The pride of his personal digital operating room one of three operating rooms is a huge Zeiss Pantera surgical microscope that he helped develop. He uses it to perform intricate spinal procedures while making only tiny incisions. Such equipment is in part why patients are able to go home to recuperate a few hours after surgery.

In addition to Carl Zeiss Inc., Bray also has developed corporate partnerships with other medical device makers that not only given him cost-effective access to the latest equipment, but is establishing his center as a training facility. Cameras and monitors in the operating rooms not only enable the patient to watch the surgery if they desire, but also other physicians, either from on-site conference rooms or remotely.

British endoscopy equipment company Smith & Nephew plc has a $3 million equity investment in the venture. The U.S. subsidiary of Germany's Siemens AG has provided the center some of its latest digital imaging equipment even before some larger, more established institutions.

And surgical and pain management equipment maker Medtronic Inc. has designated D.I.S.C. as a training center. Bray's doctors also are participating in clinical trials for a shock-absorbing spinal stabilization implant developed by Medtronic, one of two trials under way at the center.

Bray also established partnerships with two neighboring hospitals to refer patients who may need more intensive care. The Marina del Rey campus of Centinela Freeman Medical Center operates a sports rehab and medicine clinic at D.I.S.C. In addition, D.I.S.C. also has a relationship with St. John's Health Center in Santa Monica, where Bray serves as medical director of Saint John's Spine Institute.

"Their approach to medicine, multiple specialties operating in an integrated, patient-friendly environment, is very much in line with our model at the hospital," said Lou Lazatin, St. John's chief executive.

Another challenge Bray experienced in setting up the center was its ownership structure. Federal and state law strictly regulate non-physician ownership of physician groups and surgical centers, and restrict how doctors can refer patients to facilities they own. While all of D.I.S.C's physicians have an equity stake in the business, Bray knew he needed greater flexibility to make his integrated medicine concept work and eventually open other centers.

A team at the law firm of Shepherd Mullin Richter & Hampton led by partner Bob Spanlotti worked out a single-integrated medical group structure for the center, similar to the medical group subsidiary of Kaiser Permanente, that Spanlotti said should stand up to regulatory scrutiny.

At least one of Bray's recently recruited surgeons says D.I.S.C.'s integration works even better than the Kaiser model. "I was really attracted by the multi-disciplinary approach with state-of-the-art equipment under one roof," said Dr. Sanjay Khurana, who came from a San Diego Kaiser facility. "In this setting there are really no hurdles to getting the patient treated quickly."

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