For this discussion, write and submit a 1–2-page summary. Review the Community Board Centers case study assigned in the studies for this unit (attached).
Respond to the following:
According to Martin Gable, the future of the Community Blood Centers of the Carolinas is in donor development. Based on your analysis of the case, do you agree or disagree with his perspective?Community blood center of the Carolinas by Linda E. Swayne. Reproduced with permission of Linda E.
Swayne in the format post in a course management system.
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Center of the
Torn Hassett, group vice president for Carolinas Healthcare System,
was responsible for studying the laboratory service line for his hos
pital system in 2002 (one of 17 service lines with escalating costs).
He recalled, “Our costs were actually going down from vendors
who were working with us in a very tight time for health care in
general and hospitals specifically. But blood costs kept increasing.
In just one year, our cost for blood doubled! Discussions with the
Red Cross – which was the dominant supplier of blood in our
area – went nowhere. I think there were a couple of reasons for
that. Charlotte is headquarters for a blood services region for the
Red Cross and one of eight national blood testing labs is located
This case was written by Linda E. Swayne, The University of North Carolina at
Charlotte and Thomas Hassett, Group Vice President for Carolinas Healthcare
System. It is intended as a basis for classroom discussion rather than to illustrate
either effective or ineffective handling of an administrative situation. Used with
permission from Linda Swayne.
D I SCUSS I O N S B E G I N
here, but all business decisions are made i n St. Louis and they don’t appreciate
our problems since they have problems of their own. They’re trying to cover the
costs for all the activities required by the consent decree. The St. Louis guys told
us if we didn’t like their prices we should get our blood elsewhere. That’s when
we really got serious about an independent blood center.”
“We began to talk with hospitals in our immediate area about their experiences
and found them to be similar to our experience. As informal word got around,
more hospitals called to express their interest in looking at an alternative. Then
we discovered America’s Blood Centers – a national group serving as the umbrella
organization for some 75 independent community blood centers spread around
the country. When we approached them, ABC suggested that we contact two
or three members about their centers and their willingness to help our group
look at how we might set up an independent community blood center,” Hassett
He continued, “We then found out some interesting things. The Red Cross
had a blood center in Springfield, Missouri that the hospitals there were not
very happy with. When discussion began about a community blood center in
Springfield, the Community Blood Center of Greater Kansas City was contacted
for assistance. Don Thomson, CEO of the Red Cross center was hired to become
the executive director of the Springfield area center, named the Community
Blood Center of the Ozarks. Not long afterward, almost the entire staff of the
Red Cross resigned and moved to the Community Blood Center of the Ozarks.
This caused such a wrangle that the Red Cross filed lawsuits against the
Ozarks and brought in a Red Cross executive by the name of Bob Carden. After
an unfruitful battle against the community blood center, Bob resigned from
the Red Cross, switched sides, and became the executive director at Virginia
Blood Services, a community blood center in Richmond, Virginia.
“With the Ozark group’s experience in mind, we pulled together the 22 hospi
tals that had indicated interest in a community blood center and asked these two
gentlemen to speak to our group. Certainly, the event in Springfield became a
model for what could happen with the start-up of a new center both positively
and negatively. Shortly thereafter, the North Carolina Hospital Association became
interested in what was going on. At a meeting they organized for the state, some
60 hospitals attended to hear these same speakers, as well as Bill Coenen, the CEO
of Community Blood Center of Greater Kansas City.”
Although a statewide effort did not emerge, ten Charlotte-area hospitals com
mitted to work together to develop a community-based blood organization. It
was the first time that there had been such collaboration. Hassett recalled, “The
hospitals worked extremely well together to resolve a common problem. The rising
cost of blood was an issue for us all and blood is critical to all hospitals’ opera
tions. Although there is pretty intense competition among some of us, we had a
common need and blood was neutral territory.”
CASE 3: CO M MUN I TY BLOO D C E N T E R OF T H E CAROL I N AS
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Hassett continued, “Although the Red Cross says it has ‘national pricing,’ Premier
did a study that documented the variation in the cost of blood across the United
States. The lowest costs were in places where there was competition. We decided that
we needed the competition in the Charlotte area and, despite some misgivings over
tackling the Red Cross, we decided to investigate an independent blood center.”
The hospitals’ leadership group commissioned Astraea, Inc., parent company
of Virginia Blood Services (VBS) in Richmond, Virginia, to evaluate the feasibil
ity of starting an independent blood center to serve the Charlotte region. The
VBS study showed that more than 1.5 million people lived in the region and if
60 percent of the population was eligible and able to donate blood, there were
900,000 potential donors in the area. Typically, about 5 percent of the population
actually donated (75,000 people).
Community Blood Center of the Carolinas, the first community blood center
in North Carolina, was the result of the collaboration by the hospitals. Because
licensing generally takes three years to complete and the hospitals were anxious
to begin operations, CBCC began by working under Virginia Blood Center’s
US Food and Drug Administration blood license. CBCC focused on serving the
needs of blood donors, patients, and health care providers in the Charlotte region.
(See Exhibit 3/1 for an overview about blood and blood collection.)
Exhibit 3/1: Blood: The River of Life
Using human blood to treat disease and trauma began in France in 1667 when Jean-Baptiste Denis
documented a direct human blood transfusion. These early direct donor-to-patient transfusions were
often unsuccessful because it was not possible to predict donor-recipient blood type compatibility.
In 1901, a German scientist, Dr. Karl Landsteiner, discovered that there were different blood groups.
Since he found that all humans fall into one of these groups, the ABO system provided an answer
to the puzzle of why some transfusions had worked and others failed.
Blood had no substitute. Individuals who donated blood literally saved lives – more than 4.5 million
American lives each year. Someone needed blood every three seconds. One pint (unit) of donated
blood could save three lives. One out of ten hospital patients needed blood. Car accident and blood
loss victims often needed transfusions of 50 pints or more of red blood cells. Bone marrow trans
plant patients needed platelet donations from about 120 people and red blood cells from about
20 people. Severe burn victims typically needed 20 units of platelets during their treatment.
The amount of blood in the body of an average adult was ten pints. Blood made up about 7 percent
of a person’s body weight. Sixty percent of the US population was eligible to donate blood but only
5 percent did so. About 32,000 pints were used each day in the United States.
When patients had organ transplants, cancer treatments, gastrointestinal disease, trauma, aneu
rysms, anemia and clotting disorders, accidents, open heart surgeries, burns, and so on, blood was
required. However, blood from anyone would not necessarily be what the patient required.
C BCC B E G I N S
Exhibit 3/1: (cont’d)
Blood came in four different types – A, B, AB, or 0 – and differed by Rhesus factor (RH) as either
positive or negative (approximately 15 percent of the population had negative blood). Nearly half of
the blood ” ordered” by hospitals was 0- because it was the universal donor, meaning that everyone
could safely receive 0- type blood. Patients with any of the positive blood types could safely receive
0+ blood, but only 0- could be used safely with all blood types. The most common type of blood
was 0+ (37.4 percent of the population) and the least common was AB- (0.6 percent).
Blood types in the population were as follows:
Percent of the population
Blood type compatibility was as follows:
Could be transfused to patients with blood type:
0+, A+, B+, AB+
0+, A+, B+, AB+, 0- , A- , B- , AB
A+, AB+, A- , ABB+, AB+, B- , ABAB+, AB-
Volunteers were screened to determine whether they were likely to be successful blood donors. The
screening process became far more arduous after the emergence of HIV/AIDS and the discovery that
numerous patients were infected from blood transfusions and organ transplants. Volunteer donors
used to answer about 15 questions. After belatedly understanding that HIV was carried in trans
fusions, screening intensified. With the advent of mad cow disease, SARS, and West Nile virus,
the number of questions increased to 50 or more, covering health, travel, and sexual history.
Blood was withdrawn from the volunteer to fill several vials and a one pint plastic bag (each marked
with a unique bar code to match a particular donor’s record and to track it electronically until the
pint was delivered to a hospital and administered to a patient). The actual blood donation only took
about 10 to 20 minutes, although the entire process took from 45 minutes to an hour. The blood
was kept refrigerated until it reached a lab, where the unique bar code was read into the computer
for tracking and monitoring of test results. The vials were used to type the blood (0, A B, AB, plus
RH factor) and to determine whether there were any transmissible diseases present. Fourteen tests
(11 for infectious diseases) were performed on each unit of donated blood.
The pint of blood was separated into its components: leukocytes (white blood cells), red blood cells,
platelets, and plasma. (Some patients required whole blood, but some did not. By separating the blood
into these components, as many as three patients’ lives could be saved from one donated unit.) Then the
blood was stored under refrigeration until the test results were received. Testing generally took 12 to 16
CASE 3: CO M MUN I TY BLOO D C E N T E R OF T H E CAROL I N AS
Exhibit 3/1: (cant’d)
hours and the results were returned electronically, enabling the blood to be distributed for use generally
within 24 hours. Hospital professionals transfused the blood (or blood components) to the patient.
Patients seldom required all the components of whole blood. The request for blood transfusion was
specified based on the blood component needed for the patient’s condition or disease. Thus, several
patients benefited from a single pint of donated blood.
Apheresis, an increasingly common procedure, was the process of removing a specific component
of the blood, such as platelets, and returning the remaining components, such as red blood cells and
plasma, to the donor. This process allowed more of one particular part of the blood to be collected than
could be separated from a unit of whole blood. Apheresis was also performed to collect red blood
cells, plasma (liquid part of the blood), and granulocytes (white blood cells). The apheresis donation
procedure took longer than the 45-60 minutes for whole blood donation; an apheresis donation might
take between one to two hours. Not only were blood components different in the benefits they offered
to patients, they had different shelf lives.
Red blood cells- Red blood cells had a shelf life of 21 to 42 days and could be treated and frozen
for up to ten years. Red blood cells were particularly needed by patients who had chronic anemia,
malignancies, gastrointestinal bleeding, and those with major blood loss from trauma.
Patients scheduled for surgery might be eligible to donate blood for themselves, a process known
as autologous blood donation. In the weeks before nonemergency surgery, an autologous donor
could have blood drawn that was stored until the surgical procedure.
White blood cells (leukocytes)- White blood cells protected the body from invasion by bacteria and
viruses but they were also a factor in making some patients intolerant to blood transfusions. There
fore, much whole blood was filtered to remove leukocytes. The filtration had to occur within 48 hours of
donation. However, for immunosuppressed patients, one type of white blood cells – granulocytes- were
used to attempt to improve resistance to infection. Granulocytes were collected through apheresis donation
or through centrifuging whole blood. White blood cells had to be transfused within 24 hours.
Plasma was 90 percent water and contained albumin (protein). fibrinogen (helps with
clotting) , and globulins (antibodies). Although it looked like dirty river water, plasma maintained
blood volume and pressure, supplied critical proteins for blood clotting and immunity, and provided
a medium of exchange for vital minerals. This liquid component of blood was frozen soon after
donation and could be stored for up to one year.
Platelets- Platelets helped to clot blood (stop the bleeding) . They were collected by apheresis (or
plateletpheresis) and through centrifuging whole blood. Platelets could be stored for up to five days
at room temperature, provided that temperature was maintained at 72°F and the platelets were kept
moving to avoid sticky clumps.
Blood was tested for a variety of diseases that were determined to be transmitted (or theoretically could
be transmitted) through blood donation. Prior to identification of the HIV/AIDS virus, blood was tested
for syphilis and hepatitis B. During the 1980s, a number of tests were added: HIV/AIDS antibody tests
(starting in 1985, with additional tests in 1992, 1996, 1999), hepatitis C (with additional tests for hepatitis
A in 1986 and hepatitis B in 1987), human T-cell, and human lymphotropic virus. During 2000, blood
tests and screening questions were added for SARS; in 2003, tests were added for West Nile virus.
The tests were performed to maintain a safe blood supply, but many blood collection organizations
were concerned that the increased number of deferrals (healthy individuals who are not permitted
to donate because of their travel or place of residence) would decrease the number of blood donors
and endanger the blood supply.
C BCC B E G I N S
A s a blood center, CBCC gathered blood donations – the raw material for
its operations – from people in the community and after breaking down the
whole blood into red cells, plasma, platelets, and other components and test
ing for safety, the blood was returned to the community that donated it. CBCC
planned to serve residents in York, Chester, and Lancaster counties in South
Carolina; and Anson, Cleveland, Cabarrus, Catawba, Gaston, Iredell, Lincoln,
Mecklenburg, Rowan, Stanly, and Union counties in North Carolina (Exhibit
3/2 maps the service area). Residents in these counties were served by the ten
hospitals that originally developed the plans to establish CBCC (see Exhibit
3/3 for a brief description of the hospitals). The CBCC partner hospitals had
2,985 beds and used about 62,000 units of red blood and about 6,000 platelet
Exhibit 3/2: Map of CBCC’s Service Area
CASE 3: CO M MUN I TY BLOO D C E N T E R OF T H E CAROL I N AS
Exhibit 3/3: Hospitals that Formed CBCC
Ten hospitals came together to form the Community Blood Center of the Carolinas.
Carolinas Healthcare System, a not-for-profit, self-supporting organization, was the largest health
care system in the Carolinas and one of the largest publicly owned systems in the nation. CHS was
a vertically integrated system that owned and managed hospitals, nursing homes, physicians’ prac
tices, and physical and radiation therapy facilities in both North and South Carolina. It was comprised
of more than 4,900 beds and employed more than 23,000 people. Its physicians’ network included
approximately 640 primary care doctors and other providers. The flagship hospital, Carolinas Medical
Center, was named in US News & World Report’s 2002 America’s Best Hospitals list. CMC Mercy
Hospital, CMC- University, and CMC- South were three partner hospitals to Carolinas Medical Center,
the region’s only Level 1 Trauma Center.
Gaston Memorial Hospital, with 1,543 employees, was operated by CaroMont Health and located
in Gastonia, North Carolina (to the west of Charlotte). The 442-bed, independent, not-for-profit
hospital was recognized nationally as one of the 100 top hospitals in the country. The growth of spe
cialty services, such as the CaroMont Heart Center, the Comprehensive Cancer Center, and Women’s
and Children’s Services, along with the addition of state-of-the-art surgical and treatment options,
underscored Gaston Memorial Hospital’s commitment to meeting the region’s health care needs.
NorthEast Medical Center was established in 1937. This private, not-for-profit medical facility offered
state-of-the-art services in affiliation with Duke University School of Medicine and Johns Hopkins.
Offering a broad scope of services, 457 licensed beds, 275 skilled physicians and 3,500 employees,
NorthEast Medical Center was a leading health care facility located in Kannapolis, North Carolina (in
the north Charlotte region).
As one of the 118 hospitals owned by Tenet Healthcare, Piedmont Medical Center, located in Rock Hill,
South Carolina, prided itself in keeping health care affordable, accessible, and effective for all families.
With a staff of 1,400 employees combining advanced technology and highly skilled doctors, Piedmont
provided a comprehensive care facility offering a wide variety of programs including cardiac surgery,
neonatology services, emergency medical care, a cancer center, and a sleep disorder center.
Based in Charlotte, Presbyterian Healthcare was in the Southern Piedmont Region of Novant Health,
the largest private, not-for-profit health care system in North Carolina. Presbyterian was comprised
of four hospitals, Presbyterian, Presbyterian Matthews, Presbyterian Orthopaedic Hospital (one of the
top 100 orthopedic hospitals in the nation), and Presbyterian North (opened in fall 2004). Novant’s
Southern Piedmont Region had 581 licensed beds and 5,772 employees, a skilled-nursing facility,
physician division, and ancillary services.
Gregory A Ball was hired as the first executive director in November 2002 to start
the Center. A native of Gastonia, he had worked for the American Red Cross for
26 years before doing consulting work in the blood industry. At the Red Cross he
was credited with starting one of the first automated platelet-collection programs
in the industry and building four local offices or manufacturing facilities. He
had managed eight different Red Cross business units around the country. As a
consultant, Ball worked with Astraea, Inc. (Virginia Blood Services) to develop
the feasibility study for CBCC. He was then hired as the first executive director
responsible for start-up, from identifying a local board of directors and a medical
advisory board to finding a facility and beginning production.
C BCC M I SS I O N
In November, Ball stated his goals: “I need to hire 50 people necessary to staff
CBCC, find the Center’s first Charlotte collection facility, draw the first unit
of blood by spring 2003, raise the percentage from the typical 5 percent of the
population donating in Charlotte to 9 percent, and bring in revenues of $3.4 million
in the first year.”
In addition to Greg Ball, CBCC was led by a group of local business people
who served as its board of directors and advised about the organization’s busi
ness decisions – the products offered, where those products were to be sent,
and how much they would cost. A medical advisory committee, comprised of
local professionals, counseled the directors about medical concerns. Experts on
this team – business and medical – were entrusted as stewards of local health
care resources and were responsible for ensuring that the community received the
most value possible for its health care dollars. (Exhibit 3/4 lists the 2004 board
of directors and the medical advisory board.)
Temporary housing for the Center was in Presbyterian Hospital. The Center
handled its first unit of blood on August 15, 2003. Ball estimated that a facility
of 20,000 sq. ft. was needed initially, but 32,000 sq. ft. would be needed when
CBCC was collecting 60,000 units per year – the community’s annual need for
blood. A 30,000 sq. ft. facility was found on South Boulevard, a major artery
near Charlotte’s city center, less than five miles from the two major hospitals
in Charlotte and with easy Interstate access for the other hospitals. Leased for
seven years, the price was $3.50 per sq. ft. in the first year and escalated over
the period of the lease to $7.00 per sq. ft. (Exhibit 3/5 has a schematic of the
Ball stated at a September 19, 2003 open house for the new facility, “My
requirements are two: compliance and customer service. Compliance requires
that we have the size and the capabilities to keep the blood supply protected.
Customer service has enabled us to have one to three blood drives a day with
about one-third of the donors not having participated in a drive previously.”
CBCC became a member of America’s Blood Centers (ABC) because the group
subscribed to the same philosophy as CBCC – community-focused blood banking
meaning that community donors knew that the blood they gave stayed in the
community to help family members, friends, and neighbors. Only excess supply
was shared with other communities when needed. CBCC was a member of the
American Association of Blood Banks (AABB) as well. (Exhibit 3/6 contains an
overview of these organizations.)
CBCC’s mission was to provide local control of the blood supply, ensuring that
local needs were met first. This local control provided greater choice for blood
CAS E 3: CO M MUN I TY BLOO D C E N T E R OF T H E CAROL I N AS
Exhibit 3/4: CBCC Board of Directors and Medical Advisory Committee
Each of the five hospital systems involved with CBCC had a permanent seat on the board of dir
ectors. The remaining CBCC directors were elected to represent the communities served. These
volunteer members of the board were business leaders and medical experts who made decisions
to benefit the patients and donors in the greater Charlotte community. Board members included:
Jennifer Appleby- President and Chief Creative Officer, Wray Ward Laseter Advertising Agency.
Steven Burke- Vice President, Ancillary Services, Presbyterian Hospital* and CBCC Board Chair.
Jeffrey Canose, MD – Vice President, Medical Services Division, Gaston Memorial Hospital.*
Bob Carden- President /Chief Executive Officer, Virginia Blood Services.
John Cox- Chief Executive Officer, Cabarrus Regional Chamber of Commerce.
Scott Go/linger- Vice President, Clinical Services, NorthEast Medical Center.*
Mark Keener- Regional Chief Financial Officer, Carolinas Healthcare System.*
Edward Lipford, MD – Carolinas Pathology Group.
Kim McMillian- Vice President, Marketing/Public Relations, Allen Tate Realty Co.
Mark Patafio- Vice President, Small Business Sales Leader, Wachovia Bank.
Jeff Smyre- Senior Manager, PricewaterhouseCoopers CPA.
Joseph Stough- Vice President, Piedmont Medical Center.*
*System permanent seats.
The CBCC medical advisory committee advised the board on medical matters. The medical
advisory committee members were:
Linda Boggs – Transfusion Medicine Section Chief, Presbyterian Hospital.
Pam Clark, MD – Medical Director, Community Blood Center of the Carolinas.
Beth Curtis- Blood Bank Specialist, NorthEast Medical Center.
Rita Duffy- Blood Bank Supervisor, Gaston Memorial Hospital.
Stephen D. Harris, MD – Presbyterian Pathology Group.
Philip Leone, MD – Leone Pathology, Gaston Memorial Hospital.
Ned Lipford, MD- Carolinas Medical Center Laboratory.
Barbara McElhiney- Manager, Transfusion Services, Carolinas Laboratory System, Carolinas Healthcare
Beth Prichard, MD – NorthEast Medical Center Department of Pathology.
Rita Tate- Technical Director, Community Blood Center of the Carolinas.
Rob T homas, MD – Piedmont Medical Center.
Kelly Ware- Transfusion Services Team Leader.
Jennifer Carpenter- Laboratory Director, Piedmont Medical Center.
products and services. Local doctors could select products and services that best
met the needs of their patients. And for the first time in the region, donors had
a choice of where they gave blood. CBCC was a customer-focused organization,
and its service philosophy was to exceed expectations.
Ball said, “Control and choice lead to lower costs. CBCC is committed to offering
services of the highest quality at more affordable and predictable pricing. Lower
costs reduce patient charges and help our hospitals to control costs, become better
stewards of resources, and improve patient care.” CBCC emphasized regulatory
C BCC MISSION
Exhibit 3/5: Plan of the CBCC South Boulevard Facility
@ Central Receiving
@ Component Production
@ Hospital Services
@ Administrative Offices
@ Collection Staging and Training
Exhibit 3/6: Blood Banking Organizations
AM ERICAN ASSOCIATION OF BLOOD BANKS
Founded in 1947, the American Association of Blood Banks (AABB) was organized to support and
encourage continued blood research, promote exchange of scientific information, and develop stand
ards of practice for blood banks. The AABB was an international association of blood banks, includ
ing hospital and community blood centers, transfusion and transplantation services, and individuals
involved in activities related to transfusion and transplantation medicine. The AABB supported: high
standards of medical, technical, and administrative performance; scientific investigation; clinical appli
cation; and education. It was dedicated to encouragement of voluntary donations of blood and other
tissues and organs through education, public information, and research. The AABB member facilities
were responsible for collecting virtually all of the nation’s blood supply and transfusing more than
The AABB’s mission statement was to establish and promote the highest standard of care for
patients and donors in all aspects of: blood banking; transfusion medicine; hematopoietic, cellular,
and gene therapies; and tissue transplantation. The AABB International’s mission statement was to
CASE 3: CO M MUN I TY BLOO D C E N T E R OF T H E CAROL I N AS
Exhibit 3/6: (cont’d)
coordinate and promote improvements in blood banking and transfusion safety internationally by
supporting: (1) the development of national and/or regional standards in blood banking; transfusion
medicine; hematopoietic, cellular, and gene therapies; tissue transplantation; and (2) the development
of mechanisms for assessing compliance with those standards.
More than 2,200 institutions (community and hospital blood banks, hospital transfusion services,
and laboratories) were AABB members (AABB accreditation was a requirement for institutional
membership). More than 8,500 individuals were members of the AABB (anyone interested in or
actively involved in transfusion medicine and related biological therapies was eligible for individual
membership, including physicians, scientists, administrators, medical technologists, blood donor
recruiters, and public relations personnel). Members were located in all 50 states and 80 foreign
countries. The AABB’s active membership provided direction to the Association through its elected
board of directors and more than 30 committees of volunteer professionals.
The AABB Accreditation Program strove to improve the quality and safety of collecting, process
ing, testing, distributing, and administering blood and blood products. The Accreditation Program
assessed the quality and operational systems in place within the facility. The basis for assessment
included compliance with Standards, Code of Federal Regulations, and federal guidance docu
ments. This independent assessment of a facility’s operations helped the facility to prepare for other
inspections and served as a valuable tool to improve both compliance and operations. Accreditation
was granted for: collection, processing, testing, distribution, and administration of blood and blood
components; hematopoietic progenitor cell activities; cord blood activities; perioperative activities;
parentage testing activities; immunohematology reference laboratories; and specialist in blood bank
schools. Since 1957, the AABB has been a leader in the development of standards for voluntary com
pliance in blood bank blood component collection, processing, and transfusion. Standards for Blood
Banks and Transfusion Services was developed by experts in blood banking and transfusion medi
cine. Standards were based on good medical practice and, when available, scientific data, principles
associated with good manufacturing practices and quality assurance that were consistent with FDA
regulations. These standards, along with the requirements specified in the Accreditation Information
Manual provided the basis for the AABB Accreditation Program.
AMERICA’S BLOOD CENTERS
In 1962, seven community-based blood centers came together with the help of local hospitals, phy
sicians, and civic groups to establish America’s Blood Centers (ABC). Medical expertise, customer
service, and a community-first blood banking philosophy were the founding principles of America’s
Blood Centers. The community-based blood banking philosophy meant that community donors
knew that the blood they gave stayed in that community first- helping family members, friends, and
neighbors. Any excess supply was shared with other communities that needed it most.
America’s Blood Centers became an international network of 76 community-based blood .centers
around the United States and Canada. ABC members collected 7.5 million units of whole blood in 2003nearly half of the United States as well as 25 percent of the Canadian blood supply. ABC members
yearly provided more than 10 million blood components (including red blood cells, platelets, and
plasma) to hospital customers.
ABC members supplied a majority of the nation’s tissue, bone marrow, stem cell, and transfusion
services. In addition, America’s Blood Centers members received the majority of blood-related NIH
research funds. Fifteen members managed cord blood banks for transplantation. The New York Blood
Center operated the largest cord blood bank in America.
ABC’s national office provided members with support for national awareness campaigns, lobbying
with the government, information on medical issues of concern to the blood banking community,
blood resource sharing, group purchasing, educational programs, fund-raising support, blood center
quality management issues, and federal regulation training programs.
Six ABC centers were located in South Carolina; Community Blood Center of the Carolinas was the
only ABC center in North Carolina.
T H E A M E RICAN R E D CROSS
and quality assurance standards to help make certain that only the highest
quality blood products were collected and used, and ensured that the safety and
well-being of donors and patients were protected. Residents of the region had
an alternative to the Red Cross.
Clara Barton and a circle of acquaintances founded the American Red Cross
(ARC) in Washington, DC on May 21, 1881. Barton first heard of the Swiss-inspired
International Red Cross Movement while visiting Europe following the Civil War.
After returning home, she campaigned for an American Red Cross Society and
for ratification of the Geneva Convention protecting the war-injured. She was
successful on both.
Prior to World War I, the ARC introduced first aid, water safety, and public
health nursing programs. With the outbreak of war, ARC staffed hospitals and
ambulance companies, and recruited 20,000 registered nurses to serve the mili
tary. Additional Red Cross nurses came forward to combat the worldwide
influenza epidemic of 1918. As a member of the International Federation of Red
Cross and Red Crescent Societies, which it helped found in 1919, the American
Red Cross joined more than 175 other national societies in bringing aid to victims
of disasters throughout the world.
After World War I, ARC focused on service to veterans and enhanced its
programs in safety training, accident prevention, home care for the sick, and
nutrition education. In addition, it provided relief for victims of major disasters
such as the Mississippi River floods in 1927 and severe drought and the Depression
during the 1930s.
The Red Cross provided extensive services once again to the US military, Allies,
and civilian war victims during World War II. It enrolled more than 104,000
nurses for military service. At the military’s request, the Red Cross initiated
a national blood program that collected 13.3 million pints of blood for use by
the armed forces. After World War II, the Red Cross introduced the first nation
wide civilian blood program that supplied nearly 50 percent of the blood and
blood products in the United States. In addition, the Red Cross expanded its
role in biomedical research and entered the new field of human tissue banking
ARC’s Biomedical Services2
The biomedical services division of the Red Cross comprised blood services,
tissues services, plasma services, and research. Blood Services was the most
visible of ARC’s Biomedical Services Divisions and collected about 50 percent
of the blood donated in the United States through 36 blood services regions.
The Red Cross estimated that the United States needed 38,000 units of blood
CASE 3: CO M MUN I TY BLOO D C E N T E R OF T H E CAROL I N AS
per day (over 13 million units annually). In fiscal year 2003, 6.42 million units
were collected through the Red Cross – a decrease of 2.6 percent compared with
Although the Red Cross was known for its disaster relief as well as its blood
products, it was the blood services division that caused its headaches.
The Red Cross had been under a court-supervised consent decree since 1993
to eliminate safety problems in its blood program. In the 1993 consent decree,
the Red Cross agreed to establish clear lines of managerial control over a newly
established, comprehensive, quality assurance program in all regions; to enhance
training programs; and to improve computer systems, records management, and
policies for reporting problems, including adverse reactions.
In February 1999, the ARC had completed its “Transformation,” a $287 million
program that reengineered its Blood Services’ processing, testing, and distribution
system and upgraded its computer system for tracking blood products (among
other management activities). As a result of this investment, the ARC’s Biomedical
a single, standardized computer system that efficiently maintained its blood
a network of eight national testing laboratories;
a biomedical institute that provided training and other educational resources
to Red Cross Blood Services’ personnel;
” a quality assurance/regulatory affairs department to assure compliance with
FDA regulations; and
” a centrally managed blood inventory system to ensure the availability of blood/
blood components throughout the country.
Poor donor screening, the release of mislabeled blood, collecting blood from
disqualified donors, flawed procedures aimed at keeping unsuitable blood in
quarantine, falsified records, retaliation against employees who reported prob
lems, poor inventory controls, computer errors in tracking blood, and failing to
ask donors about risky health practices were some of the issues that the FDA had
identified over time in various ARC facilities or its home office in Washington,
DC. An FDA inspection of the Red Cross headquarters in December 2002 revealed
that the ARC failed to correct deviations from the last inspection, that the ARCs
lack of quality assurance oversight led to the release of unsuitable blood products,
and that the lack of inventory control led to the unknown disposition of blood
products. Thus, the FDA was ready to sue for a revised consent decree.
MERICAN RED CROSS
The revised consent decree stemmed from “FDA concerns arising from inspec
tions over the past 17 years revealing persistent and serious violations of blood
safety rules.” The revised consent decree included the following fines if the ARC
failed to comply with blood safety rules and the revised requirements:
$10,000 per event for any violation of the ARC’s standard operating procedures
(FDA mandated and approved written procedures designed to help ensure
product quality), the law, or consent decree requirements and timeline.
$50,000 for the preventable release of each unit of blood if the FDA determined
that there was a reasonable probability that the product might cause serious
adverse health consequences or death, as well as $5,000 for the release of each
unit that might cause temporary problems, up to a maximum of $500,000 per
” $50,000 for the improper re-release of each unsuitable blood unit that was
returned to inventory.
$10,000 for each donor inappropriately omitted from the National Donor
Deferral Registry, a list of all unsuitable donors.
In February 2004, the FDA informed the ARC of its intention to assess fines
because the ARC’s Problem Management Standard Operating Procedures, sub
mitted October 2003, did not meet the terms of the Amended Consent Decree.
The Red Cross issued a statement that it “continues to share with the FDA the
steadfast commitment to the safety and availability of the blood supply” and was
“working diligently to review and implement satisfactory SOPs” that would bring
it to “swift regulatory compliance.” In addition, the Red Cross stated that it had
made provisions within its operating funds to cover the cost of the penalties and
that “no monetary donations will be used to pay these penalties.”4
2001: ATTACKS AND DISCARDED BLOOD UNITS5
According to The Washington Post, the General Accounting Office reported
that the vast amount of blood collected from new donors was not needed by
victims of the terrorist attacks – fewer than 280 units were used of the approxi
mately 572,000 additional pints collected. In the end, one in every three pints
was thrown away – about 208,000 pints. The Los Angeles Times reported that
critics had faulted the Red Cross for its “umelenting call for blood donors after
September 11th resulting in more than 250,000 pints being discarded because
it was too old to use.”6
The Red Cross was criticized for continuing to collect tens of thousands of pints
after it was clear the blood would not be needed by the victims of the September
11 attacks and after many members of America’s Blood Centers had halted col
lections rather than accept surplus blood. The Red Cross defended its actions
and said it continued collections because it needed to build inventories in case of
future attacks and wanted to enable Americans to do something for their country.
In addition, the Red Cross said it planned to freeze more than 100,000 pints for
future emergencies, but ended up freezing about 9,000 units.
CASE 3: CO M MUNITY BlOOD CEN TER OF THE CAROLINAS
Because of the bad publicity over the discarded blood, a backlash occurred,
resulting in apathy toward donating. These first-time donors did not return. The
Red Cross had 276,423 first-time donors within weeks of the attacks, but fewer
than one in 20 returned.
Red Cross Research
The Red Cross national research program was established to make contributions
to biomedical science, blood safety, plasma-derived therapeutics, and transfusion
technology. Red Cross scientists were engaged in research to develop the next
generation of blood products and services. Each year, the Red Cross invested
more than $25 million in research projects seeking to improve the safety, purity,
and efficacy of blood.
Recent examples of research results were the actions taken for leukocytes and
cellular therapy. Ordinarily, leukocytes (white blood cells) help fight off foreign
bodies, such as bacteria, viruses, and abnormal cells, to avoid sickness or disease;
however, when transfused to another person, these foreign leukocytes in whole
blood were often not tolerated well by some patients and have been associated
with transfusion complications. Although not required by many patients, the
Red Cross moved to a system-wide, pre-storage leukocyte reduction to improve
patient care. Within 48 hours of donation, all blood was filtered to remove leu
kocytes, adding about $65 to the cost of processing each unit of blood.
Cellular therapy involved collecting and treating blood cells from the patient or
another blood donor. The treated cells were then returned to the patient to help
revive normal cell function; to replace cells that were lost as a result of disease,
accidents, or aging; or to prevent illnesses. Cellular therapy might prove to be
helpful for patients undergoing treatment for cancer, because researchers hoped
that treated cells would battle cancerous cells.
ARC’s Carolinas Blood Services Region7
Headquartered in Charlotte, North Carolina, Carolinas Blood Services was estab
lished to serve a population of more than 6 million people from 82 counties in
North Carolina and parts of South Carolina, Georgia, and Tennessee. In addition,
Charlotte was the location for one of eight Red Cross national testing laborator
ies. The Red Cross estimated that more than 1,500 units of donated blood were
needed daily in the Carolinas region; between 1,500 and 1,600 blood products
were distributed daily to more than 100 hospitals. Blood was collected from ten perman
ent sites (Asheville, Cary, Charlotte, Durham, Greensboro, North Raleigh, Raleigh,
Wilmington, and Winston-Salem in North Carolina and Johnson City, Tennessee)
and more than 10,000 blood drives each year involved businesses, churches,
schools, shopping malls, and so on. In 2002, individuals donated more than 400,000
units of whole blood and more than 50,000 apheresis products. The Carolinas
Blood Services Region led the nation in collections from 1997 through 2003.
BlOOD CHAllEN GES
Additional services offered by the Carolinas Blood Services Region included:
two reference labs (operated 24/7); frozen units of rare blood (the American
Red Cross maintained the National Rare Blood Registry); therapeutic apheresis; peri
operative autologous salvage (recycling of a patient’s blood during surgery); and bone
marrow, stem cell, and sickle cell programs (typing for matching, and so on).
ARC collected about 45 percent of the blood supply, ABC-related organizations
collected about 45 percent, and hospitals collected about 10 percent. Estimates were
that approximately 32,000 units of blood were needed daily in the United States.
The major challenge in blood banking was to increase the number of donors
as well as increase the number of donations made by each individual donor.
A healthy person could donate blood every 56 days (six times per year). Only
5 percent of the population donated blood. During the late 1990s and the early
years of the new millennium, the advent of mad cow disease, SARS (severe acute
respiratory syndrome), and the West Nile virus severely impacted the number
of potential donors.
Donors had to be at least 17 years old, 110 pounds or more, and meet the
requirements of the screening process. As the number of screening tests per
formed and the restrictions on donors increased, blood donors decreased. Screening
for HIVj AIDS and hepatitis had been done for some time, but new tests were
required for mad cow disease, SARS, and West Nile virus.
ScREENING FOR MAD Cow DISEASE
In 2002, because of mad cow disease, the FDA enacted restrictions on blood
donations from anyone who lived in the United Kingdom for three months or
more between 1980 and 1996; spent five years or more in Europe since 1980; spent
six months or more from 1980 to 1990 on a military base in Belgium, the Nether
lands, Germany, Spain, Portugal, Turkey, Italy, or Greece; or who received a blood
transfusion in the UK since 1980.
SCREENING FOR SARS
The first SARS case was identified in November 2002 and in April 2003 the FDA
recommended guidelines for donations:
Individuals who had traveled to high-risk areas for SARS (People’s Republic of
China, Hong Kong, Hanoi, Vietnam, Singapore, Taiwan, and Toronto, Ontario)
CASE 3: CO M MUNITY BLOOD CEN TER OF THE CAROLINAS
were deferred from giving blood for 14 days after returning even if they showed
no symptoms of infection.
Individuals who had close contact with someone who had SARS were deferred
for 14 days following the last close contact.
Individuals who had SARS or were suspected of having SARS were deferred
for 28 days after complete symptom resolution and termination of medical
Recent donors who experienced a SARS related exposure were encouraged to
report the information up to 14 days after donation.
ScREENING FOR WEST NILE VrRus
The first West Nile virus cases in the United States occurred in 1999. Over the
three years till 2001 there were 18 deaths. Then, in 2002, the number jumped to
over 4,000 cases and 284 deaths. At least 23 people were infected by the virus
through blood transfusion and four more through organ transplants. Nucleic
acid amplification tests (NATs) of collected blood were required by the FDA as
of July 1, 2003. Although donors were specifically asked if they had experienced
fever with headache during the seven days prior to donation, only about 20
percent of individuals who had been exposed to the virus actually developed
symptoms (flu-like, with headache, fever, and muscle aches). Individuals were.
deferred for 14 days after the last occurrence of symptoms (headache and fever)
or if the NAT identified the presence of the virus.
Although donated blood is free, there are significant costs associated with:
collecting, testing, preparing components, labeling, storing, and shipping blood;
recruiting and educating donors; and quality assurance. As a result, processing
fees are charged to recover costs. Hospitals charge for any additional testing that
may be required, such as cross matching, as well as for the administration of the
blood. When CBCC began operations in 2002, the Red Cross charged about $200
per unit and CBCC charged $150. For CBCC hospitals, the difference amounted
to a $3 million saving. In 2004, the differential remained about the same.
The blood supply level fluctuated throughout the year. During holidays and
in the summer, supplies tended to fall because donations declined, but demand
remained stable or even increased. Persons 69 years and older accounted for
approximately 10 percent of the population, but they required 50 percent of all
whole blood and red blood cells transfused, according to the National Blood Data
Resource Center. Using current screening and donation procedures, a growing
number of blood banks found blood donation by seniors to be safe and practical.
REAliTY SETS IN FOR C BCC
Trouble in collection volume became apparent in October 2003. Ball’s estimates
for blood collection were not being met (700 units collected versus 1,400 projected
per month) and costs were considerably higher than budgeted. In November 2003,
CBCC was required to undergo some “rightsizing.” The board replaced Ball with
an interim executive director, Linda O’Neal, who was director of marketing and
strategic planning at Virginia Blood Services. O’Neal traveled to Charlotte each
week from November to May, when chairman of the board, Tom Hassett, became
the interim director.
Hassett had been intimately involved with CBCC since its inception. He flatly
stated, “The critical success factors for CBCC are donations, donations, dona
tions. The regulatory part is critical but it’s a given. We need to be as near perfect
as humanly possible. But if we don’t have donations, it doesn’t matter.”
He continued, “When the budget was so bad, the board reduced the staff from
50 to 31. Blood requires a highly specialized staff and if they are not kept busy,
we can’t reduce the time they work per week because they will quit and go else
where – and there are plenty of places that will hire them.”
One concern in particular to Hassett was that the board found it necessary to
wipe out the marketing budget at a time when it was so necessary to get CBCC’s
name out to the community. He went on to describe other cost-cutting measures:
“We have two apheresis machines that lease for $4,000 per month. We are not
using those machines sufficiently and I’m trying to get out from one of the leases
until we build the number of apheresis donors. In addition, several of the hos
pitals wanted us to do autologous blood collection at the hospital. We had three
set up with that capability but it really made more sense for us to centralize that
process. Now we have autologous collection, apheresis collection, and whole
units collected at the Center.”
Hassett expressed some frustration in CBCC’s inability to attract donors. He
commented, “The Red Cross is really entrenched here. They have had drives at
companies and churches for years. We were warned that it would be challenging
for CBCC to get started, but I don’t think any of us realized how hard it would
be. That’s why we put back some marketing money in our tight budget. We began
the ‘100 Sponsors in 100 Days’ campaign that ran from April to August 5, 2004.”
Exhibit 3/7 shows one of the ads that ran in local newspapers.
Hassett summarized, “We ended up with 112 new sponsors, bringing the total
number to 285 organizations. We are trying to contact new organizations that
do not have pre-set ideas about only donating to the Red Cross. We are happy
when anybody gives blood because it saves lives – but we would like more
donors to give through CBCC. We’ve had some success going to high schools.
Kids have to be over 17 to donate, but there are a good number of seniors
who are. Targeting them is really a long-range strategy because we hope that
over their lifetime they will continue to donate to CBCC.”
He continued, “We collected about 1,000 units a month – by fiscal year end
2004. In 2004-05, CBCC is satisfying 70 percent of the need for blood in the
CASE 3: CO M MUNITY BLOOD CEN TER OF THE CAROLINAS
Exhibit 3/7: 100 in 100 Ad
For a number of years, local hospitals have been struggling to have a voice in their blood
program. Their doctors have asked for a choice in products and services to best meet the
To sign up your organization,
please call 704/972-4701.
needs of their patients. They’ve sought predictable blood prices to help contain rising
Or visit 100in100.org. Because
healthcare costs in our community. That’s why 10 of those hospitals you trust for
your healthcare decisions made just that- a decision. They decided to put the needs
the value of a pint of your
blood is immeasurable.
of local patients, donors and doctors first.
Hence, the creation of Community Blood Center of the Carolinas and the 100 in 100 blood
drive challenge. During the next 100 days, we’ll be contacting organizations like yours to secure
100 new blood drives so local donors will have opportunities to help save local patients.
100 days to secure blood drive commitments
with 100 additional organizations
Carolinas HealthCare System • Caromont Health • NorthEast Medical Center • Piedmont Medical Center • Presbyterian Healthcare
region – from what we draw [local donations] and from other independent centers
that are ABC members. Charlotte area hospitals need about 60,000 units a year.
With CBCC collections nearing 14,000 this fiscal year, and increasing help from
other centers, we are well on our way to supplying the entire blood need in just
a few years. It is important to the hospitals we serve to do that.”
Some ABC blood centers were fortunate enough to collect more blood than they
regularly use. CBCC contracted with some of them for excess blood for one year;
contracts with others were by the quarter. Because it was excess blood for the centers,
the price was reduced. Hassett said, “We don’t want to rely on blood from other
centers, but for now it is an effective bridge to help us get where we need to be.”
“We have three crews that handle our drives,” explained Hassett. “We need to
keep them and the Center staff busy to lower our costs of production. We have also
been talking with hospitals in western North Carolina and Greensboro that might
start community blood centers and ship blood to us for processing. It seems logi
cal that we don’t all need processing facilities and ours is certainly large enough.
REAliTY SETS IN FOR C BCC
I don’t know if we can make that work, but it is an interesting scenario. Right
now our hands are full managing our operations and building the number of
“Our original budget (see Exhibit 3/8) was optimistic. When we didn’t hit
the numbers, we were fairly drastic in ‘rightsizing.’ We cut staff – from 50
employees to 31 – and reviewed all ways to manage more efficiently. Despite
A: Forecasted Collections
FY 2003 (April through September)
Whole B l ood
1 , 1 00
1 , 1 05
1 ,3 1 5
Whole B l ood
B: CBCC Summary P&L ( Forecasted} ($}
P u b l i c Relations
Red B l ood Ce l ls ( R BCs)
5 1 3,000
Fresh Frozen Plasma
Random Donor Platelets
88,3 1 6
E q u i pment Repair
503, 1 00
S u p p l ies
1 87,7 1 2
Professi o n a l Services
U N CAP E q u i p m e nt
E q u i pment Rentals
Uti l ities
B u s iness Expense
I ns urance
I nterest Expense
D u p l ication Expense
B u i l d i n g Repair
S a l a ries
S h ipped-i n-Blood
7 1 1 ,785
59,6 1 8
1 1 ,250
1 46, 1 22
Total Operating Expense
Net Income ( Loss}
P u rchase Expense
CASE 3: CO M MUN I TY BLOOD C E N T E R OF T H E CAROLINAS
the loan guarantees from the hospitals that created CBCC, projections were that
we might run out of cash by September.”
Hassett’s task during the summer of 2004 was straightforward:
Increase cash flow to keep the Center alive.
Increase the number of donors and sponsors.
Increase the level of customer service.
Hire a highly talented and energetic executive director.
With a projection of running out of credit in September, the hospitals agreed
to institute a fast-pay program – CBCC submitted invoices daily and was paid
weekly. Consequently, days in accounts receivable were significantly reduced and
the Center was positioned to stay alive while the other cost-reduction strategies
SPONSORS AND DoNORS
The “100 in 100” campaign was given major focus with a very positive outcome
of signing 112 new sponsors in 100 days. Because of new sponsors, future dona
tions would increase because of the relationships being built.
Every drive needed to be as near perfect as possible. Collecting blood was nearly
identical no matter whether it was the Red Cross or a community blood center
because the process was so heavily regulated by the FDA. The difference would
be seen in donor satisfaction and sponsor satisfaction. Survey instruments were
implemented so that CBCC could score and track satisfaction. The reports pointed
out where improvement could be made and provided positive feedback to the
collection and support staff. Satisfaction scores increased to the level of between
“very satisfied” and “extremely satisfied.”
With cash flow in order, the number of sponsors significantly increased, and donor
satisfaction high, it was time to recruit a permanent executive director. First, the
board defined the qualities desired in CBCC’s top executive. A proven track record
of success in a sales-oriented business was considered to be of utmost importance.
Secondly, the individual’s personality would need to exhibit passionate energy
for the community role and success of CBCC. Thirdly, it would take someone
who could manage operations well. Because of the expertise of Virginia Blood
Services regarding all regulatory and quality functions, the board felt that the
executive director did not have to be an expert in the science of blood banking
but he or she would certainly have to have a healthy respect for the need to be
outstanding in the areas of quality and regulation and to assure compliance.
W H AT ‘ S N E X T ?
Challenges remained for CBCC. Although the budget for the Center called for
breakeven operations by September 2005, it also called for a 40+ percent increase
in the number of collections. It was considered doable, but challenging. The largest
companies and government agencies in the region had a long history of sponsor
ship with the Red Cross; it continued to fight to maintain its market share despite
70 percent of the blood collected in the Charlotte area being sold across the coun
try. CBCC had to earn its way to increased blood drive sponsors by proving over
and over its commitment to the local community and telling its story by every
After an extensive search, Martin Grable was hired as executive director in Sep
tember 2004 (see Exhibit 3/9 for the news release announcing the appointment).
In accepting the position, he stated, “It’s all about donor development – there is
nothing else. CBCC is meeting the quality and service standards. Clearly we have
to build the donor and sponsor base.”
He continued, “The fiscal year has just started. Three days after I arrived one
of the recruiting managers resigned. We can’t get behind the curve in October
Exhibit 3/9: N ews Release
CBCC APPOINTS NEW EXEC U T IVE DI RECT OR
Charlotte, NC- Community Blood Center of the Carolinas’ Board Chair, Steven Burke, announces the
appointment of Martin A. Grable of Charlotte as Executive Director. Mr. Grable has 17 years of experi
ence delivering consulting, financial, and professional services to large corporations. Most recently,
he was cofounder, p resident and CEO of Matrix Absence Management, Inc. of San Jose. Founded
in 1985, Matrix is a national benefits administrator providing professional services to many of the
Fortune 500 companies – a number of which have remained with the company since its beginnings.
The first seven Matrix clients – Philips Semiconductor, U niversity of the Pacific, Amdahl, LSI Logic,
National Semiconductor, Sun Microsystems and Intel Corporation – have remained as clients. He
sold the company in 1998 to Delphi Financial Group and agreed to remain as President and CEO for
In 2002, Martin Grable had the good fortune to travel and reflect on the opportunities that might
lie ahead. He did an exhaustive search for the right community for his family – one that was grow
ing, with a diverse economic base, in a good location with a great climate and a major airport, and
a strong sense of community. After many visits to a number of locations, he became a Charlottean
His interest in doing something different that would make a difference led Grable to apply for
the position of Executive Director at CBCC. Grable stated, “I came to CBCC because I recognized the
importance and value a community blood center brings to the community. T he blood supply is a
community asset, best managed locally, with the interests of the local community as the top priority.”
CBCC was established in 2003 through the collaborative efforts of ten area hospitals to better provide
for the blood needs of the communities in the Charlotte area. Steven Burke, CBCC Board Chair said,
“The Board is really excited that Martin Grable is bringing both his concern for the community and
his entrepreneurial spirit to assist in meeting the blood needs for our community.”
Grable was born and raised in Kansas and attended the U niversity of Kansas. He is married to
Cathy and they have three children: Lauren 20, Nicole 26, and Heather 30.
CASE 3 : CO M MUN ITY BlOOD CEN TER OF THE
because the months of November and December are traditionally slow months
for donations. I have to figure out what to do now – the immediate plan. Then,
determine a mid-range plan for the next two quarters, followed by a longer term
strategic plan . . . But, they all have to work together or there will be a mixed
message to donors and sponsors and that won’t help us at all.”
He concluded, “I like the odds. We’ll have a few bumps in the road, but I like
the geometry of the hospitals, the community, and the blood center. We are a
service to the community and we will develop that sense of community.”
1 . This section is taken from ” A Brief History of the
museum/history/brief.asp, accessed July 10, 2004.
http:/jwww .redcross.org/ services/
biomed/, accessed July 10, 2004.
5. Gilbert M. Gaul and Mary Pat Flaherty, “Troubled
Times for Red Cross; Blood Bank Faces Shortages,
Dispute over Safety Violations,” The Washington Post
(September 16, 2002), p. A-2.
Red Cross’ Handling of Blood,” Los Angeles Times
3. “American Red Cross Agrees to Revised Consent
Decree to Improve Blood Safety,” FDA News at http://
(December 11, 2001), p. A-44.
7. This section is adapted from “About Us,” American
fda.gov/bbs /topics/NEWS/ 2003 /NEW00891 .html,
Red Cross Carolinas Blood Services Region at http://
accessed September 18, 2004.
www.redcrossblood.org/ about.htm, accessed on July
4. “American Red Cross Statement on FDA Adverse
www . r edcro s s . or g/ pressrelease / 0,1 077,0_314_
227l,OO.html, accessed September 18, 2004.
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