AlumniBulletin
ALABAMA MEDICAL
V O L U M E 3 0 • N U M B E R T W O • S U M M E R 2 0 0 4
UASOM DOCTORS
Serving Our Nation in Times of Need
Dean’s Corner
Dear Colleagues: This past December we wrapped up the Campaign for UAB. Launched in November 1999, the Campaign met with unprecedented success in meeting its $250 million goal, which prompted an extension and a revised goal of $350 million.
By the end of 2003, the Campaign for UAB raised more than $388 million. The School of Medicine raised more than $260 million—money that will help fund its departments, research programs, endowed chairs, professorships, lectureships, scholarships, and more. Indeed, many of you have gone above and beyond expectations in giving, and for this I thank you. Your generosity is a direct reflection of your belief in the UASOM: our education, our research, our outreach programs, and our patient care. Many others share your belief in our institution. For example, some recent recognitions include:
• The naming of 49 UAB physicians in the respected reference book America’s Top Doctors; University Hospital was named as one of the top medical centers in the same publication. • The designation of UAB as a National Autoimmunity Center of Excellence by the National Institutes of Health.
Our reputation as a leader in medicine continues to grow, and the UASOM continues to see its faculty, researchers, and programs recognized in a variety of ways. This recognition would not be possible without hard work and support on everyone’s part, most notably yours.
While the Campaign for UAB has ended, the need for your support is ongoing. Opportunities to fund important research, faculty positions, scholarships, and more remain. To learn more about these, please contact the development office at (205) 934-4469 or visit them online at [www.uab.edu/uasom/development]. In addition, the University of Alabama Medical Alumni Association needs your continued support in order to assist UASOM students, residents, and alumni. Please call Elaine Chambless at (205) 934-4463 to learn more about what you can do to help the Association.
My best to you.
Sincerely,
William B. Deal, M.D. Vice President for Medicine and Dean
On the Cover: Alumnus Lonnie Funderburg (’50) aboard LST 124 in the South Pacific. Funderburg served as
chief engineer and executive officer of the landing ship during the Second World War.
ALUMNI ASSOCIATION BOARD OF DIRECTORS
President
Betty W. Vaughan, M.D., ’63 - Decatur
President-Elect
Albert J. Tully Jr., M.D., ’64 - Birmingham
Secretary/Treasurer
Alan R. Dimick, M.D., ’58 - Birmingham
AlumniBulletin
ALABAMA MEDICAL
University of Alabama School of Medicine, Birmingham-Huntsville-Tuscaloosa; Telephone: (205) 934-4463; Fax: (205) 975-7299; Address: MAB, 811 20th Street South, 1530 3RD AVE S, BIRMINGHAM AL 35294-2140; Executive editor’s e-mail address: ppowell@uab.edu
Past President
T. Riley Lumpkin, M.D., ’58 - Tuscaloosa
The Caduceus Club President
Ronald W. Orso, M.D., ’72 - Birmingham
Vice Presidents
William R. Staggers, M.D., ’89 - Fairhope J. Noble Anderson Jr., M.D., ’89 - Montgomery Katherine R. Cooper, M.D., ’90 - Alexander City Bill Beasley, M.D., ’74 - Athens Ricky L. Irons, M.D., ’82 - Florence Helen R. Thrasher, M.D., ’63 - Birmingham James S. Woodard, M.D., ’85 - Columbus, MS Betty Ruth Speir, M.D., ’63 - Point Clear Martha E. Pugh, M.D., ’65 - Houston, TX Robert M. Dimick, M.D., ’84 - Hermitage, TN Neil E. Christopher, M.D., ’58 - Guntersville Jarvis D. Ryals, M.D., ’65 - Pueblo, CO
Table of Contents • Summer 2004 Issue
News Briefs ....................................................................................................................... 2
School and university news, faculty news, research and clinical news
Cover Story: A Tradition of Service................................................................... 6
UASOM doctors recall their war years
Big Changes .................................................................................................................... 10
A fast-paced day in the life of a UASOM resident
House Staff Representative
Edward R. Anderson III., M.D. - Birmingham
Senior Class President
Darren Malone - Birmingham
Making Connections .................................................................................................. 12
Robert Koehler takes the helm in the Department of Radiology
Vice President and Dean
William B. Deal, M.D. - Birmingham
Four SPORE .................................................................................................................... 12
UAB’s latest SPORE grant boosts pancreatic-cancer research
Executive Secretary
Elaine O. Chambless - Birmingham
Administrative Secretaries
Donna F. Thompson - Birmingham Diane A. Woods - Birmingham
The Big Move
................................................................................................................. 13
Sprinting toward completion at University Hospital’s North Pavilion
BULLETIN STAFF
Executive Editor
Pam Powell
Ready for the Future
................................................................................................ 14
Researchers lay the groundwork for a new biodefense laboratory in Birmingham
Managing Editors
Dawn Mesa, Matt Windsor
Searching for a Diabetes Cure ............................................................................ 14
Islet cell transplantation offers hope of life without insulin
Editor, Alumni Affairs
Elaine O. Chambless
Editors, Development Office
John Lankford, Ph.D. Meredith Murdock
In Praise of Wine ........................................................................................................ 15
Is the fruit of the vine the great protector?
Editorial Advisory Board
J. Noble Anderson Jr., M.D. Wayne H. Finley, M.D. Ronald E. Henderson, M.D. Paul S. Howard, M.D. Ronald W. Orso, M.D. Stephen P. Suggs, M.D. C. Bruce Alexander, M.D. Dennis W. Boulware, M.D. Pam Bounelis, Ph.D. Amie B. Jackson, M.D. Sharon A. Spencer, M.D. Carlton J. Young, M.D.
Physicians’ Forum ....................................................................................................... 16
Indigent care, part II
Student Rounds
........................................................................................................... 18
How new duty-hours rules have changed resident life
From the Development Office
.............................................................................20
Kennamer Gift • Programs Worth Supporting • Lanier Gift • Film Premiere
Executive Art Director
Ron Gamble
ALUMNI ASSOCIATION NEWS
....................................................................... 24
Art Director
Jason Bickell
2004 Annual Alumni Weekend • Class Notes • Alumni News • Prescription Pad • Alumni Form
Medical Editor
Julius Linn, M.D.
Production Manager
Lynn Lowrie
Alumni Profile: The Schmitt Family, M.D.s
For these doctors, the UASOM runs in the blood
............................................. 30
Production Assistant
Monica Ssenkoloto
Alumni Profile: Tracey Miles, M.D.
Making the commitment to family medicine
Dale Short Anita Smith Russ Willcutt Matt Windsor
................................................................. 31
Writers
Sandra Bearden Elaine O. Chambless Steve Dupont Laura Freeman Doug Gillett
Charles A. Goldthwaite Jr. Dawn Mesa Meredith Murdock Tim L. Pennycuff
From the Archives ...................................................................................................... 32
A look at the Alabama Healthcare Hall of Fame
Photographers
Elaine O. Chambless, Steve Wood
CME Calendar .................................................................................................. Back Cover
Published three times a year by the University of Alabama School of Medicine, Birmingham, Alabama. Produced by UAB’s Publications and Periodicals Group, Office of Public Relations and Marketing, with the cooperation of Medical Publications, Office of the CEO of UAB Health Systems.
Editorial Contributors
UAB Media Relations UAB Medical Publications UAB Synopsis
SCHOOL AND UNIVERSITY NEWS
REMEMBERING DR. KIRKLIN
John W. Kirklin, M.D., the quiet, supremely efficient surgeon who shaped both UAB and the field of cardiology, passed away the night of April 21. Born in Muncie, Indiana, Kirklin revolutionized cardiovascular surgery through his development and refinement of the heart-bypass machine. In the 1950s, he modified the Gibbon heart-lung machine and performed the first openheart operations carried out at the Mayo Clinic. “The world of medicine lost one of its giants today,” said UAB president Carol Garrison, Ph.D. “Dr. Kirklin’s dedication to continually find better methods for treating patients resulted in surgical techniques and health-care treatments that saved literally millions of lives.” Kirklin’s efforts led to the development of a computerized intensive-care unit with continuous monitoring of vital functions that became a model for modern ICUs around the world. “The contributions that John Kirklin made to care provided to patients cannot be measured in any other terms other than those who are alive as a result of his efforts,” says Albert Pacifico, M.D., director of cardiovascular surgery at UAB. “Those of us who were fortunate enough to have trained under Dr. Kirklin learned the value of continually striving to improve patient care.” In 1966, Kirklin brought star power to UAB when he arrived as the new chair of the Department of Surgery and surgeon in chief for University Hospital, positions he would hold until 1982. His presence acted as a magnet for other talented physicians, who followed him to the young university. Over two decades, he built one of the most prestigious cardiovascular surgical training programs in the world before retiring from surgery in 1989. But Kirklin’s innovative ideas went beyond direct patient care. His organizational capabilities led to the formation and development of the University of Alabama Health Services Foundation, the practice plan for faculty physicians at UAB. “John Kirklin recognized that a public institution could not be saddled with the burdens associated with yearly appropriations from the state if it wanted to reach the level of excellence he envisioned,” says Arnold G. Diethelm, M.D., who joined UAB in 1967 to establish the transplantation program and succeeded Kirklin as chairman from 1982 to 1999. “Bringing together the disparate parts of this fledgling medical center creat-
ed the atmosphere necessary to bring world-class medical care to the city of Birmingham.” A hallmark of Kirklin’s career was his determination to share information. He authored more than 700 publications, and his textbook Cardiac Surgery remains the premier reference work on its subject. Future issues of the Medical Alumni Bulletin will take a closer look at the life, work, and legacy of this groundbreaking physician. HOIDAL NAMED INTERIM CEO OF UAB HEALTH SYSTEM David Hoidal, chief operating officer of the UAB Health System, has been named interim chief executive officer, assuming the role following David Fine’s appointment as CEO of St. Luke’s Episcopal Health System in Houston. “As a result of his four years at UAB, and his many years of experience in health-care management, David Hoidal is very well suited to lead our management team,” says Carol Garrison, Ph.D., UAB president and chair of the health system board. Hoidal joined UAB in 2000 as executive director of The Kirklin Clinic and president of the Callahan Eye Foundation Hospital at UAB. In 2002, he was named chief operating officer for clinical programs for the health system. Prior to joining UAB, he served as senior vice president and COO of Tulane University Hospital and Clinic. AMWA HONORS ALABAMA LEGENDS The American Medical Women’s Association (AMWA) and the National Library of Medicine recently honored seven “local legends” from the state of Alabama, four of whom have ties to the UASOM. A joint effort between the AMWA and the Library of Medicine, the Changing the Face of Medicine: Local Legends program was designed to celebrate the contribution of women physicians around the country. Members of Congress were asked to nominate physicians who have made a “significant impact in the field of medicine.” Alabama’s seven nominees were honored at a banquet in San Diego on Feb. 6, 2004. Those with ties to the UASOM are Sara Finley, M.D., a 1955 graduate, now retired as professor emeritus in the Department of Genetics after a distinguished career at the school; Sandral Hullett, M.D., a resident in 1979, now CEO of Cooper Green Hospital; Pamela Hudson, M.D., a resident in 1986, now chief operating officer and ethics and compliance officer for Crestwood Medical Center in Huntsville; and Lindy Harrell, M.D., a professor in the Department of Neurology. In another UASOM connection, alumna Regina Benjamin, M.D. (class of 1984) was a
member of the selection committee. She is now the associate dean for rural health at the University of South Alabama College of Medicine in Mobile. COLLECTING AMERICA’S TOP DOCTORS In a sign of the depth and breadth of experience at the UASOM, 49 physicians from UAB have been listed in the 2003 reference book America’s Top Doctors. The doctors were nominated by other physicians and screened by a physician-directed research team. Top Doctors is a major medical-referral service; it surveys leading medical specialists and asks them which doctors they would visit if they needed treatment in their specialty. Only about 20,000 doctors—or 3 percent of all physicians in the United States—are eventually included in the list. The service offers data on each doctor’s credentials, licensing, and disciplinary review, as well as other information such as listening and communication skills. The service also lists 620 leading hospitals in the nation, including UAB Hospital and Children’s Hospital. UAB HOSTS NEUROFIBROMATOSIS PATIENT SYMPOSIUM UAB and the National Neurofibromatosis Foundation (NNFF) hosted a symposium for patients and families with neurofibromatosis (NF) on January 17. Neurofibromatosis is the most common neurological disorder caused by a single gene mutation, affecting more than 100,000 Americans. The disease can lead to disfigurement, blindness, deafness, skeletal abnormalities, brain and spinal tumors, loss of limbs, and learning disabilities. It is more prevalent than cystic fibrosis, hereditary muscular dystrophy, Huntington’s disease, and Tay-Sachs combined. The symposium was held in the Finley Conference Center, part of the Kaul Human Genetics Building. Featured speakers included Bruce Korf, M.D., Ph.D., chair of the UASOM’s Department of Genetics and chair of the medical advisory board for the NNFF; Ludwine Messiaen, Ph.D., director of the first laboratory to offer mutational analysis for NF1, the most common form of NF; and Judy Small, Ph.D., director of the clinical trials and technology transfer office for the NNFF. The panel conducted a questionand-answer session with attendees, and tours of the clinical and research laboratories of the Kaul Human Genetics Building were offered. In addition, the NNFF’s board of directors held its semi-annual meeting at UAB on the same day. This group normally meets in New York, but met in Birmingham because of Korf.
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News Briefs
“SOWING THE SEEDS OF HEALTH” TRAINS HEALTH-CARE PROMOTERS
Nine members of the Birmingham Latino community have been trained to serve as resources for information on health topics and health-care services to Latino members of three area Catholic churches, thanks to a collaborative endeavor known as Sowing the Seeds of Health. This program is funded by Mission and Ministry, Inc.; UAB’s Educational Foundation; and St. Vincent’s Foundation. Sowing the Seeds of Health aims to eliminate or reduce barriers by allowing lay persons in church communities to help one another by bringing together resources from UAB and St. Vincent’s. The program teaches health information and develops important skills in the volunteer promoters while providing a solution to many problems that immigrant communities face, such as isolation and dependency. “The program gives us [trained promoters] an opportunity to live out our faith by helping others, and the community has been very receptive,” says Brenda Bullock, director of Hispanic ministry for the Catholic Diocese of Birmingham. “They feel like the church is taking an active role in caring for their needs.” Promoters have the knowledge and skills needed to assist community members with health issues. With training complete, these volunteers are available after Sunday church services and on a regular basis to answer questions and promote health in their communities. Each promoter is equipped with a resource manual of health services and topics, and is prepared to share this information through lectures, brochures, announcements, health fairs, and other appropriate avenues. Monthly meetings allow the volunteers to share ideas and address concerns and issues. “The goal of training the Sowing the Seeds of Health promoters is to assist the Latino community in the greater Birmingham area in accessing health-care services, and to increase awareness among Latinos of health and wellness services in their communities,” says Lisa Reddington, Hispanic outreach coordinator at St. Vincent’s Hospital, and Sowing’s program director along with Isabel Scarinci, M.D., assistant professor in the UASOM’s Division of Preventive Medicine. A key component of this program is empowering community members and giving them the ability to lead and guide others, according to Scarinci. “The program belongs to the promoters, we just provide the guidance,” she says.
Health Information Awards program, organized by the Health Information Resource Center. Now in their 10th year, the World Wide Web Health Awards are designed to establish a seal of quality for consumer health information. UAB’s “Tone Your Bones” osteoporosis site [www.toneyourbones.org] won a gold medal in the Hospital/Healthcare System category. The question-and-answer column “Dear Doctors” [www.health.uab.edu/deardoc] received a bronze medal in that category. The “Tone Your Bones” site, which went online less than a year ago, is a component of UAB’s Osteoporosis Prevention and Treatment Clinic. The site walks patients through a virtual clinic visit and provides up-to-date information on ways to prevent, treat, and minimize the effects of osteoporosis. “Dear Doctors,” published by the UAB Health System’s Office of Medical Publications since 1985, has received numerous state and national awards for excellence in providing consumers reliable, up-to-date health and fitness information. Questions are submitted by readers and answers are provided by Health System physicians and other health-care professionals. The Health Information Resource Center is a national clearinghouse for consumer-health programs and materials.
degree at the University of Alabama School of Medicine and his master’s degree in public health from the UAB School of Public Health.
FACULTY NEWS
LINDSEY HONORED AS DISTINGUISHED FACULTY LECTURER J. Russell Lindsey, D.V.M., professor emeritus of genetics, has been chosen as the recipient of the 2003 Distinguished Lecturer Award, the highest honor bestowed on a faculty member by the academic health center. Lindsey, who is internationally known for his research in the field of comparative medicine, received the award on Oct. 28, 2003 at the Harbert Center. At the ceremony, he presented a lecture titled “A Celebration of the Family” and received a check for $5,000. This award marks the latest memorable moment in a long history between Lindsey and UAB. He joined the faculty 36 years ago as professor and chair of the Department of Comparative Medicine. Under his leadership, the department became one of the top programs in the nation in the discovery and investigation of animal models of human diseases. He also established graduate biomedical research and laboratory-animal model training programs for veterinarians and programs in managing animal resources for the university’s biomedical research community. A renowned researcher, Lindsey pioneered the study of diseases caused by microscopic organisms called mycoplasma. His early studies of one species, mycoplasma pulmonis, which causes pneumonia in mice, led him to engineer an animal model of “walking pneumonia” in humans. Subsequently he and his research team have engineered animal models for the study of human diseases including diabetes, Alzheimer’s, prostate cancer, interstitial cystitis, and various viral infections. Lindsey has published more than 130 articles about his work and has received numerous national honors. Among his many professional affiliations, he has served on scientific review boards of the National Institutes of Health, the Food and Drug Administration, Veterans Affairs, and the Department of Energy. He also represented the National Association of State Universities and Land Grant Colleges on the board of trustees of the Association for Assessment and Accreditation of Laboratory Animal Care. Lindsey received his Master’s of Science degree from Auburn University and his degree in veterinary medicine from the University of Georgia. Since his retirement from UAB in 2001, he continues to teach and consult for universities and
ALUMNUS TAPPED TO LEAD UNC HEALTH CARE SYSTEM
William L. Roper, M.D., dean of the School of Public Health at the University of North Carolina at Chapel Hill (UNCCH), has been named CEO of the University of North Carolina Health Care System. The appointment, effective March 15, 2004, was announced January 23 by UNC president Molly Corbett Broad and ratified by the UNC Board of Governors during a special meeting in Chapel Hill. Roper, who will serve concurrently as dean of the School of Medicine and vice chancellor for medical affairs at UNCCH, succeeds Jeffrey L. Houpt, who announced last spring his plans to step down from those posts. A pediatrician, Roper has been dean of UNCCH’s School of Public Health since 1997. He holds dual appointments as professor of pediatrics in the School of Medicine and professor of health policy and administration in the School of Public Health. Roper, 55, began his career in public health in his home state of Alabama, where he was health officer for the Jefferson County Department of Health from 1977-83 and assistant state health officer for the Alabama Department of Public Health from 1981-83. A graduate of the University of Alabama, Roper earned his medical
WEB SITES WIN MEDALS FOR PUBLIC INFORMATION
Patient-friendly Web sites run by UAB have won gold and bronze medals from the National
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News Briefs
research institutions worldwide, including the UASOM’s Department of Anesthesiology. WHITLEY NATIONAL FINALIST FOR HUMANISM IN MEDICINE AWARD Richard Whitley, M.D., professor of pediatric and infectious diseases at the UASOM, has been selected as a distinguished finalist for the 2003 AAMC Humanism in Medicine Award. The annual award is sponsored by the Association of American Medical Colleges (AAMC) through the support of the Pfizer Medical Humanities Initiative. Whitley is one of 50 honorees from across the nation nominated by the AAMC Organization of Student Representatives, based on five defining characteristics of humanism in medical education: positive mentoring skills, involvement in community service, compassion/sensitivity, collaboration, and observance of professional ethics. Whitley’s nomination is a tribute to his commitment to training and mentoring young physicians and having them, in turn, pass on their knowledge to a new generation of physicians. “Like healing, learning happens best when expertise is joined with caring and partnership,” says Mike Magee, M.D., vice president of medical relations and science policy for Pfizer Inc. and director of the Pfizer Medical Humanities Initiative. “The medical students who nominated Dr. Whitley recognized the human qualities that make him both an outstanding teacher and an outstanding physician. It’s through the stellar example of mentors like Dr. Whitley that the next generation of physicians will learn how to practice compassion, partnership, and understanding in the practice of medicine.” KOEHLER NAMED RADIOLOGY CHAIR Robert E. Koehler, M.D., has been appointed chair of the Department of Radiology effective Nov. 1, 2003. Koehler was vice-chair of the department before being named interim chair last year. In announcing the appointment, William B. Deal, M.D., dean of the School of Medicine, said, “We are pleased that we were able to find such a highly qualified person within our own faculty to lead this large department that is so integral to the quality of patient care and research at UAB. Bob Koehler’s credentials and long service to UAB will serve him well.” Koehler, who joined UAB in 1982, says, “It is definitely an honor and a challenge to have the opportunity to lead this distinguished faculty. The talent and dedication of our radiology faculty have brought national recognition to UAB, especially for resident education and skilled, subspecialized service to patients. We will now work to further strengthen those areas and to grow the department’s research and extramural funding.” For more on Koehler and his new position, see the article Making Connections on page 12. DACHEUX WINS EYE RESEARCH AWARD Ramon F. Dacheux II, Ph.D., professor in the Department of Ophthalmology, has been granted a $65,000 Senior Scientific Investigator Award by Research to Prevent Blindness (RPB). RPB Senior Scientific Awards support nationally recognized scientists conducting eye research at medical institutions in the United States. Dacheux is one of 122 scientists at 50 institutions to be honored since the award was established in 1987. Dacheux’s primary research interest is in the role of the ganglion cell in the onset of glaucoma, the most common cause of blindness worldwide. Dacheux is examining how different ganglion cell types respond to changes in intraocular pressure. This information could lead to a test for early diagnosis of glaucoma, before cell death and vision loss occur. RPB is the world’s leading voluntary organization supporting eye research. Since it was founded in 1960, RPB has channeled hundreds of millions of dollars to medical institutions throughout the United States for research into all blinding eye diseases. To date, the organization has awarded grants totaling more than $2 million to UAB. PIONEERING ENT JACK ODESS DIES John S. “Jack” Odess, M.D., of Chelsea, a pioneer in developing new services and new medical procedures for ENT patients, died Nov. 4, 2003. He is credited with helping organize the first cleft-palate clinic in the United States and with pioneering the operating microscope. He was 80 years old. “Dr. Odess was a brilliant and generous man, who was dedicated to the health and well-being of this community,” says UAB president Carol Garrison, Ph.D. Odess was a graduate of Vanderbilt University School of Medicine. In the 1950s, he returned to Birmingham, where he entered private practice and joined the faculty of the UASOM. In 1956, he helped reestablish the otolaryngology residence training at University Hospital. He pioneered the operating microscope and became the first surgeon in the state to use it to perform a stapedectomy, a procedure that restores mobility to the small bones of the inner ear, thereby improving hearing. He also worked with the Talladega School for the Deaf and the Junior League Speech and Hearing Clinic, and was on staff at St. Vincent’s Hospital, Baptist Medical Center–Montclair and –Princeton, and Children’s Hospital. In addition, he worked with the Council of Accreditation on Hearing Conservation and assisted in the development of the Occupational Safety and Health Administration standards to prevent hearing loss from industrial noise. Although Odess retired from private medical practice in 1981, he remained active in business and civic endeavors and the ongoing evolution of the UASOM’s Division of Otolaryngology. In 1989, he provided funding to establish the John S. Odess Professor and Division Director-Otolaryngology/ Head and Neck Surgery Chair in the School of Medicine.
RESEARCH AND CLINICAL NEWS
UAB JOINS CONSORTIUM TO STUDY RARE DISEASES Researchers at the UAB Civitan International Research Center will be part of a new multicenter Rare Diseases Clinical Research Center (RDCRC) to study three rare syndromes: Rett, Angelman, and Prader-Willi. The center is funded by a $6.25 million, five-year grant from the National Institutes of Health (NIH). “The center will help develop an understanding of how these diseases affect individuals throughout their lives and set the stage for studying treatments that may help reduce the effects of such diseases,” says Alan K. Percy, M.D., associate director of the Civitan Center and a leading international authority on Rett syndrome. The grant is intended to interface with the UAB General Clinical Research Center and the Mental Retardation and Developmental Disabilities Research Center. The principal investigator in the study, Arthur Beaudet, M.D., chair of the Baylor College of Medicine’s Department of Molecular and Human Genetics, says the grant will promote clinical research into disorders that are “often neglected because they affect a small percentage of the population.” Beaudet expects that the focus of the center will expand to other disorders in the coming years. UAB NAMED AUTOIMMUNITY CENTER OF EXCELLENCE UAB has received a five-year, $3.6 million NIH grant to establish an Autoimmunity Center of Excellence—one of four newly named centers and one of only nine such centers nationwide. The centers bring together investigators representing diverse disciplines from across the country to conduct basic research and clinical studies aimed at developing new therapies for autoimmune diseases. “Autoimmune disorders and diseases comprise a significant portion of the health-care burden in this country,” says Robert H. Carter, M.D., associate professor of medicine with the Division of Clinical Immunology/Rheumatology and director of the UAB center. “NIH created the network
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N e w e r BSr ti e fr s Cov s o y
of autoimmunity centers to speed translation of basic research into new therapies and to further our understanding of human immunology.” UAB’s long and notable history of basic and clinical study in the field of autoimmune research was a key factor in the NIH’s decision to name it a center of excellence. “UAB received the highest score among all institutions applying for this award,” Carter says. “We have great expertise and many proven strengths in this area of research.” In addition to its basic research activities, the center, as part of its grant application, has proposed two clinical studies: one on psoriatic arthritis and one on lupus. “A steering committee of leaders representing all the centers will decide which clinical studies to conduct and which centers will participate based on each center’s expertise,” Carter says. “If one or both of UAB’s proposed clinical studies are selected, the center will receive additional funding to support these trials.” “Collaborative center projects will unite the expertise of investigators working in diverse areas of human autoimmune disease,” says Larry W. Moreland, M.D., director of clinical activities for the UAB center. “Taking part in the development and implementation of these groundbreaking investigations will expand our collective knowledge and place UAB at the forefront of human immunological research.” NIH AWARDS UAB NEW CENTER ON MINORITY HEALTH DISPARITIES Diabetes kills African Americans at a rate double that of whites. Colon-cancer mortality is a third higher, and overall mortality is 50 percent higher. Now UAB will use a $4.25 million federal grant to try to help change those statistics through research, screening and education programs, and training of health-related professionals. The four-year grant comes from the NIH’s National Center on Minority Health and Health Disparities. It establishes a Regional Deep South Project Export Center of Excellence for Minority Health (Project Export) to begin developing a health-disparities center. Selwyn M. Vickers, M.D., professor of surgery, is principal investigator for the program. The grant was developed in conjunction with co-principal investigators Mona Fouad, M.D., Edward Partridge, M.D., and Catarina Kiefe, M.D. “The health gap between minorities and whites is a problem that statistics make obvious, and it is particularly severe in the Black Belt counties of Alabama with highest concentrations of African Americans,” Vickers says. “This new center of excellence, incorporating Project Export, will help coordinate and build on existing efforts at UAB to combat this problem of health disparities in our state and region.” UAB’s center is one of seven around the nation to receive status as a comprehensive center of excellence and full funding in this fiscal year. The center aims to build partnerships at institutions enrolling a significant number of students from health-disparity populations and will promote participation and training in biomedical and behavioral research at these historically black colleges and universities. Vickers noted that Project Export initially will reach out to the community through screening and education programs for diabetes and colon cancer. The diabetes program will be conducted in Jefferson County in association with the faithbased Center for Urban Missions, and colon cancer will be the target of programs in Macon County in partnership with the BND Cancer Center, a private organization. Project Export will be an integral part of the center and make use of UAB’s research and training expertise in partnership with historically black colleges and universities in the state. “There is a need to recruit and train minorities as health workers, particularly in the Black Belt,” Vickers says. “A summer training program is planned in conjunction with the black colleges in order to prepare students for careers in allied-health professions.” USING WIRELESS TECHNOLOGY TO IMPROVE EMERGENCY MEDICAL CARE Rapid advances in wireless communication technology could provide big benefits in improving emergency medical response, say UAB researchers. The latest technology could produce major improvements in the 911 system and in how Emergency Medical Services (EMS) teams handle medical emergencies ranging from heart attacks to large-scale disasters. UAB researchers have received a $3.2 million contract from the National Library of Medicine, a branch of the NIH, to study the integration of wireless technology with EMS services. The study, called Advanced Network Infrastructure for Health and Disaster Management, is directed by Helmuth Orthner, Ph.D., professor of health informatics in UAB’s School of Health Related Professions. “Our ability to handle medical emergencies is at a revolutionary threshold with the emergence of technologies such as secure, high-speed wireless communications and powerful hand-held computing and communication devices,” says Orthner. “This study will allow us to test how to integrate these technologies within the EMS community in an important new way.” Orthner says the lessons learned will have value for EMS teams responding to any kind of medical emergency. He says any changes to the current system must be capable of rapid, failsafe escalation so that the system can seamlessly respond to situations ranging from an individual 911 call to major disasters such as catastrophic weather events or terrorist attacks. Co-principal investigators with Orthner are Gary Grimes, Ph.D., UAB professor of engineering, and Thomas Terndrup, M.D., chair of the Department of Emergency Medicine. SCREEN-SAVER PROVES EFFECTIVE IN EDUCATING HOSPITAL PHYSICIANS A training program that uses interactive screensaver images linked to a Web site to prepare hospital-based clinicians to respond to bioterrorist attacks is an effective alternative to more costly and more time-consuming educational methods, according to a recent study published in the American Journal of Infection Control. Thomas Terndrup, M.D., chair of the Department of Emergency Medicine and director of the Center for Emergency Care and Disaster Preparedness, led the pilot study to develop and test the new training program, available on the center’s Web site at [www.uab.edu/cecdp]. “Before the terrorist attacks in September 2001 and subsequent anthrax attacks, few hospitals considered it a priority to integrate bioterrorist preparedness into their disaster plans,” Terndrup says. “Afterward, however, the challenge to educate hospital-based clinicians and infection-control practitioners to recognize and respond to a bioterrorist event took precedence.” The pilot study, funded in part by the Agency for Healthcare Research and Quality, aimed to streamline hospital preparedness efforts through the implementation of a screen-saver program as an educational tool for clinicians. “Initiatives to prepare hospital-based practitioners must fit among the demands of patient care, administrative duties, and continuing education within specialties,” Terndrup says. “The interactive screensaver program was designed with these considerations in mind.” The screen-saver program also may direct the user to access a Web site for additional bioterrorist information and Web-based learning modules relevant to the user’s particular specialty. The site, [www.bioterrorism.uab.edu], currently offers nine continuing-education courses developed specifically for the following specialties: emergency medicine, radiology, pathology, infection control, pediatrics, family practice, internal medicine, and dermatology.
5
Cover Story
★★★★★
UASOM DOCTORS
SERVING OUR NATION IN TIMES OF NEED
By Dale Short
A
LANDING SHIP IN THE PACIFIC OCEAN, NEAR GUADALCANAL. A FIELD HOSPITAL IN
THE VIETNAMESE COUNTRYSIDE. A PRISONER-OFWAR CAMP IN THE IRAQI DESERT. FOR DECADES, SCHOOL OF MEDICINE STUDENTS AND ALUMNI HAVE BEEN CALLED TO SERVE THEIR COUNTRY IN TIMES OF WAR. BY ITS NATURE, THAT SERVICE ENTAILS AN INTENSE EMOTIONAL CONFLICT FOR DOCTORS: WORKING TO SAVE LIVES, AS PART OF AN ENTERPRISE WHOSE GOAL IS TO TAKE LIVES. BUT A COMMON THEME, FOR THOSE WILLING TO TALK ABOUT THEIR EXPERIENCES, IS THAT MILITARY DUTY HELPED THEM BECOME BETTER PHYSICIANS.
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★★★★★
Catching Up:
Phillip Foshee, Korean War Veteran
Phillip Foshee, M.D. (’62), also found that his military service—as an Air Force pilot and instructor during the Korean War—shaped his career choice. When he joined the Air Force in December 1950, he was facing the draft while home from college and partway through a degree in architecture, the profession his older brother had chosen. “My local draft board had just announced they were taking pretty much everybody in town,” Foshee recalls, “so I could see it was time for me to sign up.” For Americans, it was a time of shock and crisis in the burgeoning Korean conflict. Just weeks earlier, a surprise attack by Chinese and North Korean soldiers had trapped 15,000 Marines, killing 3,000 of them and wounding another 7,000. With ground troops struggling, America’s air power seemed the only answer for turning the tide, and the Air Force began a massive buildup. Foshee’s first duty station was San Francisco, where he trained as a radio operator on the B-29 bomber. He applied for pilot school, and graduated as a pilot with a knack for teaching. For the remaining three years of his stint, he worked as a flight instructor at a training facility in Greenville, Mississippi. After his Air Force career, he joined the Alabama Air National Guard and began taking premed courses in college. “I had two cousins who were surgeons,” says Foshee, “and my father always wanted to be a physician, but for some reason I didn’t think I was cut out for it. I’ll never be sure exactly why I finally chose medicine, but I decided it was what the Lord wanted me to do.” The relatively late start was a big hurdle to overcome: “I was the next-to-oldest guy in my class, and by the time I graduated I had three children. I was afraid I wouldn’t get a residency.” That fear turned out to be unfounded, as he was accepted at Mobile General Hospital and later worked at South Highlands Infirmary in Birmingham. For a while he gravitated toward surgery, but eventually chose general practice, serving for 39 years in the town of Clanton, where he has remained since his retirement. Foshee still does flight physicals for pilots at a small office in his home and treats his grandchildren’s occasional playground injuries. One of the pleasures of retirement is meeting multiple generations of his former patients as he goes about his day. “I see them on the street, or in the grocery store, all the time.”
Full Speed Ahead:
Lonnie Funderburg, World War II Veteran
Lonnie Funderburg, M.D. (’50), says his World War II service as a naval officer was the precursor to his decision to enroll at the then-Medical College of Alabama in 1946—after initially pursuing a career as a pharmacist. “The majority of the students that year had come out of the military,” Funderburg recalls. “After experiencing life in the service, we had a chance to go to school full-time on the G.I. Bill, and we felt pretty privileged. “I was no honors student, but I wasn’t afraid of work. I felt I had to prove to them that I could make the grade, so I bore down pretty hard. We all knew how important education was, and we felt we had to get busy, making up for lost time. There was no time to waste, no time to be foolish.” Funderburg’s damn-the-torpedoes approach has continued throughout his career. He served an internship in the naval hospital in Philadelphia, conducted research in narcotic and spinal anesthesia, and worked for 32 years at what is now Baptist Medical Centers. Along the way he found time to study business at Harvard, and to teach anesthesia on mission trips to Nigeria, Haiti, and Gaza, and English on trips to China. “I guess I’m sort of manic-compulsive,” Funderburg laughs. “I want to get things done, and I can’t stand to waste an opportunity.” He and his wife, Mary, who worked as a religious educator before rearing their two sons and a daughter, will celebrate 61 years of marriage this spring. “I like to make money, but it’s never been a major factor in what I choose to do,” Funderburg says. “If the military and God taught me anything, it’s to take a crooked stick and make the most you can from it. But God’s been good to us. I’ve got no complaints.”
(Clockwise from top left) Lonnie Funderburg ashore in New Zealand; Terrell Spencer at his Army Medical Corps station in Pleiku, Vietnam; camels paid frequent visits to Charles Kent Powers Jr.’s field hospital in the Iraqi desert; Robert Lee Henderson in his school days; medical students at the Tuscaloosa campus during the Second World War; Henderson at a camp for Special Forces advisors in Vietnam; Spencer on a medical tour of Army firebases; wartime medical students in Tuscaloosa; Ronald Orso graduated in the class of 1972; Phillip Foshee with his Air Force F-80 fighter; by the time he graduated from medical school in 1962, Foshee had three children; Henderson treating a Montagnard villager in Vietnam.
(Left) Lonnie Funderburg in his “dress whites” as a U.S. Navy officer. “About the only time I wore those was when I got married in 1943,” he says. (Above) Phillip Foshee was a flight instructor with the Alabama Air National Guard while taking pre-med classes at college.
7
Cover Story
He’s given up flying and has donated his home-built Viking airplane to the Wings of Hope humanitarian group in St. Louis. “They’ll use it in their medical missions around the world,” Foshee says. “I’m just glad to be able to help.” enemy soldier came in wounded, it was my job to treat him, too. There’s an old saying that war is 29 days of boredom followed by one day of sheer terror, and that’s very true.” Two indelible memories of Spencer’s Vietnam service are the .45 automatic pistol he carried everywhere, but never had to fire, and the phone call he received in the middle of the jungle telling him his first child had been born. “The main thing those experiences taught me,” he says, “is how similar all people are, how many things they have in common. Under stress, you learn pretty fast which aspects of our lives are just cultural and which ones strike a chord with everybody. The Vietnamese prisoners had the same fears and wants as everybody else. You learn to connect with patients as people, because all those surface differences just wash away.”
Recognizing the Enemy:
Terrell Spencer, Vietnam War Veteran
Like countless other physicians around the country, Terrell Spencer, M.D. (’68), attended medical school under the constant shadow of the Vietnam War. “Nearly everybody was being called up,” he says. “I could have been deferred an extra year for more training, but since I had to go anyway, I decided to go.”
Left to right: During his time in Vietnam, Spencer was awarded the Bronze Star, the Air Medal, and the Army Commendation Medal; Henderson prepares for a training parachute jump with Vietnamese special forces troops; Ronald Orso poses with General Norman Schwarzkopf in Saudi Arabia during Operation Desert Storm.
In the Line of Fire:
Robert Lee Henderson, Vietnam War Veteran
Robert Lee Henderson, M.D. (’62), went to Vietnam a few years before Spencer. After failing to get the field surgery slot he wanted because too many other doctors had already applied, Henderson volunteered for the Special Forces. He went to jump school at Fort Benning, Georgia, studied special warfare at Fort Bragg, North Carolina, and was assigned to a unit outside Saigon whose job was transporting medical supplies to hospitals in the hinterland. “Besides furnishing supplies and protecting soldiers from tropical diseases,” he says, “we did medical visits to local villages, trying to get people more on our side by taking care of their health problems.” But some days, the stakes were much higher. Henderson remembers flying in to treat soldiers at an American camp that had been completely overrun by Vietcong forces, and its two medics killed. “It was nighttime, and there were .50-caliber tracer rounds coming up alongside the helicopter,”
As a member of the Army Medical Corps, Spencer was stationed in the rural town of Pleiku in Vietnam’s central highlands. “It was a fairly primitive setup, from which we crafted a very fine medical group,” he says. “We had some 30 medics, aid stations, helicopter services, ambulances. We learned from scratch, and as a result we learned quickly.” A popular misconception, according to Spencer, is that military doctors mainly treat combat wounds. In fact, he says, “Illnesses always outnumber injuries. You can have whole divisions taken out by diarrhea, malaria, dengue fever. We saw injuries from field stoves blowing up, from two-ton truck tires falling on people. “Then, once every few weeks, there were combat injuries, which we tried to stabilize in the field and then medevac out. And when an
8
he says. “I thought, ‘Well, I could die right here.’ But strangely enough, that realization was like a huge weight being lifted off of me. I just said, ‘Okay, let’s go.’ ” One of the clippings in Henderson’s scrapbook is a United Press International news story written by a journalist who was on the last helicopter into the devastated camp. “The reporter saw my M1 carbine and my .45 sidearm and he said, ‘Aren’t you a doctor? What kind of medicine do you practice with those?’ And without thinking, I told him, ‘Preventive medicine.’ “The news story didn’t mention my name, but my mother read the article in the paper and she told me later, ‘That sounded just like something you’d say.’ ” Like Spencer, Henderson says his time in Vietnam changed his life. “It’s an experience I wouldn’t have missed for the world. Before going in the service I was a hard worker, but I didn’t have a lot of confidence or self-esteem. After three years in Special Forces, though, I wasn’t afraid of anything or anybody. I knew exactly what I could do and what I couldn’t do, and it stood me in very good stead for my residency.”
Other memories that linger are an Easter sunrise service in Saudi Arabia, with a white sheet draped on a makeshift cross, and the faces of wounded Iraqi prisoners as they were being returned to Baghdad. “They were afraid that Saddam would kill them if he found out that the Americans had saved their lives. I’m not sure what happened to them. I’ll never know.” The biggest differences between the Vietnam and Desert Storm experiences, according to Orso, were the levels of preparation and the rate of casualties. “Doctors in Vietnam were overwhelmed with the massive numbers and the terrible trauma,” he says. “By contrast, we weren’t short of anything. We were actually overstaffed, which was great. “I’m practicing today with two surgeons who were
Sunrise in Saudi:
Ronald Orso, Operation Desert Storm Veteran
Ronald Orso, M.D. (’72), saw wartime service at a much later stage in his life. Orso was already a 19year veteran of the National Guard when his 109th Evacuation Hospital unit was dispatched to the Desert Storm conflict in early 1991. “It was something of a shock,” he recalls. “In November we were sent to Fort Benning for training, and we got to come home for Christmas before being deployed.” While American troops moved toward Kuwait, Orso’s group set up their 450-person hospital on the border between Iraq and Saudi Arabia. As it happened, the majority of their patients were Iraqi soldiers. “It was a really pitiful situation,” Orso recalls. “Those guys had been in the middle of the desert for months or years. They were undernourished, they had virtually no medical facilities, and their hearts were not in what they were doing. When they saw we were going to take care of them, not kill them, they were so appreciative. “It’s hard to hate somebody who’s wounded. You naturally feel sorry for them. People would ask me, ‘How does it feel to take care of Iraqis?’ and I would answer, ‘I don’t, I take care of human beings.’ I think it’s a real tribute to our profession that we’re in a war zone with people trying to kill us and still we’re trying to save their lives. I believe that’s one thing that sets our culture apart from some others.” The few American casualties that Orso did see are still vivid in his mind.“The only female pilot to die in that war died in our hospital,” he says. “It was a very sad time.”
(Top) Charles Kent Powers Jr. at the 800th M.P Battalion headquarters, Camp Bucca. . (Bottom) “Like many of the soldiers, I lost 30 pounds” in the Iraqi sun, Powers says.
“It’s a very austere environment,” Powers says. “Basically, the Army found a plot of desert and fenced it off. For the troops there are tents with dirt floors, no air conditioning. The prisoners have a variety of illnesses and injuries that war-time life in the desert involves—knife and gunshot wounds, snakebite, scorpion bites, heat exhaustion. When I left at the end of May, it was 123 degrees during the day and 100 degrees at night.” Staying focused and encouraged under such grim conditions was a priority: “Every day you get up and try to do your best, try to have a positive attitude and set a good example as an officer,” he says. “You’re serving with young ‘kids,’ men and women in their early 20s, and you try to keep them cheered up, and encourage them to complete their mission and continue treating the prisoners with human dignity. I think the Army was proud of the job we did there.” Powers had a little outside help. “I cannot relay how much I appreciate the thoughts and prayers of those Stateside,” he says. “Cards and goodie boxes lifted our spirits, and God used it as a time to build me spiritually and physically.” The first day at the camp is still a fresh memory. “When we got there, the smell told us immediately where we were,” he recalls. “They had been operating about 10 days with no latrines. You could hear a lot of yelling and chanting—minor riots broke out on a frequent basis. There were escape attempts, with flares going off at night and dogs looking for the escapees. I really missed my wife and seven children. “One thing I particularly remember is a speed-limit sign at the edge of the camp, and on the back of it somebody had written ‘Hell.’ And though the Army is not generally big on individualism, the sign was not taken down. The place was like Hell, in a way. It was hot and miserable and you didn’t know who to trust.”
A Terrible Intensity:
Pictures That Never Fade
Terrell Spencer says that, regardless of the conflict in which they served, one common thread for all physicians is the indelible impression war leaves on the memory: “Under battlefield conditions, your senses seem to be hyper-acute. Everything looks brighter, smells stronger, is more intense. Your timeline for events starts to be a single day, because you know you might be dead by nighttime. You don’t necessarily try to remember things, but you can’t help it. The impressions are so strong. “I’ve found that when I have a patient who’s in his 80s, and his mind might be wandering, one way to connect with him is to ask, ‘What’s your unit, sir?’ A man who’s been in the service can tell you his unit and his serial number, almost every time. Those memories of the military seem to last until the very end.”
in Vietnam, and they’re excellent. That’s because all they did, every day, was operate. Whereas in Saudi Arabia I would do maybe three or four surgeries a week. I’m really concerned about the soldiers who are in Iraq now, because they seem to be having a much harder time than we did.”
A Hospital in Hell:
Charles Kent Powers Jr., Operation Iraqi Freedom Veteran
Charles Kent Powers Jr., M.D. (’88), knows about that firsthand. He recently spent six months serving in a field hospital for a military police unit that operates the main prisoner-of-war camp in Iraq, Camp Bucca in Umm Qasar.
9
Feature Stories
BIGChanges
A Day in the Life of a Resident Under New Duty-Hours Restrictions
By Anita Smith It’s a Sunday on the Trauma Service at UAB’s University Hospital. Fourth-year surgery resident Phillip Lackey, M.D., is a chief resident on the service; he’s on call today, and he’s busy. Arriving at the hospital before 5:30 a.m., Lackey has a junior resident in tow as he makes rounds at trauma patients’ bedsides in intensive care and on floor units. He makes notes and puts in orders for what needs to be done for these patients. timetables for various procedures. And they run a tally of available beds. After Morning Report, Lackey joins an attending surgeon and a junior resident for more patient rounds. Summoned frequently by his pager, Lackey answers some patient-care questions by phone and temporarily interrupts rounds to handle other needs in person. He receives word that a truck collision victim is being brought in, and he and an attending surgeon report to the emergency room to lead the assessment, make sure the patient is stabilized, and put in orders for diagnostic scans of his injuries. A few minutes later, Lackey interrupts his rounds again to go to the CT-scan area to reassure the accident victim, who is having trouble lying still for the scan. departure time that precisely. “Back then, we went off-duty whenever our work was done,” he says. The difference between then and now is the “80-hour rule,” a hot topic of discussion in residency programs at the UASOM and across the United States. In effect since July 1, 2003, the rule specifies that all residents must be limited to 80 hours on duty within a seven-day workweek. This includes in-house call and encompasses all overnight-duty hours spent in the hospital, regardless of whether a resident spends some of those hours resting. The 80-hour rule covers all 119 specialties and subspecialties in 7,800 residency programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).
ROUNDS IN A RUSH
Shortly before 8 a.m., Lackey walks to a conference room in an adjoining building, where Trauma Service Morning Report is about to begin. This morning, 13 people are participating. Using Morning Report time to review the status
of every trauma patient in the hospital, residents and attending physicians go over what has been done for patients thus far, their progress, and what will be done next. They review patients who
Yet in all the uncertainty of this busy day, Lackey is aware of something about his own schedule that he would not have known several months previously. “I know it’s very likely I’ll be going off
JUDGING THE IMPACT
One of those dealing with the effects of the hours change is Dennis W. Boulware, M.D., the UASOM’s senior associate dean for education. “This new rule has somewhat polarized the medical community nationally,” says Boulware. “Some greatly welcomed it. Others think it is horrible and that it will contribute to the destruction of the tradition of medicine. My opinion is somewhat mixed.” Boulware says years must pass before the full impact of the 80-hour rule will become clear. However, he has come to some conclusions after a few months of experience with the rule and its consequences. Boulware says the rule came into being because the ACGME was feeling pressure from consumer groups and Congress, fueled by worries that overtired residents were contributing to errors in patient care.
“Our restricted duty hours make it even more important that we as residents become better at communicating with one another about such issues as tests and other care we’re ordering for our patients.… We need to learn how to have better communication.”
— Anne B. Davis
are victims of everything from car accidents to gunshot wounds. They discuss special issues— such as patients who have been intubated and those dealing with complications such as pneumonia and kidney dysfunction. They identify duty and leaving the hospital this evening between 5 and 6 o’clock,” he says. At that point, he will be expected to hand off in-progress patient-care work to other residents. Prior to mid-summer 2003, Lackey could not have pinpointed his expected
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Feature Stories
Regarding his own concerns about the potential negative impact of the rule, Boulware notes that by reducing residents’ on-duty hours, ACGME has created the need for additional “patient-care handoffs”—residents having to hand off patient-care responsibilities to others. Boulware fears additional handoffs could contribute to lack of continuity in patient care and could result in more confusion in the health-care system. He says this is ironic, since the ACGME was trying to use this new rule to contribute to a smoother system. “I am concerned, too, about what this might mean down the road regarding public trust in a health-care system already under fire by the public,” says Boulware.
Regardless of one’s opinion about the 80-hour rule, Boulware says, it’s here to stay—at least for the foreseeable future. “The ACGME planned for this a long time and it has a reputation for sticking to its rules.” Another prediction that the ACGME will hold fast comes from Marshall M. Urist, M.D., vice chair of the Department of Surgery and co-director of the General Surgery Residency Program. “At least where surgery is concerned, I think arguments to the ACGME appealing for exceptions are not going to go very far,” he says. “Although we do know that it will be possible to increase residents’ on-duty hours from 80 to 88 in special cases, we also know such an increase can be made for educational purposes only, not to accommodate service needs.”
other care we’re ordering for our patients. This is good in that we need to learn how to have better communication. Some of us tend to be solitary thinkers, and while solitary thinking can have good points, it’s also important to learn to be great team players. After all, most of us will have partners with whom we will be communicating after we go into practice.” Another positive, says Davis, is the injection of some balance into doctors’ lives. “Physicians need to be well-rounded. They don’t need to be trained as individuals who work all the time. These morerestrictive duty hours address that.” Surgery resident Lackey says there is no doubt that his own family life has benefited from the new rules. He has more time with his wife and
He is uneasy about the consequences on the structure of residents’ educational experiences. At least until residents become accustomed to the new rule, Boulware says, senior residents often will spend time supplementing what junior residents can do for patients within limited duty hours. In addition, he notes, the new rule poses challenges in scheduling certain educational experiences for residents. Boulware is worried, too, about the long-term impact the duty-hours changes could have on medical-school faculty: “Faculty are being impacted in two ways. Because of fewer resident duty hours, some faculty who once had residents with them now do not. Also, fewer resident duty hours result in additional patient-care responsibilities being shifted to the faculty. I fear that these impacts could drive some faculty out of medical education into private practice, particularly if they already had been considering private practice as an option.”
Based on his own observations, Urist questions the validity of linking sleep-deprived residents to errors in patient care. “I have not observed a big problem with residents making bad decisions because they were sleep-deprived,” he says. Urist adds that he had been concerned about whether the new rule would permit surgery residents to take part in the diverse surgery experiences they need, but he says so far that has worked out well. On the positive side, he says the 80-hour rule will free residents to explore outsidethe-hospital learning experiences such as independent reading.
In order to hand off patients at the end of shortened duty hours, residents such as Phillip Lackey must put an even greater emphasis on coordination and communication.
MORE TIME, MORE QUESTIONS
Residents themselves see some positives about the rule. Anne B. Davis, M.D., a third-year resident in internal medicine, says, “Our restricted duty hours make it even more important that we as residents become better at communicating with one another about such issues as tests and
two children, and he even can make plans for predictable weekend time off. At the same time, he worries about the impact that restricted duty hours might have on continuity of patient care and on the quality of training that residents receive. He wonders, “Will residents receive less training because the training is less rigorous? Will they have the skills they need to have?” Lackey also ponders possible future implications for residency programs—implications that are topics of debate throughout the medical profession. Will the 80-hour rule set the stage for major changes in the way residents are trained? Will it in fact help set the stage for residencytraining periods that will become even longer than they are today? As Boulware says, “Only time will tell.”
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Making Connections
Koehler Named Chair of Radiology Department
By Charles A. Goldthwaite Jr. Robert Koehler, M.D., may be just beginning his tenure as chair of the Department of Radiology, but he’s anything but a novice. Koehler brings more than 20 years of experience in the department to his current post, having joined the department in July 1982 as vice chair and director of the program in gastrointestinal radiology. He held those positions until 2002, and was named the new department chair last November after serving as interim chair during a year-long candidate search. A Fellow of the American College of Radiology and the 2002 recipient of the American Board of Radiology’s Distinguished Service Award, Koehler is a nationally recognized clinician, scholar, and teacher. At the UASOM, Koehler received the Department of Radiology’s Teacher of the Year Award in 1989 and its Distinguished Faculty Award in 2003. “Of all the great things about my profession, I enjoy the interpersonal elements the most,” Koehler says. “Before I became chair, I was primarily a doctor and a teacher, either communicating with patients or training residents. As chair, I’ve become much more involved in faculty development and getting people to work effectively together.” Surprisingly, radiology was not the first area of specialty for Koehler. After receiving his medical degree from Cornell University Medical College he completed an internship and residency in internal medicine at Washington University School of Medicine in St. Louis. During that time, he developed an affinity for diagnosis and technology, which was encouraged by colleagues in radiology. “My mentors at Washington University felt such an utter enthusiasm for their work that it was infectious,” Koehler recalls. “I developed a deeper interest in radiology and came to see that it was the field that I wanted to specialize in.” After serving a two-year stint as an epidemiologist with the United States Public Health Service, Koehler completed a diagnostic radiology residency and fellowship in gastrointestinal radiology at the University of California San
“Before I became chair, I was primarily a doctor and a teacher, either communicating with patients or training residents. As chair, I’ve become much more involved in faculty development and getting people to work effectively together.”
— Robert Koehler
Francisco (UCSF). He spent one year as a clinical instructor of radiology at UCSF before returning to the Washington University School of Medicine as an assistant—and later, an associate—professor of radiology. From there, he moved to Birmingham, serving as the vice chair
of radiology under the leadership of Robert Stanley, M.D. “When I look back, it is remarkable how much positive change has occurred since I came to the university,” Koehler notes. One of 11 faculty hires in the 1982–1983 year, Koehler worked firsthand with Stanley as the department expanded rapidly in scope. “The whole fabric of radiological care at UAB changed markedly in the 1980s, and we have continued to recruit outstanding people, increase our level of National Institutes of Health funding, and expand our residency training.” As he looks forward to radiology in the 21st century, Koehler recognizes that there are many challenges ahead. “Radiologists must constantly stay in motion, because the dimensions of the field are always changing,” he notes. Many of the tools that are standard today did not exist when Koehler was a resident, a situation that will be true for today’s graduates as well. “When I was training, the most common indication for abdominal surgery was exploratory laparotomy, literally cutting open the belly to determine the problem,” Koehler recalls. “Now, radiology provides a way to determine the answers, which has led to less-invasive treatments and increased effectiveness when surgery is required.” Upon embarking on his journey as department chair, Koehler envisions the Department of Radiology as one part of an even more integrated future. “During the last 20 years at the UAB medical center, I have been impressed daily at the great mutual support and collegiality here,” he says. “We are blessed with talented faculty and staff who pull together to improve all aspects of care, and it is great to be part of such a community.”
Four SPORE
UAB Tops in Cancer Research
By Russ Willcutt When Selwyn Vickers, M.D., learned that he had landed a SPORE (Specialized Programs of Research Excellence) grant for pancreatic-cancer research, he was pleased—out of 15 applicants, only UAB, the Mayo Clinic, and M.D. Anderson had been funded, so there was good
reason to celebrate. Still, the news was bittersweet, because the $4.5 million awarded was far less than the $10 to $12 million that had been requested—a shortfall experienced by all three institutions due to budgetary constraints at the National Institutes of Health. “We’re definitely better off than we were,” says Vickers, “but pancreatic cancer is a disease that needs as much help as any, and maybe even more.” That’s because pancreatic cancer hasn’t generated the same level of attention as have others, such as prostate and breast cancer, resulting in
12
The Big Move
Sprinting Toward Completion
By Emily Delzell, courtesy of UAB Synopsis, and Dawn Mesa
“Our first and most important goal is to create as seamless a transition as possible in order to continue providing the same quality of care and services our patients now enjoy.”
— Jane Chandler
To ensure a flawless move to the new University Hospital, units are carrying out test runs with mock patients.
As most everyone can attest, a lot of work goes into moving a home or office, even if it’s just a move across the street. Now imagine moving an entire hospital across the street—one with many departments and patients, and lots of equipment, as well as a bustling emergency room. That’s the challenge being faced by UAB’s North Pavilion Project Operations Office, led by coordinator Jane Chandler, RN, Ph.D. “Our first and most important goal is to create as seamless a transition as possible in order to continue providing the same quality of care and services our patients now enjoy,” notes Chandler, who has organized and implemented the operations planning initiative and who, along with many others, is coordinating the relocation effort. “We also are focused on maintaining continuity of operations and minimizing downtime.”
The 885,000-square-foot University Hospital will have 37 operating suites, two procedure rooms, three medical/surgical units, four intensive-care units—trauma and burn, surgery, neuroscience, and cardiovascular—and the University Emergency Department (UED) spread among nine patient-care floors. At 38,000 square feet, with up to 45 private treatment rooms, the UED is nearly three times larger than the old space. The department is located on the first floor, along with a large public lobby. The second floor will serve as the main concourse into the University Hospital complex from the new visitor parking deck, with the primary entrance located on Fourth Avenue South. The new University Hospital has 10 elevators, and visitor elevators are oriented at each level to either the three-story lobby or the open
light well, which will help with orientation. A total of six bridges connect the new University Hospital with the Wallace Tumor Institute, Spain Wallace, the West Pavilion, and other patient-care areas. Designed to be patient- and family-friendly, the new facility has seating for more than 900 visitors, including large, open public accommodations centered around the atrium and skylight. A healing garden—a stress-relieving place for patients and their families to sit quietly among plants and seasonal displays of colorful flowers—will be located around the fifth-floor skylight, where it can be viewed from the floors above. The Operations Planning Committee will be working with all affected units and services to finalize the relocation plans in the coming months. The move is currently scheduled to take place in five stages, with some support services occupying the building as of July. Currently, the Committee estimates that most clinical areas will relocate during the second half of August, with all moves being completed by early fall.
fewer available research dollars. “Nearly everyone knows somebody who’s had prostate cancer, for example, and they also know people who’ve survived it, and those survivors are powerful advocates,” says Vickers. “In 2000, something like $190 million was awarded to fund prostate-cancer research, and about $380 million for breast cancer—but only $15 million for pancreatic-cancer research.” Morbidity rates are especially discouraging: Of 29,700 cases of pancreatic cancer reported in a recent year, there were 29,300 deaths, according to Vickers. “That makes it the fourth most deadly cancer, but 10th
Selwyn Vickers leads UAB’s pancreaticcancer research efforts.
in terms of incidents reported,” he says. That’s why funding to develop screening tests (none currently exist) and effective treatments for pancreatic cancer is so important, and Vickers believes that UAB is just the place to make a start. “The Cancer Center has a very good reputation, and UAB has a history of collaborative effort, so I think that in addition to our three existing SPORE grants for brain tumor and breast and ovarian cancer research, those were the deciding factors in the decision to award us these funds, and we’ll certainly make the most of them … and hope for more in the future.”
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READY FOR THE FUTURE Biodefense Preparations
In November 2003, the National Institute of Allergy and Infectious Diseases (NIAID) announced plans to build two national and nine regional level-three biocontainment laboratories and issued a call for proposals. Of the more than 30 responses that NIAID received, UAB was among those funded, receiving a $15.9 million grant. “The grant was structured so that it required a one-to-three match, however, so the university needed to secure about $5 million in matching funds,” says Richard Marchase, Ph.D., senior associate dean for biomedical research at UAB and principal investigator on the grant. “About a month later, in response to a request by President Garrison and Chancellor Portera, Governor Riley pledged the money from the state, which will allow us to build this $21 million facility.” Sites are being evaluated on and near campus for the 40,000-square-foot facility, which will be known as the Southeast Biosafety Laboratory Alabama Birmingham (SEBLAB). Marchase says it should be operational by early 2007. “We expect to continue our anthrax-related research, as well as research to develop diagnostic screening methods and vaccines for anthrax, West Nile virus, and the flu,” says Marchase, adding that investigators from throughout the region will have access to the facility. “In writing the proposal, we made the case that we have an exceptional group of investigators here at UAB, and that we’re one of the strongest universities in the country in terms of our potential to understand and defend ourselves against these deadly agents.” Those strengths will be bolstered by a consortium of universities known as the Southeastern Regional Center of Excellence for Emerging Infections and Biodefense (SERCEB). According to Richard Whitley, M.D., a founding member of the National Institutes of Health-funded organization, “This is a founding group of six universities—indeed, all academic medical centers in our region—that will work together to develop vaccines, drugs, and diagnostic
By Russ Willcutt
West Nile virus under the microscope.
tests against emerging infections such as West Nile virus, among many others. We will also be conducting research into organisms such as smallpox that could be used in bioterrorist attacks.” UAB’s partners in this effort are Duke University, Emory University, the University of Florida, the University of North Carolina, and Vanderbilt University.
Taking the results from research conducted through the NIAID Collaborative Antiviral Study Group (CASG) contract—which was recently refunded for $34 million over a seven-year period, with Whitley as principal investigator—scientists at UAB, Southern Research Institute, and other SERCEB member institutions will work to develop antiviral drugs to combat emerging infections such as West Nile virus and, eventually, even severe acute respiratory syndrome (SARS). “We’re especially interested in the orthopox family, which includes smallpox and monkeypox,” says Whitley. “Just to give you an example of what this collaboration is allowing us to do here on campus, we have Earl Kern and Mark Pritchard doing antiviral drug screening in the Division of Infectious Diseases at Children’s, and Ming Luo and Larry DeLucas at the Center for Biophysical Sciences and Engineering studying the 3-D structure of the enzymes necessary for these viruses to replicate. David Chaplin examined innate host immune responses to biothreat organisms, and Jack Secrist, Tom Voss, and colleagues at Southern Research Institute are synthesizing drugs based on these structures that will attack smallpox from a completely different angle, as well as providing animal models to study the efficacy of these drugs. So it’s this huge, multidisciplinary effort, with the same shared goal. “Our hope is that SERCEB and SEBLAB will help unite scientists from all across campus, and the region, with each contributing their particular expertise,” says Whitley. “Because, to me, that’s one of the most important characteristics of UAB—we truly are an institution without walls.”
Searching for a Diabetes Cure
I S L E T C E L L T R A N S P L A N TAT I O N
By Laura Freeman As anyone suffering from the complications of type I diabetes can attest, insulin is far from a cure. Even if patients manage to avoid blindness and amputation of extremities—for which they are at high risk—they are still more likely to die prematurely from heart or kidney disease than nondiabetics. While transplants have been changing the lives of patients with other organ failures for years, until recently the sensitivity of pancreatic islet cells to immunosuppressive drugs has limited the effort to bring that hope to diabetics. However, Devin Eckhoff, M.D., and his team are working to change that situation. In April, they performed the first islet-cell transplant in Alabama, using a technique pioneered in Canada that employed a less-toxic combination of immunosuppressive drugs and reversed diabetes in 85 percent of patients. After two years, the success rate for the University of Alberta at Edmonton program continues to be an impressive 75 percent.
A LIFE WITHOUT INSULIN
“Our ultimate goal is to help patients live without insulin or immunosuppressive drugs,” says Eckhoff, division director of transplantation surgery. “The transplant procedure injects islet cells through a catheter. The cells lodge in the liver and begin producing insulin.” The team, which includes Carlton Young, M.D., overseeing clinical aspects, and Juan Contreras, M.D., heading up the lab, hopes to take what they learn in duplicating the Edmonton study and make modifications in the second stage of their program. “We’ll be working on finding new approaches to improve the survival of islet cells,” adds Eckhoff. “We want to transplant more viable cells and learn how to help more of them survive without damage or rejection.” Since only about half of the new islet cells typically make the transition to become a functioning transplant, living donors are not an option at this point; they would be unable to contribute sufficient numbers of islet cells to free a diabetic from the need for insulin. However, the patient and donor have to share only the same blood type, which improves the odds of finding a compatible donor organ. Close tissue matching is not necessary and perhaps not even desirable, since a too-close match could make the new islet cells vulnerable to the same type of attack that damaged the patient’s pancreas.
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IN PRAISE OF WINE The Great Protector
By Laura Freeman
“To your health!” That traditional toast, long raised over glasses of wine, is lipoprotein-cholesterol pool in the vessel wall and its deleterious effects in vasproving to be prophetic. cular tissue and cells,” notes Booyse. Recent major studies have shown a consensus that light to moderate conWould a glass of grape juice with breakfast every morning have the same bensumption of alcohol (one to four drinks daily for men, one to two for women), eficial effects? Probably not. Although both juice and wine may begin with particularly red wine, can help prevent coronary-artery disease and heart attacks. grapes from the same vineyard, chemical changes happen along the way. The big question that remains centers on the mechanisms “Polyphenol composition, content, and often structure behind wine’s preventative benefits. are modified and altered during fermentation,” Booyse UASOM professor Francois Booyse, Ph.D., and his explains. “Grape juice contains lower levels and a different team of 17 researchers are working on a study funded by a composition of polyphenols.” $7.6 million, five-year grant from the National Heart, The long-term goal of studying the heart benefits of wine is Lung and Blood Institute to find the answer—or in this to gain insights that can be used in developing better drugs case, the answers. and therapeutic strategies to help both wine drinkers and nonMultiple components in wine appear to work together to drinkers avoid heart disease and live longer, healthier lives. attack heart disease on several fronts simultaneously. In Working with animal models, mouse-derived blood vesaddition to helping prevent arteriosclerosis and lowering sels and hearts, and cultured endothelial cells and carblood pressure when consumed in moderation, elements diomyocytes, the UAB team draws on the talents and within wine seem to help reduce thrombic risks that could expertise of researchers from multiple disciplines. In addilead to a heart attack. tion to Booyse, who is a professor of medicine and director “Our program specifically focuses on studies related to the of the Molecular Cardiology Research Program, the princieffects of low to moderate levels of alcohol and polyphenols pal investigators and project leaders include Edlue on the mechanisms of fibrinolysis, a normal ongoing process Tabengwa, MSC, and Hernan E. Grenett, Ph.D., of the that results in the removal of small blood clots, and vasoreacDepartment of Medicine; Dale A. Parks, Ph.D., of the tivity,” says Booyse. “Both alcohol and various individual Department of Anesthesiology; and Victor Darley-Usmar, polyphenols inhibit the activity/production of a number of Ph.D., of the Department of Pathology. Twelve other specific enzymes as well as fibrinogen, all directly involved in researchers include faculty and co-investigators from the and responsible for reduced coagulation or clotting. In addidepartments of Genetics, Pathobiology, Pharmacology tion, alcohol and polyphenols will simultaneously increase the and Toxicology, and Physiology and Biophysics. production of various enzymes involved in clot lysis, further Unlike fine wines, which may require years of aging, the first reducing the overall risk of clot formation and heart attacks.” fruits of this study are already being shared. The team is conAlcohol and polyphenols have also been shown to Why wine? Fermentation raises the tributing its insights and conclusions on a continual basis, typnumber of beneficial polyphenols— increase plasma High-Density Lipoprotein (HDL) choles- giving it an edge over grape juice. ically publishing 10–12 papers and 15–20 abstracts per year. terol, which many investigators believe helps protect the carWhen the study’s final results are gathered, learning more diovascular system through a process known as reverse cholesterol transport. about how wine helps to save hearts may teach us something worth celebrating “Increased plasma HDL will bind more cholesterol and reduce the level of the with a sip of champagne—or better yet, a hearty burgundy or merlot.
IMPROVING IMMUNOSUPPRESSION
UAB transplant immunologist Judith Thomas, Ph.D., has been working with primates with diabetes to improve their tolerance to immunosuppressive drugs and to reduce their need for insulin. “We’re hoping to build on her success,” says Eckhoff. “Data from her research is helping the transplant program select immunosuppressive drugs that are more effective and less damaging to islet cells.” There is a possibility UAB’s genetic research could make a contribution down the line. “Perhaps we’ll eventually be able to modify islet cells from pigs and make transplants available to more diabetics so they won’t
Fighting a killer: This April, a team led by Devin Eckhoff (seated), and colleagues Juan Contreras and Carlton Young, perfomed the first islet cell transplant procedure in Alabama. Their efforts may one day give type I diabetics a life without insulin injections.
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have to depend on insulin injections,” Eckhoff adds. Meanwhile, the team is still evaluating and selecting patients for the first stage of the study. They will continue to perform transplants as often as donor islets become available. “For now, our selection criteria include making sure a transplant could be a net benefit for any patients we choose,” says Eckhoff. “Rather than selecting those whose diabetes is well controlled with insulin, we’ll be looking at patients who are having complications from diabetes or difficulty maintaining blood-sugar levels due to hypoglycemic unawareness or other factors. “The potential for helping patients with type II diabetes is limited, since their problem is insulin resistance rather than lack of insulin. Transplants, however, could eventually be part of an approach to help those whose islet cells have been exhausted,” he adds. For Eckhoff and other UAB researchers—and the one million insulin-dependent diabetics in America—developing a cure to end diabetes would be sweet success indeed.
Physicians’ Forum
INDIGENT CARE: A CRISIS
By Dawn Mesa and Russ Willcutt
IN THE
WORKS
With one of the lowest per-capita income levels in the United States, Alabama has more than its fair share of indigent residents. They come from many different walks of life: homeless, homeowners, elderly, infants and children, single mothers, families, and both legal and illegal immigrants. The delivery of health care to these largely uninsured populations is reaching crisis proportions in the state as more and more indigent patients seek care in our hospitals and clinics. Ultimately, it is these institutions that bear the brunt of the financial cost for treating the indigent—a burden that is pushing some facilities to the breaking point. In the second of a two-part Physicians’ Forum series, the Alabama Medical Alumni Bulletin asked two prominent alumni about their experiences in treating the medically indigent populations in two of the largest metropolitan areas in Alabama. Wickliffe (Wick) Many, M.D., heads up the internal medicine residency program at the UASOM in Montgomery; Iris Fancher, M.D., is a pediatrician who practices at the Bessemer Health Center in metropolitan Birmingham.
What medical programs are currently in place in your community to assist the indigent population?
Iris Fancher (IF): I’m employed with the Jefferson County Department of Health, where I am a Public Health Medical Officer and pediatrician at Bessemer Health Center. The health department has a primarycare program that provides services to all who present, including the indigent and under-insured, as well as those with insurance. Our fees are based on a sliding scale according to income. It is not unusual for 50 percent of our clientele not to have insurance coverage. Many of our patients are eligible for Medicaid services, but are unaware of their eligibility and never make any attempts to apply for these benefits. There are six health centers across Jefferson County, staffed by about 16 physicians, pharmacists, and dentists. Each center offers pediatric, family planning, maternity, adult health, pharmacy, and dental services. In addition, we provide immunization services at all our clinics and in Tot Shot Centers at specified sites. We also have nutrition consultants who manage the federal WIC program at all our centers. Wick Many (WM): We have several programs. The first is the county health department, which has some clinics. There is also a federally funded clinic here—Lister Hill Clinic—and Baptist Health, the parent company of Baptist Medical Center, started an indigent clinic several years ago called Medical Outreach Ministries, which is staffed mainly by retired physicians. There’s also the UASOM clinic here, staffed entirely by UAB employees, which takes care of both in- and outpatients—we’re really the only facility that takes care of both. We see patients who present to our hospital, Baptist Medical Center South, with no physician and no insurance, which is part of our mission. We take care of patients not only from Montgomery County but also from Lowndes, Macon, Bullock, and other counties traditionally considered part of the Black Belt. Our facility also provides space for pediatric specialty clinics even though we are an internal-medicine residency program. We have three clinics that deal exclusively with children. Two are HIV-related; one is an adolescent HIV clinic and the other is a family clinic that provides care for newborns born to HIV-infected mothers. We also have a sickle-cell clinic. Unfortunately, we have been too successful. Our adolescent HIV clinic started with only two patients and now they’re up to 45. Because of the lack of resources, lack of awareness, and poor public health, HIV in rural Alabama is similar to that seen in underdeveloped nations. It’s a health-care crisis that’s going to be with us for quite some time.
Iris Fancher
Wick Many
What has been your experience in treating indigent patients?
IF: I have worked with the health department for about 16 years, and a great deal has changed since I first joined. At that time, we would see everyone without regard to his or her ability to pay. Now, because of
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Physicians’ Forum
budget cuts, the department is facing a tremendous challenge. As a pediatrician, I see patients from birth to age 19. I will sometimes see some of my chronically ill patients, such as those with sickle-cell disease or cerebral palsy, beyond that age. Most of these patients have Medicaid coverage and they are able to receive services as needed. We are associated with Children’s Hospital, where we refer our more complex patients for specialty care or those requiring hospitalization. WM: Working in infectious disease, I see consults at the hospital who may be people who are fully insured or people who have absolutely no resources whatsoever. As part of my responsibilities here with the UASOM Montgomery, we have a private practice that is part of the school, similar to The Kirklin Clinic in that we do see private patients. Typically, I see about 30 to 35 consults a month in the hospital, and anywhere from 10 to 15 of those patients will be completely indigent. Currently, I’m seeing three or four in the hospital who have catastrophic diseases because they didn’t have access to preventive health care. I have two others in the hospital right now with newly diagnosed HIV infection.
support from the county and from the city. The amount we’ve received each year has remained the same, and we’ve been blessed that is hasn’t been cut. We consider that a success.
Do you have any ideas or suggestions for improving indigent care in Alabama?
IF: Education of the public and funding for public health are essential to improving health care in our area. The Jefferson County Department of Health is aggressively pursuing getting the public involved in learning about healthier lifestyles. If funding is not available, then programs that are put in place for specific health-care issues will not be available to those who need them most due to the cost—specifically, issues and programs that address weight management, increased cholesterol, and epidemic increases in diabetes mellitus type II in pre-teen and adolescent patients. Funding is the central issue as always, but I think it is also important to build a strong relationship between the county health department and the various health systems in the area. This relationship should be so interrelated as to avoid duplication of services and conserve limited funds. The community should also have significant input as to the design and delivery of these services. WM: I can speak medically and I can speak politically. Medically, I think that we need to do a better job of supporting our health departments in the sense that—again, this goes back to money— they are working on shoestring budgets. They have been cut back so badly that public-health clinics have basically been annihilated. They’ve cut back on important programs, such as those for hypertension, and it’s a short-sighted move. I think developing a more coordinated health-care policy will be important. The other thing is that, locally, we have a lot of organizations that are providing indigent care, but there’s no “czar of health care” in that regard. Obviously, everyone is doing the best job they can, but there is some duplication of resources. It would be nice to have someone who is in absolute charge to designate and better coordinate, or at least get everyone together to formulate some sort of long-term plan. Also, our legislators are going to need to realize that health care and education are so intertwined that, unless they make courageous moves, we’re going to continue to lag behind. As physicians, we’ve been blessed and we need to continue to take the noble approach of providing the best medical care regardless of the patient’s ability to pay. We’ve got to instill this notion in today’s medical students from the earliest stages.
Has your patient base changed in the last five years, and if so, how?
IF: A few years ago, we began to see an increase in the number of Hispanic patients presenting to our clinics. We adjusted by offering Spanish classes to our staff as well as training in cultural diversity. At present, most of our Hispanic patient services are consolidated at two facilities, Central Health Center and Chris McNair Health Center, where we have full-time interpreters who assist staff in communicating with and providing services to our Hispanic patients. Currently, more patients are presenting from the private setting for care. Usually there is a loss of insurance coverage or the patients may be under-insured. WM: The patient base has stayed pretty much the same. Because of the fact that there is no hospital in Lowndes or Macon counties, we continue to serve both urban and rural communities. Patients come in from the small rural areas with very little, if any, preventive health care. Our main sources of patients are some of the smaller communities near here where there is a very high rate of either uninsured or Medicaid patients.
In what ways has this impacted you and/or your practice?
IF: Medicaid coverage changes from day to day, and many times patients arrive assuming they have coverage when they do not. Coverage may be suspended because the patients did not reapply for coverage, because there’s been an address change, or for various other reasons. Occasionally, a patient needing care will leave the clinic because of lack of coverage. Sometimes patients will leave the clinic with a prescription and not fill it because they have no funds for medication. Whenever we become aware of patients’ inability to pay we implement several creative approaches to provide care. The health centers and staff also contribute to funds that are administered through the social workers to help cover medication and some transportation costs. WM: It impacts us quite a bit because we have budget constraints. When you have to write off large amounts of bad debt, the money has to come from somewhere. We’ve been impacted by the state budget cuts and, in a very unusual move, we are considered a non-state agency, so our funding was cut 75 percent. Unlike Birmingham, we do not have a charity hospital—there’s no Cooper Green here; we are the area’s Cooper Green. Fortunately, we do receive
How does indigent care affect other physicians and medical facilities in the area?
IF: I believe the biggest challenge we are facing in health care is funding, or lack of it. I am sure that private practitioners see patients who have no medical insurance coverage, especially long-term patients who for various reasons have lost their insurance coverage. However, one cannot run a practice for indigent patients unless there is some source of funding—and providing hospital care is almost out of the question. WM: I think it has a big impact on some of the surgical subspecialties. Because we don’t have a charity hospital here, if you have an indigent patient who is involved in a car accident or sustains a gunshot wound, the physicians still have to treat them, and still have to deal with their share of the costs involved. It is also somewhat of a negative in recruiting for our surgical colleagues. It’s an issue because they can’t compete with communities like Birmingham, for example, as far as reimbursement or compensation. This is a spillover effect of indigent care.
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Student Rounds: Resident Life
By Dawn Mesa
As previously reported in the Summer 2003 issue of the Alabama Medical Alumni Bulletin, and in this issue on page 10, the Accreditation Council for Graduate Medical Education (ACGME) has set new rules regarding the maximum number of hours residents can now work per week. The rules, which went into effect on July 1, 2003, limit residents to no more than 80 work hours per week and no more than 30 consecutive work hours at a stretch. In addition, residents must be given one day out of seven free from all clinical and educational responsibilities, they cannot be scheduled for in-house call more than once every three nights, they should be given at least 10 hours for rest and personal activities between daily duty periods and after in-house call, and in-house moonlighting counts toward the weekly limit. All limits are averaged over four weeks. To see how the new rules are affecting resident life at the UASOM, the Alabama Medical Alumni Bulletin asked three current residents about their experiences in light of these changes and their opinions about what the changes have meant for UAB’s hardest-hit specialties: surgery, OB/GYN, and internal medicine. Laurence Rosenberg, M.D., is a fifth-year general-surgery resident; Erika O’Donnell, M.D., is a fourth-year OB/GYN resident; and Elizabeth Turnipseed, M.D., is a first-year internal-medicine resident.
What has been the biggest change since the new regulations went into effect?
Laurence Rosenberg (LR): I think the biggest difference, overall, is that residents aren’t chronically tired all the time now. Residents are better-rested, they’re able to read and study more. I’m sure there’s not a resident out there from the previous generation who doesn’t have a story about falling asleep at the dinner table or while driving. I know I’ve done that once or twice. Erika O’Donnell (EO): I think that some of the OB/GYN rotations had higher time requirements than others and the 80-hour restriction impacted those services—oncology and antepartum particularly—more than others. We had to adjust our call schedule and, like surgery, changed our night-float system. It’s working out really well now; when we converted initially it was slightly problematic in terms of coverage issues. Elizabeth Turnipseed (ET): Given that I never worked in the previous environment, I’ve noticed that, in internal medicine, we can rather easily facilitate the 80-hour workweek. The post-call, 30-hour regulation is a little bit more difficult to adhere to and more noticeable. If this system is going to work as it’s intended, it’s got to involve more shared responsibility.
EO: We take a lot less calls, which means less experience. I think we’re doing a good job maximizing the calls and experience that we have, but when I was an intern, I was taking nine calls a month. When you compare that to interns now who are taking five or six calls a month, they’re missing out on a lot of experience. ET: I think, for me and for a lot of the interns, the rule that has affected us most is the 30-hour post-call rule. I don’t like to walk out of the hospital feeling like things are unfinished, for a variety of reasons. One, you don’t want to put off what you’re doing on someone else and, two, it’s really hard—especially at my level in learning— to really get a sense of what’s going on if you don’t see something through to fruition.
What is the schedule like now for residents in your field?
LR: General surgery has a “float” group of residents who take turns in the night rotation. Each resident spends a rotation each year—four to seven weeks—working from 5 p.m. to 7 a.m., Monday till Friday morning; Sunday they then come in at noon and work until 7 a.m. Monday. They continue that pattern and each level is assigned to a team—vascular surgery, general surgery, and so on. There is also a senior-level resident on call for each team, which allows for easier access to these residents, who can help out with certain problems. EO: The OB/GYN schedule is very manageable. We didn’t really change anything with our general service, as far as how many are on it. Things will change next year when the new hospital facility opens and we have an extra person to cover triage.
What has been the biggest negative since the new regulations went into effect?
LR: The biggest negative that most faculty and people complain about is a perceived lack of continuity of care. I don’t necessarily agree with that, though, because prior to the regulation change, residents weren’t on call every night—so they weren’t there all the time to take care of those patients regardless.
Erika O’Donnell says the 80-hour workweek has created a more tight-knit group of residents.
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some nurse clinicians for the different divisions. They help tremendously, and take care of discharges, setting up home health and social services, and answering patient phone calls—this does help out a lot. EO: We cover two hospitals for call: Cooper Green and University. The nightfloat system is in place at University, and then we have people at Cooper Green for a particular rotation who cover most of the call during the week, one night a week, and the general call pool team covers the weekend and Friday. Everyone takes their turn. The biggest change at Cooper Green is that one resident covers there with an attending present at all times, except for Thursdays when there are two people there. We’ve had to have our third-year on night float at University act as a floater at Cooper Green—they’ll help out if it gets busy there. ET: Our department has increased the number of residents that it’s getting every year. I think we increased by five this past year and that we’ll be increasing by five for the next several years.
Restricted duty hours give residents more time to rest and catch up on their reading, says Laurence Rosenberg. “We’re here to learn and be educated— that’s the point of residency.”
On a personal level, how is your situation now that these limits are in place?
LR: It affects the junior-level residents a little more than the senior-level residents, but I am able to read more and I’m not fatigued all the time. I can clearly feel a difference; it allows me to be more communicative and have a more positive attitude. I think that’s a true benefit from the patient’s standpoint.
ET: Most of our ward medicine months have a night-float system where some member of the team is on every fourth night and night float comes in to help them, but the other members get to go home. Ultimately, you have to spend every eighth night at the hospital, but the team is on call every fourth. The subspecialty services are a little different. In pulmonary, for instance, there are five of us, but only one member takes call every night. In medicine, at least, we never have call nights more frequently than every fourth night, but then they range from every fourth night to every eighth night.
Do you think this system is working out well?
LR: I think it works well. Nothing’s perfect, and every situation has problems, but the old way had problems too. I know that, overall, most people are significantly happier in terms of their ability to complete and tolerate five years of a general-surgery residency. EO: As a chief, I’ve been here going on four years now, and I think that our faculty and residents have a great rapport and work together very well. I think the 80-hour workweek has made us a tighter group; we’ve had to rely on each other for coverage, and it’s brought us even closer together. ET: There is still some tweaking to be done, but I think for the most part it’s worked out. From a patient-care perspective, there were a lot of problems with residents being so grossly overworked. We can’t take our education out on the patients that are here for care.
With in-house call limited to every fourth night, Elizabeth Turnipseed and fellow residents have more time for family and hobbies.
How have the new rules affected hospitals that employ residents?
LR: In the past, it wouldn’t be uncommon for residents to work 110 to 115 hours a week, and if they can now only work 80 hours a week, that time has to be made up. There was no argument that a lot of the time residents are in the hospital is a waste of their time—they’re not being educated or doing productive things to learn. Instead, they’re doing tasks that in other places are done administratively but, because residents are the cheapest form of labor, the residents have to do them.
EO: I have a four-and-a-half-month-old daughter, so it’s given me more time at home with my family. I think going home post-call has allowed me to be rested and get some sleep. I think I’m more efficient the next day because I’m not so tired and not taking a ton of calls a month. Being a chief and looking for a job this past year, it’s also allowed me the time needed to interview. ET: It’s definitely been a busy year, but it’s not overwhelming. I do come in early in the morning, but I leave the hospital in time to go home and see my family. I think it’s nice to know that there’s a little bit of predictability to it. Looking at the residency program in general, there are a lot of residents who are married, who have children, who have hobbies—I think that’s a good indicator that it’s working.
How have the new rules affected your department?
LR: In surgery, either our director—Dr. Kirby Bland—or the hospital has hired
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From the Development Office
California Alumnus Funds Endowed Lectureship for Montgomery Program
By Dawn Mesa S. Rexford Kennamer, M.D., recently made a generous gift to the School of Medicine that provided for the establishment of the S. Rexford Kennamer, M.D., Endowed Lectureship in Internal Medicine for the Montgomery Internal Medicine Residency Program. Kennamer, who has spent the majority of his professional life in California, was raised in Montgomery and is eager to help the cause of medical education in his hometown. The gift will be used to establish a lectureship that will support education for residents, fellows, faculty, and private practitioners in the Montgomery area, and to bring renowned physicians to the area. Kennamer graduated from the two-year program of the Medical College of Alabama in 1943, then went on to finish his medical degree at Jefferson Medical College in Philadelphia. He served his internship at Jackson Memorial Hospital in Miami and his residency in internal medicine at Veteran’s Hospital in Dallas before heading even farther west—to stay. Kennamer completed a fellowship in cardiology at Cedars of Lebanon Hospital in Los Angeles and the UCLA School of Medicine. In 1954, he opened a private cardiology practice in Beverly Hills and during the course of his career was the personal physician to such stars as Gary Cooper, Frank Sinatra, and Elizabeth Taylor. Among his career achievements, Kennamer was a longtime co-investigator in the research lab at Cedars-Sinai Medical Center (CSMC); served as clinical chief of cardiology at CSMC; was named a fellow of the American College of Physicians; and is founder and president of the Western Cardiac Foundation, which helps fund cardiac research and biomedical teaching. Over the years, Kennamer has funded a variety of educational initiatives, including the Kennamer Fellowship Program in internal medicine at CSMC and the UCLA Medical Center.
PROGRAMS WORTH SUPPORTING:
Division of Infectious Diseases
By Dawn Mesa The Division of Infectious Diseases in the Department of Pediatrics does not focus solely on medicine for children. In fact, collaborative research programs currently in place in the division are making a difference in the lives of both children and adults. Directed by Richard Whitley, M.D., the division is one of 14 within the Department of Pediatrics. With 21 faculty members, the division has a primary focus on herpes viruses, but there are several faculty members who delve into areas outside this arena, such as severe acute respiratory syndrome (SARS), West Nile virus, and the human immunodeficiency virus (HIV). The division brings in about $18 million in annual support from the National Institutes of Health (NIH), second only to the Division of Hematology/ Oncology division in NIH support at UAB. “What’s fun about this division,” says Whitley, “is that our people not only really like to do research, but they also like to take care of patients as well. When you look at the division’s research interests, we focus our work on herpes viruses, but we also recognize the need to move into emerging infections and microbial agents that compromise our nation’s biodefense—areas which have now become key components of the division.” With this in mind, Whitley himself is a co-chair of the newly formed Southeast Regional Center of Excellence for Emerging Infections and Biodefense
(SERCEB), of which UAB is a member institution—as are Duke University, Emory University, the University of Florida, the University of North Carolina, and Vanderbilt University. The consortium is centered at Duke and led by Barton Haynes, M.D., of the Duke Human Vaccine Institute. The consortium will initially work on developing new vaccines, diagnostics, and treatments for orthopox viruses (including smallpox and monkeypox), bacillus anthracis (anthrax), and yersinia pestis, the bacteria that causes plague. SERCEB also will develop new vaccines to prevent emerging infections, including SARS (Dr. Sullender), and innovative diagnostics (Drs. Lakeman and Sullender) and new drugs to treat infections for which current treatments may not be optimal. In addition to SERCEB, there is other cutting-edge research taking place within the division. Much work is being done to study congenital cytomegalovirus (CMV) infection (Drs. Britt, Boppana, Fowler, and Pass)— the most common cause of congenital infection in the United States today, one with a societal cost of about a billion dollars a year. Whitley notes, “From the perspective of the National Academies of Science, they’ve made it their highest priority to find methods to prevent the infection.” The division also has made CMV research a high priority—both its molecular aspects and the mechanics of the body’s response to the virus. Work is being done to develop third- or fourth-generation vaccines against the virus and to prevent hearing loss in children afflicted with the condition. Additional studies are underway to implement a national screening program for babies at risk for hearing impairment due to CMV. Other important research in the division comes by way of the gene therapy group, which includes Drs. Parker, Cassady, and Markert. In particular,
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says Whitley, “we are using genetically engineered herpes simplex virus to treat the tumors of glioblastoma multiforme—the most lethal form of brain cancer—and understand how the tumor and virus interact, which is leading to the design of new viruses that are more active in the tumor. The ultimate goal is to have a virus that can be administered intravenously to go directly to the tumor and ‘shell’ it out.” Developing new antiviral drugs is another research focus in the division. Funding has recently been awarded to develop orthopox vaccines that will treat the viruses that are a factor in bioterrorism and emerging infections, such as smallpox and monkeypox, as led by Drs. Earl Kern and Mark Pritchard. It is hoped that these vaccines will be available for use in patients in the fall of 2004. Other projects in the division include the development of HIV intervention techniques for adolescents (Drs. Wilson and Crain), as well as hospital models for improved antibiotic usage and ambulatory care (Dr. Hutto) so that children won’t have to be kept in hospitals for long periods of time. Plans are also in the works to develop a protocol to treat SARS and West Nile virus. — Richard Whitley “At the end of the day,” says Whitley, “the division is primarily focused on virology, but we have a lot of fun in terms of addressing the contemporary needs of the population at large, not just the needs of children.” For more information on how you can help the division further its research, please contact Jennifer Philpot in the Development Office at (205) 975-7298, or see the envelope enclosed in this issue. To learn more about the work being done in the division, please visit its Web site at [main.uab.edu/uasom/2/ show.asp?durki=23257].
“We focus our work on herpes viruses, but we also recognize the need to move into emerging infections and microbial agents that compromise our nation’s biodefense.”
PROGRAMS WORTH SUPPORTING:
Sparks Clinics Rett Syndrome Clinic
By Doug Gillett For the first six to 18 months, everything appears normal. Then the girls start to regress. They lose any progress they made in learning to walk, as well as whatever vocabulary they’ve developed. They don’t make eye contact the way they used to. And they engage in strange, constant hand motions like wringing their hands or pulling at their hair. The worst part is that this regression is permanent—these girls will grow and develop little over the remainder of their lives. The disease that has subjected thousands of baby girls to this fate, Rett syndrome, was first diagnosed by an Austrian pediatrician in the 1960s. But it was only in the early 1980s that the world began taking notice. Since then, Alan K. Percy, M.D.—director of the Sparks Clinics and associate director of the Civitan International Research Center—has dedicated himself to tracking down the syndrome’s causes and devising treatment.
“We always thought it was a genetic condition, because it only affected girls,” he says. “The unusual thing about it is that it rarely recurs in the family, so that made traditional genetic-linkage studies impossible.” Working with Rett expert Huda Zoghbi, M.D., in Houston, Percy located a gene with which the syndrome was associated, and he says that 80 to 85 percent of the girls who meet the clinical criteria for Rett syndrome have mutations in that gene. Researchers have identified more than 200 different mutations, but eight specific mutations make up the vast majority of those cases, Percy explains. “By the nature of this gene, we think we have at least a ballpark idea of what the problem is—the connections that nerve cells make with each other, the synapses, are not formed stably, or they’re not formed at all,” he says. “And if they are formed, they’re not maintained properly, so the brain itself doesn’t develop the way it would in a normal person.” Estimates once put the incidence of the disease at one in 40,000 females, but the frequency increased as doctors got better at differentiating the syndrome from disorders that had similar symptoms, such as autism and cerebral palsy. Incidence is now estimated at approximately one in 20,000. continued on next page
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From the Development Office
continued from previous page Percy has a rare-disease grant proposal in the works to study the natural history of the disorder. “The only way we can do that is to follow large numbers of girls and women over time to see how they mature,” he says. “Then we’ll have some kind of composite information. . . . And if we collect a significant number of girls with each of those mutations, perhaps we can make inferences about what one mutation does versus another.” UAB’s database contains information on more than 150 girls, in addition to more than 300 in the database Percy started during his time at the Baylor College of Medicine. “The goal of this natural-history study, which is being conducted between the two locations, is to follow 1,000 girls,” he says. “Our costs are minimized by the fact that the clinic visits are free—the families simply have to get here,” Percy explains. “We will see girls up to age 12 twice a year, and over age 12 once a year. We’re not trying to become the physicians for these girls—they’ll remain with their own doctors, wherever they are. We just want to have the information.” These efforts have applications beyond research. The work is proving to be an invaluable resource for families, Percy says, “because we’ve gathered things from our own experience as to how to approach various aspects of care.” Families need all the help they can get. Girls with Rett syndrome are classified as “total-care,” meaning they need lifelong assistance with everyday concerns such as feeding, transportation, and hygiene; they also experience a higher incidence of health problems ranging from constipation and gastric reflux to scoliosis so severe it requires surgery. “We’ve learned a great deal about that,” Percy says. “So there are aspects of this disorder for which we’ve become a resource for people all over the country.” For more information on how you can contribute to the efforts of the Sparks Clinics Rett Syndrome Clinic, please contact Jennifer Philpot in the Development Office at (205) 975-7298, or see the envelope enclosed in this issue. In addition, to learn more about the work being done in the clinic, please visit its Web site at [www.circ.uab.edu/Sparks/Rett/index.html].
Alan K. Percy has spent decades investigating Rett syndrome.
PROGRAMS WORTH SUPPORTING:
Division of Orthopaedic Surgery
By Russ Willcutt Knees are necessary. That’s why research being conducted in the Division of Orthopaedic Surgery is so important. Not only are they working to design better artificial-knee mechanisms, they’re testing those that have been in use for some time, and then removed, to examine the wear and tear they’ve undergone—all in an attempt to provide better future materials and designs. Division of Orthopaedic Surgery in the School of Medicine and Prosthodontics and Biomaterials in the School of Dentistry. “We receive about 400 devices each year, and we rely on residents and graduate students to perform the majority of the analyses.” The program is mostly funded internally at this point, with additional funds provided by the National Institutes of Health (NIH)—but more help is needed. “While we need stipends for the students and money to cover the costs of materials, what we need more than anything is to be able to purchase new equipment and to refurbish our labs,” Lemons says. He adds that he has hopes of gaining new laboratory space in the Shelby Building once it’s completed, but there is still the matter of the new equipment that will be needed to continue the division’s research and achieve successful outcomes. “To re-outfit our current facilities, we’d need something along the lines of half a million to a million dollars,” he says. “The various micro- and nanoFar left: Jack Lemons. Left: The orthopaedic surgery division’s analysis of wear and tear on existing artificial knee mechanisms will help engineers design stronger, more durable joints for elderly patients.
“We’re working with the Department of Biomedical Engineering both to design new totalknee replacement mechanisms, along with other components, and to examine those we’ve retrieved through replacement procedures—known in the orthopedic community as ‘device retrieval and analysis,’ ” says Jack Lemons, M.S., Ph.D., who is the director of laboratory surgical research for the
hardness machines, for instance, can cost anywhere from $30,000 to $250,000, but the return on that investment can be quite substantial.” While these devices are sometimes used to aid trauma victims or younger individuals afflicted with osteoarthritis, the vast majority of the patients who will benefit from the division’s research findings are elderly. “We’re constantly looking to the NIH and the National Science Foundation for funding,” Lemons says. “But we also feel that there might be members of the community who would be interested in furthering our efforts, too.” To learn more about contributing to this worthy cause, including naming opportunities, contact Jeannie Horton at (205) 325-8660, or see the envelope enclosed in this issue. In addition, to learn more about the work being done in the division, please visit its Web site at [main.uab.edu/ uasom/2/show.asp?durki=23738].
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Lanier Gifts Support Neurology Research
Family Foundation Aids Efforts to Solve Parkinson’s Disease
By Matt Windsor When Ray L. Watts, M.D., came to the UASOM from Emory University last year, he brought with him decades of research into neurological disorders and an invaluable partner: the Sartain Lanier Family Foundation. The charitable organization, founded by successful apparel businessman Sartain Lanier, had a history of contributions to Vanderbilt University and Atlanta-area institutions such as Emory. But personal tragedy brought the foundation into contact with Watts, and the relationship has continued to flourish in Birmingham.
Film Premiere Benefits 1917 Clinic
By Dawn Mesa A bit of Tinseltown came to Birmingham this past November, when a Hollywood-style movie premiere at the Alabama Theatre was held to benefit UAB’s AIDS Outpatient (1917) Clinic. The Trip was produced by two Alabama natives, producer Houston King and executive producer Tom Blount. “The benefit was our most successful ever, in a number of ways,” says Michael Saag, M.D., director of the clinic. “Financially, we netted more than $31,000 for the clinic, which is quite remarkable … and even more important, the turnout was quite phenomenal.” The clinic, which opened in 1988, conducts high-quality research protocols in both the clinical science and basic science arenas, provides education to health-care providers, and establishes vital links with the patient community and general population through orchestrated outreach programs. The clinic provides many services to individuals living with HIV/ AIDS, including an outpatient treatment clinic, research clinic, dental clinic, women’s HIV clinic, and oncology clinic. The 1917 Clinic also serves as one of 28 federally funded AIDS Clinical Trials Group sites involved in the evaluation of experimental therapeutics. Looking ahead, the clinic is planning to host additional fundraising events—though not on the scale of a Hollywood-type movie premiere. Presently, plans are under way to host a theater-type event later this year. In addition, volunteer opportunities are available for those interested in assisting in the clinic. For more information on how you can help the 1917 Clinic and its patients, please contact Rebecca Lark in the Development Office at (205) 975-6149.
An expanding neurology department is working on treatments for Parkinson’s, Alzheimer’s, and more, says Ray L. Watts.
“My longtime patient, Vance Lanier [vice chairman of the foundation’s board of trustees and Sartain’s son], was a very strong supporter of Parkinson’s research—he had Parkinson’s himself,” Watts explains. “He passed away in December of 2003, but the family and the foundation continue a strong interest in helping to solve Parkinson’s disease.” Watts has received gifts of $300,000 from the foundation both last year and in 2004, and those gifts are helping support research efforts in the UAB Parkinson Disease and Movement Disorders Center. The center, designated by the National Institutes of Health in 2003, offers comprehensive clinical care, conducts clinical research to evaluate novel treatment options for the disease, and educates health-care professionals and the public. Philanthropic support will also help Watts and colleagues reach two ambitious goals, he says: “What brought me back to UAB was the opportunity to help build on the excellence already present in the Department of Neurology, and perhaps even more important, the opportunity to work with others at UAB in an effort to build a comprehensive Neurosciences Center of Excellence and position that center to become a national and international leader in the coming five to 10 years.” To achieve those goals, “we’re going to recruit about 25 additional faculty in Neurology, half of whom will be laboratory research-oriented, and half of whom will be clinical research-oriented,” says Watts. The expansion will double the size of the department; plans call for Neurology to move to the Sparks Building so it will be in close proximity to investigators in Psychiatry, Neuropathology, and Neurobiology. “That’s what it will take to get us to a size comparable to the best departments in the nation,” he says. “And if we recruit the right people, then with them will come excellent clinical programs, research programs, and educational programs.”
While Watts is an internationally known leader in Parkinson’s research, his department’s interests run the gamut of neurological problems. “We want to understand basic normal processes in the brain,” he says, “but our real focus is on understanding disease mechanisms so that we can develop new and better treatments in many different areas: Parkinson’s disease, Alzheimer’s, brain tumors, stroke, multiple sclerosis—you name it.” A Birmingham native, Watts says he relishes his return to the campus where he earned undergraduate degrees in electrical and biomedical engineering. “I love UAB, and I love Alabama, so it’s great to be back.”
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2004 Alumni Weekend Report
The 31st annual Medical Alumni Weekend, February 27-28, 2004, featured the traditional activities: the Reynolds Historical Lecture, the Alumni Association Board of Directors’ meeting, the Scientific Program, the annual luncheon and association meeting, the Constance and James A. Pittman Lecture, and 13 class reunion dinners. We also featured two book signings just before the luncheon: Martin L. Dalton Jr., M.D., class of 1957, brought his new book, Champ Lyons: Surgeon; and former dean Clifton K. Meador, M.D., signed his newest publication, Med School.
REYNOLDS LECTURE
The 25th annual Reynolds Historical Lecture on Friday evening featured James H. Thrall, M.D., lecturing on “Scientific Reductionism and 21st-Century Radiology.” The lecture was presented in the Historical Library’s Ireland Room, located in Lister Hill Library. It was followed by a reception sponsored by the Reynolds Library and the Caduceus Club at the Woodward House.
SCIENTIFIC PROGRAM
Saturday morning, President Betty W. Vaughan, M.D., welcomed everyone to the scientific program, “Medical Issues 2004.” Then she turned the program over to chair Alan R. Dimick, M.D. There was something for everyone, starting with the presentation on “Organization and Functions of the Jefferson County Coroner/Medical Examiner’s Office,” by Robert M. Brissie, M.D. Brissie is professor and director of the UASOM’s Division of Forensic Pathology and serves as chief coroner/medical examiner of Jefferson County. Next on the program was “The Management of Menopause” by R. Edward Varner, M.D., professor in the Department of Obstetrics and Gynecology. Sarah L. Morgan, M.D., associate dean for research compliance and professor of nutrition science, followed with a discussion titled “Osteoporosis 2004.” After the coffee break, Ray L. Watts, M.D., professor and chair of the Department of Neurology, presented “Recent Advances in the Understanding of Parkinson’s Disease.” The program closed with a fascinating presentation, “Skin Grafting Between Burned Twins,” by William D. Hardin, M.D., associate professor of surgery and director of the Burns and Trauma Center at Children’s Hospital.
ANNUAL LUNCHEON
President Vaughan presided over the annual luncheon, held at the Birmingham Marriott. The traditional awards were presented as follows:
has been the trauma director at Charity Hospital Level I Trauma Center, Medical Center of Louisiana at New Orleans; special assistant, clinical medicine, at the Johnson Space Center; and associate residency program director and director of the Trauma Program in the Department of Surgery at Tulane University School of Medicine. He has been a member of the teaching staff in the emergency department at Charity Hospital of Louisiana at New Orleans and the attending staff at Tulane Medical Center Hospital and Clinic and Charity Hospital. He has also served as police surgeon at the New Orleans Police Department and medical director of the New Orleans Jazz and Heritage Festival. McSwain is founder, medical director, and editor-in-chief of the PreHospital Trauma Life Support (PHTLS) training program for the National Association of Emergency Medical Technicians (NAEMT). The program has trained more than 300,000 pre-hospital providers in 37 countries since it started in 1981. He has served as a member of the Prehospital Care Committee of the American College of Surgeons (ACS), and as chair and initial member of the ad hoc committee to start the Advanced Trauma Life Support program (ATLS) for the ACS. This program has trained more than 400,000 physicians since 1980. He also founded the Emergency Medical Technician Training Program at the University of Kansas School of Medicine and served as chair from 1973–1977. McSwain is certified with the American Board of Surgery (1972); National Registry of Emergency Medical Technicians–Ambulance (1978); and National Registry of Emergency Medical Technicians–Paramedic (1980). He has physician certificates in diving medicine from the International Society of Aquatic Medicine in Los Angeles, California, and hyperbaric medicine from St. Luke’s Hospital in Milwaukee, Wisconsin. He also has a divemaster certificate from the National Association of Underwater Instructors and an enriched air (nitrox) diver certificate from Technical Diving International in Coral Star, Bahamas. He was a founding member of the board of directors and director of Continuing Medical Education for the International Society of Aquatic Medicine from 1975–1995. A prolific writer, McSwain has authored 26 books and 105 book chapters since 1976, contributed to 331 publications since 1968, and made more than 700 presentations since 1972. His significant professional honors include the Commendation Medal, United States Air Force (1965); NAEMT President’s Leadership Award (1980, 1984, 2000); U.S. Naval Forces Central Command Citation for Outstanding Performance as General Surgeon, Medical Treatment Facility, USNS Comfort (T-AH 20), during Operation Desert Storm (1991); Surgeons Award for Service to Safety, American College of Surgeons, American Association for the Surgery of Trauma, National Safety Council (1998); and the NAEMT’s Rocco V. Morando Lifetime Achievement Award (2002). In 2003, he was named the Scudder Orator by the American College of Surgeons. McSwain served as a captain in the United States Naval Reserve on active duty from 1965–1967; he served in the Medical Corps of the Reserve from 1984–1995.
2004 HETTIE BUTLER TERRY COMMUNITY SERVICE AWARD
For outstanding commitment to community service James H. Alford Jr., M.D. James H. Alford Jr., M.D., is a native of Albertville, Alabama. He graduated from Albertville High School in 1955 and earned a Bachelor of Science degree from the University of Alabama in 1959. He graduated from the Medical College of Alabama in 1963 and remained there to complete his internship and residency in obstetrics and Susan and James Alford. gynecology in 1968. He is a fellow of the American College of Obstetrics and Gynecology, and is a member of several other medical organizations, including the Medical Association of the State of Alabama and the American Society of Addiction Medicine. Alford is an active member of the Alabama Physicians Health Program and has
2004 DISTINGUISHED ALUMNUS
In recognition of outstanding contributions in the field of medicine and demonstration of the high principles of the medical profession Norman E. McSwain Jr., M.D., FACS Norman E. McSwain Jr., M.D., is a native of Albertville, Alabama. He received his Bachelor of Science degree from the University of the South, Sewanee, Tennessee, in 1959 and graduated from the Medical College of Alabama in 1963. He is currently professor of surgery in the Department of Surgery at Tulane University School of Medicine in New Orleans, Louisiana, and has been the visiting clinical professor for NASA at the Johnson Space Center in Houston, Texas, since 2002. Over the course of his career, McSwain
Norman McSwain and his daughter Merry.
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served on the Alabama Impaired Physicians Committee for the past four years. He also serves on the boards of Recovery Ministries of the Episcopal Church and the Council on Substance Abuse. For the past two years he has been active as a speaker for the Alabama Campaign to Prevent Teen Pregnancy. Since 1992, he has been a member of International Doctors in Alcoholics Anonymous (IDAA). Founded in 1949, this organization has 4,500 doctorate-level members of health-care professions who are recovering from addiction. IDAA is dedicated to promoting recovery from addiction and its consequences for its members and their families. Jim has served on the Steering Committee for the past four years; last year he was the chair of the group’s annual meeting, which was held in Mobile, Alabama, with more than 650 members and their families in attendance. Jim is the father of three children: Vivian, Bradley, and Gregory. He and his wife, Susan, live in Montgomery, where he has practiced medicine since 1968. They have one grandson, Huston, and are anticipating the birth of a second grandchild this fall.
to all first-year students at Harvard Medical School. His book based on this course, Human Genetics: A Problem-Based Approach (published by Blackwell Science), is currently in its second edition, and has been translated into Italian and Korean. Korf is also co-editor of the fourth edition of Emery and Rimoin’s Principles and Practice of Medical Genetics. He is president of the Association of Professors of Human and Medical Genetics, and just completed a term as vice president for clinical genetics of the American College of Medical Genetics. He also serves as a member of the Liaison Committee on Medical Education, which accredits U.S. and Canadian medical-education programs. His research interests focus on the natural history and treatment of neurofibromatosis type 1.
SATURDAY EVENING REUNIONS
The reunion classes of 1949, 1954, 1959, 1964, 1969, 1974, 1979, 1984, 1989, 1994, and the classes of 1947, 1956, and 1958 gathered on Saturday evening for a reception at the Marriott for all the classes, sponsored by the Medical Alumni Association. After an hour of fellowship, each class went to a separate class dinner. Special thanks go to alumni Tom Caldwell, M.D., Bob Lauderdale, M.D., John Rochester, M.D., Walter Pittman, M.D., Richard Lytle, M.D., George Adams, M.D., Jimmy Chambers, M.D., Karl Egerman, M.D., Bill Staggers, M.D., Kevin
2004 GARBER GALBRAITH MEDICAL-POLITICAL SERVICE AWARD
For outstanding service to the medical profession George C. Smith Sr., M.D., FAAFP George C. Smith Sr., M.D., is a boardcertified family physician from Lineville, Alabama. He received his Bachelor of Science degree in pharmacy from Howard College and graduated from the Medical College of Alabama in 1965. After an internship at Lloyd Noland Hospital he opened his pracWanda and George Smith. tice in Lineville in 1966, and still practices family medicine there with three partners. But his avocation is cattle farming; he and his wife, Wanda, live on their cattle farm in Lineville. They have five sons. Currently, Smith is a clinical assistant professor in the Department of Behavioral Community Medicine at the College of Community Health Services of the University of Alabama. He is active in serving as a preceptor for medical students, residents, and nurse practitioners. He also has been active in organized medicine most of his career, as president of the Alabama Chapter of the American Academy of Family Physicians, as a member of the board of directors of Alabama Quality Assurance Foundation, and as a member of the task force on health-care reform. He serves as an alternate delegate of the American Medical Association. Smith was elected to the Board of Censors of the Medical Association of the State of Alabama in 1994. He has served as chair of the Board of Censors, State Board of Medical Examiners, and State Committee of Public Health since 2000.
A large and voluble crowd made up of several decades of medical school alumni filled the Marriott for the Saturday evening reunions.
Hornsby, M.D., Bill Beasley, M.D., Alan Dimick, M.D., Frank Waldo, M.D., and Bob Adams, M.D., for all their help with reunions. Jimmy Chambers and Karl Egerman raised the bar for everyone else—they worked the phones for their 1974 class, and were rewarded with record attendance! The class reunions are a highlight of the Alumni Weekend each year. If you have a reunion coming up in 2005 (if your class ends in a “5” or “0”) and would like to help, please call Elaine Chambless at the Medical Alumni Office at (205) 934-4463.
CONSTANCE S. AND JAMES A. PITTMAN LECTURE
The Pittman lecture featured Bruce R. Korf, M.D., Ph.D., with a presentation titled “Medicine in Transformation: Integration of Genetics into Medical Practice” Bruce R. Korf, M.D., Ph.D. Bruce R. Korf, M.D., Ph.D., received his medical degree from Cornell University Medical College and his doctorate in genetics and cell biology from Rockefeller University. He then completed training in pediatrics, pediatric neurology, and genetics at Children’s Hospital in Boston, Massachusetts. He served as clinical director in the Division of Genetics at Children’s Hospital from 1986 to 1999 and as the medical director of the Harvard-Partners Center for Genetics and Genomics from 1999–2002. Currently he is the Wayne H. and Sara Crews Finley Professor of Genetics and chair of the Department of Genetics at the UASOM. In his previous appointment at Harvard Medical School, he served as codirector of the course Genetics, Developmental and Reproductive Biology, taught
HERE’S TO SIXTY YEARS The class that matriculated in 1943 held a 60-year reunion on December 5-6, 2003. One of their weekend activities was a luncheon at the Medical Alumni Building featuring Kirby Bland, M.D. (’68), chair of the Department of Surgery at the UASOM, as the speaker. Dewey White, M.D., organized the host committee, which included Jack Alexander, M.D., Robert M. Bryan, M.D., John Harris, M.D., William Kessler, M.D., and Wiley Livingston, M.D.
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medical alumni bulletin C L A S S N O T E S
1955 GEORGE ELLIS RUDD received the Delta Chi University of Alabama Jefferson J. Coleman Alumni Award for personal and professional achievement in August 2003. Rudd is retired from family practice and lives in Pinson, Alabama. 1955 and 1960 SARA CREWS FINLEY AND WAYNE HOUSE FINLEY were honored with the Lifetime Achievement Award at the Health Care Heroes Awards Luncheon on Nov. 4, 2003 at The Club in Birmingham. They worked together for more than 35 years as geneticists and established the first medical genetics program in the southeastern United States at the UASOM in 1962. The Finleys’ program was one of the first to be accredited by the American Board of Medical Genetics in the early 1980s. Since retiring, they have continued at UAB as professors emeriti and each serves on numerous advisory boards and committees. Sara also was nominated by representative Spencer Bachus at the American Medical Women’s Association’s (AMWA) Vision and Voice of Women in Medicine banquet. Changing the Face of Medicine: Local Legends, a collaboration between AMWA and the National Library of Medicine, was created in an effort to highlight the contribution of women physicians around the country. Members of Congress were invited to nominate women physicians from their state who have made a significant impact in the field of medicine. 1961 FLEMON CARDEN JOHNSTON JR. became president of the American Academy of Pediatrics (AAP) at the 2003 AAP National Conference and Exhibition in New Orleans on November 3. He has served as the president of the Alabama chapter of the AAP, chair of the AAP’s Annual Chapter Forum Committee, chair of the AAP Section on Pediatric Emergency Medicine, and member of the AAP board of directors. He has also served as president of the Jefferson County Medical Society and the Council of Medical Specialty Societies. Johnston has contributed more than 600 health segments for the television news program Kids M.D., seen on more than 40 stations. He lives in Birmingham and currently practices emergency medicine at Children’s Hospital. 1964 WILLIAM E. DISMUKES has been named Laureate of the Alabama Chapter of the American College of Physicians (ACP). This high honor recognizes senior physicians with “acknowledged excellence and peer approval in the field of internal medicine.” Dismukes received the award in recognition of his exceptional career as a clinical educator and investigator. He has been a fellow of the ACP since 1972, a master of the college since 1996, a governor of the Alabama chapter of the ACP-ASIM from 1999–2003, a member of the Executive Committee of the ACP-ASIM Board of Governors, and a member of the Board of Trustees ACP Foundation. He has been with the UAB faculty for 33 years, is professor of medicine and microbiology and vice chair of the Department of Medicine, and was selected as one of the Top Ten Teachers in that department from 1995 to 2002. He also served as director of the clerkship in medicine from 1972 to 1981 and was director of the Department of Medicine’s residency training program from 1981 to 2002. Dismukes lives in Birmingham and specializes in infectious diseases. dent, and chair of the county Board of Health. Folmar lives in Birmingham and specializes in internal medicine. 1973 THOMAS F. DODSON is currently serving a second year as secretary-treasurer of the Georgia Surgical Society. He was selected to the steering committee of the Eastern Surgical Society in 2003 and selected by his peers to be included in Best Docs in America for 2003-2004. He continues as program director and vice chair for education in the Department of Surgery at Emory University. Dodson lives in Atlanta, Georgia, and specializes in vascular surgery. 1973 ROBERT EDWARD MORRIS was appointed as chief of staff of Callahan Eye Foundation Hospital by the board of directors of The Eye Foundation, Inc. He assumed his duties in April 2003 and is the first chief of staff for the hospital, which joined the UAB Health System in July 1997. Morris is an associate professor in the Department of Ophthalmology, the immediate past president of the CEFH Medical Staff, president of the Helen Keller Foundation for Research and Education, president of the International Society for Ocular Trauma, and a member of the board of directors for the United States Eye Injury Registry. He lives in Birmingham. 1973 EDWARD E. PARTRIDGE has stepped down as the director of the Division of Gynecologic Oncology after 13 years to devote more time to communitybased research and service, particularly ongoing programs for the underserved in cancer care, prevention, and control. He will continue to see patients and continue as vice chair of UAB’s Department of Obstetrics and Gynecology, and associate director for cancer prevention and control in the UAB Comprehensive Cancer Center. He lives in Birmingham and specializes in gynecologic oncology. 1974 GEORGE MARSHALL ADAMS retired March 31, 2004, after 30 years of family practice to enjoy Italy and various avocations and diversions. He lives in Tampa, Florida. 1978 MELINDA G. ROWE accepted the position of commissioner of health for the Lexington-Fayette County Health Department in Lexington, Kentucky, on Nov. 1, 2003. She has served as health director
1970
RICHARD C. DALE has been recognized by the Alabama Quality Assurance Foundation as one of Alabama’s outstanding Medicare providers for patients receiving mammograms. To achieve this recognition, claims data from the Centers for Medicare and Medicaid Services had to suggest that 90 percent or more of the female Medicare patients seen by Dale between July 1999 and June 2001 had at least one mammogram. He is one of only 117 physicians in Alabama to be recognized for this mammography indicator, which is identified by expert panels as a health-care issue critical to the care of female patients. Dale lives in Birmingham and specializes in internal medicine. 1972 PINK L. FOLMAR JR. has been named Laureate of the Alabama Chapter of the American College of Physicians. This high honor recognizes senior physicians with “acknowledged excellence and peer approval in the field of internal medicine.” Folmar received the award in recognition of extensive service to organized medicine in the state. He has practiced internal medicine at the Simon-Williamson Clinic in Birmingham for 27 years. Folmar was president of the 35-physician clinic from 1986–1989 and is a member of Baptist Princeton Medical Center’s teaching faculty, where he currently serves on the Baptist Regional Board of Trustees. He has been a member of the School of Medicine Dean’s Advisory Council, president of the Medical Association of the State of Alabama (MASA), a MASA and Jefferson County Medical Society (JCMS) Board of Censors member, JCMS presi-
26
of the East Health District in Savannah, Georgia, for the past two years and was previously the director of health for the Louisville/Jefferson County Health Department in Louisville, Kentucky, from 1995 to 2001. Rowe specializes in pediatrics and public health. 1979 MICHAEL PAUL PRUITT was recently elected vice president of the Jacksonville Psychiatric Society. He lives in Neptune Beach, Florida, and specializes in psychiatry. 1980 LEIGH FINCHER graduated from the University of Arkansas School of Law, magna cum laude, J.D., in June 2003, and was awarded a health-law scholarship. Her interest is in health-care policy as it affects the doctor-patient relationship. She lives in Fayetteville, Arkansas, and specialized in emergency medicine. 1987 (Resident) 1988 (Fellow) RONALD D. ALVAREZ has succeeded Edward E. Partridge, M.D. (class of 1973), as director of the Division of Gynecologic Oncology in UAB’s Department of Obstetrics and Gynecology. Alvarez lives in Birmingham and specializes in OB/GYN. 1993 RICHARD “CLARK” CROSS was appointed as assistant professor in UAB’s Department of Anesthesiology by Alfred Habeeb Professor and Chair David H. Chestnut (class of 1978). Cross is a diplomate of the National Board of Medical Examiners and the American Board of Anesthesiology. He lives in Birmingham and specializes in anesthesiology. 1993 LETA LOU HERRING was recently appointed as assistant professor in Prime Care by Nancy F. Dunlap, M.D., Ph.D., chief of staff of The Kirklin Clinic and medical director of TKC Primary Care Services and Clinics. Herring is board-certified in internal medicine and advanced cardiac, pediatric, and trauma life support. She is a resident of Birmingham and specializes in internal medicine. 1993 JENNIFER R. ROOT has been South Carolina’s delegate to the American Medical Association Young Physicians Section (AMA-YPS) for the past two years and was elected this past summer to the board of trustees of the South Carolina Medical Association. She recently attended the annual
meeting of the American Society of Anesthesiologists as a delegate from South Carolina. She resides in Columbia, South Carolina, and specializes in anesthesiology. 1995 STEVEN PRESLEY is on the faculty at Baptist Health System in the Internal Medicine and Transitional Year Residency Program. He lives in Birmingham and has a small primary-care practice in addition to his faculty and teaching responsibilities. 1995 (Resident) JEFFREY D. KERBY was appointed as associate professor in UAB’s Department of Surgery in July 2003 by Kirby I. Bland, M.D., professor and chair of the department; and Loring W. Rue III, M.D., professor and chief of the section of Trauma/Burns and Surgical Critical Care. Kerby was appointed chief resident during his residency, completed a research fellowship at UAB, and was awarded a Ph.D. in biochemistry and molecular genetics. A lieutenant colonel in the U.S. Air Force, he provided direct surgical support to U.S. forces during Operation Enduring Freedom, for which he was awarded the Air Force Joint Service Achievement Medal. 1996 LAWRENCE S. “LANCE” PRINCE was recently appointed as assistant professor in UAB’s Department of Pediatrics by Sergio Stagno, M.D., professor and department chair. Prince is a resident of Vestavia Hills, Alabama, and specializes in pediatrics. 1997 RANDALL SCOTT DAVIS was recently appointed as assistant professor of medicine with a secondary appointment in the Division of Hematology and Oncology by Max D. Cooper, M.D., professor and director of Development and Clinical Immunology. Davis was the recipient of the UASOM Walter B. Frommeyer Jr. Fellowship in Investigative Medicine Physician Scientist Award in 2000; he was honored with the J. Claude Bennett Award for Excellence in Research in 2001 and 2002. Also in 2002, he received the UAB Division of Hematology/Oncology Award for Best Research Fellow. He is a resident of Birmingham and specializes in internal medicine. 1998 SARAH MARIE BOYCE was recently appointed as assistant professor in UAB’s Department of Dermatology and director of cosmetic dermatologic surgery by Professor and Chair Craig A. Elmets,
M.D. Boyce graduated cum laude from the UASOM and received the Samuel Clements Little Neurology Award. She was the recipient of a fouryear Missouri Delta Medical Center scholarship, a Russell Medical scholarship, and a Southern Medical Association scholarship. She is a resident of Birmingham and specializes in dermatology. 1999 REBECCA W. MILLER was appointed as assistant professor of medicine by Professor Robert M. Centor, M.D., director of the Division of General Internal Medicine and associate dean for Primary Care. Miller lives in Birmingham and specializes in internal medicine. 1999 DIAMOND VROCHER III was appointed assistant professor of medicine by Thomas Terndrup, M.D., chair of UAB’s Department of Emergency Medicine. Vrocher received the Dean’s Award for Medical Student Excellence in Emergency Medicine, presented by the Society for Academic Emergency Medicine, in 1999. His clinical interests center on acute treatment of stroke and hypertension in emergency patients, and his current research focuses on emergency management of neurovascular emergencies. He lives in Birmingham. 2001/2003 PEILY SOONG AND AMANDA L. DUNCAN were married in May 2003. Amanda (class of 2003) is currently a pediatrics resident at UAB. Peily (class of 2001) will be practicing at Pediatrics East after he completes his pediatric residency training at UAB.
CORRECTION JON D. HOLMES, class of 1997, specializes in oral and maxillofacial surgery.
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Alumni Association News
ALUM BABES
LAURA NORELL, class of 1991, announces the birth of her second daughter, Alice, born Nov. 12, 2003. Alice joins her sister, Eva, who is two-and-a-half years old. Norrell is the medical director of St. Luke’s Women’s Center and department chair of OB/GYN at St. Luke’s Hospital in San Francisco, California. JOHN DAVID WHEELER II, class of 1992, and his wife, Alison, announce the birth of twins Anna Wallace Wheeler and John David Wheeler III on Dec. 9, 2003. John specializes in obstetrics and gynecology in Huntsville, Alabama. JENNIFER R. ROOT, class of 1993, and husband Forest Evans Jr., M.D., announce the birth of their first child, a baby boy; Finley Lloyd Evans was born Jan. 14, 2004. Jennifer specializes in anesthesiology and lives in Columbia, South Carolina. V. SEENU REDDY, class of 1995, and wife Meera announce the birth of their first child, Amelia Katheryn, born Sept. 21, 2003. Reddy recently became board-certified in general surgery and is a senior fellow in the Department of Cardiothoracic Surgery at Emory University. He lives in Decatur, Georgia, and specializes in cardiothoracic surgery. FRANK SCHEFANO III, class of 1998, and his wife, Mary Dell, announce the birth of their daughter, Abby Della Schefano, born Sept. 12, 2003. She joins her sister, Anna Maria Schefano, who is seven. Frank is the director of the Department of Anesthesiology at Arkansas Methodist Medical Center in Paragould, Arkansas. LESLIE HARRIS JR., class of 1999, and wife Katrina announce the birth of their son Nicholas Harris, born Dec. 25, 2003. He joins sister Nyla Harris, born Feb. 26, 2001. Leslie is currently clinical instructor of medicine and director of the Ambulatory Care Clinic at the UAB Montgomery Internal Medicine Residency Program. He lives in Montgomery, Alabama. ANGELA H. REDMOND, class of 1999, and her husband, John, announce the birth of their son Alex Michael Redmond, born Jan. 16, 2004. Angela specializes in pediatrics, and she lives in Cullman, Alabama. JOANNE CHEN MYERS, class of 2000, and her husband, Warren, announce the birth of daughter Hayden Elizabeth Myers, born Jan. 24, 2004. Joanne joined OB/GYN of West Alabama in Tuscaloosa this June. LISA J. RUSCHAK, class of 2000, and her husband, Scott, announce the birth of their son Zachary Joseph Ruschak, born Feb. 17, 2004. Lisa specializes in family practice and lives in Greeley, Colorado. ELIZABETH (BETH) TURNER FALKENBERG, class of 2000, and her husband, Mark, announce the birth of their son, Luke William Falkenberg, born March 16, 2004. Beth lives in Birmingham and specializes in radiation oncology.
IN MEMORIAM
CLYDE DAVIS MCLALLEN, 1943 graduate of the two-year school, died Jan. 5, 2004. A native of Anniston, Alabama, he moved to Birmingham, where he specialized in internal medicine. JAMES MACON BURNETT, class of 1946, died Jan. 7, 2004. He served in the U.S. Army from 1943 until 1946 and in the U.S. Air Force from 1951 to 1952. He lived in Birmingham and had a family practice until his retirement in 1988. LAMAR MCWHORTER CAMPBELL, class of 1955, died Jan. 26, 2004. He was a member of the Jefferson County Medical Society, the Alabama Medical Association, the American Medical Association, and the Birmingham Surgical Society. He was a diplomate of the American Board of Ophthalmology with certification in 1963, a past president of the Birmingham Clinical Club, an instructor at the University of Alabama, and a chief of the Division of Ophthalmology at the Baptist Medical Center. He lived in Ashville, Alabama, and specialized in ophthalmology. WILLIAM SAMUEL MITCHELL, class of 1955, died Feb. 15, 2004. He was a general practitioner for 42 years and lived in Calera, Alabama. CHARLES HAROLD SMITH, class of 1955, died June 28, 2003. He lived in Montgomery, Alabama, and specialized in psychiatry. ANDREW JACKSON GAY JR., class of 1955, died on Jan. 18, 2004. He lived in Belfast, Maine, and specialized in ophthalmology. OLIVER CHARLES MITCHELL, class of 1959, died Oct. 31, 2003. He lived in Houston, Texas, and specialized in neurological surgery. WILLIAM “BILL” LLOYD MITCHELL, class of 1963, died in June 2003. He was a fellow of the American College of Obstetricians and Gynecologists. Mitchell resided and practiced OB/GYN in Enterprise, Alabama, for 35 years. He also was a genealogist, computer programmer, historian, pilot, and accomplished artist. RICHARD DAVIS “DICK” HARP class of 1964, died Dec. 30, 2003, in , Panama City, Florida. A native of Birmingham, he was a member of numerous organizations, including the Medical Association of the State of Alabama, the American Medical Association, the American College of Radiology, and the American Academy of Radiology. He served on the board of trustees for Walker Baptist Medical Center in Jasper, Alabama; as president of the UASOM from 1983–84; and as founder and senior partner of Radiology Associates of North Alabama, P.C. He was a recipient of the Paul Harris Fellow Award from Rotary International for outstanding achievement and community service. He specialized in radiology. JAMES EUGENE THOMAS, class of 1976, died Dec. 15, 2003. Born in Birmingham, Thomas moved to Troy, Alabama, where he opened a medical practice in 1979. He retired in 2002.
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Alumni Association News
Nation’s Pediatricians Select UASOM Alumnus as New Leader
The nation’s pediatricians have chosen a new leader, and he’s one of our own. Carden Johnston, M.D., FAAP, was elected as the vice president of the American Academy of Pediatrics (AAP) at the organization’s annual meeting in June 2002. He took office as the president-elect in October 2002 and recently began serving as president for 2003–2004. The AAP is the nation’s largest pediatric organization, with more than 58,000 primary care pediatricians, pediatric medical specialists, and pediatric surgical specialists. In taking the office of president, Johnston has identified two issues he believes are essential to securing optimal child health and well being. “My first priority is financial access to health care for all grandchildren,” he says. “As a grandparent myself, I know firsthand how important grandchildren are to their grandparents. To that extent, I believe pediatricians and grandparents are natural allies.” With this in mind, Johnston plans to work with the AARP on several child-related health projects. Johnston’s other issue of primary importance as he takes office is obesity prevention in children. Today’s children are heavier than ever—a trend that shows no sign of slowing down any time soon. Johnston says, “By tracking body-mass indexes in children, we have an opportunity for early detection of those who are becoming overweight or obese. Prevention is the cornerstone of pediatric care, and I believe we can advance our advocacy efforts by exporting obesity-prevention strategies into our other prevention activities. This is crucial not only for our children today but also for our adults tomorrow; adult disease, after all, begins in childhood.” Johnston currently practices at Children’s Hospital and has served as past president of the Alabama chapter of the AAP, chair of their Annual Chapter Forum Committee, chair of their Section on Pediatric Emergency Medicine, and a member of the AAP Board of Directors.
WHY BELONG TO THE MEDICAL ALUMNI ASSOCIATION?
By Paul S. Howard, M.D. It was February 1975. I was expecting a letter any day from the UASOM Admissions Committee. Henry Hoffman had assured me that my acceptance was imminent; nonetheless, I was anxious, uncertain, and frankly scared of what the next four years might entail. I had no idea what a doctor-in-training did, nor was I certain that I had made the correct decision in applying to medical school. Yet even with my personal misgivings, the notion of becoming a doctor made my parents so very proud that I knew it was my destiny. The next four years would be the most intense and satisfying of my young life. Not only did we all learn to be doctors, we were also required to make irrevocable decisions regarding future training. These decisions shaped our future and were considered without enough information. I suppose most of us chose well. Regardless, we as a group had achieved greatly. We would then stumble forward into our careers forever known as the “class of 1979.” I still see, talk with, and enjoy the company of many of my medical school classmates. Although we rarely speak of it, we are all proud of our school. Whenever a UAB doctor is quoted in the national press or UAB is touted as an important place, we all suppress a grin and find ourselves walking a little taller. Many of us remember when today’s famous surgeon or internist was a young faculty member or even our junior resident. Whether we will admit it or not, we take collective pride in our medical school, our achievements, and the achievements of all alumni. The ultimate mission of the Alabama Medical Alumni Association is to be a voice for its membership. We remain proud of who we are and where we come from. I like to think of UAB as an institution not of bricks and mortar but one built on the history of its medical alumni. Our collective memories and experiences are the foundation of a great school. Tinsley, Champ, and Garber still reside in the clinics, labs, and operating rooms where we were created. Their legacy must be nurtured and protected for the students and residents of today. We, the medical alumni, are the ones to keep the traditions alive; it should be our charge to be the collective memory of those who preceded us. Our mission is to remind the leaders of today where we have been and on whose shoulders we have all ridden. Is there a better reason to belong to the Medical Alumni Association? I think not.
Alumni, Let Us Hear From You
Please take a few minutes to share with us any personal or professional news for publication in a future issue of the Alabama Medical Alumni Bulletin.
Name ______________________________________________ Today’s date __________ Year graduated ________ Specialty _______________________ Home address ________________________________________________________________________________________________________________ Business address ______________________________________________________________________________________________________________ Phone (H) _____________________ (W) ____________________ E-mail _________________________________________ Fax _________________ Spouse’s name ____________________________________ Children (if recent, include date of birth) __________________________________________ Personal/professional update (List names/dates of recent publications, awards, honors.) ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________
Please return this form to: Elaine Chambless - Director of Alumni Affairs
The University of Alabama Medical Alumni Association - MAB • 811 20th Street South • 1530 3RD AVE S • BIRMINGHAM AL 35294-2140
29
Alumni Profile
Alumni Profile: The Schmitt Family, M.D.s
By Sandra Bearden
medicine. “But a lot of his golfing buddies were doctors, and several took an interest in my future career,” Kim says. “One of them gave me discarded medical journals to read when I was only 12 or 13. I didn’t know what the heck I was looking at, but the gesture was encouraging. Another friend of my dad’s arranged for me to go into an operating room to observe surgery when I was in high school. That was a great experience for me.”
“My parents were great believers in education as a key to preparation for life.”
— Kim Schmitt
Kim’s enthusiasm for medicine caught hold with Adam, the middle child, and Lee, the youngest, both several years younger than she. By the time they were ready to start thinking of careers, she was enrolled at the UASOM. “I think I deliberately tried to influence Adam,” she says. “Why one does this, I don’t know. But I really was enthralled with medicine and thought Adam would be a good doctor. I didn’t try so hard to influence Lee. I thought he had his mind set on law.” He did. “I majored in English and was planning to enter law school,” says Lee Schmitt. “But I used to visit Kim’s Southside apartment when she was in med school, look at her books, and learn about her work. Somewhere along the way, I switched to premed, took the required science courses, and entered the UASOM.” In deciding on a specialty, Lee wanted to “do something that would permit me to work with my hands,” and completed a residency in general surgery at UASOM. Although he still does general surgery, much of his practice in the past year has been in laparoscopic weight-loss surgery. Although she also has a clinical practice, Kim Schmitt became interested in head and neck surgery during her surgical residency, and also does a good deal of nasal and sinus surgery. “It’s delicate surgery, and having small hands helps,” she says. Adam Schmitt, like most emergency-department physicians, keeps a frenetic pace and contributes interesting ED experiences to the conversations at family get-togethers. “But there’s less shop talk than you might think,” Lee comments. While his children chose medicine, Vernon Schmitt may still have an attorney in the family. Lee’s son Payton is still too young to decide, but Kim’s 16-year-old daughter, Alexandra, an honor student at Altamont School, has set her sights on law school.
Kim and Lee Schmitt.
If Kim Schmitt had chosen tap-dancing, would her younger brothers have followed in her footsteps as fledgling Fred Astaires? The world will never know. Kim opted for a medical career, and that influenced brothers Adam and Lee Schmitt to become physicians, too. All three are graduates of the University of Alabama in Tuscaloosa and the UASOM. All three—Kim (’81), Adam (’90), and Lee (’90)—completed residencies at University Hospital. And all three practice medicine in the Birmingham area. There the similarities end. They’re siblings, but not clones. Kim Schmitt, M.D., practices otolaryngology as well as head and neck surgery at Medical Center East. Adam Schmitt, M.D., is an emergency physician at Shelby County Medical Center. And Lee Schmitt, M.D., is a general surgeon at Medical Center East. Although the three all chose medical careers, medicine is a family business only in their generation. As the eldest, Kim led the other two in that direction. “As far back as I can remember, I wanted either to be a doctor or a tap-dancer,” she laughs. “My parents [Vernon Neil Schmitt of Leeds and the late Jean Schmitt] were great believers in education as a key to preparation for life. So the tap-dancing idea didn’t go over very well. “I knew I was going to have a career, even though I was born in 1955, when women didn’t prepare for careers. But my mother was forward-thinking in this regard. And it happened that my pediatrician was Dr. Vera Stewart. So I had a role model, and in my early years I thought all doctors were female.” The Schmitts’ father, who went to college on the GI Bill while his wife worked to help support the family, practiced law, not
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Alumni Profile
Alumni Profile: Tracey Miles, M.D.
By Steve Dupont
Tracey Miles admits there are times she questions her career path. “Sometimes when I’m still working at nine o’clock at night, I think, ‘If I were a radiologist or a pathologist, I’d be home right now,’” she says with a hint of irony. But Miles opted to forgo those more lucrative specialties. Instead she chose family medicine—and the depth of her commitment is in proportion to the needs of her patients.
Since beginning her post-residency work at Tuscaloosa’s Maude Whatley Health Center in 1998, Miles has performed a sort of clinical balancing act, weighing treatment options against economic realities. “I’m very mindful of staying abreast of the latest treatments,” she says. “But usually it’s a matter of what my patients can afford.” And in many cases, that’s not much. Upwards of half her patients lack health insurance, and many live on fixed incomes. A case in point is the victim of two strokes who faced a decision between buying aspirin or food. Needless to say, he chose the latter—and, as a result, increased his risk of suffering another stroke. Having grown up in Fort Mitchell, Alabama, a humble community in its own right, Miles knows firsthand how difficult it can be to escape the cycle of indigence. “Out of all my friends, I was the only one who didn’t get pregnant in high school,” Miles recalls. “And I was the only one to go to college.” It is an achievement she attributes to the strong values reinforced at home. Despite the fact that neither of her parents graduated from high school, they were strong believers in the value of education. However, Miles’ own ambition was likely a prevailing factor as well. After all, when asked when she decided to become a doctor, she says, “I remember it very clearly. I was 11 years old.” Her inspiration? A family pediatrician who treated her numerous times during a year of nagging health problems. After receiving her high school diploma, Miles headed to Macon, Georgia, where she used a full scholarship to study biology at Mercer University. Then it was on to the UASOM, where she began her medical training on another generous scholarship, this one compliments of the National Health Service Corps. There was just one string attached—an obligation to work in an “underserved community” after graduating in 1995. As it turned out, her residency in — Tracey Miles family practice at DCH Regional Medical Center in Tuscaloosa would prepare her especially well for the challenge ahead. Then, as now, she had to combine her medical knowledge with diplomacy and resourcefulness to help patients coping with the effects of diabetes, high blood pressure, heart disease, and stroke. “We’re kind of in the ‘stroke belt’ here,” Miles says; she believes this is the result of cultural and socioeconomic factors, namely poor diet and lack of preventive care. Poor prioritizing is also a factor for many of the patients she sees on a daily basis. “I do have some patients who say they can’t afford care and then pull out their cell phones,” she notes. Clearly, Miles’ role in the clinic goes far beyond medicine. On any given day she’s there for her patients, not only as a doctor but as a social worker, a nutritionist, a financial counselor, and, most important, as a friend. “What keeps me going,” Miles says, “is that I really know I’m making a difference.”
“I’m very mindful of staying abreast of the latest treatments. But usually it’s a matter of what my patients can afford.… What keeps me going is that I really know I’m making a difference.”
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From the Archives: Alabama Healthcare Hall of Fame
By Tim L. Pennycuff
University of Alabama School of Medicine alumni, faculty, and administrators are featured prominently in the recently installed Alabama Healthcare Hall of Fame display on the UAB campus. The display, unveiled last year in University Hospital’s West Pavilion adjacent to the patient-discharge area, is dominated by a mosaic of photographs of the numerous individuals who have been inducted into the Hall of Fame since it was founded in 1997. The organization honors those who have worked in the fields of medicine, dentistry, nursing, optometry, pharmacy, public health, and allied health. Pictures in the display include former UAB presidents Joseph F. Volker, D.D.S., Ph.D.; S. Richardson Hill Jr., M.D.; and Charles A. McCallum Jr., D.M.D., M.D.; and former UASOM faculty members J. Garber Galbraith, M.D.; Tinsley R. Harrison, M.D.; Howard L. Holley, M.D.; John W. Kirklin, M.D.; Roy R. Kracke, M.D.; Champ Lyons, M.D.; and James S. McLester, M.D. Others featured include alumni and faculty from the UASOM’s earlier incarnations—as the Medical College of Alabama—in Mobile, Tuscaloosa, and Birmingham. Also included are photographs of campus landmarks such as the Hillman and Jefferson Hospitals, and scenes of clinical, surgical, and laboratory work at various periods over the past decades. The West Pavilion display could not possibly accommodate photographs of all 76 individuals who have thus far been inducted into the Hall of Fame but the display does include a complete list of each
induction class honored by the organization. UASOM alumni to be so honored include William H. Cooner, M.D.; Sara C. Finley, M.D.; Wayne H. Finley, Ph.D., M.D.; Carl A. Grote Sr., M.D.; Charles A. LeMaistre, M.D.; Ira L. Myers, M.D.; and Martha C. Myers, M.D. Also honored are numerous current and former members of the faculty, including Alston Callahan, M.D.; Jerome Cochran, M.D.; Max D. Cooper, M.D.; Arnold G. Diethelm, M.D.; Seale Harris, M.D.; Basil I. Hirschowitz, M.D.; Sandral Hullett, M.D.; Josiah C. Nott, M.D.; and James A. Pittman Jr., M.D. Additional information, including biographical summaries of all inductees and procedures for nomination, can be found on the organization’s Web site at [www.healthcarehof.org]. Members of the Alabama Healthcare Hall of Fame Committee selected all of the images in the display. Of the almost 60 photographs used, more than 80 percent came from UAB Archives, which has a photographic collection numbering more than 50,000 images. The official archival repository for the University of Alabama at Birmingham, the UAB Archives collects and preserves material about UAB, its schools, departments, and offices, and its faculty, staff, and students. The Archives also include materials that document the history of the health sciences in Alabama and the South, with a considerable amount of historical information about the UASOM, from its founding in Mobile in 1859 until the present.
(Clockwise from top left) John W. Kirklin, M.D.; the Healthcare Hall of Fame display, located in University Hospital’s West Pavilion; Hillman Hospital, circa 1905; Buford Word, M.D., S. Richardson Hill Jr., M.D., and Charles A. McCallum Jr., D.M.D., M.D., with the instruments of J. Marion Sims at their donation to the Reynolds Historical Library, 1965; Jefferson Hospital, circa 1958; James S. McLester, M.D., with Hillman Hospital residents and interns, 1933–1934; (left) Tinsley R. Harrison, M.D.; (right) Roy R. Kracke, M.D.
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UASOM ANNUAL FUND
“While interviewing for residency positions and touring another university’s facilities, a fellow applicant observed from my name tag that I was from UAB. He had visited the campus a few years earlier. ‘UAB … I was very impressed by the facilities they had down there,’ he said. ‘What a great hospital!’ I agreed with him and proceeded to tell him about the new state-of-the-art hospital being built and the newly approved Women and Infants Facility. The student was extremely impressed, as was everyone I met on the interview trail who had contact with UAB or a UASOMtrained physician. “These experiences impacted my decision about where to do my residency. Why leave such a good thing? My classmates have faced a similar scenario. Many of us will be here next year, because the UASOM is the most impressive institution we have seen, and it is only getting better.”
JAMIE WORTHEN
MS-IV Class of 2004 President
Every dollar you give to the University of Alabama School of Medicine Annual Fund helps the school educate the next generation of physicians. Make an investment that will last for generations. Your gift, regardless of the amount, will make a difference. Please take the time now to write a check payable to the School of Medicine Annual Fund and return it in the attached envelope. All gifts are tax-deductible.
For online gifts, go to [www.uab.edu/supportmedicine]. For more information, contact Meredith Murdock at (205) 934-4469.
C O N T I N U I N G M E D I C A L E D U C AT I O N S C H E D U L E
This is a sampling of the dozens of live and online CME courses scheduled for the next several months. For a complete listing, contact the UASOM Division of Continuing Medical Education at (205) 934-2687 or (800) UAB-MIST, or visit their Web site at [www-cme.erep.uab.edu/home.asp].
Live CME Courses
August 2-7, 2004 “24th National Symposium for Healthcare Executives”; sponsored by the Division of Continuing Medical Education and the Center for Health Services Administration; 24.5 CME credits. August 5-8, 2004 “Southeast Trauma Symposium”; sponsored by the Division of Continuing Medical Education and supported by an unrestricted educational grant from Smith & Nephew; 17 CME credits. October 11, 2004 “UAB Emergency Medicine Program”; sponsored by the Division of Continuing Medical Education and the UAB Department of Emergency Medicine; supported by unrestricted educational grants from Aventis, BMS, Elan, GlaxoSmithKline, Guilford, Millenium, Pfizer, and Ortho McNeil; 3 CME credits.
October 17, 2004 “SMDM 26th Annual Meeting: Public Health Decision Making”; sponsored by the Division of Continuing Medical Education and the Society for Medical Decision Making; 22.5 CME credits.
Online CME Courses
“Diabetic Complications in the Elderly”; sponsored by the Division of Continuing Medical Education; 1 CME credit. “Highlights in Hyperlipidemia Treatment”; sponsored by the Division of Continuing Medical Education; 1 CME credit. “Evaluating a Clinical Approach to West Nile Virus”; sponsored by the Division of Continuing Medical Education; 0.25 CME credit.
AlumniBulletin
ALABAMA MEDICAL
University of Alabama Medical Alumni Association MAB • 811 20th Street South 1530 3RD AVE S BIRMINGHAM AL 35294-2140
Non-Profit Org. U.S. Postage PAID Permit No. 1256 Birmingham, AL