Ellis Fischel relocation could mean improved care for patients, efficiency for physicians

COLUMBIA — In the early years of the Ellis Fischel State Cancer Hospital, the three staff doctors would meet regularly in the medical staff conference room, which consisted of a single table, a projector and three chairs, to discuss the diagnosis and treatment options of cancer patients.

Today, more than 50 physicians work with the Ellis Fischel Cancer Center between the inpatient and outpatient sites. Physicians still use the multi-discipline care model to diagnose and treat patients that was developed by Ellis’s first staff doctors. As opposed to other settings where a patient might have to visit several different doctors at different times, Ellis’s multi-disciplinary approach brings all of the doctors to a patient at one time to discuss his or her best treatment options.

In 2007, Ellis Fischel Cancer Center physicians treated about 1,100 new cancer cases, said Jeffery Hoelscher, media relations coordinator for MU Health Care. Approximately 30,000 people in Missouri were diagnosed with cancer in 2007, according to the American Cancer Society.

Ellis Fischel State Cancer Hospital, the first cancer hospital west of the Mississippi River and second cancer hospital in the United States, opened its doors in 1940. Ellis Fischel has been dedicated to providing comprehensive cancer care to patients in nearly every county in Missouri since that time.

Established in a time before chemotherapy treatments, Ellis Fischel has experienced many changes in the past seven decades.

Ellis Fischel’s origins can be traced to a standing committee on cancer, which was appointed by the Missouri State Medical Association in 1931. The committee was established to inform citizens about cancer and to educate physicians about methods of treatment.

The success of the program highlighted the growing need for cancer treatment services in Missouri.

A Jan. 10, 1937, editorial in the St. Louis Post-Dispatch said:“In view of the alarming increase in cases and deaths, in view of the deplorable shortage of facilities for needy sufferers, Missouri needs a state hospital for this purpose and clinics at various central points. The Legislature should consider this problem seriously at its next session.”

Later in 1937, Sen. Michael Kinney introduced a cancer hospital bill to the 59th General Assembly. The bill provided for the building and operation of a state cancer hospital. It was passed and signed by Gov. Lloyd C. Stark on May 28, 1937.

Ellis Fischel, a St. Louis physician, was selected as the first chairman of the State Cancer Commission.

In November 1937, the Missouri State Cancer Commission selected Columbia as the site for the hospital. Columbia’s central location and the presence of two major highways, U.S. 40 and U.S. 63, intersecting in the city, contributed to this decision. In January 1938, with funding from the state and the Federal Works Program, a 40-acre tract of land where the seven-story hospital was built was bought from the Proctor family.

“This building and those inside of it have quite a history in terms of how they serve the people of the state of Missouri,” said Jane Armer, professor of nursing and director of nursing research at Ellis Fischel.

One of these services includes striving to offer the most up-to-date treatments available.

“Any protocols that are available and are funded by National Cancer Institute through the country, are available here… ,” Armer said. “People may think they need to go to a big city, or some place else to get the latest treatment, but those latest treatments that have been approved are here.”

In addition to providing modern treatments, an essential function of Ellis Fischel in its early years was to take care of people who had no means of paying their hospital bills. The state paid for their care.

In order to receive treatment, two pieces of paper were required from patients: one stating that they were suspected of having cancer and another documenting their financial status, said Michael Perry, director of the Division of Hematology and Medical Oncology at Ellis Fischel.

This provided a great service to citizens for many years, though the introduction of Medicare and private insurances in the 1960s made this assistance less necessary. These insurance programs made it possible for patients to receive treatments at other locations.

Although the hospital started collecting some money from insurance companies, Ellis Fischel was not treating enough patients annually to be self-sustaining.

As a result, the State Cancer Commission and the Board of Curators arranged for a merger of oncology services with MU Health Care. The two systems merged in 1990.

It took time for University faculty and Ellis physicians to adjust to the transition from the culture of a state-funded hospital to a hospital operated by MU Health Care.

“Until we all got to know each other and work together, there were a few bumps in the road, but nothing major,” said Bill Caldwell, medical director of Ellis Fischel. “Over time, it all melded together.”

In November 2000, the inpatient and outpatient units were divided between the two locations. As cancer treatments and therapies evolved, the need grew for better intensive care units and around-the-clock support, which the University hospital could provide. However, the distance between the two units has posed inconveniences for patients and medical staff.

“It’s not unusual for physicians to average one or two trips a day back and forth,” Caldwell said.

When the Ellis Fischel Cancer Center was built 70 years ago, it was a state-of-the-art facility. Since that time however, the stationary walls have not been able to evolve with the ever-advancing medical field.

“We’ve had to put functions in this building not based on how well they work with each other, but what available space we had to put them into,” Caldwell said. “They don’t work together as smoothly or synergistically as they could.”

The clinic areas, laboratory and chemotherapy sites exemplify this problem. “It would make sense to put all of these into close proximity, but because of space constraints, they are all on separate floors,” Caldwell said.

In 2005, MU Health Care began a planning process to map out the future of the system through 2010. The relocation of the Ellis Fischel outpatient services to the University Hospital and Clinics campus was part of this plan, Hoelscher said.

A new Ellis Fischel Cancer Center will be built adjacent to University Hospital on the MU campus. The tower will be built on the north side of University Hospital. Groundbreaking is expected to occur in February 2009.

“This new building is giving us an opportunity to redesign how everything works together,” Caldwell said.“It is an opportunity for us to improve the way that we deliver care.”

The new facility will bring outpatients and inpatient services together and will help to improve the coordination between University Hospital and Ellis Fischel physicians.

Phase I of MU Health Care's master facility plan is projected to cost $220 million. It will be funded with $31 million from the state, $120 million in bonds, $75 million in operating revenue and $25 million from philanthropy. The portion of the new facility that will be the Ellis Fischel Cancer Center will cost an estimated $52 million, Hoelscher said.

Included in the facility will be space for radiation oncology, expanded radiology and imaging capabilities, chemotherapy treatment, outpatient surgical procedure rooms and recovery areas, 24 examination rooms, the Margaret Proctor Mulligan Breast Center, Cancer Screening Services, Mid-Missouri’s only lymphedema center and a variety of cancer survivor and quality-of-life services, Hoelscher said.

“We are just now in the process of working with architectural design firm to build the building,” Caldwell said. “As we’re designing, we’re going to be figuring out what functions we need in the new building versus in the main hospital, and how these would interact with each other, and which need to be in closer proximity to each other than farther apart.”

Cancer is the second-leading cause of death in Missouri, resulting in more than 12,500 deaths in 2007, according to the American Cancer Society. The new Ellis Fischel Cancer Center facility will increase the center’s potential for timely screening, diagnosis and treatments in hopes of improving and extending the lives of cancer patients.

Referring to the 70-year-old building where Ellis Fischel first started, Caldwell said, “A lot of us have real sentimental attachment to the place, but at the same time, we know that to provide better care for more people, that it is going to require a new building and move.”