Anchoring the Regional Safety Net -- $25 million

Subsidized Services

James Musgrave remembers going to bed the night of April 25 with plans to report, as usual, the following morning to his Metro East employer. The next thing he can recall is waking up in the trauma Intensive Care Unit at Barnes-Jewish Hospital four days later. A work-related electrical accident left him with severe electrical burns and no memory of the intervening days.

A 23-year-old former high school triathlete, James learned later that he suffered electrocution after touching a work truck that had come in contact with a power line. He suffered cardiac arrest in addition to the burns and was stabilized at Alton Memorial Hospital before being helicoptered to the Barnes-Jewish trauma Intensive Care Unit. James was lucky to be alive, but just walking was an almost impossible task. After several days in intensive care, he entered rehabilitation on his road to recovery.

Today, thanks to an intensive, six-month individualized exercise program, James is in even better physical condition than before the accident. His success was helped in no small part by his determined attitude and previous good physical condition.

Tim Buchman, MD, chief of acute and critical care surgery at Washington University School of Medicine and Barnes-Jewish Hospital, says the meaningful standard of care for trauma patients is not just survival, but return to the function and activities they enjoyed before their accident.

“We view even the most serious injuries as ‘dings and dents’ and focus our efforts on sustaining and strengthening the core physiological systems,” says Dr. Buchman. “We aim for complete restoration of function.”

When he entered therapy in October 2007, James estimates his strength was about half that of his previous level. He had trouble balancing, couldn’t turn easily and had difficulty getting up from a seated position. Exercise therapy involving basically every muscle in his body -- individualized boot camp, says Buchman -- built his core strength and helped him regain his balance.

James’ accident changed his life in more ways than one. He is enrolled at Clark Community College to become a personal trainer. He wants to help others overcome their personal obstacles.

In the complicated world of hospital finance, some health services help bring in revenue while other needed services are provided to the community at a financial loss to the hospital. Referred to as subsidized services, these are the very services that are most important to the community: trauma care, neonatal intensive care, obstetrics and mental health.

BJC operates the only hospital in the city of St. Louis that still offers maternity services, as well both adult and pediatric Level One trauma centers that treat the most severely injured in need of the most advanced and complex care. BJC’s pediatric hospital, also located in the city, has a Level One neonatal intensive care unit for premature and critically ill infants. BJC’s Christian Hospital in north St. Louis County is one of the few area hospitals remaining that offers inpatient psychiatric services, including specialized care for geriatric patients. BJC Behavioral Health offers comprehensive community-based behavioral health services to children and adults and is part of a regional collaboration that provides a 24-hour mental health crisis service featuring telephone intervention, mobile assessments and stabilization beds.

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