Time was, if you lived in West Virginia and had a major health problem, you had little choice but to go to Cleveland, Pittsburgh or elsewhere to seek the kind of medical treatment you needed.

That’s no longer the case.

Today, West Virginia offers a broad range of sophisticated medical services unheard of just a few years ago. And make no mistake about it, the hospitals offering that advanced level of care are big business in West Virginia. Big and getting bigger.

The West Virginia Hospital Association lists 63 hospitals and health systems of varying sizes as members. Another half a dozen more are, for various reasons, not members of the association. Thirty of West Virginia’s 55 counties have at least one hospital. Twelve counties have two or more. Thirteen counties have no hospital.

Collectively, West Virginia’s hospitals last year contributed $9.8 billion to the state’s economy. They employ more than 44,000 people — doctors, nurses, support staff and others. That represents more than $2.6 billion in payroll and benefits expenses. Check the list of the state’s 100 largest private employers, and you’ll find 15 of them are hospitals.

A few statistics offer a look at the vital role West Virginia’s hospitals play. In 2017, they:

Admitted more than 245,000 patients.

Provided care for more than 7 million outpatient visits.

Treated patients in more than 1.2 million emergency department visits.

Performed 270,000 surgeries.

Welcomed more than 19,500 newborns into the world.

Trained 737 medical residents.

•••

With around 15,000 employees,

West Virginia University Medicine

is one of the largest private employers in the state.As a land grant university, WVU automatically has a statewide mission, one it doesn’t take lightly, said Albert L. Wright Jr., WVU Medicine president and CEO. “We think that’s very important,” he said. “In many ways, the state relies on us for excellent healthcare, wellness and advanced specialty care.”

In 1960, WVU opened a teaching hospital in Morgantown as a component of the university’s medical center. That original facility is now the WVU Health Sciences Building.

In 1986, West Virginia University Hospitals Inc. began construction of its current facility, J.W. Ruby Memorial Hospital, a 10-story, 500,000-square-foot structure that began operating in 1988. Ruby Hospital is a tertiary care referral center and serves as the principal clinical education and research site for the WVU School of Medicine. As part of its 690-bed complement, the hospital operates a 119-bed Children’s Hospital.

The health system now known as WVU Medicine was formed in 1996 with Ruby Memorial Hospital and United Hospital Center as the original two hospital members. Since then, the system has grown dramatically. Today, it has nine hospitals throughout the state, and one in Maryland.

Ruby Hospital in Morgantown is the largest hospital in the system and serves as its flagship. Other hospitals in the system include four community hospitals (United Hospital Center in Bridgeport, Camden Clark Medical Center in Parkersburg, Berkeley Medical Center in Martinsburg, and Reynolds Memorial Hospital in Glen Dale) and three critical access hospitals (St. Joseph’s Hospital in Buckhannon, Jefferson Medical Center in Ranson and Potomac Valley Hospital in Keyser).

WVU Medicine also has a variety of clinical and operational affiliations with dozens of hospitals across the West Virginia-Pennsylvania-Maryland region, including Wetzel County Hospital in New Martinsville, Davis Health System in Elkins and Garrett Regional Medical Center in Oakland, Maryland.

The system also includes a number of specialized medical institutes, including the WVU Cancer Institute, WVU Eye Institute, the WVU Heart and Vascular Institute and the WVU Rockefeller Neuroscience Institute.

In 2017, WVU Medicine announced plans to construct a 10-story tower to better serve the needs of West Virginia’s women and children. When completed in 2020, the $152 million project will add 150 beds to Ruby Hospital.

“As West Virginia’s leading academic medical center, we have a responsibility to the children of our state and their parents to provide the highest level of care close to home,” said Wright. “The demand for our services has increased so that we must grow in order to meet their needs.”

A capital campaign has been launched to raise $60 million for the project. WVU Medicine will finance the remainder of the cost. No state funds will be sought, and no extraordinary rate increase is anticipated as a result of the construction.

At a Sept. 19 news conference, WVU Medicine announced it plans to start West Virginia’s first heart transplant program at its Heart and Vascular Institute.

Gordon Gee, WVU president and chair of the WVU Health System Board of Directors, said, “As a land-grant institution, West Virginia University’s purpose is to help people when it matters most. In a state where heart disease is the leading cause of death, that means making state-of-the-art cardiac care available close to home. Offering heart transplantation here is another huge advance toward a healthier West Virginia.”

Currently, there are 22 West Virginia residents on the waiting list for a heart transplant. Those residents generally have to travel to Pittsburgh or Cleveland to receive their transplants.

“We need to end this out-migration of West Virginia residents, and allow West Virginia residents to receive heart transplants in West Virginia,” Gov. Jim Justice, who attended the news conference, said. “This is for the benefit of all West Virginians, and all West Virginians should support this measure. It’s about our people, and our people deserve to have this life-saving care available to them right here at home.”

•••

In the Charleston area, Charleston Area Medical Center (CAMC) is the largest health system, operating four branches, with a total of 956 beds, more than 6,000 employees and 668 doctors on staff.The largest branch is CAMC Memorial Hospital, located in the Kanawha City neighborhood. It’s home to one of the highest volume heart programs in the United States. Each year, its physicians perform about 8,000 procedures in the cardiac catheterization labs and more than 1,600 open-heart bypass surgeries. The campus is the site of a comprehensive diabetes center, family medicine and internal medicine clinics, Vascular Center of Excellence and general medical-surgical inpatient services.

The second largest branch is CAMC General Hospital, located in downtown Charleston, which focuses on neurology, orthopedics, trauma and rehabilitation care.

Each year, its experienced Trauma Center staff cares for more than 3,000 patients. Plus, nearly 1,500 patients also receive neurosurgery and medical rehabilitation services.

Opened in 2015, the three-story CAMC Cancer Center is located directly across MacCorkle Avenue street from CAMC Memorial Hospital in the site that formerly housed Watt Powell Park. The CAMC Cancer Center offers comprehensive cancer care.

Each year, more than 3,000 babies are born at the system’s third campus, CAMC Women and Children’s Hospital, located on the banks of the Elk River in Charleston. Its pediatric physicians provide consultation and care in more than 30 specialties.

The system’s fourth campus, CAMC Teays Valley Hospital, is a 70-bed hospital located in Hurricane. More than 100 doctors have privileges to practice at the hospital. Along with physicians, nearly 400 nurses and non-clinical staff serve the residents of Putnam County and surrounding areas with emergency services and other specialized care.

CAMC is a teaching institution with a number of education affiliations, the most significant of which is an agreement with West Virginia University. Under the agreement, CAMC hospitals function as training sites for WVU medical students and WVU medical faculty supervise CAMC residents and fellows.

Looking for a way to improve its operations, CAMC took a leaf out of Toyota’s playbook. Several years ago, the CAMC system turned to the Toyota Motor Manufacturing plant at Buffalo in Putnam County, asking plant staffers to teach it the fundamentals of the Japanese automaker’s time-honored management processes.

The change didn’t happen overnight, but over time the impact on the hospital system’s operations was dramatic — so much so that in 2015 CAMC received the Malcom Baldridge National Quality Award, the nation’s highest honor for performance excellence.

The award, says David Ramsey, the system’s president and CEO, was “a critical recognition that our employees and physicians are committed to performing at the level necessary to maintain our services in these difficult economic times.”

•••

Charleston area patients are also served by Thomas Health System, a partnership that was forged in 2007 between two established hospitals — Thomas Memorial and Saint Francis. The merged system has 383 beds, more than 1,800 employees and 450 physicians.Both hospitals have rich histories of serving the community.

Saint Francis Hospital was organized in 1913 as a 25-bed hospital operated by the Sisters of Saint Francis of Perpetual Adoration from Williamsville, New York. The Sisters of St. Francis were recalled to New York in 1921 and the Sisters of Saint Joseph of Wheeling sent five sisters to administer the hospital.

Through the Sisters of Saint Joseph, the first formal medical staff was formed in the 1930s and a foundation put in place for decades of “extending Christ’s mission of healing with justice and charity toward the sick and all who care for them.”

Throughout its long history, Saint Francis has remained in its original location. It opened in the former Laidley mansion at 333 Laidley Street but quickly outgrew it. In 1917, a new hospital was built, and, over the years, additional construction transformed the old hospital into the modern medical complex Charlestonians are familiar with today.

Located in South Charleston, Thomas Memorial Hospital opened in 1946 and was named in memory of a South Charleston resident and West Virginia’s first Medal of Honor recipient. Marine Corps Sgt. Herbert J. Thomas Jr. was killed in World War II when he covered an exploding grenade with his own body, saving the lives of his fellow Marines.

Originally, Thomas Memorial had 70 beds and 100 employees. Throughout the years, like many hospitals, it has been steadily renovated and expanded while increasing the services it provides. By 2005, it was three times its original size with 261 beds and more than 1,000 employees. In 2010, it opened a six-floor $70 million addition.

Thomas Memorial’s services include a level 4 trauma center, a full-service regional cancer center, a sleep disorder center, joint replacement surgery and therapy, a cardiac catheterization lab, an imaging center, and, for substance abuse and mental health services, a Behavioral Health Center, among other services.

•••

The growth of Huntington into a major healthcare center can be credited in large measure to establishment of the Marshall University

School of Medicine

, which admitted its first students in 1978. In its 40-year history, the Marshall Medical School, now named for benefactor Joan C. Edwards, has attracted a cadre of talented physicians who have put down roots here. At the same time, the region’s hospitals have continuously expanded to provide the latest facilities and equipment.Now, healthcare in the Huntington area is entering a dramatic new chapter. After nearly four years of debate and delay, long-time rivals Cabell Huntington Hospital and St. Mary’s Medical Center have now officially joined forces as partners in a new healthcare team.

“Uniting for a common purpose is really powerful,” said Dr. Kevin Yingling, chairman of the Cabell Huntington Hospital Board of Directors. “Unification will provide a pathway to outcomes and successes not possible if we remained separate.”

Cabell Huntington signed an agreement in 2014 with Pallottine Health Services to acquire St. Mary’s. The proposed acquisition immediately made headlines and remained very much in the news as the agreement moved forward, attracting supporters and opponents and ending up in court. But the legal questions were successfully resolved. The final step clearing the way for completing the deal was Vatican approval, which came earlier this year.

“Due to the declining number of sisters in our community, we are no longer able to continue our health care ministry,” said Sister Mary Grace Barile, the provincial of the Pallottine Missionary Sisters at St Mary’s. “We are transferring the leadership of our health care ministry to Cabell Huntington Hospital for the benefit of the community and the patients we both serve.”

Kevin Fowler, president and CEO at Cabell Huntington, said the agreement provides an opportunity for both hospitals to work together and share the best practices in quality and patient experience that will move care in the region to the next level.

“We look forward to continuing as independent entities, yet challenging each other to improve specialized services, implementing new technologies and defining the future health care for this region and beyond,” Fowler said.

Michael Sellards, president and CEO of St. Mary’s, noted that it has grown to be “the seventh largest corporation in the state of West Virginia. If you were to ask the reasons for that, I could tell you that a core reason was the guiding hand and constant guiding principles of the Pallottine Sisters. So when they were forced to an unfortunate and very, very difficult decision, they decided they had to find just the right partner to carry that mission forward.”

“Over the course of a number of months, through due diligence, a national search was convened to find that right partner,” Sellards said. “As it turned out, we didn’t have to go 2,000 miles to find the right partner. We didn’t have to go 200 miles to find the right partner. We didn’t even have to go 20 miles to find the right partner, because 2 miles from the core of St. Mary’s is Cabell Huntington Hospital, and that is the right choice.”

Founded in 1924, St. Mary’s is the larger of the two Huntington hospitals. With more than 2,600 employees and 393 beds, it’s one of the largest health facilities in West Virginia. It prides itself on its medical expertise in cardiac care, cancer treatment, emergency/trauma services, neuroscience and orthopedics.

Long a teaching facility, it’s home to the St. Mary’s School of Nursing, St. Mary’s School of Medical Imaging and St. Mary’s School of Respiratory Therapy.

Opened in 1956, Cabell Huntington cares for patients from more than 29 counties in West Virginia, eastern Kentucky and southern Ohio. It has 303 beds. Its Edwards Comprehensive Cancer Center opened in 2006 and its Hoops Family Children’s Hospital in 2012.

Marshall President Jerry Gilbert has labeled the merger of the two hospitals a “once in a lifetime opportunity” for the MU medical school and the community. The merger, Gilbert has said, “is going to present tremendous opportunities for our medical school to enhance and expand its services, its residency programs, its scope of care and its medical research.”

“There is an excellent chance,” Gilbert said, “the comprehensive academic medical center created by the full integration of Cabell Huntington, St. Mary’s and the Marshall Medical School will become a destination medical center — along the lines of some of the top clinics and hospitals in the nation.”

•••

The West Virginia Hospital Association now offers a new digital resource detailing services, events and careers at West Virginia’s hospitals. Association president and CEO Joseph M. Letnaunchyn describes the website as a “one-stop shop for health-care consumers.”The site —

HospitalSmartWV.com

— is the first of its kind, according to Jim Kranz, the association’s vice president of quality and data services. The site includes three options users can access.

The first is the healthcare services each hospital offers. Second is a calendar listing all community health care activities happening across the state. The final option offers information about healthcare careers.

James E. Casto is the retired associate editor of the Huntington Herald-Dispatch and the author of a number of books on local and regional history.