The Cleveland Clinic 2002 Annual Report Investing in the

The Cleveland Clinic 2002 Annual Report Investing in the Future

Alfred Lerner, 69, president of The Cleveland Clinic, died on October 23, 2002. His extraordi-nary philanthropy has had a powerful impact on the future of medicine, research and the healthof the community.

Mr. Lerner, along with his wife, Norma, was instrumental in building the modern ClevelandClinic. Through their $16 million naming gift for the Lerner Research Institute, and recent$100 million gift for science and education at The Cleveland Clinic, they created a permanentlegacy of care and the advancement of medical knowledge. The new Cleveland Clinic LernerCollege of Medicine of Case Western Reserve University has been named in their honor.

Mr. Lerner was chief executive officer and chairman of the board of directors of MBNACorporation, and chairman and owner of the Cleveland Browns since October 1998. A graduateof Columbia University and vice chairman of its board of trustees, Mr. Lerner also was a trusteeof Case Western Reserve University and a member of the board of directors of the MarineCorps-Law Enforcement Foundation.

In 2001, Mr. Lerner, a former Marine Corps pilot, was appointed by President George W. Bushto the President’s Foreign Intelligence Advisory Board.

In 2002, Mr. and Mrs. Lerner were made distinguished fellows of The Cleveland Clinic for theirextraordinary philanthropy and humanitarian devotion to the cause of health and medicine.

On the cover: Teresa Moenich, R.N. Thoracic and Cardiovascular Surgery

ALFRED LERNER 1933–2002

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INVESTING IN THE FUTURE The Cleveland Clinic and its philanthropic partnersare making unprecedented investments of time, effort and money inthe future of medicine and the health of humankind. Everyday,Cleveland Clinic physicians, scientists and educators invest their pro-fessional lives in the patient care, research and education that are themission of The Cleveland Clinic.

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

To benefit humanity through the efficient, effective, and ethical practice of medicine,by advocating scientific investigation and medical education, by maintaining the highest standards of quality, and by honoring creativity and innovation. Each memberof the organization is a guardian of this enterprise and is responsible for assuring that The Cleveland Clinic is synonymous with the finest health care in the world.

• Physicians see more patients with more complex disorders and pursue new levels of quality and reliability of outcomes.

• Scientists probe the basic building blocks of life for the root causes of disease and work to bring innovative treatments directly to the patient bedside.

• Educators prepare the next generation of physicians, scientists and allied health professionals for the challenges of a new world of knowledge and discovery.

2 T H E C L E V E L A N D C L I N I C

Knowledge continues to be the new wealth, and we continue tostrengthen our knowledge-building resources of research and education.Developments in these areas include the appointment of PaulDiCorleto, Ph.D., as chairman of the Lerner Research Institute, theconstruction of a five-bed general clinical research center, the awardingof our first-ever Research Program-of-the-Year honor to the prostatecancer program, and increased funding for research from outsidesources – a total of $106 million in 2002, moving us from seventh tofifth nationally in NIH-funded research.

The Cleveland Clinic Lerner College of Medicine of Case WesternReserve University will enroll its first class in 2004. It is the first newmedical school to be accredited in America in the past 26 years andwill be dedicated to the training of physician–scientists. This joint ven-ture brings together one of the nation’s leading hospitals with a topmedical school recognized for its history of curricular innovation.

Our single most important priority in coming years will be the campaignfor the new Cleveland Clinic Heart Center. This is the largest, mostcomplex building project ever undertaken by The Cleveland Clinic. Itwill be the world's leading heart care center, an immeasurable benefitto the health of the nation and a permanent asset to the community.With nearly a million square feet of floor space, it will centralize allheart services and free up hundreds of thousands of square feet ofspace in our existing facilities – allowing us to expand other clinicalareas as well. This new Heart Center will help us meet the challengeof the aging demographic and provide access for what is expected tobe an unprecedented rise in heart cases in coming years.

Within our institution, we have inaugurated the most ambitious serviceand leadership program in our history. Called World Class Service, ithas united Cleveland Clinic personnel at all levels in the ongoing effort

DEAR FRIENDS:

to enhance patient satisfaction and implement new ideas for improvedservice and efficiency. The goal of World Class Service is to make TheCleveland Clinic the best place to work, the best place to be a patient,and the best place to practice medicine.

The volume of patients seen at our consolidated sites rose in 2002.New patient visits, and inpatient and outpatient surgeries all sawincreases over the year. International patient numbers have been downsince September 2001, but we look forward to seeing this numberrecover in coming months. Overall, the numbers are positive.

Revenue from patient care is significantly higher in 2002. ClevelandClinic Florida performed better than budget, and our Naples hospitalis close to 100 percent occupied. Florida has seen a steep increase ininternational patient visits, especially from the Caribbean.

The Cleveland Clinic was heavily invested in equities throughout the1990s. This was a successful strategy in that it financed fully 40 percentof our building activities in that decade and essentially provided theengine that is taking us into the 21st century. In response to externalchanges, we have shifted the bulk of our investments to the fixed-ratemarket and restructured our debt portfolio. The Cleveland Clinicremains financially stable. Our most recent bond sale met with over-whelming demand, reflecting our national reputation among investorsand continuing confidence in our stable core of experienced managers.

Health care is the leading issue of our generation. The field of medicineoffers more opportunities to enrich human life today than at any time inhistory. Our greatest gift is hope. Because of our hard work and prepa-ration over the past 12 years, The Cleveland Clinic is well-positioned tolead in this new era. We will be a beacon of hope to all people, in timesof wellness and illness, and through all the seasons of life.

Sincerely,

Floyd D. Loop, M.D.

Chairman and Chief Executive Officer

The Cleveland Clinic enters 2003 with a distinct clarity of purpose. Our principal objective is tobecome the number one academic medical center in America. We have the motive, the opportunity andthe means to achieve number one status, and we intend to make it happen.

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EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES 2002-2003

FRONT ROW (L TO R ): Patrick F. McCartan, Esq. | Stephen R. Hardis | Robert Kay, M.D. | Floyd D. Loop, M.D. | A. Malachi Mixon, III | Samuel H. Miller* | Joseph M. Scaminace | John J. Kahl, Jr.BACK ROW (L TO R ): William E. Conway* | Gordon R. Bell, M.D. | Robert J. Tomsich | Stephen F. Lau, Ph.D. | John V. McFadden | Dan T. Moore, III | Ivan J. Winfield | Nancy F. Beck, Esq.

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

*Emeritus Trustee


HEALTH IS A PRICELESS COMMODITY. To secure it, no effort is too exhausting, no commitment toodeep. Words alone cannot do justice to the full breadth of activities taking place at TheCleveland Clinic in a given year. It is for this reason that we include in this annual reportpictorial essays – dramatic black and white photographs illustrating some of the manystories of patient care, research and medical education that unfold every day at TheCleveland Clinic. These are the images of people who, through their untiring dedicationto advancing the art and science of medicine, make a remarkable difference in the livesof patients of today and tomorrow.

P I C T O R I A L E S S A Y S


THE CENTER OF HEART CARE

The Cleveland Clinic Heart Center is America’s busiest heart center. Heart Centersurgeons perform more heart valve operations than any other hospital in the United States.Delos Cosgrove, M.D., chairman of Thoracic and Cardiovascular Surgery, pioneeredtechniques and devices that enable surgeons to repair and reshape, rather thanreplace, damaged valves. Continuing with the Heart Center’s tradition of firsts, Dr.Cosgrove also performed the world’s first minimally invasive heart valve surgery.


SHARING MEDICAL WISDOM

Under the auspices of the Division of Education, some 800 residents and fellows received medical training at The Cleveland Clinic in 2002. Thesephysicians-in-training learn at the side of leading specialists, such asMarshall Strome, M.D., chairman of Otolaryngology and CommunicativeDisorders, whose achievements include the world’s first successful larynxtransplant. The Clinic’s high patient volume, diversity of clinical problems andgroup practice model provide an ideal teaching and learning environment.

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INNOVATIVE SPINE SURGERY Isador Lieberman, M.D., uses minimally invasive techniques to perform major spinalreconstruction. Where previously two operations were required to correct a particularspinal deformity, Spine Center surgeons now are able to perform both at once, one fromthe front (endoscopically) and the other from behind. This technique spares patientsthe rigors of two trips to the operating room, as well as two recovery or rehabilitation periods.


BEATING CANCER

Chemotherapy can be demanding. But new drugs and refined protocols are making it moreeffective than ever. Monoclonal antibody therapy has proved effective in treating certain typesof non-Hodgkin's lymphoma. The treatment works by stimulating the body's own ability todestroy cancer cells. At the Cleveland Clinic Taussig Cancer Center, chemotherapy sessionsare offered in a comfortable environment, with compassionate concern for the patient’s needs.

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SIGHT-SAVING SURGERY

Submacular hemorrhage is a complication of age-related macular degeneration that can leadto blindness or loss of vision. A surgical technique developed by Hilel Lewis, M.D., director ofthe Cleveland Clinic Cole Eye Institute, can treat this condition. Under Dr. Lewis’ leadership,the Eye Institute has grown to become one of the largest ophthalmic practices in the UnitedStates and one of the world’s leading research institutes into the diseases of the eye.

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SEARCHING FOR ANSWERS Work at the Cleveland Clinic Lerner Research Institute ranges from the most basic scientific investigations to nationwide clinical trials involving thousands of patients. In the BiomechanicalEngineering Laboratory, researchers seek to expand the interface between technology and the body. In the Prostate Cancer Group – winner of the 2002 Cleveland Clinic Research Program ofthe Year Award – physicians and basic scientists collaborate on projects that may lead to newtreatments and cures.


CARING FOR OUR CHILDREN

From premature infants to adolescents, patients at The Children’s Hospital are surrounded by caringhands. The Children’s Hospital staff provides innovative care for children with complex medicalproblems, such as epilepsy and cancer. Critically ill newborns are cared for in a Level III NeonatalIntensive Care Unit. The hospital’s Center for Pediatric and Congenital Heart Diseases serves as aworldwide referral and second opinion center for patients with pediatric and congenital heart disease.

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A BETTER APPROACH TO PAIN Pain should be treated as a disease, not a symptom. That is the philosophy of the Clinic’sDepartment of Pain Management. Under the chairmanship of Nagy Mikhail, M.D., Ph.D.,the department takes a multidisciplinary approach to pain. Innovative therapies include thespinal cord stimulator, which is surgically implanted and can provide years of relief fromchronic pain. The Clinic is one of only a small percentage of hospitals nationally to have adedicated pain management program.


The Year in Review

The year 2002 found The Cleveland Clinic engaging the challenges of patient care, researchand education at the highest levels of commitment and expertise. Hard work was thekeynote, as staff physicians and scientists, nurses and support personnel maintained thedaily pace of a leading academic medical center, making major contributions to science,medicine, and the efficiency and effectiveness of care.

This annual report presents a few highlights of this very productive year. A chronicle aslimited as this cannot comprehensively record the multiplicity of events that make up thelife of an institution as busy and complex as The Cleveland Clinic. This year, as everyyear, Cleveland Clinic personnel saved many lives and enhanced the quality of life for manymore. What follows are some of the achievements, honors and insights of the past 12 months.

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THE CLEVELAND CLINIC RANKED THIRD IN AMERICA

The Cleveland Clinic was ranked third inAmerica in the 2002 U.S.News & World Reportannual “America’s Best Hospitals” survey – itshighest ranking ever. In the specialty rankings,the Heart Center was named best in Americafor the eighth year in a row. The UrologicalInstitute ranked number two in the nation.Other specialties ranking in the top 10 wereendocrinology, gastroenterology, geriatrics,gynecology, nephrology, neurology and neuro-surgery, orthopaedics, otolaryngology, pulmonaryand rheumatology. Ophthalmology, cancerand psychiatry also were ranked nationally. Inother national recognition:

• The Cleveland Clinic was named one of thenation’s top 100 hospitals by health data con-sultants Solucient in a survey that recognizedmedical and operations excellence.

• 73 Cleveland Clinic physicians were named inthe 2002 edition of “America’s Top Doctors.”The Cleveland Clinic was one of the best-represented hospitals in the directory.

• 195 Cleveland Clinic physicians were namedin “The Best Doctors in America,” a survey of30,000 physicians nationwide. This was themost of any hospital in Ohio and among thelargest number of any hospital in America.

NURSING LEADERSHIP ACADEMYLAUNCHED

Nurse managers are key to effective and com-passionate nursing. They are among the mostsuccessful leaders in all areas where they work.Now, the Division of Nursing has launched aprogram to help nurse managers refine andstrengthen their leadership and managementskills even further. This comprehensive trainingprogram is called the Nursing LeadershipAcademy. Undertaken in partnership with theAdvisory Board Company, the Nursing LeadershipAcademy began in 2002 with a 360-degreeevaluation of leadership skills and will proceedto master’s level courses in areas targeted forimprovement.

NURSE RECRUITMENT SUCCESS

The Cleveland Clinic has made progress in anumber of areas addressing the national per-sonnel shortage in nursing. A recruitment driveundertaken from September to November2002 resulted in a record number of inquiries.“In 100 days, 103 nurses accepted job offers,”says Lois Bock, R.N., director of NurseRecruitment. “We’re very pleased with theseresults.” The campaign reached out to nursesthrough radio and newspaper advertising, directmail and the Internet. Recruitment events alsowere held, and bonuses were offered toCleveland Clinic employees who referred nurseswho were successfully hired. A ClevelandClinic tuition assistance program also hasresulted in great success. This program helped51 Cleveland Clinic employees graduate fromnursing school in 2002 and start new jobs asregistered nurses. The program providesfinancial support in return for a work commit-ment. Overall, 377 nurses were hired in 2002.

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

WOMEN’S HEALTH CENTER OPENED

Women now can access specialized healthcare at the new Cleveland Clinic Women’sHealth Center. Located on the first floor of theCrile Building, the center provides convenient“one-stop shopping” for all women’s healthcare needs. In addition to routine wellnessexams and health care screenings, the centeroffers evaluation and treatment of numerousmedical problems of special concern towomen. Center professionals accommodatepatients who are seeking second opinions, aswell as patients who prefer female providers.The new center includes the services of theClinic’s Breast Center, as well as the depart-ments of Internal Medicine and Obstetrics &Gynecology.

NEW TREATMENT MAY EXTEND LIVES OF BRAIN TUMOR PATIENTS

A new treatment protocol being refined at TheCleveland Clinic has been shown in preliminaryresearch to help extend the lives of certainbrain tumor patients by almost three-fold thatof the average anticipated life expectancy forthis disease. The treatment involves slowingthe activity of the thyroid gland in patients with recurrent gliomas, then treating them withhigh doses of tamoxifen. Highly resistant toboth chemotherapy and radiation treatment,gliomas are the most common form of cancer-ous brain tumors. Each year, 18,000 to 20,000new cases are diagnosed in U.S. adults.

SPORTS HEALTH HOSTS PROFESSIONAL AGENTS

Cleveland Clinic Sports Health continues to beone of the largest sports health practices in the nation, providing services to a number ofprofessional and amateur teams and athletes.In 2002, Sports Health hosted two Agents’Medical Summits to give professional sportsagents a functional knowledge of the medicalproblems, issues and concerns they and theirclients face when a medical condition, injury orillness challenges a sports career.

DEFIBRILLATOR STUDY HAS SURPRISING RESULT

For patients who need implantable cardioverterdefibrillators (ICDs) to control abnormal heartrhythms, simple ventricular backup pacemakertherapy provides better outcomes than sup-porting the heart rhythm with more sophisti-cated stimulation of both the right atrium andright ventricle, according to Cleveland Clinicresearch published in the Journal of theAmerican Medical Association. “This studyproduced opposite results from expectations,”says Bruce L. Wilkoff, M.D., director ofCardiac Pacing and Tachyarrhythmia Devicesand chairman of the study’s committee.“About 75 percent of ICDs implanted in theUnited States include dual chamber pace-makers, and these are the first randomizeddata evaluating their impact on congestiveheart failure and mortality. The implicationsfor patients are compelling.”

NEW HOPE OFFERED FOR NON-HODGKIN’S LYMPHOMA PATIENTS

Doctors at the Cleveland Clinic Taussig CancerCenter are using a new biologically targetedradioactive “smart bomb” to treat patients withcertain types of non-Hodgkin’s lymphoma. Thedrug, Zevalin, is the first radioimmunotherapytreatment approved by the U.S. Food and DrugAdministration. It is approved to treat patientswith relapsed or refractory low-grade, follicularor transformed B-cell non-Hodgkin’s lym-phoma who have not responded to traditionaltreatment. “Zevalin is designed to deliver apowerful ‘double whammy’ to tumors,” saysRoger Macklis, M.D., chairman of RadiationOncology. “This ‘smart bomb’ technology rep-resents the realization of a 100-year-old dreamof science pioneers like Marie Curie and PaulEhrlich, who envisioned radiolabeled antibodytherapy in the early years of the 20th century.”Zevalin is given as a collaborative effort bymembers of the departments of RadiationOncology, Medical Oncology and Molecularand Functional Imaging.

MASTECTOMY TECHNIQUE PRESERVES APPEARANCE

Cleveland Clinic Breast Center physicians havedeveloped a new mastectomy technique thatleaves the nipple intact, allowing for a morenatural-looking breast reconstruction. “Theresponse that we are getting from patients tothis surgery is the most overwhelming I haveseen in 25 years,” says Joseph Crowe, M.D.,director of the Breast Center, who developedthe new technique. Since January 2002, Dr.Crowe and colleague Julian Kim, M.D., in collaboration with plastic surgeons JillianBanbury, M.D., and Randall Yetman, M.D.,performed nipple-sparing mastectomies onmore than 50 women. The operation is not forall breast cancer patients, but is applicable tothose within certain limitations.

TONSIL TECHNIQUE OFFERS LESS PAIN

A new technique that shaves away a portion ofthe tonsils rather than completely cutting themout results in less pain, quicker recovery timesand fewer complications than standard tonsil-lectomy, a new study shows. The procedureuses an endoscopic microdebrider to shaveaway tonsil tissue. A portion of the tonsils is leftintact, leaving the underlying muscles of thethroat unexposed, which cuts down on painfulrecovery times. “We perform this procedureprimarily on children whose tonsils are solarge that it disrupts their breathing whenthey sleep,” says Peter Koltai, M.D., head ofthe Section of Pediatric Otolaryngology anddeveloper of the new technique. “The rapidrecovery and lower incidence of bleedingmake it easier on the children themselves andallow parents to return to work more quickly.”

DISEASE MANAGEMENT PROJECT LAUNCHED

More than 80 Cleveland Clinic physicianshave collaborated to produce a unique onlinemedical resource (www.clevelandclinicmed-ed.com/diseasemanagement), under thedirection of the Center for ContinuingEducation. Called the Disease ManagementProject, this free Internet resource is intendedas a tool for the general practitioner andincludes chapters in cardiology, dermatology,endocrinology, gastroenterology, infectiousdiseases, neurology, nephrology, psychiatryand psychology, pulmonary diseases, andwomen’s health. Each chapter offers treat-ment strategies based on nationally acceptedpractice guidelines. William D. Carey, M.D.,director of the Center for Continuing Education,is editor-in-chief and presides over a 10-mem-ber editorial board. All content is free andauthored exclusively by Cleveland Clinicphysicians.

NEW DRUG FOR HEART FAILURE

A new drug for people with severe congestiveheart failure provides patients with early reliefand gives physicians additional treatmentchoices, according to Cleveland Clinic HeartCenter research published in the Journal ofthe American Medical Association. The drug,nesiritide, was shown to be more effectivethan intravenous nitroglycerin when used inaddition to standard treatment for congestiveheart failure in hospitalized patients. It is thefirst new drug approved for severe congestiveheart failure in 15 years. The trial was led byJames Young, M.D., medical director of theKaufman Center for Heart Failure at TheCleveland Clinic.


Joseph Crowe, M.D.

CLEVELAND CLINIC COLE EYE INSTITUTE

RESEARCHERS ANALYZE DRUSEN, A MATERIAL

THAT INCREASES THE RISK OF AGE-RELATED

MACULAR DEGENERATION.

Macular Degeneration Secrets Unlocked

Researchers at the Cleveland Clinic Cole EyeInstitute have begun to unlock the secrets ofdrusen, material that collects in the eye andincreases a person’s risk of developing age-related macular degeneration (AMD). Led byJohn W. Crabb, Ph.D., and Joe G. Hollyfield,Ph.D., Cole Eye Institute researchers analyzeddonor drusen using new, more sensitive tech-niques that combine liquid chromatographyand mass spectrometry methods. “Ourresearch is the first to establish a molecularconnection between oxidative damage andage-related macular degeneration,” says Dr.Crabb. “Our goal is to take this knowledge,expand upon it, and find a way to halt orslow drusen formation and AMD.” Thisinvestigation combines the development ofa new drusen micro-isolation technique withproteomic analyses by mass spectrometryand bioinformatics and promises furtherinsights into the pathology of AMD.

“Age-related macular degeneration is a common disease with links to both genetic and environmental causes. We just don’t know enough to understand it,” says Hilel Lewis,M.D., director of the Cole Eye Institute. “I believe that this technology and line of researchwill bring us closer to the cause of age-related macular degeneration.”

CHILDREN’S HOSPITAL OFFERS UNIQUE GI TESTING

Nothing could be more alarming to a parentthan a child with unexplained nausea, abdom-inal pain or failure to thrive. The Center forPediatric Functional Gastrointestinal andMotility Disorders at The Children’s Hospital atThe Cleveland Clinic offers two uniqueresources for investigating these conditions:antroduodenal manometry and colonic motilitytesting. “Few centers in the country offer theseprocedures to children, due to their complexityand the time needed to record the physicalprocesses of digestion,” says Rita Steffen,M.D., a pediatric gastroenterologist in the center.These two tests, which involve catheter place-ment, anesthesia, and as many as eight hoursof monitoring, can reliably assess whether a child’s problem is neurological, muscular,behavioral, or has other causes. Able to beperformed simultaneously, the tests give doctors the most comprehensive picture of achild’s total intestinal situation, allowing themto choose the most appropriate treatment.

LARGEST TEST OF COATED STENTS UNDER WAY

The Cleveland Clinic Heart Center will helpoversee the largest clinical trial to date to eval-uate whether stents coated with anticancerdrugs can prevent restenosis. “This is atremendous opportunity to assess the potentialfor a treatment that might resolve restenosis,which some specialists have dubbed the‘Achilles heel’ of angioplasty,” says StephenG. Ellis, M.D., co-principal investigator for theclinical trial and director of the Heart Center’sSones Cardiac Catheterization Laboratories.

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Photo courtesy of Conor Medsystems, Inc.


A NEW HOME WILL GIVE AMERICA’S NUMBER ONE

HEART CENTER THE SPACE IT NEEDS TO TACKLE

THE NATION’S LEADING CAUSE OF DEATH.

THE BONE BIOLOGY LABORATORY STUDIES

HOW ADULT STEM CELLS CAN HELP BREAKS

AND FRACTURES HEAL FASTER.

MASSAGE THERAPY IN CARDIAC SURGERY PATIENTS

Encouraged by results from a pilot study,Cleveland Clinic Heart Center researchershave launched the first clinical trial to determinewhether therapeutic massage can help heartsurgery patients have less pain and recovermore promptly. “Relaxation techniques likemassage may lead to decreased pain and narcotic use to cope with pain as well as lessphysiologic stress,” says A. Marc Gillinov,M.D. “We want to see if results indicated inour pilot study are reflected in a randomized,controlled study.”

PALLIATIVE MEDICINE RESEARCH FELLOWSHIP

The Harry R. Horvitz Center for PalliativeMedicine at The Cleveland Clinic establisheda research fellowship to train a physician in research methodologies and techniquesinvolving palliative care, an area of medicinethat encompasses the comprehensive care ofpatients with incurable illnesses. The Mt. SinaiResearch Fellowship in End-of-Life Care isbeing made possible through a three-year,$188,315 grant from the Mt. Sinai HealthCare Foundation. “Palliative medicine contin-ues to be a growing and evolving area of med-icine with significant issues that need to beaddressed,” says Declan Walsh, M.D., direc-tor of the Horvitz Center and holder of theHarry R. Horvitz Chair in Palliative Medicine.“This fellowship will serve as a bridge todetermine and extend information about thebest practices in palliative medicine.”

Stem Cells to Repair Bone

Over the past year, adult stem cell research has attracted national attention as a new thera-peutic approach for many diseases. Adult stem cells are normal cells found in our bodies thatretain the ability to repair or regenerate new tissues throughout our lives. Some adult stemcells have the ability to regenerate only one or two types of tissue. However, some have beenshown to be able to regenerate many tissues, including bone and cartilage and even heartmuscle and nerve tissue.

George F. Muschler, M.D., director of the Bone Biology Laboratory in the Lerner ResearchInstitute, is among several Cleveland Clinic researchers investigating adult stem cells. Dr.Muschler has received two National Institutes of Health grants for stem cell studies. In themost recent, Dr. Muschler and his colleagues will analyze human bone tissue, bone marrow,muscle tissue and fat to determine the types and number of stem cells to be found there.Efforts will be made to determine differences between these sources of stem cells and howthese differences might guide the strategic use of these cells for the repair of various tissues.

Dr. Muschler’s other grant is a collaborative project investigating the best methodology for rapid concentration, selection and transplantation of bone marrow-derived stem cells topromote bone repair and regeneration.

“Stem cell biology is one of the true frontiers of science,” Dr. Muschler told Crain’s ClevelandBusiness. “Stem cells are at the foundation and root of all growth, all development, all healing,all regeneration and all maintenance of our minds and bodies. As a result, understanding andmanaging stem cells and their activity increasingly will be the target of medical care.”

New Heart Center Planned

The Cleveland Clinic Heart Center faces an extraordinary challenge. Restricted space and theneeds of a rapidly aging population threaten to overwhelm the Heart Center’s current facilities.This, combined with the need to free up space at The Cleveland Clinic for other critical services,has made it necessary to plan the construction of a new building dedicated to heart care and itsattendant services.

Currently, the Cleveland Clinic Heart Center is America’s largest and busiest heart practice.Ranked best in America for eight years in a row by U.S.News & World Report, it is the idealoccupant for a building that is destined to be a world capital of heart care.

The Heart Center will be comprehensive in its capabilities and distinctive in its design. Nofeature of heart care or patient comfort will be overlooked. The complex includes a 10-storyhospital tower; a fully equipped surgery, laboratory and technology center; up-to-dateresearch laboratories; and high-tech classroom capabilities. It will be united with the existingbuildings of The Cleveland Clinic by a splendid atrium.

Driven by a need for larger facilities, the Heart Center is using its unparalleled expertise to create an optimum environment for patient care, research and the training of heart specialists.

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Katherine Lee, M.D.

DEFENSE MECHANISM IN SMALL INTESTINE UNRAVELED

Researchers led by Charles Bevins, M.D., Ph.D.,Immunology, have unraveled the system ofchecks and balances governing full potency ofthe immune defense systems protecting thesmall intestine from microbial infection. Theresearchers defined the activation process fora natural antibiotic of the small intestine thatdisrupts bacterial cell membranes, and identifiedthe key enzyme involved in this mechanism ofthe body’s natural defenses. This understandingmay lead to new therapies for certain forms offood poisoning and open new avenues of ther-apy for inflammatory bowel disease (IBD).

HEPATITIS C TREATMENT RE-BALANCES IMMUNE SYSTEM

A new treatment for hepatitis C utilizing acombination of the drug etanercept along withthe standard therapy of interferon and ribavirinis more likely to result in virus eradication thanthe standard therapy alone, according to astudy by Nizar N. Zein, M.D., director ofClinical Hepatology. “It is believed that thiscombination therapy may be an improvementbecause it may re-establish the natural balance of the immune system, which is lostdue to the infection. The results of this studyare extremely encouraging,” says Dr. Zein. “Alarge study that will include 75 medical cen-ters throughout the United States and Canadais planned to begin in the summer of 2003 toconfirm these findings and establish the roleof this new therapy for patients with chronichepatitis C.” Dr. Zein will be the principalinvestigator for this additional study.

EYE RESEARCH COLLECTION OVERSEEN

The Foundation Fighting Blindness, a nonprofitorganization whose mission is to find the causes,treatments, preventions and cures for inheritedretinal diseases, has chosen the ClevelandClinic Cole Eye Institute to host its collectioncenter for eyes donated by individuals acrossthe United States for blindness research. Joe G. Hollyfield, Ph.D., director of OphthalmicResearch for the Cole Eye Institute, overseesthe eye collection center, conducts researchon these tissues, and shares tissue samplesfrom the collection with researchers worldwide.“Eye donations are vital to research that oneday will lead to a cure for these diseases andhelp to prevent blindness,” says Dr. Hollyfield.

UNIQUE METHOD FOR DETERMINING BREAST CANCER RISK

Specialists in the Cleveland Clinic BreastCenter have helped pioneer an early detectionprocedure for women at high risk for develop-ing breast cancer. Called ductal lavage, theprocedure involves using a tiny catheter togather cells from the milk ducts, where mostbreast cancers develop. The cells are thensubjected to microscopic examination for pre-cancerous changes. “Ductal lavage provideswomen with unique and personal informationabout their breast health, which can helpthem make important decisions about pursuingcloser follow-up and risk reduction options,”says the Breast Center’s Katherine Lee, M.D.Dr. Lee has initiated a study that uses ductallavage to assess cellular atypia in a group ofhigh-risk African-American patients. Theresults may lead to the use of ductal lavage todetermine the eligibility of high-risk African-American patients for certain therapies orclinical trials.

BLOOD TEST RESEARCH REVERSES LONG-HELD BELIEF

Suspected heart attack victims with mild kidneydysfunction benefit equally from a standarddiagnostic test as do patients whose kidneys arefunctioning properly, according to ClevelandClinic Heart Center research published in theNew England Journal of Medicine. Physiciansoften measure blood levels of troponin, a protein, in patients thought to have had heartattacks. High levels of troponin generally indicatethat a heart attack has occurred and thataggressive treatment is necessary. Previously,however, troponin measurement was not con-sidered reliable in those with kidney dysfunction.On the contrary, Michael Lauer, M.D., and col-leagues found that troponin levels were usefulfor diagnosing heart attack and determiningappropriate treatment for patients, regardlessof their kidney function. “Suspected heartattack patients with kidney dysfunction whohave high troponin levels may well be bestserved by aggressive therapy such as heartcatheterization,” says Dr. Lauer, director ofClinical Research in the Department ofCardiovascular Medicine. “We’re rapidly dis-covering that a blood test for troponin levelsshould be the standard for all patients thoughtto have experienced an acute coronary event.”

NEW DRUG STABILIZES CANCER PROGRESSION IN EARLY TRIAL

Research at the Cleveland Clinic Taussig CancerCenter shows that a new experimental anti-cancer drug, phenoxodiol, produced minimaltoxicity and stabilized cancer progression ina number of patients. “Phenoxodiol is an interesting new drug. It may target certainproteins in cancer cells that could be key to thecancer process,” says Thomas Hutson, D.O.,Pharm.D., the trial’s co-investigator.


Bravo pH capsule

REGENERATIVE THERAPY MAY HELP MULTIPLE SCLEROSIS

The brain can replace cells destroyed by mul-tiple sclerosis much longer than previouslybelieved, according to Cleveland Clinicresearch published in the New EnglandJournal of Medicine. The research, directedby Bruce D. Trapp, Ph.D., chairman of the Department of Neurosciences at theCleveland Clinic Lerner Research Institute,provides new insight about potential therapyto treat people who have multiple sclerosis.“We have known for decades that the braincan repair the lesions of multiple sclerosisduring the disease’s early stages. We haveassumed that the brain did not repair thelesions during more chronic stages of multiplesclerosis because we believed the new cellswere not being generated,” Dr. Trapp says.“What we discovered in this research is thatthe brain is producing the appropriate cellsand that these cells are making significantattempts to repair the lesions.”

NEW SYSTEM MAKES WHEELCHAIR USERS SAFER IN BUSES

Researchers in the Department of PhysicalMedicine and Rehabilitation have devised anew system that quickly and easily lockswheelchairs into place inside public and para-transit vehicles, school buses and privatevans. In many cases, wheelchair users areable to secure the chairs themselves withoutthe aid of a driver or assistant. “Our automatictensioning system gives wheelchair usersmore independence while traveling andensures them that the wheelchair will remainsafely and securely locked in place despiteany bumps that may occur along the road,”says Steven I. Reger, Ph.D., director ofRehabilitation Technology. In field trials, thenew design has received wide acceptancefrom transit providers and wheelchair users.The patent has been applied for, and a com-mercial agreement signed with Kinedyne, Inc.

CAPSULE MONITORS ACID LEVELS

A revolutionary device that may help treat people with chronic indigestion has been tested by Joel Richter, M.D., chairman ofGastroenterology and Hepatology. Called theBravo pH system, it is a tiny device that isattached to the wall of the patient’s esophagusand monitored via radio by a small receiverworn around the patient’s waist. Not muchlarger than a cold capsule, the device isintended to stay inside the patient for only twodays, during which it collects information onacid levels. This information is then down-loaded onto a doctor’s computer. The devicewill allow doctors to more accurately diagnosegastroesophageal reflux disease (GERD) andother disorders.

SEARCH FOR IBD GENES

There is strong evidence that an individual’sgenes are responsible for a predisposition tothe inflammatory bowel diseases (IBD) knownas Crohn’s disease and ulcerative colitis.There also is evidence that such genes maydetermine a particular clinical course or outcome of IBD. Jean-Paul Achkar, M.D.,Gastroenterology and Hepatology, is heading amulti-center collaborative research projectthat intends to analyze genetic linkages inCrohn’s disease based on clinical parametersin 405 Crohn’s disease-affected individuals.Dr. Achkar also is establishing an IBD bank ofDNA material as part of an infrastructure tobuild a dedicated IBD genetics program atThe Cleveland Clinic.

THE CLEVELAND CLINIC IN NASA RESEARCH CONSORTIUM

The Cleveland Clinic has joined with NASAand other local institutions in a new consor-tium to create technology that protects thehealth of astronauts on long-duration spacemissions and to advance the practice of medicine on earth. Called the John GlennBiomechanical Engineering Consortium, itincludes NASA Glenn Research Center, TheCleveland Clinic, Case Western ReserveUniversity, University Hospitals of Clevelandand the National Center for MicrogravityResearch. The consortium is sponsored by a$7.5 million grant from the Office of Biologicaland Physical Research at NASA headquarters.Three projects by Cleveland Clinic scientistswere selected for funding by the consortium.They are:

• Ulf Knothe, M.D., Orthopaedic Surgery, inves-tigating whether the application of acousticenergy, which induces microdamage and naturalrebuilding of bone, will facilitate maintenanceof bone mass in astronauts during extendedspace travel and for people on earth who suffer from osteoporosis.

• Shuvo Roy, Ph.D., Biomedical Engineering,leading studies aimed at developing a battery-free, potentially implantable unique drug-delivery device that exploits the ability ofmicroelectromechanical systems (MEMS)technology to generate precise pore sizes onthe order of the size of drug molecules.

• Susan D’Andrea, Ph.D., BiomedicalEngineering, leading studies to develop anovel treadmill equipped with dual track andvirtual reality to help maintain astronaut bonemass while in space and minimize the diffi-culty of re-adapting to gravity upon return toEarth. Use of the device could be extendedas an ideal tool for the rehabilitation of balancedisorder patients on Earth and is alreadybeing used to rehabilitate patients with gaitabnormalities.

CCF Innovations Deploys Technology

Innovation is the key to high-quality, affordable health care in the years to come. To promoteinnovation and expand treatment of the sick through the broad and rapid deployment ofCleveland Clinic technology, CCF Innovations was founded in 2000.

“The Cleveland Clinic has a wonderful entrepreneurial spirit,” says Joseph Hahn, M.D.,chairman of CCF Innovations. “We are determined to harness that spirit to speed the commercial application of new ideas for the benefit of patients and the treatment of disease.”

In 2002, Cleveland Clinic staff disclosed 113 new inventions – an all-time record. TheCleveland Clinic ranked first in Northern Ohio of major hospitals and universities, and inthe top third nationally in commercialization revenues (dollar-per-dollar sponsored research).In addition, The Cleveland Clinic secured $3.4 million in commercialization revenue anddistributed $1.5 million to 32 Cleveland Clinic inventors. More than 700 Cleveland Clinicpersonnel attended a first-ever Inventors Forum on commercializing technology.

“We are strongly committed to establishing Cleveland-based companies to propel the economic renewal of Cleveland,” says Executive Director Chris Coburn. As part of theseactivities, CCF Innovations raised or facilitated $4.25 million in equity investments inCleveland Clinic spin-offs and partner companies. The Cleveland Clinic invested nearly $1million in two Cleveland Clinic spinoffs. Three companies were launched based on intellectualproperty developed at The Cleveland Clinic. After Quark Biotech, now located on TheCleveland Clinic campus, a second Israeli medical technology company, Simbionix, hascome to Cleveland as a result of CCF Innovations’ efforts. $1.3 million in grants was securedfrom the state of Ohio, the Generation Foundation and the Codrington Foundation to fur-ther the commercialization of Cleveland Clinic technologies.

Brain Tumor Institute Formed

Specialists from Neurosurgery, Neurology,Radiation Oncology, and Hematology andMedical Oncology formed the ClevelandClinic Brain Tumor Institute (BTI) to provide multidisciplinary treatment for braintumor patients, and to broaden research into the causes and treatments of primarymalignant and benign brain tumors.Chaired by neurosurgeon Gene H. Barnett,M.D., the BTI is one of only a few national

and international neuro-oncology resource centers in the nation. “The institute offers the latest diagnostic capabilities, drug-delivery systems and advanced radiosurgery technology,such as the Gamma Knife and CyberKnife,” says Dr. Barnett. “New radiation, chemotherapeuticand surgical approaches offer hope to many with previously untreatable disease.”

2 0 0 2 A N N U A L R E P O R T 29

A NEW PROGRAM COMBINES THE EXPERTISE OF

MULTIPLE SPECIALTIES TO TREAT A CHALLENGING

FORM OF CANCER.

THE CLEVELAND CLINIC’S TECHNOLOGY TRANSFER

OFFICE IS LAYING THE GROUNDWORK FOR THE

FUTURE OF INDUSTRIAL GROWTH.

CHEMOTHERAPY AFTER PROSTATE SURGERY STUDIED

The Cleveland Clinic Taussig Cancer CenterDepartment of Hematology and MedicalOncology, and the Glickman Urological Instituteare conducting several new studies for patientswith advanced prostate cancer. “We are inves-tigating the use of chemotherapy either priorto or following prostate cancer surgery,” saysRobert Dreicer, M.D., Hematology and MedicalOncology. “Chemotherapy is frequentlyadministered after surgery for breast cancer,for example, because it’s known to improvesurvival, but we’re now exploring its use withrespect to prostate cancer.” Prostate cancer isthe most common cancer among men in theUnited States, affecting African-Americanmales at the highest rate in the world.

INTERNET SITE HONORED

The Cleveland Clinic earned six 2002eHealthcare Leadership Awards for the qualityof its Web site content, design and function.The awards were given to five areas of theWeb site, with the Heart Center earning twoplatinum awards, the highest ranking available.“With so much medical information availableonline today, it is vital that people seek helpfrom a health care provider and an Internetsite that they know and trust,” says C. MartinHarris, M.D., chief information officer andchairman of Information Technology. “I’mhonored the Clinic is being recognized for thecaliber of its Web site.” Additionally, TheCleveland Clinic Web site earned eight WorldWide Web (WWW) Health Awards in 2002. TheWWW Health Awards is a program that recog-nizes the best health-related Web sites for con-sumers and professionals. The program is heldtwice a year – spring and fall – with the goal of providing a “seal of quality” for electronichealth information.

Cleveland Clinic Lerner College of Medicine Established

In May 2002, The Cleveland Clinic andCase Western Reserve University enteredinto an historic partnership to create a unique,new medical school program dedicated tothe teaching of physician-scientists. TheCleveland Clinic Lerner College of Medicineof Case Western Reserve University links oneof the nation’s top hospitals with one of thenation’s leading research universities. Thecollege will combine education and researchin an innovative program that will graduate32 medical students each year who are mentored to become physician-scientists.The collaborations made possible by thisnew endeavor are expected to have a majorimpact on medical education and the field ofmedical science.

The Cleveland Clinic Lerner College ofMedicine will attract and educate a selectgroup of highly qualified individuals whoare motivated to become physician investi-gators and scientists and who are committedto the advancement of biomedical researchand practice.

The college program will instill in all graduates a passion for scientific inquiry that will carrythem forward into academic residency programs and professional careers as successful physi-cian investigators. Current and future generations of patients will benefit from these gradu-ates, who will advance the field of medicine through scientific discovery, therapeutic innova-tion and clinical excellence. The first class will begin in the summer of 2004.


NEW PROSTATE CANCER GENE LINK FOUND

Graham Casey, Ph.D., Cancer Biology, andinvestigators from Case Western ReserveUniversity, Washington University and theNational Institutes of Health uncovered acommon genetic mutation that doubles therisk of prostate cancer in the men who pos-sess it. Results of the study suggest that up to13 percent of prostate cancer cases are attrib-utable to this specific genetic mutation. Menwho inherited only one copy of the mutationfrom a parent had a 50 percent increased riskof prostate cancer, while those who inheritedtwo copies of the mutation – one from eachparent – had a two-fold increased risk of thedisease. “These findings suggest that screen-ing men for this mutation may be justified infuture risk assessment of prostate cancer,”says Dr. Casey. Study collaborators from theCleveland Clinic Lerner Research Instituteincluded Robert Silverman, Ph.D.; Phillippa J.Neville, Ph.D.; Sarah J. Plummer; Lisa M.Krumroy; and Ying Xiang, Ph.D.

STUDY OF FEMALE PELVIC FLOOR DISORDERS

Despite the fact that 50 percent of Americanwomen are affected by pelvic floor disorders,there is remarkably little basic science andclinical research on these disorders. To remedythis shortcoming, Firouz Daneshgari, M.D.,Glickman Urological Institute, is undertaking amajor academic research project that will helpdevelop new knowledge of and treatments forfemale pelvic problems. Dr. Daneshgari’s proj-ect includes the design and implementation ofclinical and basic science research projectsthat address the problems of female pelvicdisorders such as urinary incontinence, pelvicorgan prolapse and bladder control problems,and more focused collaboration among clinicalinvestigators.

AN INNOVATIVE NEW PROGRAM SEES THE

CLEVELAND CLINIC AND CASE WESTERN RESERVE

UNIVERSITY JOINING FORCES TO MEET A CRITICAL

EDUCATIONAL NEED.

2 0 0 2 A N N U A L R E P O R T 31

Steveland Arnold, Cleveland Clinic/John Hay Partnership graduate

EDUCATING FOR THE FUTURE

The Cleveland Clinic Division of Educationcontinues to impact the future of medicinethrough a wide-ranging and expanding arrayof programs. In 2002, the division continuedto operate one of the largest graduate medicaleducation programs in the country, with 683residents and fellows in ACGME/ABMS programs at The Cleveland Clinic, and 121 inadvanced fellowship programs. Every year,these numbers increase in response toadvances in medicine, and 2002 was noexception. Seven new advanced fellowshipswere added, including cardiovascular tomog-raphy, female pelvic medicine and reconstructivesurgery, gynecologic laparoscopic surgery,hospital medicine, medical informatics, obstetricanesthesia, and urologic laparoscopic surgery.The Division’s Department of ContinuingMedical Education sponsored 509 activities in2002 (almost double the number five yearsago) with more than 110,000 participants,half of whom received CME credits online.The Department of Patient Education andHealth Information continued to expand itsaudience as well. Services supported byPatient Education include CCTV in-hospitalprogramming, public health talks, JewishCommunity Center health exchange programs,Cleveland Clinic Health System smoking pre-vention programs, and five health informationkiosks around campus. The department alsois responsible for the Clinic’s HealthInformation Center Web site (www.cleveland-clinic.org/health), which offers a broad rangeof information on the body, its diseases andtreatments. The Web site grew to 3,470 docu-ments in 2002, and 343,907 health infor-mation searches were performed by patients and the public.

THRIVING IN FLORIDA

Cleveland Clinic Florida continues to thrive inWeston and Naples, enjoying unprecedentedgrowth driven by multiple factors, including aninflux of top physicians, expanded programs andrecognition from the community in the form ofincreased patient visits. Twenty-nine ClevelandClinic Florida physicians were listed amongthe nation’s top doctors in 2002. Outstandingnew physicians were added to the staff in both Weston and Naples in a variety of specialties, including cardiology, neurosurgery,orthopaedic surgery and vascular surgery.New procedures and programs includeepilepsy surgery, a Center of Excellence forParkinson’s disease, cardiac electrophysiologicstudies, a highly successful bariatric surgeryprogram, and the expansion of robotic-assistedtechnology for minimally invasive surgery fromcardiac surgery to general surgery. A $10 mil-lion charitable contribution from John andMargaret A. Krupa, given for future developmentof Cleveland Clinic Florida, will ensure thatadditional state-of-the-art services can beadded in response to need and demand.Patients from throughout the region and theUnited States continue to seek care atCleveland Clinic Florida. The number of inter-national patients seeking both primary careand specialty services has grown exponentiallythroughout the Caribbean and Central andSouth America. Cleveland Clinic Florida’sgraduate medical education programs are ingreat demand. The internal medicine residencyprogram likely will expand from seven to 10residents per year. Cleveland Clinic Floridacontinues to maintain an active presence inboth communities by conducting free medicalseminars and partnering with communityorganizations to offer free health care screeningsand increase the awareness of risk factors andappropriate care for particular medical condi-tions. Service excellence, always a goal, hasnow taken center stage with a new initiativecalled World Class Service. In addition tofocusing on continual improvement in serviceto patients, their families and physicians, theinitiative seeks to make Cleveland ClinicFlorida the health care employer of choice inboth Broward and Collier counties.

COMMUNITY SERVICE RECOGNITION

The Cleveland Clinic was one of 11 recipients ofthe 2002 Pillar Award for Community Service.This award, developed by Smart BusinessNetwork and Medical Mutual, honors busi-nesses and organizations that make outstand-ing contributions to their communities. One ofthe many programs recognized by the PillarAward was the Clinic’s partnership with John Hay High School. The Cleveland Clinic/ John Hay High School Educational Partnershipoffers the opportunity for students to attainequal access to higher education and employ-ment following high school graduation. Theprogram emphasizes health sciences, healtheducation and health career awareness, andblends in-depth study of health sciences withopportunities for learning and exposure to various careers in health care. In addition tothe Pillar Award, The Cleveland Clinic receiveda certificate of special recognition from theUnited States Congress for the AGAPEHIV/AIDS outreach program, a partnershipwith Antioch Baptist Church.


Generous Donors Support The Cleveland Clinic

GRATEFUL KIDNEY RECIPIENT THANKS

THE CLINIC FOR SAVING HIS LIFE.

TRANSPLANT LANDMARKS

Since 1963, when The Cleveland Clinic per-formed the first kidney transplant in Ohio andbecame a recognized pioneer in the field oftransplantation, the Clinic has been committedto expanding the staff, resources and technicalsupport necessary to stay in the forefront oftransplant technology. In 2002, the TransplantCenter achieved a number of milestones:

Nation’s Best Heart Transplant ResultsThe Cleveland Clinic’s Heart Transplant Programat the Kaufman Center for Heart Failure wasthe only one of 168 U.S. heart transplant pro-grams to achieve better-than-expected patientsurvival rates at three different time periodsafter transplant, according to data released bythe U.S. Organ Procurement and TransplantationNetwork (OPTN) and the Scientific Registry ofTransplant Recipients (SRTR). The Clinic’sprogram is the third largest in the UnitedStates and overwhelmingly the largest in Ohio.

300th Lung Transplant The Cleveland Clinic Lung Transplant Program –Ohio’s largest program and one of the fivemost active programs in the United States –completed its 300th lung transplant in 2002.The Clinic’s first lung transplant was per-formed in February 1990.

600th Liver TransplantJ. Michael Henderson, M.D., chairman ofGeneral Surgery and director of the TransplantCenter, performed The Cleveland Clinic’s600th liver transplant in 2002. The Clinic’sfirst liver transplant was performed inNovember 1984.

Carl and Babs Glickman

Normally, undergoing a kidney transplant is a physically and emotionally challenging experience for a patient. When Carl Glickman, a distinguished fellow of The ClevelandClinic, faced the procedure, he also required preliminary surgery for diverticulitis and kidney cancer. While such an ordeal might have left some defeated, Mr. Glickman says of hisCleveland Clinic experience, “I was encouraged all the way.”

To show his thanks for the expert diagnosis, treatment and supportive care he received, theCleveland businessman and his wife, Babs, donated $8 million to the Clinic’s UrologicalInstitute. The inspiration for the generous gift? “They saved my life,” Mr. Glickman states simply.

In honor of the couple, the facility has been renamed the Glickman Urological Institute ofThe Cleveland Clinic. This is not the first time the two have contributed to the Clinic.

“Carl Glickman has been a Cleveland Clinic patient for 25 years and a leadership donor inall four of the Clinic’s fund-raising campaigns. The commitment that he and his wife haveshown toward our urology program is humbling,” says Andrew C. Novick, M.D., chairmanof the Glickman Urological Institute. “The Glickmans’ generous gift will support our effortsto learn even more and improve treatment in all areas of urology.”

U.S.News & World Report has ranked the Glickman Urological Institute staff of 55 physiciansand scientists second in the United States for the past three years and the best in Ohio everyyear since 1990.

Mr. Glickman currently serves as a director of Bear Stearns Companies Inc., presiding trusteeof Lexington Corporate Properties Trust and a trustee of Cleveland State University. Mrs.Glickman is a director of the Cleveland Institute of Music.

2 0 0 2 A N N U A L R E P O R T 33

EMERGENCY SERVICES SERVES AS GATEWAY

BETWEEN CLINIC AND COMMUNITY.

Allan Siperstein, M.D.

Sam and Maria Miller

If you ask Sam Miller, no one can put a dollar value on a human life. There’s no doubt,though, that $8 million could help save countless lives.

Mr. Miller and his wife, Maria, recently made such a commitment to The Cleveland Clinic,naming the Sam and Maria Miller Emergency Services Building. Mr. Miller, co-chairman ofForest City Enterprises Inc. and a Clinic trustee and executive committee member, holdsemergency care close to his heart.

“I find The Cleveland Clinic to be a veritable lifesaver, for Cleveland and the entire world,”Mr. Miller says. He refers to the emergency treatment facility as the “gateway to the Clinic,a place where the poor and rich can go.” His efforts have proved instrumental to the Clinic’sdebut in emergency services.

“Sam’s gift goes far beyond the naming of the building,” says Floyd D. Loop, M.D., chairmanand CEO of The Cleveland Clinic. “He has formed vital relationships with our physiciancommunity and has shown great leadership in the development of emergency services fromThe Cleveland Clinic.”

The Emergency Services Building, which opened in 1994, houses an emergency treatmentarea and a “fast-track” and minor illness area. The facility is adjacent to a Clinical DecisionUnit shared with Kaiser Permanente. In this unit, patients who do not require immediatehospitalization may be observed and treated for up to 24 hours.

While the Millers’ recent support focuses on emergency services, “this gift was given inappreciation for the doctors, nurses and all employees at The Cleveland Clinic,” saysMr. and Mrs. Miller.

THERAPY INCREASES SURVIVAL TIME FOR LIVER CANCER

Patients with inoperable liver cancer whoundergo a combination of chemotherapy andradiofrequency thermal ablation, a type oftherapy that applies heat to destroy tumors,live longer than patients treated withchemotherapy alone, according to a study byAllan E. Siperstein, M.D., General Surgery.“These findings are particularly significantgiven more than 2 million patients worldwidewill develop primary and metastatic liver cancer, and chemotherapy has limited effica-cy for these patients,” says Dr. Siperstein.

As of March 2003 *Executive Committee **Emeritus Trustee

The Cleveland Clinic Foundation


BOARD OF TRUSTEES

OFFICERS

A. Malachi Mixon, III *Chairman and Chief Executive Officer Invacare CorporationChairman, Board of Trustees The Cleveland Clinic Foundation

Floyd D. Loop, M.D. *Chief Executive OfficerChairman, Board of GovernorsExecutive Vice President The Cleveland Clinic Foundation

Stephen R. Hardis *Chairman and Chief Executive Officer (Retired)Eaton Corporation Vice PresidentThe Cleveland Clinic Foundation

MEMBERS

Theodore M. Alfred, Ph.D. **Professor Emeritus and Dean Emeritus Weatherhead School of Management Case Western Reserve University

Patrick V. AulettaPresidentKeyBank, N.A.

Nancy F. Beck, Esq. *Former ProsecutorCity of Cleveland

Edward F. Bell **President and Chief Executive Officer (Retired)The Ohio Bell Telephone Company

Gordon R. Bell, M.D.*The Cleveland Clinic Foundation

James M. Biggar **Chairman and Chief Executive OfficerGlencairn Corporation

Edward B. Brandon **Chairman and Chief Executive Officer (Retired)National City Corporation

Jeanette Grasselli Brown, DSc. **ChairOhio Board of Regents

Flora M. CafaroVice President and Assistant TreasurerThe Cafaro Company

F. Joseph Callahan **Chairman (Retired)Swagelok Company

Bruce A. CarbonariPresident and Chief Executive OfficerFortune Brands – Home and Hardware

Guy M. Chisolm, Ph.D. The Cleveland Clinic Foundation

Jeffrey A. ColeChief Executive OfficerCole National Corporation

Thomas A. Commes *President and Chief Operating Officer (Retired)The Sherwin-Williams Company

William E. Conway * **Chairman Fairmount Minerals, Ltd.

William R. CosgroveChairman and Chief Executive OfficerSwagelok Company

Thomas M. CoughlinPresident and Chief Executive OfficerU.S. Operations Wal-Mart Stores, Inc.

Robert Cunningham, M.D.The Cleveland Clinic Foundation

E. M. de Windt **Chairman and Chief Executive Officer (Retired)Eaton Corporation

Umberto P. FedeliPresident and Chief Executive OfficerThe Fedeli Group

Gay Gilanyi, Ed.D.Professor, Teachers CollegeColumbia University

Lilian V. Gonsalves-Ebrahim, M.D.The Cleveland Clinic Foundation

Joseph T. GormanChairman (Retired)TRW Inc.PresidentMoxahela Enterprises

William R. GortonSenior Vice PresidentDawson Companies

Cynthia Gutierrez, M.D.The Cleveland Clinic Foundation

Gordon E. Heffern **Chairman and Chief Executive Officer (Retired)Key Bank, N.A.

David J. Hessler, Esq. *Wegman, Hessler & Vanderburg

David G. Hill, Esq. **David G. Hill & Associates, Co.

Arthur S. Holden, Jr. **Vice President (Retired)The Coe Manufacturing Company

Elton Hoyt, III **President and Chief Executive Officer (Retired)Pickands Mather & Co.

James A. Hughes **Chairman (Retired)First Union Real Estate InvestmentsDiamond Shamrock Corporation

Ruth K. Imrie, M.D.The Cleveland Clinic Foundation

Jerry V. Jarrett **Chairman and Chief Executive Officer (Retired)AmeriTrust Corporation

E. Bradley Jones **Chairman and Chief Executive Officer (Retired)Republic Steel Corporation

John J. Kahl, Jr. *PresidentJack Kahl & Associates, LLC

Robert D. KainSenior Executive Vice PresidentIMG

Robert Kay, M.D. *Chief of StaffVice Chairman, Board of GovernorsThe Cleveland Clinic Foundation

John W. Kemper, Sr.Chief Executive OfficerAvalon Precision Casting Co.Vice President, Treasurer Kemper House

Thomas G. Knoll, Esq.Stark & Knoll Co., L.P.A.

Stephen F. Lau, Ph.D. *PresidentIndustrial First, Inc.

Robert L. Lintz *Plant Manager (Retired)Parma Metal Fabricating DivisionGeneral Motors Corporation

William E. MacDonald **President and Chief Executive Officer (Retired)The Ohio Bell Telephone Company

William E. MacDonald, III *Vice ChairmanNational City Corporation

Patrick F. McCartan, Esq. *Managing Partner (Retired)Jones Day

John V. McFadden *Vice Chairman (Retired)MTD Products

Robert F. MeyersonChairman (Retired)Telxon Corp.

Samuel H. Miller * ** Co-Chairman of the Board Forest City Enterprises, Inc.

James P. MooneyChairman and Chief Executive OfficerOM Group, Inc.

Dan T. Moore, III *PresidentThe Dan T. Moore Company, Inc.

David T. Morgenthaler **Managing PartnerMorgenthaler Ventures

Bert W. MoyarPresidentMEI Hotels Incorporated

William C. MulliganManaging DirectorPrimus Venture Partners

James R. NevilleExecutive Vice PresidentChristian & Koppler, Inc.

Carmen A. PolicyPresident and Chief Executive OfficerThe Cleveland Browns

Robert E. Rich, Jr.President Rich Products Corporation

Paul G. Rogers, Esq. **Hogan & Hartson

Ronald J. Ross, M.D., F.A.C.R.Director EmeritusDepartment of RadiologyHillcrest Hospital

Hassib J. Sabbagh **Chairman Consolidated Contractors InternationalCompany, S.A.L.

Bill R. SanfordChairman SYMARK LLC

Joseph M. Scaminace *President and Chief Operating Officer The Sherwin-Williams Company

Ralph E. Schey **Chairman and Chief Executive Officer (Retired)The Scott Fetzer Company

Martin J. Schreiber, M.D.The Cleveland Clinic Foundation

Samuel K. ScovilChairman and Chief Executive Officer (Retired)Cleveland-Cliffs Inc

The Honorable Raymond P. Shafer**Former Governor, State of Pennsylvania Shafer, Swick, Bailey, Irwin, Stack & Millin

2 0 0 2 A N N U A L R E P O R T 35

John Sherwin, Jr.PresidentMid-Continent Ventures, Inc.

Jack C. Shewmaker *Chief Financial Officer (Retired)U.S. OperationsWal-Mart Stores, Inc.PresidentJ-Com, Inc.

James P. Storer **Past PresidentCleveland Sight CenterTrustee & SecretaryGeorge B. Storer Foundation

Ralph A. Straffon, M.D. **Chief of Staff (Retired)The Cleveland Clinic Foundation

Thomas C. Sullivan, Sr.Chairman and Chief Executive OfficerRPM, Inc.

Brian J. TaussigPresident and Chief Executive OfficerClassic Direct, Inc.

C. Carlisle Tippit **President (Retired)Mogul Corporation

Robert J. Tomsich *Chairman NESCO, Inc.

Thomas V.H. Vail **Publisher and Editor (Retired)The Cleveland Plain Dealer

Tom WambergChairman and Chief Executive OfficerClark/Bardes Consulting

Morry Weiss *Chairman and Chief Executive OfficerAmerican Greetings Corporation

Alton W. Whitehouse **Chairman and Chief Executive Officer (Retired)Standard Oil Company of Ohio

Herbert P. Wiedemann, M.D.The Cleveland Clinic Foundation

Loyal W. WilsonManaging DirectorPrimus Venture Partners

Ivan J. Winfield *Managing Partner (Retired)Coopers & Lybrand Northeast Ohio Office

Ambassador Milton A. Wolf, Ph.D.**Former U.S. Ambassador to AustriaChairmanMilton A. Wolf Investors

ADMINISTRATION

Floyd D. Loop, M.D.Chief Executive Officer Chairman, Board of Governors

Robert Kay, M.D.Chief of StaffVice Chairman, Board of Governors

Muzaffar Ahmad, M.D.ChairmanDivision of Medicine

Gene AltusAdministrator, Board of GovernorsAssistant Secretary

Philip L. Bailin, M.D.Director Office of Practice Management

James M. BlazarChief Marketing OfficerChairman, Division of Marketing

David L. Bronson, M.D.ChairmanDivision of Regional Medical Practice

Angela M. CalmanChief Communication OfficerPublic & Media Relations

John D. Clough, M.D.ChairmanDivision of Health Affairs

Christopher CoburnExecutive DirectorCCF Innovations

Robert W. Coulton, Jr.AdministratorOffice of Professional Staff Affairs

Paul E. DiCorleto, Ph.D.ChairmanLerner Research Institute

F. George Estafanous, M.D.ChairmanDivision of Anesthesiology

Melinda L. Estes, M.D.Chief Executive Officer Cleveland Clinic Florida

Andrew J. Fishleder, M.D.ChairmanDivision of Education

Joseph F. Hahn, M.D.ChairmanDivision of Surgery

C. Martin Harris, M.D.Chief Information OfficerChairman, Information Technology Division

William R. Hart, M.D.ChairmanDivision of Pathology and Laboratory Medicine

Robert Ivancic, J.D.Executive DirectorDivision of Human Resources

Stuart W. KlineDirectorEnvironmental Health and Safety

Hilel Lewis, M.D.Director, Cole Eye InstituteChairman, Division of Ophthalmology

Bruce A. LoessinSenior Vice President andChairman & Executive DirectorInstitutional Relations and Development

Alan E. London, M.D.Executive DirectorDivision of Managed Care

Frank L. LordemanChief Operating Officer

Walter G. Maurer, M.D.DirectorOffice of Quality Management

Michael T. Modic, M.D.ChairmanDivision of Radiology

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

Daniel E. NickelsonDirectorGovernment Affairs

Michael P. O’Boyle, C.P.A.Chief Financial Officer

Lisa RamageExecutive DirectorInternational Center

Susan J. Rehm, M.D.Associate Chief of Staff

David W. Rowan, Esq.Secretary and General Counsel

Richard A. Rudick, M.D.ChairmanDivision of Clinical Research

Anthony J. Senagore, M.D.Medical DirectorMedical Operations

Donald SinkoDirectorInternal Audit

John E. Steiner, Jr., Esq.DirectorCorporate Compliance

James K. Stoller, M.D.Associate Chief of Staff

Eric Topol, M.D.Chief Academic Officer

Shawn Ulreich, R.N., M.S.N. Chief Nursing OfficerChairman, Division of Nursing

T. Declan Walsh, M.D.ChairmanDivision of Post Acute Medicine

Steven D. Wexner, M.D.Chief of StaffCleveland Clinic Florida (Weston)

Robert J. Zehr, M.D. Chief of StaffCleveland Clinic Florida (Naples)

BOARD OF GOVERNORS

Floyd D. Loop, M.D.Chairman

Robert Kay, M.D.Vice Chairman

Frank L. LordemanChief Operating Officer

Michael P. O’Boyle, C.P.A.Chief Financial Officer

Eric Topol, M.D.Chief Academic Officer

Gene H. Barnett, M.D.

Gordon R. Bell, M.D.

David L. Bronson, M.D.

Linda M. Graham, M.D.

Eric Klein, M.D.

Walter G. Maurer, M.D.

Michael T. Modic, M.D.

Martin J. Schreiber, M.D.

Herbert P. Wiedemann, M.D.

PATIENT CARE 2002 2001

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

Emergency Visits 50,561 50,194

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

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

Surgical Cases 65,684 62,445

Operating Rooms 78 77

EDUCATION

Residents and Fellows in Training 804 767

Medical Students 548* 459

Accredited Residency Training Programs 51 51

Allied Health Students 305 265

Programs for Allied Health Specialists 29 32

RESEARCH

Total NIH Multiyear Grants Awarded 187 150

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

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

Other Funding $5.1m $4.36m

FACILITIES

Million Square Feet of Campus Building Space 6.3 6.0


2.5

3.0

1999 2000 2001 20020

2.0

1.5

1.0

0.5

50

55

1999 2000 2001 200225

45

40

35

30

60

70

1999 2000 2001 20020

50

40

30

20

10

TOTAL CLINIC VISITS

(in millions)

ADMISSIONS

(in thousands)

SURGICAL CASES

(in thousands)

THE CLEVELAND CLINIC FOUNDATION

1999–2002 TREND ANALYSISTHE CLEVELAND CLINIC FOUNDATION STATISTICAL HIGHLIGHTS

CLEVELAND CLINIC HEALTH SYSTEM FINANCIAL HIGHLIGHTS†

$ IN THOUSANDS 2002 2001

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

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

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

Charity Care 157,300 125,600

†Current year estimates subject to final year-end audit.

THE CLEVELAND CLINIC FOUNDATION AT A GLANCE

*From 70 medical schools.

In 2002, The Cleveland Clinic launched an unprecedented effort to enhance patient satisfac-tion and create a permanent service culture for all personnel. Called World Class Service, theprogram involves every department and every employee in an ongoing effort to implement newideas and make a difference in service, people, quality, growth and finance. It is an investmentin the future of patient care. Through World Class Service, The Cleveland Clinic intends toachieve a reputation for service and patient satisfaction equal to its achievements in medicine.

WORLD CLASS SERVICE

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THE CLEVELAND CLINICFOUNDATION

9500 Euclid Avenue, Cleveland, Ohio 44195

Please visit our Web site at www.clevelandclinic.org

Documents

The Cleveland Clinic 2002 Annual Report Investing in the