For the health of a city

For decades the fifty acres at the bend of the Spokane River just east of downtown was a forgotten freight yard, a pocket of blight. Originally an industrial complex dotted with warehouses and laced with train tracks, the city made it a dumping ground for incinerator waste.

By the 1980s, Spokane was also in the weeds. The mining and timber industries that had built the city and sustained it for more than a century were collapsing. Commodity agriculture, the third leg of the city’s economic stool, wasn’t much better.

“This was having a terrible impact on our economy,” says Dave Clack, former chairman of Old National Bank who served on an assortment of regional boards and committees. Every business, every sector was in the same predicament.

“We decided to have a retreat and air it out,” says Clack. In 1987, a hundred business people and ten elected officials holed up at the Red Lion Hotel in the Spokane Valley. For two and half days they brainstormed, argued, and tried to think their way out of the economic slump. With the help of a trained facilitator and five executive secretaries perched at electric typewriters, the participants broke into groups and boiled down their ideas for saving the city. Their thoughts were quickly edited, condensed, and disseminated back into the meeting.

In the end, “we came up with ten strategies,” says Clack. “A main one was to develop the equivalent of a research university on a piece of property as close to downtown Spokane as possible.”

WSU Spokane (Isaacson Aerial Photography)

Twenty-seven years later that scarred acreage on the east side of downtown has blossomed into a park-like campus. The river gurgles nearby and sidewalks crisscross from red brick building to red brick building. Washington State University nursing students in scrubs cross paths with their white jacketed counterparts in the pharmacy program as well as with Eastern Washington University’s occupational and physical therapy majors. Up above in the newest of the eight brick and glass structures, researchers are investigating genes, cancer, diabetes, sleep, diet, and pharmacotherapies.

This dream of a research campus, a home for WSU and EWU’s urban education efforts as well as a collaboration with the area’s community colleges and a connection with Spokane’s two private universities, not only came to life, it came together much more quickly than expected. And now the dream goes further—to make the site a full-blown college of medical sciences with a medical school all its own.

From Calamity to Campus

Spokane leaders called their brainstorming endeavor “Momentum ’87.” Turning it into a nonprofit, over the next decade they managed to find about $12 million to make their list a reality.

Meanwhile, across the state, the legislature debated, discussed, and finally approved the development of branch campuses, because the four-year schools and graduate programs did not fully meet the needs of the state. Five branch campuses, three to be operated by WSU, and two to be operated by the University of Washington were to be built in growing urban areas. Their mission would be to serve place-bound students, offer graduate programs, and promote economic development, responding to the needs of local business and supporting the region through research.

In 1989, WSU set up its first Spokane office and started offering classes. It moved to a downtown bank building where Eastern Washington University was also offering classes. But to fulfill the state’s direction and build an urban campus, the two schools needed more space.

“Every business association and community had its own ideas about where a campus should be,” says Bill Gray, WSU Spokane’s first chancellor. In spite of some environmental cleanup issues, the area just east of downtown, across the river from Gonzaga University’s gleaming grounds, trumped the others. A siting study confirmed that and the legislature authorized first the purchase of 2.5 acres, then 7.5. Later the remaining 40 acres were acquired, with help from the Momentum endeavor.

Gray, who had attended Portland State University, knew a few things about an urban campus in a tight location. “We wanted to build something that was not as compressed, in a space where we could scale it up appropriately,” he says. “The site fit the needs of the community, but it also fit the needs of the University’s research community.”

But building a campus from scratch meant many outings to Olympia “hat in hand” to ask the legislature for money, says Gray. He recalls one particularly disheartening trip he made with William H. Cowles III, The Spokesman-Review newspaper publisher. “We came back empty handed,” says Gray. “But Bill said, ‘Don’t worry. We’re going to pull this off if we have to bring these dollars back one at a time.’”

That’s pretty much what they did, and the University sold properties in other parts of the state to purchase adjacent land. Settling the Phase 1 building in 1996, WSU got to work absorbing, adapting, and aligning its teaching and research for the new campus. At first it was called the Riverpoint Campus. Then the notion broadened into “University District,” a term which included the surrounding neighborhoods and Gonzaga and encompassed the programs offered by WSU, EWU, Gonzaga and Whitworth. Now, most know it as WSU Spokane, once a branch of Pullman-based WSU and now an “urban campus” all its own.

Since 1978 EWU had been offering undergraduate courses in downtown Spokane, first leasing space in the Bon Marché building and then buying a former Farm Credit Bank building. By the early 1990s, both state schools offered undergraduate and graduate classes. WSU was trying to build its profile and Eastern was struggling with a drop in overall enrollment. At one point, turf wars over who did what devolved into discussions of merging the two schools. A senior administrator at Eastern, Elson S. Floyd had a clear view of the needs of Spokane and the concerns of both schools. From the day he interviewed for the job as WSU’s next president, he knew it was something he would have to address.

Healthy Heart of the city

Lisa Brown’s view over WSU Spokane looks west—over downtown. In the far distance is Eastern’s main campus in Cheney where she once taught economics, and just over the river is Gonzaga where she taught organizational leadership. Until two years ago, Brown worked in Olympia as the state’s Senate majority leader. “This is the right place to be,” she says, describing the campus location, and maybe also her relatively new post as chancellor of WSU Spokane.

Pointing south to the city’s medical complex, west to downtown, north toward Gonzaga, and all around at the river, the Centennial Trail, the neighborhoods nearby, she describes a lively urban campus and a city changing around it. Students and faculty are moving into the area, and Spokane’s businesses are serving them as they come, go, and stay to study. “The location is ideal,” she says.

Instead of looking at how to divide up the territory, a few years ago WSU and the community started considering how to make it all work together, with a specific focus. A survey of the community’s strengths revealed health care as Spokane’s leading industry. The city has 35,000 health care workers in a $6 billion industry serving patients from Eastern Washington, Montana, Idaho, Eastern Oregon, and Canada.

For years, WSU had been locating programs in Spokane that might mesh with what the city could offer: an applied sciences laboratory, a veterinary teaching clinic, and graduate studies in criminal justice. In 1998 WSU’s interdisciplinary design institute offered architecture, design, and landscape architecture
students an opportunity to attend classes in a city where they might find internships. But “realignment” in 2011, among other things, moved the institute back to Pullman.

The University is more deliberately focusing its urban campuses on the specific needs of their regions, Floyd recently told community leaders in Everett. For Spokane it’s creating “an academic health center,” he says, “in the heart of Spokane.”

As senator, Brown was skeptical of WSU’s effort to be the lead institution at the Spokane site. “I wasn’t sure at that point in time what the University’s investments would be in the community.” But President Floyd’s focus overcame her concerns. In 2010, the WSU Board of Regents declared the Spokane campus as the health science campus for the University. “It crystallized the vision for our higher education partners,” she says. And it ended much of the territorial squabbling between the region’s higher education institutions. “As a state senator, I saw an amazingly aligned community,” says Brown. The schools were working together and business and civic leaders wanted medical education here in Spokane.The regional intercollegiate nursing school moved to campus in 2009 and became the WSU College of Nursing. It shares the site with the College of Pharmacy, the recently established College of Medical Sciences, Eastern’s dental hygiene students, occupational therapy, physical therapy, and behavioral sciences programs, and with the University of Washington’s physician assistant program and UW’s joint effort with WSU and Eastern to train first-year medical and dental students, respectively.

“We took a different approach,” says Floyd. “We sought collaborative partnerships.” Listing medical training, WSU and EWU’s health professional schools, and an affiliated relationship with a teaching hospital health system, “we have all of that right here,” he says. “If we do it appropriately we can become a model for health centers across the country.”

In May, the WSU Board of Regents approved the creation of a new College of Medical Sciences. This comes in the wake of EWU creating its own College of Health Science and Public Health. The next step is building a $15 million primary care clinic operated by WSU, Providence Health Care, and Empire Health Foundation.

“We’re all bringing something to the table,” says Brown. The University is providing the faculty and funding for a new clinic building, Empire offers community resources, and Providence brings accredited medical residencies. Spokane citizens will have a walk-in clinic and students from nursing, pharmacy, physical therapy, and other programs can learn a team-based health approach. And a certain number of the new residents will be out working in rural and underserved areas. With WSU leading the effort, and pending approval next month from the WSU Board of Regents, the newest addition is slated to be operating by early 2016, says Brown. “This is about Spokane reaching its potential as a health care city.”

In May, the WSU Board of Regents approved the creation of a new College of Medical Sciences, which comes in the wake of Eastern creating its own College of Health Science and Public Health. This fall, a study on the feasibility of a WSU-led community-based medical school will be released.

On a mid-week spring afternoon, the chancellor’s offices are buzzing. Brown just scheduled an on-campus meeting for a UW task force to look at the future of the UW’s medical education program, with the possibility of adding more medical students in Spokane.

And she’ll soon be in an interview on the subject with an Associated Press reporter about WSU’s efforts to create a second medical school in the state. This is a complex issue. But need, says Brown, dictates that our state should have a second medical school. The UW admits about 220 students to its first year medical program, with 120 coming from Washington. The school turns away hundreds more. They go to other regions of the country to study medicine, and may not come back to the Northwest. When Brown took the job as chancellor at WSU Spokane, she knew that the health services were evolving on campus, “but I didn’t realize how much potential there was,” she says. “I also didn’t realize how great the need was for primary care physicians.”

The shortage is a lingering complaint. In 1971, the UW created a multi-state program to address the need, training physicians from Washington and neighboring states that didn’t have their own medical schools. They named it WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) and provided medical training to all first- and second-year students. The Washington students can either spend their first year in Seattle or stay in a small group setting and train in eastern Washington.

But WWAMI hasn’t done enough, say its participating states. Seven years ago, the state of Idaho commissioned a study because Idaho was, in the words of the study, “extremely low in physicians per capita.” In fact, it ranks 49th out of 50 states. Change “Idaho” to “Eastern Washington,” or “outside of King County,” says Brown, and the number of primary care physicians per 10,000 patients is significantly lower than the national average. Even though the state has grown, “There really hasn’t been any expansion to the Washington class,” she says. That is one of the reasons, she says, WSU is exploring the idea of a second medical school.

The University of Washington has some of the world’s leading doctors and researchers in a number of specialties, including HIV treatment, cancer treatment, and cardiovascular disease. It owns or operates four large medical centers, nine medical clinics, and partners with three other hospitals. It is consistently ranked by U.S. News and World Report as one of the top primary-care medical schools in the country and ranks in the top 10 in bringing in research dollars from the National Institutes of Health.

For its part, says Brown, WSU Spokane is exploring a complementary medical school alternative: a community-based model. From their first day on campus, students at WSU Spokane are working and taking classes together whether they’re from the nursing school, EWU’s physical therapy program, the pharmacy school, or medicine. Here they can find deeper rural connections, they can reach communities with limited medical resources. With Spokane’s multiple hospitals and clinics, the students have many opportunities to work with medical providers. Lastly, a second medical school would offer more room for medical students.

A pair of students in crimson scrubs cross our path as Scott Hippe leads me up a new sidewalk to the building where the second year medical student and WSU Spokane student body president spends most of his days. We enter the Pharmaceutical and Biomedical Sciences Building— a modern-style monument of brick and glass with an interior of wood detailing offering a touch of Northwest warmth. “Yes, it still has that new car smell,” he quips. This year Hippe and his Spokane classmates studied ethics, hematology, pharmacology, and genetics, a basic science curriculum identical to that in Seattle. But here, they have more opportunities to interact with students and faculty from different disciplines, he says.

The $80 million structure—the newest building—is a heady combination of laboratories, classrooms, and offices for the doctors who train the medical students and health scientists. On the upper levels pharmacy scientists explore ways to kill cancer cells, address chronic pain, identify genes involved in leukemia, and perform liver regeneration.

Relocating the pharmacy program to Spokane in 2013 has expanded research efforts like the Department of Pharmacotherapy’s clinical trials team.

The news about an evolving health campus and efforts to build a second me
dical school is just a sidelight to the first and second year WWAMI medical students based in Spokane, says Hippe. Their real focus is the first two very intense years of their medical training.

Hippe can see the benefits of expanding health education, whether it’s through medical training or by offering more health services in general. “It’s the biggest city east of Seattle, and the medical community here serves so much of the West.”

Changing the city

Slowly. Quietly. Civilizing forces have been working their way from downtown toward the new campus.

Nearly 15 years ago, back when the Spokane campus was a single classroom building and a business incubator, Jim Sheehan, an attorney and philanthropist, came upon this neighborhood while looking for a building for his nonprofit law firm. “The block was pretty rough,” he says. Sheehan got out of his car and approached the owner of the multi-story Longbotham Building. “He said he didn’t want to sell, but that the guy across the street did.”

“So I bought that building,” says Sheehan. “And then the one next door. And the one next door to that. And the one next door to that.” The Main Market Co-op just two blocks from campus opened in 2010. Instead of using one of the century-old buildings, Sheehan modified the large Goodyear Tire Store and transformed the busy corner to one frequented by families and hungry students. “We’re a viable, energized area right now,” he says. Along Main Street, vacant buildings, pawn shops, and bars where you could drink at 8 a.m. have been transformed into an art house theater, gastro pubs, a yoga studio, a food co-op, and boutiques. Even on nights and weekends, when many cities’ neighborhoods empty out, West Main is alive.

Whether there was a budding campus at the edge or not, Sheehan says he would have invested in the neighborhood because he wanted to bring it back to life, save the buildings, and change the local culture. When he started buying buildings, “the University District was more a rumor than it was a reality.” But now that it’s there and growing, the campus is feeding the change. Sheehan believes “there is a healthy synergy between our block and the University District.”

The beauty of the architecture in the old neighborhood is “soul building,” says Sheehan. It’s a character found in areas like Seattle’s Pioneer Square and Portland’s Pearl District. “I think it has been a really good thing both for us and for Spokane. You just need a little bit of vision and some political will to get things done.”

From that 1987 meeting of city leaders several other ideas emerged: Build a new arena to replace the very dated and deteriorating 1950s coliseum, and expand the convention center that was built for the Expo ’74 between the downtown businesses and the Spokane River. Both endeavors would bring money, visitors, and jobs. A more distant dream was to aggressively engage the 1,200 doctors working in the community at that time and to build on their work and knowledge in an effort, “that in time might rise to the level of providing four years of medical education in Spokane,” says Clack.

Momentum ’87 seems to have worked. “The Convention Center and the Arena have really transformed downtown, drawing visitors to the city’s core,” he adds. But the University is doing something different— bringing people to stay. Students, employees, and health workers are coming into the city and through the neighborhood every day.

“When we bought the property, we hired a planner to design what the campus would look like. He proposed a 50-year build-out plan. It’s just a major change in the economics, the building, and the physical plan and architecture of the city,” says Clack. “We thought we’d never live to see it. But it all happened in 25 years.”

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