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Modern Medicine in New Mexico: The State Medical Society from 1949 to 2009

Modern Medicine in New Mexico: The State Medical Society from 1949 to 2009

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Modern Medicine in New Mexico: The State Medical Society from 1949 to 2009

Lunghezza:
675 pagine
7 ore
Pubblicato:
Jul 16, 2011
ISBN:
9781450764964
Formato:
Libro

Descrizione

Sixty years ago, modern medicine finally made its way to New Mexico. As World War II wound down, the state was a quaint backwater filled with aging quacks, Grade C medical graduates, and a vest-pocket professional organization. A group of young-gun doctors and an ex-Marine from Oklahoma changed all that. The state boomed with postwar specialists and patients seeking the sun, and the New Mexico Medical Society (NMMS) quarterbacked the sea changes in state health care. At any number of tipping points--physician shortages, malpractice nightmares, and the crisis of managed care--the state Society played a pivotal role.

Based upon archival research and extended interviews with more than fifty past presidents of the NMMS, this volume issued in 2010 describes how the New Mexico Chapter of the American Academy of Family Physicians became a national leader on medical-legal matters, clinical prevention, and continuing education. Rich with anecdotal detail, this work uses the careers of physician-leaders as a prism to present the evolution of state medicine from World War II into the new millennium.

Pubblicato:
Jul 16, 2011
ISBN:
9781450764964
Formato:
Libro

Informazioni sull'autore

Author Michael Joe Dupont is a former newspaper reporter who now writes award-winning, book-length nonfiction.

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Modern Medicine in New Mexico - Michael Joe Dupont

www.nmms.org

Introduction

Sixty years ago, modern medicine finally made its way to New Mexico. Until the state society hired an ex-Marine out of Oklahoma, the Land of Enchantment was a quaint backwater filled with aging quacks and Grade-C medical graduates, and its professional organization existed only in the vest-pocket of whichever physician was supervising the social hour. When a group of young-gun doctors—Artesia’s Pardue Bunch, Roswell’s Earl Malone and Leland Evans of Las Cruces—roped Ralph Marshall into migrating West in 1949, the New Mexico Medical Society (NMMS) became the last AMA chapter to set up an office and hire an executive director. Its first home was the second bedroom of the modest Marshall manse, and when Valmora’s Carl Gellenthien destroyed a dining-room chair at the initial Council caucus, the organization was off and running. The evolution was immediate. New Mexico boomed with post-war specialists and patients seeking the sun, and the NMMS quarterbacked the changes in healthcare with centralized committees, quarterly meetings, and statewide communication. Fear of governmental intervention fueled the chapter during the Fifties, but it was also a Generation of Joiners. Practitioners who were serious about their profession paid dues to the organization that represented them, and its gatherings were a place for isolated providers to take a break from their practices and seek companionship with colleagues. Leaders like Espanola’s Sam Ziegler, Santa Fe’s Robert Derbyshire, and Allan Haynes Sr. in Clovis grew the chapter and guided advances in healthcare delivery. They set the stage for the next six decades of medicine in New Mexico.

This Anniversary volume celebrates their stories, and all the episodes that followed. Extensive interviews with 36 living NMMS past presidents form the foundation for this work, along with oral-history transcripts for another 16 former leaders contained in the Health Historical Collection at UNM. Combined with research into NMMS proceedings and newsletters, and additional transcripts and interviews with those connected to the chapter (including executive directors Ralph and Randy Marshall), those resources allow a detailed rendering of the remarkable trajectory of the state society. While hundreds of New Mexico doctors have contributed to the success of the Society as Councilors and committee chairs, this tale is primarily told through the career experiences of the chapter’s presidents, as they describe the development of New Mexico medicine and the milestones achieved by this medical organization. Those presidents are the prism—how they chose medicine, came to New Mexico, built a practice and became NMMS leaders—through which this sketch of contemporary healthcare is crafted.

At any number of tipping points in New Mexico medicine, the state medical society played a pivotal role. When the state searched for solutions to its first physician shortage at the start of the Sixties, the NMMS was crucial to the creation of the UNM Medical School. Society members from around the Land of Enchantment lobbied the Legislature in support of the school, and then followed up on that foundation by training the next generation of New Mexico providers as field faculty and community preceptors. When medicine almost left New Mexico altogether in the mid-Seventies, it was the NMMS that cobbled together a uniquely creative remedy. The Traveler’s Insurance Company rocketed it rates by 74 percent in 1975, and then announced they were abandoning the state completely. When the medical society looked for another liability insurer, they found no company willing to come. Panic coursed through the physician community, as doctors considered going bare or going away, and many members applied for medical licenses in neighboring states. Santa Fe’s Harry Ellis and Albuquerque’s Bud Hodgin headed an NMMS task force that brought together legislators, lawyers and physicians to save the state’s healthcare. In a single year, that collaboration created a doctor-run insurance company and a Medical Malpractice Act that set limits on liability awards. That resolution was a revelation to the rest of the country. Seventeen different AMA chapters came to New Mexico to survey our set-up, and then began bed-pan Mutuals of their own. In the Eighties and Nineties, when Albuquerque’s over-saturated managed-care market suffocated physicians with redundant requirements, and starved them with late payments, the NMMS calmed the crisis with Common Credentialing and a Prompt Pay Law. And when another physician exodus started in the new Millennium, the medical society trekked to Santa Fe for tax relief on gross receipts, and rate hikes for Medicaid reimbursements.

Among the smallest chapters in the AMA, the New Mexico component has always been a national innovator. A decade before the Malpractice Act, the Little Chapter That Could pioneered a Medical-Legal Panel that considered potential tort claims long before they reached a courtroom. The joint committee of doctors and lawyers was so productive in resolving possible liability problems that it was soon copied in other parts of the country. New Mexico was also the first state to legally require continuing medical education (CME) as a condition for licensure. The 1971 statute was suggested by NMMS leaders like Santa Fe’s Derbyshire (educational credits earned here were often known as Derby Points) to improve the quality of patient care. Within five years, the regulation was replicated in 17 other states, and is now a national staple. The Peer Review mechanism that the state society assembled to meet the mandates of Medicare and Medicaid was so impressive that Social Security officials and the Senate Finance Committee traveled here in the late Seventies to inspect its operation. When the needs of New Mexico changed, so did the chapter’s focus. The NMMS participated in Public-Health projects, sponsoring Clean Indoor Air legislation, working on domestic violence and smoking cessation, and its collaboration with the NM Department of Health on the Clinical Prevention Initiative raised New Mexico’s childhood immunization rates from 49th in the nation in 2003 to 15th by 2005. One tradition that never caught on nationally, but never changed locally, was the state society’s annual tour of its county components. No other AMA chapter scheduled a similar circuit, but the yearly campaign by the current or incoming NMMS president was a custom that Ralph Marshall started in 1950, and it never stopped. Some leaders called it the Traveling Circus, and others complained they couldn’t consume one more enchilada, but it was a chance for county societies to ask pointed questions, air their particular concerns and create a sense of inclusion.

At its root, the state society is a fraternity of physicians, but it’s the kind of brotherhood where siblings sometimes scuffle. Urban doesn’t always get along with Rural, North doesn’t fully see eye-to-eye with South, and that competition has occasionally been characterized as Peripheral Paranoia vs. Central Sloth. Yet that’s only natural for such a strong set of personalities and colorful cast of characters. A colleague once threatened to kill Roswell surgeon Emmit Jennings, and later as a legislator he authored a bill to give graffiti offenders five swats on the butt with a bamboo cane. Raise Cane in Roswell!, was his slogan. Deming generalist Bill Hossley had ten kids, and sometimes he’d be miles down the road after a highway rest-stop before he realized he’d picked up an 11th. UNM professor Warren Heffron was hailed as a Man of the Jungle after delivering 15 babies during a single day in the wilds of Puerto Rico, and then he came home to found a family-practice department. Albuquerque neurologist Don Seelinger sometimes slept overnight in the insane asylum at Las Vegas, listening to the shrieks and howls as he slowly built his late Sixties practice. Santa Fe ophthalmologist Walter Levy’s training at London’s Royal College of Surgeons still didn’t fully prep him for artist Georgia O’Keefe’s regal reluctance to keep her appointments. Roswell anesthesiologist JoAnn Levitt was the first female leader of the NMMS in 75 years, and she liked to label herself, The Meanest White Woman West of the Mississippi. Albuquerque obstetrician Steve Komadina spent his 4th year of med school having Christmas dinner in the Himalayas with Sir Edmund Hillary, then returned to prospect a West Side practice. Taos internist Michael Kaufman fell hard for the film Easy Rider while training in San Francisco during the "Summer of Love, and it inspired a move to northern New Mexico where he bridged the generations by taking care of Kit Carson’s kin. Every one of those singular individuals was a state-society president.

Schmalzy as it sounds, the New Mexico Medical Society is ultimately a family, and that’s far more than a tired euphemism. There’s the intimate integrity of the doctor-patient relationship, which the organization has long lobbied to uphold. And there’s the dysfunctional fighting of colleagues who are sometimes too close. But, at the last, there’s a powerful lineal component, as well. Ralph and Randy Marshall, father and son, have been the only two executive directors in this chapter’s existence. For six decades, the NMMS has derived significant benefit from the day-to-day consistency, massive institutional memory, and important professional relationships those men have maintained. But, wait, there’s more. Four father-and-son teams have led the medical society in the modern era. We’ve had Allan Haynes Sr. from Clovis, and his sons Stephen and Allan Jr.; Bob Beaudette from Raton, and his son Peter; and Pardue Bunch from Artesia, and his son George. Those second-generation presidents pooled their pocketbooks to keep alive an annual NMMS Community Service Award in honor of the historical linkage their leadership represents. And it’s not likely to end there. Professional legacies like the Kaufmans and Friedmans, Heffrons and Tryons, and Ponds and Legants offer a connection to the past and bridge to the future. New issues will emerge, and old ones will linger, but the modern age of New Mexico medicine will move forward nonetheless.

— Michael Joe Dupont, May 7, 2010

SECTION ONE

Finding Our Feet in the Fifties

Medicine in New Mexico was a fractious mess. As World War II wound down, doctors were scarce, devastating disease ruled the state’s rural districts, and if you were fortunate enough to find a physician, he was often otherwise engaged—either brawling with a brother doctor or dealing with some demon of his own. The fight against the Axis powers had drained the pool of New Mexico doctors almost completely dry. Some estimates indicated that the state tripled its assigned quota of Armed Services physicians—after every doctor in New Mexico under the age of 42 received a telegram the day following Pearl Harbor ordering them to enlist immediately or be brought in as a buck private—leaving behind only the infirm, the ill-favored and the extremely aged. New Mexico’s physician population was notoriously unhealthy to begin with, and the military conscription of its hale and heartiest didn’t help matters. Many of the state’s healers originally headed here hoping the high altitude and arid climate might cure their own afflictions. Men who would later lead New Mexico medicine in the 1950’s and 1960’s—Santa Fe’s Robert Derbyshire, Artesia’s Pardue Bunch, Albuquerque’s Stuart Adler and Bill Badger from Hobbs—first made their way West to tackle the tuberculosis or severe asthma that ailed them.

Dr. James Sedgwick

The war-related depletion of New Mexico’s medical stock left the profession in the incapable hands of an older generation of colorful characters and dangerous quacks who had graduated from the diploma mills, night schools and Grade C medical institutions of the late 19th century. When surgeon James Sedgwick came to Las Cruces in 1938, he didn’t think he’d discovered the Land of Enchantment. He worried instead that he had somehow wandered into the Land of the Lost. I’ve always said New Mexico was a refuge for guys who couldn’t make a living anywhere else, Sedgwick told UNM’s History of Medicine Project in 1983. I wound up going to a town that didn’t even have a hospital. It was pretty primitive as far as medicine was concerned. Sedgwick wasn’t alone in his shock. Other freshly-minted physicians later recalled healthcare horror stories they witnessed prior to leaving for the military or shortly after returning. Roswell’s Earl Malone rescued two people from an older generalist who was convinced that bronchitis should be treated with arsenic IV’s and poisoned patients to the brink of death. There was also a senior surgeon who used his x-ray machine to sterilize women with irregular periods. The x-ray was not well calibrated and the dimensions of exposure to these people was almost unknown, Malone told UNM’s History of Medicine Project in 1984.

Emmit Jennings hung his shingle in his hometown of Tucumcari before entering the Army, and encountered a practitioner who addressed abdominal pain by injecting barium through the patient’s ruptured appendix. It looked like somebody had thrown barium at his belly, Jennings told the UNM History of Medicine Project in 1991. The patient didn’t do well, of course, because barium doesn’t treat you well as a foreign body. Then there was the elderly radiologist who had a magical way with a patient’s chart. He was a master at getting anything you wanted on a report to just sort of appear, Jennings remembered. He hedged a lot. One day a colleague passed by that doctor’s office, and saw him sitting side-by-side with a mother and her child. All of them were looking at an open medical book which the radiologist was reading, Jennings recalled. My colleague heard him pause and say, ‘This sounds like what it might be.’ He was letting the mother help make the diagnosis!

Ira Marshall migrated to Chaves County in 1934 to open a general practice, and the 29-year-old Baylor-trained physician felt as if he had traveled back in time. I was the youngest man, Marshall told the UNM History of Medicine Project in 1983. The rest were men 60-to-75 years old, and some were near 80. Those men had come here for their health. It was rather strange to me because they didn’t do things at all like I had been taught. I knew some of the drugs they used existed, but I’d never used them. For example, I’ve never prescribed Calomel in my life, and really didn’t know anything about it. But it was rather common when I came here. There had never been a transfusion given in this hospital when I came to Roswell. I gave the first one. They objected to the transfusions, of course, and the stomach surgery. I was criticized for the first spleen I removed, a ruptured spleen following an accident. They said, ‘You can sew those up and they’ll be alright.’ But in those days we didn’t think you could ever suture one to make it stay.

Dr. I.J. Marshall

Marshall made $21 during his first month of practice, and he was publicly called on the carpet for his obstetrical methods during his second appearance at the Chaves County Medical Society. He learned those techniques—a small incision followed by sedation and a forceps delivery—during an OB rotation at prestigious Parkland Hospital in Dallas. I was stunned, Marshall remembered. I couldn’t believe it. I got to my feet and said, ‘I have just finished 300 deliveries, and this is exactly the way it’s done in Dallas, Fort Worth, Abilene, San Angelo and Albuquerque, and I am not going to stop it in Roswell. If you want to throw me off the staff because I’m practicing medicine the way I was taught to practice it, that’s your business.’ The discussion was never brought up again. As frightening as his fellow generalists could be, the performance of local chiropractors was even creepier. When I started, Marshall recounted, you didn’t even have to study to become a chiropractor. There was an office in Washington where you sent $50, and they sent you a certificate. The chiropractors all had x-rays, and although they didn’t know how to read them, they knew how to charge for them. It was strictly a financial venture. I remember seeing a little girl who had been having repeated colonic irrigations by one of the chiropractors. By the time I saw her, her tummy was as hard as this table, and very, very tender over the appendix. I took her to the hospital and operated on her, and I think there were more soapsuds in her abdomen than anything else. The little girl had a ruptured appendix and, of course, she did die.

Robert Derbyshire was dumbfounded at the state of New Mexico medicine when he arrived in Albuquerque in 1942. Derbyshire attended medical school at Johns Hopkins, completed a surgical residency at the Mayo Clinic, and crossed the country to join the Lovelace Clinic for a six-year stint. I had tuberculosis, and it was the fashion in those days to go West for your health, Derbyshire detailed for the UNM History of Medicine Project in 1982. When I came out, they were very short on doctors at the Clinic—I think they only had seven or eight. As a consequence, I think I would not have worked nearly as hard had I been accepted in the military as I did at the Lovelace Clinic. When he wearied of Uncle Doc’s empty promises, the restrictive covenant portion of his commitment—Labor lawyers called it a Yellow-Dog Contract—kicked him out of Bernalillo County. That provision said that when providers left Lovelace, they couldn’t practice within fifty miles of the Clinic, and many moved to the City Different. Derbyshire doctored for awhile in Artesia, until a switch to Santa Fe secured him a spot as Secretary of the state’s Board of Medical Examiners in 1952. Derbyshire dominated that position for the next three decades, and he dedicated himself to cleaning up the corruption surrounding the state’s licensing of physicians.

Dr. Robert Derbyshire

It was completely chaotic, Derbyshire remembered. I was horrified to find the number of doctors who had been licensed illegally, because the law specifically stated that a person had to be a graduate of an approved medical school. I was pretty disturbed by the performance of some graduates of the so-called ‘night schools.’ Not only were these people not practicing good medicine—they were harming a lot of people—but there was also a high incidence of alcohol and drug addiction among them. I wondered why they were licensed in the first place. In the Minutes, I found that the previous Secretary would come right out and say, ‘This person is not a graduate of an approved medical school, but Dr. So-and-So says he’s a nice fellow.’ So they would give him a license. We had very few disciplinary hearings due to the fact that a curtain or conspiracy of silence was in existence then much more than it is today. But also because people weren’t looking, they weren’t paying much attention. It gets back to the old apocryphal story of the lady who moved to a new town and asked, ‘Who’s the best doctor in town?’ The reply was, ‘Dr. Green, when he’s drunk.’ That was the attitude. People looked with tolerant amusement on the drunken doctor, a difficult thing that we didn’t have much control over.

I’m Planning To Kill Dr. Jennings!

When doctors weren’t drinking, it sometimes seemed like the only other activity that held any appeal was duking it out. You could find a physician free-for-all in almost every outpost on New Mexico’s medical frontier. Artesia’s Bunch said he couldn’t practice in Carlsbad because it was just too contentious. Taos generalist Ashley Pond III considered setting up shop in the City Different, until he realized that, well, it was just too different. I had some thoughts of going to Santa Fe, Pond told the UNM History of Medicine Project in 1983, but the doctors in Santa Fe were a queer bunch. They fought with each other all the time, so I didn’t like the atmosphere there. Santa Fe pathologist Harry Ellis disagreed. He said his situation was just peachy, and that the real problems were further north. Compared to Raton, Santa Fe was superb, Ellis explained to the UNM History of Medicine Project in 1991. They’ve been fighting in Raton for years, and I think they’re going to fight forever.

Dr. Emmit Jennings

But for full-on fisticuffs, Roswell surgeon Emmit Jennings said his town took second to no city. A fellow named Dr. Harry LeVeen, whose wife was an obstetrician, moved to town, Jennings remembered in 1991. Apparently being a little abrasive, he got on the wrong side of I. J. Marshall and Steve Marshall, and one day made a remark about a patient Dr. Richard Waggoner had operated on. This happened just before I got to Roswell, and one of the urologists told me he was in the doctors’ lounge at St. Mary’s Hospital with Dr. Waggoner when Waggoner noticed Dr. LeVeen getting out of his car, and heading up to change in the doctors’ lounge. So Dr. Waggoner walked over to his locker, got out a pair of gloves he always wore in wintertime to protect his hands, put them on, and as soon as LeVeen walked in the room, he popped him one! So there was a slight split in town among the LeVeen followers and the Waggoner followers when I came.

Jennings himself became directly embroiled in some of that Chaves County conflict a few years later. The board-certified surgeon got crossways with another Roswell doctor, who had the unfortunate habit of diagnosing hepatitis in blood results that were actually clean. One of my patients who had to see that other doctor for an insurance physical was told during the course of the physical that he had hepatitis, so he came to me just scared to death, asking what he should do, Jennings recalled. I checked him out and everything was alright, but the patient said he was still very disturbed about it. He wanted to know what to do, and I told him he could report it to the ethics committee at the County Medical Society, which he did. It wasn’t too long after that when (NMMS Executive Director) Ralph Marshall came in one day, saying he thought he would just stop down to see how I was doing. But while he was there, he thought I would like to know that Bing Blasingame, who was an AMA vice-president, had called Ralph asking him to go to Roswell because an old classmate of Bing’s who was in practice in Roswell called him to say that he ‘planned to kill Dr. Jennings!’ The other doctor ended up leaving Roswell and going to work at a mental hospital in Texas. Other than that, the medical climate was good.

But maybe the maximum tension in New Mexico medicine was not found in some remote rural outpost, but instead festered in the very center of the state’s most metropolitan setting. Downtown Albuquerque was the site of the bedpan battle between the city’s solo practitioners and the clinical group assembled by Uncle Doc Lovelace. In 1946, Albuquerque generalist Hubert Teague started a general practice in the Duke City, and he watched the warfare from ground zero. There was a lot of dissension in town. Teague told the UNM History of Medicine Project in 1987. Either you belonged to the Lovelace Clinic or you did not, and the two sides hated each others’ guts. Dr. Lovelace had the idea—and he told everybody—that his was the only kind of medicine there was. He was the cause of a number of lawsuits in town because somebody would go there, and he would say, ‘This is too bad. This should have been take care of beforehand. Had you come to Lovelace Clinic in the first place, you wouldn’t be in this bad of a condition.’ He was a real money-grabber, and there was a great deal of dislike for Lovelace—both inside the Clinic and outside as well.

Uncle Doc Lovelace at his first office in 1905. (New Mexico Health Historical Collection, Health Sciences Library and Informatics Center, University of New Mexico)

Robert Derbyshire was one of those doctors on the inside. Dr. Lovelace had a great way with patients, Derbyshire told the UNM History of Medicine Project, although he asked the interviewer to turn off the tape for his most caustic comments. They all felt better the minute he walked into the room. He handled people very well, except for those who worked for him. Even with a shortage of doctors, Dr. Lovelace was able to attract a lot of good, well-trained physicians. But the thing that bothered me was the tremendous turnover. I would just get used to working with somebody—some of my best friends were colleagues—and they would come to say, ‘Well, I’m leaving in a month.’ That was very disconcerting. The reasons for their leaving were mostly due to long hours, hard work, and we weren’t paid very generously in those days. But the worst thing they had at the Clinic was the contract (containing the restrictive covenant). That created a tremendous amount of ill will. It was designed, of course, to keep down the competition. A lot of people who left the Clinic because they were dissatisfied, settled in other parts of the state. Senior used to say, ‘Well, I train these boys and then I send them out to the small towns.’ He forced them out! On the whole, I had high regard for him personally. We were fed, however, on what I might go so far as to say were false promises. Because he would repeatedly say to the inner circle, of which I was part, ‘One of these days, I’m going to turn this all over to you boys.’ And, of course, that never happened.

The bedrock problem with all of the bad habits and bad outcomes and bad blood that saturated New Mexico medicine as it entered the post-War world was that they synergized to form a supreme distraction that stole focus from a patient population desperately starving for attention. By almost any measure, there were few places as sick as this state. New Mexico was crippled by the combination of its punishing poverty and its geographic expanse. The Land of Enchantment was the fifth largest state by square footage, but barely ten percent of its 65,000 miles of roadway were paved as late as 1955. The state was suffering a critical shortage of physicians—its doctor-patient ratio of one practitioner for every 1,352 residents in 1950 was almost twice the national average—but even if there had been more, it’s hard to know if they could have gotten where they needed to go. In New Mexico, you simply couldn’t get there from here, even when it was medically imperative. It made the state’s healthcare prohibitively expensive. In 1948-49, the average per capita public health cost in New Mexico was three times the national number.

St Joseph Sanatorium in Albuquerque in 1920. (The Albuquerque Museum/St. Joseph’s Collection/Item PA1992.005.467)

And so a woeful population got worse. The first time I was in Albuquerque in 1918, it was a town of perhaps 20,000 people, I. J. Marshall remembered. Of those, I suspect 8,000 were tubercular. Roswell was the same way. They thought coming to this dry country was the thing for tuberculosis. Sanatoriums stretched up and down Albuquerque’s Central Avenue into the War years, and outlying New Mexico cities like Roswell had several of their own. Those thousands of White Plague victims formed the foundation of the state’s health statistics, but the newest arrivals weren’t faring any better. In 1948, New Mexico had the highest infant mortality rate in the country. The city of Albuquerque and the county of Bernalillo was at one point the least safe place for a woman to have a baby in the United States, pediatrician Stuart Adler told the UNM History of Medicine Project in 1982. (It had) an infant mortality rate of over 130, and I think the national average was down around the 20’s then.

Dr. Sam Ziegler

It was just as rough in the rural precincts. Surgeon Sam Ziegler opened a mission hospital in the Española area in 1946, and his spirit was crushed by some of his first pediatric cases. My early practice involved heartbreaking and traumatic experiences for me, because in those days infantile diarrhea was a real problem and we lost a lot of those kiddos, Ziegler told the UNM History of Medicine Project in 1984. They lived out in the boondocks, and (my wife) Isabel and I made house calls all over the place—Truchas, Cundiyo, Vallecitos, you name it. We ran well-clinics out of those places and did the best we could. When we went to these homes, the kids would be covered with flies. They were all over the place. In those days, we still saw a lot of typhoid fever. I even saw tuberculosis meningitis.

Pediatrician Eleanor Adler arrived in Albuquerque in 1947 to practice with her brother, and together the pair put an instant emphasis on the infant-mortality issue. It was a goal of the Public Health Department and the Pediatric Society to improve that situation, Adler told the UNM History of Medicine Project in 1984. The population among both the Spanish and Indian cultures was very remote and access to medical care was a real problem. Roads were terrible. They had no way to go anywhere, and no one could get to them. A lot of the infant mortality was related to neonatal problems of delivery and the first months of life—obstetrical situations, and lack of preventive measures during pregnancy, and lack of medical care if something did go wrong with the infant. There was always a high level of diarrhea and inadequate treatment, and nutritional problems that add to any illness. Immunization programs for measles, polio and the like came later. The Public Health Department was busy immunizing against whooping cough, diphtheria and tetanus, but a lot of people didn’t get immunized because they were not able to get to the clinics.

Midnight Meetings With A Former Marine

New Mexico medicine needed more of everything. It needed more doctors, more cooperation, more discipline, more expertise, and more access. The end of World War II would resolve some of that, as physicians began trickling back into the state, bringing with them the battlefield experience and specialized excellence that could lift the quality of local healthcare. But New Mexico medicine needed something more. It needed a cohesive leadership that could systematically resolve the various problems that plagued the profession, and create a consistent vision for medical care in the post-war world. The New Mexico Medical Society (NMMS) should have been the appropriate vehicle for facilitating that change, but as the fighting ended on both fronts, the state organization was still a clubby little trifle concerned more with petty squabbles and the occasional cocktail than dynamic direction for the new decade. At the dawn of 1949, the state society had 335 semi-committed members, but it was regularly referred to as either a vest pocket or hip pocket group.

That snide phraseology meant that every shred of organizational activity could fit snugly into the pocketbook of the society’s ceremonial President, and varied only with where that official wore his wallet. Committees rarely met, reports were never written, there were no administrative staff, and no established address. On the cusp of the Atomic Age, the New Mexico chapter of the American Medical Association was the only organizational affiliate that possessed neither a permanent headquarters nor a professional executive director. It was just one more measure that ranked New Mexico medicine at rock bottom. A revolution was required, and the reasons were obvious: Unruly behavior, unfilled positions, untreated illness and unmet need. But as the Fabulous Fifties unfolded, there was one final incentive that pushed matters past the tipping point. President Harry Truman was putting together a package of healthcare legislation that would make the Federal government a fellow practitioner in the medical field. If physicians refused to modernize their profession, then Washington politicians proposed to do it for them.

Midnight was approaching when Ralph Marshall was finally summoned from the waiting room of Harold January’s office in the Lovelace Clinic to interview as the sixth and last candidate for executive-secretary of the state society. Marshall was the son of an Arkansas sharecropper, who bussed 60 miles every day, and then walked another two, to attend high school. The rural farm where he was raised had no plumbing, no electricity, and when he returned home from school after dark, he completed his homework by the light of a coal-oil lamp. Marshall made for Alaska and worked as a laborer until the War broke out, and then he and his two best buddies enlisted. One was shot from the sky in the South Pacific, another was slashed to pieces on Saipan, but Marshall somehow marched through his stint in the Marines without a scratch. It’s an interesting story, was all he would later share about that experience. Marshall was 29 when he graduated from the University of Oklahoma in June, 1949, and now he faced a phalanx of physicians on the third floor of Albuquerque’s First National Bank for the right to haul the NMMS out of the horse-and-buggy era. That, quite possibly, represented the most daunting assignment of his life’s first three decades.

Ralph Marshall, c. 1946

Artesia’s C. Pardue Bunch was staggered by the state of the NMMS when a recurrence of his asthma forced his return to the Southwest in 1944. After graduating from Duke’s medical school six years earlier, Bunch delivered healthcare on horseback in the hills and hollers of rural North Carolina. He prescribed calomel and castor oil, learned folkways from the granny-women, and received cabbages and shoulders of pork as payment for his services. He also met a medical organization that was miles ahead of New Mexico’s. North Carolina had an active medical society and published a professional journal, and I’d gone to a few state meetings in the rural areas, Bunch told the UNM History of Medicine Project in 1984. I came out here and found nothing going on in the (NMMS). I went to Denver to attend a graduate course, as I did on several occasions. While there, we went to the headquarters of the Colorado Medical Society, and found out what a professional executive can do. Two things were going on in Colorado in 1949—public relations and the discipline of professionals through grievance committees and what they called a Board of Supervisors. So Leland Evans from Las Cruces, and George Prothro from Clovis, and a doctor from Deming, and I got together in Roswell in May, 1949. At that meeting, we raised the dues from $20 to $30 a year, with the object of getting money to hire an executive secretary. Dr. Harold January was the Secretary-Treasurer, and he held things together, but it was purely voluntary work.

Pardue Bunch on the porch of his Sturgills, N.C. office in 1942. (New Mexico Health Historical Collection, Health Sciences Library and Informatics Center, University of New Mexico)

Ralph Marshall remembered it similarly. Several physicians in (NM) at that time were familiar with larger state medical societies and how they conducted their affairs, Marshall told the UNM History of Medicine Project during separate interviews in 1982 and 1991. They came to the (NMMS) House of Delegates and announced, ‘Hey, we need to increase our dues and hire a man to have a headquarters, so we can get involved in this arena.’ We were the only state in the union that didn’t have a full-time office, and national health insurance was breathing down their neck, and the AMA was putting pressure on leadership of the medical societies to help them beat this legislation. So, since new doctors were coming along , they decided they needed an office, needed to publish a newsletter, and start doing things. They were young doctors, just out of the War, getting established, and wanting to do more. The time was right for it, so they appointed a public-relations committee that went to Denver to see what their medical society was all about. They returned home, developed a small budget to open an office, and attended the state meeting in Roswell. Pardue Bunch was the one who got up and sold it to the House of Delegates. He was a very convincing fellow.

Marshall was recommended for the job by the boss of his new bride. Elaine Marshall worked for Dick Graham, the director of the Oklahoma Medical Association, and Graham dictated a letter on Ralph’s behalf. But he’s just an old country boy, Elaine said about her husband of three months, uncertain if Ralph was really up to the task. That’s okay, Dick Graham reassured her, I’m just an old country boy, too. Marshall may have been the final applicant to appear, but at the finish of the interview he sensed he stood first on the society’s list. I felt confident because the meeting ended with (the seven interviewers) asking me stories about the Marine Corps, Ralph remembered. The next day—June 8, 1949—NMMS president J. W. Hannett and Harold January took Marshall to lunch at the Albuquerque Country Club and presented their offer: A salary of $4,000 for Ralph, an hourly wage of $1 for Elaine’s secretarial services, and $30 per month to rent office space in the Marshall home. Only one complication stalled the consummation of the hand-shake contract—the Marshalls needed to find a nest.

The 1949 message that brought Ralph Marshall to New Mexico.

Well, in 1949 here in Albuquerque, housing was a mess, Ralph Marshall recalled. Houses were being built by the blocks, and renting was simply out of the question. We looked and looked, and finally found a floor plan that Elaine liked. The house had 843 square feet in it, and cost a little less than $10,000. It was just off San Mateo S.E., which was a dirt street leading to the (not-yet-finished) VA Hospital and Lovelace Clinic. We were out in the country. There were few other houses out there, and we could sit out and watch the jackrabbits. We moved in with no furniture at all. We bought a bed, and eventually found a used dining-room table and chairs, which we bought for $30, but we had no living-room furniture. We didn’t have a phone for two months because none were available. Dr. Louis Levin lived a few blocks away, and his wife took our telephone calls for us. The next thing I knew, they wanted to have a council meeting. So along with the four chairs we acquired with that fine dining-room table, I borrowed folding chairs from the Strong-Thorne Mortuary, and held my first council meeting, which consisted of seven officers and the delegate to the AMA.

The first NMMS office in the Marshall home near Lovelace and the VA in 1949.

To Make A Medical Society, You Have To Break A Few Chairs

That first society session became legendary when one of New Mexico’s most famous physicians—a two-time NMMS president and Mora County mainstay—had a minor mishap that dismantled a portion of the Marshall home. The first raise I got was a result of that council meeting, Ralph Marshall later recounted. Dr. Carl Gellenthien from Valmora, who attended as our delegate to the AMA, happened to pick up one of our dining-room chairs, brought it over near the fireplace and sat in it. Well, Dr. Gellenthien was a lively, boisterous individual who loved to smoke cigars, and when he reared back on two legs of that chair near the fireplace, we heard it creak and crack, and we looked at each other, wondering what would happen next. Well, not long after that, someone said something Dr. Gellenthien thought was unusually funny, and he began laughing and stomping, and that chair came crashing to the floor. When the meeting was over, he offered to ‘pass the hat to get Ralph and Elaine a new chair.’ So they gave me a raise so I could buy a chair.

Dr. Carl Gellenthien

Marshall was ordered to spend a week each with the Colorado and Oklahoma offices to learn the ropes, and then return to the Land of Enchantment to put those lessons into action. I didn’t have the foggiest notion what I was supposed to do, Ralph Marshall remembered.

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