Oral History Collection

MAIN ENTRY: Salem, Dr. Robert
DATE OF INTERVIEW: April 30, May 15 & 26, June 15 & 25, July 20, 1998
LOCATION OF INTERVIEW: Lubbock, Texas
INTERVIEWER: Fred Allison
LENGTH OF INTERVIEW: 6 hours, 25 minutes
SCOPE AND CONTENT NOTE: Dr. Salem, a leading Lubbock surgeon and top administrator at Methodist Hospital, reminisces about his upbringing, his father, and his career. He includes an insightful perspective on developments in Lubbock medicine, culminating in the merger of Methodist and St. Mary’s hospitals.
TAPE ONE, SIDE ONE: Background
Raised in Sudan, Texas
Father owned department store
School in Sudan
To Texas Tech University
Studied chemistry and biology
Medical school at Southwestern Medical School in
Dallas, Texas
Obtained medical deferment during Korean War
Served 3 years in the U. S. Air Force
1 year internship at Fitzsimmons Army Hospital in
Denver, Colorado
Air Force Hospital in Paris, France
Specialization in surgery
Surgical residency at Baylor Hospital in Houston
under Dr. Michael DeBakey for four years
Return to Lubbock, Texas (1962)
General surgeon at Methodist Hospital
Private practice
Political activities on behalf of Texas Tech Medical
School
President of Lubbock, Crosby, Garza County
Medical Society (LCGCMS)
Senate and House hearings
Effect of Texas Tech Medical School on Lubbock
medicine
Temporary chair of Surgery Department
Faculty shortage for three years
Dr. Michael DeBakey
Residency with (1958-1962)
Pioneer heart surgeon
Synthetic arterial grafts
Nylon
Leakage problem
Improvements
Open-heart surgery
Characteristics
20 hour days
Demanding
Didn’t leave hospital for 3 months
1998 visit
90 years old, excellent health
Effect
Inspiration
Artificial heart
Greatest contributions to health
Cardiovascular research
International stature
Innovations
Heart transplants
Supply
Mechanical hearts
Early interest in medicine
Boyhood in Sudan, Texas
Interest in science and helping people
Curiosity
Farm background
Sudan (c. 1940-50s)
Dynamic
Labor force, large, little mechanization
Saturday nights
Farm mechanization and Lubbock caused
businesses to go out
Migrant workers
Origins of name, ‘Sudan’
Importance of irrigation for growth
Diminishing water supply
U.S. Air Force (USAF)
General medical officer
Service at Fitzsimmons Army Hospital, Denver,
Colorado
President Eisenhower
Heart attack while serving there
Treating
Security precautions
Paris, France, USAF Hospital (1957-58)
President Eisenhower, medical precautions
Memories of dignitaries
John Foster Dulles
Gen. Curtis LeMay
Travels in Europe
Uncle's gravesite in Belgium
Grateful for freedoms of U. S.
Contact with Eisenhower
Characteristics and impressions
John Foster Dulles
Led church service with him
Curtis LeMay
As characterized in movies
Decision to go to Lubbock
TAPE ONE, SIDE TWO Robert Salem
Decision to go to Lubbock (continued)
Friends’ influence
West Texas culture
Father’s work in Methodist Church
Member of Executive Committee of Northwest
Conference of Methodist Church
Takeover of Memorial Hospital (1954)
Memorial Hospital, background
Methodist Church takeover (again)
Service and mission of helping people
Older doctors’ perspective of takeover
Indebtedness
Dr. J. T. Kreuger (c. 1962)
To Lubbock (1918)
Dr. J. T. Hutchinson, background
Ear, Nose and Throat doctor
Dr. M. C. Overton
Partner with Dr. Hutchinson
Pediatrician
Dr. Krueger (again)
Threatened in World War I because of German
ancestry
Stroke while in operating room
Son, Dr. Tom Krueger at Mayo Clinic
Daughter, Carol married Bobby Layne
Bobby Layne
Characteristics
Salem operated on (1968)
Death from liver disease
Reputation
Lubbock medicine (c. 1962)
Booming city
Methodist Church takeover of Memorial Hospital
(again)
‘Open Staff’ improved medicine
Specialists
Pioneer doctors
Dr. Sam Dunn anecdote
‘Making round of oil wells’
First major vascular procedure in Lubbock
Visionaries
Background on Memorial Hospital (c. 1918)
Set the tone for Lubbock medicine
19th Street hospital attracted good doctors
Geographical coverage
Reputation as medical center
Known around the nation
Medical school
Texas Tech Medical School, origins
Shortage of doctors in West Texas (late 1960s)
Competition with Amarillo and El Paso
Lubbock’s efforts
Combined effort of Texas Tech, community and
LCGCMS
Preston Smith’s role
John Connally’s veto
University of Texas competition for medical school
LCGCMS support (again)
Robert Salem, president
High percentage of doctors supported
Grover Murray, President of Texas Tech, support
Lubbock community support (again)
Competition with Albuquerque, New Mexico
Vascular/cardiac surgery background
Dr. Don Bricker, first open-heart surgery in Lubbock
(1970)
Studied under Dr. DeBakey
Cardiac catheters and angiograms
Dr. Bricker’s move to Lubbock
Dr. Jerry Stirman
1,000 open heart surgeries in 1997
Catherization surgery described
Coronary angioplasty
Laser surgery to dissolve clots
Lubbock pioneers invascular surgery
Robert Salem (again)
Surgery he specializes in
Golden Age of Medicine
Most enjoyable period in 1950s-60s
Little bureaucratic (government and insurance)
interference
TAPE TWO, SIDE ONE: Robert Salem (continued)
Golden Age of Medicine (continued)
Government involvement and managed care
Doctors’ loss of control
New doctors have different attitude
Retrospective on career
Autonomous in first half
Controlled by outside agencies in second half
Standard of care equal
Regulations imposed by insurance
Screening criteria
Preapproval
Shortened hospital stays
Patients stay in motels instead of hospital
Doctor/patient relationships
Less patient care now
Future
State laws that mandate hospital stays
Example of hernia surgery
Laproscopic techniques
Gall bladder surgery
Most important development in general surgery
Positive aspects of managed care
Cost containment
Caused by rising costs
Progressivism of American medicine
Expensive
Private funding
Problems with French medicine
Amputation over rehabilitation
Medicare/Medicaid
Not a factor in commercial costs rise
Indigents never refused care before
Question need for
Agencies that cared for indigents
Emergencies
Effect on doctors’ image
Doctors’ refusal to treat
Medicare/Medicaid patients
Doesn’t pay enough
Paperwork
Irony of situation
TAPE TWO, SIDE TWO: Lubbock as a regional center, background
Lubbock Sanitarium (1918)
Drs. Peebler, Ponton, Overton
Modern
Started influx of doctors and patients
Texas Tech (1923)
Agriculture’s influence
Drs. Overton, Hutchinson, Krueger
Developed Lubbock Memorial Hospital (1953)
Memorial becomes Methodist Hospital (again)
Dr. Krueger (again)
Salem with him when had stroke in operating
room
Methodist Hospital ‘open staff’ (1954)
‘Closed staff’ defined
Specialists
Texas Tech Medical School, 1970 origins (again)
Cooperation of city officials, LCGCMS and Texas
Tech (again)
Robert Salem role
President of LCGCMS (again)
Chief of Staff at Methodist Hospital
Bill Parsley role
Background
Lobbying efforts
Robert Salem his ‘medical informant’
Deals made at 40 Acre Club, Austin, Texas
Meeting with Frank Erwin
Governor Connally’s veto of first bill
University of Texas and Texas Tech competition
Agreement not to oppose each other
Effectiveness
Preston Smith role
Contribution to Lubbock medicine
Satellite campuses
Enrolling first classes
Students from 2-year schools
Salem’s agreement to be Chief of Surgery if town
surgeons will assist
Setting up curriculum
Thompson and Drane Halls at Texas Tech
Administrative offices
Methodist Hospital teaching hospital
Students’ comments on training
On par with intern training
Salem, Chief of Surgery, 3 years
Replaced by Dr. Francis Jackson
Background
Veterans’ Administration
Organizational abilities
Problems recruiting faculty
Nothing to show them
Surgical residency program established (1980)
Under SWAT (Drs. Salem, Tim West, Ted Allen
and Teb Thames)
Methodist Hospital residency program (again)
General surgeons trending toward trauma care
Lubbock medicine, future
Pediatric surgical program
Try not to duplicate services
Cooperation between University Medical Center and
Methodist
LCGCMS support of school in late 1960s
Support decreased with increased competition
Practices not negatively affected
Hospital competition
TAPE THREE, SIDE ONE: Texas Tech Medical School (continued)
Enhanced attraction of Lubbock medicine
Enhanced doctor competence
Quality of Lubbock medicine
SWAT Surgical Associates, background
Fears that school would not survive
Funding threatened
Animosity from Amarillo and El Paso
School opened in record time
Support of city doctors
Not paid
Created their own competition
Service mentality
Increased doctor population in Lubbock
Managed care
Current trend toward primary care and away from
specialists
Creating competition
Robert Salem—concerns
Less in impact in Lubbock
Few large medical groups
Changes in medicine

Medicine (c. 1946)
Few specialists
Effects of World War II
Treating war wounds revealed need for specialists
Growth in specialization
Robert Salem (again)
Attended medical school (1951-1955)
Students headed for specialization
Technology as a factor
Views on Medicare
Opposed then and now by most doctors
Government intrusions
American Medical Association (AMA) opposition
Driving costs up
People demanded more medical care
Doctors could do more and get paid
Health Maintenance Organizations (HMOs) and
PPOs further regulates
Description of regulations
Hernia example
Calling in blood counts
Screening personnel
Registered nurses (RNs) do initial screening
Insurance companies
Rarely override doctors
Little harmful effects in medical care from 3rd parties
Specialists vs. primary care physicians (again)
Less hospital usage
Emphasis on preventative care
Cycles
Medicare/Medicaid (again)
Questions actual need for AMA and doctors
Most indigents previously cared through churches
and other private means
Doctors’ contribution of time
AMA had no suitable options
Not an effective lobby
Political opposition from implementation

TAPE THREE, SIDE TWO: Robert Salem (continued)
Medicare/Medicaid (continued)
Doctors’ refusal to accept patients
Pay too low
Cost of medical training
Caps on fees
Advice for aspiring medical students
Less autonomy, less money
Doctors not content with changes
Doctors searching for alternatives
Rising costs, causes
Medicare (again)
Technology
Doctor/patient relationship
Making rounds—more time in past
Importance of bonding
Perspective on doctor as healer/medicine man
Family relationships
Example of Dr. Clifford Payne
Dr. Arla Shoppa
Childhood injuries
Importance of old time doctors to communities
Early interest in surgery
Dr. Payne
Surgery viewing areas
Dr. L. T. Green in Muleshoe, Texas
Attributes of old time doctors
Changes brought by age of specialization
‘Calling’—Religious connotations
Emotional responsibility
Patient confidence
Present-day doctors’ views
Advice to new doctors
Service oriented
Effected by new regulations
Political efforts
Opposition to President Bill Clinton’s health care
plan
Political views
Comparison to military medicine
Panel that briefed Senator Phil Gramm
Board of American College of General Surgery
Doctors’ interest in politics
Little opposition to Medicare
TAPE FOUR, SIDE ONE: Robert Salem (continued)
Political efforts (continued)
Bill Clinton’s efforts (again)
Government involvement caused less time to
practice medicine
Need to balance business and profits, regulation
and service
Minority doctors
Medical school class
Hispanics
Assisted black student to get in medical school
Women in medicine
Partner in surgical practice
Family practitioners
30-40% in medical school now
10% in his class
Causes for change
Husband and wife doctors
Tendency to get in medical groups
Time for family and leisure
Insurance companies preference for working with
medical groups
Methodist and St. Mary’s groups
Few independent doctors now
Costs
Patients in health care plans
Methodist Hospital’s attempts to forestall HMO entry
into Lubbock
HMO Blue and St. Mary’s medical groups
Questions if groups really needed
Interest in folk medicine and spiritual aspects of
medicine
Chaplain’s role
Spiritual needs of patients
Women doctors
Differences in practicing methods
Women prefer women doctors
Patient relations
Little differences
Nursing care changes
Shortages of nurses
Managed care caused more home bound nurses
International nurses
Home health care
Nurses work for doctors
Number of home health agencies
Nurse practitioners, RNs, LVNs
Making house calls
Caregivers
Doctors’ concerns
Liability
Political action, AMA involvement
TAPE FOUR, SIDE TWO: Robert Salem (again)
First repair of ruptured abdominal aorta aneurism in
Lubbock
Dr. Sam Dunn asked him to do it
Methodist Hospital equipment
Operation lasted 6 hours
Unusual character of surgery
Description
Dacron graft used
Developed by Dr. DeBakey
Patient’s recovery

Normal life span
Gall bladder surgery
15 years later
Article in Texas Medical Association journal
Irony
First time performed by Drs. DeBakey and
Denton Cooley 10 years earlier on Lubbock
man
Dr. Cooley’s talk
"Fly-over-syndrome"
Training, preparation
Common surgery now
Little blood loss
Performed in two hours
Same type grafts used
Description
Dr. DeBakey, pioneer
Invitation to attend
International Surgical Society meeting in
Portugal
Impact on medicine
Surgery on Boris Yeltsin
Lubbock’s medical reputation
Prominence of Methodist Hospital
Influx of specialists
Vascular surgery
Regional medical coverage
American College of Surgeons stopped ‘itinerant
surgery’
Community hospitals
Limitations
CAREFLIGHT
Contribution to medical care
Unprofitability
Providing needed care
Negative effects of managed care
Political efforts
HMOs focus on the ‘bottom line’
Gatekeepers and primary care doctors
Limits on benefits imposed by HMOs

TAPE FIVE, SIDE ONE: Managed care (continued)
Unpopularity among doctors and patients
Lack of choice for patients
Cumbersome
Costs savings
Methodist Hospital’s strategy to deal with changes
Administrator William Poteet
Financial shortfall’s causes
Medicare payments less than expected
Subject to political whim
Hospital raised prices
Government costs underbid
Deceived by expected government payments
Methodist HMO seen by Poteet as way to stop
loss of profits
Aligning with regional hospitals
Cardiac tower too grandiose
Development of Methodist Physician Group
Bought out practices
Excessive outflow of money, diminished cash
reserves
Declining income from lowered government
and insurance payments
Comparable to farm programs
Changing nature of government programs
Merger, St. Mary’s and Methodist Hospitals
Expansion of Methodist and shortage of income
Methodist sought merger
Common ideology: Christianity and philanthropy
Discussions started 2 and a half years ago
Methodist’s dispute with the Internal Revenue
Service (IRS)
Helicopter service
Federal Trade Commission’s evaluation and approval
Signing ceremony, June 10, 1998, only 3 hours
before FTC deadline
Complexity of merger
Relative size of physicians groups
Lawyer involvement
Anti-trust
Medical merger experts
Vision
Consolidation and lower costs
Nature of the original problem for Methodist
10% of profit returned to community
Supportive of Texas Tech Medical School
Residencies
Personal and historical loyalties set aside
Salem’s close ties to Methodist
Gala celebration on June 10, 1998
Salem presents history of Lubbock medicine
5 most significant events
Creation of Lubbock Sanitarium (1918)
Move to 19th Street (1953)
Methodist Church takeover (1954)
TAPE FIVE, SIDE TWO: Merger (continued)
Gala celebration (continued)
Lubbock medical history (continued)
Creation of medical school (1972)
Merger (1998) "Colossal"
Summarization
Importance of unity
Monumental task
Committees (task forces) created to effect transition
Decision on surgery facilities
Impact on rest of hospital
Consolidation
Collecting data
Acute care moved to Methodist
Chronic care to St. Mary’s
Need for remodeling operating rooms
Cost savings
Cancer centers
St. Mary’s Joe Arrington Center
Background on Dr. Joe Arrington
Early Lubbock cardiologist
Dr. Sam King
Heart catherization
Coronary angiograms
Dr. Don Bricker, 1st heart surgery
Methodist’s Hodges Center
All cancer patients to Arrington
Expansion of Arrington
Hodges part of emergency room
Primacy of economics
Closing St. Mary’s emergency room
Savings incurred
Consolidating pediatrics
Other consolidations
Data gathering studies
Name change
Hospitals’ old names removed
Tugging at heart strings
Drs. Krueger, Overton and Hutchinson difficulties in
releasing hospital to Methodist Church
Dr. Krueger’s background
Loss of control and autonomy
Hand picked physicians
Effects on Lubbock medicine
Positives of ‘open staff’
High standards
Theological implications of merger
Addressed by task force
Investigating different religions
Involvement by Rev. Cliff Wright, First
Methodist Church
More similarities than differences
Importance of keeping health care in forefront
Hospital mission
Adjustments for each side
Federal government’s concerns
Monopolistic
Defense: competition included all of Texas
Example of Texas Instruments’ contract with
Baylor Hospital, Houston
New Mexico attempting to restrict insurance to
New Mexico
Covenant is 25th largest health organization in U. S.,
5th west of the Mississippi River
New Mexico laws restricting insurance (again)
TAPE SIX, SIDE ONE: Robert Salem (again)
Role in merger
Co-chief Medical Officer with Dr. James Burrell of
St. Mary’s
President of Methodist Medical Group
Dr. Burrell at St. Mary’s Group
Importance of patient choice
Merger of two physician groups
Groups’ operations
Contracts in-place prevent merger
Reaction of UMC
Strong financial base (tax supported)
Legal status
Faculty staffs hospital
Covenant’s pledge of support to Texas Tech Medical
School
Residencies at Methodist required to keep
school’s accreditation
Background on Methodist’s support of medical
school
First teaching hospital
Dr. George Brewer’s opposition and concern
Bad experience with another hospital
Protective of Methodist
Methodist staff doctors’ opposition
Salem caught in middle
Chief of Surgery Department at medical
school
Chief of Staff at Methodist
Brewer’s suspicion about loyalty
Saw need for medical school
Doctors’ fear of competition developed later
Over supply of doctors never a problem
Brewer, good administrator
Long term as director
Poteet’s responsibility in ‘bad’ decisions
Board of Directors’ responsibility
Consultants
Joe Salem (Robert Salem’s father), background
Born: Lebanon, to U. S. when 7 or 8 years old
School background
Various moves around West Texas
Mother from Spur, Texas
Business in retail and dry goods
Move to Sudan (1930)
Established store in 1940s
Successful businessman and merchant
Robert Salem working at store as a boy
Prosperous even in Depression
Agriculture
Business good in 1940s
Laborers and little mechanization (again)
Robert Salem memories of harvesting cotton
Sudan (c. 1940s-1950s)
Businesses, movies, stores
Effects of farm mechanization (again)
Effects of larger stores in Littlefield and Lubbock
Robert Salem, work ethic instilled by father
Joe Salem (again)
Created Love Overcomes the World (LOTW)
organization
Help to underprivileged children
Games in old store in Sudan
Library
Lay mission trips to other nations
LOTW (again)
Religious services in store
Kids worked first, then played and had Bible
lessons
Policeman in San Antonio who had been in
program
Community effort
United Nations festival every fall
Activities
Attracted attention of the U. N. and Eleanor
Roosevelt
TAPE SIX, SIDE TWO: Joe Salem (continued)
LOTW (continued)
Eleanor Roosevelt (continued)
Acquaintance with Billy Graham (1964)
Correspondence
Lay missionary work (again)
Impact on Robert Salem
Publication of LOTW handbooks
Impact on Robert Salem (again)
Work ethic
Helping people
Pursuit of medicine
Influence on medical scene
Lay leader of Northwest Texas
Conference of Methodist Church
Responsibilities
Takeover of Memorial Hospital
Leader in Boy Scouts and Red Cross
Tried to volunteer for World War II
Views on religion and medicine
Medicine second only to ministry as servant to
people
Hypothesizing about his perspective of merger
Love of Methodist Church
Pragmatism
Religious background
Father was Greek Orthodox
Return to Lebanon for 50th wedding anniversary
Mother, Catholic
Robert Salem (again)
Mother’s background
Maiden name: Harkey
Family original settlers in Spur, Texas
Established Spur Hotel
Father met mother there
Father (again)
Dry good business
Traveled circuit selling goods
Discrimination faced
Diminished over time
Established city park in Sudan
Merger, St. Mary’s and Methodist Hospitals (again)
Cost, efficiency and quality sought
Emotions and passions involved
Methodist to be acute care (again)
St. Mary’s to be chronic care (again)
Not feasible to move all pediatrics to Methodist
HMO Blue does not recognize Methodist
Hospital ‘camps’ and ‘groups’ created
Patients’ loss of choice
Robert Salem (again)
Future will bring changes
Political issue now
Slogan of Covenant emphasis on Christianity
Pushed by St. Mary’s
Carryover
Sisters/nuns administrators
Pastoral staff at Methodist are support only
Direct link with Catholic Church
Methodist Church has no financial links
Dealing with dissimilarities
Keeping health care in forefront
Protestant opposition
Father’s views
TAPE SEVEN, SIDE ONE: Merger (continued)
Covenant organizational structure
Equal representation of both hospitals on boards
Brad Trimble, Chief Executive
Duties
"Thinness" at upper levels
Reductions in staffs before merger
Combination of forced removals and voluntary
Large number of women in executive positions
Methodist Hospital Nursing School
Background
Alleviates shortages
Relationship with Texas Tech School of
Medicine
Prominent women on staff
Sharon Ivory
Dana Rains
Attributes
Potential
Diana McKenney
Director of Nursing
Perspectives on large number of women
executives
Medical school classes
Marcelle Combs
Home Health Division
Ration of men to women
Size of Covenant
Incredible growth of Lubbock medicine
Robert Salem (again)
Perspectives on future of Lubbock Medicine
Areas of concern
Poor regional economy
HMOs
Difficulty in maintaining profitability
Optimism
Dependence on local economy
RANGE DATES: c. 1900-1998
BULK DATES: 1962-1998