Dallas Medicine: Behind Closed Doors

Dr. Wayne H. Gossard, 55, a native of Colorado who hunts quail and is a sometime rancher and carpenter, will probably make less money this year than he did the year before. The reason, simply enough, is that this widely admired Dallas physician is currently “first among equals” in the city’s medical ranks. He is serving a one-year term as president of the Dallas County Medical Society, the physicians union. And being president of the county medical society is a demanding chore.

The society’s board meets once a month, at noon on the first Tuesday, but that is only the beginning of the demands on its president. There are committee meetings and community duties on several nights each week, and on several weekends per quarter. One afternoon every week, Gossard wheels his car into the asphalt lot at 3630 Noble Avenue, parks quickly and strides into the new $350,000 headquarters of the DCMS. It will be several hours before he exits.

Wayne Gossard’s afternoons at the society are immersions in medical politics. Some are spent on strict “doctor business”: placing recent med school grads, calming irate patients, counseling physicians about personal and professional problems. But other afternoons are devoted to issues that may affect large groups in the county: medical malpractice, political campaign contributions, doctor incompetence. In either case, it will be business that seldom sees the light of public scrutiny. Like most professional groups, the doctors union is something of a “conspiracy against the laity.” Only, the doctors sometimes seem to conspire more than most.

The Dallas County Medical Society is, at 101, one of the nation’ s oldest medical societies, and one of its most astutely run. It has already produced two presidents of the American Medical Association – perhaps the most powerful professional group in the world – and may, in an amiable North Dallas surgeon euphoniously named Dr. Charles Max Cole, be about to produce a third. Its women’s auxiliary is the nation’s oldest and one of its most active. Although the local society sends seven of every ten dollars it collects from its 1,823 members on to its state and national affiliates, the DCMS still has a 1977 budget exceeding a quarter of a million dollars, which is a record.

But in spite of its size, its wealth and the pivotal role of its members in the life of the city, the medical society shrinks from public examination, a “shrinkage” that borders at times on paranoia. Getting a look at the workings of this small, well-heeled, vastly influential group is like attempting to infiltrate some illegal activity, a cat-and-mouse game that the DCMS’s officials appear to enjoy. “I know who you’ve talked to,” volunteered Robert L. Heath, a pleasant, low-keyed Methodist minister’s son who serves as the society’s executive officer. “They’ve been calling me to tell me they’ve talked to you.”

Heath spoke with D Magazine only briefly, responding to a request for information about the society’s workings and duties with a 36-page booklet on the AM A: “Working for a Healthier America.” The publication said nothing of Dallas or its doctors.

Most of the information in this article comes from physicians who were intrigued by the idea of a research project into the political aspects of medicine or who are turned off by, and have largely tuned out, the local medical society, believing it to be removed from the community issues that really count. Because of the medical society’s continuing ban on almost all forms of publicity (which is condemned as advertising) and its still substantial powers of economic censure, most of the doctors quoted will not be identified for their own protection.

Few Society members are present at Gossard and Heath’s afternoon meetings, since the two can seldom predict with any certainty what the agenda for their session will be. The DCMS prides itself on being an organization that’s available to the physician-member for whatever problem he encounters. Some of the problems, like those involving irate or obnoxious patients, are easily handled, often with a simple call by Heath. Others are much more serious. One Dallas physician began to prescribe drugs for himself, and it took two years of concentrated counseling by the society staff to get him rehabilitated. Today, according to admiring colleagues, he’s back on the job at full strength.

The so-called malpractice insurance crisis still occupies some of the society leadership’s time. At other times it may have to deal with a looming revolt by patholo-gists at a Dallas hospital, rumors that the medical community’s political action funds have made illegal campaign contributions, or the embarrassment caused by release of a list of physicians receiving more than $100,000 yearly in Medicaid reimbursements.

One recent afternoon, gossard would have found a relaxed Bob Heath, leaning back in his chair with his telephone handset up to his ear. “Have you tried our clinics – we have two large ones in town,” Heath inquires, his voice fatherly and soothing. “I see,” he says after a moment. “Well, let’s put an ad in our journal. Just write it out so that it will take up about an inch… No. no charge.” He laughs. “We’ll get you when you come.”

The young surgical resident at the other end of the line is just finishing up his training in Austin. Talking to Bob Heath about job possibilities in Dallas is a comforting thing. Heath is a square-jawed, wavy-haired executive, imbued with a Southern gentleman’s grace and timing, articulate, capable of being firm without any need to be brusque. He’s just like his father Millard, whom he succeeded in January. 1975. Neither is a physician, although both understand doctors better than most doctors understand themselves.

Millard J. Heath never enjoyed the comforts and conveniences of the new society headquarters. For the 27 years he ran the DCMS, the society was quartered in the Medical Arts Building, built by the most powerful doctor Dallas has ever produced, the late Dr. E. H. Cary, who headed the AMA in 1932 and who practiced medicine until the late 1940’s. But it is not Cary’s shadow that falls on the society. It is, instead, Millard Heath’s.

When he chose to speak out, Heath had, according to one physician, “a nice specific gravity of information per cubic meter of speech.” But the soft-spoken, dignified Heath was at his best behind the scenes, where his instincts were unerring and his informational network for- midable. A doctor knew that he was part of the inner workings of the Dallas County medical realpolitik when he was admitted to Heath’s private coterie. One longtime Dallas physician who tends to take a mild view of Heath’s methods remembers him as an “ombudsman,” who was “awfully good at bringing the facts out so that everybody understood them the same way.” A second veteran physician, who admits to being part of Heath’s “apparatus,” speaks more to the point: “I knew when he sent somebody to me that he was participating in the process and that the right degree of confidentiality would be preserved. If we had unearthed someone who needed some chastisement, that it would get done – and it did.”

When Millard Heath retired on Dec. 31, 1974, he was considered the “dean” of U. S. county medical society executives. His influence in the past 27 years had been felt nationwide as county medical societies shaped themselves as the indi-vidual physician’s first line of defense a-gainst an increasingly hostile world. He shaped the society like himself, a man with no readily visible edges. At his retire- ment banquet in late October, 1974, he stayed entirely in character. He quoted Donne (“No man is an island. . .”) and Shakespeare (“There is a tide in the affairs of men. . .”), warned of the “winds of change” and, in somewhat veiled terms, told the society’s faithful to be careful whom they trusted to lead them. He added, “no matter what else – keep your hand on the helm.”

The son then took over, having waited in the wings for five years. “The transition,” says one doctor, “was undetectable.”

In 1969, when Bob Heath came aboard as assistant executive director, the DCMS had already gone through three “assistants,” none of whom could stand the late-night, every-night pace of county medical affairs. One witness to the proceedings says, “They were about to panic when they suddenly realized that Bob Heath was exactly what they were looking for.” Like his father before him, young Heath was an executive with Goodwill Industries when the summons to the medical society came.

The younger Heath, at the time of his advancement in early 1975, took charge of the DCMS’s day-to-day affairs at a particularly delicate time. The society was, and to a lesser extent still is, losing members. Eight months into Heath’s tenure, the Texas Medical Association took away another of Dallas County’s seats in the state group’s House of Delegates, blaming a drop in dues-paying membership. Meanwhile, those dues were swelling steadily, irritating further the ultra-conservative brand of doctor who populates Dallas County. Many local doctors had never been fully comfortable with the idea of the county medical society forwarding to the TMA and the AMA approximately 70 percent of every dollar collected in annual dues. Consequently, Heath found himself in the midst of. . . not a revolt, but a growing spirit of indifference by a growing number of doctors.

Embarrassingly, the society’s membership had ignored in droves a plea by the leadership for donations to cover the $350,000 already spent on the DCMS’s new Noble Avenue building. The situation might have been critical if it had not been for Heath’s hurried arrangement to borrow $200,000 from a sister organization, the Dallas Southern Clinical Society, and (blush) the Millard Heath Scholarship Fund. That’s how short the pledges and gifts from Dallas doctors had fallen: $200,000. Throughout much of 1975, Heath guided then-president Dr. Elgin W. Ware Jr., a Highland Park-bred urologist who looks like Con Ed’s Charles Luce, in making a plea for funds to repay the loans.

By February of this year. Heath had been able to repay $ 150,000 – $75,000 of each of the two $100,000 notes – but by then, another embarrassing contretemps had developed. The society’s Physicians Benevolent Fund had gone dry, and it had proved necessary to make an emergency appeal for money. The Fund needed only $1,490 a month, which was parceled out in checks to two widows, an orphaned child and a physician who had been in ill health for years. In a message carried by the society’s Journal, the Dallas physician attempting to administrate the tuna noted that a donation of only $12.77 from each member would keep the fund solvent.

At that point, the society’s dues had been raised again. They now totaled $545 a year, with $115 going to the DCMS, $180 to the TMA and $250 to the AMA. Many younger doctors in the city, even those who remained members, were less and less supportive of the DCMS. One of the county’s leading medical politicians tells of a recent encounter with a young physician who announced “one more chance” for the organization before he quit. What does the young doctor want changed? “Damn if I know,” the older doc shot back. “He’s got one pet peeve that bugs him. . . These are the doctors that I get impatient with.”

It is an impatience that cuts both ways. Some Dallas doctors say that they are tired of the DCMS’s cat-and-mouse games, believing that these are conducted at the expense of the medical/social issues in town that really count. Of course, some of the society’s power- political power that was easily subject to abuse – has been trimmed back. A doctor can no longer be blackballed by a hospital staff simply because he is not a member of the local medical society. Nor does the society exercise much, if any, clout over appointments at Southwestern Medical School. At the med school, the politics are educational politics, with a strong state-wide orientation. But in the eyes of its critics, the society still retains enough of its smoke-filled-room character of self-interest to warrant outcries. A physician in his late forties sits on the veranda of his Dallas home and speaks of the DCMS:

“We all know that the county commissioners are rupturing Parkland Hospital. But have you heard the Dallas County Medical Society say anything about that? When have you ever heard the Dallas County Medical Society say anything about the need for preventive medicine in Dallas County? It’s always HEW or somebody else. Why hasn’t the Dallas County Medical Society said anything about the proliferation of hospital beds in North Dallas, where we have too many? The real sad part about it is that the Dallas County Medical Society has never gotten involved in what goes on in this town in any way, lately at least, that has ever been felt by anybody.”

There was a time, in this doctor’s estimation, when the society was important. It was needed in those pre-World-War-I days to fight the “jerk-leg” diploma mills, the kind of “second-floor schools of medicine in low-rent areas downtown” that Dr. John S. Chapman describes in his book Medical Education in Dallas 1900-1975. In the Twenties and Thirties, the society was needed to bring certain autocratic doctors in Dallas to heel. The doctor recalls, “In those days the doctor was king – in hospitals, in his practice, in medical ethics. And there were about eight or ten hidebound physicians in Dallas with a lot of God-like images.”

But those days are past. Today is the day of the specialist and his professional society. Today is a day of seeming inter-dependence between medicine and the community. Today is a day when large gaps have appeared in the ranks of doc-tors, and in the swirl of all of these op-posing cross-currents, this particular doc-tor doesn’t think the county medical socie-ty is making much headway. Jnstead, in Dallas, it is fast becoming the personal dominion of the 250-some doctors who, year after year, call its shots, operate its committees, choose its leadership, ferret out the individuals they will promote for American medicine’s top political slot, and seek to control what the public learns about the community of doctors that serve it.Nothing goads “organized medicine” into action faster than a doctor calling “undue” attention to himself, a circum-stance that landed a certain Dallas physi-cian in the medical society soup early in 1970. The “1-Asparaginase Affair” could have been one of the nastiest episodes in Dallas County medical history had the targeted doctor chosen to fight; instead, it turns out to be a near-perfect example of how the Dallas physicians union works its private will.

The doctors who will talk about the affair say that the DCMS’s crackdown was necessary, that the physician involved was making extravagant claims of cure where only limited claims were warranted. He was producing a drug, 1 -Asparaginase, from asparagus in his laboratory, and using it to treat patients – mostly children – suffering from acute leukemia. With some patients, it seemed to be helping. The word got out, the press came calling, and the headlines that resulted were literally international in their scope and attention.

Then, virtually overnight, there were no more interviews and no more headlines. And no explanation. A Dallas physician close to the matter describes what he thinks happened, but he warns, “If any of this comes out, I will deny saying anything. It was an extremely delicate situation. 1 would guess that what happened is that somebody, maybe not even a physician, went to the doctor and said, ’Mister, if you don’t shut your mouth the following nasty things are going to happen and the following people, better known than you, are going to say the following things in public, and it’s really going to get bad. You have overstepped yourself and you have misbehaved. You have done a cruel thing to other people with this disease, and you cut it out right this minute.” And it worked. The whole thing simmered down and assumed its proper proportion as an interesting development and disappeared below the surface. That individual has never done this again.”

In the opinions of doctors who talked of the 1-Asparaginase case, the actions of the county medical society were admirable in this instance, and perhaps they were. But they also smacked of coercion and intimidation. One doctor conceded, “I don’t think that [the 1-Asparaginase theory] was quackery. There was another research institute working on it. He [the Dallas doctor pursuing the theory] is an ambitious individual, and he was doing some very accepted work in the field of oncology. And he felt like he had the answer to one of the malignant conditions. He knew that this other research institute up in the East was working on it too. And he wanted to get recognition for it.” Instead, like Galileo, he got put up against the wall by the power structure, all without any kind of due process.

At one time or another, most Dallas medical reporters have run afoul of the DCMS for using the names of physicians in print or for other real or imagined shortcomings. In one instance, a photographer shooting a photo essay at Parkland Hospital on doctors who deliver babies snapped his shutter just as an obstetrician lifted a cigarette to his lips. A letter from the DCMS came quickly, accusing the city’s afternoon daily of deliberately embarrassing the physician. Another time, a reporter spent the night in a Dallas hospital, without being identified to the staff. In writing the article, the reporter mentioned a doctor by name. “They gave him hell, too. They can make life miserable for a doctor,” says this journalist.

Perhaps the most ridiculous episodes of all surround the broadcasting or telecasting of sports events. Football produces injuries and injuries require doctors. But for years the DCMS attempted to prevent local sports announcers from mentioning the names of team doctors on the air. Both the doctors and the announcers rebelled, and the practice has waned somewhat. “I think doctors have learned that we have some rights too,” says one former team physician. “I always thought that if I went out and sat in the mud, snow and slop and cold and left my family at home to go to the Cotton Bowl or fly across the United States I ought to get some credit, because I sure wasn’t getting much money.”

What upsets doctors most about a colleague’s getting his photograph or a few inches of ink in the newspaper is that it can, and indeed does, serve as a form of advertisement. And doctors, though this “ethic” may change, are still prohibited by their own rules from running ads that say, “Delivery of babies in clinics, $675, Abortions, 1st 3 months, $150.”* Barred from this kind of self-promotion, doctors react quickly to any doctor who catches the public eye, intentionally or not.

The intensity of feeling against doctors who manage, wittingly or unwittingly, to capture a moment in the media spotlight can be surprising. One of those moments of surprise came recently in the emergency room of the new Richardson Medical Center. The patient was a woman in her thirties, her lip split by a baseball missed in a game of catch. Her husband, making conversation while the suturing went on, asked the doctor for his thoughts on the Dallas County Medical Society. The answer from the physician was swift and unexpected. “They should have clamped down on this doctor out here,” he snapped. “What doctor? The plastic surgeon that got the article in the paper the other day,” he answered testily. “That’s inexcusable. I can’t imagine why they didn’t move on him.”

If a move is made, it comes from the DCMS’s three-man “board of censors,” a hush-hush committee that is listed in the society’s official yearly directory above even the all-important “board of directors.” The censors are the enforcers for the society. They can literally strike fear in most members, even if a report that they are investigating is merely rumor. “I would still respect a summons from the censors, since they could cut off my referrals from other doctors,” says one physician.

There is a need, obviously, for some aspects of the censors’ role. Notes one highly placed Dallas doctor, “Over the years, there have been a few people that I know of who have been found to be clandestine drunks and junkies and so forth.” These people need to be moved on. Last July, in the Dallas suburb of Irving, sheriffs deputies arrested a 40-year-old physician on a felony charge of putting a contract out on the life of his partner. At that point, the medical profession’s self-policing mechanisms moved swiftly, cutting the accused doctor off from hospital privileges and launching a challenge to his right to practice. It was comforting to learn that the doctor’s amphetamine-prescribing weight clinic was already under investigation by the DCMS’s “board of censors.” Some of the physician’s colleagues had complained, alerted by a parade of drug addicts, pimps and prostitutes to the doctor’s door.

The Hoxie case of the mid-1950’s was a memorable time for the society’s board of censors. Remembers one physician, “Hoxie had a cancer clinic, so called, on Gaston Avenue, and he had lines of people in front of his doors like Star Wars. What kind of degree he had, I was never sure. Maybe a naturopath or something by mail.” The DCMS denounced him as a fraud, prompting Hoxie to file a libel suit, which he lost. He finally left for Los Angeles, where he made a new fortune in oil.

The Hoxie-type cases are, fortunately, uncommon. The censors, headed this year by Dr. John E. Eisenlohr, an ophthalmologist who has his offices on lower Lem-mon Avenue, are usually much busier handing out their “traffic summonses” to doctors believed displaying too much enthusiasm for publicity. And sometimes, a reprimand is obviously justified. One Dallas doctor was interviewed so often by the club editor of one of the Dallas dailies that he offered her a job as a ghost writer, a job she refused.

There has been a clampdown recently on the flagrant abusers of the society’s no-publicity rule. “These were the guys who would appear every so often in the newspaper talking about their new office with equipment not available elsewhere in Texas,” says one doctor. “Or the faces peering over the governor’s shoulder every time he was in town. Most of those fellows have dropped from view, and deep down inside I know that somebody from the board of censors has been over there talking to them.” On the other hand, there is a classification of publicity that the board ignores – although it can be a fine line between publicity that falls in this category and publicity that “marks” a doctor. Probably no doctor in Dallas has received more media exposure in the past ten years than Dr. Emmett Conrad, the surgeon and former school board member. “But it never comes across as if he’s trying to advertise himself,” explains a fellow physician.

There is more to the DCMS than its board of censors, however, The society is not a totally self-serving body. It has committees galore, on blood banks, cancer, community health, mental health, nursing, occupational health, prenatal health, rehabilitation, tuberculosis, respiratory disorders, emergency medical services, you name it. Every maternal death that occurs in Dallas County is reviewed by a DCMS committee, interested in its cause. The paramedic program of the Dallas Fire Department was a consequence of three years of hard work by a medical society committee.

The society’s gainsayers are quick to give credit where it is due, and say they only wish that the organization would put more emphasis on and exercise more daring in the areas of the public’s, as opposed strictly to the private physician’s, concern. If it did so, in these doctors’ opinions, then the society would drop some of its highly traditional activities, like its orientation lectures for new members. (“A total waste of time,” says one doctor.) The society’s mediation committee is another function that draws criticism. The committee listens to complaints from consumers who feel their doctor has mistreated them.

“This committee carried clout up until recently,” says a physician. “But then the doctors who had the grievance filed against them began showing up with an attorney, and the attorney would tell the doctors on the grievance committee that if the grievance led to a malpractice suit, he was going to sue every one of them. And when you are serving for nothing, what the hell? In its day, the committee was fine. Today, it is not.”

Some of the county’s doctors would dismantle the Dallas Southern Clinical Society as another dinosaur. Heath is also the director of this yearly educational event, which brings in specialists in various fields to lecture on the “state of affairs” in their area of medicine. Complains one of the dissident doctors, “It is neither fish nor fowl. We bring in a well-known orthopedist every year, for instance. And then we tell him that he must talk to both orthopedists and general practitioners. You can’t do that. The g.p. can’t set bones now anyway because he can’t get malpractice insurance. And the specialists don’t want to hear him tell the g.p.’s how to spot hip abnomalities in children – they already know that. They want to know how the specialist does his operations. It doesn’t work, the clinical society. They ought to kill it.”

The way the county medical society selects its leadership is also under question. It is, without a doubt, a very, very private process. Even its defenders profess to being baffled at times by it. Says one former president of the DCMS, “The day that the nominating committee called, I was totally surprised. I wasn’t aware they were considering me at all.”

That kind of “summons in the night” interpretation of how medicine’s top politicians in Dallas County are named ignores some obvious points, however. The doctor who wants to ascend to political power in this county can, if he wishes to pay the price, draw himself a blueprint that will almost guarantee his emergence 10 or 15 years hence as a medico-politician of considerable influence. It will not guarantee him the presidency of the AMA, but it will almost guarantee him the right to operate in its shadow.

Here is how to achieve political power in Dallas County medicine:

Be a local product: An ideal combination: high school diploma from Highland Park, undergraduate degree from Southern Methodist University, medical degree from Southwestern Medical School and intem-.ship and residence at Parkland Hospital. If you come from a family with roots deep in Dallas’ past, so much the better. One can, as it did in Dr. James Downs’ case, even offset the other. Downs, 60, an obstetrician who recently headed the DC MS, can, in one of his colleague’s words, “choose to go as high in medical politics as he wishes.” He went away to school (University of Texas at Austin, UT medical branch at Galveston, Detroit for internship and Galveston’s John Sealey Hospital for residency), but his grandfather was an early-day Dallas stalwart. Graduates of Houston’s Baylor College of Medicine have a strike against them, a carryover of the feuding that marked that school’s abrupt exit from Dallas in 1943. But the mark of Baylor isn’t fatal. Dr. L. S. Thompson Jr., vice president and medical director for Southland Life Insurance Co. in Dallas, has done well in local medico-politics despite his Baylor sheepskin (Class of ’48). He headed the TMA in 1976.

Be an excellent physician: “Generally, the men who are recognized in medical politics are the kind of physicians that we’d like to go to ourselves for our own medical treatment,” admits one Dallas medical politician. Thus, in effect, the DCMS has itself done the very thing that its own censors have worked so hard through the years to prevent: advertising individual physicians. For $2.50, anyone can purchase a copy of the society’s official 1977 directory and have, in the listing of the society’s committees, access to the names of the physicians that the county’s medical leadership itself believes to be the most outstanding at their craft.

Do the dirty jobs willingly and successfully: Two of the dirtiest are giving the society’s orientation lectures and putting out its dull, soporific magazine, the Dallas Medical Journal. “Terribly thankless tasks. No glory,” says a Dallas physician now active in state medical politics. “However, if you are asked to do it, do it, and somebody will mark down in a mental book somewhere that Doctor A was asked to do this and did it. Volunteer, but only if you can carry out what you volunteer for. There are some smart people looking at you, and they write it down and tell one another in little conclaves.”

Be fearless, but respectful: It’s a combination that automatically excludes a lot of doctors, who lack the ability to get along with the right people. But it takes more than this, one physician reminds. “You’ve got to be so full of rectitude that you can create your own following and run right down the gullet of the opposition.” The late Dr. Joe Nelson of Wea-therford, Texas, was a master at this sort of thing. Before his death by cancer earlier this spring, most observers of medical politics believed Nelson was headed for the AMA presidency. Another master of the art is Dr. James H. Sammons, a family medicine practitioner at Baytown, Texas, for 21 years, who twice sold the idea of integrating M.D.s and osteopathic physicians to the TMA purely on the strength of his command of the issue and his presence. (The D.O.s’ official echelon reneged each time.) Today, as executive vice president of the AMA, Sammons is the world’s most powerful physician.

Make sure your wife is highly visible in the Dallas County Medical Society Auxiliary: Dr. Cary’s wife started the auxiliary in 1918, and three years later the doctor introduced the AMA resolution setting up a national auxiliary. The local group has its own headquarters, the old Aldredge home at 5500 Swiss Ave. The loyalty of the group to the physician’s cause is – understandably – blind and in no way liberated. Last March, the auxiliaiy corps gainerea to near one macho-minded doctor say, “Through joining and knowing about her husband’s contributions to ’hurting folks,’ the doctor’s wife gains a potential for real meaning in her life.” More important to the politically ambitious doctor, his wife will come in contact with the wives of the politically powerful, and it is here, as well, that medico-political careers are made or lost.

Steer clear of issues not central to medico-political process: The leadership selection process tolerates few errors in judgment, few indiscretions of tongue, and only a limited measure of independence. One young Dallas general practitioner, heretofore earmarked for promotion to higher prominence, has recently lost ground over his views on laetrile, the controversial cancer treatment. He thinks the drug should be bottled and put on the drugstore shelves, properly marked, for anyone who wants it. This is a view with probable merit, but it is not a view that a young doctor with political ambitions in medicine can afford to espouse.

Allow time, probably a decade at least: “You’ve got to work your way up,” says one Dallas physician, who is both a student and a successful product of the system. “It’s a process that takes the better part of a decade. There is very little impulse judgment about leadership, very little room for promise. You have to prove yourself in the trenches and in combat before anybody trusts you sufficiently to advance you.”

And what is the reward at the end of this rather arduous pursuit? In the words of one of Dallas’ most successful and powerful medical politicians, “A little glory but a hell of a lot of work.” This physician estimates that his income will be cut this year by one-fourth to one-third because of the demands of looking after medicine’s political interests. “I’m not after personal gain – there is just none there. Personal pleasure? Yes, I wouldn’t do what I’m doing if I didn’t get some personal pleasure out of it.”

Medicine today is on the defensive, or at least feels that it is. In one of his recent “President’s Page” columns in the Journal, Dr. Gossard paints a grim picture of a “bleeding” profession preparing for “the arena” and being asked, in many instances by government, “to help make one’s own hanging rope.” He quotes from “The Ballad of Sir Andrew Barton” as he draws a noble picture of involvement in medical politics:

Fight on, my men, Sir Andrew says, A little ime hurt, but yett not slaine, He but laye downe and bleed awhile, And then ile rise and tight againe.

The implication: the leadership of the Dallas medical community sees itself at war with the outside world, and one can only wonder what that means for the patient.

The Most Powerful Doctors in Dallas



Dr. Charles Max Cole is a solidly-built, silver-haired physician who heads the surgical staff at Presbyterian Hospital. At the moment, he is the highest ranking: Dallas physician in American medical politics, and his close friends in the local medical community think he may well go all the way, winning the AMA presidency.

Cole takes a que será, será attitude toward that possibility, noting that he is now a member of the AMA’s powerful 15-member Board of Trustees only because of the untimely death last spring of Dr. Joe Nelson of Weatherford, whose vacant seat Cole now fills. But Cole allows himself to dream. “You know, things sometimes may fall into place. I told people a year ago that I’d never run for the board of trustees, but this year I did.”

He first caught the eye of the Dallas medical establishment as a possible highflyer in 1959 when he did an exemplary job of coordinating the Dallas Health Fair. For that effort, he was awarded the Dallas Hospital Council Award the following year. Four years later, he was given the presidency of the local medical society. Then in 1969-70, he was elected to head the Texas Medical Society.

“Cole is a very liberal man, in many respects,” says an admiring colleague. “That is, he does not drag his heels over every piece of health legislation, and he can foresee what the future of medicine logically may be. He’s an excellent administrator, and he assumes power with a modest demeanor.”

It was his handling of the Medicaid issue in Texas that convinced many of his backers that he was AMA presidency material. Cole chaired the committee that implemented the government health payment program in Texas. Describes one Dallas physician, “Whereas in a lot of other states, there was a lot of shirt-rending and screaming and hollering, that didn’t happen here, and one of the reasons is the expeditious way that Cole got his committee to recognize that Medicaid was a fact of life. He was able to persuade extremely conservative elements to work with him in his program.”

If Cole is the most powerful physician around today, there are several other doctors who can, if they choose, swing a heavy political club in medical matters:

L. S. (Buddy) Thompson, a surgeon and medical director for Southland Life Insurance Co. He’s an expert on insurance matters as they affect medicine, which was probably the reason why Texas doctors chose him to head the TMA in 1976, the year of the medical malpractice crises.

Gladys Fashena, a pediatric cardiologist, the most powerful woman in Dallas County medicine. Extremely bright, she is one of the only two original faculty members at Southwestern Medical School left. Last year, she headed the DCMS. She’s heavily committed to a variety of interests. That and a health problem may keep her from seeking national office.

Elgin Ware Jr., a former president of the DCMS, has just been elected president of the American Association of Clinical Urologists, succeeding a former president of the AMA. An “all-Dallas” product (Highland Park, Southwestern Med, Baylor Hospital internship and Parkland residency), Ware may forgo the AMA power route in the interest of his very busy practice.

Frederick Bonte, dean of Southwestern Medical School and probably the Dallas medical community’s most articulate spokesman. A radiologist, he has served as a Dallas County delegate to the TMA for the past 15 years and could go far in national medical politics if he doesn’t have higher personal priorities.

James T. Downs, an obstetrician and sometime stamp collector who is especially adept at handling delicate issues under fire. He has headed the DCMS and served in the TMA House of Delegates, demonstrating staying power and finesse in the heat of medical controversy.

Milton Davis, a thoracic (chest) sur-geon who is now vice speaker of the TMA House of Delegates. A yeoman of Dallas County medical politics, he will – if tradition holds – get a shot at the presidency of the TMA and higher things, if he chooses.

Atticus J. Gill, ex-dean and retiring professor of pathology at Southwestern Medical School and incoming vice president of the TMA. An arch conservative. Gill is still highly effective as a political administrator because of his unabrasive manner. For health reasons, he will probably not push for higher office.

Wayne Gossard, general surgeon and current president of the DCMS. This former chief pharmacist’s mate for the U. S. Navy so impressed his profs at Southwestern Medical School in the late Forties that they were wagering then that he would go far in medical politics. He both interned and did his residency at Parkland; has the credentials and demeanor to go far.