Hospital poised to grow with area

Brandon Regional Hospital has gone from small-town hospital to overburdened ER in a short decade, prompting a new addition.

By JAY CRIDLIN
© St. Petersburg Times
published February 21, 2003

Mike Fencel was the picture of health when he checked into Columbia Brandon Regional Medical Center. No temperature, no broken bones, not even a case of the sniffles.

It was 1997, and Fencel had just been named the hospital's new CEO. He'd always made a practice of living a couple of weeks in the office to get a good feel for a new job, so he unpacked his bags and stayed a month.

"When you're living there, sleeping there, when you can get up in the middle of the night and easily walk around and see how people are working -- it's worked well for me," he says. "Our environmental services department would periodically come up and bring some fresh towels."

The experience taught Fencel a lot about the hospital. But there's only one reason a perfectly healthy man, even the CEO, was able to live in the hospital for a month.

There were dozens of empty beds.

Flash forward five years. The beds are filling up, and the medical center, now known as Brandon Regional Hospital, hopes to cut the ribbon on a $120-million addition by the end of the year.

In fact, at no time during its 25-year history has Brandon Regional Hospital grown as rapidly as it has during the last decade.

"Even though we were a growing hospital (in 1997), we were nowhere near where we are today," Fencel says. "When I arrived, I think our average daily census was in the 160s. This past year, 2002, we were right at 220."

As Brandon and the rest of eastern Hillsborough County expands, so must the largest local hospital. The addition will include a 500-car parking garage, a five-story patient tower with a potential capacity of 160 beds, and more room for its cardiovascular surgery program, which opened last June.

Straining to keep up

"I started out at the hospital at day one, and I've seen the hospital grow from infancy to the mammoth medical center that it is now," says longtime cardiothoracic surgeon Dr. Husain Nagamia. "I never imagined that it would be such a big hospital."

Dan Noland, who served five three-year terms on the hospital's board of trustees, says even he has been surprised by its rapid expansion.

"It's about like the difference between a Model T Ford and a modern-day Cadillac," he says.

Brandon Regional's growth has mirrored that of its community. Brandon's population has grown by more than 20,000 since 1990, and the population of its surrounding communities -- Dover, Seffner, Mango, Riverview and Bloomingdale -- has grown by about 12,000. Fencel says that a decade ago, the hospital primarily served three or four zip codes; today, it serves nine.

A recent study commissioned by the economic development group Tampa Bay Partnership found that 71 percent of bay area residents turn to their hometown doctors for major medical treatment. All the more reason to keep building, says Fencel.

"The more that we can do where people stay here in this community, there's less of a likelihood that they're going to even think about going elsewhere for their health care needs," Fencel says.

"The most important priority is to make sure that our facilities are capable of handling the continued projected growth over the next five years," he adds. "I don't want to be in a diversion situation, where we are telling our EMS providers, 'Don't come to Brandon, because I don't have any beds for you.' "

In Hillsborough County today, only St. Joseph's in Tampa handles more ER patients than Brandon. But St. Joseph's has nearly 1,000 beds to handle its 103,000 annual ER patients. Brandon has 88,000 ER patients, but only 277 beds.

Some doctors say the supply hasn't met the demand.

The hospital is "trying to keep up with the community, and it's not even being able to do that," says Dr. Stuart Goldsmith, another 25-year doctor. "There are so many emergency room visits that now they actually have to expand on what is an enormous emergency room."

One problem, Noland says, is that the ability to add beds depends on funding, which can only come after demonstrating need. While the new addition can hold 160 beds, it won't hold any unless the hospital's request for funding -- from the state and elsewhere -- is approved.

"You're always playing catchup," Noland said. "The growth and the need comes first, then you have to go through this permitting process. You're always running behind, and I think that has hampered the ability of the corporation to meet the growth needs of the area."

It wasn't always this way, Goldsmith says.

"Twenty-five years ago, it was a true community hospital," Goldsmith says. "This was a nice little community hospital where you knew everybody. I literally remember putting on a tie and jacket if I got called to come into the emergency room.

"Now, it's not like that. Now you're rushing in, and when you get there, you're just one of many, many people who are serving the community."

In recent years, the increased number of patients has stretched the hospital's doctors and resources to their limits. The number of staff physicians has increased from 70 when it first opened, to 439 today. In the last 10 years, the operating budget has increased from $66.7-million to $180.6-million.

"A lot of doctors were frustrated because they were not having enough facilities to perform the work that they thought was necessary," Nagamia said.

Fencel said understaffing was a problem nationwide, not just in Brandon.

"I'm sure there have been some additional challenges for our physicians, especially if we lose some physicians within a certain specialty area," he said. "But I think most physicians would probably say that they've been additionally stretched over the years. They're asked to do more, and it seems like they're receiving less and less reimbursement."

A key to growth

The latest addition will go a long way toward lightening physicians' workloads, Nagamia said.

"I think the hospital has taken positive steps in expanding and taking in more staff," he said. "It is now catering more to the needs of the doctors."

At first, no new beds will be added to the upcoming addition, though there will be more private rooms. The hospital has asked the state and other groups to fund an additional 110 to 130 beds for the new unit.

Fencel says expanding Brandon's hospital is as crucial to the community's expansion as opening new schools or building housing developments.

"If you don't have a viable health care system," he says, "your growth at some point probably will be limited, because that is an integral part of any community."

As more young families move into eastern Hillsborough, the hospital has focused much of its expansion on its pediatric and obstetric units. In 1991, the hospital opened a pediatric intensive care unit; five years later, it opened a $7.8-million women's center, doubling its obstetrics and perinatology capabilities.

In each of the last four years, the hospital has seen a 10 percent increase in babies delivered. Its obstetrics programs have begun to attract expectant families not only from Brandon, but from Plant City, Apollo Beach and Ruskin.

Word has also spread regarding the hospital's quality of service. Five times between 1996 and 2001, Brandon Regional was named one of the best 100 hospitals in the United States in a nationwide health care survey based on average expense and length of stay per patient, profitability and productivity, and rates of patient deaths and complications.

One potential roadblock to future expansion could be space. When it opened, Brandon Regional was surrounded by dairy pasture. Now, the Parsons Avenue area is so densely packed that there's virtually nowhere left to expand.

Goldsmith said he expects one day the hospital will grow out to his own office building, located about 100 yards from the emergency room. "Maybe they'll need my building for medical reasons," he says.

One fear, says Goldsmith, is that the community could eventually outgrow the hospital's capabilities, causing a need for a second hospital.

Fencel says another hospital could happen, but the addition will go a long way in alleviating the need for one.

"We certainly want to see this hospital grow to keep up with the demands that the community is placing upon it," he said.

"Would another hospital try to come in? I think there's always a possibility there. But we're going to do everything we can to make sure we meet the community's needs."

-- Jay Cridlin can be reached at 661-2442 or cridlin@sptimes.com .