Launching University Hospital
By Ellen More, PhD
The initial legislation to establish the University of Massachusetts Medical School in 1962 omitted any mention of a hospital. Many legislators who voted for the bill assumed that an existing municipal hospital in Boston, Worcester, or Springfield would serve the purpose well enough. But the early leaders of UMass Medical School—Dean Lamar Soutter and founding chair of Surgery, H. Brownell ("Brownie") Wheeler—never doubted that their new medical school would include a new teaching hospital. The 1960s, the years during which UMMS was legislated, coincided with the construction of dozens of medical schools, most of which also built academic teaching hospitals. Particularly after Worcester was chosen as the school's location in 1965, the Trustees, too, came to believe in the need for an academic hospital to effectively compete with the existing hospitals in nearby Boston. Just as important, however, the advent of Medicare in 1965 provided general hospitals with an unprecedented infusion of money for services that many patients had previously been unable to afford. As historian Rosemary Stevens has written, hospitals that were built or expanded to meet new patient demand could even recoup the capital expense of borrowing through increased—but reimbursable—charges to patients.1 By 1980, two-thirds of all U.S. state medical schools were affiliated with an academic teaching hospital. Although not all of those were newly built, the sixties and early seventies were overall a period of bullish growth for hospitals. Perhaps Massachusetts could share in the windfall?
Unfortunately, delays and mismanagement of the initial federal grant proposal for hospital construction in 1967 cost the school dearly. By the time the proposal was finally approved in 1969, the Nixon administration drastically curtailed funding for hospitals. UMass was too late. Even worse, inflation had caused a ballooning of construction costs just at the moment when, in the early 1970s, the state of Massachusetts faced an enormous budget shortfall of its own—an unprecedented deficit of close to $700 million.2 To give some idea of the gap between initial expectations and ultimate outlay for the hospital, compare the estimated cost in 1964 of using Worcester City Hospital, $20,360,300, with the estimate of $95,000,000 for construction and financing costs of a new 400-bed building in 1971. With funds from Washington no longer an option and both Governor Francis Sargent and the state legislature dismayed about rising construction costs for the teaching hospital, funding was anything but assured. In the fall of 1971, both the House and Senate approved spending $53 million for the hospital, but Governor Sargent did not approve the bill until March, 1972.3
By the fall of 1974, the state's deficit required severe fiscal restraint among all state departments. University Teaching Hospital, just coming online in 1975, presented a multi-million dollar expense ripe for the cutting. (Despite the fact that its construction was almost complete, it still required another large outlay for equipment and furnishings.) To the people of Central Massachusetts, of course, the prospect of the Hospital looked quite different. Organized labor understood its value in terms of jobs; local business and industry saw a more generalized boon to the regional economy; and local citizens looked to the prospect of being able to stay near home if a serious health problem loomed. The Comprehensive Health Planning Council of Central Massachusetts, Inc., especially chair Robert S. Bowditch and former chair, Robert D. Cope, added their support.4 Labor leaders James F. Loughlin, Dan Murray and others did likewise. Local politicians such as John J. Conte, Daniel J. Foley, James A. Kelley, Jr., and Joseph Early, vice chair of the Massachusetts House Ways and Means Committee, provided the linkage among these various groups and lobbied for the necessary votes on Beacon Hill. The local papers followed the story with passionate headlines: "Officials Predict 'Disaster' if UMass Hospital Stalled;" "Early Says State Stifles Medical School Growth;" and "End Delay on UMass Hospital."
The budget battle dragged on, despite a change of administration when Michael Dukakis succeeded Governor Sargent in 1975. To Governor Dukakis and his newly appointed Secretary of Educational Affairs, Paul Parks, the hospital represented all that they disliked about the new UMass Medical School-unnecessary expense in service to a mistaken idea, namely, to create an elitist medical research institution educating medical specialists at the expense of primary care practitioners. Each side understood that the school itself would stand or fall with the fate of its proposed teaching hospital. On the Governor's side, Paul Parks publicly stated a preference for using the hospital as an HMO with prepaid medical contracts for inpatient and outpatient care, rather than as a tertiary care hospital. He thought "we ought to ... develop something in between a tertiary care hospital and a community hospital or community medical center. We could develop a new model, something that has not been done anywhere else in the country."5 From another corner of the field, potentially competing institutions such as Boston University, led by new president John Silber, also voiced strong doubts about the wisdom of the state supporting yet another academic health science center. After all, Silber claimed, the state could subsidize all the medical students it might need-and at much less cost-at private schools like BU. (Such claims blatantly contradicted the admissions trends at the three Boston medical schools, all of which had decreased the percentage of in-state students admitted over the past decade.) Silber's contribution to the debate garnered little support, especially since the state was legally forbidden to fund private education.
The Governor himself was less inflammatory. During meetings of the UMass Board of Trustees, he stressed his concern to see primary, not tertiary, care as the medical school's chief mission. Why did we need a tertiary care hospital? UMass President Robert Wood, echoing the argument of the UMMS faculty, insisted that "for any doctor to be capable of providing comprehensive care, he must be well-trained in the total spectrum of medicine. This kind of training ... can only be learned in a university hospital center."6 Dr. Wheeler, as the Hospital's Chief of Staff, wrote a blistering letter to the Boston Globe bluntly explaining that, "If the medical school and its teaching hospital are allowed to become a political football that can be kicked about by any new cabinet secretary, they will soon become substandard institutions for both education and patient care."7
The budget battle came to a head during the summer and fall of 1975 over restoring $5.5 million to the state supplemental budget to complete the construction and equipping of the hospital. It played out primarily in two venues, on Beacon Hill and in meetings of the University Board of Trustees. Some idea of the activity of Worcester's legislative delegation can be gained from the following news clipping:
State senators from the Worcester area rallied to the defense of the proposed teaching hospital at the University of Massachusetts Medical School in Worcester yesterday. Sens. James A. Kelley, Jr., D-Oxford, chairman of the Senate Ways and Means Committee, Daniel J. Foley, D-Worcester, and John J. Conte, D-Worcester, issued a statement saying they were 'confident that the Massachusetts Legislature will find the bulk of the budget for the medical school ... Secretary Parks does not see fit to insert it as a supplementary request, we in the Senate will insert it,' they said.8
In addition, pressures were applied by organized labor, especially in the person James T. (Jimmy) Loughlin, Secretary-Treasurer of the Massachusetts Labor Council of the AFL-CIO, and a Worcester native. Loughlin had been one of the first public figures to support Worcester as the medical school site in 1965. His presence at the school's groundbreaking, holding a shovel, testifies to his influence. Now, a decade later, Loughlin was no less an advocate for the hospital. In a crucial meeting with the Governor, school leaders, and the Board Chair, Joseph Healey, Loughlin minced no words. If the Governor wanted Labor in his corner, he should understand how much Labor cared about UMass Hospital. Loughlin told a Worcester Telegram reporter that "he met with Dukakis yesterday and Dukakis agreed to come with him and Parks to meet with [City Manager] McGrath and officials of the school."9
Still, compromise was elusive. The Governor's objections to funding University Hospital were more than fiscal. Dean Soutter always insisted that UMMS would not limit itself to primary care education, but instead provide opportunities for all potential medical careers. This did not satisfy Governor Dukakis nor, in fact, a number of liberal Democrats in the statehouse. One essential compromise, therefore, required the school's senior faculty and administration to hammer out a new "Statement of Goals" that explicitly emphasized primary care education. Easing the development of the document, ironically, was the much-lamented early retirement of Dr. Soutter from UMMS for reasons of health in February, 1975. Tensions between the Dean and UMass President Robert Wood had likely impeded such recalibration of the school's stated goals. Now, with prodding from the Governor's office as well as the Board, acting dean Bill Butcher shepherded the revised statement through the faculty. The Governor was impressed, as were many legislators. From the fall of 1975 one can date the beginning of the school's overt identification with primary care education.
Governor Dukakis and others in the statehouse held out for additional concessions. In private meetings with Dr. Roger Bulger, the Board's candidate to become the new medical school Chancellor/Dean, Dukakis, acting dean Butcher, and Bulger agreed that the school should take on a greater role in providing medical and psychiatric care for clients under the authority of the Departments of Mental Health, Public Health and Corrections.10
This was not enough, however. The final component of compromise, and surely the most important in the short run, was budgetary. Against a background of severe austerity throughout state institutions in Massachusetts, including a freeze on hiring and salaries, the Trustees and school officials agreed to reduce the budget request for the hospital from $7.8 to $5.5 million. They further agreed to the insertion of a ceiling of $3.5 million on University Hospital's deficit for fiscal year 1976 (ending June 30, 1976) and the creation of a legislative oversight committee for the first half of 1976. With these controls in place, and a general sense of the momentum behind the hospital, the Legislature passed a funding bill on November 8; the Governor signed it into law on November 10, 1975. The Ambulatory wing opened in December, while the inpatient facility accepted its first patients on January 18, 1976.11
Launching the Hospital
Thus, after a year of delays, the Hospital did open in 1976. Dr. Arthur Pappas, chair of Orthopedic Surgery, admitted the first two patients. Pappas, a native of nearby Auburn, Massachusetts was an orthopedic surgeon best known for his expertise in treating sports injuries. (One of UMMC's early Public Affairs directors, Carole Cohen, recalled the many occasions when her office was strictly forbidden to acknowledge the presence of Red Sox players temporarily in residence under Dr. Pappas's care—no matter how large the local headlines announcing their presence.) Susan Fitzpatrick, who helped care for those first two patients, was the first RN hired and, like Dr. Pappas, remained a part of UMMC for many years. The two patients, a ten-year-old girl from Dudley and a three-year-old boy from Worcester, must have felt the full weight of the hospital's enormity—as a 400 bed hospital with only a few dozen doctors, nurses, and technicians on duty, they may have felt both privileged and amazed at their situation. Both did well and at least one sent grateful notes and Christmas cards for many years afterward. That first week, most patients (there weren't many) were admitted either by Dr. Pappas or by the Chief of Plastic Surgery, Dr. Wallace Chang. The Emergency Room, under acting director, Dr. Wayne Silva, opened the same day with Dr. Alvin Blaustein admitting the ER's first patient.12
The plans for the Hospital's first year called for opening beds on a gradual, need-determined basis. But, indisputably, the growing numbers of medical students at UMMS required a broad range of clinical services—and patients—to address their educational needs in the near future. Whereas in 1973 only 16 students required clinical rotation, by 1975, 48 were doing clinical rounds, followed by 104 in 1977. Once the school reached its maximum enrollment, approximately 200 third and fourth year students would need clinical training at University or other hospitals in the region. Thus, the Hospital's growth pattern attempted to balance educational need, patient demand, and strategies to further increase patient demand. As the "Maintenance Budget Request" for the Hospital's first year of service noted, "The growth of the Medical Departments will be influenced by the rapidity with which the physicians [and surgeons] build firm referral patterns and the academic emphasis on a particular medical specialty." The pattern of nurse staffing would, of course, have to follow the patterns established by the medical services. Overall, the total staff projected for the Hospital's first year numbered 175.13
Initially, besides the Nursing, Laboratory, Housekeeping, and Food Services, the hospital's clinical departments included Ambulatory Medicine, Anesthesiology, Cardiology, Medicine, Obstetrics-Gynecology, Pathology, Pediatrics, Psychiatry, Radiology, and Surgery. Within a year, their number and complexity grew enough to require a full organizational chart of departmental divisions and new departments, including Family and Community Medicine, Laboratory Medicine, Nuclear Medicine, Orthopedics, Physical Medicine and Rehabilitation, and Ophthalmology.14
Staff and Program Development
Recruiting for department chairs began with the basic sciences and Community Medicine as early as 1969, in anticipation of the first class in 1970. But the clinical departments were a bigger challenge, given the continuing uncertainty over funding for the hospital. Dean Soutter had played the major role in the earliest recruiting, with significant assistance from John Stockwell, the man he recruited from Children's Hospital of Minneapolis to be the first Hospital Director, and from Dr. Brownie Wheeler, a young professor of Surgery at Harvard who was also the Surgical Chief at the Veteran's Hospital in Roxbury, Massachusetts. Dr. Wheeler, who had impressed Soutter with a combination of fairness, toughness, and compassion, was hired as a paid consultant in the fall of 1966 and became the Chief of Surgery at St. Vincent's from 1971 until the University Hospital opened. At that point he became the Chair of Surgery, later taking on various additional roles such as Hospital Chief of Staff, and Hospital Director after Stockwell's departure. Through a long and distinguished career here, he well deserves to be called "the patriarch of the place," as one of his fellow chairs referred to him.
Harvard was the source for many of the early Clinical Chairs, such as Surgery (Brownie Wheeler), Cardiology (James Dalen), and Orthopedics (Arthur Pappas). Roger Hickler, Chair of Medicine, came from BU, but had spent his previous career in the Harvard system. In keeping with the philosophy of Soutter and Wheeler, they all understood the short and long-term value of building up a patient base before embarking on major research initiatives. As James Dalen, Chair of Cardiology emphasized, "You've got to have a base ... if you don't have [patients], you have nothing." More important, in Dr. Dalen's words, "the first priority, of course, is teaching, and that's why we're here. In order to have teaching, you ought to have patients."15
Worcester at that time, despite having three large community hospitals, three smaller hospitals, and one state psychiatric hospital, did not have the kind of advanced cardiac surgery—coronary artery bypass surgery, for example—then becoming available in most cities of its size. Such surgeries, besides extending lives considerably, also brought in sizeable reimbursements to the hospitals that performed them. Nor did it overtly challenge Dean Soutter's longstanding claim that UMass Hospital would be a referral center and thus, no direct competition to existing Worcester hospitals. Soutter, a thoracic surgeon himself, no doubt with the strong encouragement of Brownie Wheeler and John Stockwell, decided very early in the hospital's planning phase to make cardiac surgery and cardiovascular medicine centerpieces of the Hospital's offerings. The presence of a space for a heliport on blueprints from 1968 attest to the Dean's advanced planning for a Trauma Center, too. While the creation of a Life Flight service only received approval in 1982, cardiac care was the focus of some of the earliest efforts at patient recruiting.16 As Dr. Dalen recalled, he and his early faculty recruits (all from his own service at Peter Bent Brigham Hospital), arrived about six months before the hospital opened.
I had four cardiologists just sitting on their thumbs, planning things. And just about that time the CPR became an important thing ... And so we trained doctors in CPR all over the state, all over the western and central part of the state. We'd actually – we went to almost every hospital in ... western and central Mass[achusetts] that would have us, and put on programs in ... cardiac resuscitation. And that's how we got to know all the doctors.17
For the first few years of the Hospital's operations, therefore, Cardiology and Orthopedics, which became a separate department within a year or two, dominated the inpatient census.18
By the end of its second fiscal year, the Hospital submitted a Five-Year Plan, as required by law, to the state and local health planning agencies. The Plan reported that 121 beds were currently available for use out of 403 projected to be in use by 1981. As Chancellor/Dean Roger Bulger wrote to UMass acting president Franklin Patterson, the plan included nine new initiatives projected for the coming five years. These included the establishment of
- a comprehensive regional cancer management program
- the opening of an inpatient palliative care service
- the opening of a 25-bed inpatient psychiatric service
- the planning of a gerontology Program
- the development of an 8-10 bed clinical research center
- further growth of cardiac care programs
- development of a regional Maternal and Child Institute in conjunction with Memorial Hospital
- further development of tertiary care referral services which are not currently available in Worcester (Neurology, Ophthalmology, Surgery)
- the planning of a rehabilitation medicine program.19
Within ten years, its inpatient census had reached 11,000, nearly tripling since 1978; ambulatory visits reached 190,700, compared to 57,200 in 1978.20 Many challenges lay just over the horizon. But, the Hospital had been launched.
- Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century (NY: Basic Books, 1989), pp. 294-296.
- Board of Trustees, "Minutes," Sept. 11, 1975, p. 5.
- Anthony J. J. Rourke, June, "UMass University Hospital Cost Study," June 1, 1964, p. 13; Ray E. Heiney, Jr., "University of Massachusetts Teaching Hospital Study of Projected Operating Costs and Income including Analysis of Capital Cost Recovery," May 1971, p. 13. The federal hospital construction grant submitted in 1968, incidentally, estimated the total cost of constructing and equipping the hospital at $38, 833,341, absent finance charges. Cf. "University of Massachusetts Medical School Teaching Hospital, Application for a Joint Construction Grant, June 14, 1968. Cf. Steven J. Wallach, "Work at UMass Hospital, 3 Other Facilities, OK'd," Evening Telegram, March 3, 1972.
- Jon A. Towne, "Health Planner Raps Park's Hospital Plan," Worcester Telegram, Aug. 4, 1974, p. 9.
- Board of Trustees, "Minutes," August 6, 1975, p. 3; Loretta McLaughlin, "UMass Medical School at Crossroads," Sunday Herald Advertiser, May 25, 1975.
- McLaughlin, "UMass Medical School at Crossroads."
- Wheeler's remarks were quoted from a letter "being prepared for Globe editors," according to Jon A. Towne, "Officials Predict 'Disaster' If UMass Hospital Stalled," Aug. 1, 1975, Worcester Telegram, Margaret Cope Collection, UM/W.
- Edward T. McHugh, "Senators Urge Funding of Med School Hospital," Worcester Telegram, August 8, 1975.
- Edward T. McHugh, "Senators Urge Funding."
- Robert C. Wood to Lamar Soutter, Feb. 18, 1975; Reginald W. ("Bill") Butcher to Robert C. Wood, Sept. 16, 1975; R.W. Butcher to Robert C. Wood, Nov. 25, 1975; Robert C. Wood, "Memorandum," Dec. 2, 1975; Michael Dukakis, Oral History Interview transcript, Ellen More, interviewer, Boston, MA, Aug. 21, 2013; Roger Bulger, Oral History Interview (by telephone) transcript, Ellen More, interviewer, April 20, 2010.
- Edward T. McHugh, "Compromise May Remove UMass Hospital Roadblock," Worcester Telegram, Aug. 27, 1975; "Acts and Resolves," Chap. 684, Item No. 7411-1005, Nov. 8, 1975, p. 780-781; Board of Trustees, "Minutes," August 6, 1975, p. 4.
- UMass Hospital Notes, 1976, 1:1; Carole Cohen, Oral History interview, Ellen More, interviewer, Worcester, MA, Sept. 16, 2010.
- Doc. T75-40, "University of Massachusetts Teaching Hospital Maintenance Budget Request, Fiscal Year 1976," pp. 2, 23, 24.
- Doc. T78-99, "University of Massachusetts Hospital One and Five-Year Plan, FY 1978-1982," p. 9.
- James Dalen, Oral History telephone interview, "Transcript," Ellen More, interviewer, Worcester, MA, May 6, 2009, pp. 3, 8, 18. For Dr. Hickler, see Mary Anne Magiera, "Medical School Accepts 24, 8 More than Its First Class," Worcester Telegram, April 27, 1971. Although Hickler was on the faculty at BU School of Medicine immediately before coming to UMMS, he had spent the previous 20 years affiliated with Harvard.
- Board of Trustees, "Minutes," Aug. 11, 1982.
- Dalen, Oral History interview "Transcript," p. 9. Cf. "In 1975, there were 1,420 open heart surgical procedures and 828 by-pass procedures performed in Massachusetts. All but 2 of those procedures were performed in Boston," from Doc. T78-099 "One and Five-Year Hospital Plan for University Hospital, FY 1978-1982."
- Dalen, Oral History interview "Transcript," p. 4.
- "Memorandum: The 5-year plan for University Hospital," Roger J. Bulger to Franklin Patterson, May 8, 1978, pp. 1-2.
- "University of Massachusetts Medical Center Annual Report," 1983, p. 25, fol. "Annual Reports, 1982-1984"; "University of Massachusetts Medical Center Annual Report," 1986, p. 23, fol. "Annual Reports, 1985-1990," both in Box 1, Publications Collection, UM/W.