Harborview Medical Center traces its roots to 1877, when the first King County Hospital opened on the county poor farm south of Seattle. The hospital moved into an attractive Art Deco building on Seattle's First Hill in 1931 and adopted the name Harborview Hospital; the hospital -- now Harborview Medical Center -- has been at this location since. Since 1931, Harborview has grown from a county hospital in a single structure to a regional medical powerhouse that covers two square blocks and offers treatments far beyond anything envisioned in the early twentieth century.
King County Hospital
In 1855, two years after the formation of Washington Territory, the territorial legislature mandated that each county in the new territory would be responsible for caring for its indigent population. Individuals were originally paid by the county to care for the poor, and in King County this was initially handled by Dr. David (Doc) Maynard (1808-1873). Maynard, who was Seattle's first physician, also opened the county's earliest hospital on December 15, 1863, in Pioneer Square. The building had two rooms: one for childbirth, and another that served as a pharmacy and "notions counter" (Becker). Maynard's second wife, Catherine (1816-1906), helped him tend to the sick and poor until his death in 1873. Afterward, other doctors filled in. However, it was soon apparent that a better solution was needed.
In May 1877, the county opened a 10-bed hospital in a remodeled farmhouse on the King County Poor Farm, located near the Duwamish River south of Seattle (in what is now Seattle's Georgetown neighborhood). This is considered the birth of the King County Hospital. The Sisters of Providence contracted with the county to manage the hospital, and received their first patient on May 19, 1877. But the sisters felt that the building was unsatisfactory, and they also wanted to be closer to the city center. In 1878, they opened their own hospital in a converted house at 5th Avenue and Madison Street in Seattle. At first, they continued to call it the "poor house" before deciding on a new name: Providence Hospital. The sisters cared for the indigent until 1887, when all county cases were transferred back to the Georgetown location under the management of Dr. C. H. Merrick. They were housed in a somewhat larger building than the original, but in just a few years demand outgrew it.
In 1894, a three-story brick building for the King County Hospital opened on the property, which today is on Corson Avenue S. The new hospital had 11 employees and beds for 125 patients. Capacity expanded to 225 when a new wing was added in 1908. Tuberculosis patients were housed in tents on the grounds until 1907, when a small 12-bed building opened for them. This was replaced by the Morningside Sanitorium (also called the King County Tuberculosis Hospital) in 1928.
Despite the expansions, the main hospital's capacity at Georgetown became strained by the 1920s, with reports of overcrowding so severe that patients' beds sometimes lined the corridors. In 1925, the legislature passed laws authorizing first-class counties to issue bonds to finance the construction and maintenance of hospitals for the indigent. This in turn led to King County voters approving a $2.75 million bond issue (equivalent to $45 million in 2022) in 1928 to finance a new county hospital. It would be built on the southwest shoulder of First Hill at 325 9th Avenue.
The Seattle Times held a contest in 1929 to name the hospital something more elegant than King County Hospital, and a resident of Seattle's Ballard neighborhood, Elva Patterson, selected the winning entry. The name Harborview came from the view of the harbor (Elliott Bay) from the western side of the hospital. Construction of the 10-story structure and its two-story tower (which is at least twice the height of a typical two-story tower) began in early 1930 and was completed in about a year. Harborview Hall, a 10-story building built to serve as a residence for the hospital's nursing students and nurses, also was built during this time directly across 9th Avenue from the hospital.
The 246,800-square-foot hospital had room for between 400 and 500 patients (accounts vary), and it also served as home to a nursing school, which was affiliated with the University of Washington. Some of the building's floors were dedicated to a particular specialty. For example, the 5th floor was devoted entirely to psychiatric cases, while the hospital's 9th floor served as the maternity ward and the 10th floor operated as the pediatric ward. These top two floors also had an extra touch: solariums at both ends. There was a kitchen and a cafeteria on the ground floor, as well as a diet kitchen for those with dietary restrictions.
The building is an example of Moderne architecture, a popular style of Art Deco architecture in the 1930s. The Art Deco style was meant to command attention, and the new hospital accomplished that. The structure is built of reinforced concrete faced with varying colors of buff brick, and it has setbacks on its 9th and 10th floors, giving a stairstep appearance to the top two floors of the building. Its square tower has a pyramid-shaped roof, while a green copper figure which has been described as looking like a stylized flame adorns the peak of the pyramid. In 1931, the building's entryway led into an elegant lobby that had tan marble wainscotting and light fixtures housed in square, opaque lanterns. The hospital's interior colors were described at its dedication as "soft and warm throughout ... greens and yellows and pinks and browns. No bleak white walls ..." ("Report on Designation ...").
The hospital was dedicated in a well-attended ceremony on February 27, 1931, and began admitting patients several days later. (The Georgetown location remained open, primarily treating elderly and chronic care patients.) Harborview's first superintendent was Dr. Willis H. Corson (1879-1943), a well-known and respected county physician who served as the superintendent of the Georgetown hospital from 1906 to 1912 and subsequently as King County Coroner from 1921 to 1927. (Corson Avenue, where the Georgetown hospital was located, is named after him.) Corson wasted little time in affirming that Harborview would remain a public hospital, explaining to The Seattle Times two weeks after the hospital's opening, "We cannot permit paying patients to enter here. The charity cases keep us filled to capacity" ("'Indigent Only' Notice…"). It was a statement the hospital would similarly repeat over the ensuing years.
More Growth, More Services
It didn't take long for the new hospital -- sometimes still referred to in contemporaneous newspaper accounts as King County Hospital or King County Hospital No. 1 -- to become overcrowded. The problem was particularly acute in the hospital's outpatient clinic, which by 1939 was treating an average of more than 500 patients a day in a department built to handle 75 patients daily. However, a proposed 1-mill levy to provide additional facilities at the clinic was rejected by King County voters in March 1940.
The problems with overcrowding continued during the 1940s, but America's entry into World War II in 1941 took precedence until the war ended in 1945. By 1946, Harborview's issues were again demanding attention. Albert D. Rosellini (1910-2011), chairman of the hospital's board of trustees (and later governor of Washington state), gave an interview to the Seattle Post-Intelligencer spelling it out: The hospital was handling a patient load that was 150 percent of capacity, and its rooms were so full that beds often lined the corridor, even in the contagious-disease wards. Visitors were denied entry into some wards simply because there was no room for them. Rosellini asked for public support for funding for a major expansion for hospital, which appeared as a bond issue on the ballot that autumn. Voters turned down the proposal.
Part of the difficulty was that the hospital had grown almost beyond its means in its first 15 years, and it had added more services than it anticipated. This included the first blood bank in Seattle in 1940, which offered transfusions of blood plasma, a relatively new treatment at the time. The hospital also became the center for polio treatment in 1945. In 1946, the University of Washington established the University of Washington School of Medicine at Harborview, but since there wasn't room for it, its first home was in a recycled army barrack next to the hospital. There were other changes too: Harborview hired its first Black nurse in 1943, and by the late 1940s, the first Blacks had enrolled in the hospital's nursing school.
Voters approved a scaled-down bond issue to expand Harborview in 1948, and construction began in the early 1950s. The seven-story south wing, now known as the East Clinic, was dedicated in 1955. At the same time, the original hospital was updated. The University of Washington Hospital opened in 1959, alleviating the load at Harborview to a degree, and eventually there was a separation of surgical care between the hospitals. For example, trauma and burn care are now provided solely by Harborview, while the University of Washington handles transplants and elective cardiac surgeries.
From Hospital to Medical Center
Despite the new construction and modernization in the 1950s, some of Harborview's facilities were becoming obsolete by the mid-1960s. To add to its problems, in 1966 hospital trustees announced that Harborview was facing an operating deficit in the coming year. Still another problem was the low rate of pay for hospital employees, which was supported by studies that showed they were being paid between six and 15 percent less than the community average. Staff began quitting; 485 employees left Harborview in just six months between January and June 1966. The employee shortage became so acute that in July of that year the director of the hospital's extension services gave an interview to The Seattle Times asking for volunteers to drive patients to physical-therapy appointments at Harborview's Queen Anne unit. (The Queen Anne location replaced the Georgetown unit of Harborview after it closed in 1956.)
A $15 million bond issue (equivalent to $130 million in 2022) was placed on the ballot that autumn to expand and modernize the hospital. There was some skepticism -- the Seattle Chamber of Commerce opposed the bond, and The Seattle Times expressed doubts in an editorial shortly before the election. There was little disagreement that the hospital needed an update. The issue was how much of an expenditure was warranted. One of the biggest questions involved the introduction of Medicare, which had just taken effect the preceding July. Medicare offered a federal healthcare program to the elderly and allowed them to choose treatment at any hospital they wished. Bond opponents suggested that Harborview's patient load would decrease as a result, making extensive changes unnecessary. Another (and more prescient) question was whether it was fair for King County taxpayers to pay the costs of a hospital that was beginning to evolve from a county medical center into a statewide one.
Nevertheless, the bond passed that November, kicking off a round of construction that lasted into the early 1980s. There were other developments as well. In July 1967, the University of Washington took over management of Harborview pursuant to a contract with King County. And in April 1969, county commissioners approved a request from the hospital's board of trustees to rename the facility Harborview Medical Center. But it was a more substantive introduction at Harborview the following year that would bring national attention to the hospital.
Medic One, Level I
By the late 1960s, there was a growing recognition of the need for more rapid intervention for heart attack victims. Dr. Leonard Cobb, a cardiologist at the hospital, approached Seattle Fire Department Chief Gordon Vickery (1920-1996) about forming a program to train firefighters to act as a rapid-response team to patients suffering cardiac events, and training began in 1969. Service to the public followed in March 1970, and it was so successful that it was soon expanded to cover other serious medical emergencies. Seattle's Medic One program became so renowned that it was featured in a segment on the popular television news show 60 Minutes in 1974. Long-time correspondent Morley Safer (1931-2016) traveled to Seattle to cover the story, which focused on cardiac events. He rode with paramedics on a call and was so impressed that he memorably concluded the clip with a quip: "If you have to have a heart attack, have it in Seattle" (60 Minutes).
There also was a growing recognition that specialized rapid-response centers for trauma care could save lives, and in the 1980s there was an increasing effort to establish such centers with various levels of care to better treat the critically injured. After a lengthy legislative and review process, Harborview Medical Center was designated as the only Level I Trauma Center in Washington in December 1993. (The center also serves Alaska, Idaho, and Montana.) A Level I Trauma Center -- the highest ranking for trauma centers in the United States -- is defined by the American College of Surgeons as "a tertiary care hospital that offers a comprehensive approach to the trauma patient from injury through rehabilitation" ("EMS, Trauma Center Designation"). These hospitals offer 24-hour access to surgeons skilled in a wide variety of specialties, and offer complex care to patients with multiple injuries, including head trauma.
A $176 million expansion during the 1990s doubled Harborview's size to nearly 900,000 square feet, more than three-and-a-half times the size of the original hospital. The expansion, built just to the west of the original structure, included the West Hospital and West Clinic, which fronts 8th Avenue. The new hospital (which had a trauma center with a 25,000-square-foot emergency department) and clinic opened in 1997. The overall expansion was completed the following year.
A $257 million expansion began in 2005, which included seismic upgrades and construction of three new buildings. One of them was the 10-story Norm Maleng Building, which opened in 2008 and was named after long-time King County prosecutor and Harborview advocate Norm Maleng (1938-2007). It housed a wide variety of services, including eight new operating rooms and specialty-care clinics. The Maleng Building, located on the east side of 9th Avenue next to Harborview Hall, is connected to the hospital on the west side of the street by a six-story "bridge building," which opened at the same time. This building is suspended over 9th Avenue by a giant metal truss and anchored to the Maleng Building and the East Hospital.
In 2020, King County voters approved a $1.74 billion bond for further construction. One of the primary drivers for the bond's passage was the same problem that had dogged Harborview since its 1931 opening -- overcrowding. On hectic days patients still spilled out into the hospital's halls, a problem exacerbated by the appearance of the COVID-19 virus in 2020. (The COVID problem became so severe that some of its patients were housed in the long-maligned Harborview Hall, which ceased to be a residence hall in the 1960s and had most recently been relegated to a homeless shelter before the pandemic.) Nearly $1 billion alone was allotted to go to construction of a 10-story medical tower on the western edge of the Harborview complex, at the present site of View Park.
Since 1931, the Harborview campus has grown into a network of buildings that covers more than two square blocks. Because of seismic concerns in the original hospital building, now known as the Center Tower, most of the medical center's patients are treated in other structures on the campus. The Center Tower primarily houses the hospital's faculty and staff offices, as well as its support and supply services. Seismic upgrades are planned for the structure as part of the most recent plans to modernize the hospital. In early 2022, the project was still in its planning phases.