BY DELONA LANG BELL AND GEORGE ALAN HEIN

HEN ELLEN WHITE ENVISIONED Adventist hospitals, she insisted that they be marked by a spirit of service.

Today, as the Los Angeles-based White Memorial Medical Center celebrates its ninetieth year, few attributes would characterize it better than a spirit of service--an attitude deeply etched in the hearts of those who have chosen to work at this inner-city hospital. That eagerness to serve has held together an institution that almost closed its doors on many occasions in the face of daunting challenges.

If it had the habit of fleeing when hard-pressed, White Memorial
--the hospital that bears the name of Ellen White-would long since have packed its bags and moved to greener pastures.

But White Memorial is a hospital of grit and courage. A hospital that has learned to hang on through tough times. A hospital that believes that extending the healing ministry of Christ means staying and providing excellent care to its community--regardless of the obstacles it may face.

In fact, the ability to hang on through tough times has characterized White Memorial from day one.

On the Wings of Hope
The air hung heavily at the 1915 Autumn Council as church leaders struggled to find a way to keep open the College of Medical Evangelists--later to become Loma Linda University School of Medicine--open. The medical school was in its infancy, and its future seemed tenuous at best. Four months after the death of Ellen White, the church's preeminent leader and cofounder, the existing debt for the CME was sobering to the still-tiny denomination. Some leaders felt that perhaps the school should be closed or made into a two-year institution.

To secure accreditation, the church had already borrowed the then-staggering sum of $400,000 (approximately $7.2 million in 2003 dollars) to invest in the college--an investment that included purchasing a clinic in East Los Angeles to provide a broader spectrum of patients for medical students to treat.

Even so, the American Medical Association still denied the school its coveted "B" rating, which meant that graduates were also denied practice rights in many parts of the United States. Disheartened constituents realized that a better hospital facility would be required to achieve the advanced rating.

While church leaders wrestled with the financial issues, four women knocked at the door and asked to speak. Josephine Gotzian, Hetty Haskell, Emma Gray, and Florence Keller, M.D.--none of whom were delegates--presented a plan for the women of the Seventh-day Adventist Church to raise the needed $61,000 to construct a hospital named after Ellen White.¹

"There was a hush in the room," says Jewell Parrilla, M.D., author of Prayers, Tears, Sacrifice: The White Memorial's Story. "And after that they adjourned. But the next morning when they met again, they said, 'We do not stop, we go forward.'"

The women immediately went to work spearheading the drive for money. Women from all walks of life rallied and sent donations large and small earned by sewing clothes, selling farm products, and auctioning treasured household items.

By December 1916 the funding was in hand to build the hospital and other necessary buildings, including a student dormitory.

Out of the Briar Patch
The grit and courage that became central to the hospital's institutional culture took root early. Perhaps no one exhibited this spirit more than Percy Magan, M.D., who served as the dean of the College of Medical Evangelists, with the added responsibility of developing the Los Angeles-based campus.

A potential building site had been located just across the Los Angeles River from the city's booming downtown in a community of working-class immigrants called Boyle Heights. When Magan first saw the property, some goats happily grazed there on weeds and cockleburs.

Armed with approval from a fiscally conservative board to buy only half of the available tract, Dr. Magan personally negotiated the land purchase. He returned with startling news: He had bought it all.

In retrospect, the acquisition of the entire plot proved to be providential for growth decades later, but at that moment it seemed breathtakingly risky. It was only one more example of a faith-based spirit of initiative that increased as the campus grew.

When the first patient entered White Memorial "Cottage" Hospital in 1918, its 11 one- and two-story buildings could accommodate up to 200 patients. It quickly emerged as the largest facility of its kind west of Chicago.²

Battling Depression
Soon after the hospital opened its doors, however, another crisis loomed on the horizon.

During the 1920s the United States enjoyed another of its periods of unbridled prosperity. Unemployment rates were very low: anyone who wanted a job could find work, often in a factory mass-producing automobiles, radios, or other consumer goods. Stock market investments fueled the dramatic growth and provided a ready source of capital for plants and equipment. Everyone, it seemed, was making money.

In 1929 construction started on a new headquarters for the Los Angeles Stock Exchange at 618 Spring Street, less than three miles from White Memorial. But no sooner had the ceremonial shovels turned sod at the Stock Exchange groundbreaking than Black Tuesday (October 29, 1929) arrived with an economically deadening thud.

Undaunted A robust crowd of several thousand people gathered to herald the completion of White Memorial Hospital in 1918. The keynote speaker was delivering an impassioned address when the earth started to tremble and shake. Instantly a hushed silence fell over the crowd. Then from the roof of the building someone shouted, "Don't worry; it's only an earthquake." The crowd quieted, and the ceremony continued. If the event was a foreshadowing of challenges White Memorial would face in the years ahead, it was also a foreshadowing of its unshakable spirit. Special thanks to Richard Schaefer, whose historical review of the article helped verify important information.

Massive layoffs followed in almost all industries, banks called in loans, and within weeks a once-prosperous economy spiraled into what historians now call the Great Depression.

Just up the street from the ill-fated stock exchange, White Memorial too reeled under the loss of revenue and struggled to regain some kind of financial equilibrium. In an era before public or private medical insurance provided a safety net, almost all patients paid for their own medical treatment and care. And when a person needed to choose between food on the table for the family or a visit to the doctor, the decision was clear. At one point the hospital occupancy fell to 50 patients.³

Some physicians agreed to take their wages in the form of eggs and flour. Without pay, medical students scrubbed floors, cooked, and did everything possible to keep White Memorial in operation. A group of employees rallied, calling themselves "Ellen White" nurses, and donated time to care for the poor in Los Angeles.⁴

By the mid-1930s, as the country lifted itself from the financial disaster, White Memorial too had weathered the financial storm. But it had barely survived the lean years when the hospital leadership discovered that new building ordinances and an inadequate size meant that a new facility would have to be built. By 1936 they constructed a new hospital building, which at the time was called "one of the best-built structures in Los Angeles."⁵

No Travel to This Mission Field
The challenges for White Memorial were just beginning, however.

As the population of Boyle Heights shifted, the organization faced new and different tests. Citizens of Mexico, frustrated and frightened by an unstable government and a lackluster economy in their own country, migrated to East Los Angeles, attracted by affordable housing and jobs. Boyle Heights and East Los Angeles eventually became home to the largest Hispanic community north of Mexico. Today it is a proud community comprised largely of young, hardworking first-generation Americans who work at jobs that often barely lift the family income above the poverty level.

This demographic shift stretched White Memorial to find new and better ways to understand the community it served, and to provide care in a way that was culturally sensitive. It also pushed the hospital to the brink of financial calamity, as much of its patient base had no health insurance--but still had pressing medical needs.

A "strictly business" approach would have demanded that the hospital pack its bags and move to the more affluent suburbs. But the spirit of service deeply embedded in its core values insisted that neither the hospital nor Adventist Health, its church-sponsored health system on the West Coast, could leave during hard times.

Providential direction had been clear in its past, and many hospital leaders and employees believed it would be clear in its future as well. White Memorial persisted in welcoming those in need of care--knowing full well many would be unable to pay. Its work, after all, was a mission. And its mission field, after all, was in Boyle Heights. White Memorial worked hard to embrace new populations and to find new and better ways to serve them.

"Because of its resolve, the hospital's management team and medical staff have worked to create a model of care that understands the culture of the people it serves," says Donald Ammon, president and chief executive officer of Adventist Health, the church-sponsored health system on the West Coast. "It now has the proud distinction of being the first hospital in the United States to offer a medical residency specifically for doctors who plan to serve a largely Latino population."

One can't help thinking that Ellen White and other founders would smile with satisfaction at the way the story was unfolding.

Saying Goodbye to Loma Linda
For White Memorial, adaptation has always been a central theme of its survival. But even as the hospital grappled to adapt to its changing community, it faced pressures that again threatened its viability.

A decision in the early 1960s to consolidate all the clinical years of medical training at Loma Linda University, almost 60 miles away, brought another crushing blow to White Memorial. Under extreme pressure from the accrediting organization to operate classroom and clinical programs at one location, leaders agonized over the impact of ending these programs at White Memorial.

For 50 years White Memorial had worked hand-in-glove with Loma Linda University School of Medicine in the training of physicians. The goal of creating a teaching hospital had up to that point been the driving force that had led the White to recruit a strong faculty and to invest in technology and equipment that went well beyond what a typical community hospital would need.

Even so, in 1963, the clinical programs all returned to Loma Linda University.6

The staff left at White Memorial may have understood the decision rationally, but they couldn't escape the sense of loss. Rather than retreat, however, the hospital regained its equilibrium and vowed to remain true to its mission. It renewed its commitment to provide not just good--but exceptional--care to the people of East Los Angeles.

Determined to carve out a special future for their hospital, physicians and leaders went to work redefining White Memorial. Over time they succeeded in transforming the hospital from a specialty-driven teaching facility to a community hospital that teaches but that also has retained high-level specialty-care services.

Many of the physicians so believed in this mission that they opted to stay during this dark time, rejecting other job offers that would have significantly increased their income. Like others throughout the hospital's history, those who remained vowed that this hospital would survive--and even thrive.

Even so, the decades that followed were defined by financial difficulties, as White Memorial struggled financially year after year--losing money consistently from the mid-1970s until the late 1980s. Were it not for the hardy will of the White Memorial staff and physicians, the hospital would probably not have survived the nation's long recessionary cycle in the mid-1970s and late 1980s.

A Near-fatal Blow
As the U.S. economy rebounded in the mid-1980s, the hospital was powerfully tested in other ways. A near-fatal blow landed when the U.S. government made a major change in the way it paid hospitals for providing care. For decades the government had paid for each service, procedure, and test, albeit at a discounted rate. But because of skyrocketing health-care costs, the government instituted a new policy of paying a single flat fee for care once a diagnosis was established. This instantly put pressure on hospitals to do business in an entirely new way, and dramatically reduced already-shrinking revenues.

In the face of these changes, administrators of White Memorial Medical Center took stock of their situation. They served a community unable to pay. Now the government had ratcheted down reimbursement rates. As if matters weren't bad enough, outside consultants began evaluating the hospital for potential sale.

It was certainly one of the darkest hours in the medical center's history, and clearly no place for the faint of heart. Financial pressures intensified as White Memorial tightened its belt, and even drastic attempts at cost-cutting seemed inadequate. The hospital had by now taken on more debt than it was worth. Logic dictated selling the hospital and using the proceeds as seed money for a brand-new facility in a more affluent community.

At its founding, four women had unexpectedly arrived with the promise of $61,000. This time much more was needed.

The Vision Continues Groundbreaking took place in July 2003 for a new main hospital building at White Memorial Medical Center, the hospital named after Ellen White that is located just east of downtown Los Angeles. The construction is part of a $183 million project that will rebuild or renovate the entire White Memorial Medical Center campus. More than $30 million of the funds for this project will come from donations from people who want to continue the legacy of Ellen White and the work of those who have sustained her vision at White Memorial. For more information contact: Mary Anne Chern, Charitable Foundation, White Memorial Medical Center, 1720 Cesar E. Chavez Ave., Los Angeles, California. Phone: 323-268-5000, ext. 1212.

And it arrived, just in time.

As White Memorial struggled to care for an increasingly diverse population in the late 1980s, the state of California determined that medical care would evaporate from poor neighborhoods unless it acted quickly to help. Legislation was proposed to provide additional funding to hospitals that served exceptionally poor communities. That legislation might well have had the name of White Memorial Medical Center stamped on the cover, for the hospital was a textbook example of an inner-city hospital in crisis.

Frank Dupper, then chief executive officer of Adventist Health, remembers vividly the miraculous series of events that changed the future of White Memorial.

"I was sitting in my office in 1989 when I got a call from a consultant who told me about a bill that was slated to give federal dollars to the state of California for public and children's and state hospitals. He believed that some wording changes to this bill might make White Memorial eligible to get these funds. I had no idea this was coming. This was a public/county hospital program, and we didn't think there was a chance a private hospital like ours could get these funds. That bill was to be voted on the next day in the senate. It was a last-hour miracle."

Soon the first of checks that would amount to millions of dollars arrived-dollars used to ensure that the hospital would be able to continue its mission in the future.

Faith and sticking to its mission had been rewarded.

"But that wasn't the end," says Dupper, who still gets teary-eyed when talking about the White.

Not long after, the Federal Emergency Management Agency (FEMA) approved funding for select hospitals throughout Los Angeles in order to provide structural upgrades that would ensure that these "safety net" hospitals would remain standing after a major earthquake. Because of its medical excellence and leading role of providing care to a neighborhood of more than 200,000 people, White Memorial was designated to receive $90 million to upgrade its facilities.

"This proved to be another miracle," says Robert Carmen, then chief executive officer of White Memorial and now executive vice president and chief operating officer of Adventist Health. "Without this it would have been impossible to embark on the present project of rebuilding and renovating our campus."

Courage--From the Past, for the Future
Those who work today at White Memorial are hardy stock, not blinded by the miracle funds that will pay for a large portion of their new campus. They are well aware that the future will hold challenges for the hospital--just as the past has. They know full well that the realities of a nursing shortage, continued belt-tightening in reimbursement, and spiraling malpractice insurance rates are only a few of the challenges that loom on the immediate horizon.

"The family at White Memorial knows that it will be able to continue to draw on its past, the courage and commitment of the people who work here, and the divine guidance that has so often sustained this hospital through previous trials," says chief executive officer Beth Zachary, herself the daughter of missionary parents.

Today, despite its challenges, White Memorial has regained a strong financial position through careful stewardship and prudent planning for the future. The hospital is forging ahead with a $183 million project that will rebuild its facilities for patients and physicians and will stand as a proud tribute to the gospel commission to serve people in need. Though nearly half of the dollars will come from FEMA, many credit a watchful heavenly Father for once again watching out for White Memorial--the hospital committed to serving the underserved.

Beth Zachary sums it up best: "To draw courage for the future, one only needs to look to our history."

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¹ The Medical Evangelist, Feb. 15, 1940, p. 4.
² Jewell Parrilla, Prayers, Tears, Sacrifice, the White Memorial's Story, p. 34.
³ Ibid., p. 60.
⁴ From Vision to Reality, p. 86.
⁵ Diamond Memories, p. 85.
⁶ Ibid., p. 86.

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DeLona Lang Bell is a communications consultant and entrepreneur living in Walla Walla, Washington. George Alan Hein has worked in health care and communications for more than 20 years and abundant faith kept this hospital alive.