Robert Emerson Windom oral history interview

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Robert Emerson Windom oral history interview

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Robert Emerson Windom oral history interview
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University of South Florida -- Library. -- Special & Digital Collections. -- Oral History Program

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Oral history ( local )
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Full cataloging of this resource is underway and will replace this temporary record when complete.
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interviewed by E. Charlton Prather.

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University of South Florida Library
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University of South Florida
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C53-00039 ( USFLDC DOI )
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subfield code a C53-000392 USFLDC DOI0 245 Robert Emerson Windom oral history interviewh [electronic resource] /c interviewed by E. Charlton Prather.500 Full cataloging of this resource is underway and will replace this temporary record when complete.Transcription and timecoding of this interview is underway and will be added when complete. At that time the audio link will be replaced with the OHPi player link (player supporting syncronized audio and full-text transcription).7 655 Oral history.localOnline audio.local710 University of South Florida.b Library.Special & Digital Collections.Oral History Program.1 773 t USF College of Public Health oral history project4 856 u http://digital.lib.usf.edu/?c53.39


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text Charlie E. Prather (CP): Say to our audience that were privileged to have you here, Dr. Bob Windom of Sarasota. Dr. Windom is a former lot of things. Hes an internist from Sarasota, but thats not the reason we have special interest in him today. Hes former president of Florida Medical Association and was in that position over a period of some crisis moments in the movement of Floridas public health activities.
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Hes also a past president of the Florida Heart Association and has some very notable things there, and I cant separate that experience with the Florida Heart from public health history. But, notable also, hes a former assistant secretary for health with the HHS for the federal, oh shoot, public health service.
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Robert Emerson Windom (RW): Health and Human Services and in that was the public health service.
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CP: Yeah. Thank you, thank you, thank you. During the Reagan administration, does it comes with great experience in public health and has been a witness to significant events in the public health history of both the nation and of Florida. Dr. Robert Windom, its a pleasure to have you here. Tell me, how it is you got interested in public health as a title?
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RW: Well, first of all, Dr. Prather, its a privilege for me to always be in your presence because you have been a shining light in Florida in public health. Dont let anybody deny it, and dont you deny it. And I respected you for many years, so its always an honor just to be with you and to chat about old times.
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CP: Thank you, Dr. Windom. I remember that I served in your administration as the president of Florida Medical Association. Thats a highlight of my career.
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RW: Thats right. We had good times together.
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CP: Yeah, we did.
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RW: But you asked how I got interested in public health. Well, first of all, you mentioned that I am an internist by training from Duke University and came to Sarasota, where I had gone to high school. Came back there in the 60s to practice internal medicine.
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And in the time of the early 60s, I also knew our health officer, at that time, the director of our local public health unit, health department, a fine gentleman who was very active in our local county medical society meetings. And he would bring up issues that we would discuss.
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And, of course, we all remember the Sabin vaccine Sunday and the time that public health and the doctors got together and volunteered their time to work on a community wide basis. And that was the realization to me that, as a physician, taking care of a patient, one must look at a physician as he looks at the whole community in which he resides. So that was sort of an interesting aspect that I became aware of.
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And then, in the late 60s, I never shall forget the Constitutional Revision Board and the act that they took when they said, Were going to take the Department of Health away and put it into this superstructure.
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CP: In essence, they were going to abolish public health, as we know it, in this state.
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RW: Thats right. And during those years, up to that point in time, I had been aware of how outstanding our state department of health was and recognized how well it was. And how well it worked with our counties and the state office.
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And then, in the early 70s, I became president of the Florida Heart Association in 1972. Well, working in that organization, working my way up, it became very clear to me that I was seeing, in these meetings of committees that we all get together, a lack of physicians there but a large number of lay people.
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CP: Thank you for that, go ahead.
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RW: It was lay people who were there for one reason. They werent doctors, nurses, or anything. They had a vested interest in that particular problem, either from themselves having heart disease, a relative having had it, or so forth.
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But that interest that they had made them come together with the idea that they want to enhance education about heart disease, so I served with them. I tried to get one of my colleagues to be a part of it. But again, theres even a reluctance of many doctors to take time to participate. And Id say to them, Well, youve got to work on committees. You cant be president when you first walk in the door.
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It takes time. Work your way up. And you can do it in the Cancer Society, or you can do it in the Lungany association, but take some volunteer agency, and youll be so pleased to see the support that people put into it.
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CP: And a lot of personal satisfaction. Once they get in it, they recognize it. Im sorry. Im sorry. This is your talk.
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RW: Not at all. I want you to interrupt all the time, you can. But what they were doing, Dr. PratherIll call you Skeeter, if I may.
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CP: Please do.
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RW: Skeeter, weve known you as Skeeter.
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CP: Yes.
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RW: Skeeter, what was pointed out to me was that if this is a group of people in a community interested in one specific aspect and trying to educate people about that, its important to get people in all phases to become involved, the citizens in the community, because if you dont have the citizens, the ones youre serving, how can I, as a physician or any physician, change somebodys habit if they arent educated as to why?
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CP: Thats public health, Dr. Windom.
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RW: Thats right. Thats right.
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CP: Go ahead.
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RW: Thats right. And you know as well as I do. And it happens today, it happened eons ago. The public does not think that the doctor spends any time in prevention.
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CP: That is so true.
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RW: But I will tell you that is not true, though. Thats what they think, but its a falsehood of what they are thinking. And back in the 60s, as I said, in early 70s when I was active in the Heart Association, in my office every patient received a pamphlet on heart disease, lower cholesterol, exercise. We gave them out. The Heart Association had them by the bushels.
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CP: That was before cholesterol became awhats the word?
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RW: Widely popular, popular. But at least in the medical professional we knew the importance of it.
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CP: Yes, we did.
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RW: And so we would hand these out. And wed tell the patient, Now, this is what wed like for you to do, but heres a way to take it home and remember it better, learn it better. And the patient would go home and tell the wife, Oh, how did the doctorwhat did he say? Oh, Im fine, just fine. He gave me this piece of paper. And never looked at it again.
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You see? The problem of treatment prevention education does not fall on the fault of the physician. It falls, primarily, on the fault of the recipient wanting to accept what is a change in a lifestyle that these people dont want to change or have difficulty changing.
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CP: So true.
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RW: That is so true today as it was then. So anyway, back in those days of the early 70s when this change had occurred already in our health department in Florida, there was still a health officer, Dr. Sowder as you
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CP: Yes.
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RW: We all
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CP:love, love.
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RW: His history we love.
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CP: Love, love, yes.
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RW: Youve already recorded all about Dr. Sowder. But anyway, his power and his base was changed what, in 1968 wasnt it or 70?
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CP: In 69, effective July 1no, January 1, 69.
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RW: So, after that, he was still in leadership to a degree, but he was enmeshed in a hierarchy
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CP: Large bureaucracy. And he reported to a secretary. And the secretary was a nonprofessional in the sense of things medicine or preventative medicine or public health or any of what was called HRS. He was a mathematician.
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RW: Thats right. Lost all the power and respectnot the respect, but the power he had. So anyway, during the 70s, after I was president of the Heart Association in 72, in 76, I became secretary of the Florida Medical Association and became more involved in its activities.
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And around 74 or 5, I was working in that area, toward that area, became aware to me and to another very distinguished colleague, Dr. Gerry Schiebler. Do you know him?
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CP: Oh yes.
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RW: Dr. Gerold Schiebler. Dr. Schiebler was the, as you know, professor, chairman of pediatrics at the time at the University of Florida. He was also past president of the Florida Heart Association. He followed me as president.
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And he was very interested in rheumatic heart disease as it affected young people. Hes a pediatrician, and thats what his focus was. I, at that time, was active in the Florida Medical, understanding this importance of rheumatic heart disease.
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And so we said we needed to form a coalition or a task force to look at this problem, and how we can improve it or try to correct it. So we got together; they had Florida Medical; I represented Florida Heart; Dr. Schiebler, Dr. Sowder, at that time, in his position as health officer for the department, as it was. But it took us four years.
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My point is, at that point in time when we introduced our program, to get his hierarchy and his bureaucracy to accept what he wanted to do and for us to get it all maneuvered together, it took about four years to get the legislature to adopt a rheumatic fever control program.
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Which meant that we would identify Streptococcal infection in the doctors offices, report them, treat the patient properly. And we could eradicate rheumatic heart disease; wipe it off the map.
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CP: Yes, we could. Theoretically, its possible, yeah.
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RW: And it wasnt expensive. It wasnt expensive. But once you got the patient, who developed rheumatic heart disease with the valvular compromise and then later on all the costs of that, it was a tremendous saving.
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So anyway, we got it started. But the sad part of it is that after it got started, it took so long to get going because the public health program was weakening. And then Dr. Sowder was even lessened in his position. And subsequently, today, that residual of that program is very limited. Some reporting is still going on. But it is not this coalition of Florida Medical, Florida Heart, and the Public Health.
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CP: You need a spotlight to keep it lighted with a special program, and that was lost.
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RW: But Im optimistic, though, when we have this new department of health today. That this will go back and revitalize this and bring it up and really work as a preventive program.
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CP: Oh, yes, yes, yes, yes. Okay, good.
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RW: Well, thats so, then that again was another reason and another example of my going from practice per se, every day at practice, to focusing on some areas that related to public health.
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CP: Very distinctly, and it took a public health approach to do something about that. You and your private office could really never have an impact on the prevalence of rheumatic fever in this state.
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RW: No way, in fact, and I was doing internal medicine and adult medicine, the instance of strep infections is limited compared to that of pediatric AIDS, so the family practitioner and the pediatrician were the primary doctors who were seeing so much of these streptococcal diseases. So anywayand also we had the support of a Dr. Ayoub whos one of the worlds leading infectious disease experts at the University of Florida. So were not
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CP: Yes, with a special interest in rheumatic fever, too, and strep disease.
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RW: Exactly. So not only do we have organized medicine, we had the voluntary health agency, the State Department of Health, as it was, and the academic centers.
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CP: The universities.
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RW: So youve got great coalition there. And Im hoping that
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CP: Thats the recipe for successful programming.
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RW: Thats right. And what were seeing today, Skeeter, in the programs that are going on and looking at bringing together these two disciplines of public health and organized medicine again, I think were going to come back. The future was going to be very good for what we had before.
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CP: Yeah, it is. Yeah, a return to the future.
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RW: A return from the past.
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CP: Go back to the future.
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RW: Go back to theyeah.
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CP: Yeah, thats great. Yes, yes, yes. I recently saw that the New Yorkuh, no, the Academy of Medicine, is taking on Florida as an example of the uniqueness of the cooperation for the public good between organized medicine and the public health organizations.
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RW: I attended that task force meeting just a few weeks ago, the last, sort of the wrap up of their year session of where theyve had interviews around the state like how to bring public health and organized medicine together. And, at that session, just a few weeks ago, I understand that the New York Academy of Medicine, which is putting togetherthey had some 600 types of input around the country of how programs were working.
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They were able to take only 20 of those, and Florida was one that they were going to use as a site as a prime example of how revitalization of public health, and then the relationship of the private sector, is working.
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CP: Oh, it is so important. You know, the public health folks have known all along that without the cooperation of the physicians who see the patients, public health programming is suffering without the willful cooperation and vice versa. You know, you who have an orientation to the publics welfare, the publics health, youre stymied unless you have the cooperation of the organized public health department.
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RW: Thats right.
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CP: And our goals are the same, we use a different language toexcuse me, Im talking too much. But Im just agreeing with you. Im just appreciating what youre saying.
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RW: The goals are the same. But, you know, Skeeter, what happened in the past to cause this separation in Florida more, was when they went to the regions of the state and separated the liaison from the region to the Department of Health as far as a good, direct line. So that really
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CP: Oh, there was not a direct line?
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RW: Theres no direct line. And so, if you go to your local public health unit, as they called it, and you had problems, well, theyd have to go to the region, to that doctor, who was under another administrator and go to the HRS, so that doctor who was enmeshed in another administratorit was frustrating.
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CP: Before you got to the experts in the matters of the publics health.
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RW: And that points out their whole purpose of public health: to provide health for the public. If we have an epidemic, a sudden outbreak, or whatever, how could you mobilize any forces when you had that type of obstruction?
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CP: Almost impossible.
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RW: Impossible. But now, we had that in 1960. We had a wonderful liaison. Were back to that today, starting to get back to it with a new department of health, the direct line to the physicians at the public health department and to, then, the county societies.
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You and I have talked about this before. And this is sort of a little pet peeve we both have: the importance of the county health officer. And I say that that should be a physician.
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CP: I agree.
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RW: There are circumstances where
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CP: And I think he must be a formal part of the county medical society.
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RW: Thats right. And I dont want to lessen the impact of the other public health people who may serve in that position because of whats happened over the years. But now, I think once we get back into what it used to be, we need to reform the program so that that physicianman or womanand then that person who goes to the public health, I mean, to the county society meetings.
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The doctors in the community then hear, and then also that public health doctor will go to the hospital and will talk to the doctors there because a lot of opportunities where they do work together, particularly in the community clinics, that they need to have a liaison with and know what medicine is, how to deliver it.
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CP: As the state epidemiologist for your state, I had complimentary staff appointments to a number of hospitals in Florida. I was there, and I was notified of all their staff meetings. And I went to their clinical rounds and as many staff meetings, but I had, at one time, I was on the complimentary staff of like 19 Florida hospitals.
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RW: See, isnt that wonderful? And those hospitals benefited and got to become more knowledgeable about epidemiology.
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CP: Yeah, they did. Yeah, they did. And it was great. But that, to me, is the relationship between public health and the practicing physician. The practicing physician is the eye of the public health organization, in terms of disease prevention.
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RW: Right, exactly.
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CP: Well, you and I agree. Were preaching to the choir.
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RW: Choir, right. Youre the director of the choir; Im just singing with you. But the other thing weve got to realize is that the public health service or the health department over the years, because of however the system evolved, got into the delivery of healthcare.
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And I think that theyre spending their timeit was thought maybe this is an indigent health service. And they were having doctors taking care of patients in the area who were indigent. Well, that takes away from public health. What is their primary role?
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And so, when they take away their primary role and put it into seeing sick patients then were compromising the public health of the whole community by the fact that were not doing the immunizations properly, as well; were not doing surveillance, epidemiology, sanitation, all those things. So I hope, and I think that we will see that changing
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CP: It already has.
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RW: It already has. So if we separate the delivery and put into communities clinics separate from the health department, maybe a liaison, but separate and let those be funded independent from what wed have to do with public health.
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CP: Im agreeing with you. Im just sitting here anxious to useone of my pet peeves is that, I know all the explanation, but I wont waste your time and tell you, but I would like for you, when youre talking about care of the sick, I want you to use medical care. When youre talking about care of the well, talk about health care. We have confused the American public by talking, by including everything healthcare
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RW: Its sick
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CP: Do you go into a hospital for healthcare?
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RW: Thats right, thats right, its sick
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CP: No, you dont.
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RW: Its sick care.
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CP: Thats one of my favorite peeves.
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RW: Well, I share it with you, and I hope that whatever little effect what were talking about will have, that those who come behind us will recall the importance of this
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CP: Oh, I totally agree.
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RW: Yeah, yeah, yeah.
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CP: Well, you had a good introduction into public health in the sense of you recognizing the need for a community, combined approach to a problem, thats public health. And you came through it through a very interestingI didnt know that piece of history, but I loved that. And it ultimately ended up with your being, kind of, the chief health officer for the nation in a funny sort of way.
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RW: Well, it did come out as a funny sort of way, and it was a very happy way for me, anyway.
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CP: Yeah, talk about that some. Talk about your appointment to the public health service.
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RW: Well, as I was involved in the 70s and 80s60s and 70s, with these things weve talked about. I was very disturbed in 65, 67 when Medicare/Medicaid came about. And we heard from the great orator of medicine, Dr. Ed Annis. Our great doctor from Miami who still is just as viable at 82 years old.
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Dr. Annis, in his presentation to the country from Madison Square Garden, pointed out that if we go with this type of government program, Doctors, youll find, that the government is going to tell you when you can admit your patient. The government is going to tell you how long your patient can stay in the hospital.
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The government is going to tell you what you can do to your patient. Dont accept this program. Accept the one where we support those who need the care, not just categorically to everybody just because theyre 65 years of age. Well, that was his message. And, in giving that message, he failed. Congress did not go along, and the Great Society Program intervened.
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Well, that was 67, 66. From that point on, I was seeing then government intervening in our practices, government requiring more. So I said, You know, you can sit back and accept all of this government direction, but if youre starting to interfere with healthcare, nobody is going to do anything. They said, Talk to those people who are making the decisions, who are writing the laws.
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CP: As an aside, who was directing the governmental effort? Was it doctors?
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RW: Oh, excuse me, back with the government?
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CP: Yeah, who was directing
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RW: Oh, no, no, excuse me
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CP: It was accountants.
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RW: Oh certainly, these people that were in the management of the Medicare/Medicaid program were not physicians is right.
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CP: No, and their goal was not the healthcare, the medical care, folks. Go ahead.
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RW: Yes, it was just the monetary aspect. It was just the monetary aspect. But, to start off, you know, it was really very nice to many people. I remember, in my office, a patient would come in prior to Medicare and Id say, Youll come back next year or two years, well do another checkup. Thats what we need to do then. You dont need to see me just for everything.
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Medicare comes in, heres a patient calling in the next week after theyve been seen before, Oh, doctor, Ive got this little problem. Well, you dont need to come in for Well, dont worry, doctor, Medicares going to pay for it. Youre going to get paid. Sure, dont worry about it. So we were besieged.
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CP: Thats not the point.
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RW: We were besieged by people wanting to seek care, take our time, for services that they could handle themselves so much of the time. So then that was when Medicare was very gracious. Also, wonderful Great Society program, its only going to cost six billion dollars. Thats all, six billion.
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CP: Just six billion.
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RW: Lyndon Johnson said, (unintelligible) throw in the extended nursing home care, thats only three billion more. Thats not nine billion. We can afford that. Now, were up to over 250, almost 300 billion with those two programs.
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CP: Thats correct.
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RW: Ed Annis was right. So anyway, we saw what happened coming up, government couldnt afford that. They went to DRGs, cutting back. Theyre now controlling the resource base, the value studies, and all that. So, a long story short was, I was seeing government intervening along the way in the late 60s and 70s.
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CP: And increasingly.
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RW: Increasingly so. So, as I said, we need to talk to those who do write the laws. So I got involved in supporting, in the sense of trying to meet our congressmen. There was an organization of a senatorial group, which I joined, to go to Washington about three or four times a year to meet with the senators of the Republican party. There are two parties, as you know.
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CP: Well, yes, thats right.
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RW: Thats right. And so I happened to choose one. And, at that point, you went to those meetings. So, from the mid-70s on, I got to know quite a few Republican senators.
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I want to point out one thing right now. People say, Well, you buy your way. You influence them by buying into it. You dont. I can tell you, guarantee that nothing that they did ever was based upon the money I had donated.
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CP: I found that distinct legislature.
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RW: It is based upon getting to know the person, that theyll know youre a human being.
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CP: Rapport and respect.
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RW: Right.
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CP: And trustworthiness for your factual information is critical.
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RW: My whole point has always been, all I ever wanted to do, is to give the elected person the best knowledge I had about the medical issue of which they were discussing. I want them to be truly informed because, as you know, a politician serving in a state or county government, state, federal government, theres no way that person knows everything about everything.
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CP: No way.
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RW: They do need the input. So, therefore, I would hope to give them the best input. They go ahead and make their decisions, they pass a law is against what I said, but at least I know that they had the input, and they had the right to make the decision. I guess what I wanted. You know that. So anyway
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CP: But I want them to have good information. I want him to have fair information.
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RW: Thats all.
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CP: And balanced information.
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RW: Thats right.
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CP: And I got an obligation to see to it that he gets my unique expertise piece of that.
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RW: Thats right.
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CP: Go ahead. Im liking what youre saying. Go ahead.
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RW: And not to say that I own you, and Ive put my money into it, so forth. So, anyway, over the years of having become a friend of a number of the senators, I said, If theres ever an opportunity where I could provide some of my expertise in the federal system, I would like to be considered. And so my name was in, some of these people said, Okay fine.
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So they put my name into the [Executive] Office of the President and the Office of Personnel [Management]. And that sits in a file. And its there for a period of time, maybe for several years. Nothing happened. But then, in 1986, in December, noexcuse me, in 85, December 85, Dr. Otis Bowen was selected as a secretary of HHS.
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Dr. Bowen, as you know, we know, a family practitioner from Bremen, Indiana, 3,000, 2,000 people. He went from general practice to state legislature to Speaker of the House of legislature, governor, governor twice. And during his term as governor, Dr. Bowen, in that leadership role, was able to make their legislature aware of the fact that they had to put a cap on professional liability.
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And they put a cap at $100,000 on professional liability for pain and suffering. And this is what has been a model for the nation; today still exists. As you know, what weve done in Florida fighting that issue, we still have not accomplished as what we need to. California has a $250,000 cap.
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So, anyway, Dr. Bowen, a great man of public health and legislative health, was appointed. So, in his job, December of 85, January of 86, he has to go through a list of people and so forth that are on the presidential list. Plus, he has other people.
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So in February of 86, I got a call to come up and had a visit with his deputy. And they said (inaudible). I said, Okay. Well talk to you later. A couple of weeks later I got a call and it said, When can you come up? We have something important to talk to you about. Can you come up this week? I said, Well, I can be up there tomorrow.
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So I got on a plane, went up there tomorrow, got up there, and sat down. And I met with, like I said, the deputy, and he said, I want you, (inaudible) we like your interview, and wed like for you to come in and meet Dr. Bowen. So we walk in, and we sit down, and Dr. Bowens in his big desk there, and I sit down in front of him, Hello, Dr. Bowen. I had never met him personally, but I certainly had known of him.
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CP: Oh, everybody knew him.
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RW: He said, Yes, Dr. Windom, were glad youre here. And we would like to offer you the job of I said, What job? Job of assistant secretary for health.
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I said, Dr. Bowen, are you sure you know what youre talking about? And he said, Yes. We want you to, if you will, accept the job of assistant secretary for health. So, I said, Well, thank you, and thats a mighty great challenge and offer. And let me think about it because I have to talk to my wife.
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So we had a little visit, and I left and went out to meet his chief of staff, whom I never met. And we were talking there, and the chief of staff said, You better call your wife. So I called and broke the news to her and shocked her a little bit because she didnt want to leave too much from our little small Sarasota to go to big Washington. So, anyway, it worked out, and she accepted it.
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I called back a couple of days later and said, Fine. So that was in about February of 86. So to go through the process once I accepted his appointment, which came from hishe had to have my name accepted and approved by the president before he could make anybodys appointment. So that had been already cleared. President Reagan had accepted his choice of me.
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Well now, Im not in the job yet. So, I have to be confirmed by the United States Senate. There are about 550 or maybe 600 now in the federal government, there are that many presidential appointees that have to be approved by the Senate. So that takes about three months to go through, because I had a lot of learning to do.
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CP: Oh, Im sure you did.
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RW: So I started going up on a basis of about three or four days a week from February, on until June when I was through the hearings. I went to the Senate hearings, and I was introduced to the Senate by Lawton Chiles and by Paula Hawkins. And they both made their little speech as youve seen them make for everybody.
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And then, I had the whole health services committee, Health Welfare Senate Committee [Labor and Human Resources], and President Kennedy, not President Kennedy. Senator Kennedy was chairman. And he had the routine questions. Senator Kennedy, who was very adamant in a way of saying, Well, how much public service have you had?
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So I tried to give a little history. Well, thats not much. What kind of administration have you had? Well, president of the Heart Association. Well, thats not much. So really, he said, You know, Dr. Windom, Im going to approve you, but I really dont think youve had that much experience in public health, but since President Reagan is, and so forth, Im going to approve you.
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And the whole committee unanimously approved me, thank goodness. So, after that, he and I got to be friends. Wed see each other, and I think that by the end of the three years I was there, he acknowledged the fact that I had learned a lot anyway. On-the-job training, I guess.
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So that meant I had to leave my practice. And I had been in practice at that time about 30lets see, from 60 to 8626 years. And it was a big decision to make because I was 56 at the time. And my question was to whether to continue in practice and relax and enjoy life that way, or make a major change in closing down everything in Sarasota and going up there for three years.
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But I wouldnt exchange it for anything in the world. And my wife, she did enjoy it. It was a great experience. And Ill point out one thing that is a disadvantage to that type of an appointment: that once one gets in, you have to have a learning curve.
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CP: Oh, Im sure.
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RW: So it takes you months, or so forth, or to a year to really get you a good feeling. So, by the time youre in a position to have some knowledge of how this person is doing something wrong to get in there and really work on it, you are about ready to go out. But you are just getting on the crest of, the crest rather
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CP: Of how the system works.
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RW: Of how it works, and how you can really implement some things you want to do because you know how it works. Boom. Youve got to appointment somebody else. A new administration comes in, and they get somebody else.
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CP: Ive heard that a lot, particularly in the federal, higher-level, federal positions, and how come the long-time bureaucrats are so influential. You have to trust them until you know for sure you cant.
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RW: Well, Ill tell you what, that was interesting in my knowledge of the HHS, Health and Human Services, the largest department in our federal government, just like HRS was at one time. It was largest in Florida government in many states. But
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CP: It was the largest department of state government, of all states
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RW:in the nation. Thats right. Because HHS had the Social Security, had the HIPAA, had family services, and public health was only, at that time, a 12 billion dollar budget out of 600 billion. So, you see, we were just like pocket change. But my division, as the assistant secretary of health, ran the whole public health service. And I want to point out, as were talking today, next year, 1998, will be the 200th birthday of the US Public Health Service.
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CP: That is correct.
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RW: It started 1798, under President Adams. And his reason for starting it was that our various businesses at that time, industry, had some shipping up and down, and sailors taking ships up and down the eastern seaboard. And a lot of these seamen were getting sick and so forth, and they set up the marine hospitals at that time. Little small areas where, along the eastern seaboard
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CP: Really, infirmaries.
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RW: Infirmaries, right, to take care of the sick sailors. And, its interesting, after that got started, they had to pay for it. And so they said, How are we going to finance it? It was in the Department of Treasury at that time, the Marine Hospital. And they said, Okay, well just take 25 cents out of every sailors monthly check.
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So, every sailor, 25 cents a month went into this fund to help take care of the sick sailors. Thats our first prepaid health program in the history of this country.
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CP: Yeah, it was.
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RW: Isnt that something?
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CP: Ah, I love it.
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RW: Twenty-five cents.
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CP: I love it.
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RW: So those are the great days of public health. It changed, of course, in many ways. But one thing Id like to point out today is that, for many years, they were treating sick people.
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They had more hospitals around the country, public health hospitals, but in the early 80s, under President Reagan, he felt that the public health should not be in the delivering health care. And they closed down these hospitals. They were all closed down by 83 or 4, and the Public Health Service is out of patient care and doing the things that public health should do.
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CP: Supposed to be doing.
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RW: Research, prevention, epidemiology, surveillance, sanitation, and all that. And now, we are hopefully seeing that public health in Florida will get out, as much as possible, of direct health care and do the things that they do well.
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CP: Theres others who are better prepared for providing medical care. And thats their motivation. Thats what they want to do, you know.
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RW: Thats exactly right. So
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CP: Its misconceived that, since were already funding those doctors and nurses that the health department has, just tell them to take care of the sick. It was a cost avoidance move, which was contrary to the best interest of Florida, as far as Im concerned.
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RW: You and I remember days gone by when I was first in the early 60s in the medical society at home. We did spend time taking care of charity patients before Medicare. In our offices we would see them. In the hospital emergency room, you would see them, and youd never get paid.
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And then Medicare, of course, came in and started paying, but in public health we, then the department, started taking over because doctors were doing their own thing again. But we can go back to say, Keep the funding we need for public health in this direction and have another funding for the clinics we may need
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CP: Totally separate pocket over there.
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RW: You cant have all doctors volunteer all the time. Theyre doing a lot of that in Florida, as you know.
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CP: The Sarasota special clinic. You got a special clinic for senior.
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RW: Okay, now, Ill tell you
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CP: Who did that? Now, you were involved with that. Thats good public health from a medical practice point of view.
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RW: In 1978, Dr. Irwin Portner, P-o-r-t-n-e-r, came down from Philadelphia. Hes a family practitioner. And he had Legionnaires disease; acquired that in Philadelphia in a hotel. And he saw a lot of those patients, and he got Legionnaires disease. And he was probably, at that time, in his early, late 60s.
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And he came to Sarasota to sort of convalesce. And in Sarasota, at that time, we had a program called Senior Friendship Center candlelight dinner. So this was a group formed by a Bro. Bill Geenen. Brother Geenen was of a church discipline, was not a Catholic, it was, I forget the name of it, was it
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CP: Episcopal?
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RW: Well, wasnt Episcopal, it was anotherFather Bill Geenen. But anyway, his whole mission was to help the underserved. And they had a community candlelight dinner for people in the community who couldnt afford a full meal. They came in.
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Well, Dr. Portner met Brother Geenen and liked him very much. And Dr. Portner said, You know, these people also need healthcare, sick care. They are senior citizens who arent getting the benefits of anything, Medicare or anything. Theyre not in that qualification, they are too much or too below.
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So, anyway, so we need to form some kind of health program. So they agreed to that, but Dr. Portner, in his wisdom, said, You know, youre not going to get this through unless you work with the county doctors in Sarasota who will support this because they dont want you to be taking quote, patients, from them, Eddie. They get worried about that, so they said, Okay.
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Well, Dr.Bro. Geenen knew me quite well as a friend, too. He said, Why dont we get Bob Windom because he is very active in the Florida Medical, and hes been president of our county society here. So they called me, and I met with the three of them. And the idea was wonderful.
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And so we talked to Henry Morton. Who, at that time, was our health officer. Dr. Morton, a pediatrician who was doing the health office job at that time. And we went to the county medical society.
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And I presented it to them, so that they would hear their viewpoints and everything, and assured them that this was going to really help them because it was going to be taking care of people that werent in the system already, secondly, couldnt afford the system. And it gave these doctors who were going to be involved the opportunity to continue their expertise.
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CP: Yeah, these are, for the record, retired physicians now living in Sarasota with their focus on medical.
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RW: That was it: to get the retired physician who wanted to be involved. And Dr. Portner, of course, did. He said, Well, Im not going back to Philadelphia. And hes going to stay down here and run this program. So he got the county doctors to do it.
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Then Henry Morton with I, we flew to Jacksonville and met with the Board of Governors of the Florida Medical Association. And they gave their stamp of approval, so we knew that the state doctors in organized medicine accepted it. Then we went to doctorwho was it? Dr. Sowder then, I believe, to explain it to him.
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CP: You went to the board of health.
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RW: Board of health.
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CP: You met before the board of health.
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RW: That was it.
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CP: I remember yours and his presence there.
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RW: Right, and then we explained it to them what we wanted to do. And that got their sanction so we covered all our bases and the profirst of all, we had to figure out how to get them licensed. These were retired doctors in Sarasota who had left their practice and were licensed elsewhere.
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So, they set up this program of licensing through the state, to the county health department, through the state so that the doctor had his sovereign immunity from the state.
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CP: And he worked on the auspices of the county health department.
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RW: And he worked under
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CP: jurisdiction of the county health department.
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RW: Thats right, and he only did work in that particular clinic environment. So, really, was no threat to anybody. And it gave them the opportunity to do the things they wanted to do.
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CP: And competent physicians. Just beingoh, yeah, that was a marvelous program.
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RW: And now, over time, today, they have about 50 physicians, I believe, in the program. Of course, they may work only half a day or a day a week, but then theyre away for summer. But they still have a cadre there, year round. And this expanded down to Fort Myers and to Naples and over in the East Coast, and its throughout other areas of Florida.
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CP: And the nation.
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RW: The nation gave the
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CP:the example, that the example has been picked up. There are several locations in Texas, for example, and retired places that Im personally aware of.
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RW: In 1988, when I was in Washington, I wrote awell, I had a regular article I put in the JAMA [The Journal of the American Medical Association] every month from the assistant secretary of health. And one of those articles was about this type of thing. And I got tremendous inquires around, How did you do it? and so forth.
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So, from Sarasota, even today, the wonderful woman, Jane Isley, is running that program as a director and shes been there probably 15 more years. And she has sent out voluminous material to all these areas in the country who are inquiring about how we can do it. How can we simulate your program?
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And, in the last couple, three years, weve had the president of the American Medical Association, at that time. And when he was in office would come down and speak to our county society, but each time they wanted to go over and visit this center. So, here is a remarkable way of doctors keeping their mind alert, keeping their interest in practice, to a degree.
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CP: And doing a great
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RW: In a remarkable way, a great service
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CP: public service, both to organized medicine and to the image of the public. Its a service to both of those.
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RW: And when the patient would be sick enough that required care beyond what they could do in their limited environment, the medical doctors in the community knew about it, and they would refer to this doctor, surgeons, whatever the need was, or hospitalization. They would refer to this doctor, and he would put them in this hospital.
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RW: Yes, in fact the We Care program started in Alachua County, in Gainesville. And, I dont recall the exact year, but it began because the doctors in that community realized there was a need to help the underserved. And these were also, primarily, practicing physicians who were just donating their time.
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This was not a retiree program to start with. It was a volunteer program that the county medical society established. And the doctors there realized there were a lot of people underserved, so they said, Well go and set up a clinic, and well set up a
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They had a wonderful system. They had a coordinator. And this person was hired, and her job was to relate from the patient seen in the doctors office. The doctor would see the patient in his office, at no charge.
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And if the patient required hospitalization, the hospitals already were set up to accept this type of person. The patient could go right there; admission was automatic because they knew they werent going to get paid. It was a volunteer program, and you didnt have to go through all this bureaucracy.
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CP: All the paperwork.
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RW: Paperwork
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CP: And I cant pay.
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RW: Thats right, so that worked very well. And the patient was in and out of the hospital quickly as possible, and then back into the active life again.
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CP: And the hospital care was cared for through volunteer physician efforts.
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RW: Thats right. And the payment was through the hospitals indigent fund program. So that started and was very successful. And they presented a program to the Florida Medical Association, and it was accepted in other counties. And a lot of places now are doingId have to say most all counties are doing it.
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CP: Yeah, its my impression its going on in almost all counties.
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RW: Right, to some degree. And I recall, I believe, the last time I heard, it was 20 million dollars a year saved in Florida just from the free care.
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CP: Free service.
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RW: Free services for people who otherwise couldnt get it or didnt know how to get it, werent in the system.
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CP: Yeah, they were too rich to pay for it and too poor for Medicaid.
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RW: Thats right. Theres a sort of that niche in there. It was that area where they werent covered.
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CP: Yeah, thats a good program. I want to think that it kind of grew out of the attitude in Sarasota.
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RW: That was the beginning.
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CP: Yeah, the beginning, kind of the beginning of it, and thats good. And you were partial to that, too. While you were president of the Florida Medical Association, I know you did a lot of talking before the legislature on matters of the publics health in other places, speak to some of that.
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RW: Well, as the year I was president in 197no, 82, we were having a very significant concern about physicians and the cost of their malpractice insurance. That was the number one issue that was confronting the doctors, having to pay so much. Doctors in Miami, for example, were paying, I guess, over $100,000 for their premiums.
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And so this, they were saying, Florida medicine, what are you doing for us? What are you doing? So much of my year of 81, 82, during my presidency and president elect, spent a lot of time going around the state talking to the county societies, explaining that we were trying to get a program through the legislature, and how we needed their help to talk to their elected representatives.
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And then we presented to the legislative committees proposals that the state hopefully would follow. To enact laws that would limit the cap, put a cap on pain and suffering. Thats all we needed was a cap on that one thing. People would get all the medical care they needed and all that, thats no problem, but the pain and suffering
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CP: Those were the big awards, and they continue to be the big awards.
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RW: Thats right. But we lost. We didnt get what we wanted at all. We didnt get anything. So that was a frustrating result of my year of president, but since then, that was 82, in 87, I believe, when I was in Washington, they were down here in Florida, set up the Proposition 10. That may have been 88 or 87.
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But, you know, the big effort throughout the state to have a constitutional amendment, Proposition 10. And I understand, I wasnt here at the time, but I understand the public response was very good. But, in the last hours before the voting, the trial lawyers came out with their campaign on TV of a big bus accident and all these children were either killed or
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CP: Yeah, I remember that.
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RW: badly injured. And, Do you want your child in this situation, whos going to be incapacitated for life, to not get the award for pain and suffering that you should get? So, boom, Proposition 10 lost.
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CP: I remember that.
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RW: And yet, in Indiana, Governor Bowen was very able to get that through back in the 1970s for a cap of $50
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CP: $100
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RW: $100,000. So, it just shows how it varies from state to state. But the state of California has a program thats been in effect for a number of years now, where their cap is $250,000 and a state that size accepted it, but we couldnt get through in Florida.
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CP: Were going to come again on it.
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RW: I think we are. Florida Medical Board of Governors is looking at it again, but its a costly thing. Its expensive to put a proposition out.
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CP: I know.
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RW: To get the vote, to get all the people to sign up and all that, its aif you dont, youve got to have your whole membership wanting to do it.
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CP: With the (inaudible).
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RW: Yes, sir.
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CP: Im aware that youve accepted the position of historian for the Florida Medical Association. And, I need not remind you, but I want you to speak to it in your new capacity, that the history of Florida medicine is intrinsically accountable, if I may, for the history of Florida public health organization.
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RW: It is.
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CP: It was one of your former presidents and a dominant member from Tampaas a point of interest, a physician from Tampa, now a legislatorwho, in 1887, was responsible for a particular constitutional insertion for a board of health for Florida, and when he was president of the Florida Medical Association. And then, two years later, as a legislator, managed to get it activated. I just want to remind
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RW: That was Dr. Wall, wasnt it?
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CP: Right.
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RW: Dr. Wall.
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CP: Dr. Wall from Tampa.
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RW: And he had a brother, also, who was in the Senate.
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CP: He was in the Senate, yeah. Oh, Im having trouble with Dr. Walls initials, but Dr. Wall was in the House. The Dr. Wall who was, his brother was not a physician.
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RW: Yes, he wasnt.
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CP: Yeah, but the physician was in the house and from Tampa, but Im constrained quickly to tell you that they were born and raised in my home county of Hamilton County. I have to say that with pride.
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RW: Well, Im sure you will. That exemplifies the reason why you became such an important person because the genetics of that county were in your body.
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CP: Theres no question about it.
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RW: It must be in the water up there.
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CP: Well, speak to your new job as the historian. And Im all excited about that because Im aware of the fact that youre interested in history and that youre one of those who, if we dont understand how we got here, were going to having trouble getting yonder.
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RW: Thats right. You dont want to repeat and reinvent those wheels and everything.
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CP: No.
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RW: Well, thank you. Im glad to be appointed this year by Dr. Cecil Wilson, who is president of the Florida Medical Association, to be the historian. And we are now in the process of looking at our records that we have for our annual meetings, for example.
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These need to be, by our statutes and by our organizations rules, to be maintained and so forth. Were trying to figure out how best of way to preserve them. What to take out that wont be necessary or needed to preserve.
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So thats a process right now, which is going to take some funding for us. And were working to take that history and get it documented in a better fashion. Yeah, and then I want to go back and review a number of the historical issues of our Journal of the Florida Medical Association over the years, that have been published on various special issues of public health.
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CP: Yeah, and you used to have an issue every year called the historical issue.
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RW: Thats right. And William Straight of Miami was editor of that for a number of years. So we need to put that back intoDr. Shea, now, is editor of our journal. And we hope to get more in the historical message out to the public, I mean, to our members, and even to the public in some ways, or even to understand what we did do in the past. So we got to put all this together.
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CP: Yeah. Im not aware that there is a written, quote, history of the Florida Medical Association.
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RW: I dont believe so either, and thats what were trying
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CP: And its been passed down by word of mouth. You know, youre very knowledgeable of it. I have some familiarity, and its very colorful. The importance of that organization to the health and welfare of this state cannot be underestimated.
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RW: Exactly.
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CP: And Im just now thinking of it, theres not, this hasnt been written down anywhere. And it needs to be, Dr. Windom.
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RW: And to take advantage of you and all the others and Dr. Sowder and different ones who are still active and able, still living, and be able to give us vital information. And Im hopeful that in Jacksonville, the house of the former building of the Regional Department of Health, right?
308
00:52:50.2
CP: Yes, the Julius Street [Julia Street] building. The public health home.
309
00:52:51.5
RW: Will be revitalized and be a museum.
310
00:52:57.1
CP: The repository for a while.
311
00:52:58.8
RW: Right, right. So were working on that too, so.
312
00:53:0.8
CP: Marvelous.
313
00:53:2.0
RW: Theres a lot to do in the area of history, to put it together. But I think the Medical Association is knowledgeable of the need to do it, so I hope I can help get it started.
314
00:53:10.6
CP: Well, under your leadership itll get done.
315
00:53:12.7
RW: Help get it started.
316
00:53:13.2
CP: Itll get done. Thats great.
317
00:53:15.1
RW: Right, right.
318
00:53:16.1
CP: Its been stymied. Ive been kind of partial; I was on the history committee for a number of years.
319
00:53:21.2
RW: Right now, we have no committee, which were putting together in your name
320
00:53:25.7
CP: I dont think you need one. Use an ad hoc committee.
321
00:53:27.6
RW: Ad hoc, and wed call up on people.
322
00:53:29.2
CP: If you need me, call me.
323
00:53:30.7
RW: Youre on the list. Youre on the list.
324
00:53:32.4
CP: But if you need Dr. Sowder, call him.
325
00:53:34.0
RW: Thats right.
326
00:53:34.5
CP: We need one person to spearhead it.
327
00:53:36.8
RW: Exactly.
328
00:53:37.5
CP: I agree with no committee. But, the point being, I remember the committee was frustrated when wed go to the Board of Governors for consideration of some money. You know, not a lot of money, some money.
329
00:53:48.5
To hire us a staff person on a part-time basis, or let Tom Jarvis, is a specific name, let Tom Jarvis spend some time, but we got to pay him to do it. Your predecessors were regularly frustrated with the lack of wherewithal to get some of this stuff. So, Im excited about your being the historian.
330
00:54:9.8
RW: Well, thank you.
331
00:54:10.1
CP: Ive now gotten in my kicks, too. I hope you noticed.
332
00:54:12.8
RW: Yes, yes, you certainly did. And thats so important, what youre doing here in this program, right here, in public health. Youre putting together a documentary for historical perspective.
333
00:54:22.6
CP: Yes, it is.
334
00:54:22.9
RW: And so this is very important.
335
00:54:24.8
CP: And for future research and for future use. Thats the reason for this.
336
00:54:28.3
RW: Right. And I think that this avenue would be excellent in medicine, too, since today so much of our education is through video, this medium.
337
00:54:39.1
CP: You know, you mention Dr. Annis, the innuendos and thewe know a lot about Dr. Annis. We know a lot about him. But theres a lot about Dr. Annis thats verywhos the man, back of this, that caused this person to be such a great person in organized medicine for this world?
338
00:55:2.4
Annis. You know, we need to get him on tape. Let him talk some. Tell about what went inlike youve done today, Dr. Windom. Youve introduced us to the man, that you cant read about that anywhere.
339
00:55:15.4
RW: No. Hes the most eloquent speaker today. And its interesting that the tape of his presentation in Madison Square Garden was revived, and the Florida Medical Association got it. And I have one of those copies, that excerpt.
340
00:55:31.0
And it is most heartwarming to hear him, see him on video, talking to an empty Madison Square Garden with debris of cups and so forth all around because, for those that dont know, this occurred the day after President Kennedy had addressed the full Madison Square Garden, the whole nation, about this wonderful program of healthcare that the government was going to provide.
341
00:56:1.1
And so the American Medical Association said, We have to have some defense to counter that. And who can do it? Somebody knew Dr. Annis because Dr. Annis, in his early training, was a debater. And he knew how to talk on both sides of an issue. But he is so wonderful in his eloquence, presentation. And so they called him, and he agreed to come up.
342
00:56:26.7
And the people putting this on tried to figure out what kind of environment; you just cant have him in front of a camera. And they thought about it, See, you know, lets not have the people at Madison Square Garden, the maintenance people, clean up that auditorium.
343
00:56:42.8
We want it to be completely like its just been used by hundreds and they left, which it was. And here he is speaking out to the nation, to an audience and no ones there. And he had, I think, more viewers even than the night before, when the president was on, because they knew something unusual was coming up to counter this. And so I cant believe
344
00:57:6.4
CP: He wasnt president of AMA at the time, was he?
345
00:57:8.4
RW: No, he was just a
346
00:57:10.7
CP: He was just a Joe Blow physician.
347
00:57:11.8
RW: Physician in Miami, Florida, who had been known as a speaker. He was not activeI mean, as a leaderin Florida medicine at that time. But AMA was so impressed, as was the general public, about this mans ability. So, within a short time, they got him involved right away in some committees, and the next year he was president of AMA. Hes the only one in the history of AMA to become a president at that
348
00:57:34.2
CP: Without coming up through the ranks.
349
00:57:35.1
RW: Sure, at that sudden way. But then he became president of the World [Medical] Association. And so, but to see him, that was in the 60s, mid-60s, and to see him today, of course, he hasnt practiced for all these years, but he has been a spokesperson and out before the public.
350
00:57:56.1
CP: Hes on my list to come here, by the way.
351
00:57:58.7
RW: So vital, so vital. So Im glad youre going to have him because your audience and the audience of people for years to come who will watch this history will be most impressed to hear him.
352
00:58:10.2
CP: And our approach is different, and I wanted to do that.
353
00:58:12.4
RW: And his book that he wrote is really the, sort of, the bible, in a sense, to know what has happened over the years with the government involvement, the intervention of certain personalities.
354
00:58:25.3
CP: I havent read that book.
355
00:58:26.9
RW: Code Blue.
356
00:58:27.9
CP: Yeah, I need to get it. I need to get a copy.
357
00:58:29.4
RW: I would hope that every physician, every public health official, would put in his or her library an issue of Code Blue. Its not very big.
358
00:58:39.8
CP: Yeah. Im aware of the book, knowledgeable of it. But I have not read it, and I dont have a copy, so I shall get me one.
359
00:58:45.6
RW: And theres no history represented in any other publication in the detail that he has there and the nuances and the innuendos and everything that went on. And it points out very clearly that the personality of the person in that public office in Washington, that personality and that knowledge that person has, is what causes the changes.
360
00:59:9.0
And they werent all aware of what Dr. Annis was saying at the time, enough of them, to understand that his predictions were going to be true. But, after that, he also became a member of the American Chamber of Commerce, Board of Directors.
361
00:59:24.6
CP: He did? I dont think I knew that.
362
00:59:27.0
RW: American Chamber knew his wonderful ability to present and educate. And so, he would sit at the meetings, and maybe here itd be the president of General Motors and heres the president of IBM, for example. And he would talk to them about health issues. And these presidents would say, You know, Dr. Annis, if I had known that, I would have never supported what the government did, or I never knew this.
363
00:59:54.7
It boils down to one basic factor, Skeeter. As physicians, our obligation is to do everything we can to give our best knowledge and information to those people who are in elected positions to know what it is and get businesses involved. Business figures.
364
01:00:14.1
CP: Im reminded of my professor emeritus of medicine when I was in medical school would tell us, Your first obligation is to educate. He would tell us that. Your first obligation is to educate. And I remember that so well. And this, well, professor emeritus is still lecturing, he lectured, he had a course on the art of medicine in my medical school.
365
01:00:44.6
And I remember more that that man had to say than all the rest of my professors put together for my four years of medical school. Dr. Johnson, every Saturday morning, seven oclock to eight oclock, first two years of medicine. Medical school, the Art of Medicine, Dr. Wingate Johnson.
366
01:01:2.6
RW: So important.
367
01:01:4.2
CP: Your first obligation is educate. Oh, and its so true, Bob, so true.
368
01:01:8.3
RW: This brings up another interesting point about that. As I told you about my interest in the Heart Association and how the Heart Association, with all of its volunteers, wants to educate others about heart disease just like all the voluntary agencies want to do.
369
01:01:21.3
CP: Yes, thats first thing.
370
01:01:22.2
RW: So, at one of the annual meetings of the Florida Heart Association, back in the early 70s, we had a guest speaker who was the retired emeritus professor of business, economics at the University of Florida. I dont remember his name, but he was just a wonderful speaker. So, the purpose of his coming was, how can we sell our message and educate the public. So he was talking about salesmanship. He used his palm of his hand.
371
01:01:49.0
He said, Okay, so now youre selling a product. 20 percent of the people here are going to buy your product if its no good at all because you just are promoting it, because they got faith in you. Theyll buy it if its nothing. You got 20 percent of the people on this side who, if you were going to give them gold for five cents they wouldnt buy it.
372
01:02:9.3
So, youve 40 percent right here, I mean, 20, 10, 20. 40 percent of the people right here, you dont worry about. You dont need to worry about talking to the ones that are for you because they are going to support you. The ones against you will never change. What you got here in the middle, 60 percent of the people, these are the people who really analyze what they hear.
373
01:02:28.9
And, if you can present to them a legibleor not legible but understandablea clean, clear, precise bit of information and its important, youre going to get 60 plus 20, 80 percent to support your program. But, if you cant convince them or show them that what you have is right, what youre trying to educate the public is right, you got 80 percent of the people against you. And I think it holds true
374
01:02:55.1
CP: Isnt it so true?
375
01:02:56.0
RW: in everything you do in life. And if were trying to educate the public, we need to look at that, and how were going to do it. And focus on that 60 percent who will listen, and dont waste our time on the person who is going to be against us because theyll never change.
376
01:03:9.5
CP: Oh, its so true, so true. Well, looking back on your very, very colorful, very, very productive career, whats the two highlights of your career, up to this point? You still got a long way to go, Im just talking about up this point.
377
01:03:24.4
RW: Well, I would say it would probablythe main highlight was being a leader in Florida medicine. That was my first highlight, to be able to say that here I am in Florida as a physician, and Im head of this great organization.
378
01:03:38.9
CP: Very prestigious.
379
01:03:40.0
RW: But it gave me the opportunity to, I think, exchange and deliver some the messages that I thought about. And the second highlight would be the opportunity to serve under President Reagan and to direct the whole United States Public Health Service, because not only did that give me a wonderful opportunity here in the country, but I also represented all of the biomedical research agreements that we did in the federal government with other foreign countries.
380
01:04:6.6
So I traveled and I metsee, I was the peer, as a minister of health of every nation, the same fate as peer here. I was minister of health of the United States. So that opportunity to meet such wonderful people and to travel as I did around the world on several occasions in World Health Organization meetings that was a highlight Ill never forget.
381
01:04:28.7
Because it just pointed out to me, to see so vividly, that the people in all these countries, developing countries, developed countries, and everything, people in health have had the same basic background training, the same reason to go into health program because they want to help others.
382
01:04:48.4
You talk to them on health anywhere in the world. Its the only discipline, as I see it, as Ive ever seen, that has a uniformity around. And it remains everywhere.
383
01:04:57.7
CP: The common denominator of language and motivation and goals to them.
384
01:05:2.2
RW: You cant take a county; laws differ. You cant take any other profession. You look at any of them. They have differences.
385
01:05:8.6
CP: Thats right, thats right. I hadnt thought of that.
386
01:05:10.9
RW: And who touches more people in their lifetime than a physician? Because many people dont go to churches. And thats one of two true professions and law. Many people dontthree professions. Many people dont seek a lawyers help.
387
01:05:29.6
CP: Not anymore.
388
01:05:30.6
RW: Occasionally some. But over a lifetime, from birth, everybodys kept a medical contact, not always with a physician, with abut still. So the medical profession has the greatest opportunity to reach the masses.
389
01:05:45.1
And thats why its so important for every one of us in the medical profession, public health and organized medicine, to take that opportunity, as we are seeing throughout the nation, millions of people every day, over and over.
390
01:05:59.5
CP: Oh, and we miss it.
391
01:06:1.2
RW: Throw in a little bit of education. Let them know. Pass this on. I use the acronym PR. We all need to practice PR. And what do you think about that when I say PR? What comes to your mind right away?
392
01:06:16.7
CP: Public relations.
393
01:06:17.5
RW: Thats right.
394
01:06:17.9
CP: Yeah. But Im sure thats not what yours is.
395
01:06:20.6
RW: My PR is prevention and responsibility.
396
01:06:24.2
CP: Very good.
397
01:06:25.2
RW: PR. You cannot, you can preach prevention to your mouth and you get hoarse, dry up.
398
01:06:31.2
CP: Until you phone home.
399
01:06:32.9
RW: You dont have the person accepting the responsibility to follow out what their direction should be
400
01:06:38.4
CP:save your breath.
401
01:06:39.0
RW: Were not going to create, maintain the health of our nation.
402
01:06:43.3
CP: No, were not. No, were not.
403
01:06:44.7
RW: Thats right.
404
01:06:45.4
CP: Within the US Public Health Service, what was your highlight during your three years as the big boss?
405
01:06:51.2
RW: Well, the highlight was probablyI got in office, officially, in June 1986. I was sworn in. September 8 or so, we had a presentation. I spent, probably, three days prior to that September 8 with our leadership because we were presented with something that had never been presented before in science: a controlled study on the use of AZT in AIDS patients had been started.
406
01:07:22.2
But this study was not at its endpoint yet. But the data, early, showed that out of 16 people that were taking AZT, 16 not taking it, there were 3 alive not taking it, there were 14 alive taking it. So the data was so strong, so the question is, Am I going to take the responsibility to accept this study being terminated and present to the American public?
407
01:07:53.7
So, on that September 8 or whatever it was, I said, Yes, were going to go forward; were going to terminate the study; were going to announce to the American public that we have a drug, which has been shown to be effective.
408
01:08:8.4
And so we go downstairs, and the department of HHS is sitting in the [Hubert H.] Humphrey Building, and we have our media room there. And I cant believe it; at this microphone, at this dais, there were more microphones than had ever been before a federal presentation at that time. Microphones come up from all over. And here I was, I had only been there for four monthsJune, July
409
01:08:33.3
CP: Two months.
410
01:08:34.5
RW: Three months. And so
411
01:08:36.4
CP: You didnt even know who was on first base yet.
412
01:08:38.0
RW: Thats right. Thats right. I didnt know where the ballgame was being played. No, I did know that. And I respected the judgment from my scientist friends. And Secretary Bowen suggested go forward with it, and we did. And that was what I felt was probably the major thing that turned the table.
413
01:08:56.2
But then, after that, from 86 to when I left in 89, the AIDS education was a very important part of my administration because I was not able to devote as much time on the other things, in my own personal time, because youre trying to educate the public. We didnt have more than AZT. We had not much information for people to prevent the disease. We tried to.
414
01:09:20.9
And I got so frustrated, Skeeter, when people would say, Well, we dont know what causes AIDS. We dont know. Can you get it from kissing? Can you do it from this and that? And I said, No, the information is out. Weve told you.
415
01:09:32.7
No, no. So we sat down, I said, Theres only one way, I dont want somebody coming to me and saying that we havent told you so. I said, Lets send a letter, a pamphlet, out to every household in the nation.
416
01:09:45.4
We did. We took 110 million homes that had post office boxes or homes. 110 million, its the largest ever in the country, I mean, the largest mailing, a mass mailing, it cost us 20 million dollars out of my budget. And you got one, you remember?
417
01:10:1.0
CP: I got mine.
418
01:10:1.7
RW: Its about six pages. It has Chick Koop on there. A wonderful man. The Surgeon General had great charisma with his beard and all that, Dr. Bowen, and I. But anyway, and all these pictures in there writing exactly what causes AIDS, how you can prevent AIDS. We dont ever need to take drugs because you can prevent it. Okay?
419
01:10:19.7
And now we enjoy, later on, talking to people. And theyd say, I dont understand. Did you get the mailing? Oh my goodness. They threw it away. It just shows the communication break is on the other end.
420
01:10:34.7
CP: Yeah, and communication is so tough, so tough.
421
01:10:38.6
RW: I wrote an article as the president of the Florida Medical Association, The Communication Gap, because this was evident to me back when I was even president of Florida Medical. We would talk about issues, liability or whatever, doctors didnt understand, but we wrote articles and everything.
422
01:10:53.9
I said the communication gap is on the terminal point. Thats where the gap is. We gave it out. But it gets down to the receiving end, and if it doesnt go across the barrier, for the person to retain it, communication is no good.
423
01:11:7.4
CP: So true. What have I left out?
424
01:11:10.9
RW: Not a thing. I think weve covered pretty much organized medicine, voluntary health agencies, community health, public health. I will point out again the importance of voluntary agencies because I think that they are center of appeal to a person whos had cancer, lung disease, whatever it is, multiple sclerosis, you name it.
425
01:11:32.4
But those are people dedicated, so we need to then educate them more about other issues but to capitalize upon their involvement to help us if they commit.
426
01:11:41.3
CP: And their motivation.
427
01:11:42.5
RW: Thats right.
428
01:11:42.7
CP: Yeah. Yes, yes, yes. Good point, thats worth repeating. And thank you for repeating that because that will be useful forever.
429
01:11:50.0
RW: Voluntary agencies, Im sure, will always remain, but we need to get doctors more involved in them. The excuse that doctors used to have is, Im so busy. Which was true in many times. You were working day and night; you had no coverage. But today, I dont know of any doctors practicing that doesnt have such a group that theyre probably one night a month theyre on duty or two nights, but, I mean, there is time.
430
01:12:17.0
CP: You can arrange if hes so motivated.
431
01:12:18.7
RW: I think that doctor practicing this needs to develop that motivation if he can. He should have it, but if they want him to have it, they shouldif theyre going into medicine, the motivation needs to be beyond just the one-on-one in the office.
432
01:12:33.2
CP: Another comment from Dr. Johnson that Im constrained to remark, he would tell us young physicians, Every patient that enters your office is only an index of something larger going on. Its your obligation to find it.
433
01:12:50.8
RW: Thats a very good point.
434
01:12:52.2
CP: Isnt that the truth?
435
01:12:53.7
RW: Yes, sir.
436
01:12:55.0
CP: He went on several lectures on the impact of this is the breadwinner there, standing before you, and youre fixing to put him to bed for week? Think about those kids. Think aboutyouve got to think about the larger thing thats going on if youre going to be a good physician, hed always say. Isnt that marvelous?
437
01:13:16.2
RW: Remarkable. But you know what has happened to maybe lessen that degree of feeling? Has been the invention of the technology we have today. A recent article came out showing, for one of the journalsjournal of medicalJAMA. In the public news, in the newspapers recently, that doctors cant diagnose heart murmurs anymore.
438
01:13:39.2
CP: Oh, I saw that.
439
01:13:39.6
RW: Well, I dont think that is as true as theyre saying, but the point is, doctors often do less because they can send you over and get a test here, get this here, get that there. In fact, I know doctors today who do certain procedures in that they might operate on this or that.
440
01:13:55.3
They wont even see the patient in the office first until theyve been through this MRI or this study, then you come in and see me. So technology, I work on that tiny bit here. I do this, wonderful work, no question.
441
01:14:8.3
CP: Technically, yeah.
442
01:14:9.6
RW: Its wonderful, but weve lost our knowledge of the patient.
443
01:14:13.7
CP: Lost our patient contacts, but were getting so much better medicine.
444
01:14:17.7
RW: Were getting better medicine for it, thats true, but you cant
445
01:14:19.6
CP: Were getting better care, but I dont feel better about it. Dr. Robert Windom, it is truly a pleasure to have you here today, and for you to share your life and fun with us and future viewers, into the historical libraries of the University of South Florida. Thank you for coming, Bob.
446
01:14:38.6
RW: Thank you so much, Skeeter. And if you dont have fun at what youre doing, youre not in what you should be.
447
01:14:43.0
CP: You as well ought to go back to the desk.
448
01:14:44.4
RW: Thats right.
449
01:14:44.9
CP: Put your head under the



PAGE 1

COPYR I GHT NOTI CE This Oral History is copyrighted by the University of South Florida Libraries Oral History Program on behalf of the Board of Trustees of the University of South Florida. Copyright, 19952016, University of South Florida. All rights, reserved. This oral history may be used for research, instruction, and private study under the provisions of the Fair Use. Fair Use is a provision of the United States Copyright Law (United States Code, Title 17, section 107), which allows limited use of copyrighted materials under certain conditions. Fair Use limits the amount of material that may be used. For all other permissions and requests, contact the UNIVERSITY OF SOUTH FLORIDA LIBRARIES ORAL HISTORY PROGRAM at the University of South Florida, 4202 E. Fowler Avenue, LIB 122, Tampa, FL 33620.


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