We begin with children's healthcare in Nevada-- how it's improved, what it still lacks, and what legislation could impact it.

For that, we bring in Dr. Joseph Lasky, Medical Director at Cure 4 The Kids Foundation; Dr. Mark Nunes, Director of Genetics at Cure 4 The Kids Foundation; and Lawrence Barnard, President of the future Intermountain Health Nevada Children's Hospital.

And that is where I want to start, because it's important that we say "standalone hospital," right?

-Yes.

-And why is that?

(Lawrence Barnard) If you look at a standalone and a dedicated children's hospital, it really is a focal point of all of the pediatric care in the city.

You have physicians currently going to different facilities that might not run into each other during the rounding.

And so creating something like this children's hospital is going to give the opportunity for physicians to work closely together, to talk about different cases, to talk about the future of their different disciplines.

You add in research and then you put in graduate medical education, and it's really needed in this, in this valley.

-You did work for UMC at one point?

-Yes.

-And they have a children's hospital?

-Yes.

-But this is better, in addition to the collaboration, because?

-Well, I think that's kind of the point of this is really the children's hospital, the intent of it is to work with everyone in the community already.

We have some really great providers.

We have a lot of things that are going really well for us, but having a place dedicated to only children will make the difference in a lot of cases.

Right now we have-- like in the OR, there are nurses that have to take care of adult orthopedics and then turn around and look at pediatric orthopedics.

And having more of a specialization and focus on just children is what really is going to help us increase the capabilities of the entire state, actually.

-Okay.

We have increased--we, being Nevada--in terms of genetics.

You were able to bring in Dr. Nunes, the first state-- the state's first family geneticist.

How difficult was that process, Dr. Lasky?

(Dr. Joseph Lasky) I mean, I would say it's been since 2008 in the making, so many, many years when Annette Logan-Parker, our founder, you know, first started Cure 4 The Kids clinic back then.

And we, even back then, had patients with metabolic diseases that we were caring for, but we had to call the geneticists of Utah or in California to help manage them.

But these were patients who were local, who lived in Las Vegas and needed their care here.

And we helped facilitate their infusions and some of the complicated treatments they needed, but, still, the brainpower behind the management of those was not in the state.

And so it's, you know, over that time, we were able to get some traveling geneticists to, you know, who, you know, were primarily at Utah or UCLA to come and visit once or twice a month.

But still, that was really not adequate care for these kids with really complicated genetic diseases.

And now that we have our own local geneticist full time, it's just going to make managing those patients so much better for them.

And again, the collaboration is just working great.

-Dr. Nunes, why would someone need a geneticist in the first place?

(Dr. Mark Nunes) Well, genetics is complicated, even for physicians.

It's considered one of the harder areas to understand--the options for testing, interpreting the genetic tests, the interaction of genes and environmental influences.

So I think genetics is important in finding answers for children with multiple congenital anomalies and families with rare disorders.

So currently, we're completing the decade of the diagnostic odyssey, but we've had about 10 years in which our diagnostic yield has gone routinely, from when I see a child that I know has a genetic condition, from about 10 to 15% chance of finding an answer to around 40 to 45% chance of finding an answer.

The service that we provide to families in finding these answers is increasingly more difficult and more complex, and finding an answer often opens up additional questions.

And so we're starting to move into the decade of treating genetic diagnoses, and that's one of the reasons that I've come to Cure 4 The Kids, you know, for this exciting period of time where, where all of a sudden genetic diagnoses that when I was training to be a geneticist didn't have a treatment or cure and nobody could imagine a treatment or a cure now have therapies and cures for them.

-Wow.

But did you just say that it's getting more difficult to diagnose or... -Not difficult to diagnose.

It's difficult to get access to diagnosis.

And so we don't have that.

We don't have genetic providers in the state who are able to help families access somebody that's able to order the appropriate test.

It's one of the reasons that we're really excited that SB 189, a bill for genetic counseling licensure, has made its way to the Governor's desk.

That bill, you know, providing allowing genetic counselors to practice as health-- independent healthcare providers in collaboration with a physician like myself, extends that access for families so that they can get the testing that they need in order to come to that diagnosis.

-Larry, you told me off camera how needed his position is.

What else is needed in Nevada for your particular hospital, and how is recruiting going?

There is a tremendous healthcare shortage.

-Definitely.

It is the one thing that kind of keeps me up at night.

You know, when it was about building the facility, I was like, this is going to be the hardest thing.

As soon as we moved on that, then it went from that being the hardest thing to, how are we going to get the staff and physicians into this?

It has been going well.

I think that a brand new children's hospital brings people interest.

They want to be a part of something new.

It's a potential for them to take all of their learnings and create something fresh and something different, and we've got a lot of that.

There are still some challenges.

-What are those?

-Well, unfortunately, people still think we all live on the Strip and we eat at buffets.

I think getting them here, once they're here, they start to see the beauty of it.

We've been partnering with different people in the community, having physicians speak with other doctors that have come here to talk about their experiences.

But getting them in the door is always that question of, you know, is Vegas where I want to practice?

Is it a place I want to raise my family?

And I think that we've done a really good job of changing that narrative, but we still have a little ways to go.

-And, you know, and I think going back to the original question, I think sometimes those difficulties and perceived fragmentation and maybe perceived lack of collaboration amongst the physicians in this community are what keep other physicians from coming in.

And I think just the act of potentially having a place that truly is a freestanding children's hospital dedicated to pediatric and rare disease care is going to help bring those physicians into the community.

-Please, go ahead.

-I think that us having that children's hospital will be a milestone to show everyone that this is a focus for us.

And right now we do provide care, but having it very focused and dedicated in a certain place, I think, marks a disembarkment from where we normally go for this.

And I'm not a physician, but I appreciate you calling me one.

I just-- having a beard and the white in it might give me the look of wisdom, but I-- and I'd love for you guys to chime in on this.

But in my mind, if I were a physician coming into a new city, I want to know that that city supports what I'm doing, that the other physicians support me, and that they want collaboration.

I, you know, I know that he's going to be able to come up with some diagnoses under the genetics piece and oncology, but that's just a part of the journey, and it is a long journey.

So I love your odyssey piece.

These parents are looking at multiple comorbidities, multiple diagnoses, and it's not just a doctor, it is a whole team of people coming around and helping these families navigate through that.

And I think having the hospital shows physicians that potentially could come in that we are dedicated to this.

-I think it brings the game to the next level, you know?

So in addition to providing graduate medical education, treating future generations of pediatricians and emergency room doctors and intensivists, we're also-- a freestanding children's hospital is going to be a focus for continuing medical education in the community.

So you bring in experts to talk about things, you talk about the new standard of care in a certain area, whether it be gastroenterology or infectious disease, and you're bringing the practice level of those pediatricians in the community up to a higher level by engaging in these dialogs.

So it really becomes a nice focal point for providing the highest standard of care.

-It improves the reputation and, in turn, will attract more people.

But what did Dr. Lasky tell you to get you here?

-Well, I think that it was more the environment than anything else.

You always want to go someplace where you can make a difference, where you can teach a little bit--that's a passion of mine--but also where you can have some fun, where the people that you're working with are collegial, that at the end of the day that you can have a beer with them or at the beginning of the day you can share a coffee, and you know that you're sharing, you know, sharing these experiences.

So I think, from the standpoint of making a difference, I had lived through the decade of the diagnostic odyssey, and that will continue for the families that I care for, but going to a place where you actually could make a difference in treating those genetic diagnoses is really a fantastic opportunity.

And that only expands with a freestanding pediatric hospital, the ability to kind of have the facility to do bone marrow transplant and stem cell therapies for, you know, for families and patients.

It only increases, you know, with that -Well, that makes me think of another piece of legislation that I'm not so sure is going to pass this session, but it is for a stem cell and bone marrow transplant program for pediatrics.

What would you say to lawmakers who are on the fence about this?

-Right.

I think a lot of this has been already talked about at the legislative level, but I'll just reiterate that, you know, even though we in the-- I'll start with pediatric leukemias, which we cure nearly 90% of, and that includes the ALLs and the AMLs, but that still leaves 10% of, you know, probably a good 5,000 kids per year, at least in the U.S., who relapse from that disease.

And almost all of those kids with relapsed leukemia require bone marrow transplant as a curative option.

Chemotherapy a second time oftentimes does not work.

And so we have a significant population of patients who relapse from leukemia, unfortunately, and we do not offer curative, allogeneic bone marrow transplantation here in Nevada.

And so we have had to send out hundreds of kids now over the last few years to receive those life-saving therapies at other hospitals in the area, not in the state of Nevada, and that's costing at least our Medicaid population, you know, at least $7 million to get those kids out of state just to receive that curative care.

And so if we can develop that program here and get it up and running, we'll be able to keep those kids in state, those families won't have to travel to other cities and live there for three months at a time.

They'll be able to stay in their homes here in Nevada, which will impact their jobs a lot less, impact their children's education a lot less, and is just going to be much more appropriate care for these families suffering, you know, with these children with devastating diseases.

And that's just about oncology.

That doesn't count the children who have complex genetic diseases that you know might be cured by some forms of gene therapy now, but, oftentimes, bone marrow transplant is the only way of curing some of those diseases as well.

There are also, you know, a number of other genetic diseases, such as sickle cell disease, that although, again, there is a gene therapy that's available now for that.

It may not be right for all patients, and it may still be bone marrow transplantation that is the right therapy for those children as well.

And again, we're not offering that in Nevada yet, but I think having the means and the money to try to get a program up and running is really necessary to help those families.

-You bring up something about sending patients out of state.

Larry, that is one of the rumors, I believe, you told me that you are addressing, people think this new children's hospital is just going to be sending children out of state.

-Yes.

-Why would people even think that, and what would you say in response to it?

-I think this is-- this has been something that's been going on for 40 years.

People have wanted to see this children's hospital here for good reason, but there's always been barriers to that.

And there's just tons of different obstacles and people with different focuses on this and how it should be done.

And so rumors start on what this actually is.

And you know, we've heard anywhere from, This is going to be a 70-bed, small little hospital, to, The hundreds of millions you're putting into this facility, it's just a feeder for Salt Lake City.

-And the doctors are both nodding here.

Have you both heard these rumors, too?

-Absolutely.

-Yeah.

It's a common one, because it's very easy to say, Oh, wow, if that's what's happening, I don't support it.

And the reality is, just from a practical sense businesswise, no one's going to put hundreds of millions of dollars to send kids to Salt Lake City or to LA when they're already going.

It's not going to be a financial windfall for anyone.

But in the reality, one kind of story always comes to mind.

There's one pediatric neurosurgeon in the state of Nevada, only one, and that is through Intermountain Health.

We don't have a hospital, so they can't practice in our facility.

And people say, Why do you have one there now if you're not able to do the surgeries in your own facility?

And it really is because it's the right thing to do.

And it is such an impressive organization, and obviously I'm biased, but coming from the outside and seeing that this truly is about, how do we make healthcare better for the kids of this state versus a financial play?

Because there are plenty of other ways to make money in healthcare, and pediatrics is not it.

And I know that you and your colleagues and all of them know this truly is about helping kids.

It's not about how do you get rich.

And so when I look at physicians like this, caregivers out in the community that are doing it, you absolutely know they're doing this for the right reason.

-When are you going to break ground?

-So the plan is to break ground in next, early next year, and we're looking at a 2030 opening date.

-Okay, so still on track for 2030, but a little bit later for the groundbreaking?

-A little bit later for the groundbreaking.

-Well, we'd love to have you back on when you do break ground, or we'll be there for that.

-Thank you.

-And thank you all for joining us for this important conversation.