LLUMC Legacy: Daring to Care
Chapter Eight
SERVICES AND FACILITIES EXPAND
By 1997, Loma Linda University Medical Center had grown 600 percent since it moved into the existing facility on July 9, 1967. A hundred and twenty-five patients were moved from the old hospital on the hill into the new facility, a 320-bed hospital. The top two levels of its three towers were temporarily vacant.
Within several years the new hospital was completed and the bed capacity reached 516. Phenomenal growth to 797 beds doubled the Medical Center's square footage from 1986 to 1993, and moved out of the building the School of Nursing, Personnel, Payroll, Patient Business Office, Laundry, Dialysis Center, Pain Control Center, Home Care, Hospice, Outpatient Rehabilitation Center, and almost all of the outpatient doctor's offices. The Psychiatric Unit became the Behavioral Medicine Center, a free-standing, 89-bed psychiatric hospital. The 120-bed Loma Linda Community Hospital became the Loma Linda University Medical Cener East Campus Specialty Hospital. The institution's total bed capacity is now 886 beds. The bed capacity may surpass 900 when the Children's Hospital is completed.
A 140,000-square-foot Cancer Research Institute was completed in 1996. The new building also houses School of Medicine administration and conference facilities. The Emergency Department recently increased its bed capacity from 22 to 45.
Children's Hospital
The Grand Opening of Loma Linda University Children's Hospital, affectionately known as "The New Place for Little Faces," was held November 7, 1993. Patients moved into the new structure on December 14. The first patient was a little boy recovering from heart transplant surgery. The Children's Hospital is now licensed for 244 beds. The middle floor (of five stories) is temporarily vacant for future expansion. At a time in the nation's history when hundreds of hospitals are having serious financial difficulties, merging, and even going out of existence, building such a facility underscores Loma Linda's commitment to and compassion for children.
Since it began in 1905, the institution has earned an international reputation for high-quality, service-oriented medical care. It has always had an interest in and caring sensitivity for children and their special needs. In the 1980s Loma Linda became one of the largest centers for neonatal and pediatric care in California and a worldwide leader in infant heart transplantation.
Meanwhile, the health of the nation's children continued to decline. Facing the need for a dramatic improvement in children's health locally and nationally, the institution's administration focused on increasing its commitment to children. According to an official statement of purpose, "Loma Linda decided to devote the full spectrum of its institutional resources toward the establishment of a children's hospital and to become an international advocate for children's healthcare."
The Children's Hospital's 72-bed neonatal intensive care unit (NICU) is one of the largest and most advanced in the world. Half of the NICU's tiny patients are referred and transported from outlying hospitals. Because half of those transported come by helicopter, the institution's second heliport was built on top of the Children's Hospital.
The Children's Hospital was designed to provide an environment that is less frightening than many regular healthcare settings. Its cheerful atmosphere includes bright colors, pictures and graphics of animals, and even "bear tracks" and "deer tracks" (embedded in the floor of the lobby).
The Children's Hospital schedules 12,000 admissions annually. The patients' combined annual hospital stays total 80,000 patient days. The emergency room accommodates 24,500 acute care visits by children each year. The Children's Hospital staff includes 60 physicians, 50 resident physicians, 1,200 nurses and ancillary personnel, and 700 volunteers.
The staff were chosen because of their deep interest in children. They are people who have been specially trained to give children emotional support and personal attention. They include child-life specialists who have bachelor's and master's degrees in their specialty and who know how to help children process their fears and anxieties with play. Play areas are designed to help patients enjoy their favorite activities and escape from the hospital routine. These areas are for fun and games only. No injections or any procedures that might cause discomfort are administered in these "safe" rooms. The child-life specialists can listen to parents' concerns and explain to little ones how hospital personnel can take away their "owies" and help them feel better.
People in other areas of the Medical Center help children to relate to different surroundings as well. One day a little girl and her mother were in the fixed-beam room of the Proton Treatment Center. The young girl was going to have proton therapy for a brain tumor. The technician, a woman, asked, "Would you like for your dolly to go for a ride?
The little girl answered, "Yes."
The doll was placed on the treatment table, and the technician raised and lowered the table.
"Would you like to give your dolly a ride?" asked the technician. The little girl agreed. The technician handed the controls to the little patient, and she made the table go up and down.
"Would you like to go for a ride on the table?" asked the technician.
"Yes," the little girl answered. She wanted to go for a ride and climbed onto the treatment table for her ride. The technician took the little patient step-by-step through the treatment setup so that when she returned for her first treatment, she would remember her visit as a happy occasion and not be frightened by the surroundings. One of the goals of the Children's Hospital is to have the children who are old enough to understand, be informed, active partners in their treatment.
The Children's Hospital features a postoperative recovery room where parents are welcome to be present for their children's recovery from surgery. Family support services include access to a new Ronald McDonald House.
Transplantation Institute
Most people have heard about Loma Linda as a result of the infant heart transplant program beginning in 1984. Some of the coverage has been national and international in scope. Much of it has been hometown stories telling the experiences of various individual heart transplant patients.
But organ transplantation really began in Loma Linda with a kidney transplant on April 17, 1967, just 11 weeks before the institution moved from the old hospital on the hill. The recipient was a 38-year-old man who had suffered from kidney failure, severe hypertension, and generalized seizures. Kidney transplantation has developed over the years to the point where more than 100 patients are transplanted each year at LLUMC. In December 1994, LLUMC transplanted its 600th kidney. One-year graft survival is 95 percent, and patient survival is 97 percent. Several patients have been maintaining transplanted kidney function for more than 22 years.
LLUMC's new Transplantation Institute began developing serious plans in 1992 with the recruitment of a multiorgan transplant surgeon and liver transplant nurse, both from the Mayo Clinic. Under the direction of Erik Wahlstrom, M.D., the Transplantation Institute began performing pancreas and combined kidney/pancreas transplants on diabetic patients in January, 1993. Following transplant, these patients no longer need hemodialysis or insulin injections.
The first kidney/pancreas transplant patient was a 29-year-old man from Rancho Cucamonga, California, who had such a severe case of diabetes that his kidneys were damaged and useless and he was forced to undergo hemodialysis to cleanse his blood. He faced possible blindness, coma, gangrene, heart attack, stroke, and even death. He left the Medical Center 11 days later, no longer a victim of diabetes and with normal kidney function. His mother called the day of his transplant his second birthday.
A rare combined heart/kidney transplant was performed on November 3, 1993, on an 11-year-old boy.
Liver transplantation began in August, 1993. The first liver transplant patient, a 54-year-old man from Salem, Oregon, suffered from chronic hepatitis B and C. The surgery (which sometimes lasts 12 hours) was another milestone in Loma Linda's effort to become a comprehensive transplant center. A second liver transplant was performed four days later on a 40-year-old gentleman from Tucson, Arizona.
According to Dr. Wahlstrom, "The integration of the kidney, pancreas, and liver transplant programs provides an unusually broad range of expertise available for transplant recipients."
The Transplantation Institute performed its first stemcell transplant in September 1999. By mid-2004 it had 699 patients on its kidney transplant list alone.
The Transplantation Institute has a fully developed multidisciplinary transplant team with excellent initial experience. Following the transplant the patient is coached extensively by specially trained transplant coordinators in how to look for early signs of infection or rejection. Self-medication to prevent rejection is a critical component of the program's success. Patients not only learn how to administer their own anti-rejection medications but also are able to do so under the supervision of their primary care nurse. Follow-up includes initial clinic visits three times weekly, during which the transplant coordinator reviews the patient's transplant log book. This log book was developed by the patient care manager and allows for educational reinforcement of the patient on the importance of following post transplant protocols accurately.
Cancer Institute
On Tuesday, April 3, 1990, David B. Hinshaw, M.D., then president of Loma Linda University Medical Center, appeared before the United States Congress House Appropriations Energy and Water Development subcommittee and asked for $10 million to help build a cancer research institute to complement the Proton Treatment Center. The research facility cost $20 million.
With the world's first hospital-based proton accelerator for the treatment of cancer and other diseases, Loma Linda University Medical Center also became the nation's first medical center conducting proton therapy research and education.
Representative Jerry Lewis, R-35th Congressional District, introduced Hinshaw to the lawmakers and told the panel, "This new program will expand the center's work to find the best treatments for cancer. It will keep this country on the leading edge of life saving research, technology, and patient care.
Hinshaw reported that the Medical Center wants to expand ongoing research into the use of "radio-labeled monoclonal antibodies" to fight the spread of cancer cells. In such research, antibodies treated with small amounts of radiation are used to search for and destroy scattered tumor cells. Such therapy, according to Hinshaw, "represents the wave of the future.... What we are anxious for is a facility to advance this particular research, as well as other immunological approaches to cancer.
Congressman Lewis, in an accompanying press release, said, "Loma Linda has taken a very courageous step by being the first medical institution to bring a practical medical treatment to what has been--up to now--largely highly scientific research. The proton beam cancer treatment center and the future Loma Linda Research Institute will be models to be emulated around the world. It is characteristic of Loma Linda University Medical Center to be in the forefront of this type of medical research and to have the vision to provide this sophisticated technology to cancer patients."
Loma Linda University Medical Center requested $10 million. The United States Congress granted $10 million.
The Loma Linda University Cancer Institute was established in 1991 in response to the growing need for a cancer center in Southern California's Inland Empire, and to further cancer research on a local, regional, and national level. The new, 140,000 square-foot, research building houses modern, state-of-the-art laboratory space, some of which is used by NASA.
Cancer Institute scientists, under the leadership of James M. Slater, M.D., are developing programs to further explore the basic biology of proton beam irradiation. They use their findings to design innovative therapies based upon the ability of protons to destroy tumor tissue more precisely than can conventional radiation therapy. Working with scientists at the Lawrence Berkeley Laboratory, the Jet Propulsion Laboratory, and the Johnson Space Center, Cancer Institute scientists have established a Proton Beam Biology Research Team. Other basic science research projects are in development.
The Cancer Institute not only is involved in basic sciences research, but also has a comprehensive program of clinical research studies, public and patient education, prevention, and early detection of cancer. It works closely with the American Cancer Society.
Rehabilitation Institute
Because of the level 1 trauma center status of LLUMC, the Rehabilitation Institute provides physicians who are trained to provide care for the traumatically injured, and services for patients who have severe, life-threatening injuries requiring the need for specialized therapy. Recent advances in healthcare have increased the numbers of patients surviving severe illnesses and injury.
Loma Linda University Medical Center established the Rehabilitation Institute to help these patients achieve maximum recovery, following neurosurgery, disabling disease, or injury. The Rehabilitation Institute offers a comprehensive range of clinical programs for both inpatients and outpatients who have experienced stroke, heart attack, spinal cord injury, brain damage, amputation, chronic neurological disease, Guillian-Barré syndrome, arthritis, multiple trauma, or other complex orthopaedic problems. In 1994 all outpatient rehabilitation programs and services were consolidated in a newly enlarged 73,000 square foot facility.
All attending physicians in the Rehabilitation Institute are specialists in physical medicine and rehabilitation. They work closely with allied health professionals assigned to every patient, creating a team of 200 multidisciplinary specialists, sharing a broad base of knowledge and experience.
The Rehabilitation Institute also includes comprehensive programs in sports medicine, performing arts, vocational counseling, work re-entry, adult day care, pulmonary rehabilitation, pain control, speech and language therapy, nutritional counseling, hand rehabilitation, burns, wound care and scar management, and a social club for patients with spinal cord injuries or amputations.
Orthopaedic Institute
The Orthopaedic Institute was organized in 1994 to integrate already existing Medical Center and orthopaedic faculty-practice efforts into a comprehensive, efficient, yet convenient and cost-effective program that focuses on patient satisfaction and quality. The effort already has improved the teamwork approach to integrated orthopaedic services.
The Orthopaedic Institute's joint-replacement center not only continues to perform total hip, knee, and shoulder-joint replacement, but also performs research on a variety of new joint-replacement products to test their wear capabilities and longevity. Initial results already have been reported at international meetings. The joint-replacement program now includes an outcomes-research component to monitor total-joint-replacement patients and to assure long-term follow-up and patient satisfaction.
The Orthopaedic Institute is supported by a multidisciplinary team of specialists and professionals with vast experience and training in their areas of expertise. It has developed an industrial partnership agreement with one of the fastest-growing, most progressive, prosthetic device/orthopaedic supply manufacturing companies in America.
The faculty orthopaedic medical group's board-certified surgeons are specially trained to provide comprehensive treatment of the spine--including the neck and back--for children and adults.
International Heart Institute
After many years as an international leader in research and treatment of heart disease, in 1987, Loma Linda University Medical Center with Loma Linda University faculty cardiac physicians organized the Loma Linda International Heart Institute. Outpatient heart services were moved from the Faculty Medical Offices to the street level of the Schuman Pavilion, a new wing built near the main entrance of the Medical Center. The first patients were seen in the new facility on February 8, 1988. Now, close to 30,000 outpatient visits occur in the outpatient clinic annually, resulting in 24,000 noninvasive cardiac studies such as echocardiograms and cardiac stress test, 2,800 invasive cardiac studies such as cardiac catheterizations and coronary angiograms, 3,000 cardiac rehabilitation visits, and more than 1,000 cardiothoracic surgeries each year. About one-third of the patients admitted to the Medical Center and Children's Hospital are admitted because of a primary or secondary cardiac problem.
Patients are referred to the Heart Institute by their primary care physicians or by other cardiologists for consultation for specialized heart-care situations. Patients with acute heart symptoms go to the Emergency Cardiac Care Center developed in the Emergency Department to assure that patients with heart problems get immediate evaluation and treatment. This program assures that patients experiencing a heart attack will receive initial treatment and be admitted to the coronary care unit in less than one hour.
The Heart Institute offers comprehensive clinical programs for both inpatients and outpatients of all ages. The medical staff of the Heart Institute includes 30 physicians and surgeons who are specialists in adult and pediatric cardiology and heart and thoracic (chest) surgery. Specialized clinics serve patients with specific heart problems, including cardiac failure/cardiomyopathy, congenital heart disease, heart transplant (adult and pediatric), pacemakers, implantable cardioverter defibrillators, and arrhythmias (irregular heartbeats). Heart Institute physicians and staff are involved in more than 50 research projects to improve cardiac diagnostic techniques and patient care for the future.
On March 21, 1995, Loma Linda University Medical Center's heart-transplant program received approval for funding by Medicare. By November 2004, 569 infants, children, and adults had undergone heart transplantation at the Medical Center and the Loma Linda University Children's Hospital.
Bruce Vladeck, administrative director of the U.S. Department of Health & Human Services, in a letter to Joyce Johnston, R.N., at the time LLUMC's administrative director of cardiac transplant, said, "In making a decision, we considered recommendations made by experts we consulted from outside the government.... Our review of your facility indicated that it met or exceeded all the necessary criteria. Therefore, heart transplants performed on Medicare beneficiaries on or after this date may be covered and paid by the Medicare program...."
According to Dr. Leonard Bailey, chair of the department of surgery, "this Medicare designation offers many potential benefits to LLUMC and the patients we serve. It may increase the Medical Center's number of ÔCenter of Excellence' contracts. [Medicare approval for heart transplantation is often a qualification for selection by insurers.] It will increase the number of referrals for all cardiac services, including implantable and external heart-assist devices and heart transplantation for adults and children."
Introduction to original edition (published in 1978)
DARING TO CARE--A LEGACY
After Loma Linda University Medical Center received international attention from the infant-heart-transplant program pioneered by Dr. Leonard Bailey, some news media produced "back-grounders" on Loma Linda. These feature stories appeared on television and in print.
The media felt the public wanted to know the story of Loma Linda--specifically, what influence provided an atmosphere that contributed to Loma Linda's boldness? What was the story behind a relatively obscure institution getting so much important, widespread, albeit sometimes controversial, attention in such a short period of time?
This legacy begins in 1866. It was preceded by the practice of medicine without physicians--amusing but deadly remedies of the 1800s: patent medicines, home-health guides, secret Indian remedies, and folklore that cured everything from Saint Vitus's Dance (a nervous disorder) to "brain fag."
It includes the story of John Harvey Kellogg, M.D.--medical pioneer, prolific inventor, skilled surgeon, brilliant administrator, influential author, enthusiastic health educator, and the creator of cornflakes and peanut butter.
It is the story of "the largest institution of its kind in the world"--the 1,500-bed Battle Creek Sanitarium--which touched the lives of Henry Ford, Harvey Firestone, James Buick, John D. Rockefeller, Jr., Alfred du Pont, J.C. Penney, Montgomery Ward, George Bernard Shaw, Dale Carnegie, Billy Sunday, Thomas A. Edison, Luther Burbank, Booker T. Washington, and Amelia Earhart.
The Loma Linda legacy includes one of the largest schools of medicine in the western United States which has produced almost 9,000 physicians.
And it includes the dynamic story of a regional trauma center that continues pushing back the frontiers of modern medicine and surgery.
What follows, with the addition of Chapter 19, is the original edition of LEGACY, updated to reflect developments that have occurred since the book was first published in 1978.
The story of Loma Linda is really a saga--a story of heroes and heroines...a story of faith...of mission...of daring...of continued daring. It is the story of a deep desire to serve God and humanity, a story that is rich in compassion and vision. It officially begins in 1905, as one of the greatest adventures of faith in the history of Christian outreach. It is the story of a basic belief in the value of the individual. It is a heritage of men and women demonstrating the kindness and compassion of God.
This LEGACY was influenced by incredible events occurring as early as the 1830s.