OAKLAND -- A typical hospital bed costs $1 a day.

And if you wanted to splurge for a private room? That would set you back $2.50.

Running the entire 38-bed hospital costs $2,000 a month -- more than a quick emergency room visit today.

Things have changed dramatically since nurse Bertha Wright and social worker Mabel Weed began planning an Oakland hospital in 1912 that would have the special equipment and expertise to serve and save children.

After raising $12,500 to buy an old estate at 51st and Dover streets, the women opened what was then known as the Baby Hospital on Sept. 6, 1914.

A century later, Children's Hospital Oakland plays a pivotal role in the East Bay and beyond by treating many of the region's most severely ill -- and some of its most severely indigent -- young people.

Changes and challenges

As it celebrates the 100th anniversary of its founding, the hospital faces major challenges and opportunities, including an upcoming capital campaign to finance $450 million in seismic upgrades and renovations, a possible partnership with UC San Francisco, a new state-of-the-art electronic medical record system, and the financial difficulty of getting by with 70 percent of its patients on Medi-Cal.

Medi-Cal, the state's version of the federal Medicaid program for low-income people, pays only 20 cents for every dollar in costs, hospital officials estimate.

For 100 years, the hospital has survived massive changes in health care and the obstacles in serving everyone, including those who cannot afford to pay, said Dr. Bert Lubin, president and chief executive officer of the hospital.

"We're going to be here for another 100 years," he said.

Children's operates the Bay Area's only level one pediatric trauma center, a designation meaning that it has trauma surgeons and a variety of specialists available around the clock.

It has 300,000 patient visits per year, and its 201 hospital-based physicians provide care in 30 pediatric subspecialties, from neonatology to neurosurgery.

It draws patients from throughout the world for its sickle cell program, which has cured children through bone marrow and cord blood transplants.

Seven-year-old Autumn Leader and her mother, Sylina Maestas, fly to the hospital once a week from their home in Huntington Beach so Autumn can participate in a study for children who have Morquio Syndrome or MPS, a hereditary disorder that stunts growth and causes other problems in people who lack an enzyme that breaks down complex sugars. One of the things Autumn likes best about coming is that she has made new friends, including 11-year-old Angelica Mendoza, who flew up from Delano.

"I can see other people that have my disease," Autumn said.

Her mother noted that no cure exists for the condition.

"This is awesome because we've never been around any other Morquio people," Maestas said. "There's no guarantee, but if this works, it could help her with her strength and endurance."

Stuffed animals, tiny blood draws

The difference between Children's and hospitals that serve adults is apparent from the moment you walk through its doors and see the huge stuffed animals behind the reception desk.

"Little people are not like shrunken adults," said Cynthia Chiarappa, vice president of strategy for the hospital. "There's a lot of things in children that are highly unique and highly specialized. An X-ray needs to be calibrated from a dosage standpoint for children, so that you're not overexposing them."

To take an MRI and perform other procedures, the hospital often has to sedate children who can't lay as still as adults. A blood draw from a baby weighing two pounds has to be much smaller than that from an adult, Lubin notes.

Because of its young clientele, the hospital offers an array of non-medical services, including an educational program for those who will be in the hospital an extended period of time, art, music, dance and origami activities.

The hospital also has a well-known research arm -- Children's Hospital Oakland Research Institute -- that employs 315 scientists.

Registered nurse Carolyn Lund has seen big changes at the hospital since she began working in its newborn intensive care unit in January 1974.

Prior to the 1970s, babies who were critically ill often didn't have much chance of survival. But then specialized equipment became available, including baby-sized ventilators, IV pumps and catheters, that meant many more infants could be saved.

"Every year, there is something new," said Lund, adding that this is why she has spent her career at the hospital.

She is not alone. Eighty-five to 90 percent of the nurses there have been at the hospital 20 years or more, Lubin estimates.

The expense of going it alone

Unlike UCSF Benioff Children's Hospital and Lucile Packard Children's Hospital at Stanford, Children's Hospital Oakland is unaffiliated with other institutions and thus must survive on its own resources and donations.

In recent years, the 190-bed hospital has dealt with operating losses as high as $29 million in 2008 and $26 million in 2009.

Today, it is on more solid financial footing after reducing expenses through some cutbacks and a restructuring of its outpatient services in 2010.

The hospital also has benefitted from a provider fee that the state's hospitals agreed to pay to draw down additional Medicaid funding from the federal government. Through that arrangement, Children's will receive an additional $47 million for the period from July 2011 through 2012. Without that, the hospital would have a $10 million loss in 2012, Chiarappa noted.

Because of the financial challenges in being the only independent pediatric hospital in Northern California, leaders at Children's have been discussing partnering with UCSF after earlier talks with Stanford and Sutter Health did not result in an agreement.

Lubin said it is too early to provide specifics, but he noted, "We don't want to lose our identify of who we are as a hospital."


Planned renovations

Children's Hospital Oakland hopes to do $450 million in seismic work and renovations on its current site, but will need to conduct a capital campaign to raise much of that money.
Plans include:

In mid-2014: A $150 million retrofit and upgrade, including expansion of the outpatient clinic.
In 2016: Renovation of the pediatric and neonatal intensive care units.
After the first two phases: A new inpatient tower with private rooms.