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Case Statement – Hospital

The following is an actual case statement used during the successful $5.5 million capital campaign for Carondelet Health Care in Tucson, Arizona. It comes to this website courtesy of Carondelet Health Network and Capital Quest.

Historical Perspective
For 111 years, the Sisters of St. Joseph of Carondelet have been a part of Tucson in its move from pioneer, frontier medicine to modern technology with all its scientific knowledge and medical advances. Changes have occurred and expansion has taken place, adding new areas of patient care in an ever more complex setting. Innovative programs, as much a part of vision as of necessity, have continually been undertaken in response to personal and community needs.

In 1880 the call for medical service was answered by the physicians and the sister-nurses who cared for the injured employees of the Southern Pacific Railroad, the poor and medically indigent patients, and everyone who came to the small twelve-bed hospital named St. Mary's. It is answered today by physicians, nurses, therapists and technicians working on shifts that punctuate the hospital’s twenty-four hour availability.

In 1870, seven Sisters of the Congregation of the Sisters of St. Joseph of Carondelet made an arduous journey from St. Louis, by way of San Francisco, Los Angeles, and finally through the "trek" across the desert to Tucson. Their mission was to answer the plea of the newly appointed Vicar Apostolic of Arizona, Jean Baptiste Salpointe to teach at the Mission School in Tucson. The Sisters quickly expanded their work beyond the school to include an Indian school at San Xavier, a hospital in Prescott for men injured in mining accidents, and a school in Yuma. By 1880, the Sisters of St. Joseph of Carondelet were an established part of life in Tucson.

In 1877 Bishop Salpointe faced a dilemma. He was erecting a trade school for the Indian youth of the area and, with the Indians help, the building was almost complete. However, there was also no questioning the need for a hospital for the community and railroad workers. The painful decision was made - the trade school, named The Mission School, was postponed and the building was turned into a hospital with the Sisters agreeing to staff the new facility. St. Mary’s Hospital was dedicated on April 24, 1880 and received its first eleven patients on May 1. It is Arizona’s longest continually existing hospital.

The past century has seen St. Mary’s pioneer many aspects of health care with numerous "firsts." During the frontier days, the hospital provided such revolutionary services as a separate Isolation Cottage for patients with communicable diseases, a separate surgical area, and a Sanatorium. The Sisters also pioneered firsts for Arizona in the area of Nursing Education and Professional Standards for Physicians. The hospital provided Arizona with its first X-ray machine, Intensive Care Unit, and open heart surgery. St. Mary’s Burn Center is still the only such facility in southern Arizona.

Throughout the years, during wars and peace, during good times and bad, the Sisters of St. Joseph of Carondelet offered the citizens of Tucson such cutting edge technology as the first electroencephalogram (EEG) machine. From the original eleven patients, St. Mary’s Hospital grew to 374 beds to be the fourth largest hospital in Arizona and the second largest in Tucson. It offers a full range of medical services.

In 1961, the Sisters of St. Joseph of Carondelet recognized that the city of Tucson was growing at such a rate it was difficult for the residents on the fast-growing east side to utilize the services of St. Mary’s Hospital on the west side. The Sisters then built St. Joseph’s Hospital and created a two hospital system to maximize health care coverage and reduce expenses. Carondelet St. Joseph's Hospital is a 338 bed, comprehensive general, acute-care facility with a major emphasis on ambulatory care. It offers complete OB-GYN services, O’Rielly Care (an eighteen-bed substance abuse treatment center), a comprehensive Cardiac Rehabilitation Center, a Diabetes Care Center, Home Health Care services and a full range of rehabilitation programs. It also provides southern Arizona’s Regional Eye Center and Regional Hand Center.

Incorporated in 1983 as Carondelet Health Care Corporation, today the health care system includes Holy Cross Hospital in Nogales, Arizona and Holy Family Center, an extended care facility in addition to St. Mary’s and St. Joseph's.

The Situation Today
Today Carondelet Health Care is the largest health care provider in southern Arizona with three hospitals (Holy Cross in Nogales, Arizona and Holy Family Center, a long term care facility) was added to the system in 1987), two hospices, fourteen wellness centers, and a host of outreach programs designed to meet the healthcare needs of the community.

Today Carondelet Health Care:
  • Has 755 beds available for patient use.
  • Will admit over 27,000 patients this year.
  • Will treat an additional 50,000 people on an outpatient basis.
  • Will deliver over 2, 000 babies this year.
  • Will treat over 60,000 people through its 24-hour Emergency Departments.
Of Carondelet Health Care’s 27,000 admissions, almost 14,000 of those will be on some type of government assistance program.

Yet even with this tremendous volume, Carondelet retains the mission of the original Sisters to provide quality healthcare for all the people of Tucson.

St. Mary’s Hospital serves the "western corridor" of Tucson and gives special attention to minorities and those with lower incomes. It is the only private hospital serving the west side population. Carondelet Health Care provides over $10,000,000 per year in charitable care to persons who would not otherwise be able to afford quality healthcare.

Both Carondelet St. Mary’s and Carondelet St. Joseph’s retain a commitment to providing the most technologically advanced healthcare in Tucson.

Specialized services provided by Carondelet Health Care include:
  • The Burn Center: The first and only fully accredited burn center in southern Arizona serving the immediate area, surrounding states and Mexico.
  • Hospice: The first facility in southern Arizona serving the needs of the terminally ill and their families in a compassionate, Christian environment.
  • Cardiac Rehabilitation Program: Southern Arizona’s largest rehabilitation service for victims of heart problems.
  • Diabetes Care Center: Arizona’s only Medicare and American Diabetes Association certified care center.
  • Heart Surgery: Carondelet Health Care system performs more heart surgeries than any other area institution - over 325 this year.
  • Regional Eye Center and Low Vision Clinic: Carondelet St. Joseph’s is home to southern Arizona’s only Eye Center providing a full range of surgical, laser, ocular prosthetics and low vision services.
  • Regional Hand Center: Carondelet St. Joseph’s is home to southern Arizona’s only center specializing in the treatment of disorders of the hand.
  • O'Rielly Care: Specializing in the treatment of alcohol and substance abuse patients.
  • Nurse Case Management: Carondelet St. Mary’s was selected on January 1, 1991 by the General Mills Foundation to work with thirteen other hospital’s in a National Chronic Care Consortium to develop programs dealing with geriatric chronic care.
  • Community Health Care Centers: Are located throughout Tucson serving those who do not have ready access to healthcare providers.
The Challenge Facing Carondelet Health Care
After intense study by experts within and outside the hospital family, Carondelet Health Care has identified the two most pressing healthcare issues which face the citizens of southern Arizona.

1) Maternity and Delivery Services: Currently Carondelet Health Care delivers approximately 2,200 babies each year. This is the maximum number of births the present facilities can accommodate. Carondelet continues to provide the maternity and delivery services to the community, often despite the patients ability to pay. Carondelet Health Care provides well over $1,000,000 in charity care to maternity patients who cannot afford this health care.

Carondelet provides this service to the community, in spite of the adverse financial effects, because of the Sisters' commitment to Christian family values.

2) Outpatient Rehabilitation and Surgical Services: Currently in Tucson and southern Arizona there is no comprehensive outpatient rehabilitation service facility. Additionally, Carondelet St. Mary’s and the west side of Tucson lack necessary outpatient surgical facilities. This lack of outpatient services on the west side presents a burden on the very people who are least able to acquire medical care.

One major trend in health care in the 1980’s and 1990’s is the move toward outpatient services. A procedure performed on an outpatient basis traditionally costs 30% less than a similar procedure on an inpatient basis. This simple economic statement is the underlying reason insurers and third party payors are insisting on more outpatient services and even refusing to reimburse the total inpatient costs in many cases.

Additionally, the project at Carondelet St. Mary’s Hospital will include a surgical center that will add four inpatient and four outpatient surgical rooms and create a larger recovery room. A gastroenterology laboratory and laser treatment room will also be added. These additions will enable Carondelet Health Care to continue to meet the healthcare needs of the citizens of Southern Arizona.

Because of the location chosen for the new outpatient center, a new chapel will need to be constructed and many of the furnishings of the soon to be displaced St. Catherine’s Chapel will be used in the construction of the new chapel.

Carondelet's Urgent Response
The Sisters of St. Joseph of Carondelet are still responding to the healthcare challenges of the community. To meet the growing needs of the southern Arizona community, Carondelet Health Care has committed to two exciting and important capital projects. For Carondelet St. Joseph's Hospital a commitment has been made to reconstruct the maternity facilities to create a new Labor, Delivery, Recovery, and Post Partum (LDRP) Program. At Carondelet St. Mary’s Hospital, a commitment has been made to construct an entirely new Comprehensive Outpatient Rehabilitation Facility (CORF) and Outpatient Surgery Center.

Carondelet St. Joseph's Hospital and Carondelet St. Mary's Hospital serve distinct communities. The physicians are, for the most part, geographically divided between the two hospitals with less than 10 percent of the active physicians practicing at both. Despite these differences, both hospitals are managed with the same commitment to quality and excellence and are governed by a single board of directors.

To meet the growing need for outpatient services on the west side of Tucson, Carondelet Health Care has chosen to construct an outpatient facility on the campus of Carondelet St. Mary’s Hospital.

The facility will be the:
Comprehensive Outpatient Rehabilitation Facility (CORF)

Carondelet Health Care is the primary provider of rehabilitation services in Tucson and southern Arizona.

While Carondelet St. Mary’s Hospital was the first accredited rehabilitation center in Tucson, it has, over the last 50 years, performed these services through traditional inpatient facilities. In effect, the outpatient services are "fit in" around inpatient operations, lacking adequate space and equipment to meet patient needs.

CORF will create the only comprehensive rehabilitation location in southern Arizona. It will be medicare certified. It will be located on the first floor of a two story building located next to the hospital. Included as part of the Comprehensive Outpatient Rehabilitation Facility will be Physical Therapy, Occupational Therapy, Speech-Language-Hearing, and Psychological Counseling Services.

The Comprehensive Outpatient Rehabilitation Facility (CORF) will create a center where the treatment plan for each patient's physical therapy, occupational therapy, and speech therapy will be coordinated and managed together, instead of separately.

CORF will also expand Carondelet’s rehabilitation programming to include clinics to treat chronic diseases such as Multiple Sclerosis and arthritis. CORF will also create an Educational Resource and Technology Center where patients can borrow rehabilitation equipment and receive education on their particular condition and treatment program.

The major difference between the new and the old is the comprehensive nature of CORF. Currently, other rehabilitation facilities for other hospitals are spread throughout the medical center campus’ or even the community. The problem this creates is fairly obvious. People who seek rehabilitation services (for treatment of stroke, head and spinal cord injuries in particular) need to attend one area for speech therapy another area, often outside the hospital, for physical therapy, and a third area if they need occupational therapy.

The rehabilitation services of Carondelet Health Care are perhaps its finest example of commitment to maximizing the quality of a patients life and lifestyle.

What good does it do a patient, and in turn society, if we save the lives of stroke victims, heart attack victims, car accident victims, and, by the very act of saving their life, we condemn these people to a life of uselessness and limitations to the point where they are reliant on other people for the basics of life such as eating, drinking, personal hygiene, and other functions we take for granted each day?

Rehabilitation services are good for the patient and the community as well. Experience shows that every year one in twelve Arizona workers is involved in an occupational injury and, on average, 19 work days are lost for each injury.

Perhaps most impressive is the fact that a single dollar spent on rehabilitation saves up to $30 in disability payments.

The CORF will focus on new approaches in therapy utilizing specially designed spaces and equipment including:
  • the addition of biofeedback capabilities
  • aquatic therapy
  • a fully equipped apartment for those who will need to relearn the basics of living.

The CORF will consist of a variety of therapy programs that will encompass the therapy needs of virtually every patient. The CORF has been designed to optimally meet the goals of comprehensive rehabilitation.

It will include:
  • a state-of-the-art speech-language-hearing clinic with three separate speech therapy treatment rooms.
  • an aquatic therapy area to provide an alternative environment for exercise to benefit patients with special needs.
  • a large, fully carpeted conjoint occupational and physical therapy room.
  • a "work hardening" clinic where specialized work injury management programs will be designed to provide services to major employers.
  • individual treatment rooms for physical and occupational therapy with specialized areas for orthopedic and manual therapy, splinting and cognitive evaluation.
  • an area for specialty team programs utilizing coordinated interdisciplinary approaches for arthritis, strokes, brain injuries and other disabilities.
  • whirlpools for hydro-therapy
  • a fully equipped apartment for those people who will need to relearn the very basics of living such as cooking, cleaning, etc.
  • rooms for group and individual psychological counseling with a state of the art biofeedback program.
  • community education and resource center with accommodations for support groups and seminars.
  • "noisy" area for patients who need "work hardening" involving heavy equipment or shop-type trade skills.
  • a technology center with loaner adaptive equipment for the physically challenged.
Perhaps the greatest benefit to the community is that the CORF is one of the few improvements in medical treatment that will offer better efficiency and service at lower costs.

Additionally, beginning in 1992, the United States Congress has mandated, through the American Disabilities Act, that all businesses must accommodate physically-challenged employees. Carondelet Health Care, through its rehabilitation services, will offer to southern Arizona's employers services that will enable the employers to be in compliance with this act.

In essence, the CORF will provide southern Arizona residents with a rehabilitation center that can accommodate, in one location, all the tools necessary to fully rehabilitate all patients to their fullest potential.

As part of Carondelet’s commitment to outpatient care, plans also include construction of a new Outpatient Surgical Center which will add four inpatient and four outpatient surgical rooms, enlarge the recovery room, and add a gastroenterology laboratory and laser treatment room.

The Labor, Delivery, Recovery and Post-Partum (LDRP) Program

The opportunities at Carondelet St. Joseph’s Hospital are primarily family oriented. Carondelet Health Care, in large part because of the Catholic mission of the Sisters of St. Joseph of Carondelet, is committed to providing an alternative birthing facility for Carondelet's traditional market.

Meeting the expectations of our patients and their families and efficiency of service and staff are the guiding principles behind Carondelet St. Joseph’s new LDRP concept. Under the LDRP program, the entire maternity experience takes place in one room with one or two nurses throughout. This concept allows the mother and family to avoid the inefficiency and inconvenience of being moved from room to room during the birthing process. The entire process (labor, delivery, recovery, and post-partum) is done in the same room, which allows for more time for the new mother and family to learn about the care of their new baby.

Each room is especially designed to create a comfortable and relaxing home-like atmosphere with the latest in technology. Included in the rooms are television/VCR’s for the family to use with special educational videotapes supplied by the hospital. This concept combines the comforts of home with the medical technology and safety of the hospital environment.

During fiscal year 1988-89, Carondelet St. Joseph’s hospital provided obstetrical services for 2,200 Tucson families. Over the last several years, families selecting the services of St. Joseph’s have grown from an average of 60 to over 200 deliveries per month. The need for these services will continue to grow over the years until Carondelet may not be able to provide maternity services to all members of the community regardless of their ability to pay without expansion.

Carondelet St. Joseph’s provides comprehensive high technology services as well as family centered care. These service include 24 hour coverage by anesthesiologists, neonatologists, perinatologists, neonatal nurse practitioners and clinicians, and a highly advanced special care nursery.

To continue to provide this quality service, the administration and boards of Carondelet have chosen to convert two wings of its Obstetrical Unit into 25 LDRP rooms to meet growing needs. The Labor Delivery Recovery Post-Partum (LDRP) concept provides for a reduction in the cost of delivery and care of newborn babies. By cross-training the nursing staff the family receives the full attention of their own personal nurse and support staff. The cost is further contained due to the fact that, under the LDRP concept, more deliveries can be handled in the same amount of physical space.

For example, under the current delivery system, St. Joseph’s is delivering about 2,200 babies per year. Under the LDRP concept, approximately 3,400 newborns can be delivered with a minimum increase in hospital staff and no increase in square footage. In essence, the family and baby benefit from the closer experience and the community will have additional resources available to them through contained costs.

Program Financing
The cost of constructing the LDRP at Carondelet St. Joseph’s Hospital will be paid through the Foundation for St. Joseph’s Hospital, a non-profit organization which raises funds for the hospital.

The primary funding for the construction of St. Mary’s Outpatient Facility will be a bond issue of approximately $20,000,000. This bond issue will cover the 80% of the cost of constructing 1) a two-story building consisting of the CORF (first floor) and physician’s offices (second floor), 2) a 500 car parking structure for Carondelet St. Mary’s Hospital, and 3) an Outpatient Surgery Wing adjacent to Carondelet St. Mary’s Hospital. St. Mary’s Second Century Foundation will raise an additional $2.4 million to cover the cost of equipping the CORF and building a new chapel.

Both foundations have combined efforts to launch a $5,000,000 fund raising campaign.

The funds raised will be spent as follows:

Comprehensive Outpatient Rehab. Facility Equipment $1,900,000

Construction of New Chapel $ 400,000

Renovation and Construction of LDRP $1,900,000

Creation of Endowment for Carondelet St. Mary’s Hospital $ 350,000

Creation of Endowment for Carondelet St. Joseph’s Hospital $ 350,000

A Special Financial Appeal
Carondelet Health Care, through the Foundations of the two hospitals, has chosen to launch a $5,000,000 capital campaign to support construction of the LDRP and purchase necessary equipment for CORF and the Outpatient Surgical Center.. From June, 1990 through June, 1991, executives of Carondelet Health Care and the trustees of the foundations have conducted in-depth planning and study to determine both the necessity and feasibility of conducting a successful campaign.

The feasibility of raising the money was studied. Detailed meetings and interviews were held with community, corporate, business, foundation, and government leaders. Much care and planning went into whether a campaign for Carondelet could succeed. Many obstacles needed to be overcome including a slowdown in the southern Arizona economy, the competition for charitable dollars, and the lack of major, capital fund raising experience on the part of Carondelet Health Care.

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