Trani: Time to plan the VCU Health Children’s Hospital – Richmond Times-Dispatch

It did not take long for Dr. Marsha Rappley, VCU’s vice president for health sciences and CEO of VCU Health, to hit the ground running. In her second week on the job, she took on the most difficult issue that has divided the local medical community in recent years — whether the Richmond region needs a new independent children’s hospital.

In a long article entitled, “New VCU Health CEO Says Hospital Wants a New Pediatric Inpatient Facility,” which was written by Tammie Smith and appeared in the Richmond Times- Dispatch on Aug. 31, Dr. Rappley sets out three very important observations on this issue. First and foremost, she supports the development of a new children’s hospital for the Richmond area. Such an undertaking is a worthy goal for Richmond so that it can be “leading the nation in care of children through a state-of-the-art facility but also through state-of-the-art design of health care that will take us into the future and be sustainable. That sustainability piece is key.”

Dr. Rappley, whose field of specialization is pediatrics, then stated her second observation: It should be part of VCU Health, the newly branded name for the VCU Medical Center. Being part of VCU Health would meet the goal of the Virginia Children’s Hospital Alliance, the community group advocating construction of the new children’s hospital, that any new hospital should be affiliated with an academic medical center that trains the next generation of pediatricians and pediatric subspecialists and conducts cutting-edge research that influences the practice of pediatric medicine.

Being part of VCU Health would also follow the path of the development of many of the recent constructions of children’s hospitals across the United States. Another recent article in the Richmond Times-Dispatch, also written by Tammie Smith, noted that all of the major independent children’s hospitals in our country were established many years ago and also that almost all of the recent children’s hospitals are part of health systems or academic medical centers.

The recently built hospitals affiliated with academic medical centers are generally two kinds of institutions. The first are called “leaning” hospitals that refer to hospitals that are located on academic medical centers, are part of their universities’ health systems, and include the hospitals of North Carolina, Stanford and Vanderbilt. The second are hospitals within hospitals and include Duke, Johns Hopkins and Arizona. A noteworthy one for Richmond is Monroe Carell Jr. Children’s Hospital at Vanderbilt, also known as Vanderbilt Children’s Hospital, in Nashville, which was visited by Richmonders as part of the Greater Richmond Chamber’s city visitation in March.

Being part of VCU Health would also address the question of “sustainability” mentioned by Dr. Rappley, and make such an inpatient facility part of other first-rate pediatric facilities. The sustained infrastructure that comes by being part of VCU Health is very significant. The same individuals who oversaw the construction of the McGlothlin Medical Education Center and the now-being-constructed Children’s Hospital of Richmond pediatric pavilion for outpatient care would be the team that would guide the construction of the new inpatient pediatric hospital at a much reduced cost than if it were independent and had to get its own construction team.

Additionally, in terms of information technology and other items of infrastructure, such as the utility grid, air conditioning and heating resources, sterile processing and dietary services, being part of VCU Health would result in lower aggregate costs in the construction stage and lower ongoing operational expenses over the next 50 years. Again, this would save millions of dollars of expenditures in contrast to a separate independent children’s hospital.

The third observation that Dr. Rappley makes is that the new hospital should be located downtown at the VCU Medical Center. She noted that such a hospital cannot be “something remote from all of the resources that we think are necessary for it to be a vision of the future. But it’s got to be accessible. It’s got to have green spaces. It’s got to be welcoming of children and supportive of children, and I think it needs to be downtown. I think it needs to be accessible to all people.”

Such a location would put the hospital close to VCU Health’s new 40-bed neonatal unit, located in the Critical Care Hospital, near the $20 million new pediatric emergency room, near the operating rooms located in the Critical Care Hospital, some of which would be redone entirely for pediatric surgery, and near the new outpatient facility, now being constructed on Broad Street.

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These three observations from Dr. Rappley give us the ability to plan in detail a new VCU Health Children’s Hospital. And there are at least two possible sites at the VCU Medical Center for the new hospital.

The first is the city-owned Public Safety Building, which can be combined with the about-to-be-demolished Virginia Treatment Center for Children’s site (a new VTCC is planned to be built at the Children’s Hospital of Richmond site on Brook Road). These sites on 10th Street in downtown Richmond would give the children’s hospital significant room to be developed.

The second site, which in many ways is the most appealing, lies north of VCU Health’s Critical Care Hospital on the site of the current Visitors Parking Deck. A tower, similar to the Critical Care Hospital, could house both the Children’s Hospital as well as a Massey Cancer Center Hospital. And both of the downtown sites would fulfill the major wish of Mayor Dwight C. Jones, that the new hospital be located in the city of Richmond. Both sites would also give the city the possibility for other functions to be located at The Diamond on the Boulevard.

The time is now to begin planning for the new VCU Health Children’s Hospital. One of the major reasons local pediatricians have called for an “independent” children’s hospital is so that all the physicians from across the region would have staff privileges at such a hospital, and that should be part of the VCU Health Children’s Hospital. The hospital should be a model for community-based access for its patients, their families and local health care providers.

Additionally, I believe that VCU Health should assume responsibility for the costs of building the facility. But the community should be responsible, through the Children’s Hospital of Richmond Foundation, for raising a significant endowment, at least $300 million, to help VCU Health with the sustainability of the new hospital.

The merger of VCU Health and the Children’s Hospital of Richmond several years ago was a major step in the direction of providing world-class pediatric care to the children of our area.

The new construction of the VTCC at Brook Road will be another step. And finally, the opening in early 2016 of the Children’s Hospital of Richmond pediatric pavilion should be a “game-changer” for the delivery of pediatric care at VCU Health.

Additionally, the dramatic increase in the quality and quantity of health care pediatric providers and new pediatric facilities at the Bon Secours and HCA hospitals in the Richmond area is another major step in that direction and working in concert with a new children’s hospital at VCU Health will certainly improve the quality of pediatric health care in our region.

In the time I was president of VCU (1990-2009), I tried three times unsuccessfully to get a children’s hospital built. The time is now for everyone to rally behind VCU President Michael Rao and Dr. Rappley, the new CEO of VCU Health, and get this divisive issue behind us and get on with taking care of our young people in this area.