Dr. Steven Corwin went into medicine to help people, focusing on cardiology because his mother’s father and his father’s father both suffered from heart disease.

“You have somebody in your family that has a disease, you want to help them,” he said. “Even though I couldn’t help my two grandparents, there are other people who have this type of problem who I can help. And I think that the knowledge you get gives you a sense of not being powerless.”

Corwin went to medical school at Northwestern and trained in cardiology and internal medicine at Columbia-Presbyterian Medical Center.

Over time, he took the administrative route, something he said he didn’t expect. He also didn’t expect to be appointed as Chief Executive Officer of NewYork-Presbyterian in 2011.

“But life has its twists and turns and so you never can quite know what’s going to happen,” he said. “It’s a busy but a very exciting job.”

Another unexpected turn was Hurricane Sandy’s effect in New York City. Corwin said NewYork-Presbyterian took in patients from neighboring institutions that had closed. Corwin said over 1,000 patients were staying the night, and that included NewYork-Presbyterian employees as well.

“We’re very proud of the way our hospital responded. Our employees wouldn’t leave because they were afraid that if they left they wouldn’t be able to get back to work,” he said. “It was very heartwarming to see the response from our employees and we felt that was part of what we had to do for our city, was be here.”

Corwin said he was hoping the flu season would be mild after the overwhelming surge of displaced patients that came in because of Sandy.

According to Corwin, NewYork-Presbyterian started seeing a lot of flu patients around Christmas time and that extended through the month of January to February.

“The flu epidemic this year was pretty pronounced,” he said. “We’re crossing our fingers now, we’ve seen it dissipate a little bit but it’s still pretty prevalent.”

As the CEO, Corwin said he misses the personal one-on-one time he had with patients when he was a doctor. However, he still gets the satisfaction of helping patients, on a larger scale.

Some of that includes community work in Washington Heights and Inwood where they have school-based clinics, community clinics, outreach to homes and free medical screenings. Corwin said buildings are going through renovations and they are looking at putting up new buildings.

Corwin also spends time sharing information across hospitals and handles policy questions on how to get better health care for New Yorkers. He also focuses on making sure NewYork-Presbyterian has a great staff and administration that delivers excellent care.

“There’s nothing that can replace the joy that you get when you’re taking care of individual patients and you’re making somebody better,” he said. “That being said the joy in doing this job is we can help the city.”

Corwin said he thinks the nation is going through a lot of controversy when it comes to expanding health care. Regardless, Corwin’s message to his 20,000 employees and the New Yorkers he sees is plain and simple.

“We’re going to be here, NewYork-Presbyterian is going to be here and we’re going to be the very best hospital and that’s something we’re not going to deviate from regardless of what the financial challenges may be at the state and the Washington level,” he said. “That’s what we’re here to do, give the best care to New Yorkers.”

Last week, Mayor Bloomberg announced that the Upper East Side will soon be home to a brand-new building housing a brand-new partnership of city institutions. Memorial Sloan-Kettering Cancer Center and the City University of New York’s Hunter College will be teaming up to construct a connected science facility on East 73rd Street, on what is now city-owned property. At this month’s Community Board 8 meeting, officials from both MSK and CUNY presented the project to the board for the first time, soliciting ongoing community input.

Iris Weinshall, CUNY’s vice chancellor of facilities planning, explained that the new facility will replace two buildings that currently house Hunter’s science programs, citing the master plan that CUNY developed for Hunter in 1999.

“The master plan found the current science facilities, both at Hunter’s main campus and their Brookdale campus, were outdated and inefficient, and would be costly to modernize due to the age of the buildings,” Weinshall said. She also noted that the Brookdale campus, located on East 25th Street and First Avenue, is disconnected from the other science and main buildings of Hunter, a problem that the new building will rectify.

“This new science building would replace obsolete labs and classrooms and be within walking distance from the main campus,” Weinshall said. Hunter’s portion of the facility, which will occupy about 40 percent of the western side of the building, will house space for nursing, physical therapy, chemistry, biology, psychology, physics and astronomy programs, with research labs and lecture halls.

The school will also benefit from the proximity to a top-notch cancer center. “Hunter’s nurses and researchers will have the opportunity to develop new collaborations and expand on existing ones with Memorial Sloan-Kettering, an institution with an inspiring and crucial mission,” Weinshall said.

John Gunn, executive vice president of Memorial Sloan-Kettering, said that the partnership will benefit the cancer center as well.

“A hospital like ours that uses leading edge technology in the treatment of cancer is more than simply the best physicians in the building,” Gunn said. “A quality hospital requires well-trained nurses, technicians, researchers and clinicians who are able to collaborate efficiently on behalf of their patients.”

The MSK facility will be an ambulatory outpatient care center that will aim to reduce the time cancer patients spend in the hospital. It will treat lung, head and neck and hematological (blood) cancers.

Todd Schliemann of Ennead Architects, which has designed the building in partnership with Perkins Eastman, presented the preliminary architectural plans to the board, showing how the building will be integrated into the block. The property is bounded by East 74th and 73rd streets to the north and south, and FDR Drive and York Avenue on the east and west.

“What we have tried to do is to break down the massing of the building into eight-story elements so that we can reduce its bulk, create enough setbacks along 74th and 73rd so that we can fit the building into the neighborhood,” Schliemann said. “We believe it’s an institutional building, so we have tried to give it a dignified and institutional character.”
The proposed building’s façade would be a combination of glass and masonry, and would include a number of outdoor terraces cut into the building. The CUNY side will be 16 stories above grade, including a covered penthouse for the rooftop mechanicals, and the MSK side will be 21 stories.

While this first presentation doesn’t merit a formal response from the Community Board, several members expressed their concern that the project will take traffic patterns and light and air for the neighborhood into account as it moves forward. The board will have a chance to make official comments and must approve the project’s forthcoming ULURP application, which is expected to come through sometime in 2013.

Photos Courtesy of Alissa Fleck

A number of groups and individuals met today in Foley Square to rally in support of SCOTUS upholding the Affordable Care Act (ACA). Health Care for All New York organized a “Rally to Respond” to the ruling, which was quickly retitled a “Rally to Celebrate,” announced Director Mark Hannay to the crowd. Hannay was among several speakers—doctors, advocates and elected officials—addressing the jubilant crowd of community supporters at the evening rally.

(by Alissa Fleck)

Hannay called the ruling a “milestone step forward in the history of justice,” pointing to the Declaration of Independence’s insistence on the right to life, liberty and the pursuit of happiness. Hannay said these rights cannot be met without affordable, accessible healthcare for all.

Hannay added SCOTUS making healthcare a right for all means America is finally moving toward other industrialized nations, though he said we are only “9/10ths of the way down the field” and must continue to politically support those who uphold affordable healthcare.

Other speakers laid out the main points of what the ruling would mean for Americans, and New Yorkers in particular, including a breakdown of what could be expected by 2014. State Assemblyman Richard Gottfried explained the ACA would help make health funding available for working families, encourage providers to communicate with one another and ensure senior citizens can afford necessary drugs among numerous other modifications. Preventive care will become more widely accessible, particularly pertinent to many women’s health issues.

Georgetown law student and women’s rights advocate Sandra Fluke took the stand to applaud the efforts of Americans who worked to support the SCOTUS decision as well as to remind crowd members the fight is not over.

“I don’t want to see ideologically-driven legislators work to repeal this decision so they can say they fought Obamacare,” said Fluke. “We want the implementation of the whole Affordable Health Care Act and we want it now.”

All the speakers agreed this decision, while important, is foundational and there are still hurdles from here, including building on decisions made in Washington to make laws in New York “even better” and make health care “a right, not a privilege.”

Speaker Quinn called what happened in Washington an “incredibly American act” and said the days of no options for many sick people and “whether you could get treatment [meaning] how big your paycheck was” are coming to an end.

“All have the right to get well, be well and stay well,” said Quinn. “Let’s make it even better.”

Traver Hutchins

NYC is finally seeing urgent care centers for times when your life’s not in danger

By Traver Hutchins
It’s long been known that the East Coast represents the epicenter of medical academia. What’s lesser known, however, is that innovation in health care almost always travels from the West Coast to the East. The recent crush of urgent care organizations hitting the greater New York area are arriving a full 10 years after they first gained popularity out West.

“Urgent Care” is defined as all care other than emergent. In other words, a patient can be seen in an urgent care facility for almost any condition other than the truly life-threatening ones. Recent entrants into the greater New York City area include City MD and Med Excel, to name a few.

The rise of urgent care has paralleled both the rise of the utilization of health care and the concurrent drop in the number of doctors to meet the growing demand. As a result, when you suddenly have a health issue and try to see your doctor immediately, you will often find that they can’t see you in a timely fashion. Before, your main alternative was to go to the emergency room.

The East Coast sees more visits to the ER per capita than anywhere else in the country. As a population, we have grown accustomed to the four-hour waits, the uncomfortable environment and the pricy service that sums up the ER experience. Not surprisingly, there are fewer urgent care facilities on the East Coast per capita, as well.

Only a small percentage of the cases that are presented at the ER are life-threatening, which is what it is geared toward. That poor service is a result of all the non-emergency cases who didn’t realize they had an alternative.
That’s about to change.

Today, there are over 9,000 urgent care facilities, and they are growing by over 5 percent per year. Compare that to in-pharmacy clinics, which handle minor health issues such as flu shots, etc, of which there are only 1,000 locations and virtually no growth over the past decade. There are now 15 urgent care chains backed by institutional funds rolling out their brands in their region of influence but there is as of yet no national player, nor is there a significant player in the Northeast.

How will the change happen?

While the rest of the country knows what urgent care is, Easterners generally do not. There is a new educational campaign underway by the Urgent Care Association of America designed to raise awareness and make people comfortable with the idea that you can see a medical practitioner right away at a reasonable cost and with a quality outcome. Once experienced, that trifecta of benefit will rapidly migrate the patient flow from the ER to the urgent care clinic, as it has in the rest of the country.

From a cost perspective, any time a health issue can be handled by a lower-cost provider with the same level of outcome, the service should be done by that lower-cost provider. While this is disruptive to the general hospital model still so prevalent in the Northeast, this change is unstoppable and ultimately benefits both our health care system and the individual.

The average cost for an ER visit is $600, and the patient’s average co-pay is $100. Compare that to $130 for an urgent care visit with a $30 co-pay on average for the very same case. Not surprisingly, insurers are now heavily educating their Eastern insureds on this new class of care option that has long been in fashion out West.

So the next time a health issue arises and your doctor isn’t available, do yourself (and your wallet) a favor: go to an urgent care facility. You will wonder why you didn’t do it sooner.

Traver Hutchins is the chairman and founder of Remedy Health Media. He is also the CEO and founder of ASAP Urgent Care, which is focused on bringing urgent care to New England.

Many older people live alone and do not have a close family member or friend living nearby who can help them if they become ill and unable to do all the tasks necessary to maintain their lives at home. They or a family member will sometimes employ a geriatric care manager.

A geriatric care manager can perform a range of needed tasks, such as helping with paying bills; planning for medical care and ensuring that a client goes to doctor’s appointments; working with doctors, nurses and social workers at hospitals and rehabilitation centers to ensure that a client receives the best possible medical care; arranging for and supervising home care aides; and working with a client to maintain his or her quality of life.

For example, a professional colleague referred me to Ms. D, who lives alone. She had been a professor until she was diagnosed with Alzheimer’s disease.

The first time I met her, she told me that she had been having increasing trouble remembering how to pay her bills. Sometimes she got disoriented on the subway, even when going to a familiar place, and panicked when she realized she did not know where she was. She needed help logging on to check her email. She did not remember how to tell the time from a digital clock. She did not know how to retrieve messages from her answering machine. She was overwhelmed, uncertain and close to despair.

Since that first meeting, I have met with her in her home for two hours a week. As I help her go through her mail, pay bills, check her email and do other tasks, I repeatedly confirm what she can do. She is a witty conversationalist. She has become active in the senior center and is going to be teaching a writing class there. She maintains close friendships.

By the second or third meeting, she had become more confident. She has stopped getting lost or panicked on the subway. She continues to have difficulties with other tasks, but, as I help her with them, her lack of ability rarely overwhelms her. She is enjoying her time at the senior center and conversations with friends.

This case illustrates a principle in working with someone suffering with dementia: Help with the specific tasks with which she is having difficulty, but repeatedly and consistently confirm her remaining abilities and help her find others who will appreciate what she knows and can do.

Roy Herndon Smith, Ph.D., is with Community Geriatric Care (communitygeriatriccare@gmail.com), a subsidiary of Foremost Home Care.

By Laura Shin

Carmelita Blake is a clinical associate professor of health care management and the coordinator of health administration and health care management at NYU’s School of Continuing and Professional Studies. She spoke with Manhattan Media about education.

What is health administration and health care management? What types of jobs do these programs lead to?
Depending on their area of interest, students have a choice between community health, health advocacy or long-term care. For those students interested in long-term care, the areas where they would seek employment are nursing homes, assisted living facilities or there are some day-care programs for older adults. It could be a program that focuses on specific diseases, like Alzheimer’s, or people with other forms of dementia.

For those students with a concentration in community health or health advocacy, those students usually get positions in hospitals or diagnostic centers or freestanding, community-based ambulatory centers. And then there are students who will get positions in hospitals, in a variety of departments. These could include patient relations that some hospitals refer to as customer service—they have different names. Some students get jobs in ambulatory care in a hospital-based setting. They are employed in many departments where they work as an assistant to other higher-level managers that manage areas like clinical services. And then we have some students who obtain positions at the YAI, the Young Adult Institute, where they provide services for individuals for a variety of disabilities, or the Cancer Society or American Heart Association.

What degrees are offered?
There is an associate’s program as well as a bachelor’s program. For the associate’s program, students are required to take fewer credits and they don’t have the breadth of courses that are offered for the baccalaureate degree. Those students, depending on their prior experience, can also get jobs in a variety of settings. Most of our students have some experience in health care. There are few that don’t. For some, it’s a career change.

How does someone become a student?
For those individuals who are career changers, we do have students who previously attended college but didn’t get a degree and we have a lot of those students who come back, and then we have students in addition to that, who can apply for what we call “life experience credits” and they attend a seminar and write a portfolio. If they have life experience that we can somehow match with a course that they’d be required to take, they would write the portfolio and upon acceptance of the portfolio they would get the credits for a specific course or courses.

Does a student have to have experience in health care in order to obtain the life experience credits?
Not necessarily. Let’s say we get somebody who worked in human resources, and they are required to take a human resources course, so even though it may not have been in health care, they could petition to write a portfolio. Let’s take a person who worked in any industry, where they did customer service management—they could petition for the customer service in health care course. If we’ve got someone who has been working in accounting or financial management, and they can demonstrate to us that they have the skills that are necessary, they can write a portfolio for that.

Who are your current students?
Our age demographic has changed. We’re getting younger people in their twenties and thirties. The predominant age range is between 30 and 40, but we do have quite a few students now who are in their twenties.

Why is this a good option for someone changing careers?
According to the Bureau of Labor Statistics, health care is one of the areas where there will be growth. And as the Affordable Care Act gets implemented, it will grow. We have students who work in finance in a variety of settings in health care and we also have some students who are into computers; one of the areas that the Affordable Care Act is actually going to increase numbers in is information systems management, and our students do take a computer course. One of the reasons we say our degree can really help, is that students who have experience in information systems management are very marketable in the health care industry right now.

How do you help students find jobs?
We have a career services office, but they don’t really help students find a job. They help students with what I call “starting the process”: They’ll help them write a résumé, they’ll teach them interview skills and they do have career fairs for students. We do have a board online where they post whatever positions are sent in to the university.

How long does it take to complete the degrees?
It varies. For students who transfer with prior college credits and for those students who are eligible and do have the life experience credits, it varies. So some people come, they complete in two years, based on what they came with and what they’re able to get. Some students have finished within three years. Some students need four or five. The average is three to four, because many come with college credits. For those who don’t, many are able to get prior learning experience credits.

What else would you tell prospective students about the program?
Well, we are very student-centered—we offer all types of academic support for those students who have not been attending college for a while, and we do have advisers available to meet with individuals who are interested in applying.

When health lifestyle emporium Thérapie New York shut down its pharmacy department last month, customers’ prescriptions were sold to a Duane Reade branch a block away.

Some regulars were incensed while others were merely miffed or confused.

Was this a violation of privacy? An inconvenience?

According to state regulations, the transfer was simply protocol: pharmacies that are shutting down can sell patient information as long as they tell patients such a transfer has occurred.But there are customers who say they would prefer notification before the transfer is made. Some even believed the transfer of records violated a privacy law. The common denominator seemed to be that no one knew exactly what a pharmacy was required—or ought—to do upon closing. More confusion is likely as independent pharmacies continue to struggle and close due to low reimbursement rates and competition from large chain stores.

From January 2008 to February 2010, 44 pharmacies—many independently-owned—closed in Manhattan, five on the West Side, according to a list compiled by the Society of Pharmacists for the State of New York. However, some may have reopened under different management.

When stores close, big chains often get the prescription information. Since 2008, only one West Side pharmacy, on Columbus Avenue between West 104th and 105th streets, transferred prescriptions to another independent store after closing.

Thérapie, at 309 Columbus Ave. between West 74th and West 75th streets, sent letters to its customers notifying them about the transfer to Duane Reade, at 325 Columbus Ave.

A Thérapie customer, John Mainieri said he started to go to the pharmacy after experiencing unsatisfactory service at Duane Reade. Three days after a Thérapie employee told him that the pharmacy was closing, he received a letter informing him that Duane Reade would be holding his prescriptions.

“If I wanted to go back to Duane Reade, I’d do it myself,” Mainieri said.

But Thérapie was following regulations set by the state’s Education Department Board of Pharmacy.

“I just assumed it was against the law because they were shipping private information without knowledge or without consent,” Mainieri said.

Selling or transferring records to another pharmacy is actually meant to benefit consumers so they can seamlessly continue getting medication and to prevent someone who is not a pharmacist from getting their information.

“[The law] requires that all prescription records be maintained in one location, known to this agency, for at least five years,” Jonathan Burman, spokesperson for the state Department of Education, wrote in an email.

Thérapie echoed that statement, explaining that by selling the information, they were merely following state requirements.

“By law, the New York State pharmacy board, we are required to [transfer prescriptions] because we are a closing pharmacy,” said Dionisio Lee, a partner at Thérapie. “We have to transfer all the prescription records to the nearest pharmacy. It has to go somewhere. If those prescriptions are not in a pharmacy and you have a reaction or need a refill and you don’t know where your scripts are and can’t get it, you can suffer a major health crisis.”

Industry groups say that prescriptions contain personal information that needs to be held in a regulated establishment. If left dormant, that information could be lost, stolen or misplaced.

“The state board, in order to protect the patient, allows those prescriptions to be transferred to another location. It has to be retrievable,” said Charles Catalano, president of the New York City Pharmacists Society. “Say I close my door tomorrow and someone breaks into the pharmacy and steals patient records.”

The notification process for telling consumers that their information is being transferred, however, is minimal.
“Basically, notification is a sign in the window,” Catalano said.

Other customers at Thérapie were similarly confused by the notice. Rachel Dean, now a Duane Reade customer, courtesy of the prescription transfer, felt the notification was backwards.

“They were able to [send out the letter] after the fact,” she said. “It would have been nice to do it before the fact.”
Some pharmacy customers, however, noted that the transfer allowed prescriptions to be picked up from another location immediately after a store closes.

Outside of Joseph Pharmacy, on West 72nd Street and Broadway, Carole Berk, felt that transferring prescriptions would be a convenience.

“It might be good for people to know where to pick up your antihistamine,” she said.

But Richard Lubarsky thinks the notification process needs to be enhanced. Lubarsky, an attorney, represented a New York City man with AIDS who sued CVS and his former pharmacy in 1999 for selling his prescription when the owner retired. The suit was the first of its kind in the country, Lubarsky said. There was a settlement in 2005, and the judge decided that the independent pharmacy had a responsibility to inform its customers of the transfer.

“Consumers should be given notice and the opportunity to decide where their information could go,” Lubarsky said. “But the customer can’t even make that decision unless they know in advance.”

Confusion over prescription transfers could become a recurring issue for Upper West Side pharmacy customers, as these are lean times for independent establishments. Unlike big chains with large front-ends that sell food and other merchandise, these establishments’ main source of revenue is prescriptions. And the state has cut Medicaid reimbursement rates.

“It has severely weakened them, made them financially fragile,” said Craig Burridge, executive director of the Pharmacists Society of New York State. “This is not healthy for the state. [Independent pharmacists are] hoping for relief from the Legislature.”

Lee, the partner at Thérapie, said the store’s pharmacy department was losing $200,000 a year. Insurance companies and state prescription reimbursements barely covered the cost of filling the script.

“Sometime you have to cut the loss,” Lee said. “We are dictated not by the market rate [that prescriptions] will pay, but what the state will pay and what the insurance companies will pay.”

Ricky Pisapia, who has owned Joseph Pharmacy for 10 years, also feels the pinch. His gripe was insurance companies forcing customers to take a 90-day supply sent through the mail, instead of ordering from their local pharmacy on a monthly basis. But Pisapia and other independent pharmacy owners say they do have a leg up on chain drug stores when it comes to personalized service, which helps them retain customers. He sends his pharmacists to senior centers and has a delivery service.

“We have a one-on-one relationship with customers,” Pisapia said. “We know them by name and they like that.” 

“It’s a fundamentally conservative bill,” Nadler said to his constituents at the April 6 Community Board 7 meeting. “But from the rhetoric today, it’s a left wing, government takeover. I wish it were in some ways.”

Nadler, a prominent House liberal and supporter of a single-payer health care system, lamented some of the bill’s provisions, such as the strict anti-abortion rights language (which he said tempted him to vote against it) and the lack of a public option, the government-run health care program that will compete with private insurers.

“We didn’t get it in the end because the president didn’t support it,” Nadler said.

Nadler spoke about fighting against other provisions included in health care reform, such as the “Cadillac” tax on high-cost insurance plans. He told the crowd that he opposed the tax that is going into effect in 2018, and that Congress has eight years to repeal it.

But after explaining his gripes and criticisms, he dove into the details of reform: how people will be covered, how the plan is financed and how it will affect businesses.

Regarding benefits, Nadler said he was pleased that coverage will no longer be dropped for pre-existing conditions, and that women will not be charged higher premiums for insurance.

“We’re solving a lot of the problems,” he said.

Despite his misgivings about the bill, the most important aspect of reform is that it “saves 40,000 lives a year.”

“How can you vote against it?” Nadler asked. “Everything else is secondary.”

“And medicine does too little about improving balance, which erodes with the years,” says Boomer Nancy Adlfinger, whose ankle was broken in a fall. She is also “so grateful that now I know what my husband suffers with his disability.” Empathy—and how when to know it’s deficient, is the real shortcoming to be overcome.

It’s good to know that Sal has a supportive friend to help him in the recovery process. Far more should be said about why so many don’t in this go-it-alone society, even with all the technology that supposedly connects some, but not all. Sal also has offspring about whom my informer knew little because we parents of adults aren’t asked about these most significant others.

And yet as the late patriarch Joseph Kennedy strongly maintained, “The greatest Kennedy asset is our closely connected interdependent extended family.” And yes, you’ve heard that here in myriad ways before, but until it takes hold, to quote Dr. Samuel Johnson, “We need as much to be reminded as informed.”

And with the enormous outpouring of tributes to Sen. Ted Kennedy, let’s not forget his also greatly missed sister, Eunice Kennedy Shriver, and her “labeling people” concern. “No more saying, ‘the disabled,’ but rather, ‘persons with such and such a disability,’” insisted this foremost champion of persons with any and all disabilities. She might also prefer “a person who is alcohol-dependent,” rather than “an alcoholic.” Sadly, this dependence did not spare the Kennedys and intervention is still too little considered.

If ever preventative medicine and treatments were needed, it’s for alcohol dependence, which unlike widely “addressed” smoking and obesity problems, so adversely—even criminally—affects behavior. Ah, and not for Catholics only surely, is Recovery Sunday, Sept. 13, “the 11th annual Day of Prayer in all the New York Archdiocese parishes for those struggling with and in recovery from addictive illnesses (www.recoveryweekend.org). Other faiths take note! (To be continued.)

And the life/limb/health-saving endeavor called CARR (Coalition against Rogue Riders) needs all the help possible to fight City Hall brass, so blinded by its love of two-wheeling that it can’t see how these silent wheelers’ wholesale aversion to the laws of the road endangers other travelers in this high-density city.

Ah, how incredibly blessed to have safe and convenient public transit—preventative medicine of the very first kind. Except, must say it—again, and for however long it takes—the articulated bus’ interior noise and lack of temperature control (in all city buses) are unhealthy, uncomfortable and energy-wasteful. So please, help, and get mad as hell, o-o-ps, the dickens, and tell 311, “These very real, everyday health blights just have to go!” And while you are telling…
–
dewingbetter@aol.com

Ruth A. Unterberg
York Avenue

Letters have been edited for clarity, style and brevity.