Buffalo Niagara Medical Campus | Clinical, Research, and Academic Excellence

Heart center plan boasts best quality
Institute’s goal is to centralize care

By Henry L. Davis
The Buffalo News
May 4, 2008

The heart-vascular institute planned for the Buffalo Niagara Medical Campus is a $250 million project that advocates say will lay the foundation for a signature medical program capable of attracting patients and doctors from around the country.

Confidence is so high in the institute that a prominent local family plans to donate $10 million toward the facility.

For patients, the center promises to offer one-stop shopping and superior quality. Just about every aspect of care will be provided, from prevention to treatment, with physicians and their staffs sharing information and working as a team.

For doctors, the project represents more than a chance to work in a new facility that marries treatment, research and education. The plan is to copy how the highly regarded Cleveland and Mayo clinics do business by giving physicians a stake in the institute’s operations and making them accountable for its performance.

“This could be one of the best things to happen in this community. In our vision, a doctor would have to be nuts not to want to work here,” said Dr. L. Nelson Hopkins III, chief of neurosurgery at Kaleida Health and chairman of neurosurgery at the University at Buffalo.

Although a local family that so far is remaining anonymous plans to donate $10 million, most of the money for the project is expected to come from the state, as an offshoot of the state-ordered consolidation of Kaleida Health and Erie County Medical Center.

Advances in medicine have blurred the lines between specialties that handle conditions in the body’s vascular highway. Many of the best medical centers are bringing together different specialists who deal with the same diseases in different parts of the body — cardiac surgeons, cardiologists, vascular surgeons, neurosurgeons, interventional radiologists — and putting them in one building.

This is a key concept of the institute, which has been proposed by a state-appointed board overseeing the hospital consolidation. With shortages of nurses and specialists, rising technology costs and gaps in UB’s doctor-training program, the thinking also goes that if Kaleida and ECMC combine, they can build something better.

“Fifteen percent of patients who need heart and vascular procedures go elsewhere even though we could do the work here. The problem is we only have pockets of medical excellence in Buffalo,” said Dr. Robert Gatewood, president of Buffalo Cardiology and Pulmonary Associates.

Gatewood is a longtime advocate for a “hub-and-spoke” system in which complex heart and vascular care is centralized on a single medical campus, with links to physician groups and smaller hospitals.

“Doctors and their staffs are all stretched too thinly,” he said. “We need to take the talent and resources that we have and try to create something that is more effective and that allows us to learn from each other.”

Physicians plan center

Physicians say they have been put in charge of planning the institute, as well as working out the complex arrangements for credentialing who can work there and under what conditions. Unlike a traditional academic medical center, the plan envisions a mix of community physicians and doctors affiliated with UB’s School of Medicine.

“The challenge is to avoid the turf battles when you put together people from different disciplines. But we’ve all been talking for months, and everyone is willing to work in the same sandbox,” said Dr. M. Hashmat Ashraf, chief of cardiothoracic surgery at Kaleida.

Plans call for a 200,000- square-foot addition to Buffalo General Hospital that takes up a section of Goodrich Street and connects to a parking ramp on Ellicott Street. Kaleida would demolish its Community Mental Health Center after moving the services to make room for the new building.

Key elements of the facility include an emergency room on the ground floor, an outpatient center, digital links to rural hospitals, and new “hybrid” operating suites in which doctors who specialize in minimally invasive therapies can work side by side with surgeons during a procedure. Plans also are to move the Toshiba Stroke Research Center, which Hopkins directs, from UB to the institute.

The architect is Mehrdad Yazdani, a rising star who designed the Hauptman-Woodward Institute, considered one of the most interesting buildings constructed in the city in years.

Officials plan to seek $105 million from the state over a number of years, of which $65 million already has been committed, and $35 million from Kaleida Health. They also hope to raise an additional $40 million from private donors.

If all goes well, officials say the institute could open in 2011.

But what ultimately gets built likely will be influenced by what happens with the forced marriage between Kaleida Health and ECMC.

ECMC’s counter plan

The state’s Berger Commission in 2006 called for construction of a heart-vascular center when it ordered the consolidation, which also calls for including UB in the new organization.

“If we don’t provide the infrastructure for where the hospital industry is headed, we will do the community a great disservice,” said Robert Gioia, a Buffalo businessman who is chairman of the board.

ECMC has pushed a proposal to build a heart center on the medical center grounds, saying it has land and money to start construction right away. The medical center portrays plans for the downtown heart-vascular institute as a sign that the board will take profitable services out of the medical center.

ECMC and Erie County filed a lawsuit Friday against the state Health Department, contending the state has treated ECMC unfairly and acted improperly on a number of issues in the contentious effort to combine the institutions by a June 30 deadline set by the commission.

ECMC has refused to sign a memorandum of understanding about how the hospitals should combine, describing the document as too vague. It wants a more detailed contract, especially about how the board will locate services.

ECMC also contends Dr. Richard Daines, the state health commissioner, violated the approval process for hospital projects when he recently backed the institute plan.

“The issue is not so much about location as it is about including the clinical and financial expertise of our people in the process. It’s also about understanding that the new facility will affect business at ECMC,” said Tom Quatroche, senior vice president of marketing and planning.

Gioia and others have repeatedly said there’s no intent to harm ECMC and that provisions in the memorandum, as well as the structure of the board, will prevent it.

State officials say they will only support a joint plan from the board appointed by the state to oversee the combined organization, and their support of the project is about upholding the Berger Commission mandate to put a heart-vascular center in Buffalo.

Without an acceptable agreement, three members of ECMC’s governing board who were appointed to the new panel stopped attending meetings, and ECMC refused to participate in a study of the project by PriceWaterhouse Coopers.

ECMC rep OK’d plan

The commission also ordered Kaleida Health to close Millard Fillmore Hospital, which includes the regional stroke center and a major heart surgery unit. Kaleida received $65 million from the state to get it done, and planned to relocate the doctors and staff in and around Buffalo General Hospital regardless of how the consolidation played out.

The consultant, which interviewed 60 physicians, endorsed a concept of building on the relocation to achieve the larger vision of the institute.

A fourth ECMC representative, Dr. James Evans, president of the hospital’s medical staff, did vote for the plan.

Evans said he voted for the project because of expectations that the state will provide an additional $40 million that could benefit Buffalo and the necessity of moving the doctors from Millard Fillmore. He also said many of the physicians he represents have dual appointments at Kaleida and different opinions of the situation.

He remains skeptical about the project’s ambitious goals.

“There isn’t enough money to achieve a great vision. It’s just enough to relocate those folks,” Evans said. “My objective is to get as much money as possible from the state because we have a limited opportunity and hospitals here don’t have much money. No one has a big endowment. Unlike other cities, there are no big corporate donors.”