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t m c p u l s e | m a r c h 2 02 0 23 rehabilitation, Bower said, and the pending merger will allow those patients to receive care at one location. "Shriners as a whole is seeing more patients than before, but the majority are in an outpatient setting," Bower said. "That's a trend in health care and pediatrics." The merger aims to create a stronger facility with a bigger footprint. "It's going to be Shriners Hospitals for Children – Texas," Ashley said. With a single Texas facility, the Houston chairman emeritus added, Shriners also intends to devote more time to researching some of the conditions it treats. "Cleft lip and palate? They still don't really know what causes it," Ashley said. "If we could figure out the genetic cause and find a fix for it, what kind of impact would that have on humanity?" 100 years in Houston Shriners – Houston, in one form or another, has existed for a century. The Houston facility traces its ori- gins to the Arabia Temple Crippled Children's Clinic that was housed inside the Baptist Sanitarium in downtown Houston between 1920 and 1932. After moving several times and sharing space with other hospitals, the current hospital in the Texas Medical Center—located near Main Street and Holcombe Boulevard—opened in 1996. In 2018, Shriners – Houston provided care for more than 450 inpatients and more than 10,000 outpatients, according to the hospi- tal's 2018 annual report. When asked what will happen to the Houston building, which the Shriners own, Bower said: "We're looking at a timeline so elongated that the building conversation is secondary. … Part of it is using our Galveston facility more efficiently." A different mindset Shriners Hospitals are funded through donations and an endow- ment that the hospitals draw from each year. Shriners International, the fraternal arm of the organiza- tion, also donates money to the hospitals, including transportation fees, Martin said. To bring a pediatric patient from South America to Galveston on an emergency medical flight costs $15,000 to $20,000, Martin said, adding that Shriner's – Galveston cared for some of the children who were injured after the Volcán de Fuego, or Volcano of Fire, erupted in Guatemala in June 2018. "Especially with a burn patient, the quicker we get them here, the better the outcome," Martin said. Over the past decade, Shriners Hospitals started accepting medi- cal insurance, including Medicaid and Medicare. "Prior to 2008, we were able to survive without having to touch the principal capital on our investments—we could run the hospital system on the interest of our investments," Martin said. "But then everyone's 401Ks and stock investments went in the tank. ... We had money in stocks and bonds—a lot of the same investments that a lot of Fortune 500 companies had— that went down in value, just like everyone else's. That forced us into a different mindset." Shriners – Galveston has a current operating budget of $30 million, Martin said, but that will need to increase when Houston is brought into the fold. "We're not sure where we're going to be," he said. "It's a work in progress. We don't want to do anything to hurt anyone who currently works for us. We want to save as many employees as we can." Ten or 15 years down the road, Shriners Hospitals may look very different, Martin added. Generally speaking, you could walk into a non-Shriner's hospi- tal someday and find one floor dedicated to Shriners patients and services, he said. "To have a hospital takes, for the basics, more than 100 employ- ees," Martin said. "We are more interested in treating kids than having more facilities. We could have many touch points around the country and treat many more kids than we're treating now." Patients and families face adjustment Latonia Jenkins was surprised to learn that Shriners – Houston would be merging with Shriners – Galveston. Her 10-year-old daughter, Madilyn, has cerebral palsy and has benefited for more than three years from surgeries at Shriners – Houston as well as therapy in its esteemed motion analysis center. Before that, the family traveled to the Shriners hospital in Shreveport, Louisiana for treatments. Over the years with Shriners, Madilyn's mobility has improved. "We were driving all the way to Shreveport. The medical center is right there—it's closer," Jenkins said. "Galveston is a little ways. It's another drive." Still, the determined mother plans to continue treatments for her daughter with Shriners. "I don't know what the next step will be, but I'm going to try to stick with them," Jenkins said. Cindy George contributed to this report.

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