Centennial Stories: Specialists advance patient care

Published 05/20/2019

Local writer, Betty Cotter, chronicles the 100 year history of South County Health.

In the 1960s, medical specialists began to join the staff of South County Hospital, transforming the delivery of care and changing the dynamic among doctors. The first specialists to arrive were Dr. William McDermott, a pediatrician, in 1964, Dr. Robert L. Conrad, a surgeon, and Dr. Joseph O'Neill, a board-certified obstetrician, in 1965. Dr. Alexander A. McBurney, a urologist, followed in 1969.

Dr. Robert ConradIt would be another two decades before the hospital had its own cardiologist, Dr. J. Robert McGhee, who arrived in 1984, and pulmonologist (lung specialist), Dr. Anne Hebert, in 1989. These trail-blazers brought with them vital expertise. They also worked largely solo for years, with little to no backup coverage.

 

 

Dr. Joseph O'Neill

 

Dr. O'Neill practiced alone for seven years, until his brother, Robert, joined him in 1972.

“I'd never do that again,” he said. “I lived here,” he added, describing the long hours at the hospital. “My wife would bring me clothes.” Since Dr. O’Neill missed out on going home for meals, the cafeteria chef and his wife made sure he had meals at work. It was a lonely occupation.

“After a while almost all of those practitioners stopped delivering babies, so I was the only one here,” Dr. O’Neill said.

Dr. McGhee, the first cardiologist to join South County Health, also recalled the long hours spent at the hospital. Precious family time was often interrupted by patient needs. Enjoying time with his newborn daughter was no exception.

“I was asleep with my daughter on my lap (in the hospital room) when there was a gentle knock on the door,” Dr. McGhee recalled. “A very apologetic ICU nurse said that she was sorry for waking me up, but they needed me downstairs in ICU for a patient who needed an emergency pacemaker.”

This was the norm in the early days of the hospital.

“There were a lot of things like that, where we had to drop things and run,” he said.

Specialists often took over procedures that had been referred to Providence hospitals or performed by South County's general surgeons.

When Dr. McBurney arrived in 1969, he began performing prostate operations, vasectomies, and removing tumors and kidney stones. By the time of his retirement in 2000, his urology team had fiber optic scopes to detect kidney stones as well as lithotripsy, a method of breaking up stones using shock waves.

When Dr. McGhee joined the staff in 1984, the hospital had been relying on a cardiology consultant from Miriam Hospital. He started a cardiac rehab program, upgraded the echo lab to a color machine, and brought nuclear cardiology and thrombolytic therapies to the hospital.

Similarly, Dr. Anne Hebert ushered in a new era of care when she became the hospital's first pulmonologist in 1989. Now patients with a host of lung conditions – anything short of thoracic surgery – could be treated locally. Working with Sherri Zinno, then a part-time respiratory therapist, and with the support of hospital President Ralph Misto, Dr. Hebert upgraded the hospital's respiratory therapy program to 24 hours a day. In 1995, she brought in Dr. Leon D. Puppi as her partner.

Dr. Leon PuppiDr. Puppi, who had completed a critical care fellowship, was a board-certified intensivist – that is, a doctor who specializes in intensive care. He eventually became the medical director of the ICU and is credited with upgrading that facility. South County Hospital’s ICU was named in his honor after his death in 2014.

Dr. Neil Brandon, who joined the hospital staff as a cardiologist in 1990, said Dr. Hebert had an “enormous impact” on the hospital, citing the pulmonary rehab program and her expertise in ventilator management, bronchoscopy and sleep ailments.

After seeing patients with sleep apnea in the ICU, Dr. Hebert and Dr. Puppi, along with neurologist Dr. Carlo Brogna, attended special training at Stanford before opening the hospital's sleep lab in the 1990s.

“Leon was an excellent, excellent physician,” said Dr. Donald M. McNiece. “When he ran the ICU … South County Hospital had the best survival rates of any ICU in the state.”

Very few of the doctors were Rhode Island natives. Some served in the U.S. Navy; others came to the area for family business or a funeral and decided to stay. Some graduated from Brown University’s medical school and did their residency in Providence.

Dr. Hebert, a graduate of Dartmouth Medical School, did an internal medicine residency at Brown followed by a three-year pulmonary fellowship there. It was while working at Roger Williams Hospital that she met her husband, who lived in Narragansett, which led to her applying for privileges at South County Hospital.

Physician involvement
Two advances at the hospital had a positive impact on the doctors' ability to do their jobs. One was the opening of the Medical Office Building (sometimes called the Medical Arts Building) in 1998, which enabled doctors to keep an office on the hospital campus. The other was granting physicians a seat on the board of trustees.

Dr. Brandon credited his partner, Dr. Steven Fera, who had joined the hospital staff in 1987, with convincing President Misto that the doctors needed on-site offices. The planning for the building was completed before Misto retired in 1996. For physicians like Dr. Brandon, the Medical Office Building allowed him to be just steps away in case of a cardiac emergency. Previously, he and Dr. Fera had maintained an office in Narragansett.

“We had to come to the hospital urgently quite a bit,” he recalled. “If someone had a heart attack, nothing happened until we showed up in the ER and assessed the patient.”

Over the years, the doctors had tried to get closer to the hospital. Dr. McNiece and some partners built a medical building at the Dillon Rotary in Narragansett, and a private developer put up a suite of offices in the early 1980s known then as the Salt Pond Office Park, located around the corner from the hospital, and attracted a number of physicians.

Dr. McBurney was one of the first doctors to set up an office on the hospital campus in the 1970s, at Bacon House. The same building had been nurses' quarters long before it became a patchwork of offices. Dr. McBurney also was the first one to sign on to the Medical Office Building, securing the third floor office overlooking the picturesque Ram Point Marina.

In the 1990s, the role of the physician would be enhanced by a greater role in the governance of the hospital. It happened almost accidentally as a new Physicians Health Organization meant a physician was granted a voting seat on the board. The first doctor to hold this role was Dr. James L. Smythe, the hospital's first oncologist.

“It brought the physician perspective to the board,” said Dr. Nitin S. Damle, who served on the board after Dr. Smythe.

The role of Hospitalists
Arguably the biggest transformation of the physicians' role at the hospital occurred in 2004, when South County Hospital started a hospitalist program for inpatient care. In this model, the hospital employed full-time doctors to care for patients, as opposed to their personal physicians visiting them twice a day. The advantages: doctors are freed up to focus on their private practices; and patients get immediate attention when they need to be admitted to the hospital.

Dr. Louis RubensteinThe hospitalist movement had gained traction in Rhode Island by 2004, but the issue had been debated for decades. Indeed, as far back as October 1952, the South Kingstown Town Council passed a resolution to ask South County Hospital to appoint a full-time staff doctor.

Councilman Fred O. Whiting, who introduced the measure, stated that “the hospital serves 28,000 to 30,000 persons in the area and many believed a resident physician might be able to help save lives when it was impossible to contact one of the regular staff physicians.”

Dr. Damle remembers that he and his partner, Paul F. Barratt, M.D., were among the doctors supporting the change.

“It allowed us to stay in our office and not have to run back and forth, not have to do early morning and late morning rounds on patients,” he said.

“It freed us up to do other projects we started to work on as an office and as outpatient physicians.”

Among those was making their practice, South County Internal Medicine in Wakefield, a Level III patient-centered medical home, a national model in which primary care physicians provide comprehensive care to patients. Dr. Louis J. Rubenstein, who had practiced with South County Internal Medicine for eight years, became the first medical director for the hospitalist program, a role he maintained until fall of 2018. He recalled that half of the physicians signed on immediately and stopped doing rounds at the hospital. Within three years, nearly every doctor had joined. One who did not was Dr. McNiece, who up until about a year and a half before he retired last year, continued to make hospital rounds twice a day.

“We loved having him work beside us,” Dr. Rubenstein said. “In my opinion I always held him up as being the ultimate primary care [doctor]. I don't know how anyone could do that much work.”

Dr. McNiece described his typical day: He was at the hospital by 6 a.m. seeing his patients, maybe four or five people, and was in his office by 9 a.m. to see patients. At noon the office closed for an hour lunch break, and he resumed seeing patients until about 5 p.m. After office hours, he made phone calls, then returned to the hospital for evening rounds, leaving about 7 p.m. He would also see patients on Saturday and Sunday mornings.

He saw it as the “best of both worlds,” because the hospitalists provided coverage for him at all other times, including nights. Primarily, though, he did not want to give up the advantages of daytime rounds.
“What you did making rounds, aside from seeing your patients, was you saw your colleagues,” he said. “You saw the surgeons, you saw the cardiologists, you saw the pulmonologists. You could ask them a question about a patient … there was a camaraderie you kind of missed with [the hospitalist program].”

Dr. Damle agreed. When he came to the area in 1988, hospital duty helped him find patients.

“That's how I built my practice, was through the patients I saw in the hospital, taking call and seeing them in the Emergency Room,” he said.

Two years before the hospitalist program was formally instituted, the hospital hired in-house doctors for night coverage. When the full program took flight, staffing was a challenge. Only three doctors constituted the staff – Dr. Rubenstein, Dr. Kris Cunniff and Dr. David Tomlinson. The program was run by an outside firm called Team Health, and within 10 years it was taken over by the hospital through its primary care office, South County Medical Group.

“Kris and I were routinely seeing 20 or more patients a day for a while, before we got more help,” Dr. Rubenstein recalled. Dr. Tomlinson provided night duty.

By 2019, the program had eight full-time doctors, two of whom worked nights, and three nurse practitioners - two full-time and one part-time.

Upon Dr. Rubenstein’s decision to give up his role as medical director of the hospitalist program, Dr. Robert Kornas accepted the role. Still, Dr. Rubenstein continued his work as a hospitalist. The program received praise form hospital administrators for its role in patient care.

“I think it's been phenomenal,” Dr. Lisa Rameaka, vice president of medical staff affairs and chief medical officer, said of the hospitalist program.

The hospitalist program gave inpatients immediate access to physicians during their stay at the hospital, while freeing up doctors to concentrate on their office patients.

Early multi-disciplinary approach
The hospital has come a long way since the Cottage Hospital, when Dr. John Paul Jones was the attending physician, assisted by a handful of other doctors in the area. When Donald L. Ford joined as president in 1958, he estimated the staff included 14 or 15 physicians.

By 1982, when the hospital campus was beginning to expand, that number had grown to 67, and by 1997 the number of doctors grew to 111 active physicians and 63 in a consulting capacity.

In 2019, approximately 280 physicians have hospital privileges at South County Health, some of them in a consulting capacity. They represent a wide range of specialties and offer top-notch care in a community setting.

“One of the things that was really nice about practicing here … there were never any prima donnas or big egos on the staff,” said Dr. McNiece. “Everybody really cooperated with each other. Nobody talked about it, but we were here for the patient.”

Next: The stories told about surgeon Robert L. Conrad, M.D., embody the hospital's twin identities as a rural hospital with a tradition of quality care.