History of Healthcare in Roanoke & New River Valleys Volume III by OurHealth Media LLC

THE

HISTORY OF HEALTHCARE

IN THE ROANOKE VALLEY PRESENTED BY THE PUBLISHER OF OUR HEALTH MAGAZINE

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READ THIS EDITION OF THE HISTORY OF HEALTHCARE IN THE

SPECIAL EDITION • VOLUME III

ROANOKE VALLEY ON YOUR TABLET McClintic Media, Inc. PUBLISHER

Stephen C. McClintic, Jr.

PRESIDENT AND EDITOR-IN-CHIEF

Angela Holmes ASSOCIATE EDITOR

Jenny Hungate

VICE PRESIDENT, PRODUCTION

Rick Piester EDITORIAL

ART

OR SMART PHONE!

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Kim Wood 540.798.2504 kimwood@mcclinticmedia.com

COMMENTS/FEEDBACK/QUESTIONS Our Health Magazine, Inc. welcomes your feedback. Please send your comments and/or questions to: “Letters,” Our Health magazine, Inc., 305 Colorado Street • Salem, VA 24153, 540.387.6482 or you may send via email to steve@ourhealthvirginia.com. Information in this magazine is for informational purposes only. The information is not intended to replace medical or health advice of an individual’s physician or healthcare provider as it relates to individual situations. DO NOT UNDER ANY CIRCUMSTANCES ALTER ANY MEDICAL TREATMENT WITHOUT THE CONSENT OF YOUR DOCTOR. All matters concerning physical and mental health should be supervised by a health practitioner knowledgeable in treating that particular condition. The publisher does not directly or indirectly dispense medical advice and does not assume any responsibility for those who choose to treat themselves. The publisher has taken reasonable precaution in preparing this publication, however, the publisher does not assume any responsibility for errors or omissions. Copyright © 2013 by Our Health magazine, Inc. Reproduction in whole or part without written permission is prohibited. Our Health is published bi-monthly by Our Health magazine, Inc. 305 Colorado Street, Salem, VA 24153, P: 540.387.6482 F: 540.387.6483. www.ourhealthvirginia.com. Advertising rates upon request.

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VOLUME III

TABLE OF CONTENTS 10.

Introduction

12.

Healthcare Development

24.

Education

31.

Rescue

34.

Heroes

39.

Nursing

43.

Nursing Homes

49.

Technology

ABOUT THE AUTHOR Rick Piesterâ&#x20AC;&#x2122;s

career has included successful experience as a

musician, a newspaper reporter and magazine editor, a healthcare communications executive, a symphony orchestra executive and a freelance writer. He has worked in healthcare communications for more than 30 years, including service as executive communications officer for a large New England health system, and providing communications counsel for the Massachusetts Medical Society, publishers of the New England Journal of Medicine. He is now semi-retired, living and writing in Lynchburg, VA, while he and his wife Patricia make their way through their bucket list. the history of healthcare

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ROANOKE, 1960’S

VOLUME III

INTRODUCTION

his third volume of our history of healthcare in the Roanoke Valley takes us from the 1960s into the 1990s, three decades of almost constant change and progress. In those thirty years, the region’s healthcare organizations were very much in motion. Multiple construction projects gave hospitals the physical appearance that most people would recognize today. Hospital alliances formed, then dissolved, and then reformed again in patterns that would be confusing to today’s observer unaided by a scorecard. One major fixture in the healthcare landscape came into being during the years covered by this volume, and another revered organization name disappeared, only to resurface years later as a dominant factor among the region’s health education resources.

People who would become legends for their leadership in the field devoted entire careers to building the healthcare organizations that we depend upon today. And elements that we consider routine parts of our modern background — the 9-1-1 emergency telephone number, for example — first came upon the scene. We at Our Health Magazine were delighted at the wonderful reception that greeted the first two volumes of this history when they were published last year, just as we are grateful for the kind words and encouragement that you have for our “regular” magazine editions for the Roanoke Valley, Central and Southside Virginia our Richmond Virginia editions.

We hope you like Volume 3 of Our History…

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Courtesy of Lewis Gale Medical Center | ANESTHESIA AT LEW GALE, 1970â&#x20AC;&#x2122;S 10

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VOLUME III

HEALTH DEVELOPMENT

n 1960, America was on the threshold of a tumultuous decade. Interrelated cultural and political events would at first convince the nation that a new age was at hand, only to sour and spoil by the decade’s end. The inauguration of John Kennedy as President in 1961 set the tone, many thought, for the rest of the decade. His promises of a “New Frontier” offered laws and reforms that would reshape America by eliminating inequalities and social injustice, but the dream was brought short by resistance to sweeping social change within Kennedy’s own party, and, tragically, by Lee Oswald’s bullets in Dallas’ Dealey Plaza on November 22, 1963. Kennedy’s successor as president, Lyndon Johnson, was a veteran of Washington politics and government who had the political clout to engineer and enact his own set of stunning social reforms in the aftershock of the Kennedy assassination, creating a “Great Society” in which poverty, hunger, lack of education, and lack of healthcare had no role. Another Kennedy imperative, the quest to put an American on the moon within the decade, would produce unimagined progress in medicine. The decade-long race with the Soviet Union to dominate space would spin off almost unlimited advances in technology and medicine, including the creation of a whole new field of science — space medicine. Physicians and scientists studied the problems inherent in keeping astronauts healthy as they traveled through the solar system, confronting and conquering problems that had never occurred to gravity-bound medicine. As time has proven, the astronauts were hardly the only people who benefited from the U.S. space program. Among the technologies that were perfected — or uncovered — in space were all forms of digital imaging, cardiac health including the development of implantable pacemakers, kidney dialysis, and even the technology that provides the

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telemetry to monitor patient vital signs in hospitals and aboard rescue vehicles. The hope and promise of the 1960s, however, was colored by the growing social tumult triggered by the steady escalation of the war in Vietnam. U.S. military advisors had been in place in Southeast Asia since the 1950s. Their numbers were increased in the early 1960s as tensions there mounted, and President Johnson escalated the U.S. commitment in 1965, sending combat troops to a war that would claim 60,000 American lives, injure another 300,000 troops, and entangle the country in controversy into the 1970s. The war — along with the assassinations of Dr. Martin Luther King and Robert F. Kennedy, brother of the slain president — had a profound effect on almost every aspect of American life. It left Americans with a jaundiced view of the government, the media, and authority in general. The turmoil of the 1960s forever changed our society, leaving a lasting mark on our perceptions of the world around us and fostering our expectations to be informed. In the Roanoke Valley, the pieces were in place for the explosive growth of medicine and healthcare that was to come. As an industry, healthcare was one of the largest employers in the region. Population in the metropolitan Roanoke area in 1960 was nearly 125,000, a 20 percent increase from just ten years earlier. Roanoke citizens and health professionals had four hospitals to choose from — Roanoke Memorial and Crippled Children’s Hospital, Jefferson Hospital, Lewis-Gale Hospital and Burrell Memorial Hospital, which was dedicated to serving the African American community in a modernized building that opened in 1955. Still, health planners determined that the metro Roanoke area did not have enough hospital beds to serve a growing population, and the Roanoke healthcare organizations made ready to accommodate the expected demand. Two hospitals with older buildings — Jefferson Hospital and LewisGale Hospital — saw their opportunity to grow as a merged hospital under a new name. By 1960, plans were largely complete for the two organizations to combine and build a new facility, a 400-bed medical center to be built in southwest Roanoke. The new hospital would be named Community Hospital of the Roanoke Valley. But little did local planners know that obstacles they encountered in the early 1960s would shape the way healthcare was delivered, and the locations from which it was delivered, over the decades to follow. Finances were becoming tight for Lewis-Gale in 1961. In the same year, Lewis-Gale administrator Stuart G. Aldhizer died, leaving the organization without administrative leadership. Although some in both organizations wanted to make the merger effective and allow

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the Jefferson Hospital leadership to run the new organization, others favored a search for a new chief executive. Their view prevailed, and in May 1961, David G. Williamson began a long and fruitful period leading Lewis-Gale Hospital. Williamson proved to be a visionary who would lead Lewis-Gale through evolutionary change for the next 13 years, before he took a position with the for-profit hospital corporation that had acquired Lewis-Gale. Williamson soon began planning the expansion of the existing hospital, beginning with a three-story addition to the outpatient clinic, which opened in 1963 to rave reviews for its services and the level of its technology. Planning for the merger with Jefferson Hospital continued, along with fundraising efforts for the new hospital, but the plans came up against some hard real-world conflicts that fostered doubts as to whether the marriage would really work. Lewis-Gale physicians began to worry that the demands of the new hospital would interfere with the time and loyalty they devoted to the Lewis-Gale clinic. Physicians on the staff of both hospitals were uncertain of the effects of combining physician training programs at each hospital. And finding a suitable site for the new hospital in downtown Roanoke proved to be difficult. At the same time, Williamson and others realized that the demand for new healthcare facilities was a regional issue, not confined to just the city of Roanoke. Adding 400 beds in Roanoke might help serve demand there, but there was no wisdom in allowing the rest of the metropolitan area to go wanting for hospital beds. While the two partner hospitals contemplated next steps, the LewisGale Hospital and the Lewis-Gale Clinic, as the group practice of physicians staffing the hospital was named, became separate legal entities. Begun in 1963, the intensive three-year process was a fundamental shift in the way the physicians and the hospital operated and related to each other. Creating the separation was tortuous for all parties involved, but it proved to be an enduring structure, in place and thriving today. Planning for the new Community Hospital of the Roanoke Valley continued. Originally planned to be built on a site at the intersection of U.S. 220 and Virginia Route 119 in the Edgehill section of the city, hospital planners later decided that the construction site would be in downtown Roanoke, at the edge of Elmwood Park, with the front of the building facing Elm Avenue. Roanoke businesses and individuals reversed their reluctance of earlier years to donate to hospital construction projects, exceeding goals by raising a total of $3.3 million for the building fund. Matched by another $3 million in federal Hill-Burton funding, the success of the financial campaign inspired a Durham (NC) Morning Herald reporter to write, “in Roanoke, the middle-class guy is used to paying his own way.”

Courtesy of Carilion Clinic

TOP A RACIALLY INTEGRATED PATIENT WAITING ROOM IN THE MID-1960’S ABOVE PEDIATRIC PATIENTS AND THEIR FAMILIES AWAIT TREATMENT IN THE REHAB CENTER IN THE EARLY 1960’S

But progress on the hospital suffered from construction delays. In the interim, Lewis-Gales Hospital administrator David Williamson and his leadership group looked increasingly to Salem, which was actively recruiting the hospital. With the agreement of Jefferson Hospital, Lewis-Gale leadership decided to continue operations as a separate hospital. The separation agreement negotiated by the two hospitals stipulated that Lewis-Gale would contribute $400,000 to the new Community Hospital of the Roanoke Valley. In addition, Community Hospital would assume Lewis-Gale activities in obstetrics, and Community Hospital would become owner of the combined school of nursing formed from the separate schools each hospital had maintained — the Lewis Gale School of Nursing (1911) and the Jefferson Hospital School of Nursing (1914). The combined schools of nursing became the

Community Hospital of the Roanoke Valley School of Nursing, which began operations in 1965 and graduated its first class in 1968. While all of this was being sorted out, Roanoke Memorial Hospital administrator William H. “Ham” Flannagan was continuing his string of hospital construction projects. A major modernization of the hospital completed in 1957 revamped old sections of the building on a wholesale basis. Flannagan then turned his gaze to the construction of new structures that would enhance new health services in the region. Nursing education programs — the hospital had operated a nurse training program since 1900, and it launched a school of practical nursing in 1957 — were the focus of a new construction project to house the School of Nursing. Aided by federal HillBurton funds that Flannagan had become so expert in securing, the new school building

and dormitory accommodating up to 124 student nurses opened in 1959. Flannagan then analyzed some of the societal factors that would be shaping healthcare. He noted that Americans were tending to live longer — average life expectancy had reached 70 years by the early 1960s —and he recognized that his hospital would be well-positioned to adapt itself to a healthier aging population and the new health issues that older Americans would face as they aged. As a result, Roanoke Memorial Hospital once again qualified for Hill-Burton funding for the building that would house Roanoke Memorial Hospital Rehabilitation Center, a project completed in 1962 at a cost of $3 million. Throughout the decade and beyond, refinements large and small were being accomplished at Roanoke Memorial. A chaplaincy program begun in 1962 was

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Courtesy of LewisGale Medical Center

complemented by a hospital chapel completed in 1963. That same year, the hospital was expanded to create more space for the emergency room, the radiology department, and Cobalt 60 treatment. An eight-bed intensive care unit (ICU) was created in 1966; a neurological intensive care unit followed in 1968; respiratory, neurosurgical and neonatal ICUs opened during the 1970s; and in 1985, the hospital started a pediatric intensive care unit. In the meantime, Lewis-Gale Hospital, Lewis-Gale Clinic and their respective administrators, David Williamson at the hospital and Eugene Sharpe at the clinic, were investigating future paths for their organizations. At the end of December 1967, Salem’s town council had quietly changed its status from town to city. Salem residents had welcomed the possibility of a hospital nearby when Lewis-Gale and Jefferson Hospitals first considered locating their new merged hospital near U.S. Route 220, but those hopes were lost when plans for the merger died. Still, some of Salem’s leaders persisted in their desire to bring a hospital to

Courtesy of LewisGale Medical Center

the city. In fact, the Salem Chamber of Commerce had completed a study in 1966 that came to the rather unsurprising conclusion that a hospital in or near the city would be appropriate. City leaders took the desire a step further, securing a 23-acre parcel of land on Keagy Road, hoping that a hospital— in particular, the new Lewis-Gale Hospital — would be built upon the site. But hospital leaders faced serious uncertainties in their search for a new facility. Hill-Burton funds, the federal construction assistance program that had been used so effectively by “Ham” Flannagan at Roanoke Memorial Hospital, were drying up, and earlier fundraising activities had not produced satisfactory results. Hospital officials were still not sure where the new hospital would be located.

Courtesy of LewisGale Medical Center

TOP CARDIAC CARE AT LEWIS GALE, 1970’S MIDDLE COMMUNITY HEALTH FAIR AT LEWIS GALE, LATE 1970’S ABOVE DARRELL WHITT, LEWIS GALE CLINIC ADMINISTRATOR AND SAM OWEN, LEWIS GALE HOSPITAL ADMINISTRATOR, LATE 1970’S

A solution to the short-term problems, along with an operating framework for many years to come, would be found in Nashville, TN, where a fledgling for-profit hospital management company was in the midst of a growth spurt – acquiring and operating hospitals, building new hospitals and managing others. The Hospital Corporation of America, now known as HCA, became interested in establishing a statewide group of hospitals in Virginia. Williamson knew that Salem had expressed a desire to have a hospital and that the property on Keagy Road was available. HCA had the necessary financial resources to make the hospital a reality. With that in mind, Williamson and Lewis-Gale orthopaedist Richard Fisher, MD, (president of the Lewis-Gale Education Foundation) went to Nashville in August 1968 to explore a relationship with HCA. In Nashville, HCA founder Thomas Frist Sr., MD was impressed with the visitors and their plans for a hospital for Salem and equally impressed with the medical foundation that Lewis-Gale physicians had established to address medical education needs in the Roanoke Valley. Later that month, Lewis-Gale announced that it had been acquired by HCA and that the hospital company had purchased the 23 acres on Keagy Road for a $17.5 million hospital to be built there, while operations

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continued in the old hospital building in Roanoke. Five acres at the new location were to be set aside for an outpatient clinic building, and adjacent land would be used for the Lewis-Gale Foundation. Ground would be broken in August, 1969, with completion of the hospital scheduled for 1972. Lewis-Gale and Salem would have a new hospital. Community Hospital of the Roanoke Valley, now without its LewisGale Hospital partner, had broken ground for its new building on Elm Avenue on May 10, 1963, with Governor Albertis Harrison, Jr. as principal speaker. The new building became a focal point for Roanoke’s urban renewal effort, along with the “707 Building” (707 S. Jefferson St.) and the route for the I-581 extension. Originally scheduled for November 1965, the opening was pushed forward to the fall of 1967 due to delays in construction caused by needed replacement of faulty concrete columns and construction site cave-ins and mudslides. Overarching all of healthcare everywhere was the implementation of a national healthcare insurance program for Americans aged 65 and over. Compassionate leaders in every walk of life recognized that the nation would not realize its full potential — “a destiny where the meaning of our lives matches the marvelous products of our labor,” in the words of President Lyndon B. Johnson in his “Great Society” speech — without some way to maintain the health of its citizens. The health insurance plans developed in the 1930s had slowly become part of the healthcare landscape. Employer-provided health insurance became a nearfixture in union negotiations. The concept of private health insurance was well established. But there were major gaps in who among the population could afford and benefit from health insurance. The poor, employees of small companies that could not provide insurance, selfemployed people, and unemployed people were among those who had no healthcare safety net. When people retired from their jobs, usually beginning at age 65, they had no health coverage to protect them in their old age.

Medicaid, programs funding medical care for the aged and medically indigent. The hospital industry, understandably, became obsessed with the workings and impact of the new law. In a special issue of the American Hospital Association magazine that was devoted to Medicare, a healthcare expert observed that “for the first time, it is possible for millions of people to plan their lives with some real assurance that, when they reach old age and retirement, their savings need not be jeopardized by the cost of illness.” With the enactment of the new law, the healthcare industry witnessed dramatic growth. The government paid for the medical care of the elderly, and physicians set their fees arbitrarily. Hospital admissions skyrocketed, and hospitals were enabled to do more for more people. But this was not the only legislation that gave healthcare something of a Golden Age. The 1968 Heart, Cancer and Stroke legislation provided funds to create centers of medical excellence in just about every major city in the country. To staff these centers, the 1965 Health Professions Educational Assistance Act provided resources to double the number of doctors graduating from medical schools, from 8,000 to 16,000. That Act also increased the pool of specialists and researchers, nurses, and paramedics. The Great Society’s commitment to fund basic medical research lifted the National Institutes of Health to unprecedented financial heights, seeding a harvest of medical miracles.

Providing the NRV with

All of this was a cogent argument for a national health insurance program, something that would provide a modicum of protection for all Americans when they became ill or were injured. But government leaders recognized that creating government-sponsored healthcare insurance would have to be done slowly. And with half of older people without health insurance, and with those who had insurance paying exorbitant premiums, a program for people over 65 was a natural segment with which to begin. In the summer of 1965, Congress passed and the President signed legislation creating Medicare and

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There was a second societal shift caused by the implementation of Medicare, as the plan came to be called. It furthered the racial integration of hospitals and physician waiting rooms by making payment to healthcare providers subject to desegregation. Roanoke was ahead of the desegregation curve, in that African American patients had been admitted to Roanoke Memorial Hospital since 1954, and many patients of Burrell Memorial were transferred to the University of Virginia Hospital in Charlottesville. Fueled by the explosion of activity resulting from the adoption of Medicare, hospital construction continued almost unabated. Two new hospitals were under construction — the new Community Hospital of the Roanoke Valley in downtown Roanoke and the new Lewis-Gale Hospital in Salem. Roanoke Memorial Hospital, at about 500 beds in 1967, broke ground that year for a 15-story, $15 million West Pavilion that would add 225 beds when it opened in 1971. At Roanoke’s new Community Hospital, opening day crowds were large (about 10,000 people) and spirits were high despite the rainy day on August 28, 1967. Virginia Governor Albertis Harrison, who had been principal speaker at the building’s groundbreaking four years earlier, repeated the honor, calling the new hospital “a monument of civic enterprise.” The 400-bed hospital offered much in the way of modern healthcare equipment and facilities. An up-to-date surgical suite, labor and delivery rooms, modern patient rooms and more were complemented within a year by a new unit for cardiac intensive care and a new department specializing in nuclear medicine. Not included in the new hospital’s list of modern amenities was sufficient parking. For 400 patient beds and a payroll of 880 employees, only 60 parking spaces had been set aside for hospital parking in the downtown setting. Those spaces were quickly filled, sending everyone else to park wherever they could. Tempers shortened as frustrations grew. By February 1968, zoning changes allowed the hospital to use two additional lots for employee parking, but the lack of parking continued to draw the ire of employees and visitors alike. And in a 1970 newspaper editorial, a clergyman declared that the downtown location of the hospital was “the most profound manifestation of sheer stupidity of the century.” Gradually, the hospital was able to buy up land and build a parking garage, but parking problems would persist for much of the next decade. The first year of hospital operations was a good one for the Community Hospital of the Roanoke Valley. By the hospital’s first anniversary, some 15,500 patients had been admitted; 1,465 babies had been born there; 7,643 surgeries had been performed; and more than 27,000 patients had visited the hospital’s emergency room.

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Community Hospital affiliated with Burrell Memorial Hospital in 1968. Burrell Memorial, founded in 1915 as Roanoke’s only hospital serving African Americans, had fallen on hard times. Business had never been easy for the hospital, but a near-fatal blow was delivered, ironically, by the 1965 passage of Medicare and by the Civil Rights acts. These laws allowed Roanoke’s African Americans to go to hospitals that they and their physicians considered more capable. The hospital’s staff and board was integrated, and the hospital did treat white patients, but not enough to offset losses caused by the flow of African Americans to other hospitals in the city. The affiliation with Community Hospital gave the struggling hospital a temporary reprieve, yet Burrell Memorial was unable to convince residents that it offered quality care. The facility steadily declined, and in 1979, it became the Burrell Home for Adults. In Salem, construction of the new Lewis-Gale Hospital and the new Lewis-Gale Clinic stayed on schedule, despite extra work and an extra $2 million in construction expenses stemming from the need to pour concrete into underground caves that had been discovered on the building site. When the 320-bed hospital was ready for occupancy in late December 1972, “Operation Transplant” was triggered, moving the 63 patients to the new building from the old, vintage 1909 building that over the years had become a beloved but problematic building of window air conditioners, closed-in porches, and quickfix additions that complicated the already complex care of hospitalized people. All rescue squads in the Roanoke Valley and United Ambulance Service provided one ambulance apiece for the December 28 move, which was completed without a hitch within three hours. The new hospital’s emergency room opened at 7 a.m. that day, the time that the first patient arrived. The new clinic building was ready for move-in at the same time, and physicians and their office staffs began arriving on December 29. At the new hospital, employees, patients, and visitors were greeted by seas of sound-dampening carpet in areas for patients and guests (the hospital had “more carpeting than any other hospital,” wrote a Roanoke Times reporter), plenty of parking on the 23acre site, and stunning views of the Blue Ridge from every patient window. A heliport had been built adjacent to the new emergency department, and the building was filled with the foundations and mechanics that would take full advantage of the technology of the 1970s. As the 1970s advanced, rapidly rising energy costs and lowered federal reimbursement from Medicare and Medicaid resulted in more costs for medical care being shifted to patients, but then the resulting pressure from individuals, employers, and insurance companies forced hospitals to explore new methods of financing and new ways to deliver care.

Courtesy of LewisGale Medical Center

CONSTRUCTION OF THE NEW LEWIS GALE HOSPITAL IN SALEM, EARLY 1970’S

In the late 1960s, the hospital industry’s trade association, the American Hospital Association, had begun exploring the concept of regionalized networks of healthcare providers as a way of sharing costs and gaining new technology and expertise. Leaders of healthcare organizations in the Roanoke Valley paid close attention to these developments, gaining knowledge that would prove valuable over the next few years. Community Hospital of the Roanoke Valley had been feeling anxious about patient activity in 1970 and 1971, although occupancy remained at high levels. The building’s previously unoccupied 10th floor was activated as a service floor in 1972. Opening of the new Lewis-Gale Hospital in 1973 produced severe reductions in pediatric and maternity activities at Community Hospital of the Roanoke Valley. When they dissolved their partnership, Lewis-Gale and Community Hospital’s progenitor Jefferson Hospital had agreed that all of Lewis-Gale’s obstetrics activity would take place at Community Hospital. The purchase of Lewis-Gale by HCA in 1968 had negated that provision, however, and many of the former Lewis-Gale obstetrics and gynecology staff, surgeons, and physicians had returned to Lewis-Gale when it opened in late 1972.

Growth continued at the hospital, however, and in 1973, a 10-bed intensive care unit was opened at CHRV. By the time the hospital observed it’s 10th anniversary in 1977, a total 159,884 patients had been treated and just over 17,000 babies had been born there. By 1976, the hospital was said to have enjoyed the highest occupancy rate of any hospital in the Roanoke Valley. And in 1978, the hospital announced its first major expansion project – a multiyear $16 million undertaking that would include the construction of a badly needed parking garage for 600 cars and moving the hospital entrance to link to the new parking facility. It would also create an outpatient department and building on the west side to house an expanded radiology department, outpatient clinic space, a new surgical suite, and new emergency cardiac rehab and physical and respiratory care departments. Lewis-Gale Hospital underwent a major leadership change in 1974. David Williamson had made a major impact on the hospital during his 13 years as administrator, guiding Lewis-Gale through its separation from the partnership that would build Community Hospital of the Roanoke Valley and managing Lewis-Gale’s purchase by HCA. The hospital’s parent company called Williamson to its Nashville headquarters to become the corporation’s vice president of

LEWIS GALE HOSPITAL, 1970’S

legislative affairs and later its president. Williamson died shortly after assuming the presidency of the corporation, a death that was broadly mourned back in the Roanoke Valley. Sam Owen, who had been associate administrator under Williamson, was named the new administrator. Lewis-Gale Hospital continued to make refinements and advancements in its facilities and programs of care through the 1970s, progress complicated by an increasingly problematic reimbursement environment on the part of federal insurance programs Medicaid and Medicare. Hospitals everywhere were beginning to operate at a loss because of inflation-driven rises in costs coupled with lowered reimbursement from Washington. In the summer of 1978, administrator Sam Owen was promoted by HCA to become a division vice president in Atlanta. He was succeeded by Terry Hiers, Jr., who focused on efforts to contain costs from within the organization, while also continuing the hospital’s expansion. Between 1979 and 1980, the hospital added intensive care and critical care units and also installed its first CAT scan machine.

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1983 adoption of diagnosis-related groups (DRGs) as an effort to rein in what had become out-of-control spending by the federal government in paying for the hospitalization costs of patients insured by Medicare.

Courtesy of Carilion Clinic

Under the approach, a numeric value — the DRG — was assigned to each type of inpatient hospital episode of care, to serve as a relative weighting factor intended to represent the resource intensity of hospital care. As a reimbursement system, the DRG assignment determined the payment level the hospital would receive. If the hospital exceeded costs for any particular DRG, it absorbed the additional cost. It was the most significant change in health policy since Medicare and Medicaid’s passage in 1965, but it went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary. “For the first time,” according to industry observer and author Rick Mayes, “the federal government gained the upper hand in its financial relationship with the hospital industry.

Courtesy of Carilion Clinic

TOP THE FAMILY PRACTICE RESIDENCY PROGRAM OPENED ITS FIRST MEDICAL CENTER ON JEFFERSON STREET IN 1971 ABOVE ROANOKE MEMORIAL HOSPITAL 1956

Roanoke Memorial Hospital was taking a temporary breather from major construction projects, but growth of another sort was very much on the agenda during the 1970s. Having studied the concept and procedures of forming hospital alliances during preceding years, Roanoke Memorial made itself the hub of consulting and management relationships with many of the hospitals in the region. By 1980, the hospitals that had established relationships with Roanoke Hospital Association (the body that governed Roanoke Memorial Hospital) included Franklin Memorial Hospital in Rocky Mount, Lonesome Pine Hospital in Big Stone Gap, Wythe County Community Hospital, Russell County Medical Center in Lebanon, Giles Memorial Hospital in Pearisburg, and Tazewell Community Hospital. The Roanoke Hospital Association had also purchased the Burrell Home for Adults (the former Burrell Memorial Hospital) in 1981 and Gill Memorial Hospital in 1982. Bedford County Memorial Hospital affiliated with the association in 1984. Southside Community Hospital in Farmville also established a relationship with the association in 1985, but in 2006, the hospital became part of the Centra Health system based in Lynchburg. The Roanoke Hospital Association was reorganized into a holding company that allowed the organization to generate income from hospital management activities, consulting relationships, and property management and transportation services provided by trained medical personnel. The healthcare industry was made much more complicated by the

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Medicare’s new prospective payment system with DRGs triggered a shift in the balance of political and economic power between the providers of medical care (hospitals and physicians) and those who paid for it – power that providers had successfully accumulated for more than half a century.” Hospitals reacted by seeking new markets as sources of additional income to offset potential losses under the DRG system. Feared and detested at the outset, the system has served to drive change in the delivery of healthcare services and it has fostered advances in medicine. For hospitals as well, it has given hospitals information for data management, reimbursement and comparability, benchmarking, and other types of research. At Roanoke Memorial Hospital and its parent Roanoke Hospital Association, the name William H. “Ham” Flannagan had become COMMUNITY HOSPITAL, 1980’S

Courtesy of Carilion Clinic

iconic, representing a 32-year record of growth, innovation, and dedication to patients, along with the drive and ambition that made his organization the Roanoke Valley’s largest employer.

highest-available quality to the people of the Roanoke Valley and represent a stable source of healthcare services for patients and employees.

Flannagan reached the retirement age of 65 in 1985, and the larger-than-life executive announced his retirement effective the next year. His successor as president, Thomas L. Robertson, took the reins of a healthcare organization that had grown from a failing Memorial and Crippled Children’s Hospital, as it was named in 1954, into one of the most successful and copied healthcare organizations in the country.

He would pursue a strategy of consolidating affiliated hospitals and allied healthcare interests into a single organization that would work as one sharing core values that would offer all of its component organizations more efficiency and purchasing muscle, qualities that would be badly needed in the heavily competitive health landscape that was developing.

With a background in accounting, Robertson had served as the Roanoke Hospital Association’s chief financial officer since 1969. He was well-suited to continue shaping the organization into a regional powerhouse of a healthcare system that would offer

In the Roanoke Valley alone, the consumer’s healthcare dollar was being sought by at least four growing organizations. The Hospital Corporation of America, parent of Lewis-Gale Hospital and Lewis-Gale Clinic in Salem, had also acquired Pulaski Community Hospital and Montgomery Regional Hospital. Community Hospital

the history of healthcare

of the Roanoke Valley was a competitive factor not far away in downtown Roanoke, and even the University of Virginia Medical Center was flexing its muscle as a regional healthcare provider. In response, Roanoke Memorial Hospital and the Roanoke Hospital Association became the Carilion Health System, a name derived from the French term carillion, referring to the sets of bells in towers that ring together in harmony. Roanoke Memorial and its crosstown rival Community Hospital of the Roanoke Valley had been working at joint efforts for some time, beginning in 1986 when a joint project brought the highly sophisticated diagnostic technique magnetic resonance imaging

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the history of healthcare

(MRI) to Roanoke. The partnership worked well, and on a Friday in 1987, Carilion president Robertson visited the office of CHRV administrator William R. Reid. Robertson brought with him a proposal for the merger of the two organizations. That visit triggered a flurry of meetings within each organization and mutual meetings by representatives of each organization that would culminate in a joint announcement on June 30, 1987 that the two intended to become one under the Carilion banner. The announcement in turn touched off suits filed by the U.S. Department of Justice, which took the position that the merger would create a hospital monopoly. Finally, in 1990, the legal battle was over and the merger was approved, setting the framework within which hospital care would operate into the next century.

the history of healthcare

Courtesy of LewisGale Medical Center LEWIS GALE SCHOOL OF NURSING IN A LAB AT ROANOKE COLLEGE

VOLUME III

EDUCATION

o history of healthcare in the Roanoke Valley would be complete without examining educational programs to train nurses, physicians, administrative personnel, and technical personnel.

The earliest educational programs in the region were for nurses, beginning with the founding of Roanoke’s hospitals in the early 20th century. Please see this volume’s section on “Nursing” for more detail. It was one such hospital-based nursing program that became the foundation of an institution that is now central to healthcare education in the region — The Jefferson College of Health Sciences. When they were planning the partnership that would become the Community Hospital of the Roanoke Valley, the leadership of Jefferson Hospital and Lewis-Gale Hospital agreed that the two hospitals’ respective schools of nursing would be merged under the umbrella of CHRV. Those schools were merged in 1965, but the hospitals later decided to sever the partnership. The Community Hospital School of Nursing continued to operate for some 15 years.

the history of healthcare

In 1980, a task force looking at the overall health education needs of the region recommended that the hospitalâ&#x20AC;&#x2122;s 33-month nursing program be phased out in favor of a two-year degree in nursing and that allied health science programs such as respiratory therapy be added. The reformatted nursing program would make it easier for nursing graduates to transfer their credits to four-year degree programs, if they chose to do so. In 1982, under the new name of Community Hospital College of Health Sciences, the school offered courses in respiratory therapy, paramedic training, food and dietary service, and medical records technology. It was the first hospital-based college in the state and one of only seven in the country to have its program accredited by the Council for Higher Education. In 1986, the college was accredited by the Southern Association of Colleges and Schools (SACS) to grant degrees at the associate level. It has continued to grow, adding international students and gaining accreditation to award baccalaureate degrees. The college was renamed Jefferson College of Health Sciences (JCHS) in 1983, recognizing both its past and future in the Roanoke Valley. The name change was due, in part, to the fact that the Community Hospital of Roanoke Valley no longer existed, having changed its name to Carilion Roanoke Community Hospital. The new name was selected to honor the roots of the college in Jefferson Hospital. A school of radiologic technology also traces its foundation to Community Hospital. The two-year program, launched when the hospital opened in 1967, offered students classroom and hands-on instruction in X-ray technology, opening the door to further training and advanced jobs in nuclear medicine and radiation therapy. This program was eventually folded into courses at Virginia Western Community College. At Lewis-Gale, most educational activities were grouped under the Lewis-Gale Foundation, organized in 1964 as a nonprofit organization to facilitate continuing medical education for area physicians and training for healthcare careers. As the foundation evolved, it would take on activities as diverse as helping physicians and other health professionals keep abreast of developments in their fields, offering seminars to emergency service workers, and even collecting and displaying items of medical/historical interest. A teaching institution since its earliest days, Roanoke Memorial has maintained physician training at various levels since the early 1930s. The hospital had maintained a training program for interns since 1933, and in 1946, the hospital was granted accreditation by the American Medical Association. AMA accreditation was important because it put Roanoke Memorial on the official list of choices for graduate medical students looking for hospital internships. Rural hospitals â&#x20AC;&#x201D; and Roanoke was quite rural in the 1950s â&#x20AC;&#x201D; shouldered particular problems when it came to attracting young

the history of healthcare

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Courtesy of LewisGale Medical Center

LEWIS GALE SCHOOL OF NURSING STUDENTS TAKING CLASSES AT ROANOKE COLLEGE, EARLY 1960’S

medical talent as interns and residents, who would hopefully stay on to practice in the community. As an enhancement, an annual PostGraduate Day was launched to bring national names in medicine to lecture in Roanoke. The program was continued and expanded, and it proved to be a valuable forum for physicians in the region. Under the guidance of Director of Medical Education Charles R. Young, MD and Medical Director Charles L. Crockett, Jr., MD, Roanoke Memorial became a direct affiliate of the University of Virginia School of Medicine in 1971. Full-time physician-instructors at the hospital had faculty appointments at UVA, serving as instructors for residents and interns at the hospital. Dr. Crockett explained the mutual advantages of the education program: “The intellectual stimulus and constant information resource that bright, young physicians bring to our attending, nursing, allied health, and administrative staffs is invaluable. Residents are an essential part of patient care in that they have an understanding of recent technology and procedures. Attending physicians, in turn, have skills, experience, and judgment that the young have not yet developed. So their skills are complementary to one another.” It was the same sort of symbiosis that resulted in the surgical residency’s expansion to four years in 1968, establishment of an internal medicine residency in collaboration with the Veterans’ Administration Medical Center in Salem, and an obstetrics/gynecology residency in 1978. By 1982, Roanoke Memorial hosted residents and interns from 40 different medical schools, a record in the country for community hospitals. People interested in hospital administrative careers were given an opportunity to gain first-hand experience in the field with a residency program launched under longtime Roanoke Memorial Administrator William H. “Ham” Flannagan. Running between nine and 12 months, the program provided day-to-day exposure of hospital operations and executive decision-making.

the history of healthcare

Courtesy of Jefferson College of Health Sciences

ENTRANCE TO JEFFERSON HOSPITAL SCHOOL OF NURSING

Medical technologists, who staff hospital laboratories, began to receive training at Roanoke Memorial in 1952. About half of the school’s graduates over the years have stayed on to work at the hospital. With the increasing complexities of radiologic technology, particularly as a product of what the science learned during World War II, demands for trained workers in the field became almost overwhelming. Roanoke Memorial and its Chair of Radiology, Charles D. Smith, MD, responded by establishing a program to provide trained personnel to the hospital. The very successful program combined classroom and clinical experience that post-graduate students applied at hospitals in the Roanoke Valley and throughout the country. Dr. Smith was also a moving force in establishing a school of nuclear medicine technology, which graduated 52 students before it was terminated in 1997. And from 1974 to 1998, a total of 116 students graduated from the hospital’s school of radiation technology. To keep current with medical education trends that are calling for degree programs for allied medical professionals, the hospital’s medical training programs were transferred to the Jefferson College of Health Sciences early in the 21st century.

the history of healthcare

Courtesy of REMS, Inc.| MID 1970’S, THE ROANOKE LIFE SAVING WOMEN’S AUXILIARY

VOLUME III

RESCUE

rom its origins as the world’s first volunteer life saving and rescue squad (recognized as such by a letter from thenPresident Richard M. Nixon in 1972), the Roanoke Life Saving and First Aid Crew grew both in terms of its capabilities to serve the region and in terms of the confidence that residents of the region put in those capabilities.

But America in the 1960s was in the midst of a lifestyle revolution. America was becoming motorized. The numbers of cars increased geometrically, traveling on an increased number of highways, including the development of the country’s Interstate Highway System beginning in the late 1950s. Since 1925, the number of vehicles on the highways had increased eleven-fold.

the history of healthcare

Courtesy of REMS, Inc.

THE ROANOKE LIFE SAVING AND FIRST AID CREW, MID 1980’S

But there was a cost in human lives. The number of people killed on American streets and roads had increased six-fold. By the mid1960s, more than 1.5 million people had died in traffic accidents, more than the number of Americans who had lost their lives in all wars to that time. Congress acted in response to the carnage, as well as public outcry following publication of consumer advocate Ralph Nader’s book Unsafe at Any Speed, an indictment of the lack of safety features in American-made cars. In September 1966, Congress passed and President Lyndon Johnson signed two bills — the National Traffic and Motor Vehicle Safety Act and the Highway Safety Act, assigning responsibility to the federal government for setting and enforcing safety standards for cars and roads. In addition to mandating safer design of highways and the autos that were on them (headrests and seat belts were first required in US autos), the acts also began to set standards that helped to train rescue personnel as physician extenders. Medical programs began to be coordinated under state laws by state health departments and state emergency medical service departments, guided by the US Department of Health and Human Services and the US Fire Administration. Later, in the 1970s, the states became more active in regulating ambulance equipment and in standardizing and regulating training for emergency medical technicians. And by the mid-1970s, at least one EMT was required on each ambulance to transport a patient.

began what would become a fixture in the region for the next 15 years — frequent Bingo nights in the crew hall on Day Avenue, with the proceeds from the games used for the purchase of muchneeded equipment. A second major element in the work of rescue crews everywhere in the country also occurred in the late 1960s, when the Federal Communications Commission and AT&T worked together to establish a standard, nationwide telephone number that would summon emergency responders of all types — police, rescue, or fire. (Great Britain had used a 999 emergency telephone number since 1937.) Those working on the assignment wanted a unique number that was short and easy to read. It had to be a telephone number that had never been designated for an office code, an area code, or any kind of service code. The emergency number they wound up with — 911. LATE 1970’S, THE ROANOKE LIFE SAVING AND FIRST AID JUNIOR CREW AMBULANCE

The standards made vehicles and roads safer and resulted in vastly improved rescue personnel and the equipment they used, but progress came with a price in terms of improved equipment the crew needed to buy and maintain. To help, in 1971 the crew Courtesy of REMS, Inc. 30

the history of healthcare

Congress supported the 911 emergency number standard for the nation, passing legislation making 911 the exclusive number. A central office was established by the Bell System to develop the infrastructure for implementation. On February 16, 1968, the first 911 test call was made by Alabama Senator Rankin Fite in Haleyville, AL. A week later, Nome, Alaska implemented a 911 system.

Courtesy of REMS, Inc. THE MERGER OF THE ROANOKE LIFE SAVING AND FIRST AID CREW AND THE WILLIAMSON ROAD LIFE SAVING CREW INTO ROANOKE EMERGENCY MEDICAL SERVICES, DECEMBER 1989

After its initial acceptance in the late 1960s, 911 systems quickly spread across the country. By 1979, about 26 percent of the

United States population had 911 service, and nine states had passed legislation for a statewide 911 system. Through the latter part of the 1970s, 911 service grew at a rate of 70 new local systems per year. About 50 percent of the U.S. population had 911 service by 1987. And by 1999, about 93 percent of the U.S. population was covered by 911 service. In the late 1960s, the Roanoke crew established a Junior Crew as an organization for young people interested in volunteer rescue service. Members of the Junior Crew often served as patient attendants while senior members drove ambulances, and they also assisted with fundraising activities. Many Junior Crew members went on to become badged senior members, helping to oversee the activities of new groups of junior volunteers. Wives and girlfriends of crew members formed the Roanoke Life Saving Women’s Auxiliary in October 1972, devoting themselves to fundraising activities and other special events. The Auxiliary stayed active until the late 1990s, as more women became interested in joining the crew itself and less interested in serving as Auxiliary members.

Courtesy of REMS, Inc.

And more societal change reshaped the way emergency services were provided in the region. As the 1980s wore on, adults began to focus more time on work and family, making less time available for volunteer activities. By 1984, the Roanoke crew was having trouble covering calls during daylight hours, and the crew asked the city for assistance in providing personnel to cover calls. In January 1985, the city hired 12 full-time paramedics and six part-time paramedics to staff eight-hour shifts around the clock. The city formed Roanoke Medical Services in 1989, and both the Roanoke and Williamson Road life saving crews were absorbed by Roanoke EMS. Julian Wise, who as a boy helplessly watched a drowning in the Roanoke River and was inspired to form the Roanoke Life Saving Crew in 1928, went on his last call in the late 1970s and died in Roanoke on July 22, 1985, at the age of 85. In a poignant twist, about five hours after Wise’s death, the crew responded to a call for a possible drowning. The 13-year-old victim was saved.

Courtesy of REMS, Inc.

TOP BY THE END OF THE 1960’S, THE CREW OWNED THREE CADILLAC AMBULANCES & A 4-WHEELDRIVE, ALL EQUIPPED FOR TRANSPORTATION ABOVE THE ROANOKE LIFE SAVING CREW AMBULANCE

the history of healthcare

& FIRST AID

VOLUME III

HEROES

n their thousands, all who work in healthcare have a measure of heroism. They are from all walks of life and the nature of their work varies greatly, but they all share a singleness of purpose: helping, healing, and saving lives. They work tormenting hours, many manage life-and-death situations daily, and they live lives of emotions ranging from pain and sorrow to exhilaration and relief. Guiding their efforts is a special breed of person, the healthcare administrators, who devote most of their lives to the stability and relevance of their organizations, and in doing so, change the face of healthcare and improve the human condition. Here are four of the people whose vision and vitality did much to advance their organizations between the 1960s and the 1990s. WILLIAM H. “HAM” FLANNAGAN Flannagan’s contributions, whose impact is still felt throughout the Roanoke Valley, span a critical 32 years in the history of the hospital that became an anchor of today’s Carilion Clinic, Roanoke Memorial Hospital. Flannagan became administrator of what was then Memorial and Crippled Children’s Hospital in 1954, after serving in the top administrative slot at Franklin Courtesy of Carilion Clinic Memorial Hospital. He became widely known for his vigor and bluntness, as well as his charm, vision, and thoughtfulness. “He was a force of nature,” said one person who worked with him and knew him well, “kind of larger than life.” He remade what was a financially challenged hospital into a regional powerhouse, while also establishing medical and

the history of healthcare

administrative residency programs, developing Roanoke Memorial’s school of nursing, and establishing the regional, collaborative framework that, after his retirement in 1986, became Carilion. Flannagan died on May 4, 2010, at the age of 89.

RAYMOND E. HOGAN Hogan worked in one of the hospitals that would later become part of Carilion, but he is best known for his role in creating another major Virginia health system. A native of Indianapolis, Hogan served in administrative roles in his native city and in Richlands, Grundy, and Pikeville, KY, before becoming administrator of Giles Memorial Hospital in the mid-1950s. In 1957, he moved to Lynchburg, where he spent the rest of his career building Lynchburg General Hospital into one of the founding partners of the Centra Health System. He also served the industry as president of the Virginia Hospital Association and a member of the board of directors of Blue Cross and Blue Shield of Virginia. Hogan retired from Centra in 1987 and died in February 1993.

WILLIAM REID When he came to Roanoke as administrator of Jefferson Hospital in 1953, William Reid became Roanoke’s first hospital leader who had been schooled in the profession. He had graduated from the Medical College of Virginia School for Hospital Administration in 1951. Reid spent nearly 40 years in hospital administration in Roanoke, guiding Jefferson Hospital through its partnership

Courtesy of Jefferson College of Health Sciences

the history of healthcare

and subsequent breakup with Lewis-Gale Hospital, the construction of Community Hospital of the Roanoke Valley, and CHRV’s partnership with Carilion. After his retirement from CHRV in 1992, Reid remained a member of the Carilion board until 1999.

Courtesy of LewisGale Medical Center AUGUST 1969 GROUNDBREAKING OF HCA OWNED LEWIS GALE HOSPITAL IN SALEM. * ADDITIONAL PHOTO DETAILS CAN BE FOUND BELOW

DAVID G. WILLIAMSON, JR. David G. Williamson joined Lewis-Gale as its administrator in 1961. He would lead the hospital and its healthcare community for the next 13 years. Those years were devoted to guiding the hospital through expansion and relocation, the delicate matter of separating the hospital from the Lewis-Gale Clinic, and affiliation with a for-profit hospital organization, all the while becoming a respected and beloved community leader. In 1974, Williamson moved to Nashville to become Vice President of Legislative Affairs for Lewis-Gale’s parent company Hospital Corporation of America, and he later became HCA’s president. He died shortly after becoming president of HCA. Upon its completion in 1986, a new oncology center at Lewis-Gale was named in Williamson’s memory.

* (LEFT TO RIGHT) DR.W.L. SIBLEY, SR., THE PRESIDENT

OF THE LEWIS GALE’S BOARD

ELIZABETH W. BOGLE, R.N., AND DIRECTOR OF NURSES DR. THOMAS FRIST, SR., THE CHAIRMAN OF HOSPITAL CORPORATION OF AMERICA DAVID G. WILLIAMSON ADMINISTRATOR

JR.,

HOSPITAL

IN 1986, THE ONCOLOGY CENTER WAS DEDICATED IN THE MEMORY OF DAVID G. WILLIAMSON, JR.

the history of healthcare

Courtesy of LewisGale Medical Center | LEWIS GALE SCHOOL OF NURSING EARLY 1960â&#x20AC;&#x2122;S

the history of healthcare

VOLUME III

NURSING

uring the years between the 1960s and the 1990s, the nursing profession and the lives of nurses went through profound changes.

The days when nurses were thought to be no more than helpers or assistants to physicians were replaced by a new perception of nurses as healthcare professionals in their own right. A nurse’s role as a simple caretaker of the patient grew into that of an advocate for the patient. The work of nurses became much more of a technical and technological challenge, with nurses also taking over roles that were once the exclusive domain of the physician. None of it came easily, and all of it is testament to the competence and drive of the people in the nursing professions. Nurses still rely on their eyes and ears, their knowledge, and their intuition to look into the lives of patients and reveal health needs, but technology has made much of the work of nursing easier and quicker, freeing up time to devote to hands-on patient care and comfort. Nursing has become much more specialized since the 1960s. Such specialties as operating room nursing, critical care nursing, pediatric nursing, psychiatric nursing, and high-level nurse practitioners require nursing professionals now to be at the top of their game every day, putting even more emphasis on continuing education. Nursing is no longer a “ladies only” profession. Women still outnumber men in the profession, but the old stereotype has been broken and men have entered the field and proven that both men and women are capable of handling the multiple demands of nursing. Nursing has been a field in which women have traditionally broken through the “glass ceiling” that separates their earnings from those of men. Although in many fields men outpace women in earnings for the same or similar jobs, there is parity in nursing. Nurses in the 1990s were able to take home in a month what the nurse of the 1960s earned all year.

the history of healthcare

Courtesy of LewisGale Medical Center

LEWIS GALE SCHOOL OF NURSING CLASS, EARLY 1960’S

And a much-recognized symbol of the nursing profession — the nurse’s uniform — has undergone almost constant change. A nurse’s hat — each one a distinctive style of the nursing school from which a nurse graduated — was an essential element of workday dress in the 1960s that was gone by the 1990s. Most nurses were not unhappy to see the demise of the cap. Most, in fact, rejoiced. The heavy, starched layers and aprons of nursing wear in the 1960s gave way to more casual, comfortable, and user-friendly scrubs that became almost universal during the 1990s. In the Roanoke Valley, nursing education programs were stepped up in the early 1960s as healthcare leaders recognized the growing demand for nurses. New quarters for the Roanoke Memorial Hospital School of Nursing were completed in 1959 to provide classrooms and living space for up to 124 students. During most of the history of the nursing school, nursing students were able to take advantage of patient care experience unavailable in Roanoke by spending several months of their senior year in hospitals in larger cities. For most of the 1960s, senior nurses traveled to Sheppard-Enoch Pratt Hospital in Baltimore, but in 1968, senior nursing off-campus field experience was transferred to the Veteran’s Administration Medical Center in Salem. As a result of the planned merger of Jefferson Hospital and Lewis-Gale Hospital (called off before it actually happened), the two respective nursing schools merged under the banner of Jefferson Hospital, and later the

the history of healthcare

Community Hospital of the Roanoke Valley. With 825 graduates, however, the Lewis-Gale nursing alumnae association remained active. At the new Community Hospital of the Roanoke Valley, hospital administrator William Reid spoke of sitting on the floor with the hospital’s director of nursing services Lavinia Duncan and several others to design a new uniform that would be more fashionable — more workable apparel without the former uniform’s intricate design and heavy starching requirements.

Courtesy of LewisGale Medical Center

“We designed one that wasn’t very popular,” he recalled, “because it was kind of like a waitress’ uniform, but where we really messed up is when we designed the cap. Since we were bringing three nursing schools into one, we decided to recognize that by having three points on the nurse cap. The nurses just about rebelled to get their own hat and so we redesigned it.”

LEWIS GALE SCHOOL OF NURSING LAB, EARLY 1960’S

As time went on at all nursing schools, the sentiment became that a three-year diploma program was not the best way to train nurses and that a more effective educational setting would be a two-year degree program. As the 1980s ended, the hospital-based nursing programs were all folded into the nursing programs offered by what was then called the Community Hospital College of Health Sciences, which eventually became the Jefferson College of Health Sciences.

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VOLUME III

NURSING HOMES

n today’s world, nursing homes are almost as much a part of the healthcare spectrum as hospitals and doctors’ offices. With nearly six percent of older Americans in nursing homes, residential facilities that provide multiple levels of care for the elderly are a standard form of care. But this is a relatively recent option for aged or incapacitated people. Not until well into the 20th century did America have anything like nursing homes as we know them now: regulated, licensed, and professional facilities. Until the 1940s and into the 1950s, people who could not work, could not provide for or could not pay for their own care were largely at the mercy of their families, or they ended their days in almshouses, or “poor folks’ homes.” There, they lived at a subsistence level, often alongside the insane or the homeless. In the 1950s, federal legislation required the states to write standards and maintain licensing bureaus for nursing homes, which by then could receive federal operating funds if they complied with state standards. And in 1972, sweeping federal legislation aimed at reforming nursing homes. The growth in nursing homes has largely been fueled by private industry. Government nursing homes are available, but most nursing home patients live in commercially run facilities.

Courtesy of Friendship Retirement Community

Some of the more familiar nursing homes in Roanoke can trace their origins to factors that played major roles in the broader economic and spiritual life of the community. For more than 100 years, for example, a simple wooden building on what is now Brandon Avenue (the date 1735 was written in berry juice inside the structure) was a house of worship. Generations of Moravians — some of the early settlers of the Roanoke Valley — shared the building with Lutherans as they bowed their heads in prayer. It was known as the Old Zion Church. The congregation moved in 1897 and the church was decommissioned, falling slowly into ruin.

Courtesy of Friendship Retirement Community

TOP CONSTRUCTION BEGINS ON FRIENDSHIP MANOR’S FIRST BUILDING, MANOR EAST I, 1965 ABOVE AERIAL VIEW OF MANOR EAST, MANOR

The owners of the land donated the old building and the land on which it stood to Virginia WEST, APARTMENT VILLAGE THE CONVALESCENT CENTER AND MANOR NORTH I, 1976. Lutheran Homes, which built and operated a home for the elderly in Roanoke. The home, known as the Health Center at Brandon Oaks, opened in 1973. In 1993, Virginia Lutheran Homes opened the Brandon Oaks Lifecare community on the spot where the house of worship once stood, and in 2003, the new Brandon Oaks Nursing and Rehabilitation Center replaced the old Health Center. What is now the Roanoke Methodist Home was once Casselwold, a Georgian style mansion built in 1916 by N&W Railroad superintendent James Cassel. Casselwold (meaning a home in the woods) sat on 53 acres adjoining the Roanoke Country Club golf course. The Cassel family lived in the home until 1921, when it was bought by Roanoke businessman Elmore D. Heins. The Heins family lived in the home until the 1960s, when Mr. Heins developed the area known as Grove Park. After Heins’ death, his widow sold the home to the Roanoke District of the United Methodist Church in March of 1964. It was renovated and furnished, and the Roanoke Methodist Home opened as a retirement home with accommodations for six people in November of the same year. In 1965, The Roanoke Methodist Home

the history of healthcare

Courtesy CourtesyofofRoanoke RoanokeUnited UnitedMethodist MethodistHome Home

Courtesy of Roanoke United Methodist Home

TOP FLORIDA ROOM OF THE ROANOKE METHODIST HOME, 1967Methodist ome) LEFT ROANOKE METHODIST HOME PATIO DEDICATION, 1980 RIGHT ONCE A PRIVATE RESIDENCE KNOWN AS “CASSELWOLD”. THE ROANOKE METHODIST HOME, 1987

entered into the Virginia United Methodist Homes, Inc. system. Ground was broken in March 1965 for a new three-floor addition to Casselwold, a million dollar project. It opened for occupancy in September 1966. Ten apartments were constructed in 1971, and 12 more were added in 1979. The Ring house, a Tudor-style mansion, was purchased in 1979 and made into four one-bedroom apartments. Roanoke United Methodist Home is now a continuing care retirement community offering independent living apartments, multiple levels of assisted living, and healthcare services. The main building of the Home, once a private residence, now houses the administrative offices.

accommodates 98 residents. The Carters’ son, Charles Jr., now heads up the facility.

The late Charles Carter and his wife Lois established the South Roanoke Nursing Home as a privately owned facility on Franklin Road, SW in 1964. The facility expanded in 1967, and it now

As the need for more senior housing increased, the first units of Apartment Village were built in May 1968. In 1971, the five-story Manor West — now Westwood — was completed.

the history of healthcare

One of the region’s larger facilities, Friendship Retirement Community, traces its history back to the 1950s, when the leaders of the Church of the Brethren realized a need for a retirement community in southwest Virginia. Control of the community passed to the privately owned Friendship Group. Construction of the facility, on what was then a Hershberger Road cow pasture, was completed in 1966, with the opening of Manor east, now Friendship Assisted Living.

Friendship introduced a new phase of resident care in 1974, with the opening of the Convalescent Center. Ultimately, two wings were added to the original structure. Today, the Convalescent Center is known as Friendship Health and Rehab Center, a comprehensive, 373-bed skilled nursing facility. It offers intermediate and skilled care with such services as an Alzheimerâ&#x20AC;&#x2122;s unit, dialysis unit, an orthopaedic rehab unit, lab, x-ray, physical, speech and occupational therapy, and a retail pharmacy. Further residential space was opened during the 1980s, along with construction of a west wing of the Friendship Health and Rehab Center. The 1990s saw the construction of the HartsookTomkins Residentsâ&#x20AC;&#x2122; Center, a recreational facility, and two more apartment buildings, Wellington II and Wellington III. In December 2007, Friendship created a new company, Friendship Outpatient & Wellness Services, and opened a free-standing outpatient rehab clinic providing physical, occupational, and speech therapy to patients of all ages.

the history of healthcare

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VOLUME III

TECHNOLOGY

n September 24, 1955, President Dwight D. “Ike” Eisenhower was on vacation, staying at his in-laws’ home near Denver, CO. After a breakfast of sausage, bacon, mush and hotcakes, the President played 27 holes of golf, pausing for a lunch of a hamburger with raw onion. After lunch, he experienced some indigestion, which he blamed on the raw onion. Dinner that night at his in-laws’ home was roast lamb with accompanying side dishes. Eisenhower — who had been a four-pack-a-day smoker but who quit cold turkey in 1949 — went to bed that evening still feeling some discomfort. In the very early hours of the next morning, a Saturday, Eisenhower suffered a major heart attack. His White House physician, General Surgeon Howard M. Snyder, MD, injected him with morphine and other drugs and told Mamie Eisenhower to snuggle in bed with her husband to keep him warm. Eisenhower slept until noon. Then, a cardiologist was called in to do an electrocardiogram (an EKG, which produces a graph tracing the electrical activity of the heart, often used to identify heart problems). He was later taken by car to Fitzsimmons Veterans Hospital in Denver and was confined to bed, a chair, and limited physical activity for about seven weeks. He and Mamie returned to Washington on November 11 but then went almost immediately to their home in Gettysburg for further recuperation.

discharged to physical therapy and a more-or-less normal life. The difference lies mostly in advances of basic science, medicine, and medical technology. In fact, medicine has advanced more since World War II than in all of history in all the years that preceded it. Drugs, medical devices, new procedures, and a better understanding of diseases have made ours a vastly healthier civilization. In the United States, male babies born in 1960 had a life expectancy of 66.6 years. Female babies born in 1960 had a life expectancy of 73.1 years. For 2010, the figures are 75.7 for males and 80.8 for females. Roanoke Valley patients, perhaps without even knowing it, were both witness to and beneficiaries of this explosive growth in technology. By the early 1960s, for example, health professionals at Roanoke Memorial Hospital were comfortable using a full array of up-todate diagnosis and treatment tools — electroencephalography (EEG) to measure the electrical activity in the brain; radioisotope therapy to target and kill malignant cells; physicians in almost DATA CARE AT ROANOKE ROANOKE MEMORIAL HOSPITAL IN THE MID 1970’Shodist ome)

By the standards of the time, his recovery was remarkably aggressive. The heart specialist called in to take charge of his care, Paul Dudley White, MD, of the Harvard Medical School faculty, was criticized by his peers for mobilizing the President so quickly. At that time, heart attack patients were normally hospitalized for up to six months, and having a heart attack in those years often signaled the abrupt end of an active, normal life and the start of a sedentary, slow wait for death. Today, men and women with chest pain or other signs of a heart attack call 911. This sets off a chain response that usually results in medical care within minutes. Emergency medical technicians go to the scene and transmit EKGs to a receiving hospital. They can reset faulty heart rhythms at the scene or in the ambulance to stop a heart attack before it does lasting damage. Most patients are in the hospital for a few days of further treatment and are then

Courtesy of Carilion Clinic 47

the history of healthcare

Courtesy of LewisGale Medical Center

Courtesy of Carilion Clinic

Courtesy of Carilion Clinic TOP CARDIAC CARE AT LEWIS GALE HOSPITAL IN THE MID 1970’SMethodist ome)

every medical specialty, and more. In 1963, almost the prehistory of today’s digital images of the organs and functions of the body, Roanoke Memorial received its first electroencephalograph, which uses reflected sound waves to build digital images of the brain.

Community Hospital surgeons performed their first organ harvest surgery in 1974, removing a kidney from a deceased 34-year old Roanoke man for transplantation at the University of Virginia Medical Center. The next year, the hospital premiered minimally invasive tubal ligation in the Roanoke Valley. The procedure, also called “band aid surgery” because the small abdominal incisions are covered by band aids, is now a favored method of birth control for women. The technique, known more widely as laparoscopic surgery, is now used in the surgical correction of many disorders in the body’s abdominal and pelvic cavities.

Roanoke Memorial pioneered the concept of intensive care units (ICUs) in the region in 1966, not long after the first application of the idea in US hospitals, at DartmouthHitchcock Medical Center in New Hampshire. The concept — to provide constant nursing care and monitoring to patients — was expanded to neurological care in 1968, respiratory care in the 1970s, and pediatric care in 1985.

In 1982, Community Hospital became the first in the region to pioneer progressive obstetrics, a multi-faceted program that included birthing rooms, homelike private rooms equipped for labor and delivery with dads always present and participating in the births of their babies.

Dedicated cardiology care MIDDLE PEDIATRIC REHABILITATION came to the Roanoke Valley FOR POLIO PATIENTS AT ROANOKE MEMORIAL HOSPITAL IN THE EARLY in 1968, making it no longer 1960’S. necessary for heart patients ABOVE CARILION’S LIFE GUARD 10 to travel to Charlottesville or Richmond, and cardiac catheterization was introduced in 1972. The hospital unveiled its open heart surgery program in 1982. Not long ago, a diagnosis of cancer — if that were even possible given the limited diagnostic abilities of the early 20th century — was almost certainly a death sentence. Even into the 1960s, only one in every three cancer patients would live for another five years. But vast strides in the prevention, detection and treatment of cancer have improved a person’s chance of surviving and thriving after cancer. In the 1970s, medical affiliations with major cancer centers brought opportunities to participate in major clinical trials of new techniques in oncology. The opening of Roanoke Memorial’s Cancer Center of Southwest Virginia (later the Carilion Cancer Center of Western Virginia) in 1980 anchored steady innovations in cancer care, including the 1994 unveiling of pediatric oncology programs. Not willing to be outdone, Community Hospital of the Roanoke Valley opened an intensive cardiac care unit and a nuclear medicine department within a year of its opening in 1967.

the history of healthcare

Before Roanoke Memorial created Carilion and Community Hospital became part of that system, the two hospitals partnered on construction and operation of a broad capability imaging center, incorporating highly advanced MRI technology along with CT scanners, ultrasounds, traditional X-rays and fluoroscopic equipment —noninvasive techniques to provide accurate visual representations of disease and injuries that had not been imagined just a few years before. Roanoke Memorial introduced emergency transport of patients via helicopter with its launch of the Life-Guard 10 service in 1982, and three years later, they began training flight nurses to staff this new mode of lifesaving service. MRI capability also appeared at Lewis-Gale Hospital in Salem when the hospital purchased its first MRI machine in 1985. At about the same time, the hospital also acquired two CT scanners, one of them a mobile unit that was shared with other hospitals in the region. Although the hospital was in a new building, the structure had been designed before the advent of CAT scans, MRI machines, or nuclear medicine. The building had to be altered to accommodate the new equipment, with special shielding to isolate the equipment and reinforced foundations to bear the weight of the equipment. In 1986, ground was broken for a $3.7 million radiation therapy center at Lewis-Gale, over the objections and legal action from Roanoke Memorial EXAM ROOM AT LEWIS GALE HOSPITAL IN Hospital, which THE LATE 1970’Sist ome) contended that its own radiation therapy program was adequate to handle demand in the region. Lewis-Gale Hospital’s capabilities in obstetrics and gynecological

Courtesy of LewisGale Medical Center.

services were spotlighted with the 1983 birth of Salem’s first baby conceived via in vitro fertilization (the so-called “test tube” babies conceived outside the mother’s body by combining one male sperm cell with one female egg cell and then implanting the fertilized egg into the mother’s uterus). Just four years after the world’s first in vitro baby was born in Great Britain, the local parents were sent from Salem to Chapel Hill Hospital in North Carolina for the in vitro process, and the six-pound, eight-ounce baby was delivered in Salem. While we may be amused by some of the steps taken in the care of President Eisenhower in 1955, physicians then were working with the most recent medical information available to them, nearly 60 years ago. And the explosion of new medical knowledge during those 60 years has been a driving factor in the increasing specialization within medicine, especially among physicians.

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Newly minted physicians in the 1960s would likely practice what today would be a cross-section of specialties. One physician would treat patients, young and old alike, for a variety of ailments that today would be seen by an orthopaedist, an obstetrician, a dermatologist, on and on. And some physicians even performed basic surgery. Many physicians today limit their practice to certain types of ailments, to specific areas of the human body, and even to individual organs of the body. In 1970, according to the American Board of Medical Specialties, there were but ten areas of physician specialty practice. By the early 1990s, that number had increased to nearly 70 medical specialties. And today, the number of physician specialties is approaching 100. No one in healthcare today can imagine what technological marvels the next 60 years might bring and whether readers in 2072 will look back at the “medical marvels” of 2012 and consider them quaint.

the history of healthcare