2011-08-08T19:01:15-05:00 2010-09-30 ERNST & YOUNG US LLP 4370 LA JOLLA VILLAGE DR SUITE 500 SAN DIEGO CA 92122 990 2009-10-01 951684089 SCRIPPS HEALTH SCRI 8586787226 4275 CAMPUS POINT COURT SAN DIEGO CA 92121 RICHARD ROTHBERGER 2011-08-08 8585357200 2009 2016-02-24 21:20:13Z CHRISTOPHER VAN GORDER 4275 CAMPUS POINT COURT SAN DIEGO CA 92121 2693465167 false X WWW.SCRIPPSHEALTH.ORG X 1924 CA FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.3 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. (CONTINUED IN SCHEDULE O) 14 11 14405 2017 988085 54820 30425804 32675457 2016636410 2168904416 -10248946 43151540 20239239 21717638 2057052507 2266449051 270251 248745 0 0 915530734 1007336617 0 0 8524146 1041973712 1069409188 1957774697 2076994550 99277810 189454501 2176075012 2593861709 833431959 1028635427 1342643053 1565226282 FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.3 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. (CONTINUED IN SCHEDULE O) false false 1874199299 248745 2191088303 SEE SCHEDULE O 1874199299 true true false true false false false false true true false true false false true false false false true false true true false true true false false false false false false false false true true true true false false true true true false false true 1418 0 true 14405 true true true true CJ false false false true true true 1 false false 14 11 false false false false false false false true true false false true true true true true true true true true false CA X RICHARD ROTHBERGER 8586786828 4275 CAMPUS POINT COURT SAN DIEGO CA 92121 Christopher Van Gorder 40.0 X X 1387827 0 521147 Mary Jo Anderson CHS 5.0 X 0 0 0 Douglas A Bingham Esq 5.0 X 0 0 0 Jeff Bowman 5.0 X 0 0 0 Judy Churchill PhD 5.0 X 0 0 0 Gordon R Clark 5.0 X 0 0 0 Martin C Dickinson 5.0 X 0 0 0 Virginia Gillis RSM EdD 5.0 X 0 0 0 Richard L Hall MD 5.0 X 0 0 0 Ernest S Rady 5.0 X 0 0 0 Abby Silverman Weiss 5.0 X 0 0 0 Maureen Stapleton 5.0 X 0 0 0 Robert Tjosvold 5.0 X 0 0 0 Richard Vortmann 5.0 X 0 0 0 Richard Rothberger 40.0 X 842733 0 144334 Richard Sheridan 40.0 X 523157 0 147177 Gale Keel 40.0 X 80794 0 12186 Virginia Leary 40.0 X 89718 0 20183 Arnold Brent Eastman MD 40.0 X 691405 0 213765 Victor V Buzachero 40.0 X 626695 0 91718 June Komar 40.0 X 585377 0 360335 Larry Harrison 40.0 X 632349 0 105624 Thomas Gammiere 40.0 X 581345 0 112478 Gary Fybel 40.0 X 591195 0 100979 Robin Brown 40.0 X 541933 0 217373 Carl Etter 40.0 X 503898 0 82237 John Engle 40.0 X 474273 79001 Mary L Carraher 40.0 X 292435 0 33653 Barbara Price 40.0 X 480859 0 90403 David M Cohn 40.0 X 387141 0 69096 Marc A Reynolds 40.0 X 388901 0 72261 John E Armstrong 40.0 X 357804 0 58009 Patric Thomas 40.0 X 349029 0 33293 Glen Mueller 40.0 X 365554 0 63652 Brian Issell MD 40.0 X 646144 0 101475 Dana Launer MD 40.0 X 385221 0 30126 Jean Hitchcock 40.0 X 345118 0 37620 John Orsini 40.0 X 383495 0 80688 Robert T Hoff 40.0 X 379886 0 57552 12914286 0 2936365 1263 false true false Scripps Clinic Medical Group 10666 N Torrey Pines Rd MS 129 LA JOLLA CA 92037 Physician Services 143212619 Scripps Coastal Medical Group 501 Washington Street 601 SAN DIEGO CA 92103 PHYSICIAN SERVICES 27233730 Swinerton Builders 17140 Bernardo Center Dr 216 SAN DIEGO CA 92128 CONSTRUCTION 24787711 ARB Structures Inc 26000 Commercentre Dr LAKE FOREST CA 92630 Construction 12243212 Sundt Constructions Inc 1660 Hotel Cir N Ste 400 SAN DIEGO CA 92108 Construction 10255482 104 1130497 51600 31493360 2087506 32675457 Healthcare Delivery 622110 2056373479 2055499709 873770 Capitation Premium 622110 71846620 71846620 Research Revenue 541700 8634495 8580112 54383 Joint Venture- Children's Hospital 622110 6599217 6599217 Rental Income- Medical Office Bldgs 531120 11132454 11132454 14318151 14318151 2168904416 25933242 3362360 47768 22523114 0 0 443311475 426093177 17218298 17218298 17218298 676360 1130497 922939 -246579 -246579 0 0 Cafeteria 722310 5506634 5506634 Parking 812930 2859637 2847473 12164 Gift Shop 453220 1514236 1514236 12083710 9881337 2202373 21964217 2266449051 2191088303 988085 41697206 248745 248745 0 0 0 16508482 16508482 0 773520542 694319272 74227801 4973469 30793485 24431961 6247662 113862 129817149 114132936 15065670 618543 56696959 50022289 6388750 285920 0 3871574 280725 3586112 4737 586692 68984 517708 495790 495790 0 2502590 2502590 357224322 335419101 21143952 661269 4313702 1759867 2553835 382081104 371103371 9844350 1133383 0 0 70666966 62314135 8155967 196864 0 0 0 14667154 12041686 2625468 0 89524377 84708583 4815794 13008423 12683365 325058 Bad Debt Expense 68915784 68908099 7685 Repairs and Maintenance 40113897 22325952 17742565 45380 Professional Claims Expense 6976625 6976625 Loss on Impairment 8454643 8454643 All other expenses 6005545 3998960 1515866 490719 2076994550 1874199299 194271105 8524146 404345528 506688259 30147019 26952656 266174063 250792672 281032 515667 28048542 30659540 7398808 13822671 1688410031 906419572 747569776 781990459 488471869 525186264 102025000 343111000 10969544 9233008 37508462 33914773 53135369 70994740 2176075012 2593861709 319111797 303777923 8960944 11302644 410623828 619641282 10611915 8446438 84123475 85467140 833431959 1028635427 X 1149341585 1376703739 124564281 119066984 68737187 69455559 1342643053 1565226282 2176075012 2593861709 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 301114 true 29055 true 165621 495790 false PUBLIC AFFAIRS EDUCATION AND INFORMATION SCHEDULE C, PART II-B, LINE 1I ORGANIZATION IS A MEMBER OF HOSPITAL ASSOCIATIONS AND HEALTH CARE ORGANIZATIONS AND HAS PARTICIPATED IN PUBLIC AFFAIRS ACTIVITIES ORGANIZED BY THESE ORGANIZATIONS. THIS ACTIVITY HAS INCLUDED BRIEFINGS OF LEGISLATORS AND LEGISLATIVE STAFF MEMBERS (FEDEERAL, STATE AND LOCAL) ON MATTERS AFFECTING HEALTH CARE AND HEALTH CARE OPERATIONS. SUCH MATTERS INCLUDE: HEALTH REFORM LEGISLATION, INSTITUTION OF A HOSPITAL PROVIDER FEE RELATED TO MEDICAID REIMBURSEMENT, DATA AND IMPACT OF PUBLIC PROGRAMS, STATUS AND IMPACT ON MANDATED PROGRAMS SUCH AS SEISMIC SAFETY COMPLIANCE, QUALITY AND PATIENT SAFETY REPORTING, EMERGENCY ROOM CAPACITY, CARE OF UNINSURED AND OTHER SAFETY NET NEEDS AND IMPACTS, COMMUNITY BENEFIT PROGRAMS, DEVELOPMENT OF HEALTH INFORMATION TECHNOLOGY. THE ORGANIZATION STAFFS A GOVERNMENT RELATIONS DEPARTMENT THAT COORDINATES INFORMATION AND EDUCATION PROGRAMS ON PUBLIC POLICY AND ADVOCACY MATTERS. ALL WORK IS FOCUSED ON ISSUES AND NOT ON PARTISAN MATTERS, CANDIDATES OR POLITICAL ACTIVITIES. NO CORPORATE ACTIVITY ADDRESSED PARTISAN CAMPAIGNS. A PORTION OF ANNUAL MEMBERSHIP DUES SCRIPPS HEALTH PAYS TO CALIFORNIA HOSPITAL ASSOCIATION (CHA) AND ITS SUBSIDIARY THE HOSPITAL ASSOCIATION OF SAN DIEGO AND IMPERIAL COUNTIES (HASD & IC), AMERICAN HOSPITAL ASSOCIATION (AHA), THE ALLIANCE OF CATHOLIC HEALTH CARE AND PRIVATE ESSENTIAL ACCESS COMMUNITY HOSPITALS (PEACH) IS DIRECTED BY THESE ORGANIZATIONS TO DIRECT LOBBYING SERVICES. 81098000 685000 7714000 36000 1636000 768000 87057000 69740000 7288000 5902000 0 1372000 460000 81098000 0.00000 1.00000 0.00000 true false 12804000 65153697 77957697 728607963 381874483 346733480 73996597 28831910 45164687 655096631 495713179 159383452 152751143 152751143 781990459 0 0 ANNUITY AND UNITRUSTS 10656666 Deferred Retirement Liability 13211030 Deposits and Contingencies 89287 Self Insured Malpractice Liability 13850479 Self Insured Workers Comp Liability 33262499 Asset Retirement Obligation 13813293 Intercompany Liabilities -661630 Agency Endowment Liability 852358 Arbitrage Rebate Liability 393158 85467140 INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS SCHEDULE D, PART V CONTRIBUTIONS RECEIVED FOR CAPITAL PROJECT USE INCLUDING BUILDING PROJECTS, MAJOR RENOVATIONS, AND EQUIPMENT PURCHASES. - $1,086,131 CONTRIBUTIONS RECEIVED TO FUND GRADUATE MEDICAL EDUCATION PROGRAMS, FELLOWS, AND LECTURE SERIES. - $2,715,531 CONTRIBUTIONS RECEIVED FOR USE IN SPECIFIC DEPARTMENTS OR DIVISIONS IN THE HOSPITALS AND/OR CLINICS. - $38,152,760 CONTRIBUTIONS RECEIVED TO COVER THE COSTS OF HEALTHCARE PROVIDED TO INDIVIDUALS WITHOUT INSURANCE OR THE MEANS OF PAYING FOR THEIR CARE. -$12,820,849 CONTRIBUTIONS RECEIVED TO FUND RESEARCH PROJECTS IN SPECIFIC AREAS OR DIVISIONS. - $14,683,155 TOTAL - $69,458,426 UNCERTAIN TAX POSITIONS UNDER FIN 48 SCHEDULE D, PART X SCRIPPS HEALTH IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, SCRIPPS HEALTH IS SUBJECT TO INCOME TAXES ON ANY NET INCOME THAT IS DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, AND NOT IN FURTHERANCE OF THE PURPOSE FOR WHICH IT WAS GRANTED EXEMPTION. NO INCOME TAX PROVISION HAS BEEN RECORDED IN THE CONSOLIDATED FINANCIAL STATEMENTS AS THE NET INCOME, IF ANY, FROM ANY UNRELATED TRADE OR BUSINESS, IN THE OPINION OF MANAGEMENT, IS NOT MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS TAKEN AS A WHOLE. 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X FINANCIAL SUPPORT REFLECTS THE COST (LABOR, SUPPLIES, OVERHEAD, ETC) ASSOCIATED WITH THE PROGRAMS/SERVICE LESS DIRECT REVENUE. THE FIGURE DOES NOT INCLUDE A CALCULATION FOR PHYSICIAN AND STAFF VOLUNTEER LABOR HOURS. IN SOME INSTANCES AN ENTIRE COMMUNITY BENEFIT PROGRAM COST CENTER HAS BEEN DIVIDED BETWEEN SEVERAL INITIATIVES. SCRIPPS EMPLOYEES TRACK COMMUNITY BENEFIT PROGRAMS/ACTIVITIES VIA AN ACCESS COMMUNITY BENEFIT DATABASE. THE ACCESS COMMUNITY BENEFIT DATABASE HAS BEEN ALIGNED TO THE SCHEDULE H 990 CATEGORIES AND REPORTING CRITERIA. THE DATABASE IS USED TO RECORD INFORMATION FOR EACH ACTIVITY (SERVICE OR PROGRAM) WHICH PROVIDES COMMUNITY BENEFIT. THIS DATABASE IS USED TO RECORD ACTUAL EXPENSES AND FUNDING/OFFSETTING REVENUE FOR SINGLE OR MULTIPLE OCCURRENCES OF AN "ACTIVITY". ALL COMMUNITY BENEFIT PROGRAMS/ACTIVITIES ARE THEN ENTERED INTO THE "COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY" (CBISA) DATABASE. CBISA SERVES AS THE ROLL UP AND OR END PRODUCT OF COMMUNITY BENEFIT TRACKING. IT IS ALIGNED WITH THE NEW SCHEDULE H REQUIREMENTS AND HOUSES THE SCHEDULE H WORKSHEETS THAT CAN BE USED FOR AUDIT PURPOSES. FINANCE WORKS TO RECONCILE UNCOMPENSATED CARE NUMBERS ACCORDING TO THE SCHEDULE H METHODOLOGY. FINANCIAL PLANNING EXCEL WORKSHEETS ARE USED TO RECONCILE COMMUNITY BENEFIT NUMBERS INCLUDING UNCOMPENSATED CARE NUMBERS. SCRIPPS UNCOMPENSATED CARE FY2010 METHODOLOGY SCRIPPS CONTINUES TO CONTRIBUTE RESOURCES TO PROVIDE LOW- AND NO-COST HEALTH CARE SERVICES TO POPULATIONS IN NEED. CALCULATIONS FOR BAD DEBT AND CHARITY CARE IS ESTIMATED BY EXTRACTING THE GROSS WRITE-OFFS OF BAD DEBT AND CHARITY CARE CHARGES AND APPLYING THE HOSPITAL RATIO OF COST TO CHARGES (RCC) TO ESTIMATE THE COST OF CARE. CALCULATIONS FOR MEDI-CAL AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS AND MEDICARE SHORTFALL ARE DERIVED USING THE PAYOR-BASED COST ALLOCATION METHODOLOGY. SUBSIDIZED HEALTH SERVICES SUBSIDIZED HEALTH SERVICES ARE CLINICAL PROGRAMS PROVIDED DESPITE A FINANCIAL LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN EVEN AFTER REMOVING THE EFFECTS OF CHARITY CARE, BAD DEBT AND MEDI-CAL SHORTFALLS. SCRIPPS PROVIDES SUCH SERVICES BECAUSE THEY MEET AN IDENTIFIED COMMUNITY NEED AND, IF NO LONGER OFFERED, THEY WOULD EITHER BE UNAVAILABLE IN THE AREA OR FALL TO GOVERNMENT OR ANOTHER NOT-FOR-PROFIT ORGANIZATION TO PROVIDE. SUBSIDIZED SERVICES DO NOT INCLUDE SUCH ANCILLARY SERVICES AS LAB WORK AND RADIOLOGY. IF THESE SERVICES ARE PROVIDED TO LOW-INCOME PERSONS, THEY ARE REPORTED AS CHARITY CARE/FINANCIAL ASSISTANCE. SCRIPPS' TOTAL NET COST FOR SUBSIDIZED HEALTH SERVICES FOR FY10 WAS $8,806,307. THIS INCLUDES SCRIPPS INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES, MERCY CLINIC AND SCRIPPS IN-LIEU OF FUNDS, WHICH ARE USED FOR UNFUNDED OR UNDERFUNDED PATIENTS AND THEIR POST-DISCHARGE NEEDS INCLUDING BOARD AND CARE, SKILLED NURSING FACILITIES, LONG-TERM ACUTE CARE AND HOME HEALTH. IN ADDITION, THE FUNDS MAY BE USED FOR MEDICATIONS, EQUIPMENT AND TRANSPORTATION SERVICES. MERCY CLINIC OF SCRIPPS MERCY HOSPITAL SAN DIEGO FOUNDED IN 1930 AND ADOPTED BY THE SISTERS OF MERCY IN 1961, MERCY CLINIC OF SCRIPPS MERCY HOSPITAL IS A PRIMARY CARE CLINIC THAT TREATS MORE THAN 2,000 PATIENTS EACH MONTH. TOTAL PATIENT VISITS FOR PRIMARY AND SUBSPECIALTY CARE AT THE CLINIC IN FY10 WERE 15,272. A FULL TIME CLINIC STAFF OF NURSES AND OTHER PERSONNEL WORK HAND-IN-HAND WITH PHYSICIANS FROM SCRIPPS MERCY HOSPITAL. AS AN INTEGRAL PART OF TREATING ITS PATIENTS, MERCY CLINIC SERVES AS A TRAINING GROUND FOR MORE THAN 50 RESIDENTS EACH YEAR FROM THE SCRIPPS MERCY HOSPITAL GRADUATE MEDICAL EDUCATION PROGRAM. ESTABLISHED WITH THE INTENT OF CARING FOR THE POOR, MERCY CLINIC HAS BECOME A CRITICAL SOURCE OF MEDICAL CARE FOR SAN DIEGO'S WORKING POOR. EACH YEAR, 80 PERCENT OF PATIENT VISITS ARE PAID THROUGH MEDI-CAL, MEDICARE OR SOME OTHER INSURANCE PLAN. THE REMAINING 20 PERCENT PAY WHAT, AND IF, THEY CAN. THOUSANDS OF PEOPLE IN THE REGION RELY ON MERCY CLINIC; MOST ARE LOW-INCOME, MEDICALLY UNDERSERVED ADULTS AND SENIORS WHO OTHERWISE WOULD HAVE NO ACCESS TO HEALTH CARE. THE TOTAL SUBSIDIZED NET COST FOR MERCY CLINIC FOR FY10 WAS $2.2 MILLION (EXCLUDES MEDI-CAL, BAD DEBT AND CHARITY CARE). $68,915,784 IS THE AMOUNT OF BAD DEBT INCLUDED IN PART IX, LINE 25 BUT BACKED OUT FOR THE PURPOSE OF CALCULATING THE PERCENTAGES IN SCHEDULE H, PART I, LINE 7, COLUMN (F). FOOTNOTE FOR PART III LINE 4, BAD DEBT FOOTNOTE: BAD DEBT FOOTNOTE FROM THE AUDITED FINANCIAL STATEMENTS REVENUE AND RELATED RECEIVABLES ARE RECORDED NET OF CONTRACTUAL DISCOUNTS. PROVISIONS FOR UNCOLLECTIBLE RECEIVABLES ARE RECORDED AS OPERATING EXPENSES. PROVISIONS FOR CONTRACTUAL DISCOUNTS AND UNCOLLECTIBLE ACCOUNTS ARE ESTIMATED BASED UPON AN EVALUATION OF HISTORICAL COLLECTION EXPERIENCE. ADJUSTMENTS AND CHANGES IN ESTIMATES ARE RECORDED IN THE PERIOD IN WHICH THEY ARE DETERMINED. BAD DEBT METHODOLOGY UNCOMPENSATED COST IS ESTIMATED BY APPLYING RATIO-COST-TO-CHARGE (RCC) PERCENTAGES FOR THE HOSPITAL TO THE GROSS BAD-DEBT ADJUSTMENTS, LESS RECOVERIES. THE FOLLOWING COSTS ARE EXCLUDED: BAD DEBT ADJUSTMENTS AT COST FOR MEDI-CAL AND CMS PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. THE AMOUNT ON PART III, LINE 2 REPRESENTS PATIENT CARE CHARGES WRITTEN OFF TO BAD DEBT WHERE THE PATIENT HAD THE ABILITY TO PAY. WHERE A PATIENT QUALIFIED FOR PARTIAL OR FULL CHARITY CARE, THE UNPAID AMOUNT IS NOT CONSIDERED BAD DEBT. WE BELIEVE THAT BAD DEBT PERTAINING TO PATIENT CARE CHARGES SHOULD BE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THESE PATIENTS RECEIVE TREATMENT REGARDLESS OF WHETHER WE COLLECT PAYMENT FOR THE SERVICES PERFORMED. DESCRIBE HOW THE ORGANIZATION HAS ACCOUNTED FOR DISCOUNTS IN DETERMINING BAD DEBT EXPENSE (E.G. SELF-PAY DISCOUNTS) A PROMPT-PAY DISCOUNT OF 50 PERCENT IS AVAILABLE. BAD DEBT DOES NOT INCLUDE ANY AMOUNTS RELATED TO DISCOUNTS. MEDICARE AND MEDICARE HMO: HOSPITALS MEDICARE ALLOWABLE COSTS ARE DETERMINED USING A COST TO CHARGE RATIO. THE FOLLOWING COSTS ARE EXCLUDED: CHARITY AND BAD DEBT ADJUSTMENTS AT COST FOR MEDICARE AND MEDICARE SENIOR PATIENTS, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND RESEARCH, SUBSIDIZED HEALTH SERVICES PROVIDED TO MEDICARE PATIENTS AND EXPENSES EXCLUDED IN THE MEDICARE COST REPORT. DESCRIBE THE ORGANIZATION'S RATIONALE FOR THE POSITION THAT MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT AS A NOT-FOR-PROFIT, COMMUNITY BENEFIT 501(C)(3) ORGANIZATION, SCRIPPS HEALTH'S PURPOSE IS TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES SERVED. MEDICARE COVERS A SIGNIFICANT PROPORTION OF THE SAN DIEGO COMMUNITY PATIENT POPULATION, INPATIENT AND OUTPATIENT. THE LEVEL OF QUALITY AND ACCESS TO CARE IS THE SAME, REGARDLESS OF PAYER. HOSPITALS DO NOT DETERMINE THE LEVEL OF PAYMENT FOR MEDICARE; RATHER, IT IS SUBJECT TO GOVERNMENT REIMBURSEMENT POLICY. THERE IS A WELL-DOCUMENTED MEDICARE REIMBURSEMENT SHORTFALL OF PAYMENT FOR CARE NOT MEETING THE COST OF DELIVERING CARE. THAT SHORTFALL IS AN UNREIMBURSED AMOUNT THAT MUST BE ACCOUNTED FOR IN THE HOSPITAL'S FINANCIAL STATEMENTS. IT IS REAL AND SUBSTANTIAL. IT SHOULD BE ACCEPTED AS A SHORTFALL IN IRS REPORTING STANDARDS. SCRIPPS MUST ACCEPT THE PATIENTS REGARDLESS OF REIMBURSEMENT RATES FROM MEDICARE AND IF PATIENTS ARE NOT CARED FOR BY SCRIPPS IT IS LIKELY THAT ANOTHER COMMUNITY OR GOVERNMENT AGENCY WOULD HAVE TO COVER THE CARE OF THE PATIENT. COLLECTION POLICY ALL PATIENT FINANCIAL RESOURCES ARE EXPLORED PRIOR TO USING A COLLECTION AGENCY OR OTHER MEANS TO COLLECT ON ACCOUNTS. THE ORGANIZATION ALSO SCREENS PATIENTS WHO CANNOT AFFORD TO PAY CO-INSURANCE AND DEDUCTIBLES TO SEE WHETHER THEY QUALIFY FOR FINANCIAL ASSISTANCE OR CHARITY CARE PROGRAM. IF THE PATIENT DOES NOT QUALIFY, OR IF THERE IS A LACK OF INFORMATION AVAILABLE TO MAKE A DETERMINATION AND NO CONTACT IS ESTABLISHED WITH THE PATIENT, THEN THE ORGANIZATION MAY USE A COLLECTION AGENCY OR INTERNAL STAFF TO COLLECT THE ACCOUNT. WHEN A COLLECTION AGENCY OR THE ORGANIZATION STAFF DETERMINES THAT A PATIENT CANNOT PAY ON THE ACCOUNT, THE ORGANIZATION WRITES THE ACCOUNT OFF AS CHARITY. SHOULD A PATIENT MAKE A PAYMENT ON AN ACCOUNT THAT HAS BEEN WRITTEN OFF TO BAD-DEBT EXPENSE, BAD-DEBT EXPENSE IS REDUCED TO THE EXTENT OF THE PAYMENT. SCRIPPS HEALTH HAS 22 OUTPATIENT CLINIC FACILITIES. DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. CALIFORNIA SENATE BILL 697 (CHAPTERED IN 1994) REQUIRES AN UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST EVERY THREE YEARS. IDENTIFYING SAN DIEGO COUNTY'S HEALTH PRIORITIES IS A COMPLEX PROCESS. THE WORKING GROUP KNOWN AS THE SAN DIEGO COUNTY SB697 COALITION WAS FORMED WITH THE GOAL OF PRODUCING ONE NEEDS ASSESSMENT TO MAXIMIZE RESOURCES AND DEVELOP A MORE COMPREHENSIVE REPORT FOR THE COUNTY OF SAN DIEGO. THE COALITION, RENAMED COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP) SHORTLY AFTER THE COMPLETION OF THE FIRST ASSESSMENT, FORMALIZED ITS ROLE TO PROVIDE OVERSIGHT AND DIRECTION TO THE PERIODIC NEEDS-ASSESSMENT PROCESS. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, THE ORGANIZATION IS BETTER ABLE TO BUILD UPON EXISTING ASSETS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. COMMUNITY HEALTH IMPROVEMENT PARTNERS SCRIPPS IS AN OFFICIAL PARTNER AND AN ACTIVE PARTICIPANT IN COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP). THROUGH CHIP, MORE THAN 25 COMMUNITY HEALTH-RELATED ORGANIZATIONS COME TOGETHER TO JOINTLY ADDRESS THE COUNTY'S HEALTH NEEDS. SCRIPPS WORKS WITH CHIP AND OTHER HEALTH CARE SYSTEMS AND PARTNERS TO DEVELOP A COMPREHENSIVE COUNTY HEALTH NEEDS ASSESSMENT, UPDATED EVERY THREE YEARS, INCLUDING COUNTY, STATE AND NATIONAL HEALTH STATISTIC COMPARISONS. THE COLLABORATIVE ASSESSMENT PROCESS IS ONE OF THE MOST RESPECTED IN CALIFORNIA. CHARTING THE COURSE VI: HEALTH NEEDS ASSESSMENT FOR SAN DIEGO COUNTY "CHARTING THE COURSE VI," CHIP'S 2010 HEALTH NEEDS ASSESSMENT FOR SAN DIEGO COUNTY, BUILDS ON THE WORK DONE IN THE FIVE PREVIOUS ASSESSMENTS IN 1995, 1998, 2001, 2004 AND 2007. THE CHIP HEALTH NEEDS ASSESSMENTS MONITOR CHANGES AND TRENDS IN HEALTH STATUS AMONG SAN DIEGO COUNTY RESIDENTS. THIS INFORMATION PROVIDES THE BASIS UPON WHICH PROGRAMS AND INTERVENTIONS CAN BE TARGETED, DEVELOPED AND EVALUATED, WITH THE ULTIMATE GOAL OF IMPROVING THE HEALTH OF THE COMMUNITY AND ITS MEMBERS. IN ADDITION TO FULFILLING LEGISLATIVE REQUIREMENTS, "CHARTING THE COURSE VI" PROVIDES A RESOURCE FOR INDIVIDUALS, AGENCIES AND INSTITUTIONS TO IDENTIFY COMMUNITY HEALTH NEEDS AND CONCERNS. IT IS AVAILABLE VIA THE CHIP WEBSITE (WWW.SDCHIP.ORG). DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY. HOSPITAL CARE CAN BE EXPENSIVE AND IS OFTEN UNEXPECTED. TO HELP MEET THE NEEDS OF LOW-INCOME UNINSURED AND UNDERINSURED PATIENTS WHO USE SCRIPPS HOSPITALS, SCRIPPS HAS A PATIENT FINANCIAL ASSISTANCE POLICY CONSISTENT WITH CALIFORNIA AB774 "FAIR PRICING POLICY" LEGISLATION, CHAPTERED IN 2006. FOLLOWING PRINCIPLES AND GUIDELINES SET BY THE AMERICAN HOSPITAL ASSOCIATION AND THE CALIFORNIA HOSPITAL ASSOCIATION, THE POLICY ESTABLISHES STANDARDS FOR CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES AND LOW-INCOME PATIENT ASSISTANCE THROUGH DISCOUNTED HOSPITAL CHARGES. SCRIPPS ACTIVELY SCREENS, MONITORS AND IDENTIFIES PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE, PROVIDES COUNSELING, INFORMATION AND LANGUAGE INTERPRETATION AND MAKES EVERY REASONABLE EFFORT TO ASSIST PATIENTS IN MEETING FINANCIAL OBLIGATIONS. WHEN NECESSARY, SCRIPPS ALSO HELPS PATIENTS UNDERSTAND AND PARTICIPATE IN FINANCIAL ASSISTANCE OPTIONS. THIS INCLUDES BILLING STATEMENTS THAT ALERT PATIENTS TO THE AVAILABILITY OF ASSISTANCE AS WELL AS LIMITS ON ACCOUNT COLLECTION ACTIVITIES. (SCRIPPS DOES NOT, FOR EXAMPLE, APPLY WAGE GARNISHMENT OR LIENS ON PRIMARY RESIDENCES AS A MEANS OF COLLECTING UNPAID HOSPITAL BILLS.) ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON AN EVALUATION OF INCOME AND EXPENSE INFORMATION. FOR LOW-INCOME, UNINSURED PATIENTS EARNING LESS THAN 200 PERCENT OF THE FEDERAL POVERTY GUIDELINES (FPG), SCRIPPS FULLY FORGIVES THE ENTIRE BILL. FOR INDIVIDUALS WHO EARN BETWEEN 201-400 PERCENT OF THE FPG, FINANCIAL ASSISTANCE IS BASED ON A SCHEDULE WITH SHARE-OF-COST DISCOUNTS. SCRIPPS POSTS A SUMMARY OF ITS CHARITY CARE POLICY ON THE SCRIPPS WEB SITE AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE FINANCIAL ASSISTANCE POLICY IS IN WRITTEN FORM TO GUIDE AND DIRECT STAFF AND EFFECTIVELY COMMUNICATES HOW OUR COMMITMENT WILL BE APPLIED CONSISTENTLY TO ALL PATIENTS. THE POLICY INITIALLY ESTABLISHED IN 2001 WAS REVISED TO BE CONSISTENT WITH AB774 "FAIR PRICING POLICY" LEGISLATION. THE PRACTICES ESTABLISHED IN THE POLICY REFLECT SCRIPPS' CONTINUING COMMITMENT TO ASSISTING LOW-INCOME UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES. POLICY HIGHLIGHTS INCLUDE: - SCRIPPS HEALTH WILL RESPECT THE DIGNITY OF EACH PATIENT, ACT ETHICALLY IN ALL PATIENT FINANCIAL MATTERS AND COMMUNICATE EFFECTIVELY TO ASSIST PATIENTS IN RESOLVING THEIR FINANCIAL OBLIGATIONS. EVERY REASONABLE EFFORT IS MADE TO ASSIST PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION TO PAY FOR HOSPITAL SERVICES. SCRIPPS FINANCIAL ASSISTANCE IS DESIGNED TO SUPPORT PATIENTS WITH DEMONSTRATED FINANCIAL NEED AND IS NOT INTENDED TO SUPPLEMENT OR CIRCUMVENT THIRD PARTY COVERAGE INCLUDING MEDICARE. - FINANCIAL ASSISTANCE INFORMATION IS POSTED IN CONSPICUOUS REGISTRATION AREAS INCLUDING THE EMERGENCY DEPARTMENT, BILLING OFFICE, MAIN ADMISSION, AND ANCILLARY SERVICE LOCATIONS. PATIENT ACCOUNTS THAT MAY BENEFIT FROM FINANCIAL ASSISTANCE ARE ACTIVELY SCREENED, MONITORED AND IDENTIFIED AS SOON AS POSSIBLE. EVALUATION FOR FINANCIAL ASSISTANCE ELIGIBILITY IS BASED ON THE EVALUATION OF INCOME AND EXPENSE INFORMATION PROVIDED BY THE PATIENT. - SCRIPPS HEALTH WILL WORK TO ASSIST ANY PATIENT UNABLE TO PAY FOR SERVICES, WHO COOPERATIVELY PROVIDES INFORMATION ABOUT HIS/HER ABILITY TO PAY. FAILURE BY THE PATIENT TO COOPERATE MAY RESULT IN THE INABILITY OF THE HOSPITAL TO PROVIDE FINANCIAL ASSISTANCE DETERMINATION. - PATIENTS ARE PROVIDED WITH COUNSELING AND WRITTEN INFORMATION REGARDING FINANCIAL ASSISTANCE. LANGUAGE INTERPRETIVE SERVICES ARE UTILIZED FREE OF CHARGE WHENEVER NECESSARY TO FACILITATE THE PATIENTS UNDERSTANDING AND PARTICIPATION IN FINANCIAL ASSISTANCE OPTIONS. - FINANCIAL ASSISTANCE APPLIES TO INDIVIDUALS WHOSE FAMILY INCOME LEVEL IS 400 PERCENT OF THE FEDERAL POVERTY LEVEL OR BELOW. DETERMINATION IS MADE ON AN ALL OR PARTIAL BASIS USING THE APPROVED DISCOUNT SCHEDULE. DESCRIBE THE COMMUNITY THE ORGANIZATION SERVES, TAKING INTO ACCOUNT THE GEOGRAPHIC AREA AND DEMOGRAPHIC CONSTITUENTS IT SERVES. (E.G., URBAN, SUBURBAN, RURAL), THE COMMUNITY OR COMMUNITIES (E.G., POPULATION, AVERAGE INCOME, PERCENTAGES OF COMMUNITY RESIDENTS WITH INCOMES BELOW THE FEDERAL POVERTY GUIDELINE, PERCENTAGE OF THE HOSPITAL'S AND COMMUNITY'S PATIENTS WHO ARE UNINSURED OR MEDICAID RECIPIENTS), THE NUMBER OF OTHER HOSPITALS SERVING THE COMMUNITY OR COMMUNITIES, AND WHETHER ONE OR MORE FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS ARE PRESENT IN THE COMMUNITY. MEETING THE CHALLENGES OF A DIVERSE BORDER COMMUNITY SAN DIEGO COUNTY IS AN INTERNATIONAL BORDER COMMUNITY COMPRISED OF 3.2 MILLION PEOPLE. GEOGRAPHICALLY DISPERSED OVER 4,300 SQUARE MILES, THE POPULATION REPRESENTS MULTIPLE ETHNIC GROUPS. THE SAN DIEGO ASSOCIATION OF GOVERNMENT'S (SANDAG) POPULATION GROWTH PROJECTION FOR 2030 IS 3.98 MILLION, A 24% INCREASE FROM 2010. DEMOGRAPHIC ESTIMATES AND PROJECTIONS ARE BASED ON SANDAG 2010 ESTIMATES AND ARE AVAILABLE AT THE ZIP CODE LEVEL AT HTTP://DATAWAREHOUSE.SANDAG.ORG. A BREAKDOWN OF THE REGIONAL DEMOGRAPHICS CAN BE FOUND IN THE REGIONAL FORUM SECTIONS OF THE CHARTING THE COURSE VI: HEALTH NEEDS ASSESSMENT FOR SAN DIEGO COUNTY HTTP://WWW.SDCHIP.ORG. SCRIPPS SERVES A QUARTER OF THE TOTAL COUNTY POPULATION, CONCENTRATING SERVICES IN THE NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTH REGIONS OF SAN DIEGO COUNTY WHERE SCRIPPS FACILITIES ARE LOCATED. SCRIPPS MERCY HOSPITAL (INCLUDING SAN DIEGO AND CHULA VISTA CAMPUSES) PROVIDES 69 PERCENT OF THE CHARITY CARE WITHIN THE SCRIPPS SYSTEM. SCRIPPS MERCY'S SERVICE AREA HAS A MORE ECONOMICALLY DISADVANTAGED POPULATION COMPARED TO THE COUNTY AS A WHOLE, WITH THE LOWEST NUMBERS OF INSURED ADULTS IN THE COUNTY AND A MUCH HIGHER PERCENTAGE OF ETHNIC MINORITIES, PRIMARILY HISPANIC AND ASIAN. AS A DISPROPORTIONATE-SHARE HOSPITAL, SCRIPPS MERCY SAN DIEGO AND CHULA VISTA CAMPUSES PLAY IMPORTANT HEALTH CARE SERVICE ROLES IN THE CENTRAL/SOUTHERN SAN DIEGO COUNTY SERVICE AREA (RANGING FROM INTERSTATE 8 TO THE UNITED STATES-MEXICO BORDER). MORE THAN HALF OF SCRIPPS MERCY SAN DIEGO AND CHULA VISTA PATIENTS ARE GOVERNMENT INSURED-MEDICARE AND MEDI-CAL. FOUNDED IN 1930 AND ADOPTED BY THE SISTERS OF MERCY IN 1961, MERCY CLINIC OF SCRIPPS MERCY HOSPITAL IS A PRIMARY CARE CLINIC THAT TREATS MORE THAN 2,000 PATIENTS EACH MONTH. TOTAL PATIENT VISITS FOR PRIMARY AND SUBSPECIALTY CARE AT THE CLINIC IN FY10 WERE 15,272. ESTABLISHED WITH THE INTENT OF CARING FOR THE POOR, MERCY CLINIC HAS BECOME A CRITICAL SOURCE OF MEDICAL CARE FOR SAN DIEGO'S "WORKING POOR." EACH YEAR, 80 PERCENT OF PATIENT VISITS ARE PAID THROUGH MEDI-CAL, MEDICARE OR SOME OTHER INSURANCE PLAN. THE REMAINING 20 PERCENT PAY WHAT, AND IF, THEY CAN. THOUSANDS OF PEOPLE IN THE REGION RELY ON MERCY CLINIC; MOST ARE LOW-INCOME AND MEDICALLY UNDERSERVED ADULTS AND SENIORS WHO OTHERWISE WOULD HAVE NO ACCESS TO HEALTH CARE. THE TOTAL SUBSIDIZED EXPENSE FOR MERCY CLINIC FOR FY10 WAS $2.2 MILLION (EXCLUDES MEDI-CAL, BAD DEBT AND CHARITY CARE). SCRIPPS HOSPITALS HOUSE 24.3 PERCENT OF THE COUNTY'S GENERAL ACUTE-CARE LICENSED BEDS. SCRIPPS PROVIDES SIGNIFICANT AND GROWING VOLUMES OF EMERGENCY, OUTPATIENT AND PRIMARY CARE. IN FY10, SCRIPPS PROVIDED 2.0 MILLION OUTPATIENT VISITS. ALMOST HALF (43.4 PERCENT) OF SAN DIEGO SAFETY NET DISCHARGES ARE FROM CENTRAL AND SOUTH SUBURBAN REGIONS. SAFETY NET DISCHARGES INCLUDE COUNTY INDIGENT PROGRAMS, MEDI-CAL AND SELF PAY. COUNTY SAFETY NET DISCHARGES CY09: - CENTRAL DISCHARGES - 17,038 - SOUTH SUBURBAN DISCHARGES - 12,904 SCRIPPS OSHPD SAFETY NET DISCHARGES CY09: - SCRIPPS CENTRAL DISCHARGES - 4,954 - SCRIPPS SOUTH SUBURBAN DISCHARGES - 3,921 COUNTY OVERVIEW ACCESS TO MEDICAL CARE IS CRUCIAL TO THE WELL-BEING OF INDIVIDUALS AND THE SAN DIEGO COMMUNITY AS A WHOLE. THERE ARE MANY BARRIERS TO CARE FOR THE SAFETY NET POPULATION THAT PREVENT THEM FROM OBTAINING MUCH NEEDED MEDICAL SERVICES. LACK OF INSURANCE IS A PRIMARY BARRIER, AS EVIDENCED BY THE 17.2 PERCENT OF ADULTS AGE 19-64 (EXCLUDING MEDICARE AND MILITARY) WHO LACK HEALTH INSURANCE IN SAN DIEGO COUNTY. DURING 2005, AN ESTIMATED 510,000 CHILDREN AND ADULTS LIVING IN SAN DIEGO WERE UNINSURED FOR ALL OR PART OF THE YEAR. APPROXIMATELY 95,000 WERE UNINSURED CHILDREN; 415,000 WERE UNINSURED NONELDERLY ADULTS. ACCORDING TO A 2006 SAN DIEGO COUNTY HEALTH CARE SAFETY NET STUDY, NEARLY ONE-THIRD OF SAN DIEGO COUNTY'S POPULATION (909,661) IS UNINSURED OR UNDERINSURED, WITH THE HIGHEST CONCENTRATION - HALF OF THE TOTAL - SOUTH OF INTERSTATE 8. THE HOSPITALS AND COMMUNITY CLINICS THAT PROVIDE HEALTH CARE TO THIS POPULATION COMPRISE THE SAFETY NET. SINCE SAN DIEGO COUNTY DOES NOT OPERATE A PUBLIC HOSPITAL, THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO PROVIDE CARE TO UNINSURED AND MEDICALLY UNDERSERVED POPULATIONS. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE CURRENT SAFETY NET IS A CRITICAL POLICY CHALLENGE. THE SAN DIEGO COUNTY HEALTH CARE SAFETY NET STUDY FOUND THAT THE CENTRAL AND SOUTH REGIONS HAVE THE LARGEST PROPORTION OF UNINSURED. NORTH CENTRAL HAS THE LEAST NUMBER OF UNINSURED. THE COUNTY HAS 14.3 PERCENT OF ITS POPULATION ON MEDI-CAL (434,936). CENTRAL AND SOUTH REGIONS HAVE THE LARGEST NUMBER OF MEDI-CAL BENEFICIARIES (22.3 AND 19.4 PERCENT, RESPECTIVELY). COMBINED, THE SAFETY NET CONSUMER COMPRISES 29.5 PERCENT OF THE POPULATION (907,661). WHILE PUBLIC SUBSIDIES (E.G., COUNTY MEDICAL SERVICES) HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ARE LEFT TO ABSORB THE COST INVOLVED IN CARING FOR UNINSURED PATIENTS INTO THEIR OPERATING BUDGETS. THE FINANCIAL BURDEN PLACED ON HOSPITALS AND PHYSICIANS CARING FOR UNINSURED PATIENTS IS SIGNIFICANT. SAN DIEGO MEDI-CAL REIMBURSEMENT IS AMONG THE LOWEST IN CALIFORNIA, ALREADY THE STATE WITH THE NATION'S LOWEST MEDICAID REIMBURSEMENT RATE. ECONOMIC DEVELOPMENT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 2. EXECUTIVE LEADERSHIP, SPONSORED BY THE OFFICE OF THE PRESIDENT, DONATES TIME ON NOT-FOR PROFIT BOARDS REPRESENTING SCRIPPS HEALTH, INCLUDING THE FOLLOWING ORGANIZATIONS AND BOARDS: SAN DIEGO REGIONAL CHAMBER OF COMMERCE (CHAMBER BOARD, CHAMBER CEO ROUNDTABLE AND POLICY COMMITTEE ASSIGNMENTS); SAN DIEGO COUNTY TAXPAYERS ASSOCIATION (SDCTA BOARD, EXECUTIVE COMMITTEE AND HEALTH COMMITTEE WORK ASSIGNMENTS); SAN DIEGO REGIONAL ECONOMIC DEVELOPMENT CORPORATION (EDC BOARD AND POLICY COMMITTEE ASSIGNMENTS); AND THE DOWNTOWN SAN DIEGO PARTNERSHIP (DSDP BOARD AND WORKING COMMITTEE ASSIGNMENTS). COMMUNITY SUPPORT - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 3. THE CITY HEIGHTS WELLNESS CENTER (CHWC) IS A UNIQUE RESOURCE, AS THERE IS NO OTHER COMMUNITY-BASED FACILITY PROMOTING HEALTH AND WELLNESS IN CENTRAL SAN DIEGO. THE OVERALL GOAL OF CHWC IS TO PREVENT DISEASE AND PROMOTE HEALTH, STRENGTHEN COMMUNITY PARTNERSHIPS AND PROVIDE OPPORTUNITIES TO RESIDENTS TO BECOME SELF-EMPOWERED AND BECOME MORE INVOLVED IN MANAGING THEIR OWN HEALTH. IN FY10, THE CENTER PROVIDED 70 COMMUNITY MEETINGS FOCUSED ON ACCESS TO HEALTH CARE SERVICES, CREATING A SAFER COMMUNITY ENVIRONMENT AND COMMUNITY-WIDE COMMUNICATION AND COMMUNITY BUILDING STRATEGIES. THE CENTER IS OPERATED JOINTLY BY SCRIPPS MERCY HOSPITAL AND CHILDREN'S HOSPITAL, AND SERVED 1,617 INDIVIDUALS IN FY10. CAR SEAT CLASS THE CITY HEIGHTS WELLNESS CENTER (CHWC) HOSTS CLASSES GIVEN TO PARENTS, PROVIDED BY PACIFIC SAFETY COUNCIL, TO SHOW THE RISKS AND OUTCOMES OF NOT SAFEGUARDING CHILDREN IN A CAR SEAT. PARENTS SEE A VIDEO SHOWING THE RESULTS OF ACCIDENTS AND LATER, A STEP-BY-STEP VIDEO ON HOW TO PROPERLY INSTALL A CAR SEAT. CHWC NOT ONLY PROVIDES THE NEEDED SPACE FOR THIS PROGRAM, BUT ALSO ACTIVELY PARTICIPATES BY DEVELOPING OUTREACH FLYERS, SCHEDULING COMMUNITY RESIDENTS, AND OVERALL COORDINATION FOR THE CLASS. CAR SEAT CHECK CAR SEAT CHECKS ARE SCHEDULED BY CITY HEIGHTS WELLNESS CENTER STAFF AFTER PARTICIPANTS ATTEND A CAR SEAT CLASS. PARENTS ARE GIVEN THE OPTION TO TRADE IN THEIR OLD CAR SEAT (IF THEY HAVE ONE) FOR A NEW CAR SEAT. IF PARENT DOES NOT HAVE A CAR SEAT, THEY RECEIVE A NEW ONE FOR THEIR CHILD. PARENTS MUST PROPERLY INSTALL THEIR CAR SEAT IN THEIR OWN CAR AND HAVE IT INSPECTED BY A CAR SEAT SPECIALIST BEFORE LEAVING THE EVENT. FOOD STAMP ASSISTANCE THE CITY HEIGHTS WELLNESS CENTER (CHWC) HOSTS ELIGIBILITY WORKERS FROM THE SAN DIEGO HUNGER COALITION WHO ARE AVAILABLE TO COUNSEL PEOPLE AND HELP FILL OUT APPLICATIONS FOR FOOD STAMP ASSISTANCE. CHWC NOT ONLY PROVIDES THE NEEDED SPACE FOR THIS ACTIVITY, BUT ALSO ACTIVELY PARTICIPATES BY DEVELOPING OUTREACH FLYERS, SCHEDULING COMMUNITY RESIDENTS, AND OVERALL COORDINATION FOR THE CLASS. FARMERS' MARKET PLANNING CITY HEIGHTS WELLNESS CENTER HOSTS AND PARTICIPATES IN STEERING COMMITTEE MEETINGS FOR THE CITY HEIGHTS FARMERS' MARKET. THE COMMITTEE MEETS TO DISCUSS FARMERS' MARKET EVENTS AND PLANNING FOR FUTURE EVENTS THAT BENEFIT THE CITY HEIGHTS COMMUNITY. MID-CITY CAN, SAN DIEGO CITY HEIGHTS WELLNESS CENTER HOSTS AND PARTICIPATES IN MONTHLY NETWORKING MEETINGS FOR MID-CITY CAN (COMMUNITY ADVOCACY NETWORK). THESE MEETINGS PROVIDE AN OPPORTUNITY FOR COMMUNITY RESIDENTS AND REPRESENTATIVES FROM PRIVATE AND PUBLIC ORGANIZATIONS, FAITH COMMUNITIES, SCHOOLS AND BUSINESSES TO COME TOGETHER FOR ACTION ON AREAS OF COMMON INTEREST. IN ASSOCIATION WITH THESE MEETINGS, SELF-DIRECTED MOMENTUM TEAMS HAVE BEEN DEVELOPED TO PROVIDE DIRECTION AND LEADERSHIP AS NEEDS AND ISSUES ARISE WITHIN THE COMMUNITY. SAN DIEGO CAREGIVER ACTION NETWORK (SANDI-CAN) THE CITY HEIGHTS WELLNESS CENTER HOSTS MONTHLY MEETINGS FOR SANDI-CAN, A COMMUNITY PARTNERSHIP OF 200 CONSUMERS, VOLUNTEERS, CAREGIVERS, AND SERVICE PROVIDERS DEDICATED TO WORKING TOGETHER ON PROJECTS THAT ENHANCE THE LIVES OF OLDER ADULTS AND ADULTS WITH DISABILITIES LIVING IN THE CITY OF SAN DIEGO. DISASTER PREPAREDNESS - COMMUNITY OUTREACH AND EDUCATION THE ABILITY TO PROVIDE EMERGENCY SERVICES TO THOSE INJURED IN A DISASTER WHILE CONTINUING TO CARE FOR HOSPITALIZED PATIENTS IS A CRITICAL COMMUNITY NEED. SCRIPPS DELEGATES PARTICIPATE IN COUNTY AND STATE ADVISORY GROUPS TO PLAN, IMPLEMENT AND EVALUATE KEY DISASTER PREPAREDNESS RESPONSE PLANS AND FUNDING. SCRIPPS' EFFORTS ARE LED BY THE DISASTER PREPAREDNESS PROGRAM UNDER THE DIRECTION OF THE CHIEF MEDICAL OFFICER. AMERICAN HEART WALK - SCRIPPS COORDINATED WALKER PARTICIPATION AND FUND RAISING EFFORTS. IN 2010, MORE THAN 2,500 SCRIPPS HEART WALK PARTICIPANTS - EMPLOYEES, FAMILIES AND FRIENDS WALKED AND HELPED RAISE MORE THAN $159,000. ADDITIONALLY, SCRIPPS REACHED OUT TO THE COMMUNITY AT THE EVENT BY PROVIDING BLOOD PRESSURE SCREENINGS, HEALTH EDUCATION, MATERIALS AND MORE. LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 5. CITY HEIGHTS WELLNESS CENTER - HEALTH ADVOCACY PROJECT THE CITY HEIGHTS WELLNESS CENTER HEALTH ADVOCACY PROJECT IS SUPPORTED BY A GRANT FROM THE CALIFORNIA ENDOWMENT FOUNDATION AND IS DESIGNED TO STRENGTHEN THE CAPACITY TO DELIVER CULTURALLY AND RELIGIOUSLY COMPETENT HEALTH PROMOTION SERVICES TO SOMALI AND EAST AFRICAN WOMEN AND THEIR FAMILIES. THIS PROGRAM ADDRESSES UNMET NEEDS LIKE PRENATAL OUTREACH AND EDUCATION, CULTURALLY ADAPTED NUTRITION AND FITNESS EDUCATION, BREASTFEEDING EDUCATION, EARLY CHILDHOOD HEALTH, AND NUTRITION AND SAFETY CLASSES. THE PROJECT IS SPONSORED BY SCRIPPS MERCY SAN DIEGO COMMUNITY BENEFIT SERVICES. LEAD SAN DIEGO VISIONARY AWARDS THROUGH THE OFFICE OF THE PRESIDENT, SCRIPPS SPONSORED THE LEAD SAN DIEGO VISIONARY AWARDS HELD ON MAY 27, 2010. LEAD SAN DIEGO MEMBERS AND INVESTORS PLAY A VITAL ROLE IN DEVELOPING DIVERSE LEADERS. THE VISIONARY AWARDS STRIVE TO INSPIRE INNOVATIONS AND SHARE SUCCESSES IN COMMUNITY LEADERSHIP. LEARNING FOR LIFE SAN DIEGO - IMPERIAL COUNCIL BOY SCOUTS OF AMERICA SCRIPPS SPONSORSHIP, PROVIDED BY SCRIPPS OFFICE OF THE PRESIDENT, SUPPORTED THE DISTINGUISHED CITIZEN'S DINNER. THE EVENT RAISED FUNDS FOR OUTREACH PROGRAMS DELIVERED BOTH IN SCHOOL AND AFTER SCHOOL TO SUPPORT YOUTH IN HIGH-RISK AREAS OF SAN DIEGO COUNTY, AFFORDING THEM THE OPPORTUNITY TO BUILD LEADERSHIP SKILLS, DEVELOP CHARACTER AND LEARN JOB SKILLS. COALITION BUILDING - THE COSTS ASSOCIATED WITH THE FOLLOWING PROGRAMS ARE REPORTED ON SCHEDULE H, PART II, LINE 6. COMMUNITY HEALTH IMPROVEMENT PARTNERS - CHIP FLIGHT 15: OUR JOURNEY TO BETTER HEALTH FUNDRAISING EVENT THIS FUNDRAISING EVENT - A COLLABORATION OF SAN DIEGO HEALTH CARE SYSTEMS, HOSPITALS, COMMUNITY CLINICS, INSURERS, PHYSICIANS, UNIVERSITIES, COMMUNITY BENEFIT ORGANIZATIONS AND THE COUNTY OF SAN DIEGO - RECOGNIZES THOSE WORKING IN CRITICAL AREAS LIKE ACCESS TO CARE, PREVENTION AND POLICY. THE PARTNERS ARE DEDICATED TO A COMMON VISION AND MISSION OF IMPROVED HEALTH FOR ALL OF SAN DIEGO COUNTY'S COMMUNITIES THROUGH COLLABORATION AND ASSESSMENT. THE LEGACY AWARD HONORS A CHAMPION FOR THEIR CONTINUED EFFORTS TO IMPROVE OUR COMMUNITY'S HEALTH AND WELL-BEING. CALIFORNIA ENDOWMENT MEETING THE CITY HEIGHTS WELLNESS CENTER (CHWC) HOSTS MEETINGS OF THE CALIFORNIA ENDOWMENT (A PRIVATE, STATEWIDE HEALTH FOUNDATION) FOR ITS 10-YEAR BUILDING HEALTHY COMMUNITIES INITIATIVE, WHICH AIMS TO SUPPORT THE DEVELOPMENT OF COMMUNITIES WHERE YOUTH ARE HEALTHY, SAFE AND READY TO LEARN. THE CHWC HAS BEEN INVOLVED, PARTICIPATORY AND SUPPORTIVE OF THE ENDOWMENT AND THEIR EFFORTS IN THIS INITIATIVE. FOOD JUSTICE MOMENTUM TEAM THE CITY HEIGHTS WELLNESS CENTER HOSTS AND CO-CHAIRS MONTHLY MEETINGS OF THE FOOD JUSTICE MOMENTUM TEAM. THE MISSION OF THIS TEAM IS TO GATHER A DIVERSE COMMUNITY WORKING TOGETHER TOWARDS CREATING AN ECOLOGICALLY SOUND, ECONOMICALLY VIABLE AND SOCIALLY JUST FOOD SYSTEM FOR ALL. ACCESS TO HEALTH CARE THE CITY HEIGHTS WELLNESS CENTER HOSTS AND PARTICIPATES IN MONTHLY MEETINGS OF THE ACCESS TO HEALTH CARE MOMENTUM TEAM. THIS TEAM SEEKS TO EMPOWER THE CITY HEIGHTS COMMUNITY THROUGH EDUCATION AND RESOURCES AND TO SET RESIDENTS ON A PATH TO WELLNESS. THE MISSION ALSO INCLUDES PROVIDING A COMPREHENSIVE HEALTH HOME WITH ACCESSIBLE SERVICES DELIVERED IN A CULTURALLY AND LINGUISTICALLY APPROPRIATE ENVIRONMENT. CITY HEIGHTS WELLNESS CENTER (CHWC) - COALITION BUILDING THE CITY HEIGHTS WELLNESS CENTER IS A UNIQUE RESOURCE, AS THERE IS NO OTHER COMMUNITY-BASED FACILITY PROMOTING HEALTH AND WELLNESS IN CENTRAL SAN DIEGO. THE OVERALL GOAL OF THE CHWC IS TO PREVENT DISEASE AND PROMOTE HEALTH, STRENGTHEN COMMUNITY PARTNERSHIPS AND PROVIDE OPPORTUNITIES TO RESIDENTS TO BECOME SELF-EMPOWERED AND BECOME MORE INVOLVED IN MANAGING THEIR OWN HEALTH. IN FY10, THE CENTER PROVIDED 70 COMMUNITY MEETINGS FOCUSED ON ACCESS TO HEALTH CARE SERVICES, CREATING A SAFER COMMUNITY ENVIRONMENT AND COMMUNITY-WIDE COMMUNICATION AND COMMUNITY BUILDING STRATE PROVIDE ANY OTHER IMPORTANT INFORMATION TO DESCRIBING HOW THE ORGANIZATION'S HOSPITALS OR HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY (E.G., OPEN MEDICAL STAFF, COMMUNITY BOARD, USE OF SURPLUS FUNDS ETC). FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2.3 BILLION, PRIVATE, NOT-FOR-PROFIT COMMUNITY HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS A HALF-MILLION PATIENTS ANNUALLY THROUGH THE DEDICATION OF MORE THAN 2,500 AFFILIATED PHYSICIANS AND 13,000 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE, AND AN AMBULATORY CARE NETWORK OF CLINICS, PHYSICIAN OFFICES AND OUTPATIENT CENTERS THROUGHOUT THE SAN DIEGO REGION. SCRIPPS IS A RECOGNIZED LEADER IN THE PREVENTION, DIAGNOSIS AND TREATMENT OF DISEASE AND IS AT THE FOREFRONT OF CLINICAL RESEARCH AND GRADUATE MEDICAL EDUCATION. AS A NOT-FOR-PROFIT HEALTH CARE SYSTEM, SCRIPPS TAKES PRIDE IN ITS SERVICE TO THE COMMUNITY. THE SCRIPPS SYSTEM IS GOVERNED BY A 14-MEMBER VOLUNTEER COMMUNITY BOARD OF TRUSTEES. THIS SINGLE POINT OF AUTHORITY FOR ORGANIZATIONAL POLICY ENSURES A UNIFIED APPROACH TO SERVING PATIENTS ACROSS THE REGION. THE BOARD IS RESPONSIBLE FOR PROMOTING CORPORATE PURSUIT OF ITS MISSION, APPROVAL OF THE BUDGET AND ASSURING THROUGH OVERSIGHT THE EFFECTIVE FUNCTIONING OF THE CORPORATION. ITS PURPOSE IS TO ESTABLISH AND MAINTAIN A NONPROFIT PUBLIC BENEFIT CORPORATION ORGANIZED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC AND EDUCATIONAL PURPOSES, WHOSE ACTIVITIES ARE CONDUCTED IN SUCH A MANNER THAT NO PART OF ITS NET EARNINGS WILL BENEFIT OF ANY TRUSTEE, OFFICER OR OTHER INDIVIDUAL. THESE VOLUNTEERS GIVE COUNTLESS HOURS OF SERVICE TO THE HOSPITAL SYSTEM IN THEIR OVERSIGHT ROLE, PARTICIPATION IN VARIOUS BOARD COMMITTEES AND GENERAL STEWARDSHIP. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES HAVE AN OPEN MEDICAL STAFF FOR ALL QUALIFIED PHYSICIANS. THE BOARD OF TRUSTEES HAS AUTHORITY TO APPROVE BYLAWS, RULES AND REGULATIONS FOR THE MEDICAL STAFF OF EACH HOSPITAL, SURGERY CENTER OR SIMILAR FACILITY, AND TO APPOINT, SUSPEND OR REMOVE ANY PHYSICIAN FROM THE MEDICAL STAFF. ALL FIVE ACUTE-CARE HOSPITAL CAMPUSES PARTICIPATE IN MEDI-CAL AND MEDICARE CONTRACTS. SCRIPPS SURPLUS FUNDS ARE REINVESTED BACK INTO THE SAN DIEGO COMMUNITY. SURPLUS FUNDS ARE UTILIZED FOR NEW FACILITIES, EQUIPMENT, SEISMIC RETROFITTING, PROFESSIONAL EDUCATION AND HEALTH RESEARCH, ACCESS TO PATIENT CARE AND COMMUNITY BENEFIT PROGRAMS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO ADVANCE HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH AND MEDICAL EDUCATION PROGRAMS. DURING FY10 (OCTOBER 2009 TO SEPTEMBER 2010), SCRIPPS INVESTED $34,845,254 IN PROFESSIONAL TRAINING PROGRAMS AND HEALTH RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES FOR SAN DIEGO COUNTY. QUALITY HEALTH CARE DEPENDS ON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WOULD BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH THROUGH THE DEVELOPMENT OF NEW AND INNOVATIVE TREATMENT OPTIONS. PROFESSIONAL EDUCATION AND HEALTH RESEARCH REFLECTS CLINICAL RESEARCH, AS WELL AS PROFESSIONAL EDUCATION FOR NON-SCRIPPS EMPLOYEES INCLUDING GRADUATE MEDICAL EDUCATION, NURSING RESOURCE DEVELOPMENT AND OTHER HEALTH CARE PROFESSIONAL EDUCATION. RESEARCH TAKES PLACE PRIMARILY AT SCRIPPS CLINICAL RESEARCH SERVICES, SCRIPPS WHITTIER DIABETES INSTITUTE, SCRIPPS GENOMIC MEDICINE AND SCRIPPS TRANSLATIONAL SCIENCE INSTITUTE. CALCULATIONS ARE BASED ON TOTAL PROGRAM EXPENSES LESS APPLICABLE DIRECT-OFFSETTING REVENUE. EXPENSES ARE NOT OFFSET BY GRANT REVENUE OR RESTRICTED FUNDS ACCORDING TO THE SCHEDULE H 990 IRS GUIDELINES. A LACK OF HEALTH INSURANCE AND ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS ARE TWO OF THE PRIMARY BARRIERS TO HEALTH CARE ON BOTH A LOCAL AND NATIONAL LEVEL. WITHOUT ACCESS TO BASIC HEALTH CARE SERVICES, INDIVIDUALS SUFFER FROM MORE ACUTE EPISODES OF ILLNESS, INJURY AND MORTALITY. LACK OF INSURANCE ALSO INCREASES THE BURDEN ON HOSPITALS AND HEALTH PROVIDERS. IN AN EFFORT TO PROVIDE FOR POPULATIONS IN NEED, SCRIPPS ASSISTED IN FY10 WITH THE FOLLOWING HEALTH CARE PROGRAMS AND PROJECTS. MERCY OUTREACH SURGICAL TEAM (MOST) REACHING OUT TO THOSE WHO HAVE LIMITED ACCESS TO HEALTH CARE, THE MERCY OUTREACH SURGICAL TEAM (MOST) PROVIDES MEDICAL AND SURGICAL CARE TO UNDERPRIVILEGED CHILDREN AND ADULTS FROM OTHER COUNTRIES. THE VOLUNTEER GROUP OF PHYSICIANS, NURSES, TECHNICIANS AND OTHERS PERFORM LIFE-CHANGING SURGERIES TO CORRECT CLEFT LIPS, CLEFT PALATES, BURN SCARS, CROSSED EYES, HERNIAS AND A VARIETY OF OTHER CONDITIONS. DURING FY10, THE MOST TEAM PROVIDED 53 KINDS OF RECONSTRUCTIVE SURGERIES FOR MORE THAN 575 CHILDREN. GRADUATE MEDICAL EDUCATION STAFF SUPPORT TO ST. VINCENT DE PAUL VILLAGE MEDICAL CENTER AND MID-CITY COMMUNITY CLINICS THE GRADUATE MEDICAL EDUCATION (GME) PROGRAM AT SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC FOCUSES ON PHYSICIAN TRAINING AND CLINICAL RESEARCH, WITH 28 RESIDENTS AND 37 FELLOWS. THE PROGRAM ALSO GIVES BACK TO THE COMMUNITY BY STAFFING EVENING CLINICS AT ST. VINCENT DE PAUL VILLAGE AND THE MID-CITY COMMUNITY CLINIC, WHERE SCRIPPS RESIDENTS AND STAFF PROVIDED MEDICAL CARE TO APPROXIMATELY 600 OF OUR COUNTY'S MOST VULNERABLE RESIDENTS DURING FY10. SCRIPPS HEALTH COMMUNITY BENEFIT GRANTING IN 2010, SCRIPPS AWARDED A TOTAL OF $200,000 IN SEVEN COMMUNITY GRANTS TO PROGRAMS BASED THROUGHOUT SAN DIEGO, RANGING FROM $10,000 TO $120,000 EACH. THE PROJECTS THAT RECEIVED FUNDING ADDRESS SOME OF SAN DIEGO COUNTY'S HIGH-PRIORITY HEALTH NEEDS WITH THE GOAL OF IMPROVING ACCESS TO VITAL HEALTH CARE SERVICES FOR A VARIETY OF AT-RISK POPULATIONS, INCLUDING PEOPLE WHO ARE HOMELESS, ECONOMICALLY DISADVANTAGED, AND MENTALLY ILL. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $1.7 MILLION DOLLARS. IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. SCRIPPS HEALTH IS AN INTEGRATED HEALTH SYSTEM, OPERATING FIVE ACUTE CARE HOSPITALS AND TWENTY-TWO OUT PATIENT CLINICS IN SAN DIEGO COUNTY. IN ADDITION, SCRIPPS HEALTH IS THE PARENT ORGANIZATION OF THE WHITTIER INSTITUTE OF DIABETES WHICH OFFERS IMPROVED QUALITY OF LIFE FOR INDIVIDUALS WITH DIABETES THROUGH INNOVATIVE EDUCATION PROGRAMS, CLINICAL CARE, RESEARCH AND COLLABORATIONS THAT PURSUE PREVENTION AND A CURE. ALL STATES WHICH ORGANIZATION FILES A COMMUNITY BENEFIT REPORT: CA SCRIPPS HEALTH COMMUNITY BENEFIT REPORT CAN BE FOUND AT WWW.SCRIPPS.ORG/ABOUT-US__SCRIPPS-IN-THE- COMMUNITY. true INFOLINE OF SAN DIEGO COUNTY PO BOX 881307 SAN DIEGO CA 92018 331029843 501(C)(3) 20000 FACING THE FUTURE TOGETHER. NATIONAL 211 DAY. FUNDING WAS AWARDED FOR ONGOING OPERATIONS OF ITS TELEPHONE DIALING CODE, WHICH PROVIDES THE PUBLIC WITH INFORMATION ABOUT COMMUNITY, HEALTH AND DISASTER SERVICES. AN EMPHASIS IS ON THE HEALTHCARE NAVIGATION PROGRAM. 2-1-1 SAN DIEGO IS THE DIALING CODE FOR INFORMATION ABOUT COMMUNITY, HEALTH AND DISASTER SERVICES. IT CONNECTS PEOPLE WITH RESOURCES OVER THE PHONE, ONLINE, AND IN PRINT. LOCALLY, 2-1-1 SAN DIEGO WAS LAUNCHED IN JUNE 2005 AS A MULTILINGUAL AND CONFIDENTIAL SERVICE COMMITTED TO PROVIDING ACCESS 24/7. COMMUNITY HEALTH IMPROVEMENT PARTNERS 5575 RUFFIN RD STE 225 SAN DIEGO CA 92123 330496092 501(C)(3) 5245 HEALTH EVENT AMERICAN HEART ASSOCIATION 9404 GENESEE AVE STE 240 LA JOLLA CA 92037 135613797 501(C)(3) 10000 PROGRAM SUPPORT MEDSHARE 3240 CLIFTON SPRINGS RD DECATUR GA 30034 582433968 501(C)(3) 16500 PROGRAM SUPPORT LEGAL AID SOCIETY OF SAN DIEGO 1475 SIXTH AVENUE SAN DIEGO CA 92101 951869806 501(C)(3) 120000 CONSUMER CENTER FOR HLTH ED & ADVOCACY CATHOLIC CHARITIES DIOCESE OF SAN DIEGO 349 CEDAR STREET SAN DIEGO CA 92101 237334012 501(C)(3) 40000 PROGRAM SUPPORT PARTNERSHIP FOR SMOKE FREE FAMILIES 3020 CHILDRENS WAY SAN DIEGO CA 92123 953545901 501(C)(3) 15000 PROGRAM SUPPORT 7 0 DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS FORM 990, SCHEDULE I A SEMI-ANNUAL REPORT AND A LINE ITEM FINANCIAL ACCOUNTING OF THE GRANT DISBURSEMENT TO DATE IS REQUIRED. THIS SEMI-ANNUAL REPORT SHALL INCLUDE PROGRESS MADE TOWARD MEETING OBJECTIVES OUTLINED IN THE GRANT APPLICATION. A FINAL REPORT IS DUE WITHIN THIRTY (30) DAYS FOLLOWING THE EXPIRATION DATE OF THE GRANT. IN ADDITION TO THE PROGRESS MADE TOWARD MEETING THE OBJECTIVES OUTLINED IN THE GRANT APPLICATION, THE FINAL REPORT SHALL INCLUDE QUANTITATIVE AND QUALITATIVE RESULTS OF THE PROGRAM AGAINST ITS STATED GOALS AND OBJECTIVES. A FINANCIAL ACCOUNTING OF THE GRANT DISBURSEMENT AGAINST THE BUDGET MUST BE INCLUDED AS PART OF THIS FINAL REPORT. X true true X X X X X false true false false false false false false false Christopher Van Gorder 975349 0 383093 0 29385 0 472750 0 48397 0 1908974 0 0 0 Richard Rothberger 590114 0 205930 0 46689 0 112717 0 31617 0 987067 0 0 0 Richard Sheridan 395597 0 117031 0 10529 0 123157 0 24020 0 670334 0 0 0 Arnold Brent Eastman MD 506541 0 147847 0 37017 0 155141 0 58624 0 905170 0 0 0 Victor V Buzachero 411002 0 147537 0 68156 0 59283 0 32435 0 718413 0 33429 0 June Komar 429019 0 127305 0 29053 0 337536 0 22799 0 945712 0 0 0 Larry Harrison 431476 0 115831 0 85042 0 62436 0 43188 0 737973 0 53133 0 Thomas Gammiere 464610 0 104105 0 12630 0 83363 0 29115 0 693823 0 0 0 Gary Fybel 454660 0 100686 0 35849 0 60650 0 40329 0 692174 0 0 0 Robin Brown 414468 0 99966 0 27499 0 184992 0 32381 0 759306 0 0 0 Carl Etter 359403 0 81848 0 62647 0 53604 0 28633 0 586135 0 34844 0 John Engle 312560 90261 71452 57236 21765 553274 47366 Mary L Carraher 218616 0 36799 0 37020 0 17584 0 16069 0 326088 0 15642 0 Brian Issell MD 415684 0 101601 0 128859 0 81413 0 20062 0 747619 0 115934 0 Barbara Price 339373 0 74705 0 66781 0 63416 0 26987 0 571262 0 43572 0 Dana Launer MD 358066 0 24763 0 2392 0 7350 0 22776 0 415347 0 0 0 David M Cohn 271194 0 60250 0 55697 0 45564 0 23532 0 456237 0 35038 0 Marc A Reynolds 296429 0 81708 0 10764 0 57541 0 14720 0 461162 0 0 0 Jean Hitchcock 255761 0 62754 0 26603 0 9978 0 27642 0 382738 0 0 0 John E Armstrong 268654 0 55935 0 33215 0 33665 0 24344 0 415813 0 15704 0 John Orsini 340194 0 31200 0 12102 0 58517 0 22172 0 464184 0 0 0 Patric Thomas 282919 0 56029 0 10081 0 24586 0 8707 0 382322 0 0 0 Robert T Hoff 297211 0 61347 0 21328 0 31812 0 25740 0 437438 0 0 0 Glen Mueller 267125 0 63248 0 35181 0 1345 0 62307 0 429206 0 0 0 SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 1 SCRIPPS HEALTH INCURS THE COST OF A MEMBERSHIP FOR A BUSINESS NETWORKING CLUB IN SAN DIEGO FOR THE CHIEF EXECUTIVE OFFICER. THIS MEMBERSHIP IS USED 100% FOR BUSINESS PURPOSES AND ACCORDINGLY, NO PART OF THIS BENEFIT IS INCLUDED WITHIN THE CHIEF EXECUTIVE OFFICER'S TAXABLE COMPENSATION. THE MEMBERSHIP FEE IS $82 PER MONTH. SCHEDULE J, PART I, LINE 4B SCRIPPS HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) PROVIDES SUPPLEMENTAL RETIREMENT BENEFITS TO CERTAIN KEY EMPLOYEES. IT HAS BEEN CLOSED TO NEW PARTICIPANTS SINCE 2001. THE PLAN PROVIDES A BENEFIT DETERMINED BY A FORMULA DRIVEN BY THE EXECUTIVE'S AVERAGE OF THE FIVE HIGHEST YEARS OF PAY AND TAKES INTO CONSIDERATION TENURE AT SCRIPPS HEALTH, AGE AND LIFE EXPECTANCY AND ASSUMES MAXIMUM PARTICIPATION IN OTHER RETIREMENT PROGRAMS. SCRIPPS HEALTH EXECUTIVE BENEFITS PROGRAM PROVIDES A 457F PLAN WITH A FLEXIBLE BENEFIT ALLOWANCE THAT CAN BE USED TO PURCHASE ADDITIONAL INSURANCE COVERAGE FOR CERTAIN EXECUTIVE LEVEL EMPLOYEES. ANY REMAINING BENEFIT ALLOWANCE CAN BE DEPOSITED INTO THE SUPPLEMENTAL ACCUMULATION RETIREMENT ACCOUNT (SARA) WITH A FUTURE VESTING DATE. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SARA PLAN IN CALENDAR YEAR 2009: VICTOR V BUZACHERO 33,429 LARRY HARRISON 53,133 CARL ETTER 34,844 JOHN ENGLE 47,366 MARY L CARRAHER 15,642 BARBARA PRICE 43,572 BRIAN ISSELL 115,934 DAVID COHN 35,038 JOHN E ARMSTRONG 15,704 PRIOR YEAR FORMS 990 (FOR TAX YEARS 2005-2008) OVERSTATED THE DEFERRED COMPENSATION ACCRUAL RELATING TO THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) FOR ONE EXECUTIVE, ARNOLD BRENT EASTMAN, MD. THE PREVIOUSLY REPORTED DEFERRED COMPENSATION BENEFITS FOR THIS EXECUTIVE WERE OVERSTATED BY THE FOLLOWING AMOUNTS: FY06: $295,869 FY07: $392,137 FY08: $545,841 FY09: $691,391 CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033FWK2 2005-06-02 40975000 SEE SCHEDULE O false false CA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 680164610 1309116Y1 2007-03-02 49995000 SEE SCHEDULE O false false CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033F5A4 2008-08-14 99830304 SEE SCHEDULE O false false CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033F5LO 2008-08-14 221230000 SEE SCHEDULE O false false CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033LFG7 2010-02-04 120000000 SEE SCHEDULE O false false 40975000 0 40975000 0 0 0 0 true false true true 49995000 0 0 0 146070 0 0 2005 true false true true 99830304 9902000 89928304 0 0 0 0 true false true true 221230000 0 221224456 0 0 0 0 true false true true 120122508 0 0 0 0 0 0 false false false true false false true false true 0.00000 0.00000 0.00000 true false false true false true 0.00000 0.00128 0.00128 true false true true Citibank NA 14.3 false false false false true false false true false false false false false false false false true true Citibank NA 23.1 false false false false false false false false true HG FENTON COMPANY INC SEE SCHEDULE O 2497676 SEE SCHEDULE O false MATTHEW BALOGH SEE SCHEDULE O 38064 SEE SCHEDULE O false X 1 X 30 468214 COST/SELLING PRICE X 2 1250000 COST/SELLING PRICE X 3 304460 OPINIONS OF EXPERTS X EQUIPMENT 2 64832 COST COMPARABLE PROP X EVENT INVENTORY 626 0 0 4 false true true THIRD PARTIES ENGAGED TO SOLICIT, PROCESS AND SELL NON-CASH CONTRIBUTIONS SCHEDULE M, PART I, ITEM 32B SCRIPPS HEALTH USES A NUMBER OF BROKERS AND VENDORS IN THE COURSE OF SOLICITING, PROCESSING AND LIQUIDATING DONATED NON-CASH ASSETS: REAL ESTATE BROKERS: LOCATE BUYER AND NEGOTIATE/CLOSE SALE THROUGH ESCROW; SECURITIES BROKER: RECEIVE DONATED SECURITIES INTO SCRIPPS ACCOUNTS, SELL ASSETS ON SECURITIES MARKET, AND REMIT NET PROCEEDS TO SCRIPPS; TRANSACTION SERVICES PROVIDER: PROVIDE HOSTED WEB SITE SUPPORTING EVENT REGISTRATION, ON-LINE AUCTIONS, AND/OR EVENT ON-SITE AUTOMATED PROCESSING SYSTEM FOR SPECIAL EVENTS; CONSIGNMENT AUCTION HOUSE: ACCEPT GOODS FOR SALE THROUGH AUCTIONS, LOCATE BUYERS, SETTLE PAYMENT WITH BUYERS, AND REMIT NET PROCEEDS TO SCRIPPS HEALTH; DIRECT MAIL SERVICES PROVIDER: PLAN AND SCHEDULE MAILINGS, DESIGN AND PRODUCE COLLATERAL MATERIALS, DELIVER MAIL LIST WITH MATERIALS TO COMMERCIAL MAIL HOUSE, ANALYZE RESULTS, AND PROVIDE GUIDANCE ON FUTURE STRATEGIES. NON-CASH GIFTS- REVENUE RECOGNITION SCHEDULE M, PART I, ITEM 33 IT IS SCRIPPS HEALTH'S POLICY TO ONLY RECORD CONTRIBUTION REVENUE FOR NON-CASH ITEMS IF THE FAIR MARKET VALUE IS OVER $10,000. GIFTS OF SECURITIES ARE AN EXCEPTION TO THIS POLICY AND ARE RECORDED AS CONTRIBUTION REVENUE ONCE THE SECURITY IS SOLD. BRIEFLY DESCRIBE THE ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES FORM 990, PART I AND PART III, LINE 1 FOUNDED IN 1924 BY PHILANTHROPIST ELLEN BROWNING SCRIPPS, SCRIPPS HEALTH IS A $2 BILLION, PRIVATE NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM IN SAN DIEGO, CALIFORNIA. SCRIPPS TREATS OVER HALF A MILLION PATIENTS ANNUALLY THROUGH THE DEDICATION OF 2,500 AFFILIATED PHYSICIANS AND 13,500 EMPLOYEES AMONG ITS FIVE ACUTE-CARE HOSPITAL CAMPUSES, HOME HEALTH CARE, AND AN AMBULATORY CARE NETWORK OF CLINICS, PHYSICIANS' OFFICES AND OUTPATIENT CENTERS THROUGHOUT THE SAN DIEGO REGION. SCRIPPS HEALTH'S MISSION STATEMENT IS AS FOLLOWS: SCRIPPS STRIVES TO PROVIDE SUPERIOR HEALTH SERVICES IN A CARING ENVIRONMENT AND TO MAKE A POSITIVE MEASURABLE DIFFERENCE IN THE HEALTH OF INDIVIDUALS IN THE COMMUNITIES WE SERVE. WE DEVOTE OUR RESOURCES TO DELIVERING QUALITY, SAFE, COST-EFFECTIVE, AND SOCIALLY RESPONSIBLE HEALTH CARE SERVICES. WE ADVANCE CLINICAL RESEARCH, HEALTH EDUCATION, EDUCATION OF PHYSICIANS AND HEALTH CARE PROFESSIONALS, AND SPONSOR GRADUATE MEDICAL EDUCATION. WE COLLABORATE WITH OTHERS TO DELIVER THE CONTINUUM OF CARE THAT IMPROVES THE HEALTH OF OUR COMMUNITY. FY10 PROGRAM SERVICES ACCOMPLISHMENTS FORM 990, PART III, LINE 4A ORGANIZATIONAL FOUNDATION SCRIPPS PROVIDES A COMPREHENSIVE RANGE OF INPATIENT AND AMBULATORY SERVICES THROUGH OUR SYSTEM OF HOSPITALS AND CLINICS. IN ADDITION, SCRIPPS PARTICIPATES IN DOZENS OF PARTNERSHIPS WITH GOVERNMENT AND NOT-FOR-PROFIT AGENCIES ACROSS OUR REGION TO IMPROVE OUR COMMUNITY'S HEALTH. AND OUR PARTNERSHIPS DON'T STOP AT OUR LOCAL BORDERS. OUR PARTICIPATION AT THE STATE, NATIONAL, AND INTERNATIONAL LEVELS INCLUDES WORK WITH GOVERNMENT AND PRIVATE DISASTER PREPAREDNESS AND RELIEF AGENCIES, THE STATE COMMISSION ON EMERGENCY MEDICAL SERVICES, NATIONAL HEALTH ADVOCACY ORGANIZATIONS, AND EVEN INTERNATIONAL PARTNERSHIPS FOR PHYSICIAN EDUCATION AND TRAINING AND DIRECT PATIENT CARE. IN ALL THAT WE DO, WE ARE COMMITTED TO QUALITY PATIENT OUTCOMES, SERVICE EXCELLENCE, OPERATING EFFICIENCY, CARING FOR THOSE WHO NEED US TODAY, AND PLANNING FOR THOSE WHO MAY NEED US IN THE FUTURE. FULFILLING THE SCRIPPS MISSION DURING THIS FISCAL YEAR, SCRIPPS DEVOTED $337,784,350 TO COMMUNITY BENEFIT PROGRAMS AND SERVICES IN THE AREAS OF UNCOMPENSATED CARE, COMMUNITY HEALTH SERVICES, PROFESSIONAL EDUCATION AND HEALTH RESEARCH. OUR PROGRAMS EMPHASIZE COMMUNITY-BASED PREVENTION EFFORTS AND USE INNOVATIVE APPROACHES TO REACH RESIDENTS AT GREATEST RISK FOR HEALTH PROBLEMS WE MAKE COMMITMENTS TO IMPROVE THE HEALTH OF OUR PATIENTS AND OUR SAN DIEGO COMMUNITIES. AS A LONG-STANDING MEMBER OF THESE COMMUNITIES, AND AS A NOT-FOR-PROFIT COMMUNITY RESOURCE, OUR GOAL AND RESPONSIBILITY ARE TO PROVIDE HELP AND ASSISTANCE FOR ALL WHO COME TO US FOR CARE, AND TO REACH OUT ESPECIALLY TO THOSE WHO FIND THEMSELVES VULNERABLE AND WITHOUT SUPPORT. THIS RESPONSIBILITY IS AN INTRINSIC PART OF OUR MISSION. THROUGH OUR CONTINUED ACTIONS AND COMMUNITY PARTNERSHIPS, WE STRIVE TO RAISE THE QUALITY OF LIFE IN THE COMMUNITY AS A WHOLE. ASSESSING COMMUNITY NEED CALIFORNIA SENATE BILL 697 REQUIRES THE UPDATING OF A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST EVERY THREE YEARS. IDENTIFYING SAN DIEGO COUNTY'S HEALTH PRIORITIES IS A COMPLEX PROCESS OUTLINED IN THE FOLLOWING PAGES. SCRIPPS STRIVES TO IMPROVE COMMUNITY HEALTH THROUGH COLLABORATION. WORKING WITH OTHER HEALTH SYSTEMS, COMMUNITY GROUPS, GOVERNMENT AGENCIES, BUSINESSES AND GRASSROOTS MOVEMENTS, WE ARE BETTER ABLE TO BUILD UPON EXISTING ASSETS TO ACHIEVE BROAD COMMUNITY HEALTH GOALS. THE REPORT IS THE SIXTH EDITION OF THE TRIENNIAL NEEDS ASSESSMENT. THE PROJECT WAS INITIALLY UNDERTAKEN BY THE HOSPITAL COUNCIL OF SAN DIEGO AND IMPERIAL COUNTIES IN 1995 TO ASSIST PRIVATE NOT-FOR-PROFIT HOSPITALS TO COMPLY WITH STATE COMMUNITY BENEFIT LEGISLATION SENATE BILL 697 (SB697), WHICH REQUIRED THEM TO CONDUCT A PERIODIC ASSESSMENT OF THE HEALTH NEEDS OF THOSE LIVING IN THEIR SERVICE AREA IN ORDER TO BETTER RESPOND TO THE COMMUNITY'S HEALTH NEEDS. THE GROUP WAS INITIALLY KNOWN AS THE SAN DIEGO COUNTY SB697 COALITION AND ATTENDED BY REPRESENTATIVES FROM OVER 25 HEALTH CARE-RELATED ORGANIZATIONS. THE GOAL OF THE COALITION WAS TO COLLABORATE AND PRODUCE ONE NEEDS ASSESSMENT IN ORDER TO MAXIMIZE RESOURCES AND DEVELOP A MORE COMPREHENSIVE REPORT FOR THE COUNTY OF SAN DIEGO. DURING THE FIVE SUBSEQUENT NEEDS ASSESSMENTS, THE COALITION, RENAMED COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP), SHORTLY AFTER THE COMPLETION OF THE FIRST ASSESSMENT, FORMALIZED ITS ROLE TO PROVIDE OVERSIGHT AND DIRECTION TO THE PERIODIC NEEDS ASSESSMENT PROCESS. COMMUNITY HEALTH IMPROVEMENT PARTNERS SCRIPPS IS AN OFFICIAL PARTNER AND AN ACTIVE PARTICIPANT IN COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP). THROUGH CHIP, MORE THAN 25 COMMUNITY HEALTH-RELATED ORGANIZATIONS COME TOGETHER TO JOINTLY ADDRESS THE COUNTY'S HEALTH NEEDS. SCRIPPS WORKS WITH CHIP AND OTHER HEALTH CARE SYSTEMS AND PARTNERS TO DEVELOP A COMPREHENSIVE COUNTY HEALTH NEEDS ASSESSMENT WHICH IS UPDATED EVERY THREE YEARS, INCLUDING COUNTY, STATE AND NATIONAL HEALTH STATISTIC COMPARISONS. THE COLLABORATIVE ASSESSMENT PROCESS IS ONE OF THE MOST RESPECTED IN CALIFORNIA. CHARTING THE COURSE VI: HEALTH NEEDS ASSESSMENT FOR SAN DIEGO COUNTY CHARTING THE COURSE VI IS INTENDED TO HELP FULFILL LEGISLATIVE REQUIREMENTS OF SB 697 AND TO PROVIDE A RESOURCE FOR INDIVIDUALS, AGENCIES AND INSTITUTIONS TO IDENTIFY COMMUNITY HEALTH NEEDS AND CONCERNS. READERS ARE ENCOURAGED TO EXPLORE CHARTING THE COURSE VI TO LEARN MORE ABOUT THE CRITICAL HEALTH ISSUES IMPACTING SAN DIEGO COUNTY RESIDENTS. THIS DOCUMENT PRESENTS A WEALTH OF INFORMATION RELATING THE HEALTH ISSUES TO RACE/ETHNICITY, GENDER, AGE CATEGORY AND GEOGRAPHIC REGION. THE REPORT ALSO MONITORS CHANGES AND TRENDS IN HEALTH STATUS AMONG SAN DIEGO COUNTY RESIDENTS. THIS INFORMATION PROVIDES THE BASIS UPON WHICH COMMUNITY HEALTH PROGRAMS AND INTERVENTIONS CAN BE TARGETED, DEVELOPED AND EVALUATED, WITH THE ULTIMATE GOAL OF IMPROVING THE HEALTH OF THE COMMUNITY AND ITS MEMBERS. TO GAIN A FULL UNDERSTANDING OF SCRIPPS' HEALTH ASSESSMENT AND ANALYSIS OF COMMUNITY NEED IN SAN DIEGO, WE RECOMMEND REVIEWING THE CHIP 2010 "CHARTING THE COURSE VI" SAN DIEGO COUNTY HEALTH NEEDS ASSESSMENT AT HTTP://WWW.SDCHIP.ORG. 2010 PRIORITY SETTING PROCESS ONE OF THE MAJOR FEATURES OF EACH NEEDS ASSESSMENT IS THE REVIEW OF HEALTH ISSUES FELT TO BE IMPACTING THE SAN DIEGO REGION. THESE HEALTH ISSUES ARE EXAMINED FROM A LOCAL (SAN DIEGO COUNTY), STATE AND NATIONAL PERSPECTIVE. THE STARTING POINT FOR THIS PROCESS WAS A REVIEW OF THE 38 HEALTHY PEOPLE 2020 FOCUS AREAS. BECAUSE OF THE LARGE NUMBER AND THE DIVERSITY OF HEALTH ISSUES, THE NEEDS ASSESSMENT COMMITTEE SELECTED 17 OF THESE HEALTH ISSUES FOR ADDITIONAL STUDY AND POSSIBLE INCLUSION IN THIS YEAR'S NEEDS ASSESSMENT. THESE ISSUES WERE SELECTED BASED ON AN EXTENSIVE REVIEW OF THE ISSUES AND A RANKING OF THEIR PERCEIVED IMPORTANCE BY THE NEEDS ASSESSMENT COMMITTEE. THE GOAL OF THE PRIORITY-SETTING PROCESS FOR CHARTING THE COURSE VI WAS TO PROVIDE AN ORGANIZED, OBJECTIVE METHOD OF REVIEWING AND PRIORITIZING THE HEALTH ISSUES FACING SAN DIEGO COUNTY. BECAUSE OF THE LARGE NUMBER AND THE DIVERSITY OF HEALTH ISSUES, THE NEEDS ASSESSMENT COMMITTEE SELECTED 17 OF THESE HEALTH ISSUES FOR ADDITIONAL STUDY AND POSSIBLE INCLUSION IN THIS YEAR'S NEEDS ASSESSMENT. THESE ISSUES WERE DIVIDED INTO THREE CATEGORIES: - OVERARCHING ISSUES (4 ISSUES) - CONSIDERED OVERARCHING BECAUSE THEY POTENTIALLY IMPACT ALL OF THE OTHER ISSUES IN THIS REPORT. THESE INCLUDED: O ACCESS TO HEALTH SERVICES O HEALTH COMMUNICATIONS AND HEALTH INFORMATION TECHNOLOGY O PUBLIC HEALTH INFRASTRUCTURE O SOCIAL DETERMINANTS OF HEALTH - HEALTH-RELATED BEHAVIORS (6 ISSUES) - BEHAVIORS THAT ARE IMPORTANT COMPONENTS IN LONG-TERM HEALTH, SUCH AS: O IMMUNIZATION O SMOKING CESSATION O IMPROVING NUTRITION O INCREASING PHYSICAL ACTIVITY O ACHIEVING A HEALTHY WEIGHT STATUS O ORAL HEALTH O VIOLENCE AND INJURY PREVENTION - HEALTH OUTCOMES (7 ISSUES) - LOOKS AT THE CHANGE IN THE HEALTH STATUS OF THE POPULATION AND VARIOUS DEMOGRAPHIC GROUPS OVER TIME RELATED TO: O CANCER O DIABETES O HEART DISEASE AND STROKE O INFECTIOUS DISEASES O MATERNAL, INFANT AND CHILD HEALTH O MENTAL HEALTH O RESPIRATORY DISEASES TO HELP NARROW THE NUMBER OF HEALTH ISSUES, 379 COMMUNITY LEADERS FROM THROUGHOUT SAN DIEGO COUNTY WERE INVITED TO PRIORITIZE EACH ISSUE BASED ON THE FOLLOWING FOUR CRITERIA: 1. WHAT IS THE SIZE OF THE HEALTH ISSUE IN SAN DIEGO COUNTY? 2. WHAT IS THE SERIOUSNESS OF THE HEALTH ISSUE IN SAN DIEGO COUNTY? 3. WHAT COMMUNITY RESOURCES ARE CURRENTLY AVAILABLE TO ADDRESS THE HEALTH ISSUE? 4. HOW MUCH DATA OR INFORMATION DO WE HAVE TO EVALUATE THE HEALTH ISSUE'S OUTCOME? PARTICIPANTS IN THIS PRIORITY-SETTING PROCESS WERE ASKED TO REVIEW THE INFORMATION FOR EACH HEALTH ISSUE COVERED IN A BRIEFING DOCUMENT, PROVIDE THEIR RATINGS FROM THEIR PERSPECTIVE AND WEIGH EACH ISSUE USING THE INFORMATION PROVIDED ALONG WITH THEIR KNOWLEDGE OF THE HEALTH ISSUE. OVERALL, 72 COMMUNITY LEADERS PARTICIPATED IN THE PRIORITY SETTING PROCESS. BASED ON INPUT FROM THIS PRIORITY-SETTING PROCESS, THE NEEDS ASSESSMENT COMMITTEE SELECTED FIVE HEALTH ISSUES FOR THE FOCUS OF CHARTING THE COURSE IV. - ACCESS TO HEALTH SERVICES - SOCIAL DETERMINANTS OF HEALTH - WEIGHT STATUS AND PHYSICAL ACTIVITY - INJURY AND VIOLENCE - MENTAL HEALTH CHARTING THE COURSE IV CONTAINS AN IN-DEPTH REVIEW OF THESE FIVE HEALTH ISSUES ABOVE ALONG WITH THE PRIORITY-SETTING PROCESS USED TO SELECT THESE ISSUES AND THE BACKGROUND INFORMATION RELATED TO 17 ADDITIONAL ISSUES REVIEWED AS PART OF THE PRIORITY-SETTING PROCESS. IN ADDITION, INFORMATION IS PRESENTED RELATED TO THE COMMUNITY FORUMS HELD IN EACH OF THE SIX REGIONS OF SAN DIEGO COUNTY TO GAIN INSIGHTS INTO THE HEALTH ISSUES OF WEIGHT STATUS, MENTAL HEALTH, AND INJURY AND VIOLENCE, AND TO BEGIN THE PROCESS OF IDENTIFYING SOME OF THE ROOT CAUSES RELATED TO THESE ISSUES. MEETING THE CHALLENGES OF A DIVERSE BORDER COMMUNITY SAN DIEGO COUNTY IS AN INTERNATIONAL BORDER COMMUNITY COMPRISED OF 3.2 MILLION PEOPLE. GEOGRAPHICALLY DISPERSED OVER 4,300 SQUARE MILES, THE POPULATION REPRESENTS MULTIPLE ETHNIC GROUPS. THE SAN DIEGO ASSOCIATION OF GOVERNMENT'S (SANDAG) POPULATION GROWTH PROJECTIONS ARE JUST OVER 1 PERCENT PER YEAR, EXTENDING OUT 25 YEARS TO THE YEAR 2030. THE SANDAG 2050 SUB-REGIONAL GROWTH FORECAST PROJECTS POPULATION GROWTH TO 4.4 MILLION BY 2050. THIS IS A 40.0% INCREASE IN POPULATION GROWTH. DEMOGRAPHIC ESTIMATES AND PROJECTIONS ARE BASED ON SANDAG 2010 ESTIMATES AND ARE AVAILABLE AT THE ZIP CODE LEVEL AT HTTP://DATAWAREHOUSE.SANDAG.ORG. A BREAKDOWN OF THE REGIONAL DEMOGRAPHICS CAN BE FOUND IN THE REGIONAL FORUM SECTIONS OF THE CHARTING THE COURSE VI: HEALTH NEEDS ASSESSMENT FOR SAN DIEGO COUNTY (APPENDIX SECTION) HTTP://WWW.SDCHIP.ORG. SCRIPPS SERVES A QUARTER OF THE TOTAL COUNTY POPULATION, CONCENTRATING SERVICES IN THE NORTH COASTAL, NORTH CENTRAL, CENTRAL AND SOUTH REGIONS OF SAN DIEGO COUNTY WHERE SCRIPPS FACILITIES ARE LOCATED. COUNTY OVERVIEW ACCORDING TO A 2006 SAN DIEGO COUNTY HEALTHCARE SAFETY NET STUDY, NEARLY ONE-THIRD OF SAN DIEGO COUNTY'S POPULATION (909,661) IS UNINSURED OR UNDERINSURED, WITH THE HIGHEST CONCENTRATION - HALF OF THE TOTAL - SOUTH OF INTERSTATE 8. THE HOSPITALS AND COMMUNITY CLINICS THAT PROVIDE HEALTH CARE TO THIS POPULATION ARE THE SAFETY NET. THE HEALTH CARE SAFETY NET IN SAN DIEGO COUNTY IS HIGHLY DEPENDENT UPON HOSPITALS AND COMMUNITY HEALTH CLINICS TO PROVIDE CARE TO UNINSURED AND MEDICALLY UNDERSERVED POPULATIONS. FINDING MORE EFFECTIVE WAYS TO COORDINATE AND ENHANCE THE CURRENT SAFETY NET IS A CRITICAL POLICY CHALLENGE. WHILE PUBLIC SUBSIDIES (E.G., COUNTY MEDICAL SERVICES) HELP FINANCE SERVICES FOR SAN DIEGO COUNTY'S UNINSURED POPULATIONS, THESE SUBSIDIES DO NOT COVER THE FULL COST OF CARE. COMBINED WITH MEDI-CAL AND MEDICARE FUNDING SHORTFALLS, SCRIPPS AND OTHER LOCAL HOSPITALS ARE LEFT TO ABSORB THE COST INVOLVED IN CARING FOR THE UNINSURED IN THEIR OPERATING BUDGETS. THE FINANCIAL BURDEN PLACED ON HOSPITALS AND PHYSICIANS TO CARE FOR UNINSURED PATIENTS IS SIGNIFICANT. SAN DIEGO HAS EXPERIENCED A BRIEF IMPROVEMENT IN THE NUMBER OF INSURED RESIDENTS FROM 2003 TO 2009. AT THAT TIME, 17.2 PERCENT OF THE ADULT (19 TO 64 & NON-MILITARY) POPULATION IN SAN DIEGO COUNTY LACKS HEALTH INSURANCE COVERAGE. ACCORDING TO AN AUGUST 2010 UCLA HEALTH POLICY RESEARCH BRIEF, NEARLY 8.4 MILLION CALIFORNIANS WERE WITHOUT ANY HEALTH INSURANCE COVERAGE FOR ALL OR SOME OF 2009. THE REPORT BACKS UP THE FINDINGS OF A PREVIOUS STUDY THE CENTER RELEASED IN MARCH THAT SHOWED NEARLY ONE IN FOUR CALIFORNIANS LACK HEALTH INSURANCE. ACCORDING TO THE LATEST ESTIMATES, THE STATE'S UNINSURED POPULATION HAS REACHED 24.3%, OR ABOUT 8.4 MILLION, UP FROM 6.4 MILLION IN 2007. THIS NUMBER REPRESENTS 22.9 PERCENT OF ALL CALIFORNIANS UNDER AGE 65. WHILE THE PERCENTAGE OF UNINSURED HAS REMAINED HIGH BUT RELATIVELY STEADY FOR THE LAST FOUR TO FIVE YEARS IT IS WIDELY BELIEVED THAT THE CURRENT ECONOMIC CONDITION IS CAUSING THE NUMBER OF UNINSURED TO ONCE AGAIN INCREASE. LAST YEAR, CALIFORNIA HOSPITALS SPENT $12 BILLION ON UNCOMPENSATED PATIENT CARE, UP FROM $8.3 BILLION IN 2005, ACCORDING TO THE CALIFORNIA HOSPITAL ASSOCIATION. THE NUMBER OF UNINSURED PATIENTS IS THE SINGLE BIGGEST PRESSURE POINT ON HOSPITALS. IN 2009, CALIFORNIA HOSPITALS PROVIDED $12.2 BILLION IN UNCOMPENSATED CARE. OF THAT AMOUNT, MEDICARE SHORTFALLS ACCOUNTED FOR NEARLY $3.8 BILLION, WHILE MEDI-CAL UNDERFUNDED HOSPITALS BY $4.6 BILLION AND CHARITY CARE BY $3.8 BILLION. FINANCIAL ASSISTANCE ASSISTING LOW-INCOME, UNINSURED PATIENTS THE SCRIPPS FINANCIAL ASSISTANCE POLICY IS CONSISTENT WITH THE AB774 "FAIR PRICING POLICY" LEGISLATION. THE PRACTICES ESTABLISHED REFLECT OUR COMMITMENT WITH RESPECT TO ASSISTING LOW-INCOME, UNINSURED PATIENTS WITH DISCOUNTED HOSPITAL CHARGES, CHARITY CARE, BILLING AND DEBT COLLECTION PRACTICES. OUR PROGRAM IS PROVIDED WITHOUT REGARD TO RACE, ETHNICITY, GENDER, RELIGION OR NATIONAL ORIGIN. SCRIPPS PROVIDES FULL FINANCIAL ASSISTANCE TO LOW-INCOME AND UNINSURED PATIENTS EARNING LESS THAN 200 PERCENT OF THE FEDERAL POVERTY LEVEL GUIDELINES. FOR INDIVIDUALS WHO QUALIFY BETWEEN 201-400 PERCENT OF THE POVERTY LEVEL, FINANCIAL ASSISTANCE IS BASED ON A DISCOUNT SCHEDULE. FOR 2011, HEALTH AND HUMAN SERVICES DEFINED THE 200 PERCENT FEDERAL POVERTY LEVEL OF A FAMILY OF FOUR AS $44,700. COMMUNITY HEALTH SERVICES COMMUNITY HEALTH SERVICES INCLUDE PREVENTION AND WELLNESS PROGRAMS SUCH AS SCREENINGS, HEALTH EDUCATION, SUPPORT GROUPS AND HEALTH FAIRS, WHICH ARE SUPPORTED BY OPERATIONAL FUNDS, GRANTS, IN-KIND DONATIONS, AND PHILANTHROPY. THESE PROGRAMS ARE DESIGNED TO RAISE PUBLIC AWARENESS, UNDERSTANDING OF AND ACCESS TO IDENTIFIED COMMUNITY HEALTH NEEDS. SCRIPPS CATEGORIZES COMMUNITY HEALTH SERVICES ACCORDING TO THE SCHEDULE H 990 CATEGORIES MANDATED BY THE IRS. IT IS CATEGORIZED INTO FIVE MAIN AREAS: o COMMUNITY HEALTH IMPROVEMENT SERVICES o COMMUNITY BENEFIT OPERATIONS o CASH AND IN-KIND CONTRIBUTIONS o SUBSIDIZED HEALTH SERVICES o COMMUNITY BUILDING ACTIVITIES DURING THIS FISCAL YEAR, SCRIPPS INVESTED $16,016,598 IN COMMUNITY HEALTH SERVICES. THIS FIGURE REFLECTS THE COST ASSOCIATED WITH PROVIDING SUCH ACTIVITIES, INCLUDING SALARIES, MATERIALS AND SUPPLIES, MINUS REVENUE. FOLLOWING ARE HIGHLIGHTS OF JUST SOME OF THE ACTIVITIES CONDUCTED BY SCRIPPS DURING THIS FISCAL YEAR. ACCESS TO CARE A LACK OF HEALTH INSURANCE AND ACCESS TO SPECIALTY AND PRIMARY CARE PROVIDERS ARE TWO OF THE PRIMARY BARRIERS TO HEALTH CARE ON BOTH A LOCAL AND NATIONAL LEVEL. WITHOUT ACCESS TO BASIC HEALTH CARE SERVICES, INDIVIDUALS SUFFER FROM MORE ACUTE EPISODES OF ILLNESS, INJURY AND MORTALITY. IT IS ALSO AN INCREASED BURDEN ON HOSPITALS AND HEALTH PROVIDERS RESULTING FROM PROVIDING UNCOMPENSATED CARE TO THE UNINSURED. RISING RATES OF UNINSURED MAY BE REFLECTED IN HIGHER USE OF EMERGENCY DEPARTMENTS, WHICH BY LAW MUST PROVIDE AT LEAST STABILIZING CARE TO ALL PATIENTS REGARDLESS OF ABILITY TO PAY. REVIEW OF THE SAN DIEGO COUNTY ED DISCHARGES BY SOURCE OF PAYMENT BETWEEN 2006 AND 2008 FOUND THE DEMAND OF ED SERVICES INCREASED BY 11.9%, 582,129 AND 651,595 RESPECTIVELY. IN ADDITION, SEVERAL SHIFTS IN PAYOR SOURCES WERE NOTED INCLUDING A DECLINE IN PRIVATE HMO AND WORKER COMPENSATION ED DISCHARGES AND INCREASES IN BOTH SELF PAY AND MEDI-CAL ED DISCHARGES, SUGGESTING MORE PATIENTS ARE RELYING ON ED CARE DUE TO LACK OF INSURANCE COVERAGE. IN AN EFFORT TO PROVIDE FOR POPULATIONS IN NEED, SCRIPPS ASSISTED IN FY10 WITH THE FOLLOWING EXAMPLES OF HEALTH CARE PROGRAMS AND PROJECTS. MERCY OUTREACH SURGICAL TEAM (MOST) - THE MERCY OUTREACH SURGICAL TEAM (MOST) WORKS TO MITIGATE THE EFFECTS PHYSICAL DEFORMITIES HAVE ON CHILDREN BY PROVIDING RECONSTRUCTIVE SURGERIES AT NO COST TO CHILDREN IN NEED. IN SPECIAL CIRCUMSTANCES, SURGERIES ALSO ARE PROVIDED FOR ADULTS. DURING FY10, THE MOST TEAM PROVIDED RECONSTRUCTIVE SURGERIES FOR MORE THAN 575 CHILDREN AND 53 PROCEDURES WERE DONE. (SPONSORED BY SCRIPPS MERCY HOSPITAL SAN DIEGO AND AFFILIATED PHYSICIANS) GRADUATE MEDICAL EDUCATION STAFF SUPPORT TO ST. VINCENT DE PAUL VILLAGE MEDICAL CENTER AND MID-CITY COMMUNITY CLINICS - WEEKLY COMMUNITY CLINICS WERE HELD AT THE ST. VINCENT DE PAUL AND MID-CITY COMMUNITY CLINICS. STAFFED BY THE SCRIPPS GREEN HOSPITAL AND SCRIPPS CLINIC INTERNAL MEDICINE RESIDENTS, THESE CLINICS PROVIDED MEDICAL CARE TO APPROXIMATELY 600 OF OUR COUNTY'S MOST VULNERABLE RESIDENTS DURING FY10. (SPONSORED BY SCRIPPS CLINIC/GREEN HOSPITAL) FIJI ALLIANCE PROJECT - IN PARTNERSHIP WITH THE INTERNATIONAL RELIEF TEAMS OF SAN DIEGO, THE LOLOMA FOUNDATION, SCRIPPS EMPLOYEES, SCRIPPS CLINIC PHYSICIANS AND OTHER SCRIPPS AFFILIATED PHYSICIANS PROVIDED MEDICAL AND SURGICAL SERVICES IN FIJI TO PERSONS IN NEED. RESIDENTS FROM SCRIPPS CLINIC AND SCRIPPS GREEN HOSPITAL HAVE AN OPPORTUNITY TO PARTICIPATE IN THE MEDICAL MISSIONS AS ONE OF THEIR ROTATIONS. EXAMPLES OF PROCEDURES INCLUDE CLEFT LIP AND PALATE REPAIRS, REPAIRS OF DEFORMITIES OF EYELIDS, FACE AND FEET, BURN SCAR REVISION, BREAST MASSES, DIABETES MANAGEMENT AND HERNIA REPAIRS. ALL SURGICAL SUPPLIES WERE DONATED BY PROFESSIONAL HOSPITAL SUPPLY CORPORATION (PHS), THE SUPPLIER FOR SCRIPPS HEALTH SYSTEM. THE SUPPLIES INCLUDED SURGICAL GOWNS, GLOVES, DRAPES, DRESSINGS, BANDAGES, SUTURES, ETC. CARDINAL HEALTH SYSTEMS, WHICH PROVIDES PHARMACEUTICALS AND OTHER SUPPLIES TO SCRIPPS HEALTH, DONATED ALL THE MEDICATIONS NECESSARY. IN FY10, A CLINICAL TEAM OF 6 PRACTITIONERS PROVIDED CARE TO 2,000 PATIENTS IN JUST TWO WEEKS. (SPONSORED BY SCRIPPS CLINIC/GREEN HOSPITAL) CONSUMER CENTER FOR HEALTH EDUCATION AND ADVOCACY (CCHEA) FUNDING PROVIDES LOW INCOME UNINSURED MERCY CLINIC PATIENTS' AND BEHAVIORAL HEALTH PATIENTS WHO NEED ASSISTANCE IN OBTAINING HEALTHCARE BENEFITS, SSI AND RELATED SERVICES, WHILE SIMULTANEOUSLY REDUCING UNCOMPENSATED CARE EXPENSES FOR MERCY. THIS PROJECT PROVIDES ADVOCACY SERVICES FOR THE TIME-INTENSIVE GOVERNMENT BENEFIT CASES. (SPONSORED BY SCRIPPS MERCY HOSPITAL ADMINISTRATION) SCRIPPS HEALTH COMMUNITY BENEFIT (CB) FUND - IN 2010, SCRIPPS AWARDED A TOTAL OF $80,000 IN COMMUNITY GRANTS TO PROGRAMS BASED THROUGHOUT SAN DIEGO. SCRIPPS AWARDED SIX GRANTS RANGING FROM $10,000 TO $120,000 EACH. THE PROJECTS THAT RECEIVED FUNDING ADDRESS SOME OF SAN DIEGO COUNTY'S HIGH-PRIORITY HEALTH NEEDS WITH THE GOAL OF IMPROVING ACCESS TO VITAL HEALTH CARE SERVICES FOR A VARIETY OF AT-RISK POPULATIONS, INCLUDING THE HOMELESS, ECONOMICALLY DISADVANTAGED, MENTALLY ILL AND OTHERS. SINCE THE COMMUNITY BENEFIT FUND BEGAN, SCRIPPS HAS AWARDED $1.7 MILLION DOLLARS. PROGRAMS FUNDED DURING FY10 INCLUDE: * CB FUND - CONSUMER CENTER FOR HEALTH EDUCATION AND ADVOCACY (CCHEA) FUNDING PROVIDES LOW INCOME UNINSURED MERCY CLINIC PATIENTS AND BEHAVIORAL HEALTH PATIENTS WHO NEED ASSISTANCE IN OBTAINING HEALTHCARE BENEFITS, SSI AND RELATED SERVICES, WHILE SIMULTANEOUSLY REDUCING UNCOMPENSATED CARE EXPENSES FOR MERCY. THIS PROJECT PROVIDES ADVOCACY SERVICES FOR THE TIME-INTENSIVE GOVERNMENT BENEFIT CASES. (SPONSORED BY SCRIPPS MERCY HOSPITAL ADMINISTRATION) * CB FUND - CATHOLIC CHARITIES - FUNDING AWARDED TO PROVIDE SHORT-TERM EMERGENCY SHELTER TO MEDICALLY FRAGILE HOMELESS PATIENTS BEING DISCHARGED FROM SCRIPPS MERCY HOSPITAL SAN DIEGO. CASE MANAGEMENT AND SHELTER IS PROVIDED FOR PREVIOUSLY HOMELESS PATIENTS DISCHARGED FROM SCRIPPS MERCY HOSPITAL WHO NO LONGER REQUIRE HOSPITAL CARE BUT DO NEED A SHORT-TERM SUPPORTIVE RECUPERATIVE ENVIRONMENT. PATIENTS DEMONSTRATING A READINESS FOR CHANGE ARE ASSISTED WITH ONE WEEK IN A HOTEL ALONG WITH FOOD AND BUS FARE TO PURSUE CASE PLAN. THE FOCUS OF THE CASE MANAGEMENT IS TO STABILIZE THE CLIENT BY HELPING THEM CONNECT TO MORE PERMANENT SOURCES OF INCOME, HOUSING AND ONGOING SUPPORTS FOR EFFORTS TOWARD SELF-RELIANCE. THE GOAL OF THIS PARTNERSHIP IS TO REDUCE THE INCIDENCE OF ER RECIDIVISM IN THIS POPULATION AND IMPROVE THE QUALITY OF LIFE FOR THE PATIENT. * CB FUND - 2-1-1 NEW ACCESS SYSTEM - FUNDING WAS AWARDED FOR ONGOING OPERATIONS OF ITS TELEPHONE DIALING CODE, WHICH PROVIDES THE PUBLIC WITH INFORMATION ABOUT COMMUNITY, HEALTH AND DISASTER SERVICES. 2-1-1 SAN DIEGO IS THE DIALING CODE FOR INFORMATION ABOUT COMMUNITY, HEALTH AND DISASTER SERVICES. IT CONNECTS PEOPLE WITH RESOURCES OVER THE PHONE, ONLINE AND IN PRINT. LOCALLY, 2-1-1 SAN DIEGO WAS LAUNCHED IN JUNE 2005 AS A MULTILINGUAL AND CONFIDENTIAL SERVICE COMMITTED TO PROVIDING ACCESS 24/7. * CB FUND - PARTNERSHIP FOR SMOKE-FREE FAMILIES - THE PARTNERSHIP FOR SMOKE-FREE FAMILIES PROGRAM (PSF) IS A COMPREHENSIVE TOBACCO CONTROL PROGRAM TO REDUCE TOBACCO SMOKE EXPOSURE AMONG PREGNANT WOMEN AND SMALL CHILDREN BY SYSTEMATICALLY SCREENING PREGNANT WOMEN AND NEW PARENTS FOR TOBACCO USE IN THEIR OBSTETRICIAN'S AND PEDIATRICIAN'S OFFICE AND LINKING THEM WITH TAILORED INTERVENTIONS. PSF HAS BECOME A STANDARD OF CARE IN SAN DIEGO COUNTY AND A NATIONALLY RECOGNIZED MODEL. PSF PROVIDES A VALUABLE RESOURCE FOR PHYSICIANS AND SMOKING CESSATION SERVICES SPECIFICALLY FOR PREGNANT WOMEN AND NEW PARENTS THAT WAS PREVIOUSLY NON-EXISTENT IN SAN DIEGO. * CB FUND - AMERICAN HEART ASSOCIATION - FUNDING AWARDED FOR THE 2010 HEART WALK SPONSORSHIP. HEART DISEASE AND STROKE ARE THE NUMBER ONE AND NUMBER THREE CAUSES OF DEATH IN THE NATION FOR MEN AND WOMEN. HEART DISEASE IS THE NATION'S LEADING CAUSE OF DEATH, CLAIMING MORE THAN 950,000 AMERICAN LIVES EACH YEAR. SCRIPPS PARTNERS WITH THE AMERICAN HEART ASSOCIATION ON THEIR ANNUAL HEART WALK, TO RAISE FUNDS FOR RESEARCH, PROFESSIONAL AND PUBLIC EDUCATION AND ADVOCACY. CANCER/ONCOLOGY CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE U.S. EXCEEDED ONLY BY HEART DISEASE AND ACCOUNTS FOR ALMOST ONE QUARTER OF ALL DEATHS IN SAN DIEGO COUNTY. ACCORDING TO NATIONAL CANCER INSTITUTE (NCI) ESTIMATES, IN 2009 THERE WILL BE 1,479,350 NEW CASES OF CANCER DIAGNOSED AND AN ESTIMATED 562,540 DEATHS RELATED TO CANCER. CURRENTLY LUNG, BREAST, COLORECTAL AND PROSTATE CANCERS ACCOUNTED FOR 53% OF ALL NEW CASES OF CANCER AND 50% OF ALL CANCER DEATHS. IN SAN DIEGO COUNTY DURING 2007, PERSONS AGE 55 AND OVER ACCOUNTED FOR ALMOST 88% OF CANCER DEATHS WITH MORTALITY RATES PER 100,000 POPULATION RANGING FROM 267.7 AMONG THOSE IN THE 55 - 64 AGE CATEGORY TO 1,533.5 AMONG THOSE AGE 85 AND OVER. TRENDS BETWEEN 2000 AND 2007, SAN DIEGO COUNTY'S AGE-ADJUSTED MORTALITY RATE FOR CANCER HAS DECLINED FROM 189.1 TO 162.6 PER 100,000 POPULATION. IN RESPONSE TO THIS SERIOUS HEALTH CONCERN, SCRIPPS HAS DEVELOPED A SERIES OF PREVENTION AND WELLNESS PROGRAMS DESIGNED TO EDUCATE PEOPLE ON THE IMPORTANCE OF EARLY DETECTION AND TREATMENT FOR SOME OF THE MOST COMMON FORMS OF CANCER. THE FOLLOWING ARE SOME EXAMPLES OF CANCER PROGRAMS AND ACTIVITIES IN WHICH SCRIPPS ENGAGED IN DURING FY10. BREAST AND CERVICAL CANCER CANCER CONTROL - SCRIPPS BREAST CANCER DIAGNOSIS PROJECT (SCRIPPS PROJECT) - PROVIDES FREE DIAGNOSTIC IMAGING SERVICES TO LOW-INCOME, MEDICALLY UNINSURED OR UNDERINSURED WOMEN AGE 39 AND YOUNGER, AND MEN OF ANY AGE, WHO RESIDE IN SAN DIEGO AND PRESENT WITH A BREAST MASS OR ABNORMALITY. THIS PROJECT IS FUNDED BY SUSAN G. KOMEN FOR THE CURE, SAN DIEGO AND THE SCRIPPS CANCER CENTER. IN FY10, 126 QUALIFIED COMMUNITY MEMBERS PARTICIPATED IN THE PROGRAM, 76 RECEIVED DIAGNOSTIC MAMMOGRAMS, 77 RECEIVED BREAST ULTRASOUNDS AND 33 RECEIVED BIOPSIES. FOUR CANCER CASES WERE DETECTED. (SPONSORED BY SCRIPPS CANCER CENTER) CANCER DETECTION PROGRAMS: EVERY WOMAN COUNTS THIS IS A STATE OF CALIFORNIA GRANT PROGRAM THAT PROVIDES FREE BREAST AND CERVICAL CANCER TAILORED HEALTH EDUCATION TO LOW-INCOME, UNINSURED AND UNDERINSURED WOMEN WHO RESIDE IN SAN DIEGO AND IMPERIAL COUNTIES. UNFORTUNATELY THIS STATE GRANT ENDED IN JUNE 2010. SCRIPPS HEALTH PROVIDED CLINICAL ADMINISTRATIVE OVERSIGHT OVER 75 COMMUNITY-BASED CLINICS THAT ARE CONTRACTED WITH THE STATE TO PROVIDE FREE BREAST CANCER SCREENINGS FOR WOMEN AGE 40 AND OLDER AND CERVICAL CANCER SCREENINGS FOR WOMEN AGE 25 AND OLDER. DURING FY010, THE FOLLOWING OUTCOMES WERE ACHIEVED: EDUCATION - BREAST AND CERVICAL CANCER EARLY DETECTION AND PREVENTION EDUCATION WAS PROVIDED TO 536 QUALIFYING WOMEN. (SPONSORED BY SCRIPPS CANCER CENTER) SCRIPPS GREEN CANCER CENTER SUPPORT GROUPS SCRIPPS GREEN CANCER CENTER SUPPORT GROUPS OFFER CANCER PATIENTS THE OPPORTUNITY TO EXPRESS THE EMOTIONS THAT COME WITH A CANCER DIAGNOSIS AND HELP THEM COPE MORE EFFECTIVELY WITH THEIR TREATMENT REGIMEN BY NURTURING THEIR PHYSICAL, EMOTIONAL AND SPIRITUAL WELL BEING. CLASSES AT SCRIPPS GREEN HOSPITAL SUCH AS THE FREE CANCER WRITING WORKSHOP, WHEN WORDS HEAL, ARE DESIGNED TO USE EXPRESSIVE WRITING TO HELP PATIENTS NAVIGATE THEIR JOURNEY WITH CANCER. IN 2010, 30 CANCER PATIENTS ATTENDED A SUPPORT GROUP AT SCRIPPS GREEN AT A COST OF $2,648 TO PROVIDE THESE FREE SERVICES TO THE COMMUNITY. (SPONSORED BY SCRIPPS GREEN HOSPITAL) SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFIT SERVICES BREAST HEALTH CLINICAL SERVICES A TOTAL OF 3,948 WOMEN WERE REFERRED TO CLINICAL BREAST HEALTH SERVICES IN THE COMMUNITY AND SCRIPPS MERCY HOSPITAL CHULA VISTA RADIOLOGY SERVICES. A TOTAL OF 9,527 SERVICES WERE PROVIDED INCLUDING TELEPHONE REMINDERS, OUTREACH AND EDUCATION, CASE MANAGEMENT AND A VARIETY OF PRESENTATIONS. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) SCRIPPS POLSTER BREAST CARE CENTER MUSIC AS MEDICINE PROGRAM PATIENTS AND THEIR SUPPORT PERSON PARTICIPATE IN THE MUSIC AS MEDICINE THERAPY CLASS FACILITATED BY A MUSIC THERAPIST. THE MUSIC THERAPIST ASKS QUESTIONS AND TAILORS THE THERAPY TO THE PARTICIPANTS' EMOTIONAL AND PHYSICAL NEEDS. SESSIONS INVOLVE LISTENING TO MUSIC, WRITING SONGS, DISCUSSING WHAT LYRICS MEAN TO THE PARTICIPANTS, USE OF SINGING BOWLS, VOCALIZATION, AND DRUMMING. RESEARCH HAS SHOWN MUSIC'S ABILITY TO BOOST THE IMMUNE FUNCTION, TO BLOCK INCOMING PAIN STIMULI, LOWER BLOOD PRESSURE AND INFLUENCE EMOTIONAL WELL BEING. (SPONSORED BY SCRIPPS POLSTER BREAST CARE CENTER) SCRIPPS POLSTER BREAST CARE CENTER SUPPORT GROUPS SCRIPPS POLSTER BREAST CARE CENTER SUPPORT GROUPS PROVIDE A VENUE FOR WOMEN TO COME TOGETHER, DISCUSS ISSUES RELATING TO DIAGNOSES, AND RECEIVE SUPPORT. THE SUPPORT GROUPS ARE OFFERED TO WOMEN IN THE SAN DIEGO COMMUNITY. (SPONSORED BY SCRIPPS POLSTER BREAST CARE CENTER) CANCER CENTER AWARENESS AND EDUCATIONAL EVENTS A SERIES OF EDUCATIONAL EVENTS, COORDINATED WITH AMERICAN CANCER SOCIETY AWARENESS MONTHS, ON VARIOUS TYPES OF CANCER, SUCH AS BREAST CANCER, LUNG CANCER, CERVICAL CANCER, COLORECTAL CANCER, SKIN CANCER, OVARIAN/GYNECOLOGICAL CANCER, AND PROSTATE CANCER. AN RN CLINICIAN ANSWERS QUESTIONS AND PROVIDES WRITTEN EDUCATIONAL MATERIAL. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL LA JOLLA CANCER CENTER) HEALTH EDUCATION AND SUPPORT GROUPS EDUCATION AND SUPPORT GROUPS PROVIDED TO SAN DIEGO COUNTY RESIDENTS REGARDING A WIDE VARIETY OF HEALTH CONCERNS AND DISEASES - EDUCATION AND SUPPORT GROUP TOPICS INCLUDE: FAMILIES WHO HAVE EXPERIENCED THE LOSS OF A CHILD, CHILDREN WHO HAVE LOST A PARENT TO CANCER, INFERTILITY, PARENTING TWINS, IMPROVING CHILDREN'S READING ABILITIES, HUNTINGTON'S DISEASE, PARKINSON'S DISEASE, MENTAL ILLNESS, OSTOMY, POSTPARTUM, GYNECOLOGICAL CANCER, AFRICAN AMERICAN BREAST CANCER, FRIEND TO FRIEND, CHRONIC PAIN, AND MULTIPLE SCLEROSIS. (SPONSORED BY SCRIPPS LA JOLLA COMMUNITY BENEFIT SERVICES) CARDIOVASCULAR DISEASE CORONARY HEART DISEASE AND STROKE ARE THE NUMBER ONE AND NUMBER THREE CAUSES OF DEATH IN THE NATION FOR BOTH MEN AND WOMEN. HEART DISEASE IS OUR NATION'S LEADING CAUSE OF DEATH, CLAIMING MORE THAN 950,000 AMERICAN LIVES EVERY YEAR. STROKE IS AMERICA'S THIRD KILLER AND IS A LEADING CAUSE OF SERIOUS, LONG-TERM DISABILITY. ACCORDING TO THE AMERICAN HEART ASSOCIATION, AN ESTIMATED 80,000,000 AMERICAN ADULTS HAVE ONE OR MORE TYPES OF CARDIOVASCULAR DISEASE (CVD). IT IS ESTIMATED THAT FEWER THAN HALF OF THESE, 38,100,000, ARE AGE 60 OR OLDER. HIGH BLOOD PRESSURE, CORONARY HEART DISEASE (CHD) AND STROKE ARE THE MOST COMMON FORMS OF CVD. CHD WAS THE LARGEST SINGLE KILLER OF AMERICANS IN 2006, RESULTING IN 445,687 DEATHS. THE PREVALENCE OF CHD AMONG U.S. ADULTS AGE 20 AND OLDER WAS 16,800,000 AND AN ESTIMATED 785,000 PERSONS IN THE U.S. HAD A NEW CORONARY ATTACK AND ANOTHER 470,000 HAD A RECURRENT ATTACK DURING 2006. AN ESTIMATED ADDITIONAL 195,000 PERSONS HAD A SILENT ATTACK DURING THIS SAME PERIOD. STROKE KILLED 137,119 PEOPLE IN 2006. IT'S THE THIRD LARGEST CAUSE OF DEATH, RANKING BEHIND "DISEASES OF THE HEART" AND ALL FORMS OF CANCER. STROKE IS A LEADING CAUSE OF SERIOUS, LONG-TERM DISABILITY IN THE UNITED STATES. THERE ARE NINE POTENTIALLY MODIFIABLE RISK FACTORS FOR CVD THAT HAVE BEEN IDENTIFIED AS CONSISTENT IN MEN AND WOMEN ACROSS ETHNIC GROUPS AND REGIONS. THEY INCLUDE CIGARETTE SMOKING, ABNORMAL BLOOD LIPID LEVELS, HYPERTENSION, DIABETES, ABDOMINAL OBESITY, A LACK OF PHYSICAL ACTIVITY, LOW DAILY FRUIT AND VEGETABLE CONSUMPTION, ALCOHOL OVERCONSUMPTION, AND PSYCHOSOCIAL INDEX. DURING 2007, DISEASES OF THE HEART WERE THE SECOND LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY, ACCOUNTING FOR 4,743 DEATHS DURING THIS PERIOD. BETWEEN 2003 AND 2007, THE NUMBER OF HEART DISEASE DEATHS DROPPED 12 PERCENT FROM 5,404 IN 2003. THE AGE-ADJUSTED RATE OF DEATH RELATED TO HEART DISEASE DURING 2007 WAS 151 PER 100,000 POPULATION. DURING 2007, THE SAN DIEGO COUNTY DEATH RATE PER 100,000 ATTRIBUTED TO CHD WAS 112.5. THOSE MOST IMPACTED WERE MALES 148.3, WHITES 118.8, AFRICAN AMERICANS 179.0 AND PERSONS AGES 65 AND OLDER, ACCOUNTING FOR 82% OF CHD DEATHS. THE SAN DIEGO DEATH RATE FOR STROKE WAS 36.1 PER 100,000 POPULATION. HISPANICS AND AFRICAN AMERICANS HAVE THE HIGHEST RATE OF STROKE, 43.1 AND 41.0, RESPECTIVELY. WOMEN, WITH A RATE OF 36.1 ACCOUNTED FOR 59.1% OF SAN DIEGO COUNTY STROKE DEATHS. DURING FY10, SCRIPPS ENGAGED IN THE FOLLOWING HEART HEALTH CARDIOVASCULAR DISEASE PREVENTION AND TREATMENT ACTIVITIES. AMERICAN HEART WALK SCRIPPS ALLOCATED $10,000 IN OPERATIONAL FUNDS AND $30,000 IN IN-KIND DONATIONS TO SUPPORT THE AMERICAN HEART ASSOCIATION'S EFFORTS TO FIGHT HEART DISEASE AND STROKE. IN ADDITION, THE SCRIPPSASSISTS EMPLOYEE VOLUNTEER PROGRAM COORDINATED WALKER PARTICIPATION AND FUND RAISING EFFORTS. THE SAN DIEGO HEART WALK EXCEEDED ITS GOAL BY RAISING MORE THAN $1 MILLION. IN 2010, MORE THAN 2,400 SCRIPPS HEART WALK PARTICIPANTS - EMPLOYEES, FAMILIES AND FRIENDS - WALKED TO HELP RAISE MORE THAN $149,000 ADDITIONALLY, SCRIPPS REACHED OUT TO THE COMMUNITY AT THE EVENT BY PROVIDING BLOOD PRESSURE SCREENINGS, HEALTH EDUCATION MATERIALS AND MORE. (SPONSORED BY SCRIPPS COMMUNITY BENEFIT SERVICES) COMMUNITY HEALTH EDUCATION PROGRAMS THE COMMUNITY HEALTH EDUCATION PROGRAMS COVER A WIDE VARIETY OF HEALTH RELATED TOPICS ON DISEASE MANAGEMENT, HEALTH CARE UPDATES, AND PREVENTION. THE TOPICS INCLUDE: ALTERNATIVES TO HYSTERECTOMY, STROKE, STRESS, VARICOSE VEINS, INFERTILITY, CARDIAC, DEPRESSION, MACULAR DEGENERATION, MEMORY, BRAIN, ORTHOPEDIC CARE, ROBOTIC SURGERY, SKIN CARE, BACK CARE, MIGRAINES, KNEE PAIN, PELVIC FLOOR INCONTINENCE, SAFETY AND FALL PREVENTION, BLADDER HEALTH, HEALTHY DINING, EXERCISE, VOICE, FLU PREVENTION, SLEEP DISORDERS, NUTRITION, HYPERTENSION, FOOT CARE, SPINE SURGERY, JOINT REPLACEMENT, BREATHING, PAIN MANAGEMENT, AND MEDICATION MATTERS. (SPONSORED BY SCRIPPS LA JOLLA COMMUNITY BENEFIT SERVICES) CPR CLASSES FOR PATIENTS AND FAMILIES OF THE CARDIAC TREATMENT CENTER CPR CLASSES ARE OFFERED TO CARDIAC TREATMENT CENTER PATIENTS AND THEIR FAMILIES. CPR CERTIFICATION CLASSES (FRIENDS AND FAMILIES) ARE OFFERED 4 TIMES A YEAR TO PATIENTS AND FAMILY MEMBERS. THE CLASSES ARE DESIGNED TO IMPROVE COMMUNITY HEALTH THROUGH INCREASED KNOWLEDGE OF CARDIOPULMONARY RESUSCITATION PRACTICES. (SPONSORED BY CARDIAC TREATMENT CENTER AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA) CARDIAC TREATMENT CENTER GROUP EXERCISE PROGRAMS CARDIAC TREATMENT CENTER GROUP EXERCISE PROGRAMS INCLUDE: TAI CHI- TWICE WEEKLY- DESIGNED TO DECREASE STRESS & IMPROVE BALANCE; RESTORATIVE YOGA- THREE TIMES A WEEK- DESIGNED TO DECREASE STRESS, IMPROVE STRENGTH & FLEXIBILITY; FITBALL- TWICE WEEKLY- DESIGNED TO IMPROVE STRENGTH, POSTURE, CORE STABILITY & BALANCE; YOGA FOR CANCER RECOVERY- WEEKLY- DESIGNED TO DECREASE STRESS, IMPROVE CIRCULATORY FLOW, EASE TENSION DURING HEALING; BALANCE- WEEKLY- DESIGNED TO BUILD BALANCE, POSTURE & COORDINATION; POWER YOGA- TWICE WEEKLY- DESIGNED TO IMPROVE STRENGTH & FLEXIBILITY; PILATES-WEEKLY- DESIGNED TO IMPROVE STRENGTH, BALANCE & FLEXIBILITY; YOGA FOR MS-WEEKLY- DESIGNED TO PROMOTE HEALING & IMPROVE STRENGTH & FLEXIBILITY; AND MEDITATION-WEEKLY. (SPONSORED BY THE CARDIAC TREATMENT CENTER, SCRIPPS MEMORIAL HOSPITAL LA JOLLA) STROKE CARE PROGRAMS A WIDE VARIETY OF COMMUNITY EDUCATION AND AWARENESS WAS PROVIDED ON STROKE RELATED ISSUES. (SPONSORED BY SCRIPPS MERCY SAN DIEGO AND CHULA VISTA STROKE PROGRAM) HEART HEALTH - SCRIPPS HOME HEALTH SERVICES SCRIPPS HOME HEALTH PROVIDED COMMUNITY EDUCATION TO PROMOTE INDEPENDENT MANAGEMENT OF CONGESTIVE HEART FAILURE (CHF) IN ORDER TO PREVENT EXACERBATIONS AND HOSPITALIZATIONS. EDUCATION INCLUDES WHAT IS CHF, MEDICATIONS, DIET, WEIGHT AND EXERCISE. IN FY10, 116 SAN DIEGO COUNTY RESIDENTS WERE SERVED. (SPONSORED BY SCRIPPS HOME HEALTH SERVICES) PREVENTION OF CARDIOVASCULAR DISEASE - SCRIPPS HOME HEALTH SERVICES SCRIPPS HOME HEALTH PROVIDED COMMUNITY EDUCATION TO PROMOTE INDEPENDENT MANAGEMENT OF CONGESTIVE HEART FAILURE (CHF) IN ORDER TO PREVENT EXACERBATIONS AND HOSPITALIZATIONS. EDUCATION INCLUDES WHAT IS CHF, MEDICATIONS, DIET, WEIGHT AND EXERCISE. IN FY10, 100 SAN DIEGO COUNTY RESIDENTS WERE SERVED. (SPONSORED BY SCRIPPS HOME HEALTH SERVICES) DIABETES DATA FROM THE 2007 NATIONAL DIABETES FACT SHEET (THE MOST RECENT YEAR FOR WHICH DATA IS AVAILABLE) ESTIMATED A TOTAL OF 23.6 MILLION CHILDREN AND ADULTS IN THE US, 7.8% OF THE POPULATION, HAVE DIABETES. THESE INCLUDED 17.9 MILLION PEOPLE WHO HAVE BEEN DIAGNOSED WITH DIABETES AND ANOTHER 5.7 MILLION PEOPLE WITH UNDIAGNOSED DIABETES. ADDITIONALLY, THERE WERE 57 MILLION PEOPLE WITH PRE-DIABETES. EACH YEAR 1.6 MILLION NEW CASES OF DIABETES ARE DIAGNOSED IN PEOPLE AGED 20 YEARS AND OLDER. THERE ARE THREE MAJOR TYPES OF DIABETES: TYPE 1 DIABETES, TYPE 2 DIABETES, AND GESTATIONAL DIABETES. ALL THREE TYPES OF DIABETES SHARE THE SAME BASIC CHARACTERISTIC -- THE BODY'S INABILITY EITHER TO MAKE OR TO USE INSULIN. WITHOUT ENOUGH INSULIN, GLUCOSE STAYS IN THE BLOOD, CREATING HIGH LEVELS OF BLOOD SUGAR. OVER TIME, THIS BUILDUP CAUSES DAMAGE TO KIDNEYS, HEART, NERVES, EYES, AND OTHER ORGANS. TYPE 1 DIABETES MOST OFTEN OCCURS DURING CHILDHOOD OR ADOLESCENCE, ACCOUNTING FOR 5% TO 10% OF ALL DIAGNOSED CASES OF DIABETES. TYPE 2 DIABETES TYPICALLY OCCURS LATER IN LIFE, FREQUENTLY AS THE RESULT OF OBESITY, PHYSICAL INACTIVITY AND OTHER RISK FACTORS. TYPE 2 DIABETES ACCOUNTS FOR 90% TO 95% OF DIABETES CASES. HOWEVER, DUE TO THE CURRENT OBESITY EPIDEMIC, IT IS ESTIMATED THAT 39% OF THE GIRLS AND 33% OF THE BOYS WHO ARE NOW HEALTHY 2 TO 3 YEAR OLDS ARE LIKELY TO DEVELOP DIABETES. MORE THAN 90 MILLION AMERICANS (33 PERCENT) LIVE WITH A CHRONIC DISEASE. WHILE THERE ARE MANY DISABLING CHRONIC DISEASES, DIABETES HAS BEEN IDENTIFIED AS ONE OF THE PRIMARY CHRONIC CONDITIONS IN SAN DIEGO COUNTY. AS THE SEVENTH LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY DURING 2007, DIABETES WAS RESPONSIBLE FOR 2.7% (520) OF DEATHS DURING THIS PERIOD. IN SAN DIEGO COUNTY, THE AGE-ADJUSTED ESTIMATE OF ADULTS DIAGNOSED WITH DIABETES IN 2007 WAS 6.7%. NATIONALLY, DIABETES WAS THE SIXTH LEADING CAUSE OF DEATH DURING 2006, ACCOUNTING FOR 72,449 DEATHS DURING THIS PERIOD. HEALTH CONSEQUENCES THE COMPLICATIONS ASSOCIATED WITH DIABETES ARE SIGNIFICANT AND WELL ESTABLISHED. THE CDC REPORTS COMPLICATIONS INCLUDING HEART DISEASE, STROKE, HYPERTENSION, BLINDNESS, KIDNEY DISEASE, PREGNANCY COMPLICATIONS, LOWER-LIMB AMPUTATIONS, PERIODONTAL DISEASE AND NERVOUS SYSTEM DISEASE. - THE AGE-ADJUSTED RATE OF HOSPITALIZATION FOR PERSONS WITH DIABETES AMONG SAN DIEGO COUNTY RESIDENTS IN 2008 WAS 128.5 PER 100,000 POPULATION, AN 18.9% INCREASE SINCE 2001. - IN 2008, HISPANICS AND AFRICAN AMERICANS LIVING IN SAN DIEGO COUNTY HAD DIABETES-RELATED HOSPITALIZATION RATES 1.8 AND 2.6 TIMES HIGHER THAN THAT OF THE OVERALL POPULATION. - IN SAN DIEGO COUNTY, THE AGE-ADJUSTED DIABETES-RELATED MORTALITY RATES DECREASED FROM 21.4 PER 100,000 POPULATION IN 2005 TO 17.5 IN 2007, AN 18.2% DECREASE. - IN 2007, DIABETES WAS THE SEVENTH LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY, ACCOUNTING FOR 520 DEATHS. - IN 2007, DIABETES WAS THE SEVENTH LEADING CAUSE OF DEATH IN THE U.S. WITH AN AGE-ADJUSTED DEATH RATE FOR DIABETES AT 23.5 PER 100,000 POPULATION. AMONG THOSE 65 AND OVER, DIABETES WAS THE SIXTH LEADING CAUSE OF DEATH WITH A DEATH RATE OF 135.6 PER 100,000 POPULATION. OVER SIX MILLION AMERICANS ARE UNAWARE THEY HAVE DIABETES. THE COMPLICATIONS RELATED TO DIABETES ARE SERIOUS AND CAN BE REDUCED WITH PREVENTIVE PRACTICES. LEADING TO SCHOOL AND WORK ABSENTEEISM, AN ELEVATED RATE OF HOSPITALIZATION, FREQUENT EMERGENCY ROOM VISITS, PERMANENT PHYSICAL DISABILITIES AND SOMETIMES DEATH, DIABETES IS A SERIOUS COMMUNITY HEALTH PROBLEM. DURING FY10, SCRIPPS ENGAGED IN THE FOLLOWING DIABETES MANAGEMENT INITIATIVES. PROJECT DULCE - FORMED THROUGH COLLABORATION BETWEEN THE SCRIPPS WHITTIER DIABETES INSTITUTE, THE COUNCIL OF COMMUNITY CLINICS, AND COMMUNITY HEALTH IMPROVEMENT PARTNERS (CHIP). PROJECT DULCE IS A COMPREHENSIVE, CULTURALLY COMPETENT DIABETES MANAGEMENT PROGRAM FOR UNDERSERVED AND UNINSURED POPULATIONS IN SAN DIEGO COUNTY. PROJECT DULCE INCORPORATES THE CHRONIC CARE MODEL IN ITS TEAM-BASED APPROACH TO CARE. PROJECT DULCE HAS BEEN WORKING IN COMMUNITIES ACROSS SAN DIEGO FOR THE PAST 10 YEARS BY PROVIDING DIABETES CARE AND SELF MANAGEMENT EDUCATION. NURSE-LED TEAMS FOCUS ON ACHIEVING MEASURABLE IMPROVEMENTS IN THE HEALTH OF THEIR PATIENTS; NURSE EDUCATORS LEAD MULTIDISCIPLINARY TEAMS THAT PROVIDE CLINICAL MANAGEMENT; AND PEER EDUCATORS FROM EACH CULTURAL GROUP, KNOWN AS PROMOTORAS, PROVIDE PUBLIC AND PATIENT EDUCATION TO THEIR PERSPECTIVE COMMUNITIES. THIS INNOVATIVE PROGRAM COMBINES THE STATE-OF-THE-ART IN CLINICAL DIABETES MANAGEMENT WITH PROVEN EDUCATIONAL AND BEHAVIORAL INTERVENTIONS. PROJECT DULCE PROVIDED 8,120 DIABETES CARE AND EDUCATION VISITS FOR LOW-INCOME AND UNDERSERVED INDIVIDUALS THROUGHOUT SAN DIEGO IN FY10 AND ENROLLED MORE THAN 1,148 NEW PATIENTS IN PROJECT DULCE. THE PROGRAM ALSO INITIATED FOUR NEW PROGRAMS: 1) DIABETES PREVENTION FOR WOMEN WITH A HISTORY OF GESTATIONAL DIABETES; 2) REPLICATING PROJECT DULCE IN TIJUANA; 3) DIABETES PEER CARE COORDINATION PROJECT AT SCRIPPS MERCY CHULA VISTA HOSPITAL AND 4) DIABETES GENEBANK PROGRAM. SCRIPPS WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION AND TRAINING THE SCRIPPS WHITTIER DIABETES INSTITUTE PROFESSIONAL EDUCATION TEAMS PROVIDE STATE-OF-THE-ART EDUCATION AND TRAINING FOR PEOPLE WHO WISH TO INCREASE THEIR DIABETES MANAGEMENT KNOWLEDGE AND SKILLS. WITH THE RISE IN THE NUMBER OF PEOPLE WITH DIABETES, MEDICATION UPGRADES, NUTRITION CHANGES AND CHANGES IN DIABETES RELATED DEVICES, THERE IS A GREAT NEED TO EQUIP HEALTH CARE PROFESSIONALS WITH THE LATEST INFORMATION AND CLINICAL PRACTICE SKILLS. THE WHITTIER'S PROFESSIONAL EDUCATION PROGRAM IS LED BY A TEAM OF EXPERTS THAT INCLUDE ENDOCRINOLOGISTS, NURSES, DIETICIANS, PSYCHOLOGISTS, AND OTHER DIABETES SPECIALISTS, THESE INDIVIDUALS TRAIN PRACTICING PROFESSIONALS TO DELIVER THE BEST CARE POSSIBLE FOR THEIR PATIENTS WITH DIABETES. COURSES ARE DESIGNED TO RESPOND TO THE NEEDS OF ALLIED HEALTH PROFESSIONALS SEEKING AN UNDERSTANDING OF THE NEW AND COMPLEX CLINICAL TREATMENT OPTIONS FOR TYPE 1, TYPE 2 AND GESTATIONAL DIABETES. PROVIDED PROFESSIONAL EDUCATION TO 1,346 INDIVIDUALS ON DIABETES TOPICS, INCLUDING INSULIN MANAGEMENT, INCRETIN THERAPY, THE DIABETES DIET, THE BASICS OF DIABETES, HOME HEALTH EDUCATION AND 5-DAY COMPREHENSIVE TRAINING FOR DIABETES CARE PROFESSIONALS. INDIVIDUALS CAME FROM THROUGHOUT THE UNITED STATES, AS WELL AS FROM LOCAL HEALTH INSTITUTIONS, TO LEARN FROM THE WHITTIER INSTITUTE'S MOST EXPERIENCED DIABETES EXPERTS, INCLUDING ENDOCRINOLOGISTS, NURSES, DIETICIANS, PSYCHOLOGISTS AND COMMUNITY EDUCATORS. OVER THE LAST YEAR, THE WHITTIER INSTITUTE'S PROFESSIONAL EDUCATION DEPARTMENT PROVIDED 53 SEPARATE PROGRAMS TO PHYSICIANS, NURSES, PHARMACISTS, SOCIAL WORKERS, DIETITIANS, MID-LEVEL PROVIDERS AND SOCIAL WORKERS. HEALTH RELATED BEHAVIORS HEALTH-RELATED BEHAVIOR IS ONE OF THE MOST IMPORTANT ELEMENTS IN PEOPLE'S HEALTH AND WELL-BEING. ITS IMPORTANCE HAS GROWN AS SANITATION HAS IMPROVED AND MEDICINE HAS ADVANCED. DISEASES THAT WERE ONCE INCURABLE OR FATAL CAN NOW BE PREVENTED OR SUCCESSFULLY TREATED. HEALTH-RELATED BEHAVIORS SUCH AS IMMUNIZATION, SMOKING CESSATION, IMPROVED NUTRITION, INCREASED PHYSICAL ACTIVITY, ORAL HEALTH, AND INJURY PREVENTION HAVE BECOME IMPORTANT COMPONENTS OF LONG-TERM HEALTH. UNDERSTANDING THAT PERSONAL BEHAVIORS PLAY A SIGNIFICANT ROLE IN AN INDIVIDUAL'S OVERALL HEALTH STATUS, SCRIPPS HAS DEVELOPED A SERIES OF PREVENTION AND WELLNESS PROGRAMS THAT HELP PEOPLE TAKE CHARGE OF THEIR OWN HEALTH AND THAT OF THEIR FAMILIES. DURING FY10, SCRIPPS PARTICIPATED IN A NUMBER OF HEALTH BEHAVIOR MODIFICATION EFFORTS. FLU VACCINATION CAMPAIGN ACCORDING TO THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), AN AVERAGE OF 50,000 ADULTS DIE ANNUALLY IN THE UNITED STATES FROM DISEASES THAT ARE PREVENTABLE THROUGH VACCINATION. APPROXIMATELY 36,000 ADULTS DIE FROM INFLUENZA, OVER 6,000 FROM INVASIVE PNEUMOCOCCAL DISEASE, AND 5,000 FROM HEPATITIS B. IN SAN DIEGO COUNTY, INFLUENZA AND PNEUMONIA WERE THE TENTH LEADING CAUSE OF DEATH IN 2007, WITH 1,111 DEATHS RECORDED BETWEEN 2005 AND 2007. BASED ON 2007 CHIS DATA, ONLY 34.6% OF SAN DIEGO COUNTY RESIDENTS REPORTED RECEIVING AN INFLUENZA VACCINATION DURING THE PAST 12 MONTHS. BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) DATA FOR 2008 REPORTED ONLY 26.5% OF ADULTS AGED 65 AND OVER HAD BEEN VACCINATED FOR INFLUENZA DURING THE PAST 12 MONTHS. VACCINATIONS MAY NOT BE RECEIVED DUE TO COST AND LOCAL AVAILABILITY ISSUES OR A LACK OF EDUCATION ABOUT TIMING AND EFFECTIVENESS. MISUNDERSTANDING, MISINFORMATION, OR SKEPTICISM RELATED TO THE BENEFITS AND POSSIBLE DISKS ASSOCIATED WITH VACCINES MAY ALSO REDUCE VACCINATION RATES. IN AN EFFORT TO MINIMIZE THE NUMBER OF PERSONS THAT CONTRACT PNEUMONIA AND INFLUENZA, SCRIPPS IS COMMITTED TO ENSURING HIGH-RISK POPULATIONS HAVE ACCESS TO FLU VACCINATIONS REGARDLESS OF THEIR ABILITY TO PAY. IN PARTNERSHIP WITH THE COUNTY OF SAN DIEGO, SCRIPPS ADMINISTERED MORE THAN 300 DOSES* OF THE FLU VACCINATION TO HIGH-RISK POPULATIONS THROUGHOUT SAN DIEGO COUNTY IN FY10. *NOTE: REPRESENTS VACCINATIONS PROVIDED THROUGH COMMUNITY OUTREACH EFFORTS AND DOES NOT INCLUDE VACCINE PROVIDED TO PATIENTS BEING TREATED WITHIN SCRIPPS HOSPITALS OR RECEIVING CARE FROM A SCRIPPS AFFILIATED PHYSICIAN. (VACCINE PROVIDED BY THE SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY). SCRIPPS' PARTICIPATION LED BY SCRIPPS MEMORIAL HOSPITAL ENCINITAS, COMMUNITY BENEFIT SERVICES. MATERNAL CHILD HEALTH THE HEALTH OF MOTHERS, INFANTS, AND CHILDREN IS A REFLECTION OF THE CURRENT HEALTH STATUS OF A LARGE SEGMENT OF THE US POPULATION AND A HEALTH PREDICTOR FOR THE NEXT GENERATION. THE FOCUS OF THE INFORMATION IN THIS TOPIC INCLUDES INDICATORS OF MATERNAL ILLNESS AND DEATH AND THOSE THAT AFFECT INFANT HEALTH AND SURVIVAL. AMONG THESE ARE INFORMATION RELATED TO INFANT MORTALITY RATES, ACCESS TO PREVENTIVE CARE, AND FETAL, PERINATAL, AND OTHER INFANT DEATHS. THERE ARE NUMEROUS RISK FACTORS ASSOCIATED WITH MATERNAL AND INFANT HEALTH INCLUDING: - ALCOHOL, TOBACCO, AND ILLEGAL SUBSTANCES DURING PREGNANCY - A MAJOR RISK FACTOR FOR LOW BIRTH WEIGHT AND OTHER POOR INFANT OUTCOMES - VERY LOW BIRTH WEIGHT - ASSOCIATED WITH PRETERM BIRTH, SPONTANEOUS ABORTION, LOW PRE-PREGNANCY WEIGHT, AND CIGARETTE SMOKING - INFANT DEATH - RATES ARE HIGHEST AMONG INFANTS BORN TO YOUNG TEENAGERS AND MOTHERS AGED 44 YEARS AND OLDER BEING PREGNANT OR TRYING TO BECOME PREGNANT ACCOUNTS FOR A SMALL PORTION OF A WOMAN'S LIFE. AN UNINTENDED PREGNANCY IS A PREGNANCY THAT IS EITHER MISTIMED OR UNWANTED AT THE TIME OF CONCEPTION. UNINTENDED PREGNANCY ACCOUNTS FOR AN ESTIMATED 49% OF ALL PREGNANCIES IN THE U.S. AND IS ASSOCIATED WITH INCREASED MORBIDITY AND WITH BEHAVIORS DURING PREGNANCY THAT ARE LINKED WITH ADVERSE HEALTH EFFECTS. WOMEN WHO CAN PLAN THE NUMBER AND TIMING OF THE BIRTHS OF THEIR CHILDREN ENJOY IMPROVED HEALTH, EXPERIENCE FEWER UNPLANNED PREGNANCIES AND BIRTHS, AND HAVE LOWER RATES OF ABORTION. WHO IS MOST IMPACTED DURING 2008, SAN DIEGO COUNTY'S CRUDE BIRTH RATE PER 1,000 POPULATION WAS 14.9, ACCOUNTING FOR 46,742 LIVE BIRTHS. CRUDE BIRTH RATES RANGED FROM 9.2 AMONG WHITE WOMEN TO 22.3 AMONG HISPANIC WOMEN. DURING 2008, HISPANICS ACCOUNTED FOR 44.7% OF ALL LIVE BIRTHS FOLLOWED BY 30.9% FOR WHITES. WOMEN BETWEEN THE AGES OF 20 AND 34 ACCOUNTED FOR 74.2% OF BIRTHS. SCRIPPS HEALTH CONTINUED TO ENHANCE PRENATAL EDUCATION OFFERINGS FOR LOW-INCOME WOMEN IN SAN DIEGO COUNTY IN FY10. THE FOLLOWING ARE EXAMPLES OF PROGRAMS: SCRIPPS MEMORIAL HOSPITAL LA JOLLA, COMMUNITY BENEFIT SERVICES * OFFERED A TOTAL OF OVER 575 MATERNAL CHILD HEALTH CLASSES THROUGHOUT SAN DIEGO COUNTY DESIGNED TO ENHANCE THE PARENTING SKILLS. LOW-INCOME WOMEN IN THE COUNTY OF SAN DIEGO WERE ELIGIBLE TO ALL ATTEND CLASSES AT NO CHARGE OR ON A SLIDING FEE SCHEDULE. * MAINTAINED THE EXISTING PRENATAL EDUCATION SERVICES IN THE ALL REGIONS OF THE COUNTY ENSURING THAT PROGRAMS CONTINUED TO DEMONSTRATE A MORE THAN 90 PERCENT SATISFACTION RATING. * PROVIDED AND SUPPORTED FIVE WEEKLY BREASTFEEDING SUPPORT GROUPS THROUGHOUT SAN DIEGO COUNTY. THIS INCLUDES TWO WITH BILINGUAL SERVICES. * OFFERED A MATERNAL CHILD HEALTH EDUCATION SERIES COVERING ISSUES SUCH AS DOGS AND BABIES: SAFETY, GRANDPARENTING AND BABY SITTER SAFETY IN NORTH COUNTY. * OFFERED THE FOLLOWING MATERNAL CHILD HEALTH CLASSES AT THE MENDE WELL BEING CENTER: BASIC TRAINING FOR DADS, BREASTFEEDING CLASSES, CHILD BIRTH PREPARATION CLASSES, GETTING READY FOR THE BABY, THE INFANT CPR AND SAFETY PROGRAM, PARENT CONNECTION PROGRAMS, REDIRECTING CHILDREN'S BEHAVIOR AND SIBLING CLASSES. * OFFERED DOGS & BABIES PROGRAM QUARTERLY WITH MORE THAN 50 ATTENDEES. * OFFERED BI-WEEKLY MOMMY & ME YOGA & INFANT MASSAGE PROGRAMS TO NEW PARENTS. * OFFERED A PRENATAL YOGA PROGRAM FOR EXPECTANT WOMEN IN SAN DIEGO COUNTY. * OFFERED A PREGNANCY NUTRITION PROGRAM QUARTERLY AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA. * DEVELOPED AND OFFERED "PELVIC FLOOR AND PREGNANCY CHANGES" FOR EXPECTANT FAMILIES AT SCRIPPS MEMORIAL HOSPITAL LA JOLLA. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL LA JOLLA, COMMUNITY BENEFIT SERVICES) HEALTHY START CASE MANAGEMENT SERVICES A TOTAL OF 300 OR HIGHER RISK PREGNANT WOMEN WERE CASE MANAGED THROUGHOUT THE YEAR. A TOTAL OF 6,261 SERVICES WERE PROVIDED INCLUDING HOME VISITS, PHONE CALLS, BUS TOKENS AND EDUCATIONAL MATERIALS DISTRIBUTED. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) FIRST 5 MORE THAN 398 SERVICES WERE RECEIVED FOR FIRST TIME MOTHERS INCLUDING: HOME VISITS, REFERRALS RECEIVED, DATA ENTRY, FOLLOW UP PHONE CALLS, PARENTING CLASSES AND OTHER SUPPORT SERVICES. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA, COMMUNITY BENEFITS) SUBSTANCE ABUSE AND TOBACCO USE SUBSTANCE ABUSE HAS A MAJOR IMPACT ON INDIVIDUALS, THEIR FAMILIES, AND THEIR COMMUNITIES. THE EFFECTS OF SUBSTANCE ABUSE ARE CUMULATIVE, CONTRIBUTING TO COSTLY SOCIAL, PHYSICAL, MENTAL AND PUBLIC HEALTH PROBLEMS. THESE PROBLEMS INCLUDE TEENAGE PREGNANCY, HIV/AIDS, OTHER SEXUALLY TRANSMITTED DISEASES (STDS), DOMESTIC VIOLENCE, CHILD ABUSE, MOTOR VEHICLE CRASHES, PHYSICAL FIGHTS, CRIME, HOMICIDE AND SUICIDE. ACCORDING TO THE NATIONAL INSTITUTE ON DRUG ABUSE, THE TOTAL ESTIMATED ANNUAL COSTS ASSOCIATED WITH SUBSTANCE ABUSE EXCEED HALF A TRILLION DOLLARS. THIS INCLUDES APPROXIMATELY $181 BILLION FOR ILLICIT DRUGS, $168 BILLION FOR TOBACCO AND $185 BILLION FOR ALCOHOL. DURING 2009, CALIFORNIA'S ESTIMATED HEALTHCARE COSTS DIRECTLY CAUSED BY SMOKING WERE $9.14 BILLION TOBACCO USE - DURING 2007, BASED ON THE YOUTH RISK BEHAVIOR SURVEILLANCE SURVEY (YRBSS), 43.6% OF STUDENTS IN GRADES 9-12 WITHIN THE SAN DIEGO UNIFIED SCHOOL DISTRICT REPORTED THEY HAD EVER TRIED CIGARETTE SMOKING. - DURING THIS SAME TIME PERIOD, 11.0% OF STUDENTS IN GRADES 9-12 REPORTED CURRENT CIGARETTE USE AND 7.0% REPORTED THEY SMOKED MORE THAN 10 CIGARETTES PER DAY. - OF THOSE STUDENTS WHO REPORTED THEY CURRENTLY SMOKE, 41.4% REPORTED THEY HAVE TRIED TO QUIT SMOKING AT LEAST ONCE DURING THE PAST 12 MONTHS. - DURING 2008, BASED ON BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM DATA FOR SAN DIEGO COUNTY, 14.5% OF ADULTS, AGED 18 OR OLDER, CURRENTLY SMOKE. MOREOVER, 23% ARE FORMER SMOKERS AND 62.5 HAVE NEVER SMOKED. ALCOHOL USE - DURING 2007, BASED ON THE YRBSS, 72.0% OF STUDENTS IN GRADES 9-12 WITHIN THE SAN DIEGO UNIFIED SCHOOL DISTRICT REPORTED THEY HAD AT LEAST ONE DRINK OF ALCOHOL ON AT LEAST 1 DAY DURING THEIR LIFE. - DURING THIS SAME TIME PERIOD, 36.7% OF STUDENTS IN GRADES 9-12 REPORTED THEY HAD AT LEAST ONE DRINK OF ALCOHOL ON AT LEAST 1 DAY DURING THE 30 DAYS PRIOR TO THE SURVEY. - EPISODIC HEAVY DRINKING, HAVING FIVE OR MORE DRINKS OF ALCOHOLIC IN A ROW WITHIN A COUPLE OF HOURS ON AT LEAST ONE DAY DURING THE 30 DAYS PRIOR TO THE SURVEY, WAS REPORTED BY 21.8% OF STUDENTS. - DURING 2008, BASED ON BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM DATA FOR SAN DIEGO COUNTY, 55.1% OF ADULTS, AGED 18 OR OLDER, HAVE HAD AT LEAST ONE DRINK DURING THE PAST 30 DAYS. IN AN EFFORT TO ENCOURAGE MORE PEOPLE TO TAKE STEPS TO PREVENT SUBSTANCE ABUSE, SCRIPPS ENGAGED IN THE FOLLOWING ACTIVITIES: INTERVENTION WORKSHOPS AIM TO IMPROVE COMMUNITY HEALTH THE INTERVENTION PROGRAM AT SCRIPPS MCDONALD CENTER OFFERS FREE WORKSHOPS FOR PARENTS TO HELP THEM BETTER UNDERSTAND ADOLESCENT ALCOHOL AND SUBSTANCE ABUSE AND THE WIDESPREAD PROBLEM OF TEEN ADDICTION. OTHER INTERVENTION WORKSHOPS ADDRESS THE WARNING SIGNS OF ADULT ADDICTION FOR FAMILIES AND EMPLOYERS, PROVIDING AGE-SPECIFIC INFORMATION ON HOW TO HELP LOVED-ONES RECOGNIZE THE SIGNS OF ADDICTION AND HOW TO GET AN ADDICTED INDIVIDUAL TO SEEK TREATMENT. MORE THAN 11,000 PEOPLE ATTENDED THE WORKSHOPS ON THE SCRIPPS MEMORIAL HOSPITAL LA JOLLA CAMPUS IN 2010. EVERY 15 MINUTES THE EVERY 15 MINUTES PROGRAM IS A TWO-DAY EVENT THAT EXPOSES HIGH SCHOOL STUDENTS TO THE CONSEQUENCES OF DRINKING AND DRIVING THROUGH A DRAMATIC REENACTMENT OF AN ALCOHOL-RELATED TRAFFIC ACCIDENT. THE "INJURED" STUDENTS ARE TAKEN TO SCRIPPS MERCY TRAUMA CENTER. THIS PROGRAM IS SPONSORED JOINTLY BY LOCAL HIGH SCHOOLS, COUNTY POLICE, SHERIFFS, CHP, EMERGENCY DEPARTMENTS AND AMBULANCE SERVICES. DURING FY10, SCRIPPS MERCY HOSPITAL PARTICIPATED IN THREE EVERY 15 MINUTES PROGRAMS, REACHING MORE THAN 3,000 HIGH SCHOOL STUDENTS IN SAN DIEGO COUNTY'S EAST AND CENTRAL REGIONS. (SPONSORED BY SCRIPPS MERCY HOSPITAL SAN DIEGO TRAUMA CENTERS) PARTNERSHIP FOR SMOKE-FREE FAMILIES PROGRAM CIGARETTE SMOKING HAS BEEN IDENTIFIED AS THE MOST IMPORTANT SOURCE OF PREVENTABLE MORBIDITY AND PREMATURE MORTALITY WORLDWIDE. CIGARETTE SMOKING CAUSES HEART DISEASE, SEVERAL KINDS OF CANCER (LUNG, LARYNX, ESOPHAGUS, PHARYNX, MOUTH AND BLADDER) AND CHRONIC LUNG DISEASE. APPROXIMATELY 11% OF PREGNANT WOMEN SMOKE. AN ESTIMATED 25-60% OF ALL FEMALE SMOKERS QUIT SHORTLY AFTER LEARNING THEY ARE PREGNANT (RECENT QUITTERS). AMONG THOSE WHO QUIT ON THEIR OWN, 20% TO 40% WILL GO BACK TO SMOKING DURING PREGNANCY. IN THE US, 25% OF CHILDREN UNDER THE AGE OF SIX YEARS LIVE IN A HOUSE WHERE SOMEONE SMOKES INSIDE AT LEAST FOUR DAYS PER WEEK. PRENATAL RISKS SMOKING DURING PREGNANCY HAS BEEN SHOWN TO CAUSE ADVERSE OUTCOMES INCLUDING MISCARRIAGE, PLACENTAL ABRUPTION AND SEPARATION AND INCREASED PERINATAL MORTALITY. IT ACCOUNTS FOR 20% OF LOW BIRTH WEIGHT DELIVERIES, EIGHT PERCENT OF PRETERM BIRTHS, AND 5 PERCENT OF ALL PRENATAL DEATHS. INFANT/CHILD RISKS THE EFFECTS OF MATERNAL SMOKING ARE NOT LIMITED TO THE PRENATAL PERIOD. MORE INFANTS DIE OF SUDDEN INFANT DEATH SYNDROME WHETHER THE MOTHER SMOKED DURING PREGNANCY OR AFTER THE BIRTH. CHILDREN OF SMOKERS HAVE MORE RESPIRATORY PROBLEMS, EAR INFECTIONS, ASTHMA, AND DOCTOR VISITS. CHILDREN WHOSE PARENTS SMOKE ARE MORE LIKELY TO HAVE BEHAVIOR PROBLEMS AND TROUBLE WITH SCHOOLWORK. LAUNCHED IN 1998 BY THE CEOS OF RADY CHILDREN'S HOSPITAL, SCRIPPS AND SHARP HEALTHCARE, PSF HAS THE GOAL OF REDUCING TOBACCO SMOKE EXPOSURE AMONG PREGNANT WOMEN AND YOUNG CHILDREN. THE PROGRAM WORKS DIRECTLY WITH OBSTETRICIANS AND PEDIATRICIANS ACROSS SAN DIEGO COUNTY TO IMPLEMENT "BEST PRACTICES" AS OUTLINED IN THE USDHHS TREATING TOBACCO USE AND DEPENDENCE CLINICAL PRACTICE GUIDELINE. PSF HAS BECOME A STANDARD OF CARE IN SAN DIEGO COUNTY, AND IS RECOGNIZED NATIONALLY. AS OF NOVEMBER 30, 2010 NEARLY 300,000 PREGNANT WOMEN AND PARENTS OF SMALL CHILDREN HAVE BEEN SCREENED FOR TOBACCO USE/EXPOSURE AND MORE THAN 55,000 PROACTIVELY LINKED WITH TARGETED INTERVENTIONS. (SPONSORED BY SCRIPPS HEALTH SYSTEM, COMMUNITY BENEFIT SERVICES) HOSPITALIZED PATIENTS SMOKING CESSATION STUDY A TOTAL OF 126 PARTICIPANTS WERE INCLUDED IN THE PILOT RANDOMIZED CONTROL TRIAL TO ASSESS HOW BEST TO ASSIST HOSPITALIZED SMOKERS QUIT SMOKING. THIS STUDY IS A PARTNERSHIP WITH THE CALIFORNIA SMOKERS HELPLINE. A LARGER STUDY WILL BE IMPLEMENTED IN 2011. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA) YOUTHFUL DRINKING AND DRIVING PROGRAM CONSIDERING THAT AT LEAST 74.3 PERCENT OF HIGH SCHOOL STUDENTS IN THE U.S. REPORT DRINKING ALCOHOL, IT IS IMPERATIVE THAT STUDENTS UNDERSTAND THE RISKS ASSOCIATED WITH ALCOHOL ABUSE. IN AN EFFORT TO EDUCATE AT-RISK STUDENTS ABOUT THE DANGERS ASSOCIATED WITH DRINKING AND DRIVING, SCRIPPS MERCY HOSPITAL'S EMERGENCY DEPARTMENT AND TRAUMA CENTER PARTICIPATED IN THE CORRECTIVE BEHAVIOR INSTITUTE'S YOUTHFUL DRINKING AND DRIVING PROGRAM, PROVIDING 48 TEENS WITH A TRAUMA CENTER VISITATION EXPERIENCE. THIS FOUR-HOUR SUPERVISED TRAUMA VISITATION PROGRAM FOR YOUNG DRIVERS AGES 14 AND OVER SHOWED THEM THE REALISTIC CONSEQUENCES OF DRIVING UNDER THE INFLUENCE. PARTICIPANTS VISIT THE TRAUMA ROOM, ER, ICU, CAT SCAN AND OTHER HOSPITAL AREAS. (SPONSORED BY SCRIPPS MERCY HOSPITAL'S EMERGENCY DEPARTMENT AND TRAUMA CENTER) UNINTENTIONAL INJURY AND VIOLENCE IN CALIFORNIA, INJURY, INCLUDING BOTH UNINTENTIONAL AND INTENTIONAL, IS THE NUMBER ONE KILLER AND DISABLER OF PERSONS AGED 1 TO 44 (CDPH, 2010). THE NUMBERS OF DEATHS ASSOCIATED WITH UNINTENTIONAL INJURY ARE SIGNIFICANT, YET PRESENT ONLY A SMALL PART OF A MUCH LARGER AND SERIOUS PUBLIC HEALTH PROBLEM. HOSPITALIZATION DATA IS MORE INDICATIVE OF THE EXTENT OF THE INJURY PROBLEM THAN DEATH DATA ALONE. IN SAN DIEGO COUNTY DURING 2008 THERE WERE OVER 930 DEATHS, MORE THAN 20,800 SAN DIEGANS WERE HOSPITALIZED AND NEARLY 150,000 WERE TREATED ANNUALLY IN EMERGENCY DEPARTMENTS FOR UNINTENTIONAL INJURIES. THE NUMBER OF UNINTENTIONAL INJURIES TREATED IN PHYSICIANS' OFFICES AND CLINICS RELATED TO UNINTENTIONAL INJURY, WHILE UNKNOWN, IS LIKELY MUCH HIGHER THAN THE NUMBER OF EMERGENCY DEPARTMENT VISITS. UNINTENTIONAL INJURIES ARE ONE OF THE LEADING CAUSES OF DEATH FOR SAN DIEGO COUNTY RESIDENTS OF ALL AGES, REGARDLESS OF GENDER, RACE, OR REGION. DURING 2008, UNINTENTIONAL INJURY WAS THE LEADING CAUSE OF DEATH FOR PERSONS AGES 1 TO 4 YEARS AND 15 TO 34 YEARS AND THE SIXTH LEADING CAUSE OF DEATH OVERALL. OVER 930 SAN DIEGANS DIED IN 2008 AS A RESULT OF UNINTENTIONAL INJURIES. DURING 2008, THERE WERE 149,900 UNINTENTIONAL INJURY DISCHARGES FROM SAN DIEGO COUNTY EDS, ACCOUNTING FOR ALMOST ONE IN FOUR (24.2%) OF ALL ED DISCHARGES DURING THIS PERIOD. THE RATE OF ED DISCHARGES RELATED TO UNINTENTIONAL INJURY WAS 4,735 PER 100,000 AND REPRESENTED THE LOWEST RATE DURING THE PAST THREE YEARS. UNINTENTIONAL INJURIES CAN OCCUR AT HOME, AT WORK, WHILE PARTICIPATING IN SPORTS AND RECREATION, ON THE STREETS, AND AT SCHOOL. CAUSES OF UNINTENTIONAL INJURIES INCLUDE MOTOR VEHICLE ACCIDENTS, FALLS, FIREARMS, FIRE/BURNS, DROWNING, POISONING (INCLUDING DRUGS AND CAUSTIC SUBSTANCES) AND ALCOHOL, GAS, CLEANERS AND INJURIES AT WORK. THE FOLLOWING ARE SOME OF SCRIPPS HEALTH PROGRAMS THAT ADDRESS UNINTENTIONAL INJURIES AND VIOLENCE FOR FY10. HEALTH AND SAFETY FAIR - SCRIPPS HOME HEALTH SERVICES PROVIDED EDUCATION FOR SENIORS ON FALL PREVENTION (PRIMARY CAUSES OF FALLS AND FRACTURES) AND FIRE SAFETY. HOME HEALTH NURSES PROVIDE INFORMATION TO SENIORS AND THEIR FAMILIES ON CONTINUUM OF CARE OPTIONS. IN FY10, 550 SAN DIEGO RESIDENTS WERE SERVED. (SPONSORED BY SCRIPPS HOME HEALTH SERVICES) FALL PREVENTION - SCRIPPS MEMORIAL HOSPITAL LA JOLLA AND THE LAWRENCE FAMILY JEWISH COMMUNITY CENTER PARTNERED TO OFFER A CLASS TAUGHT BY TRAUMA CARE EXPERTS TO LEARN WAYS TO REDUCE FALL RISK, IMPROVE SAFETY AWARENESS AND UTILIZE AVAILABLE RESOURCES TO PROMOTE INDEPENDENCE AND OVERALL SAFETY. FORTY-SIX PARTICIPANTS FROM THE COMMUNITY ATTENDED THIS CLASS. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL LA JOLLA) SPORTS CONCUSSION PROGRAM - REHABILITATION CENTER AT SCRIPPS MEMORIAL HOSPITAL ENCINITAS EVERY YEAR IN THE U.S., ALMOST 300,000 SPORTS-RELATED CONCUSSIONS OCCUR PER YEAR - 100,000 IN FOOTBALL ALONE, AND APPROXIMATELY 130,000 HIGH SCHOOL ATHLETES SUFFER A CONCUSSION. A RECENT REPORT SHOWED THAT CLOSE TO 40 PERCENT OF HIGH SCHOOL ATHLETES WHO SUSTAIN A CONCUSSION RETURN TO PLAY TOO SOON. THE REHABILITATION CENTER AT SCRIPPS ENCINITAS HAS DEVELOPED A PUBLIC EDUCATION AND COMMUNITY OUTREACH PROGRAM DESIGNED TO BRING AWARENESS TO CONCUSSION, SIGNS AND SYMPTOMS OF CONCUSSION, HOW TO AVOID THEM, TREAT THEM AND UNDERSTAND THEIR CONSEQUENCES. FOUR HUNDRED STUDENTS HAVE BEEN SERVED BY THIS PROGRAM. (SPONSORED BY SCRIPPS MEMORIAL HOSPITAL ENCINITAS) SAN DIEGO FALL PREVENTION TASK FORCE THIS COUNTY HHSA- AGING AND INDEPENDENCE SERVICE-SUPPORTED TASK FORCE SEEKS TO REDUCE FALLS AND THEIR DEVASTATING CONSEQUENCES IN SAN DIEGO COUNTY. GOALS AND STRATEGIES INCLUDE: (1) INCREASE CONNECTIONS BETWEEN PHYSICIANS AND OTHER COMMUNITY SERVICE PROVIDERS THAT PROVIDE FALL PREVENTION SERVICES; (2) INCREASE AWARENESS AMONG OLDER ADULTS AND SERVICE. SCRIPPS MERCY HOSPITAL TRAUMA DEPARTMENT PARTICIPATES IN THIS TASK FORCE. WEIGHT STATUS, NUTRITION, ACTIVITY AND FITNESS THE NUMBERS SPEAK FOR THEMSELVES - 63% OF AMERICAN ADULTS ARE EITHER OVERWEIGHT OR OBESE! NATIONALLY, THE PREVALENCE OF OBESE ADULTS (THOSE WITH A BODY MASS INDEX [BMI] OF 30 OR MORE) HAS INCREASED BY 68% SINCE 1995, FROM 16% TO ALMOST 27%. DURING THIS SAME PERIOD, THE PREVALENCE OF OVERWEIGHT ADULTS HAS INCREASED BY ONLY TWO PERCENT, 35.5% TO 36.2%. 2009 BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) DATA FOR SAN DIEGO COUNTY INDICATES THAT ALMOST 59% OF THE ADULT POPULATION IS CONSIDERED EITHER OVERWEIGHT OR OBESE. SINCE 2005, THE FIRST YEAR BRFSS DATA WAS REPORTED FOR SAN DIEGO COUNTY, THE PREVALENCE OF OBESE ADULTS HAS RANGED FROM 20% IN 2005 TO 26.7% IN 2006, WITH THE MOST CURRENT MEASURE AT 21.6% SINCE 2006. THE PREVALENCE OF OVERWEIGHT ADULTS IN SAN DIEGO COUNTY HAS INCREASED SLIGHTLY FROM 36.5% TO 37.7%. REVIEW OF ADULT OVERWEIGHT AND OBESITY PREVALENCE DATA BY ETHNICITY, RACE AND GENDER INDICATES THE PREVALENCE RATES OF OBESITY AMONG LATINOS AND AFRICAN AMERICANS ARE SIGNIFICANTLY HIGHER THAN THOSE FOR WHITES AT THE NATIONAL, STATE AND COUNTY LEVELS. OBESITY RATES BY GENDER ALSO VARIED SIGNIFICANTLY IN THE 2007 CHIS, THE MOST RECENT COUNTY LEVEL DATA AVAILABLE BY GENDER, WITH 25.4% OF MALES AND 18.1% OF FEMALES HAVING A BMI OF 30.0 OR HIGHER. MOREOVER, MALES WERE SIGNIFICANTLY MORE LIKELY TO BE OVERWEIGHT (BMI BETWEEN 25.0 AND 29.99) THAN FEMALES, 40.5% AND 25.8%, RESPECTIVELY. CAUSES OF OBESITY MANY FACTORS PLAY A ROLE IN OVERWEIGHT AND OBESITY, MAKING IT A COMPLEX HEALTH ISSUE TO ADDRESS. SOME OF THE FACTORS THAT ARE MAJOR CONTRIBUTORS TO THE OBESITY EPIDEMIC INCLUDE (DH&HS, 2010): - GENETIC PREDISPOSITION - ENVIRONMENTAL INFLUENCES - BEHAVIOR (DIETARY PATTERNS AND PHYSICAL ACTIVITY) - CULTURAL INFLUENCES - SOCIOECONOMIC STATUS IN THE CONTEXT OF PREVENTION, IT IS IMPORTANT TO UNDERSTAND THE AFFECT EACH OF THESE FACTORS HAS ON OBESITY AND WHICH CAN BE CHANGED AS A MEANS OF REDUCING THE PREVALENCE OF OBESITY. THE FOLLOWING ARE SOME EXAMPLES OF SCRIPPS PROGRAMS THAT ADDRESS THE HEALTH ISSUES DESCRIBED ABOVE. NUTRITION SERVICES ACCORDING TO THE 2009 BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) DATA FOR SAN DIEGO COUNTY, MORE THAN 59 PERCENT OF THE ADULT POPULATION IS CONSIDERED EITHER OVERWEIGHT OR OBESE. OBESITY INCREASES THE HEALTH RISK FOR CHRONIC DISEASES, SUCH AS HEART DISEASE, TYPE 2 DIABETES, HIGH BLOOD PRESSURE, STROKE AND SOME FORMS OF CANCER. AT EVEN GREATER RISK ARE THE NATION'S LOW-INCOME MINORITY POPULATIONS. IN AN EFFORT TO ADDRESS THIS CRITICAL HEALTH CONCERN, STAFF MEMBERS BASED AT THE CITY HEIGHTS WELLNESS CENTER HAVE ESTABLISHED A VARIETY OF NUTRITION EDUCATION AND COUNSELING SERVICES, DESIGNED SPECIFICALLY TO MEET THE NEEDS OF LOW-INCOME MINORITY POPULATIONS. THE CENTER USES A COMBINATION OF APPROACHES TO ADDRESS A BROAD ARRAY OF COMMUNITY HEALTH PRIORITIES, INCLUDING NUTRITION, ACCESS TO SERVICES AND COMMUNITY ENGAGEMENT. THE "HUB" OF THE WELLNESS CENTER IS A TEACHING KITCHEN; A HANDS-ON INTERACTIVE SETTING FOR COOKING DEMONSTRATIONS, WEIGHT MANAGEMENT AND MEAL PREPARATION CLASSES, NUTRITION EDUCATION AND COUNSELING. DURING FY10, MORE THAN 3,000 PEOPLE ACCESSED NUTRITION EDUCATION AND COUNSELING SERVICES AT THE CITY HEIGHTS WELLNESS CENTER. (SPONSORED BY SCRIPPS MERCY HOSPITAL, COMMUNITY BENEFIT SERVICES) SCRIPPS MERCY'S SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) SCRIPPS MERCY HOSPITAL IS ONE OF FIVE REGIONAL ORGANIZATIONS THAT ADMINISTER THE STATE-FUNDED WIC PROGRAM, SERVING 6 LOCATIONS THAT ARE CONVENIENTLY SITUATED EITHER IN OR NEXT TO COMMUNITY CLINICS AND/OR HOSPITALS IN THE CENTRAL SAN DIEGO AREA OF SAN DIEGO COUNTY. WIC'S TARGET POPULATION IS LOW-INCOME PREGNANT AND POSTPARTUM WOMEN, INFANTS AND CHILDREN (AGES 0 TO FIVE). ON AN ANNUAL BASIS, SCRIPPS MERCY WIC SERVES APPROXIMATELY 9,000 WOMEN AND CHILDREN WITH 44% IN THE CITY HEIGHTS COMMUNITY. THE CLIENT BASE IN CITY HEIGHTS IS 91% HISPANIC AND MADE UP OF PREGNANT AND POSTPARTUM WOMEN (24%), INFANTS (20%) AND CHILDREN (56%). IN FY10, THE PROGRAM PROVIDED NUTRITION SERVICES AND FOOD VOUCHERS TO 108,158 WOMEN AND CHILDREN IN THE SOUTH AND CENTRAL REGIONS OF SAN DIEGO. (SPONSORED BY SCRIPPS MERCY SAN DIEGO) HEALTHY LIVE HEALTHY - FAMILY NUTRITION PROGRAM USING THE COOPERATIVE EXTENSION'S RESEARCH-BASED CURRICULUMS AND BILINGUAL STAFF, A REGISTERED DIETITIAN SUPERVISED THE IMPLEMENTATION OF WEEKLY NUTRITION EDUCATION CLASSES IN SPANISH. PROGRAM TARGETS THE LOW-INCOME, FOOD STAMP POPULATION. IT CONSISTS OF A SERIES OF EIGHT WEEKLY CLASSES AND THE PRIMARY GOAL IS TO INCREASE KNOWLEDGE, SKILLS AND MOTIVATIONAL LEVEL OF AREA RESIDENTS TO PRACTICE HEALTHY EATING AND RELATED BEHAVIORS. CLASS TOPICS FOCUS ON NUTRITION, PHYSICAL FITNESS, FOOD SAFETY, MEAL PLANNING AND FOOD SHOPPING. (SPONSORED BY SCRIPPS MERCY HOSPITAL, COMMUNITY BENEFIT SERVICES) MENTAL HEALTH AND MENTAL DISORDERS ACCORDING TO THE NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH), ANNUALLY, AN ESTIMATED 13 MILLION AMERICAN ADULTS (APPROXIMATELY 1 IN 17) HAVE A SERIOUSLY DEBILITATING MENTAL ILLNESS (NIMH, 2008). FURTHERMORE, MENTAL HEALTH DISORDERS ARE THE LEADING CAUSE OF DISABILITY IN THE U.S., ACCOUNTING FOR 25% OF ALL YEARS OF LIFE LOST TO DISABILITY AND PREMATURE MORTALITY (WHO, 2004). MOREOVER, IN 2007, SUICIDE WAS THE 11TH LEADING CAUSE OF DEATH IN THE U.S., ACCOUNTING FOR OVER 34,500 DEATHS (NVSS, 2010). SAN DIEGO COUNTY - PREVALENCE OF SERIOUS MENTAL ILLNESS THERE ARE 141,420 PERSONS IN SAN DIEGO COUNTY WITH SERIOUS MENTAL ILLNESS, REPRESENTING 4.9% OF THE HOUSEHOLD POPULATION IN SAN DIEGO COUNTY (DMH, 2007). THE MOST IMPACTED BY SERIOUS MENTAL ILLNESS IN SAN DIEGO ARE PERSONS UNDER AGE 18 AND THOSE LIVING IN HOUSEHOLDS UNDER 200% OF THE FEDERAL POVERTY LEVEL, 7.4% AND 8.8% RESPECTIVELY. EMERGENCY DEPARTMENT DISCHARGES DURING 2008, THERE WERE 25,468 DISCHARGES FROM SAN DIEGO COUNTY HOSPITAL EMERGENCY DEPARTMENTS WITH A PRIMARY DIAGNOSIS OF MENTAL DISORDER, ACCOUNTING FOR 4.1% OF ALL ED DISCHARGES. (NOTE, THE PRIMARY DIAGNOSIS OF MENTAL DISORDER INCLUDES A WIDE RANGE OF DIAGNOSES INCLUDING ALCOHOLIC AND DRUG PSYCHOSES, DEPENDENCE AND ABUSE.) THE OVERALL RATE OF ED DISCHARGES WITH A DIAGNOSIS OF MENTAL DISORDER WAS 809.5 PER 100,000 POPULATION. HOSPITALIZATIONS DURING 2008, THERE WERE 22,971 HOSPITALIZATIONS IN SAN DIEGO COUNTY HOSPITALS WITH A PRINCIPAL DIAGNOSIS CODE OF MENTAL DISORDERS (ICD-9-CD CODE 290 - 319), ACCOUNTING FOR 7.4% OF ALL HOSPITALIZATIONS. THESE HOSPITALIZATIONS INCLUDED 17,556 WITH A PRINCIPAL DIAGNOSIS OF PSYCHOSES, ACCOUNTING FOR 59% OF ALL MENTAL HEALTH HOSPITALIZATIONS. THERE WERE 6,210 WITH A PRINCIPAL DIAGNOSIS OF SCHIZOPHRENIC DISORDERS AND 4,583 WITH A PRINCIPAL DIAGNOSIS OF MAJOR DEPRESSIVE DISORDER, ACCOUNT FOR 27% AND 20% OF ALL MENTAL HEALTH HOSPITALIZATIONS, RESPECTIVELY (COSDEPI, 20010). SUICIDE AND SUICIDE ATTEMPTS (SELF-INFLECTED INJURY) SUICIDE OCCURS WHEN A PERSON ENDS HIS OR HER LIFE AND IS A MAJOR COMPLICATION OF DEPRESSION. IN 2008, IT WAS THE EIGHTH LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY, ACCOUNTING FOR 369 DEATHS WITH AN OVERALL RATE OF 11.3 SUICIDE DEATHS PER 100,000 PEOPLE (SDEPI, 2010). SUICIDE DEATHS ARE ONLY PART OF THE PROBLEM, MORE PEOPLE SURVIVE SUICIDE ATTEMPTS THAN ACTUALLY DIE. THOSE WHO ATTEMPT SUICIDE ARE OFTEN SERIOUSLY INJURED AND REQUIRE MEDICAL AND PSYCHIATRIC CARE. BETWEEN 2000 AND 2008, 2,896 SAN DIEGANS HAVE DIED AS A RESULT OF SUICIDE. SCRIPPS OFFERS BOTH INPATIENT AND OUTPATIENT ADULT BEHAVIORAL HEALTH SERVICES AT THE SCRIPPS MERCY HOSPITAL SAN DIEGO CAMPUS. SCRIPPS MERCY'S BEHAVIORAL HEALTH PROGRAM ALSO ACTIVELY SUPPORTS COMMUNITY PROGRAMS DESIGNED TO REDUCE THE STIGMA OF MENTAL ILLNESS AND HELP AFFECTED INDIVIDUALS LIVE AND WORK IN THE COMMUNITY. SCRIPPS HEALTH BEHAVIORAL HEALTH INPATIENT PROGRAMS INDIVIDUALS SUFFERING FROM ACUTE PSYCHIATRIC DISORDERS ARE SOMETIMES UNABLE TO LIVE INDEPENDENTLY OR MAY EVEN POSE A DANGER TO THEMSELVES OR OTHERS. IN SUCH CASES, HOSPITALIZATION MAY BE THE MOST APPROPRIATE ALTERNATIVE. SCRIPPS MERCY HOSPITAL'S BEHAVIORAL HEALTH INPATIENT PROGRAM HELPS PATIENTS AND THEIR LOVED ONES WORK THROUGH SHORT-TERM CRISES, MANAGE MENTAL ILLNESS AND RESUME THEIR DAILY LIVES. CHALLENGES * LIKE MANY BEHAVIORAL HEALTH PROGRAMS ACROSS THE COUNTRY, FUNDING IS DIFFICULT, AS PAYMENT RATES HAVE NOT KEPT PACE WITH THE COST TO PROVIDE CARE. * IN 2010, SCRIPPS MERCY'S BEHAVIORAL HEALTH PROGRAM LOST $5.1 MILLION. * IN 2010, 20 PERCENT OF PATIENTS IN THE INPATIENT UNIT WERE UNINSURED. SCRIPPS HEALTH BEHAVIORAL HEALTH OUTPATIENT PROGRAMS SCRIPPS MERCY PROVIDES COMMUNITY-BASED ADULT PSYCHIATRIC TREATMENT AT SCRIPPS MERCY SAN DIEGO. THE OUTPATIENT PROGRAM IS AN INTENSIVE DAY PROGRAM DESIGNED TO HELP INDIVIDUALS REDUCE THEIR SYMPTOMS WHILE THEY CONTINUE TO LIVE IN THE COMMUNITY. THE PROGRAM PROVIDES TWO LEVELS OF CARE: * THE OUTPATIENT PROGRAM OFFERS PATIENTS ONE TO FOUR TREATMENT DAYS PER WEEK * THE PARTIAL HOSPITALIZATION PROGRAM PROVIDES MORE INTENSIVE TREATMENT FIVE TO SIX DAYS PER WEEK. MENTAL HEALTH OUTREACH SERVICES A-VISIONS SERVICE PROGRAM BEHAVIORAL HEALTH SERVICES AT SCRIPPS MERCY HOSPITAL ESTABLISHED THE A-VISIONS VOCATIONAL TRAINING PROGRAM, IN PARTNERSHIP WITH THE SAN DIEGO MENTAL HEALTH ASSOCIATION TO HELP DECREASE THE STIGMA OF MENTAL ILLNESS. THE PROGRAM HELPS PEOPLE RECEIVING MENTAL HEALTH TREATMENT BY PROVIDING VOCATIONAL TRAINING, POTENTIALLY LEADING TO A GREATER LEVEL OF INDEPENDENCE. THIS YEAR, BEHAVIORAL HEALTH CONTINUED PARTICIPATION IN THE A-VISIONS PROGRAM (SOCIAL REHABILITATION AND PREVOCATIONAL SERVICES FOR PEOPLE LIVING WITH MENTAL ILLNESS). IN FY10, 54 CLIENTS WERE SERVED. CURRENTLY 8 PEOPLE ARE VOLUNTEERING AND 16 PEOPLE ARE PARTICIPATING IN SUPPORTIVE EMPLOYMENT. THE TOTAL EXPENSE FOR THE A-VISIONS PROGRAM FOR FY10 WAS $84,000. INCREASE AWARENESS OF MENTAL HEALTH AND GERIATRIC PSYCHIATRIC ISSUES IN FY10, SCRIPPS BEHAVIORAL HEALTH DEPARTMENT IMPROVED AWARENESS OF MENTAL HEALTH AND GERIATRIC ISSUES BY PROVIDING INFORMATION AND SUPPORTIVE SERVICES TO MORE THAN 900 PEOPLE AT COMMUNITY EVENTS. MENTAL HEALTH EMERGING ISSUES HEALTHY PEOPLE 2020 HAS IDENTIFIED SEVERAL MENTAL HEALTH ISSUES THAT HAVE EMERGED AMONG SOME SPECIAL POPULATIONS; THESE INCLUDE: POST-TRAUMATIC STRESS DISORDER (PTSD) AMONG VETERANS AND OTHERS WHO HAVE EXPERIENCED SOME TYPE OF TRAUMATIC EVENT. THESE TRAUMATIC EVENTS MAY INCLUDE: WAR, RAPE, NATURAL DISASTERS, A CAR OR PLANE CRASH, KIDNAPPING, VIOLENT ASSAULT, SEXUAL OR PHYSICAL ABUSE AND MEDICAL PROCEDURES (ESPECIALLY IN KIDS). SCRIPPS MEMORIAL HOSPITAL AT ENCINITAS OFFERS A TWO DAY COURSE CALLED "BRAIN INJURY REHABILITATION CONFERENCE: BEYOND THE HOSPITAL, INTO THE COMMUNITY". THIS TWO DAY COURSE ON PTSD AND STRESS DISORDER IS DESIGNED TO PROVIDE STRATEGIES AND A FRAMEWORK FOR THE MANAGEMENT OF BRAIN INJURED PATIENTS BOTH WITHIN AND OUTSIDE THE CLINICAL SETTING. TREATMENTS ARE FOCUSED ON THE TOTAL CARE CONTINUUM-PHYSICAL, COGNITIVE, PERCEPTUAL, EMOTIONAL AND SOCIAL-IN A MULTIDISCIPLINARY FORMAT. THIS CONFERENCE ALSO PROVIDES THE PARTICIPANT WITH THEORETICAL, PRACTICAL, AND ADVANCED APPLICATIONS IN BRAIN INJURY REHABILITATION. THE COURSE IS TAUGHT BY AN INTERDISCIPLINARY TEAM OF SPECIALISTS IN BRAIN INJURY REHABILITATION AT SCRIPPS MEMORIAL HOSPITAL ENCINITAS. INFECTIOUS DISEASE SEXUALLY TRANSMITTED DISEASES AND HIV/AIDS SEXUALLY TRANSMITTED DISEASES (STDS) HAVE BEEN REFERRED TO BY THE INSTITUTE OF MEDICINE AS A "HIDDEN EPIDEMIC OF ENORMOUS HEALTH AND ECONOMIC CONSEQUENCE IN THE U.S. THEY ARE HIDDEN BECAUSE MANY AMERICANS ARE RELUCTANT TO ADDRESS SEXUAL HEALTH ISSUES IN AN OPEN WAY AND BECAUSE OF THE BIOLOGICAL AND SOCIAL CHARACTERISTICS OF THESE DISEASES". STDS ENCOMPASS MORE THAN 25 INFECTIOUS ORGANISMS TRANSMITTED PRIMARILY THROUGH SEXUAL ACTIVITY. LOCAL, STATE AND NATIONAL HEALTH AGENCIES ARE RESPONSIBLE FOR SURVEILLANCE AND MONITORING OF STDS. TUBERCULOSIS TUBERCULOSIS (TB) IS AN AIRBORNE INFECTIOUS DISEASE CAUSED BY THE BACTERIUM MYCOBACTERIUM TUBERCULOSIS THAT USUALLY AFFECTS THE LUNGS, ALTHOUGH OTHER ORGANS AND TISSUES SUCH AS THE KIDNEY, SPINE, AND BRAIN CAN BE AFFECTED AS WELL. TB CAN BE SPREAD BY COUGHING, SNEEZING, LAUGHING OR SINGING. AS OF DECEMBER 31, 2008, 13,820 ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) CASES HAVE BEEN REPORTED IN SAN DIEGO COUNTY SINCE 1981. INDIVIDUALS MOST COMMONLY DIAGNOSED WITH AIDS IN SAN DIEGO COUNTY ARE WHITE, MALE, AGED 30 TO 39 YEARS AND HAVE MALE SEX PARTNERS. DURING THIS PERIOD, 3,847 HUMAN IMMUNODEFICIENCY VIRUS (HIV) CASES HAVE BEEN REPORTED. BECAUSE OF A CHANGE IN THE HIV REPORTING SYSTEM, ALL HIV REPORTING DATA CURRENTLY AVAILABLE COVERS THE PERIOD APRIL 17, 2006 THROUGH DECEMBER 2008. INDIVIDUALS MOST COMMONLY DIAGNOSED WITH HIV ARE WHITE, MALE AND AGED 30 TO 39. DURING 2009, THERE WERE 264 TUBERCULOSIS CASES. INDIVIDUALS MOST COMMONLY DIAGNOSED WITH TB ARE HISPANIC (52.3%) OR ASIAN/PACIFIC ISLANDER (31.1%), MALE (62.5%) AND BETWEEN THE AGES OF 25 AND 64 YEARS SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CENTER SENIOR PREVENTION AND WELLNESS SENIOR HEALTH CHATS WERE IMPLEMENTED TO PROVIDE HEALTH EDUCATION TO THE OLDER ADULT COMMUNITY IN SOUTH BAY. APPROXIMATELY 25-20 SENIORS ATTENDED THESE MONTHLY THROUGHOUT THE YEAR. THESE PRESENTATIONS INCLUDED A VARIETY OF HEALTH AND AGE RELATED PREVENTION AND WELLNESS. ONE OF THE TOPICS WAS ABOUT TUBERCULOSIS AND HOW TO PREVENT AND TREAT. IN ADDITION, INFORMATION WAS PRESENTED ABOUT SIGNS AND SYMPTOMS. THE PRESENTATIONS ARE FACILITATED BY VARIOUS SCRIPPS MERCY HEALTH CARE PROFESSIONALS, PHYSICIANS AND FAMILY MEDICINE RESIDENTS. TOPICS ARE ALL CHOSEN BY THE SENIORS THEMSELVES SO AS TO MEET THEIR LOCAL NEEDS. ALSO, THE HEALTH CHATS PROVIDE AN INTERCHANGE BETWEEN THE COMMUNITY MEMBERS AND MEDICAL RESIDENTS AND OTHER HEALTH CARE PROFESSIONALS TO FOSTER HEALTHY LIFESTYLES AND HEALTH PREVENTION. SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CENTER STAFF PREPARE AND CONDUCT THESE SESSIONS WITH THE SENIORS TO FOSTER HEALTH PREVENTION, AWARENESS AND DIALOGUE BETWEEN THE SENIORS. MANY QUESTIONS ARE ASKED ABOUT CHRONIC HEALTH ISSUES AND OTHER GERIATRIC RELATED HEALTH CONCERNS. SCRIPPS MERCY HOSPITAL CHULA VISTA WELL-BEING CENTER YOUTH PREVENTION AND WELLNESS SCRIPPS MERCY HOSPITAL HEALTH CARE PROFESSIONALS, FAMILY MEDICAL RESIDENTS, DIETICIANS, NURSES AND DOCTORS, ENLIGHTEN STUDENTS IN THE CLASSROOM OF TEN LOCAL SOUTH BAY HIGH SCHOOLS ON HEALTH RELATED TOPICS. SOME OF THE TOPICS INCLUDED SEXUALLY TRANSMITTED ILLNESSES AND TUBERCULOSIS 101. STUDENTS RECEIVED HEALTH CAREER TOOLS/BROCHURES THAT INCLUDED INFORMATION ON PREVENTION AND DETECTION AS WELL AS TREATMENT, SIGNS AND SYMPTOMS. SCRIPPS MERCY HOSPITAL FAMILY MEDICINE RESIDENCY RUN TWO HEALTH CLINICS ESTABLISHED AT PALOMAR AND SOUTHWEST HIGH SCHOOL FOR FAMILY MEDICINE RESIDENTS TO GAIN ADDITIONAL SKILLS IN ADOLESCENT MEDICINE AND FOR YOUTH TO GAIN THE KNOWLEDGE, ATTITUDES, AND SKILLS NECESSARY TO PURSUE HEALTH CAREERS. FAMILY MEDICINE RESIDENTS AND FACULTY INTERACT TWICE PER WEEK AT THE CLINIC PROVIDING ADOLESCENT MEDICINE. SOME TEACHING AND EDUCATION TAKES PLACE ONE-ON-ONE WITH STUDENTS REGARDING SEXUALLY TRANSMITTED ILLNESSES PREVENTION, SIGNS, SYMPTOMS AND TREATMENT. ALSO, INFORMATION IS PRESENTED ON TUBERCULOSIS PREVENTION, SIGNS, SYMPTOMS AND TREATMENT. RESPIRATORY DISEASE RESPIRATORY DISEASES SUCH AS ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) ARE A SIGNIFICANT PUBLIC HEALTH BURDEN IN THE UNITED STATES. ASTHMA AND COPD ARE AMONG THE 10 LEADING CHRONIC CONDITIONS CAUSING RESTRICTED ACTIVITY. AFTER CHRONIC SINUSITIS, ASTHMA IS THE MOST COMMON CAUSE OF CHRONIC ILLNESS IN CHILDREN. COPD, WHICH INVOLVES EMPHYSEMA AND CHRONIC BRONCHITIS, IS THE FOURTH LEADING CAUSE OF DEATH IN SAN DIEGO COUNTY AND THE US. IN 2007, COPD ACCOUNTED FOR 1,023 DEATHS IN SAN DIEGO COUNTY AND 123,311 DEATHS NATIONALLY FOR AN AGE-ADJUSTED MORTALITY RATE PER 100,000 POPULATION OF 34.1 AND 40.5, RESPECTIVELY. HOSPITALIZED PATIENTS SMOKING CESSATION STUDY A TOTAL OF 126 PARTICIPANTS WERE INCLUDED IN THE PILOT RANDOMIZED CONTROL TRIAL TO ASSESS HOW BEST TO ASSIST HOSPITALIZED SMOKERS QUIT SMOKING. THIS STUDY IS A PARTNERSHIP WITH THE CALIFORNIA SMOKERS HELPLINE. THE SMOKING CESSATION PILOT AND EXPANDED STUDY ARE PREVENTION PROGRAMS RELATED TO RESPIRATORY DISEASE CONSIDERING THE RESPIRATORY THERAPISTS ARE CORE TO THE PILOT AS WELL AS THE LARGER NIH STUDY. MANY OF THE HOSPITALIZED SMOKERS ARE ADMITTED FOR PULMONARY AND RESPIRATORY DISEASE THAT IS OF COURSE LINKED TO SMOKING. (SPONSORED BY SCRIPPS MERCY HOSPITAL CHULA VISTA) PARTNERSHIP FOR SMOKE-FREE FAMILIES PROGRAM SECOND-HAND SMOKE IS CLEARLY A COMMUNITY HEALTH RISK ATTRIBUTING TO LOW BIRTH WEIGHT IN NEWBORNS, SUDDEN INFANT DEATH SYNDROME (SIDS), RESPIRATORY INFECTIONS, ASTHMA AND MIDDLE-EAR DISEASE IN INFANTS AND CHILDREN. THE PARTNERSHIP FOR SMOKE-FREE FAMILIES (PSF) IS A COLLABORATIVE EFFORT SUPPORTED BY SCRIPPS, SHARP HEALTHCARE AND CHILDREN'S HOSPITAL FOCUSED ON IMPROVING THE HEALTH AND WELL BEING OF CHILDREN BY REDUCING THEIR EXPOSURE TO SECOND-HAND SMOKE. (SPONSORED BY SCRIPPS HEALTH COMMUNITY BENEFITS) CITY HEIGHTS WELLNESS CENTER, "HEALTHY HOMES AND ASTHMA TRIGGER NIGHT FORUM". THE CITY HEIGHTS WELLNESS CENTER PARTNERED WITH THE COMMUNITY ASTHMA TASK FORCE (CAT FORCE). FAMILIES WITH ASTHMATIC CHILDREN OFTEN FACE A NUMBER OF CHALLENGES THAT CAN LEAD TO ANXIETY, FEAR OR CONFLICT. THE FORUM PRESENTED WAYS FOR PARENTS TO LEARN TO OVERCOME OBSTACLES AND CHALLENGES PRESENTED BY THEIR CHILD'S CONDITION AND FIND WAYS TO WORK WITH THEM TO MAINTAIN A HEALTHY AND POSITIVE LIVING ENVIRONMENT. SOME OF THE TOPICS THAT WERE PRESENTED INCLUDED: LEARNING HOW TO GET AN ASTHMA ACTION PLAN COMPLETED BY A DOCTOR; LEARNING HOW TO HAVE A SCHOOL NURSE AND THE CLASSROOM TEACHER FOLLOW THE ASTHMA ACTION PLAN; LEARNING HOW TO RID HOMES OF MOLD, ALLERGENS AND OTHER ASTHMA TRIGGERS; AND LEARNING WHAT CAN BE DONE IN HOMES TO HELP CHILDREN FROM HAVING ASTHMA ATTACKS AND LEARNING ABOUT QUALIFYING TO HAVE HOMES OR APARTMENTS RENOVATED AT NO COST. (SPONSORED BY SCRIPPS MERCY HOSPITAL, COMMUNITY BENEFIT SERVICES) ORAL HEALTH ORAL HEALTH IN AMERICA: A REPORT OF THE SURGEON GENERAL, DECLARES THAT "ORAL HEALTH IS ESSENTIAL TO THE GENERAL HEALTH AND WELL-BEING OF ALL AMERICANS." THE REPORT IDENTIFIES HUGE DISPARITIES IN THE ORAL HEALTH STATUS OF CERTAIN POPULATIONS IN THE UNITED STATES, INCLUDING LOW-INCOME FAMILIES, THOSE LIVING IN RURAL COMMUNITIES, RACIAL OR ETHNIC MINORITIES, CHILDREN, THE ELDERLY AND THE DEVELOPMENTALLY DISABLED. THE 2005 CALIFORNIA ORAL HEALTH NEEDS ASSESSMENT REPORTED 54% OF KINDERGARTENERS AND 71% OF THIRD GRADERS HAVE A HISTORY OF TOOTH DECAY AND MORE THAN 25% OF ELEMENTARY SCHOOL CHILDREN HAVE UNTREATED DECAY. A REPORT CARD ISSUED IN 2010 BY CHILDREN NOW GAVE CALIFORNIA A D+ FOR HEALTH COVERAGE AND A D+ FOR ORAL HEALTH. THOSE WHO SUFFER THE WORST ORAL HEALTH ARE FOUND AMONG THE POOR OF ALL AGES, WITH POOR CHILDREN AND POOR OLDER AMERICANS PARTICULARLY VULNERABLE. IDENTIFIED BARRIERS TO CARE INCLUDE: NO PERCEIVED NEED FOR ORAL CARE AND/OR THE PUBLIC AND POLICYMAKERS PLACING A LOW PRIORITY ON ORAL HEALTH AND PREVENTION STRATEGIES; LACK OF ACCESS TO DENTISTS; LOW SOCIO-ECONOMIC STATUS AND/OR LACK OF FINANCIAL RESOURCES TO PAY FOR CARE; INADEQUATE REIMBURSEMENT BY GOVERNMENT INSURANCE PROGRAMS AND EXCESSIVE PAPERWORK REQUIRED FOR REIMBURSEMENT; LACK OF PROVIDERS TRAINED TO CARE FOR DIVERSE POPULATIONS, VERY YOUNG CHILDREN AND PEOPLE WITH SPECIAL NEEDS; AND MEDI-CAL BENEFICIARIES BEING UNAWARE THAT DENTAL BENEFITS ARE INCLUDED AS PART OF THEIR INSURANCE PLAN. PROJECT DULCE PROJECT DULCE ADDRESSES ORAL HEALTH ISSUES WITH PATIENTS DURING COUNSELING VISITS. FOSTERING VOLUNTEERISM SCRIPPS BELIEVES THAT HEALTH IMPROVEMENT BEGINS WHEN COMMUNITY MEMBERS TAKE AN ACTIVE ROLE IN MAKING A POSITIVE IMPACT ON THEIR COMMUNITY. FOR THIS REASON, SCRIPPS SUPPORTS VOLUNTEER PROGRAMS FOR SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS WHO WANT TO HELP MAKE EVEN MORE OF A DIFFERENCE IN THE HEALTH OF THEIR COMMUNITY. THE SCRIPPSASSISTS EMPLOYEE VOLUNTEER CLUB IS ONE AVENUE THROUGH WHICH SCRIPPS MATCHES THE TALENTS AND INTERESTS OF EMPLOYEES AND PHYSICIANS WITH COMMUNITY NEEDS. THIS INCLUDES, BUT IS NOT LIMITED TO, MENTORING PARTNERSHIPS WITH LOCAL SCHOOLS AND EFFORTS TO PROVIDE FREE MEDICAL AND SURGICAL CARE TO PATIENTS IN NEED. IN ADDITION TO THE FINANCIAL COMMUNITY BENEFIT CONTRIBUTIONS MADE DURING FY10, SCRIPPS EMPLOYEES AND AFFILIATED PHYSICIANS CONTRIBUTED A SIGNIFICANT PORTION OF THEIR PERSONAL TIME VOLUNTEERING TO SUPPORT SCRIPPS-SPONSORED COMMUNITY BENEFIT PROGRAMS AND SERVICES. WITH CLOSE TO 22,452 HOURS OF VOLUNTEER TIME, THE ESTIMATED DOLLAR VALUE OF THIS VOLUNTEER LABOR IS $955,153.21. PROFESSIONAL EDUCATION & HEALTH RESEARCH QUALITY HEALTH CARE IS HIGHLY DEPENDENT UPON HEALTH EDUCATION SYSTEMS AND MEDICAL RESEARCH PROGRAMS. WITHOUT THE ABILITY TO TRAIN AND INSPIRE A NEW GENERATION OF HEALTH CARE PROVIDERS OR TO OFFER CONTINUING EDUCATION TO EXISTING HEALTH CARE PROFESSIONALS, THE QUALITY OF HEALTH CARE WOULD BE GREATLY DIMINISHED. MEDICAL RESEARCH ALSO PLAYS AN IMPORTANT ROLE IN IMPROVING THE COMMUNITY'S OVERALL HEALTH THROUGH THE DEVELOPMENT OF NEW AND INNOVATIVE TREATMENT OPTIONS. EACH YEAR, SCRIPPS ALLOCATES RESOURCES TO THE ADVANCEMENT OF HEALTH CARE SERVICES THROUGH CLINICAL RESEARCH AND MEDICAL EDUCATION PROGRAMS. DURING THIS FISCAL YEAR, SCRIPPS INVESTED $34,845,254 IN PROFESSIONAL TRAINING PROGRAMS AND CLINICAL RESEARCH TO ENHANCE SERVICE DELIVERY AND TREATMENT PRACTICES FOR SAN DIEGO COUNTY. PROFESSIONAL EDUCATION AND HEALTH RESEARCH: REFLECTS CLINICAL RESEARCH AS WELL AS PROFESSIONAL EDUCATION FOR NON-SCRIPPS EMPLOYEES, INCLUDING GRADUATE MEDICAL EDUCATION, NURSING RESOURCE DEVELOPMENT AND OTHER HEALTH CARE PROFESSIONAL EDUCATION. RESEARCH TAKES PLACE PRIMARILY AT SCRIPPS CLINICAL RESEARCH SERVICES, SCRIPPS WHITTIER DIABETES INSTITUTE, SCRIPPS GENOMIC MEDICINE AND SCRIPPS TRANSLATIONAL SCIENCE INSTITUTE. 990 REVIEW PROCESS WITH GOVERNING BODY FORM 990, PART VI, LINE 11 THE FORM 990 WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE SUPPORT OF THE CORPORATE FINANCE TEAM WITH INPUT FROM HUMAN RESOURCES, FOUNDATION, AND LEGAL OFFICE. THE FORM 990 WAS REVIEWED BY THE PRESIDENT, LEGAL COUNSEL, CHIEF FINANCIAL OFFICER, AUDIT COMMITTEE, HUMAN RESOURCES AND COMPENSATION COMMITTEE PRIOR TO FILING. IN ADDITION, A FULL COPY OF THE 990 WAS PROVIDED TO THE BOARD OF TRUSTEES VIA EMAIL IN ADVANCE OF FILING FORM 990 WITH THE IRS. COMPLIANCE POLICY MONITORING FORM 990, PART VI, LINE 12C WITHIN 60 DAYS OF HIRE AND ANNUALLY THEREAFTER ALL SUPERVISORS AND ABOVE; ALL EMPLOYEES IN THE SUPPLY CHAIN MANAGEMENT DEPARTMENT, AUDIT & COMPLIANCE SERVICES DEPARTMENT, AND CASE MANAGEMENT DEPARTMENT OR FUNCTION; AND ANY OTHER EMPLOYEE WHO IS IN A POSITION TO REFER PATIENTS THAT ARE FEDERALLY FUNDED HEALTHCARE BENEFICIARIES TO OTHER PROVIDERS AND SERVICES; AND OTHERS AS DETERMINED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE WILL BE REQUIRED TO COMPLETE AND SIGN THE CONFLICT OF INTEREST COMMITMENT DISCLOSURE FORM. IT IS THE RESPONSIBILITY OF ANY EMPLOYEE WHO HAS A CHANGE IN OUTSIDE PROFESSIONAL ACTIVITIES, SIGNIFICANT FINANCIAL INTERESTS, OR POTENTIAL OR ACTUAL CONFLICT OF INTEREST, OR COMMITMENT SITUATIONS THAT ARISE DURING THE YEAR TO DISCLOSE THE INFORMATION TO THEIR SUPERVISORS AS SOON AS THE EMPLOYEE BECOMES AWARE OF THE POTENTIAL OR ACTUAL SITUATION CREATING A POSSIBLE CONFLICT OF INTEREST OR CONFLICT COMMITMENT. SUPERVISORS WILL ASSESS THE SITUATION AND REFER TO THEIR BUSINESS UNIT MANAGEMENT AND/OR THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE, AS APPROPRIATE. IN ADDITION, EACH PERSON ENTRUSTED WITH A POSITION OF RESPONSIBILITY IN THE GOVERNANCE AND MANAGEMENT ARE REQUIRED TO COMPLETE AND SUBMIT DISCLOSURE STATEMENTS AS FOLLOWS: 1. INITIAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT (INITIAL DISCLOSURES) 2. ANNUAL CONFLICT OF INTEREST AND 990 TAX RETURN DISCLOSURE STATEMENT 3. SUBSEQUENT OCCURRENCES REPORTING UPON THE OCCURRENCE OF ANY NEW POTENTIAL CONFLICT OF INTEREST ACTUAL OR POTENTIAL CONFLICT DISCLOSURES REGARDING EMPLOYEES ARE REVIEWED BY THE CONFLICTS AND BUSINESS PRACTICES REVIEW COMMITTEE. DISCLOSURES REQUIRING MITIGATION ARE DISCUSSED WITH THE BUSINESS UNIT CHIEF EXECUTIVE AND EMPLOYEE'S SUPERVISOR. LEGAL COUNSEL REVIEWS EACH BOARD OF TRUSTEES MEETING AGENDA PRIOR TO THE MEETING AND POTENTIAL CONFLICTS OF INTERESTS ARE IDENTIFIED, CONSIDERED AND AN APPROPRIATE COURSE OF ACTION IS DETERMINED BY THE MEMBER AND LEGAL COUNSEL WITH THE INVOLVEMENT OF THE PRESIDENT AND BOARD CHAIR, WHERE APPROPRIATE. COURSE OF ACTION MAY INCLUDE THE CONFLICTED BOARD MEMBER RECUSING THEMSELVES, ABSTAINING FROM VOTING AND/OR READING A STATEMENT INTO THE BOARD MINUTES REGARDING SUCH CONFLICT. AS IT RELATES TO BOARD OF TRUSTEES, WHEN A DETERMINATION IS THAT AN ACTUAL CONFLICT OF INTEREST EXISTS AND A COVERED INDIVIDUAL IS AN "INTERESTED PERSON" UNDER CALIFORNIA LAW, THE TRANSACTION BEING CONSIDERED WILL COMPLY WITH APPLICABLE STATUTORY REQUIREMENTS TO AVOID PARTICIPATION IN THE DECISION MAKING PROCESS BY THE COVERED INDIVIDUAL. THE MINUTES OF BOARD MEETINGS SHALL DOCUMENT ALL RECUSALS FROM DISCUSSION AND VOTING. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN FORM 990, PART VI, LINE 15A & 15B PURSUANT TO PROCEDURES REQUIRED BY TAX EQUITY AND FISCAL RESPONSIBILITY ACT OF 1983 (TEFRA), SCRIPPS HEALTH'S PROCEDURES ARE AS FOLLOWS: THE BOARD OF TRUSTEES REVIEWS EXECUTIVE COMPENSATION FOR OFFICERS AND ALL KEY EMPLOYEES ON AN ANNUAL BASIS UTILIZING COMPARABILITY DATA OBTAINED BY AN EXTERNAL CONSULTANT. IT IS THE PHILOSOPHY OF THE SCRIPPS BOARD OF TRUSTEES TO COMPENSATE THE CORPORATION'S EXECUTIVES FAIRLY RELATIVE TO THE MEDIAN COMPENSATION OF PEER ORGANIZATIONS, CONSIDERING AND MAKING APPROPRIATE ADJUSTMENTS FOR THE COST OF LIVING IN SAN DIEGO, CALIFORNIA AND OTHER RELEVANT FACTORS. TO ACCOMPLISH THIS, THE BOARD HAS ADOPTED A PHILOSOPHY OF TARGETING EXECUTIVE SALARIES AT APPROXIMATELY THE 65TH PERCENTILE OF A NATIONAL PEER GROUP OF ORGANIZATIONS AS DETERMINED THROUGH AN INDEPENDENT OUTSIDE CONSULTANT ENGAGED BY THE BOARD AND WILL RELY ON THEIR RECOMMENDATIONS USING A DATABASE OF INDEPENDENTLY COLLECTED DATA. THE PHILOSOPHY STATES: -FOR PURPOSES OF EXECUTIVE COMPENSATION COMPARISONS, SCRIPPS WILL USE A NATIONAL PEER GROUP OF MEDICAL DELIVERY SYSTEMS OF SIMILAR REVENUE SIZE AND COMPLEXITY. THE PEER GROUP WILL BE REVIEWED AND APPROVED BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. -SALARIES ARE TARGETED AT APPROXIMATELY THE 65TH PERCENTILE OF THE PEER GROUP AND WILL REFLECT THE PERFORMANCE OF THE INDIVIDUAL. -TOTAL CASH COMPENSATION IS POSITIONED AT APPROXIMATELY THE 75TH PERCENTILE OF THE PEER GROUP WHEN MAXIMUM LEVEL INCENTIVES ARE PAID FOR ACHIEVEMENT OF MAXIMUM LEVEL OF PREDETERMINED OBJECTIVES AGREED UPON BY THE BOARD. -BENEFITS ARE POSITIONED AT THE 65TH PERCENTILE OF THE PEER GROUP. -ANNUALLY, TOTAL CASH COMPENSATION FOR EACH POSITION WILL NOT EXCEED THE BASE SALARY ESTABLISHED FOR THE PERIOD PLUS THE MAXIMUM INCENTIVE PERCENTAGE PAYOUT ALLOWABLE AS DETERMINED BY THE SCRIPPS MANAGEMENT INCENTIVE PLAN APPROVED BY THE BOARD OF TRUSTEES FOR THE RESPECTIVE POSITION. THE REPORT FROM THE EXTERNAL CONSULTANT ENGAGED TO REVIEW EXECUTIVE COMPENSATION IS PRESENTED TO THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ON AN ANNUAL BASIS AND THE MOST RECENT REPORT WAS REVIEWED ON DECEMBER 8, 2010. REVIEW AND DISCUSSION OF SUCH REPORT IS DOCUMENTED IN THE MINUTES. JOINT VENTURES FORM 990, PART VI, LINE 16 SCRIPPS HEALTH HAS MAINTAINED A LONG STANDING PRACTICE OF REVIEWING ALL POTENTIAL JOINT VENTURE OR SIMILAR ARRANGEMENTS TO ENSURE THAT CONTRACT TERMS ARE CONSISTENT WITH THE PROTECTION OF ITS TAX-EXEMPT STATUS. AVAILABILITY OF DOCUMENTS TO THE GENERAL PUBLIC FORM 990, PART VI, LINE 19 FINANCIAL STATEMENTS ARE POSTED QUARTERLY ON THE DAC (DIGITAL ASSURANCE CERTIFICATION) WEBSITE AND THE MUNICIPAL SECURITIES RULEMAKING BOARD'S (MSRB) ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE IN SATISFACTION OF CONTINUING DISCLOSURE REQUIREMENTS RELATING TO THE ORGANIZATION'S TAX-EXEMPT DEBT ISSUANCES. SCRIPPS HEALTH'S CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. MANAGEMENT COMPANIES/JOINT VENTURES SCHEDULE H, PART IV, COLUMN A & B 1. SCRIPPS ENCINITAS SURGERY CENTER JOINT VENTURE (JV) TO OPERATE AMBULATORY SURGERY CENTER 2. SCRIPPS MEMORIAL-XIMED MEDICAL JV TO OPERATE MEDICAL OFFICE BUILDING 3. SCRIPPS MERCY AMBULATORY SURGERY CENTER JV TO OPERATE AMBULATORY SURGERY CENTER TAX-EXEMPT BONDS FORM 990, SCHEDULE K, PART I, ISSUE PRICE BOND ISSUE B (2007A): THE STATED PAR OF $49,995,000 DIFFERS FROM THE $149,875,000 REPORTED ON THE 8038 TAX FORM AS THE $49,995,000 AMOUNT REPRESENTS ONLY SCRIPPS HEALTH'S PORTION IN A POOL BOND LOAN PROGRAM. FORM 990, SCHEDULE K, PART I, CUSIP NUMBER BOND ISSUE A (2005A/2008G): THE SERIES 2005A BONDS, CUSIP 13033FWK2, WERE EXCHANGED FOR THE CALIFORNIA HEALTH FACILITIES FINANCE AUTHORITY VARIABLE RATE REVENUE BONDS, SERIES 2008G, CUSIP 13033F5M8 (SCRIPPS HEALTH), ON AUGUST 14, 2008. FORM 990, SCHEDULE K, PART I, DESCRIPTION OF PURPOSE BOND ISSUE A (2005A/2008G): THE $40,975,000 (2008G) EXCHANGED THE 2005A BOND. THE ISSUE DATE FOR THE 2005A WAS 6/2/2005. THE PROCEEDS OF THE CALIFORNIA HEALTH FACILITIES FINANCE AUTHORITY VARIABLE RATE REVENUE BONDS, SERIES 2005A (SCRIPPS HEALTH), WERE ISSUED FOR THE PURPOSE, TOGETHER WITH OTHER AVAILABLE FUNDS, OF ADVANCE REFUNDING THE ORGANIZATION'S SERIES 1998C BONDS. THE SERIES 2005A BONDS, WERE EXCHANGED FOR THE CALIFORNIA HEALTH FACILITIES FINANCE AUTHORITY VARIABLE RATE REVENUE BONDS, SERIES 2008G (SCRIPPS HEALTH), ON AUGUST 14, 2008. BASED ON THE ADVICE OF BOND COUNSEL, THE ORGANIZATION IS TREATING THE SERIES 2008G BONDS AS THE SAME ISSUE AS THE SERIES 2005A BONDS FOR FEDERAL INCOME TAX PURPOSES. FURTHER INFORMATION REGARDING THE SERIES 2008G BONDS: ISSUER NAME: CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY; ISSUER EIN: 52-1643828; CUSIP #: 13033F5M8; DATE EXCHANGED: 8/14/2008; ISSUE PRICE: N/A; DESCRIPTION OF PURPOSE: EXCHANGE FOR SERIES 2005A BONDS (SAME ISSUE). BOND ISSUE B (2007A): POOL BOND. PROCEEDS USED FOR EQUIPMENT PURPOSES. BOND ISSUE C (2008A): REFUNDING OF PRIOR ISSUES 07/07/2005 BOND ISSUE D (2008B-F): THE $221,230,000 (2008B - F) REFUNDED THE 2005B - F BONDS. THE ISSUE DATE FOR THE 2005 B - F WAS 6/17/2005. BOND ISSUE E (2010A): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. BOND ISSUE F (2010B & C): PROCEEDS USED FOR CAPITAL EXPENDITURES FOR HEALTHCARE BUILDINGS, RENOVATION AND EQUIPMENT. FORM 990, SCHEDULE K, PART II, QUESTION 8 BOND ISSUE A (2005A/2008G): SUBSTANTIALLY COMPLETE PRIOR TO ISSUANCE BOND ISSUE C (2008A): SUBSTANTIALLY COMPLETE PRIOR TO ISSUANCE BOND ISSUE C (2008A): SUBSTANTIALLY COMPLETE PRIOR TO ISSUANCE FORM 990, SCHEDULE K, PART III, QUESTION 3C THE OBLIGOR'S LEGAL DEPARTMENT REVIEWS CONTRACTS AND AGREEMENTS TO ENSURE COMPLIANCE WITH PRIVATE BUSINESS USE REGULATIONS, ENGAGING OUTSIDE LEGAL COUNSEL, AS NECESSARY. FORM 990, SCHEDULE K, PART IV, ARBITRAGE, QUESTION 5 BOND ISSUE A (2005A/2008G): THE COST OF ISSUANCE WAS NOT EXPENDED UNTIL 1/4/2006. PER THE TAX CERTIFICATE IT WAS EXPECTED TO BE EXPENDED WITHIN 180 DAYS. BOND ISSUE B (2007A): AN AMOUNT IN THE COSTS OF ISSUANCE FUND NOT EXCEEDING $100,000 WAS NOT DISBURSED UNTIL MAY 2008. BUSINESS TRANSACTIONS WITH INTERESTED PERSONS FORM 990, SCHEDULE L, PART IV MARTIN DICKINSON IS ON THE BOARD OF H.G. FENTON COMPANY, INC., A REAL ESTATE COMPANY, FROM WHICH THE ORGANIZATION LEASES LAND AND BUILDINGS AND HAS ENTERED INTO A DEVELOPMENT AGREEMENT. MATTHEW BALOGH, SON-IN-LAW OF BOARD MEMBER GORDON R. CLARK, IS EMPLOYED BY SCRIPPS HEALTH. RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIPS FORM 990, SCHEDULE R, PART III SCRIPPS MERCY AMBULATORY SURGERY CENTER EIN: 45-0503246 4275 CAMPUS POINT COURT, SAN DIEGO, CA 92121 SCRIPPS ENCINITAS SURGERY CENTER EIN: 20-5942958 4275 CAMPUS POINT COURT, SAN DIEGO, CA 92121 TRANSACTIONS WITH RELATED ORGANIZATIONS FORM 990, SCHEDULE R, PART V, LINE 2 THE AMOUNTS IN SCHEDULE R, PART V, LINE 2 WERE DETERMINED USING THE ACCRUAL METHOD OF ACCOUNTING. SCRIPPS CARDIO&THORACIC SURGERY BILLING 4275 CAMPUS POINT COURT SAN DIEGO CA 92121 270602996 HLTHCR ADMIN CA 3716855 0 NA SCRIPPS CLINIC BILLING LLC 4275 CAMPUS POINT COURT SAN DIEGO CA 92121 870737749 HLTHCR ADMIN CA 755016567 0 NA SCRIPPS MERCY BILLING LLC 4275 CAMPUS POINT COURT SAN DIEGO CA 92121 870737748 HLTHCR ADMIN CA 75568490 0 NA THE WHITTIER INSTITUTE 9894 GENESEE AVENUE LA JOLLA CA 92037 953621314 RSRCH & EDU CA 501(C)(3) 4 NA SCRIPPS CLINICAL SCIENCE CENTER 4275 CAMPUS POINT COURT SAN DIEGO CA 92121 264479543 RESEARCH CA 501(C)(3) 4 NA MERCY HOSPITAL FOUNDATION 4275 CAMPUS POINT COURT SAN DIEGO CA 92121 942958094 FUNDRAISING CA 501(C)(3) 11, I NA SCRIPPS MERCY AMBULATORY SURGERY CENTER 4275 CAMPUS POINT COURT SAN DIEGO CA 92121 450503246 AMBUL. 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