I have been meeting regularly with the ISH Consultants. Each week we spend approximately one hour reviewing the meticulous data compiled regarding the improvements necessary to maximize the utilization of the operating room facilities and equipment. This includes reallocation of resources, acquisition of materiel, and scheduling of employee converges.

I am writing this unsolicited letter in support of this consulting firm in their efforts to improve our operating room capability. Since their arrival, there has been a substantial improvement in operating room turnover time, equipment utilization and quality, and reorganization of personnel. I have also noticed that their management style has been a sharp contrast to that in our past whereby the new environment is far more nurturing to the new operating room personnel. For the first time in years discouragement has been replaced with hope. They have treated these employees with the utmost of support, firmness, and respect.

I have found that ISH has been most accommodating to the new arrival of my full time orthopedic surgeon who will shortly be followed by a second orthopedic surgeon and then two other orthopedic surgeons consistent with my business plan in August 2002.

As you know our orthopedic surgeons are building a referral practice base and have by their efforts contributed substantial revenues to the hospital side of the equation. This must continue in order for the institution to be viable; and although I have been here since 1983, and have seen many consulting firms pass through this institution, this particular group is in a class by itself. The ISH people are most experienced and by virtue of breadth of knowledge and experience completely understanding in an intuitive manner the needs of the operating room, the physician, and the nursing staff.

I strongly urge your continued relationship with this firm.

Should you have any further questions, please do not hesitate to call.

I remain.