Ballard Hospital closed its intensive care unit on Oct. 9 as part of the hospital's owner plan to reconfigure the mix of health services offered there.

Owner Swedish Medical Center said the move would make its Ballard campus more financially viable and to fit more cohesively within the larger framework of the Swedish system.

"Ballard isn't isolated. We've decided to specialize at our two downtown hospitals and now we're looking at Ballard," said Rayburn Lewis, the medical director for Swedish's Ballard and Providence hospital campuses.

Lewis said the hospital's emergency department, which treats about 400 patients a week, would remain in place, and some of the functions formerly provided in the intensive care unit would still be available in that department. But for a patient requiring longer term intensive care, treatment would be provided elsewhere, after his or her condition was stabilized.

"That patient won't stay in the emergency department for more than 12 to 24 hours," Lewis said. "If they have a longer-term problem, we send them downtown."

Swedish Medical Center made public plans to change the mix of services at Ballard Hospital as early as last year, citing multimillion dollar annual losses and changing demographics at the 165 bed campus. That announcement came on the heels of a collapsed merger attempt with Northwest Hospital, off of Aurora Avenue North and North 115th Street, originally hailed by executives as a way to defray high capital costs needed to update infrastructure at both hospitals.

The closure of Ballard's intensive care unit follows the closure of the transitional care unit earlier this year. The hospital still provides a number of inpatient services including obstetrics, addiction recovery services and a low intensity medical surgical unit.

But there are concerns among the Swedish medical staff over the loss of the intensive care unit, and the expertise it provides.

"There are doctors struggling with this change," Lewis said. "They've got to be heard."

One such doctor at Swedish Ballard, urologist Jim Ballo, said he was concerned about patients' welfare as the unit closed.

"If you're a surgeon and you're doing surgery, 99.9 percent of the time, things go well, but in the .1 percent that things don't go well, it's a little worrisome to not have highly trained intensive care unit nurses . . .," he said.

Ballo said that as Ballard Hospital loses units like intensive care, it can create a brain-drain where specialist physicians choose to work with other hospitals offering more sophisticated services, which in turn requires patients to go farther for care.

"A lot of patients, especially elderly ones - and baby boomers are going to be elderly too - it's hard for them to go downtown for specialty care," he said.

But Swedish's strategy for Ballard is driven in part by a survey the medical center conducted last year that found many young people moving into Ballard with the expectation of traveling for services, instead of finding them down the block. According to Swedish, that demographic change, combined with declining inpatient numbers, meant reconfiguring services to stay viable. The alternative would be continuing to hemorrhage money subsidizing the revered but ultimately outmoded notion of a community hospital.

But Swedish has had to tread carefully where advocating business goals impacts perceptions about its community obligations. As a non-profit medical center, Swedish spent nearly $50 million on charity care and other community benefits last year, and raised more than $11 million in charitable contributions. Their annual report is peppered with references to community and Swedish's beneficial role in it. Their responsibility as a community steward is vital to the way they market their business.

In their 1992 merger with Ballard Community Hospital, Swedish gained a larger share of the market for health services, as well as a loyal base in the Ballard community, sometimes fiercely proud of a hospital born of their own collective effort. Indeed, the hospital changed its name in 1968 from Ballard General to Ballard Community Hospital to reflect this community covenant.

"Swedish Ballard was built by its residents. If I was a member of the Knuckle Knockers, I'd be emotionally attached to Ballard Hospital and there's no getting around it. But we get that. That's why we want the hospital to be here," said Ed Boyle, spokesperson for Swedish Medical Center.

The "Knuckle Knockers" (see accompanying story) Boyle referred to were the Ballard residents who, in 1952, went out at night pounding on doors seeking contributions for building a new hospital. They were ultimately successful in raising the $900,000 needed to make the new hospital a reality.

But that hospital is now part of a $1 billion medical services organization with four campuses and 7,000 employees, which provided 91,000 emergency room visits and 33,000 surgeries last year. The competition Swedish must face is not only other health care behemoths like the University of Washington Medical Center, but increasingly, its own doctors. Technology advances have allowed physicians to turn many inpatient procedures into outpatient ones, forcing hospitals to offer ever more elaborate and sophisticated specialty services.

At Swedish's Ballard campus, that specialization comes in the form of babies. Obstetrics programs are being enhanced and Swedish hopes to grow the delivery numbers in Ballard - 623 in 2005 - by 50 percent in the next three years.

But while Swedish plans to welcome more babies to Ballard, the hospital here will not become the capital of obstetrics in the Swedish network. In fact, Swedish's First Hill Campus delivered more than 10 times as many babies as did Ballard last year, as well as having the largest perinatal medicine program in the state for expecting mothers, and Swedish's only neonatal intensive care unit.

"Especially if there's a high-risk element to a woman's delivery, First Hill is the place to be," said Swedish spokesperson Boyle.

But those same high-risk elements are what concern Ballo about the departure of Ballard's intensive care unit, though the urologist has come to view what he sees as a decline in the range of services at Ballard Hospital as inevitable.

"The attitude here is one of resignation. We'll make do with what we have as long as we have it," he said. But Ballo is not the only doctor who has felt despondent about the leadership at Swedish Medical Center.

In 2004, Swedish narrowly avoided a leadership crisis when physicians demanded a confidence vote on Chief Executive Richard Peterson. In the vote by 643 Swedish doctors, Peterson, the first non-physician chief executive at the medical center, received a vote of no confidence from 49 percent of the physicians.

That vote took place during merger negotiations between Swedish and Northwest Hospital. Those talks were ultimately unsuccessful and in October of that year, the Puget Sound Business Journal ran a story reporting that Northwest Hospital doctors helped scuttle the deal because they, too, lacked confidence in the leadership at Swedish. The story sources the chief of staff at Northwest Hospital for saying that doctors at Northwest felt Swedish doctors were poorly treated by management and that "Swedish traditionally has dismantled" those hospitals it took over in mergers.

Peterson has announced he will retire in 2007. If a new chief executive decides to renew talks with Northwest Hospital, it could mean even more significant changes for Ballard Hospital, but in the short term, Swedish hopes to present a business plan for the Ballard campus to its board of trustees in November, which will say much about the direction of the hospital and its future.

In order to convince the faithful that these designs will not dismantle Ballard's notion of what a hospital is, Swedish will need to convince the neighborhood that hospitals can no longer afford to be all things to all people and that the leadership at the medical center has the community's interests at heart.

For Eddy Harrison, a fourth generation Ballardite, there was a time when he said he was critical of the organization for endangering his sense of what a community hospital should be. But he says he's willing to give Swedish a chance.

"Do we need to hip replacements in Ballard? The emotional side of me says yes, we need everything we can out here. On the other hand ... Swedish is going to find out what's going to work in this area and go for it."

Steve Clark may be reached via bnteditor@robinsonnews.com