If, God forbid, a child is going to get sick, it'd be tough to find a brighter, more cheerful, and less hospital-like place for treatment than the Children's Hospital at Montefiore Medical Center in the Bronx. Designed by architect-about-town David Rockwell, the hospital, which opened in the fall near 210th Street, has DNA-strand tiles on the floor of its reception area, a biosphere, a Foucault pendulum, and a library for parents to learn more about what brought them there in the first place. In-patients are grouped by age range rather than by ailment, and all have easy access to play-family spaces. There is a computer at every bedside, along with dioramas, exhibits, charts, photographs, and murals of flora and fauna so that children can get better -- and better educated at the same time.
"Our first mission, obviously, was to provide state-of-the-art medical care and to create a space that would recognize the needs of the family and community," says Irwin Redlener, the hospital's president. "But beyond all that was the opportunity to recast what could be achieved in a children's hospital." He adds that he was guided by the philosophy and lifework of his late close friend, the populist astronomer Carl Sagan.
"I've always believed design can have a strong emotional impact," Rockwell says. "I thought about what it was like to be a child in a hospital and afraid. We did all our initial sketches from a child's point of view. Here, if you're on a gurney and look up, you see stars and birds embossed on the ceiling. Each floor has an art installation at the elevator lobby with some piece of Sagan's teachings. Each room has a symbol, like a bumblebee, rather than a number."
All of this has had a galvanizing effect on the medical community. "Graduating med students are going to Montefiore for their residency largely because of that hospital," says Wade Parks, chairman of pediatrics at NYU Medical Center. The newcomer in the Bronx has also stimulated a lot of discussion, according to Parks, about why there isn't a similar facility in Manhattan south of 168th Street, the site of the only other contender, Babies Hospital, a.k.a. the Children's Hospital of New York Presbyterian.
In fact, a midtown or downtown children's hospital was Redlener's dream in the late eighties, when he was head of ambulatory pediatrics at Cornell. "I was amazed that we didn't have any place to refer people other than Babies Hospital," he says. "I don't want to imply that it's anything but excellent, but in terms of convenience, I thought there should be a downtown hospital, and I still do. I feel uncomfortable that for people who live in lower Manhattan, it's a major hassle to go to a children's hospital, whether they should decide to come to us at Montefiore or to 168th Street."
"In any other city, if you get off the plane and tell the cabdriver, 'Take me to Children's Hospital,' they know exactly where to go. If you try that at La Guardia, no one would know what you're talking about," concedes Cynthia Sparer, executive director of Babies Hospital, who's overseeing construction of a new $120 million "family-centered" facility due to open in the fall of 2003.
It isn't that children can't get a bed or excellent care on the pediatric wards at general hospitals in town. How welcome they are to the bean counters is another matter. Kids make up the smallest percentage of admissions; caring for them contributes the least to the bottom line and is the first service to be sacrificed when there's a budget cut. Indeed, Roosevelt Hospital has shuttered its pediatrics unit altogether.
"No one in purchasing at a general hospital starts by thinking what would be needed by children; for example, syringes appropriately sized for babies," says Ian Holzman, chief of newborn medicine at Mount Sinai and a longtime champion of a new children's hospital. "We demand things that are child-appropriate, but it's a fight. There is obviously some self-interest here" -- on his part, he means -- "but we think services are best given to children in a hospital for children."
At a children's hospital, all the social workers are oriented to kids and their families; the equipment is appropriately scaled. There's also the critical mass of patients necessary to attract top medical talent. "The reality," says Redlener, "is that it's harder to recruit pediatric subspecialists if you're not recruiting them for a children's hospital."
Which brings us back to the Manhattan project. Build it and they will come -- from Manhattan, Queens, and parts of Brooklyn, according to Holzman's demographic research. There are just a few things holding up the groundbreaking. First, no one's got a clue about where that ground can or should be. On the campus of a medical center? Which one? Or on some neutral territory? ("Think the Arab-Israeli conflict," says one Mount Sinai doctor.) But pin the lion's share of the delay on the usual suspects: money, of course, and politics.
"If you don't have an average daily census of more than 200 children, you're not going to sustain a freestanding children's hospital," says NYU's Parks. And unless institutions like Mount Sinai, NYU, and Lenox Hill decide to consolidate, that's not going to happen. The construction of another children's hospital in Manhattan would mean closing pediatrics units at the partnering hospitals and, of course, coping with metastasized egos. "Everybody has a job and a title and a hat and a uniform, and no one wants to give that up," says Holzman.
He may look with envy at Montefiore, where, even in a none-too-healthy climate for health care, the medical center's CEO, Dr. Spencer Foreman, gave the nod to the $120 million children's-hospital project, and where two trustees each gave $10 million to get the ball rolling. A clutch of other donors, among them Sagan's widow, Ann Druyan, and the singer Paul Simon, each ponied up $1 million, because they "had a connection to the Bronx because they were born and raised here," says Redlener, "or were attracted to the idea of doing something spectacular for kids in need in one of the most medically underserved areas in the United States."
Manhattan, too, has its underserved areas, believes Ramon Murphy, a popular Upper East Side pediatrician. "Accessibility is important," he says, "and Babies Hospital is just too far away."
"We have a strong relationship with families who need access to what we provide, and we believe our location is just not an impediment," Sparer counters, adding that the hospital's volume has increased dramatically over the past few years. "The $120 million we're spending for the new facility is going to services," she adds, some of which will be focused on education, though nothing patterned on Montefiore.
"The reality is that if you look at major cities where children's hospitals are located, they're out of the business district," Sparer notes. "If your child needs a transplant or neurosurgery, 40 blocks is not going to make a difference."
In the eighties, when Redlener and his team were talking up a children's hospital in central Manhattan, they found little enthusiasm for the idea among their colleagues. "I talked to a bunch of potential donors who could help seed the project," he says, "but administrators weren't interested. They said the pediatric departments at the other hospitals wouldn't go along with it."
That was then. Now Mount Sinai says it's game and is looking to team with erstwhile merger partner NYU. "This hospital does very high-tech pediatric things like bowel and liver transplants," says Holzman. "We have the second-largest cardiac service in the city. NYU has had a lot of neurosurgery and neuro-oncology.
"Yes, there are people who don't think we need another children's hospital," he adds. "They're at Presbyterian."
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