Louisville Medicine Volume 67, Issue 10 | Page 35

DOCTORS' LOUNGE Fig. 1 The first hospital (1823). The central building is now the UofL Abel Administration Building. Fig. 2 Louisville General Hospital. The many added wings on each side of the central building reflect a century of expanded patient services. Fig. 3 Counties across Kentucky and Southern Indiana served by the UofL Health Trauma Center in 2017. a surgical technique for deep burns called “early tangential exci- sion and grafting,” which was originated by a Yugoslavian plastic surgeon, and which I learned from one of the earliest international adopters. In refining this technique here, it became apparent that this method substantially lowered infection rates and severity, and greatly decreased mortality and permanent disabilities. We applied this technique to the Radcliff children, and all survived. TRANSPLANTATION With the introduction of effective immunosuppression, UofL Health surgeons working principally at UofL Health Jewish Hospital pio- neered kidney, liver, pancreas, heart and lung transplantation, and brought these to recipients across Kentucky. Recently, the Center (now named the Trager Transplantation Center) marked its 5,000 th patient transplanted, including 3,000 kidneys, 900 livers and 500 hearts. The Center’s immunosuppression skills allowed the partner- ship of UofL Health Plastic Surgery and Kleinert-Kutz Hand team at UofL Health Jewish Hospital to perform the world’s first skin-bearing transplant, a hand, 20 years ago. The landmark procedure opened up face, abdominal wall and other new reconstructive transplantation procedures in centers worldwide and brought international acclaim to UofL’s pioneering efforts. CARDIAC SURGERY AND CARDIOLOGY UofL Health Jewish Hospital is also home to leading cardiac surgery and cardiology, another set of services that have saved thousands of Kentucky lives. Citizens from every Kentucky county have received their heart care here. Also, substantial advanced technology has been pioneered by UofL Health surgeons, including the world’s first implantable artificial heart and its subsequent evolution into increasingly effective life-saving technology called ventricular assist devices. UofL Health cardiologists address the most difficult con- ditions of arrhythmias and severe heart failure. In addition, UofL Health cardiologists and surgeons now partner to treat many defects, such as some valve replacements and vessel aneurysms, by less inva- Fig. 4 Helicopter flights speed transport to UofL Health the many patients needing emergency care. sive vascular passage, rather than open-heart surgery. UofL Health also sponsors leading cardiovascular research, including the newly established Christina Lee Brown Envirome Institute. This research facility focuses on heart/lung disease prevention and environmental safety, which will benefit all Kentucky citizens and those beyond. A THREAT TO CONTINUED SERVICE The ongoing service to Kentucky citizens by UofL Health and the affiliated hospitals is severely threatened by recent changes in de- mographics and Health care economics, especially by the large burden of uninsured and underinsured patients that they serve. In November 2019, Jewish Hospital came to the point of closure, as then-owner, KentuckyOne, could not reverse several years of deficits, and decided to leave the area market. UofL Health hero- ically stepped in to preserve Jewish Hospital and its vital services by purchase and full affiliation. This action preserves the services described above, as well as the Emergency Department that serves over 3,000 patients each month. These benefit all of Kentucky, as over one-third of admissions to UofL Health Jewish Hospital come from outside Jefferson County. Also preserved are UofL Health medical education programs for our future practicing physicians, and over 1,900 hospital jobs and their contribution to Kentucky’s economy. Thus, an enormous effort has been organized to rescue this invaluable resource. Under ideal circumstance, the University and UofL Health leaderships would be spared the substantial economic risks involved. However, the loss of care to citizens locally and across the entire state demand this action. As this article is being written, a loan request of $35 million from the state is before the state leg- islature. It is essential that the great value of this institution to all of Kentucky be recognized, and that support be given to sustain this noble legacy of service. Dr. Tobin is a professor at the University of Louisville School of Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery. He practices with UofL Health Physicians - Plastic and Reconstructive Surgery. MARCH 2020 33