Responses​ ​to​ ​ProPublica​ ​Questions​ ​from​ ​Robert​ ​de​ ​Luna,​ ​a​ ​spokesperson​ ​for​ ​the​ ​NYC
Health​ ​+​ ​Hospitals​ ​Corporation,​ ​December​ ​18,​ ​2017:
1)
NYC​ ​Health​ ​+​ ​Hospitals/Kings​ ​County​ ​does​ ​use​ ​the​ ​venous​ ​thromboembolism​ ​bundle.
Since​ ​pregnancy​ ​itself​ ​is​ ​a​ ​risk​ ​factor​ ​for​ ​thromboembolism,​ ​all​ ​patients​ ​undergoing​ ​cesarean
delivery​ ​are​ ​placed​ ​on​ ​thromboprophylaxis.​ ​This​ ​may​ ​take​ ​the​ ​form​ ​of​ ​sequential​ ​compression
devises​ ​placed​ ​on​ ​the​ ​lower​ ​extremities​ ​or​ ​chemoprophylaxis.​ ​Chemoprophylaxis​ ​is​ ​frequently
used​ ​in​ ​conjunction​ ​with​ ​SCDs.
2)
NYC​ ​Health​ ​+​ ​Hospitals/Kings​ ​County​ ​is​ ​a​ ​Level​ ​I​ ​trauma​ ​center​ ​and​ ​a​ ​referral​ ​center​ ​for
patients​ ​from​ ​all​ ​over​ ​NYC.​ ​Some​ ​of​ ​our​ ​patients​ ​come​ ​from​ ​all​ ​over​ ​the​ ​world​ ​(self-referred),​ ​a
good​ ​number​ ​coming​ ​to​ ​us​ ​too​ ​late​ ​to​ ​benefit​ ​from​ ​our​ ​pre-natal​ ​care​ ​services.​ ​Patients​ ​may
hemorrhage​ ​for​ ​a​ ​variety​ ​of​ ​reasons​ ​including​ ​abruption,​ ​placental​ ​abnormalities,​ ​fibroids,
hypertensive​ ​disorders​ ​of​ ​pregnancy,​ ​etc.​ ​Hemorrhage​ ​in​ ​itself​ ​is​ ​a​ ​proxy​ ​indicator​ ​of​ ​morbidity,
but​ ​the​ ​real​ ​assessment​ ​of​ ​quality​ ​is​ ​how​ ​early​ ​a​ ​hemorrhage​ ​is​ ​recognized​ ​and​ ​responded​ ​to,
so​ ​as​ ​not​ ​to​ ​lead​ ​to​ ​maternal​ ​death​ ​or​ ​permanent​ ​disability.​ ​The​ ​team​ ​at​ ​NYC​ ​Health​ ​+
Hospitals/Kings​ ​County​ ​has​ ​been​ ​trained​ ​to​ ​recognize​ ​hemorrhage​ ​early​ ​and​ ​treat—so​ ​as​ ​to
save​ ​lives.​ ​The​ ​OB-GYN​ ​service​ ​has​ ​been​ ​proud​ ​to​ ​partner​ ​with​ ​the​ ​blood​ ​bank​ ​and​ ​trauma
service​ ​to​ ​deliver​ ​world-class​ ​care​ ​to​ ​our​ ​high-risk​ ​patient​ ​population.​ ​We​ ​have​ ​saved​ ​lives​ ​with
our​ ​response​ ​to​ ​maternal​ ​hemorrhage.
All​ ​patients​ ​are​ ​assessed​ ​for​ ​hemorrhage​ ​risk.​ ​Cross-matched​ ​blood​ ​is​ ​ordered​ ​for​ ​patients​ ​who
are​ ​at​ ​moderate​ ​or​ ​high​ ​risk​ ​for​ ​hemorrhage.​ ​A​ ​hemorrhage​ ​cart​ ​is​ ​available​ ​on​ ​the​ ​unit.
Simulation​ ​has​ ​been​ ​used​ ​to​ ​train​ ​our​ ​doctors,​ ​nurses,​ ​and​ ​midwives​ ​in​ ​hemorrhage​ ​response.
OB,​ ​Trauma​ ​and​ ​the​ ​ED​ ​use​ ​the​ ​Massive​ ​Transfusion​ ​Protocol​ ​to​ ​deliver​ ​blood​ ​quickly​ ​in​ ​case
of​ ​hemorrhage.​ ​In​ ​case​ ​of​ ​emergency,​ ​four​ ​units​ ​of​ ​un-cross-matched​ ​blood​ ​are​ ​always
available​ ​on​ ​the​ ​unit,​ ​and​ ​the​ ​blood​ ​bank​ ​stores​ ​thawed​ ​FFP.​ ​The​ ​provider​ ​staff​ ​has​ ​been
trained​ ​on​ ​all​ ​of​ ​the​ ​elements​ ​of​ ​the​ ​hemorrhage​ ​bundle.​ ​Hemorrhage​ ​cases​ ​are​ ​reviewed​ ​for
opportunities​ ​for​ ​improvement.​ ​Our​ ​department​ ​is​ ​participating​ ​in​ ​the
NYSDOH/ACOG/GNYHA/HANYS​ ​Hemorrhage​ ​Project.​ ​It​ ​should​ ​be​ ​noted,​ ​NYC​ ​Health​ ​+
Hospitals​ ​continues​ ​to​ ​be​ ​the​ ​only​ ​health​ ​system​ ​or​ ​hospital​ ​in​ ​New​ ​York​ ​State​ ​identified​ ​by​ ​the
American​ ​Congress​ ​of​ ​Obstetricians​ ​and​ ​Gynecologists​ ​(District​ ​II)​ ​as​ ​a​ ​collaborator​ ​on​ ​the​ ​Safe
Motherhood​ ​Initiative​ ​guidelines.