When David A. Kessler, M.D., began speaking with faculty and top administrators in early 1997 before coming to the School of Medicine as dean, he found two issues on everyone's mind: a mounting budget deficit and a critical shortage of space that threatened the school's ability to recruit and retain the best faculty and students. Both problems demanded immediate attention, and, as the new dean soon learned, they were intricately linked.

“Depending on how you calculate, the school had a deficit of $23 million or more for the 1997-98 budget year,” Dr. Kessler said in an interview in late June. Flaws in the school's computerized billing system, combined with lower revenues from managed care, had contributed to the deficit. The lack of laboratory space had been recognized since at least 1989, when then-Dean Leon E. Rosenberg, M.D., formed a committee to address the issue, but plans for a new building stalled in the mid-1990s. A second committee, chaired by faculty members Carolyn W. Slayman, Ph.D., and Arthur E. Broadus, M.D., was formed to consider educational and programmatic goals in greater detail before new construction was proposed.

Dean Kessler, with the participation of the school's leadership, set about the task of crafting solutions to both problems, spending much of his first year at Yale quietly analyzing the circumstances that produced them. The result of that process was apparent in two state-of-the-school presentations in late spring and early summer. In a series of meetings with department chairs, senior faculty, administrators and, ultimately, the Yale Corporation, the dean released a detailed account of the school's finances and presented a plan to balance the budget by Jan. 1, 1999, six months earlier than he promised when he took office. Then in June, Dr. Kessler proposed a strategic facilities plan to meet a large portion of the school's space needs. After reviewing the draft proposal at its June 19 meeting, the Yale Corporation approved funds to begin the formal planning process for renovations and new construction.

The centerpiece of the plan is a proposed building at the corner of Congress Avenue and Cedar Street that would provide 139,000 square feet of laboratory space for disease-oriented research. The $160 million complex, one of the largest building projects ever undertaken at Yale, also would house a Magnetic Resonance Center to enable expansion of Yale's cutting-edge capability in imaging, which is driving advanced research in nearly every discipline. Also included is space for offices, animal care, laboratory support and a teaching facility to replace the school's overcrowded and outmoded gross anatomy laboratory in Sterling Hall of Medicine. State-of-the-art teaching laboratories and classroom space are also part of the new construction, which would total 201,000 net square feet.

Still in the earliest stages of development, the plan will require the approval of city planning agencies and in-depth discussion by the medical school, the University and their New Haven partners, including the mayor, Board of Aldermen and the Hill Development Corporation. Once planning is complete, the school will return to the Yale Corporation for approval of construction funding. The project is only possible, Dean Kessler said, if the school secures significant funds from philanthropic sources. A portion of that total already has been committed by foundations and private donors.

According to Dr. Kessler, balancing the budget was and will remain the key to University support. “Getting our fiscal house in order was the first step toward gaining the backing of the Corporation. They asked some hard questions and thanks to the chairs, the deputy deans, the faculty and the administration, we were well-prepared,” Dean Kessler said. “The key to this is living up to our responsibility.”

Balancing the budget has been an across-the-board effort, with strategic cuts in the coming year's expenses made by the departments, administrative offices and the Yale Psychiatric Institute, one of the clinical entities hardest hit by managed health care. “It required the entire school coming together,” Dr. Kessler said. “The chairs did it, the senior leadership in the faculty did it, and it wasn't without hardship. It took real sacrifice.”

Driving the strategic facilities plan is a concise statement of four academic goals for the coming decade that places increased emphasis on the clinical enterprise. The goals are to strengthen disease-related research in the clinical departments, to sustain the high quality of basic science research, to promote research in epidemiology and public health, and to upgrade core facilities needed for biomedical research throughout the University. The plan also calls for capital spending for renovations of $50 million a year for the next 10 years and outlines a process for upgrading and filling in space vacated by the laboratories that would move to the new building. That “backfill” plan ultimately will group together researchers from various departments who share scientific and clinical interests. Renovation of the Laboratory of Epidemiology and Public Health will also continue. Other important priorities include upgrading the space of the Yale Cancer Center in cooperation with Yale-New Haven Hospital, making improvements to the Yale Physicians Building, and expanding the space available for clinical neurosciences.

The Department of Internal Medicine, which faces perhaps the most severe shortage of space, would benefit significantly from the new building, which would house programs in eight areas, according to the facilities plan. However, the building is not envisioned as a departmental structure, Dr. Kessler said, but rather as one organized around program goals, similar to the Boyer Center for Molecular Medicine, which was completed in 1991.

“More than ever this is an opportunity for us to ensure that Yale creates the environment for collaboration between basic and clinical scientists around disease-oriented research,” said Ralph I. Horwitz, M.D., chair of Internal Medicine. “It will enable the school to remain at the forefront, and to recruit and retain the world-class physician-scientists needed to pursue this research.”

According to Sally E. Shaywitz, M.D., a leading brain researcher and pediatrician who specializes in the study of dyslexia, the Congress Avenue Building's proposed magnetic resonance facility would effectively double the medical school's current capacity to image brain activity. “It means we can enter the next century,” said Dr. Shaywitz, who in 1995 with her colleague and husband Bennett A. Shaywitz, M.D., produced the first evidence of gender differences in brain activity. “It means we can do the kind of work that will allow us to understand better how people think and learn and read–and to learn why some very bright people have difficulty learning to read.”

Robert H. Gifford, M.D., HS '67, deputy dean for education, said that the teaching component of the proposed building “will make a huge difference for students, in particular during the first two years of medical school.” The school's current anatomy laboratory, built in the 1930s to accommodate a class of 50, has been stretched past capacity for decades and now, and is currently used by 130 medical and physician associate students. “We will have an anatomy lab that is state-of-the-art, rather than one of the oldest in the nation.” The new building would also consolidate other student teaching facilities now scattered across the campus.

For Dr. Kessler, who would like the see the new building completed in four years, the strategic facilities plan is about “more than bricks and mortar. It is not about a building. It's about people and ideas, and the creation of an environment for research,” he said. “By having the clear sense of focus on disease, I think we will see real advances that impact both individuals and the health of the public. Our goal is to advance the scientific basis of the practice of medicine.”

He recalled talking about the plan with W. Maxwell Cowan, M.D., Ph.D., vice president and chief scientific officer of the Howard Hughes Medical Institute, when Dr. Cowan visited Yale recently. “We took a walk and I showed him the site where we envision all this happening. I told him it was an ambitious plan, and not without difficulty,” Dr. Kessler said. “Max turned to me and said, 'David, this may well be the best investment Yale will ever make.' ”