Unique L.A. hospital undergoes complex operation

The old cottage was lost long ago to the folds of a hillside in Elysian Park, near Dodger Stadium. You do not need a key to get inside.

The door was left ajar some years ago and is now stuck open on a stubborn pile of leaves. Inside, there are faint suggestions of life -- a fork and spoon on a shelf, a frayed Brillo pad. But the elements have corroded the place inside and out. Windows are cracked. There are holes in the roof. The green shower tile is still there, but you can look through the drain into the dirt below.

Here, 106 years ago, W. Jarvis Barlow built one of the more unusual and venerable pieces of Southern California's healthcare network. Barlow Respiratory Hospital was launched largely to serve tuberculosis patients; Barlow, a New York physician, was himself a patient, prompting his move to California for the warm, dry air, the chief remedy at the time. Patients lived in these cottages, sometimes for years, once they were well enough to leave the central sanatorium.

The hospital has always felt timeless, partly because it looks like a borscht belt summer camp and partly because its central mission -- helping people breathe -- has always been so fundamental. Lately, the hospital has taken on another fundamental mission -- survival.

To achieve that, big changes are afoot on the hospital campus, a scenario that will include a new hospital and the extraordinary opportunity to redevelop 25 acres of pastoral, privately owned land just two miles north of downtown.

The hospital has hired Jensen + Partners, a downtown project management firm, to oversee two dozen urban planners, architects, geologists, traffic analysts, civil engineers, historians and others who have begun piecing together preliminary ideas for the site.

Sarah Jensen, the president and founding partner of Jensen + Partners, said when she started, she attempted to find what are known in the world of real estate as "comps" -- comparable properties that help determine value and demand. "There is no 'comp,' " she said.

That suggests this isn't going to be easy. Barlow, in fact, once tried to sell some of its grounds to the highest bidder to raise money for renovations. It didn't work out.

After the 1994 Northridge earthquake, 11 hospitals were closed, at least partially, because of damage. The state adopted new seismic standards to help ensure that hospitals could continue operating in the event of a large quake -- "and not," said Barlow CEO Margaret Crane, "in parking lots with strobe lights."

"It's a worthy law," Crane said. It is also, in today's economic climate, a tremendous challenge for many facilities.

This is particularly true at a specialty hospital like Barlow, which has just 49 beds and treats complex cases.

A typical patient has at least one chronic disease in addition to an acute medical problem, such as pneumonia, said the medical director, Dr. David R. Nelson.

The average stay is 30 days, 10 times longer than the average at many larger, general hospitals.

If the hospital can't figure out a way to rebuild before 2013, it could be forced to close, Jensen said.

Hospital administrators determined quickly that retrofitting the hospital's main infirmary would be impossible. Barlow is a famously quirky and dated facility, with narrow hallways and nursing stations that are crowded on the best days, and unworkable on the worst.