History of Healthcare in Lynchburg & Southside Volume III

THE

HISTORY OF HEALTHCARE

IN LYNCHBURG PRESENTED BY THE PUBLISHER OF OUR HEALTH MAGAZINE

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VOLUME III

TABLE OF CONTENTS 10.

Introduction

12.

Healthcare Development

31.

Rescue

37.

Heroes

43.

Nurses

47.

Technology

ABOUT THE AUTHOR Rick Piester’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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VOLUME III

INTRODUCTION

T

his third volume of our history of healthcare in Lynchburg takes us from the late 1950s into the late 1980s, three decades of almost constant change and progress.

During those thirty years, the region’s healthcare organizations were very much in motion. There was new construction, new technology, new service programs, and a new face of healthcare in America and in Lynchburg.

One major fixture in the healthcare landscape came into being during the years covered by this volume, and another revered hospital name faded and then disappeared.

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. And we are grateful for the kind words and encouragement that you have for our “regular” magazine editions for Southwest Virginia, Lynchburg and Southside Virginia and greater Richmond, Virginia.

We hope you like VOLUME III of our Healthcare History of Lynchburg.

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LYNCHBURG RED CROSS NURSES

1982 AERIAL VIEW OF DOWNTOWN LYNCHBURG | Courtesy of Lynchburg Photo Credit History’s News & Advance collection the history of healthcare

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VIRGINIA BAPTIST HOSPITAL NURSES, 1970 | Courtesy of the Virginia Baptist Hospital historical collection

HEALTH DEVELOPMENT

B

y the late 1950s, anyone with an interest in healthcare in Central Virginia had a good many reasons to be proud and excited.

The community had recently opened a brand-new Lynchburg General Hospital in a new mid-town location, a hospital that thenGovernor Thomas B. Stanley, speaking at dedication ceremonies in November 1956, praised as being “of untold value to hundreds, and even thousands, of persons.”

There and elsewhere in the city, it seemed that there was an unquenchable need for hospital beds. All of the city’s healthcare institutions — Marshall Lodge Memorial Hospital on Grace Street, Virginia Baptist Hospital on Rivermont Avenue, and Guggenheimer Memorial, also on Grace Street (by now a long-term care facility),

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as well as Lynchburg General — were on the cusp of a prolonged series of construction projects, adding beds that seemed to be occupied as soon as they were made available throughout the following decades.

The 1924-vintage Virginia Baptist Hospital, for example had doubled its patient capacity to 180 beds with the opening of the six-floor, $1.5 million Krise Building in late 1957, about a year after the new Lynchburg General Hospital went into service. The hospital, which in the past had been supported entirely by the Baptist Church and by its own operating income, conducted its firstever public fundraising campaign to raise money for part of the building’s cost.

The Krise Building housed new space for surgery, a new emergency

entrance, a new pharmacy, and improved space for maternity services and other refinements. As important, it seemed, it also cleared the way for extensive renovation and expansion of the existing buildings, and a major fundraising and construction campaign was in the works.

Marshall Lodge Memorial Hospital, founded by Masons in 1898 and by the late 1950s housed in a building dating back to the 1920s, kept up with the progress of medicine with the addition of new equipment and services, according to then-administrator Robert E. Cundiff. By this time, Guggenheimer Memorial Hospital and Marshall Lodge Memorial Hospital had merged under a single management structure, although not much time would go by before Marshall Lodge would sail into treacherous financial waters.

A new, modern, city-owned nursing home had opened under the management of the Lynchburg Health Department. Housing 75 patients, the Lynchburg Nursing Home was housed in the Federal Street building that was the former Lynchburg General Hospital.

Nursing home patients occupied the two upper floors of the building, while the Health Department moved into new offices on the lower two floors.

Healthcare observers of the day noted that the 168 new hospital beds added during the 1950s construction projects would be the equivalent of a fourth hospital for the area.

Healthcare management had seen some key changes, as well, and Lynchburg began to become acquainted with some of the personalities that would guide the region’s health activities for as long as the next 30 years.

Charles S. Elliott became the administrator of Virginia Baptist Hospital and would shepherd the hospital and its beloved school of nursing until his retirement in 1980.

In April 1956, J.C. Ellington, MD left the Lynchburg Health Department to become health director for the city of San Antonio, TX. His replacement in January 1957 was John T.T. Hundley, MD, who had practiced internal medicine in the city for about 30 years. He would continue his services as an honored and respected

advocate for the people of Lynchburg and for medicine until his retirement in 1969.

And at Lynchburg General Hospital, administrative director Robert Smith Hudgens decided in 1957 to return to his school, the Medical College of Virginia, to become director of the MCV school of hospital administration. Hudgens, who spent about a decade in the Hill City before he left at age 56, was credited with “doing more than any one man” to make the new Lynchburg General Hospital a reality over its more than 10 years of study, planning, and construction.

To fill his shoes, hospital trustees reached into Giles County, VA to recruit a young up-and-coming hospital administrator named Raymond E. Hogan, who would be a prime architect of the widely admired health system that is now the engine for much of the healthcare activities in Central Virginia.

By 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 go 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.

HELICOPTER LANDS AT LYNCHBURG GENERAL HOSPITAL AFTER HURRICANE CAMILLE ON AUGUST 20, 1969 Courtesy of Lynchburg History’s News & Advance collection

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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 in 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 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.

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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.

Lynchburg in the early 1960s was home to about 55,000 people who were witnessing “the Second Northern Invasion.” This was the sobriquet that popular newspaper columnist and author Darrell Laurant ascribed to “some old-time Lynchburgers” in his 1997 book A City unto Itself: Lynchburg, Virginia, in the 20th Century.

The thriving industrial plants of Lynchburg’s wartime years were slowing down as the 1950s wore on, but in their place came cleaner industries to replace the old smokestack manufacturing, many of them from the north. Chief among them were Babcock & Wilcox, the heavy construction and nuclear services firm, and a large General Electric plant, moving hundreds of families from the Syracuse, NY area to manufacture mobile communications equipment. In the years between 1950 and 1980, the area’s population grew by almost 50 percent.

The impact of population growth on healthcare in Lynchburg seemed a study in contrasts. On the one hand, such hospitals as Lynchburg General and Virginia Baptist seemed to thrive, adding a constant stream of new programs and services. The practically new Lynchburg General was a magnet for patients

Courtesy of the historic photograph collection of Centra

and physicians alike, seeming to lack nothing as a modern medical center.

Virginia Baptist, as well, reported a constant busy stream of patients. Before many years were to pass, the hospital would launch an array of services for psychiatric patients, it would unveil intensive care patient facilities, and it would create innovations in its nursing education program. It had even begun an office of development to raise public funds for future construction projects.

On the other hand, Marshall Lodge Memorial Hospital, the city’s oldest hospital, hovered on the brink of closure throughout the 1960s. The hospital twice sought and gained the safety of a merger with a more stable local partner, but even that ultimately failed.

Marshall Lodge Memorial’s struggle became public in late September 1960 when the board informed the hospital’s medical staff that occupancy had dropped to a point where it was “uneconomical to continue operation.” Board chair Morris W. Whitaker stopped short of saying that the hospital was looking at the possibility of closing, noting instead that the board of trustees wanted the public to know that the institution would remain open “so long as the patient census is at a sufficient level.”

Courtesy of Lynchburg History’s News & Advance collection TOP LYNCHBURG GENERAL HOSPITAL, EARLY 1960’S ABOVE SIGNAGE FROM LYNCHBURG GENERAL HOSPITAL, 1978

In a long statement to clarify the hospital’s status, Whittaker also articulated what had been a longstanding hallmark of inter-hospital cooperation in Lynchburg. “It has been the board’s policy,” he wrote, “...to practice all reasonable economies in order to keep the cost to the patient within reasonable bounds. The determination not to duplicate facilities and the preservation of endowment funds are of great benefit to those needing the medical and surgical services which the Hospital offers.”

While the hospitals did openly compete with some services, many other specific services (such as pediatrics and obstetrics to Virginia Baptist and emergency medical services to Lynchburg General) were confined to each of the hospitals, allowing them to focus on their respective expertise and capabilities and avoid the high cost of duplicative services. This view would form the basis of the merger of the two hospitals’ medical staffs in the mid-1970s and the creation of the area’s dominant health system in the late 1980s.

Members of the Lynchburg Academy of Medicine, as they had in 1950, once again urged the merger of Marshall Lodge Memorial with Lynchburg General Hospital.

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They urged that Memorial continue as one of the city’s principal medical facilities, and they also appointed a committee to work with Memorial’s administration in overcoming the hospital’s crisis.

The hospital survived, for the moment, and the view seemed to improve. A scant six months after rumors flew of the impending closure of Marshall Lodge Memorial, the hospital launched its Diamond Jubilee, a yearlong celebration of the hospital’s 75 years of service to the community.

Later, in January 1963, Memorial reported that it had made major strides in the previous two years, with the 1962 patient census being the best since 1957. The hospital also reported that operating expenses during 1962 had been met by operating income for the first time in years, it had initiated a five-day workweek for its nursing staff, and it had made a variety of important building improvements during the previous year. “All in all, Memorial Hospital had a good year,” noted Claude M. Allison, who had become administrator of the hospital after service as assistant administrator at Virginia Baptist Hospital.

Later in 1963, plans were announced to expand and update both Marshall Lodge Memorial and Guggenheimer Memorial Hospital, as the two hospitals — within a quarter mile of each other on Grace Street near downtown

Lynchburg — had by then come under the governance of a single board.

At Memorial, construction in the mid-1960s added central air conditioning to the operating rooms, which were themselves doubled in size.

As the years went by, however, it became steadily more evident that Memorial would be hard pressed to survive in the emerging healthcare world of rapidly expanding technology, higher salaries and more competition for highly trained employees, and the inevitable comparisons between it and the city’s two larger, better-equipped, and more fully staffed hospitals.

In 1968, Lynchburg General leaders and their counterparts at Marshall Lodge began meeting to plan the merger of the organizations. The city’s physicians enthusiastically endorsed the planned merger. “We have recognized for a long time the increasing problems of adequately maintaining three separate hospital organizations,” said G. Edward Calvert, the president of the Lynchburg Academy of Medicine. In its announcement to pursue the merger, the two hospital’s boards noted that “...it behooves us to work diligently and objectively toward the elimination of duplication in facilities and services and the improper use of scarce health care personnel.”

The merger, when it came on June 2, 1969, provided ample hints that the hospital would be slated for eventual closure. Operating under a new nonprofit named Lynchburg General-Marshall Lodge Hospitals, Inc., the organization would also operate Guggenheimer Memorial Hospital as a 68bed extended care hospital. Marshall Lodge would be operated as an intermediate care hospital, for patients who did not need the more extensive capabilities of Lynchburg General.

Indeed, less than two years after the merger, the possibility of closing the old hospital was announced by Raymond E. Hogan, who by then carried the title of executive vice president of the hospital parent company. He added that hospital leadership was investigating “the manner in which all services currently provided can be provided at two facilities instead of three.” Several months after that, in mid-June 1971, the last patients at Memorial were transferred to Guggenheimer. Marshall Lodge Memorial, which 85 years earlier had been named the “Home and Retreat” to avoid

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NEWLY INTEGRATED CLASSROOM AT ROBERT MOTON HIGH SCHOOL, 1963 | Courtesy of Lynchburg History’s News & Advance collection the history of healthcare

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the sinister name “hospital,” once again became a “home,” this time as Grace Lodge, a residence for the elderly.

Photo Credit Courtesy of the historic photograph collection of Centra

Just up the street from the newly renamed Grace Lodge, Guggenheimer Memorial had begun life as a private residence, which then became a children’s hospital in 1931 and in 1944 became a maternity hospital until its conversion to a long-term care facility in 1951.

In

1963,

Guggenheimer

trustees announced a threepart multi-year project to upgrade and expand Guggenheimer. The first phase would focus on plant improvements such as improvements to the hospital’s heating system as well as new kitchen, dining room, and lounge areas.

The next year, Virginia Baptist Hospital announced its own high-dollar construction project, along with its first public fund drive to raise $1 million to support the construction. Virginia Baptist had also embarked on a service sector that would be one of its strengths during coming decades — psychiatric care. In 1961, the hospital opened a 14-bed unit for the short-term, inpatient care of people going through emotional difficulties.

Courtesy of Lynchburg History’s Fred Menagh photos for News & Advance collection TOP RENOVATION PROGRAM IN THE EARLY 1960’S ADDED A $1.4 MILLION WING TO THE GUGGENHEIMER HOSPITAL. ABOVE NURSING STAFF OVERLOOKING THE NEW LYNCHBURG GENERAL HOSPITAL, 1956.

It was Lynchburg General Hospital, however, that continued to set the pace for the creation of new patient services that went into new spaces and that brought in new waves of patients from throughout the region. The hospital unveiled a new pediatrics wing in April 1962, air conditioned (a choice feature in the day) and designed specifically for the care of young patients and their families. The patient rooms even included Barcalounger reclining chairs for overnight stays by parents, a marked difference from the not too distant past when overnight stays by parents were discouraged by most hospitals in the country.

The new pediatrics unit was followed closely by announcement of the area’s first intensive care unit for the care of critically ill patients boasting an array of electronic monitoring equipment.

But a perfect storm of the increasing use of hospitals (particularly a new hospital in a largely rural area), powerful social forces, and the increasing presence of government policy and funding in American healthcare would shape the way healthcare was delivered and the locations from which it was delivered over the decades to follow.

In late 1991, Raymond E. Hogan of Lynchburg General announced that, with the exception of dire medical emergencies, the hospital could no longer absorb the cost of care for “indigent” patients from three nearby counties for which no reimbursement was being received and which caused the hospital to suffer major financial losses. An “indigent” patient was defined as a non-Lynchburg

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VIRGINIA BAPTIST HOSPITAL | Courtesy of the Centra Historical Collection the history of healthcare

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resident who had been hospitalized but within 48 hours of the hospitalization had not been able to make arrangements to pay his or her bill and who was certified as needing hospitalization by the physician in charge.

Many of the nearby counties had by then signed agreements that they would cover the cost of care, although three counties — Amherst, Halifax, and Buckingham — had not by the time Hogan made the announcement. Halifax and Buckingham counties subsequently signed agreements with other hospitals, but Amherst refused. The refusal was based largely on the recommendation of the Amherst County health director, who objected to the hospital having recently become a “luxury hospital.” The county health director had argued that the features that made Lynchburg General a “luxury hospital” included air conditioning and in-room patient radios, which he deemed were “not essential for indigent care.” Amherst County officials also declared the hospital actions an unfair attack on county residents.

After hurried meetings and expressions of apology, a truce was declared and a new pact for the care of Amherst County indigent patients was renewed, but the incident put on the public radar the question — still being confronted — of how to care for patients who cannot afford the cost of their hospitalization.

A second surge in the “perfect storm” brought America’s struggle with racial equality face-to-face with Lynchburg healthcare.

The fight for civil rights made an early appearance in conservative Lynchburg in fairly typical fashion – a lunch counter sit-in. On December 14, 1960, four white and two black college students refused to leave the lunch counter at Patterson’s Drug Store on Main Street when asked to do so by owner William Patterson.

The so-called “Patterson Six” were arrested for trespassing and sentenced to a month in jail, but were released for good behavior after 18 days.

After this, integration came slowly to Lynchburg. In September 1961, a lawsuit was filed to force the integration of all public facilities in the city, including Lynchburg General Hospital. Plaintiffs in the suit were three prominent black Lynchburg residents, including the Rev. Virgil A. Wood, pastor of Diamond Hull Baptist Church. Wood also served as president of the Lynchburg branch of the Southern Christian Leadership Conference, who would go on to work with the Rev. Martin Luther King as the Virginia coordinator for the historic march on Washington, D.C. in April 1963.

During prolonged court proceedings, U.S. District Court Judge Thomas J. Michie split the suit into two actions — one against the city and the second against the hospital. On June 2, 1962, the state allowed the corporate status of the hospital to change from semi-

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public to private — moving governance of the hospital from the Lynchburg Hospital Authority to a private board of directors. This enabled hospital attorneys to argue that the suit no longer applied to Lynchburg General, now a private, nonprofit organization. In response, attorneys for the plaintiffs countered that the change in status was a “sham” to avoid desegregation.

In fact, black patients had been admitted to Lynchburg’s hospitals for years, but the central issue was whether white and black patients could be assigned to share the same room, without their permission.

While these matters were being debated, racial equality was making slow, painful strides forward in Lynchburg.

Part of the suit to force public school desegregation resulted in the admission of two young black students — Lynda Woodruff and Owen Cardwell — to formerly all-white E.C. Glass High

program. To complete the requirement, Dr. Johnson chose to train at the Freedman’s Hospital and D.C. Hospital in Washington, DC. In March and April 1963, he worked at the hospital every Sunday, Monday, Tuesday, Thursday, and Friday, returning to Lynchburg each Wednesday and Saturday to conduct office hours for his patients. He received the qualifying letter and became the first African American physician to join the hospital’s medical staff.

Gains were made slowly, but it was a powerful financial incentive from the federal government that cemented the concept of racial integration in Lynchburg’s hospitals.

The third surge of the “perfect storm” affecting healthcare in Lynchburg, and overarching all aspects of healthcare everywhere, was the implementation of a national healthcare insurance program for Americans aged 65 and over. Compassionate leaders in every

School in January 1962, and Lynchburg’s school board completed a plan calling for gradual integration of all its schools, beginning with all first grades in the fall of 1962 and continuing at the rate of at least one grade a year until the entire school system had achieved integration.

By the fall of 1962, area colleges had become integrated as well.

The Lynchburg Academy of Medicine took a secret vote to on June 11, 1962 to eliminate the word “white” from membership qualifications in its by-laws.

The measure resulted in a 31-9 vote in favor.

And in May 1963, Lynchburg General granted medical staff privileges to R. Walter Johnson, MD, after he had tried and failed to gain a spot on the staff for several years.

A graduate of Meharry Medical College in Nashville, TN, Dr. Johnson had been practicing for about 30 years in Lynchburg, but as a general practitioner, and he sought obstetrical privileges at Lynchburg General. Before he was allowed staff privileges, the hospital required that he complete two months of obstetrical training in a hospital approved by the American Medical Association and also that he obtain a statement of qualification from the head of the training

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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. Employerprovided health insurance became a near-fixture 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, self-employed 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.

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.

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 Medicaid, funding medical care for the aged and medically indigent. The hospital industry, understandably, became obsessed with the workings and impact of the new law.

With regard to hospital integration, Medicare requirements were immovable: Hospitals patients will be assigned accommodations without regard to race. Hospitals that do not agree to this will not be eligible for Medicare funds.

Passage of Medicare legislation sparked immediate speculation over what the overall impact of the new law would be. Hospital administrators wondered what would happen on July 1, 1966, the date that 19 million persons age 65 and over would become eligible for government-paid healthcare.

Before the law became effective, hospitals in Lynchburg started to declare whether they were ready to comply with the Federal requirements having to do with racial equality.

The mechanism was a hospital official’s signature on a Civil Rights Act compliance form stating that the hospital would not discriminate in admissions on the basis of race. The signature on the form made the hospital eligible to participate in Medicare.

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Marshall Lodge Memorial and Virginia Baptist hospitals agreed to the requirements early in the year. Statements from the two hospitals were heavy on altruism. Both noted that officials of the two institutions felt that it would not be fair to deny hospital services to those 65 and over. “If we failed to accept them (Medicare patients) under the new federal program,” said a statement from Virginia Baptist, “it would not only penalize the individual who desires to use our facilities, but would also throw the community’s hospital balance into chaos. The other hospitals simply could not absorb the increase in patient load.”

Memorial Hospital administrator Claude M. Allison noted that half of his hospitals’ patients were over 65 and that his board “felt it could not deny Medicare benefits to these patients.”

Less emphatically mentioned was the prospect that noncomplying hospitals would lose droves of patients, and mountains of income, to other hospitals.

Not every hospital in Lynchburg was eager to comply with the Civil Rights Act. Lynchburg General administrator Raymond E. Hogan said that although he felt his hospital was in compliance with the requirements, the hospital had not yet placed black and white patients in the same room without their consent. Splitting semantic hairs, Hogan noted that the Medicare program did not specifically state that patients of different races must be put into the same room without their consent but did acknowledge that Medicare requirements did say that patients must be assigned without regard to race.

Lynchburg General finally relented shortly after the Medicare

program began. The final holdout was Guggenheimer Memorial Hospital, which joined the other three hospitals in integrating its facilities in November 1966. Hospital board president William R. Perkins, Jr. noted that the hospital board’s feeling was that it would be “impossible to maintain a segregated facility and meet the demand for long term medical care in the community.” The board chair also noted that the federal department of Health, Education and Welfare had relaxed room mixing guidelines for extended care facilities, allowing patients to be assigned more on a basis of compatibility than what was required for acute care hospitals.

With the enactment of Medicare, 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.

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Throughout the rest of the decade and beyond, refinements large and small were being accomplished in Lynchburg hospitals.

As 1966 ended, Guggenheimer Memorial Hospital announced plans for an accelerated construction project, spurred by the greatly increased number of patients since the advent of Medicare and the increasing population of people over age 65. The hospital had earlier planned a three-phase expansion, with the first phase completed in late 1964 and early 1965. But, fueled by the Medicare-driven need for more accommodations for patients, hospital leaders combined the final two phases into a single project that would add 72 beds in a new, three-story hospital wing. This would more than double the patient capacity of the hospital.

Guggenheimer was identified as one of only three extended care facilities licensed as hospitals in Virginia and the only one that was

nonprofit and not state supported. Extended care was the term used to describe accommodations for patients who were not sick enough to require care in an acute care hospital, yet were too sick to live at home.

To fund construction at a total cost of $1.2 million, the hospital unveiled its intention to conduct a community fundraising campaign targeted to raise $600,000 of the total. When completed in 1970, the new wing would also house space for physical and occupational therapy, recreational space, and storage areas.

The advent of Medicare, while providing older Americans with health services that many had not had before, and while giving the healthcare community major increases in the numbers of people eligible for care, brought with it new demands for health staffing and increased costs. Even before Medicare took effect, hospitals in the nation were considering the possibility of raising room rates because of the prospect of the new payment system, the certainty of new minimum wage legislation, and the increasing competition to find and retain qualified healthcare personnel, particularly nurses. Between the middle of 1966 and early 1967, nursing salaries in Central Virginia went up by about 30 percent.

In late January 1967, Lynchburg’s three hospitals — Marshall Lodge Memorial was still an independent hospital and would not merge with Lynchburg General until 1969 — announced that room rates would rise between $5 and $8, placing the new daily rates for semi-private rooms at $24.50 to $26 per day.

In the late 1960s, the hospital industry’s trade association, the American Hospital Association, began 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 Central Virginia paid close attention to these developments, gaining knowledge that would prove valuable over the next few years.

In 1970, Lynchburg General’s Hogan and Virginia Baptist’s Elliott released a joint statement stressing the need for community planning for healthcare and codifying much of what would happen in Lynchburg healthcare for the rest of the 20th century.

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Courtesy of the Virginia Baptist Hospital historical collection NURSE AND PATIENT AT VIRGINIA BAPTIST HOSPITAL, 1970

“We must all think and work collectively,” their statement said, and much of what happened in subsequent years was guided by their declaration. Board members of both hospitals started meeting to discuss ways in which services could be combined, both to avoid the work and cost of duplicative services and to focus efforts on the proven strengths of each of the hospitals to enhance the quality and effectiveness of healthcare in the region.

Lynchburg General’s emergency room, for example, would for the first time be staffed by physicians who were at the time called Emergency Room Specialists (this was before the creation of the specialty of emergency medicine). The Emergency Room Specialists — four of them recruited by Lynchburg General — would be scheduled around-the-clock with the sole duty of treating emergency victims.

Examples of the cooperative approach were not long in coming. In 1971, the laboratories of Virginia Baptist and Lynchburg General were placed under a single management structure. Later that same year, the two hospitals announced plans to combine their pediatric and obstetric programs. The plan, done with the approval of the physicians who would be involved in the blended services, was recommended by the committee of board members as a way to obtain an intensive care unit for young people and newborns in Lynchburg.

And by the time the Emergency Room Specialists were in place, Lynchburg General was studying the possibility of installing a heliport on hospital grounds. The idea of a heliport first surfaced in August 1969. On the clear morning of August 20, seemingly washed clean by heavy rain in Lynchburg the night before, military helicopters bearing dead and injured people suddenly appeared and started landing on the hospital grounds.

Virginia Baptist Administrator Elliott explained that physicians had felt the need for an intensive care unit locally for some time. “When a child is born with or develops an illness shortly after birth, that child needs intensified care immediately.” However, he noted, “we felt that such a unit could not be justified at both hospitals.”

Noting that the nearest such unit was then at the university hospital in Charlottesville, planners, health professionals and parents sought to eliminate the factors involved in transfers to the Charlottesville hospital from Lynchburg.

The two hospitals were able to separate services when one or the other hospital had deeper expertise and more appropriate staff for the task at hand.

The people were some of the residents of nearby Nelson County killed or injured by the remnants of Hurricane Camille, which produced 27 inches of rainfall within a 12-hour period that caused flash flooding and mountain landslides, washed out 133 bridges, and left entire communities under water. The storm came as a surprise overnight, with no advance warning, catching most of the victims as they slept in their beds. In the nearby Virginia mountains, 153 people died, 123 of them in Nelson County. At least 37 people were never found.

The following April, the Greater Lynchburg Chamber of Commerce asked that the hospital give “earnest consideration” to the establishment of a heliport on hospital grounds.

As the 1970s advanced, rapidly rising energy costs and lowered federal reimbursement from Medicare and Medicaid resulted

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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.

assisted living

This 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.

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 provided information for data management, reimbursement and comparability, benchmarking, and other types of research.

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.

The healthcare industry was made much more complicated by the 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.

Under the approach, a numeric value — the DRG — was assigned to each type of inpatient hospital episode of care, to serve as a

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In the 1980s, Lynchburg General and Virginia Baptist began to consider the benefits of working together on a more formalized basis. At the helm of Virginia Baptist was George Dawson, who had come to Lynchburg in 1980 from the Holston Valley Community Hospital in Kingsport, TN, guiding “The Baptist” through years of financial challenge and a major renovation project. At Lynchburg General Marshall Lodge Hospitals, president Raymond E. Hogan had guided his institution through more than 25 years of almost constant change, and the two leaders and their boards were eager to determine whether the longstanding tradition of cooperation among healthcare organizations in Lynchburg could be strengthened.

The medical staffs of the two hospitals had merged in 1978, and area physicians were pleased with the new arrangement that allowed them to admit patients to either hospital while eliminating the need to attend medical staff meetings at both organizations.

The impetus to combine medical staffs was born in a committee, active since 1970, that served as a liaison between the two hospitals in considering cooperative operations.

And then in 1985, the hospitals decided to conduct a more formalized study of “alternatives available to continue cooperative healthcare efforts between the two institutions.” The hospitals brought in the accounting and consulting firm Ernst & Whinney to help identify strategies that would work within four guidelines: • C ONTINUE OFFERING A WIDE RANGE OF HIGH QUALITY HEALTH SERVICES • MINIMIZE HEALTHCARE COSTS TO THE COMMUNITY • BE SENSITIVE TO PATIENT CONVENIENCE AND PREFERENCE • CONTINUE THE ROLE AND TRADITION OF EACH HOSPITAL A full merger was not mentioned as an option, although Virginia Baptist board president James K. Candler noted that a “full spectrum” of options would be examined with “no preconceived idea” of the outcome.

By February of 1986, the committee had settled on the need for

a closer look at merger. The committee found that the tradition of cooperation between the two independent organizations that had been such a point of pride for many years “will not be capable of continuing” because of “the changing economic climate of the healthcare industry.”

There was wide agreement that the hospitals should survive and thrive in a new economic climate marked by cutbacks in insurance and government payment for health services, combined with fast emerging demand among consumers for new services requiring expensive equipment. The committee found, however, that this would create pressures for the two organizations to move to positions of head-to-head competition if they did not consolidate.

No single issue prompted the decision to shift the committee’s focus to consolidation. Instead, the Baptist’s Candler said, “it was the committee’s goals to see how to maintain high quality, low-cost healthcare in Lynchburg.” The committee set itself a deadline of July 1986 to complete its work and produce final recommendations.

Their work delayed by complexities that they had not been able to foresee, committee members completed their work in August, recommending merger of the two hospitals under one nonprofit corporate ownership.

The 13-member committee made up of representatives of both hospitals had done their work thoroughly. Each hospital would retain its own name and operate separately under the single parent

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organization. The total numbers of employees (nearly 1,900) and beds (nearly 700) would not be reduced. The merger would save the community about $11 million in costs that would be avoided over the next five years while preserving a high level of quality.

Anti-trust concerns (fears that the combination of the two hospitals would create a local monopoly on hospital care) were lessened by the long record of cooperation between the two hospitals. The two hospitals’ boards, which then contained a total of 40 members, would be pared down over the next two years to a single board of 24 members, some drawn from each hospital board.

Employees of the organization had by then said that they thought the merger was a good idea. Most employees were “upbeat and unruffled” by the proposed merger, according to newspaper

reports, although there were still questions about how the merger would affect benefits, seniority, and pensions. “I don’t think that we were ever really in competition,” one employee said. “We’ve always had a working relationship.”

Named to head the new organization as chairman of the board and chairman of the board’s executive committee was Raymond Hogan, the longtime president of Lynchburg General. George Dawson, a relative newcomer to Lynchburg and executive director of Virginia Baptist Hospital for the previous six years, would be named president of the new parent organization.

The two boards approved of the changes in November, along with approval coming from the joint medical staff. Following approval by the State Corporation Commission, the new organization came into being on January 1, 1987.

And a new name — Centra Health — would be affixed to signage at the holding company’s new offices in the Tate Springs Road Medical Center, a group of physician’s offices near Lynchburg General Hospital.

Centra Health: a very unfamiliar name at first. But under that banner, healthcare leaders would pursue a strategy of consolidating the two member hospitals and allied healthcare interests into a single organization that would set the framework within which healthcare in Central Virginia would operate into the next century.

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MARY HUBBARD, FIRST FEMALE AT THE BROOKNEAL VOLUNTEER FIRE DEPARTMENT SWITCHBOARD, 1953 | Courtesy of Lynchburg History’s Fred Menagh photos the for News & Advance collection history of healthcare 30

RESCUE

T

he From its origins in 1934 as one of Virginia’s first volunteer life saving and rescue squads, the Lynchburg 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.

There was a cost, however, in human lives. The number of people killed on American streets and roads had increased six-fold. By the mid-1960s, 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.

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MONELISON RESCUE SQUAD’S NEW AMBULANCE WITH SQUAD SECRETARY RALPH GODSEY AND RESCUE MEMBER CARL FARMER, MID 1960’S | Courtesy of Lynchburg History’s News & Advance collection

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.

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.)

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 crews needed to buy and maintain.

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 second major element in the work of rescue crews everywhere

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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.

A week later, Nome, Alaska implemented a 911 system.

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.

BROOKVILLE-TIMBERLAKE VOLUNTEER FIRE DEPARTMENT, 1963 | Courtesy of Lynchburg History’s News & Advance collection

As the Lynchburg crew and its equipment became more sophisticated, crew members realized that their department home since 1948, a building at 1216 Rivermont Avenue that still bears the LFD (Lynchburg Fire Department) emblem, was becoming inadequate.

In 1966, Lynchburg City Council gave the crew a corner

FIRE TRUCKS ON 7TH STREET, 1956 | Courtesy of Lynchburg History’s News & Advance collection the history of healthcare 33

ROAD MAINTENANCE AND HIGHWAY CONSTRUCTION UP MADISON HEIGHTS HILL TO THE LYNCHBURG EXPRESSWAY | Courtesy of Lynchburg History’s News & Advance collection

property at Memorial Avenue and Page Street for a new headquarters.

In 1970, the crew moved into their new building that included eight vehicle bays, a kitchen, meeting rooms, a bunk room, and a new communications center, the hub where the crew received emergency calls and dispatched crews on rescue missions.

A major test of the crew’s capabilities began on August 20, 1969, when the remainder of Hurricane Camille became stalled over nearby Nelson County, causing massive loss of life and injuries and more than $100 million in property damages(for more information, please see the Healthcare Development section of this Volume). Lynchburg Life Saving Crew members and their equipment, vehicles, and supplies remained on station in Nelson county for weeks.

In late 1972, the crew obtained their first of what would come to be an iconic piece of rescue equipment nationwide. The “Jaws of Life” made by Hurst Products Corporation has become almost indispensable as a rescue tool in highway, airline, and plane crashes. It was the second such tool to go into service with a rescue squad in Virginia. It was the manufacturer’s Serial Number 3, presented as a gift by the people of Thomas Road Baptist Church and their pastor, the Rev. Jerry Falwell. Serial Number 3, which remained in service until age and a supplier of newer versions forced its retirement with appropriate ceremony in 2001, helped save countless lives during its years in service.

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And more societal change reshaped the way emergency services were provided in the region. As the 1970s and 1980s wore on, adults began to focus more time on work and family, making less time available for volunteer activities. Volunteer rescue crews were having trouble covering calls during daylight hours, and municipal governments started organizing their own fulltime functions to make sure that their citizens were covered in times of emergency.

The City of Lynchburg, which began a formal emergency medical services program within the ranks of the city’s fire department, began to take on the majority of emergency rescue work in the city, staffing cityowned ambulances with paid rescue personnel. The role of the Life Saving Crew steadily diminished, until the United Way, the source of much of the crew’s funding, decided that the crew had become a “duplication of services” in view of the city’s increasing role.

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HEROES

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ll 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 lifeand-death situations daily, and they live lives of emotions ranging from pain and sorrow to exhilaration and relief.

They are a special breed of person, devoting most of their lives to the stability and relevance of their organizations, and in doing so, changing the face of healthcare and improving the human condition.

Here are five of the people whose vision and vitality did much to advance their organizations between the 1960s and the 1990s.

EVELYN KOWALCHUK, RN Most people who work in healthcare are heroes in their own right, but some exhibit a special kind of heroism. Some practice their craft under horrid circumstances, even under the threat of gunfire from an armed enemy army, and a few of those are honored for their bravery.

Courtesy of the National D-Day Memorial Museum

One of those few was Evelyn “Chappy” Kowalchuk, RN, one of 25 flight nurses to brave the hell of Omaha Beach three days after the initial D-Day invasion. Her mission was to rescue and evacuate wounded soldiers, often under fire from German forces, and keep them alive until they could be transported to safety and further care.

Evelyn and her husband Andrew became Bedford County residents in 1988, after her retirement from a lifelong career in nursing.

She became a fixture as a volunteer for many community activities.

One of her involvements included escorting then President George

W. Bush to the dedication of the National D-Day Memorial on June 6, 2001. And on Memorial Day, 2012, she was part of the program dedicating a new narrative plaque at the D-Day Memorial commemorating the role of flight nurses during World War II. A New Jersey native, Evelyn, she earned her RN degree from Newark Memorial Hospital in 1941 and enlisted in the U.S. Army the following year.

After entering the Army, she saw a notice on a bulletin board that the Army was looking for nurses to volunteer as flight nurses.

Kowalchuk and some others asked the head nurse what flight nurses were.

“I have no idea,” the head nurse replied.

But she volunteered anyway, and found herself riding in C-46 and C-47 cargo planes flying across the English Channel to land on improvised runways on the Normandy beachhead in the days following D-Day. It was the job of the flight nurses to take care wounded soldiers as they were ferried to hospitals in Great Britain. The men were missing arms, missing legs and had head and chest wounds.

“When we got those boys on the plane,” she continued “we had the worst shock. We had nurses that were training in New York and California. They had never, never seen the injuries and the blood and the pain these boys were going through.”

Flight nurses served in all embattled theaters during World War II, and they did so with distinction. It is a testament to their training and dedication that of the 1,176,048 patients air evacuated during the war, only 46 died en route. Seventeen flight nurses were killed during the war.

After her military service, Evelyn continued her nursing career, first as a school nurse in the Newark Board of Education and Health, then becoming the first female school nurse at Newark Academy in

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Livingston, NJ. She finished her nursing career in the Irvington, NJ, Board of Education.

Moving to Bedford County, she became active as a volunteer with community organizations and made numerous speaking engagements about her military and nursing experiences. She was also recognized for many more accomplishments and achievements, but most of all was known for her sense of humor, her courageous ambitions, her remarkable smile and loving nature, all of which served her well as a pioneer flight nurse who took care of so many.

Bedford County and the country lost Evelyn on April 7, 2013 at the age of 93.

CHARLES HENRY SACKETT, MD Dr. Sackett, beloved in life and revered after his death on August 13, 2010, is widely credited with building a firm foundation for the world-class cardiac care that patients in Lynchburg and surrounding communities now enjoy.

He retired from active practice in 1996 but remained a widely Courtesy of the Centra respected role model and mentor Historical Collection for the generations of health professionals who followed him. After his college studies were interrupted by wartime service with the U.S. Navy, Dr. Sackett completed his medical studies at the University of Virginia in 1951 as class valedictorian. He completed residencies in internal medicine at UVA and at Peter Bent Brigham (now Brigham and Women’s) Hospital in Boston, as well as a fellowship in cardiology in Boston. He practiced internal medicine and cardiology in Lynchburg from 1956 to 1996. In those 40 years, he played pivotal roles in establishing coronary care, cardiac rehabilitation, cardiac catheterization, and cardiac surgery in Lynchburg. He was also instrumental in the merger of Virginia Baptist Hospital and Lynchburg General Hospital to form the present day Centra Health, and in all that time, he remained fiercely dedicated to his patients and put in countless hours to make sure they all had the best care possible.

As mourners left a memorial service a few days after Dr. Sackett’s death, they were accompanied by the slow, sad tolling of the St. John’s Episcopal Church bell — a bell that had been recently donated to the church by Dr. Sackett and his family. He was 86 years old.

RUBY ASHWELL MCCRICKARD, RN, PHD Ruby McCrickard at first wanted to be an operating room nurse.

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She and her sister decided to go to nursing school while doing the dishes one evening, and they graduated in 1956 from the Riverside Hospital School of Nursing in Newport News. She headed into the OR as a nurse but shortly after was asked to become a head nurse on a medical unit.

That set her on a path that led her to the post of director of nursing services at Lynchburg General in 1969 and to steadily more responsibility. In 1985, she became the first woman to be named a senior vice president and chief operating officer of the hospital.

Along the way, she was a daily inspiration to untold numbers of nurses, guided by her own personal credo of hard work, dedication, and lifelong education.

McCrickard, who died in Lynchburg in 2007 at the age of 76, said that she herself was inspired by a plaque she saw on a desk during her years at Riverside Hospital: “He can, who thinks he can.”

Spurred by her own desire to seek ever higher educational credentials, McCrickard earned a bachelor’s degree at Goddard College in Vermont, and two years later she started working on her master’s at the Medical College of George, Augusta, commuting each week to Lynchburg to keep up with her responsibilities as director of nursing. She then began rigorous work on her doctorate in hospital administration at Walden University in Minneapolis, completing that program in 1985.

In a 1986 News and Advance profile, reporter Cynthia Pegram wrote that people who knew her knew that she was highly driven and highly organized. While working on her master’s, for example, she concentrated on her studies between 11 PM and 4 AM, so that she could share breakfast with her family.

During her 25 total years at Lynchburg General, she was a constant reminder to other nurses of the value of hard work and education.

Because of her, scores of nurses have pursued advanced degrees, gone for periodic recertification of their professional credentials (the nursing world’s method of keeping current and expanding professional skills), and become better nurses and better members of the community in the process.

McCrickard retired from Lynchburg General at the end of 1987 and then worked with the Joint Commission Accreditation of Health Care Organizations, Oakbrook Terrace, Il until March 1995. While at JCAHO, she was a field representative surveying hospitals across the country.

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RAYMOND E. HOGAN After coming to Lynchburg to take the reigns of Lynchburg General Hospital in 1957, Raymond Hogan spent the bulk of his career transforming the institution from a highly respected community hospital into a regional powerhouse medical center, which he then blended into a premier health system.

Courtesy of the Centra historical collection

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, now a part of Carilion Clinic, in the mid-1950s.

In 1957, he moved to Lynchburg, where he ushered Lynchburg General through nearly 30 years of almost continual growth and change before it — along with Virginia Baptist Hospital — became 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 the Blue Cross and Blue Shield of Virginia.

He was known in the community as a successful hospital executive as well as an intelligent, determined and hardworking activist, devoting countless hours as president to the United Way of Central Virginia, the Fine Arts Center, the Lynchburg YMCA, and the Lynchburg Sports Club.

Hogan retired from Centra in 1987, and he died in February 1993.

PETER W. HOUCK, MD The neonatal intensive care unit (NICU) at Centra Virginia Baptist Hospital now bears the name of Peter W. Houck, MD, the wellknown physician/historian/author/ publisher who has devoted his career of nearly a half-century to the health of young people, with a special lifelong interest in the care of premature and other at-risk babies.

It’s a fitting tribute: the Lynchburg physician was at the center of creating neonatal intensive care in Lynchburg and establishing Virginia’s statewide transportation system for at-risk babies.

Courtesy of the Centra historical collection

unit is equipped and staffed to take care of sick or premature babies. They greatly increase the survival rate of very low birth weight and extremely premature infants.

A Lynchburg native, Dr. Houck was recruited back to his hometown to help establish a NICU. He had graduated from medical school at the University of Virginia in 1965, going from Charlottesville to two years of service with the U.S. Army at Ft. Polk, LA. Trained as a pediatrician, Dr. Houck took part in the care of several premature babies while at Ft. Polk, and he developed an interest in their special needs.

Post-army, Dr. Houck went into a fellowship for further training in the then-new field of neonatology at Parkland Hospital in Dallas, TX and was later recruited by physicians back home in Lynchburg, who saw the need to establish a neonatal care program. At the time, Dr. Houck was one of only three practicing neonatologists in Virginia. “We had to improvise a lot in those days, the early 1970s,” he remembers. “The proper equipment hadn’t been developed yet, so we adapted existing equipment for special use with premature babies.” He also led a team developing the vehicle that would safely transport hundreds of babies to help in the neonatal unit in Lynchburg.

Continuing to practice in Lynchburg for the next 40 years, Dr. Houck also exercised his long-standing interest in history. He is the author of a number of books on local history, including a masterful work on Lynchburg’s life as a major hub for the care of ill and injured soldiers during the Civil War. The book, A Prototype of a Confederate Hospital Center in Lynchburg, Virginia, was published

by Dr. Houck’s Warwick House Publishing, which specializes in works on local history. He also serves as publisher of Lynch’s Ferry magazine, the official publication of the Lynchburg Historical Society.

In addition, he served as medical director of the Johnson Health Center, which provides health services to families regardless of their ability to pay, and he sees pediatric patients at the Johnson Pediatric Center.

In 2012, Dr. Houck was invited to be the principal speaker at a gathering to celebrate the 40th anniversary of the NICU at Centra Virginia Baptist Hospital. After giving a talk on the steps involved in establishing the NICU and the transport service, he was surprised when hospital officials unveiled a plaque designating the NICU in his name.

So now Dr. Peter W. Houck, who has left an indelible stamp on the care of at-risk babies statewide, will leave his name on one of the first specialized neonatal units to be established in his native Virginia.

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CLASSROOM STUDIES | Courtesy of the Centra historical collection 42

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NURSES

D

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 the status 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. In the 1960s, Lynchburg had yet to see the development of intensive care, chemotherapy, dialysis, even cardiopulmonary resuscitation and comprehensive cardiac care. Few, if any, nurses owned a stethoscope — they didn’t need them. Nurses still finished their education with capping ceremonies, they wore starched white uniforms, and they were unmarried. No nursing school in Lynchburg admitted a married woman until 1965.

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THE DAVID HUGH DILLARD NURSES RESIDENCE AT LYNCHBURG GENERAL HOSPITAL | Courtesy of the Centra historical collection

VIRGINIA BAPTIST HOSPITAL STUDENT NURSES | Courtesy of the Virginia Baptist Hospital historical collection

VIRGINIA BAPTIST HOSPITAL NURSING INSTRUCTION | Courtesy of the Virginia Baptist Hospital historical collection

But now, such specialties as operating room nursing, critical care nursing, pediatric nursing, psychiatric nursing, and high-level nurse practitioners require nursing professionals 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.

And a much-recognized symbol of the nursing profession — the nurse’s uniform — has undergone almost constant change. A nurse’s hat

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— 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 Lynchburg, hospital-based nursing education programs were stepped up in the early 1960s as healthcare leaders recognized the growing demand for nurses. Lynchburg General Hospital nursing students had moved in 1958 from their former location on Federal Street to new quarters in the new hospital building. And in 1960, as demand for nurses increased further, the hospital broke ground on a new dormitory building to house nursing students, now expanded to 100.

A second nursing education program at Lynchburg General — this one for licensed practical nurses — started in May 1964. It was the first completely hospital-sponsored education program for LPNs in Virginia. A one-year program aimed at providing bedside assistance to increasingly overworked registered nurses, the school operated until 1986. It closed when graduates of the program encountered decreasing employment opportunities due to an oversupply of LPNs, but then the school reopened in 1989 when demand for the occupation once again became strong.

But as time went on in many American 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 college-level degree program.

VIRGINIA BAPTIST HOSPITAL SCHOOL OF NURSING’S 1967 ANNUAL Courtesy of the Virginia Baptist Hospital historical collection.

The first local casualty of the revamped view was the nursing education program at Virginia Baptist Hospital, which since its beginnings in 1924 had graduated more than 1,000 nurses. In 1982, the nursing education program at Virginia Baptist ended, and nurse training shifted to Lynchburg College. On June 20, 1982, the final graduating class heard an address by Charles S. Elliott, administrator of the hospital from 1953 until his retirement in 1980 and a staunch advocate of the hospital’s training program.

“Technology and medicine can work wonders with diseases,” noted the Lynchburg News in an editorial noting the end of the program, “but the gentle hand and warm smile of a nurse who knows what she’s doing goes

VIRGINIA BAPTIST HOSPITAL SCHOOL OF NURSING CLASS OF 1973 | Courtesy of the Virginia Baptist Hospital historical collection

that invaluable step beyond: she can lift a heart and kindle hope.”

THE LAST GRADUATING CLASS AT VIRGINIA BAPTIST HOSPITAL the history of healthcare 45 SCHOOL OF NURSING, 1982 | Courtesy of the Virginia Baptist Hospital historical collection

NEONATAL UNIT IN LYNCHBURG GENERAL HOSPITAL | Courtesy of the Centra historical collection 46

the history of healthcare

TECHNOLOGY

O

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 lunch — 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 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.

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.

Heart attack patients at that time 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.

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 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.

Central Virginia 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 Lynchburg General Hospital were comfortable using a full array of up-to-date diagnosis and treatment tools — such as electroencephalography (EEG) to measure the electrical activity in the brain and radioisotope therapy to target and kill malignant cells.

Not all of the new technology was terribly high-tech, however.

Lynchburg hospitals reported in 1961 that they were seeing record numbers of patients during the summer months. It was not a new specialized service, nor was it a newly arrived physician practicing a hard-to-find medical specialty. There were no epidemics that year to drive scores of people to the hospitals. There were no disasters.

NEWBORN NURSERY AT LYNCHBURG GENERAL HOSPITAL | Courtesy of the Centra historical collection and Peter Houck

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 discharged to physical therapy and a more-or-less normal life.

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Courtesy of the Centra historical collection

It was air conditioning. It was new, and hospitals broke occupancy records because of it.

of misidentification.” At the time, Virginia Baptist officials said, there were four patients in the hospital with the same last name.

Lynchburg General reported the largest number of patients in the history of the hospital — in any season. Hospital president Raymond Hogan called it “part of the changing picture of hospitals.” Many people who would be suffering in the heat at home during the summer months were now choosing to have elective surgery and recuperate in the air-conditioned comfort of a hospital.

Virginia Baptist pioneered the concept of intensive care units (ICUs) in the region in 1962, not long after the first application of the idea in US hospitals at Dartmouth-Hitchcock Medical Center in New Hampshire. The concept — to provide constant nursing care and monitoring to patients — was added to Lynchburg General capabilities beginning in 1962 as well, with intensive care space completed in 1963.

Virginia Baptist administrator Charles Elliott noted that his institution had been almost at capacity during the summer, with some being turned away at times because of the demand for hospital beds.

And at Marshall Lodge Memorial Hospital, the staff was caring for more patients in May, June, and July of that year than they had during the previous winter months.

Air conditioning was also a major feature mentioned when a new wing for pediatric patients opened at Lynchburg General in April 1962. Other features of the new unit included a room next to the unit nursing station specially equipped for the care of critically ill young patients, as well as a nursery unit for babies who had been readmitted to the hospital after birth.

A second major lower-tech but still important innovation was identifying wrist bands for patients, the ubiquitous bracelets that we now take for granted with any hospitalization. They made their first Central Virginia appearance at Virginia Baptist Hospital in August 1961, praised for their power to “eliminate the possibility

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Also in 1962, Virginia Baptist added a variety of technological improvements, largely as a gift of the hospital’s auxiliary funding and profits from its coffee shop and television rentals. Auxiliary funding provided a cardiac pacemaker for external stimulation of the heart in cases of cardiac arrest, a positive pressure breathing therapy unit to help patients with respiratory difficulties, and arteriogram equipment, used in conjunction with taking X-rays of the brain.

Lynchburg General received vastly improved radiology equipment in 1964, giving caregivers much clearer and more detailed images than equipment in use at the time, while also reducing radiation exposure to patients. The new images were also much more portable. Whereas equipment in use at the time required the X-rays to be read in a darkened room, the new images could be viewed via closed circuit television, and physicians in remote locations could also see the images via videotape. At the same

time, portable X-ray equipment became available at Lynchburg General for diagnostic tests at the patient’s bedside.

The year 1968 marked the introduction of a totally new, specialized service. Dedicated cardiology care came to Central Virginia on November 11, with the opening of a coronary care unit at Lynchburg General Hospital, the result of a two-year-long pilot investigation by the Piedmont Heart Association. The coronary care unit included continuous electronic monitoring for its patients, and nursing professionals assigned to the unit received intensive training in cardiac care. The equipment was so advanced for its time that even physicians who would be taking care of patients received special training.

The unit and the concept of coronary care were so new to the region that the hospital held a pre-opening open house for physicians, nurses, hospital managers, board members, and others engaged in healthcare.

As part of the pilot project, a team of Lynchburg physicians, nurses, and administrators traveled to and studied similar units that had been established elsewhere in the US, taking the best elements of each to be designed into the unit in Lynchburg. In turn, lessons learned in Lynchburg were used in planning coronary care facilities elsewhere, including one that opened at Virginia Baptist Hospital in 1970.

Chairing the committee planning the program was Charles Henry Sackett, MD, a driving force in many aspects of healthcare in the region. This was the first element of a wide ranging cardiac care program that went on to become a major strength in the regional health community. Dr. Sackett continued his advocacy for heart patients, resulting in the nearly back-to-back establishment of programs for cardiac rehabilitation, cardiac catheterization, and heart surgery.

By the mid-1970s, the concept of critical care hospital units had extended to the care of babies who were sick or who were born prematurely at Virginia Baptist Hospital, which established one of the first neonatal intensive care units (NICU) in the state in 1976. The 12-bed unit for tiny, underdeveloped babies required not only highly specialized equipment, but also vastly expanded capabilities on the part of nurses who cared for the babies.

capabilities into areas of care that had once been the exclusive domain of the physician. Methods and equipment that were by then common in adult critical care units were greatly modified for small patients.

Those who staffed the NICU also had to be innovative when it came to having a large enough number of tiny patients to justify the costs of maintaining the specialized hospital unit. There was no doubt of the value of the work done in the unit, but there were not enough premature babies in Lynchburg alone to support the expense of the neonatal program. At the same time, other hospitals in the region had no organized, safe way to transport premature and other at-risk babies to the NICU being established at Virginia Baptist Hospital. It was risky business for babies from Danville or Farmville, for example, to be sent to Lynchburg via standard ambulances.

Neither the vehicles nor the transport personnel were up to the task of providing appropriate care en route to Lynchburg.

Led by Peter Houck, MD, the NICU staff worked with the Lynchburg Life Saving and First Aid Crew to design and outfit a vehicle that would serve as a mobile neonatal unit. Funded by local Jaycees, the vehicle contained an incubator along with equipment and space for a physician or nurse to monitor and see to the baby’s needs. By the time it was completed, the vehicle was ready to go anywhere in the region to pick up babies and give them uninterrupted care on the way to the hospital.

In 1977, Lynchburg General was building a new wing to house its radiology department, which that year would be adding much-anticipated cobalt equipment for the treatment of cancer.

Construction of the wing was part of a $5 million, multi-phase project that also doubled hospital laboratory space and introduced laminar air flow system into operating rooms for enhanced control of the surgical environment.

One of Lynchburg’s major advances in healthcare — cardiac catheterization — would likely not have happened had it not been for the intervention of the person who would become the chief VIRGINIA BAPTIST HOSPITAL NEONATAL EMERGENCY UNIT

Nurses at that time were comfortable performing supportive nursing care, but they were less than comfortable when it came to inserting catheters through which blood would be drawn and fluids and antibiotics would be administered. The establishment of NICUs opened nursing

Courtesy of the Centra historical collection the history of healthcare

49

executive of the Centra Health System, George Dawson.

Lynchburg hospitals in the mid-1980s were hard at work building a world-class cardiac program. Thomas W. Nygaard, MD had been brought to Lynchburg to expand the cardiac services that already existed. A key part of that expansion was the availability of cardiac catheterization, the minimally invasive technique to locate, identify, and treat many heart conditions.

To not have that capability would have been a major roadblock to any sort of advanced cardiac services. There was little question of the need for the service locally, but state health regulations prohibited establishment of a cardiac catheterization laboratory with two similar facilities nearby, in Roanoke and in Charlottesville.

Dawson studied referral patterns and learned that few Lynchburg

patients went to Roanoke for cardiac treatment. He then went to Roanoke to speak with cardiac physicians there, who would not feel the loss of patients they were not getting anyway. Next he went to Charlottesville with a pledge to UVA Medical Center physicians that Lynchburg patients who needed open heart surgery would be referred there. At the time, open heart surgery was not done in Lynchburg.

The result is that the Virginia Baptist application for cardiac catheterization services was approved by state regulators, having the support of neighboring hospitals that would otherwise have opposed the plan.

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

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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 the orthopaedist, the obstetrician, the 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.

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been a driving factor in the increasing specialization within medicine, especially among physicians.

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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 today and consider them quaint.

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