Wellness, revolutionized. - Children's Hospital Central California

Children’s Hospital Central California’s 2009 Annual Report
Wellness,
revolutionized.

A Revolution.
To change something, to turn it around, to give it a different perspective. In the middle of California’s heartland, in a tight-knit family of large and small communities, we’ve done just that.
We’ve spent 60 years building a medical marvel that rivals those in any large American city. And our revolution moves forward every day as we strive to improve pediatric specialty care, to be safer, to
be as advanced and forward thinking as possible. All the while, we ensure that everything we do, every resource we apply, and every person on our team revolves around children and the loving care
they receive.
This is another kind of “revolution”, a safety net of specialized medical professionals orbiting our patients like planets around a star. And these team members are just as varied and different as the lights
you see in the sky. Doctors, nurses, respiratory care technicians, dietitians, social workers - every aspect of a child’s care has a place in our universe. Like planets, our team moves together, their “gravitational fields”
creating an environment that keeps everything in place. We call that kind of teamwork multidisciplinary care, and it is as dependable as the sun.
Join us as we take a look through our telescope at 2009, at the ways we revolutionized wellness, and how our care revolved around the region’s kids. We’ll show you the people who are our
stars and the professions they practice, and we’ll zoom in on how everything and everybody works together to make one great big revolving (and revolutionary) universe of care, spinning in unison
around the sunshine of our lives.

Dear Friends, Contents
On a clear spring night here on the bluffs you can see forever.
This small distance from the city gets us out from under the ever-present glow. It lets us watch a sky
full of stars, a universe packed with wonder that moves in unison like clockwork. Inside Children’s
Hospital, we strive to perform with our own graceful precision. Whether it’s surgeons performing
advanced procedures, a pediatric critical care unit executing like no other, or a financial team
navigating the stormiest era in memory, we owe our precise performance to one simple thing - a
near-religious belief in planning.
As President and CEO, and Chair of the Board of Trustees, we began our friendship and working
relationship a decade ago. In that decade we have seen this organization go through unprecedented
growth and change. We’ve helped steer Children’s toward an operating methodology built on goalplanning,
focused on keeping all of our strategies aligned with our mission and vision.
Working with The Board of Trustees and every staff member and doctor within our walls,
we’ve made sure that every transition has been proactive and planned. We’ve minimized surprises
without sacrificing flexibility. We implemented a 10-year financial plan that has helped us not just
survive the current economic crisis, but continue to thrive and make advances that will help the
Valley’s kids for decades to come.
As you read this report, you should easily recognize that the story of 2009 is really the story of
all the years of planning that preceded it. The vast construction on our west end owes its existence
to strategic moves made years ago. Our patient safety and performance improvement initiatives
are seeing fruition now because of strategies implemented much earlier. The examples go on, and
are all evidence of a culture of planning that permeates our organization and has allowed every
service line we offer to grow and improve in measured steps. It is a belief in strategy that has made
us not just one of the largest hospitals of our type in the country, but one of the best.
This culture of planning has another advantage in 2010 as one CEO moves to new horizons
while another, Dr. Gordon Alexander, Jr., picks up the torch of caring for kids. This too, is planned.
Many organizations our size do not have the luxury of calm succession planning, but at Children’s
Hospital Central California, we do. As one person put it, “At Children’s, the big deal is that this is
not a big deal.” It’s the result of the kind of planning that has made us who we are, and it’s what
ensures that we’ll be here for a long, long time, no matter who sits in the big office at the end of the
hall. Our history is proof of our future, and out here on the bluffs you really can see forever.
William F. Haug
President & CEO
Children’s Hospital Central California
Greg Coleman
Chair, Board of Trustees
Children’s Hospital Central California
1
Focusing on
Improvement
Using national, international
and in-house outcomes
measurements as benchmarks,
Children’s has mapped
improvements across our entire
spectrum of care. We’ve cut
down medication errors with
technology and teamwork,
utilized unique medical devices
to enhance patient safety, and
participated in studies that
reduced infection rates in our
intensive care units. And that’s
just the 2009 short list.
Powered by
People
9
Technology has advanced
medicine at hyper-speeds,
but nothing fuels healing
as much as well-trained
experts practicing with
compassion in a teamdriven
environment.
Children’s Hospital
recruits, retains and
rewards medical professionals
at the top of their
fields because we know
that in the end, it’s people
that heal people.
17 Procedures &
Implants
Surgeons are helping
kids with advanced
procedures and
devices, including
orthopaedists using
Internal Traction and
the Shilla procedure to
give children a mobile
life, otolaryngologists
installing boneanchored
hearing
devices and neurosurgeons
implanting
self-activated nerve
stimulators to help
kids stop uncontrollable
seizures.

25
The View
from the Outside
Children’s has been accredited
and honored by some of
the most prestigious medical
commissions and organizations
in the world. A 2009 survey by
The Joint Commission highlighted
the impression we make
outside of our region, and our
PICU has been given the
prestigous Beacon Award.
29
Technology in
Transition
Technology is a wonderful thing,
until it starts to age. A nearcomplete
replacement of all of
Children’s digital systems in
2009 included clinical information
management systems,
pharmacy systems, employee
record keeping and physician
management. This monumental
change took us from a capablebut-aging
environment into
technologies that will help us
help kids for years to come.
Central to
California35
While most folks don’t know
what it means to be a regional
tertiary hospital, we certainly
do. While giving incredible care
to our own patients, we also
provide support and education
for medical providers
and hospitals throughout
Central California. We provide
services in places like Modesto
and San Luis Obispo, and we
partner with other hospitals in
providing specialized care.
Wellness,
Well Managed41
Children’s Hospital’s business
success is due in large part to
strong financial integrity. Our
community has built an amazing
resource here, and we take great
pride in managing it well.
Helping
Kids
45
The residents of our Valley are
open-hearted when it comes to
caring for children. There is a lot
of need in our world today, but
when the lives and well-being of
our youngest citizens are on the
line, our neighbors step up with
pride, and right now is a great
time to join them. The Campaign
for Children’s is in full swing, and
this is where you’ll find out who
is on the team and how you can
get on board.

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1
Keeping the focus on
improvement.
You’ve seen examples of high-quality care at Children’s Hospital
Central California for years. As the only regional tertiary pediatric
institution in this part of the state, we set the standard for
children’s healthcare. But like a high-performance athlete or
any perfection-minded individual, the Hospital has a hard time
accepting “good enough” when great remains achievable.
Even with the advancements to care we’ve made in the
Valley and the nation, we still look both internally and out to
the world medical community to measure our performance and
indentify improvement opportunities. The quality and safety of
the care we provide our little patients is strong motivation for a
focus on improvement, and the primary driver behind all of our
decisions.
Improvement opportunities can come to light in national
studies, like the Institute of Medicine’s report “To Err is Human”,
which gave solid examples of the alarming ways patients were
endangered by care systems throughout the country. Rather
than assume that we aren’t like those other facilities, Children’s
conducted (and continues to conduct) internal reviews of the
nationally identified problem areas. We’ve found valuable opportunities
to improve, to keep our patients from harm, and to take
another step towards perfection.
The Joint Commission surveys Children’s Hospital about every
three years, measuring our care at core levels, and we received
high praise from them in 2009. But we still work just as hard at
Children’s keeps looking inward,
creating paths to improved care.
their nationally-published care goals.
We participate in unit-based measurement
groups as well. Our neonatal
intensive care and pediatric intensive
care units belong to national cooperatives
consisting of similar hospitals and
units comparing outcomes data. These
groups also work on problems together,
sharing innovative methods to improve
care throughout the world. Finally, our
own staff are always aware of how well
we perform, and we value and protect any
individual who comes forward to point
out a need for improvement.
There are many ways to make
improvements once a need is identified,
but it really boils down to three areas -
people, systems and tools.
Improving tools and technology
is a constant process in healthcare
(pg. 29), while training and education
are the primary methods for improving
care provided by people (pg. 9). Systems,
however, are a different matter. Systems
are intended to make it easy to always do
We make Children’s Hospital as stress-free as
possible for kids and their families. Parents
become an important partner in safety,
joining us in our effort to keep their
child’s care error-free.
the right thing, to put caregivers in situations
where mistakes are very hard to
make.
The Joint Commission puts a high
value on systems. An example is the
“read back” methodology pioneered by
The Joint Commission and adopted by
Children’s Hospital a few years ago. The
system is simple - any caregiver (such as
a nurse) receiving verbal instruction from
a doctor must write it down and read it
back - always. This ensures that the caregiver
correctly received and understood
the instruction, and that the doctor hears
exactly what the caregiver is going to do.
By making this a system that everyone
uses, Children’s eliminates senseless
miscommunication that could result in
improper care. It is a system that works.
In 2009, Children’s continued to
identify opportunities and implement
training, systems and tools to improve
care, with positive results.

We’ll take care of that.
Nobody likes a catheter. But if you have to have one, you want it to work.
When bedside nurses in Children’s Neonatal Intensive Care Unit (NICU)
noticed repeated incidences of catheter breakage, they took action.
“The tiny catheters serve as a lifeline for these babies, providing needed
medication and nutrition,” said Clinical Nurse Specialist Kimberly Sutters,
who leads the Children’s pain management program and the PICC (peripherally
inserted central catheter) team. “A break in the line can interrupt
therapy, require an emergency replacement, and create a risk for infection.”
In 2007, 12 percent of silicone PICCs in the NICU required repair, so
Children’s switched products. Soon, however, nurses began reporting incidences
of “leakage” from the new catheters’ hub.
Rather than switch again, the team decided to work with the manufacturer
to build a better PICC. Nurses, risk management staff, materials
management and purchasing professionals collaborated with the manufacturer,
Medcomp, and the Food and Drug Administration (FDA) to design a
safer, more efficient catheter. In June 2009, Medcomp obtained FDA approval
for the new neonatal PICC. Children’s debuted the redesigned product a
month later. The Hospital has had zero incidents of PICC cracking since.
Success in the NICU drove Medcomp to improve products for bigger
kids, too, and Children’s began using the larger pediatric catheters this year.
The FDA, Center for Devices and Radiological Health, and Medical
Product Safety Network recognized Children’s with a certificate for
outstanding contribution to promoting patient safety
with medical devices.
“This effort started with the bedside staff,” said Sutters.
“They identified a problem, spoke up and we took action.”
A beacon in the night.
Ah, the night shift. A quiet time to reflect, unless of
course, you happen to be a nurse in the pediatric intensive
care unit (PICU). You see, it’s always busy in the
PICU. But night nurse Lee Pelayo found time to come
up with a brilliant idea. What if PICU staff applied for
(Continued on page 3)
Kimberly Sutters, CNS, PhD, was the coordinator of the team
that helped redesign the PICC (peripherally inserted central
catheter). The new PICC, shown here in its package, is used by
hospitals throughout the country.
Layla is all dressed up
for her photo in the
NICU, happily sporting
a very important
accessory. PICC lines
provide our babies
with the medicine and
nutrients they need to
grow and get better.
Children’s staff helped
the manufacturer
redesign the product
so that it wouldn’t
leak, break or crack.
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2

3
In 2009
we reached an
impressive 205
days, or nearly
seven months,
without a single
CLABSI infection.
Diane Civiello,
BSN, MS, RN, NE-BC,
is the director of
Children’s Pediatric
Intensive Care Unit.
Her team is on
the front lines of
the batlle against
hospital-acquired
infection.
(Continued from page 2)
the American Association of Critical Care Nurses (AACCN) Beacon Award?
It meant measuring the unit against the highest critical care standard, and
PICU staff jumped at the idea.
Beacon specifically recognizes the nation’s top pediatric, progressive
and adult critical care units. Measuring against evidence-based national
criteria, it uses 42 standards including research and evidence-based practice;
patient outcomes; leadership and healing environment.
The PICU worked toward the award in 2009 and received it this year,
becoming one of only three pediatric intensive care units in the state and 10
in the country to become Beacon recipients. What is the continued motivation
for improvement? Providing the best care to kids by maintaining these
standards, and reapplying for the award every year.
Improvement should be the
only thing that’s infectious.
Of all the dangers patients can face in a hospital, few are as threatening as
infection. CLABSI, VAP, SSI, MRSA and C.diff. (see the acronymns chart
below) are some of the deadliest infections a child can acquire, and children
can get them from hopitalized care.
CLABSI:
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS
These are infections in the patient’s bloodstream while a
catheter line is present. Up to 500,000 CLABSIs occur in
U.S. hospitals each year, with an estimated attributable
mortality rate up to 25 percent for each infection, according
to the Centers for Disease Control and Prevention. The Joint
Commission has made CLABSI prevention one of its national
patient safety goals. The PICU reduced CLABSI infection
rates (per 1,000 catheter line days) from 1.9 percent in
2008 to 1.78 percent in 2009. The NICU reduced theirs
to 1.6 percent.
Following the lead of groups like The Joint Commission and the World
Health Organization, Children’s incorporated national recommendations
for infection prevention into daily care for our patients. Practices called
care bundles are a key strategy. The Institute for Healthcare Improvement
(IHI) describes care bundles as groupings of best practices that individually
improve care, but when applied together result in substantially greater
improvement. They are considered the highest standard of care.
Bundle elements that help prevent infection, for example, include
emphasis on hand hygiene, proper care of dressings, and the use of standardized
kits. The kit is a package that contains all the supplies a nurse
needs for a dressing change or a blood draw.
“It’s like a one-stop shop,” said Carole Cooper, Children’s program
manager of nursing practice. “The nurse doesn’t need to leave the bedside
to get something.”
Staying at the bedside reduces the risk of contamination, as well as error
or distraction.
The PICU is a great example of the impact of bundles. In 2008, Children’s
PICU joined 60 hospitals in a National Association of Children’s Hospitals
and Related Institutions’ (NACHRI) infection prevention collaborative. The
unit reduced CLABSI infection rates (per 1,000 catheter line days) from 1.9
percent in 2008 to 1.78 percent in 2009 – both well below the 2.1 percent
national average.
VAP:
VENTILLATOR-ASSOCIATED PNEUMONIA
VAP is the leading cause of death among hospital-acquired
infections. Hospital mortality of ventilated patients who
develop VAP is 46 percent, compared to 32 percent for
ventilated patients who do not develop VAP, according to
the Institute for Healthcare Improvement. VAP also prolongs
time the patient spends on the ventilator and length of
hospital stay. The NICU achieved a 144-day stretch
without a VAP incident while the PICU went 151 days.

“Our CLABSI bundles consist of two parts – insertion and maintenance,”
said Diane Civiello, director of Children’s Pediatric Intensive Care
Unit (PICU). “We have made huge strides in becoming consistent with each
of these bundles.”
“In 2009 we reached an impressive 205 days, or nearly seven months,
without a single CLABSI infection,” said Civiello. “We were ecstatic.” In 2008,
the longest the PICU went without an infection was 119 days. Next door, the
Neonatal Intensive Care Unit (NICU) halved its CLABSI rate from 3.6 percent
in 2008 to 1.6 percent in 2009. Children’s PICU and NICU also reduced incidences
of VAP. The NICU achieved a 144-day stretch without an incident
while the PICU went 151 days.
The units’ exceptional success with care bundles inspired the formation
of a task force to assess catheter-associated urinary tract infections
(CAUTI) in the PICU. Implementing best practices and creating a measuring
process, the PICU reduced its incidence to zero CAUTI infections in 2009.
Now interdisciplinary teams are sharing expertise to spread these best practices
throughout the Hospital.
Surgical teams, meanwhile, tackled another type of infection, adopting
a surgical site infection protocol. One of the most important components of
this care bundle is optimizing the use, timing and duration of antibiotics,
resulting in decreased surgical site infections of up to 80 percent.
SSI:
SURGICAL SITE INFECTIONS
Just as the name implies, SSIs are postoperative wound
infections. They are the third most-commonly reported
healthcare-associated infection and a major cause of
both mortality and rising healthcare costs. Both The Joint
Commission and The World Health Organization have sponsored
initiatives to reduce SSIs. Optimizing the use, timing
and duration of antibiotics resulted in decreased surgical
site infections of up to 80 percent.
MRSA and C.diff. are the other key battlegrounds. In 2009, Children’s had
only 15 nosocomial MRSA infections, significantly reduced from 24 infections
in 2008. In addition, Children’s decreased its rate of hospital-acquired
C. diff from 42 cases in 2007 to 26 in 2009.
Isolation compliance and patient screening played a role in infection
reduction as well. In 2009, 99.3 percent of all patients needing isolation were
identified and isolated. In addition, of the 196 confirmed cases of the H1N1
flu at Children’s in 2009, only two patients acquired the disease while at the
Hospital: one in July, the other in September.
The power to heal.
Not the power to harm.
Modern healthcare is powerful, it has the ability to heal in seemingly miraculous
ways. One of the most effective tools in a doctor’s bag is medication. But
if a child receives the right medicine in the wrong dose, or the wrong medicine
in any dose, great healing power can become life-threatening instead
of life-saving. That’s why the Institute for Healthcare Improvement (IHI)
MRSA:
METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS
A 2007 report from the Centers for Disease Control and
Prevention estimated the number of MRSA infections in
hospitals doubled nationwide, from about 127,000 in 1999
to 278,000 in 2005, while annual deaths increased from
11,000 to more than 17,000. MRSA is a bacteria that is
resistant to certain antibiotics. Staph infections like MRSA
occur most frequently among persons in hospitals and
healthcare facilities who have weakened immune systems.
In 2009, Children’s had only 15 nosocomial MRSA infections,
significantly reduced from 24 infections in 2008.
(Continued on page 5)
Improvement
means advancing
care, which we’ve
always done well.
Looking at national
trends, we also put
a top value on
having systems
in place to keep
patients safe.
No child should
be harmed here.
C.diff.:
CLOSTRIDIUM DIFFICILE
C.diff. is a bacterium that causes diarrhea and more
serious intestinal conditions such as colitis, a life-threatening
swelling of the colon. Each year, tens of thousands
of people in the United States get sick from C.diff. Children’s
decreased its rate of hospital-acquired C. diff from
42 cases in 2007 to 26 in 2009.
4
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(Continued from page 4)
5
calls adverse drug events the greatest risk of harm in a hospital.
According to the IOM “To Err is Human” report, 7,000 deaths
are caused annually by medication errors in U.S. hospitals. At
Children’s, our position was simple - not even one error is acceptable,
so we developed a measured plan to eliminate mistakes.
In 2009 the Hospital saw results of two years of hard work
that began with intensive reviews of individual events, new policies,
evaluation of potential failures, and the development of a
comprehensive Medication Error Reduction Plan.
Children’s also implemented the second generation Bedside
Medication Verification (BMV) system. The system scans the
barcode on the patient’s identification bracelet and integrates
with a barcode-based pharmacy robot to package the drugs.
Those drugs are delivered to the child’s bed where the nurse
scans and verifies everything before administering the medicine.
Implementation of all phases of our medication plan
resulted in decreased adverse drug events from 14 per 10,000
administered doses to eight by the end of the second year. And
we decreased the most serious errors by 38 percent by the end
of the first year. In fact, we reduced the number of adverse drug
events related to opioids and sedatives by 60 percent and we have
had no over-sedation events since June 2008.
In 2010 Children’s will take its successful Computerized
Physician Order Entry systems from the Emergency Department
into the rest of the Hospital, adding one more tool to help caregivers
avoid this most tragic mistake.
Dr. Samuel Lehman is Children’s medical director
of patient safety. A specialist in our PICU,
Dr. Lehman has seen first-hand the importance
of safety in the hospital environment.
It always comes back
to patient safety.
At the heart of every initiative that bore fruit in 2009 was the
desire to always do the right thing. “It’s not important to focus
on imperfection if you’re perfect,” said Dr. Samuel Lehman, Children’s
medical director of patient safety. “But if one of my three
kids is being treated here, I want perfection for them. All of our
patient families want perfect care, too. The goal of our improvement
efforts is to come as close to perfect as possible.”
Children’s Board of Trustees member Dr. Robert Kubo
echoed the sentiment, “Quality and patient safety are top priority.
We are committed to becoming the safest children’s hospital in
the Western United States.”
“There’s a tendency to think that patient harm is caused by
one big mistake, but most patient harm is caused by a culmination
of small things,” said Dr. Lehman. “We are creating systems
and developing a patient safety culture to prevent these small
errors and keep them from turning into patient harm.”
Children’s takes a number of steps to achieve safe, quality
care and enhance communication. We comply with – and often
exceed – patient safety recommendations from The Joint Commission
and other regulatory agencies. We learn from evidence-based
literature, and participate in multidisciplinary committees and
collaboratives to share best practices and develop better methods
to deliver care. We engage Hospital leadership in initiatives, and
conduct frequent reviews and assessments. We encourage staff
and patient families to report mistakes and promote a “just
culture” in which errors are evaluated objectively.
We are
committed
to
becoming
the safest
children’s
hospital
in the
Western
United
States.

We allot resources where we need to improve the
most. “In addition to our success with the National
Patient Safety Goals, we tailor our improvement
program to focus on the areas that will prevent the
most harm to our special type of patients – children,”
said Dr. Lehman.
In 2009, Children’s piloted a “global trigger
tool” to measure and quantify levels of harm in
our hospital. The tool uses “triggers,” red flags in
patient charts that could signal a harmful event.
Children’s randomly selects several charts a month
from various areas of the Hospital and conducts a
systematic review to identify these harmful events.
Our goal is to use this system to monitor ourselves
and focus on outcomes to drive our patient safety
program.
But none of these efforts are accomplished
without the work of many. Organizations that
demonstrate the most progress know that commitment
to continuous improvement and patient safety
is everyone’s responsibility, and everyone at Children’s
Hospital embraces this concept.
More about performance improvement . . .
Changing the playing field.
2009 plan lays groundwork for launch of Maternal-Fetal Center.
Performance improvement is
often very focused on details.
At Children’s we improve a
lot of “forests” by carefully
working on one tree at a time.
But sometimes improvement
means looking at the bigger
picture, changing the landscape
in a major way.
Neonatal and prenatal
care have long been two of
our premier service areas.
Along with our Prenatal Diagnostic
Center to help identify
early problems, families
with high-risk pregnancies
have relied on our regional
Neonatal Intensive Care Unit
(NICU) to give their little
ones a better chance at life.
Our outcomes have been
excellent compared to peer
hospitals, and the quality
of care has put us amongst
the best in the country. That
said, we still developed a
plan to take us from “very
good” to “great.” Looking
at best-practices nationwide,
we decided to change our
approach to high-risk births,
to treat not just the child,
but the mother. So over the
past years we have worked
to lay the foundation for our
new Maternal-Fetal Center. In
2009 this included the recruitment
of Dr. Jeffrey Pietz as
chief of newborn medicine as
well as two perinatologists.
Dr. Armando Fuentes will be
Children’s medical director of
perinatology and be joined
by Dr. Beni Adeniji. This will
be part of a partnership with
Saint Agnes Medical Center,
where Children’s has operated
a level II NICU for almost 25
years. Saint Agnes received
the HealthGrades 2009/2010
Maternity Care Specialty
Excellence Award, a designation
that ranks them among
the top five percent of hospitals
nationwide for maternity
care services.
Studies have shown a
need for additional access to
perinatal care in our region.
The program will cover our
45,000 square-mile service
area, bringing this sort of
unified regional center to the
Valley for the first time.
In partnership with Saint
Agnes, Children’s will now
offer care from the point
that a high-risk pregnancy
is identified, through birth,
and enhancing the care we
offer into childhood and up
to adulthood. Children’s new
physicians come from environments
where perinatologists
and neonatolgists partner to
improve prenatal care.
“The partnership changes
emergencies into planned
situations,” said Dr. Pietz. “It
means all the doctors know
what to expect, the parents
know what to expect, and a
plan of care is being implemented
long before birth.”
Dr. Fuentes agreed. “A
baby is in the system from the
minute of diagnosis. We can
prepare the parents and take
steps to improve or prolong
the pregnancy. We can bring
in specialists and surgeons
and make sure the baby is
born with all the right care
available.”
Children’s introduction of
perinatologists into the pediatric
specialty environment is
a best-practice that no other
Valley hospital offers.
“Where I came from,”
said Dr. Pietz, “perinatologists
and neonatologists had
offices in the same building.
If there was need for an
immediate consultation, I
would drop what I was doing.
I would go to the perinatologist’s office and
talk to mom, help her understand what to
expect. Everyone gets involved in an open
dialogue, and the family gets a plan.”
That plan can include many of the pediatric
subspecialties at Children’s. Babies
resulting from high-risk pregnancies often
need advanced pediatric treatment or
surgery, and we have teams available for
nearly any kind of specialized care. It’s one of
the main reasons to bring this kind of service
inside of a major pediatric facility. Physicians
such as cardiologists and geneticists can also
play a key role in diagnosis.
Dr. Pietz is already on-hand and treating
patients in our NICU, and Dr. Fuentes and
Dr. Adeniji will join us in the summer of 2010.
The research and planning that has led to the
development of the Center is finally coming
to fruition, and over the next year you will
see the additional services come online,
augmenting the fantastic care that exists
today. The Maternal-Fetal Center at Children’s
Hospital Central California is an excellent
example of large-scale program change,
and it brings an unprecedented level of care
to the region’s babies - and their moms.
For more about Dr. Pietz’, Dr. Fuentes’ and Dr. Adeniji’s experience and expertise, go to ChildrensCentralCal.org.
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7
Carter Bell benefited
from programs that
his family never
knew existed.
Dr. Michael Allshouse
was among the first
practitioners in
the country
to perform
the advanced
pull-through
procedure.
Improved Access
Children’s throughput initiative was implemented in 2006 to address escalating inpatient volumes as well as patient access challenges.
Every hospital gets full at some point, but our throughput efforts are designed to keep that from affecting care. In 2009, an average
of six patients a month were sent elsewhere due to the lack of an available staffed bed, reduced from 27 in 2005. In addition, only 2.8
percent of all patients arriving at the Emergency Department (ED) left without treatment in 2009. This three-year shift in performance
allows for an additional 4,500 patients to be seen in the ED every year. Wait times have also been significantly reduced. This data gains
importance when you know that we treated about 67,000 children in the ED in 2009 compared to the 45,000 we saw in 2005.
Behind-the-Scenes
Improvement.
When Sara and Scott Bell’s newborn, Carter, required
emergency surgery for blocked intestines, they knew
he was in good hands. Dr. Michael Allshouse, Carter’s
surgeon and Children’s medical director of pediatric
surgery and trauma, is an expert in anorectal malformation
and colorectal disorders. He was among
the first practitioners in the country to perform the
advanced pull-through surgery that Carter needed to
save his life.
But the Bakersfield parents were probably not aware
of the behind-the-scenes improvements that had made
Carter’s surgery safer. Children’s Hospital Central California
has adopted a surgical site infection protocol, a care bundle
and safety checklist that ensures that the right surgery is
performed on the right patient at the right surgical site. A
host of caregivers used the error-reduction systems to make
sure they didn’t make a mistake that could harm Carter.
In the operating room, the surgeon, anesthesiologist,
nurse and technician announced his surgery description,
name and medical record number, and compared that
to his chart and ID bracelet. They verified that all equipment,
medications, and supplies were in place and sterile.
They ensured that Carter was in the correct position, given a prophylactic
antibiotic within 60 minutes of incision, and received the correct
anesthetic. And they confirmed that no equipment or instrument was
left in the open surgical site. During the process, anyone in the room
could stop the procedure to call attention to concerns. The checklist is
used in the exact same way in every surgery performed at Children’s.
“The use of a checklist represents one of the most significant
changes in surgery in the past decade,” said Dr. Joseph Gerardi,
Children’s chair of the Department of Surgery, and medical director of
orthopaedic surgery. “It standardizes care and improves consistency.”
Carter’s surgery was successful. Prior to the creation of the pullthrough
technique more than a decade ago, kids like Carter needed a
colostomy.
“Dr. Allshouse explained everything that was going to happen.
We knew we had the best team,” Sara said.
Even after surgery, the bright-faced youngster continued to
receive the same focused care. He underwent three more surgeries
for various conditions. Children’s also diagnosed Carter with Mowat-
Wilson syndrome. Accompanied by Hirschsprung’s disease, this is a rare
genetic abnormality affecting many parts of the body, with only about
180 cases worldwide.
“Carter’s recovery after each surgery was remarkable,” said Sara.
“I had a more difficult time with him teething.”
Now a toddler, Carter knows about all the people who helped him.
He never had to know about all the people behind the scenes who made
sure that his surgery was safe.

The kind of results
we’re looking for.
A great example of innovation leading to an improved
method of care delivery is Children’s Critical Care Transport
Team. The Hospital approaches our program in a
different way. Our team is composed of 15 Intensive Care
Unit (ICU) registered nurses and 11 ICU respiratory therapists.
Each team member has specialized training and
advanced practice certifications in their specialty, as well
as many years’ experience in either the PICU or NICU
setting. One of each of these specialists is present during
every transport.
“This specialized team is an extension of Children’s
PICU and NICU, with the ability to take intensive care to
the patient, putting the patient on the road to recovery
sooner,” said Jennifer Reyes, manager of Children’s Access
Center. In fact, Children’s “Air George” helicopter is often
referred to as an ICU on skids.
The results of our approach? The team transports
more than 1,600 critically ill and injured neonates and
children a year by helicopter, ambulance and plane. We
completed 1,019 neonatal transports in 2009, more than
any other California transport team – and we do it faster
with better patient survival rates, according to California
Perinatal Quality Care Collaborative (CPQCC) data. We
also completed an additional 583 pediatric transports.
Our team is especially quick, departing for the referring
facility in an average of 52 minutes while other California
neonatal teams average 74 minutes. And although
Children’s has such a broad coverage area (45,000 sq.
miles), we reach our patient faster. From when the patient
is referred to the time the team arrives at the hospital of
origin takes an average of 1 hour 38 minutes, compared
to 2 hours 39 minutes for other regional teams.
Every “Air George” transport flight has a critical care nurse, respiratory care practitioner and pilot. Children’s Critical Care Transport Team, both in the air and on the roads, has set and achieved some of
the highest quality standards in the state.
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8

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9
Powered by people.
The practice of medicine is a science, and to the average healthcare
consumer, it can be fairly esoteric. The nightly news shows us every
new discovery, medication and test available, and we put great faith
in advanced medical technology. The 10 o’clock dramas portray the
miracles of DNA matching, the clues you get from the human body,
and miracle-cure stories based on real events (names changed to
protect the innocent, of course). On the 11 o’clock news you watch
reports of medical applications gone wrong, drugs recalled. The
wealth of unfiltered information begins to cloud over a common
personal healthcare question – who should you trust?
That is a key question, not just for obvious reasons, but because
of how it is constructed. When you ask “who”, you’re not asking
about a machine, a drug or a procedure. You’re asking about a
person or group of people. As astounding as medical technology
has become – and it is astounding – the key factor in all medicine
practiced in the world today is still the people who practice it.
At Children’s Hospital Central California, we invest in technology
and understand its transforming nature. We invest far
more in people, though, because it’s their expertise that turns
the raw data of a machine into a diagnosis. It is trained human
cognition that understands what a five-year-old means when she
holds her side and says, “I hurt right here.” It’s human compassion
that both searches for the cause of that pain, and comforts the
In an advancing and scientific workplace,
“people helping people” is still the greatest
healing technology you’ll encounter.
child who has it. And it’s the pure spirit
of caring that makes that compassion a
common thread through our inpatient
units, surgical practices, outreach facilities,
administrative offices, hallways and
anywhere you find a Children’s Hospital
employee.
“You’ll notice,” said Diane Civiello,
director of Children’s Pediatric Intensive
Care Unit, “… that kids never draw us
pictures of machines.”
As an organization, it is our responsibility
to care for the people who care for
your children. It is also our responsibility
to recruit the best physicians, nurses,
health professionals and support staff
available. We do that in many ways, from
a compensation philosophy and stimulating
environment that makes sure we
are the greenest pasture, to a core value
of education and advancement that gives
employees opportunities to challenge
themselves and promote their careers.
Volunteers are a big part of Children’s Hospital.
We have over 500 selfless individuals who give
their time to help our kids. Every year the people
in the purple aprons do the work of 20 full-time
employees, and they do it for nothing more than
the joy of helping a child.
It’s human
compassion that
both searches for the
cause of pain and
comforts the child
who has it.
Our people also take part personally
in creative problem solving, as evidenced
by our Pediatric Intensive Care Unit’s
inspired methods to recruit more nurses
into the challenging critical care setting.
Physicians find strong collaborative
surroundings at Children’s, and a caseload
drawn from a region that covers
nearly a third of one of the largest states
in the nation. And more than 500 Valley
residents choose to work here for free,
(Continued on page 11)

Hi. I’m Marta,the vice president Howdy. I’m Bryan and I’m
Hello. I’m Dr. Kaji. I’m a of Human Resources.
an inpatient pharmacist.
urologist at Children’s. Buenas tardes. I’m Jorge, and
I’ll be your interpreter.
Hi. You can call me Lisa.
I’m a nurse practitioner.
Hello. I’m Brandon and
I’m an imaging technician.
Welcome. My name’s Janelle.
I’m a Child Life specialist.
Counting doctors, volunteers, employees, and professional services, there are well over 3,000 people working at Children’s Hospital in hundreds of different positions, all focused on creating a better world for children.
Hi there. I’m Lucy, and these
people all work for me.
10
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Working in the PICU
requires both a unique
skill set and an ability
to manage the inten-
sity of the job.
It’s also very
11
rewarding.
You see smiles,
and you hear
humor.
You see
families
receiving
encouragement.
(Continued from page 9)
volunteering an amount of shared time every year that has the value of
more than 20 full-time employees.
How do we find, keep and satisfy the kind of compassionate experts you see
every day at Children’s Hospital Central California? Here are a few examples.
Welcome to the intensive
care unit.
These are words parents never want to hear, but more than 1,200 families
experience it at Children’s every year. The Pediatric Intensive Care Unit, or
PICU, is one of the most “hospital-like” parts of Children’s Hospital. While
still child-friendly, the PICU is all-business, because this is where the sickest
kids are treated. Children are often on ventilators, in serious condition, and
fighting for their lives. The unit’s hallways are active, people in scrubs and lab
coats moving from one glass-walled room to another. You will see doctors
from nearly every subspecialty, as well as physicians trained specifically in
pediatric intensive care medicine. Respiratory Care Practitioners, dietitians,
case managers, health unit coordinators and more, all working intently, in
an intense atmosphere, to pull a handful of children back from the brink.
It’s a tough place to work.
Yet you see smiles, you hear humor. You see families receiving encouragement.
But the nurses in Children’s PICU found that the unit’s reputation
for high-intensity made it difficult to find new nurses to work there.
While Children’s as a whole has an amazingly low nurse vacancy rate
(below 2 percent compared to a 12 percent national average) in the midst of
a national nursing shortage, PICU vacancies were holding at over 25 percent.
This was not unusual. The American Association of Nursing Executives
reported that national critical care vacancies were over 20 percent, and
taking 7 percent longer to fill.
PICU leaders examined the ways other Hospital units were filling vacancies
and saw that they supplemented recruits with new graduates. It has
always been thought that the PICU was no place for new grads, but the unit
decided to find a way to screen, train and utilize them in the intensive care
setting.
Enter the Pediatric Nurse Extern (PNE) Program, an educational
program comparable to internships and residencies that doctors go through.
Externs are students from local nursing programs who meet minimum
requirements and serve about six months in the Hospital. The extern
program has been successful in several units, so the PICU began using these
students as non-productive staff, meaning that all of their time was spent
learning with a hands-on trainer in the clinical environment. They picked
up both clinical practice skill sets and socialization into the hospital setting.
“They get exposed to the PICU culture,” said Randy Guerrero, RN, Children’s
executive director of critical care. “They see the personalities, the
stresses, the adrenaline, and not just the lows, but all of the highs that come
with the job. They develop the skills they need to be here.”
While staff takes this time to evaluate the student’s acclamation, the
student can also use the opportunity to decide whether the intensive care
setting is right for them. There are no guarantees that the department will
hire the student, but the program has had a success rate of better than 80
percent. In a few short years the PICU has transformed its own culture,
changing the belief that critical care is no place for new grads. Now they
believe that for some new nurses, it may just be the perfect place.
As you saw in the preceding story, the PICU was given the Beacon Award
in early 2010. The award had a unique recruitment goal as one of its qualifications,
a requirement that nursing staff be directly involved in nurse recruitment.
The application asked how many of the department’s last ten hires
were recruited directly by existing nurses. In Children’s case, it was ten out
of ten.

Hi. I’m Susan, accreditation
and regulatory manager .
I’m Randy, the executive
director of Critical Care.
Bringing special talent to a
special place.
My name’s Virginia, I work
in Environmental Services.
Nurse, physician, health professional and support staff recruitment has been
a solid victory throughout the Hospital for several years. At the end of 2009,
Children’s overall vacancy rate was only 1.15 percent, and the nurse vacancy
rate was 1.58 percent. That is astounding, considering that the vacancy rate
for California, though down, is still at 7 percent.
“We’re very well known throughout the country,” said Suzan Parsons,
Children’s director of recruitment services. “Ten years ago no one knew who
we were. That has changed. The Magnet award had a lot to do with it, as did
growth of our reputation for quality and changing recruitment strategies.”
Being up-front with recruits has always been important. The Hospital
looks for employees who understand the expectations of their job, and know
that they are here for one reason only – the patient. New recruits come in
with a predisposition for quality, and they want to leave a footprint on their
world. Once here, they find robust training. Everyone can take courses both
at the Hospital and in other institutions to improve job-specific skill sets.
Hello, I’m Tim, and I’m a
Social Worker.
You can call me Julian, I’m
with Safety and Security.
I’m Jenny, a phlebotomist
in the laboratory.
Physician recruitment has been similarly successful, though finding pediatric subspecialists presents
unique challenges. Some subspecialities have only a handful of graduates from medical schools every year, and
small numbers of doctors practicing nationwide, with few willing to leave existing posts. In addition, Children’s
is a freestanding hospital that is not attached to a medical school. While the home of UCSF-Fresno’s pediatric
residency program, we do not have the resources of a large academic institution. We do, however, meet and
often beat the clinical outcomes of those institutions. So the kinds of doctors we attract are always passionate
clinicians.
In 2009 Children’s recruited 15 new pediatric subspecialists. This has provided an improvement in access in
areas like orthopaedic surgery, neurology and oncology. Children’s Craycroft Cancer Center is a great example
of the kind and number of physicians the Hospital has attracted. The Center now has a staff of eight hematologists
and oncologists, including a neuro-oncologist that joined the team in 2009.
A higher-quality work environment.
There are 89 images
of employees, doctors
and volunteers in
this annual report,
including George the
Giraffe (See page 56).
That’s less than 2%
of the total number of
people who serve at
Children’s. We would
have needed a much
bigger book to
show us all.
The Hospital recognizes and rewards employees with fair, competitive compensation and benefits. We foster an environment
that gives employees permission to do what is right for the patient, so that they can embrace our culture of
caring and find that they are still working in pediatric healthcare for all the right reasons. We also provide the proper
tools to do their jobs, staffing levels that ensure they remain efficient, and opportunities for growth and education.
“We let people fit their work and life together,” said Marta Boyer, Children’s vice president of human
resources. “We respect people’s lives and understand that work is part of a bigger picture.”
(Continued on page 13)
12
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13
(Continued from page 12)
Using a total compensation strategy, Children’s has fine-tuned its programs. The Hospital conducts
regular market studies on every position, making needed adjustments to keep pace with the
industry. Employees also receive annual merit increases. Children’s has embraced the idea that
increased annual compensation should be tied closely to performance and quality, making reward
and recognition the key to increase, rather than the arbitrary fluctuations of the economy.
The whole compensation package includes retirement benefits, health benefits, paid time off,
and the option to buy into additional benefit packages based on personal needs.
We never stop learning.
The world constantly changes, requiring a steady effort just to
keep up, so Children’s Hospital Central California has embraced
a culture of learning. Employees are encouraged and often reimbursed
for pursuing higher education, and the Hospital offers
on-site programs to renew certifications, develop specific skills,
and meet licensing requirements.
The number of health professionals who have pursued
education beyond their baseline clinical-practice need has
continued to grow. Children’s entire respiratory care practitioner
staff has national pediatric certification, and our nursing staff is
chasing national benchmark numbers for degree percentages.
When a student graduates from a community college
nursing program they receive an associate degree. With that
degree they can practice, and at Children’s they all receive
further pediatric training. At many institutions, very few
nurses pursue their education farther than this. At Children’s,
62 percent of our nurses have gone on to get their bachelor’s
degree, 7 percent have received their masters, and a handful
have achieved their doctorate.
Nurses can also pursue national certification. The American
Nurses Credentialing Center (ANCC) points out that more than
90 percent of doctors in the United States have at least basic
board certification. The group believes strongly in setting the
same standards for nurses, and offers RN certification, Clinical
Nurse Specialist certification, and Nurse Practitioner certification.
Other organizations also offer advanced certifications.
Children’s, being a Magnet hospital, benchmarks itself
against other Magnet institutions for number of certifications,
comparing ourselves with the best nursing hospitals
in the country. Of nurses participating directly in
patient care, Children’s nurses are nationally certified at
almost exactly the same rate as other Magnet hospitals.
Measured against Magnet hospitals our own size, 40
percent more of our nurses are certified. These certifications
include areas like pediatrics, nurse executive certification,
nursing informatics and pain management.
Children’s also has an organizational development department
that offers training to all staff. This includes the Children’s
Leadership Institute, a training environment where Hospital
managers and executives hone leadership skills in the same
development model used by many Fortune 500 companies.
Lending a hand.
You won’t find a more dedicated group of people than Children’s
volunteers. These generous souls give their time, freely, to help
our kids. They perform hands-on tasks with our patients as well
as rolling up their sleeves and helping with behind-the-scenes
administrative efforts.
Children’s 500-plus volunteers gave more than 46,000
hours of time in 2009, the equivalent of more than 20 full-time
employees. They range in age from 13 to 90, and give a minimum
six-month commitment at six hours a week. In a place with more
than 2,700 employees and several hundred doctors, you will
find that this army of volunteers is everywhere, always helping.
There is no greater badge of honor at Children’s Hospital Central
California than wearing the purple apron of a volunteer.
We respect
people’s
lives and
understand
that work
is part of
a bigger
picture.

2009 top volunteers.
Volunteer Hours
1. Warren Higginbotham 1,521
2. Joanne Merchant 966
3. Beverly Walters 890
4. Nicanor Garcia 680
5. Jeff McAdoo 481
6. Jim Etherton 415
7. Leslie Chavez 359
8. Brenda Pretzer 356
9. Amber Vanderville 350
10. Shirley Provencher 338
People powered.
Healthcare is a service industry, a customer-driven
experience. But our customers are children, and we
know that they deserve not just the best care possible,
but the most compassionate care. We believe in a team
that is strong enough to stand up with the biggest
names in the industry, and caring enough to get down
on our knees to speak eye-to-eye with a child. Talented
enough to battle illness and injury and win more often
than not, and smart enough to know that the fight
is never over, that we can always get better. We have
an incredible facility filled with state-of-the-art technology,
but without the people, it would all be in vain.
Children’s Hospital Central California comes alive
and provides incredible care because it is powered by
amazing people.
More about the power of people . . .
Paul Talanoa never thought
he would be working for the
pediatric hospital that saved
his life as an infant.
Born in 1981, three
months premature and
weighing 1 pound 7 ounces,
Talanoa was a twin, though
his twin brother passed away
a few days after birth.
“I didn’t know who the
doctors and nurses were that
saved my life until I started
working at Children’s,” said
Talanoa. “It wasn’t until I
spoke with them that it sunk
in.”
Talanoa paid a visit to
the doctor who cared for
him after birth, Dr. Nadarasa
Visveshwara (Dr. Vish),
program director of newborn
medicine at Children’s.
“The reason I remember
him so well is because of all of
the misfortunate events that
happened on the way to help
him,” said Dr. Vish.
Now that’s a
positive outcome.
Dr. Vish had been on his
way home when he received
an urgent page. He rushed to
the nearest payphone – as cell
phones weren’t around yet –
but it didn’t work. Hurrying
to the next payphone, he
responded to the page.
Detoured by an oil spill, then
delayed by a train crossing, he
finally made it to the rescue.
With breathing tubes in
place, Talanoa was brought to
Children’s Neonatal Intensive
Care Unit (NICU).
“The more premature
they are, the more immature
their systems are. We support
each of their systems until
their body is strong enough to
take over on its own,” said Dr.
Vish. “It’s the whole team,
respiratory therapists, nurses
and nutritionists.”
At the time, survival
rates for neonates like Paul
were less then 50 percent.
A bedside nurse in the
NICU at the time, JoAnn Sindt
was part of the team that
cared for Talanoa.
“We were affected even
more than usual because he
was the surviving twin,” said
Sindt, now a charge nurse in
the Hospital’s 88-bed NICU
at the main campus. “His
lungs collapsed more than
once because they were so
immature.”
Talanoa spent nearly
three months in an incubator
on a breathing machine, fed
through a tube. Gradually
his body became stronger
and he was able to go home
to his parents Jan and Nano
Talanoa.
“For a baby of that size
to grow up with no complications
is a big deal for us,” said
Dr. Vish.
Talanoa’s life came fullcircle
September 10, 2001
when he began working at
Children’s. Now 28, Talanoa
is a technical support analyst,
troubleshooting computer
issues and managing network
resources.
“If Children’s wasn’t here,
I wouldn’t be here either,”
said Talanoa.
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15
Children’s Hospital
Central California is
fortunate that more
than 500 volunteers
like Andrea give their
time to help care for
children and their
families. While not
all volunteer jobs are
hands-on with kids,
they are all important.
The work is its own reward.
Andrea Yeh began volunteering at
Children’s in 2004 as a way to honor a
childhood friend who passed away from
cystic fibrosis.
The pair became close as lab partners
in seventh grade. Her friend was
treated frequently for her condition at a
children’s hospital in Southern California,
and Andrea quickly realized the importance
of pediatric hospitals.
“When I moved here with my
husband a couple of years after college, I
was looking for volunteer opportunities,”
said Andrea. “It was something I decided
I wanted to do in memory of her.”
Nearly six years and 485 donated
hours later, her passion for volunteering
is as strong as ever.
“It’s such a rewarding experience to
see the kids faces brighten up when you
enter their room,” said Andrea. “They
want someone to play with. There’s
always a need, but not enough volunteers
to go around.”
Wednesday nights she volunteers in
the Hospital’s playroom and The Craycroft
Cancer Center inpatient unit – playing board games, making arts and
crafts and watching TV with patients; giving parents a much needed
break to shower, eat or have some time to themselves.
“Many kids in Craycroft are either too sick to come down to the
playroom or cannot leave their room because their immune systems are
compromised,” said Andrea. “So I try to bring the playroom to them.”
Andrea always had a passion for helping others, a trait instilled in
her early on in life as a Girl Scout.
“She has a great attitude,” said Child Life Assistant Mary Panella.
“I think our volunteers are an important component in helping kids get
well. They make it happen for the kids who can’t make it to the playroom.
The volunteers could be doing something else with their time,
but they’re here.”
In 2009, Andrea and her husband, Ian, welcomed their first child.
Being a new mom, she learned some parenting skills through her experience
at Children’s.
“It helped that I had a lot more experience in that area,” said
Andrea. “I learned how to calm a baby down and how to relate to kids
of all ages.”
Volunteering at Children’s has made Andrea more appreciative of
how healthy her son is. She plans to instill the tradition of volunteering
in him.
“It’s such a rewarding experience to be at Children’s,” said Andrea.
“Just to know that this place is here with such good physicians and
nurses, it’s what the community needs.”

Nurse Practitioner Carol Cramer’s advanced practice training is an excellent
example of how Children’s nurses pursue their careers
far beyond the norm.
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17
Advanced procedures
and implants.
In a world of emerging technologies and rapid advancements,
Children’s pediatric surgeons strive to provide the most up-todate
procedures. They also work to use less-invasive techniques,
decrease post-operative pain, and shorten recovery. But even
more important, they want kids to feel better, and go home with
improved function and quality of life.
Surgeons at Children’s see some of the most difficult cases,
from operating on a heart the size of a walnut, to utilizing the
advanced “pull-through” procedure for anorectal malformation
and colorectal disorders. Recognizing that a multidisciplinary
approach is effective when caring for complex conditions, they
work with the patient’s other caregivers to share information and
develop a treatment plan that’s best for the child.
The only pediatric hospital between Los Angeles and the Bay
Area, Children’s offers many specialized services and alternative
options not available elsewhere in Central California. The following
procedures show how Children’s surgeons use cutting-edge techniques,
state-of-the-art devices, and their own expertise to provide
the best outcomes for their young patients.
Improving the quality of a child’s life, and
sometimes saving it, pediatric surgeons are
on the front lines of advanced care.
Throwing scoliosis a curve.
Already the first in Central California to perform the Vertical Expandable
Prosthetic Titanium Rib (VEPTR) technique, Children’s Orthopaedic
Surgery Department has added two more cutting-edge interventions to treat
children with severe scoliosis. The new Shilla and Internal Traction techniques
build upon the department’s alternative options for young patients
who don’t respond to conventional management.
“We have the best options available with modern technology that we
can tailor to each patient,” said Dr. Michael Elliott, who specializes in scoliosis
and spinal deformity and is one of five pediatric orthopaedic surgeons
at Children’s.
The Shilla is a new dual-rod technique that can be more stable and have
fewer complications than the traditional single-rod approach for spinal
correction. Surgeons implant a pair of rods that hold the most curved portion
of the center of the spine straight and fused. Ends of the rods are not fused,
but held in place with growing screws, allowing the spine to lengthen as the
child grows. With other techniques patients had to return every six months
for adjustments, but with the Schilla they
don’t have to come back for two years.
Internal Traction is used for curves
of 100 degrees or more and is completed
in two stages. The first surgery implants
a rod that partially straightens the spine.
A week later, a second operation inserts
double rods allowing further improvement,
gaining about an 80-degree total
correction. This gradual approach is
safer for the patient and results in shorter
hospitalization.
In addition to Shilla and Internal
Traction, Dr. Elliott also performed Children’s
first VEPTR titanium rib technique.
The titanium rib treats early onset

of scoliosis and thoracic insufficiency
syndrome (TIS). TIS is a congenital
condition causing severe deformities of
the chest, spine, and ribs that prevents
normal breathing and lung growth.
The titanium rib - a curved metal rod
attached to ribs near the spine - helps
straighten the spine and separate ribs
so the lungs can fill with adequate air to
breathe. The length of the device can be
adjusted as the patient grows.
“These procedures are very complex
and should be done at a children’s
hospital such as ours that specializes in
spinal surgery,” said Dr. Elliott.
Up to 4 percent of children age 10 to
16 in the U.S. have adolescent idiopathic
scoliosis (AIS); the majority of those
affected are girls.
This before-and-after shot
shows the difference the Shilla
procedure can make. With the
implant, the patient went from a
50 degree curvature of the spine
to a 10 degree curvature.
We have the
best options
available to
modern
technology
that we can
tailor to each
patient.
Bone anchored hearing.
In the U.S., up to three out of every 1,000 children are born deaf or hard of
hearing, and more lose their hearing later in childhood. Hearing is vital to
a child’s early speech and language growth, and hearing devices can be key
to a child’s development.
The type of hearing loss a child has determines what kind of hearing
device is most appropriate. Bone Anchored Hearing, or BAHA, is a surgical
alternative when traditional “in the ear” or “behind the ear” devices are
not effective. The amazing device directly stimulates the inner ear through
the bone.
“The BAHA is appropriate for those who have conductive hearing loss,
mixed hearing loss, or single-sided deafness,” said Dr. Jairo Torres, a surgeon
in Children’s ear, nose and throat division. “We learn speech by the feedback
we hear. If a child has one normal ear, usually their speech is fine, but if not,
this can help.”
Bone conduction transmits sound directly through the jaw and skull,
bypassing the outer and middle ear. Conventional hearing aids rely on air
conduction and won’t work if the middle ear isn’t functioning. The BAHA is
designed to bypass the outer and middle ear altogether.
The short, outpatient procedure is done under general anesthesia for
children age 5 and up. It involves surgically implanting a titanium screw
into the skull and leaves a small abutment exposed outside the skin. After
the titanium attachment has had three to six months to integrate with the
bone, the sound processor, or hearing device, is snapped onto the abutment.
The surgeon may also implant a “back-up” titanium post in case the initial
receptor fails or becomes damaged.
The child’s hair grows over the abutment, concealing the device. The surgery
is easily reversible, but Dr. Torres said few people choose that option because,
“the sound quality is so great.”
(Continued on page 19)
Children’s
otolaryngology
surgeon
Dr. Jairo Torres
uses the BAHA
implant to help
kids have better
lives.
18
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19
Having a procedure
done at Children’s has
other benefits. All of
our pre-op rooms are
private and children
and families have their
physician and
anesthesiologist
consultations in a
comfortable
environment that
helps relieve some of
the stress that comes
with surgery.
(Continued from page 18)
Supprelin LA and
Precocious Puberty.
Young girls and boys diagnosed with central
precocious puberty (CCP) are often treated
with monthly shots to stop the progression of
premature sexual development. But now there
is another option: a minor surgical implant that
needs replacing only once a year.
Supprelin LA is a small, thin, flexible tube
composed of the same material as a soft contact
lens. Children’s surgeons place it just under the
skin of the child’s inner upper arm. The implant
continuously releases a steady flow of the medicine,
histrelin, to lower the patient’s sex hormone
levels for one year.
“The injections every 30 days can be painful
for these kids and psychologically difficult,” said
Dr. Michael Allshouse, Children’s medical director
of pediatric surgery and trauma, who performs
the procedure. “The implant seems to sustain
the medicine better and we’ve had fewer reports
of mood swings in the patients. There’s also less
worry that puberty will start up again if injections
are missed.”
The procedure is completed either in the
doctor’s office or the operating room. Done under
local anesthesia, the office procedure takes only
about 10 minutes. Many of the patients are referred
from Children’s endocrinology practice. It is a great
example of how a small advancement in treatment
can make a giant difference to a child.

A stimulating alternative.
Trips to the Emergency Department (ED) for partial-onset seizures can be
a way of life for kids with epilepsy. If the child is not a candidate for epilepsy
surgery and has tried multiple antiepileptic medications with little relief,
the vagus nerve stimulator (VNS) can be an effective option.
“VNS is not a cure for seizures, but it can mean fewer visits
to the ED and fewer stays in the Pediatric Intensive Care Unit,”
said Dr. Steven Ehrreich, Children’s medical director of neurology.
Since approximately one-third of patients taking medication for epilepsy
continue to have seizures, VNS can provide a valuable secondary form of
treatment. VNS does not eliminate the need for medicine, but can help
reduce the risk of complications from severe or repeated seizures.
Similar to a cardiac pacemaker, the VNS is a silver-dollar-sized device
surgically implanted under the skin near the collarbone. A wire, or lead,
under the skin connects the device to the vagus nerve in the neck. The
patient’s neurologist programs the device to produce weak electrical signals
that travel along the vagus nerve to the brain at regular intervals. These
signals help prevent electrical bursts in the brain that cause seizures. The
lithium batteries need to be changed about every five to seven years.
If a seizure feels like it’s about to start or is already in progress, the
patient simply uses a handheld magnet to trigger the device.
“The quality of the device keeps getting better,” said Dr. Michael
Dunham, Children’s medical director of otolaryngology, who performs the
majority of VNS implants at Children’s. “They’re smaller, easier to program,
and have a longer battery life.”
Children’s has one of the highest case volumes in the state, but before
turning to VNS as an option, caregivers collaborate to ensure the patient is
a good fit.
“We’ve seen patients tremendously helped by VNS, but the key is to
select them properly,” said Dr. Gary Magram, Children’s medical director of
neurosurgery.
Most patients experience fewer and less severe seizures after the
implant, with the median reduction in seizure frequency about 50 percent.
Video Nasoendoscopy.
Video nasoendoscopy (VNE) is a procedure frequently
used to assess speech in young children, including
those with a cleft palate. Utilizing an endoscope, the
VNE procedure allows an otolaryngologist and speech
pathologist to look at the soft palate and the back of the
throat as the patient speaks. A camera attached to the
eyepiece of the endoscope records the test.
“The video nasoendoscopy provides more precise
results,” said Children’s otolaryngologist Dr. Jairo Torres.
The otolaryngologist, speech pathologist, and
plastic surgeon review the recording and discuss the
case together.
The results, coupled with those of a nasometry
test – measuring the amount of air coming out of the
nose and mouth – help determine the most appropriate
intervention.
“It’s a very interactive process,” said Dr. Peter Witt,
Children’s medical director of plastic surgery. “We
get consensus on the best course of treatment for the
patient.”
Dr. Witt specializes in cleft lip and palate repair and
subsequent speech issues. Cleft lip and palate is the most
common birth defect in the U.S., affecting one in every
600 newborns.
“There is tremendous stigma associated with this
condition,” said Dr. Witt. “Those affected don’t speak
or swallow properly, and they often have impaired
hearing and respiratory and nasal problems, among
other things.”
Team care, such as that demonstrated with the
VNE test, has shown to be effective in addressing such
complex cases and improving long-term outcomes for
these patients.
(Continued on page 21)
20
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21
Dr. Magram
has the vision
and skill to
develop better
and more
affordable
shunts for
patients here
and around
the world.
That’s worth
investing in.
(Continued from page 20)
Improving Treatment of
Hydrocephalus.
Dr. Gary Magram, Children’s medical director of neurosurgery,
works to improve the treatment of hydrocephalus by developing
better devices and instruments.
With more than 20 years’ surgical experience, Dr. Magram
is an expert on shunt design, holding several device patents. But
he wants to do more, and a grateful patient family has decided
to help.
Scott and Debbie Amey of Virginia donated $100,000 to
provide seed money for the Hospital’s neurosurgery fund. They
say their daughter, Kara, now 17, is alive and going to college
next year because of Dr. Magram’s expertise. Dr. Magram treated
Kara on the East Coast before coming to Children’s. “He saved
my life,” agreed Kara.
When Kara was 10 years old, Dr. Magram diagnosed and
removed a brain tumor. Weeks later she acquired hydrocephalus,
a potentially life-threatening accumulation of fluid around the
brain that affects about one in every 500 children. Dr. Magram
surgically inserted a ventricular shunt system to relieve the
pressure.
Appreciative of the funding, Dr. Magram has big plans. With
project planning already underway, he identified and contacted
companies to work with him on developing minimally invasive
endoscopes specifically designed for neurosurgery; shunt
components such as connectors; and a prototype for a more
efficient shunt. Next on his list - if additional funding becomes
available - is to improve the shunts’ exterior drainage mechanism
and alarms for patient safety.
“These are projects I’ve
dreamed about doing but
didn’t have the money,” said
Dr. Magram.
All donations to the
neurosurgery fund directly
benef it hyd rocepha lu s
research and development.
None of the funding is used
for grant writing, physician
salaries or overhead.
“Dr. Magram has the
vision and skill to develop
better and more affordable
shunts for patients
here and around the world,”
said Debbie. “That’s worth
investing in.”
Kara talks to Dr. Magram in her home hospital on
the East Coast. Dr. Magram treats children and
adolescents from across the United States.

Pulmonologist Dr. Lauro Roberto and
cardiologist Dr. Carl Owada improvised a way
to save Helena Phillips’ lung. This image shows
where the pin was located as well as
the devices being used to retrieve it.
More about advanced procedures . . .
On-the-spot innovation.
Helena Phillips’ X-ray – with
a straight pin lodged deep
in her right lung – is one of
those pictures worth a thousand
words.
The 14-year-old’s tale
began while she was sticking
a photo to her bedroom
bulletin board with a pin.
Like so many of us do, Helena
stuck the pin between her
lips to free her hands. You
can guess what happened -
it quickly slipped down her
trachea when she took a
breath.
“I wasn’t sure at first
if I swallowed it,” recalled
Helena. She later learned
that lungs do not have nerve
endings, making it difficult
for her to feel the pin. “I
searched the floor but didn’t
find anything. I told my mom
that I thought I just did something
horrible!”
Helena’s parents drove
her from their Kerman home
to Children’s Emergency
Department where an X-ray
confirmed their fears. Helena
had aspirated the pin. Emergency
Department physicians
called in Dr. Lauro Roberto,
a pediatric pulmonologist at
Children’s.
“We knew we couldn’t
leave the pin in there,” said
Dr. Roberto, pointing to Helena’s
X-ray. “Chances are the
injury from the pin could
fester or get worse.”
Dr. Roberto tried to
retrieve the tiny object using
a bronchoscope, but the
instrument could only go so
far, reaching to just a millimeter
from the pin. The other
alternative was surgically
removing part of Helena’s
lung, but Dr. Roberto didn’t
care for that option. “I didn’t
want to give up,” he said.
Dr. Roberto decided to try
a technique that a pulmonologist
and cardiologist at Children’s
had used to retrieve a
pushpin from a teenage boy.
In that case a team had used a
bronchoscope, catheters and
guide wires, watching them
simultaneously on an X-ray
screen, to extract the pushpin.
It was a rare combination of
tools usually used for separate
pulmonology and cardiology
procedures.
Rather than run the
bronchoscope and catheter
parallel, however, Dr. Roberto
and Dr. Carl Owada, medical
director of cardiac catheterization
at Children’s, actually
placed the smaller catheter
inside the bronchoscope.
Once the brochoscope
reached its previous spot in
Helena’s lung, Dr. Owada
used the inserted catheter to
pull the pin out safely. The
process took only 20 minutes,
and Helena suffered no significant
trauma.
“They saved our daughter’s
lung,” said Brendan Phillips,
Helena’s dad. “How can
we ask for more than that?”
The pediatric specialists
say their approach could be
used in other cases. “In the
future, I think we’ll be faster
at pulling out things that
children swallow,” said Dr.
Owada. “We want all stories
to have a positive ending.”
22
Helena could be flashing a peace sign, or it could
be a “two”, for her two favorite doctors.
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The more
specialized we
get in healthcare
the more
multidisciplinary
we need to be.
Complex problems
need more than
one expert.
23
Dr. Peter Witt - pictured here and performing
surgery on the opposite page - leads a team
of pediatric plastic surgeons that offers kids
procedures that improve their lives in ways
you may never have imagined.
A better team for
a better life.
No one likes to be teased. Yet children
suffering from a cleft lip and/or cleft
palate are often mocked for the shape of
their mouth, protruding teeth and unclear
speech. Compounded with other health
issues like hearing loss, respiratory and
psychosocial problems, the visible disfigurement
can be devastating for a child’s
development and self-esteem.
Dr. Peter Witt, medical director of
Children’s Department of Pediatric Plastic
Surgery, strongly supports what research
shows – patients receiving comprehensive
team care have the best chance
of becoming functioning, contributing
members of society.
“Current standards of cleft care
include multidisciplinary management
by a qualified cleft palate team in accordance
with American Cleft Palate-Craniofacial
Association (ACPA) criteria,” said
Dr. Witt. “The complexities of the condition
make it necessary for a variety of
clinicians to collaborate on planning and
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delivery of treatment, including specialists from medical and surgical,
dental, and speech and hearing.”
Dr. Witt strongly believes that the kind of team expertise practiced
at pediatric hospitals is key to this treatment.
“The more specialized we get in healthcare the more multidisciplinary
we need to be,” he said. “Complex problems need more than
one expert. That’s why these kinds of conditions should be treated at
a tertiary institution equipped to handle them.”
Cleft facial patients typically undergo multiple surgeries and procedures
over many years, sometimes until they are young adults. “It’s
one of the most rewarding aspects of what I do, to see them grow up,
graduate, get married – succeed,” said Dr. Witt.
Board certified in plastic, hand and general surgery, Dr. Witt is
nationally known for his skilled cleft lip and palate repair and personal
interest in subsequent speech issues. The plastic surgery program at
Children’s serves more than 1,650 kids a year. The busy department
has three board certified plastic surgeons.
“Because of what Dr. Witt has helped establish with his team at
Children’s, there’s no reason for any child to go outside the Valley for a
cleft-craniofacial issue,” said Todd Suntrapak, Children’s executive vice
president and chief operating officer. “When I think of all the incredible
work that we do here, I still get amazed by some of the things that
Peter is able to achieve. I hope the Valley truly understands the special
talent we have here with this plastic surgery team.”

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24

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25
The view from the
outside.
Hospitals don’t usually get excited when The Joint Commission
shows up to conduct an unannounced survey, at least not in a
positive way. But when surveyors arrived for Children’s triannual
surprise audit they found a staff that was not only ready, but excited
at the opportunity to show the world how well we were doing.
“In the past we prepared for Joint Commission visits by
assuring we met their standards,” said Children’s Executive Vice
President and Chief Operating Officer, Todd Suntrapak. “But really,
those standards are the minimum. We don’t want to just meet
minimum standards, we strive to provide care to our patients
every day that exceeds those standards, and to be able to demonstrate
that during a survey.”
Children’s approached this creatively and aggressively. Staff
abandoned the old way of thinking, of “preparing for a survey”.
We were determined to prove that we are always ready, always
exceeding standards, and that every member of our team could
demonstrate how we do it. In other words, kids always get the level
of care that exceeds Joint Commission standards, no matter when
they are here.
The Joint Commission survey is one
of the most important ways a
hospital’s quality is measured.
We started by taking the high-level concepts of “standards” apart,
showing them as processes that happen daily, like hand hygiene compliance
and environmental checklists. This allowed staff to see the tangible
connection between The Joint Commission standards and patient care. We
removed standards from the realm of the theoretical and put them solidly
in the hands of bedside caregivers.
Then, conducting surprise audits of our own, we learned that everyone
knew how to do their jobs well, but they needed access to information that
would help them prove it.
“That part was hard to articulate,” said Susan Wisniewski, Children’s
manager of accreditation and regulatory compliance. “Really, we had to help
people think about where data comes from. We needed to not only know
what we do, but also how to quantify it and where we get that information.”
A tool kit was developed surrounding Complete Quality, or CQ as it
came to be called. The “CQ-IQ Tool Kit” provided resources to evaluate the
quality of care, and to create a safer environment. It incorporated everything
from information about hospital safety to presentations on key areas like
infection control. Residing on the hospital intranet, it was available to all
staff for both personal review and training sessions.
We strive to
provide care
to our patients
every day that
exceeds those
standards.

Joint Commission surveyors use
tracers to conduct audits. They choose,
at random, a patient chart and examine
everything on it in detail. If a child had
lab tests, surveyors audit the lab. If the
child had X-rays, they go to radiology,
“tracing” the child’s entire
visit through the Hospital.
Children’s emulated the
method, sending executive
leadership on tracers every
month. The process put vice
Children’s executive leadership conducted patient tracers as a means to improve care and meet standards. They even
include Children’s trustees, like Guilds Coordinating Council Chair Stephanie Houlding, who is having an element of the
tracer explained by Vice President and Chief Nursing Officer Beverly Hayden-Pugh.
presidents and executive leaders in the field, looking closely at the care we
provided. This had many benefits. First, the organization was engaged in
quality management from top-to-bottom, and leadership also got a handson
look at the work our teams do every day. The tracers helped us to identify
opportunities for improvement and made staff familiar with the process. It
also helped train a wide group of leaders to accompany the surveyors when
they were on site.
Over time staff lost their fear of tracers and looked forward to explaining
their work. When the Hospital entered the window in which our survey would
fall, people began to get excited. Months passed, we waited, and the surveyors
didn’t come. It wasn’t odd to hear someone say, “Will they ever get here?”
They did, early on a Monday morning. And they were surprised to find
a Hospital not just ready for them, but eager to get the survey started.
“One of our strengths was our preparedness for the opening session,”
said Wisniewski. This is the Hospital’s first opportunity to share with the
surveyors. “They want to hear all about your hospital, what you do, what you
have in place.”
With more than a year of education, presenters were informed, confident
and had a good handle on what the surveyors needed to know in order to
start the process.
Taking tips from some of our Child Health Corporation of America
(CHCA) colleagues who had recently been through surveys, we had some
things already in place for our surveyors. Required documents were already
prepared and ready for review, and we were able to produce other requested
documents in a timely way. Several dedicated staff members provided
surveyors whatever they needed to get their job done.
“The preparation made all the difference,” said Wisniewski. “We were
quite ready when the surveyors arrived, and they told us many times that
they had everything they needed.”
(Continued on page 27)
In addition to Joint Commission
accreditation, Children’s received
the Beacon Award for Critical Care Excellence in 2009
and had our Magnet Certification renewed in 2008.
26
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27
The Joint Commission and Children’s Hospital
have the same goal - to make sure that kids like
Josiah, a urology patient at Children’s, get the
highest-quality, safest healthcare possible.
(Continued from page 26)
Surveyors were able to wrap-up by mid-afternoon most
days. Surveys usually last about a week, and the team saw everything
they needed to see a full day before their allotted survey
time. In the middle of the week staff was informed that some
surveyors had finished their work and were leaving early.
On the final day it is customary for the survey team to meet
with executives to give preliminary results. The Joint Commission
representative made an unusual request. Rather than meet
with the Hospital’s top management, they wanted to present
their findings to all of the managers, directors, executives and
physician leaders. With well over a hundred people in the room,
the final two surveyors laid out the final surprise of the week.
“The surveyors addressed leadership and physicians calling
us a ‘phenomenal organization with phenomenal physicians and
phenomenal staff,’” said Children’s President and CEO William
F. Haug. “The word phenomenal was used several times.”
The Joint Commission praised Children’s and recognized
us for having “best practice” in four areas. Medical staff was
recognized for an outstanding physician evaluation program.
Clinical Education was complimented on their excellent assessment
and planning for orientation, and their continuing education
for clinical staff. The Children’s Fall Prevention Program
was commended for developing an assessment unique to our
patient population. Finally, patient safety in the Surgical Department
was acknowledged for the consistent use of “time out”
procedure.
In the end, it was the surveyors who got the biggest surprise
at Children’s Hospital. Instead of having to be the “police” of the
hospital world, for one week they were able to see a place where
the very spirit of what they do had taken root and grown into
exceptional patient care.
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The word
phenomenal
was used
several
times.

More about the view from the outside . . .
A new understanding.
The Institute for Healthcare
Improvement’s (IHI) National
Forum for health literacy
recognized Children’s in 2009
for an initiative called “Mind
the Gap: A Health Literacy
Initiative Aimed at Improving
Patient Safety.”
Children’s Hospital was
awarded the “Service Quality
Award” for Health Equity at
the IHI National Forum for a
poster about the initiative,
and was invited to publish
the research in The Permanente
Journal.
What’s health literacy all
about? Well, have you ever
visited a doctor’s office and
found yourself struggling to
remember what the doctor
told you, why your loved ones
were taking so many pills, or
what you were supposed to do
when you got home? Imagine
how much harder that would
be if you and the doctor spoke
different languages.
C h i l d r e n ’ s u n d e r -
stands that the ability to
remember and follow doctors’
instructions is a key component
to a patient’s wellbeing
after discharge. Health
literacy issues, like language
barriers, reading skills and
education differentials all
impact a patient’s understanding
of those instructions,
and may result in less
than optimum aftercare. Children’s
Hospital addressed the
situation with a pilot program
to provide recorded discharge
instructions to families after
their child leaves the Hospital.
“We knew the need
was there,” said Simranjit
Kaur, patient safety program
manager at Children’s.
“Research has shown that
80% of all patients forget
their doctors’ instructions
by the time they get home.
That’s not taking into account
language or literacy issues.
We went into it knowing that
health literacy impacts all
patients at some level.”
The situation is further
complicated in pediatrics.
“Unlike adult medicine,
the instructions are being
given to a caregiver, not the
patient,” said Dr. Samuel
Lehman, medical director of
patient safety at Children’s
Hospital. “In some cases the
parent receiving the instructions
is not even the parent
who provides the care. Maybe
dad had the car today, but
mom is at home and she’ll
be taking care of the baby. It
was important for us to find
a way to transmit the written
information to the caregivers
in a way that overcame all of
those different health literacy
issues.”
Lehman said they chose
a means that almost all
patient families have access
to – a telephone message.
During discharge the medical
interpreter wore a headset
that recorded the aftercare
instructions as they were
provided. Those instructions
were posted on a private,
password-protected voicemail
box for two weeks, and
the family was given a refrigerator
magnet with the information
on how to access the
voicemail box. “It was really an enhancement of the
process we already had in place,” said Lehman. “It
just took it a step further by recording the instructions
and having them somewhere that was accessible
to the family once they got home.”
Funded by a $25,000 grant from Cardinal Health,
the pilot program ran from April through September
of 2009 and concentrated on Day Surgery patients.
During that time about 30% of the families participating
accessed the voicemail boxes, some more than
once. The project initially started with Hmong and
Mixteco speaking families, and was later expanded
to include Spanish speaking families.
“Now we’re evaluating it and looking to see what
we do next,” said Lehman. “The question is where do
28
we go from here? We need to decide the best way to
expand and what other languages to include. Meanwhile,
we’ve set the bar high. No one has ever done
this before. Other hospitals are contacting us to see
how they can replicate this program.”
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Families can now get post-surgical
instruction - in their own
language - as a voicemail
message they can
access from home.
28

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29
Technology in transition.
Physicians electronically enter their prescription orders directly
into the computer rather than handwriting or faxing them to the
pharmacist. Nurses key in a patient’s vital signs at the bedside
that caregivers can view simultaneously in the computer system.
Patients have one seamless electronic health record complete with
medical history, medication and allergies, immunization status,
laboratory test results, radiology images and billing information.
That’s what the future looks like.
And yet, fewer than 2 percent of U.S. hospitals use comprehensive
electronic health records. Children’s Hospital Central
California moved into electronic records well ahead of the curve,
but a few years ago Hospital leaders could clearly see the incredible
advances on the horizon, and had a problem to address – our
systems were getting old, and were not going to be able to support
a great leap forward. We were going to have to replace everything.
So, after a year-and-a-half of detailed preparation and planning,
Children’s launched a major conversion to new digitized
systems. The $8 million effort impacted every Hospital employee
Aging systems and high
expectations brought about a
massive change at Children’s.
and touched multiple departments and processes, from clinical information
access to patient scheduling and billing. The improvements followed more
than $3 million of preliminary technology upgrades begun a few years ago,
including rebuilding our infrastructure and data center, and replacing the
telephone system and every old computer in the Hospital.
“Our ultimate goal is to provide as much patient information as possible
to caregivers on the computer in real time,” said Todd Suntrapak, Children’s
executive vice president and chief operating officer. “That way they can make
the best decisions for the patient. The new system provides a solid foundation
to build upon for the next five years and beyond.”
Here comes the big upgrade.
Meditech’s Magic platform served admirably as the Hospital’s legacy
computer system for more than two decades. In fact, Children’s is the largest
pediatric hospital in the U.S. utilizing Meditech. Outdated but stable, the
system had inherent limitations and could not support the more advanced
functionality needed.
We were going to
have to replace
everything.
Nurses use the handle at the top of these handheld
computers to pop them out of their cradles and use
them at the bedside.

Chief Medical Information Officer Dr. Joel Brownell and Manager of Business and Operational Systems
Leo Baranda stand in Children’s primary server room. The tech heartbeat at Children’s, this room is a
great example of the behind-the-scenes systems and people that make advanced medical care possible.
After careful evaluation, the Hospital
chose to move to another Meditech
product as we stepped into the future,
the newer Client/Server platform. In
addition, Children’s added the Lawson
Enterprise Resource Planning system to
handle a smaller, more unique portion of
our information.
“This is a more contemporary
platform,” said Dr. Joel Brownell, Children’s
chief medical information officer.
“Although we tweaked Magic several
times over the years, we wouldn’t have
been able to move forward.”
Interdisciplinary teams and committees
across the Hospital customized and
streamlined the system, reducing the
systems’ 83 custom programs to 16. They
debated issues and conducted assessments
on how to improve workflows
and processes and educate staff, always
keeping patient care front and center.
“This wasn’t an Information Technology
project, this was a Hospital-wide
project,” said Suntrapak. “We looked at
things from an end user’s point of view
and what made the most sense for the
caregivers and patients.”
Denise Zeitler, an experienced nurse
executive serving as project manager, said
that everyone came together and focused
on the bigger goal - even when project
team members didn’t agree on details.
“Not a lot of organizations this size
can do that, and do it well – I think that’s
what’s unique about us,” said Zeitler, Children’s
director of clinical education and
informatics and change management.
It was as if we were driving
100 mph while replacing the
car’s engine. And we did it
all safely.
One of the most difficult aspects of the conversion
was bringing up both new systems simultaneously.
While the platform experienced some bumps
in the beginning, those were to be expected. Hospital
leaders addressed each issue accordingly, and the
system stayed on track.
“The task was momentous,” said Zeitler. “We
did in 18 months what most places take four years
to complete. And we did it without cutting corners
or putting our patients at risk. There was no expense
spared maintaining patient safety and efficiencies.”
Specifically, major functions transferred to the
new system included our inpatient units, the Emergency
Department, imaging, and the laboratories;
general financial system, including human resources,
accounts payable, payroll, and materials management;
and physician credentialing, staff scheduling, incident
reporting and more.
“We essentially pulled out every piece of software
and data,” said Suntrapak. “It was as if we were driving
100 mph while replacing the car’s engine. And we did
it all safely.”
“When the system went live, there were no fatal
flaws,” he added. “It took a lot of talent to pull that off.
Everyone throughout the Hospital rose to the occasion
to make this work. Our people were phenomenal.”
(Continued on page 31)
30
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The new system
provides a solid
foundation for
the next five
years and
beyond.
There is a lot more
to come in Children’s
transformation.
These are some
of the highlights.
31
(Continued from page 30)
Reaping the benefits.
In 2010, Children’s will continue to expand its use of electronic
physician documentation. As paperless medical records become
the norm, the days of physicians scribbling patient care notes
followed by dictation and transcription are numbered. Electronic
documentation, in which physicians type the information directly
into the computer system, produces faster, more accurate results.
In fall 2008, Children’s non-intensive care physicians –
including our hospitalists, Charlie Mitchell Children’s Center
primary care physicians, cardiologists, oncologists, physiatrists,
and more recently, our residents – began writing inpatient notes
electronically. The new approach makes patient notes available
for referring physicians while the child is still in the Hospital and
at the time of discharge.
This launch put us more than halfway toward our goal of creating one
complete electronic health record, and Children’s expects to maximize the
benefits over the next three to five years. With improved communication
among caregivers and increased availability of data, the electronic record
is expected to increase patient safety through evidence-based decision
support, quality management and outcomes reporting.
And while completing the conversion was a significant accomplishment,
there is much more to do. Project participants will continue to stabilize the
new platform and core functionality, making adjustments as needed, as well
as educate staff, and plan and implement additional system improvements.
The next big phase will affect about 60 percent of our employees,
primarily physicians and nurses. “The impact will be about four times larger
than what we did in 2009,” said Brownell.
The Hospital is ready and eager to embrace a future with a seamless
electronic medical record for all of our patients .
Electronic physician documentation.
“The new process also means that
caregivers don’t need to follow the paper
chart everywhere in order to obtain patient
information or track the patient’s progress,”
said Dr. Brownell.
About 52 percent of the approximate
1,000 patients discharged every month at
Children’s now get an electronic-generated
copy of their treatment instructions when
they walk out the door. Children’s goal is
for all patients to have that same service,
and will expand the effort to the neonatal
and pediatric intensive care units in 2010.
The impact.
Imagine that a 9-year-old boy is seen in the Emergency
Department (ED) for gastric bleeding and is referred to the
Hospital’s Gastroenterology Department for additional evaluation.
Following treatment, he is sent home and receives
a medication prescription. The next day the same child is
back in the ED, only this time for a cracked elbow following
a vehicle accident.
“People come into the ED and the parents have a hard
time remembering exactly what medications their child is
taking or the doses,” said Dr. Brownell. “The ED physician
may accidentally put the child on a medication that’s in
conflict with what the child is already taking, and unintentionally
cause the patient’s condition to become worse.”
With Children’s new system, the ED physician will
immediately know when (and for what) the child was
treated previously, the medications he was prescribed and
more. An alert will indicate if the new drug shouldn’t be
combined with the patient’s current prescriptions, or is the
wrong dose, among other warnings.
Clinical documentation.
In 2009, we began planning for the transfer and implementation
of advanced clinical documentation to the Client/Server
platform in late 2010. This will primarily affect our nurses
and other clinical staff including respiratory therapists, dietitians
and social workers.
Ambulatory platform.
In 2010, we will develop a strategy and select the best tool
to integrate the outpatient clinical record process for about
30 practices into our system. Project planning will take place
in 2011, with implementation expected in 2012.

This office used to be filled, floor to ceiling, with files of paper medical records.
A few years ago the paper was reduced enough that the entire Health Information
Management Team fit in the space it used to occupy.
Expanded CPOE.
CPOE stands for Computerized Physician Order Entry.
An early adopter, Children’s Emergency Department
implemented CPOE in 2007 when less than 17 percent
of hospitals with more than 200 beds were using the
technology.
CPOE allows physicians to enter medical orders such
as medications, X-rays and IVs into a computer program.
Physicians can check for drug-drug interactions and drug
allergies, monitor patient dosage levels and reduce errors
from look-a-like and sound-a-like drugs. Order sets are
also built into the program to standardize practice.
Over the next 18 months, Children’s will push CPOE
into all inpatient units.
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More about the tech transition. . .
Change is good.
“People don’t resist change;
they resist being changed,”
wrote the well-known scientist,
Peter Senge.
The method of handling
large-scale change became
so important during the
tech upgrade that Children’s
created a permanent change
management team.
The new Organizational
Project Management
Office is composed of four
members who helped lead
the technology conversion.
The team provides support
for teams while working
closely with Hospital leadership,
project participants
and staff to ensure project
success. It also serves as a
resource and provides essential
tools, processes and facilitation
skills as requested,
with emphasis on helping
staff internalize the change,
develop acceptance and
modify their behaviors.
“We realized that if
we don’t deal with the
change process, we won’t
be successful, no matter
how good our project plans
are,” said Jeff LeFors, Children’s
executive director, of
professional services and
change management. “And
it goes hand in hand with
project communication and
education.”
Based on the Satir
Change Model, Children’s
change management model
features a five-stage approach
that describes the effects
each phase has on feelings,
thinking, performance and
physiology. Developed by
family therapist Virginia Satir,
the model outlines actions for
each stage that will help those
affected adapt more quickly
and effectively.
“The goal is for the group
to successfully transform from
the ‘Status Quo’ stage to a
‘New Status Quo,’ with the
least disruption to individuals
and the organization,” said
LeFors. “The key is to have a
proactive action plan.”
It’s natural for people
to be hesitant about change,
said LeFors, even when they
know it’s ultimately for the
better. It can be difficult at
first to adjust to a new way of
doing something or learning a
new process.
One of the team’s first
assignments is to take the
next step in our tech transition.
The systems are in
place, but the people are still
adapting.
Physicians long accustomed
to writing individual
prescriptions, for example,
will utilize specific order sets
with the new tech system,
standardizing care. Caregivers
may spend additional
time inputting information
into the computer system,
with possibly more screens to
fill out or click through.
“There can be more work
on the front-end and less
opportunity to skip steps, but
Executive Director of Professional Services and Change Management Jeff LeFors leads a
team that helps people adjust when systems are changed.
we believe this will improve
patient care and increase efficiency
on the back-end,” said
Dr. Brownell. “The system
people use didn’t just change
but also how they use and
interact with the system – it’s
a cultural shift.”
Denise Zeitler agreed.
Part of her role on the organizational
project management
team is helping people
adapt to the new way they
need to conduct their work.
“It’s not as much about the
technology as it is about the
behavior – behavior is the true
transformation.”
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33
A high-energy leader for a high-energy moment.
“It was exciting, nerve-wracking
and everything in between,” recalls
Denise Zeitler, who was handpicked
by Hospital executives to be
project manager for Children’s technology
transition. “I felt a particular
responsibility to ensure that everything
went well.”
A leader known for her dedication
to quality and spirited style,
Zeitler will never forget the day
Children’s transitioned from the
legacy system to the new platform.
The Hospital had determined
that the only way to effectively
launch the system was to bring
all elements online at once.
And it worked. Mostly.
Not long after flipping the
switch, problem reports
began coming in from
different areas of the Hospital. Already
prepared, Children’s administration had
set up a Command Center to identify and
address issues. Even with the thoughtful
preparation, though, the number of
concerns began to look overwhelming.
She creates confidence in everyone
and everything around her.
“Given what we were hearing during that first 72 hours we thought
perhaps this was a disaster,” said Zeitler. “It was intense.”
According to Beverly Hayden-Pugh, Children’s vice president and chief
nursing officer, this is when the “high-energy” high performer is at her best.
“She was like the general in that Command Center,” said Hayden-Pugh.
“She’s direct and in your face about the right thing. She holds herself and
everyone around her accountable, and what she is most passionate about
is doing what’s best for the patient and clinician.”
After staff began to dig in and solve the immediate problems, it became
apparent that the conversion was going to be a success. No issues were
raised that couldn’t be resolved in a manner that would keep the Hospital
from having to move back to the old system.
Several briefings were held during the first days of the transition to
update nurses, doctors and managers, with Denise presenting a transparent
and bold assessment of the situation. She was up-front about problems,
but presented solutions just as energetically.
“With Denise in charge, you just knew that everything was going to
come out right,” said one manager about the briefings. “She wasn’t going
to let it come out any other way. She creates confidence in everyone and
everything around her.”
A tour of the Hospital units confirmed this assertion. “I expected to see
chaos,” said Zeitler. “But as I looked around, people were doing what they
needed to do to take care of our kids. A physician came up to me and said,
‘People are doing fine with this,’ and that gave me perspective. I realized
we were OK and it wasn’t as bad as it seemed in the Command Center.”
Executive team and project leaders, including Zeitler, spent the next two
weeks problem solving, working around the clock.
For Zeitler, a former Pediatric Intensive Care Unit director and ambulatory
manager at Children’s, and former chief nursing officer at another
hospital, the conversion was one
of the most challenging assignments
of her career.
“This was the most complex
project I’ve managed,” she said.
“The intricacy of the initiative
and technology could be mindparalyzing
at times. The most
daunting task was bringing up
the entire organization at once.
It took everyone coming together
to make that happen and we did
it well.”
Executive Vice President
and Chief Operating Officer
Todd Suntrapak was certain of
his executive team’s recommendation
when he drafted Denise
out of her regular job.
“Zeitler was perfect for the
moment,” he said. “She was the
obvious choice. We felt that our
best chance at success was to put
this project in her hands, and we
were right.”

This image from our PICU shows the astounding amount of technology that can be in use
at a child’s bedside. Getting all of this information, including information from doctors
and other providers, into an electronic medical record is a challenge for every hospital.
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Children’s
Service area
includes Fresno,
Madera, Stanislaus,
San Joaquin, Merced,
Mariposa, Tulare,
Kings, Kern and San
Luis Obispo counties.
35
Children’s pediatric experts provide
much more than medical care to
our part of the world.
Central to California.
Children’s Hospital Central California serves a 45,000 square-mile
area that covers the heart of the state. In fact, the other 111,000
square miles in California are covered by no fewer than seven other
children’s hospitals. To put it in perspective, our service area is
larger than Ireland – the country and the island.
Children’s sees more pediatric patients than any other hospital
in Fresno and Madera counties, and the majority of pediatric
patients who leave Merced, Stanislaus, Tulare, Kern, Mariposa and
Kings counties for care. We treat 14 percent of the same types of
patients from the Central Coast, a segment that grows every year.
Our high-level of expertise is very rare for a primarily rural region
this large, giving us a great deal of responsibility for serving not
just the region’s children, but the medical professionals who care
for them.
We honor this duty by providing accredited medical education
for doctors, nurses, and healthcare professionals. This takes
the form of partnerships with educational institutions like
UCSF-Fresno, UC Merced, CSU Fresno and dozens more, as well
as pediatric symposiums that our subspecialists offer existing
practitioners throughout the state. All practicing doctors must complete a
certain amount of accredited medical education every year, and for many
physicians, the pediatric elements of this are provided by Children’s Hospital
Central California.
There are also specialty courses for nurses, pharmacists, respiratory
care professionals and more. Looking at the big picture, Children’s partners
with nearly 60 schools offering training in 17 disciplines.
In addition to education programs, the Hospital leverages expertise in
the area of child advocacy. We have programs aimed at child safety, literacy,
water safety, and the prevention of child abuse. Business partnerships with
companies like Walgreens Pharmacies helps us take our specialized knowledge
into neighborhoods, sharing vital information on pediatric medication
throughout their entire chain. Nurses at Children’s have also been key
members of regional associations that advance the practice of nursing, and
our pediatric subspecialist physicians are actively involved in ensuring that
the Valley’s kids are well cared for.
If there is any place in Central California where children’s health is being
discussed, taught or promoted, Children’s Hospital is most likely involved.

The SimNewB is an advanced baby simulator that allows our Neonatal Intensive Care nurses to train staff in a hands-on
environment. It is also used to train nurses from throughout the region who take advantage of the courses our NICU offers.
Sharing our knowledge base.
Children’s Hospital Central California is not part of a university-based
system, but don’t let that fool you. We have strong, accredited academic
programs, many affiliated with the region’s top learning institutions. With
so many pediatric experts under one roof, Children’s is able to offer education
to clinicians and students from throughout our region and beyond.
Children’s offers postgraduate medical education to physicians through
its affiliation with the UCSF Fresno Pediatric Residency Program. Medical
school graduates focusing on pediatrics come from throughout the country
to this three-year, fully accredited post-graduate training program that
encompasses all aspects of pediatric medicine. Children’s trains about 30
new doctors every year.
Children’s also offers a one-year, postgraduate residency program in
pharmacy practice with an emphasis in pediatrics. Throughout the year,
residents provide patient-specific clinical pharmacology in both inpatient
and outpatient areas, providing drug education to medical residents and
nurses, and precepting pharmacy students.
Children’s Hospital participates in several academic programs in partnership
with schools from throughout the region, state and nation. We are
part of nursing programs from California State University schools including
CSU Fresno, CSU Bakersfield, CSU Dominguez Hills, and CSU Stanislaus, as
well as UCSF. We work with community college RN programs that include
Fresno, Reedley, West Hills, Pacific Union, College of the Sequoias and San
Joaquin Valley College. Our pharmacy programs include University of the
Pacific, UC San Diego and others. All in all, we offer clinical rotations in
17 disciplines, providing a pediatric training ground for our region’s future
pediatric caregivers.
Central California’s practicing physicians fulfill their continuing medical
education (CME) requirements by attending Children’s pediatric clinical
symposiums. The Hospital hosts several symposiums every year in locations
throughout the region including Madera, Modesto, San Luis Obispo and
Bakersfield. Children’s subspecialists conduct the half-day events offering
credits in a variety of pediatric health topics. These continuing medical education
programs are taught in accordance with the standards of the Institute
for Medical Quality (IMQ), the Accreditation Council for Continuing Medical
Education (ACCME) and the Children’s Hospital CME Mission Statement.
New in 2009 was the University of California Merced lecture series. The
monthly series at UC Merced pairs local practitioners and students with
Children’s pediatric subspecialists for hour-long sessions in pediatrics.
(Continued on page 37)
Children’s
partners with
schools from
throughout the
region, state
and nation.
36
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37
Partnering with
Sierra Vista
Regional Medical
Center, Children’s
brought pediatric
subspecialty
services to
San Luis Obispo
in 2009.
(Continued from page 36)
Pediatric Cardiology Medical Associates of Central California, composed
of Children’s cardiology physicians, hosted the 2009 meeting of the Western
Society of Pediatric Cardiology at Yosemite National Park’s historic Tenaya
Lodge. The group meets annually for a scientific session featuring courses
on a large number of topics.
Other disciplines also offer outreach education. Our Neonatal Intensive
Care Unit, or NICU, offers a full course catalog for nurses and other neonatal
clinicians. This advanced program, offered by the only Level III Regional
NICU in Central California, became the only area program in 2009 with the
SimNewB, a high-fidelity newborn simulator.
Respiratory Care Practitioners at Children’s hosted quarterly pulmonary
conferences open to all patient care providers, respiratory care students and
nursing students in the region. The conference draws about 80 participants
to each session. Children’s also hosts an annual Palliative Care Conference
that brings together the Hospital’s staff with palliative care professionals
from throughout the state. About 100 hospice care providers, representatives
of groups like Exceptional Parents Unlimited, pediatricians and nurses from
as far away as the Bay Area come to Madera for this unique gathering.
Children’s Clinical Education Department will be expanding outreach
education in 2010. Working with the staff that developed the NICU course
catalog, as well as physicians and nurses from throughout the facility,
the department will use this program as a model for education in other
disciplines.
Pulmonologist
Dr. Reddi Sudhakar
is one of Children’s pediatric
subspecialists who now sees
patients in San Luis Obispo.
New clinical partnerships.
Children’s Hospital Central California began an exciting partnership with
Sierra Vista Regional Medical Center in San Luis Obispo in 2009, opening
The San Luis Obispo Pediatric Subspecialty Center at Sierra Vista. Providing
children and families access to some of the world’s finest pediatric subspecialists
in an environment that is close to home, the San Luis Obispo Pediatric
Subspecialty Center serves patients from San Luis Obispo County
and the Central Coast. The Center is a partnership between Sierra Vista
Regional Medical Center and Specialty Medical Group (SMG), in affiliation
with Children’s Hospital Central California. Supspecialists from Children’s
currently provide clinical services in cardiology, endocrinology and pulmonology.
These three subspecialties were selected based on results from
Sierra Vista’s own survey of community pediatricians who identified these
as the greatest needs.
The San Luis Obispo Pediatric Subspecialty Center becomes the third
practice in SMG’s and Children’s network, joining the Merced and Modesto
Pediatric Subspecialty Centers to bring care to kids where they need it most
– close to home.
The Hospital also entered into a relationship with Walgreens Pharmacies
in 2009. Children’s has traditionally operated two kinds of pharmaceutical
businesses. The first is within the Hospital itself. These are the pharmacists
and technicians who provide direct care to our inpatient, Emergency
Department and outpatient center populations. The second was our retail
pharmacy, a place where families could get their prescriptions filled, confident
that the pharmacists on hand understood children’s unique needs. As
Children’s Hospital examined business operations in 2008, we looked for
ways to improve our retail pharmacy business. The method for improvement
eventually presented itself to us - Walgreens wanted to buy Children’s retail
pharmacy.
This sale made sense in many ways, but Hospital leaders were concerned
about continuing to provide specific pediatric-based service. Children’s
and Walgreens came up with a solution. Not only would Walgreens keep
members of the existing staff and focus on kid’s needs, they would take this
newly-acquired pediatric expertise and spread it throughout the region.
There are many pediatric drug compounds that, in the past, you could only
get at Children’s. With Walgreens using our pharmacy as a launching pad,
the expertise and knowledge required to serve pediatric patients is making
its way into Walgreens stores throughout the Valley.

Community Benefits.
The Community Benefits program at Children’s Hospital Central California
contributed to programs and services designed to meet the needs of Central
Valley children and families.
In keeping with its Mission, Children’s Hospital accepts all patients,
regardless of their ability to pay. As part of that commitment, the Hospital
provided $13 million in charity care to patients who met certain criteria
under the Hospital’s charity care policy. In order to assist families with
ongoing care needs, Children’s Hospital requires patient families to apply for
appropriate government funding in conjunction with applying for financial
assistance (charity care). As a result, many families qualify for government
programs and do not ultimately require charity care.
Given the large number of Medi-Cal patients treated at the Hospital and
the historically low Medi-Cal reimbursement we receive for providing those
services, the Hospital also absorbs a significant amount of uncompensated
care annually. Uncompensated care represents the difference between what
we get paid for providing services, and the cost of providing those services.
We partner with a variety of community-based organizations to
help prevent or treat childhood illness in our region. For instance, Children’s
Hospital founded the Childhood Obesity Prevention Task Force, a
consortium of public and private agencies in Fresno and Madera counties
The Guilds Child Abuse
Prevention and Treatment
Center helps us reach outside
our walls to stop intentional
injury to children. The Center
is designed to use
education and partnerships
throughout the region to give
these kids a voice,
and to avoid injury rather
than treat it.
committed to reducing the incidence of childhood obesity through networking, coordination, and development
of best practices. Activities supported by the Task Force included the development of community consensus on
the indicators used to measure obesity and increased coordination among existing programs and services.
Another important service is The Guilds Child Abuse Prevention and Treatment Center. In partnership with
a number of private and public agencies, the Center provided education, leadership, and direct services for children
who were victims of abuse and to parents and community based organizations to help prevent abuse. The
Program provides education and training to over 17,000 individuals annually in the areas of child maltreatment,
pediatric trauma, water safety, wheeled sports safety, childpassenger safety, the choking game, Munchausen by
Proxy syndrome, and shaken baby syndrome.
We also help treat and prevent childhood developmental disabilities through our work with Exceptional
Parents Unlimited, March of Dimes, and local First 5 agencies. And with advances in technology, more and more
children with complex medical conditions are able to attend school full time. To help ensure they continue to
receive medically appropriate care, Children’s Hospital provided education and training to school nurses on a
variety of clinical procedures, including care of gastrostomy tubes and tracheostomy tubes, and use of insulin
pumps.
The Hospital also provides assistance to our patients’ families so that they can effectively participate in their
child’s care. These services include transportation services, meal assistance and a family assistance fund that
helps families obtain items needed when they return home.
Central to California.
You’ve heard it before - Children’s Hospital provides services and resources from Modesto to Bakersfield, the
Sierra Nevada Mountains to the Pacific Ocean. Direct patient care, outreach centers, medical and community
education are all a part of our important impact on the region. We are Central California’s pediatric experts,
and we are so intricately tied into children’s lives that it would be almost impossible to imagine the heart of
the state without us. As years go by, we continue to find new ways to help both children and those who care for
them, and we take our responsibilities very seriously. Central California is our home, and all of the people we
reach out to are our family.
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More Central to California . . .
39
Rare research is a part of our residency program.
Dr. Aaron Reitman, a pediatric
resident at the University
of California, San Francisco-Fresno
(UCSF) program
at Children’s Hospital Central
California, won the American
Academy of Pediatrics’ (AAP)
annual “Best Abstract for
Physician in Training Award.”
His research focused on
procalcitonin as a biomarker
for bacteremia in pediatric
patients with a fever and
abnormally low white blood
cell count.
Children’s Hospital is
only one of two children’s
hospitals nationwide actively
conducting pediatric research
on the topic. Results of
Dr. Reitman’s study with
about 400 pediatric oncology
and Emergency Department
(ED) patients at Children’s
in 2009 showed that procalcitonin
is an effective tool to
quickly distinguish whether
a patient has a serious, and
sometimes life-threatening,
bacterial infection. Results
also indicate that procalcitonin
is superior to the standard
C Reactive Protein (CRP)
test in predicting the absence
of bacteremia.
The 20-minute test may
provide physicians a more
effective method to determine
if a patient should be
admitted to the hospital or
qualify for early discharge, as
well as the level of antibiotics
to administer to the child.
“I ’ve had amazing
support from Children’s
Hospital,” said Dr. Reitman,
who plans to specialize in
pediatric oncology. “You can
have a great idea but you
need help to get you the rest
of the way.”
Dr. Robert Dimand, chief
of pediatrics, UCSF-Fresno,
at Children’s and a pediatric
intensivist at Children’s,
commended Dr. Reitman for
his efforts: “It’s wonderful to
see Dr. Reitman participate in
leading the charge to expand
clinical research related to
the superb patient care here
at Children’s. The Central
Valley has endless potential
and opportunities for clinical
research.”
Procalcitonin is a biological
marker that is normal in
healthy children. Elevated
levels have been present in
children with bacterial infections
but not those with viral
infections. Increased procalcitonin
levels also have correlated
with increased severity
of the infection.
Little information exists on
procalcitonin as a biomarker
for bacterium in pediatric
patients; Children’s and Children’s
Hospital Boston are
the only facilities nationwide
actively researching the pediatric
population. Dr. Reitman’s
research results indicated
that procalcitonin has a
greater specificity and negative
predictive value in ruling
out bacteremia compared to
the more common CRP test.
The ability to measure
procalcitonin levels in the
blood quickly is a new technology
that received FDA
approval in 2008. Children’s,
The Children’s Hospital near
Denver and Phoenix Children’s
are the only pediatric hospitals
west of the Mississippi
with the capability.
The A AP recognized
Dr. Reitman for his procalcitonin
research at its annual
National Conference & Exhibition
in Washington, D.C.
He was one of 11 participants
selected to give an oral
presentation on their abstract
during the section on critical
care. “The award is a nice
representation of the work
itself and the resident who
championed it,” said Dr. J.
Daniel Ozeran, a Children’s
oncologist.
Dr. Reitman’s
career is just
starting, but he
obviously has the
right frame of mind to
work in a children’s
hospital.
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NICU nurses Leslie
Williams and Jennifer
Norgaard provided
invaluable lessons to
healthcare providers
in Nepal, and received
a rich cultural reward
in return.
40
Serving the region and beyond. Way beyond.
Halfway across the world, nurses from Children’s
Hospital helped with the first baby ever to be put on a
ventilator at Patan Hospital. The hospital is in Nepal,
the 12th poorest nation on earth. Before installing
these ventilators, babies who could not breathe on
their own died because there was no way to assist
them.
The moment marked the culmination of a nearly
three-year “Friends of Patan Hospital NICU/PICU”
project. A developing country of nearly 30 million,
Nepal struggles with one of the highest infant mortality
rates in the world, nearly 10 times higher than the U.S.
Dr. Nadarasa Visveshwara (Dr. Vish), program
director of newborn medicine at Children’s, took a
leadership role early in the project and got Children’s
medical staff involved. Neonatal Intensive Care Unit
(NICU) nurse Leslie Williams and Jennifer Norgaard,
RNC-NIC, MSN, led a Children’s team that worked
with international volunteers including physicians and
critical care nurses in developing training curriculum
focusing on critically ill newborn care, protocols and
securing donations for equipment and supplies. The
local Central California Association of Neonatal Nurses
donated funds to buy textbooks and the NICU staff
donated baby clothes.
During the summer of 2009, the team of Children’s
volunteers traveled more than 6,788 miles to help set
up the first neonatal and pediatric intensive care units
in Nepal.
“They didn’t have any kind of intensive care and very little
prenatal care, so anything you can do to get these mothers and
babies care will help survival rates,” said Norgaard.
The trio spent nearly a month training the staff in neonatal
care and providing ongoing clinical support for the opening of
the units. Beth Case, a retired Children’s respiratory care practitioner
and clinical educator, was highly utilized for her respiratory
expertise. They encouraged them to focus more on patient care,
hand hygiene and infection control – staples of patient safety at
Children’s.
“It was really a wonderful experience to learn about the type
of nursing they have there, and to make a difference by changing
their practice and helping their babies,” said Williams.
The six-bed pediatric and six-bed neonatal units have been
full since opening last summer. Williams and Norgaard realize
this is the beginning of a new era in medical care in Nepal, and
that it will need ongoing support to thrive. They plan to return
to Patan Hospital in November.
“We have made a commitment to ensure that these units
succeed and survive,” said Norgaard. “There might be smaller
babies we can save.”
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41
Wellness,
well managed.
Hospital executives could see the writing on the wall when they
began planning the 2009 budget cycle. The country had dropped
into one of the worst financial crises in recent memory, the Hospital’s
investment income had gone negative, and the State of California
was headed into a tumble that threatened several revenue
sources. In addition, Children’s was in the middle of a large technology
infrastructure improvement and several construction projects,
including the largest expansion since the Hospital moved to
its new location. At the same time, unreimbursed or underinsured
care was rising in the form of higher Medi-Cal percentages. Financially,
they knew, this was going to be a rough year.
“We didn’t assume anything was going to go our way,” said
Executive Vice President and Chief Operating Officer Todd
Suntrapak. “We put together a well thought-out, conservative operating
plan that focused on our strengths and minimized expenses.
We found new ways to be efficient while still offering the best care.”
Children’s has a 10-year financial plan that is continually
reviewed and adjusted as times demand, and by taking a planned,
conservative approach to 2009, the Hospital was able to stay on
course. The financial statements show that despite rough economic
seas, our team was able to improve operating efficiencies and cut
costs, continue with systems and facilities improvements, keep and
recruit top talent, and still have a positive year. In fact, Children’s
net gain improved in 2009, allowing us to
make crucial continuing investments in
patient care.
It was a team effort. Transparency in
the financial plan allowed every employee
and physician to understand and take
part in our initiatives. The Hospital‘s
Foundation did their part, establishing an
urgency to giving in 2009 and managing
the silent phase of The Campaign for
Children’s, a mammoth fundraising effort
that provides for operating costs, endowment
growth and our largest construction
projects. The Campaign now goes
into a higher-visibility phase in 2010, with
an even greater urgency as large projects
near completion.
The story of 2009 is all about the
successful implementation of a plan. The
plan was about one thing – funding our
current and future ability to provide the
best care possible for the children we take
under our wing.
$228,192,000
Inpatient Net Revenue
$90,274,000
Outpatient Net Revenue
Consolidated Fiscal Year 2009
Operating Revenues
$41,033,000
Patient Disproportionate
Share Revenue
$13,024,000
Other Revenue
$4,369,000
Philanthropy*
*Represents unrestricted donations. An additional $8,787,000 in restricted donations were recognized in 2009.
The successful implementation of a
plan protected us from the worst of
an international economic downturn.

Understanding the challenge.
Children’s Hospital Central California faces a unique budgetary challenge
that sets it apart from its peers. Unlike Children’s, many large hospitals
intentionally plan on having a negative operating margin. It’s true - they plan
to lose money every year, sometimes a lot of money. This is made possible by
large endowments, long-term investments of donated funds reaping millions
of dollars in interest. Any operating losses the hospital incurs can be wiped
away by tapping into an endowment’s interest. Any large capital expenditures
can be paid from endowment earnings.
At Children’s, there is no century-old endowment to fall back on. The
Hospital has to plan for a positive operating margin every year. If we need to
purchase new equipment, or build a new wing, or do anything that requires
Consolidated Fiscal Year 2009
Operating Expenses
$225,817,000
Labor & Benefits
$22,223,000
Depreciation and Interest
$25,197,000
Other Expenses
$39,690,000
Supplies
$42,839,000
Professional Fees &
Purchased Services
a large cash expenditure, we need to have an established revenue stream in place before we start. Whether that
is true operating revenue, savings, bond borrowing, investment income, or fundraising, we have to know that we
can afford both the improvements and the ongoing associated operating costs. Our services, meanwhile, have
to remain affordable and attractive to all payors. In short, Children’s has to plan much like a for-profit company
instead of the not-for-profit that it actually is. For a business our size, a 3% to 5% operating margin is an appropriate
target. In 2008 our margin was 3.0%, and in 2009 it reached 5.6%.
In many ways, running a hospital with no endowment looks a lot like running a middle-class household. You
have to have more money coming in than going out, and you have to be able to save for a rainy day and borrow
when you need to. You manage your debt to keep a good credit rating, and sooner or later things need to be fixed
(or in a hospital, you have to account for depreciation), improvements need to be made, and if you can’t bring
more money in, you have to cut expenses.
Value analysis.
Because every decision may affect a child’s life, Children’s Hospital has to be very careful when
cutting expenses. We’ve all heard horror stories of large corporations committing heinous acts of
bureaucracy and eliminating things that were absolutely necessary to care. To avoid this, Children’s
created the Value Analysis Team, or VAT, in 2006. The team was composed not just of purchasing
professionals, but doctors and clinicians who could help weigh decisions with patient care in mind.
Instead of looking for the best price on supplies and equipment, the team looked for the best value.
For example, if several surgeons at Children’s performed the same type of surgery but used
different equipment, implants or supplies, the VAT called the surgeons together to discuss standardization.
Often, a great deal of savings could be achieved if all the surgeons simply used the
same materials, even if those materials were still the best available. By standardizing purchases
and eliminating additional supply paths, the team could get the best value for the patient and the
Hospital, all at the same time.
The Value Analysis Team has chalked up several victories by simply reviewing the way we
spend money and trying to make improvements. Even simple changes had significant impact.
Changing the Hospital’s office supply vendor saved $54,000, moving to remanufactured toner
cartridges in our printers saved $61,000, and adjustments to oxygen purchases saved over $95,000.
A single departmental medical implant change saved more than $280,000. Since 2006 the program
has saved over $3.89 million, with a savings in fiscal year 2009 of nearly $1.1 million. These savings
help us put money back where it belongs - providing quality patient care.
In addition, Children’s Patient Throughput Department continued to improve access to care
as well as offer significant savings to the Hospital. By improving the way patients are processed
(Continued on page 43)
42
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Capital
investments are
made with one
purpose, to
provide the
best medical
care to children.
43
(Continued from page 42)
through the Hospital we saw an 82% decrease in the number of patients
who were referred to other hospitals because of a lack of available bed space.
This number dropped from 411 in 2006 to only 72 in 2009. That means more
kids are getting great treatment, and Children’s is capturing the additional
corresponding revenue.
There are also a certain number of patients, referred from community
physicians, who do not show up for their appointments in our outpatient
practices. Focusing on both physician and family communication methods,
as well as our own scheduling practices, we reduced our outpatient practice
no-show rate by just over 7% in 2009. Our reschedule rate for outpatient
appointments dropped by 4%, representing over 4,000 appointments.
Consistently
well-managed
performance has
helped Children’s do
things like maintain
an excellent bond
credit rating.
Operating Gain Trend
0
2009
2008
2007
2006
$5m $10m $15m $20m $25m
$21m
$10.5m
$10.5m
$23.5m
2005 $10.4m
Operating gain excludes: Loss on extinguishment of debt,
change in swap liability, and investment income/loss.
Capital Investments
& Depreciation
$10.8m
$6.8m
2005
Capital Investments
$15.2m
Depreciation
2006
$9.9m
2007
$16.7m
$10.9m
2008
$28.7m
$12.3m
2009
$29.6m
$13.6m
The big investments.
Children’s Hospital
requires constant
re-investment to
maintain quality
patient care. The bulk
of these investments
come in the form
of construction and
equipment.
Children’s Hospital continued to invest in improved patient care in 2009.
Capital expenditures totaled about $29.6 million. The bulk of this investment
centered on our facility expansion, the Paramount Farms Plaza. Construction
includes large additions to our Emergency Department, surgical suites,
radiology and Pediatric Intensive Care Unit. Increasing volumes of patients
in these areas have required growth. For instance, our Emergency Department
saw a 43 percent increase in patient volume between 2006 and 2009.
Our Cardiac Catheterization Laboratory opened in 2010 with a cost
of $3.9 million. This upgrade keeps us on the technological forefront and
ensures we can handle a high complexity and volume of patients. Most
important, kids with complicated heart problems get advanced care.
Children’s also increased administrative space in 2009, completing a
24,000 sq. ft., four-floor expansion to our Professional Center. This eliminated
our need to rent space offsite for some of our administrative departments,
and 70 employees returned to the Hospital campus. With this move we save
$180,000 in rent every year, and by leaving the fourth floor open we ensure
room to expand.

The Hospital also identified a need to invest in significant new equipment
in 2009. Children’s Medical Imaging Department had seen a sharp rise
in MRI appointments, and while an additional MRI will come online when
the Paramount Farms Plaza opens in 2011, appointments were now being
scheduled as late as ten o’clock in the evening to satisfy need. In the fiscal
year 2010 operating plan we have funded a portable MRI trailer to handle
the overflow, increase access and provide our patient families with the care
they need. Children’s will have three MRIs in service when the Paramount
Farms Plaza is completed.
As you read in the “Technology in Transition” section of this book,
the Hospital has invested in an extremely large upgrade of many of our
information systems. An upgraded system that manages data like patient
records carried a cost of $3.4 million, and a new enterprise resource planning
system was $4.2 million. And something as simple as installing a voiceover-internet-protocol
phone system to replace our analog devices cost $1.6
million, but will reap significant long-term savings. This system is sustainable
and provides flexibility to meet 21st-century communication demands.
All of these capital investments are made with one purpose – to offer
the best medical care to the Valley’s children. The healthcare industry moves
very quickly, and the need for good planning shows itself very plainly when
you speak of these kinds of investments. Children’s has to identify need years
in advance, plan appropriately, and be fiscally able to execute change when
the time comes. A positive revenue gain in 2009 is vital for these types of
investments to happen in the future.
The human resource.
As shown in the “Powered by People” section of this book, there would be no
Children’s Hospital without the employees and physicians who work here.
This place is built on talent, and an expert labor force requires a considerable
investment. This includes all forms of compensation, from wages and
benefits to education and advancement. In 2009, Children’s cost for labor
and benefits was almost $226 million, 63.5% of our total expenditures.
Children’s also invests heavily in recruiting physicians, nurses and health
professionals to the region. These investments more than pay for themselves
in the end by increasing access to care and improving the number
and quality of services we offer our patients. Children’s currently has one
of the lowest nurse vacancy rates in the country at 1.58%, and we hired an
additional 15 pediatric subspecialty physicians in 2009.
Getting help to close the gaps.
Philanthropy plays an important role in helping us reach our goals, and
we can never say enough about the generous souls who give of themselves
to help children. Throughout 2009 the Children’s Hospital Foundation
conducted the “quiet phase” of The Campaign for Children’s, working with
large donors to set the cornerstone for a campaign that will raise $42 million
for our kids by the time it finishes in 2011. As of September 30, 2009, The
Campaign had reached 59% of its fundraising goal. This included gifts from
corporations, individuals, families and The Guilds of Children’s Hospital.
At the launch of the public phase of The Campaign, Children’s has already
recognized $24.7 million.
Community support has been steadily increasing for the past three
years, and while we don’t have an endowment in the hundreds-of-millions
like some peer hospitals, we have seen our own endowed funds increase
from $1.6 million in 2006 to $11.7 million in 2009. With time, this growth will
eventually provide the same safety net for our Hospital that large urban and
academic centers enjoy. Giving increases have been seen across the board
as well, with overall contributions to the Hospital more than doubling in
the last three years. The urgency remains, however, and philanthropy will
always be one of the key elements that holds the plan together.
The results and the team.
Put simply, we did it. Children’s cut costs, increased efficiency, invested in
the future, and produced a revenue stream that allowed for vital growth
and security. It took a strong and transparent plan, and relied heavily on
community support. In addition to finishing the year in a positive position,
Children’s Hospital’s bond ratings with two independent agencies actually
improved during one of the largest financial crises in recent history.
The Hospital obviously has a talented group of financial experts, led
by Chief Financial Officer Michele Waldron. She will be the first to tell you,
however, that the team making this all happen consists of more than 3,000
people – every employee and doctor at Children’s Hospital Central California,
diligently following a plan.
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45
Helping kids is
always the right thing to do.
This annual report has covered many topics, showcasing the
incredible care Children’s provides for our region’s kids. You’ve
also seen how we manage our resources to improve patient safety,
update technology, and recruit top healthcare practitioners. We,
however, are not an entity set apart. The staff at Children’s represents
you, as we are the stewards of an institution built by all the
people of this great Valley.
Children’s Hospital is owned by everyone, and you see that
pride of ownership in our caring philanthropic community. These
are people who give selflessly to help children – their own, and
those they never meet. They understand how essential and rare
this pediatric facility is, and that the health of our community is
truly measured in the health and well being of our children.
The Campaign for Children’s.
The most important thing we can tell you about The Campaign for Children’s
is that it is happening right now. The comprehensive $42 million fundraising
initiative will help provide needed equipment, services and facilities,
allowing the Hospital to apply resources where the need is greatest. Our
2009 launch was supported by some of our oldest and most reliable friends,
shooting us well on our way to success. There is, as you might expect, a long
way to go.
How will we reach our $42 million goal? A combination of support from
the community, a well thought out and defined plan, committed leaders who
can rally support, and the solid launch we got from early givers.
With the early phase of The Campaign for Children’s wrapping up, The Children’s Hospital Foundation is
reaching out to the entire Valley for the help we need to finish strong and reach our $42 million goal.
The people of the Valley created
Children’s Hospital 57 years ago, and
they still provide for it today.
Early supporters of The Campaign for Children’s were
on hand for the topping-off ceremony at Children’s
Paramount Farms Plaza. This expansion is the most
immediately visible result of The Campaign.

Part of the family.
In 2009, the Berberian family helped us launch The Campaign for Children’s
with a $250,000 gift. They are dear to our hearts for many reasons, including
the fact that one of their children grew up to become a part of Children’s
own family.
“Our whole family came here growing up, our experience here was
always good,” said Erin Berberian-Gleason, who has been an employee at
the Hospital since 1996, starting out as an intern, then becoming a nurse
and now a nurse practitioner. “After I did my rotation at the old hospital, I
knew I wanted to be a pediatric nurse here.”
Major citrus growers in the area, the Berberian family are long time
supporters of the region’s only pediatric medical facility. And as a nurse
practitioner in the Hospital’s Neurosurgery and Trauma Departments, Erin
provides inpatient rounds, consults, and sees patients in the Neurosurgery
Clinic. Erin shared stories about her experiences at Children’s with her
family.
“I talked a lot about the trauma patients, their attitude astounded me,”
said Erin. “I was completely amazed at the kids who would come in, and at
the end of their stay, they could walk out of here with a smile on their face.”
Feeling such conviction for the work she does, Erin wanted to do more
for the Hospital. In 2008, she became part of the Hospital’s Foundation board
of directors and also joined her mother-in-law as a member of La Feliz Guild.
“I only saw things from the clinical side, I had no idea how much it takes
from the financial side,” said Erin of her experience as a foundation board
Member. “The amount of resources it takes to run this hospital is mind
boggling.”
I think it’s
so important,
and hope it
will spur
others to
give.
Erin Berberian-Gleason, CPNP, shared stories with her
family about the kids she helped every day. They, in turn,
decided to do some sharing of their own.
It costs a little under a million dollars a day to
operate Children’s, with annual expenses over $350
million. There are also other reasons that Erin gives.
When Erin’s brother passed away from head
trauma, the family created a memorial fund in the
Hospital’s Trauma Department as a way to honor
their son. Compelled by Erin’s stories of inspirational
healing at Children’s, the Berberians decided to do
even more. They became early givers to The Campaign
for Children’s. In honor of their generosity, the Hospital
will name two of its new trauma rooms in memory of
their son, John Mihran Berberian, MD.
“He was a student doctor and he really loved
children,” said Erin. “We thought it’s what he would
have wanted. It’s what his work would have been.”
The Berberian family also feels it is important that
children can get the best pediatric care close to home.
“The closest children’s hospital besides our pediatric
facility is in the Bay Area or Los Angeles,” said
Erin. “Most families don’t have the resources to get
to those places. Even if they do have the resources, it
still places a heavy burden on them. We need to have a
place like Children’s. We can’t forget about the middle
of California and people with needs.”
“I think it’s so important, and hope it will spur
others to give,” said Erin. “We feel it’s important to
keep this hospital viable. Children’s serves such a large
geographical area, taking care of children that have
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47
There is no such
thing as a child
we shouldn’t
care for.
Campaign
Co-Chairs Bill and
Linda Smittcamp
were also early
contributors.
(Continued from page 46)
nothing, to children that have everything. They are treated all the same with
the best care.”
“The generosity of this wonderful family is vital in helping us fulfill our
mission. Their reason for giving serves as an inspiration for others,” said
Children’s Vice President of Philanthropy Jim Meinert. “Just like Children’s,
they have roots in the Central Valley. We cared for their children growing
up and they want to make sure that same care is around for generations of
children to come.”
A well defined plan.
The Campaign for Children’s is the blueprint of how we’ll provide for the
daily needs of our patients, a large facility expansion and three separate
endowments.
Every year, the Hospital’s Foundation raises millions of dollars that can
be applied where the need is greatest. The Campaign calls this segment of
giving The Children’s Fund, and it is used to address immediate program
needs, provide for capital expenses and do everything necessary to maintain
the highest levels of pediatric care.
The second component of The Campaign, and the most visible, is the
Paramount Farms Plaza, the 60,000 square-foot, expansion of Children’s
Emergency Department (ED), Pediatric Intensive Care Unit (PICU), Surgical
Suites and Imaging Center. The largest grower and processor of almonds
and pistachios in the world, Paramount Farms donated $4 million to The
Campaign for Children’s. Children’s named the expansion in their honor.
Since 2007, the company donated an additional $417,000, of which $385,000
came from their employee-giving campaign.
The last component is the funding of three separate endowments. As
seen in the “Wellness, Well Managed” section of this book, some institutions
have endowments in the hundreds of millions of dollars, grown with seed
money planted long ago. The interest is used without affecting the initial
sum. We don’t have that at Children’s, but we are doing something about it.
The Endowment for Excellence will support the whole of Hospital operations
including direct patient care, physician recruitment, The Craycroft
Cancer Center, The Pediatric Diabetes Care Center, Child Life, and many
more aspects of what we do. You could consider it the endowment version
of The Children’s Fund.
Philanthropist Jane Seddon Willson, President of Sunnyland Farms in
Georgia, donated $1 million to seed an endowment for The Willson Heart
Center. The plan to grow The Willson Heart Center Endowment is part of
The Campaign for Children’s. Mrs. Willson’s gift honors her daughter Jane
H. Willson, vice president of corporate development at Children’s, and her
son-in-law, Dr. Malcolm J. MacDonald, a pediatric cardiac surgeon at the
Heart Center.
The Guilds Child Abuse Prevention and Treatment Endowment is the
third part of The Campaign for Children’s endowment plan. Up to 5 percent
of the inpatient population at Children’s come through our doors because
of suspected abuse or neglect, the majority under age 5. About one-third of
our trauma cases under age 1 are non-accidental injuries.
This Guilds’ endowment will provide long-term support for the Child
Abuse Prevention and Treatment Program, including a medical clinic, SCAN
(Suspected Child Abuse and Neglect) Team and community outreach and
education.
The Guilds are Children’s all-time largest financial contributor, having
raised more than $22 million in 61 years. The 1,200 devoted women and men
have pledged a record $5 million for the endowment.
Committed leadership.
The Campaign for Children’s is led by devoted community members, with
Bill and Linda Smittcamp co-chairing. The Smittcamp’s commitment of time
was given an exclamation point with a $500,000 early gift to The Campaign.
“There is no such thing as a child we shouldn’t care for, whether they are
ours, our neighbor’s or from across the Valley,” said Bill, President of Wawona
Frozen Foods. “The opportunity to invest in one of the community’s greatest
resources is truly rewarding.”
Over the past 30 years, Wawona Frozen Foods has donated about $1.1
million to the Hospital. Bill also became one of the first lifetime cornerstone
members – a $25,000 membership – in the Hospital’s Corporate Council, a
group of area business leaders with a goal of raising $100,000 in membership
fees as part of The Campaign. Linda is a long-time La Feliz Guild member
who has raised funds for Children’s for many years.

A solid
foundation.
In addition to Paramount Farms, The
Berberians, Mrs. Willson, The Guilds of
Children’s Hospital, and the Smittcamps,
several others became early Campaign
supporters. Ruiz Foods, Margaret
Bennett, The Radin Foundation, Matty
Matoian and Family and Bank of America
all jumped on board to launch The
Campaign with major gifts.
Why the need?
Children’s Hospital has experienced
significant growth in virtually every
service area since it relocated to its new
campus in 1998, growing from 230 to
338 beds today. There are between 200
and 300 children in our inpatient units
every day and 200,000 outpatient visits
annually. Currently, there are nearly 1.2
million kids (age 0 to 17) in our service
area and over the next five years population
growth in our area is expected
to increase by nearly twice the national
average.
“Sick kids don’t take a day off,” said
Peggy Dunlap, Campaign Coordinator
for The Campaign for Children’s. “And
neither do we.”
For more information on The
Campaign and ways to give, go to
ChildrensCentralCal.org/HelpTheChildren.
More about helping kids . . .
Whole-hearted support.
Alexandria Cordova’s family’s
world was turned upside
down after her birth in 2005
when she was diagnosed with
Down syndrome and two lifethreatening
congenital heart
conditions. Alexandria’s
pediatrician detected a heart
murmur and referred her to
The Willson Heart Center at
Children’s Hospital. An echocardiogram
revealed major
abnormalities.
“There were a lot of
emotions,” said her father,
Roy Cordova. “We didn’t
know what was going on.”
“She had a combination
of a severe case of the
narrowing of the aorta,
decreasing the blood flow to
her lower body, and a very
large hole in her heart,” said
Dr. Edwin Petrossian, Children’s
medical director of
Cardiothoracic Surgery. “The
combination of both of these
conditions caused her heart
to become enlarged and
weakened.”
“She was hours, maybe
days away from a life-threatening
decomposition,” said Dr.
Petrossian, who has extensive
expertise in complex pediatric
and congenital cardiovascular
surgical repairs. “If she had
not been referred here and
seen early enough, she would
have passed out, become pale
and unresponsive, and gone
into cardiac arrest.”
Alexandria was admitted
to the Hospital’s Pediatric
Intensive Care Unit (PICU)
where intensivist Dr. Adam
Birek put her on medication,
allowing her heart to get
stronger in preparation for
surgery.
Dr. Petrossian removed
the narrow portion of Alexandria’s
aorta and connected
the wide portions above and
below the narrow portion,
allowing normal blood flow to
her lower body. He also used a
piece of the sack surrounding
Alexandria’s heart to patch
the hole. She was only two
weeks old.
Children’s helped turn
the family’s world right side
up again. Touched by the care
they received, the Cordovas
donated $10,000 in 2006
and another $10,000 to The
Campaign for Children’s in
2009.
“We can’t thank this
Hospital enough,” said her
mother, Michele. “We are
grateful to Children’s for
saving our daughter’s life and
want to support the Hospital’s
growth.”
Now 5, Alexandria is
doing well and has no symptoms.
She sees Dr. James
Prochazka at The Willson
Heart Center once a year
and will need to be monitored
by a cardiologist for the rest
of her life.
“There are a lot of non-profits out there,
but Children’s is right around the corner.
You can see what your gift does,” said Roy.
“There’s not enough we can do to give back
to the Hospital, telling people about our
experience goes a long way.”
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49
Good deeds getting recognized.
PLANNED GIFTS
Burks Charitable Trust
E. Pusey Cain & Dorothy M. Cain Memorial Trust
Mrs. Rinko Yoshioka
WILLS/ESTATES
Katie Ann Buzbee Trust
Charles Coelho Sr. Trust
Susan B. Furze Trust
Debra E. Hendricks Family Trust
Evelyn Tashjian Trust
Estate of Lynn Van Skike
Albert C. Yost Trust
$1,000,000 & Above
Paramount Agricultural Companies, Inc.
Donors listed in this Annual Report are honored for their cash contributions given in 2009.
This includes payments on pledges made prior to 2009. We offer each of you our deepest
gratitude for your continued contributions to Children’s Hospital Central California.
$100,000 - $999,999
ABC 30
Bank of America Foundation
Berberian Bros., Inc.
Children’s Miracle Network Sponsors
CO-OP Financial Services
Costco Wholesale Corp.
Credit Union For Kids
IHOP
Kiwanis International
Marriott
McLane Pacific
Microsoft
Miss America Organization
Newman’s Own, Inc.
Panda Express
Phi Mu Sorority
RE /MAX
Rite Aid
Round Table Pizza
Sam’s Club
Sigma Alpha Epsilon
Sigma Chi Fraternity
Valero
Walmart Stores, Inc.
$100,000 - $999,999 (Continued)
The Fresno Bee
Health Net
Mr. Don B. Huntley
David & Jeanette Olson - OCAT, Inc.
Radin Foundation
Taco Bell Restaurants
The Guilds of
Children’s Hospital Central California
Alegria Guild
Del Corazon Guild
Holiday Guild
Kings Guild
La Comida Guild
La Feliz Guild
La Sierra Guild
La Tienda Guild
La Visionaria Guild
Las Madrinas Guild
Los Niños Hispanic Guild
Los Rancheros Guild
Sequoia Guild
Tenaya Guild
Color the Skies.
More than 10,000 spectators supported Children’s Hospital
at the Color the Skies Hot Air Balloon Festival organized by
Children’s Champions Greg and Jessica Coleman.
Out of This World Sponsors
Gallo Family Vineyards
Taco Bell/ OCAT, Inc.
Oak Valley Community Bank
KAT Country
Van Unen Miersma Propane
Marcia Herrmann Design
Bank of Stockton
Save Mart Supermarkets
Mid Valley Promotions
Greg and Jessica Coleman
Above the Clouds Sponsors
Ag Industrial Manufacturing
Holiday Inn Express & Suites
Soroptimist International of Ripon
McManis Family Vineyards
Pepsi
Brocchini Farms, Inc.
Artemis

Roll Giving
Antonio Acevado
Mario E. Acevedo
Olga Acevedo
Enrique Acosta
Hector Acosta
Reyna Acosta
Chad Actis
Eliseo Aguilar
Margarita Aguilar
Tomas Aguilera
Jose Aguirre
Alicia Aispuro
Celso Alanis
Isaias Alfaro
Salud Alfaro
Eliseo Alonso
Roll Giving is an Employee Grant
Program at Roll Industries and
Paramount Farms, created as a way
to give back to the communities
where their employees live.
Employees are given the opportunity
to enroll and choose a charity of
choice. Roll Giving then makes a
donation in their honor. Children’s
Hospital Central California is grateful,
and the choices of these individuals
added up to a total gift of more
than $100,000 in 2009.
Roll Giving (Continued)
Amadeo Alvarado
Consuelo Alvarado
Francisco Alvarado
Francisco Alvarado-Murillo
Juan Alvarado
Liduvina Alvarado
Luis Alvarado
Maria Alvarado
Carmen Alvarez
Maria Alvarez
Trinidad Amador
Terry Andersen
Juan M. Andrade
Manuela Andrade
Roberto Andrade
Ricky Alexander Aparicio
Martha Araiza
Blanca Arce
Ofelia Arechiga
Adela Arellano
Maria Arellano
Guadalupe Arevalo
Juliana Arevalo
Maria L. Arias
Silveria Armenta
Maria Arreola
Patricia Arreola
Ana C.Arroyo
Tim Atkin
Juan Avila
Maria E. Avila
Ana Ayala
Jose Ayala
Leoguardo Ayala
Maria Ayala
Pedro Ayala
Perfecto Ayala
Roberto Baltazar
Roll Giving (Continued)
Maria Banales
Maria L. Barajas
Roberto Barajas Moran
Artemio Bares
Maria Barraza
Mayra Barriga
Ana Batres
Imelda Becerra
Silvia C. Benavides
Brandon Bennett
Bruno Bermudes
Maria Bernal
Jeffrey Bertolucci
Beverly Bervel
David Betancourt
James Bettiga
Joseph Biangione, Jr.
Graciela Borboa
Angela Borrayo
Maria Bracamontes de Vargas
Rafael Bravo
Clifford Burnett
Martin Bustamante-Renteria
Jose Cabral-Huizar
Francisco Cabrera
Maria Cabrera
Martha Cabrera
Santos Cabrera
Bertha Calderon
Carlos Calvillo
Carlos Camarena
Maria Campos
Maria Cantu
Clara Carabes
Manuela Cardenas
Ofelia Cardenas
Michael J. Carlisle
Ana M. Carlos
Roll Giving (Continued)
Doug Carman
Maria M. Carmona
Ramon Caro
Josefina Carrasco
Maria A. Carrillo
Amadeo Casarez
Lionel H. Castaneda
Silvia Castaneda
Ysais Castaneda
Primo Castanon
Jose Castillo
Juan Castillo
Luis Castillo
Maria A. Castillo
Alejandro Castro
Enriqueta Castro
Gustavo Castro
Alicia Cazares
Juana Cazares
Victor H. Cazares
Jose Tomas Ceballos
Maria Jimenez Ceja
Roberto Ceja
Maria Celis
Virginia Celis
Yesica Celis
Joel Cerna
Delfino Cervantes
Jose Cervantes-Esquivel
Virginia Cervantes
Juan Cervasio
Luis Chairez
Amalia Chavez
Carlos Chavez
Jose J. Chavez
Luis Chavez
Marcos Chavez
Amanda Cisneros
Roll Giving (Continued)
Torivio Cisneros
Leonel Claustro
Willie Clopton
David Coad
Alma Contreras
Fortino Contreras
Guillermina Contreras
Jesus Contreras
Luz Contreras
Rosa Contreras
Jose Coria
Boyd Corkins
Javier Coronel
Alfonso Cortez Martinez
Diego Cortez
Ignacia Cortez
Isidro Cortez
Israel Cortez
Juan Cortez
Darrell Cross
Jason Crosswell
Ronald Crosswell
Anne Crutchfield
Catalina Cruz
Elias Cruz
Elvira Cruz
Eladia De Galvan
Salomon De La Cueva
Dora De Leon
Laura De Leon
Leticia De Leon
Mari de Rubio
Julia M. De Tafolla
Emmett Deitz
Maria Del Carmen Soto
J. Nieves Delgado-Tovar
Tersem S. Dhillon
Fely Diana
Roll Giving (Continued)
Maria Diaz
Abel Dominguez
Samuel Dominguez
Sergio Dominguez
Martin Duenas
Gary Dunn
Candelario Edeza
Gary Elzey
Randy Embers
Laura Enriquez
Maria Enriquez
Ricardo Enriquez
Maria Equihua
Maria Escobar
Kevin Eskew
Juan M. Espinosa
Manuel Espinoza
Refugio Espinoza
Alejandro Espitia
Guadalupe Estrada
Ignacio Estrada
Daniel Evangelista
Frank Factor
Jesus Fernandez
Agustin Figueroa
Elvia Flores
Jesus Flores
Jose Flores
Juan Flores
Juana Flores
Socorro Flores
Theodore Folmar
Richard R Fontaine
Maria Franco
Michael Freeman
Maria A. Fuentes
Jesus F. Fuentez
Jose Galindo
Roll Giving (Continued)
Leobardo Gallardo
Sanjuana Gallardo
Gregoria Gallegos
Sabina Gallegos
Jacinto Galvan
Juan Gandra
Jose Garanados
Antonio Garcia
Francisco Garcia
Gabriel Garcia
Juan Garcia
Juan S. Garcia
Juana C. Garcia
Julia Garcia
Lourdes Garcia
Lucas Garcia
Maria Garcia
Maria Garcia de Nunez
Marta Garcia
Valente Garcia
Azucena Gaytan
Celia Gomes
Paola Gomez
Gerardo Gonzales
Mercedes Gonzales
Adan Gonzalez
Amelia Gonzalez
Angel Gonzalez
Angel Gonzalez
Armando Gonzalez
Arnaldo Gonzalez
Catalina Gonzalez
Conrado Gonzalez
Edelia Gonzalez
Jesus Gonzalez
Jorge Gonzalez
Manuel Gonzalez
Maria Gonzalez
50
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Roll Giving (Continued)
Martin Gonzalez
Mateo Gonzalez
Ofelia Gonzalez
Teodoro Gonzalez
Guadalupe Granados Soto
Javier Guerrero
Hector Guevara
Maria Guevara
Lilia Guillen
Alicia Gutierrez
Antonio Gutierrez
Demetrio Gutierrez
Randy Guzman
Raul Guzman
Rosalva Guzman
Serafin Guzman
Andres R. Hernandez
Angelina Hernandez
Benito Hernandez
Cesar Hernandez
Dario Hernandez
Esther Hernandez
Gabriela Hernandez
Jose Luis Hernandez
Macario Hernandez
Maria Hernandez
Maria S. Hernandez
Mayela Hernandez
Miguel Hernandez
Olga Hernandez
Ruben Hernandez
Yolanda Herrara
51 Abel Herrera
Olivia Herrera
Roberto Hinojosa
Luis Huape
Carolina Huizar
Samuel Ibanez
Roll Giving (Continued)
Hugo S. Ibarra
Jesus Ibarra
Juan Ibarra
Maria Ibarra
Rosalio Ibarra
Rosendo Ibarra
Jose Ignacio Arias
Tait Imperial
Jose Jasso
Crystal Jimenez
Guadalupe Jimenez
Leonardo Jimenez
Maria Jimenez
Martin Jimenez-Castro
James Jordan
Benny Juarez
Esmeralda Juarez
Juan Juarez
David Krause
Maria C. Landeros
Camilo Lara
Victor Lara
Roberto Larios
Carmen Ledesma
Ruben Ledesma-Ledesma
Jose Ledezma
Martin Ledezma
Juana Legaspi
Hector Leon
Joaquin Leon
Maria Leon
Nancy Leon
Rosalia Leon
Felix Alday Leyva
Manuel Leyva
Juan Limon
Jose Llamas
Juan C. Llamas
Roll Giving (Continued)
Maria Llamas
Roberto Lomeli-Gonzalez
Alonso Lopez
Fernando Lopez
Francisco J. Lopez
Luz Lopez
Maria Lopez
Mariela Lopez
Refugio Lopez
Reyna Lopez
Ricardo Lopez
Rita Lopez
Maria Luna
Socorro Luna
Maria Luque
Sergio Macias
Maria Maciel
Maria Madrigal
Josefina Magana
Maria Magana
Pedro Magana
Juan Magdaleno
Elisa Maldonado
Gloria Maldonado
Jose Maldonado
Juan Maldonado
Maria Maldonado
Maria Maldonado de Serrano
Blanca Mancilla
Tomas Mandujano
David Manzo
Alfredo Maravillas
Hilario N. Marquez
Venus Marquez
Abel R. Martinez
Angelita Martinez
Benjamin Martinez
Juan Martinez
Roll Giving (Continued)
Maria Martinez
Rafael Martinez
Rosalia Martinez de Mendoza
Eddie Mascorro
Jose Mata
Emmanuel Mayorga
Jose L. Mayorga
Ryan McCaffrey
Alejandro Medina
Florencio Medina
Jennie Medina
Nicolas Medina
Luis Mejia-Garcia
Leticia Mejia
Miriam Melendez
George Mendez
Liliana Mendez
Maria Mendez
Mercedes Mendez
Nicolas Mendez
Jose Mendoza
Rosa Mendoza
Raquel Meraz
Cecilia Meza
Gerardo Meza
Pedro Mirafuentes
George Misso
James F. Molatore
Mario Molina
Abel Monroy
Juan Pacheco Monroy
Garardo Montejano
Irma Montes
Maria Montes
Alfonso Montoya
Juana Mora
Rafael Morales
Vicenta Moran
Roll Giving (Continued)
Antonio Moreno
Claudia Moreno
Epigmenio Moreno
Nicolas Moreno
Noemi Moreno
Patricia Moreno
Consuelo Morillon
Manuel Morillon
Maria Morillon
Trinidad Morillon
Adolfo Morin
Jose Mozqueda
Raudel Munoz
Mario Murillo
Martha Naranjo
Jorge Navarrete
Manuel Navarrete
Miguel A. Negrete
Veronica Negrete
Howard Nelson
Jason Nelson
Ernesto Nunez
Josefina Nunez-Mora
Daisy Obeso
Eleanor Ochoa
Javier Ochoa
Hilda Olivas
Leopoldo Ordaz
Oscar Orellana
Ranulfo Orozco
Leticia Ortiz
Lorenzo Ortiz
Lucila Ortiz
Pio Ortiz
Yolanda Ortiz
Redd Owens
Eliseo Pacheco
Jose Padilla
Roll Giving (Continued)
Nenita Pagala
Primo Pagdilao
Maribel Palacios
Rosa Palacios
Maria Palafox
Fabian Parde
Maria Patino
Guillermo Paz
Alejandro Pelayo
Alma Perez
Eva M. Perez
Fidel Perez
Gregoria Perez
Juan Perez
Maria Perez
Rafael Perez
Maria Perez de Perez
Allan Perfecto de Jesus
Tony Pham
Eliseo Pimentel
Jaime Pimentel
Jesus Pimentel
Rosa Pimentel
Rosalina Pimentel
Eva Plascencia
Jose Ponce
Maria Ponce
Aleja Preciado
Norma Pulido
Maria Quezada
Gloria Quinonez
Martha Quintanilla
Carlos Quintero
Carlos Vaca Quintero
Humberto Quintero
Jose Quintero
Francisco Radillo
Antonio Ramirez

Roll Giving (Continued)
Arturo Ramirez
Agusto Ramirez
Eugenio A. Ramirez
Eva Ramirez
Jesus Ramirez
Jose Ramirez
Jose Ramirez
Margarita Ramirez
Maricela Ramirez
Vinisa Luna Ramirez
Delia Ramos de Ledesma
Francisco Ramos
Jose Ramos
Simon Ramos
Martha Rangel
Veronica Rangel
Leonor Guadalupe Rangel Munoz
Gilbert Rascon
Margarita Renteria
Maria Renteria
Alfonso Resendez
Victor Resendez
Maria C. Retana
Alexander H. Reyes
Eduwiges Reyes
Gerardo Reyes
Maria Reyes
Ma Jesus Reyes Velez
Rosalinda Reyes
Luz Rico
Guadalupe Rios
Anau Rivas
Hilda Rivera
Maria Rivera
Martha Rivera
Raquel Rivera
Syed Rizvi
Clemencia Rodriguez
Roll Giving (Continued)
Guadalupe Rodriguez
Jesus Cortez Rodriguez
Jorge Rodriguez
Jose Rodriguez
Juana Rodriguez
Olivia Rodriguez
Salvador Rodriguez
Simon Rodriguez
Mario Rojas
Guadalupe I. Romero
Martha Romero-Diaz
Alfonso Rosas
Graciela Rosas
Eulalia Ruiz
Evaristo Ruiz
Jose Ruiz
Mario Ruiz Padilla
Maria Salamanca
Carminia Salas
Juan Salazar
Julian Salazar
Shalome Saldana
Juan Saldivar
Laura Saldivar
Maria Salgado
Johnny Salinas
Maria Salinas
Alberto Sanchez
Concepcion Sanchez
David Sanchez
Guillermo Sanchez
Juan Sanchez
Maria A. Sanchez
Miguel Sanchez
Zoila Sanchez Hernandez
Juventino Sandoval
Moises Sandoval
Gabriel Sandoval-Gomez
Roll Giving (Continued)
Jonathan Santiago
Rodrigo Saucedo
Maria Saucedo
Thomas Schwartz
Gustavo Sicairos
Veasna Sok
Antonio Solorio Lopez
Carolina Solorio
Luz Solorio
Soledad Soria
Ambrosio Soto
Francisca Soto
William Spalding
Ron Steele
John Stone
Agapito Suniga
Maria S. Tafolla
Monica Tafolla
Lolita Talosig
Amelia Taloza
Angelina Tamayo
Luis Tello
Edgar Tepezano
Ivan Toledano
Huber Torres
Juan Torres
Maria Torres
Maria Torres-Navarro
Daniel Trujillo Arias
Irma Ugalde
Norma Urbano Tamayo
Maria Vaca de Leal
Manuel Valencia
Maria Valencia
Miguel A Valencia
Bernardo Vargas
Jose Vazquez
Jose Nino Vasquez
Roll Giving (Continued)
Irma Vega
Eduvijes Velasquez
Jose L. Velazquez
Sara Venegas
Urbano Venegas-Mejia
Socorro Vento
Humberto Vera
Juan Vidal
Isabel Villa
Maria E. Villa
Jorge Villagomez
Rita Villalobos
Lidia Villanueva
Wenceslao Villanueva
Alberto Villasana
Gloria Perez Villasana
Luis Villasenor
Victor Villalvazo
Alvaro Villegas
Dora Villegas
Gabriel Villegas
Tom Ward
Nathan Young
Narciso Zamora
Juan M. Zapata, Sr.
Abel Zapien Torres
Carlos Zarate
Jose Zarate
Nicolasa Zarate
Salvador Zavala
Gricelda Zendejas
Andres Zermeno
William Ziegenbein
Rodolfo Zuniga
The Children’s Miracle Network.
Children’s Hospital Central California has been a member of Children’s Miracle
Network (CMN) since 1994, benefiting from corporate campaigns that provide
millions of dollars to help our kids. CMN is a non-profit organization dedicated
to raising funds for children’s hospitals. Each year, the 170 CMN member hospitals
help kids from throughout the country overcome diseases and injuries of
every kind. These are some of our CMN events and campaigns and the donors
who make them possible.
KISS Country for Kids Radiothon
Main Sponsors: Tachi Palace Hotel
& Casino, Fresno Lexus
2009 results: $163,144
Change Bandits
Main Sponsors: Tachi Palace
Hotel & Casino, Comcast, Cricket
Communications, Riverpark
Shopping Center
2009 Results: $100,980
Costco Wholesale
2009 Results: $285,000 +
The Visalia Costco was third in the
country, raising $72,171.
Walmart
2009 Results: $96,000 +
Valero
2009 Results: $57,668 +
Rite Aid
2009 Results: $61,825 +
Credit Unions for Kids
2009 Results: $21,000 +
RE/MAX
2009 Results: $4,000 +
McLane Pacific
2009 Results: $85,242
McLane Pacific had a 100 percent increase
in fundraising in 2009.
Additional Children’s Miracle Network partners
include IHOP, Marriott International, Dairy Queen
and Phi Mu just to name a few. Collectively, these
partners raised more than $60,000 in 2009 thanks to
the hard work of their employees and the generosity
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53
Kids Day
$50,000 - $99,999
Mr. & Mrs. Scott Amey
Chukchansi Gold Resort & Casino
CVS Pharmacy
Mr. & Mrs. Richard V. Gunner
Happy Hearts
Kohl’s
KSKS - Peak Broadcasting
Rotary Club of Fresno
Ruiz Food Products, Inc.
Bill & Linda Smittcamp - Wawona Frozen Foods
Wells Fargo Bank
$25,000 - $49,999
California Dairies, Inc.
Derrel’s Mini Storage, Inc.
John & Christine Ferdinandi
- Milano Restaurants International, Inc.
Fresno/Madera Combined Federal Campaign
Mr. & Mrs. Jeffrey S. Mayer
North Fresno Rotary Club
Riverbend Dairy
Table Mountain Rancheria
Trinity Fruit Sales Co. - David & Lisa White
Our 22nd annual KIDS DAY raised $425,000 to benefit the kids at
Children’s. Our sponsors included: City Press, DiBuduo & DeFendis
Insurance, Educational Employees Credit Union, Fogg, Maxwell, Lanier &
Remington EyeCare, Fresno Trade Bindery and Mailing, Granville Homes,
Pacific Service Credit Union, Table Mountain Casino & Rancheria, The
Brownie Baker, Val-Pak, Walgreens, Pelco,Wells Fargo and of course . . .
$10,000 - $24,999
Actagro, LLC
Mr. & Mrs. Bruce G. Allbright III
Mr. & Mrs. James S. Anderson
Mr. Travis O. Baker
Ms. Loren Booth - The Otis Booth Foundation
Buchanan High School - Ambiance Fashion Show
Central Valley Petroleum Golf Invitational
Color the Skies
Mr. & Mrs. Stephen Dalich
Mr. & Mrs. David Dunlap
East Fresno Rotary Charity Foundation
Emergency Physicians Medical Group, Inc.
Emmett’s Excavation, Inc.
Mr. & Mrs. Manuel L. Fagundes
Mr. & Mrs. Ray T. Fisher, Jr.
Mrs. Shirley Fisher
G.L. Bruno Associates, Inc.
Nigel & Jeannine Grech
Mr. William Haug
Mr. & Mrs. Mark S. Helm
Mr. & Mrs. Mark Hurst
K-Jewel & KYNO
Kerman Rotary Club
Kiwanis Division 5
Mr. & Mrs. David Krause - DWK Farms
Ms. Michelle Lewis Heredia
Mr. & Mrs. Manuel Mancebo, Jr.
Jim Meinert
MLF Insurance Services, Inc.
Paramount Farming Company
Edwin A. Abrego Torres
Jaime Baca
Lilia Barajas
Reberiano Barboza
Isidro Bravo
Israel Bravo Casteneda
Javier Bravo
Jose Guadalupe Bravo
Tomas Brito
Isidro D. Cassillas
Jose Enrique Cazares Puga
Benjamin Celis
Heraclio Celis
Alfredo Chavez Guzman
Rodolfo Chavez
Vicente Chavez
Demetrio Diaz
Mauricio Enciso
Salome N. Estrada
Antonio Gabriel
Oscar Gallardo
Pedro Magana Garcia
David Garcia Lopez
Arcario Garza
Ruben Larios Romero
Cornelio Mendez
Ricardo Naranjo
Rodrigo Navarro
Juan Manuel Navarro Witrago
Gilberto Ocegueda Martinez
Ramon Pacheco Munos
Jose Guadalupe M. Perez
Manuel Perez Magana
Ruben Reyes
Jose Rodriguez Sotelo
Jamie Rodriguez Salazar
Victor Hugo Solorio
Marco Antonio Tapia
Paramount Farming Company (Continued)
Jesus Torres
Jose Trinidad Salgado Castillo
Ismael Vargas Vasquez
Eriverto Vargas Chavez
Salvador Vargas-Gusman
J. Juan Vasquez Valdobinos
Marcos Vega Albor
Pablo Villalobos Cruz
Erik Dean Wilkins
Bengamin Zoperanez Alcantara
Cornelio Zuniga
Pelco
Dennis & Gina Perkins
- The Brownie Baker, Inc.
PG&E Corporation
Campaign for the Community
Stepanie Arreguin
Thomas Baldwin
Kristine Campbell
Tami Castro
John Chagoya
Grady Climer
Rita Comaggia
Chris Cowin
Alec Dieter
Dennis Dyer
Jeffrey Fleming
Steven Fraley
Maria Fuentes
Carlos Garza
Katie Giles
Michael Kennedy
Barry Knapp
Michael Lincicum
Gabriella Macias
Ron Moody

PG&E Corporation
Campaign for the Community (Continued)
Graciela Nunez
William Philpott
Celia Ramirez
James Redman
Michael Redman
Gregory Seidel
Gurmitt Singh
Simon Tafoya
Berta Vargas
Helmut Weissmann
Ashley Williams
Resource Lenders
Rotary International District 5230
Mr. & Mrs. Jose M. Sandoval
Save Mart
Ms. Rhonda R. Slater
St. Baldrick’s Foundation
The Sence Foundation
TRUIST
United Way California Capital Region
United Way Special Distribution Account
Walgreens
Scott & Tami Workman
Larry & Jody Young
$5,000 - $9,999
Abbott Laboratories
Agriland Farming Co., Inc.
AmeriPride Services Inc.
AMGEN
Bank of America
Bedard Controls, Inc.
- Paul & Elizabeth Bedard
Mr. & Mrs. Lane Blue
Britz Fertilizers, Inc.
Campos Land Company
Central High West - FFA
Champions in Courage Foundation
Chowchilla-Madera County Fair
Citizens Business Bank
Mr. & Mrs. Gregory J. Coleman
Edison International
- Employee Contributions Campaign
Educational Employees Credit Union
Mrs. Kaye Fisher
Foster Farms & Foster Farms Dairy
Fresno City College
Fresno Lexus
Fresno Truck Center
Mr. & Mrs. Les Gallagher
The Bertha & John Garabedian Charitable Foundation
Mr. & Mrs. Mike Good
Granville Homes
Harris Construction
- Richard & Karen Spencer & Tim & Sandy Marsh
Mr. Michael G. Hurst
Ms. Alysha Izoco
J & D Food Service
Kenneth L. Jue, M.D.
Julio R. Gallo Foundation
Ms. Susan L. Keogh
Kerman Unified School District
Dr. & Mrs. Robert Kubo - Kubo Orthodontic Group
Mrs. Melinda Laval & Mr. Khaled Alkotob
Dr. Malcolm MacDonald & Ms. Jane Willson
Manheim Auctions Central California
Mr. & Mrs. James R. Maxwell
Merrill Lynch - The Bell, Edwards Group
Mrs. Tamsen N. Munger
Ms. Yoana Orozco
Pacific Service Credit Union
Mr. & Mrs. Dennis Parnagian - Fowler Packing, Inc.
Pediatric Anesthesia Associates Medical Group, Inc.
Pediatric Cardiology Medical Associates of Central CA., Inc.
Mr. & Mrs. Randy Pennebaker
Mr. & Mrs. William D. Phillimore
Quaker Oats
Mr. & Mrs. Thomas M. Beck
Dr. & Mrs. Lawrence J. Satkowiak
Dr. & Mrs. Newton L. Seiden
Sireno Communications, Inc.
Dr. & Mrs. J. Charles Smith
Ms. Helen Snyder
Trajan J. Soares, O.D., F.A.A.O
St. John’s Festa, Inc.
Sumner Peck Ranch, Inc.
Sunrise Medical Quickie Designs Inc.
Mr. Todd Suntrapak
Dr. & Mrs. Edward Tang
TCM Investments LP - Tom & Karen McGowan
Bernard Te Velde Sr.
Tulare Rotary Club
Mr. & Mrs. Ted Waldron
Wishon Radiological Medical Group, Inc.
Yosemite High School Golf Team
First Tee Program
Mike Firpo
Jordan Keyser
Kristen Keyser
Hunter Lassos
Tyler LeQuia
Rusty Oetinger
Mr. & Mrs. DeWayne Zinkin
$2,500 - $4,999
Mr. Luis Aguilar & Dr. Graciela Esquivel-Aguilar
Ahart Benefit Insurance Services
AIAA
Allegiance Benefit Plan Management, Inc.
Baker, Manock & Jensen
Bank of the Sierra
Lisa Benham - Pay It Forward Barrel Race
Birdstone Winery
Mr. David Bollwine
Lisa & John A. Bonadelle
- Bonadelle Neighborhoods, Inc.
Mr. & Mrs. Ken Boyd
- The Boyd Company
Ms. Marta L. Boyer
Dr. Joel Brownell & Dr. Jolie Limon
Central Valley Vietnam Veterans Club
ChildNet Medical Associates, Inc.
Clovis Rodeo Association
Comcast Cable
CU Cooperative Systems, Inc.
Mrs. Lynne E. Davis
Mr. & Mrs. BJ Diedrich
Dr. & Mrs. Joseph C. Duflot
EYE-Q Vision Care
Fairwinds Woodward Park
Fishman, Larsen, Goldring & Zeitler Law Corporation
Mr. & Mrs. Max Flaming
Fogg, Maxwell, Lanier & Remington Eye Care
Foodsco Foundation
Fresno County Federal Credit Union
Fresno Police Department Credit Union
Dr. & Mrs. John V. Gates
Godinho Holsteins
Golden 1 Credit Union
Mr. & Mrs. Michael W. Goldring
Mr. & Mrs. Greg Grannis
Mr. & Mrs. Robert Griffin
Mr. Randall Guerrero
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55
$2,500 - $4,999 (Continued)
Mr. & Mrs. Greg Gustafson
Ms. Linda Henry
Mr. Jessie Hudgins
In-N-Out Burger Foundation
James G. Parker Insurance Associates
JEM Management Corporation
Kathleen L. Behr, M.D.
Robert H. Kezirian, M.D.
Kiwanis Club of Tipton
Krafters For Cancer
Lane Blue Enterprises, Inc.
Mr. Jeffrey D. LeFors & Mrs. Monica LeFors
Dr. & Mrs. Charles L. Lutz
Madera Jet Center, Inc.
Marriott International, Inc.
Paul McDougal Marketing, Inc.
- Paul & Kathryn McDougal
Jason Mendez - Snapshot Media
Mr. Michael Moats & Mrs. Dawn Moats
Morgan Stanley
Mr. & Mrs. David Nalchajian
Oakland Raider Boosters of Tulare & Kings Counties
Mr. Timothy A. Oliver
Pardini’s, Inc.
- Mr. Jim Pardini
Mr. Bob Pugh & Mrs. Beverly Hayden-Pugh
RE/MAX
Mr. & Mrs. Alex Riddering
Mr. & Mrs. Norman S. Sakamoto
Schafer Group, Inc.
Stammer, McKnight, Barnum & Bailey, LLP
Stockbridge Development, Inc.
Mr. & Mrs. Keith C. Stouffer, Jr.
Sundale Social
Tachi Hotel & Casino
Target
The Doctor’s Management Company
The Pine Inn-Carmel by the Sea
Mrs. Mary G. Trichell
Tulare County Employees
Terry Dill
Nicholas Hahn
Robin Owen
Tiffany Pryor
Lynn Tarr
Courtney Venegas
Johan Wall
Turner Construction Company
United Way of Stanislaus County
Utility Trailer Sales of Central Calif., Inc.
Mr. & Mrs. Brandon Vance
Wal-Mart Foundation
Wells Fargo Advisors - Hobbs & Conner Group
Witbro, Inc.
Mr. & Mrs. Richard P. Wolf, Jr.
$1,000 - $2,499
A Plus Signs
Adeline Ritchie Charitable Trust
Aetna Foundation Giving Campaign
Jamie Berberian
Kristi Bogert
Perla Bustillos
Maria Felix
Laura Harris
Karen Pipkin
Kristin Weber
Agrimar Corporation
Rick & Teri Amerine
Ameriprise Financial
Anberry Rehabilitation Hospital
Mr. Glenn Arnold
Mr. & Mrs. Dale Ashcraft
AT&T United Way
Employee Giving Campaign
Jonathon Anderson
Felicia Champion
Lisa Cisneros
Yvonne Martinez
Erin Pence
Nancy Pence
Janine Ramos
Alex Valencia
Emma Williams
Jerome Wood
Belinda Zamarripa
ATHS Westside
- San Joaquin Valley Chapter
Bank of America
United Way Campaign
Della Bursiaga
Rachel White
Bank of the West
Dr. & Mrs. Vinod K. Bansal
Baskin Robbins
Dr. & Mrs. Charles W. Beam
Beecher/Ryan Harvesting, LLC
Beeler Industries, Inc.
Mr. & Mrs. Hank Bennett
Mr. & Mrs. John F. Bennett
BennettFrost Personnel Services, Inc.
Dr. & Mrs. George A. Bertolucci
Dr. & Mrs. Adam Birek
Mr. Edward E. Blake
Mr. & Mrs. Bryan Boardwell
Mrs. Pauline Bonadelle
Mr. & Mrs. John P. Border
Mr. Ernie Brandi
Broadway in Fresno
Ms. Kathy Brown
Buhler Sortex Inc.
Keith & Robin Butterfield
California Information Management
California Law Enforcement’s Wish Upon a Star
Celebracao de Nossa Senora de Fatima
Central California Implement Company
Central Valley / Sierra CFC
Central Valley Community Bank
Ms. Rosalie Chase
Chevron Humankind
- Mr. Walter Scruggs
C-III Construction, Inc.
City of Fresno
Cohen Communications
Mr. & Mrs. Christopher Conner
Mrs. Stephanie G. Copner
Mr. Allen A. Costa
Credit Union Miracle Day, Inc.
D & G Chopping
Mr. Neil J. Dau
David & Carolyn Johnson Family Fund
Davis Wright Tremaine LLP
Mr. & Mrs. Don N. DeBernardi, Jr.
Mr. & Mrs. Bobby DeFrance
Jane F. Donat, M.D.
Mr. & Ms. Dan Dooley
Dorsey & Whitney Trust Company LLC
Mr. & Mrs. Lee A. Duckering
Mr. & Mrs. Lance E. Dueker
Dr. & Mrs. Antonio Durazo
DW Harper Group
Dr. & Mrs. Michael L. Elliott
Erick Nielsen Enterprises, Inc.
Eurodrip U.S.A., Inc.
Facility Designs
- Suzanne Byrnes & Kay Garabedian
FAST Federal Credit Union
Mr. & Mrs. Tom Ferdinandi

Ms. Cecilia Ferrer-Heyne
Ms. Tillie Finn
First California Federal Credit Union
Forcum / Mackey Construction, Inc.
Ms. Alyce Fourchy
Fowler High School
Freshko Produce Services, LLC
Fresno Fab-Tech, Inc.
Fresno Supreme, Inc.
Frito-Lay, Inc.
G & J Truck Sales
Mr. & Mrs. John Gahvejian
Mr. & Mrs. Vincent P. Genco
General Mills, Inc.
Drs. Joseph & Sharon Gerardi
Ms. Joan M. Germain
Ms. Frances Graf
Grancell, Lebovitz, Stander, Reubens & Thomas
Mr. & Mrs. William E. Griffith, C.L.U.
Dr. Deborah Gumina & Dr. Ming Lee
Mr. Perry Gustafson
Betty Hagopian
The Law Offices of William C. Hahesy
Hanford Sentinel
Harry & Ethel West Foundation
Mr. & Mrs. Ron Hassett
Dr. & Mrs. William Hastrup
Mr. & Mrs. Hugh Hatten
Mr. Robert Heers
Helena Chemical Company
Mr. Cliff Henes & Mrs. Debbie Smades-Henes
Robert & Elida Herrera
Mr. Donavon Heslep
Mr. & Mrs. Larry Holcomb
Ms. Wendi Howard
Mr. & Mrs. John Hudson
Industrial Design & Const. Inc.
Jamba Juice
Janz Drycleaning
Mrs. Barbara J. Jenkins
Mr. & Mrs. James R. Jones
Dr. & Mrs. Leo J. C. Jou
Ms. LuAnn Joy
Mr. Cornell Kasbergen
Kaiser Permanente
Community Giving Campaign
James Hughbanks
Supot Siriphand
Mr. & Mrs. Edward M. Kashian
Kaufman Hall & Associates
Mr. & Mrs. Randy J. Keiser
Ms. Sandra Kelly Wright
Kiwanis Cal-Nev-Ha Foundation
KJUG-FM
Dr. & Mrs. Badrinath Kulkarni
Mr. & Mrs. Peter Kwok
Ms. Britney Lambrecht
Dr. & Mrs. Fred H. Laningham
Ray & Rosetta Lasswell
Ms. Susan Lea Sturgill
Mr. & Mrs. Fred E. Leavitt
Lee’s Concrete
Mr. & Mrs. Herbert L. Liles
Linda I. Ridenour Foundation
Mrs. Isabel Lion
Jonathan & Carol Logan
Mr. & Mrs. Christopher Long
Longs Drug Stores
Mr. & Mrs. Robert Lowrimore
Lyles Construction Group
Lyles Diversified, Inc.
Mr. & Mrs. Richard Maccagno
August Madrigal
Sukhminder K. Mann
Mr. & Mrs. Nick Marziliano
Mr. Jeffrey L. McAdoo
Dr. & Mrs. Peter D. McGann
Medtronic Neurological
Mr. Jerry Menefee
Merck Employee Giving Campaign
Mr. Marvin Meyers
Ms. Linda Miller
Monterey Chemical Company
Mr. & Mrs. Harry D. Moore
Mrs. Marie A. Motte
Mrs. Betsy E. Muller & Mr. Peter Muller
Mr. Don Munoz
Mr. George Murphy
Dr. & Mrs. Michael R. Myracle
Nalchajian Orthodontics
- Drs. Greg & Nikki Nalchajian
Mr. & Mrs. R. Eugene Nickel
Mrs. Sandi Nystrom
One Nation Under God Motorcycle
Orrick, Herrington & Sutcliffe
Warren & Lesa Paboojian
Mr. & Mrs. Cecil Pace
Pacific Printing, Inc.
Mr. Ray Palomino
PARC Environmental
Mr. & Mrs. Kirk Parrish
Pendola Truckee Venture
Pepsi Cola Bottling Company
Mr. & Mrs. Albert Petersen
PG&E
Philoptochos Society #4011
Mr. Phil Pierce
Mr. & Mrs. Llewellyn F. Pimentel
The Law Office of G. Bryan Pinion
Pistoresi Ambulance
Placer Title Company
Pleasant Valley State Prison
Mr. & Mrs. Richard A. Porter
Mr. Dick Powell
Premier Valley Bank
Price, Paige & Company Accountancy Corporation
Purl’s Sheet Metal
Quinlan, Kershaw & Fanucchi
Mrs. Joanne Quinn
Ms. Sandra W. Rachal
Randolph Associates, Inc.
RBC Wealth Management
Mr. & Mrs. Carl Refuerzo
Regency Investment Advisors Inc.
Mr. & Mrs. Robert W. Reniers, Jr.
Retirement Plan Consultants
Deborah Reyes
Mr. & Mrs. Brook Reynolds
Mr. & Mrs. Bud Richter
Nutra Systems Inc.,
- Tim & Deborah Riordan
River Park Golf Center
Lorenzo & Elena P. Romero
Rotary Club of Monterey Pacific
Saladino’s, Inc.
Sam’s Club Foundation
San Joaquin Chemicals, Inc.
Satake USA, Inc.
Mr. & Mrs. Steve Schaad
Mr. & Mrs. Michael A. Schuh
Security First Bank
Realty Concepts LTD.,
- John & Shelly Shamshoian
Mr. & Mrs. Ronald G. Shaw
Mr. & Mrs. Richard Shehadey
Singhayz Riderz
Mr. & Mrs. Blake E. Smittcamp
Bob & Mary Solis
Mr. & Mrs. Daniel Souza
Mrs. Della Wathen
- Spalding G. Wathen General Contractor
Spencer Enterprises
STAT Revenue Consulting
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57
$1,000 - $2,400 (Continued)
Mr. & Mrs. Ray Steele
Mr. & Mrs. Donald O. Steward
Stoughton Davidson Accounting Corporation
Mrs. Frances L. Sullivan
Sunnyland Bulgar Wheat, Inc.
Suterra, LLC - Oregon
Sutter Middle School
T & R Ranch
Andrew Tatarakis Sr., Michelle Jones, Lea & Mia
Teixeira & Sons
Tesei Petroleum
Mr. James Thaxter
Mr. Ron Thomas
Mr. & Mrs. Michael Thomason
Tony’s Fine Foods
Mr. Michael Torosian
Mr. & Mrs. Don Triplett
Tulare County Federal Credit Union
Ms. Wendy L. Turner
Union Bank of California
United Security Bank
United States Cold Storage, Inc.
Chris & Christine Valadez
Valley Glass, Mike & Marti Salinas
Valley Oak Credit Union
Valley Wide Beverage Company, Inc
Verdegaal Bros. Inc.
Versa Marketing, Inc.
Visalia Times-Delta
Mr. & Mrs. Ken Walls
Warnock Foods
Dr. & Mrs. Richard A. Wheatley
Wholesale Grocers, Inc.
Mr. Glenn F. Wilkins
Mrs. Jane Seddon Willson
Ms. Susan Wisniewski & Mr. John Matsuoka
Mrs. Rebecca Wuth
Mr. & Mrs. Anthony Yamamoto
$500 - $999
Ms. Dianna M. Young
Mr.& Mrs. Mark Zielazinski
Zumwalt Contruction, Inc.
Mr. Roger Acres
Ms. Lillian D. Alcantar
All-Crop Insurance Services
American Pie, LLC
American Truck Historical Society
Ms. Karen Andrew
Ms. Leigh-Anne Aschenbrenner
Mrs. Sarah Aschenbrenner
Atlas Pacific Engineering Co., Inc.
Mr. John Atmajian
Mr. & Mrs. Michael Aubry
Mrs. Ashley N. Ave
Mr. & Mrs. Jerry L. Baird
Bank of Stockton
Mr. & Mrs. Daniel Baradat
Mr. Charles Barnhart
Bar-S Foods Co.
BASF Corporation
Beef Packers, Inc.
Mr. & Mrs. Frank Belk
Mr. & Mrs. C. J. Bennett
Mr. Dave Bennett
Gurdeep S. Billan
Mr. Paul Bishop
Mrs. Betty Bogosian
The Bolton Family Foundation
Ms. Maria Brazil
Ms. Lyla Brewer Mon Pere
Bridge Store
Ms. Diane L. Brooks
Mr. Rob Brown
Mr. & Mrs. Howard Brunetti
Bryan Bone Farms
Ms. Frances A. Buchnoff
Mr. & Mrs. Larry Burrows
Mr. & Mrs. Tim Byers
Cablevey Conveyors
Mary Beth Cabrera
Mr. & Mrs. Steven Campos
Carl Nelson Insurance Agency, Inc.
Ms. Wanda Carlson
Steve & Vee Carlson
Ms. Jeri Carmicheal
Mr. & Mrs. Thomas R. Carnahan
Mr. Zachary Carstensen
Caruthers District Fair
Cedar Creek Retirement Community
Mr. David Cehrs
Chamberlain Family Trust
Chinatex Grains & Oils (USA) LLC
Chowchilla Union High School District
Christian Youth Service
CoBank - Rural America Corporate Bank
Alfred Coelho & Son
Ms. Kathy A. Colacchio
Coleman Farming
Mr. & Mrs. Victor Collins
Ms. Kimberly A. Collins
John P. Conrad, M.D.
Dr. & Mrs. William J. Contente III
County of Fresno
Mr. & Mrs. R. Mitch Covington
Ms. Deborah E. Cross
Mr. & Mrs. Timothy J. Curley
Mr. & Mrs. Loren Curtis
Ms. Violet Dakovich
Mr. & Mrs. Kevin D. Darcy
Mr. & Mrs. Daniel E. Davis
Mr. & Mrs. James V. DeMera, Jr.
Mrs. Alyce Demirjian
Mr. & Mrs. Robert L. Demont
Dewey & Sons, Inc.
Mr. & Mrs. Robert Diaz
Mr. & Mrs. Carlo DiCicco
Double D Farms
Duckworth Environmental Services, Inc.
Mr. Joseph Dylina
Ms. Debra A. Eckert
Dr. & Mrs. Michael J. Elliott
Mr. Dennis Ensminger
Ms. Lacy Faber
Mr. & Mrs. Donald W. Fahrney, Jr.
Farm Credit West, ACA
Mr. Robert J. Fena
Festa Do Senhor Santo Cristo, Merced
Teresa Fierro
Ms. Linda Firestine
Fleet Card Fuels
Mr. & Mrs. Jim Fontes
Mrs. Kristi Foster
Foster & Parker Insurance
Fraternal Order of Eagles
Fresno Fire Department Credit Union
Fresno Valves & Castings, Inc.
Fruit Growers Laboratory, Inc.
Funds for Freedom
G S Sales & Associates
Mr. Peter Gadd
Mr. & Mrs. David A. Galasso
Mr. & Mrs. John H. Gallagher
Ms. Debra Ann Garcia Jiminez
Mr. James Gates
Gateway High School
Harry & Ellie Gaykian
George’s Auto Supply
Mr. & Mrs. Danny Ghilarducci
Mr. John Giacone
GIGI’s Cucina Italiano Moderno
Mr. Dawson F. Gilbert
Gillette Citrus, Inc.
Gilmore, Wood, Vinnard & Magness
Mr. David F. Glossbrenner
Mrs. Nancy Goertzen
Mr. & Mrs. Raymond Golden
Dr. & Mrs. Matthew Gollub
Gong Ventures Inc.
Good Guide
Ms. Wanda Gordon-McIntosh
Mr. Charles Gorini
Mr. Darrel Graef & Mrs. Kellene Graef
Mr. Sean Graham
Ms. Lori A. Grassmyer
Grundfos Pumps Corporation
GWF Energy, LLC
H.J. Baker & Bro., Inc.
Dr. & Mrs. Steven K. Hansen
Mrs. Alicia D. Haro & Mr. Bill Griffith
Mr. & Mrs. Kenneth Hatfield
Gordon & Susan Hayashi
Ms. Maribel Hernandez
Mr. & Mrs. Brent Hobbs
Mr. & Mrs. Darren Holt
Mrs. Helen Howe
Mr. & Mrs. Jim Huelskamp
Ms. Mary Hunsader
Mr. & Mrs. Michael Hurst
Mr. Harlan M. Husted
Mr. Richard Ingle
Mr. Christian E. Ising
James & Co. Lighting
Louis & Jean Janzen
Jay Chapel
Curt & Christina Johnson
Dr. & Mrs. Cyril H. Johnson
Mr. Frank Johnson
Victoria Johnson
Jolie Lopez Foundation
Mr. Alan Kalman
Kane & Mengshol
Karahadian Comprehensive Dentistry

Zabelle Karahadian
- Goorabian Foundation
Data Central Collection Bureau
KHI International Inc.
Dr. George King
Kings County Board of Realtors, Inc.
Klein Management, Inc.
Douglas Kliewer & Hope Nisly
Ms. Sandra D. Knudson
Mr. Thomas R. Kulikov
Thomas H. Larson, D.D.S., Inc.
Lawrence, Nye, Andersen Associates
Mr. & Mrs. Ron Leach
Vince Leal Hoof Trimming
Law Offices of Larry M. Lee
Mr. & Mrs. Charles T. Lord
M.C. Fagundes Ranch
M2M Communications Corporation
Mrs. Julie M. Macias
Macro Plastics, Inc.
Mr. & Mrs. Joel Madrigal
Mr. & Mrs. Lee Marano
Mr. & Mrs. Bryan A. Marsoobian
Mr. & Mrs. Jaime G. Martin
Dr. & Mrs. Marty Martin
Mr. & Mrs. Rene J. Martin, Jr.
Mr. & Mrs. Henry Massaro
Massetti Bros Inc.
James M. McCarty, M.D.
McKesson Corporation
Mr. Howard McMullen
Medeiros Farms, Inc.
Meisner Enterprises Inc.
Mendes Family Farms
Ms. Claudine A. Mendoza
Mrs. Ratan B. Milevoj
Ms. Linda S. Miller
Miller Chemical & Fertilizer Corporation
Dr. & Mrs. Jorge E. Montes
Moore Stephens Wurth Frazer & Torbet, LLP
Moore, Grider & Company
Mrs. Roxie Moradian
Mr. John T. Morrison
Moss Adams, LLP
Motschiedler, Michaelides & Wishon LLP
Multnomah Group, Inc.
Mr. & Mrs. Donald Munshower
Mr. Fareed W. Nader
Naffa International, Inc.
Mr. & Mrs. Bill P. Nazaroff
Netafim Irrigation
Network for Good
Dr. Haig Nishkian
Ms. Maria Nunes
Mr. & Mrs. Stan Oken
Mr. & Mrs. Paul Oliaro
Ms. Phylicia M. Oliveira
Mr. & Mrs. Richard Olsson
Orchard Machinery Corporation
Mr. Leland Parnagian
Mr. & Mrs. Edward Parolini
Ms. Lucinda A. Parrett
Suzan M. Parsons
Mr. S. Garrett Patricio
Patterson Painting
Patton Air Conditioning
Mr. George Pelch
Mr. & Mrs. Don Penner
Ms. Bernardina V. Perez
Mr. Mike Pestorich
Pioneer Elementary
Plaza Palace Inc.
Dr. & Mrs. Berkley Powell
Professional Quality Circulation
Dr. & Mrs. David Pugatch
Ms. Melanie Pulliam
Mrs. Mary Jo Quintero
Raisin Bargaining Association
Mr. & Mrs. Ruben Ramirez
Mr. & Mrs. Michael Redman
Ms. Katherine M. Reed
Mr. & Mrs. Wayne H. Rice, Jr.
Mr. & Mrs. Gary G. Rice
Rich & Row DDS
Rodolfo Valentino Lodge No 1449
Ms. Maryellen Rodriguez
Roma Lodge No 1573
Mr. & Mrs. Paul D. Ronshausen
Mr. James G. Rosander, Jr.
The Sachem Company
Mr. & Mrs. Orion Sanders
Mr. & Mrs. Danny Sanouvong
Santa Rosa Rancheria
Jane Schofield
- Rock Pride
Scoto Brothers Farming, Inc.
Seaman Nursery, Inc.
Mr. Jerry Shannon
Mr. Owen Shaw
Ms. Betty Shelley
Mr. Joseph Shen
Mr. Ken Shintaku
Short Track Management, LLC
Monty Shultz, CPA
Mr. & Mrs. Randal Simas
Mr. Anton G. Simonich
Ms. Joann Sindt
Mrs. Harlie E. Smith
Ms. Barbara Smith
Ms. Nancy A. Smith
Mr. Elmer T. Smith
Samuel M. Smith
- Casafina Enterprises LTD
Sociedade Portuguesa Rainha Santa Isabel
Sons of Italy Hanford Lodge 1543
Sons of Italy United
Lodges of the San Joaquin Valley
Sons of Italy Western Foundation
Sons of Italy, Enrico Caruso Lodge No 1463
Specialty Crop Company
Mr. Navdep Sran
Mr. Edward Stacy & Ms. Gloria Liu
Stanley M. Barnes Revocable Trust
State Farm Foundation
State Center Credit Union
State Street Bank
Mr. & Mrs. Don M. Storer
Mr. & Mrs. Stanley A. Stumpf
Mr. & Mrs. Frank J. Suryn
Mr. Mark Sutton
Mr. Leroy Swiney
Ms. Leslie Thomas
Town & Country Market
Mr. Fred Treat
United Valley Insurance Services
Valent USA Corporation
Valley Pool Service, Inc.
Mr. & Mrs. Robert Vermeltfoort
Vieira Family Ranch & Hay
Villalobos Transportation
Mr. & Mrs. Michael N. Villines
Vintage Buick Cadillac GMC
Visalia Breakfast Lions
Vollmer, Daniel, Gaebe, Grove & Grove, LLP
Mr. & Mrs. John Voss
Ms. Nita Wagner
Ms. Sharon Wandzall
Ms. Cynthia Watson
Mrs. Elizabeth S. Watson
Mr. James Weaver
Mrs. Sharon M. Weber
Mr. & Ms. Daniel J. Weinheimer
Wells Fargo Community Support Campaign
Richard Joliff
Samantha Palomino
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$500 - $999 (Continued)
Wells Fargo Foundation
Ms. Donna L. Wesenberg
Mr. & Mrs. R.L. Wilderson
Mr. & Mrs. Jim Wilhelm
Mr. & Mrs. Todd Williams
Mr. & Mrs. Kevin Williams
David & Vickie Williamson
Mr. Paul Willingham
Winton-Ireland, Strom & Green Insurance
Mr. & Mrs. Robert C. Wolf, Sr.
Mr. & Mrs. Michael G. Woods
Mr. & Mrs. Todd F. Yingling
The Harvest Ball
Hosts Kevin and Denny Tweed welcomed 750 guests into
their garden for an Enchanted Evening at the 2009 Harvest
Ball. The event raised $390,000 that will benefit many
programs at Children’s Hospital.
Presenting Sponsor: Table Mountain Rancheria
Dinner Sponsor: Wells Fargo Bank
Harvest Sponsors: Emergency Physicians Medical
Group, Inc., G.L. Bruno Associates, Inc. & The G.L. Bruno
Family Foundation, Health Net Community Solutions, Kubo
Orthodontic Group, David & Lisa Krause - Paramount
Citrus, Jeff & Melanie Mayer, Merrill Lynch , Milano
Restaurants International, Inc./ Me-N-Ed’s Pizzeria - John
and Tom Ferdinandi, Rhonda Slater & Family, Trinity Fruit
Sales - David & Lisa White, Walgreens, Wawona Frozen
Foods - Bill & Linda Smittcamp
$250 - $499
1st Choice Foods
A F Enterprises
Mr. & Mrs. Anthony Abassian
Mr. & Mrs. Kenneth Abe
Mr. Pedro E. Acevedo
Ag Reserves, Inc.
Agri-World Cooperative
Mrs. Seema Ahuja
Ms. Pamela K. Aiello
Ms. Shirley Aikens
Akers Elementary School / Naval
Air Station
Josh & Megan Alfaro
Mr. Salud Alfaro
Alzheimer’s Living Center at Elim
The American Bottling Co.
Ms. Virginia A. Anderson
Mr. & Mrs. Jay W. Andrews
Mrs. Quin Apregan
Architectural Wood Design, Inc.
Ms. Maria L. Arias
Mr. & Mrs. Warren B. Armstrong
Mr. Geary Austin
Ms. Resa Avendanio
Mr. Pedro Ayala
Mr. & Mrs. David Babers
Ms. Mary E. Ballesteros
Ms. Maria Barajas
Mrs. Lilia Barajas
Mr. Reberiano Barboza
John Barron
Ms. Edena Bausa
Ms. Leticia Bazan-Arvizu
Menouchehr Bazyani, M.D.
Mr. David A. Beaver
Mr. Harold Beck
Richard & Barbara Beck
Mr. & Mrs. Stephen A. Becker
Benevedes, Inc.
Mr. & Mrs. Stanley C. Bennett
Ms. Debra J. Bernal
Mr. & Mrs. John A. Bezmalinovic
Mr. & Mrs. Vincent Bianco
Blanchat MFG., Inc.
BMD Enterprises, Inc.
BMN Construction, Inc.
Mr. & Mrs. Thomas L. Boggs
Ms. Alexandria L. Brager
Mr. Isidro Bravo
Tracy Bressler, C.P.A.
Ms. Wanda Brown
Mr. Randy D. Browning
Dr. & Mrs. Sylvester J. Bryan
Whitney Buford
Ben & Kimberly Buford
Mr. Jeffey Busto
Ms. Javonna L. Butler
Buttonwillow Ginning Co.
Buttonwillow Land & Cattle Co.
Ms. Nona R. Byford
Mr. Steve Cade
California Ag Solutions, Inc.
Ms. Maria Carmona
Carpet One - 47th Place
Ms. Carmen Miranda
Jill E. Carson, M.D.
Mr. & Mrs. Ronald R. Case
Ms. Elaine Cash
Ms. Enriqueta Castro
Mrs. Tracy Cates
Cedarwood Parent Teacher Club
Central California Hispanic
Chamber of Commerce
Central Valley Multiples Club
Charles L Vannortwick Weed Abatement
Mr. Charles Cheek
Ms. Melissa A. Chesser
Chicca Bros. / Twin Farms
Mr. & Mrs. Larry L. Chicoine
ChicoNut Company
Mrs. Ruth Christensen
Mr. Bob Christy
Claim Jumper Restaurants, LLC.
Mr. Christopher R. Coakley
College of The Sequoia
Combined Federal Campaign of Fresno
Mr. & Mrs. John T. Conaway
Mr. & Mrs. Christopher C. Confair
Ms. Angela J. Cook
Mr. Michael E. Coonce
Mr. & Mrs. Charles Copeland
Ms. Melba Cosby
Mrs. Nadine Costa
Mr. Craig K. Costi
Council St. Herminia
Covanta Mendota, L.P.
Crop Production Services, Inc.
D & V McCurdy Farms
Dan & Rosalinda Daly
Mr. & Mrs. Jeremy A. Damas
Mr. & Mrs. Jerry H. Davis
Mr. Alan Davison
Mr. Gregory J. Dean
Mr. & Mrs. Mark DeFendis
Ms. Ann M. Dennis
Ms. Norma J. Depoyan
Tom & Renee Oki
Mrs. Tracy A. DeYoung
Ms. Joan Di Mino
Ms. Maria L. Diaz
Mr. & Mrs. Theodore G. Dick
Dr. & Mrs. Robert J. Dimand
Ms. Patricia A. Doda
Mr. & Mrs. William Y. Doug
Ms. Tara Dragon
Ms. Kellie C. Dyer
Mrs. Sandra Eaton
Ms. Sandra F. Edmiston
El Monte Dairy
Ms. Karen I. Eldredge
Elite Heavy Equipment
Ms. Peggy R. Ellithorpe
Erik Swanson, DMD
Espericueta Farms, Inc.
Ron Fanucchi Farming Company
Mr. Joshua Farmer
Mr. & Mrs. James V. Favini
Firefighters Charitable Foundation, Inc.
Ms. Amanda M. Flaherty
Ms. Sarah M. Fletcher
Mr. Jose Flores
Ms. Carol Fortel
Ms. Janet A. Freeman
Fresno-Madera Farm Credit Union
Ms. Anissa C. Funkner
Mr. Tim Gagnon
Ms. Pamela J. Gallemore
Ms. Cynthia R. Garcia
Ms. Juana Garcia
Ms. Lori D. Garcia
Ms. Peggy Garcia
Mr. Ruben Garcia
Mr. John Gebhardt
Mr. & Mrs. Thomas J. Georgouses
Ms. Debbie Gill
Mr. & Mrs. Brian Goertzen
Gold Wing Road Riders Assoc.,
- Chapter CA2N
Mr. & Mrs. Rick L. Golding
Tania Gomez
Mr. Anthony Gonzales
Ms. Amelia Gonzalez
Ms. Maria G. Gonzalez
Goode Ol’ Days Antiques
Mr. & Mrs. Paul E. Gottlieb
Mr. Al J. Goularte

Mr. & Mrs. Michael E. Gragnani
Mr. & Mrs. Ronald C. Gray
Grissom-Wallace Communications, Inc.
Mr. & Mrs. Andrew D. Gross
Mr. Robert Guillen, Jr.
Mr. & Mrs. Alan J. Guthrie
Mr. Raul Guzman
Mr. & Mrs. Mark Hamilton
Mr. & Mrs. Clark S. Hancock
Hanford Elks Lodge #1259
Mr. Jess Hansen
Mr. Raymond Hansen
Harmony Bay
Mr. & Mrs. Gary D. Harris
Harris Farms, Inc.
Ms. Phyllis Harrison
Maya S. Hattangady, M.D.
Ms. Terri S. Heitzman
Ms. Sherry L. Henderson
Ms. Sabrina Hernandez
Alicia Herrera, M.D.
Robert & Elida Herrera
Ms. Susan M. Herrera
Mr. & Mrs. G. Barton Heuler
Mr. & Mrs. Joseph P. Hill
Mr. Roberto Hinojosa
Ms. Jennifer G. Hodge
Ms. Annmarie Hof
Mr. & Mrs. Thomas Huffmon
Hungry Bear Cookies
Mr. & Mrs. Gregory D. Hunsucker
IRS Volunteers in Action
J. Poonian Limited Partnership
Ms. Marissa Jacinto
Mr. Richard E. James
David R. Jenkins, P.C.
Mr. Douglas B. Jensen
Ms. Lydia Jiminez
Mr. Brian Johnson
Mr. & Mrs. Gerald H. Johnson
Mrs. Terry Johnson
AJ Johnston
Dr. & Mrs. Harry J. Kallas
Mr. & Mrs. Fenton R. Karnes
Mr. & Mrs. Rusty Karraker
Mr. Richard Kauffman
Mr. & Mrs. Jim Kennedy
Ms. Ita H. Khoo
Mr. John Kidd
Mr. Saynisai L. Kimky
Mr. Bill Kinder
Kings Co. Firefighter’s Charity Fund
Kings/Tulare Counties CFC
Kirk Family
Knickerbocker Electric
Ms. Jodi A. Koop
Kelly L. Kriwanek, M.D.
Ms. Kirsten M. Krueger
Mr. & Mrs. Jeffrey T. Kurushima
Mr. & Ms. Stephen L. Labiak
Mr. & Mrs. Joseph W. Laing
Ms. Christina Lake
Lake Ranch Pistachio Investors
Ms. Lerose Lane
Mr. & Mrs. Timothy J. Leary
Mr. & Mrs. Brian Lee
Lemoore District Chamber of Commerce
Leprino Food Co.
Ms. Elizabeth Lester
Lester Neufeld & Son
Ms. Patricia Lewis
Ms. Tracy Lifer
Mr. & Mrs. Paul N. Lilles
Mr. & Mrs. Paul Loo
Mr. Ron E. Lopes
Ms. Lenore Lopez-Burrola
Mr. & Mrs. Robert U. Loquaci
Los Angeles Dealer Auto Auction
Stanley Y. Louie, M.D.
Mr. & Mrs. Tuyet T. Lu
Mrs. Donna K. Luce
Mrs. Gloria Lucio
Mrs. Maria Luque
Mr. & Mrs. David Macedo
Sharon & Donald Mahaffy
Ms. & Mr. Mary K. Maloney
Mr. & Mrs. Paul Mantey
Mr. & Mrs. Martin J. Marderosian
Mr. K. Phillip Maroot
Ms. Anita Marquez
Ms. Cynthia Martindale
Mr. Rafael Martinez
Mr. Jeff Mathews
Randal & Belinda Mattos
Mr. Marshall McDowell
McKinney Farming
Medical Staffing & Services, Inc.
Mr. & Mrs. George A. Mees
Ms. Cynthia A. Melander
Brian & Janalee Melikian
Ms. Guadalupe H. Mendez
Ms. Clara Mendez
Ms. Rosalina Y. Mendoza
Diane & Vic Metz
Mile High Karate
Ms. Rita L. Miller
Mr. James Miller
Mimi’s Cafe
Ms. Veronica Misquez
Mr. & Mrs. Norman D. Moglia
Ms. Alice Moitozo
Dennis & Chris Monahan
Ms. Sandra Montalvo
Mrs. Nancy E. Montoya
Mr. Enrique Morales
Ms. Linda M. Morin
Mountain View Stables
Mr. Gregory J. Muray
Dr. & Mr. Jerome L. Murphy
Mr. & Mrs. Ernie Navarette
Mr. & Mrs. Charles A. Nesbit
Mr. & Mrs. Brandon Nisbett
Mr. George Nommsen
Ms. Elizabeth Novy
Mr. & Mrs. Arthur L. Nugent
Mr. Raymond C. Nunez
Ms. Jennifer Nuovo
Mrs. Erin K. O’Connell
Optimist Club of Porterville
Oro Verde Farms, LLC
Mr. Terry Orr
Mr. & Mrs. Gordon A. Osmus
Mr. & Mrs. Michael G. Othites
Mr. & Mrs. Ronald Paliughi
Mr. Antonio Parreira
Mrs. Terrie Passarella
Mr. Blake A. Patricio
Mr. & Mrs. David J. Pearce
Mr. & Mrs. Neal G. Pearson
Mr. Kenneth Pence
Jerry Penner
Ms. Gloria Perez Villasasna
Wesley Perine
Ms. Lorilee A. Perry
Mr. & Mrs. Ronald L. Peterson
Dr. & Mrs. Edwin Petrossian
Mr. & Mrs. Philip R. Pierre
Mr. Jesus Pimentel
Ms. Rosa Pimentel
Pleasant Mattress, Inc.
Dr. Clinton Pollack, III
Mrs. Erin Ponte
Porterville Breakfast Lions
Porterville Breakfast Rotary Club
Mr. Clain M. Pritchett
Mr. David Provost
Prudential Financial
Quality Muffler Service
Ms. Doriscelle Quinones
Mr. & Mrs. Rene Quintero
Mr. & Mrs. Donald G. Quist
R.J. Berry Jr., Inc.
Dr. & Mrs. Ned Radich
Mr. Francisco Radillo
RAH Entertainment, Inc.
Raley’s
Mrs. Hortensia M. Ramirez
Ms. Margarita Ramirez
Ms. Maricela Ramirez
Ms. Roxanne D. Rankin
BCT Consulting
Reagan Elementary Community of Caring
Ms. Julie Reed
Ms. Kathleen A. Remner
Mrs. Brenda Reynolds
Mr. & Mrs. Patrick V. Ricchiuti
Ms. Maryann Ricchiuti
Ms. Gaye Riggs
Mr. Porfirio Rios
River Ranch Central Green Co.
Roberts Engineering
Mr. Gary W. Robertson
Ms. Jennifer C. Robison
Mr. & Mrs. George M. Rocha
Mr. & Mrs. Michael A. Rodriguez
Mr. & Mrs. Richard Roduner
Ms. Bonnie L. Roe
Mr. & Mrs. Felix Romero
Ms. Angela M. Romero-Waterman
Mr. James S. Rose
Kim Royal
RTS Agri Business
David Ruiz
Ms. Eulalia Ruiz
Ms. Lisa L. Ruiz
60
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61
$250 - $499 (Continued)
S & J Ranch
Mr. & Mrs. Brian A. Sabbatini
Mr. & Mrs. Claude Saiz, Jr.
Mrs. Karen Saiz
Mr. Craig A. Saladino
Ms. Jessica M. Salazar
San Joaquin Valley College
- Visalia Student Council
Ms. Christy Sanders
Ms. Laurie Santos
Mr. Paul Satragni
Ms. Kristine L. Scaffidi
Ms. Kathleen Scharton
Mr. Gregory B. Schone
Mr. David Schreibman
Mr. & Mrs. Curtis Schuh
Mr. Elmer Schuil
Joseph Sciarrone
Mr. & Mrs. William Sebastian
Service Master
Servpro of Fresno Southeast
Ms. Susan Severns Bolt
Mr. Randy R. Shadle
Mark & Susanna Shaffer
Ms. Diane Shambley
Ms. Cecilia Shorte
Dr. & Mrs. R. Alan Shows
Sierra Chapter Model A. Ford
Ms. Susan Silveira
Mr. Charles Singdale
LaVonne Smith
Mr. & Mrs. Stuart Smith
Ms. Lupe Solis
Sons of Italy in America
- Colombo-Stella Lodge #1149
Dr. Vanna Soonthon-Brant
& Dr. Adam Brant
Ms. Martha Sorondo
Mr. Jon C. Southerland
Mr. Steven R. Spate
Mr. Richard Spurgeon
Mr. & Mrs. Doug Stebbins
Mr. Christopher S. Stefanopoulos
Steibs Pomegranate
Ms. Mariam Stepanian
Mr. Philip L. Stephenson
Mr. & Mrs. Scott Stults
Sun Marble at Fresno, Inc.
Mr. & Mrs. David I. Swain
Dr. Carole L. Swain
Swanson-Fahrney Ford
Mrs. Cheryl K. Taslim
Mr. & Mrs. Wayne E. Taylor
Ms. Carolyn Tellalian
Ms. Lisa M. Thompson
Mrs. & Mr. Susan Thornton
Mr. & Mrs. Gary G. Tooley
Mr. & Mrs. Wayne Toutges
Mr. & Mrs. Matthew S. Towers
Mr. & Mrs. Wes Merritt
Triple X Fraternity Fresno Chapter
I. Trusty
Tuhop, Inc.
U-Save Market
Ms. Maria Valencia
Valley Cow Horse Association
The Van Beek Brothers’ Dairy
Cliff & Desrie Van Putten
Mr. & Mrs. Vincent P. Veneziano
Ms. Josie Verdegaal
Ms. Mary Vernava
Mr. James Vidak
Mr. Alberto Villasana
Visalia Breakfast Rotary Club
Visalia Toyota
Ms. Doreen Vitale
Ms. Deborah W. Wall
Water Safety Council of Fresno County
Ms. Carol Watson
Ms. Kim A. Weaver
Ms. Pamela K. Webb
Wegis Ranch
Western Agricultural Resources, LLC
Mr. & Mrs. Charles L. Widlund, Jr.
Mr. & Mrs. Craig Williams
Mr. & Mrs. Ward C. Wilson
Mr. & Mrs. Randy Winter
Mr. Jason Wise
Ms. Alice E. Witt
Mr. & Mrs. Bryan Wood
Mr. & Mrs. Roger W. Wood
World Class Painting
Mr. Dennis W. Yee
Mr. & Mrs. Roy York
Yosemite Smog & Electrical
Mr. & Mrs. Melvin E. Yow, Jr.
Mr. & Mrs. Rob C. Yraceburu
David Yslava
Zanola’s Marketing Service, Inc.
Mr. & Mrs. Peter N. Zeitler
Zenz & O’Sullivan
Ms. Judith Zepeda
Mr. Larry Zucker
Mr. Cornelio Zuniga
Thank You!
Community Leadership
The Children’s Hospital
Board of Trustees
Greg Coleman, Chair
Jeff Mayer, Vice Chair
Mendy Laval, Secretary
David Krause, Treasurer
Susan Boyd, Chair, Foundation Board of Directors
Dan Dooley
Gracie Esquivel-Aguilar, MD
William Haug, President & CEO
Stephanie Houlding, Guild Coordinating Council Chair
Devonna Kaji, MD, Chief of Staff
Dennis Keller
Robert Kubo, DDS
Dave Olson
Pat Ricchiuti
J. Charles Smith, MD
Bill Smittcamp
We value our donors and wish to recognize them all appropriately. While we try to be as accurate as possible we
wish to apologize if we have overlooked any individual, company, organization, or if we have made any errors in our
reporting. If you find an error, please do us the favor of letting us know by calling the Children’s Hospital Central
California Foundation at (559) 353-7100.
Donors recognized in this Annual Report have contributed cash donations to the Children’s Hospital Foundation in
2009. Pledged dollars are recognized upon receipt of payment, and donors whose large pledges are spread out over
a few years receive acknowledgement as their gift payments are received.

The Children’s Hospital Foundation
Board of Directors
William F. Haug, President
Susan Boyd, Chair
Richard Shehadey, Vice-Chair
David Nalchajian, Secretary
Michele Waldron, Treasurer
George Murphy, Past Chairman
Members:
Dan Adams
Bruce Allbright, III
Erin Berberian-Gleason
George Bertolucci, MD
Lisa Bonadelle
Jeannine Campos-Grech
John Ferdinandi
Marty Flaming
David Galasso
Ken Hatfield
Nancy Masich, Vice Chair Guild Council
Kenneth Jue, MD
Robert Kubo, DDS
Jeff Mayer
Paul McDougal
James Meinert, PhD
Caren Myers
Dave Olson
Dennis Perkins
Carl Refuerzo
Linda I. Ridenour
Kim Ruiz-Beck
Rhonda Slater
Debbie Smades-Henes
Bill Smittcamp
Nad Visveshwara, MD
Lisa White
Kevin Williams
Jody Young
How to Give
There are many ways to help our kids, but contributing directly to the services, programs, equipment
and operations at Children’s Hospital has the most immediate impact. Here’s how you can contribute
today to the Children’s Hospital Central California Foundation:
Online Donation: Children’s website offers a secure online giving portal secured by Verisign and
powered by Blackbaud. Experience a safe, fast way to get involved.
Go to ChildrensCentralCal.org/HelpTheChildren to access the online donation portal.
Traditional Donations: Writing a check? Make it out to “Children’s Hospital Central California Foundation”
and send to:
Children’s Hospital Central California Foundation
9300 Valley Children’s Place
Madera, CA 93636-8762
We encourage you to visit ChildrensCentralCal.org/HelpTheChildren and see what level of involvement
best suits your lifestyle.
If you do not want to receive further fundraising communications from Children’s Hospital Central California, please contact Children’s Hospital Foundation,
9300 Valley Children’s Place M/S PC17, Madera, CA 93636 or by calling 559-353-7100.
How to Volunteer
Volunteers are the very heart of Children’s Hospital Central California, providing crucial support
services that are vital to the well being of its patients. Each year, more than 500 Children’s volunteers,
ranging in ages from 13 to more than 90, donate their time and energy to support our mission.
The majority of our volunteers work directly with patients, playing games, reading books, delivering
crafts, magazines and movies or assisting with arts and crafts at the bedside or in the hospital playrooms.
There are also opportunities to help out in our various clinics and offices, in the Gift Shop or
at the information desks. And the best thing about this amazing team is that you can join it, giving
your time on an ongoing or short-term basis, participating in events and programs, or by making or
purchasing gifts. We have many options available for those with open hearts and willing hands.
Just contact our office or visit ChildrensCentralCal.org/HelpTheChildren/Volunteers.
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Wellness,
revolutionized.
Children’s Hospital Central California’s 2009 Annual Report
www.childrenscentralcal.org
search for Children’s Hospital Central California
go to CareForKids
CaliforniaChildrens channel
9300 Valley Children’s Place
Madera, CA 93636-8762
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NON-PROFIT ORG.
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