POLITICS OF BLOOD

MY TOUR OF THE squeaky-clean, six-story Wadley blood center was nearing an end. I had seen it all: the sophisticated computers, the nicely furnished waiting and donating rooms, the high-tech medical blood-processing equipment. Now it was time to view the literal heart of the center: a 30-by-30-foot refrigerated room, home to three out of every four pints of locally donated blood. When Dallas bleeds, this is the first place it turns.

“The red blood cells are kept here once they’re processed,” explained blood bank administrator Pete Smith, as he opened the heavy steel door. But to Smith’s surprise, the metal shelves on this day were virtually bare. Already loaded on a cart were 100 or so bulging plastic bags of blood-enough perhaps for one gunshot wound or a routine open-heart surgery. “Looks like we’re a little low today,” stammered the embarrassed administrator. “I’m sure that will improve as the donors come in.”

Smith claims that such bad days are rare at Dallas’ largest blood bank. But local hospital administrators and physicians disagree. They complain that our blood banks experience far too many lean days such as this Autumn Wednesday. They warn that Dallas has failed to supply itself with even the minimum blood requirements for years. The gory truth is that Dallas’ blood supply is in the red. a condition doctors refer to as a “negative blood balance.” If we were to experience a major disaster, such as a tornado or an air crash, local medical authorities cannot predict how well we could handle our emergency blood needs. Dallas requires an estimated 160,000 to 170,000 units of blood annually, and according to even the most optimistic donor figures, we give less than 115,000 units each year. As a result, local hospitals purchase blood anywhere they can. Critical shortages periodically cause doctors to postpone elective surgery until blood deficits disappear.

Why? Why have community leaders failed to raise a hue and cry over the city’s obvious shortages of blood? Why are we one of a handful of major metropolitan areas that don’t have one central blood bank? Why does the cost of blood in Dallas exceed the national average-in some cases by $20 to $30 a pint? And why are local doctors and hospital administrators powerless to determine blood collecting and distributing policies? The answer may lie in the pristine pathways to that bare vault: in the history of Wadley blood center and its founder. Dr. Joe Hill.



NOT MUCH HAS happened in recent decades to alter the blood-collection policy in Dallas. The technology has been upgraded, but since the Fifties, control of the city’s blood supply has rested largely in the hands of a secretive group of medical power brokers. These are the men who run the nonprofit Wadley Institute of Molecular Medicine, headquartered just off Harry Hines Boulevard at Research Row on a 10-acre tract of land donated in 1967 by Dallas real estate developer Leland Fikes. The Wadley blood bank is one in a cluster of early Seventies-vintage buildings nestled amid a string of cheap hotels, sleazy night-spots and run-down retail shops. Also located on the Wadley campus are the Granville C. Morton Cancer and Research Hospital, Goddard Computer Science Institute and Lee Fikes Research Institute. These institutions-financed by gifts, donations, services performed and private and governmental grants -all participate in efforts to treat and study blood, blood diseases and cancer.

The roots of the Wadley blood bank stretch back to 1948 when Arkansas philanthropist J.D. Wadley and his wife established the Wadley Foundation some five years after a beloved grandson died of leukemia at the age of 6. The J.K. and Susie L. Wadley Blood Bank and Research Institute was established in 1951 as a memorial. When the two-story facility was dedicated in 1952, the shy, soft-spoken Wadley said he was “led by God, who put the desire and wish in our hearts to give this building and equipment.”

The first Wadley center was built adjacent to Baylor Medical Center on Gaston Avenue with Wadley’s $650,000 gift; the land was donated by Baylor Hospital. Wadley built his fortune in the lumber business in Arkansas, but he later established oil and gas ventures, and operated gold mines in California and several other states. At one time, the devout Baptist held substantial interests in several hotels, including the Hilton chain. Although the blood bank was opened as a non-profit and non-sectarian operation, the Wadley Foundation has been a substantial contributor to the Baptist Church. (In tax year 1982, for instance, the Wadley Foundation contributed $486,000 to the Baptist Foundation of Texas for “missions.” 1RS records show that the books of the Wadley Foundation are kept by the Baptist Foundation.)

Wadley’s early search for a doctor to run his benevolent creation was a short one. Dr. Joe Hill had been director of the William Buchanan Blood Center at Baylor Hospital, Dallas’ first blood bank, and it seemed natural that he be chosen to run the new center. At the time, Hill was Dallas’ preeminent hematologist, head of Baylor’s pathology department and director and dean of Baylor’s graduate research institute. The Buffalo, New York, native had joined Baylor as a pathologist in 1934 after a stint as a professor of pathology and anatomy at the University of Oklahoma Medical School.

During those early years, Hill achieved a degree of notoriety as a blood researcher. In 1946, he founded and became the first president of the International Congress of Hematology. The ambitious M.D. was best known for discovering hidden antibodies, a breakthrough that led to improvement of many diagnostic tests. He also developed a new method for drying blood plasma from its frozen state-called the adtevac process- and he originated a method for large-scale production of potent anti-Rh serum, which made routine Rh blood typing possible.

“Joe Hill was a great scientist,” says Ralph Shannon, former director of the local Red Cross chapter. “When I knew him, he was very ambitious. Like any good researcher, he was intent upon his projects. However, it wasn’t easy to negotiate details with him.”

The only blemish on Hill’s career occurred in 1967, when he and Wadley became the center of a controversy involving the Institute’s leukemia research. In April of that year, Wadley called a news conference to announce a major blood cancer “breakthrough.” Hill and a team of researchers had developed a new drug called L-asparaginase, hailed as the key to an amino-acid depletion treatment. About a week later, Hill was formally censured by the Dallas County Medical Society, which called for a formal inquiry into the methods used in releasing information about the drug.

The following January, Hill turned over the reins of the blood bank to his son, Norwood, a 1961 Baylor Medical School grad who had just completed his residency in internal medicine at Parkland Hospital. The center moved in 1974 to the newly constructed $3.8-million, 89,000-square-foot building on Harry Hines. Today, Norwood remains the bank’s director, and his father, though retired, is a member of the Wadley Institute Board of Trustee.

The primary reason that Dallas has no central blood banking system today is because Joe and Norwood Hill don’t want one. The two M.D.s wield tremendous power because they’re the only doctors on the board. Most blood banks are governed by a predominance of medical personnel.



THE FIRST SERIOUS dialogue among the Dallas medical establishment about forming a centralized blood banking system came in 1963. Hospital administrators and physicians held two meetings to discuss the matter. At the time, there were five separate blood banks, and many hospital administrators were upset that they had no say in blood bank policy. But, according to Dr. James Wheeler, director of the Dallas Blood Center and current chairman of the Dallas County Medical Society’s blood bank committee, the talks accomplished nothing. “Most of us agreed that a central blood bank should be formed,” Wheeler recalls. “But Joe Hill made a statement at the second meeting that Dallas already had a central blood bank-and that it was Wadley.”

“We never could come to a meeting of the minds,” says Bolton Boone, then administrator of Methodist Hospital. “We had trouble getting agreement among the pathologists. They didn’t want to see one man calling the shots. I think they were afraid to surrender too much power to one man.”

Those who participated in the talks were left with a bitter aftertaste. The political lines were clearly drawn, and the controversy was fueled again in the late Sixties when the Dallas Association of Life Underwriters decided to support Wadley’s blood security program. The issue became a hot potato when the Dallas County Medical Society also recommended that the group support the other blood banks’ life membership plans. When the underwriters agreed, Wadley pulled out, leaving more hard feelings among blood bank officials in its wake.

Then, in 1970, the medical society tried for the last time to reach an agreement. It chose Dr. Charles Sprague, then dean of Southwestern Medical School, to lead another effort to form a central blood bank. Sprague, a hematologist, was the former president of Tulane Medical School and had supervised a blood bank in New Orleans. A proposal stated that “by centralizing facilities, much of the present duplication of effort and unnecessary outdating of blood will be avoided. By centralization of blood bank facilities, the public relations aspects, vital in the operation of blood recruitment and public support, can be expected to be much improved.”

Several meetings that year were attended by physicians, hospital administrators and blood bank officials, who discussed the possible formation of a central effort. Officials from the Red Cross, which collects roughly 50 percent of the U.S. blood supply in chapters throughout the country, attended at least two of the meetings. Says Shannon, “In past years, we had made offers to the medical society to look at a central Red Cross blood bank when the medical authorities determined they wanted it. We had a man from Washington attend two of the 1970 meetings. It seemed the group was at the point of recognizing that a Red Cross chapter would be the best one. But we never heard anything more. The medical society never told us why they chose not to establish a central bank. But it was evident when the medical society was trying to get a central blood bank that mere was a tremendous amount of power in the Wadley organization.”

“There was considerable resistance from the Wadley group toward a central blood bank,” recalls Sprague, now president of Southwestern. “And there was a lot of tension between the hospitals and Wadley. The personality conflicts made it a major effort. I think Wadley already felt they were serving in the capacity of a central blood bank. The tensions have lessened, but it’s my impression that things in the blood banking community are pretty much like they were then-chopped up.”

A new entry to the field-the Dallas Blood Center-was formed in 1973 by James Wheeler and medical administrator Lynn Parker to “fill a gap” in Dallas’ blood needs. At last count, the blood bank on Gaston Avenue (not far from Baylor) recruited about 14,000 blood donors a year, making it the third largest in Dallas. Wheeler claims he and Joe Hill never got along very well in the past because, as a hematologist, Wheeler was viewed as Hill’s competitor when he first came to Dallas from Johns Hopkins Medical School in 1961. Despite a historic personal rivalry, Wheeler says he respects Hill, and Wadley’s blood bank efforts. “All the blood banks in Dallas are good banks,” he says. “There’s no question about it.”

Today, there are four competing nonprofit blood collection agencies: Wadley, the Dallas Blood Center and Parkland and Presbyterian hospitals. While competition is healthy for many products, in the blood business, it’s not. Competitive agencies require a duplication of equipment, personnel and administrative efforts. “You always have a problem when there is more than a single blood collecting organization in town,” says Parkland’s Ed Stean. “It confuses the donors. It causes donor wars. The blood banks mark out their own territories and tell each other ’These donors belong to me.’” In most large cities, five percent of the eligible donor population gives blood. In Dallas, that average is slightly less than four percent.

In addition, the cost of blood in Dallas exceeds national averages. Wadley, which collects more than four times as much blood as any of the other Dallas blood banks, sells its red blood cells to area hospitals for about $60 a pint; in recent years, it has charged as much as $74 dollars a pint. (State law no longer allows blood collection agencies to pay donors for giving blood, nor does it permit them to make a profit on its sale to hospitals.) In contrast, a recent survey showed that the centralized blood bank in Fort Worth sells blood for about $42 a pint. Blood supplies purchased from the regional clearinghouse of the American Association of Blood Banks (which ship blood to Dallas from all over the country) sometimes cost as little as $40 a pint.

Although tensions have abated during the last decade, the blood supply continues to hamper local medical efforts. Says Stean: “Blood shortages are now approaching a critical level, and we are having to call on someone else for shipments of blood far more frequently than one would expect for a city the size of Dallas. We have a deficit situation in this community. A community of this size should be able to supply itself. We don’t do that. We [Parkland] buy blood anywhere we can lay our hands on it-from Houston, Oklahoma City, Lubbock, Phoenix.”

Similarly, officials at Presbyterian’s blood bank say they are unable to supply even their own hospital’s minimum blood requirements. Last year, Presbyterian recruited 2,700 donors, but used more than 7,000 units of red blood cells. The hospital fills the gap by buying blood from Wadley, the Red Cross in Wichita Falls and the American Association of Blood Banks’ clearinghouse.

Some medical officials continue to voice frustration that they have no say in such decisions as the hours that donor centers are open, when emergency drawings are necessary or what decides which patient is in the greatest need of blood. Says Stean, “Quite honestly, I think that’s a very serious problem

Perhaps one reason there has been little effort to rectify the blood shortage issues is that the powers that be in Dallas have ignored it. Ruth Guy, director of the Parkland Blood Bank for 25 years before she retired in 1978, says, “I guess it’s just not a fashionable issue. Nothing will get done until some wealthy person or his family requires a tremendous amount of blood. Then something might happen.” A prominent Dallas pathologist agrees: “Dallas is a powerful, bustling community, and our leaders have this attitude that nothing is too good for Dallas when it comes to the things that money can buy. Well, blood is one commodity that money can’t buy, and no one has really taken the personal responsibility to see that we have an ample supply. Blood is something you can’t buy like a product off the shelf. The medical community has initiated some efforts in this area, but our community leaders have never addressed the problem,”

Even as vocal a critic as Wheeler seems mollified. He describes the atmosphere of the current medical society’s blood bank committee, which includes representation from each of the four banks, as “very cordial. We meet about once a year and sit down to dinner to discuss common problems. But we don’t serve alcohol. We don’t want any body to get boisterous.” Wheeler claims that despite the evidence, there are no uproars in the medical community for a central blood bank. “It might not really be something that would be in the best interests of this community,” he says. “We’re doing all right. I’d hate to see us reopen the hard feelings and differences that might have existed in the past. I’d hate to rock the boat. But if to morrow someone said, ’Let’s have a central blood bank,’ I’d be in there pitching for it.”