With success, All Children's challenge grows

Mary Lumapas, 15, gets hooked up to an IV by oncology nurse Pamela Longe-McCann on Friday. Lumapas has been treated at All Children’s since she was diagnosed with kidney cancer at age 5.

LARA CERRI | Times

Mary Lumapas, 15, gets hooked up to an IV by oncology nurse Pamela Longe-McCann on Friday. Lumapas has been treated at All Children’s since she was diagnosed with kidney cancer at age 5.

ST. PETERSBURG — Just a few decades ago, All Children's Hospital, like the rest of pediatric medicine, had little to offer many young cancer patients, beyond comfort in their final days.

Today, children with cancer usually face a brighter future. Pediatric treatments have improved so much that three in four young patients are living into adulthood.

Cancer care is among the many success stories driving All Children's move next month into a $403 million hospital complex outfitted with the latest technology. Every floor in the 10-story building attests to how far the institution has come from its first incarnation as a charity hospital for children with polio.

The new All Children's is equipped for a mass casualty disaster, with a rooftop that can accommodate a big military helicopter. It can weather a fierce hurricane. The hospital features impressive amenities, from an interactive playroom where a sick child can take a multisensory journey to exotic places far away, to private rooms with sofas that double as beds for parents and two televisions so families won't fight over the remote.

Paradoxically, medical progress has only cemented the need for facilities like the new All Children's. Many patients whose cancers are cured return years later with treatment-related problems like heart disease, stunted growth, learning disabilities and sterility. Youngsters with heart abnormalities grow into adults who require special cardiac care. And doctors are only beginning to understand the long-term struggles faced by the extremely premature babies they now can save. The list goes on.

"We would like to see that truly cured child," said Dr. Jerry Barbosa, who started All Children's pediatric cancer center three decades ago. "But there's a price that we have to pay."

Fifteen-year-old Mary Lumapas is a prime example. She has been coming to All Children's from her home in Lecanto for almost a decade, after being diagnosed with kidney cancer as a child. She's now cancer-free, but needs weekly treatments to strengthen her battered immune system.

"You're going to see more of this," said Michael Aubin, administrator of St. Joseph's Children's Hospital of Tampa, which also offers high-tech pediatric care, although not every service found at All Children's.

"As we get better at saving kids, we're going to create other problems in their lives that we're going to have to manage."

After polio vaccine, expanded care

A bronze marker in the hospital that All Children's soon will leave for its new home recalls a very different time in children's medicine. From the 1930s through the '50s, local care centered on the American Legion Hospital for Crippled Children, where children stayed for months for physical therapy.

After the polio vaccine all but erased that scourge, community leaders wanted to expand care for children. All Children's opened in 1967, mostly serving nearby families.

A decade later, Dr. Roberto Sosa joined its small staff to create a department in an emerging field called neonatology.

"When I came here, no one had heard of St. Petersburg as a place where a children's hospital was going to flourish," Sosa said, laughing to recall his colleagues' reaction.

"Some people told me, 'Why are you going there? There are no young people there.' "

At first, premature babies at All Children's shared a unit with older children and adults. In the days before advances such as ventilators and artificial feeding, survival was touch and go for babies who weighed around 3 pounds.

Now Sosa sees infants survive at birth weights as small as 500 grams — just over 1 pound. And the 97-bed neonatal intensive care unit — with individual rooms and a unit for extremely ill babies — will occupy the entire sixth floor of the new hospital.

Just downstairs, on the third floor, Bayfront Medical Center is installing its new maternity unit, Baby Place, offering upgraded amenities for new moms, who no longer will go to a separate hospital to see their babies in neo­natal intensive care.

Many premature infants grow up to lead normal lives. But for some, complications such as chronic lung conditions can mean long hospital stays and lifelong medical needs.

"We're pushing the envelope," Sosa said of the few babies who survive as young as 24 weeks' gestation, around 13 weeks premature. "Their systems are so immature that sometimes it's scary."

So Sosa, who leads the 130 specialty physicians now employed by All Children's, is expanding his sights again. The hospital recently brought onboard a group of obstetricians with the goal of preventing prematurity.

Doing things that other hospitals can't

Because they offer advanced care for the sickest children, modern children's hospitals draw their patients from a wide geographic area. The good news is, most children never need to see a cancer or cardiac specialist.

So today, almost two-thirds of the patients seen at All Children's come from outside Pinellas County. With clinics along the west coast of Florida, the hospital draws to the region pediatric specialists, who are in short supply nationally.

And the institution is so beloved that employees at Walmart and Sam's Club raised $5 million for the new emergency center, in part by collecting customer donations in check-out lines.

"There are only a handful of children's specialty hospitals in the United States, and All Children's has been one of the leaders among them," said Jay Wolfson, a professor of public health and medicine at the University of South Florida. "They can do things no other hospital can afford to do, and no other hospital wants to do."

One example: heart transplant surgery, performed at All Children's around 15 times this year. As with other advances in children's care, the long-term consequences of early cardiac intervention are still unfolding.

For example, hypoplastic left heart syndrome, a birth defect that once resulted in death, for a number of years has been addressed with multiple surgeries. These youngsters now are reaching adulthood, and as their reconstructed hearts grow, they often require ongoing specialized care. So it's not uncommon for these adults to go back to a children's hospital, where the cardiac specialists are most familiar with their condition.

"There's nobody alive today that had open-heart surgery for congenital heart disease 80 years ago," said Dr. Michael Epstein, a pediatric cardiologist and senior vice president for medical affairs at All Children's.

"If somebody has a baby today with a heart defect and they ask the question: 'Will my baby lead a full life?" he added, "the answer is, we don't know."

Which is far more encouraging than the dire reply parents got decades ago.

Rebuilding a better option to renovating

Why a new building? Why not keep adding on to the existing hospital?

The answer lies in both medical advances and patient expectations.

The current emergency room doesn't have enough room for ambulances. The shared patient rooms no longer provide the level of comfort and privacy that today's families expect. And, doctors say, private rooms also are better for containing contagious diseases.

Above all, today's high-tech medicine is supported by webs of cables running through walls and ceilings, a tough retrofit to an old building.

The new hospital "provides us with a current vessel to be able to provide the very best care and how that care model is changing into the future," said Bill Horton, senior vice president for strategic business services.

Expansion was part of the plan too; the ninth floor is empty space, and there's room on the ground for more construction.

The question is: How will All Children's grow?

All Children's could morph into a giant intensive care unit, serving the sickest children needing the most specialized care, while the rest are treated without having to stay at the hospital. It's also possible that the hospital soon will need an even larger emergency room.

One thing seems certain. Unlike the old polio hospital, which was closed by a medical advance, the new All Children's Hospital does not look to be in danger of putting itself out of business.

Letitia Stein can be reached at lstein@sptimes.com or (813) 226-3322. For more health news, visit www.tampabay.com/health.

FAST FACTS

Hospital costs

$403 million project

$140 million funding through All Children's Hospital Foundation

$75 million funding through capital campaign

What's happening to the old hospital?

All Children's leaders are discussing options that include selling the building. They hope to see it used to meet community health needs. They estimate it would cost $1 million in annual operating expenses to maintain the building and keep it from degrading.

All Children's new hospital complex:

Space:

10 stories

12 operating suites

259 beds

1 million square feet of combined space

Costs:

$403-million project

$140-million funding through All Children's Hospital Foundation

$75-million funding through capital campaign

What's happening to the old hospital?

All Children's leaders are discussing options that include selling the building. They hope to see it used to meet community health needs. They estimate it would cost $1 million in annual operating expenses to maintain the building and keep it from degrading.

With success, All Children's challenge grows 11/20/09 [Last modified: Saturday, November 21, 2009 7:04pm]

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