The Middletown Press (Middletown, CT)
‘CENTRAL TO THE COMMUNITY’
Yale New Haven Hospital history entwined with city
Editor’s note: This is the 43rd story in the Register Top 50 series.
NEW HAVEN — When it opened 185 years ago, the future Yale New Haven Hospital primarily was a charitable institution that served the poor, sailors and strangers.
The nearly two centuries since have been marked by exponential growth and modernization.
The hospital quickly expanded to serve the general population.
Today, the Yale medical system employs thousands of workers in locations throughout the region and attracts patients from around the nation and world.
Modern medicine
Dr. Tom Balcezak, chief medical officer, has been working at the hospital for 26 years.
“While I know the history of the last 26 years intimately, I know a fair amount of our overall history,” Balcezak said. “Things have changed so much — in New Haven and at Yale New Haven Hospital, and in health care and in scientific knowledge.”
With advances in technology, many treatments that would have taken place in a hospital decades ago now are done on an outpatient basis, according to Balcezak.
“Lengths of stay have also decreased — what used to involve staying for weeks, has now been reduced in some cases to hours,” Balcezak said. “These are changes all over the United States which are also reflected here.”
Susan Dee, an archivist at the hospital, said the hospital has grown not only in size, but in technology, throughout its history. Today, for instance, patients can use FaceTime to consult with their doctors. The shift from paper charts to electronic systems has made health information more accessible to patients.
When Balcezak arrived, computers were used infrequently. He recalls having to walk to review clipboards and paper charts, to see what other doctors thought about a particular patient’s case. Now, everything is electronic and everyone involved in a patient’s care can look up information and images from anywhere across the health care system.
Even in emergencies, critical care physicians can assist with managing patients from different hospitals within the network, and off-duty physicians can use technology to assist from home.
“A doctor can help diagnose without leaving their house when needed in an emergency situation, which saves time and means better outcomes for patients,” Balcezak said.
According to Balcezak, even the nature of the types of diseases people have has changed.
“Since tobacco use was linked to cancer, the incidence of smoking has declined, so tobaccorelated diseases has fallen,” he said. “With improvements in vaccines and antibiotics, there are fewer cases of tuberculosis and childhood diseases.”
Early years
The New Haven community began discussing the need for a local hospital in May 1826 at a meeting of the New Haven County Medical Association, which brought the proposal to state lawmakers. Once the project gained support, it needed funding, and it wasn’t until the next decade that enough money was raised. A state contribution of $5,000, pledges from Yale Medical School faculty, port fees and donations from private citizens helped secure enough money to buy land and build the hospital, which opened in 1833, according to Yale.
The original hospital sat on a 7-acre parcel between Cedar and Howard streets. The three-story hospital, then called the “State Hospital,” cost just $13,000 to build and could house about 75 patients.
At its inception, most of the hospital’s patients were local underprivileged residents or visitors from out of the area. Back then, most people who could afford it preferred to be treated for their ailments at home, and doctors visited them, rather than the other way around.
“At the time, people were mostly treated at home, and the hospital primarily treated the poor and sailors who came in to port,” Dee said. “It became the place for doctors to practice medicine and to learn.”
Area physicians often worked in the hospital on a rotating basis, while doing home visitations. In addition to providing the doctors with experience, the hospital served an educational purpose for students from the Medical Institution of Yale College, now the Yale School of Medicine.
Mid-to-late 1800s — expansion
The hospital saw a rapid expansion during the Civil War era. In 1862, the United States government leased the hospital building for use as a military hospital, while non-military hospital operations took place in rented space on Whalley Avenue. This military hospital was named the “Knight U.S. Army General Hospital,” after Jonathan Knight, a professor at the Medical Institution. The government added temporary quarters around the existing hospital building. According to the hospital’s archives, this enabled it to
treat about 1,500 patients. Between 1862 and 1865, the hospital’s staff treated about 25,000 soldiers. In later conflicts, the facility served as a designated military hospital.
Jason Bischoff-Wurstle, director of photo archives with the New Haven Museum, said the hospital’s proximity to Long Wharf made it a logical choice for this purpose.
“The wounded would come in and leave by Long Wharf,” Bischoff-Wurstle said. “There are accounts of soldiers not wanting to leave, and wanting to return to the comforts of the hospital after they were treated.”
In the late 1800s, the hospital, which was officially named “New Haven Hospital” in 1884, continued to grow. Hospital officials decided to add east and west wings to the main building in 1872. These new wings made space for more than 100 additional beds. Patients typically were treated in open wards, though there were a few private patient spaces. In 1882, a dormitory for the Connecticut Training School for Nurses was built on the campus. In the late 1800s, a ride in an ambulance meant a ride in a horse-drawn carriage, and doctors went by horse and buggy to visit patients at home. Because of this, the campus had its own stable. The first motorized ambulance service didn’t arrive at the hospital until the early 1900s, according to Dee.
Growth, name changes, mergers, formal affiliations
The hospital’s affiliation with Grace Hospital led to the name Grace-New Haven Community Hospital in 1945, and later, due to its ongoing affiliation with the Yale School of Medicine, its name changed again, finally becoming Yale-New Haven Hospital in 1965, according to hospital archives.
While the hospital and Yale had a relationship from the beginning, the institutions made it more official over time due to mutual benefits, including better patient care, clinical instruction for students, opportunities for scientific research and financing for expansion. Yale School of Medicine professors worked at the hospital, often as chiefs of departments.
In 1993, the Yale New Haven Children’s Hospital was dedicated, the first full-service children’s hospital in the state. It featured more than 200 beds and, since then, it has offered pediatric care across various specialties.
Today, Yale New Haven Hospital has 1,541 beds and two main campuses, making it the largest acute care provider in southern Connecticut.
“We have grown our footprint, the number of beds, the square footage of our buildings, and our staff,” Balcezak said. “Every year, our medical staff gets larger. It takes a team to provide high-tech care.”
It has continued to grow in
recent years, including with the opening of the Smilow Cancer Hospital at Yale New Haven in 2009. It encompasses the Yale New Haven Psychiatric Hospital, and satellite facilities around the region, such as the Temple Medical Center and Shoreline Medical Center in Guilford.
Recent years have seen further expansion and affiliations, to include Bridgeport Hospital, Greenwich Hospital, and L+M Healthcare, which includes Lawrence + Memorial Hospital and Westerly Hospital in Westerly, R.I. In 2012, the hospital acquired the Hospital of Saint Raphael in New Haven, now known as the Yale New Haven Hospital Saint Raphael Campus.
Nursing — an evolving profession
Judith Hahn, director of nursing and professional practice, said the Yale medical system has approximately 7,200 licensed nurses, a number which has been growing.
Several nurses said the hospital’s culture has changed. While the culture used to be the doctors running the hospital, now it is more progressive and teamoriented, according to Hahn.
Margaret O’Brien, a patientservice manager at the Saint Raphael campus, who started in 1983, agreed.
“What has really changed is the technology, and how nurses are more respected,” she said. “There used to be a lot less staff, and we took care of a larger group of patients. Now, nursing is a highly skilled part of the team. It used to be top down. The staff is encouraged to be involved.”
Francine LoRusso, vice president of heart and vascular, transplant, and medicine services, said nursing historically was generalized, with nurses supporting doctors in a submissive role. Now, nurses are considered colleagues and professionals.
“Nurses are looked to — to be equal partners in the care we deliver,” LoRusso said. “Nurses today are more specialized —
such as a cardiac nurse, while it used to be everyone was a general nurse.”
“Historically, when nursing was in its early days, you didn’t go on to advanced degrees; now, nurses see patients independently,” LoRusso said. “Nurses are leading research and are involved in innovation.”
LoRusso said the evolution of nursing care has brought about a dramatic change in how nurses dress, from the all-white uniform and special caps to standard scrub-style uniforms.
Role in the community, economy, and medical advancements
Throughout its history and today, Yale has had an impact on the community and beyond — from the economy to health care to scientific innovation.
According to hospital officials, Yale New Haven Hospital has a tradition of service to the community. It works to address key health issues, from substance abuse to accident prevention. Through its “Now I Know Better: Kids Tell Kids About Safety” programs, children talk about their accidents and what they learned about safety because of them.
“People in the community feel connected to the hospital,” Dee said. “A lot of people were born here, and when you are born here and have your baby here, there is a connection that you build. The hospital is a leader in the community, and we like to give back.”
LoRusso said there is an expectation around community involvement, and nurses do a lot of education regarding organ donation and disease prevention.
According to Balcezak, today’s medical center serves the region because it is a major employer and economic engine.
“We serve the community because of the care we deliver and because of our research,” Balcezak said. “Even more important, we are embedded in New Haven and provide worldclass care in Connecticut and beyond.”
New Haven Mayor Toni Harp said the presence of Yale New Haven Hospital has always added to the city’s global standing as a center for excellence in education, research and applied learning — in this case, specific to the field of medicine.
“As the teaching center of the Yale School of Medicine, Yale New Haven Hospital produces some of the nation’s most talented physicians; city residents benefit because many of these doctors choose to stay and practice right here in this area.
“Ongoing success and expansion of Yale Health makes it one of the city’s premier employers, with many positions filled by city residents, and that keeps local capital circulating locally.
“Many of New Haven’s new businesses in the emerging bioscience sector are byproducts of research completed and/or still underway at Yale New Haven Hospital, and that bodes well for a vibrant local economy — in both the near term and the foreseeable future.”
Connecticut Senate Democratic President Pro Tempore Martin Looney of New Haven was born at the hospital, and in 2016 was the recipient of a kidney transplant there.
“You could say my history began there, and I found their kidney transplant care to be extraordinary,” Looney said. “The staff was superb, and I am feeling terrific now.”
A lawmaker and lifelong city resident, Looney said the hospital has served as a magnet for the city.
“Obviously, it is a major employer, and it is important for the city to have a major research center of international renown,” Looney said. “It is a magnet in terms of physicians, and an economic generator for the entire New Haven region.”
Bischoff-Wurstle called the hospital “central to the community” in the modern age.
“Today, it brings people in and out of the city and is a base for innovation,” he said. “It is a centerpiece of our local fabric. It is adjacent to downtown and convenient.”
“It is on the cutting edge and the forefront of medicine — but it has been from its inception,” Bischoff-Wurstle said. “It has a remarkable timeline. When you are there, you trust that you are at one of the best hospital networks in the world.”
Bischoff-Wurstle has firsthand experience of the Yale health system, as his son was born earlier this year at the Saint Raphael campus and received care in New Haven.
According to Bischoff-Wurstle, he was impressed with “the dedication of the staff and sheer confidence and competence.”
“The staff members have very high-intensity jobs, but the people there were very receptive and confident in what they can bring,” he said.
Today, Yale has community partnerships with area colleges, such as Gateway Community College and Southern Connecticut State University, including collaborative efforts to help identify gaps between academics and practice, so graduates are best prepared to enter the workforce, according to Hahn.
Ena Williams, vice president of patient services and senior chief nursing officer, said this collaboration with schools helped redesign curricula, specifically regarding what nurses need to know before they come out of nursing school.
The expansion of the health care system around the state and region has helped further its community role.
“We see more nurses working in outpatient clinics than we did before,” Williams said. “We are growing in the community, so we are care systems not just within the hospital walls.”
Throughout its history, Yale New Haven Hospital has made significant advances in medicine, such as the first successful clinical use of penicillin and first use of chemotherapy as a cancer treatment in the United States. Yale developed the first artificial heart pump in the United States in 1949. Other successes include the discovery of melatonin and the identification of Lyme disease.
“It is a big and rich history,” Dee said. “What really stands out to me are the first clinical use of penicillin and the first use of chemotherapy.”
According to Balcezak, the impact of the Yale medical system includes providing care, jobs, the advancement of knowledge and training to the next generation of health care professionals.
“There are a lot of firsts which have been done here,” Balcezak said. “The research and new knowledge go on to provide for the betterment of health care. We are one of about a half-dozen medical centers across the country which are heavily involved in training, and we are a major exporter of clinician talent to the United States.”
“People in the community feel connected to the hospital. A lot of people were born here, and when you are born here and have your baby here, there is a connection that you build. The hospital is a leader in the community, and we like to give back.” — Susan Dee, an archivist at the hospital