Welcome to the onlineedition of Scripps 2009Annual Report!This version of our standard print edition includes some very special bonus video. As you turn to each of our patient features, our photos of physicians, sta� and patients will come to life to tell you the story of the care they provided and received.

Videos make up the second sections of our patient features and will start automatically within 5-10 seconds of turning to those pages. The � rst one begins on pages 8-9.

We hope you � nd this version of our annual report to be inter-active, interesting and informative. These are just some of the remarkable experiences lived every day at Scripps; the stories that inspire us and our patients to even better things.

Through their stories, we hope you’ll learn a lot about Scripps Health and what we do to improve the health of our patients and our greater community.

To move back and forth through this online edition, simply click on the page curl marks in the book’s upper and lower corners, or use the tools at the top of the screen.

Happy reading!

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2 0 0 9 A N N U A L R E P O R T

healing stories

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Mission 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, socially responsible health care services.

We advance clinical research, community 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.

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On the cover: Neurosurgeon Scott Leary

and nurse practitioner Peter Schultz perform

emergency spinal surgery (see page 10).

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VisionScripps Health will continue to be the leading health care delivery system in the greater San Diego community,

as evidenced by the highest clinical quality, patient safety, and patient, physician and employee satisfaction.

This will be achieved through unending focus on patient-centered and compassionate care, cost-effective

operations, research, advanced technology and innovation.

ValuesWe provide the highest quality of service

Scripps is committed to putting the patient first and quality is our passion. In the new world of health care,

we want to anticipate the causes of illness and encourage healthy behavior for all who rely on us for service.

We teach and encourage patients to participate in their care and to make well-informed decisions. We will be

their advocate when they are most vulnerable. We measure our success by our patients’ satisfaction, their return

to health and well-being, and our compassionate care for dying patients, their families and friends.

We demonstrate complete respect for the rights of every individual

Scripps honors the dignity of all persons, and we show this by our actions toward one another and those

we serve. We embrace the diversity that allows us to draw on the talents of one another. We respect and honor

the cultural, ethnic and religious beliefs and practices of our patients in a manner consistent with the highest

standards of care. All this is done in a compassionate setting. Our goal is to create a healing environment in

partnership with all caregivers who are committed to serving our patients.

We care for our patients every day in a responsible and efficient manner

Scripps serves as a major community health care resource for San Diego County and, as such, we are accountable

for the human, financial and ecological resources entrusted to our care as we promote healing and wholeness.

We begin from a base of excellence and collaborate with co-workers, physicians, patients, and other providers

to find new and creative ways to improve the delivery of health care services. All members of our community

will have access to timely, affordable and appropriate care.

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One of the things I like most about being the CEO of Scripps Health is the ability to spend some time “on the front lines.”

That’s where I’m able to meet some of our patients and their families.

And I’m able to speak with some of our amazing doctors and staff.

Whether I’m visiting a patient floor in one of our hospitals, a recovery room

in one of our outpatient surgery centers, or one of our many patient support

offices, I am always inspired.

The stories I hear are remarkable. Some could be called miracles. Some speak to the

marvels of medical innovation. And others tell of courage, strength, compassion and

trust – of a human connection that is far from tangible but is the underlying reason

why most of us in health care do what we do.

At Scripps, we’re proud to have nearly 18,000 physicians, employees and volunteers

who together bring health care each year to more than half a million patients and

their families. I can tell you without a doubt that every one of them has a story to tell.

So in this annual report, I’ve asked our staff to share with you just some of the stories

that have been shared with me. I hope they serve as a reminder that, despite the

challenges we face in health care, there is good news.

Every day, we continue to care for one person, one patient, one family at a time –

and in their stories, we all can find our inspiration.

Chris Van Gorder, FACHE

President and CEO

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6 Dr. Giuseppe Ammirati

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The stroke had taken its toll on Claire Cordua.She had no movement on her left side, and the stroke medication didn’t seem to be helping.

At only 17 years old, it was strange that

Claire was even having a stroke. She was

driving to the beach when it happened. Her

voice began to slur and she lost control of

her body and her car. Her boyfriend got them

safely to the side of the road and called 9-1-1.

Paramedics were there in minutes, and in less

than an hour Claire was being cared for by a

Scripps’ trauma team.

A stroke is caused by a blood clot in the brain.

Treatment usually depends on medications

meant to break-up the clot and allow

blood to flow freely again. That used to

be the only hope, but now there are new

approaches – which is why a call was

made to Dr. Giuseppe Ammirati.

A neurointerventional radiologist,

Dr. Ammirati was to begin his new job at

Scripps on Monday. He had only been at the

hospital that Friday to get his ID badge and

was on his way home when the call came.

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Claire Cordua

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“They said Claire wasn’t responding to

other stroke treatments, so I turned my

car around,” says Dr. Ammirati. “Based

on where the clot was located in her brain

and how soon we were able to respond,

I thought we would be able to help before

the stroke did permanent damage.”

Dr. Ammirati performed a state-of-the-art

intra-arterial thrombolysis and mechanical

thrombectomy. Using X-ray guidance, he

inserted a catheter through a small incision

at the groin and advanced it through the

femoral artery all the way to the tiny

arteries in Claire’s brain. Once there,

he applied a clot-busting drug and

broke up the clot mechanically – piece

by piece – until it was gone.

Incredibly, Claire’s feeling began to return

just hours later and she’s now made a

full recovery. A college freshman, she’s

attending school on a volleyball scholarship

and with a whole new outlook on life.

“My life has new meaning now,” she says.

“I really appreciate every day I’m given.”

When Claire’s family arrived at the hospital, she was

completely paralyzed on her left side. Just hours after

her neurointerventional procedure, she was able to

start moving again. “It was both the worst and the

best day of my life,” says her father, Chris.

Just six months after her battle with a stroke,

17-year-old Claire Cordua is playing on the

beach again and attending college on a

volleyball scholarship.

Chris Cordua

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“ The original plan was for me

to start working at Scripps on

Monday. But on Friday I got

a call about a 17-year-old

girl who had suffered a stroke.”

Dr. Giuseppe Ammirati, Interventional Neuroradiologist

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In an intra-arterial thrombolysis

and mechanical thrombectomy,

a catheter is inserted at the groin and

advanced through the femoral artery all

the way to the brain, where the clot is

broken-up piece by piece.

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It was only a year ago that John Miksa was paralyzed from the neck down.How he got from where he was then to where he is today

is a story of medicine, miracles and mending.

Dr. Scott Leary

Dr. Scott Leary, Neurosurgeon and Peter Schultz, NP

On a sunny San Diego afternoon, the

55-year-old fitness enthusiast was headed

out for a 22-mile bike ride along the Pacific

Coast. Struck head-on by a car turning into

his lane, the impact hurled him into the air

and then onto his back, causing considerable

trauma to his C-5 and C-6 vertebrae. John

remembers the feeling slowly leaving his

body like “the lifting of a tarp.”

Five hours later, neurosurgeon Scott Leary

had John in emergency surgery.

“The trauma to his spinal cord was

devastating,” says Dr. Leary. “He was

in spinal shock and he had a massive

herniated disk. But when we pulled

the disk off the spinal cord, you could

immediately see normal pulsations,

and I knew he might have a chance.”

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11John and Sheri Miksa 11

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Two weeks after arriving in rehab on a

stretcher, John walked out of the hospital

on his own two feet. Though he still needs

regular physical therapy, he’s back to his

active and healthy lifestyle.

Within hours of surgery, John miraculously showed

movement in his hands and feet. But regaining what

he had lost would take intensive physical therapy.

“Whenever you have damage to the spinal cord, there

are tissues that die and do not come back,” says

physical therapist James Cope. “We do rehab to

help traumatized tissues heal or to help other

tissues compensate for those that are gone.”

“With John, we had to start at the beginning,” adds

occupational therapist Avi Kouzi. “He couldn’t bend,

twist, sit, stand, walk or do anything that requires

that kind of movement.”

But John was determined and motivated to return to

the active life he once had. Three hours or more of

intense therapy a day and the right attitude meant

quick progress.

“After only 14 days of in-patient rehab, and 21 days

after my accident, I walked out of the hospital on

my own,” says John. “Sometimes it takes a lot of

people for miracles to happen. But I am living proof

that they do happen.”

Though John made it to the trauma center quickly,

he was in critical condition and in spinal shock,

with no feeling below his neck. Emergency surgery

miraculously gave him another chance at life.

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“Being a guy who was so

independent, John wanted to

walk out of here with no cane,

no walker. He wanted to get

back to the active lifestyle

that he had always had.”

Avi Kouzi, Occupational Therapist

Through hours of rehab treatment

each day, John and his muscles learned

how to sit, stand and walk again.

James Cope, PT and John Miksa

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In just hours, the acute leukemia was replacing every normal cell in Diana Sanchez’s body.She was exhausted and she had bruising, but there were no other

outward signs or symptoms. Still, the doctor ordered urgent blood work.

Diana Sanchez and family

Dr. Gene Rumsey was seeing Diana

for a follow-up exam six weeks after

a routine (and unrelated) surgery.

The 34-year-old mother of two had

just returned from camping with her

family and wasn’t feeling well.

“When the blood work came back and

we looked under the microscope, we

knew immediately what it was,”

says Dr. Marin Xavier, a leukemia

specialist. “While a normal white blood

cell count is in the 5,000 to 10,000

range, Diana’s cell count was 100,000.

She had acute promyelocytic leukemia,

a type of leukemia that creates severe

internal bleeding. It would have been

fatal had we not caught it in time.”

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15Dr. Marin Xavier

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During a post-surgical follow-up exam,

Dr. Gene Rumsey noted multiple bruises on

Diana’s body. He ordered the urgent blood

test that probably saved her life.

The first priority was to stop the bleeding

and the spread of leukemia – something

that can now be done biologically, with

a vitamin A derivative.

“The vitamin A affects the DNA,” says

Dr. Xavier. “It’s a relatively new type

of treatment that immediately begins

to change leukemia cells back into

normal white cells, and it stops the

internal bleeding.”

Intense chemotherapy and blood

transfusions followed, and additional

chemo and arsenic treatments will

keep the cancer from returning. It’s an

innovative treatment regimen that has

had recent success worldwide. More than

90 percent of patients with this type of

acute leukemia are eventually cured of

the disease if they survive the first week.

“Once I heard it was curable, I was ready

to fight,” says Diana. “There was no need

to get a second opinion because I knew

my doctors were already consulting with

experts around the world.

“My son makes me pinky promise

every time I go to the hospital for

‘my vitamins,’” she adds. “He wants

to know that I’m coming home, and

because I can get this level of care so

close to my family, I can make him that

promise. I have a lot to live for, so

giving up is just not an option.”

So far, Diana has undergone intense

chemotherapy and two five-week

treatment regimens with arsenic.

Her cancer is now in remission and

she’s fighting to keep it that way.

Dr. Gene Rumsey,

General Surgeon

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Diana’s fight has been hard, but her face

lights up when she is with her two boys.

“Good doctors, prayer, family –– I think if

you’re missing one of those, you just

can’t make it,” she says.

“Fifteen years ago, Diana probably

would have died during the

first week. But with biologic

therapy, she is alive and we

expect to cure her.”

Dr. Marin Xavier, Medical Oncologist

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No one else could rebuild her hands.Afflicted with severe juvenile rheumatoid arthritis when she was only three, Rebekah Elliot has lived a life of no excuses.

X-rays vividly show the dramatic surgical

transformation of Rebekah Elliot’s left hand.

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Inspired by music, she began playing

the harp at age 9, despite an increasing

deformity in her hands.

“The harp is so beautiful,” she says. “It’s

a place I’ve always been able to go when

things get to be too much, a place where

I can relax and just focus on the music.

It’s really become a part of who I am.”

Juvenile arthritis is a disease that attacks

the joints. The body’s immune system

mistakenly believes it’s fighting

a dangerous infection. But instead of

destroying harmful bacteria, it tears

down healthy tissue, causing severe

inflammation and pain.

In Rebekah’s case, the arthritis affected

all the joints in her body but, most visibly,

her hands. Everyday tasks became chores,

and when she could no longer play her

harp, the 23-year-old Oklahoman began

to consider surgery. Other physicians

offered few options, so she turned to

Scripps and traveled to San Diego.

19Rebekah Elliot

19Harp and location courtesy of Harp Haven, Old Town, San Diego

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Rebekah’s newly rebuilt left hand is more

functional and gives her better use of her

finger tips. Regular X-rays and physical

therapy ensure her hand is healing properly.

“Rebekah’s joints were very deformed,

says orthopedic surgeon Lorenzo Pacelli.

The fact she could function as long as she

did and even continue playing the harp,

was just incredible. Her joints had worn

through almost 80 percent of her normal

bone, so she wasn’t a good candidate for

joint replacement.

“Instead we used bone grafts to rebuild

and reshape her hand,” Dr. Pacelli says.

“We had to fuse some of the joints stiff

and completely reform the bones that

had eroded away. Then we used wire

and pins to hold the bones in place

while she healed.”

Following surgery, it took months of

healing and physical therapy, but

Rebekah is now back at the harp,

making beautiful music and preparing

for surgery on her other hand.

“With a whole new hand, it’s a little like

learning to play all over again,” she says.

“But it’s still a beautiful place to be.”

Rebekah’s mother was a concert level pianist who

passed a love of music to her daughter. Rebekah

began playing the harp when she was nine,

despite the limits of her juvenile arthritis.

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“When they took the bandages off,

I had tears in my eyes. It was just

so great. The smile on Rebekah’s

face was the most amazing thing.”

Because Rebekah’s joints had worn

through 80 percent of her normal

bone, Dr. Lorenzo Pacelli used

synthetic bone grafts to rebuild

her hands, fingers and thumb.

Marilyn Hammond, Patient Services Representative

Dr. Lorenzo Pacelli, Orthopedic Surgeon

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22 Debbie Lanpheer22

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It’s new. It’s wireless. And it helped determine she was having a heart attack.

When 49-year-old Debbie Lanpheer, an avid runner, was seen by doctors for chest pain a

few hours after one of her runs, it was new heart screening technology that helped her

get the care she needed. Using a palm-sized Vscan ultrasound device, cardiologists were

immediately able to identify reduced blood flow to her heart and quickly begin treatment.

It’s something patients may soon be able to do from the comfort of their own homes,

with scan results sent wirelessly to their doctors for review.

Scripps is the first of 12 clinical sites in the world to use the device to help speed

diagnoses, reduce patient wait times and improve physician work flow.

“This is just one small example of how new technologies are changing the way heart care

is provided,” says Dr. Brent Eastman, chief medical officer. “It’s the type of progress that

can be made when an organization like Scripps gets behind something as bold as the

Scripps Cardiovascular Institute.”

“Scripps already is San Diego’s largest

provider of cardiac care, and we lead

the state in coronary angioplasty

procedures,” says Dr. Eastman.

“By bringing our surgical, catheterization,

and clinical care programs together

with advanced research, clinical trials,

education and prevention, we’ll provide

a total heart care approach that is

the most progressive available and

unparalleled on the West Coast.”

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The use of wireless health technology at Scripps will help

improve care quality and patient safety, while providing

substantial health care cost savings. Patients will benefit

from faster diagnosis, more efficient doctor visits and

more care that can be provided at home.

Wireless health technologies now in testing

and use at Scripps include:

• Palm-sized ultrasound to speed diagnoses

and treatment in hospitals and clinics

• Remote, ingestible cameras that can be

swallowed within pills to provide images

of the digestive system and colon

• Cell-phone enabled fetal monitors that allow

high-risk pregnancies to be monitored outside

the hospital or doctor’s office

On the wireless health horizon, promising advancements

include:

• Band-aid like devices that monitor blood pressure,

caloric intake, hydration and heart rate – sending

information remotely to care providers

• Pills that include wireless transmitters, notifying medical

staff when you take your medication

• Portable ECG machines no bigger than cell phones and

one-fifth the cost

• Drug delivery patches that can be radio controlled

by physicians and hospital staff

In addition, Scripps Health is the founding health care

affiliate of the new West Wireless Health Institute,

a San Diego non-profit committed to lowering health

care costs by moving wireless health technologies quickly

into the hands of doctors, health care organizations

and patients. The institute is supported through the

Gary and Mary West Foundation and its board includes

Dr. Eric Topol, chief academic officer at Scripps Health.

Wireless Health

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(From left) Mary West, Dr. Eric Topol, Gary West

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Slated for completion in 2015 at an estimated cost

of more than $462 million, the Scripps Cardiovascular

Institute will include 168 inpatient beds, cardiac

catheterization labs, centralized cardiovascular

research labs, a center for physician graduate

medical education and more – all using the latest

medical technology. The institute will provide

advanced treatment options for patients with

cardiovascular diseases, and serve as a premier

center for cardiovascular research and clinical trials.

Scripps is the largest provider of

cardiac care in San Diego, with more

than 50,000 cardiovascular procedures

each year. In addition, Scripps leads

the state of California in the number

of coronary angioplasty procedures.

• The Howard Charitable Foundation recently

made a $30 million grant – one of the largest

philanthropic donations in the history of

Scripps Health – to support initial Scripps

Cardiovascular Institute construction.

• The Scripps Cardiovascular Institute is the first phase

in the reconstruction of Scripps Memorial Hospital

La Jolla that will update the hospital to meet state

seismic standards and community need.

• The Scripps Cardiovascular Institute is being

designed by Scripps cardiovascular physicians to

create a world-class hospital for patients,

physicians, researchers and staff.

Scripps Cardiovascular Institute

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Growing in Our CommunitiesAcross the San Diego region,

from Oceanside to Chula

Vista, you’ll see growth and

development everywhere at

Scripps. From investments

in new technology

and equipment to

hospital expansions and

neighborhood outreach,

Scripps is growing

as never before to meet

tomorrow’s health care needs.

“We’re working with our

communities to determine

what needs exist today in

our communities and what

will be needed in the future.

And we’re advancing and

growing to meet those

needs,” says June Komar,

executive vice president of

strategy and administration.

“We recognize that health

care is a valuable neighbor

in the communities we serve.

Our goal is to continue

innovating so we’re San

Diego’s first choice for health

care far into the future.”

The new Conrad Prebys Emergency and Trauma center at

Scripps Mercy Hospital’s San Diego campus will double the

square footage of the existing facility, with 43 beds and

three trauma bays. A recent groundbreaking kicked-off

construction of the center, which is expected to be complete

by 2013. It is part of an estimated $200 million hospital

modernization and expansion project.

Expansion at Scripps Memorial Hospital Encinitas will see

construction of a two-story, 60,000-square-foot critical care building

as a new wing of the hospital. The first level emergency department

will double the size of the existing facility, with 27 emergency

stations, while the second level will house a new acute care floor.

The project is part of an extensive Scripps Encinitas expansion

effort that also includes a new parking structure and medical office

building. A recent ceremony marked the beginning of campus

construction and recognized the Leichtag Family Foundation for

supporting the project with a $10 million donation.

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Construction at Scripps Memorial Hospital Encinitas

301830

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It is a staggering statistic. Nearly 1 in 4 hospital patients in the United States has diabetes.

The prevalence of the disease crosses all age

and racial groups, affecting 24 million adults

across the country. And diabetes is often a

family disease.

Just ask Racheal Araujo, an educator with the

Scripps Whittier Diabetes Insitutute. She has

Type 2 diabetes. All four of her siblings have

it. And their mother died from diabetes

complications.

Sadly, this is more the rule than the exception.

In the Latino community alone, experts say

half of the children born 10 years ago will

develop diabetes in their lifetimes.

“The saddest thing of all is that people don’t

realize this disease can be controlled,” says

Racheal. “Diabetes is not a death sentence,

but based on family experiences many people

believe that it is.”

Advances in research, treatment and

technology are making control and

management of diabetes easier. Better

insulin and easier-to-use blood glucose

meters and insulin pumps are just a few

examples. But education and lifestyle

change are still the keys.

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So while Scripps Whittier continues to conduct

ground-breaking research and adopt new

technologies, Racheal continues to spread the word

– exercise daily, change your diet, and share what

you learn with your family. And she teaches from

experience. She has made the same lifestyle changes

herself and has her diabetes under control.

Her newest class is for mothers who have had

gestational diabetes, a temporary form of the disease

that occurs in women who are pregnant. New

research shows as many as 70 percent will develop

Type 2 diabetes in as little as five years. Mothers

bring their children to class so they can exercise

and learn together.

“In all our classes, we teach people about diabetes,

how to monitor their blood glucose, how to take

insulin and, most of all, what it takes to live a long

and healthy life,” says Racheal.

“We know we can give them the best of care when

they’re in the hospital,” she adds, “but it’s best for

everyone if they never have to go there.”

Specialized diabetes nurses like Tammy

Finger work with hospital nurses and staff

on diabetes care. More than a third of

Scripps hospital patients have Type 1 or

Type 2 diabetes. “The good news is that

this is a disease that people can control by

making different choices,” says Finger.

Tammy Finger, RN

Diabetes educator Racheal Araujo is a

walking lesson plan. Since making her own

lifestyle changes, she has lost more than

200 pounds, reduced her medications and

brought her diabetes under control.

Racheal Araujo

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“We know that behavioral hanges

are one of the most effective ways

of preventing and controlling

diabetes. By helping the family

and the community, we are

helping entire generations

to prevent the disease.”

Women who have gestational diabetes

during pregnancy are 70 percent more

likely to develop Type 2 diabetes.

Free classes through the Scripps Whitter

Diabetes Insitute teach lifestyle changes

that can help prevent or control the disease.

Sonia Contreras, Health Education SupervisorScripps Whittier Diabetes Institute

Maria del Rosario Cuevas,

class participant

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Just weeks after the 7.0 earthquake destroyed entire communities in Port au Prince, Haiti, thousands were homeless and in desperate need of medical care.

Makeshift tent cities and small bonfires dotted

the early morning landscape and hospitals

once challenged to provide care even in non-

emergent times were now struggling with the

aftermath of widespread destruction and the

toll of massive personal injuries.

It was long after they departed a small plane

on the Port au Prince runway, that Scripps

president and CEO Chris Van Gorder and chief

medical officer Brent Eastman realized their

fact-finding journey was the beginning of a

greater call to action.

Over the next several weeks, that

Scripps’ mission would send 17 physicians,

nurses and other staff to the region to provide

medical care at the Hospital Saint Francois de

Sales, the closest hospital to the earthquake’s

epicenter – only one mile away. Though it

had sustained heavy damage, it was open

to patients by necessity, with little resources,

equipment or staff.

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Hear the Scripps Medical Response Team’s story and see the video at scripps.org/annualreport

36

“I remember how the eyes of the Haitian

hospital staff grew warmer the longer we

were there. We were colleagues now. We

served together in a great disaster.”

Chris Van Gorder

“As we passed multiple tent cities each morning and evening

on our way to and from the hospital, I was amazed to see the

number of people who were able to find just a glimmer of joy

and the ability to smile and laugh through all of the suffering

they have had to witness.”

Michael Sykes, RN

37

From emergency surgeries conducted with few

instruments and limited anesthesia, to post surgical and

outpatient clinical care, teams rotated into Haiti to help

in any way they could and patients found their way to

the care that was available.

“The reality was that these were human beings who

deserved the best we could do with what we had,”

says Dr. Eastman. “And we all came to love our Haitian

patients, from the orphaned 8-year-old girl to the singing

100-year-old lady, and all in between – patients who had

massive injuries themselves, and who had lost some or

all of their families, and all of their homes.”

“Most Haitians live without the necessities that most

Americans take for granted,” adds Dr. Katrina Kelly.

“Yet, from what we saw during our stay, they live day

to day with this scarcity, but make up for it with an

abundance of resilience, dignity and zest for life.

“I carry an image in my head of these Haitian women

who effortlessly and gracefully walked up hills, balancing

huge baskets on their heads alone. Next time my own

concerns seem overwhelming, I will remember the

Haitian women who balance their baskets with grace

and dignity. My ‘basket’ will seem insignificant in

comparison.”

“We will never watch TV or read about

disaster without feeling the emotions,

sensing the sights, sounds and smells of

the disaster in Haiti. It will impact our lives,

and those we were able to help forever.”

John Armstrong

“I think that I leave this little country with a deeper understanding and

appreciation of humanity. In one short week, the tragedy, the bravery, the

passion, the endurance and hope of the Haitian people, as well as the

amazing compassion of the people who have come here to help them is

profound. It will be a long journey, but I am confident that we have the

capacity to fill the Haiti size hole in everyone’s heart.”

Kelly Hardiman, RN

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Scripps Health at a Glance

Inpatient Visits

Inpatient days of care provided 307,591

Average length of stay 4.4 days

Average daily inpatient census 843_____________________________________________

Total inpatient discharges/visits 70,231

Outpatient Visits

Hospital outpatients 457,206

Emergency Services 124,912

Surgery cases 19,069

Joint Venture Ambulatory Surgery 9,142

Clinic outpatient visits/surgeries 1,441,820

Home Health visits 69,358_____________________________________________

Total outpatient visits 1,977,526

Total Patient Visits/Discharges 2,047,757

Selected Services

Surgical cases – inpatient 22,362

Diagnostic imaging exams total 654,767

CT scan 135,361

MRI 29,588

Nuclear medicine 20,597

Ultrasound 67,151

X-ray 402,070

Cardiac procedures 55,547

Maternity – number of newborns 9,933

Rehab services – number of visits 828,354

Radiation therapy visits 44,661

Philanthropy Revenue

Major Gifts/Cap Campaigns $ 17,233,420

Special Gifts & Tributes $ 2,764,239

Direct Mail Annual Giving Program $ 1,846,649

Special Events $ 1,988,374

Planned Gifts and Bequests $ 7,369,870_________________________________________________

Total Net Contributions $ 31,202,552

39

Uncompensated and Undercompensated Care Costs

Professional Education & Research $ 39,226,597

Charity Care & Under-reimbursed

MediCal & other means tested gov pgms $ 92,860,912

Community Health Imprvmt Svcs &

Com Benefit Ops & Subsized Health

Svc & Cash & in-kind Contributions $ 15,674,212

Bad Debt $ 16,247,687

Under reimbused Medicare Shortfalls $ 146,475,561

Community Building Activities $ 538,576 _____________________________________________________________

Total $ 311,023,545

Facilities & Staff

Total number of employees 13,122

Total number of medical staff 2,500

Total number of licensed beds 1,372

Total number of medical

residents/fellows 111/34

Scripps Memorial Hospital Encinitas

Employees: 1,384

Licensed beds: 142

Scripps Memorial Hospital La Jolla

Employees: 2,534

Licensed beds: 357

Scripps Green Hospital

Employees: 1,418

Licensed beds: 173

Scripps Mercy Hospital

San Diego campus

Employees: 2,531

Licensed beds: 517

Chula Vista campus

Employees: 1,100

Licensed beds: 183

Scripps Home Health Care

Employees: 160

Scripps Health Administrative Services

Employees: 1,308

Scripps Clinic

Employees: 2,168

Locations: 10

Scripps Coastal Medical Center

Employees: 510

Locations: 9

Scripps Cardiovascular and

Thoracic Surgery Group

Employees: 9

Locations: 3

40

Consolidated Statements of

Financial Position

Year ended September 30, 2009

(In thousands)

Assets

Current assets:

Cash and cash equivalents $ 297,401

Accounts receivable, net $ 259,362

Assets limited as to use $ 20,278

Other current assets $ 37,152 ____________________________________________

Total current assets $ 614,193

Assets limited as to use $ 192,716

Investments $ 586,873

Property, plant &

equipment, net $ 735,328

Other assets $ 77,415____________________________________________

Total assets $ 2,206,525 ________________________________________________________________________________________

Liabilities and Net Assets

Current liabilities:

Current portion of

long-term debt $ 39,223

Accounts payable $ 127,953

Accrued liabilities $ 207,914 ____________________________________________

Total current liabilities $ 375,090

Long-term debt,

less current portion $ 384,698

Other liabilities $ 92,898 ____________________________________________

Total liabilities $ 852,686

Net assets:

Unrestricted $ 1,152,331

Temporarily restricted $ 126,077

Permanently restricted $ 75,431 ____________________________________________

Total net assets $ 1,353,839

Total liabilities and net assets $ 2,206,525 ________________________________________________________________________________________

40

Scripps Health Financials

41

Consolidated Statements of Operations

Year ended September 30, 2009

(In thousands)

Operating revenues:

Patient services $ 1,838,108

Capitation premium $ 242,832

Other $ 60,886

Net assets released from

restrictions used for operations $ 19,309__________________________________________________

Total operating revenues $ 2,161,135

Operating Expenses:

Wages and benefits $ 956,971

Supplies $ 350,866

Services $ 585,253

Provision for uncollectible

accounts receivable $ 63,406

Depreciation and amortization $ 88,482

Interest $ 15,199__________________________________________________

Total operating expenses $ 2,060,177

Operating Income $ 100,958

Nonoperating gains (losses):

Investment loss $ (11,155)

Holding gain on

trading portfolio $ 42,683

Contributions $ 2,192

Loss on disposal of property $ (28)

Market adjustment on

interest rate swaps $ (9,061)

Excess of revenues

over expenses $ 125,589_________________________________________________________________________________________

41

42

Chairman Richard Vortmann,President and CEO, National Steeland Shipbuilding Co., Retired

Vice ChairRobert TjosvoldMarket President, Bank of America,Retired

BOARD OF TRUSTEES

Mary Jo Anderson, CHSHealth Care Executive, Retired

Douglas A. Bingham, Esq.Executive Vice President,Chief Operating Officer, TSRI

Jeff BowmanFire Chief, Retired

Gordon ClarkBoard Chairman,Access Information Management

Martin DickinsonBanker, Retired

Judy Churchill, PhDClinical Psychologist, Retired

Sister Virginia Gillis, RSM, EdDHealth Care Executive, Retired

Richard L. Hall, MDPhysician, Retired Ernest S. RadyFounder, American Assets Chairman, ICW Group

Maureen A. StapletonGeneral Manager, San Diego CountyWater Authority

Abby Silverman WeissOf Counsel, Baker & McKenzie, Retired

Chris D. Van Gorder, FACHEPresident and CEO, Scripps Health

42

Scripps Health

43

EXECUT IVE TEAM

Chris Van Gorder, FACHEPresident and CEO

John ArmstrongCorporate Vice PresidentSupply Chain Management

Robin Brown, FACHEChief ExecutiveScripps Green Hospital

Mikele Bunce, PhDCorporate Vice President, Quality

Vic BuzacheroCorporate Senior Vice President Innovation, Human Resources and Performance Management

Mary Lou CarraherChief ExecutiveScripps Home Health Care Services

David CohnCorporate Vice PresidentPatient Financial Services

A. Brent Eastman, MDCorporate Senior Vice PresidentChief Medical Officer

John EngleCorporate Senior Vice PresidentChief Development Officer

Carl Etter, FACHEChief Executive Scripps Memorial Hospital Encinitas

Gary Fybel, FACHEChief ExecutiveScripps Memorial Hospital La Jolla

Thomas Gammiere, FACHEChief ExecutiveScripps Mercy Hospital

Larry HarrisonChief ExecutiveScripps Medical Foundation

June KomarCorporate Executive Vice PresidentStrategy and Administration

Glen MuellerCorporate Vice President Chief Audit, Compliance and Information Security Executive

Richard NealeCorporate Vice PresidentResearch Operations

Athena Philis-Tsimikas, MDCorporate Vice PresidentScripps Whittier Diabetes Institute

Barbara PriceCorporate Senior Vice PresidentBusiness and Service Line Development

Marc ReynoldsCorporate Senior Vice PresidentPayer Strategies and Market Development

Richard RothbergerCorporate Executive Vice PresidentChief Financial Officer

Richard SheridanCorporate Senior Vice PresidentGeneral Counsel

Donald StanzianoCorporate Vice President,Marketing and Communications

Patric ThomasCorporate Vice PresidentChief Information Officer

Eric Topol, MDCorporate Vice PresidentChief Academic Officer

Joseph Traube, MDVice PresidentMedical Director Information Services

43

44

PHYS IC IAN LEADERSHIP CAB INET 2010

Chris Van Gorder, FACHE

A. Brent Eastman, MD

Chief Executive

Robin Brown, FACHE

Carl Etter, FACHE

Gary Fybel, FACHE

Tom Gammiere, FACHE

Larry Harrison

Chief of Staff

Tom Chippendale, MD

Kent Diveley, MD

Shawn Evans, MD

Reuben Farris, MD

Ron MacCormick, MD

Jim Mason, MD

Paul Pockros, MD

Marc Sedwitz, MD

Ted Thomas, MD

Donald Vance, MD

Chief Nursing Executives

Mary Ellen Doyle, RN

Lori Burnell, RN

Valerie Walsh, RN

Marlys Vespa, RN

Jan Zachry, RN

44

Scripps Health

45

PHYS IC IAN BUS INESS LEADER CABINET 2010

Chair

Chris Van Gorder, FACHE

Co-Chair

A. Brent Eastman, MD

Davis Cracroft, MD

Frank Stewart, MD

Kevin Hirsch, MD

Jim LaBelle, MD

Michael Lobatz, MD

Robert Sarnoff, MD

Mark Sherman, MD

45

46

Awards and Recognition

BEST EMPLOYER

Named one of the country’s 50 best employers for workers age 50 or over (2009, 2008, 2007, 2006, 2005, 2004). - AARP

Named to the Working Mother 100 Best Employers list (2009, 2008, 2007, 2006, 2005). - Working Mother Magazine

Recognized as a San Diego Employer of Choice in the “mega company” category (2008, 2003).- San Diego Society for Human

Resources Management

Named one of Fortune Magazine’s 100 Best Companies to Work For (2009, 2008). - FORTUNE Magazine

QUALITY

Scripps Green Hospital, Scripps Memorial Hospital Encinitas, Scripps Memorial Hospital La Jolla and Scripps Mercy Hospital earned Certificates of Excellence for superior health care quality, patient experience and safety measures. - California Hospital Assessment and

Reporting Task Force (CHART)

TOP HOSPITALS

Scripps Green Hospital recognized as one of the nation’s “100 Top Hospitals.”- Thomson Reuters

BEST RESPIRATORY THERAPY

Scripps Mercy Hospital ranked one of America’s Best Hospitals for respiratory therapy.- U.S.News & World Report

IMAGING EXCELLENCE

Scripps Mercy Hospital Chula Vista honored as a Breast Imaging Center of Excellence (2009, 2008).- American College of Radiology

TOP STROKE PROGRAMS

Scripps Mercy Hospital (San Diego campus) certified as an Advanced Primary Stroke Center, joining Scripps Green Hospital, Scripps Memorial Hospital Encinitas and Scripps Memorial Hospital La Jolla in stroke accreditation.- The Joint Commission

BLOOD & MARROW TRANSPLANT

Scripps Green Blood & Marrow Transplant Center received Center of Excellence designation.- California Department of Health

Care Services (DHCS)

PNEUMONIA

Scripps Mercy Hospital ranked in the top 5 percent of U.S. hospitals for pneumonia care.- Centers for Medicare &

Medicaid Services (CMS)

SURGICAL INTENSIVE & CARDIAC CARE

The surgical intensive care unit and cardiac care unit at Scripps Memorial Hospital La Jolla awarded the Beacon Award for Critical Care Excellence.- American Association of Critical

Care Nurses

Scripps Mercy Hospital ranked in the top 4 percent of U.S. hospitals for survival after heart failure.- Centers for Medicare & Medicaid

Services (CMS)

CANCER NETWORK

Scripps Cancer Center earned network accreditation – the first multi-hospital cancer program in California and one of only 28 nationally. - American College of Surgeon’s

Commission on Cancer

Scripps Polster Breast Care Center one of two centers in California to be granted a three-year full accreditation for breast cancer care.- National Accreditation Program

for Breast Centers

BARIATRIC SURGERY

Scripps Clinic Center for Weight Management and Scripps Memorial Hospital La Jolla redesignated as Centers of Excellence for bariatric surgery.- American Society for Metabolic

and Bariatric Surgery

Scripps 2009 Annual Report was produced by the Scripps marketing and communications department with local photography and printing in San Diego, Calif.Copyright 2010.

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