The URL can be used to link to this page

261164 WHITE - CITY CLERK 261Z��{ PINK � FINANCE GITY OF SAINT � PALTL Council CANARY - DEPARTMENT BLUE - MAYOR File NO. � ` cil Resolution w Presented By Referred To Committee: Date Out of Committee By Date WHEREAS, a proposal has been brought forth tnat Gillette Hospital be merged with the St. Paul-Ramsey Hospital complex, and WHEREAS, the Ramsey County Board of Commissioners, by its Resolution 9-1676 dated` April 2, 1973, has endorsed and commi�ted itself to such a merc�er, and WHEREAS, the County Board, by its resolution, has stated that the funding for the expansion of said complex, be borne by the Medical Education Research Foundation if the Foundati� can pay such funding without bond.ing and that the County will provide the land necessary for the expansion necessitated by the merger, and WHEREAS, the County Board, by its resolution, has stated that if the Foundation cannot finance the expansion of the complex and bonding authority is needed, the Board will seek legis]:ation granting bonding authority to the extent of $7,000,000.00, now therefore be it, RESOLVED, that the Council of the City of Saint Paul hereby endorses the proposed merger of Gillette Hospital and. Saint Paul- Ramsey Hospital and the action of the County Board as recited herein. COUIVCILMEN Yeas BtitlEtT Nays Requested by Department of: xarrr- Konopatzki _� In Favor Levine �ry Meredith v Against BY �urafirar Roedler Tedesco Mme.President BuLlet �� AY � �� Form prove y Ci ne Adopted by Council: Date e � Certifi sed by C '1 ry B By Appro d by Ma : D M � WT3 Appr v d iss' o uncil . �- - - _ gy BY PUBLISHED MAY 5 �97� C'� .�6// --y , �=��„�� :�:�,� ��.��an o� 2047 . �3�� lo. ��> �.�.:�� :��Ji`��' �:��:D�3��1'�"�� s-�.bas �� O� ��•�:��o��. �aa. A�ril 2, 19 73 7'i�e u4teni�on of ��nty A�ministr�tor Tho�as J. K�lley; Rama�y Coanty Hospital and ��?ai.�arium Cac�niss�on, cfv Chair�s�an Ett�l; . � SgoPsul»Ramseq Fio�pftal, �,�r, pt�� J�,}�n�� d�mia�iserator° M�dical Edutatior� R��earch Fm�ndatia�n Ste paul�• ?��s�y �i�spitai, c o C�air.nan, �ibr�ason ; J�an Coa 1 n, Adzar.Gillette C'�il.slren s Ho�p. iµ reN��ec.tfully cullerl co the following Resolu�.ion of the �3oard of Coun�y Comini�'sonerA c+i �umar•y County, illiiin��otu, ndopied ai the meeting lneld on A�ril 2� 1973 Sy C:ommis�+ion�r Fis11�y �SOLVEU T'hat t�e I'3��rd caf Rams�q County Cor�issioner�s is cowuitted tu the proposal t�at the Gill�tte Haspital b� merged with the St.Paul�-Ra�ey �Eoapita� c�a.pl�e�s �nd Be It Fu�t�er �SOLVED That th� nee�a�ary fun�i�g for the exp�n�ion shall be bq the Medicai E3ucation R�se�rch Foundati�n i� the Nou�a�la�ima� can pay such fundin� �it�a�u� bandiug and ttxa� t�e Cvux��y w�ill prodide t�e l�.ad neees�ary for the merpi�ig �nd Be It Furtc��x �:SOLVBD That if �:�� e�res�id lFouudati�n can n�t finance tk�e exp�n�ion a�d bc��ii.n� �s nec�ssaxy, th,� Board of Rams�� Co�a�ntq Co�►i�sion�rs r�i�l a�ek 3,�gt;�?:��ion granti�g bnnding authoritq t� th� �xt�z�t of $7,t?OO,C�JO. ��t��,�, �, ��r County Adminia!rotor �� I.CJ� Executiva 5ecratnry , r,"_ ;'-��•^%;i �'' i� �� , ;�LL __.. . _. _,i<{ e; ,� . . t ' _ . _�_ � �� '/� • # j� �'1 �/�i / � ' �� , 1 _r /��/ i �' , I � . � . I � � �r �� .. ( ' ! � f . , � , ,,� ` ;� �--��-_, � ; , C � 1 ; ;� ;` ;� i � � / � �" � � ; % � , %� I � . � , i� i' r i :� ; �': . �+:�..r• ';� �,,• / f � j 0' �_ � �1 � �M � �� • . � . I � 'E r�f. _t.i . �• � � ; ji � , ': ..; .. �Y�'� � ' ,i i .� . ' '`��=y': . � . . `� �, , , �'� , .r• +.-..,. ti : � , ,. , : •�,.,,,. • _ �i , ;j � � ��'. � ��; . j i! i i ��" �\• a , �...,. . 3 , � ',, : , • _ � � i : . �_ . I'� - �� t , ' i � � , � ( ;� �;t ; � ,� .d.�..., � , � �. • _ � . • „�..J i � � t'•� � � } . ` ` ' � i � �..� . ��'�; - - � .� .r , � M..._ �•� �# �� ..; z ~ . ...�,:� , _ . � �'�1 '•� / r ,.� , :w.a...,.�.,.��-.. L! 1 =" ' ' �; i �,; !,I j� ��r,� � ' / .% • �� / .. 1 ..� . _ .•; j .� 1 _/1! � ' 1 �. � .'' `� . � J� � i J w . . _ -�� ' i + 51 -i � / . ' ,� ;� � � I I �:��iz; ��f __ �'� .� • . •�• . � ;��lM°'+'�s�!+yt''."j�� '�� . • �':, f'z Yf ., . .� C :� i 1- ..' T--v-`;` 1 - � , j� �°�`��,�' 1 t . . :^M , � /'� L=-_' _ y� ' - �_�: .=i `^ ''-.T�_� `��' 1 ._�v' ' •` . ! '`�-----!1 ' � E.+n t� i...i ►;d � i � • -�' °`� I �.a� � � � I ��,� . �� :=��T';—_== —_ _ . � � -�- .,�- -e� j'a �� f� � ':,.:3 j i� � ��Y:e� :a—� '� � � . '�(1 1 �'�_.�"., � w� � . (.��. �"_.s��-s w 1 � lr � � ,' ' � ^;:.^, .i':: ,�, � ai ; ' / . I �' ►----::�=_ -- ;� ;, `�' � `� �� I ,--- _ `-:�.-- � •- - �i { _ ; _+- .�_� ,�,�,,.��1�� F� � .� � � i �r . ...�+ ' � t:.' � � I �C y ._:=--�'--- _� ._.:_ i �; i � , • --- -__.. _..-'z 1'_t—:.-� � , I ��::..`_>� ` "�. -+_- ,� ---- - •—• , i / ' , .-.1� �.� ..—i ....; i--� � / � . ` . i`'U � �� ►---• ,--� }—• / , � • �f ,�.- -_. f,-r: - � � .--. N � � i, .. .tF a��.��._ _ — -- �� —� r-: :, , f�r1� � . I i i'y�C r f_�,-�,_:'- .-'- _--•�.-�_..._ .. ' � r t'A i^t��....� ��.-r-.��... _,r-L� -J :! .i�J � � � / \.J , � `;-. �_ �2 ' j • . . . i ", '�`..� `.� �: l`�.,�� .i � � :.A i7 � �� ' � 'I . • , � , i `^.- •, ��_� � � T ., ..j �7 � �� ' .�� ,.,�•+.....�._>"l_%-�...�lJ � . � . ' � � � i,� y -� ------' . - � . . , � !S ?//°��x' .� � � INTROI)U CT ION St . Paul-I:ar�sey ;Iospital l�as traditionally provided emerhency service and episodic care Yor illness to n;any residents of ti�is area. A larger portion ot tlie co�;munitv hns been unaware of the services . available, and manv have been unwilling to seek healtti services at P.ar,�sey. St. Paul-Raaisey tias the potential to be a major force in health care and we are bein� called upon to lake a leadership role in a broader range of � activities, - PART I: GOALS We should seek new �aavs to deliver comprehensive t�ealth services within ttie entire St. Paul-Ramsey area. ' We should strengthen and broaden medical education programs at all levels and should involve ali area hospitals and health organizations in coordinated educatioaal plans. . We should define our scientific research goals and make appropriate efforts to devise new forms of treatment and discover new knowledge. The steps taken to accomplish these objectives will thrust St. Paul- Ramsey_ into a leadership role in a21 of the health aspects of the Ramsey __ County consnunity. ' !. ?iealth Cwre h - St . Paul-Ramsey should broad�n its aims to er.compass a �otal com�re- hensive health care pro�ram tor a broader segment of the com.�unity. We • • have sta.rted to strengthen che emergency and walk-in services wnich we have been prov�ding, but we should also organize to deliver cemprehensive ambulatory care, both on a fee-for-service basis and under prepsici health care plans. . Preventive care and health maintenance should be available for any- one, including those having difficulty aaininQ access throuch traditional systems. Th�se include the poor and other disadvantaged minority groups; those workinc citizens who maintain theriselves without public assistance except tahen major health problems arise; those neca to our con::uunity wilo have difficulty fir.ding a family doctor; and frince groups whose social behavior makes it difficult for them to have access to the main stream of inedical care. The past few yea:s have seen an increase in the quality and quantity of specialtti� care and const�ltation available at St. Paul-Ramsev. �de should noco build upon these strengths to provide for primary care, and A develop special out:each programs ooing beyond the walls of the hospital into all areas of ttle cor.;^�unity. As part of this efiort, we should de- , velop p�i�lic healt.< <�ducation and preventive medicine programs aimed at � the individual but also involvins a broad public approach in tiie field oi "cor,auunity health." . _2_ . 2. Health Science Education St. Paul-Ramsey has had a major cor�mitment to health science educa- tion since the turn ot the century. Health science education need not . be competitive with or dilcte direct health care, but programs in health science education require sufficient funding and staffing so that resources that should �e cievot�d to patient c�re are not sinhoned off. Our present • Emphasis is on undersraduate a.nd �raduate rI.D. trainin�. We should main- tain these pro�rams and increase our efforts in training technical and paramedical personnel who can be effective in new systems of health care delivery. These educational programs are closely linked with the University of tiinnesota. In addition, r,ae should involve other St. Paul area hospitals, � clinics and similar institutions throughout the region in our educational efforts, 3. Research � � Clinical research is an important part of the activities of a major uiedical center such as St. Paul-Ramsey Hospital. To the extent that basi� investigations are of major ir�portance to members of tne facuZtv such research should be supported. G7e should not attempt to build a major __ basic research institute, however, but rather empnasize applied clinical scientific programs aad develop new programs Lor better com.;iunity health care. 4. Service . As a major arr.i of local government, St. Paul-Rar.isey Hospital is expected to assume health Ieadership for the cor.ununity. We should be the catalyst for and key element in the creation of a ;najor downto�,m medical center. We have programs in mental retardation, cnild ab.use, cne:�ical dependency and a burn unit . These are not traditionally nor easily handled by the private hospital. St. Paul-Ramsey should also serve as the base for outreach programs such as maternai and infant care and far.tily planning, and jive serious consideration to assuning many of the personal health responsibilities of local health departments. To achieve these goals will cost a great deal of money. To the ex- tent that these pro�rans fall �vithin the responsibilit�- or the State of Minnesota, we must actively seek Qreater financial support frem the Legis- ' laCure, especially in programs related to medical education. To che ex- tent that tlle objectives are part of the traditional =unction of county government, �ae must s�ek, and Famsev County shouid provide, local suppor.t . Through the i•iedical Educstion and Research Foundation ph�•sicians of the � Ramsey staif have generated funds wiiich now can signiricantly help further these goals. If these goals are accepted ttie Ramsey Hospital Co::�iission should also accept the responsibility to seek help in raisin� the necessary £unds irom the Federal and State governments, ttie University, private foundations, � the commu�iity and the staff. Only throu�h a joint effort can a unified, comprehensive and balanced progr�m be achieved. Ah OVERVIE4! OF TfIE DESTIPdY OF SAINT PAUL-RAMSEY HOSPITAL APJD P�IEDICAL CENTER In the past, the practice of inedicine involved mainly the patient and his or her general practitioner and� depended greatly on such things as sight, hearing and feel for diagnosis. However, fundamental and even radical changes are now taking � place in the delivery of health care; changes such as the growth of prepaid practice and early attempts at health maintenance organization and consumerism which are only the superficial manifestations of much more far-reaching changes that are bound to take place. Saint Paul-Ramsey Hospital was opened in 1965 and was the epitome of a modern medical diagnostic and care facility for the in-hospital patient. Unfortunately since that time, rampant inflation and demands for first-class care for all has placed an unbearable financial burden on the average citizen thus in effect denying him medical care. This was true throughout the nation. Medicine endeavored to adjust itself to the needs of the public and began an attempt to return to what may have been a more inexpensive type of inedical care, that is, outpatient or office practice with inpatient hospital care only when absolutely necessary. While it is not possible to anticipate all changes that are likely to take place in the future, the following trends are well established and should be included in our plans: 1 . Most medical care will be on an ambulatory (outpatient) basis wherever � practicable. In the past year, for instance, the number of o�atpatient visits at Saint Paul-Ramsey Hospital i�ave increased by 23% while at the same time the number of inpatient visits have decreased by approximately llo. Improvements in medical technology mean that minor surgery and complicated diagnostic procedures can now be done in the outpatient area. Thus, hospital care will likely become limited to � crisis type medical episodes, major surgery and specific specialized intensive care units such as high risk pediatrics and obstetrics, kidney dialysis, burn unit, coronary care, etc. , 2. The emphasis will switch to preventative medicine and health education, thereby laying greater stress on periodic physical exams, screening on a community- _ 2 _ � - wide basis and health education programs. 3. Emphasis will be on comprehensive medical care to take care of the total needs of the patient. This concept involves the medical team approach v�here the physician and nurse are just t�vo members of a much larger team which would include medical social workers, health educators, public health specialists, dentists, etc. � 4. It will involve the concept of trying to �dentify high risk patients in various categories so that more intensive care can be focused on this group including specialized hospital services. Lastly, we feel that it will be accepted by everyone that all patients, regardless of income, should have equal accessibility and availability to the highest quality of personal medical care. � • Consequently, it Saint Paul-Ramsey Hospital and Medical Center is to meet its goals and serve the real medical needs of its patients and be in the vanguard of providing modern ambulatory care, we envisage the following specific changes in our healtn deiivery system at Saint ?aul-Ramsey: I. An ambulatory care facilitv that would be rrany times its present size. The emphasis would be toward walk-in clinics, special evening clinics for those with employment problems, computerized multiphasic screenings for the periodic physical exams that can be done on a low cost per patient basis,and immediate care and future ., . service to that large number of patients who have no regular physician or who are not a participant in a comprehensive medical care system. A new type of clinic environment is essential for survival . A railroad station- .like waiting room with no privacy, with patients sitting waiting for long periods of time without personal concern as to their problems can no longer be tolerated. • Departmental clinics will be small , efficiently operated by the involved department itself. These small clinics will operate throughout the day and evenings. The needs of the patient will dictate an attractive and private environment where his care and service will be more persanalized. ' II . Health Maintenance Oraanization. The Ramsey Health P]an has completed its flrst four months �n operation and ls the only prepaid health plan ln the nat�on - 3 - � ' which is existing a�ithin the confines of a county teaching hospital . Its success has far outstripped its projected achievement �vithin the first six months of its existence. Furthermore, it became viable tivithout any grants and is furnishing an excellent form of inedical care to 2,000 people. The fact that we expected only 25 percent of this number in the initial enrollment speaks to the point that there ' is indeed a need for this type of inedical care in this com�nunity. The target group was the county employees and we are now extending out into the municipalities. For instance, Roseville has signed up 50 percent of their 100 contracts in their municipal government. The remaining municipalities will be offered the opportunity to come into this plan. In addition, indu�try and hopefully city and state governmznt will have open enrollment for their employees. It is mandatory that Medicaid and Medicare patients be enrolled into this plan. We clearly expect the enrollment in this p•rogram to grow to 20,000 in 5 years and to 40,000 in 10 years. This 7atter figure �NOUId require 40,000 square feet of clinic space and would employ 40 ohysicians and an appropr�atz r,u�i�be~ cf ra;a��d�,:al and nursing persc�ne� . It is rroNer t"ut Nos. 1 and 2 above should be considered together inasmuch as the working needs and the � ultimate delivery of health care of these two services are somewhat intertwined and this valuable space would have maximum utilization. III. The Ramsey County Nursing Home is now seeking a new location and a Site Selection Committee has considered that area just north of University Avenue from Saint Paul -Ramsey Hospital and Medical Center. If the new clinical building is constructed north of the present hospital , it would lie between the hospital and the nursing home site. These patients would therefore be available by stretcher or wheelchair through a tunnel to their various clinics or to the auxillary services - in the main hospital or to the Admissions Department in the hospital itself. IV. Currently the high rise apartment just north and east of the present haspital arould make an excellent ambulato�y care area which likewise could be connected to the hospital via tunnels. Such a building as this could be filled with those type patients who do not need even semi-acute nursing care but do need daily Workers or comPanions to g�ve them some quas�i-nursing home �servi,ce. - 4 - ` � V. The current �urn Unit o� 16 beds is the outstanding burn center in the en�ire metropolitan area. It serves wide areas throughout the state and a�estern Wisconsin for this most difficult type of patient. This patient needs first class care and can only obtain it in a burn unit of this sort. Because of a high rate of utilization currently, the medical and administrative staff are working tivith archi- � tectural firms to build better facilities for the Burn Unit and to increase its capacity by 50 percent. At the current time, the surgical service of the Veteran's Nospital has agreed to and are sending their severe burns to Saint Paul-Ramsey Nospital for this type of care that is so badly needed on these severely burned patients. VI. Department of Cerrections. Saint Paul-Ramsey Hospital and Medical Center has expressed itself as willing to negotiate with the State Department of Corrections regarding hospitalizing the acutely ill prison population of the Stillwater Prison at Saint Paul-Ramsey Hospital . This would be an entirely new concept. Nevertheless, 1 t 1 S �'1;1+e �7 kely ±h'ut �he `Jdt^10US S�d±° ?nSt��a�;�t'S �•:?�� dV2 �0 .^.Ctl�`�"uC� FOr their medical care, certainly on a capitation basis per inmates in each particular area. This will r�quire a great deal of specialized planning and we will begin those plans as agreed to in initial probing sessions. . . VII. Emergency Service. Saint Paul-Ramsey Hospital and Medical Center is without question the outstanding center for dealing with severely traumatized patients in this entire area. The ER is currently seeing an average of over 200 patients a day in 'ail categories. Our "Room 10" concept of the acutely and the severely traumatized patient has gained national recognition. It is imperative that all but the true emergencies would be removed from the emergency treatment _ area so that the emergency service can further expand. VIII . Gillette Hospital . Acccmpanying this presentation is an outline of the feasibility of Gillette Hospital moving to Saint Paul-Ramsey HOspital . This move allows an expanded and more up-to-date ambulatory care area for Gillette Nospital with direct connections to the Pediatric Service at Saint Paul-Ramsey Hospital . This will be accomplished without adding any beds. 7his is truly an , - 5 - an example of vrhat was expressed in part I as to the very definite trend to��ard ambulatory care. IX. Specialty Outvatient Clinics. With this new concept of ambulatory care, many departments v��ill need to have room for their expanded clinics to provide con- ' sultation for the basic outpatient clinic. Sorne of these areas, such as dentistry and oral surgery, didn't even exist when the original outpatient clinic area was built and there is certainly no room for them now. They must share rooms with other clinics. Other specialty clinics have had to curtail expansion due to lack of space as well . X. Children's Nospital SitQ. The Children' s Hospital Building Committee has not yet made a final decision regarding its building plans. A definite site will be made available for Children's Hospital if it should decide to come to Saint Paul- Ramsey Hospital and to thus create a true children's care center, together with a high risk �b ard �•,�or.atal Jnit. Childrer,'s Hospital cou?� �e a part of the current building or space will be made available to add on to it. • There is an acknowledged and fast growing need for more efficient metheds of health care delivery in this country. The health care cost in the United Stated has gone from 3.5 to 7 percent of the Gross National Product in the past 10 years. It is becoming apparent that our overall health care cost is enormous and must not increase. We must find more economical and efficient ways to deliver that care. Some of these areas that we have discussed here, such as the HMO and ambulatory care, can vastly improve the utilization of the available monies for health care delivery. Further, this new facility will meet the greatly expanded educational role that . Saint Paul-Ramsey Hospital is now playing, and will continue to play, in the University of Minnesota Health Sciences expansion plans. Part of the cost of this facility will be borne by the Ptedical Education and Research Foundation :vhich is comprised mainly of the full time and part time pt�ysicians who practice medicine at ' Saint Paul-Ramsey Hospital . We are asking the legislature of the State of Minnesota to give us bonding authority to help finance the remaining cost of the structure. - 6 - , . CONCLUSION The current trend in the long range planning for the Saint Paul-Ramsey Hospital and Medical Center should include over• the next t�n years a clearly defined and increased role in primary ca .re, for all patients regardless of their economic status. In addition, it will serve as a referral center for the highly specialized care that � can be provided by its 60 full time physicians. With proper physical facilities, Saint Paul-Ramsey Hospital and Medical Center could be in the vanguard of bringing new and more economic methods of heal �h care to Saint Paul , Ramsey County and surrounding areas. ,.__ j ra 2/22/73 . , . . � �, � � . . ��; ,l�C ;j��. . ! I �.(: � :__ _- , } I � _ , � f � 1 i`�-1 ��- � � , �i� �: ,� i � � i ��t — , ! � , � � s � � , 1; —= — � � � � � � , � j __- �, �"- . � ''i , � ' �'` � ' ; � �, . � r�_ '� ,� ' / � � , i� :C� ��- � o a 0 � �--� �� . � � ` n� � t�,+....^�-,a�;; �i � . 'f. �`\ `� � r/ j,�`y ;�•, \ �� '1 i`r' ;' � + '.� \ ' % ,�': � ; >i. A � �.. �,^ � , F� \ .�� n � . �s � . � Fi, i � � . j j: 0 '� � � . , i ' :� � �` lt �\ � ` .;� � 1L �0 , .; •� � ', � ? / �. .S ,�. i i ;.= i v;\ \�,,,� , ;� / �� 1 ` �.: � ��,� ��o\ ,� / � � (o CA - I ' > > , ,, � � N � '"O � � �, ' i :�`; � � � '� o i � � ' '� i.,f � + ;� r� 3 � { ` � \ �, � � �\' • �1 ` �� /� Q t � i ! , � ' \� f� F ' � , � ' �� ' ! � `� i � A � � � ' '.'� �� ; f � �. � I , � �� - �,. g � , , ;.� � j4-- i , '. ; � �i; 'a� � N . {�� ` ' ; �• ` � ::� [� ; � '� , . � ;'. , ; > '� i �� . , � (�, � � P i � L � •�;'.;?\ ;3v ` ,�, .�<� V( � � : C, , � ,� , ;� y ., . -S � .:� x � ; —�- . r � ,�,*�"�'�' :�..._.e.:�>��. � � :�\ � . _ ��.� . _ > _"` °�.�' „"'�'{.: . s' � ;i ;t � . a , � � ;. , � � :� � � °v i s�`, �` � ` ti ' . � ��`Q 3` � �.x � ?7 � . �. � : � �, �, � s.�.�;� � � , g � � �i � � � ,,,�— i'�. E � �t! , ; - —t9 #; '� i � s ; �` 1. � �. .� : 'J � �:_ f� + � : ; . , �, +� � _ • � - �� - - �j • I 2 =.`; � . , .i �• . � �� ( , 1.-- .�J j(� � t�-\ + Y `' .� ! •� { . �1` �/ � li !� � , � � . �� I\ y , / _ ( � � r ` L ;. ' � � . � � � - � ,� . � �� . ;� �- ;� ��;. L- �s ( . � i' , . . � �� ` _ �� ., :- �- _ �� L , �—.' � G : � �"• ��°'�.=�:� /�.-.. ,�, a � '�� n � � � • • � H r+ � ta H �� i M �y H M h w r•i . Q '" �} ry .-..-, p H f-t O r�. p H C �-3 .. ct 1�• C '� '� F: .^, � � rt ^.y =� C� � H �3 . S1� .'3 'i�7 t 7 �'.' t� rJ � H w CT' (J � :.7 !� C-� N O H C7 O : y �-7 i'� t-' O � F-J H C7 K ]: [� C ::: ��: C x � n ' '-+ 1 (� G7 `� �-. - i r � r� �. . n � H :� �-+ h �n c: r � G� �-+ x � :� �: t� �,• c��c �� cn 7 N• !� c r m �� C c� x ►� c ;=, �� rt x � c :� �n c� � o r� �• � ry ti �� n N• � c=� �-� y :� o �. r �n r• r y r� u� �• � � ;-i a m �r :� � ;, � �+ � -, c �; , ce N �•� � c r- �•�a �� - �'-r �"r• "� � 0 n � .''S- � �"3 � F�• � s2 O F� K � O C � � � tJ O L� � ~ `.'y C� H v v � `� ` ' ` � r � L/? (!� H t'j H � �' x y y � X � tD M ^.y s-3 r-3 t-�• cn n., N M v� �v N r r �� . m F-��a� tv w I-� F-� rn r� �.� �� M �ti � rt �. . . . . . . . CC� � C' W l01� N �l �D O tJ �1 ` C7 :?: C: C ;j O C� O O C, _ O O O O G:1 C,� F-� C"� C7 � 000 O ft 000 O � .] Ci 1 7 N• c� yc� � r.� � (n tl: G'] H Ul (!] tn H �j . �� tn � . . . �. . . . n r� r� :� r� K 'zJ 'T� 'T� tt +TI h] �7 G� '_': [!� '✓ • u, . . . �. . . • C y - r-s r �a ._ _ r. �p �H ►-� �n K t� ' � cn � r� .� .-. �' (7 � �r � l. .� � � . �� 1 /� /1 A� �� r (y I ti;� �;� C%i �- � n ra� n �� I H �D ''J !-i rt [�I� C� HHp N • - ' � �`'� �� ' r `r+ - � ~ ;� � . .�t�in in �to tn -cn C7 E-+ F-� N N tJ � N N N tJ d H F-� N F--' O U1 F-' F-' W O H ',3'. p . . . . . . . . y � � n� oo o � oo o � H � u� oo o � oo o O � � � 7 . ----� • . 1 . N 11 II 11 il if il . II -c� in � � . tn N cn .� r� N u, cn . N N (Jt .A .f� dl W �A F-' �) v, cn cn rn .r� u� o � o .a \ � \ \ \ \ r 1 0 � � � � V � � � 0 - ' , O O C7�0 C� O O p O O O O O O C� O O O O O + ► � 1 • t . . . hi �i Cy . . . ' y h1 ,�' iT3 �] C7 I(7 H H ' rd Z1 � ' C (� O Cn O ;� �� O O � S� t=i rt Cu r r C) ri' Ui ''�' H t't' i-� fi t-+ S� cn s� s� :� N• cn y � u� r :� N t� �� f�� 3 C� r o r• H ' ' S� ^� :� � � tTi ro � � r� n - � i n � r� f� c`, 7 F+. r �� (j a,i O �s C3 :� O ��-7 G� �7 �`t ;�i ?� �-�• n C� :� U1 �3 �F1 t-i t� tA iv rJ" . (� O f'`.' ft f'� 7 Ci F-' � � - (� 'S F; rt tt F-�• �'�:: C"' Sv N-�CS � cr c� �: o r :� I �:' ct � n c� � � � :-a �3 m �' !=� n r� c+ �-� r• c� � � �+ N z c c, ��- � N• ;� �� r � �-� . tn c1 O E� O � J'� i`� CL• � `� .< k: ;3 "C ;�� 1T7 �L (D .c �; �. � ,�-� r �• a o £ o n r-� c� ,a I v� t?- � �- � � O � U � N• rQ �l Ca F-+ �'� C7 (D .'7 � �' (� ;1• �^.-• �1' C� Ca �! � ' �' O U� o�� r H c'1' G) O :�i3 �v �t�••r-. i.!) Ct� !-'• � 1� F� 1 `�1 � � � rr �• s cJ � tti h�✓' � c~n m H u� � � �: ` n o ft H cv .�� O � H W � � � :-s :v � r, tn . . tr C) � rr'C C� A� F'• SL �' � K t3' . _ H (D N N F—' C7 " Ul � • H U! A1 �O �-' A� • � H rr r� � ' W ta Y• W (D !�! p :7.... � t� � r OG v �' �J v � f.+.d0 ro • � , . m � � . N �} � . � U7 O . O ro m n _ . . . . � ' a K � II II tl 11 II ii il tn �n -cn in . W WI N N . . � . I • �/? �/? CJ1 W \�I N lJ+N Ol W W �1 Vl N�Cl U� a1 00 �f J .A .C� O Ul � 00 lJl U7 Ui . � � � . . . . W l�� F-' �O N Gl Cl O O - OUGC� C� O O O O C� OC�(JOO � O O • � O 9 9 R H � � - H '�i H cn '=i 'Tl ~ �i H tn �i W O r-� x t� r-� r1 � H x CTJ H C 'd �T 'TJ H L7 "�C1 7. � 'T1 H C7 7� H '� W H � O Cn r-i cn � �-3 � O cn ['' C - � �"' -�- C7 � H x ►,rrt o w C7 � H d l'�' �-+ � ~ 9 1 '�7 < C t'7 C � rA'* � C C ['r-'] C � �' r+� Ci C7 C Cz] Z G LT7 C7 C7 C G7 Cn � � rrrtir cn n x rrr� r y � � r y cs �. r• � ,.e �' C � ,-�r � � O f�D �v � z � �' �r � c � �' � A �' �i � ,� r � ►�. � w � r O r-� r.� w r ra � iv r., � r-a w � N O� �O Oo 00 r• N � ln Oo N � � 00 � � r• ln O O � � y r+ 0 000o m o 0 00o cn r �n 0 000o v� o 0 00o H t� a c� H Hz � � H cn cn cn cn cn �n cn cn H � � ro �i ''ii �i ''_! �i �i '=i 'zi H [-�-y L-H� � C -. H H t7 G) � C7 � � H c/� . HcZi� cna � c�nu � c�i nn !c� �rJc I� .� '� � r� W N N N N N N N C=J O � � �70 tn .� O oo • r.� � r.� O �d cn H 7 H "d H O O O O O O O O O y H O 0000 0 000 � 9 � � 9r d � d � H II II 11 II II II II 11 I� H x O Z � � ' N N 1-� ' v �D �o w ln v �n O � rn � r-+ W �l N � �t 0� N l.n l� O O� W O �O N O V� N N OOON Oo O OOOO O O O O O O O O O O ty n y ':i r3 lT� r-3 cb O o o r� o �%' 09. A�i t�7 . R fD � l� rt m � R f? f't ',..� S11 L1. A �'1 � a� v� a� w tu r� cn w a� ce �n � r• w �' � � i"' w '''� � "'r ~ ,� rS rt r• � � [� �J � C7 R C7 � � � K A O � �00 t7 a o a a o � o r-�3 � cn � �' r y n c�n £�i d �� p rN'r � n ��-r O 9 r� r f?� o n o � � n � r� rr n r� Z � � ar C � o n � n rt R n � n o�o a� � r* � tD z C] rt rr c� R N C fi � a � � r�r H O C r- C w � �''' � D�i � rt rt � �C � `G � �.ni r+ G. � � �'. r� � ~ :� � ° ° ° O � d � � � zO x � � `� � R O rt � � Y '�" fD fT f+' K �' � �d� O d� `d � O rt 1-+ F�/� o° .�. CrJ O W C r• G � �+ p '� � �' � � z � x H lD C�7 O • H � Nn ►'! �' �• � � � � GD (D 1-r (p� v � H y � W H rt �v H nA �'' o° � • O C�7 tr '� .II r' • � o° F'� '� � '•�y N h9.a (a r � 1--� r-+ v £ � N . Q1 W � � . � ' f) A O �p (D O �d N rt C) W ri il II II II 11 II II II 11 II �� ' -cn -cn {n � � � �O x 00 �J r-• o� � J V O �I rn O p w O O� ln N N O N � � O O � G� �o rn O ln O� w `p .� � �p �p O O O O � W O W W O O O O O O O Oo � r� r� 00 O O O 0 � • • _y • 1 � �G �1 � � � 7 '� O � • = 1 � �•1 � v� , L— �� '� � , -- -- . . ^ � 4 . ►� . � � � � � � `�� _ � �a 1 � S . n �' �• _ — ; {� . �— . � �--- ' • � � ,: � . . " J.-� � �. �`�� -_-""1--� � ' ' . _ !��-- � �� / , r. '..�---�^ . ----- -r�--- � , t -.�-_ � � rr _r�--�-- -� _ - �� -- --� � --�_--_ _, � -,-- -- =, � ��= -= _" � . :__ _ _-- ---�- _ . . __ -� - � . _.. � .__ _.._ ... . -_. . z � � . -- �' � �. ,��,. ..;�_ rs� ;� \ - � I��'- .._.._ " -_-_�-��(� � �� t } . � � _, '�= ,,lr� , �,/l' , �i ( , � '��, /� � I . . � �l � • . ,, � � ; . _ ,� �� ;' ,� . ► � � � , . �:sl i i ----z-----, � �, r . � � � ;� ;"' , � � �� . . . �' 1 � �= �'.�, j t r i • �`} , i ; i �i . ; .i�� . '" '" • . �,i' +l• � f , J j .�;...,.� � ;; � � r �. i :, / � , _ � ; � ,. {�,� , i .ii t • � ��Y� � � I �•`; � f /,-�=,� _;� : ��• � �� " � � : � !��.':�,; - - . ' � � / ,-•!.-s -,•.—.., ' .: '� � - '�...,.,. • i� j �� 1 f i�' `- �'; , � • �'"`Y.' . . I �I�! - � �' � ��' . � �� t . _ . � � + ! . ;, '..�.'..��...,� � �� '� ..w..� . °°+*+� _ 'j `.•( i �� ' .�°'�-� � � � � {'` � 1 t. � � I - :Lw�. �•i�',� . / s '► . +�' L�� .,;� . ' `� (�•��,� � f . ..�.,.,�., � , i�' , � � , ,. � ' � ':,...;�._.......�._;�„ .. ;� , F �� ,,r�„�{;� �' � . 1 � � ...�..� • i; t j� ; _. �-��.-� / � . i .. . _ _ I � i � _i1 i i i ---�- -.r°' .. -' � f/ � ' . '�� +� I �� - � 1 � �� •c a�� r � � � �/ �' . �' J"',j,,, ,. . , ,.+., �I !�:}Yi��i �� r',:� 1 �� :. � � '�. ,r..�:.-, �:�,.►f �. . . '�=� �� (. -�.. 1 :, . IW�"""^°"`_ � � "`^ . _ � • I ;�'.,'F� i��- _ __ • . . � , f � i. � `•� --.-.�...�a` � l-' �� .�. �.� , -•��.--"_7"y .� 1►'i_....,.... ti.�.: . _--,-.. �+ .� ..1 :_.--, . • �� . � _�. -� -S. )� 1 1 � : � / � s►� L.JG La� �.A � ' . . • . �� 7 ,�.� . �...::� + f . .� . ��, �-- ��=.� � . �� ---: �,- , �. . ��----- � ,. �� j� � .r,l� :j �;�'1��u—'CI �`��. f � . �"'�°°°' . . e�t` � t'�.--� �. . .:..j-�._i�i � � +V T� � �,� . . �y .�...._. � �d t�j � ' . . F (� �Y,��y'� !� � � n � r � / + ' . � r�.x I �.�•��j"._� W � U � � � � . �.�..lM + �:�,'.�•�� :l�r '��v � ��J . ' i c�, ,`'_ 4;i"h�""V"""'- _:_.- =� --- -`cZ"�^..�� / �► : � ' �I �s"'�7"�~�) � r-�� ,.� L-.. �,....j ~ r._� � // . . � � I i i�•`\L./ ._y- ,\"�- .J s J �--J �—{ �4-�.� ! � .� ! i i - ---•s_ , � . �� r- :% ^} 1 0� i _ •� j j:y��•'.._ ��• __ F-� r� " i � �j • ��'c,f . �:_-�" .;_-'`_ ;_ - _�~..:-zrt.� � I ��±ti.a..�. -•-�-.�_ � + � • f � � I" �� `�.' 1`-.� t�\ y- ;{..t' ..`--+J .i} f / � f_� /f � � ,i . . i' j�/ '�, � 1,�~�� t r�� y'"�...x._�..�7 . �r / � • • S . � � � � � !t. F�R„',�"�-)M_>-1...+�lJ I /� �.� � . � � . . i �a � � � � . � — � . . � � w INTRODUC7'ION St . Paul-F,amsey IIespiL-al tias tradition�lly provided emerbency service and episodic care f.or illness to many residents of this area. A larfier portion of the co;^munity has been unaiaare of the sert-ices available, and many have been unwilling to seek health services at Ramsey. � St. Paul-Ramsey t�as the potential to be a major force in health care and we are being called upon to tal:e a leadership role in a broader range of activities. - PART I: GOALS We should seek new �aays to deliver comprehensive tiealth services within the entire St. Paul-Ramsey area. � We should strengthen and broaden medical education programs at all levels and should involve ali area hospitals and health organizations in coordinated educational plans. . We should define our scientific research goals and make appropriate efforts to devise new forms of treatment and discover new knowledge. The steps taken to accomplish tt-:ese objectives will thrust St. Paul- Ramsey. into a leadership role in a21 of the health aspects of the Ramsey __ County community. • 2 . �-Iea lth C�r� St . Paul-Famsey should broaden its aims to er.compass a total conpre- hensive health care pro;ram for a broader segment of the community. We • • have started to strenQthen the emergency and walk-in services wnich we have been provid?nj, but we should also organize to deliver comprehensive ambulatory care, both on a fee-for-service basis and under prepaid health care plans. . Preventive care and health maintenance should be available for any- one, including those having difficulty gainin; access through traditional systems. Th�se ir.clude the poor and other disadvantaoed minority groups; those workin� citizens who maintain theriselves without pubZic assistance except ��hen major health problems arise; those new to our com�uunity taho have difficulty fir.ding a family doctor; and fringe groups whose social behavior makes it difficult for them to have access to the main stream of inedical care. The past few yea:s have seen an increase in the quality and quantity of specialty care and consttltation available at St. Paul-Ramsey. �de . should now build upon these strengths to provide for primary care, a.nd develop special out:each pro�rams �oing beyond the walls ot the hospital into all areas of the co�,unity. �s part of tl;is efiort, �oe should de- • velop puolic heatt}� eci�ication and preventive medicine programs aimed at the individual but also involving a broad public approach in tiie field ot "cor,.:.�unity health." -2- • 2. Health Science Education St. Paul-Ramsey has had a major cor.lmitment to health science educa- tion since the ttirn of ttie century. �-!ealth science education need not be competitive with or dilLte direct health care, but programs in health , science education require sufficient fundin� and stafting so that resources that shoa�ld �� devote� ta r.atient carc are n�t sinhoned off. Our present emphasis is on ur:der�raduate and �raduate TI.D. trainin�. We should main- . tain these pro�rams and increase our eiforts in training technical and paramedical personnel who can be effective in new systems of health care delivery. These educational programs are closely linked coith the University of M innesota. In addition, cae should involve other St. Paul 2rea hospitals, � clinics and similar institutions throuohout the region in our educational efforts, 3. Research � � Clinical research is an important part of the activities of a major medical center such as St. Paul-Ramsey Hospital. To the extent that basic investioations are of major importance to members of tne facultv such research should be sspported, L-1e should not attempt to build a major __ basic research institute, however, but rather empnasize applied clinical scientific programs and develop new programs for better communitv health care. 4. Service . As a major arr.i of local govern�ent, St. Paul-Rar�sey Hospital is expected to assur.:e health leadership for the cor:ir,iunity. We should be the catalyst for and hey element in the creation of a major downto:an medical center. �1e have programs in mental retarciation, ci:ild ab.use, chenical dependency and a burn unit . These are r.ot traditionally nor easily handled by the private hospital. St. Paul-Ramsey should also serve as the base for outreach programs such as maternal and infant care and far�ily planning, and give serious consideration to assuning many of the personal health responsibilities of local health departments. To achieve these Qoals will cost a great deal of money. To the ex- tent that these prograns tall within the responsibilit�- of the State of rlinnesota, we m.ust activel}- seek preater financial support frem the Lecis- � lature, especially in programs related to medical education. To che ex- tent that ttie objectives are part of the traditional function of county government, we must seek, and Ramsey Count�� should provide, local support . . Through the �Iedical Education and Research Foundation ph�-sicians of the Ramsey staff have generated funds which now can signiticantly help further these goals . If these goals are accepted the Ramsey Hospital Co::�nission should also accept the responsibility to seek help in raisin� tite necessary funds from the Federal and State �overnments, tlie Universit��, private foundations, the community and tf�e statf. Only throuhh a joint effort can a unified, comprehensive and balanced program be actlieved. AN OVERVIEI�! OF Tf1E DESTINY OF SAINT PAUL-RAf�1SEY NOSPITAL AND MEDICAL CENTER In the past, the practice of inedicine involved mainly the patient and his or her general practitioner and� depended greatly on such things as sight, hearing and ' feel for diagnosis. However, fundamental and even radical changes are now taking , place in the delivery of health care; changes such as the growth of prepaid practice and early attempts at health maintenance organization and consumerism which are only the superficial mani�estations of much more far-reaching changes that are bound to . take place. Saint Paul-Ramsey Hospital was opened in 1965 and was the epitome of a modern medical diagnostic and care facility for the in-hospital patient. Unfortunately since that time, rampant inflation and demands for first-class care for all has placed an unbearable financial burden on the average citizen thus in effect denying him medical care. This was true throughout the nation. Medicine endeavored to adjust itself to the needs of the public and began an attempt to return to what may have been a more inexpensive type of inedical care, that is, outpatient or office practice with inpatient hospital care only when absolutely necessary. While it is no� possible to anticipate all changes that are likely to take place in the future, the following trends are well established and should be included in our plans: 1 . Most medical care will be on an ambulatory (outpatient) basis wherever practicable. In the past year, for instance, the number of o�tpatient visits at Saint Paul-Ramsey Hospital have increased by 23% while at the same time the number of inpatient visits have decreased by approximately �lo. Improvements in medical technology mean that minor surgery and complicated diagnostic procedures can now be done in the outpatient area. Thus, hospital care will likely become limited to crisis type medical episodes, major surgery and specific specialized intensive - care units such as high risk pediatrics and obstetrics, kidney dialysis, burn unit, coronary care, etc. . 2. The emphasis will switch to preventative medicine and health education, thereby laying greater stress on periodic physical exams, screening on a community- - 2 - ` � wide basis and health education programs. 3. Emphasis will be on comprehensive medical care to take care of the total needs of the patient. This concept involves the medical team approach where the physician and nurse are just two members of a much larger team which would include � medical social workers, health educators, public health specialists, dentists, etc. 4. It will involve the concept of trying to identify high risk �atients in various categories so that more intensive care can be focused on this group including specialized hospital services. Lastly, we feel that it will be accepted by everyone that all patients, regardless of income, should have equal accessibility and availability to the highest quality of personal medical care. � - Consequently, if Saint Paul-Ramsey Hospital and Medical Center is to meet its goals and serve the real medicai needs of its patients and be in the vanguard of providing modern ambulatory care, we envisage the following specific changes in our healtn deiivery sysiem at Saint �aul-Ramsey: I. An ambulatory care facility that would be many times its present size. The ' emphasis would be toward walk-in clinics, special evening clinics for �hose with employment problems, computerized multiphasic screenings for the periodic physical exams that can be done on a low cost per patient basis,and imrnediate care and future _; service to that large number of patients who have no regular physician or who are not a participant in a comprehensive medical care system. A new type of clinic environment is essential for survival . A railroad station- _like waiting room with no privacy, with patients sitting waiting for long periods of time without personal concern as to their problems can no longer be tolerated. � Departmental clinics will be small , efficiently operated by the involved department itself. These small clinics will operate throughout the day and evenings. The needs of the patient will dictate an attractive and private environment where his care and service will be more personalized. - ' II. Health Maintenance Oraanization. � The Ramsey Health Plan has completed its flrst four months ln operation and is the only prepa�d health plan in the nat�on - 3 - � � which is existing within the confines of a county teaching hospital . Its success has far outstripped its projected achievement tivithin the first six months of its existence. Furthermore, it became viable without any grants and is furnishing an excellent form of inedical care to 2,000 people. The fact that we expected only . 25 percent of this number in the initial enrollment speaks to the point that there is indeed a need for this type of inedical care in this community. The target group was the county employees and ave are now extending out into the municipalities. For instance, Roseville has signed up 50 percent of their 100 contracts in their municipal government. The remaining municipalities will be offered the opportunity to come into this plan. In addition, indu.:try and hopefully city and state government will have open enrollment for their employees. It is mandatory that Medicaid and Medicare patients be enrolled into this plan. We clearly expect the enrollment in this program to grow to 20,000 in 5 years and to 40,OQ0 in 10 years. This 7atter figure would require 40,000 square feet of clinic sp«ce and would employ 40 physicians a�d an appropr;at2 ru�„�e; c,` ra;a:��d'�a? and �ursing perscnne', . I� is rr�rer t"at Nos. 1 and 2 above should be considered together inasmuch as the u�rorking needs and the ultimate delivery of health care of these two services are sometivhat intertwined and this valuable space would have maximum utilization. III . The Ramsey County Nursing Home is now seeking a new location and a Site Selection Committee has considered that area just north of University Avenue from Saint Paul-Ramsey Hospital and Medical Center. If the new clinical building is constructed north of the present hospital , it would lie between the hospital and the nursing home site. These patients would therefore be available by stretcher or wheelchair through a tunnel to their various clinics or to the auxillary services � in the main hospital or to the Admissions Department in the hospital itself. . IV. Currently the high rise apartment just north and east of the present haspital rrould make an excellent ambulatory care area which likewise could be connected to the hospital via tunnels. Such a building as this cQuld be filled ' with those type patients who do not need even semi-acute nursing care but do need daily Workers or comPanions to give them some quas�i-nursing home 'servi,ce. - 4 - ` . V. The current ��rn Unit �� i6 beds is the outstand�ng burn center in the entire metropolitan area. It serves wide areas throughout the state and western Wisconsin for this most difficult type of patient. This patient needs first class care and can only obtain it in a burn unit of this sort. Because of a high rate of . , �ttilization currently, the medical and administrative staff are working tivith archi- tectural firms to build better facilities for the Burn Unit and to increase its capacity by 50 percent. At the current time, the surgical service of the Veteran's Hospital has agreed to and are sending their severe burns to Saint Paul-Ramsey Hospital for this type of care that is so badly needed on these severely burned patients. VI. Department of Corrections. Saint Paul-Ramsey Nospital and Medical Center has expressed itself as willing to negotiate with the State Department of Corrections regarding hospitalizing the acutely ill prison population of the Still�vater Prison at Saint Paul-Ramsey Hospital . This ��ould be an entireiy new concept. Nevertheless, lt 15 C�'U'�? �ikeiy' ±f1dt �h° �,rarious Std±° ?;'St��'C:�S t'!',�� dVE.' �0 CCtl�l"uC� �'J�" their medical care, certainly on a capitation basis per inmates in each particular area. This will r:quire a great deal of specialized planning and v�re will begin those plans as agreed to in initial probing sessions. VII. Emergency Service. Saint Paul-Ramsey Hospital and Medical Center is without question the outstanding center for dealing with severely traumatized patients in this entire area. The ER is currently seeing an average of over 200 patients a day in 'ail categories. Qur "Room 10" concept of the acutely and the severely traumatized patient has gained national recognition. It is imperative that all but the true emergencies would be removed from the emergency treatment � area so that the emergency service can further expand. VIII . Gillette Hospital . Accempanying this presentation is an outline of the feasibility of Gillette Hospital moving to Saint Paul-Ramsey HOspital . This move allows an expanded and more up-to-date ambulatory care area for Gillette ' Hospital with direct connections to the Pediatric Service at Saint Paul-Ramsey Nospital . This tvill be accomplished without adding any beds. This is truly an � - 5 - an example of what was expressed in part I as to the very definite trend toward ambulatory care. � IX. Specialty Outpatient Clinics. With this new concept of ambulatory care, many departments will need to have room for their expanded clinics to provide con- sultation for the basic outpatient clinic. Some of these areas, such as dentistry and oral surgery, didn't even exist when the original outpatient clinic area was built and there is ceriainly no room for them now. They must share rooms with other clinics. Other specialty clinics have had to curtail expansion due to lack of space as well . X. Children's Hospital Sit�. The Children's Hospital Building Committee has not yet made a final decision regarding its building plans. A definite site will be made available for Children's Hospital if it should decide to come to Saint Paul- Ramsey Hospital and to thus create a true children's care center, together with a high ris�c C5 ard ^;Aon�tal Unit. Childrer,' s Hospital co�!?� �e a part of the current building or space will be made available to add on to it. ' There is an acknowledged and fast growing need for more efficient methods of health care delivery in this country. The health care cost in the United Stated has gone from 3.5 to 7 percent of the Gross National Product in the past 10 years. It is becoming apparent that our overall health care cost is enormous and must not increase. We must find more economical and efficient ways to deliver that care. Some of these areas that we have discussed here, such as the HMO and ambulatory care, can vastly improve the utilization of the available monies for health care delivery. Further, this new facility will meet the greatly expanded educational role that � Saint Paul-Ramsey Hospital is now piaying, and will continue to play, in the . University of hlinnesota Health Sciences expansion plans. Part of the cost of this facility will be borne by the htedical Education and Research Foundation tivhich is comprised mainly of the full time and part time physicians who practice medicine at Saint Paul-Ra►nsey Hospital . We are asking the legislature of the State of Minnesota to give us bonding authority to help finance the remaining cost of the structure. , - 6 - . CONCLUSION The current trend in the long range planning for the Saint Paul-Ramsey Hospital and Medical Center should include over the next t�n years a clearly defined and increased role in primary care, for all patients regardless of their economic status. In addition, it will serve as a referral center for the highly specialized care that can be provided by its 60 full time physicians. With proper physical facilities, Saint Paul-Ramsey Hospital and Medical Center could be in the vanguard of bringing new and more economic methods of health care to Saint Paul , Ramsey County and surrounding areas. j ra 2/22/73 . � � . � �, � i I � - ' � f- �� , l��: � � � � _ . � �� ; � �' I'- f' f� I � 1 :_ . ��- � , ; �► ; ;;:� ► „ i ! ► �� ' � ; �,�--� ,��,' , ; � � (::_ - - �f ' � I - _ � -- - � � _ ,� _ . , � ' _ � ` � � � - ; , _ -- � , :ti _ ��r � t -� f �,�� / ' �� o � 0 � � . I �-� �- . � .; �,�ara�.�r••1 �° � � f# �` 'i1 � c�`{ �� r f� i '� \ �� t� / . �� .�. A f'; < < ;� f :�� ,� � n � . ` � � '�� . \ � �j'i \1'� �� '• � �� j" � � � . � �, i�\ ' '' � � ''� � �. � ' { \ \ . , � �� ,I.. i j � �.: ; _.� (`>,:� ,/ � � �. ;� �� . t� �`%i \�� ,,� / � N � ( " � � � �. f . �j / �"C7 i ,, ! � ' � , � -S � i , ; �� 1 �,� ; / d � • .� ,� � / �� 3 k � � a , �. � � � ; ��:; � ; .( � � �s.''. p F � . � � ; .� ; K;� � �n �� , , 1 i , • � '` A � 3 � �' � � ' i,:� ; � ' ' ,� � �`�, � .� •, �� --i- � �'' � ' ' �� ' � ro � � 1 :� ;\,.3 � � ; . � � , ; '.:a' �k� ' � � � ; , � � � 'i�` (�7'. � ' /' � � ; i � ; ' �:� ` �`�c�\ � � � t.� 4 � � � Y � \ �J T�' C ' �, � :�;, �• .�� -� � :� , ;; --T--_.___.. �C" � ` s \ i i� ,r��--� r�-.�.Q,-� ; S � `' '� �' � . � �� , , .� .'�"' '�,. J� �, �' ± . --� :, � � l.i:�s�` { . � f�\'Z 1' . . . � . � ` - f , ^ � `.�\'; �� j � , � . . . l. t t. � � � �` , ' - � �- r� , ' � �... 4 � � l -° �� ; 1 , � �� ' � ' � , . � � � � � . �. ,! . - �.... _ _ }:\�` � �; � ' � ��` � .�._. _� / � � �`•; � ' ; � . 1�� ' , . � ` +� � \;� � , � — — � , l ' ' � � , �� , ,. . j \{�\ �� i�- �; ,� ( - ,� � ( \�� G, / (i .. yi�_..�• , G i 1 \�,,`�..+��p�� ' �;. ��.;r � ' ' , '.� n � � � . � . • rt r � r � � � h a� r, H M z� �i �i �"-7 O :> O :h �••� Q H H O -� O H C �-3 . rt Y• C '' 'r J ;-' �7 :� r.- � =�' c, � ►-i �3 Sv � :.l O b' fu 7J G� H �; t7' (J x7 Co �-+ C-] ~ r-S �: [� C ': y �] i':,,� �' � i � >-3 C7 � • i r � a " r ��' � ,� a _-+ � .. n r H v �-� h � �: r+ ,�. c� � � � � �; � ►,• �� o �n 7 �• c� c r (� �2 C G� �; �-� C ;=J � r* x F� <; :j tn �� i'� f"'' �+ t�y �� n � f-�• � `i-i.� �i y :� o �• r cn ►�- r y r cn w r � �i a m �r :-s .., ;� � �+ � -, � �; , (D N t-�•L4 �'J C C- h''� ��' y..�_� (A F� � � v O �3 i � O C � w �-- ►-� ►� r� -- � ;� � c� • tq � O C� � :T] O H ~� �y � ' � �.7 N ',� � � CA H t=J N c� � x j H H t�i }�• tJt N N N Ut N N N C� C=7 • �n t-� rn iv w N r rn r� �.a �1 M '�i � r-,. �. . . . . . . . cn � �� I-�� l� Ca N J lD O tJ �I ` � ��: C"; C, � o00 o C . cao o t� G� Nt1i7 �q o00 0 (t o00 0 ✓ �Jt'+ I 7 f+• G� �3 � ��C7 t7 � CA U: G� N (!� Ul (n H 7J Ty F� Ul � . . . �. . . . � r� r� ;,, ��: K 'TJ '� � [f' � *_] 'TI G^ �a U� ',�' � . . . N. . . . � r-3 - t7 t-' . I t 7 -- - N, fD y ►-i tA K t� ��: � tn � r'' .� .-. c: ��7 t'� � .1. .�. C) ,�' �T � .� � : - r �y �h1 C�� cn ;..- � rn. f7c nn nn na ro7 F-i I 'cl rJ :-t �.+. �C� 2 H H O rt tA O H F7 u � ' - ,',�- 'yv] ' . . r t-� � � b � 'f� .�.{A i/? i/} �{?ilT �C/T C7 H � 1-� N N N ..'� N N N IV C7 H t-+ cv t� o v� t-� t-� w o y x p . . . . . . . . NOO O �100 O • H � (31C70 O OJOO O z v � -_ _n . . . (D t li 11 II II If I! 11 - 11 tr� � F-+ H . � . iJ? F-' t+'t .C� t-' h-' N N N N Ul .A .I� Ol W �A 1-' �l � (,Tl (.Tl tJ1 Ql .P Ul d Al O .� � � � � . . . . � � O O O O O O al O C� O O O Q O O O O O O O O O O+O O U O C7 O Q ' � � . 1 e ' �i t� d . . . r-3 h� F-� .� ►-7 C I C� H H ' 'd � ' O t� � �i n C� �"� O O � S� tti • rt f� t� c] ri• W '_-� H t�t I—� ►S t' � r� � �� N• •cn y � tn 7: :� , N r� ^� ►-+� � t'� F-� o �• cH ' �� . ►� � (� r-t C� C: l I f? � U ri c, Q F'• O !� C� �' O :s G ;.7 O �� G� :� �i �i ?� u. n c� :� tn � I�i t-t c� m i`� O . (D O rF tt t'� O �+ F-� � � • n :s �� rt rt i-�• �_: t1 s� I-�•�G �-' ct ca � 7 �: ��s � l�: ct � C� C� !� (� �� ;:1 t� fJ ()" C-7 !� ►i �t �� • lD �:. r? G F--+ Z O f t�• � F-�• ;7 '7 [=; � �� tn �� O F-� O :� ..'� f� �• Ct �` _ �:; ;3 �C 'i�l 1T1 � (D ti (A u. �� I-j � U. �+ � -� O n f--� c� a t7. � �i � :.-t O v� U "� :� C� N• x H• rn �l cn N v t'i cD � (1' C� �' .!� �-t' c7 y =y � ' �' o �n �� r_, y rt G� o :3 :,,�,-. "v� c� F-'• � rt F� t-� �: H � h-' rrlY• � r� � �i � � c~nm H�� -; n O �t H cD .�� O � H C7 rt � ;7 iR � �; U� � . (� (�i sr c? �: rt'C C) A� I-�• Sy �' � K t3' � . H ('J N (A F-� C7 N � • H U! Sy '�J � �+ • ' H f'f cni �I ' � ta 1-'• W (D � !�! 7 ;7� t-!. �� F� :S o� .,.. G � � � F�.�o ro . � . � � � , N �} � - � N O " O � N ti -- _- . , . A . W FS • II Il ti II II il II � �n in -v> �cn . W W N N . . . ' . in iR � (,,) �i N lD�N al W W �l lJl N C1 U�'61 � �l �I .P .F'� O lJt �^. � U7 Ul (Il . . . � . , W t�� F-' �O N Gl Ol Q O OUGC� C� O O O O OOO��JO � O O O • � 0 9 a rt H � Z H 'zf H cn '=i '=i ~ '=i H C/� 'TJ Gy y • O H x C7 H H 1 H ,": h7 H C �'d �T '� re C� �7 7. � '7 r-i C� :r H ',n 1n H � Ocn ra cn 9 �-? � OCn t'i C ' ~ -�- d � y �.' ri O .rC7 � H C l� � f� � � `r~n c i � c c� � r�a rr--i c-r-y r c-r-y czi 1-�'� [�--J C'-C7 C [�7 Z G ITJ CC'-7 ['C-7 C t'C-'i t/� t�i) � r r r� r c!� ri �C t-' ^' t7 [" H L� � C' H cD r• � � � � C"' � �C n O H � � � � O cD v -�ij m Z r.+ rt �..� � - xcn . � d t�i ,� � r. . W � ,... � r-� O r-+ N W r� N r-+ N N .� r+ W � N O� �D Oo 0o w N O� ln Oo N G� o� o o � �o r �n o o �o rn y r 0 000o m o 0 00o m r �n 0 000o v� o 0 00o H t� a c'� H Hz � t��i H �n �n �n cn cn cn cn cn H � � ro 'ii '�1 '_! ''�7 '�i �7 '� �7 y � t�'' l� d H r3 Czy G� c�n � z � H cn , HCntna �C�i /� /� /� /� /� /� /� /� �-d `W �S7J `RI 'SY 'i+J �t]!�a7/�SL I��i, � ry C 'S � w x F'i W N N t--� N N N N C=J O O � I Cd �n � 00o • N � NO �d cny zHb ►� O O O O O O O O O y H O 0000 0 000 � 9 � ~ yr d � C7 H H H n :i u n n u u n n H x 0 z � � . tv N f,,� . V �D �O W ln V ln O � O� � h-+ W V N r� �I OJ r� lJt � O o� O� O �O N O �n N N O O O N Oo O O 0o O O O O O O O O O O O O O O O O O O O O O d A H '�i �-3 [T7 H (6 O O O �rn- O r%+ a � � rt m ° n ° ca Z r* rr rr a � a .A �i � . w cn tv w G� r� cn m m (fl rNirt r�-r r~r O r�+� H r., � �.., � ,.�� y� r+ r � rt w D l�7 1 � � A O � �00 C7 rt C3. O W O C� n � Cl� ;U �" r• 9 rt tn � C v t�D� p r��r � � R O a w r+ S2' o n o � 4 n � r'S rT r'i W � W R R C � O C7 � C7 rr v� c o c � " � R � z rr A f� OQ Cz7 n n rr c.-� rr co � sr � a � o � y ° � o � o � c� � � a R w w � R f7 �.3 �f'. � �. C7 l�. F'� f7 F'� 0 � r. � O � O na 9 w � � zo 7C � n rt � rt d �o p co S R O �-' � fD �'t �,'' � �' � 'ti � O a� �C '� Cr• G o~o �-a � � � � �''� r� r'S O Hc�n t7o � H � � n H � Cn • (/] � n n � 1-� R ►'l � � � � v � tn ,-.i �n w w H �"1' �� H � F'• o° • O C�i F-+ ..� .r� r+ , � o W ' 'd � � 9 � �a - � rr r� rt v p'r` p..a E E N . A� M � � A A O (p (D O . b fD K n W ri ii il II II il II II II II II II • � � � �D � 0o V 1--� rn �O v v O �! N 0o r-+ O� O OO lJ� N N O t� � O O W C� �o o� O ln O� �O ln O O � �,,� � ,� � ip �p O O O O O w O w w O O O O O O O ' m v r r� O O o O O O � � . . .,y s i �-o i � � � 1 l 7 `1 � ! � o � � � r � � � 1 j• ,�� •v� L i �� '� C � _-. _� . _ �' " � � . . �� 7 � �� ' O � � � "�' .� �� -a ^ n ., � t y ' • � � + � • a . , _ _ � . . � . � . .. . � �� , � � I � . � ' �� t � ii�sl _ , t.�� _ . M��_ � - 1 r�.' � �.-�� ' � / r �_ � �.�—r�_^ �� ..r,�-�--�'+ � . / F-__� 1 f 1� -1�' '` rrr' �� " : � -� . �:-----� .�-_- _ _ - ._._._, ,� _�____ _ s .�- �=. -� - �- -__ _� __ � _ ... _. .� - -' - --- - -._ , � .__ .__ .. .. _� r � - • _. � � _ �. � �� i��y �. �� o April 10, 1973 Mr. Kenneth Fitxpatrick City Attorney Rooan 6�47, Ci�y xaLt St. Paul., Minn�ssot�, �eir Sir: Th� City Gauncii requesta that yrr,u pr�epa�re a resolution concurrinB in tha e�ction oS the Remaey Covnty &aeard of Camani+�elonera to Qpp� tl�e propo�al the�t t2be Gillette Hc>s�ital '�e merged with the St. Paul.-Ram�ey Haepital Co4nplex aa set out in th� attached County Bc�nard re�c�lu�t3on. Yrnxrs 'v�ez'y truly, City Cle�k AAp:�tmr Attach.