The Little Hospital That Grew Up

Teddy Garcia Jr. is groggy, but his scoliosis-correcting surgery has not affected his sense of humor.

“I’m the next Wolverine,” the 17-year-old announces when visitors arrive.

So what that his titanium rods support his spine rather than erupt from his knuckles? Move over, Hugh Jackman, your replacement is ready.

“He’s doing great,” confirms his mom, Edith Velazquez. “He was up all night talking to Bethany.” The overnight nurse. Figures.

Teddy’s room has a giant picture window and a pullout couch where his mom spent the night; the intensive care unit where he’s recovering is twice the size of its predecessor; and within the next hour or so, there’d be a team of specialists stopping outside his door—and that of every other kid on the unit—reviewing his vital signs, post-surgical progress, daily goals, discharge plan, psychological state and just about anything else related to his care.

Teddy is among the first wave of patients to be treated in the new Golisano Children’s Hospital of Southwest Florida—the seven-story, 300,000-square-foot, high-tech, kid-centric, community miracle of a place built adjacent to HealthPark Medical Center, where the specialty hospital had gotten its start 23 years before.

Outwardly, it’s got the vibe of an elementary school: brightly painted walls, cartoon-character scrubs, color-changing lights, X-ray machines in the shape of fire trucks, food carts painted up like boats, chickee huts and produce stands. Internally, however, it functions like a forward-thinking executive—a place designed using “lean principles” that minimize waste and maximize efficiency, run by an administrator with expertise in process improvement, and managed by supervisors who encourage staff members to voice problems, concerns and suggestions to better their units.

Last summer, less than two months after the new facility opened, Gulfshore Life visited various departments to see how America’s newest children’s hospital ticked; understand what the community, which put $100 million toward the building, is getting from it; and hear how the hospital and its parent company, Lee Health, want to expand its reach beyond those new walls and prevent childhood disease before it takes root.

Here are some of the stories we encountered.

Back in the pediatric ICU, Teddy’s father, Teddy Garcia Sr., has stopped by before heading to work.

“These two were nervous,” the younger Teddy says, a little conspiratorially, regarding his parents. “I was just worried about the IV.”

His daytime nurse, Amber Allen, looks up from his electronic medical record. “Seriously?” she asks. “That’s the easiest part!”

Teddy’s spine had bent into an uneven S-curve, the most pronounced arch bending at 65 degrees, before pediatric orthopedic surgeons Drs. John Churchill and Brett Shannon fused the affected vertebrae to straighten and stabilize them.

A little later that morning, Teddy would get out of bed for the first time, relying on Allen and physical therapist Caroline Calacci to help him navigate from bed to a recliner. Within another day, he’d be walking.

Teddy’s case, however monumental it is for him, is routine for the pediatric intensive care unit staff, which manages lots of post-surgical recoveries.

But little else is “routine” on this floor. The PICU is, perhaps, the most versatile of hospital units—a group of people ready to manage a medical encyclopedia’s worth of illnesses, injuries, surgeries and traumas.

On the same day Teddy is recovering, there is a little boy who’d suffered what appeared to be his first major asthma attack. There are a couple of babies, who were born sick or premature and have ongoing respiratory issues. Another child had been transferred there from an out-of-county hospital because he needed a higher level of care. And in a darkened room just outside the nurses’ station, another is recovering from a near tragic accident.

That child is a slight 7-year-old boy whose 9-year-old brother inadvertently had suffocated him, pinning him against the couch pillows as they wrestled. The older one weighs twice as much as his brother and has cognitive delays that prompt him to think and act like a much younger child. Both have autism.

“He was dead. He was blue. No pulse,” says their mother, Angela, who did not want her last name used in order to protect her sons’ privacy. She tapped into her law enforcement and military training to resuscitate her child while awaiting paramedics.

Angela has just finished speaking to the hospital chaplain who’d been alerted to the situation—and the family’s distress. A neurologist is scheduled to visit. And the PICU’s child life specialist has promised to join Angela when her older son arrives. The mother is wrestling with how to explain the finality of death to a child with developmental disabilities. The child life specialists—they work in all of the patient-care areas—assist parents and kids with everything from preparing for procedures to communicating difficult information to “normalizing” hospital stays through play, activities and education.

“I want to scare him straight but not terrify him,” Angela says. “(The child life specialist) is going to help me. It can’t happen anymore.”

She rises from a sunny sitting area to return to her son’s bedside. “The staff is amazing,” she says in parting.

To grasp how monumental the new hospital is, you have to understand how decidedly un-monumental its previous home had been. The original Children’s Hospital of Southwest Florida started out as a hospital-within-a-hospital at HealthPark Medical Center. Although HealthPark had included pediatric beds at the time of its 1991 opening, it had not been built with the intention of housing a children’s hospital. There were hints of kids throughout—like the undersea mural on the second-floor lobby—but mostly the building screamed “adult” with its four-story atrium, glass elevators and grand piano.

Even if understated, children’s hospital version 1.0 delivered the goods—bringing pediatric specialists, a neonatal intensive care unit (NICU), prevention programs and access to procedures previously unavailable in Southwest Florida.

As Lee County’s population swelled, the children’s hospital began to outgrow its quarters.

“One summer, somewhere around ’06 or ’07, one of the adult units was closed (for the season). I asked, ‘Can we borrow that? Just for the summer?’” remembers Kathy Bridge-Liles, the recently retired hospital chief administrative officer who oversaw the planning of the new Golisano Children’s Hospital. “They never saw those beds again.”

The squeeze tightened. One year, the NICU had to send eight to 10 premature and sick newborns to out-of-county hospitals because it was full. “That was unacceptable to everyone,” Bridge-Liles says.

The elected board of directors and the administration agreed it was time to go from talk to action. The design process—506 meetings in all—gave hospital executives, doctors, nurses, therapists, administrative staff and parents a chance to contribute to the look, technology, services and “flow” of the new building. Family needs, such as laundry facilities, were as carefully considered as diagnostic equipment.

The project spurred a re-imagining of how care was delivered, with reviews of everything from medical protocols to room layouts to bedside equipment to the workflow of nurses. Once, Dr. Lawrence Antonucci, now the Lee Heath CEO, pretended to be a distressed dad in a “code blue” simulation. The takeaway? Child life specialists needed to take charge of scared parents.

“We looked at all the steps we currently do and, of those, which bring value to the patients?” Bridge-Liles says. “If there’s not value to the patient at the end of the day, then why are we doing it?”

Autumn Wilkins had been monitoring her 13-month-old’s rash and in contact with his pediatrician, but when Christopher Calvert awoke from a “dead sleep” one Wednesday and started projectile vomiting, Wilkins and Steve Calvert hurried their son to the new Golisano emergency department.

New operational strategies (and good timing) meant the wait time had been almost nonexistent. The clinical team determined they needed blood and urine samples and to rehydrate him intravenously.

While those providers ready the necessary equipment, child life specialist Meredith Church appears in the room. She preps the parents on what to expect (such as the startling “pop” a syringe will make), coaches Wilkins on how to securely cradle her baby during the IV insertion, and tries to ease the baby’s distress with light-up toys and bubble wands.

The baby squirms, then fusses, then screams as nurse Mariya Kulyk and technician Nick DeMarco deftly do their work.

“It’s in, Christopher, it’s in,” Wilkins says moments later.

The baby quiets almost immediately, and the whole room exhales.

The Emergency Department’s overhaul encompasses both physical changes as well as operational ones.

Before the move, children were treated along with adults at HealthPark’s ER. This intermingling sometimes led to less-than-comfortable experiences: crying children aggravating sick adults and intoxicated adults upsetting children. The volume of both meant wait times averaging 74 minutes.

When it came time to design the new pediatric emergency department, administrators hired an expert in “lean” practices, a business model that seeks to eliminate waste and maximize efficiency. He consulted with doctors, nurses and other staff in creating a physical layout and procedural guidelines that would foster a faster, less stressful ER experience.

They came up with this:

• A registration desk staffed by a triage nurse who hears patients’ symptoms and assesses the severity of their conditions right as they come in. On average, patients spend just 12 minutes in the waiting room and see the doctor within 39 minutes.
• A two-track department that can accommodate up to 25 patients at a time. There’s an area for more seriously ill children, which includes rooms for resuscitation, decontamination and isolation, and a larger space dedicated to those with milder ailments.
• Children awaiting test results relax in a shared, eight-person room, freeing up exam rooms for new arrivals.
• To the greatest extent possible, a medical team—physician, nurse, technician and any other necessary staff—sees the patient all at once, saving time and saving weary parents from repeating themselves with each new face.

“The stress level for us has gone from 100 to zero,” says Dr. Myrian Alea. The workload may appear light, she says on the night Christopher came in for treatment, but that’s because patients are moving quickly through the system.

“It’s flowing. It’s more efficient,” she says.

If the children’s hospital has a “face,” it’s generally reflected in two profiles: that of a premature baby tethered to lifesaving devices and that of a cancer patient offering defiant smiles.

We’ll meet both, but we’ll start in the NICU where registered nurse Toni Applegate is getting the low-down on three babies placed in her care on a late June morning. The overnight nurse, Karen Reynolds, gives good news about twin girls Reagan and Riley—after just 16 days, they were almost ready to go home in near record time. They’d been born at 33 weeks, five days.

The third baby, another girl, was more problematic. Her mother had carried her nearly to term, but the baby was born addicted to methadone. She suffers from neonatal abstinence syndrome, or NAS, and the NICU team is in the slow process of weaning her.

Even with 54 patients this morning, the unit is quiet—almost eerily so, compared to the former, open-ward NICU that preceded it. Rooms are private and most alarms silent (nurses carry handheld devices that receive alerts). It’s big, too, taking up nearly the entire third floor. Respiratory therapist Kim Schramm says she logs some 6 miles a day, and sometimes goes an entire shift without encountering all of the nurses staffing the unit. While the new setup encourages more parent involvement and a more healing environment, the hospital’s medical director acknowledges a need to maintain the camaraderie that has been the hospital’s hallmark.

Applegate starts with the twins and their excited mom. “I can’t wait to hold them both at once, to see them next to each other,” Sarah Haines says. She’s holding Reagan; Riley is in the adjoining room, still asleep. The mother had spent the last 24 hours caring for and nursing her daughters in preparation for the discharge that she hoped would happen that afternoon.

“For what was the scariest day of our lives, the people have been amazing. It’s not anything I would wish on anyone, but if you have to go through it, this is the place,” Haines says.

Neonatologist Dr. Amit Mukhia makes rounds at mid-morning. He is pleased to see the girls eating and maintaining their weight but wants to play it safe. One more day, he tells the mother. Haines looks deflated but manages a small smile and a compliant “OK.”

Applegate will come back about 15 minutes later, pause outside the door and listen for sounds of babies—or mom—crying. In a children’s hospital, parents are secondary patients.

A few doors down, the nurse peers over the crib to examine her third charge. Even without Applegate pointing it out, the difference between a NAS baby and her fellow NICU inhabitants is apparent.

She grunts and squirms. Applegate reviews her chart and examines her, scoring her on a numeric scale that the staff uses to track the babies suffering from NAS. It’s based on everything from the pitch of their cries to their vital signs to their sleep, stool, muscle tone, reflexes, food intake and the like. This morning, the baby is doing well. Applegate will fully examine and score her at least every three hours. The data drives the weaning and pain management strategies.

This baby’s case is no rarity. Last year, some 100 drug-addicted babies were treated in the NICU, with an average stay of 25 days. Later that afternoon, a group of community members from social service, health care, drug prevention and rehabilitation organizations will join NICU medical director Dr. William Liu and Cathy Timuta, the executive director of Healthy Start Southwest Florida, in a third-floor conference room. The group is pushing to curtail the number of babies born addicted to drugs.

“Come on, wake up,” Applegate says, shifting the baby. She’s taken less than an ounce of her bottle and is nodding back to sleep in the nurse’s arms.

The baby’s mother is not here this particular morning, though she has been cooperative and involved in her daughter’s care, Applegate says. A social worker is assigned to the unit, but the nurses man the front lines, interacting with troubled parents who grow anxious to go home. “I have to remind the moms: Your baby is in withdrawal, just like you are.”

Becca Perdue is tethered to an IV, but she pays it so little attention that you’d think she’s forgotten its presence. Score No. 1 for the hematology/oncology staff, which is always looking for ways to make the most dreaded of diagnoses somehow fun.

The 11-year-old, in pink PJs, sits in a playroom molding figures out of Play-Doh to pass the time.

“She’s a trooper,” says her mom, Anna Perdue. “She’s pushing through.”

If you want a sense of the complexity of the cases that specialists encounter here, look no further than Becca. She was born with Down syndrome. When she was 1, she was diagnosed with adrenal carcinoma, a tumor on her adrenal gland. At 8, she was diagnosed with paraneoplastic syndrome, a rare autoimmune disorder that affected her central nervous system. And then, last year, leukemia, a cancer that strikes children with Down syndrome at higher rates than the mainstream population.

“Are you kidding me?” Anna Perdue remembers saying to Dr. Emad Salman, the pediatric oncology/hematology department’s founding physician, now the hospital’s medical director. The doctor sat with the family for some five hours, going over test results and discussing treatment plans, Perdue says. “You don’t get that anywhere else.”

Nevertheless, in some ways, the hospital and its specialty care remained hidden from public view, literally and figuratively, during its years tucked inside HealthPark. Kathy Bridge-Liles says she routinely encountered residents—and even occasionally adult medicine providers—who expressed surprise when they discovered the region had a children’s hospital. That’s changing at last with the much-publicized, very visible new facility, she says. She, Salman and her successor, Armando Llechu, say the hospital’s next focus is cementing its place as a regional children’s hospital, the top-of-mind choice for physicians and parents whose children’s medical needs dictate lengthy stays or specialized care.

“It’s a beacon,” Bridge-Liles says. “A beacon of health care for children.”

If you ask Salman what he is most proud of, or you ask him to name what makes the new Golisano Children’s Hospital of Southwest Florida stand out, he won’t talk about the magnificent building (though he loves it) or the new technology (though advances such as minimally invasive robotic surgery help transform care). He talks about things like birthday parties or, more somberly, about a funeral that took place last summer for a baby lost to cancer. He and 12 colleagues drove to Charlotte County that day, a Saturday, to comfort the baby’s parents.

“I looked around and I smiled,” he says. “That’s not the place where you should be smiling, a funeral, but inside I had a feeling of warmness that (the staff) got it—the message is spreading. ... It means caring is catching on. Kindness has a place in our lives.”

Salman is right—the building’s predominant feature is not the architecture but something far less tangible.

It’s a feeling that comes across when ARNP Pam Bolton in the oncology department elicits a peal of giggles out of 3-year-old Neriah Delcin. Or when child life specialist Kristin Brown presents Jayson Olguin-Lugo, a heart transplant patient, with a pack of toy cars for his 4th birthday and then plops on the floor to play with him. Or when the hematology/oncology staff throws Becca Perdue a 12th birthday party, Moana-themed after the recent Disney film.

Or, it’s when NICU nurse Jessica Favia shows up at work on her day off, gift bag in hand, a parting gift for Mateo Nuno and his mom, Daniela Restrepo. Mateo had been born at just 24 weeks, five days, and had spent the first 98 days of his life at Golisano. He’d been the first baby brought into the new NICU; his mother had come to regard his private quarters as “Mateo’s Room.”

“The NICU is so scary and watching your baby fight for life is scary, but I have only wonderful things to say about the staff,” Restrepo says. “The way they speak to him ... just seeing how much they treat your son with love is the best thing.”

Restrepo hands Favia the baby, and the nurse cradles him in a rocker.

“I can’t wait for his birthdays,” Favia says.

Extending the Mission

The new Golisano Children’s Hospital of Southwest Florida has 128 beds, but the two men at its helm would be happy to see them empty.

No, Medical Director Dr. Emad Salman and Chief Administrative Officer Armando Llechu (pictured) are not trying to sabotage their new hospital or parent company, Lee Health. Instead, they want to extend Golisano’s mission, outreach and care beyond its walls.

“There are more children outside the hospital than there will ever be in this building,” Salman says.

The administrators and their team want to deliver care before kids ever get sick, starting with three big prevention efforts: mental health, healthy lifestyle and dental care.

“If we can’t help these kids get their teeth cared for now, what’s it going to cost society 30 years from now or 40 years from now? How many diseases will we not see if we can get these kids on better nutritional plans?” Llechu asks.

Without getting into specifics—it’s too early for that—their goals include expanding children’s mental health services, particularly for those who can’t pay for private counseling. They want to promote better nutrition through efforts like community education, diabetes management and metabolic testing. And they’d like to introduce a mobile dental clinic to cover neighborhoods where children lack oral care.

None of these ideas make money. In general, children’s medical care is a financial drain—some 75 percent of Lee County children, for example, rely on Medicaid for their care. And so the hospital team wants to appeal to a community that embraced a brick-and-mortar fundraising campaign to see if it will build endowments that allow for these and other wellness efforts.

“These are things that don’t make money. They are not glitzy or glamorous. But they are things that are going to save lives, and at the end of the day, everybody who is here in the building should be here because they are serious about saving lives and improving the lives we touch,” Llechu says.