Annual Report for 2002 - Best Hospitals, US News best hospitals

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Annual Report for 2002 - Best Hospitals, US News best hospitals

The Cleveland Clinic 2002 Annual Report Investing in the Future


ALFRED LERNER 1933–2002

On the cover: Teresa Moenich, R.N.

Thoracic and

Cardiovascular Surgery

Alfred Lerner, 69, president of The Cleveland Clinic, died on October 23, 2002. His extraordinary

philanthropy has had a powerful impact on the future of medicine, research and the health

of the community.

Mr. Lerner, along with his wife, Norma, was instrumental in building the modern Cleveland

Clinic. Through their $16 million naming gift for the Lerner Research Institute, and recent

$100 million gift for science and education at The Cleveland Clinic, they created a permanent

legacy of care and the advancement of medical knowledge. The new Cleveland Clinic Lerner

College of Medicine of Case Western Reserve University has been named in their honor.

Mr. Lerner was chief executive officer and chairman of the board of directors of MBNA

Corporation, and chairman and owner of the Cleveland Browns since October 1998. A graduate

of Columbia University and vice chairman of its board of trustees, Mr. Lerner also was a trustee

of Case Western Reserve University and a member of the board of directors of the Marine

Corps-Law Enforcement Foundation.

In 2001, Mr. Lerner, a former Marine Corps pilot, was appointed by President George W. Bush

to the President’s Foreign Intelligence Advisory Board.

In 2002, Mr. and Mrs. Lerner were made distinguished fellows of The Cleveland Clinic for their

extraordinary philanthropy and humanitarian devotion to the cause of health and medicine.


INVESTING IN THE FUTURE The Cleveland Clinic and its philanthropic partners

are making unprecedented investments of time, effort and money in

the future of medicine and the health of humankind. Everyday,

Cleveland Clinic physicians, scientists and educators invest their professional

lives in the patient care, research and education that are the

mission of The Cleveland Clinic.

• Physicians see more patients with more complex disorders and pursue new levels of

quality and reliability of outcomes.

• Scientists probe the basic building blocks of life for the root causes of disease and

work to bring innovative treatments directly to the patient bedside.

• Educators prepare the next generation of physicians, scientists and allied

health professionals for the challenges of a new world of knowledge and discovery.

Through their actions, they articulate the credo of The Cleveland Clinic:

To benefit humanity through the efficient, effective, and ethical practice of medicine,

by advocating scientific investigation and medical education, by maintaining the

highest standards of quality, and by honoring creativity and innovation. Each member

of the organization is a guardian of this enterprise and is responsible for assuring

that The Cleveland Clinic is synonymous with the finest health care in the world.

2002 ANNUAL REPORT 1


DEAR FRIENDS:

The Cleveland Clinic enters 2003 with a distinct clarity of purpose. Our principal objective is to

become the number one academic medical center in America. We have the motive, the opportunity and

the means to achieve number one status, and we intend to make it happen.

Knowledge continues to be the new wealth, and we continue to

strengthen our knowledge-building resources of research and education.

Developments in these areas include the appointment of Paul

DiCorleto, Ph.D., as chairman of the Lerner Research Institute, the

construction of a five-bed general clinical research center, the awarding

of our first-ever Research Program-of-the-Year honor to the prostate

cancer program, and increased funding for research from outside

sources – a total of $106 million in 2002, moving us from seventh to

fifth nationally in NIH-funded research.

The Cleveland Clinic Lerner College of Medicine of Case Western

Reserve University will enroll its first class in 2004. It is the first new

medical school to be accredited in America in the past 26 years and

will be dedicated to the training of physician–scientists. This joint venture

brings together one of the nation’s leading hospitals with a top

medical school recognized for its history of curricular innovation.

Our single most important priority in coming years will be the campaign

for the new Cleveland Clinic Heart Center. This is the largest, most

complex building project ever undertaken by The Cleveland Clinic. It

will be the world's leading heart care center, an immeasurable benefit

to the health of the nation and a permanent asset to the community.

With nearly a million square feet of floor space, it will centralize all

heart services and free up hundreds of thousands of square feet of

space in our existing facilities – allowing us to expand other clinical

areas as well. This new Heart Center will help us meet the challenge

of the aging demographic and provide access for what is expected to

be an unprecedented rise in heart cases in coming years.

Within our institution, we have inaugurated the most ambitious service

and leadership program in our history. Called World Class Service, it

has united Cleveland Clinic personnel at all levels in the ongoing effort

to enhance patient satisfaction and implement new ideas for improved

service and efficiency. The goal of World Class Service is to make The

Cleveland Clinic the best place to work, the best place to be a patient,

and the best place to practice medicine.

The volume of patients seen at our consolidated sites rose in 2002.

New patient visits, and inpatient and outpatient surgeries all saw

increases over the year. International patient numbers have been down

since September 2001, but we look forward to seeing this number

recover in coming months. Overall, the numbers are positive.

Revenue from patient care is significantly higher in 2002. Cleveland

Clinic Florida performed better than budget, and our Naples hospital

is close to 100 percent occupied. Florida has seen a steep increase in

international patient visits, especially from the Caribbean.

The Cleveland Clinic was heavily invested in equities throughout the

1990s. This was a successful strategy in that it financed fully 40 percent

of our building activities in that decade and essentially provided the

engine that is taking us into the 21st century. In response to external

changes, we have shifted the bulk of our investments to the fixed-rate

market and restructured our debt portfolio. The Cleveland Clinic

remains financially stable. Our most recent bond sale met with overwhelming

demand, reflecting our national reputation among investors

and continuing confidence in our stable core of experienced managers.

Health care is the leading issue of our generation. The field of medicine

offers more opportunities to enrich human life today than at any time in

history. Our greatest gift is hope. Because of our hard work and preparation

over the past 12 years, The Cleveland Clinic is well-positioned to

lead in this new era. We will be a beacon of hope to all people, in times

of wellness and illness, and through all the seasons of life.

Sincerely,

Floyd D. Loop, M.D.

Chairman and Chief Executive Officer

2 THE CLEVELAND CLINIC


EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES 2002-2003

FRONT ROW (L TO R ): Patrick F. McCartan, Esq. | Stephen R. Hardis | Robert Kay, M.D. | Floyd D. Loop, M.D. | A. Malachi Mixon, III | Samuel H. Miller* | Joseph M. Scaminace | John J. Kahl, Jr.

BACK ROW (L TO R ): William E. Conway* | Gordon R. Bell, M.D. | Robert J. Tomsich | Stephen F. Lau, Ph.D. | John V. McFadden | Dan T. Moore, III | Ivan J. Winfield | Nancy F. Beck, Esq.

Robert L. Lintz | William E. MacDonald, III | Thomas A. Commes | David J. Hessler, Esq. | NOT PICTURED: Morry Weiss | Jack C. Shewmaker

*Emeritus Trustee

2002 ANNUAL REPORT 3


4 THE CLEVELAND CLINIC

HEALTH IS A PRICELESS COMMODITY. To secure it, no effort is too exhausting, no commitment too

deep. Words alone cannot do justice to the full breadth of activities taking place at The

Cleveland Clinic in a given year. It is for this reason that we include in this annual report

pictorial essays – dramatic black and white photographs illustrating some of the many

stories of patient care, research and medical education that unfold every day at The

Cleveland Clinic. These are the images of people who, through their untiring dedication

to advancing the art and science of medicine, make a remarkable difference in the lives

of patients of today and tomorrow.


PICTORIAL ESSAYS


THE CENTER OF HEART CARE

The Cleveland Clinic Heart Center is America’s busiest heart center. Heart Center

surgeons perform more heart valve operations than any other hospital in the United States.

Delos Cosgrove, M.D., chairman of Thoracic and Cardiovascular Surgery, pioneered

techniques and devices that enable surgeons to repair and reshape, rather than

replace, damaged valves. Continuing with the Heart Center’s tradition of firsts, Dr.

Cosgrove also performed the world’s first minimally invasive heart valve surgery.

6 THE CLEVELAND CLINIC


SHARING MEDICAL WISDOM

Under the auspices of the Division of Education, some 800 residents and

fellows received medical training at The Cleveland Clinic in 2002. These

physicians-in-training learn at the side of leading specialists, such as

Marshall Strome, M.D., chairman of Otolaryngology and Communicative

Disorders, whose achievements include the world’s first successful larynx

transplant. The Clinic’s high patient volume, diversity of clinical problems and

group practice model provide an ideal teaching and learning environment.

8 THE CLEVELAND CLINIC


2002 ANNUAL REPORT 9


10 THE CLEVELAND CLINIC


INNOVATIVE SPINE SURGERY

Isador Lieberman, M.D., uses minimally invasive techniques to perform major spinal

reconstruction. Where previously two operations were required to correct a particular

spinal deformity, Spine Center surgeons now are able to perform both at once, one from

the front (endoscopically) and the other from behind. This technique spares patients

the rigors of two trips to the operating room, as well as two recovery or rehabilitation periods.

2002 ANNUAL REPORT 11


12 THE CLEVELAND CLINIC

BEATING CANCER


Chemotherapy can be demanding. But new drugs and refined protocols are making it more

effective than ever. Monoclonal antibody therapy has proved effective in treating certain types

of non-Hodgkin's lymphoma. The treatment works by stimulating the body's own ability to

destroy cancer cells. At the Cleveland Clinic Taussig Cancer Center, chemotherapy sessions

are offered in a comfortable environment, with compassionate concern for the patient’s needs.

2002 ANNUAL REPORT 13


SIGHT-SAVING SURGERY

Submacular hemorrhage is a complication of age-related macular degeneration that can lead

to blindness or loss of vision. A surgical technique developed by Hilel Lewis, M.D., director of

the Cleveland Clinic Cole Eye Institute, can treat this condition. Under Dr. Lewis’ leadership,

the Eye Institute has grown to become one of the largest ophthalmic practices in the United

States and one of the world’s leading research institutes into the diseases of the eye.

14 THE CLEVELAND CLINIC


2002 ANNUAL REPORT 15


16 THE CLEVELAND CLINIC


SEARCHING FOR ANSWERS

Work at the Cleveland Clinic Lerner Research Institute ranges from the most basic scientific

investigations to nationwide clinical trials involving thousands of patients. In the Biomechanical

Engineering Laboratory, researchers seek to expand the interface between technology and the

body. In the Prostate Cancer Group – winner of the 2002 Cleveland Clinic Research Program of

the Year Award – physicians and basic scientists collaborate on projects that may lead to new

treatments and cures.

2002 ANNUAL REPORT 17


CARING FOR OUR CHILDREN

From premature infants to adolescents, patients at The Children’s Hospital are surrounded by caring

hands. The Children’s Hospital staff provides innovative care for children with complex medical

problems, such as epilepsy and cancer. Critically ill newborns are cared for in a Level III Neonatal

Intensive Care Unit. The hospital’s Center for Pediatric and Congenital Heart Diseases serves as a

worldwide referral and second opinion center for patients with pediatric and congenital heart disease.

18 THE CLEVELAND CLINIC


2002 ANNUAL REPORT 19


A BETTER APPROACH TO PAIN

Pain should be treated as a disease, not a symptom. That is the philosophy of the Clinic’s

Department of Pain Management. Under the chairmanship of Nagy Mikhail, M.D., Ph.D.,

the department takes a multidisciplinary approach to pain. Innovative therapies include the

spinal cord stimulator, which is surgically implanted and can provide years of relief from

chronic pain. The Clinic is one of only a small percentage of hospitals nationally to have a

dedicated pain management program.

2002 ANNUAL REPORT 21


The Year in Review

The year 2002 found The Cleveland Clinic engaging the challenges of patient care, research

and education at the highest levels of commitment and expertise. Hard work was the

keynote, as staff physicians and scientists, nurses and support personnel maintained the

daily pace of a leading academic medical center, making major contributions to science,

medicine, and the efficiency and effectiveness of care.

This annual report presents a few highlights of this very productive year. A chronicle as

limited as this cannot comprehensively record the multiplicity of events that make up the

life of an institution as busy and complex as The Cleveland Clinic. This year, as every

year, Cleveland Clinic personnel saved many lives and enhanced the quality of life for many

more. What follows are some of the achievements, honors and insights of the past 12 months.

22 THE CLEVELAND CLINIC


THE CLEVELAND CLINIC

RANKED THIRD IN AMERICA

The Cleveland Clinic was ranked third in

America in the 2002 U.S.News & World Report

annual “America’s Best Hospitals” survey – its

highest ranking ever. In the specialty rankings,

the Heart Center was named best in America

for the eighth year in a row. The Urological

Institute ranked number two in the nation.

Other specialties ranking in the top 10 were

endocrinology, gastroenterology, geriatrics,

gynecology, nephrology, neurology and neurosurgery,

orthopaedics, otolaryngology, pulmonary

and rheumatology. Ophthalmology, cancer

and psychiatry also were ranked nationally. In

other national recognition:

• The Cleveland Clinic was named one of the

nation’s top 100 hospitals by health data consultants

Solucient in a survey that recognized

medical and operations excellence.

• 73 Cleveland Clinic physicians were named in

the 2002 edition of “America’s Top Doctors.”

The Cleveland Clinic was one of the bestrepresented

hospitals in the directory.

• 195 Cleveland Clinic physicians were named

in “The Best Doctors in America,” a survey of

30,000 physicians nationwide. This was the

most of any hospital in Ohio and among the

largest number of any hospital in America.

NURSING LEADERSHIP ACADEMY

LAUNCHED

Nurse managers are key to effective and compassionate

nursing. They are among the most

successful leaders in all areas where they work.

Now, the Division of Nursing has launched a

program to help nurse managers refine and

strengthen their leadership and management

skills even further. This comprehensive training

program is called the Nursing Leadership

Academy. Undertaken in partnership with the

Advisory Board Company, the Nursing Leadership

Academy began in 2002 with a 360-degree

evaluation of leadership skills and will proceed

to master’s level courses in areas targeted for

improvement.

NURSE RECRUITMENT SUCCESS

The Cleveland Clinic has made progress in a

number of areas addressing the national personnel

shortage in nursing. A recruitment drive

undertaken from September to November

2002 resulted in a record number of inquiries.

“In 100 days, 103 nurses accepted job offers,”

says Lois Bock, R.N., director of Nurse

Recruitment. “We’re very pleased with these

results.” The campaign reached out to nurses

through radio and newspaper advertising, direct

mail and the Internet. Recruitment events also

were held, and bonuses were offered to

Cleveland Clinic employees who referred nurses

who were successfully hired. A Cleveland

Clinic tuition assistance program also has

resulted in great success. This program helped

51 Cleveland Clinic employees graduate from

nursing school in 2002 and start new jobs as

registered nurses. The program provides

financial support in return for a work commitment.

Overall, 377 nurses were hired in 2002.

Sherri L.S. Brown, B.S.N., R.N.

WOMEN’S HEALTH CENTER OPENED

Women now can access specialized health

care at the new Cleveland Clinic Women’s

Health Center. Located on the first floor of the

Crile Building, the center provides convenient

“one-stop shopping” for all women’s health

care needs. In addition to routine wellness

exams and health care screenings, the center

offers evaluation and treatment of numerous

medical problems of special concern to

women. Center professionals accommodate

patients who are seeking second opinions, as

well as patients who prefer female providers.

The new center includes the services of the

Clinic’s Breast Center, as well as the departments

of Internal Medicine and Obstetrics &

Gynecology.

NEW TREATMENT MAY EXTEND

LIVES OF BRAIN TUMOR PATIENTS

A new treatment protocol being refined at The

Cleveland Clinic has been shown in preliminary

research to help extend the lives of certain

brain tumor patients by almost three-fold that

of the average anticipated life expectancy for

this disease. The treatment involves slowing

the activity of the thyroid gland in patients

with recurrent gliomas, then treating them with

high doses of tamoxifen. Highly resistant to

both chemotherapy and radiation treatment,

gliomas are the most common form of cancerous

brain tumors. Each year, 18,000 to 20,000

new cases are diagnosed in U.S. adults.

SPORTS HEALTH HOSTS

PROFESSIONAL AGENTS

Cleveland Clinic Sports Health continues to be

one of the largest sports health practices in

the nation, providing services to a number of

professional and amateur teams and athletes.

In 2002, Sports Health hosted two Agents’

Medical Summits to give professional sports

agents a functional knowledge of the medical

problems, issues and concerns they and their

clients face when a medical condition, injury or

illness challenges a sports career.

2002 ANNUAL REPORT 23


DEFIBRILLATOR STUDY

HAS SURPRISING RESULT

For patients who need implantable cardioverter

defibrillators (ICDs) to control abnormal heart

rhythms, simple ventricular backup pacemaker

therapy provides better outcomes than supporting

the heart rhythm with more sophisticated

stimulation of both the right atrium and

right ventricle, according to Cleveland Clinic

research published in the Journal of the

American Medical Association. “This study

produced opposite results from expectations,”

says Bruce L. Wilkoff, M.D., director of

Cardiac Pacing and Tachyarrhythmia Devices

and chairman of the study’s committee.

“About 75 percent of ICDs implanted in the

United States include dual chamber pacemakers,

and these are the first randomized

data evaluating their impact on congestive

heart failure and mortality. The implications

for patients are compelling.”

NEW HOPE OFFERED FOR

NON-HODGKIN’S LYMPHOMA PATIENTS

Doctors at the Cleveland Clinic Taussig Cancer

Center are using a new biologically targeted

radioactive “smart bomb” to treat patients with

certain types of non-Hodgkin’s lymphoma. The

drug, Zevalin, is the first radioimmunotherapy

treatment approved by the U.S. Food and Drug

Administration. It is approved to treat patients

with relapsed or refractory low-grade, follicular

or transformed B-cell non-Hodgkin’s lymphoma

who have not responded to traditional

treatment. “Zevalin is designed to deliver a

powerful ‘double whammy’ to tumors,” says

Roger Macklis, M.D., chairman of Radiation

Oncology. “This ‘smart bomb’ technology represents

the realization of a 100-year-old dream

of science pioneers like Marie Curie and Paul

Ehrlich, who envisioned radiolabeled antibody

therapy in the early years of the 20th century.”

Zevalin is given as a collaborative effort by

members of the departments of Radiation

Oncology, Medical Oncology and Molecular

and Functional Imaging.

MASTECTOMY TECHNIQUE

PRESERVES APPEARANCE

Cleveland Clinic Breast Center physicians have

developed a new mastectomy technique that

leaves the nipple intact, allowing for a more

natural-looking breast reconstruction. “The

response that we are getting from patients to

this surgery is the most overwhelming I have

seen in 25 years,” says Joseph Crowe, M.D.,

director of the Breast Center, who developed

the new technique. Since January 2002, Dr.

Crowe and colleague Julian Kim, M.D., in

collaboration with plastic surgeons Jillian

Banbury, M.D., and Randall Yetman, M.D.,

performed nipple-sparing mastectomies on

more than 50 women. The operation is not for

all breast cancer patients, but is applicable to

those within certain limitations.

Joseph Crowe, M.D.

TONSIL TECHNIQUE OFFERS LESS PAIN

A new technique that shaves away a portion of

the tonsils rather than completely cutting them

out results in less pain, quicker recovery times

and fewer complications than standard tonsillectomy,

a new study shows. The procedure

uses an endoscopic microdebrider to shave

away tonsil tissue. A portion of the tonsils is left

intact, leaving the underlying muscles of the

throat unexposed, which cuts down on painful

recovery times. “We perform this procedure

primarily on children whose tonsils are so

large that it disrupts their breathing when

they sleep,” says Peter Koltai, M.D., head of

the Section of Pediatric Otolaryngology and

developer of the new technique. “The rapid

recovery and lower incidence of bleeding

make it easier on the children themselves and

allow parents to return to work more quickly.”

DISEASE MANAGEMENT

PROJECT LAUNCHED

More than 80 Cleveland Clinic physicians

have collaborated to produce a unique online

medical resource (www.clevelandclinicmeded.com/diseasemanagement),

under the

direction of the Center for Continuing

Education. Called the Disease Management

Project, this free Internet resource is intended

as a tool for the general practitioner and

includes chapters in cardiology, dermatology,

endocrinology, gastroenterology, infectious

diseases, neurology, nephrology, psychiatry

and psychology, pulmonary diseases, and

women’s health. Each chapter offers treatment

strategies based on nationally accepted

practice guidelines. William D. Carey, M.D.,

director of the Center for Continuing Education,

is editor-in-chief and presides over a 10-member

editorial board. All content is free and

authored exclusively by Cleveland Clinic

physicians.

NEW DRUG FOR HEART FAILURE

A new drug for people with severe congestive

heart failure provides patients with early relief

and gives physicians additional treatment

choices, according to Cleveland Clinic Heart

Center research published in the Journal of

the American Medical Association. The drug,

nesiritide, was shown to be more effective

than intravenous nitroglycerin when used in

addition to standard treatment for congestive

heart failure in hospitalized patients. It is the

first new drug approved for severe congestive

heart failure in 15 years. The trial was led by

James Young, M.D., medical director of the

Kaufman Center for Heart Failure at The

Cleveland Clinic.

24 THE CLEVELAND CLINIC


Macular Degeneration

Secrets Unlocked

CLEVELAND CLINIC COLE EYE INSTITUTE

RESEARCHERS ANALYZE DRUSEN, A MATERIAL

THAT INCREASES THE RISK OF AGE-RELATED

MACULAR DEGENERATION.

Researchers at the Cleveland Clinic Cole Eye

Institute have begun to unlock the secrets of

drusen, material that collects in the eye and

increases a person’s risk of developing agerelated

macular degeneration (AMD). Led by

John W. Crabb, Ph.D., and Joe G. Hollyfield,

Ph.D., Cole Eye Institute researchers analyzed

donor drusen using new, more sensitive techniques

that combine liquid chromatography

and mass spectrometry methods. “Our

research is the first to establish a molecular

connection between oxidative damage and

age-related macular degeneration,” says Dr.

Crabb. “Our goal is to take this knowledge,

expand upon it, and find a way to halt or

slow drusen formation and AMD.” This

investigation combines the development of

a new drusen micro-isolation technique with

proteomic analyses by mass spectrometry

and bioinformatics and promises further

insights into the pathology of AMD.

“Age-related macular degeneration is a common disease with links to both genetic and

environmental causes. We just don’t know enough to understand it,” says Hilel Lewis,

M.D., director of the Cole Eye Institute. “I believe that this technology and line of research

will bring us closer to the cause of age-related macular degeneration.”

CHILDREN’S HOSPITAL OFFERS

UNIQUE GI TESTING

Nothing could be more alarming to a parent

than a child with unexplained nausea, abdominal

pain or failure to thrive. The Center for

Pediatric Functional Gastrointestinal and

Motility Disorders at The Children’s Hospital at

The Cleveland Clinic offers two unique

resources for investigating these conditions:

antroduodenal manometry and colonic motility

testing. “Few centers in the country offer these

procedures to children, due to their complexity

and the time needed to record the physical

processes of digestion,” says Rita Steffen,

M.D., a pediatric gastroenterologist in the center.

These two tests, which involve catheter placement,

anesthesia, and as many as eight hours

of monitoring, can reliably assess whether

a child’s problem is neurological, muscular,

behavioral, or has other causes. Able to be

performed simultaneously, the tests give

doctors the most comprehensive picture of a

child’s total intestinal situation, allowing them

to choose the most appropriate treatment.

LARGEST TEST OF

COATED STENTS UNDER WAY

The Cleveland Clinic Heart Center will help

oversee the largest clinical trial to date to evaluate

whether stents coated with anticancer

drugs can prevent restenosis. “This is a

tremendous opportunity to assess the potential

for a treatment that might resolve restenosis,

which some specialists have dubbed the

‘Achilles heel’ of angioplasty,” says Stephen

G. Ellis, M.D., co-principal investigator for the

clinical trial and director of the Heart Center’s

Sones Cardiac Catheterization Laboratories.

Photo courtesy of Conor Medsystems, Inc.

2002 ANNUAL REPORT 25


MASSAGE THERAPY IN

CARDIAC SURGERY PATIENTS

Encouraged by results from a pilot study,

Cleveland Clinic Heart Center researchers

have launched the first clinical trial to determine

whether therapeutic massage can help heart

surgery patients have less pain and recover

more promptly. “Relaxation techniques like

massage may lead to decreased pain and

narcotic use to cope with pain as well as less

physiologic stress,” says A. Marc Gillinov,

M.D. “We want to see if results indicated in

our pilot study are reflected in a randomized,

controlled study.”

PALLIATIVE MEDICINE

RESEARCH FELLOWSHIP

The Harry R. Horvitz Center for Palliative

Medicine at The Cleveland Clinic established

a research fellowship to train a physician

in research methodologies and techniques

involving palliative care, an area of medicine

that encompasses the comprehensive care of

patients with incurable illnesses. The Mt. Sinai

Research Fellowship in End-of-Life Care is

being made possible through a three-year,

$188,315 grant from the Mt. Sinai Health

Care Foundation. “Palliative medicine continues

to be a growing and evolving area of medicine

with significant issues that need to be

addressed,” says Declan Walsh, M.D., director

of the Horvitz Center and holder of the

Harry R. Horvitz Chair in Palliative Medicine.

“This fellowship will serve as a bridge to

determine and extend information about the

best practices in palliative medicine.”

Stem Cells to Repair Bone

THE BONE BIOLOGY LABORATORY STUDIES

HOW ADULT STEM CELLS CAN HELP BREAKS

AND FRACTURES HEAL FASTER.

Over the past year, adult stem cell research has attracted national attention as a new therapeutic

approach for many diseases. Adult stem cells are normal cells found in our bodies that

retain the ability to repair or regenerate new tissues throughout our lives. Some adult stem

cells have the ability to regenerate only one or two types of tissue. However, some have been

shown to be able to regenerate many tissues, including bone and cartilage and even heart

muscle and nerve tissue.

George F. Muschler, M.D., director of the Bone Biology Laboratory in the Lerner Research

Institute, is among several Cleveland Clinic researchers investigating adult stem cells. Dr.

Muschler has received two National Institutes of Health grants for stem cell studies. In the

most recent, Dr. Muschler and his colleagues will analyze human bone tissue, bone marrow,

muscle tissue and fat to determine the types and number of stem cells to be found there.

Efforts will be made to determine differences between these sources of stem cells and how

these differences might guide the strategic use of these cells for the repair of various tissues.

Dr. Muschler’s other grant is a collaborative project investigating the best methodology

for rapid concentration, selection and transplantation of bone marrow-derived stem cells to

promote bone repair and regeneration.

“Stem cell biology is one of the true frontiers of science,” Dr. Muschler told Crain’s Cleveland

Business. “Stem cells are at the foundation and root of all growth, all development, all healing,

all regeneration and all maintenance of our minds and bodies. As a result, understanding and

managing stem cells and their activity increasingly will be the target of medical care.”

New Heart Center Planned

A NEW HOME WILL GIVE AMERICA’S NUMBER ONE

HEART CENTER THE SPACE IT NEEDS TO TACKLE

THE NATION’S LEADING CAUSE OF DEATH.

The Cleveland Clinic Heart Center faces an extraordinary challenge. Restricted space and the

needs of a rapidly aging population threaten to overwhelm the Heart Center’s current facilities.

This, combined with the need to free up space at The Cleveland Clinic for other critical services,

has made it necessary to plan the construction of a new building dedicated to heart care and its

attendant services.

Currently, the Cleveland Clinic Heart Center is America’s largest and busiest heart practice.

Ranked best in America for eight years in a row by U.S.News & World Report, it is the ideal

occupant for a building that is destined to be a world capital of heart care.

The Heart Center will be comprehensive in its capabilities and distinctive in its design. No

feature of heart care or patient comfort will be overlooked. The complex includes a 10-story

hospital tower; a fully equipped surgery, laboratory and technology center; up-to-date

research laboratories; and high-tech classroom capabilities. It will be united with the existing

buildings of The Cleveland Clinic by a splendid atrium.

Driven by a need for larger facilities, the Heart Center is using its unparalleled expertise to

create an optimum environment for patient care, research and the training of heart specialists.

26 THE CLEVELAND CLINIC


DEFENSE MECHANISM

IN SMALL INTESTINE UNRAVELED

Researchers led by Charles Bevins, M.D., Ph.D.,

Immunology, have unraveled the system of

checks and balances governing full potency of

the immune defense systems protecting the

small intestine from microbial infection. The

researchers defined the activation process for

a natural antibiotic of the small intestine that

disrupts bacterial cell membranes, and identified

the key enzyme involved in this mechanism of

the body’s natural defenses. This understanding

may lead to new therapies for certain forms of

food poisoning and open new avenues of therapy

for inflammatory bowel disease (IBD).

HEPATITIS C TREATMENT

RE-BALANCES IMMUNE SYSTEM

A new treatment for hepatitis C utilizing a

combination of the drug etanercept along with

the standard therapy of interferon and ribavirin

is more likely to result in virus eradication than

the standard therapy alone, according to a

study by Nizar N. Zein, M.D., director of

Clinical Hepatology. “It is believed that this

combination therapy may be an improvement

because it may re-establish the natural

balance of the immune system, which is lost

due to the infection. The results of this study

are extremely encouraging,” says Dr. Zein. “A

large study that will include 75 medical centers

throughout the United States and Canada

is planned to begin in the summer of 2003 to

confirm these findings and establish the role

of this new therapy for patients with chronic

hepatitis C.” Dr. Zein will be the principal

investigator for this additional study.

EYE RESEARCH COLLECTION OVERSEEN

The Foundation Fighting Blindness, a nonprofit

organization whose mission is to find the causes,

treatments, preventions and cures for inherited

retinal diseases, has chosen the Cleveland

Clinic Cole Eye Institute to host its collection

center for eyes donated by individuals across

the United States for blindness research.

Joe G. Hollyfield, Ph.D., director of Ophthalmic

Research for the Cole Eye Institute, oversees

the eye collection center, conducts research

on these tissues, and shares tissue samples

from the collection with researchers worldwide.

“Eye donations are vital to research that one

day will lead to a cure for these diseases and

help to prevent blindness,” says Dr. Hollyfield.

UNIQUE METHOD FOR

DETERMINING BREAST CANCER RISK

Specialists in the Cleveland Clinic Breast

Center have helped pioneer an early detection

procedure for women at high risk for developing

breast cancer. Called ductal lavage, the

procedure involves using a tiny catheter to

gather cells from the milk ducts, where most

breast cancers develop. The cells are then

subjected to microscopic examination for precancerous

changes. “Ductal lavage provides

women with unique and personal information

about their breast health, which can help

them make important decisions about pursuing

closer follow-up and risk reduction options,”

says the Breast Center’s Katherine Lee, M.D.

Dr. Lee has initiated a study that uses ductal

lavage to assess cellular atypia in a group of

high-risk African-American patients. The

results may lead to the use of ductal lavage to

determine the eligibility of high-risk African-

American patients for certain therapies or

clinical trials.

BLOOD TEST RESEARCH

REVERSES LONG-HELD BELIEF

Suspected heart attack victims with mild kidney

dysfunction benefit equally from a standard

diagnostic test as do patients whose kidneys are

functioning properly, according to Cleveland

Clinic Heart Center research published in the

New England Journal of Medicine. Physicians

often measure blood levels of troponin, a

protein, in patients thought to have had heart

attacks. High levels of troponin generally indicate

that a heart attack has occurred and that

aggressive treatment is necessary. Previously,

however, troponin measurement was not considered

reliable in those with kidney dysfunction.

On the contrary, Michael Lauer, M.D., and colleagues

found that troponin levels were useful

for diagnosing heart attack and determining

appropriate treatment for patients, regardless

of their kidney function. “Suspected heart

attack patients with kidney dysfunction who

have high troponin levels may well be best

served by aggressive therapy such as heart

catheterization,” says Dr. Lauer, director of

Clinical Research in the Department of

Cardiovascular Medicine. “We’re rapidly discovering

that a blood test for troponin levels

should be the standard for all patients thought

to have experienced an acute coronary event.”

NEW DRUG STABILIZES

CANCER PROGRESSION IN EARLY TRIAL

Research at the Cleveland Clinic Taussig Cancer

Center shows that a new experimental anticancer

drug, phenoxodiol, produced minimal

toxicity and stabilized cancer progression in

a number of patients. “Phenoxodiol is an

interesting new drug. It may target certain

proteins in cancer cells that could be key to the

cancer process,” says Thomas Hutson, D.O.,

Pharm.D., the trial’s co-investigator.

Katherine Lee, M.D.

2002 ANNUAL REPORT 27


REGENERATIVE THERAPY MAY

HELP MULTIPLE SCLEROSIS

The brain can replace cells destroyed by multiple

sclerosis much longer than previously

believed, according to Cleveland Clinic

research published in the New England

Journal of Medicine. The research, directed

by Bruce D. Trapp, Ph.D., chairman of

the Department of Neurosciences at the

Cleveland Clinic Lerner Research Institute,

provides new insight about potential therapy

to treat people who have multiple sclerosis.

“We have known for decades that the brain

can repair the lesions of multiple sclerosis

during the disease’s early stages. We have

assumed that the brain did not repair the

lesions during more chronic stages of multiple

sclerosis because we believed the new cells

were not being generated,” Dr. Trapp says.

“What we discovered in this research is that

the brain is producing the appropriate cells

and that these cells are making significant

attempts to repair the lesions.”

NEW SYSTEM MAKES

WHEELCHAIR USERS SAFER IN BUSES

Researchers in the Department of Physical

Medicine and Rehabilitation have devised a

new system that quickly and easily locks

wheelchairs into place inside public and paratransit

vehicles, school buses and private

vans. In many cases, wheelchair users are

able to secure the chairs themselves without

the aid of a driver or assistant. “Our automatic

tensioning system gives wheelchair users

more independence while traveling and

ensures them that the wheelchair will remain

safely and securely locked in place despite

any bumps that may occur along the road,”

says Steven I. Reger, Ph.D., director of

Rehabilitation Technology. In field trials, the

new design has received wide acceptance

from transit providers and wheelchair users.

The patent has been applied for, and a commercial

agreement signed with Kinedyne, Inc.

CAPSULE MONITORS ACID LEVELS

A revolutionary device that may help treat

people with chronic indigestion has been

tested by Joel Richter, M.D., chairman of

Gastroenterology and Hepatology. Called the

Bravo pH system, it is a tiny device that is

attached to the wall of the patient’s esophagus

and monitored via radio by a small receiver

worn around the patient’s waist. Not much

larger than a cold capsule, the device is

intended to stay inside the patient for only two

days, during which it collects information on

acid levels. This information is then downloaded

onto a doctor’s computer. The device

will allow doctors to more accurately diagnose

gastroesophageal reflux disease (GERD) and

other disorders.

Bravo pH capsule

SEARCH FOR IBD GENES

There is strong evidence that an individual’s

genes are responsible for a predisposition to

the inflammatory bowel diseases (IBD) known

as Crohn’s disease and ulcerative colitis.

There also is evidence that such genes may

determine a particular clinical course or

outcome of IBD. Jean-Paul Achkar, M.D.,

Gastroenterology and Hepatology, is heading a

multi-center collaborative research project

that intends to analyze genetic linkages in

Crohn’s disease based on clinical parameters

in 405 Crohn’s disease-affected individuals.

Dr. Achkar also is establishing an IBD bank of

DNA material as part of an infrastructure to

build a dedicated IBD genetics program at

The Cleveland Clinic.

THE CLEVELAND CLINIC

IN NASA RESEARCH CONSORTIUM

The Cleveland Clinic has joined with NASA

and other local institutions in a new consortium

to create technology that protects the

health of astronauts on long-duration space

missions and to advance the practice of

medicine on earth. Called the John Glenn

Biomechanical Engineering Consortium, it

includes NASA Glenn Research Center, The

Cleveland Clinic, Case Western Reserve

University, University Hospitals of Cleveland

and the National Center for Microgravity

Research. The consortium is sponsored by a

$7.5 million grant from the Office of Biological

and Physical Research at NASA headquarters.

Three projects by Cleveland Clinic scientists

were selected for funding by the consortium.

They are:

• Ulf Knothe, M.D., Orthopaedic Surgery, investigating

whether the application of acoustic

energy, which induces microdamage and natural

rebuilding of bone, will facilitate maintenance

of bone mass in astronauts during extended

space travel and for people on earth who

suffer from osteoporosis.

• Shuvo Roy, Ph.D., Biomedical Engineering,

leading studies aimed at developing a batteryfree,

potentially implantable unique drugdelivery

device that exploits the ability of

microelectromechanical systems (MEMS)

technology to generate precise pore sizes on

the order of the size of drug molecules.

• Susan D’Andrea, Ph.D., Biomedical

Engineering, leading studies to develop a

novel treadmill equipped with dual track and

virtual reality to help maintain astronaut bone

mass while in space and minimize the difficulty

of re-adapting to gravity upon return to

Earth. Use of the device could be extended

as an ideal tool for the rehabilitation of balance

disorder patients on Earth and is already

being used to rehabilitate patients with gait

abnormalities.

28 THE CLEVELAND CLINIC


CCF Innovations

Deploys Technology

Innovation is the key to high-quality, affordable health care in the years to come. To promote

innovation and expand treatment of the sick through the broad and rapid deployment of

Cleveland Clinic technology, CCF Innovations was founded in 2000.

“The Cleveland Clinic has a wonderful entrepreneurial spirit,” says Joseph Hahn, M.D.,

chairman of CCF Innovations. “We are determined to harness that spirit to speed the

commercial application of new ideas for the benefit of patients and the treatment of disease.”

In 2002, Cleveland Clinic staff disclosed 113 new inventions – an all-time record. The

Cleveland Clinic ranked first in Northern Ohio of major hospitals and universities, and in

the top third nationally in commercialization revenues (dollar-per-dollar sponsored research).

In addition, The Cleveland Clinic secured $3.4 million in commercialization revenue and

distributed $1.5 million to 32 Cleveland Clinic inventors. More than 700 Cleveland Clinic

personnel attended a first-ever Inventors Forum on commercializing technology.

“We are strongly committed to establishing Cleveland-based companies to propel the

economic renewal of Cleveland,” says Executive Director Chris Coburn. As part of these

activities, CCF Innovations raised or facilitated $4.25 million in equity investments in

Cleveland Clinic spin-offs and partner companies. The Cleveland Clinic invested nearly $1

million in two Cleveland Clinic spinoffs. Three companies were launched based on intellectual

property developed at The Cleveland Clinic. After Quark Biotech, now located on The

Cleveland Clinic campus, a second Israeli medical technology company, Simbionix, has

come to Cleveland as a result of CCF Innovations’ efforts. $1.3 million in grants was secured

from the state of Ohio, the Generation Foundation and the Codrington Foundation to further

the commercialization of Cleveland Clinic technologies.

Brain Tumor Institute Formed

THE CLEVELAND CLINIC’S TECHNOLOGY TRANSFER

OFFICE IS LAYING THE GROUNDWORK FOR THE

FUTURE OF INDUSTRIAL GROWTH.

A NEW PROGRAM COMBINES THE EXPERTISE OF

MULTIPLE SPECIALTIES TO TREAT A CHALLENGING

FORM OF CANCER.

Specialists from Neurosurgery, Neurology,

Radiation Oncology, and Hematology and

Medical Oncology formed the Cleveland

Clinic Brain Tumor Institute (BTI) to

provide multidisciplinary treatment for brain

tumor patients, and to broaden research

into the causes and treatments of primary

malignant and benign brain tumors.

Chaired by neurosurgeon Gene H. Barnett,

M.D., the BTI is one of only a few national

and international neuro-oncology resource centers in the nation. “The institute offers the

latest diagnostic capabilities, drug-delivery systems and advanced radiosurgery technology,

such as the Gamma Knife and CyberKnife,” says Dr. Barnett. “New radiation, chemotherapeutic

and surgical approaches offer hope to many with previously untreatable disease.”

CHEMOTHERAPY AFTER

PROSTATE SURGERY STUDIED

The Cleveland Clinic Taussig Cancer Center

Department of Hematology and Medical

Oncology, and the Glickman Urological Institute

are conducting several new studies for patients

with advanced prostate cancer. “We are investigating

the use of chemotherapy either prior

to or following prostate cancer surgery,” says

Robert Dreicer, M.D., Hematology and Medical

Oncology. “Chemotherapy is frequently

administered after surgery for breast cancer,

for example, because it’s known to improve

survival, but we’re now exploring its use with

respect to prostate cancer.” Prostate cancer is

the most common cancer among men in the

United States, affecting African-American

males at the highest rate in the world.

INTERNET SITE HONORED

The Cleveland Clinic earned six 2002

eHealthcare Leadership Awards for the quality

of its Web site content, design and function.

The awards were given to five areas of the

Web site, with the Heart Center earning two

platinum awards, the highest ranking available.

“With so much medical information available

online today, it is vital that people seek help

from a health care provider and an Internet

site that they know and trust,” says C. Martin

Harris, M.D., chief information officer and

chairman of Information Technology. “I’m

honored the Clinic is being recognized for the

caliber of its Web site.” Additionally, The

Cleveland Clinic Web site earned eight World

Wide Web (WWW) Health Awards in 2002. The

WWW Health Awards is a program that recognizes

the best health-related Web sites for consumers

and professionals. The program is held

twice a year – spring and fall – with the goal

of providing a “seal of quality” for electronic

health information.

2002 ANNUAL REPORT 29


NEW PROSTATE CANCER

GENE LINK FOUND

Graham Casey, Ph.D., Cancer Biology, and

investigators from Case Western Reserve

University, Washington University and the

National Institutes of Health uncovered a

common genetic mutation that doubles the

risk of prostate cancer in the men who possess

it. Results of the study suggest that up to

13 percent of prostate cancer cases are attributable

to this specific genetic mutation. Men

who inherited only one copy of the mutation

from a parent had a 50 percent increased risk

of prostate cancer, while those who inherited

two copies of the mutation – one from each

parent – had a two-fold increased risk of the

disease. “These findings suggest that screening

men for this mutation may be justified in

future risk assessment of prostate cancer,”

says Dr. Casey. Study collaborators from the

Cleveland Clinic Lerner Research Institute

included Robert Silverman, Ph.D.; Phillippa J.

Neville, Ph.D.; Sarah J. Plummer; Lisa M.

Krumroy; and Ying Xiang, Ph.D.

STUDY OF FEMALE PELVIC

FLOOR DISORDERS

Despite the fact that 50 percent of American

women are affected by pelvic floor disorders,

there is remarkably little basic science and

clinical research on these disorders. To remedy

this shortcoming, Firouz Daneshgari, M.D.,

Glickman Urological Institute, is undertaking a

major academic research project that will help

develop new knowledge of and treatments for

female pelvic problems. Dr. Daneshgari’s project

includes the design and implementation of

clinical and basic science research projects

that address the problems of female pelvic

disorders such as urinary incontinence, pelvic

organ prolapse and bladder control problems,

and more focused collaboration among clinical

investigators.

Cleveland Clinic Lerner

College of Medicine Established

AN INNOVATIVE NEW PROGRAM SEES THE

CLEVELAND CLINIC AND CASE WESTERN RESERVE

UNIVERSITY JOINING FORCES TO MEET A CRITICAL

EDUCATIONAL NEED.

In May 2002, The Cleveland Clinic and

Case Western Reserve University entered

into an historic partnership to create a unique,

new medical school program dedicated to

the teaching of physician-scientists. The

Cleveland Clinic Lerner College of Medicine

of Case Western Reserve University links one

of the nation’s top hospitals with one of the

nation’s leading research universities. The

college will combine education and research

in an innovative program that will graduate

32 medical students each year who are

mentored to become physician-scientists.

The collaborations made possible by this

new endeavor are expected to have a major

impact on medical education and the field of

medical science.

The Cleveland Clinic Lerner College of

Medicine will attract and educate a select

group of highly qualified individuals who

are motivated to become physician investigators

and scientists and who are committed

to the advancement of biomedical research

and practice.

The college program will instill in all graduates a passion for scientific inquiry that will carry

them forward into academic residency programs and professional careers as successful physician

investigators. Current and future generations of patients will benefit from these graduates,

who will advance the field of medicine through scientific discovery, therapeutic innovation

and clinical excellence. The first class will begin in the summer of 2004.

30 THE CLEVELAND CLINIC


EDUCATING FOR THE FUTURE

The Cleveland Clinic Division of Education

continues to impact the future of medicine

through a wide-ranging and expanding array

of programs. In 2002, the division continued

to operate one of the largest graduate medical

education programs in the country, with 683

residents and fellows in ACGME/ABMS

programs at The Cleveland Clinic, and 121 in

advanced fellowship programs. Every year,

these numbers increase in response to

advances in medicine, and 2002 was no

exception. Seven new advanced fellowships

were added, including cardiovascular tomography,

female pelvic medicine and reconstructive

surgery, gynecologic laparoscopic surgery,

hospital medicine, medical informatics, obstetric

anesthesia, and urologic laparoscopic surgery.

The Division’s Department of Continuing

Medical Education sponsored 509 activities in

2002 (almost double the number five years

ago) with more than 110,000 participants,

half of whom received CME credits online.

The Department of Patient Education and

Health Information continued to expand its

audience as well. Services supported by

Patient Education include CCTV in-hospital

programming, public health talks, Jewish

Community Center health exchange programs,

Cleveland Clinic Health System smoking prevention

programs, and five health information

kiosks around campus. The department also

is responsible for the Clinic’s Health

Information Center Web site (www.clevelandclinic.org/health),

which offers a broad range

of information on the body, its diseases and

treatments. The Web site grew to 3,470 documents

in 2002, and 343,907 health information

searches were performed by patients

and the public.

THRIVING IN FLORIDA

Cleveland Clinic Florida continues to thrive in

Weston and Naples, enjoying unprecedented

growth driven by multiple factors, including an

influx of top physicians, expanded programs and

recognition from the community in the form of

increased patient visits. Twenty-nine Cleveland

Clinic Florida physicians were listed among

the nation’s top doctors in 2002. Outstanding

new physicians were added to the staff in

both Weston and Naples in a variety of

specialties, including cardiology, neurosurgery,

orthopaedic surgery and vascular surgery.

New procedures and programs include

epilepsy surgery, a Center of Excellence for

Parkinson’s disease, cardiac electrophysiologic

studies, a highly successful bariatric surgery

program, and the expansion of robotic-assisted

technology for minimally invasive surgery from

cardiac surgery to general surgery. A $10 million

charitable contribution from John and

Margaret A. Krupa, given for future development

of Cleveland Clinic Florida, will ensure that

additional state-of-the-art services can be

added in response to need and demand.

Patients from throughout the region and the

United States continue to seek care at

Cleveland Clinic Florida. The number of international

patients seeking both primary care

and specialty services has grown exponentially

throughout the Caribbean and Central and

South America. Cleveland Clinic Florida’s

graduate medical education programs are in

great demand. The internal medicine residency

program likely will expand from seven to 10

residents per year. Cleveland Clinic Florida

continues to maintain an active presence in

both communities by conducting free medical

seminars and partnering with community

organizations to offer free health care screenings

and increase the awareness of risk factors and

appropriate care for particular medical conditions.

Service excellence, always a goal, has

now taken center stage with a new initiative

called World Class Service. In addition to

focusing on continual improvement in service

to patients, their families and physicians, the

initiative seeks to make Cleveland Clinic

Florida the health care employer of choice in

both Broward and Collier counties.

COMMUNITY SERVICE RECOGNITION

The Cleveland Clinic was one of 11 recipients of

the 2002 Pillar Award for Community Service.

This award, developed by Smart Business

Network and Medical Mutual, honors businesses

and organizations that make outstanding

contributions to their communities. One of

the many programs recognized by the Pillar

Award was the Clinic’s partnership with

John Hay High School. The Cleveland Clinic/

John Hay High School Educational Partnership

offers the opportunity for students to attain

equal access to higher education and employment

following high school graduation. The

program emphasizes health sciences, health

education and health career awareness, and

blends in-depth study of health sciences with

opportunities for learning and exposure to

various careers in health care. In addition to

the Pillar Award, The Cleveland Clinic received

a certificate of special recognition from the

United States Congress for the AGAPE

HIV/AIDS outreach program, a partnership

with Antioch Baptist Church.

Steveland Arnold, Cleveland Clinic/

John Hay Partnership graduate

2002 ANNUAL REPORT 31


32 THE CLEVELAND CLINIC

TRANSPLANT LANDMARKS

Since 1963, when The Cleveland Clinic performed

the first kidney transplant in Ohio and

became a recognized pioneer in the field of

transplantation, the Clinic has been committed

to expanding the staff, resources and technical

support necessary to stay in the forefront of

transplant technology. In 2002, the Transplant

Center achieved a number of milestones:

Nation’s Best Heart Transplant Results

The Cleveland Clinic’s Heart Transplant Program

at the Kaufman Center for Heart Failure was

the only one of 168 U.S. heart transplant programs

to achieve better-than-expected patient

survival rates at three different time periods

after transplant, according to data released by

the U.S. Organ Procurement and Transplantation

Network (OPTN) and the Scientific Registry of

Transplant Recipients (SRTR). The Clinic’s

program is the third largest in the United

States and overwhelmingly the largest in Ohio.

300th Lung Transplant

The Cleveland Clinic Lung Transplant Program –

Ohio’s largest program and one of the five

most active programs in the United States –

completed its 300th lung transplant in 2002.

The Clinic’s first lung transplant was performed

in February 1990.

600th Liver Transplant

J. Michael Henderson, M.D., chairman of

General Surgery and director of the Transplant

Center, performed The Cleveland Clinic’s

600th liver transplant in 2002. The Clinic’s

first liver transplant was performed in

November 1984.

Generous Donors Support The Cleveland Clinic

Carl and Babs Glickman

GRATEFUL KIDNEY RECIPIENT THANKS

THE CLINIC FOR SAVING HIS LIFE.

Normally, undergoing a kidney transplant is a physically and emotionally challenging

experience for a patient. When Carl Glickman, a distinguished fellow of The Cleveland

Clinic, faced the procedure, he also required preliminary surgery for diverticulitis and kidney

cancer. While such an ordeal might have left some defeated, Mr. Glickman says of his

Cleveland Clinic experience, “I was encouraged all the way.”

To show his thanks for the expert diagnosis, treatment and supportive care he received, the

Cleveland businessman and his wife, Babs, donated $8 million to the Clinic’s Urological

Institute. The inspiration for the generous gift “They saved my life,” Mr. Glickman

states simply.

In honor of the couple, the facility has been renamed the Glickman Urological Institute of

The Cleveland Clinic. This is not the first time the two have contributed to the Clinic.

“Carl Glickman has been a Cleveland Clinic patient for 25 years and a leadership donor in

all four of the Clinic’s fund-raising campaigns. The commitment that he and his wife have

shown toward our urology program is humbling,” says Andrew C. Novick, M.D., chairman

of the Glickman Urological Institute. “The Glickmans’ generous gift will support our efforts

to learn even more and improve treatment in all areas of urology.”

U.S.News & World Report has ranked the Glickman Urological Institute staff of 55 physicians

and scientists second in the United States for the past three years and the best in Ohio every

year since 1990.

Mr. Glickman currently serves as a director of Bear Stearns Companies Inc., presiding trustee

of Lexington Corporate Properties Trust and a trustee of Cleveland State University. Mrs.

Glickman is a director of the Cleveland Institute of Music.


THERAPY INCREASES

SURVIVAL TIME FOR LIVER CANCER

Patients with inoperable liver cancer who

undergo a combination of chemotherapy and

radiofrequency thermal ablation, a type of

therapy that applies heat to destroy tumors,

live longer than patients treated with

chemotherapy alone, according to a study by

Allan E. Siperstein, M.D., General Surgery.

“These findings are particularly significant

given more than 2 million patients worldwide

will develop primary and metastatic liver

cancer, and chemotherapy has limited efficacy

for these patients,” says Dr. Siperstein.

Sam and Maria Miller

EMERGENCY SERVICES SERVES AS GATEWAY

BETWEEN CLINIC AND COMMUNITY.

If you ask Sam Miller, no one can put a dollar value on a human life. There’s no doubt,

though, that $8 million could help save countless lives.

Mr. Miller and his wife, Maria, recently made such a commitment to The Cleveland Clinic,

naming the Sam and Maria Miller Emergency Services Building. Mr. Miller, co-chairman of

Forest City Enterprises Inc. and a Clinic trustee and executive committee member, holds

emergency care close to his heart.

“I find The Cleveland Clinic to be a veritable lifesaver, for Cleveland and the entire world,”

Mr. Miller says. He refers to the emergency treatment facility as the “gateway to the Clinic,

a place where the poor and rich can go.” His efforts have proved instrumental to the Clinic’s

debut in emergency services.

“Sam’s gift goes far beyond the naming of the building,” says Floyd D. Loop, M.D., chairman

and CEO of The Cleveland Clinic. “He has formed vital relationships with our physician

community and has shown great leadership in the development of emergency services from

The Cleveland Clinic.”

The Emergency Services Building, which opened in 1994, houses an emergency treatment

area and a “fast-track” and minor illness area. The facility is adjacent to a Clinical Decision

Unit shared with Kaiser Permanente. In this unit, patients who do not require immediate

hospitalization may be observed and treated for up to 24 hours.

While the Millers’ recent support focuses on emergency services, “this gift was given in

appreciation for the doctors, nurses and all employees at The Cleveland Clinic,” says

Mr. and Mrs. Miller.

Allan Siperstein, M.D.

2002 ANNUAL REPORT 33


The Cleveland Clinic Foundation

34 THE CLEVELAND CLINIC

BOARD OF TRUSTEES

OFFICERS

A. Malachi Mixon, III *

Chairman and Chief Executive Officer

Invacare Corporation

Chairman, Board of Trustees

The Cleveland Clinic Foundation

Floyd D. Loop, M.D. *

Chief Executive Officer

Chairman, Board of Governors

Executive Vice President

The Cleveland Clinic Foundation

Stephen R. Hardis *

Chairman and

Chief Executive Officer (Retired)

Eaton Corporation

Vice President

The Cleveland Clinic Foundation

MEMBERS

Theodore M. Alfred, Ph.D. **

Professor Emeritus and Dean Emeritus

Weatherhead School of Management

Case Western Reserve University

Patrick V. Auletta

President

KeyBank, N.A.

Nancy F. Beck, Esq. *

Former Prosecutor

City of Cleveland

Edward F. Bell **

President and

Chief Executive Officer (Retired)

The Ohio Bell Telephone Company

Gordon R. Bell, M.D.*

The Cleveland Clinic Foundation

James M. Biggar **

Chairman and Chief Executive Officer

Glencairn Corporation

Edward B. Brandon **

Chairman and

Chief Executive Officer (Retired)

National City Corporation

Jeanette Grasselli Brown, DSc. **

Chair

Ohio Board of Regents

Flora M. Cafaro

Vice President and Assistant Treasurer

The Cafaro Company

F. Joseph Callahan **

Chairman (Retired)

Swagelok Company

Bruce A. Carbonari

President and Chief Executive Officer

Fortune Brands – Home and Hardware

Guy M. Chisolm, Ph.D.

The Cleveland Clinic Foundation

Jeffrey A. Cole

Chief Executive Officer

Cole National Corporation

Thomas A. Commes *

President and

Chief Operating Officer (Retired)

The Sherwin-Williams Company

William E. Conway * **

Chairman

Fairmount Minerals, Ltd.

William R. Cosgrove

Chairman and Chief Executive Officer

Swagelok Company

Thomas M. Coughlin

President and Chief Executive Officer

U.S. Operations

Wal-Mart Stores, Inc.

Robert Cunningham, M.D.

The Cleveland Clinic Foundation

E. M. de Windt **

Chairman and

Chief Executive Officer (Retired)

Eaton Corporation

Umberto P. Fedeli

President and Chief Executive Officer

The Fedeli Group

Gay Gilanyi, Ed.D.

Professor, Teachers College

Columbia University

Lilian V. Gonsalves-Ebrahim, M.D.

The Cleveland Clinic Foundation

Joseph T. Gorman

Chairman (Retired)

TRW Inc.

President

Moxahela Enterprises

William R. Gorton

Senior Vice President

Dawson Companies

Cynthia Gutierrez, M.D.

The Cleveland Clinic Foundation

Gordon E. Heffern **

Chairman and

Chief Executive Officer (Retired)

Key Bank, N.A.

David J. Hessler, Esq. *

Wegman, Hessler & Vanderburg

David G. Hill, Esq. **

David G. Hill & Associates, Co.

Arthur S. Holden, Jr. **

Vice President (Retired)

The Coe Manufacturing Company

Elton Hoyt, III **

President and

Chief Executive Officer (Retired)

Pickands Mather & Co.

James A. Hughes **

Chairman (Retired)

First Union Real Estate Investments

Diamond Shamrock Corporation

Ruth K. Imrie, M.D.

The Cleveland Clinic Foundation

Jerry V. Jarrett **

Chairman and

Chief Executive Officer (Retired)

AmeriTrust Corporation

E. Bradley Jones **

Chairman and

Chief Executive Officer (Retired)

Republic Steel Corporation

John J. Kahl, Jr. *

President

Jack Kahl & Associates, LLC

Robert D. Kain

Senior Executive Vice President

IMG

Robert Kay, M.D. *

Chief of Staff

Vice Chairman, Board of Governors

The Cleveland Clinic Foundation

John W. Kemper, Sr.

Chief Executive Officer

Avalon Precision Casting Co.

Vice President, Treasurer

Kemper House

Thomas G. Knoll, Esq.

Stark & Knoll Co., L.P.A.

Stephen F. Lau, Ph.D. *

President

Industrial First, Inc.

Robert L. Lintz *

Plant Manager (Retired)

Parma Metal Fabricating Division

General Motors Corporation

William E. MacDonald **

President and

Chief Executive Officer (Retired)

The Ohio Bell Telephone Company

William E. MacDonald, III *

Vice Chairman

National City Corporation

Patrick F. McCartan, Esq. *

Managing Partner (Retired)

Jones Day

John V. McFadden *

Vice Chairman (Retired)

MTD Products

Robert F. Meyerson

Chairman (Retired)

Telxon Corp.

As of March 2003 *Executive Committee **Emeritus Trustee

Samuel H. Miller * **

Co-Chairman of the Board

Forest City Enterprises, Inc.

James P. Mooney

Chairman and Chief Executive Officer

OM Group, Inc.

Dan T. Moore, III *

President

The Dan T. Moore Company, Inc.

David T. Morgenthaler **

Managing Partner

Morgenthaler Ventures

Bert W. Moyar

President

MEI Hotels Incorporated

William C. Mulligan

Managing Director

Primus Venture Partners

James R. Neville

Executive Vice President

Christian & Koppler, Inc.

Carmen A. Policy

President and Chief Executive Officer

The Cleveland Browns

Robert E. Rich, Jr.

President

Rich Products Corporation

Paul G. Rogers, Esq. **

Hogan & Hartson

Ronald J. Ross, M.D., F.A.C.R.

Director Emeritus

Department of Radiology

Hillcrest Hospital

Hassib J. Sabbagh **

Chairman

Consolidated Contractors International

Company, S.A.L.

Bill R. Sanford

Chairman

SYMARK LLC

Joseph M. Scaminace *

President and Chief Operating Officer

The Sherwin-Williams Company

Ralph E. Schey **

Chairman and

Chief Executive Officer (Retired)

The Scott Fetzer Company

Martin J. Schreiber, M.D.

The Cleveland Clinic Foundation

Samuel K. Scovil

Chairman and

Chief Executive Officer (Retired)

Cleveland-Cliffs Inc

The Honorable Raymond P. Shafer**

Former Governor, State of Pennsylvania

Shafer, Swick, Bailey, Irwin, Stack & Millin


John Sherwin, Jr.

President

Mid-Continent Ventures, Inc.

Jack C. Shewmaker *

Chief Financial Officer (Retired)

U.S. Operations

Wal-Mart Stores, Inc.

President

J-Com, Inc.

James P. Storer **

Past President

Cleveland Sight Center

Trustee & Secretary

George B. Storer Foundation

Ralph A. Straffon, M.D. **

Chief of Staff (Retired)

The Cleveland Clinic Foundation

Thomas C. Sullivan, Sr.

Chairman and Chief Executive Officer

RPM, Inc.

Brian J. Taussig

President and Chief Executive Officer

Classic Direct, Inc.

C. Carlisle Tippit **

President (Retired)

Mogul Corporation

Robert J. Tomsich *

Chairman

NESCO, Inc.

Thomas V.H. Vail **

Publisher and Editor (Retired)

The Cleveland Plain Dealer

Tom Wamberg

Chairman and Chief Executive Officer

Clark/Bardes Consulting

Morry Weiss *

Chairman and Chief Executive Officer

American Greetings Corporation

Alton W. Whitehouse **

Chairman and

Chief Executive Officer (Retired)

Standard Oil Company of Ohio

Herbert P. Wiedemann, M.D.

The Cleveland Clinic Foundation

Loyal W. Wilson

Managing Director

Primus Venture Partners

Ivan J. Winfield *

Managing Partner (Retired)

Coopers & Lybrand

Northeast Ohio Office

Ambassador Milton A. Wolf, Ph.D.**

Former U.S. Ambassador to Austria

Chairman

Milton A. Wolf Investors

ADMINISTRATION

Floyd D. Loop, M.D.

Chief Executive Officer

Chairman, Board of Governors

Robert Kay, M.D.

Chief of Staff

Vice Chairman, Board of Governors

Muzaffar Ahmad, M.D.

Chairman

Division of Medicine

Gene Altus

Administrator, Board of Governors

Assistant Secretary

Philip L. Bailin, M.D.

Director

Office of Practice Management

James M. Blazar

Chief Marketing Officer

Chairman, Division of Marketing

David L. Bronson, M.D.

Chairman

Division of Regional Medical Practice

Angela M. Calman

Chief Communication Officer

Public & Media Relations

John D. Clough, M.D.

Chairman

Division of Health Affairs

Christopher Coburn

Executive Director

CCF Innovations

Robert W. Coulton, Jr.

Administrator

Office of Professional Staff Affairs

Paul E. DiCorleto, Ph.D.

Chairman

Lerner Research Institute

F. George Estafanous, M.D.

Chairman

Division of Anesthesiology

Melinda L. Estes, M.D.

Chief Executive Officer

Cleveland Clinic Florida

Andrew J. Fishleder, M.D.

Chairman

Division of Education

Joseph F. Hahn, M.D.

Chairman

Division of Surgery

C. Martin Harris, M.D.

Chief Information Officer

Chairman, Information Technology Division

William R. Hart, M.D.

Chairman

Division of Pathology and

Laboratory Medicine

Robert Ivancic, J.D.

Executive Director

Division of Human Resources

Stuart W. Kline

Director

Environmental Health and Safety

Hilel Lewis, M.D.

Director, Cole Eye Institute

Chairman, Division of Ophthalmology

Bruce A. Loessin

Senior Vice President and

Chairman & Executive Director

Institutional Relations and Development

Alan E. London, M.D.

Executive Director

Division of Managed Care

Frank L. Lordeman

Chief Operating Officer

Walter G. Maurer, M.D.

Director

Office of Quality Management

Michael T. Modic, M.D.

Chairman

Division of Radiology

Deborah Nadzam, Ph.D., R.N.

Director

Quality Institute

Daniel E. Nickelson

Director

Government Affairs

Michael P. O’Boyle, C.P.A.

Chief Financial Officer

Lisa Ramage

Executive Director

International Center

Susan J. Rehm, M.D.

Associate Chief of Staff

David W. Rowan, Esq.

Secretary and General Counsel

Richard A. Rudick, M.D.

Chairman

Division of Clinical Research

Anthony J. Senagore, M.D.

Medical Director

Medical Operations

Donald Sinko

Director

Internal Audit

John E. Steiner, Jr., Esq.

Director

Corporate Compliance

James K. Stoller, M.D.

Associate Chief of Staff

Eric Topol, M.D.

Chief Academic Officer

Shawn Ulreich, R.N., M.S.N.

Chief Nursing Officer

Chairman, Division of Nursing

T. Declan Walsh, M.D.

Chairman

Division of Post Acute Medicine

Steven D. Wexner, M.D.

Chief of Staff

Cleveland Clinic Florida (Weston)

Robert J. Zehr, M.D.

Chief of Staff

Cleveland Clinic Florida (Naples)

BOARD OF GOVERNORS

Floyd D. Loop, M.D.

Chairman

Robert Kay, M.D.

Vice Chairman

Frank L. Lordeman

Chief Operating Officer

Michael P. O’Boyle, C.P.A.

Chief Financial Officer

Eric Topol, M.D.

Chief Academic Officer

Gene H. Barnett, M.D.

Gordon R. Bell, M.D.

David L. Bronson, M.D.

Linda M. Graham, M.D.

Eric Klein, M.D.

Walter G. Maurer, M.D.

Michael T. Modic, M.D.

Martin J. Schreiber, M.D.

Herbert P. Wiedemann, M.D.

2002 ANNUAL REPORT 35


THE CLEVELAND CLINIC FOUNDATION AT A GLANCE

THE CLEVELAND CLINIC FOUNDATION

THE CLEVELAND CLINIC FOUNDATION STATISTICAL HIGHLIGHTS

PATIENT CARE 2002 2001

Total Clinic Visits 2,492,415 2,324,946

1999–2002 TREND ANALYSIS

TOTAL CLINIC VISITS

(in millions)

Emergency Visits 50,561 50,194

Total Admissions (excluding newborns) 51,162 51,959

Available Beds (excluding bassinets) 1,058 1,008

Surgical Cases 65,684 62,445

Operating Rooms 78 77

3.0

2.5

2.0

1.5

EDUCATION

Residents and Fellows in Training 804 767

Medical Students 548* 459

Accredited Residency Training Programs 51 51

Allied Health Students 305 265

Programs for Allied Health Specialists 29 32

1.0

0.5

0

1999 2000 2001 2002

ADMISSIONS

(in thousands)

RESEARCH

Total NIH Multiyear Grants Awarded 187 150

Total Dollar Amount of all NIH Grants Awarded $55.1m $47.5m

Total Dollar Amount of all Federal Multiyear Grants and Contracts Awarded $60.3m $52.6m

Other Funding $5.1m $4.36m

55

50

45

40

FACILITIES

Million Square Feet of Campus Building Space 6.3 6.0

*From 70 medical schools.

35

30

25

1999 2000 2001 2002

CLEVELAND CLINIC HEALTH SYSTEM FINANCIAL HIGHLIGHTS †

$ IN THOUSANDS 2002 2001

Total Assets 3,738,216 3,532,570

Net Assets 1,206,958 1,348,778

Net Patient Care Revenues 2,838,645 2,593,217

Charity Care 157,300 125,600


Current year estimates subject to final year-end audit.

70

60

50

40

30

20

10

0

SURGICAL CASES

(in thousands)

1999 2000 2001 2002

36 THE CLEVELAND CLINIC


WORLD CLASS SERVICE

© 2003 The Cleveland Clinic Foundation DESIGN: Epstein Design Partners, Inc. PRINCIPAL PHOTOGRAPHY: Al Fuchs, Fuchs + Kasperek, Inc. Al Lerner photo: John H. Reid III

In 2002, The Cleveland Clinic launched an unprecedented effort to enhance patient satisfaction

and create a permanent service culture for all personnel. Called World Class Service, the

program involves every department and every employee in an ongoing effort to implement new

ideas and make a difference in service, people, quality, growth and finance. It is an investment

in the future of patient care. Through World Class Service, The Cleveland Clinic intends to

achieve a reputation for service and patient satisfaction equal to its achievements in medicine.


THE CLEVELAND CLINIC

FOUNDATION

9500 Euclid Avenue, Cleveland, Ohio 44195

Please visit our Web site at

www.clevelandclinic.org

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