”

Equally wonderful and necessary, Patty says, is her long-standing relationship with the staff of the TMC Women’s Health program, including nurse practitioner Karen Narum.

“She’s my lifeline,” Patty says. “She’s sweet and caring and you never feel like you’re in her way. I consider her my friend.”

Narum, who is co-administrator of TMC’s Komen and Avon grants, calls Patty “an inspiration. ...She is a true example of why we recommend annual mammograms.

Her diligence is what allowed her cancer to be caught as early as humanly possible.”

Narum remembers the time several months ago when Patty was in for an appointment. Another woman in the waiting room was there for a breast biopsy. “Patty struck up a conversation, told her story and convinced the patient that the biopsy was not as horrible as she imagined. When I returned from the biopsy room, I found Patty and another lady who became involved in the conversation dressed and waiting for the biopsy patient. Their appointments had long come and gone, yet there they sat waiting for the stranger they had befriended. I will forever be touched by the compassion I witnessed that day.”

Funding from Komen and Avon allowed TMC’s Breast Health program to provide free screening mammograms

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for 333 women who either had no health insurance or whose insurance did not cover prevention screenings, Narum says. Of the women who were screened, two were found to have breast cancer. TMC helped them connect with physicians and surgeons who reduce or waive their fees for uninsured patients with the Breast Health program.

Over the past 10 years, the program has provided more than 4,000 free mammograms, which led to the detection of 24 cancers.

Narum, who has been an ob-gyn nurse practitioner for 14 years, feels fortunate to be part of TMC’s Breast Health program. “It’s one of the most rewarding things I’ve ever been involved with in my career.”

Training our Future Health Care Workers High school students wanting to pursue careers in health care can get a head start through programs supported by TMC. Catalina Magnet High School’s Health Care and Community Services program emphasizes science, math and health-related training for students interested in health care careers. Students graduating from this program are then eligible to apply for TMC’s Great Opportunities in Health Careers – also known as the GO! program.

The GO! program teaches students additional acute-care skills and work-readiness training to prepare them for entry-level employment and college or university education.

“The biggest component of what we do is that the kids learn to be a part of the health care community.”

Students from Sunnyside High and other local high schools also can apply for the GO! program. Ninety-four students have taken part in the program since it began in 2004, said Katie Brooks, manager of TMC Workforce Development. Eighty-six of those students went on to become patient care technicians and eight became phlebotomists. Many of them work at TMC while pursuing college and university degrees in nursing, medicine and other health-related fields.

“The kids we’ve worked with are just fantastic,” Brooks says. “They’re very motivated. They know what they want to do. And they’re just really good kids.”

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TMC nurse Beth Francis and Tucson Unified School District teacher Joan Dawson, who is also a registered nurse, oversee and teach the health care curriculum at Catalina. They also advise the students who volunteer with the school’s chapter of HOSA – Health Occupations Students of America. HOSA students volunteer with TMC at community events, such as TMC’s annual Be Safe Saturday, a yearly safety event for children and families.

Other community partners involved in the Health Care and Community Services training program include the University of Arizona College of Pharmacy and Pima County One Stop Career Center, a job and career training program that specializes in working with youth.

“The biggest component of what we do is that the kids learn to be a part of the health care community,” Dawson says. “They get to work side by side with nurses, respiratory therapists, other hospital staff and they get to build relationships.

“We’re building the future of health care, and I’m happy to know that I’m part of that.”

TMC Designated a Neuroscience Center of Excellence Tucson Medical Center has been designated a Neuroscience Center of Excellence by Chicago-based NeuStrategy Inc., sponsor of the 2006-2007 Neuroscience Center of Excellence Survey.

The survey, the only one of its kind in the neurosciences, evaluated 150 hospital-based neuroscience programs across 41 states. A hospital’s overall performance is determined by measuring program progress in four key areas: clinical and research programs; staff; facilities; and technology and business.

Of the 150 hospital neuroscience programs surveyed, only 42 percent received the Neuroscience Center of Excellence recogntion.

“Center of Excellence designees represent many of the leading, innovative programs across the country, and Tucson Medical Center is proud to be acknowledged for our multidisciplinary approach and commitment to the highest standards of neurological and neurosurgical patient care,” said Judy Rich, TMC HealthCare president and CEO. TMC’s neurosciences program combines state-of-the-art neuroimaging technology and “the most comprehensive range of neurological specialists and services in Southern Arizona,” said Palmer Evans, MD, chief medical officer.

Tucson Medical Center has embarked on a $20 million project to improve patient safety and quality of care by replacing paper patient charts with digital records.

a lab report, a nurse wanting to double-check a medication dose, or a doctor at a clinic in an outlying county who wants to follow up on a patient she admitted to TMC.

Called OneChart, TMC’s new patient-record system is expected to be operational by mid2010. Chart notes written in doctors’ and nurses’ hurried scrawl – difficult to read and easy to misinterpret – will be a thing of the past.

And OneChart is “smart” – it will know when a patient is allergic to a type of antibiotic, and warn the doctor instantly if he prescribes a drug in the same class. OneChart also will recognize when a doctor prescribes an unusual dose of a certain drug, and ask the doctor if that really is the dose the patient should get. The doctor can override the system and in that case, the “conversation” between OneChart and the doctor will be on record as well.

And so will the kinds of medical errors that result when a decimal point is overlooked, a chart note is lost or a handwritten drug name or dosage amount is mistaken for something else.

President and CEO Judy Rich said OneChart will “protect patient safety, improve efficiencies and reinforce quality.” And by reducing TMC’s dependence on paper, it will be good for the environment, Rich says.

Doctors will no longer have to dictate chart notes, then wait 24 hours for someone to transcribe them and return the proper record to the doctor for signature. Doctors, nurses and other hospital staff will input information directly into the OneChart system, where it will instantly be available to whoever needs it. That could be a surgeon waiting in an operating room for

Only one other hospital in Arizona – Barrow Neurological Institute of St Joseph’s Hospital and Medical Center, in Phoenix – won the 2006-2007 Neuroscience Center of Excellence designation.

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“We are working with the most experienced companies to implement OneChart, and we are learning from them,” says Frank Marini, TMC vice president and chief information officer.

“Our ultimate goal is to optimize patient care, to benefit patients, physicians and TMC.”

She was born nearly two months early, weighing 2 pounds, 12 ounces.

Things were a little scary for Mom and Dad. But today, four weeks later, a very healthy baby Alexa – weighing 3 pounds, 13 ounces – is going home.

“I just hoped and prayed for the best and it looks like it’s coming out that way,” said Alison Neja, moments before she left her house to head over to TMC and bring her baby home.

ing and moving around like that, it’s a sign he’s feeling pretty good.”

Most babies admitted to the NICU were born premature, and most stay here until their due date. For Alexa, that would be April 21. But she’s growing and breathing and eating so well that she gets to go home today, April 3.

Carol would know. She’s been caring for newborns in intensive care since 1982; in TMC’s NICU since 1985. When she started, an infant as premature as Nathan would not have survived. But a breakthrough drug named surfactant came along a few years later. It protects the seriously underdeveloped lungs of babies born too early, allowing them to develop normally.

“It’s been scary, I have to admit,” Alison said of having her first-born in the NICU. “You don’t know what’s going on and you think of all the worst things that could happen.

Alexa was born by C-section shortly after midnight on March 6. “I was knocked out, so I didn’t see her right away, but my husband, Philip, was there and the doctor swaddled her up and handed her to him and she was screaming her head off,” Alison recalled. “He said she looked really beautiful. I saw her later that day and I just couldn’t believe how small she was.”

“The care she’s received has been wonderful.

The nurses are very kind”

a nurse who has been with TMC’s NICU for 25 years, the last 14 as manager.

“But the care she’s received has been wonderful. The nurses are very kind. They don’t mind how often you call. They answer every question, no matter how many times you’ve asked it before. They’ve just doted on her and kept me informed with as much information as they can. They’ve just been wonderful.”

Alexa is one of 600 or more babies who will spend their first days in Tucson Medical Center’s Newborn Intensive Care Unit – NICU, for short – this year.

Of the 28 other babies in NICU today, the littlest one is Nathan.

Sleeping on his tummy inside a $40,000 Giraffe Omnibed, Nathan is giving the NICU staff a reason to feel optimistic. He’s pushed up his little rear end and he’s kicking his feet.

She and her parents are lucky. TMC’s NICU is considered one of the best in the country.

Last year, 610 babies were admitted to the unit, all in life-threatening situations. All but 19 newborns – those who were the very sickest – survived and went home, said Pat Brown,

“We always say the butt in the air is a good sign,” said Carol, his nurse. “When he’s kick-

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Nathan is still breathing with the help of a ventilator, and being fed a special premie formula through a tube, every three hours.

Nathan’s Giraffe Omnibed is almost as amazing as the baby himself. The Omnibed allows doctors and nurses to do almost anything for the baby without having to move him—important, because every movement can stress his fragile system.

It gets its name from the fact that the top half of the bed can be lifted up high, like the head of a giraffe. That makes it possible to place a portable X-ray machine, for example, under the top of the bed and above the infant.

N

NICU Newborn Intensive Care Unit

The Omnibed is like a plastic womb, complete with humidifier and heater for perfect climate control. Because Nathan has almost no fat on his body, the temperature inside is kept at 95 degrees. That and a small quilt over the top of the Omnibed keeps things warm, moist and dark – a lot like how it is inside his mother’s womb.

TMC’s NICU is both a showcase of modern medical technology and an example of what generosity can accomplish. The quilt on top of Nathan’s Giraffe Omnibed was handmade and donated by a volunteer. The Omnibed itself – and eight others just like it – were all purchased with money given by donors to the TMC Foundation.

“It is amazing,” Brown said. “People just call me up and say, ‘Can I donate this to you?’

Practically everything we have in here is from donations.”

And the giving goes both ways. Brown and three other members of the NICU staff – nurses Angelina Price and Pauline White, and

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respiratory therapist Carolina Acuna – flew to New Orleans last September with two of the NICU’s portable infant beds, to help evacuate infants away from Hurricane Gustav. The TMC team transported nine infants – more than any other hospital involved in the rescue effort, Brown said.

But their work was only half done. Gustav was expected to cause major damage in New Orleans, as Hurricane Katrina had three years earlier, so the TMC team evacuated babies from New Orleans to Baton Rouge. But when Gustav swept past New Orleans, heading straight for Baton Rouge, the babies were airlifted back to New Orleans, Brown said.

“It was stressful,” she said, “but it was incredibly gratifying to be there and be able to help.”

Last year, the TMC Foundation awarded $147,038 in grants to organizations in Southern Arizona to help improve health and the quality of life in our community.

Supporting the Community “While the majority of our grants are for needs within the hospital,” said Michael J. Duran, TMC vice president and chief development officer, “our Grant Award Committee funds strategic community programs that align with our mission to improve the health and quality of life in our community.” These grants went to: BAG IT, which assists newly diagnosed cancer patients and their families City of Sierra Vista Fire Department to fund car seats, bike helmets, skateboard helmets and protective equipment to those who cannot afford them Habitat for Humanity for construction of a home for a TMC family Irving Greenfield Tucson Loan Chest to provide medical equipment to those in need Passages, providing hospice community awareness and education

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Employee Pride Yields $52K for the Community In these tough economic times, a lot of people are cutting back on donations to community causes. But for many who work at TMC, the choice over the past year has been to give even more.

At the direction of President and CEO Judy Rich, TMC teamed up last year with United Way of Tucson and Southern Arizona to encourage hospital employees to give to community causes, in addition to the donations they make to the programs of TMC. “Our employees think about TMC as more than just a place that gives them a paycheck,” says Donna Morton, director of annual giving for TMC Foundation. “As part of the community, we feel it’s important to give back.”

To that end, last year’s Employee Pride Campaign gave employees a choice of donating to TMC programs, to United Way or both. Both the hospital and United Way highlighted different programs to which employees could direct their contributions – to child care programs, to hospice care, to support services for the working poor – to whatever program the employee most wanted to help.

Teaching 1st Graders the ABC’s of Water Safety Arizona continues to have one of the highest drowning rates in the nation, with an average of five drownings and near drownings each year. In an effort to change that in our community, TMC presented a water safety program to 600 first graders in six local elementary schools last year. TMC expects to expand the program to 800 more first graders this year.

Water Safety is for You! was written and developed by a team of educators and public-safety and medical experts to teach basic water safety concepts to young children. These concepts can mean the difference between life and death.

The result was 252 individual gifts totaling nearly $52,000, including almost $12,000 to United Way and nearly $40,000 to TMC. Some employees chose to give through a new program called “Hour Circle,” donating one hour of pay per pay period. Some employees felt they could only give a few dollars. “We asked our employees to give what they feel they can afford. Every dollar is appreciated,” Morton says. “It all adds up to help support the needs of the hospital and the community.”

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The class is taught at elementary schools in neighborhoods that are medically underserved or otherwise “at risk.” The program concludes with a water safety class at a public swimming pool, where each child receives a backpack with a sun visor, sunscreen, water, towel and water safety information.

Water Safety is for You! teaches the ABC’s of water safety, similar to fire safety’s “stop, drop and roll.”

The concepts are: • A is for Adult supervision • B is for Barriers – fencing and gates with latches and locks • C is for Classes and swimming lessons

A Look AheadSpirit of Women Tucson Medical Center is a member of Spirit of Women®, an elite coalition of American hospitals and healthcare providers that ascribe to high standards of excellence in women’s health, education and community outreach. Spirit of Women hospitals are committed to making good health easier and to help women and their families take action that results in better health.

As a Spirit of Women hospital, TMC is dedicated to meeting the needs of women in Southern Arizona. Monthly health promotions will be posted on our website, www.tmcaz.com. Innovative and exciting community activities are planned for 2009. All events focus on women taking action to improve their health through wellness lifestyle changes.

Day of the Dance for Health specifically educates the consumer about risk factors, chronic diseases and lifestyle choices that contribute to heart disease. Or lace up your walking shoes and grab your pedometer and get moving with TMC’s Walk with Spirit community team. Join us for motivating educational seminar series like How to Wear your Genes or Manicures and Menopause.

In the Spirit of Women, Tucson Medical Center offers the most advanced healthcare available to women at every stage of life. From pregnancy and menopause through maturity, TMC continues its commitment to providing a lifetime of care.

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Business Office Celebrates Casual Fridays with a Compassionate Twist A lot of workplaces have “casual Fridays,” when employees get to dress as if the weekend had already started.

teachers. “The kids who didn’t have anything could start their first day just like all the other kids,” Montaño says.

TMC has casual and compassionate Fridays when employees can wear their favorite pair of jeans to work, in exchange for a $5 donation to help Tucson children, seniors and families in need.

Forty employees contributed the $200 used to buy the backpacks and supplies from the Jeans Fridays Fund.

“It’s a win-win,” says Rose Montaño, a senior contracts analyst with the TMC Business Office. “You get to wear jeans to work, and you can help someone at the same time.”

Montano and her business-office coworkers came up with the idea of “Jeans Fridays” as a way to boost their ongoing effort to raise donations of money, food and clothing for charitable projects throughout the community. The 175 employees are known throughout TMC for their generous giving.

Before school started last fall, the Business Office contacted Whitmore Elementary School, located just north of TMC, to see if there were children who needed help with back-to-school supplies. Indeed, the teachers had identified six children whose families could not afford to buy the things their children needed.

With $200 from the Jeans Fridays Fund, the six kids were able to start school with brand new backpacks filled with pencils, paper and other supplies requested by their

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Business Office staff also volunteered their own time and money to give 110 seniors holiday gift bags stuffed with personal care items such as lip balm, lotion and soap, Kleenex – and a pretty holiday card with a handwritten note. “That’s the most important thing,” Montaño says. “It tells the elderly person, ‘Someone is thinking of me.’”

Business Office staff also donated Christmas gifts for 60 children who attend Corbett Elementary School, which has a number of students whose families are homeless or share housing with friends or relatives.

“Some people have nothing – absolutely nothing,” Montaño says. “Times are hard for a lot of us, but when you look around you see somebody else who has less than you. You think, ‘I don’t need this blanket in my house. I have four. This other person has none.’ ”

Pediatric Fluoroscopy Lower Dose A new fluoroscopy unit and waiting room designed specifically for pediatric patients is now open for business, elevating TMC’s ability to meet the imaging needs of this growing patient group. Indeed, TMC Radiology and Imaging has seen a 50 percent increase in cases over the past five years.

Now, pediatric patients brought to TMC from throughout Southern Arizona can take advantage of this customized area that features specially trained staff and a software package that reduces radiation by almost 80 percent. That, combined with child friendly décor and amenities such as a TV/DVD system, provide for a more pleasant experience for children.

“We can make the kids comfortable and have them exposed to as little trauma as possible,” said Luis Sapien, TMC’s manager of Radiology and Ultrasound. “And it puts the parents’ minds at ease.”

With a generous grant from the TMC Foundation, the fluoroscopy machine was upgraded to allow for digital pulse fluoroscopy, a digital fluoroscopy loop and dose monitoring system.

The technology delivers the radiation in pulses, lowering the amount significantly compared to

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traditional fluoroscopy, Sapien said.

The dose monitoring system records the level of radiation each child receives, providing physicians with better information upon which to make decisions.

“Every time a child comes in, we are monitoring their dose and it is noted in their record how much radiation they received,” Sapien said. “When they come in once, it’s not really a factor. When a child comes in two to three times in a couple of weeks because of intestinal problems that need to be checked, we want to watch the accumulation.”

A video recording system is an additional upgrade that enables the technicians to record patients emptying their bladders or swallowing, so physicians can view the entire process and note any problems. “If residents or attending physicians want to come in and look, they can ask questions, fast-forward, and slow it down.

It is a great tool.”

Perhaps most importantly, the unit boasts a team of specially trained radiological technologists, a child-life specialist, diagnostic nurses and radiologists dedicated to the area every day.

Epilepsy Monitoring Top-notch facilities for kids and grown-ups Long-term epilepsy monitoring for both adult and pediatric patients at TMC underscores the hospital’s comprehensive effort to best serve patients who need crucial neurological services.

A highly trained team of EEG technologists monitors patients 24 hours a day and the hospital’s panel of neurologists and epileptologists – including Drs. David Teeple, Dinesh Talwar and Monica Chacon – interpret long-term video EEG studies and recommend further diagnostics or treatment options.

“At TMC’s epilepsy monitoring unit, we have a place where we can make the diagnosis of epileptic seizures,” said Dr. Teeple, an epilepsy specialist from the Barrow Neurological Institute in Phoenix who came to Tucson to run the adult monitoring unit.

“This can be difficult because of the many epilepsy mimics that exist in medicine,” he said. “Just as importantly, this facility helps us treat the most simple to the most complex cases of epilepsy - including identifying and

treating patients who are candidates for epilepsy surgery and vagal nerve stimulators.”

Diagnostic testing is performed on 32-channel and 64-channel instrumentation. TMC has also doubled the size of the epilepsy monitoring unit to two adult rooms located on the neurological floor and two children’s rooms in the pediatric ICU. All four rooms are equipped with high-resolution color cameras and infrared technology to ensure visibility, safety and patient documentation, said David Sholes, REEGT, RPSGT, manager of Neurophysiology, Sleep Diagnostics and Epilepsy Monitoring at TMC. The proficient monitoring team includes nationally certified neuroscience nurses – a select, specially trained group – and child-life specialists for a program that offers yet another option for physicians across Southern Arizona.

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Cardiac Care

The cardiac care services at TMC combine leading medical and surgical specialists with expert staff and state-of-the art equipment to treat patients in all stages of cardiac disease.

TMCServices

Our cardiac catheterization suites are equipped to provide diagnostic and treatment procedures performed by cardiologists, nurses and technologists.

Two operating rooms are dedicated to cardiothoracic and cardiovascular surgery. And our cardiac diagnostics program includes exercise stress testing, echocardiography, heart monitoring and other services.

Children’s Care

TMC is an associate member of the National Association of Children’s Hospitals and Related Institutions – the only NACHRI member hospital in Southern Arizona. Being an associate member reflects TMC’s commitment to children’s health care.

TMC for Children includes the region’s first dedicated Children’s Emergency Center, the only pediatric hospice and the only pediatric gastrointestinal laboratory. TMC for Children also includes inpatient and ambulatory surgery programs with dedicated pediatric anesthesiologists and child-life specialists.

In addition, TMC for Children includes the hospital’s acclaimed Newborn Intensive Care Unit, Pediatric Intensive Care and Pediatric Therapies.

Behavioral Health

Palo Verde Hospital provides behavioral health services based in a community health-care setting.

We have 48 adult inpatient beds, intensive outpatient programs for adults and seniors, and 24-hour crisis and evaluation services. Our diverse team of behavioral health professionals works in an at-

mosphere of collaboration, providing care to our community since 1960.

Emergency Care

TMC’s Emergency Department is the largest in Southern Arizona, caring for close to 100,000 patients each year. About a third of those patients are children, who receive specialized care in Tucson’s first Children’s Emergency Center. TMC has dedicated a separate area with child-focused equipment and staff to serve the families of Southern Arizona.

Intensive Care Units

TMC has adult, cardiac, pediatric and newborn Intensive Care Units, all with state-of-the-art equipment and specialized nursing staffs specially trained to care for the complex needs of critically ill patients.

Other Services

TMC offers many more programs serving Southern Arizonans from birth to the end of life. More information about programs such as therapies, gastrointestinal, vascular and much more is available at www.tmcaz.com.

Neurosciences

TMC offers a wide range of diagnostic and treatment services for patients with neuromuscular and neurological disorders. These include treatment for Parkinson’s disease, brain tumors, epilepsy, multiple sclerosis, cancer, strokes, seizures and other brain, nerve and sleep deprivation disorders.

Senior Services

TMC Senior Services offers a variety of programs and support, including services during the hospital stay and after patients go home, plus year-round wellness programming and volunteer opportunities. This unique program is offered on the El Dorado Health Campus.

Imaging and Diagnostic Services

TMC provides a full range of imaging and diagnostic services including X-ray, mammography, CT scan, MRI, EEG, EMG, diagnostic radiology and nuclear medicine imaging.

Maternity

TMC continues to deliver family-oriented, specialized obstetrical and newborn expertise to support expectant mothers and families throughout the pregnancy and birthing experience. Experienced anesthesiologists, perinatologists and neonatologists are available at all hours.

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TMC Foundation

TMC began with a single act of philanthropy when Mrs. Anna E. Erickson donated land to the community for the development of a much needed hospital. A legacy of community support continues today through the TMC Foundation.

As Tucson Medical Center’s charitable arm, the TMC Foundation is able to touch the lives of people throughout Southern Arizona. Gifts to the Foundation go toward funding the latest in lifesaving medical equipment, improving facilities, providing educational programs for TMC patients and staff, and promoting community well-being and safety.

CommunityBenefit as Reported 2008 Charity Care .........................

Unpaid Costs.........................

Community Benefit ................

Total ......................................

$4,472,242 $12,269,468 $5,823,974 $22,565,684*

*unaudited figure

GivingBackGivingMore TMC will report more than $22 million in community benefit and charity care for 2008. This is a $5 million increase over 2007 reporting.

Charity Care

What makes up that number?

Community Benefit Charity care is free or discounted health services provided to people who cannot afford to pay the full cost of care and who meet the organization’s financial assistance policy criteria. Charity care is reported in terms of costs, not charges, and does not include bad debt. For more information about TMC’s charity care policy, visit www. tmcaz.com.

19.8% 25.8%

Nonprofit hospitals also report unpaid costs of public programs for low-income people – the shortfall created when a facility receives payments that are less than the cost of caring for public-program beneficiaries.

54.4%

Community benefit programs and activities provide treatment or promote health and healing as a response to identified community needs. These programs and activities help improve access to health care services, enhance the health of the community and advance medical knowledge.

Unpaid Costs

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ReduceReuseRecycle: TMC is a good steward of resouces Tucson Medical Center recognizes the link between healthy people and a healthy environment. We do our part to help the environment through reducing, recycling and reusing, while preserving natural resources and cutting back on energy consumption.

• Outdated computers are donated to World Care, which refurbishes and distributes them around the world • Outdated medical supplies are sent to other countries

REDUCE Reducing our use of supplies and natural resources impacts the amount of waste produced and keeps costs down. Examples include:

RECYCLE Recycling reduces waste in landfills and saves natural resources. Some of the items TMC recycles are:

• Using digital storage for document management, reducing use of paper, silver and plastic

• Batteries: approximately 8,000 pounds are recycled each year

• Using natural light in building design, reducing use of electric lights

• Cardboard: approximately 150 tons are recycled each year

• Changing to new laundry equipment that reclaims heat and water for re-use, reducing water and electricity use

• Fluorescent light bulbs: about 40,000 feet are recycled each year

• Replacing over 1,000 monitors with more energyefficient models, reducing electricity use • Using electric scooters to reduce the need for fuel • Landscaping with many native plant species, reducing water needs • Using software for report management, reducing the amount of paper used RE-USE Items no longer useful to TMC can often find new uses elsewhere. These include:

• Cooking grease: TMC sells used grease to a bio-diesel company • Linens: old towels and sheets are cut and dyed for use as cleaning cloths and donated to local charities • Oil: TMC sends 500 gallons of used oils annually for reprocessing • Paper: TMC sends paper to be shredded and recycled, saving more than 5,000 trees during 2008 • Scrap metals: TMC donates metal to construction vendors for re-use on projects

• Cell phones are donated to charities

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Protecting children in and around vehicles – particularly in the heat of summer – is the goal of the TMC Hot Spot campaign.

The tragic death of a TMC nurse’s 1-year-old daughter – left unattended in a hot car by her babysitter – helped convince Tucson lawmakers that more needed to be done to keep children safe in and around cars.

The story was featured in last year’s TMC Report to the Community.

The Tucson City Council passed an ordinance in September 2008. Effective Nov. 15, 2008, the act of leaving a child under the age of 10 inside a motor vehicle without the supervision of another person who is at least 14 years old is illegal in Tucson and imposes a fine up to $1,000.

The Hot Spot program continues to be an important component of TMC’s Desert Kids Safety Program.

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As corporate citizens in the Southern Arizona community, Tucson Medical Center provides support to other nonprofit organizations serving the region. Last year, TMC provided more than $208,000 to these important community partners. Below is a list of some of the organizations receiving financial support from TMC. American Cancer Society American Diabetes Association American Heart Association American Lung Association Southern Arizona Red Cross Arizona Women’s Conference Arizona’s Children Association Arthritis Foundation of Southern Arizona Boy & Girls Club of Tucson Children’s Assistance & Resource Event - C.A.R.E. Fair Caregiver Consortium Casa de los Niños Child and Family Resources Children’s Action Alliance Education Enrichment Foundation El Rio Community Health Center Foundation Epilepsy Foundation of Arizona Gamma Alpha Boule Glassman Foundation Juvenile Diabetes and Research Foundation Susan G. Komen Southern Arizona Marana Health Center March of Dimes Muscular Dystrophy Association National Alliance on Mental Illness Ara Parseghian Medical Research Foundation Pima Council On Aging Ronald McDonald House Charities Southern Arizona Center Against Sexual Assault Southern Arizona AIDS Foundation Southern Arizona Association of Women’s Health, Obstetric and Neonatal Nurses Tucson Children’s Museum Tucson Nurse’s Week Foundation Tucson Police Department University of Arizona Women’s Foundation of Southern Arizona

5.$ )FBMUI$BSF #PBSE PG 5SVTUFFT Louise L. Francesconi, Chairwoman Matthew Atlas, M.D. Henry K. Boice Michael Bracht, M.D. Mary E. Cochran, M.D. Susan L. Ernsky Manuel M. Ferris Lou Lancero, M.D. Eduardo A. Leon Sidney “Pete” N. Mendelsohn Jr. Richard M. Moreno David F. Peachin James Topping Joel Valdez Ronald L. Widman, M.D. Jon R. Young

Barton Hodes, M.D. David Killion, M.D. Michael Lavor, M.D. Douglas Lowell, M.D. Marco Marsella, M.D. Brandon Massey, M.D. Bechara Mezher, M.D. James Myer, M.D. Soheila Nouri, M.D. Ann O’Connor, M.D. Ronald Quintia, D.D.S. Joel R. Goode, M.D. Gulshan Sethi, M.D. Mohammed Sikder, M.D. Keith Soderberg, M.D.

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J. Manuel Arreguin, M.D. Brian Cammarata, MD. Eva McCullars, M.D. Michael Probstfeld, M.D. Moira L. Richards, M.D. Steven Siwik, M.D. George Wilcox, M.D. Steven Wool, M.D.

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Robert Aaronson, M.D. Michael Badruddoja, M.D. Amram Dahukey, D.P.M. Marc Epstein, D.O. Steven Gurgevich, Ph.D. Michael Hamant, M.D. Laurence Hanelin, M.D.

Sidney “Pete” N. Mendelsohn Jr., Chairman Ann M. Aros Henry K. Boice David J. Cohen Joni S. Condit Palmer C. Evans, M.D. Dorothy Finley Louise Francesconi Anne M. Fulton-Cavett Ken Gayer Robert R. Johnson, M.D. Christine Kocsis Christopher Maloney, M.D. Kevin Morrow David F. Peachin Rory “R.J.” Riley Alan K. Rogers, M.D. Keri Lazarus Silvyn Alan Stein Arlene Webster, R.N. Jim Zarling