Interview with Dr. Arthur Rikli; Jim Watson, Association
Director, MORMP; Fred Frazier, MORMP Information Officer; W.R. Kimel,
Dean Emeritus, College of Engineering; Gayle Adams, Professor
Emeritus, College of Engineering; Dr. Joye P. Nunn, School of
Journalism; Dr. William C. Allen, Professor Emeritus, Department of
Family and Community Medicine, School of Medicine; Dr. Gordon
Brown, Chairman, Department of Health Service Management; Lloyd
Harmon, past Director, American Heart Association of Missouri;
Dr. Wyeth Hamlin, practicing physician and former chairman of the MORMP
Date: September 27-28, 1993
Location: Columbia. MO
Interviewer: Stephen Strickland
This interview was part of a sequence of such interviews and
structured conversations held over a two-day period in Columbia,
Missouri on September 27 and 28, 1993. Arranged by Dr. Arthur
Rikli, long-time director of the Missouri Regional Medical Program,
the participantes included: Jim Watson, Association Director,
MORMP; Fred Frazier, MORMP Information Officer; W.R. Kimel, Dean
Emeritus, College of Engineering; Gayle Adams, Professor Emeritus,
College of Engineering; Dr. Joye P. Nunn, School of Jorunalism;
Dr. William C. Allen, Professor Emeritus, Department of Gamily and
Community Medicine, UM School of Medicine; Dr. Gordon Brown,
Chairman, Department of Health Service Management; Lloyd Harmon,
past Director, American Heart Association of Missouri; and Dr.
Wyeth Hamlin, practicing physician and former chairman of the
MORMP.
Dr. Allen: The Bi-State program, based in St. Louis, went
ahead with the two schools in the city of St. Louis and some
counties over in Illinois which typically went towards St. Louis.
The were invited to sit in on our council or board meetings and we
sat in on theirs, and that worked out very well although they never
did quite join. I think that probably as far as the deans were
concerned, they would have come in from the start. You have to
understand that at Washington University the dean was sort of a
figurehead; the departments really ran the school and they fought
like cats and dogs. It was almost the same at St. Louis U.
although it was not as pronounced as at Washington U.
One of the thins we did early on in connection with the state
health people was to do a study of all the hospitals. I believe
there were somewhere in the neighborhood of 186 hospitals, to find
out how many had intensive care units, or if they didn't have such
units, at least intensive care capability. There were only fifteen
that had unites or intensive care capabilities. So why they hadn't
proceeded to do this, most of them said it was because they didn't
have anybody who knew how to use the equipment. So we started with
one grant to set up an intensive care unit that would serve as the
model, and a training program; and we required that the hospitals
select the personnel they sent to the program and requested that
they pay their way to the program, feeling that in that manner,
they would go back to the hospital rather than go somewhere else.
And they spent two weeks at the program here in Columbia and then
would go back and spend a month in their own hospital, do
correspondence courses in that period of time, work with intensive
care unites in their own hospitals and then come back for a final
two weeks of advanced training. So I think every hospital in the
state now has an intensive care unit.
We even had one hospital that had to build a new hospital and
I had a chance to visit with them. I suggested to them, why not
put in all the tubing and wiring while they were building the unit
if it turned out to be needed because I said, if you try to do it
later, it'll be a lot more expensive. So that hospital is one that
now has an intensive care unit, and they have a four- bedroom
intensive care unit.
Strickland: But in the period of MORMP, how many of the 186
hospitals did in fact establish intensive care units?
Allen: All of them did. Well, it might not have happened
completely within the period that RMP was still officially going,
but practically all of them.
Strickland: We were talking yesterday with Dr. Wyeth Hamlin
about elements that contributed to the reduction of mortality over
the last quarter century -- well, since World War 11, basically --
particularly from cardiovascular related problems. And I've been
struck with the fact that regardless of the diversity of interest
of the various programs across the country, almost every one of
them paid attention to the hear, cancer and stroke basis of the
original proposition. All of them had programs that supported the
development of Coronary intensive care unites, and had programs for
training personnel in the field. Of course, there were other
programs; the Public Health Service had its own heart program. And
there was a lot going on. After cancer, the Heart, Lung and Blood
Institute got more money than any of the other institutes of NIH,
so there was a heavy research component (of the government's
approach to hear and related diseases). But I can't help but wonder
if this expansion of the national capacity to treat heart-related
problems -- myocardial infarctions, more specifically arrhythmias -
- hasn't made some very significant contribution in this to this
process.
Allen: Oh, I think so. Buck in his program probably
developed the research, to where it was a practical thing (to
implement such a wide scale program). I think regional medical
programs, throughout the training of personnel -- because a
hospital wasn't about to go out and spend several hundreds of
thousands of dollars of equipment if they didn't have anybody who
knew how to use it. Now our program, in addition to nursing, was
open to physicians. We would set that up for physic and in any way
that they wanted to take the time. If they wanted to come and
spend a month straight time, fine; if they wanted to spend a week
at a time, or a day a week for a longer period of time, we would
set that up. Because we knew that they were busy and probably
couldn't take off the time a nurse might. the other thing that
helped in Missouri early on was that we met with the Governor, who
was somebody that both Vern and I happened to know, and agreed to
have an advisory committee to RMP. And that was one way to get the
Governor involved. It was agreed with eh Governor that we would
submit names and he would make the appointment, and in the case of
replacements, we would submit three names and he would pick one.
And that's how our advisory committee was established and how it
had a connection with the state government.
Dr. Rikli: Bill, you'll be interested in a story that Pete
Hamlin told yesterday which I had not heard before. And that is
that when Congressman Harold Voikmer was appointed to the advisory
council, he subsequently said he didn't know enough about the
matter or didn't have time, and asked Pete if he would serve in his
stead. (note: Tape change occurred at the beginning of this last
paragraph and editor has reconstructed it.)
Allen: Harold Volkmer was not a name we had submitted. He
was appointed because he asked to be appointed. And we chastised
the Governor over that one.
Rikli: What happened after that apparently -- and you may be
able to fix this story -- was that Volkmer's doctor was Pete Hamlin
and he asked Pete to take his place, saying "I'll have to check
this out with a few of my political friends before I can assure
that you have a place on the board."
Strickland: And Dr. Hamlin said, "What is RMP?"
(laughter) And apparently, as far as Dr. Hamlin was
concerned, he owed his appointment to Volkmer.
Allen: I had known Pete Hamlin since 1952 and Pete was
appointed because I knew what kind of physician he was and what
kind of influence he had in that area (Hannibal). It had nothing to
do with Volkmer. The other thing about Voikmer -- off the record -
- was, he showed up at one meeting with his arm in a cast and he
told us about tripping and falling at the house, and we found out
later that he was drunk and fell down the Capitol steps.
He's still a representative in Congress.
Strickland: What district does he represent?
Allen: It includes Columbia and Hannibal, and goes up
northeast. It's a very gerrymandered district, to be sure it's
Democratic.
Strickland: When you were talking about your visit to the
Governor, was that Governor Bond? No. It was Governor Hearns.
Warren Hearns, a Democrat.
Rikii: His name is on the big auditorium here.
Allen: Which Bob called "Hernia Hall" (laughter)..when he
came here for the dedication of it -- since it was an athletic
facility.
Strickland: Mr. Frazier, was this the governor you were
telling about yesterday -- about you and a group of RMP advisors
going to see him and his aide coming out and telling you, even
though you had an appointment, that "the Governor wasn't
interested" and didn't have time to see you?
Frazier: No. I was talking about Mr. Bond. We assembled a
group from the advisory board to go down (to Jefferson City) and
talk to him about what we might do to continue some of the RMP
activities in the state. And the group included people -- some
very busy people -- from all over the states, including Kansas
City, Hannibal. And we got down there, and the governor wasn't
there; and a young man came out (I guess he was a lawyer) and he
didn't know who we were. And when we told him he said: "Oh, yes.
I've talked to the Governor about it and he's not interested." and
that was it.
Allen: It was interesting. Governor Bond was chastised by
most of his friends when he ran for a second term because he had
been such an ass during his governorship. So they taught him a
lesson and elected "Walking Joe" Teasdale, an attorney from Kansas
City who couldn't get into any law school. Finally his parents
bought his was into law school and paid his way to get the degree,
and so for the campaign, he got out and walked, hence the name
Walking Joe. He was too stupid to come in out of the rain, really.
Strickland: But that was pretty smart, to walk across the
state asking for votes.
Allen: Yeah. But her really got elected because people were
so mad at Bond.
Strickland: And the Bond ran for the Senate.
Allen: Yes. He went to Kansas City and worked for one of the
insurance companies and did a lot of statewide work, and sort of
kept his name before the public. His family is from Mexico, Mo.
Rikli: Where does the money come from.
Allen: His wife has money.
Strickland: So how long did your association, cooperation
with the Governor last? It got off to a good start, but did it
last? Did it continue?
Allen: It continued, with the exception of the Volkmer
appointment.
Strickland: It sounds like you had an eye out for political
support, and to make sure you had good support, and were covering
all bases.
Allen: Correct. We felt that that was important in case the
money ever stopped, so the state might be interested in carrying
forward some of the programs that we had started. That was also
part of the foresight that Dr. Wilson had. He really was about
ten years ahead of everybody else in his thinking.
Frazier: Another group we were careful to work with were the
DO's (Doctors of Osteopathy) because they're extremely important.
Allen: Oh yes, Stan Dansiah was the head of the school, the
original osteopathic school at Kirksville, Mo., and was a good
friend of mine.
Strickland: How did that association work ... because twenty
years ago the MDs looked down on the osteopaths.
Allen: In this state for a long time there were two separate
boards, a board for osteopathic physicians and one for MDs. And
there was a lot of animosity between the two groups. They sort of
fought each other. But as things progressed and we got more
"togetherness" they established the State Board of Healing Arts,
which was to license all professional, everything except nurses,
chiropractors and Christian Science practitioners. So they set it
up in terms of making it less expensive than having a certifying
board for every group that came along. There were five MDs and tow
DOs on the board, which was about the same ratio;as between the
medical practitioners in the state, appointed by the Governor.
Strickland: But your advisory group for RMP continued to be
appointed by the governor, regardless of who was governor?
Allen: Correct. And we did it on the basis of submitting
three names for each position of the advisory board, and he would
select one of them,
Strickland: One of the things that we talked about a little
bit last night -- at least I alluded to it -- is the question of
whether partisan or party politics played a big role in the demise
of the RMP program. I've asked a lot of people about this --
people in the national coordinating office, assistant secretaries
of health in various administrations, the Democratic supporters of
RMP, and others who came in with the Nixon Administration, people
who used to be with the Office of Management and Budget. And so
far I really can't find any concrete evidence that the principal
motivation for the termination was just to get rid of an LBJ/Great
Society program. As Dr. Rikii will recall, Cap Weinberger
declined and invitation to come to the December 1991 conference,
and says he doesn't remember much about it, which basically
includes his response in writing -- meaning in published form -- to
charges, especially from the California RMP group, that his
decision was just political. Did you ever get to the bottom of the
matter of why, Mr. Frazier, Governor Bond wouldn't see you? I
wonder if he had been in touch with Washington, and Washington had
said "this program is going nowhere so don't waste your time?"
Frazier: We never found out. We didn't push it.
Watson: My view of that matter changed after I attended the
anniversary meeting in -91 where the man we called "the Zapper.. "
Strickland: John Zapp, the deputy assistant secretary for
Health/legislation.
Rikii: Appeared. And you know, I always felt that what he
said was just not based on fact. You can read the testimony, and
how he criticized Regional Medical Programs. I'm of the opinion
that he was the messenger, but that he did not formulate the
message that he presented. That was formed by the politicians
behind him, and he was simply the representative to give us that
story. I think that he was much more sympathetic to RMPs than was
his message.
Strickland: Do you mean back in the 70's (when he testified
before Congress or at the December 1971 meeting. He was the one
who went before Congress and said "the Administration wants to get
rid of this program because there is no focus, because there are no
results after years of investment, it's too expensive. he was
deputy assistant secretary, which is pretty far down on the totem
pole. instead of the Secretary going, or the Assistant Secretary
or the Director of the Office of Management and Budget, they sent
poor John Zapp, DDs, who was relatively new at the game...
Rikli: And Harold Margulies, head of RMP at that time, who
the previous year had had great praise for the program... "what a
wonderful program this is..." I think what you're fishing for is:
Who pulled the trigger.
Frazier: We had gotten some unfriendly treatment from OMB,
especially from the man who was Weinberger's deputy and
subsequently wen to the Department of Defense with him (Frank
Carlucci) I saw some talks or speeches he gave in that period of
time and it seemed to me he was developing facts to fit the case.
Strickland: On the other hand, the program actually died at a
time when the Democrats controlled Congress, including the chairmen
of some committees like Paul Rogers who liked RMP. So it obviously
involved more than just a Nixon attempt to get rid of the RMP
program. And, you know, looking at tit historically, many of the
programs didn't do a hell of a lot.
Allen: Right. Unfortunately, there were some programs
dominated by medical schools that just sort of used it for their
own school.
Strickland: That's another aspect that seems, in some cases,
to have been a problem.
Allen: One of the other things we did early on was: the
University had a couple of DC-3's, and if you had a large group of
people going somewhere you could use those. And so Vern got the
DC3's and got Lindberg and myself, and someone from radiology and
some engineers and journalists and others who might be interested
in being involved in RMP if we got the first grant. And we visited
Michael Reese Hospital in Chicago, which had one of the early blood
banks in the country; we went to Mayo Clinic to look at their
cardiology division, in fact to look at their whole clinic, and
places like that, looking for ideas that we might incorporate and
projects we might initiate. We went to the Cleveland Clinic.
Strickland: And again, this is early on. The other thing
that is striking to me is that you who came together to help Dr.
Wilson get this going had experience in the state and networks in
the state. Dr. Rikii was telling me about his experience with
Hill-Burton in the State.
Allen: Yes, and I did as well.
Strickland: And you Mr. Frazier, did you have Hill-Burton
experience as well?
Frazier: No. I came in to it from another source. I was
just recovering from an Ml (myocardial infarction); I had been in
public relations for many years, and Dr. Wilson saw that I was
interested in going back to work and asked that I come over to talk
to him and I did -- and I was glad that I did.
Allen: I had gotten acquainted with Buck Rikli before he came
to Missouri, and we twisted his arm -- along with Dr. Wilson and
Governor Dalton -- and got him to come here. And we got one of the
heart stations squeezed out of his PHS program. One of the reasons
we did that is because this in one institution where the medical
school is on the main campus of the university, and we had the
advantage of having a school of veterinary medicine and a school of
engineering, which we were working with quite closely. As a matter
of fact I was amazed that, for example, the school of veterinary
medicine was doing research all on its own, just relating to
animals, and there was no relationship between them and the medical
school. We got the two of them together, and actually the heart
station was housed in the school of veterinary medicine until we
got it moved over into the medical school and got a floor
constructed for it.
Rikii: That's right. Of course this is a little tangential
to Regional Medical Programs.
Strickland: Yes. Except it does suggest that you were all
aware that there were populations needing serving, and there were
systems that could serve them. It sounds like the cooperative
spirit existed in Missouri before Regional Medical Programs.
Rikii: That's right. I told part of the story; I'll give a
little more of the genealogy here. Karl Marionfield, assistant to
Dr. Wakeman od the Physiology Department, went with the American
Heart Association and came here. Karl went to school with my
deputy at the Heart Disease Control Program of PHS. I had the
highest regard for him; in fact we had about 100 young men out in
the field and everyone just worshipped Karl. And he chose to go to
the School of Public Health. In fact, Karl got out here and he
said "we've got to open our school" -- to the environment, to
ecology; werve got to see what the soil has to do with the plants
we eat, and that sort of thing. He had discovered in New England
the connection between water and hard pipes, where it was first
determined that the reverse was true...Well, with that information,
our epidemiology people studied this problem, and they put things
into line so that right here in the middle of the United States,
where you had had this meeting of the glaciers, we set up this
ecology field station.
Strickland: So you had to come here ahead of the army one
more time.
Rikii: You got it. I'm sorry to take so long, but I love to
tell this story about how this RMP family came together.
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