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A Tale Of 2 Hospitals: The Past And Present Of Maricopa Integrated Health System
Maricopa Integrated Health System (MIHS) is in the process of deciding how to spend almost $1 billion approved by the voters. MIHS recently bought and renovated a new hospital in Maryvale to expand the behavioral health beds available; the fate of the Maricopa Medical Center building is to be demolished to make way for a brand new county hospital. Both of these hospitals offer a lens into how the taxpayer-funded system has and will evolve
Maricopa County Public Health Care Today
Construction workers bustle around on a quiet morning outside the emergency department at the Maryvale Hospital in Phoenix.
The hospital, formerly run by Abrazo, closed in December 2017. Maricopa Integrated Health System (MIHS) bought the hospital to renovate, altogether using about $70 million of the bond money.
Kate Moodey is the emergency department nurse manager.
“One of the big challenges we had was just using the existing shell of the building,” Moodey said. “Sometimes I feel like it would almost be easier to start somewhere from scratch than update a building as it previously existed.”
She’s still getting used to the redesigned layout, badging open doors as she leads a tour.
MIHS worked quickly to reopen the emergency department this April because of such a high demand in the Maryvale community.
It was estimated 40,000 people came through the hospital when it was still open, averaging out to more than 100 each day.
“The community uses the ER a lot to access basic medical care just because of a lack of resources,” Moodey said. “So they’re just really looking to have a community center to come and seek medical care when they need it.”
Maryvale has the largest and youngest population of any village in Phoenix.
The new ER was built to accommodate the youngest patients.
“About 30 percent of their total volume for the year was pediatric patients,” Moodey said. “We did want to make sure we embraced that need. We have a separate family waiting room.”
There’s also a live interpreter at the hospital around the clock to help Spanish-speaking patients.
The rest of the Maryvale campus is still in the process of being converted to almost 100 more behavioral health beds. One floor is open now and already has patients staying there.
MIHS has a five-person elected board to oversee it.
Mary Rose Wilcox, former county supervisor and current restaurant owner, represents Maryvale and Phoenix. The Maryvale hospital wasn’t in the original bond money plan, but she said it was too good an opportunity to miss.
“And we bought it, and we got a damn good price for it,” she said.
Wilcox has close ties with the county hospital. She worked there when it first opened in the 1970s. And when she was shot in 1997 by a man upset over how she voted as supervisor, she said she asked to be taken to the county hospital for treatment.
“They said, 'Ms. Wilcox, Samaritan [hospital] is closer, we have to take you there because you’re bleeding.' And I was still upset, and the doctor who saw me immediately said, ‘Don’t worry, I was trained at county,’ and I said … OK. And I relaxed,” she said, laughing.
Wilcox said reopening the emergency department on the west side of Phoenix was a top priority.
“That was very close to my heart because you are looking at people who had to go all the way over to the freeway, and the hospitals in that area, or go all the way downtown,” she said.
About a dozen of the nurses and technicians at Maryvale now worked there before and some live in the community, too.
Others, like medical imaging manager Andrea Prado, used to work at Maricopa Medical Center downtown at Roosevelt and 24th streets. Both hospitals were built more than 40 years ago.
“I think it’s neat we were able to utilize existing space and kind of work them in for the needs we have and the needs of the patients,” she said.
Plus, the expanding footprint of MIHS means a shorter commute for her.
“It’s been great,” Prado laughed. “I have a 7-mile commute instead of a 23-mile commute.”
At the Maricopa Medical Center where Prado used to work, the emergency department feels smaller in size, though it sees more patients yearly.
Heather Jordan directs the nursing for emergency services.
“We have an older department, much like Maryvale started with, but we obviously haven’t had the renovations that have been done at Maryvale, so we kind of have a more compartmentalized department,” she said.
The ER continues to evolve with new research and technology. Jordan said they’ve moved toward internal waiting rooms so patients don’t leave before treatment. The need for more behavioral health services is also growing with the population.
“They don’t want to wait or they’ve decided they’ve waited long enough, then they can walk out the door, so our strategy here is to put them in an internal waiting room,” Jordan said. “This area gets a lot of behavioral health patients or patients we need to keep a closer eye on.”
Sometimes, patients will keep returning to emergency rooms with persisting problems. Jordan says all admitted patients now get tested for HIV unless they aren’t able to consent. One pregnant mother was found to be positive for HIV and the emergency team helped treat the mom and baby so the baby was born HIV negative — which may not have happened if the mom’s HIV status hadn’t been discovered at the Maricopa Medical Center.
“It actually saves money by not having to pay for their care later, untreated,” Jordan said.
At Maryvale, the new design features include a retrofitted Intensive Care Unit that now is built for patients who need longer, supervised care. The design there features a large circle with glass-doored rooms on the outside of it. The nurse’s station sits in the center, like a spaceship control area. At Maricopa Medical Center, that supervising room has been converted to hold regular beds. There are also beds in the hallway to help get patients in as quickly as possible.
At the medical center, Jordan said they see more than 50,000 patients yearly. That campus also has a Level I trauma center where the most seriously injured patients go.
There are 10 Level I trauma centers across the county with five in the city of Phoenix.
Jordan said the trauma room at Maricopa Medical often gets used several times a day, and those numbers aren’t dropping.
“And it’s crazy, the number of trauma centers in the Phoenix area has doubled in the last few years than what it was historically and still, we see a pretty decent volume,” she said.
Those needing intense trauma care make up only a small percentage of patients that utilize the emergency room and county hospital, a building opened in 1971.
That building is set to be demolished to make way for a new medical campus on that site, as part of the future of the bond spending plan.
The Story Behind The County Hospital's Builder
Phoenix-based architecture firm Lescher & Mahoney built hundreds of schools, hospitals and buildings across Arizona for a large portion of the 20th century. One building designed in the firm’s final years as an independent business was the county-run Maricopa Medical Center. This is story behind the hospital, which is set to be demolished.
File cabinets and rolled-up floor plans fill a small, fluorescent-lit room above the facilities department of the Maricopa Medical Center.
Within these files lie plans for the seven-story building’s exterior. Drawn by a Lescher & Mahoney architect, the details include brown brick trimmed in white concrete. The centerpiece is a striking swoop made of white concrete that flows like a banner from the top of the building to the lobby entrance.
“The building said, this is where you come. This is the entrance,” Bryce Pearsall said.
Now retired, Pearsall was part of the architecture group that bought Lescher & Mahoney in the 1970s. The Maricopa Medical Center was designed in 1967.
Pearsall, with what ultimately became known as DLR Group, said this style of building would be considered a classic, public building. There are details, like the swoop, that could be considered beaux-arts style.
“That’s where most people, unless they’re coming in the emergency room, approach the building, and that’s their first experience of it,” Pearsall said.
The front entrance opens north onto Roosevelt Street. Nowadays, almost all the parking for the hospital is behind or to the side of the building, facing the emergency department, so the first look is not the lobby entrance.
With its poured concrete sunshades that jut out like rectangular sun visors and minuscule windows, the hospital is not a classically beautiful building. Or, really, even an objectively beautiful one.
Still, it is big and a Lescher & Mahoney.
“I hate to see any of it go,” Pearsall said, about the firm’s work. “And think of the size of that in 1970. It’s a big, prominent building, and I’m sure thousands of thousands of people have had their health improved through there.”
Pearsall laments about the Lescher & Mahoney buildings that have been demolished, like the original Phoenix Public Library.
"A very good piece of architecture. I wish it could be saved, or find another life, a renewed life, but I’m not involved in making that decision," Pearsall said.
Phoenix's Most Prolific Architect Firm
Lescher & Mahoney had a hand in many civic buildings across the state. They designed buildings like the Orpheum, the Title and Trust building now called the Orpheum lofts, and the historic Phoenix City Hall. Several have already been demolished, like most of the original Phoenix Country Club clubhouse and the original terminal at Phoenix Sky Harbor. Many still exist, in remote places like Ajo, Superior and Jerome.
They also designed dozens of hospitals like the Phoenix Indian Medical Center and Good Samaritan Hospital (now Banner-University Medical Center), too.
Countless people have gone through the Maricopa Medical Center since it opened in 1971, although reports show it was a bumpy start for the building, and those who worked there, because of technical and design flaws.
Even today, Maricopa Integrated Health System’s (MIHS) chief operating officer, Kris Gaw, said the thousands of patients who get better within the center’s walls don’t remember the building, they remember the care.
“Public health people are really great at working with duct tape and bubble gum,” she said. “But what we’re going to do is change their world to be able to have state-of-the-art equipment, state-of the-art facilities that will exponentially change that experience for both the patient and the care team.”
The ultimate plan is to use a nearly billion-dollar proposition voters approved to build a new center, then demolish the old one. Gaw said the old hospital couldn’t be repurposed for another long-term patient use.
“So that analysis was done by people who are experts in the industry, and it was determined to not be a good use of those dollars,” she said.
The analysis said, though the building is over 40 years old, it scored above the 50th percentile against contemporary hospital criteria, the highest of all the MIHS buildings in 2014.
But the analysis continues saying Maricopa Medical Center’s maintenance is substantially costly. Gaw said health care is moving away from multipatient rooms to single rooms, which would be difficult to do in the existing building.
Valley historian Donna Reiner said what might end up costing a lot is just getting the structure off the map, considering a lot of it is poured concrete.
“In an interview that was done with Mahoney toward the end of his career, he said, ‘I never had a building fall down.’” Reiner said.
Reiner has advocated for saving other Lescher & Mahoney buildings. She said their value doesn’t always lie in their aesthetics but in what they represent for Arizona’s history.
“Because the firm lasted for so long, it’s a sample of changing styles, changing needs of Phoenix and the state. So it’s a record,” she said.
Reiner said the firm was so prolific because they had hustle, and they were available. She said once Royal Lescher rode his bicycle to submit a bid for a school building for a district in the East Valley.
Reiner said the Maricopa Medical Center, to her, seems like it was designed mostly to be functional.
"The front swoop is a minor concession to a plain building. Those swoops are minimalist, like the Arizona Veteran's Memorial Coliseum (designed in 1965), it has that saddle," she said. " All to give it a little pizzazz."
Just like architecture and design, the needs of health care have been changing since the Maricopa Medical Center was built in 1970. Here, it is especially with a focus on behavioral health. And the plan is still to demolish the center to make way for new beds with taxpayer-approved money.
Public Health Care Design Evolves
Hospital design evolves as technology and health care evolve. For the county public health system, that’s meant a need for more behavioral health beds for a growing population and in the midst of more awareness for mental health. This story is a look at the future of Maricopa Integrated Health System (MIHS).
Every aspect of this new behavioral health-focused room on the top floor of the recently renovated Maryvale hospital is designed to reduce the potential for patients to harm themselves, such as a padded bathroom door that is stuck to the frame with magnets. It doesn’t reach the top or bottom of the frame, but provides privacy.
“So this door has really become a new standard in behavioral health hospitals,” said Gene Cavallo MIHS senior vice president of behavioral service. “It’s called a soft suicide prevention door.”
Cavallo demonstrated that he only needed one hand to take the door off and put it back, where it snaps into place.
“We really tried to incorporate safety but still have attractiveness,” Cavallo said.
The bathroom mirror is reflective but not glass. And the common room chairs, which look like aluminum dorm chairs, along with the tables, are weighted to make them nearly impossible to pick up. It’s like a physical illusion.
“They put a weight on the bottom that adds additional weight to it,” Cavallo said.
The environment marks a big difference from when this building was a more traditional hospital.
MIHS bought the hospital to renovate and has run into some unexpected costs, having to replace the sewage and air-conditioning systems.
Still, Chief Operating Officer Kris Gaw said this was much cheaper than building a brand-new facility.
“When the Maryvale opportunity came about, it wasn’t necessarily in the vision, in the early stages, but what it did allow us to do was actually bring to life more behavioral health beds at a lower cost,” she said.
And Gaw said having more behavioral health beds on the west side of metro Phoenix creates a more comprehensive network.
“The future in health care, in anything you read, is to have fewer inpatient beds and [is] really much more on an outpatient, prevention, value-based model,” she said.
More Space For Behavioral Health As Needs Increase
Cavallo echoes that sentiment and said the need for behavioral health is ramping up in tandem.
“It wasn’t expanded as fast as other parts of health care,” he said. “And as we get to identify people earlier with behavioral health issues, and we begin to reduce the stigma of getting help for behavioral health issues, I think there are more people coming forward.”
MIHS is required to take all patients who are court-ordered to get behavioral evaluation and treatment.
Cavallo said they’ll be able to have up to 200 patients at Maryvale.
Only the top floor is open at the time of reporting, while the rest of the floors are being renovated with funds from Proposition 480. In 2014, voters approved more than $900 million to update the county health system’s services. Behavioral health was a component of that proposition.
Hospital architecture expert Joan Suchomel said hospital design has changed a lot.
“The changes I’ve seen in hospital design in the last 30 years is the explosion of technology, the embrace of evidence-based design and the concept of patient experience,” she said.
The patient experience was key for local architect firm DLR Group, which was tasked with renovating the Maryvale campus.
DLR Group, back in the 1970s, bought the firm Lescher & Mahoney, which designed the county’s main medical center.
Since the time both buildings were built, as Suchomel said, patient experience has become a higher priority than maximizing space.
DLR Group Senior Associate Richard Beach helped lead the plans.
“They want them to have a more home-like environment,” Beach said. “It’s why we went with the ‘looks like carpet on the floor but it’s really not.’ It’s a vinyl flooring. It just happens to look like carpet.”
Beach said after the initial design, the group had hospital staff walk through to point out other potential issues.
“We had a couple of things we had to modify after they walked through the first time, [the] behavioral health staff,” he said. “Those have all been rectified on the top floor and then carried through on the rest of the floors.”
About $70 million from the proposition went to renovate the hospital, where an outdoor space and courtroom for patients is also planned.