'We're getting there': Austin's Dell Children's hospital keeps taking steps toward its lofty goals

Fifteen years ago, Dell Children's Medical Center of Central Texas opened its doors in Austin. It promised to bring services to Austin for which local children were traveling to Houston, San Antonio and Dallas.

In June 2007, leaders promised that within a year Dell Children's would begin doing bone marrow transplants and kidney transplants.

Those two programs have not yet been realized.

This summer, Dell Children's expects to perform its first pediatric kidney transplant. Within a year or two, it promises to begin a bone marrow transplant program.

Dell Children's at 15 is now beginning to fulfill the promises it made to the community in 2007. It took population growth in the Central Texas, the opening of the University of Texas Dell Medical School and significant investment in the children's hospital by Ascension Seton, which owns the hospital, and private funding by donors such as the Michael and Susan Dell Foundation and the Nyle Maxwell family through the hospital's foundation.

For its first 10 years, the hospital was built as sort of a Noah's Ark. It hired two doctors for each specialty: two in genetics, two in rheumatology, two in infectious disease, etc., in addition to the cardiology, neurology and oncology practices that were already there. It didn't focus on building nationally known signature programs.

The quest to build signature programs began with new hospital leadership at the end of 2017 and the start of the Dell Medical School in July 2016. The medical school and Dell Children's formed a partnership in sharing the costs of many of these programs, including the physicians, who also teach at the school.

In the past five years, Dell Children's has begun these signature programs:

• Its Texas Center for Pediatric and Congenital Heart Disease began doing heart transplants in October 2020.

• The Comprehensive Fetal Care Center did its first in utero surgery in December 2021.

• The Pediatric Abdominal Transplant Center will start with kidney transplants this summer and expand to liver transplants.

• The UT Health Austin Pediatric Neurosciences at Dell Children's, the Dell Children’s Comprehensive Epilepsy Center and the Pediatric Neurosurgery Center of Central Texas have expanded the surgical offerings and treatments now available in neurology.

"It's full-speed ahead," said Christopher M. Born, president of Dell Children's. He arrived at Dell Children's in October 2017 from Texas Children's Hospital in Houston. He said his goal is for "every area of the pediatric ecosystem to be full spectrum" and to broaden specialty care so Austin-area families will not have to drive to other cities for care.

"We need to meet the needs of a growing community," Born said.

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In addition to starting new programs at Dell Children's, the hospital is in a period of physical expansion. In November, a second hospital, Dell Children's North, will open at Avery Ranch Boulevard and U.S. 183A. It also will open a fourth tower at the main location in East Austin. It previously added a third tower, as well as an inpatient mental health center.

Last year, it opened up Dell Children’s Specialty Pavilion next to the main hospital. The pavilion houses the cardiac, neurology, oncology and fetal centers.

More than $750 million has been invested in this recent growth.

That growth won't end with these projects. Within two or three years, Dell Children's also will be looking at expanding to the south with a medical office building and then an ambulatory surgery center, Born said.

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Austin needed to grow up

Austin's experience with a children's hospital started with incremental steps. It began as a separate wing of the city's public hospital, Brackenridge Hospital. Then in 1988, Austin Children's Hospital opened next door to Brackenridge.

By 2005, Austin had outgrown that hospital, and Ascension Seton began building what would become Dell Children's.

In the decades that Dell Children's was being built and operating, the Austin metropolitan area has grown with it. In the 2000 census, the Austin metropolitan area had 1.25 million people, according to the U.S. Census Bureau. By 2010, the population had grown to 1.7 million, and as of 2020, the population was 2.3 million.

If you compare similar metropolitan areas with about 2 million people, their children's hospitals already have many of the services that Dell Children's has just begun developing or is in the process of developing:

• In Indianapolis, Riley Hospital for Children can do heart, kidney, liver, intestine, pancreas and bone marrow transplants.

• Cincinnati Children's Hospital provides heart, kidney, liver, lung and bone marrow transplants.

• In Kansas City, Mo., Children's Mercy does heart, kidney, liver and bone marrow transplants.

• In Denver, Children's Hospital Colorado offers heart, kidney, liver, lung and bone marrow transplants.

• In Charlotte, Levine Children's Hospital does heart, kidney, liver and bone marrow transplants.

• In Nashville, Monroe Carell Jr. Children's Hospital does heart, kidney, liver and bone marrow transplants.

In Austin, Dell Children's does heart transplants.

Kidney transplants will start this summer. The pediatric kidney transplant program could not begin, Born said, until it established an adult program at an Ascension Seton hospital to share resources as well as be able to take care of the adult donors. Dell Seton Medical Center started that program last year, with its first transplant in February.

Liver transplants will start after kidney transplants and be done by the same team as the kidney transplants. It could be a year or more. The adult liver transplant program will happen first.

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Lung transplants are planned for a future date and will need a team to be recruited first.

Bone marrow transplants are expected to begin next year or the year after. Dell Children's is in the process of hiring that program's director. The new fourth tower at the main hospital will have an oncology wing that will have some negative pressure rooms designed for bone marrow transplants. Technically, the hospital does have four rooms in an existing tower that were designed for this purpose, but those rooms have never been used in that way because the bone marrow transplant program did not begin.

Dr. Meena Iyer, chief medical officer at Dell Children's, began working at the hospital when it was still Austin Children's Hospital in 2002.

To grow into its program, Austin needed a strategic children's hospital leader, she said. "It's having a vision and a leader and a strategy," Iyer said. "And not thinking of pediatrics as a service line."

What would become Dell Children's needed to see growth in programs as well as support of those programs, she said. Key to that "was our ability to hire luminary physicians," she said.

Those are the physicians that would lead the programs Dell Children's has developed in the last five years and is continuing to develop.

Austin needed a medical school

Before Dell Medical School opened its doors to the first class in July 2016, Dell Children's had a recruitment problem.

"We would have grown incrementally," said Born. "Having the medical school here gives us the ability to recruit physicians that are trained in academic medical centers."

The doctors with whom he worked in Houston were used to being able to teach the next generation of doctors at a medical school; do research in their field at both a medical school and a children's hospital; and launch initiatives and innovations.

In the past four years, Dell Children's has recruited 220 physicians, Born said, and expects to add an additional 63 within the next year. The medical school estimates that it has added 415 doctors in pediatric and adult care to Central Texas since it opened.

The first big get for Dell Children's was the recruitment of Dr. Charles Fraser Jr. from Texas Children's in 2018 to lead the pediatric and congenital cardiac disease program and to build the team that would do heart transplants, ventricular assist devices and mechanical hearts.

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That was followed by Dr. Steve Roach from Columbus, Ohio, and Dr. Elizabeth Tyler-Kabara from Pittsburgh to lead the neuroscience team, and Dr. Kenneth Moise Jr. from Houston and Dr. Michael Bebbington from St. Louis to lead the fetal care team. Dr. Nicole Turgeon came from Atlanta to start both the pediatric abdominal transplant team and the adult abdominal transplant team at Dell Seton.

These doctors built teams from what existed at Dell Children's as well as recruited from across the country. Dell Children's also started creating fellowships for these programs and others. Fellowships are key to recruiting leaders in a specialty because these are leaders who want to grow future specialists.

"Chuck (Fraser) showed us how you can do it for heart," said Dr. Leah Harris, chair of the Dell Medical School pediatrics department and director of the school's Dell Pediatric Research Institute. She predicts the same level of care and prestige will happen for abdominal organ transplants, bone marrow transplants and gene therapy.

"We're getting there," she said of Dell Children's becoming a top-tier children's hospital. "We're not there yet. We probably have another five years of putting the basic building blocks in place."

Austin needed a culture of giving

Just as Dell Children's needs to support the community, Born said, "the community needs to support Dell Children's in its growth objective."

In Houston, where many of Dell Children's leaders came from — including Born, Moise and Fraser — the community had a legacy of wealth and giving to hospitals, Born said. "Austin is a different climate all together," he said.

Austin is the University of Texas, the state capital and new technology. Born said, "it's a lot of young people that may not have the legacy of giving and supporting a children's hospital. That needs to change."

Born calls it "armed combat every single day with community stakeholders" to raise the level of support that the children's hospital needs.

Dell Children's is in the middle of its Here campaign, to raise funds to build out programs to keep kids in Central Texas for care. It's a $90 million campaign, with a $30 million match from the Michael and Susan Dell Foundation. The foundation has raised $67.3 million of the $90 million, and it is expected to wrap up the campaign by July 2023.

Meeting the needs of Austin's future

Born's goal is for Dell Children's and Dell Medical School to be known as a top-tier academic medical hospital serving all children. "A top-tier hospital for a top city," he said, as well as "truly becoming a destination medical center."

Some of that is beginning to happen. Cardiac, neurology and the fetal center are starting to see patients from around Texas as well as from around the country and with some global interest, because of the reputation for those centers' leaders and the research that they brought with them to Dell Children's.

The programs it already has established or is establishing will not be enough.

"We have to do the right thing for the children of Austin," Born said. "We have to grow and meet the growing needs of Central Texas. We have to grow, period."

One potential goal on the horizon is creating a genetic institute for rare diseases. That's Harris' passion, and she has started to pull together the people to begin initial talks on how it would be created and what the current state of genetics and rare disease treatments in Austin is versus what it could look like.

"With genetic diseases, they go without a diagnosis for extended periods of time," Harris said of those families.

Some of the kids treated would be like 8-year-old Crosby Fitzsimmons, who has Morquio syndrome, a genetic disease in which his body doesn't produce enough of an enzyme to break down sugar chains naturally. This affects the bones and spine as well as organs. For Crosby, it was first seen as a curvature in his spine when he was 8 months old, but he wasn't diagnosed until he was 2.

"It was a long process," said his mom, Kerri Fitzsimmons. Getting that diagnosis, though was affirming, she said: "You're not crazy. There is something. Now I can deal with that."

Crosby needs weekly infusions of a synthetic enzyme. The family's goal is to always make it fun. "It's social hour. He's a regular at the diner, and he has his waitresses (the nurses). He loves to be there," his mom said.

The institute would be about getting children like Crosby diagnosed earlier, researching and studying therapies that could be used or developed for these diseases, and connecting families to the leaders in those diseases. Not every disease leader would be in Austin, but the institute would connect families through telehealth methods to those leaders, while caring for the children here in Austin, instead of requiring families to travel to those leaders. The institute also would provide the overall patient navigation to resources for treatments, therapies and support.

Dell Children's already has space available. When it built the Specialty Pavilion next to Dell Children's main hospital last year, it left an empty fourth floor. Funding has not yet been earmarked for the institute and would likely happen after the funding of the $90 million HERE campaign and the $750 million investment Ascension has put into Dell Children's for the new buildings and the programs it already has begun building.

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The institute would bring together the research scientists and technology developers in the academic community as well as Austin's biotech community and the nation's Big Pharma companies, Harris said.

She sees it as a team to diagnose as well as look at research into treatments and at the repurposing of already FDA-approved treatments for other diseases. "That's how we're thinking of transforming the future," she said. "Those types of breakthroughs."

The gene therapies that have been developed for three diseases, "that's just the tip of the iceberg," for future development, Harris said.

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Harris also sees Dell Children's as having the potential to lead in the transition between pediatrics and adulthood. Many diseases were just pediatric diseases a few years ago, but now with new therapies and treatments, those children are living into their teenage years and into adulthood. They need champions to study those diseases in adults and transition care.

In the next year, Harris said, she is looking to recruit a leader for the genetics institute, what she calls the "genetic institute version of Chuck Fraser and Ken Moise. Then let the thoroughbreds run."

Within 10 years, Harris said, she believes Dell Children's will be nationally recognized for its programs. "There's a genuine commitment to the community," she said. "There's almost an addictive energy and enthusiasm in watching programs like this succeed. ... At such a high level, to be impactful and change a community is incredibly powerful and so rewarding. You want to take it to the next level."

It's that singular vision of wanting to take care of children here, which means assembling all the right players, she said.

"Fasten your seat belt," Harris said. "This is going to be a wonderful ride."

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Dell Children's key dates

June 30, 2007: Dell Children's Medical Center opens with two towers.

May 6, 2013: Dell Children's opens third tower​ to build capacity to 214 staffed beds.

May 21, 2018: Dell Children's opens Grace Grego Maxwell Mental Health Unit.

June 25, 2019: Cardiac care unit opens, making new cardiac program possible.

Oct. 3, 2020: Dell Children's First heart transplant performed.

May 4, 2021: Specialty Pavilion opens with the new Comprehensive Fetal Care Center.

July 7, 2021: First baby born at new labor and delivery unit.

Coming in November:

Dell Children's North to open: 187,000-square-foot hospital with 36 hospital beds and 18 emergency department bays alongside a 60,000-square-foot medical office building.

Dell Children's main fourth tower to open: Adds 72 beds, including space for oncology/hematology, pediatric critical care and a general unit. Dell Children's also expands its neonatal intensive care unit. 

This article originally appeared on Austin American-Statesman: Dell Children's at 15: Austin hospital moves closer to its lofty goals