Kids' hospital plan is 'politics, politics'

Julia Bolla beamed with delight as her therapist crouched beside her and launched soapy bubbles in her direction.

Though she is never more than three feet from a ventilating machine or farther than 10 yards from a nurse, the Las Vegas girl is cheerful in the only home she knows -- Sunrise Children's Hospital.

The 2-year-old triplet has spent all but two months of her life at Sunrise. Open heart surgery and pulmonary hypertension have left her unable to breathe on her own.

Although the girl's parents say they are thrilled with Sunrise's staff, they can't help but wonder what Julia's first three years would have been like if Las Vegas had its own independent children's hospital.

Perhaps instead of flying to San Francisco for open heart surgery, Julia could have seen a specialist in Las Vegas. And rather than spending two months rehabilitating in Southern California, she could have stayed home.

Throughout Julia's ordeal, the most difficult time came during the last month of her rehabilitation, when her parents had to return to their jobs in Las Vegas, leaving their daughter behind.

"It was horrible," said Ruth Bolla, cradling Julia after work Monday. "Sending a child out of town disrupts everyone's lives. The first night she was back here she slept like a rock because she knew she was home."

University Medical Center administrators and Clark County Commissioner Erin Kenny believe there could be a better home for sick children in Las Vegas -- an $80 million public, nonprofit, free-standing children's hospital.

In their effort to gain support proponents have waged war with Sunrise, saying because it's a children's hospital within an adult hospital the focus isn't solely on children.

Sunrise administrators, miffed that Kenny did not tour their facility before embarking on the multimillion dollar proposal, claims their hospital serves children as well as any children's center.

And, they claim, a county facility that isn't created with the help of the entire medical community will never make it financially.

The battle for a free-standing children's hospital is nothing new to child care experts familiar with private for-profit hospitals like Sunrise going up against public facilities such as UMC.

"It's politics, politics, politics," said Larry McAndrews, president and chief executive officer of the National Association of Children's Hospitals and Related Institutions. "You have all the different stakeholders. There has to be enough trust in the system to get together and try it."

Specialists said no population guidelines exist for children's hospitals -- while most of the 59 independent hospitals around the country are in cities larger than the Las Vegas area, some have been built in smaller communities.

Typically larger markets average about one bed per 1,428 children.

Sunrise has 144 beds in its children's hospital and UMC is proposing a 152-bed facility. Under the county's projected population figures, 410,000 children will live in Southern Nevada in 2005 when the new hospital would open. That amounts to about 1,370 children per bed.

In a smaller market like Clark County, however, 300 hospital beds split between two facilities can pose problems.

UMC would likely duplicate specialized programs or physicians who, for example, have expertise in neurology or radiology, which would dilute the quality of care.

"When you try to attract those folks you need to draw on the whole population," McAndrews said. "Otherwise each hospital tries to provide the same programs and it becomes anemic."

Medical specialists

Sunrise has a field of medical specialists including the community's only pediatric pathologist and pediatric radiologists. It only transfers children out of state for organ transplants and complex heart-lung bypasses.

It is the only hospital in the country that keeps three specialized physicians in critical care and the intensive care unit 24 hours a day.

"We are full service start to finish," said Dr. James Swift, medical director of the children's hospital. "A lot of local surgeons choose to come here because we are so family oriented."

Sunrise has introduced several programs to ease anxiety for children and their parents. Starbright World allows children preparing to be transferred to another hospital to meet patients already admitted via a telephone and monitor. And one of the more popular programs allows children prepping for surgery to drive a motorized jeep to the operating room.

Few can argue that some children's hospitals within adult hospitals are successful; Johns Hopkins in Maryland is the prime example. But most experts agree that a free-standing hospital is better for children.

McAndrews likened it to the newspaper business: The Wall Street Journal dedicates itself to business news and while other papers cover business, they are not nearly as thorough as the Journal.

After 16 years operating inside the walls of the Good Samaritan Regional Medical Center in Phoenix, the Phoenix Children's Hospital is preparing to move into its own independent building.

"A free-standing children's hospital is the right thing," said Carol Lanese, vice president of patient care and chief operating officer at Phoenix's facility. "I just feel like they attract people who are really committed to taking care of kids."

Lanese said when a children's hospital is within another facility it feels committed to the larger system, which limits the variety of programs it can offer. An independent hospital can partner with other centers in the community to create educational programs.

Independent nonprofit hospitals also invest more money into education and research while for-profit facilities tend to be in the business to make money, said Philip Pizzo, physician in chief at Boston Children's Hospital.

And free-standing hospitals don't have to answer to the larger system that may have a different agenda other than concentrating on children.

"(A free-standing facility) has a focused critical mass to push the agenda in an unwavering way toward excellence in child health," Pizzo said.

Sunrise administrators are not opposed to a free-standing hospital; they simply believe that if county funds are used to build the facility the entire community should be involved in the planning.

And, he said, no Sunrise staff member has ever been asked to sit on a task force to explore the idea of an independent center.

"I think if we do it, we should do it right so it won't be a failure, rather than say 'If we build it they will come,' " Swift said.

Swift supported Clark County Commissioner Dario Herrera's proposal last month to assemble a committee that included members of the entire medical field to conduct a needs assessment study on the feasibility of a hospital.

Herrera and fellow board members opposed an ordinance that would have allowed the board to authorize the $80 million general obligation bond needed to construct the children's center.

Kenny's colleagues were frustrated by her strong push for the ordinance and said the idea was sprung on them. Their hesitation to support the bond issue gave the perception that they didn't support child care.

Before any needs assessment meetings could be scheduled, UMC pediatricians filed an affidavit with the county registrar. If the physicians submit 38,641 signatures before July 31, the board must reconsider the bond ordinance. If it is again denied, it will be placed on the November general election ballot.

Members of the physicians group, which is calling itself "Caring for Children Committee," did not return phone calls.

Typical obstacles

Even if the county can conquer all the typical obstacles that accompany a hospital project, it might not overcome the contentious manner in which the project was brought about.

And that, according to experts, could do the hospital the most harm.

The most successful free-standing hospitals are built by involving civic leaders, the medical community and movers and shakers, McAndrews said.

"The question is whether you could achieve a new level if they all worked together," he said.

Phoenix's Lanese said splitting up community support and funding will only hurt both facilities.

"When you concentrate all your resources, you can make a difference and you can have better outcomes," she said. Kenny, who was on vacation and unavailable for comment, initiated a survey that showed the majority of pediatricians in the community favor the children's hospital. She has said a children's hospital will improve access and serve residents regardless of their insurance status.

"When the charge of UMC is to take care of all people regardless of their ability to pay, you can see the need is great," Kenny said in a recent interview. "The only thing that can happen is we can attract the absolute best health care has to offer children."

Sunrise argues that it, too, serves all income levels -- 40 percent of the patients at the hospital are poor and have no health insurance, according to Minta Albietz, vice president of maternal-child services.

Despite how the children's hospital is built, Pizzo said he is confident a community with an exploding population and more and more young families can support a free-standing children's center.

He said until it is built, the county will continue to hear arguments about how there are plenty of beds dedicated to pediatrics and Sunrise serves the community adequately.

"The argument about a lack of need for a children's hospital is not a new one; an erroneous one, but not a new one," Pizzo said. "When Boston Children's opened, the local community said there is no need for a children's hospital and in a sense it would never survive. That was in 1869."

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