Leading the Way

Most young women spend their early 20s charting a course of self-discovery, fueled by the boundless potential of an unscripted future.

At 22, Leah Ann Onan's outlook was far less promising.

The Eddyville, Ky., native had suffered from a variety of mysterious medical conditions since she was eight, beginning with generalized pain and associated seizures before progressing to hemolytic anemia and diabetes.

At one point, she was even diagnosed with leukemia -- incorrectly, Onan says -- and given a full course of chemotherapy treatments, which did nothing to improve her prognosis.

 She also suffered from multiple infections and chronic diarrhea that made it impossible for doctors to stabilize her rapidly deteriorating health. In 2002, the five-foot-six-inch Onan weighed a life-threatening 62 pounds.

"My family doctor told me I was going to end up dying if I didn't do something fast," Onan recalls.

And so Onan, who had spent nearly two-thirds of her life being evaluated by scores of physicians, selected the name of yet another doctor to visit in the hope of finding a cure.

 "I told my mom that I was tired of putting up with all this," Onan says. "I told her that if I didn't like this doctor, I was going to throw all my medication away and just let nature take its course."

Luckily for Onan, her latest physician was Louisville digestive health specialist Kristine Krueger, M.D., medical director of UofL's Digestive Health Center at University Hospital. Onan says the two developed an immediate bond, and she now regards that day as a watershed event whose date she knows as well as her own birthday -- Oct. 14, 2002.

"From the moment we met, we never looked away from each other," Onan recalls. "We just kept talking and talking. Dr. Krueger told me that she would see me again soon and, because I liked her, I told her I would come back."

Onan would soon have another reason to come back: the correct diagnosis. After running several blood tests, Krueger telephoned with news that she had identified Onan's problem -- a wheat allergy and a rare disorder called common variable immune deficiency.

Both conditions made it difficult, if not impossible, for Onan to digest food properly. As a result, her body wasn't absorbing the necessary vitamins and nutrients. Despite eating a healthy diet, Onan was starving to death.

"I was shocked that Dr. Krueger was able to diagnose my problem so fast, and I was excited too, because I didn't know what was wrong with me for so long," Onan says. "That bugged me more than anything -- not knowing."

Treatment was relatively straight-forward: Onan was admitted to University Hospital so her health could be stabilized. Upon release, she stopped eating foods containing wheat or glutens, and she began taking glutamine. She also started receiving nutritional supplements -- vitamins, minerals and fats -- intravenously to promote better absorption and intravenous gamma globulin to help fight infections.

Within 12 months, Onan's health had posted a remarkable turnaround. She felt better than she had in nearly 15 years, and her weight was inching up past 110 pounds.

"I felt great," Onan says. "It was good to start putting on some weight and regain my strength."

Unfortunately Onan's suffered a setback in late 2003 when she received multiple injuries in a car wreck, requiring surgical intervention and extensive physical therapy. The new obstacles were frustrating, but Onan had come too far to be stopped by something as insignificant as a fractured vertebrae. Today, she says her future is as bright as any twentysomething's, thanks to the care she received at University Hospital and the Digestive Health Center.

"I owe my health to Dr. Krueger and all the doctors and nurses at UofL," Onan says. "They didn't give up on me. They treated me like a person rather than a medical problem. I know that if I had not gone to (University Hospital), I would not be here today."

Onan is one of thousands of patients who have begun turning to University Hospital in recent years for a broad range of state-of-the-art care, from digestive health services and high-risk obstetrics to interventional radiology and rapid-assessment stroke treatments.

Once regarded by many as the kind of facility where a patient might go solely for trauma care or perhaps a few specialized services like bone marrow transplants, University Hospital increasingly is viewed as a top-tier institution offering the finest medical care.

There are several reasons for the shift, says Jim Taylor, president of University Hospital and CEO of its parent organization, University Medical Center Inc. Chief among these are a stronger relationship with the teaching and research programs at UofL's Health Sciences Center, a capital improvement effort that has poured nearly $100 million into the facility since 1996, and a focused marketing effort designed to inform patients, physicians and the community about the quality of advanced care available at University Hospital.

"I think we have changed the public's perception of us over the past five or six years," he says. "We certainly have improved our facility and our capacity to meet the needs of the faculty and our patients in such a way that we are becoming, for many, the hospital of choice."

This remarkable turnaround is born out by impressive growth in patient care throughout the hospital. The number of babies delivered at University's Women and Infants Center, for example, rose nine percent from 2002 to 2003, while radiology vascular procedures climbed 15 percent and the number of CT scans shot up almost 30 percent. Even more impressive, the number of advanced MRI, nuclear medicine and PET/CT procedures rose a whopping 54 percent over the same time period.

"We have effectively transformed University Hospital from a public institution into an academic institution," says Mark Pfeifer, M.D., the hospital's chief of staff and a UofL medical school alumnus. "Historically, one of our core missions was to serve the public health needs of the community. We continue to honor that mission today, but we're also focusing on specialized care, advanced treatment options and an interdisciplinary team approach that is truly state-of-the-art."

$100 million in improvements

University Hospital opened its doors in 1978 as a replacement for the aging Louisville General, which had been UofL's primary teaching hospital for decades. One of the new facility's obligations was to provide medical care for uninsured patients -- a prospect that exposed the hospital (and, by extension, the university) to potential operating losses.

In an effort to better manage these risks, UofL decided to hand off the day-to-day operations of University Hospital to a for-profit corporation, which would manage the facility under contract and assume liability for any operating losses.

The arrangement worked well as a means of reducing UofL's financial exposure, but it did little to enhance patient care. University Hospital continued to be recognized for its outstanding trauma service -- it was one of just two Level 1 Trauma Centers in the state, a distinction that continues today -- and it featured the city's only burn unit. But University Hospital slowly began falling behind other city hospitals in most areas of patient care.

To remedy the situation, UofL canceled its contract with the management organization in 1996 and formed University Medical Center Inc., a non-profit partnership between UofL, Jewish Hospital HealthCare Services and Norton Healthcare. The unique partnership immediately began laying the groundwork for today's modern hospital, and it has been operating the 404-bed facility ever since.

In that time, University Hospital officials have spent millions of dollars on upgrades and expansions, adding the latest in diagnostic and radiologic equipment like PET/CT scanners, MRI gear and ultrasound. Other improvements include remodeled surgical suites, a leading-edge cardiac catheterization lab, an enhanced trauma center and an expanded, state-of-the-art Center for Women and Infants that is dedicated to meeting the needs of women with high-risk pregnancies by providing expert, around-the-clock physician coverage.

That comfort extends to all nine floors of the hospital, each of which has been partly or totally renovated in the past five years, Taylor says.

The hospital, which has about 2,000 employees an annual operating budget of $283 million, also has been adding key programs to meet growing patient needs, including a new geriatric psychiatry unit and the world-class Digestive Health Center, which was established in freshly constructed facilities in 2000.

The center -- responsible for Leah Ann Onan's remarkable turnaround -- treats all types of gastrointestinal disorders, including pancreatobiliary diseases, swallowing and motility disorders, inflammatory bowel disease, nutritional and metabolic disorders, and liver disease.

Its multi-disciplinary team now includes gastroenterologists, surgeons, radiologists, hepatologists, endoscopists and pathologists who regularly collaborate on patient care as well as a broad range of clinical research projects.

Krueger, one of seven physicians who relocated from the University of Kentucky to establish the Digestive Health Center, credits hospital and medical school leaders for helping make the University Hospital program such a success.

"Insight, progressiveness, openness, a commonality with physicians, a true willingness to address the needs of patients -- all of these things were here with the dean, the chair of medicine and the hospital's administrators," Krueger says.

"In my entire career, I have never been as catered to."

Visionary leadership

Kerri Remmel, M.D., Ph.D., says such visionary leadership has played a key role in the ongoing development of new clinical programs that provide the latest in patient care.

"Something that sets University Hospital apart from other facilities around the country is the commitment and involvement of hospital administration," says Remmel, an assistant professor of neurology at UofL and director of the University Hospital Stroke Center, which, like the Digestive Health Center, is a relatively new addition.

"You'll see our administrators on every floor of the hospital, communicating with staff, nurses, doctors, students and patients. They are actively involved in what we do and committed to providing the best possible care."

Remmel joined UofL in 2000 and, with the backing of hospital leaders, began building the Stroke Center from scratch almost immediately. Today the team offers the region's most comprehensive care for stroke patients, with state-of-the-art diagnostic equipment and a unique interdisciplinary approach that boasts 24-hour-a-day neurological coverage.

"The center's labor and recovery rooms are by far the best in the city," Taylor notes, adding, "People who come here are totally surprised by the amenities and comfort we offer."

Team members include emergency physicians, neurosurgeons, neuroradiologists, cardiologists, physical therapists, occupational therapists, speech-language pathologists, nutritionists, stroke nurses, case managers and social workers -- all of whom are dedicated to treating and rehabilitating stroke victims.

That process starts with a "fast track" assessment the moment a stroke patient arrives in University Hospital's Emergency Department.

Time is of the essence, Remmel explains, because the debilitating effects of stroke can be reversed under certain circumstances if the proper treatment is given soon enough.

These treatments vary depending on the kind of stroke a patient has suffered, but options include endovascular and neurosurgical interventions, vascular surgery and the administration of "clot-busting" drugs.

Because University Hospital is involved in a substantial amount of clinical research, these drugs often include the latest treatments not available from other area hospitals, Remmel said.

For example, the Stroke Center recently participated in a multi-center study to determine the effectiveness of a promising new thrombolitic, or clot-busting, drug based on a protein synthesized from the saliva of bats.

The drug, called Desmoteplase, has generated a tremendous amount of interest because it can be administered up to nine hours after the onset of symptoms and still produce excellent patient outcomes. Standard intravenous thrombolitcs are typically given within just three hours of the onset of symptoms, Remmel says.

Another key component of the Stroke Center team is its approach to rehabilitation and education, which assists patients with all aspects of recovery following their release from the hospital and helps them mediate risk factors that could cause another stroke by teaching healthy lifestyle habits.

Of course, patients aren't the only ones receiving an education at University Hospital. There also are about 230 residents and several hundred UofL medical students who find themselves learning from some of the country's top clinicians and researchers in an environment dedicated to excellence.

"University Hospital is a place where the doctors are also the teachers," Taylor says. "It is, quite literally, a place where the knowledge to heal is_created."

Pfeifer echoes those sentiments.

"University Hospital has assembled a physician and faculty base with credentials and reputations at the highest level," he says. "We also have a superb patient base, a modern facility and the latest equipment to match our faculty expertise. These all combine to create an outstanding environment for clinical training."

Programs like the Digestive Health Center and the University Hospital Stroke Center make this kind of learning possible, thanks to their benchmark-setting standards, Pfeifer says.

In fact, the Stroke Center was recognized as a national model of excellence in December 2004 when it became the first organization in Kentucky to receive accreditation as a Primary Stroke Center from the Joint Commission on Accreditation of Healthcare Organizations.

Remmel's goal now is to help other hospitals establish their own teams dedicated to strokes, the nation's third leading cause of death.

"We need to be leaders in stroke education in our community," she says, in much the same way that University Hospital is now leading the charge in so many other areas.

"For stroke, trauma care, digestive health, cardiac disease, surgery and primary care, University Hospital today is a state-of-the-art facility," she says. "We've got excellent programs, top-quality people and a passion for what we do.

"I'm proud to be a part of it."