It’s almost embarrassing to admit how good the shrimp scampi at Salinas Valley Memorial Hospital is, considering it’s, well, hospital food. But this is flavored with garlic and lemon, sautéed in a mild wine-based sauce and garnished generously with fresh parsley and scallions.

The whole portion’s got 150 calories, 240 milligrams of sodium and 3 grams of fat. Executive Chef Michael Gaines ditched the usual butter base and substituted non-fat milk powder, the kind of ingredient restriction he’s gotten used to.

Computerized systems at Memorial Hospital and Community Hospital of the Monterey Peninsula mean each patient gets a personalized menu, depending on what the doctor ordered (low in carbs, salt or fat, for example) and what they like.

“We have to come up with something that has all these restrictions and still tastes great,” Gaines says. It’s a little bit like a reality cooking show, in which key ingredients are ruled out of bounds.

For Gaines, who spent more than a decade at Pebble Beach as a banquet chef, it’s an added creative challenge.

He’s currently at work on a pesto that’s free of nuts and oil. He’s loading it up with fresh herbs, including thyme and oregano, and adding a little white wine.

“It’s been a little difficult adjusting,” Gaines says. “But pulling off this enchilada – wow. I would be happy to serve this to anyone at Pebble Beach.”

And he should be. His chicken enchilada, doused in low-sodium melted cheese, is mildly smoky and satisfying. For an added kick, Franco’s salsa – named for the cook who invented the recipe – is bright and slightly sour. “Sometimes I have to put a leash on Franco because he makes it too hot,” Gaines says.

“Hospital food has come a long way from Jell-O and bouillon,” SVMH spokeswoman Adrienne Laurent says. Evolving culinary sophistication is part of a more general trend: Hospitals are looking and feeling less like hospitals, with panels hiding medical equipment and furniture that looks like it was bought at Ikea.

Not that they’ve stopped serving Jell-O. Comfort foods – generally Mexican entrees, hence Gaines’ new enchilada – remain on the menu.

“If a kid is sick and he finally gets his appetite back and all he wants to eat is a cheeseburger, you have to balance that,” SVMH dietitian Jennifer LeDuc says. “Sometimes getting food in the patient is the issue, whether it’s healthy or not.”

But some healthy ingredient substitutions, like leaner cuts of pork (Gaines’ chili verde now features a tender, slow-cooked loin cut instead of a fattier shoulder) and steak (they’ve switched to a shoulder cut with no marbling) are also driven by cost.

Price, not health, has been one of the major pressures driving old mainstays off menus. Beef Wellington and duck used to be dinner staples at CHOMP, but no longer. Now the choice is between dishes lighter on both the belly and the budget: chicken marinated in sesame-soy-garlic sauce or portobello mushroom with wasabi aioli over steamed vegetables.

Local hospital reps couldn’t calculate exactly what they spend per patient meal, considering variables like menu personalization and labor costs. But patient food is just about a third of hospital food service. Feeding family members and staff in cafeterias is also a major priority – and a classroom of healthy eating.

Natividad Food Service Director Cori Thomas prints Weight Watchers points next to every cafeteria item, and she’s started making adjustments without telling anyone – baking the French fries ($1.50), offering black-bean veggie burgers ($3.50) and eighty-sixing the Cheetos (“I got a revolt against me for that,” she says). Eighty percent of her produce is organic, including impressively crispy lettuce from Earthbound Farm.

Still, Thomas doesn’t get too Draconian. She even put up a fight to keep a candy machine after the county passed a healthy vending ordinance in 2009. But she does want to price down healthier cafeteria options. (The salad bar is $8 per pound, while frozen yogurt is just 50 cents.) That’s something CHOMP is already doing: They feature the healthiest meal of the day and sell it for $3, subsidizing with profits from pricier desserts and burgers.

For Thomas, the hospital makes for an ideal learning opportunity. Many patients land there for diet-related reasons, like complications from Type-2 diabetes, to begin with. She hopes family members snacking in the cafeteria can help absorb lessons about nutrition, maybe realizing “weird things they’ve never heard of” – like quinoa – are actually edible.

At CHOMP, dietitians are still teaching patients the basics of food groups. They order patients recovering from surgery to eat lots of protein, since proteins trigger a message to stem cells to proliferate, creating new cells to heal wounds. They’ll ask patients to point to the protein on their plates, and sometimes they’ll point at the carrots.

“We’re teaching to the patient in the room,” Thomas says. “Maybe we can affect the whole family here.”

To try the cafeteria food at any hospital, visit during operating hours 7 days a week. www.chomp.org; www.svmh.com; www.natividad.com for more.