In early 2006, Hartford, CT accountant John Richards began to have trouble hearing out of his left ear. His doctor recommended an MRI which revealed a marble-sized tumor near the base of his brain, called an acoustic neuroma. The growth was benign but pressed against the auditory canal, impairing Richards' hearing. Left untreated, the tumor could grow to push against Richards' brain stem, leading to further neurological damage and, potentially, death.
Richards' neurologist recommend he schedule brain surgery, but warned the procedure might damage the nerves connected to facial muscles and, as always with brain surgery, there was a chance he could die on the operating table. The doctor mentioned that a new technology, the CyberKnife, might be able to shrink the tumor without surgery, using focused beams of radiation, but that no area hospitals had the technology.
Richards did some research on the Internet and called Dr. Mark Brenner, director of Radiologic Oncology at Northwest Baltimore's Sinai Hospital, part of LifeBridge Health. Only a handful of hospitals in the country have the CyberKnife. Sinai has two (a distinction it shares only with Stanford University, where it was invented, the University of Pittsburgh, and Georgetown University). Richards and his wife were soon headed not to the Mayo Clinic or Johns Hopkins, but to Sinai, which, in recent years, has built its Brain and Spine Institute into a regional and national powerhouse, giving the hospital its first berth into U.S. News and World Report's hospital rankings.
"The surgery option seemed drastic," says Richards, who took a week off work to come to Baltimore for the treatment. "With the CyberKnife, I had no pain, no medication, no injections, and you can walk out and have the rest of the afternoon." (Dr. Brenner jokes that the Institute should give patients T-shirts that read "I had brain surgery today.")
John Richards is exactly the kind of patient LifeBridge CEO Warren Green hoped to attract when he first conceived the Brain and Spine Institute four years ago. "We want to be the undisputed leader in multi-disciplinary brain and spine care in this region of the country," he says.
The idea was to hire the country's top specialists and acquire the newest technology to create the one-stop-shop for brain and spine disorders. "There are many institutions in town that have strong departments of orthopedics or neurology or psychiatry or neurosurgery, but they were all operating silo fashion," he says. "We said, 'If we could create an organizational model that would allow for all of that science and medical practice to come together under one roof, under one medical director, where everybody was sitting around the table contributing, we could create something here in Baltimore that was unique."
Beyond high-profile doctors and technologies, Green and Institute medical director Michael Williams say its best selling point is that, with nearly all brain and spine services available in one place, where doctors, nurses, and administrators are all familiar with each other, the patient experience is vastly improved.
"From the patient and family's perspective, they would like to have one point of entry," says Williams, who spent 16 years at Hopkins before joining LifeBridge in 2007. "They get the care that they need and they come out on the other end, instead of pin-balling around to doctors' offices."
Richards, for one, returned to Connecticut as a very satisfied customer. In three one-hour sessions, the CyberKnife pointed hundreds of beams of radiation at his tumor, permanently shrinking it to a non-threatening size without surgery or drugs. "I always advise anyone with acoustic neuroma or other brain issues to go to Sinai," he says.
Sinai Hospital was founded in 1866 as Hebrew Hospital and Asylum, and, for much of its 143-year history, it served as the neighborhood hospital for Northwest Baltimore's largely Jewish population, which was starkly loyal to the institution. But in recent decades, the local population has become more diverse and less committed to Sinai. The current leadership recognized that, in order to differentiate itself from other community hospitals, Sinai had to earn a unique reputation, the way GBMC has become known for its obstetrics department or Mercy for women's health.
"We did a market assessment," says Jessica Cooper, administrative director of the Brain and Spine Institute, who was involved in the planning of the center. "We looked at admissions and visits for all the neurological and spine areas within the hospitals in Maryland and there was no clear market leader. There were certain programs where certain institutions excelled—neuro-oncology at Hopkins—but when you looked at them combined, there was an opportunity in the market."
Sinai already had a strong orthopedics department, and Green and Williams predicted that, with an aging population, the demand for brain and spine care would increase. "The time was ripe for neurology and neurosurgery," says Williams. "The baby boomer generation is entering a time when we're at greater risk for the neurological problems that come on with getting older, whether it's stroke or cognitive impairment, dementia as most people know it."
In 2003, Sinai staked its claim as a regional center for the treatment of brain and spine diseases, acquiring its first CyberKnife. The machine made it possible to offer non-invasive treatments of brain and spine tumors and other debilitating diseases like trigeminal neuralgia, an irritation of the facial nerves so painful that it's also called "suicide disease."
In late 2005, Green gathered a physicians advisory council for the Institute, and began building an impressive medical staff. Medical director Williams is the country's foremost expert on hydrocephalus, an accumulation of fluid in the brain, and has treated many prominent patients with the condition, including Baltimore Cardinal William Keeler; Dr. Majid Fotuhi is a nationally recognized expert in memory, who co-authored a book on crossword puzzles and memory with The New York Times' puzzle editor Will Shortz; and Dr. John Brunson is one of only about a dozen neuro-interventional radiologists in Baltimore, and the only one on staff at a community hospital.
The CyberKnife machines, housed in air-tight vaults beneath the Sinai lobby to keep radiation from escaping, are just one element in the Institute's cache of new technology. There is also the neuro-interventional biplane suite—Sinai is the only community hospital in the state with one—which allows Dr. Brunson to view brain images from two angles during procedures, reducing their duration and increasing effectiveness. The Institute recently acquired a transcranial Doppler machine, usually only available at major university hospitals, which offers the most precise monitoring of stroke patients available. And in 2007, the Institute opened a dedicated 36-bed inpatient unit, with centers for stroke, epilepsy, and spine disorders.
The Institute is still in its infant stages, but has already succeeded in broadening Sinai's base. "If you go back five years ago and look at patient origin for these services, it was Northwest Baltimore," says Cooper. "Since then, we've seen an expansion across the state of Maryland and to neighboring states."
The goal, of course, is not just to become a leader in brain and spine disorders but to lift the stature of the hospital overall, a goal Green says is within reach. "The early signs are quite positive," he says. "Ultimately, this could give us here at LifeBridge something that would stand alone in the marketplace."
The U.S. News and World Report rankings are compiled using several factors: One series of numbers measures a department's actual work—the resources it has on hand, its mortality rate, etc.—and another measures its reputation among doctors in the field. Sinai's Neurology and Neurosurgery department had lower mortality rates than many of the top hospitals in the country, comparable resources, and excellent staffing levels. But for reputation, it scored 0.0. Even so, the department squeaked in at number 47, Sinai's first department ever to make U.S. News' Top 50.
"Baltimore is a tough city for a community hospital to make a name," says Green, noting that Hopkins, which ranks as the number-one hospital overall, and University of Maryland, which has five Top 50 departments, tend to overshadow other hospitals in the city. "It's hard for any institution that isn't an international brand name to rise above the fray and be seen, but it can be done."
Community hospitals like Sinai have a hard time competing with university hospitals like Hopkins and the University of Maryland, because their mandate does not typically include the kind of research that helps to raise the institutions' profile among colleagues. But Dr. Williams says he intends to conduct more research at the Institute, not only because it improves its reputation, but because it's good for patient care.
"Getting out there and being known to our colleagues, not only because of our care, but because of our research and our teaching is going to enhance our reputation, and that automatically serves patients better," says Dr. Williams, who has assumed a prominent role in the American Academy of Neurology, as chair of its Ethics, Law, and Humanities Committee. "If you're doing a good job with your research, you're on the leading edge."
Green says it's only a matter of time before Sinai's professional profile rises. "Doctors, especially within their specialty, are very knowledgeable about who's doing what," he says. "When people are doing something special or unique, word gets out."
But it takes something more for a Baltimore-area hospital to become known as the place to go for brain and spine disorders, the way GBMC has come to be known as the place to have babies. Green estimates that the equation is 75 percent reputation among doctors and 25 percent reputation among consumers, even in a field like neurology, where medical expertise seems so key in making a decision about where to go.
"Obstetrics is a field where women will decide, 'Where do I want to have my baby?'" he says. "One could make the case that very few people think about brain tumors and who they would go and see if they got one. But I'll tell you this: When we were encouraged to start advertising for the CyberKnife, a lot of us thought that nobody is going to call us and say that they have a tumor and they want it treated here, based on seeing an advertisement—but they did."
Dr. Brenner estimates that, before the CyberKnife ads, he got a few calls a week from people outside the community looking for information. Now he gets dozens.
That may help the Institute climb higher on the U.S. News rankings, even if that's not exactly their aim.
"If we build what we want to build, that number is going to go up," says Williams. "It's not necessarily the goal, but it's a nice by-product."