SMOOT: Mr. Johnson, by way of introduction would you tell me a littlebit about yourself -- your background, where you're from, where you were born, your upbringing and so forth?
JOHNSON: Um-hm. I was born in upstate New York-- Cortland, New York,which is in the heart of the snow belt of New York State. I have spent most of my life either working with the health care field in one sense or another or with higher education: the administration of higher education. Early on in my career I worked with the New York state health department and with local health departments. I worked with a private group practice of medicine in upstate New York in the days when 00:01:00group practice was a very unusual, experimental venture. From there, which was in the mid fifties, I had the opportunity to put together a medical research foundation in Boston, Massachusetts. I became its first executive and it was from there I came to Kentucky.
SMOOT: So you were in-- in Boston--
SMOOT: --and decided to come to Kentucky from there?
JOHNSON: Yes. Actually, how that-- how that worked out was that Dr.Willard had been one of my mentors at Yale in the School of Public Health, which is where I did my graduate work, and I had just gone to Boston to put this foundation together. All it has was a board of directors and a statement of purpose and I'd been asked to, you know, take that on and Dr. Willard called and-- to talk to me about corning 00:02:00to Kentucky; that he was going to be building this new medical center. And I told him that, ah, you know, I-- that sounded just great, but I had taken on this commitment and clearly I could not leave that and that if they had not found somebody to do what he was talking about my doing in a couple of years, I thought that-- this was in 1958-- that I thought I would have things far enough along that I could with honor look at something else and lo and behold, two years later the University of Kentucky came back to me and Dr. Bost was the one who actually came up and talked with me about coming to-- to Kentucky and so I came here in 1960.
SMOOT: In what capacity did you come to the University of Kentucky?
JOHNSON: I came as the head of the Division of State and Local Services,00:03:00which was a strange kind of a creature at the Medical Center because what we were trying to do -- or what Dr. Willard, who-- really this was, you know, his concept -- what he was really interested in and what I was interested in was developing an arm of the Medical Center that would take that Medical Center, its resources, its influence, its leadership throughout the state and yet it's the kind of thing that involved what in many organizations would be conventional public relations, community relations activities, but neither he nor I nor any of us wanted it to be that kind of prosaic activity. Now, I wouldn't not - I would not have been interested in that even though 00:04:00my particular background, which was in public health education, had a good bit of experience with mass communications and those kinds of things that wasn't, you know, my big-- my big interest then. It was really more of a community organization approach, so we wanted to avoid a title that, you know, smacked of conventional PR development and that's why we came up with this strange creature of State and-- State and Local Services and what that was really was I was the Medical Center's spokesman, if you will, for the Medical Center, but more importantly the person who worked throughout the state establishing contacts with communities, professional organizations, anybody who was interested in the problems of medical care that this Medical Center would appear to have resources or capacity to influence and it was that 00:05:00kind of a-- of an effort. I can best exemplify that by the-- using the community organization analogy because-- well, we didn't have a big staff obviously and it seemed to me, and not just me, but again partly because of some of my own background-- to work very closely with the College of Agriculture because here they had what were in those days called county agents-- I guess they're farm advisors now, but they were county agents and home demonstration agents then-- and so, you know, there was this ready-made network out there plus so many of these folks were in communities that were beset with the problems of recruitment of physicians, organizing some kind of medical care, problems with hospitals, whatever. And I-- I was very, very proud of the fact that 00:06:00I not only had gotten to every one of Kentucky's counties in my sojourn with the Medical Center, so that I really got to know this state quite well, but at one time I knew every county agent in Kentucky (laughs).
SMOOT: A hundred and twenty different agents?
JOHNSON: Well, they didn't have them in every county.
SMOOT: I see.
JOHNSON: But rea--- I really did and I used to attend their professionalmeetings. I was always seemingly on their program because they were vitally interested in the Medical Center, as you can imagine and that became just a very, very good linkage and a very close relationship that we built with the College of Agriculture. That's one illustration.
[Pause in recording.]00:07:00
SMOOT: When I first saw this-- this title, State and Local Services, Iwas thinking-- well, the first thing that popped in my head was this sounds like the political front for the Medical Center. This is-- this is the contact with the state legislature or this is the contact with the governor's office. Am I off base there? Did you--
JOHNSON: No. No, we-- we certainly did that, but that was never a bigeffort. It-- probably partly because the-- it was not needed, you know--
JOHNSON: --as I know you have learned, the Medical Center got startedwith lots of pizzazz and it had good men--- you know, good money to begin with from the-- from Governor Chandler to build it. Governor Combs was very supportive in-- in supporting it and it-- and so that the Medical Center did not -- I don't mean for a moment to suggest that we weren't mindful of Frankfort, but it wasn't something that took an 00:08:00undue amount of time, you know, that one was trying to repair fences or there were difficulties. We were-- we were enjoying the advantage of a very good relationship so that other than paying attention to that, we didn't have to do more than that. So I can honestly say I did not expend, you know, undue personal time there. Most of it was out in the state--
JOHNSON: --not in Frankfort.
SMOOT: Before I move into your moving-- movement out into the stateitself, an organization had been developed in the 1950's called the Kentucky Medical Foundation, to help establish, garner support for the development of a medical center at the University of Kentucky. Did you work with this organization in any way?
JOHNSON: Only in the sense that when I came aboard, that organizationwas really defunct--
JOHNSON: --but there were individuals still around who had been00:09:00instrumental in the Foundation, who'd been quite active, and I did work with them as individuals and they were key people--
JOHNSON: --to introduce me to support groups and, you know, people thatI needed to know. The-- interestingly that you mention this, but to show you my fondness for the Medical Center, those particular prints came out of the Kentucky Medical Foundation brochure. When I came to UK I found about-- oh, about a dozen of those still in the files and they were h-- I don't imagine you've ever seen one. I don't--
SMOOT: I have seen one.
JOHNSON: Have you seen one?
SMOOT: Yes, I have.
JOHNSON: Okay. Well, you know what a handsome brochure that was and--\
SMOOT: Yes, it was.
JOHNSON: --Arnold Hanger had paid for that and I-- [microphonedisplacement] I took one and-- and ripped it apart, took those prints and had them framed and they've been with me in every office that I've 00:10:00had since. (Smoot laughs) Well, they've been to California and back.
JOHNSON: But I did work with a number of the people who had been activein the Foundation. A Mrs. Creech, for example, introduced me to a lot of the people that I needed to know in Eastern Kentucky, Coley Johnson- Johnston -- who was the physician here, Russell White, who was then alive and at Transylvania, Brick Massie and-- I mean-SMOOT: Francis.
JOHNSON: --Dr. Massie and Brick Chambers over at the-- U.K.
JOHNSON: Those-- so those were all people, but the Foundation itselfwasn't, you know, it had done its work.
SMOOT: Um-hm. Although it did carry on for several years afterwards--
SMOOT: --at least in name, did it not?
JOHNSON: Yes, it did-- in name and-- and it did make-- it did continuesome contact with the legislature. There's no question about that, but it was a waning--
SMOOT: Did you find in-- in your work with that organization that there00:11:00were any difficulties in terms of coordinating the ideas and objectives of the Foundation people with the ideas and objectives of the Medical Center or with the University as a whole?
JOHNSON: Well, at-- at least from, you know, from this perspective now,which has been many years later, I don't recall anything that, you know, that I think of that took a great deal of time or that was a, a burr under the saddle. I do recall that Dr. Chambers, over there at the Health Service, probably was the person who, you know, would intrude himself the most into-- into affairs. I'm sure he was-- he probably was a problem to Dr. Willard, but to the extent that he was-- I mean he certainly-- I never-- I never came away with the impression that, 00:12:00you know, this was something that Bill wasn't handling very, very well and that yes, Brick probably had some very clear notions of what he thought the Medical Center ought to be, but other than that, I really don't-- I don't recall, you know, anything of a substantial nature.
SMOOT: Okay. You were in-- you were charged with developing contactsstatewide.
SMOOT: Most emphasis it seems, however, was placed on Central andEastern Kentucky. Am I correct?
SMOOT: Why was this emphasis placed on these regions rather than thestate at large?
JOHNSON: Well, I don't think there's any question about that. It had todo with the Governor Chandler's own, you know, his-- his remarks, his statements that led to the creation of the Medical Center and I can't 00:13:00quote it, but I know he still can, how many of those-- how many babies (laughs) used to be delivered in Eastern Kentucky without benefit of a physician and clearly that was the under, you know, that was the under-served area and of course there was the University of Louisville in the-- in that city, which-- while not a state institution by any means-- tended to think of-- I think it thought of itself and I think people in the Central or that-- Western part of the state tended to-- the thought of medical affairs tended to think more of Louisville. But I think we were not restricted to Eastern Kentucky, but you're quite right, there's no question the preponderance of activity and concern because of the need, was directed in that region. As you know-- or I suspect you know-- from talking with others, once the Medical Center 00:14:00began to develop-- well, I've indicated that I got into every county in the state. I used to be active with lots of health organizations for the Medical Center, which covered the state. When Kurt Deuschle's community medicine program began, he had field professors in the western part of the state -- the Trover Clinic in Madisonville being, you know, an outstanding example -- as well as in the east. But there's no question about the preponderance of need was in the mountains.
JOHNSON: And that's in-- and there was also of this public perceptionthat, you know, this Medical Center was gonna turn out doctors for the mountains. Now, that was not the Medical Center's perception (laughs), but there are-- there certainly was a good bit of public--
SMOOT: Did you have specific goals in mind in-- in your work in Eastern00:15:00Kentucky particularly?
JOHNSON: Uh-- goals in the sense of knowing what I wanted to do as Ifelt I knew the Medical Center, but not goals in a-- in a quantitative sense.
JOHNSON: We were very interested, for instance in-- no matter whatthe problem was. If-- if communities were interested in recruiting physicians I would try to help them and-- and to look at that realistically. If communities were interested in developing hospitals- - and you must remember those were Hill-Burton days-- everybody was interested in having a little hospital in the backyard and, you know, that was a terribly shortsighted notion and I would try to get involved in those and again, by bringing proper people together -- the appropriate community leaders with people that I could pull out of the Medical Center that they needed to talk to -- try to give them the 00:16:00background that they needed to make a, you know, a hell of a lot more informed judgment than they would have made otherwise, and I think that certainly was the goal; really to use that Medical Center to upgrade quantity and quality of medical care.
JOHNSON: That was always the target, but there wasn't any quantifiablegoal or any set pattern that, you know, we were gonna to try to do this here or this here or this here, it wasn't that.
SMOOT: Could you give me a specific example of this process that youwere going through; coordinating health leaders, community leaders, funding, et cetera for a-- for the development of a health facility?
JOHNSON: Yes, I-- I think there are really probably several that-- thatI can think of, ranging, you know, from very simple kinds of things to 00:17:00things that were more-- more complex. One that stands out-- well, I'll mention two. One that I'm sure you've heard about is the development of the Saint Claire Medical Center in Morehead. I think this is a wo-- really a wonderful illustration of what a-- an academic which has that kind of, again College of Agriculture attitude, if you will, can do. I don't-- while others may disagree with this, I will state unequivocally that the Saint Claire Medical Center would not exist today if it were not for the University of Kentucky Medical Center. It would not exist today if I had not been travelling to and from Morehead constantly and I don't mean Johnson, I mean that the Medical Center 00:18:00had somebody to do that-- it could have been anybody-- but that the Medical Center provided a person and as I'm sure you fully appreciate, in those-- in those situations things just don't happen by themselves, (laughs) and my role was not the role of, you know, the person who dreamed of it. I'd love to take credit for that, but that's not true at all. I was really again, if you will, the community organizer. I was the catalyst when a catalyst was needed; I was the coordinator when parties needed to be brought together; I was the troubleshooter when it looked like everything was going to fall apart; I was the mediator when things were going bad in the community and I'd run up there and bring the right people together again and that was not an easy thing. 00:19:00If-- if you-- if you will stop and think about the fact that what we-- and when I say we I mean everybody, the community, the Medical Center, the original people-- what we were able to put together in that very rural Rowan County -- which probably didn't have more than forty or fifty Catholics in the-- certainly not in Morehead and I don't know if they did in the whole county-- put together a facility which was going to be administered by the Catholic church and also got that church to accept a community board which couldn't operate the hospital, because clearly legally it was a Catholic hospital belonging to the diocese, but was willing to work with that community board as if it-- it-- with substantial input and advice and would listen to it. Well, that took 00:20:00a-- that took a lot of cooperation on a lot of peoples' part (laughs)
SMOOT: I would think so.
JOHNSON: And that came off and it, you know, I know-- I'm sure you'veheard the story about-- well, Dr. Caudill -- Louise Caudill -- was the one who started this whole effort and when we got into the act was when she began to have second thoughts about whether building another rural hospital was really the thing that she should be doing. Here she had gotten this big head of steam-- and she's an unusual woman-- had turned to the diocese and gotten a commitment to operate the facility and then really began to wonder, well, you know is that what we ought to be doing in this day and age, build this little -- I've forgotten what it was originally going to be, sixty or less-- something probably bed, you know, community hospital and she came to the Medical Center 00:21:00for advice and the Medical Center then established me as the person to play this role that I've just described and there-- you know, Dr. Willard was involved, Dr. Bost was involved, Dr. Pellegrino was involved. We, you know, began to help them see that if they had a more structured, organized form of medical care, if they were interested in the different kind of quality that there was the possibility of building this relationship with the University where they could have people who would be acceptable for faculty appointments and that there would be this chance to build some cooperative programs. We called on Ed's experience with Hunterdon County Medical Center, you see, and I-- I mentioned the group practice that I had been involved with earlier, a place called the Rip Van Winkle Clinic up in Hudson, New York, so both 00:22:00Ed and I had differing kinds of experience with group practice, but a lot of experience with group practice and began to talk to them about, you know, the way that might go--
JOHNSON: --if they were interested in trying to make-- make that effort.And now that place has evolved; it is not what it was, you know, when we-- when we first began, but the fact remains, for the size of Rowan County, Saint Claire Medical Center has a nucleus of quality medical care that I would suspect that not many comparable rural areas in the United States has and it still has, you know, a good relationship with the University. Now, another illustration of my involvement in behalf of the Medical Center is-- is this organization. I recall very clearly going to Dr. Willard one time in the summer -- I guess this 00:23:00would have been 19-- oh, '63, somewhere along in there -- and telling him that I kept hearing rumors as I was travelling out in the eastern part of the state that the mine-- the Miners' Memorial Hospitals were going to go out of business. And when he was going to Washington the next time, this-- and I recall this was in the summer -- would he, you know, see if he could learn anything about this and him coming back and telling me that he talked with some of the people at the United Mine Workers Welfare Retirement(??) Fund directly and that-- now, not to worry about that, this was John L. Lewis' monument to himself and if there was anything that, you know, that he was not about to abandon it was the hospitals. And, you know, my memory of this is that this was in the summer and that October they announced that they were going to 00:24:00close the doors on all of them, that they were either to be sold to the communities or they were just going to lock them up and go away. And I was again made the University's person to get involved in this process to see whatever there was that might be done to help with what was clearly a developing crisis. Well, in the meantime the Presbyterian church had been approached through this minister in Harlan who was concerned, you know, and had written to the Board of National Missions and so it was beginning to look into the situation, but I was very much involved in this. There was a young man at that time, he was-- I mean young at that time -- by name of Bill Wester. Bill is still -- I don't 00:25:00know if you've come across that name or not. Well, I'll mention this to you in the-- as the-- part of the-- just your personal interest here -- that Bill at that time was working in the health department as an assistant to the commissioner, but he had also come out of the budget office and Bill was always involved in the political process, you know, staff level, but very much interested in the political process and he went from--you know, I lost touch with Bill after I went out to California -- but he ended up being, you know, very close to Governor Ford and when Ford became governor-- went with him to Washington when he became a senator; got more involved in political campaigning and is back here in Lexington and is one of these people who-- I can't think of who's the other guy he works with-- but manages political campaigns 00:26:00for fairly successful candidates (laughs). But anyway, Bill-- Bill and I worked at what I would call just plain, basic staff work at trying to understand the Miners' Memorial Hospitals, you know, how they were organized, where they came from, what was likely to be a possibility of any future for them and the Presbyterians, as I say, were looking at it from their vantage point. I made the comment and I believe this to be true, that at one time I think I knew more about the Miners' Memorial Hospital Association than anybody who wasn't on their payroll because I just had to learn so much about it. We put together a big meeting in Harlan; we brought together community reps from all over to take a look at the options that-- that were before us and clearly the Presbyterian interest was the most viable approach in the sense of playing, again 00:27:00a caretaker or a catalytic role to go from one organization into another if a way could be found to, you know, actually transfer title and find some funding for those hospitals. So that then I-- our work began to mesh and we played more of, again the staff role in trying to assist if they-- if they needed help, but at a-- at a fairly key time there I think we were instrumental in the sense that we were another voice that was making it very clear that there was absolutely no hope, no way that any of those communities was going (laughs) to be able to take on and fund one of those hospitals, you know, itself, which was the MMHA's position, you know, that if there were any interest 00:28:00in this they ought to take them over and hell, they had found out in eight years they couldn't fund them. The problem of indigent care was so-- so great that they couldn't-- with a seemingly bottomless pit of resources they were already calling it quits and-- and in fact, I remember when we were putting this big meeting together at-- at Harlan, Dr. Greely, who was an active pediatrician and one of the founders of the Daniel Boone Clinic in Harlan came to me and said that he had Dr. Newdorf, who was the medical director of the MMHA with him-- this was back at the old Mount Aire, which is-- was very new and since has burned-- and we were going to-- as I said, we had organized this big regional meeting. Now, Wester and I really had done that job and Dr. Newdorf came in, to, in a way, kind of lecture me that we didn't all 00:29:00seem to understand how serious this was and that these communities were showing no interest in taking over those hospitals and that they were dead serious that they were going to-- something had to begin to happen here. This was November, I want to say, and by July they were going to, you know, padlock the doors and be gone. And I remember this because I really lost my temper. I mean, we'd-- we'd been working hard and here this whole region was threatened with the loss of this major health resource and it was at the time the Economic Development Program was very big in Washington and John Wissman was active in the state of Kentucky. John was one of the intellectual fathers of the Appalachian Regional Commission, which grew out of this time. But there was this whole economic thrust of trying to help areas like Appalachia by, you 00:30:00know, by bringing in money and I remember turning around and saying to Dr--. to John Newdorf that, damn it, you know, if-- if this is your attitude then just go ahead, just bolt those hospitals up and get out and what we'll do is we'll turn to EDA and see if we can-- at least see if we can get some help to build new hospitals and at least-- that will also provide employment at the time and that would be in keeping with the economic mission and maybe we could find some ways of developing alternate facilities. Of course, you know, there wasn't a snowball's chance in hell of doing that, but I-- I never was more furious and I remember saying to so many of my friends that the attitude of the Miners' Memorial Hospital Association, which clearly was reflective of the UMW Welfare Retirement Fund-- which had Mr. Lewis as one of 00:31:00its Trustees, as I recall at that time -- that their attitude must have been precisely the same as U.S. Steel's was towards the UMW when it was first getting organized. There was no more interest in those people or what they would be doing to those people-- this had simply become an economic burden, the Fund could not handle it and they wanted out. The-- so we played a-- we meaning the Medical Center again-- and one of the things we also did was research the different possibilities that there might be for providing monies and I made trips to Washington where I would try to find out if there were little known, you know, clauses in Public Welfare laws (laughs), anything that might really be an opportunity. And one of the things that we felt-- and I say 00:32:00we, this was collectively-- was that medi--- something like Medicare was burgeoning -- or not burgeoning at that point, but was clearly coming along-- and I do remember, with Mr. Wester-- he and I were in Washington and Governor Combs was coming to Washington for another matter and we asked if we could spend some time with him; met with him privately and talked to him about the necessity of calling a special session of the legislature to provide some transition money. It seems to me it was around seven-- six or seven hundred thousand dollars, which was a lot of money then, for these hospitals and that that might very well phase into the public programs which appeared to be coming along and would give the Presbyterians some, you know, further time. And he did that; he did indeed convene a special session and he and-- did 00:33:00help that chain along. Well again, it-- it wasn't anything, you know, the point here is that that was characteristic of the Medical Center's position at that time-- that it was a citizen of the Commonwealth; it should be involved in, you know, anything that related to health of the people and we should do whatever we could do and it was the kind of thing that Kurt Deuschle-- I used to spend a lot of time with-- with Kurt because by the time Kurt came along, I knew my way around, you know, pretty well and could introduce him to people that-- that he needed to know. But that-- those are a couple of examples--
JOHNSON: --of the kind of thing we did. Now, I used to also, youknow, work closely with the professional organizations trying to again, always broaden their thinking a little bit (Smoot laughs) 00:34:00from, you know, from our perspective-- that the guilds not be quite so restrictive as-- as they tend to be and that-- that's always of course difficult, but the Medical Center, I, you know, I think really did have an unusual approach. One-- one of the things that might characterize this-- I-- I suspect this is an anecdote that you haven't heard -- the Medical Center was receiving some money -- I can't even tell you what it was for at th--- now -- that was before my time that it had engendered this from the Commonwealth Fund and Lester Evans was the director of the Fund then -- or the medical person at that time -- and I-- I remember very clearly going one morning -- he was visiting and Dr. Willard had asked us all to come and meet with Lester for awhile -- and it was one of those coincidences, we happened to converge on 00:35:00Bill's office about the same time. There was Ed Pellegrino and Howard, I think Dick Wittrup, who was the hospital administrator, Bob Straus and myself and I remember Lester saying, you know, hello to each of us and stopping and look back and he said, "You know, it just struck me, I've known every one of you people in another setting and now I see you all here together in Kentucky," and I think, you know, that did characterize what Bill had done. He had brought together a group of people who really had a public health-- and by that I mean the health of the public-- orientation, or a strong conceptual belief in that and we all had been involved in different things in, you know, in other places and he'd brought that group together and that Medical Center-- 00:36:00until it got into, you know, (laughs) later years -- it just embodied that-- that notion that it was a institution which belonged to the people of Kentucky and should be doing all it could do to improve the lot of the people of Kentucky.
SMOOT: That reminds me of-- of at least say, I've seen a more detailedstatement of the purpose and philosophy of the Medical Center, put one point of that philosophy in an abbreviated form, at least from one source that I have seen, one of the goals was to take care of the needy in Kentucky, provide health care for the needy. This is a very early statement, this is a synopsis, I'm drawing that verbatim from an 00:37:00article I've read on the dev-- on the birth of the Medical Center. And you mentioned of course that there were problems with-- with the large number of indigents in Eastern Kentucky particularly. I think many-- correct me if I'm wrong; I think many uh, indigents saw this Medical Center, this new hospital, medical center going up here in Lexington, as a place for them to come, sort of the Mecca for their health needs. Would you agree with that?
JOHNSON: Oh, I-- I don't think there's any question that there were alot of people who thought that this was, you know, as you say, from their perspective-- going to be a charity hospital in the sense that they could go and get care.
SMOOT: Um-hm. Was this ever the concept that Dr. Willard had in mind?00:38:00
JOHNSON: No, I was interested when you said you saw that in some of theearly writings 'cause I, you know, I'd be interested in-- in looking at that and at what time that was, because one of the things that I remember so clearly when I came to the Medical Center was while there was always this, you know, this social sensitivity in that we needed to-- to grapple with that problem--
JOHNSON: --there, that it was always-- what am I saying? Realistic, thatit was always precise and well thought through. The best illustration that I can give you of this is-- which-- which doesn't deal directly with the-- the indigent individual, but I think the principal will 00:39:00apply-- excuse me-- is early on, I was just, you know, I was just tremendously impressed with Howard Bost, who is one of the most able people that I've ever been associated with-- and I think I've been very fortunate in my life, the places I've been and the folks I've been associated with-- but I can recall Howard, when we would be working out our presentations to the legislature and our working with the staff members of finance, you know, just holding firm to the fact that the funding of this Center is going to have to be faced realistically and that just such commonplace things as, let's say, the state mental health hospitals or the health department, that if they had people that needed services they couldn't assume that-- well now, you know, send them to the University Hospital, we're all funded by state government 00:40:00so they'll take care of them. And this took some doing, you know, to hammer out that, look, if mental health wants to take care of those patients they've got to get money in their budget (laughs) and they can pay for the service because somebody's got to pay for this service over here and that, you know, there is no, again there is no bottomless pot that you can just go to the legislature and say we need money to do good things. And I was always impressed with the budgetary astuteness and the rigor with which that kind of financing, you know, was put together. So that I have to say to you that, yes, there was extreme sensitivity in trying to put together programs to serve those people-- and that's one of the well, you know, of Howard's tremendous leadership in the development of the medical care programs in this state. But we saw it, you know, doing that and nobody in-- in our group ever saw the 00:41:00Medical Center as just, you know, (laughs) it was there to take care of people as they walked in. I mean, that was just totally unrealistic.
[Pause in recording.]
SMOOT: We've talked-- several references here to-- to the earlyfirst team, I guess we could call them, of the Medical Center -- Dr. Willard, Howard Bost, Bob Straus--
JOHNSON: Bob Straus.
SMOOT: --could you evaluate the-- this team of players -- the foundersof the Medical Center?
JOHNSON: Yes. I-- because, you see, I came into it a little later,00:42:00they mostly -- I guess most of them were here in what, in about fifty-six or late fifty-six and I came in the very early 1960-- so by the time I came the Medical Science building was up and the Hospital was beginning to-- I mean it was just beginning and Dental-- Dental School didn't exist at that time. I did not know any of this group individually except Pellegrino. We-- and we weren't close friends, but interestingly enough this Rip Van Winkle Clinic that I had been with for a number of years-- Ed and I used to see each other at the Columbia School of Public Health because we would be invited to come and talk about these two forms of group practice and we got to know each other over that period. But I did not know Bost, Straus; I knew Willard 00:43:00as-- having been a faculty member, as I mentioned; and I did not know Wittrup or Alan Ross, who was a part of that group at that time. My-- obviously I was as very, very much at home with these people because again, they all did come from the same philosophic background that, you know, that I champion. And to paraphrase what I said earlier, I think all of them came with a public health perspective, a public health philosophy, but not public health in the traditional health department. I don't mean that, but in the interest in the health of the public, not an interest in perpetuating professions for the sake of the professions. You know, I suppose truly, all of us were what-- 00:44:00and depending on one's political views-- you'll either think of as very good, intelligent liberals or just as fuzzy headed nuts who (Smoot laughs), you know, were (laughs) leading everybody astray. Now, the remarkable genius in all of this of course was Dr. Willard, a man of infinite patience, who had a great conviction, had great sense of purpose. I don't think I ever--. I'm sure others have, but I don't believe I ever saw Dr. Willard, you know, in a-- in an ill temper, really, I don't think I ever saw him short with anybody and, you know, 00:45:00when one thinks of the scope, the scale of that undertaking and how much of this rode on-- on him, you-- it is absolutely remarkable. Uh, Bob-- Bob Straus brought to that group a rare characteristic which he to this day exhibits. He obviously is the person who has a remarkable facility for bringing dissimilar folks together and working with them over time and again, has, you know, remarkable patience. With our new department in behavioral science-- that of course was a, you know, a big-- big thrust at that time and hard working; all of this group was 00:46:00extremely hard working; all of them were selfless. You know, the hours that were given there, it just is unbelievable. People think of folks being dedicated to a job; it was just-- just really quite incredible. Howard I've already mentioned, intellectually I think Howard is one of the most superior people that I've had the good fortune to deal with and I don't mean that the others were far behind, but I think Howard really is-- is quite unusual. He was not as patient as (laughs)-- as the others, but when I say that I-- I mean, he would-- he would probably be more quickly exasperated and-- but also he saw through things quicker; he would get really to the point of an analysis quicker than most of us could, but also had a remarkable sense of political strategy, even 00:47:00so -- even though he might be impatient, you know, in the confines of this room, he was the person who could sit back and better than anybody else talk about, well now, you know if this is what we really think we want to achieve and if you look at what the Commonwealth is faced with and this is the kind of program it would take and here are the steps that it would take to-- to reach there. I just had the, you know, the greatest-- well, I had admiration for that whole group, but over the years I think, you know, Howard is the one who's just always stood out in my mind as the really superior intellect in-- in that sense. Pellegrino was a prima donna who was, uh, fun to work with. I always enjoyed being around Ed. He was an intellectual gad-fly and a physical 00:48:00gad-fly. He was-- I don't think there is any doubt about Ed's interest in-- well, that Medical Center. And again, a tribute to Dr. Willard, I must say, and to that Medical Center is that Ed could never have become a professor of medicine in this country had it not been for U.K. 'cause he just didn't come out of the, you know, the usual academic group. He was sitting there in Hunterdon as the medical director and had an affiliation with medical schools, but he did not come out of a scholarly program background - a university background-- and came to Kentucky, a ver--- again, all that-- one thing that all of these people had in common was they were fine human beings, they really were. I-- I don't have any unpleasant memories of crass, limited, selfish, 00:49:00you know, individuals in that sense. The thing that I do remember if I, you know, to enter something on the-- not necessarily negative, but maybe the most-- the most negative thing that I said is that as the Medical Center began to grow and as we began to recruit and as it became harder and harder to bring in clones of the original group and more and more traditionalists and establishment kinds of people came in and these battles became harder to, you know, maintain this different look about the Medical Center with that inexorable thrust of tradition in the way medicine was done everywhere else coming along. I always had the feeling that Ed-- Ed gave up on that when (laughs)-- earliest 00:50:00of anybody, that when it really got to where the, you know, it was beginning to really get tough and you really had to hang in there that he was the one who would be more willing to-- to make the compromises and maybe lost his zeal for the battle, I'm not sure. I don't want to misconstrue that because personally, you know, I mean, he really was a delight and-- and as I said, I always felt that I knew Ed [clears throat] -- excuse me -- quite well. We got along very well together, spent a lot of time together. Again, I'll-- in the eastern part of the state and visiting other places, did a lot of things together, but I-- I never-- or at least I always had the feeling that he did not have the 00:51:00same resolve that some of the others did when-- when the going really got tough, 'cause there were some tough fights when the departments began to grow and the traditional things came along. And it was of course to Dr. Bost's credit again, that that whole physicians' compensation plan was put together and that was a very unusual thing. And we really started out, you know, to avoid the usual geographic medicine approach in medical schools and we were going to try to avoid the traditional departments and subspecialties and we held that for a while, but again that's where, you know, as-- professor of medicine would have been absolutely key. That's-- in my judgment-- you know, that's where things began to slip when-- when-- when it really began to get extremely tough. But Wittrup-- Dick, I always just thought was 00:52:00a-- from again, my perception-- a joy to work with. And now, you have to remember I didn't deal with the hospital on a day-to-day basis; although I dealt with Dick on a day-to-day basis. I have no idea what Dick was like in the sense of an administrator of a day-to-day plant and not begging that question, I really wasn't in a good position to judge that. From my perspective, he was a delight because he was a hospital administrator who could talk about things other than staffing and, you know, the occupancy of the place and again, could talk about these kinds of issues and what the role of that hospital was as a part of the Medical Center in-- in fulfilling those goals and I thoroughly 00:53:00enjoyed that. And really, when I was invited to move across the campus I think the hardest thing for me personally was to think about, you know, not working with that-- with that group of individuals because it was an unusual group. And I would say that I didn't have a similar experience until I went to Berkeley where-- I think the two brightest people that I ever worked with, you know, one was at Berkeley and one-- the other was Howard. And I've always said that when Howard Bost has something to say to me it's worth listening to and that doesn't mean that we always agree by any means, you know, I-- but when we, you know, when-- well as I say, in-- now, like see he's on my Board of Trustees here and, you know, and if-- if Howard-- there's something going through his mind and he wants to talk about medical care, I just 00:54:00know that, my God, listen because it's worth listening to (laughs) and then go off and think about it and, you know, that's a rare-- that's a rare thing. And I worked-- when I went to Berkeley, I went as vice- chancellor-- I went to Berkeley as vice-chancellor for student affairs at the height of campus--
SMOOT: Yes (laughs).
JOHNSON: --disruption and there was a vice-chancellor for administrationat that time by the name of Bud Shite, and the next year he was going back into teaching, and they made me vice-chancellor for administration, which I said I'd do if I could keep student affairs, if we'd make it a different portfolio and he is the other person. This was one of the brightest people that I have ever been associated with. God, what a mind this guy had. But unlike Howard, Bud was a wheeler- dealer (laughs), but he was, and is, I mean, he still is just-- and-- 00:55:00and when I say this now, I, you know, I'm-- really mean this as very exalted company because I think that the president of the University of California, for whom I served several years, again was one of-- was an extremely intelligent man. He was a man by the name of Charlie Hitch. Charlie was an economist who had been an Oxford don and really just a very gifted person and Roger Hines who was my chancellor at Berkeley was certainly so. So when I say that I'd put Howard, you know, way up in there from my point of view he-- he was unusual. I'm sure you've formed your own impression (laughs); I don't need to belabor that.
SMOOT: I can-- I can agree with that without any problem. You know himbetter than I do, but--
JOHNSON: He-- he really is a very able person.00:56:00
SMOOT: Let me ask you about the University administration. You cameduring the administration of Frank Dickey--
JOHNSON: Frank Dickey, Um-hm.
SMOOT: --and then worked very closely with the administration of JohnOswald. Could you give me some background on the relationships that these two men had with the Medical Center, your own relationship with the presidents of the University, how effective they were as presidents, the differences, the similarities and so forth?
JOHNSON: Sure; now, obviously I did not know Frank as well as I knewJack; although I-- I certainly knew Frank and-- uh, I guess, you know, my-- my feeling about President Dickey was at the time-- as the 00:57:00Medical Center was developing it was beginning to create real problems for the rest of the University (laughs); pay scales were way the hell out of line, as you know and that-- that of course was a particular problem, especially in the basic sciences who are so very difficult to understand-- and which one can't-- can't justify intellectually. You know it's purely a marketplace phenomenon and if you were going to have a medical center that was the way the thing operated, uh, and I certainly had the feeling that Frank was very uncomfortable with this. You know, in the early days as the Center was developing that was one thing; it was something to be proud of and the building was going up and it was small, but as it really began to develop some mass and these issues began to hit the academic senate and that-- I always had the feeling that-- that Frank would much preferred it (laughs) all 00:58:00just sort of go away (Smoot laughs) and-- and really was at a loss as to how to deal with it. He's a very kind and a very gentle person and again, I, you know, I always enjoyed working with-- with Frank, but I always did have the feeling that this was a problem which he was over his head and he just did not know how to cope with what appeared to be this increasing bifurcation of the-- of the University. Jack was an entirely different guy. Jack was-- take charge and there was going to be no question about who in hell was the president of this University. I enjoyed working with Jack very, very much. He-- again, I think to-- you have to remember how he came to this institution. I'm sure that-- 00:59:00well, one of the things of course is very clear, was he was brought here to take a second-rate regional institution and wherever he could build it into something of-- of some quality. The Board of Trustees-- the, you know, it was-- it was clear that they wanted some changes and he was asked to do that. [Clears throat] Excuse me. I am sure, although I was never privy to this, I am sure that he was probably also made aware of the difficulties with the Medical Center and that somehow or other he was going to have to bring this thing into line and for Jack that would just be great. You know, that's just another (laughs)- - that was just another little problem that you've got to get a hold of here. Now, Jack-- Jack was not an intellectual in the sense of, you know, a scholar-- that's unfair, hell, the man was a scholar and, you 01:00:00know, here I am the non-scholar to be making these-- these comments, but I mean even though he came out of a field of scholarship-- of the people who I am associated with, Jack was not a reader. Jack did not go off and read deeply on issues, but he was a man of action and he had clear-cut goals, worked hard, had a, a charisma which certainly got a lot of people energized into, you know, to doing things and was not in the least bit reluctant to provide that kind of-- of leadership, but he was not the per--- he was not a person that one would sit around in the evening and discuss some-- either play or some tome or something, you know, that he had been reading-- it-- it just-- that was not his-- his thing at all. He was very much a now, action oriented person. 01:01:00I always felt -- and I am probably the-- the, you know, person who, having been in both camps, so to speak, could see this, I always felt that Jack had great admiration for Dr. Willard, even though he felt that, you know, he had to get that Medical Center in line, but he really did admire Bill, admired very much what had been done there. As a-- as a vice-president at that time and the team of vice-presidents when I was there was Albright, Creech came along, Bud Cochran came along, myself and Willard - I guess that's it. And-- and I found 01:02:00having, you know, come over and becoming a part of the University administration, I found that at times that I was uncomfortable in the fact that I felt that Dr. Willard was frequently coming to Jack's meetings of himself and his vice-presidents as an emissary of the Medical Center rather than as a vice-president of the University presiding over the Medical Center. Now, I think historically that's quite understandable; I mean, it started a different way; he had built it and he was the, you know, the Medical Center. Even though that I think went on, I never saw-- again, I don't know what might have gone on privately between the two men, but they handled that very well among the rest of the group. And I do know-- I was involved in other 01:03:00situations where I heard Dr. Willard explaining to partisans over there problems from the president's perspective, you know, what the University was dealing with. But I think from Jack's point of view, that he was always somewhat disappointed that-- whereas I think he felt the other vice-presidents were a part of his team-- each of whom had a responsibility to administer some part of the portfolio of the University-- in this instance it was more somebody representing a part of the University. Jack, I think-- even though I say that, he was probably more in tune with some of the things that the Medical Center was doing administratively than Frank Dickey was; and by that I mean 01:04:00the administrative organizational patterns and the way the Medical Center did things because, again it was doing things (laughs) and Jack liked to do things, clearly. But-- and you may have-- you may have heard this from somebody-- from other people, but if you haven't-- that, you know, our whole business of not having tenure for department heads-- you know, the Medical Center was the one who introduced the rotation of department heads in this University; I mean, you just didn't stay a department head forever, we couldn't live with that. It was the Medical Center who-- and I-- and then this was really an unheard of idea when the Medical Center developed, going back to Dickey's administration that-- that vice-presidents were administrative officers and served at the pleasure of the president; that they-- that, again that they didn't have tenure of some sort. I honestly think that 01:05:00Peterson and-- what was the other man's name? The academic--
SMOOT: Not Chamberlain, was it? No, it's--
JOHNSON: Yeah, Chamberlain.
SMOOT: Leo Chamberlain.
JOHNSON: Leo Chamberlain, yeah.
JOHNSON: I honestly think, you know, they thought that their jobsshould be there, you know, presidents could come and go, but by God, they were going to be vice-presidents of this-- well, you know, Jack never had that kind of a notion and neither did the Medical Center, that administrative officers did serve at the pleasure of whoever was the chief executive. So in that sense, I think Jack was probably more comfortable with the Medical Center in an operating sort of day to day sense, but was always chafing with it in terms of who was really running the University and that it had to be kept in-- in tow. I know he wanted much more to intrude in the budget of the Medical Center 01:06:00than, you know, Dickey had left them to do their thing over there--
JOHNSON: --and Jack felt very strongly that, by God, the Medical Centerhad to come forth and argue for its budget with him, you know, be presented just the same way anybody else did and that he intended to understand that, and he intended to have the rest of the people understand and well, the Medical Center hadn't been used to that for some time (laughs) and so there was, you know, that-- that kind of chafing. But I do go back-- I-- and again, I use-- I knew Jack in California. See, I-- when he resigned from here, there's-- people always have this notion that he and I went to California together and that isn't true. It-- what-- what happened was that he resigned from here to go back as the executive vice-president of the University of California and sometime after that occurred, the vice-chancellor for 01:07:00student affairs at Berkeley resigned to go on and become president of the University -- a guy by the name of Bill Boyd. Well, when they were looking, obviously Jack, you know, I mean without his good word I would not have gone to Berkeley, but I mean it was, you know, they were looking for somebody and he had mentioned me and so they called and I went out and, you know, one thing led to another, but anyway I'd--- I did go to California, but he was in the system-wide administration as executive vice-president. I was going to the Berkeley campus as vice-chancellor for student affairs. Then as I mentioned, the next year I became vice-chancellor for administration and then interestingly enough, the third year the president of the University called me and asked me if I'd come over and talk to him about becoming vice-president 01:08:00for administration of the University because, lo and behold, Oswald had taken the job at Penn State and Charlie was going to break his job up into two senior vice-presidents, one for academic affairs and one for administration and that meant that-- and-- and that's what he did. And I became vice-president for administration and all of the non-academic things came my way and a guy by the name of McCorkle, off the Davis campus became the academic senior vice-president. And that was really the relationship between w--- Oswald and me and we would see each other, you know, occasionally in Berkeley and-- and I bring this up because obviously, you know, when we did we'd talk about things that were going on in Kentucky, that had gone on at Kentucky, and I never heard him say anything-- even, you know, when he was away from the scene and might have let his hair down, so to speak, never heard him 01:09:00speak of Bill with anything but admiration, even though he might have been frustrated about again, how he felt that it fit organizationally. I think Jack, when he came was resentful of the fact that the Medical Center had such good relationships in Frankfort and throughout the state. You know, I mean it was the best part (laughs)-- the best known part of the University and-- and that whole separateness obviously hurt somebody who had the kind of ego that Jack had and his interests, you know, and that didn't settle well. Now as I say, he and, you know, and others would know more about this than I, 'cause I simply was not privy to those sessions. If he and Bill had any personal difficulties that got in the-- in the way, I-- I was not witness to them. 01:10:00
SMOOT: During your association with the University of Kentucky, whatwould you enumerate as the major achievements of the Medical Center in particular?
JOHNSON: Okay. First of all, the Medical Center shook up, without anydoubt, the whole world of medical education. You know, I don't think there's any question about and maybe its greatest achievement was the reform, if you will, or new directions that it gave to thinking about medical education even-- even to this day. I mean, there are, you know, even though we like to sit and moan and groan about all the things that didn't get done a lot of things did get done and I don't think there's any question about that. So probably it had more of an impact nationally (laughs), let's say, that it did in-- in the state. The College of Dentistry in the same way, I don't think there's, you 01:11:00know, any question about it having a profound impact on the development of other colleges of dentistry. Not so in nursing, but certainly so with dentistry. The relationship with the state government, I-- I do think that-- and I don't mean that in a, you know, the crass, political sense, I mean in a highly professional sense, the partnership of state government-- and I don't mean just the department of finance-- the relationships with the health department, the relationships with the department of mental health, economic security, I think gave to this state a professionalism, a professional relationship that previously 01:12:00had not been seen and which sort of elevated its whole notion about, you know, the kind of professionalism that could take place in public service. And I think probably thirdly, the Medical Center gave to this University-- and in a sense the state again, state government, but especially the University-- it gave to it-- what do I want to say? It made it possible for this Univers--- for the University of Kentucky to believe that it could be something other than what it had been up to that time. I just think that, you know, probably no one would ever-- will ever be able to measure the impact of that Medical Center on enlargement of horizons, ambition, attainment, you know, that Kentucky just didn't have to be last on everybody's list of 01:13:00everything-- including the University-- that, by God, it-- it could do something. I don-- I'm not sure this University-- or the University would have gone out and looked for somebody like Oswald had the Medical Center not developed. I'm not sure it wouldn't have just stayed right there looking in its own vineyards, you know, for somebody who was well liked and respected. But I think the Medical Center just brought that whole new-- now, you know, new way of looking at things, but that it was achievable, that you could do it and that, it was possible. I-- I really believe that, I-- I don't think they'd ever have gone into California looking (laughs) for-- for a president if the Medical Center hadn't shaken up everybody's thinking-- and in a very positive way. I do not associate my memories of the Medical Center-- even though I think it did shake up and jar a lot of things-- I do not have any 01:14:00association that this was, you know, negative or destructive, even though there was always wrenching and tugging and pulling, but-- but, you know, that its overall impact was very much an uplifting. Those would be the-- the things that I think just absolutely stand out about the achievements of the-- the Medical Center.
SMOOT: Um-hm. Are there any problems that-- that you would point tothat were-- you have of course touched upon several -- but any large problems that you had to face while associated with the Medical Center or as a vice-president of the University that you think changed the course perhaps of the goals and objectives of the Medical Center, things that had they not occurred perhaps the Medical Center would have gone-- 01:15:00
SMOOT: --to even greater--
JOHNSON: Yeah, I think undoubtedly the one that I alluded to earlierwhen we started the more intensive recruitment for other programs. And by the way, just to-- this is an aside, but to give you an idea of how unusual that Medical Center was, as I have indicated to you, you know, I didn't-- I never started out to, you know, be a scholar. I mean, that was just not, you know, I never thought of being involved in higher education in either as a scholar or as an administrator, so, you know, I kind of backed into this whole thing and so that (laughs), you know, I think that I-- I do have a, oh you know, kind of a different way of-- of looking at all that's-- that has taken place over there. And to show you how unusual the Medical Center, or 01:16:00really Dr. Willard, was, I used to sit in on the curriculum committee in those early days when we were-- and I was-- and was taken in as a full-fledged member. It was probably very useful, you know, I never-- I never once felt that I did-- that I was not fully accepted or didn't have, you know, adequate credentials to participate in any activity at the Medical Center. Bill opened it up to everybody and, you know, I was fully welcome. And I've often thought of how important that was because, you know, I just got very used to that. I-- and I realized one day at the University of California that I was probably the only non-Ph.D. in this whole damn group, but again it sure wasn't bothering me and it didn't seem to be bothering anybody else (laughs) and-- and of course, again, that's a remarkably mature institution 01:17:00(laughs) those people aren't hung up over things like that. But-- but that wasn't, you know, I mean that was unusual that, you know, I didn't come out with this or that kind of background. I hadn't been in medical education, but Bill was always looking for new views and different perspectives and-- and insights. So when we got into that-- that period and, you know, I know you've been told this many times and obviously it had to do when we were recruiting for surgery and when Ben Eiseman came aboard, that's when we started to move more and more and more towards the way things are done in other-- other medical centers, that we began talking about restricting beds in the hospital for subspecialties, you know. We-- we-- we just weren't going to go that route at all, but-- and-- and I-- while Ben was clearly the easy person to identify in this and because he was such a strong individual 01:18:00and-- and as I said, Ed-- Ed really wouldn't take this on and then as others came along the weight just began to develop and you can imagine how difficult it must have been for Dr. Willard to have department chairman after department chairman coming in and saying, well, you know, we can't recruit unless we can offer this or do this or do this and they were doing it the same old way. So I think, you know, at-- at that point, had we not-- had we been able to find a professor of surgery who had had a-- a different vision at that moment; yes, I think that Medical Center could have gone on and done-- done things even far more, you know, made far more accomplishment than it did. Now, I was not around because, you see, I left the Medical Center and then of 01:19:00course I left the University in 1968 and so I was not around to-- to be able to tell you what happened, you know, why-- why community medicine went the way it went, which I think it was, you know, a real tremendous tragedy. That was such an exciting, exemplary program. Kurt Deuschle had put together just an outstanding department-- an unusual program there. Well, you know what's happened to the faculty he had, hell, they all went on to bigger and better things, but-- but see, I wasn't here so I can't-- I don't know what happened during those years, why-- why it accelerated as rapidly as it did to become as traditional a medical center as it has become.
SMOOT: Now, when you say traditional, I-- I-- I take it that that's01:20:00not necessarily, a negative term, but when considering what could have been, what-- well, what-- what was started and was indeed a very innovative nontraditional institution, when it ultimately became a more traditional institution, that-- that's something that you say with some unhappiness--
SMOOT: --with some uneasiness--
SMOOT: --am I-- am I correct?
JOHNSON: That's correct, sure. Oh, I-- I don't think that there's--and uh, again, this is - what'd we do with this-- what'd I do, is the hole-- oh, here it is.
SMOOT: There it is.
JOHNSON: This is not meant to be pejorative in this-- in the sense of,you know, of present administration, actually Pete Bosomworth and I are very close friends.
JOHNSON: And I have a great deal of (laughs) empathy for Pete 'cause I--I can't even figure out how the hell the man retains his sanity with what he is beset with over there. No, I think I'm, you know, referring 01:21:00to the fact that if you were talking about medical centers around the United States, you-- neither you nor I could clearly distinguish this Medical Center from any of a dozen others (laughs) or many more the way at one time, you know, people knew the University of Kentucky yes, it was different, it was doing these things in quite different ways. Actually, in many ways this institution has reverted. They-- I think the-- the physicians compensation plan, which was a keystone to what we had had because there just was not that kind of personal incentive and again, the development was for something bigger and better. Well, 01:22:00that's gone now.
JOHNSON: You know, and it's-- it's like compensation plans that grubby,greedy people all over the county have. The-- I-- I'm not aware of really unusual outstanding things that are going on in the field of medical education in the sense of new concepts as was true when behavioral science was introduced here, for example, or community medicine was introduced or the way of thinking and I think it's-- it's very much like the colleges of medicine I knew at the University of California, you know, we had five of them (laughs), so I-- I saw a lot of those. Of course it is complicated of cour-- today by the whole 01:23:00change in the health care environment which is, you know, introducing another set of pressures. But, you know, I hear them talking a lot about research, but again it's-- it's research built around given clinicians that you, you know, that you attract and-- and I don't mean that there's anything wrong with that.
JOHNSON: I think that one is always going to have that and one tries toattract good people, but there isn't-- I don't know of an institutional position, you know, that this is what we're about and we need to be solving the problems of medical care for the people of Kentucky, you know, so--
JOHNSON: --how to organize that and get it together and that's-- that'snot what it's about.
[End of interview]01:24:00