History in the Mending


By Dennis Boone



Kansas City has long had a reputation for quality health care, but how did we get here? It was a long road of public and private efforts to treat the sick, a half century of suburbanization, and health-care policies that infused big dollars into the system.

The key players have long since moved on to that Great Operating Room in the Sky, so the trials and tribulations of building a health-care infrastructure in early Kansas City are known but to the special archive collections and libraries of the region.

But this much we know: Although Kansas City was incorporated in 1853, it didn’t have its first standing hospital until 1870. That’s when a small structure initially known as City Hospital—and later, Old City Hospital—was opened at what is now 22nd and Kenwood, on property donated by a famous Kansas Citian of that day and this, Col. Thomas Swope.

It was on a prominent point, overlooking a city that had begun its migration from riverbank origins to higher ground. The site of that first hospital would become a health-care touchstone for this region, as various hospitals have come, gone and anchored themselves to what is known today as Hospital Hill.

Sherman Steinzeig and Alan Forker, a pair of long-time physicians, have been around to witness a lot of the evolution of health care in the region, but even they don’t go back quite that far. But as members of the John Locke Society, a group organized around a shared interest in the history of health-care in this region, they know quite a bit.

Just as it’s impossible to compare modern medicine with what was being practiced back then, Steinzeig says it’s only a matter of conjecture whether the care provided at the time was as good for its day as today’s care is for its era. “You’re firing at a moving target,” he says. “There are so many things that have changed concurrent with medicine. When I started in 1956, the only thing to do was hang out a shingle and hope for best. Over time, you accumulated patients who like you, and that’s was the advantage of that form of medicine.”

In that sense, medical care was closer to the model of the 1870s than the 14th year of the 21st century. “Now, there are a hundred options for medical students entering practice,” Steinzeig says.

To study a timeline of hospital growth in this region is to see history unfolding in health care just as it did in other aspects of life in Kansas City from its earliest days. Between 1860 and 1870, the city’s population grew by 600 percent while it secured its place in history as a launching point for mass settlement of the American West.

Before Kansas City was assured of the river bridges that would determine where growth would occur, Leavenworth was the site of what may have been the first hospital in the region, and it lives on today—St. John Hospital.
But closer to Kansas City, health care then, as now, was clearly a major concern for a growing community. Hospitals would go up at a faster clip—not just in the 1880s, but in that end-of-the-century generation through 1900—than in any 20-year period since.

Developments by Decade

 1880s

The 1880s saw what was arguably the biggest hospital growth spurt that Kansas City would witness for a century. During that span, seven hospitals were founded in the region, a figure not matched since then. They included four hospitals that are a part of a regional health-care infrastructure—the forerunner to what today is Saint Luke’s Hospital, in 1882; Christ’s Hospital, a forerunner to Stormont-Vail Healthcare, and Mercy Hospital, which eventually would become a part of Heartland Health, both in 1884; and Research Hospital in 1886.

The emergence of hospitals as fixed bases for care made everything up to date in Kansas City with respect to health care, but there was little that would suggest the region would develop centers of excellence that would attract patients from multi-state areas. “People would go to the Mayo Clinic or Johns Hopkins for certain treatments, but in terms of Kansas City being a hub at that point, I would have to say no,” said Jason Roe a digital history specialist for the Kansas City Public Library. “It was not then the way it is today; that would come quite a bit later.”

All four of those programs are either market leaders or part of health systems that have major shares of their respective homes. Stormont-Vail and Heartland are the biggest in hospitals in Topeka and St. Joseph, while Research, now a part of the HCA Midwest system, is a two-campus facility in central Kansas City.

Saint Luke’s has crafted a large footprint on the Kansas City market as well, not only with development of its Mid-America Cardiology practice and its research programs, but with satellite hospitals going up in virtually every corner of the metro area over the past 25 years—first in Johnson County with Saint Luke’s South, then in the Northland with two facilities, and in Lee’s Summit with Saint Luke’s East.

1890s

The 1890s demonstrated the growth of the other Kansas City, on the Kansas side, with the founding of Bethany Hospital in 1892 and, in that era of segregation, Douglass Hospital for minorities, in 1899, the same year St. Vincent Hospital opened on the Missouri side. It also produced a small effort directed at children with physical deformities, the Free Bed Fund Association of Sick, Crippled, Deformed and Ruptured Children.

That one-bed facility, inspired by the plight of a woman trying to give away her crippled 5-year-old daughter, would have profound implications for pediatric care nearly 120 years later—it grew to become Children’s Mercy Hospitals & Clinics. Today, the system includes the main 315-bed hospital on
Hospital Hill, a 53-bed hospital in Overland Park, and clinics or care centers across the two-state area.

Children’s Mercy also has grown into a formidable research hospital, in tandem with the growth of clinical care programs that have earned it a national reputation—perhaps the best-recognized name nationally of the hospitals in this region, Forker said. “One exception to the suburbanization is Children’s,” he said. “Talk about growth that’s continue to grow: When I was a junior med student, it was in a single, tiny building on the KCUMB campus, and had about 40 or 50 beds. Now it continues to expand, and they’re becoming massive.”

 1900s

The turn of the 20th century saw a slight scaling back in construction, but the hospitals that rose across the region again included some bedrock institutions. Between 1900 and 1910, the five hospitals built included long-time fixtures Trinity Lutheran in 1906, the Downtown St. Mary’s Hospital a year later, and in 1908, what would later become General Hospital No. 1—the forerunner to Truman Medical Center. It’s something we might consider unheard of today, but General Hospital made Kansas City one of just a handful of urban areas nationwide to offer free health care for the poor.

An early hint of suburbanization came in 1909, with a facility in Independence to serve the Reorganized Church of Jesus Christ of Latter-Day Saints. It eventually morphed into Independence Regional Health Center, which itself closed in 2006 upon the opening of HCA Midwest’s Centerpoint Medical Center further to the east.

The most profound development of that decade, though, came with the opening of the Eleanor Taylor Bell Hospital. It opened in 1906 after physician Simeon Bell donated land and cash valued at $100,000 to create a hospital named after the woman who bore him 10 children. The beneficiary of his philanthropy? The University of Kansas, which later renamed the facility the University of Kansas Hospital. Separated from state control in 1998, the hospital is administered by an independent public health authority, and has grown into the market leader in admissions and revenues in the Kansas City region.

It also has achieved considerable notoriety with its research programs, particularly in the study of cancer, and boasts nationally renowned treatment in cardiac care and neurology.

“KU was always strong in research, then last year or so earned that designation as a national cancer institute,” Forker said. “That’s unique, and when you talk about a national reputation (for area hospitals), KU is a big part of that.”

 1910s

The run-up to the Roaring Twenties yielded St. Francis Hospital in Topeka in 1911 and a small hospital that would eventually become Missouri Methodist Hospital in St. Joseph—and, in turn, would merge with Mercy Hospital to form Heartland Health in 1984. The following decade, however, saw renewed growth outside the Kansas City core. Providence Hospital opened in 1920, a year before Lawrence Memorial Hospital. In 1928, the Rural Jackson County Emergency Hospital opened after a bond issuance promoted by Harry Truman, then the presiding judge for the county’s court system; we know it today as Truman Medical Center–Lakewood, primarily serving southeastern Jackson County.

 1930s

In the months leading to the heart of the Great Depression, General Hospital No. 2 opened at the site of the Old City Hospital in 1930. It was an oddity not in that it offered the best facilities for health-care in the city, but in that those facilities served the city’s minority population—a stark contrast to what one might have expected in an age when segregation was still practice.

“If anything distinguished Kansas City in earlier periods, back in the ’30s, there was more care delivered for minorities with the rise of No. 2,” said Roe. To me, that was rooted in machine politics—in cities with political machines, there was a big advantage in serving the Irish, African-Americans or other disenfranchised groups that could turn around and vote for them.”

Jewish Memorial Hospital opened a year later in the building occupied today by the Stowers Institute for Medical Research. Not long after it opened, it was rechristened Menorah Medical Center, and it relocated to Johnson County in 1996, two years after the hospital was acquired by the Health Midwest system.

 1940s

Major hospital construction slowed through the remainder of the Depression and didn’t pick up again until after the nation had endured its second set of war years in the 20th century. In 1945, Baptist Memorial Hospital opened in Brookside (it’s the Brookside campus building of Research Medical Center today), the Rehabilitation Institute of Kansas City debuted in 1947, and Stormont–Vail became a unified hospital in 1949 with the merger of Jane C. Stormont and Vail hospitals in Topeka.

 1950s

Activity picked up in the 1950s with a new east-side hospital to treat the nation’s veterans, opening in 1952, and the new Olathe Hospital a year later. Queen of the World Hospital opened its doors in 1995 on the campus of the former St. Vincent Hospital, which had closed in 1953 after a 54-year run. And North Kansas City Hospital, today’s primary care facility north of the river, opened in 1958.

That decade also produced the merger of General Hospitals No. 1 and No. 2 in 1957, a move that paved the way for a new building with a new name: Truman Medical Center, which opened in 1976. During that same stretch, suburban growth brought forth Shawnee Mission Medical Center in 1962 and Cass Regional in 1963.

And that’s when things in health-are started to get interesting in the U.S.

1960s

“Nationally, it was probably the 1960s when this really took off,” said Roe, “and 1966 was a key date with both Medicaid and Medicare enacted in 1965. Those programs pushed the industrialization of medicine in terms of large-scale medical facilities, profit generation for pharmaceutical companies, and even if they were not paying as much for medicine at that time, they were paying for the hospital stays and opening up federal dollars.”

The latter was a key to transforming American society, Roe said, because along with federal dollars came a stipulation that institutions had to be desegregated. “That was important, especially in the South,” Roe said.

With that infusion of money, specialization—and the higher treatment costs
it implied—emerged. “What distinguished many of these regional hospitals,” Roe said, “was that they became the experts in treating a particular type of cancer, or having a cardiac care center, or pediatrics, in the case of Children’s Mercy.”

 1970s

Shortly after Liberty Hospital opened in 1970, activity really picked up in the region, and for the first time, it was more through consolidation, relocation and closing than from new construction. Lee’s Summit Hospital entered the market a year after Truman Medical Center opened, and St. Mary’s opened up its Blue Springs campus in 1981.

 1980s

But the closings of Sisters Hospital and Methodist Hospital in St. Joseph, leading to the Heartland Health emergence in 1984, was followed by the merger of the Downtown St. Mary’s into Trinity-Lutheran. It was the beginning of a move that would see more urban hospitals move out of the core, and matched a phenomenon taking place nationwide. Trinity itself would fold in 2001, merged into the Baptist Memorial operations, and Baptist turned the
title on its building over to HCA Midwest in 2007.

“Those hospitals don’t exist because the population went to the suburbs, and therefore the cash flow,” said Forker.

A little more than a decade ago, the Kansas City health-care market was dramatically changed with a single deal: The $1.125 billion sale of non-profit Health Midwest to HCA, the nation’s largest for-profit hospital chain. HCA agreed as part of that deal to commit nearly half a billion dollars to improving facilities in the region (and ended up being penalized last year with a $167 million judgment for failing to properly follow that commitment.)

As part of the deal, two large health-care foundations were created—the Missouri-side Health Care Foundation of Greater Kansas City, which today has $485 million in assets, and the REACH Healthcare Foundation in Kansas, with current assets of about $125 million. Both programs promote safety-net care and healthy-lifestyles programs.

Throughout Forker’s career—which took him to the Mayo clinic as a young physician, then to Lincoln, Neb., as a private practice cardiologist before his homecoming in 1990—one thing common to health care here has been quality care influenced by skilled physicians who trained at some of the nation’s biggest-name health venues.

“The influence of the Mayo Clinic on Kansas City was direct,” Forker said. His own mentor at the clinic, the late Ben McAllister, came to Kansas City to pioneer what is now Saint-Luke’s Mid-America Cardiology. “Ben had that Mayo perspective and said we need to create a cardiovascular institute in Kansas City that mimics the Mayo. Multiple other factors allowed that, because the funding of medical care blossomed about that time after Medicare passed in 1966—that allowed funding of new procedures and the growth of higher-tech treatments, especially in cardiology, was pretty dramatic.”