At the first meeting of the University of Virginia's Board of Visitors in 1819, Thomas Jefferson authorized a School of Medicine - one of ten original schools in the new university. He sent a letter to London asking Robley Dunglison to come over and teach. Dunglison did. Classes opened in March 1825 with that single professor. The first medical degrees were awarded in 1828. Of the eight thousand books Jefferson selected for the original university library, 710 were on medical subjects - more than enough to start a working medical curriculum. The hospital came much later. The University of Virginia Hospital, designed by Paul J. Pelz - the same architect who designed the Library of Congress Jefferson Building in Washington - opened on April 13, 1901 (Jefferson's birthday) with an operating theater, laboratories, and initial ward capacity for 25 patients. A nursing training program started a few months later. It would not be formally chartered as the School of Nursing until 1956.

Until 1960, Black patients at the UVA Hospital were treated in segregated wards in the basement. The hospital that called itself an instrument of public good limited the care it offered by race for the first six decades of its existence. The integration that finally came was forced by Black hospital employees and local NAACP organizers. Randolph Lewis White, who worked at the hospital, became one of the central figures in the push. He and others lobbied state and local officials, threatened a hospital worker's strike, and prepared a lawsuit. The hospital integrated its wards in 1960. White's name is now affixed to programs at the medical school. The basement wards are not. The institution remembers the integration but is still working out how to talk about the six decades of treatment that came before it - and how to rebuild trust with the descendants of patients who were turned away or pushed downstairs.

On June 30, 1995, the maternity ward sent two newborns home with the wrong families. The mistake was not discovered until the summer of 1998, when a DNA paternity test ordered during a divorce revealed that one of the children had been switched at birth. Custody battles followed. Both children stayed with the families who had raised them, not the families they had been born to. The case made international news for years and is still cited in hospital risk-management training as one of the modern era's most consequential identification failures. The University of Virginia settled with one of the families in April 2001 for $2.3 million. The maternity ward changed its newborn-tracking procedures, as did hospitals across the country. Banded identification, DNA blood-spot retention, and ankle radio-frequency tags became standard practice. The 1995 mix-up is part of why.

Today the medical center has 701 inpatient beds plus a 71-bed Level IV neonatal intensive care unit and a separate Children's Hospital with 106 pediatric beds. It is a Level I trauma center served by Pegasus, the air-and-ground critical-care transport service whose helicopter pad sits atop the Battle Building. The main hospital tower opened in 1989, was expanded in 2004, 2012, and 2019, and now stands eight stories. The West Complex, threaded together out of buildings that went up between 1901 and 1960, holds the older clinical departments. The Emily Couric Clinical Cancer Center, named for the late state senator and sister of the journalist Katie Couric, opened in 2011. The Claude Moore Health Sciences Library, dedicated in 1976, is the descendant of the 710 medical books Jefferson set on the original university shelves. In July 2021 UVA Health completed the purchase of Novant Health UVA Health System, taking sole ownership of the hospitals in Culpeper, Manassas, and Haymarket.

From above the medical campus reads as a dense knot of brick and glass on the slope just southwest of the Lawn, distinct from the historic Academical Village but tethered to it. The main hospital tower is the tallest building. The Battle Building's helipad catches the sun on its white concrete pad. Charlottesville-Albemarle Airport lies about four miles to the north; Pegasus helicopters thread between the two regularly, ferrying patients in from across central Virginia. The medical school produces the physicians who teach in the wards, who staff the cancer center, who run the trauma bays, who deliver the babies the maternity ward now identifies with quadruple-redundant tagging. The Health System's reach extends across eight Virginia counties and into Northern Virginia. The first Jeffersonian course was taught by one man in a single room. The institution that grew from it now runs hospitals from Culpeper to Lynchburg.