Hospital adjusts for the future Sheppard Pratt reshaping its campus, offering new services

December 16, 1996|By Suzanne Loudermilk | Suzanne Loudermilk,SUN STAFF

For more than a century, world-renowned Sheppard and Enoch Pratt Hospital has sheltered famous and not-so-famous mentally ill patients at its bucolic Towson campus -- sometimes for years.

But now, payment restrictions imposed by insurance companies and new drug treatments have emptied scores of its hospital beds, trends changing the shape of Sheppard Pratt and other psychiatric institutions around the country.

Many hospitals -- from Sheppard Pratt to Menninger in Topeka, Kan., and McLean Hospital in Belmont, Mass. -- have moved to quicker patient assessments, daytime hospitalizations and community-based clinics to meet patients' needs.

And that means big changes at Sheppard Pratt's 100-acre campus.

The hospital is reconfiguring buildings to fill vacant space and has privatized its swimming pool for community use. It has leased 2 1/2 acres of land to nearby Greater Baltimore Medical Center. And recently, the Forbush School for special-education students opened new classrooms to accommodate a growing enrollment.

The not-for-profit hospital's directors also are hiring a consultant to advise them on a comprehensive land-use plan, which is expected to be completed in six to eight months.

"It might be traumatic. It might not. It's too early to tell," says board Chairman James D. Peacock. "It doesn't mean we're moving away from Towson."

Adds Dr. Steven S. Sharfstein, president and medical director of Sheppard Pratt, "We still plan to stay here. But we don't need 100 acres here in Towson."

Many in the community are concerned about the future of the 105-year-old institution -- consistently named one of the nation's top 10 psychiatric institutions by U.S. News and World Reports -- as it adjusts to the financial realities of modern medicine.

Hoke L. Smith, president of nearby Towson State University, says, "It is in all our best interests for [Sheppard Pratt] to have a stable operation. That land is integral to our campus and GBMC."

The closest neighborhoods have not taken a position on how changes to the secluded, wooded campus would affect them, said John Dahne, president of the Ruxton-Riderwood-Lake Roland Area Improvement Association.

But the Greater Towson Council of Community Associations is watching closely.

"Sheppard Pratt has long been a recognized stabilizing factor in the neighborhood," said Justin King, the umbrella group's president. "While they maintain a low profile and don't generate a lot of publicity, they have always attempted to contribute to the well-being of the community."

The hospital began with a bequest from Quaker businessman Moses Sheppard in the mid-1850s -- a time when many mentally ill people were crowded into dank, narrow cells in almshouses and chained to floors. It occupies the former Mount Airy Farm, a once-sprawling parcel which includes two grand Victorian buildings boasting 14-foot ceilings.

But because Sheppard requested that interest -- not the principal -- from his estate be used for the ornate brick structures, the hospital did not accept its first patient, a 46-year-old woman with dementia, until 1891.

The hospital's name was changed in 1898 after Baltimore philanthropist Enoch Pratt, who also provided funds for the Enoch Pratt Free Library, left $1.6 million to the hospital with the stipulation that his name be included.

At the time, there was no Towson State University, Greater Baltimore Medical Center or St. Joseph Medical Center nearby. Those institutions bought land from Sheppard Pratt, starting around the turn of the century.

Since then such celebrities as Zelda Fitzgerald -- wife of author F. Scott Fitzgerald -- and prominent figures in sports, entertainment and politics have sought help there.

But about eight years ago changes in medical insurance began to affect the operation of the nation's psychiatric institutions. In response, many have developed a range of services in addition to inpatient stays.

"We think there are more flexible and more economical ways of providing care," said Dr. Efrain Bleiberg, Menninger's recently named president. "There is a greater reliance on outpatient and partial levels of care."

McLean, a teaching hospital of Harvard Medical School, relies on such treatments, too. It also has developed a service open 24 hours a day to immediately evaluate individuals in crisis without hospitalizing them.

"The impact of managed care has been deleterious to the best hospitals' functions," said Dr. Herbert Sacks, president-elect of the Washington-based American Psychiatric Association, a group of 40,000 psychiatrists. "The pressure has been on to reduce the length of stay."

Sacks, a child and adolescent psychiatrist at the Yale University Child Study Center, said managed care's reduced payments are leading to "drive-through psychology. . . . Judgments are not being made by psychiatrists. They're being made by lawyers and business people. It's frightful."

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