From the editor

SECOND OPINION
BY SIDNEY HARRIS

Well-rested residents make fewer mistakes

“Recreating the Residency” by Peter Farley [Fall/Winter 2004] contains a large amount of palaver garnered from secondary sources. The grand jury found insufficient evidence to return an indictment of murder against the attending physician. Instead they indicted the system of graduate medical education.

Ms. Zion did not die from an overdose of cocaine. She died from hyperpyrexia—her last recorded temperature was 108 degrees.

The Accreditation Council for Graduate Medical Education rules governing residents’ work hours are based on New York state regulations enacted in 1989. Yale will find, as have many programs in New York state, that eliminating sleep deprivation and chronic fatigue will improve the physical and mental health of young doctors and reduce medical errors in patient care.

Bertrand M. Bell, M.D., Distinguished University Professor, Professor of Medicine, Albert Einstein College of Medicine of Yeshiva University

The writer was chair of the commission now known as the Bell Commission, formed by New York state health commissioner David Axelrod, M.D., after Libby Zion’s death to investigate issues surrounding patient care and the training of physicians in New York hospitals.

The cause of Libby Zion’s death remains a subject of debate, and indeed, no consensus emerged among investigating agencies as to what went wrong. A jury in a civil trial split the blame for her death between Cornell Medical Center’s New York Hospital and Zion herself. An autopsy found traces of cocaine in her nasal passages, but subsequent tests turned out negative. A grand jury blamed the death on inadequate care and numerous mistakes, including a mishandled diagnosis, made by unsupervised interns and residents. —Eds.

Zaccagnino to retire as CEO of YNHH

As this issue of Yale Medicine was being prepared, Joseph A. Zaccagnino, M.P.H. ’70, president and CEO of Yale-New Haven Hospital (YNHH) and the Yale New Haven Health System since 1991, announced his retirement after 35 years at the hospital. He will retire effective September 30.

“My decision to retire was not an easy one, but it was made with the recognition that as time passes, the opportunities for new experiences and challenges as well as the flexibility to spend more time with family cannot be deferred indefinitely,” Zaccagnino said in a statement at the end of May. “I plan to continue to actively serve in the health care sector as an advisor to senior management and governing boards, by lecturing at the graduate level more frequently than has been possible recently and by serving on additional corporate boards.”

Zaccagnino began working at the hospital in 1970 under the mentorship of John D. Thompson, R.N., M.S., professor and director of the Program in Hospital Administration at the School of Public Health. By 1978, when he was 32, Zaccagnino had become executive vice president and chief operating officer of YNHH.

Over the next 27 years, under Zaccagnino’s leadership, the medical school’s primary teaching hospital grew into a health care system that operates three hospitals in Connecticut, has annual revenues of $1.5 billion, has 1,500 acute care beds and serves one out of every five hospitalized patients in the state. At YNHH Zaccagnino also oversaw construction of the Children’s Hospital and the renovation of adult patient care areas.

A search committee representing both the hospital and the health system is already at work seeking a successor, and a new CEO is expected to be named this summer.

In late July, Marna Borgstrom, M.P.H. '79, was named his successor. See news release.

From the editor:

Small answers to big questions

They say an ounce of prevention is worth a pound of cure, but changing unhealthy behaviors is not always a simple matter—as anyone who has tried to stop smoking or lose weight can tell you. It’s that much more complicated when the goal is encouraging healthy choices for an entire community. The public health work of the Yale-Griffin Prevention Research Center, described by Jennifer Kaylin in this issue’s cover story (“Promoting Health, From the Ground Up”), is even more ambitious in that its goal is to help not just one community but a half-dozen New Haven-area towns. When you consider that Yale-Griffin is one of 28 such centers across the United States, you get a true idea of the scale and scope of the undertaking.

Nonetheless, the guiding principles of the projects are that the solutions to some national public health challenges are local, rather than global or grandiose, and that people will solve their own problems when aided by solid information derived from careful research. The community-academic partnership has already produced results: close to half the suburban high school students enrolled in the center’s smoking cessation program quit cigarettes, and in New Haven a dozen churches have educated their parishioners about diabetes prevention through a partnership with Yale-Griffin.

The other feature article this summer (“The Silent Scourge of Development”) looks at a public health crisis in Africa that evolved predictably but without restraint over several decades and has affected hundreds of thousands of people. Here, too, the prevention of disease—in this case schistosomiasis spread by freshwater snails in the Senegal River—was a key goal championed by Yale researchers hired in the 1970s to evaluate the public health impact of dam construction. Unfortunately, their recommendations were ignored. Kohar Jones, M.D. ’05, who wrote her medical school thesis on this topic after several trips to Senegal, does a skillful job of describing the economic and cultural backdrop to the crisis and telling a story that connects several generations of Yale scholars.

On a sad note, we received the news that the former managing editor of Yale Medicine, Marjorie B. Noyes, died on May 7. A 1953 graduate of the School of Art and Architecture, Noyes kept the magazine on the mark and on schedule from 1971 to 1986, according to former Editor and Deputy Dean Arthur Ebbert Jr., M.D., now a professor emeritus of medicine. “She was a very careful, very meticulous editor,” says Ebbert. “We would discuss what we wanted to put in each issue, and then she made sure it all got done.” Noyes’ history of New Haven industry, co-edited with Preston Maynard, was published in January. This issue of Yale Medicine is dedicated to her memory.

Michael Fitzsousa
michael.fitzsousa@yale.edu