The morning after Hurricane Ike crashed into Galveston Island six years ago, David Callender surveyed the sea of mud coating the 84-acre University of Texas Medical Branch campus.
The UTMB president saw oak tree limbs blocking the doors to John Sealy Hospital, which would be knocked out of service for the rest of the year. The 13-foot storm surge caused $1 billion in damage, plunging UTMB's finances into the red and prompting the layoffs of nearly 3,000 workers. A consultant even recommended that the hospital be moved off the island, an idea that found favor with the University of Texas Board of Regents and a few legislators.
Six years later, UTMB is not only off life support, it appears to have made a full recovery.
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The university is close to completing more than $1 billion in improvements and repairs to protect against future hurricanes, ranging from moving essential functions to a higher level to adding protective walls that can rise around certain buildings.
It is building a 13-story hospital in Galveston and a smaller medical center in League City. Last week, UTMB officially announced its takeover of the Angleton-Danbury Medical Center in Brazoria County.
The comeback is a story of pluck, luck, opportunity and community support. Critics, though, say UTMB has rebounded in part with a bottom-line mentality that has included doing less charity care.
Planning for UTMB's expansion was underway before Hurricane Ike struck in September 2008, Callender recalled, and it continued unabated even as the then-120-year-old medical school teetered on the brink of dissolution. Those contemplating UTMB's demise had a good point, he concedes.
"They were asking legitimate questions" about whether UTMB should be moved off the island, Callender told the Houston Chronicle (http://bit.ly/WlwzKN ). "You've got this big investment on a barrier island on the coast that is going to be forever prone to hurricane damage."
Residents, local officials and legislators ultimately persuaded the regents to keep UTMB on Galveston Island. Rebuilding UTMB on the mainland would have interrupted the flow of doctors and nurses from the medical school to a state already in short supply. It also would have affected the health care that UTMB provides to the community, as well as its extensive research into public health threats.
A UTMB vaccine research center was recently named a partner in the World Health Organization's efforts to develop vaccines for the world's deadliest diseases like Ebola, and a researcher there said Thursday that efforts nationally to develop a vaccine for it are moving at a pace unheard of only five years ago.
"If there is an outbreak anywhere in the world it can spread anywhere else," U.S. Sen. John Cornyn said Thursday during a tour of the Galveston National Laboratory. "This demonstrates the importance of the National Laboratory."
While struggling to operate after the storm, UTMB officials made a discovery that would fuel eventual expansion, said Donna K. Sollenberger, CEO of UTMB Health Systems. With UTMB's hospital shut down, patients were sent to Texas Medical Center and other hospitals. Meanwhile, UTMB rented offices in Texas City and other mainland cities to treat outpatients.
"In doing that" Sollenberger said, "we found we had a whole subset of patients who preferred or liked being seen closer to home."
Galveston County, especially the League City area, was growing rapidly and suffered a doctor shortage. Within the next six years, Sollenberger said, the area will be short by about 1,000 doctors of what it needs.
UTMB opened clinics that were close to people who were going without primary care either because doctors were too far away or because they faced waits of as long as six months for an appointment. Patients normally will forgo primary care if they have to drive more than 15 or 20 minutes, Sollenberger said.
"If you have primary care services within that radius, they will come to you," she said.
UTMB now operates 40 clinics at 30 sites in Galveston and Brazoria counties and 34 regional child and maternal clinics, including clinics outside the Galveston-Brazoria region in Orange, New Caney and McAllen.
In response to criticism that a state-funded institution might be competing with the county's only privately owned hospital and doctors in private practice, UTMB officials say they are only accommodating their patients or filling a void. "We try to be sensitive to that," Callender said of taking patients from private doctors. He said such criticism has waned in recent years.
The new 40-bed hospital and emergency room under construction in League City is designed to care for existing UTMB clients, Sollenberger said.
The takeover of Angleton Danbury resulted from UTMB being named the administrative hospital for a 16-county region under a Medicaid program that includes Brazoria County. As part of the program, UTMB did a study looking at medical needs throughout the region. The study found a need in Brazoria County just as Angleton Danbury Medical Center was looking for a partner.
The smaller medical center, operated by a hospital district, was unable to compete with Houston medical institutions when it came to recruiting doctors, said Paula Tobon-Stevens, the hospital's associate vice president. A merger with UTMB solved that problem and gave Angleton Danbury access to UTMB's greater resources, Tobon-Stevens said.
In return for a 30-year lease agreement from the hospital district, UTMB committed to spending $1 million a year in improvements over the first decade.
The merger is part of a national trend that is lagging in Texas, said David Pearson, president of the Texas Organization of Rural and Community Hospitals, of which Angleton Danbury is a member. "A lot more challenges are facing small independent rural hospitals than in the past," Person said, especially finding doctors.
Tobon-Stevens said UTMB will benefit from acquiring a thriving hospital in a county with a fast-growing population. UTMB had lost money for a decade before Hurricane Ike, which for a short time plunged it into major losses.
The medical school returned to the black for the first time in nearly a decade in 2010 with a $30 million surplus -- a figure that has since ranged between $2 million and $10 million, Callender said. Medical branch officials for many years blamed UTMB's losses on its provision of charity care. For most of its history, UTMB was a beacon for the poor.
Weeks before Ike struck in 2008, a memo advised staff to steer the uninsured elsewhere, even those who argued they would die without immediate treatment.
In 2012, UTMB admitted winnowing some potential charity patients and said that most of its charity care was given to emergency room patients.
Uninsured patients at UTMB dropped from 3,128 in 2008 to 233 in 2011, according to data collected by the Galveston County Free Care Monitoring Project.
Across Texas, hospitals are struggling with the costs of uncompensated health care. The state has resisted expanding Medicaid to cover the working poor who cannot afford insurance through the Affordable Care Act, forcing health care providers to pass on the costs or absorb them.
Callender said UTMB tries to do as much as it can for the poor, but charity care is not its "core mission," Callender said.
"We can go broke, if you will, trying to meet the huge need to provide care to the underserved," Callender said. "There is just too much need out there."