(Artvoice  1 June 2000)

Children’s Hospital:
Move It or Fix It?

Part I: Kaleida Health’s President and CEO
John E. Friedlander

By Bruce Jackson

(The first of two parts)

—Should Children’s Hospital stay on Bryant Street or should it move to High Street?

—Should millions of dollars be invested in rehabilitating and modernizing the current structure or should millions of dollars be invested in a brand-new building?

—Would the economic good resulting from moving Children’s to the East Side offset the harm the loss of Children’s would do to the West Side?

—Would it be possible to preserve the special culture of caring that makes Children’s one of the top-ranked pediatric hospitals in the nation if it were part of the Buffalo General–Roswell Park complex?

— Was the 1998 merger of Buffalo General, Millard Fillmore, and Children’s Hospital that created Kaleida Health a smart move in hard times or was it a fatal abandonment of autonomy?

— Would the present building or a new building structure better serve sick children?

—Are children better served by a hospital that deals almost entirely with children or by a hospital complex that does everything?

— Is there a correct answer to any of those either-or questions, and all the others surrounding this critical issue?

Kaleida and UB want Children’s on High Street because it will round out a coherent academic and financial complex. The Physician’s Coalition of Children’s Hospital wants it to stay on Bryant because they don’t want to be swallowed by that same academic and financial complex, and because they don’t trust the officials who’ve promised them space equal in size and function to what they have now. Shopkeepers and residents on the West Side fear the consequences of a huge block of buildings standing empty, of neighbors and shoppers who now have reason to shop and live elsewhere. City developers want it on High Street because it will help bring research labs and offices to a blighted and depressed section on and just off Main Street.

University at Buffalo Vice President for Health Affairs Michael Bernardino says the High Street location would “give this community a health science complex that would compete with anything anywhere in the country. We could compete with anywhere.  And it’s about time that we do things that make this city competitive.” The Physicians’ Coalition at Children’s Hospital worries that moving to High Street “will translate into a loss of focus on the special needs of children. Critical services dedicated to children could be diluted or eliminated in the name of consolidation and efficiency.”

There are other needs, other reasons for moving or staying, I don’t know how many.

Public policy is easy when the question can be answered rationally, when you can do a decent job of figuring the economic and social costs and benefits. Public policy is abominably difficult when the question has several rational answers, different kinds of economic and social costs and benefits.

Who’s right? Can all be right? Is any “right” more right than any other? Are there valid competing interests? If so, which shall have predominance?

We asked representatives of two of the primary participants in the debate to talk to us about the facts, the issues, the dangers, the benefits.

On May 9th I met with three members of the Physician’s Coalition: Linda Brodsky, MD, director of the Division of Pediatric Ear Nose and Throat at the Children’s Hospital, and professor of otolaryngology and pediatrics at UB;  Bradley Furhman. director of the Pediatric ICU at Children’s and a professor of Pediatrics and Anesthesiology in the School of Medicine; and Steve Lana, a private pediatrician in general practice in Buffalo. On May 26th I met with John Friedlander, president and CEO of Kaleida Health.

Neither meeting was an interview or conversation so much as a lucid representation of a complex position. Both times I asked two questions—What’s at stake here and what are the issues? How do things look from your point of view?—and the doctors and Mr. Friedlander told me. Both sessions lasted about two hours, and my subsequent questions  were few and primarily for clarification (they’re in italics in the text that follows). Since the doctors’ position is a reaction to actions by Kaleida Health, we’ll present selections from the conversation with Mr. Friedlander this week, and selections from the conversation with the doctors next week.

A Unique Asset

Children’s Hospital holds a unique position in this community. It would be foolish on my part or on anybody’s part to try to diminish the brand equity, the view of a unique children’s hospital and try to somehow– as the term has now been popularized in these discussions–try to homogenize the view of Children’s Hospital. It is a unique asset and we have every bit of interest in trying to keep that uniqueness branded and in view and recognized. Not just a name, but in substantive delivery of care for kids and high risk mothers.

If we don’t do that, then everything becomes this generic blob, which people can’t distinguish, an uncompetitive attribute for this community. Parents will seek out care elsewhere. They could go to Cleveland for specialized care, they could go to Pittsburgh for specialized care, they could go to Rochester for specialized care. So despite the popular discussions out there that this is a sinister plot to homogenize what Children’s Hospital is doing, that is the complete antithesis of what we’re trying to do. We want to try to preserve the uniqueness and reinforce it.

The other centers are advancing at very rapid levels. Rochester–they’re spending $30 or $40 million on a research center right now. They have a wonderful capability on one campus, the University of Rochester. Look at Cleveland, look at Pittsburgh, look at Boston, look at New York. Look at comparable cities like Indianapolis and Columbus. These facilities in these communities are coalesced around a set of medical missions that run from patient care to education to research. We do not have that.

We are on the cusp of being able to realize that if we can move the facility and get the collaborations built in a much more effective way. We can have a focused activity that can generate jobs from research, from applied research, that can have a focus around medical education, that can have a focus around the clinical synergies that need to take place.

The Genesis of Kaleida

Children’s Hospital serves the city of Buffalo, Erie County and Niagara County (the two most populated counties in the region), and the less populated counties where it provides inpatient tertiary care level of capability. Children’s Hospital gets referrals from across Upstate New York, and from time to time Ontario, portions of Pennsylvania, and so forth. So it serves a very large geographic area.

The ability of a specialized hospital such as Children’s to survive in a population base of 1.5 or 1.6 million, across the country, is on the cusp of beginning to have some problems. In this particular area, with some young families leaving or the birth rate declining because people are aging out, as is true across the country, the future suggests that there are going to be challenges as these demographics change—fewer and fewer kids, advancements of medicine and pharmaceuticals, pressures on keeping kids out of hospitals and keeping them in doctors offices or other ambulatory care settings.

One of the most important issues that the board at Children’s Hospital faced in 1995 and 1996 was this very dynamic. They brought in planning consultants as a free-standing hospital, got a lot of independent advice on what the demographics were saying, what technology was doing, what the future of specialty kinds of hospitals was with respect to various payment strategies, where things were going, and looked very closely at its present and future economic wherewithal. And made a decision that they needed a partner. A small group of the board spent time talking at length with the board and administrative staff at Buffalo General and similarly at Millard Fillmore health systems. The Children’s Hospital people concluded that they could not choose one health system over another, but rather what might be more possible or more likely or advisable was to bring Buffalo General and Millard and Children’s together as one.

Because Millard and Buffalo General were also facing very similar challenges in payment streams, issues of consolidation, all of the complexities that we’re dealing with in health care today, key board members began talking amongst the three organizations and the upshot of that was a decision on the part of each one of the boards to consummate a full-asset merger, which was consummated finally in April of 1998.

And that is the genesis of Kaleida?

That is the genesis of Kaleida.

I think that on balance the board and the administration of Children’s Hospital made some very sound decisions. They made the sound decisions based on what they viewed to be fundamentally the most important thing they could decide upon, and that is, how best could they deliver pediatric services in this community, how best could that be achieved? They saw the handwriting on the wall with respect to their ability to do that as an independent organization, their access to capital to refresh and acquire new technology, to carry out renovation, all of those things that they needed to do from a physical plant perspective, that are critical to the advancement of pediatric medicine.

They saw that there were limitations economically from the standpoint of recruiting faculty to Buffalo. It wasn’t so much that there was this immediate drain of dollars that all of a sudden they couldn’t do it. But that other organizations, other pediatric hospitals and other universities around the country were competing far more aggressively for a small pool of people.

You know, this is not a large group of people that we’re dealing with. These pediatric specialists are highly sought after. Other organizations compete from the standpoint of demonstrating the latest equipment and latest facilities, the depth and breadth of research laboratories, and all of those tools that you use to recruit people to a setting. Children’s Hospital, with the university, did not have that breadth and depth to do that. It’s a combined effort. It’s not only what the university can put on the table, what the medical school can put on the table, but what the hospital can put on the table. And the hospital was running out of steam with respect to putting offers on the table.

So on balance they made a decision that said in a larger merged environment they would have access to capital, access to tools and capabilities---the breadth of capability of a $750 million enterprise as we combined all three pieces---that would be far more attractive than Children’s Hospital as a $110 million enterprise.

There were a lot of issues related to it, but at the heart of it was this: how do they preserve the unique position of caring for children and high-risk women in this community? How are those roles preserved? And based on that fundamental view, that value, that perspective, they made the decision on the merger.

Credentialing, Autonomy, and Control

We have 2000 physicians, and they’re in a variety of employer arrangements. Many of the physicians are self-employed. Another group of physicians are employed as full-time faculty; their faculty support comes from University budget lines and the hospitals. There is a small group of physicians who are employed only by the hospitals. There are physicians employed by groups in this community such as Buffalo Medical Group and Promedicus. They’re separate governance structures, which essentially adds a layer of complexity to this whole dynamic.

Bringing the separate physician structures togther in a single medical staff, no one took into account the effect of trying to create, within the context of one medical staff, one credentialing process. Credentialing process is important in our environment, because that process essentially allows physicians to perform, acknowledges that they are trained, they are appropriate for the medical staff through their training and preparations, that they’re staying up with all their advanced education, that they’ve gotten their continuing education credits, they have malpractice insurance, and so forth and so on. They have all the credentials to say, “I can work here.”

The medical staff governs that process. Ultimately it is the purview of the Board of Directors of Kaleida under the regulations of the state of New York that prevails, but the medical staff really provides the oversight and governance for that on an ongoing basis.

When you bring all of these guys together under one credentialing program, there is a single set of credentials that did not take into account the unique oversight responsibilities that were formerly held by these pediatricians at Children’s Hospital. What you had was a situation where you had a lot more adult physicians, specialists, than you did pediatric specialists.

An orthopedic specialist, for example, might take care of 10-year old or 12-year-old fractures. But at Children’s Hospital you had to be a credentialed pediatric orthopedic surgeon to do that. So when these guys were merged into a single medical staff, everybody was going to be credentialed, everybody in the orthopedic area was going to be credentialed to take care of pediatric fractures.

Now, practically speaking, if you’re an adult pediatric specialist, you’re not going to start fooling around with very tiny baby’s fractures and difficulties, or even little infants’. You’re going to deal with the run of the mill multiple fractures that you see.

What happened was, the pediatricians were outnumbered. There is a small number of them relative to the large medical staff of 2000 physicians. The pediatricians asserted that they want to maintain this unique responsibility that was now captured in all of Kaleida, which was formerly captured only at Children’s Hospital in this credentialing process. They wanted to be able to sign off on these sophisticated procedures that some of these physicians were doing out there in the community. The adult physicians who were doing these pediatric specialties, perhaps not in great numbers, said, “You don’t have any standing here. We’re not going to do that. We’re not going to allow you to sign off. No one ever signed off on these before.’

So what evolved was a real pissing match between pediatric specialists and the adult physicians. The adult physicians were not going to be told what they could do or not do. But rather they were going to do what they wanted to do, and the pediatric specialists were saying ‘We are the only people that really know how to do these things.’

This has become a major issue as far as this homogenization or amalgamation within the context of this now merged entity. Because the pediatricians feel they have lost their autonomy, they have lost their control over pediatric medicine. This dispute is not going to be settled easily. It is not one that I perpetrated, that a board perpetrated, but rather one that has evolved unwittingly. Not deliberately, but unwittingly. As I said, it was omission as opposed to commission. It wasn’t purposeful.

But now we have to rectify it. Through the whole Children’s Hospital debate that has been going on, the signal words are “autonomy” and “control.” that issue of credentialing is right at the heart of autonomy and control. And so our board chairman, Tom Beecher, has extended to the pediatric services group at Children’s Hospital the idea of going out to systems and hospitals around the country and relooking at how we could address this issue. Tom said very recently, “So look, we’re going to deal with this.”

This is very important as background in terms of understanding what is one of the major issues that is really driving a group of pediatric physicians, against the merger, and a building plan or a building thought process that we’ve been going through. I believe it to be at the heart of the problem. That is one of the major issues. If they had their way I believe that they’d want to go back to pre-merger, go back to governing their own pediatric activities the way they always did. And, in the best of all worlds, sure, take advantage of anything that Kaleida wants to provide. But that’s not the real world. Tom Beecher is trying to make a change in some things that arose-- unintended issue, not deliberate---out of this merger process.

High-Risk Mothers

When we consolidated, we had an obstetrical unit at Buffalo General and we had an obstetrical unit at Children’s Hospital. It didn’t make sense to us to have two obstetrical units a mile from one another after we merged. We shut down the obstetrical unit at Buffalo General, consolidated it into Children’s, so now we have two obstetrical units: we have one at Children’s and we have one at Millard Suburban out in Amherst. When we shut the one down at Buffalo General, it was done over the protest of the obstetricians. The obstetricians said to us “If you do that we are not going to use Children’s Hospital to deliver our babies.” So a number of the obstetricians who use Buffalo General have gone. They’ve gone to either Suburban or one of the Catholic hospitals.


A couple of reasons. One is that they did not want to take their high-risk mothers to Children’s Hospital because Children’s Hospital does not have adult critical care capability.

The argument that some of these pediatricians at Children’s have made is that there are only five mothers a year that get transferred, so what is the big deal? You know what the big deal is? The big deal is that the obstetricians don’t go there any more, so they’re not taking their high-risk mothers there, because they’re not going there, period. What’s happening is, they’re taking their high-risk mothers to Suburban or to Sisters’ Hospital or to Mercy Hospital because each one of those three hospitals has a critical care unit for adults, for the mother. So they don’t go there. So it’s an illogical argument. By definition, they’ve taken them out. They said they were going to vote with their feet. “You guys are making the wrong move; we’re going to vote with our feet.” And they left.

Now on the other side, why did we consolidate the services to start with? It was probably $1.5 million worth of savings. We believed that we could provide a level of adult care at Children’s Hospital that could match the critical care capabilities that the obstetricians wanted. They said, “You can’t do it, it hasn’t been done for 25 years, and it’s not going to be done now.” So we didn’t even have the opportunity to prove it to them–because they left.

And the numbers bear it out. The decreased numbers of obstetrical admissions to Children’s Hospital is there, you can see it, from the time we shut the unit here. Where we anticipated that we were going to see an increase, we’ve actually seen a decrease. We’ve seen an increase at Suburban, but also Sisters’ Hospital has seen an increase and Mercy has seen an increase. You can look at the numbers and see how they tie together.

Some of these arguments about that kind of issue are a bit twisted.

I would say that that is an issue that we will overcome by being able to deliver babies once again at Buffalo General and where there’s a high-risk infant, which the Children’s Hospital staff are expert at taking care of, wheel them across a bridge to Children’s Hospital and take care of them in the neonatal intensive care unit. And that’s part of the design.

So that’s kind of mixing some of these problems and issues in there, but that’s kind of the thought process about doing this.

Taking Stock After the Merger

As part of the merger process, we felt it was critically important to look at all our facilities. We took stock of all of our physical assets, in addition to a lot of other things we were doing–service programs and so forth. What we did was as a result of doing that was put together a three-year strategic plan for Kaleida Health, which was essential to guide us for the future.

We found a range of ages of physical plant, usefulness of physical plant and likelihood, cost and likelihood of using this physical plant well into the future. So we settled the plan, we said ‘Here’s the plan, within the context of the plan we have these physical assets. What are we going to do with all this stuff and where do we need to go for the future?’

What we looked at in terms of the physical facilities was the development of various campus strategies. We operate Children’s, Buffalo General, Millard Gates, Millard Suburban, DeGraf, and 46 other sites, small little venues around the region. We said, “We need to begin to refine some options for the future. What are we going to do with all these physical plants? We need to consolidate, we need to reduce the campuses. We can’t continue to operate five campuses.” We developed some options out of this and then the Kaleida board commissioned a much more detailed study committee to assess the options that we had put on the table.

The strategic plan was put together in January 1999. I told the board in January of ’99 that by August of ’99 we were going to have a definitive recommendation on what to do among all of our facilities. We were going to have a definitive recommendation with respect what we wanted to do with Children’s.

There were two options with that. Actually, four or five options were looked at; we narrowed it to two. One was to stay at Bryant Street, the other was to go to High Street.

In June and July it was apparent to me that we did not have enough information to make the recommendation in August that I had committed to. So I went back to the board and I said, “We don’t have enough information. We cannot make a definitive recommendation in August as I had originally suggested. We need to get a lot more stakeholder input on this process.”

I was the one who said let’s open this process up. And the way to open this process up is to form this Ad Hoc Committee. We firmly believed that we needed far more stakeholder input. We did not want to fall into the trap of saying, “This is the recommendation, board. Vote it up or vote it down.” But rather we needed to gain more input into the process.

So we’ve gone through this prolonged process. It’s been painful, it’s been difficult, but it’s been the right thing to do. And that is to ask people to come in and give us a perspective on what they believed was necessary. Not to have these open public forums where people would be yelling. We had our share of those anyway. You know: the audience would be stacked and people would be yelling and screaming about what they needed to have and what they believed to be the case. Our board people didn’t think that was going to be helpful in terms of trying to gather that information. But there were literally hundreds of people and thousands of hours committed to listening to various people’s perspectives.

We’re still in the process. By the end of June, a full year later than I had originally gone to the Board in the hope of making a decision, we are at the point of making a decision.

The decision is really around where are going to spend the next million and a half dollars to do detailed design, financial feasibility, fund-raising feasibility, land use plans, regulatory studies—all those things that are required to build a building.

Let’s assume for a moment that the High Street option is chosen: I still have to prove that it’s financially feasible, that it works, that it can moved through the regulatory process and get financed and so forth and so on. That process necessarily is going to require very very significant involvement by physicians in designing a building.

A New Hospital

What we’re now looking at is optimally, first and foremost, how can we provide 21st century medicine for children and high risk mothers in this community? That is the heart of it. And no one seems to be talking about that. No one is talking about that. Can we do that in an efficient way, a cost-effective way and on top of doing that, first and foremost, can we gain economic development benefits in a consolidate Buffalo General–Roswell–Children’s campus site? Can that lead to major university involvement, because the University is heavily involved at Buffalo General and Roswell right now, and at Children’s separately. Can we get the synergy of a campus, of a medical campus? Is it possible to generate that kind of synergy, working off of the capabilities that Roswell has developed in the last few years in a $260 million facility? There are research capabilities, there are scientists and physicians who are there who are collaborating right now when people are all over the city. There are residents being trained, medical residents being trained, dental residents being trained. And everybody is in this disparate mode. Is there an economic benefit to coalescing an exciting, dynamic medical campus that can put Buffalo on the map from a medical perspective that can be competitive with other centers around the country?

There are people who don’t want us to build a new hospital. I acknowledge that. We’re never going to get 100% concurrence on anything, especially in this community. I acknowledge that people have different points of view. I acknowledge and respect that, deeply and sincerely. However, I’m doing the job that at first the Board asked me to do. That is, come forward with a plan in January of 1999, to rationalize what we’re doing as an enterprise for this community, the focus of which has to be how to take care of kids and high-risk mothers in this community. Not to get into debates about autonomy and control and all these other issues, which we all have to deal with practically in our jobs. Let’s try to find the right direction.

We came up with two alternatives, and I firmly believe based on evidence that we’ve been given and we’ve heard from people that—notwithstanding the issues of autonomy and control and the turf issues and credentialing issues—it makes abundant sense to go ahead and try to build a 21st century medical complex, of which we already have two major pieces in place, on High Street. That will meet every bit of the substantive care, educational and research requirements that people have said must be met.

Now, whatever the committee is going to recommend, they’re going to recommend.

Age and Consolidation

There are age considerations that we faced in terms of Children’s Hospital. The design people, the architects and the engineers told us that under the best of circumstances–not withstanding new construction–we would have to expect to expend under normal conditions over the next 10 years somewhere between $25 and $30 million on mechanical improvements to Children’s Hospital. That was a yellow flag to us. That’s without doing any construction, that’s behind the walls stuff: elevators, heating, wiring, ventilation, air-conditioning, boilers, all that stuff that people never ever see. That because of the aging of the plant it was going to require up to $30 million of expense over the next 10 years before you think about doing any kind of construction.

I want to mention to you that Children’s Hospital is but one piece of what we’re dealing with. Because as an enterprise, we have a number of other facilities. What we are trying to do, what we fundamentally need to do, is consolidate campuses. We can’t continue to operate on all of these campuses. It’s not financially feasible for us, it’s not good patient care. The accessibility is no longer an issue. And the ability for us to maintain all the campuses at a quality level and a service level is just out of reach for us. This is not something that’s unique to us or to Buffalo; it’s happening all over the country.

There was a master plan done in 1995 by Children’s alone. It contemplated actually building new facilities and doing some renovation, reorienting the whole entrance and so forth, to Children’s Hospital. This was a plan that  could not be financed and that the administrative team then walked away from because it could not be financed.

We are re-looking at this, but there was a great deal of work done on this plan prior to merger. We used that as a frame from which to say, “Here is an option for what to do with Bryant Street.” We took off from all the work that was done in 1995. We didn’t reinvent another plan for Bryant Street. The architects and engineers estimated that it would be about $175 million. This was renovating the hospital and building the ambulatory care building. This is $175 million that Kaleida would have to carry, and it did not include any kind of medical research or parking or any kind of reorientation around parking ramps or whatever. It just included what the 1995 plan contemplated with more enhancement on an apples-to-apples basis—what you would get in a new hospital, what you would have to do to the existing hospital.

For example, there are portions of these buildings that can never ever be air-conditioned because the ceilings are too low right now, they were built too low, and you can’t run ducts. You can’t drop them. There’s probably some new technology out there that you might be able to do something with but with conventional technology you can’t do it. People put up the argument about, “What’s the matter with these buildings?” Especially some of these doctors. I don’t know anything about this stuff. Doctors don’t know anything about this stuff. Leave it to the architects and the engineers. They came back and they told us what the problems were going to be, what it would take to actually make changes there.

High Street

The other option was High Street. The High Street option is the one that I’ve been very outspoken about favoring because I think it’s the most practical. What it contemplates is a free-standing hospital. It doesn’t contemplate homogenization of services.

The doctors are quite right when they say that we don’t have a plan. What we’re trying to do is avoid inappropriately spending somewhere between $2 and $3 million on doing two detailed plans. But rather make a decision on a site that we’re going to study, without the assumption that this is a done deal, because if I can’t prove to our board that this is financially feasible and we can’t get the money and we can’t architecturally do it and we can’t regulatorily do it, then it won’t get done.

The doctors have raised the issue of adjacency—putting the ICU, surgery and radiology together. We have gone back to the architects and the engineers and asked them to further substantiate that all of the adjacencies could be accommodated in the free-standing building that we committed to in our initial planning, and they have given us further assurance through further analysis that that can be achieved. They’ve proven it to us. They’ve substantiated their own work.

I wanted to be sure that we could meet every one of these commitments, and the first and foremost one was that, when the criticism was we weren’t going to build a free-standing building, this was a ruse to get everything into Buffalo General. It’s not. It would be adjacent to Buffalo General, it would be a full replacement of all pediatric services. We’re very careful about saying not all Children’s Hospital services because obstetrics is there and we’re going to move obstetrics back into Buffalo General, which will, be hope, bring back some of those obstetricians and those patients that have left.

What we would anticipate is also the fact that there is somewhere between $2 and $3 million worth of savings annually by eliminating duplicate support services, like dietary, laundry, and a variety of other services that are already done at Buffalo General. We don’t have to replicate another laundry or another dietary operation and a variety of other nonclinical activities. But every clinical activity that is carried out today we have committed to replicate in this building.

What we are debating at this point, is, I think, process. That’s where this debate ends up. Because what we have chosen to do is ask our board and in turn the board has formed a committee to make a recommendation to the board to plan either for a new facility or a renovation on Bryant street. And whatever that decision is, I think that decision has to be made so that we can direct a million to a million-and-a-half dollars in the proper way.

I do not think it’s responsible to spend twice that amount to try to prove out one plan over another because we’ll be back to where we are today arguing about which plan is which. I think a definitive decision has to be made as to what site we study and to prove it.

We’re not going to spend millions of dollars building a building until we know that it can work. If people take exception to the process, fine, I accept that. But don’t take exception to what we’re trying to do in terms of improving clinical services, educational capabilities and research in this community. And this is to the benefit of this community, not the benefit of John Friedlander. This is essentially where I’m coming out in this.

There have been comments about the safety, the community safety. We didn’t raise this issue, this was raised by the Physician’s  Coalition. But somehow people through this process have said that this part of the community is not safe, that the area where Children’s Hospital is is more safe, within the context of the community external to the hospitals. So we went to the Police Department and we said “Tell us.” We said, “Give us the areas.” They went through the geographic area around Children’s Hospital, the geographic area around Buffalo General. We didn’t go way into the Fruit Belt or anything. And the data, essentially, you can see it for yourself shows that it is somewhat higher over on the Bryant Street area than it is around Buffalo General. I will acknowledge that probably within the four walls of each one of these organizations, because of the size of Buffalo General, and we are dealing with adult populations, that there’s probably more incidents reported in Buffalo General than there are in Children’s Hospital But they raised the issue of criminal activity in the neighborhoods, and this is what the Police Department has told us.

I think we have a unique window of time, an opportunity to create something absolutely magnificent for this community that can generate terrific clinical care, education, and research. It can bring huge amount of economic viability to this community. It’s in the city. If you look around here, right over just to the south of this building is an open lot. That there is going to be a new research building developed there, a new privately developed research building, a $4 or $5 million building. The Trico Building is about to undergo major redevelopment. At the corner of High and Main, there a single residency low income apartment building. This building has been purchased through BURA and is supposed to come down this summer and in its place will be a building that is contemplated to house research, office capabilities and so forth. The process has already started through the purchase of this building. The Institute on Alcoholism, which is operated by UB and the state, operates over here.

High Street can accommodate everything that Children’s Hospital has right now and more.

Why Move to High Street?

First, the facilities at Children’s Hospital are acknowledged by everybody to be deteriorating, so there is a level of fix that is required, and everybody will acknowledge that. If you don’t, if people don’t acknowledge that, then their heads are in the sand. Given the information from the architects and the engineers and the stakeholders, my own professional judgment has gotten me to a point where I believe that rather than trying to renovate the house and trying to make a silk purse out of a sow’s ear, that at this point building new is the right decision. If we could build new on Bryant Street, that might be another issue, but we can’t build new, that just is just way out there. So where do you build new?

The second point that led me to this conclusion is that what we need is to try to optimize collaboration of the scientific enterprise that we have in this community, the clinical-scientific-academic enterprise that we have here. The university is a willing partner, Roswell is a willing partner. We have a huge medical-complex infrastructure and we have land to realize all of that medical synergy that I believe can benefit the care, education and research that this community deserves. In separate locations we’ll never realize it. It will be separate, by definition. There will be no synergy, there will be no collaborative research, the people who have to move between the sites will continue to have to go between the sites, and we as a business are going to have to reinvest in all of these separate plants.

Third, I think coalescing all of these resources in one location does not preclude others who are involved in hospital care in this community from continuing their efforts. Rather, a rising tide can float all the boats in this community. We can be seen as a collaborative medical enterprise, like many other successful communities.

Experts in Decline

I heard a comment the other day which I don’t think I’m ever going to forget. Given all the changes that Buffalo has experienced over the last 20 or 25 years or more, we have become as a community experts in managing decline. We can write as a community the textbook for managing decline. There are very few other communities in the country that have done that. Pittsburgh was heading down that path; they chose not to be experts in decline. Cleveland–same thing. Boston–same thing. Detroit is still struggling with it. We have become the national experts in managing decline. And we’ll figure how we decline: how can we absorb all this stuff, how can we absorb closing another steel mill, how can we absorb closing another chemical plant in Niagara Falls?

I fundamentally reject that principle. I fundamentally reject it. I believe that we have to become experts at managing growth. The thing that hit the nail on the head for me was an article in the paper two or three weeks ago by Robert Wilmers: “Quite simply we must develop new habits. We need to take chances, make changes, experiment, take risks.” That is the essence of what I think this represents.

If our community wants to stay with a separate Children’s Hospital, it’s going to stay with a separate Children’s Hospital But why not think about what can be, and the economic benefits, the spinoffs of what can be from the standpoint of having a platform to deliver 21st century medicine to tiny little babies or sick mothers? I’m not doing the tearjerker stuff, I’m talking about the reality of what we’re doing. Because we have to do that. We have to provide that platform. Why not do it in a new facility? And in doing that why not realize the possibility, try to challenge the possibilities of what could be out of that?

That’s part of my third reason. The other part is the economic benefits. Because businesses, pharmaceutical companies, research, venture capitalists–people will be attracted to a critical mass of scientific expertise, and we do not have that. We do not have it. It’s disparate in this community between the South Campus, High Street, Bryant Street, over here. It’s scattered all over the damned place. Out there in Audubon. What we can do is to begin to coalesce that activity. That that can be part of an economic engine for this community. And that’s very real, it’s palpable, it’s real, it’s touchable. It is. And Children’s Hospital represents an integral part of that. It is not the end-all and be-all to it, but we have to develop new habits. You know, this is a new economy.

Why I Want to Do It

We’ve got a bunch of doctors saying “The status quo is just fine.” It is NOT fine. Because every other community in the country that’s successful is doing what we’re doing or more. Vanderbilt University medical center–building $150 million new children’s hospital. Columbia-New York Hospital--building a new children’s hospital. Westchester County Medical Center--building....

Do you realize that five years ago Children’s Hospital of Buffalo was the only free-standing children’s hospital in New York State? There are now going to be in the next couple of years, five new children’s hospitals. That’s the competition that we’re dealing with.

You have to challenge this stuff. And the challenges we have in this community are massive. But why not try to leverage the assets we have here? Some would suggest, as the physicians have suggested, leverage it on Bryant Street.   It’s not enough. That’s not enough leverage. I don’t think that enough people in this community have seen what we can realize.

That’s why I want to do it.

 Part II: The Doctors Speak
 Part III: Children's Hospital: What Now?

copyright 2000 Bruce Jackson

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