It was raining softly 12 years ago,
the day Jack McConnell, MD, had the epiphany. McConnell remembers how the rain
had turned the dirt roads on Hilton Head, South Carolina, into mud, and how, as
he drove out the back gate of his subdivision, he spotted a man walking along a
path without an umbrella.
McConnell had a habit of picking up
hitchhikers. It was payback of sorts for all the rides his family received when
he was growing up in the hills of southwest Virginia. His father was a
Methodist minister who never had a car. He told folks that he "couldn't
support Mr. Ford" on a preacher's salary and send his seven children to
college.
His father also was fond of asking
his children at suppertime. "And what have you done for someone
today?"--a phrase that became part of McConnell's muscle memory as he grew
older. So, on that drizzly day 12 years ago, he slowed down without thinking
and gave a ride to a man who would change his life and thousands of others.
The man's name was James. McConnell
asked where he was going. "To look for a job. Any kind I can get." He
said he had two children, and that his wife was expecting. Always the doctor,
McConnell asked whether he had access to medical care. No, James said. "We
have to take care of ourselves. No one else is going to help us."
After McConnell drove James to a
work site, he thought about the other hitchhikers he had talked to since his
retirement on Hilton Head. They were maids, waitresses, construction workers,
and every one of them said they had trouble getting basic medical care. Someone
should do something, McConnell thought.
Then he heard an echo from his
past--"What have you done for someone today?" And, as he did in the
1960s, when he directed the development of Tylenol, and in the 1980s, when he
helped create the first commercial MRI system, McConnell began to visualize a
solution.
31 and counting
Twelve years later, McConnell is in
the reception room of the Volunteers in Medicine Clinic on Hilton Head, the
free clinic that grew from that rainy-day conversation with James. The place is
humming, as usual. Gray-haired greeters man front desks, taking information
from patients, or as McConnell likes to call them, "friends and neighbors
who don't feel well."
Other volunteers escort patients to
see doctors, dentists, and even a chiropractor. McConnell motions toward a
colorfully painted room where children read books. "We don't have waiting
rooms," he says. "If you call it that, then that's what happens, you
wait. We call it a reception room, where people are received."
McConnell's brainstorm was to take
advantage of the island's many retired doctors and nurses and build a clinic
for residents who had no health insurance or didn't qualify for Medicaid. The
clinic opened in 1994.
Last year, about 6,500 people were
treated during 21,000 visits. Known for its golf courses and wealthy gated
developments. Hilton Head also can boast that every one of its residents has
access to basic, high-quality medical care.
The Hilton Head clinic has been such
a success that it is now a prototype, or as one health policy analyst called
it, "a national destination and training site." McConnell points to a
map of the United States near the front door. Red pins mark where other
communities have built free clinics based on the Hilton Head model. So far, 31
have opened. All are independently run.
Some are small; one in New Orleans
caters only to low-income musicians. One of the newest is in Bend, Oregon, and
has eight exam rooms and an electronic medical records system. At least 40 more
clinics are scheduled to open in the next year or two. The Volunteers in
Medicine Institute, a nonprofit group in Vermont that McConnell founded, helps
communities through the process.
McConnell thinks the Volunteers in
Medicine concept could evolve into a national movement because of two
converging economic and demographic trends: the growing ranks of the uninsured
and the large number of retired physicians and nurses.
"The idea works because
everyone wins," he says. Hospitals save money because fewer nonpaying
patients show up in their emergency rooms. (The Hilton Head Regional Medical
Center estimates it saves S5 million a year because of the free clinic.)
Retirees can practice medicine in an environment free of paperwork and
bureaucracy. Residents who might have avoided seeking medical treatment because
of cost or embarrassment can get help.
Largely because of McConnell and the
Volunteers in Medicine Institute. Congress passed a law that gives volunteers
in free medical clinics federal malpractice protection. (Regulators are still
ironing out details about how the law will be implemented.)
"Our approach, if adopted
nationally, could provide much, if not most, of the health care for the 45 million
people who are uninsured, and at essentially no cost to the nation," he
says. "Of all the things I've ever done, hands down, this is what I'm
proud of most."
Considering McConnell's many and
diverse accomplishments, this is saying something.
McConnell is 79 years old and has a
wiry frame. "I was never heavy enough to have a temper." He wears
large gold-rimmed glasses and smiles often, or seems to be on the verge. When
somebody greets him and asks how he is, he answers, "Better because of
you." Friends and colleagues say he sometimes reminds them of a clergyman.
When he's not working with the
Volunteers in Medicine Institute, he listens to Dixieland jazz and practices
tap dancing on a floor he installed in his garage. He is married and has three
children. One son played piano for the band Phish, which recently split up. In
one of the group's last concerts, McConnell sang with his son and showed off
his tap steps before a crowd of 35,000. "Life doesn't get much better than
that."
McConnell knew from a young age that
he wanted to be a doctor. When he was six, his mother fell ill. "I told
her when I grow up, I'm going to take care of you." As a young man, he
made good on that vow, receiving his MD from the University of Tennessee. He
did post-graduate training in pediatrics at Baylor College of Medicine and went
into the Navy. But he contracted tuberculosis in the process and was confined
to a bed for a year.
"I listened to my Dixieland LP
records and I read my Bible every day, sometimes several times a day." He
also filled the hours by creating mental pictures of how he hoped his life
would unfold.
After the Navy discharged him in
1952, he took a job with a shipping line as a ship doctor, and eventually set
up his own practice in New Orleans. "I was having a fair amount of
success, but then I noticed something wrong with eight of my patients."
They were having problems with a new drug, Aureomycin, made by Lederle
Laboratories, now American Home Products Corp. He called the company, and a
vice president showed up at his office. The two talked and the executive was so
impressed with McConnell that he offered him a job as a researcher.
"When I got there, they had
very ineffective test routines for TB--too many false positives and
negatives," he said. "Then I read about a guy in Sports Illustrated.
He was a horse jumper, who also had a patent on a test to detect tuberculosis
but didn't know what to do with it. So we redesigned it at Lederle and figured
how to ship it safely around the world."
The result was the TB Tine Test,
which is still used today.
Perhaps McConnell's most
far-reaching commercial success took place in the early 1960s when he began to
think about acetaminophen and its potential as a pain reliever.
"You have to remember that back
then no one wanted to believe that it could compete with aspirin, which was
like apple pie and the American flag." At the time, McConnell was vice
president of new product development at McNeil Laboratories. He pushed for
trials that eventually showed how acetaminophen caused less stomach bleeding
than aspirin. He and his colleagues also figured out a way to coat pills so
they would go down quickly without a bitter taste. The result: Tylenol tablets.
He choreographed another
breakthrough in the 1980s. By then he was director of advanced technology for
Johnson & Johnson, reporting directly to the chief executive officer. He
thought about the damage caused by X-rays and learned that several scientists
were using magnets to study soft tissue. He eventually put together a team that
created the first commercial Magnetic Resonance Imaging system in the United
States.
"The company wouldn't have
gotten involved in the MRI without Jack's initiative," said Don Johnston,
a vice president with Johnson & Johnson at the time. "He has always
been interested in new things, and he knows people everywhere. He's very
gregarious. If you dropped him into Alaska, the first Eskimo he met would be an
old friend."
Near the end of his career,
McConnell was an important cheerleader for genetic research. He helped draft
federal legislation that led to the creation of the Human Genome Project. He
was a founding trustee of the Institute for Genomic Research. Among other
things, its researchers have mapped the genome sequence of pathogens that cause
cholera, tuberculosis, meningitis, syphilis and Lyme disease.
"It was the challenge that I
liked most about what I did. I wanted to do something that no one had done, but
that needed to be done by somebody."
No time to retire
When McConnell retired in 1989, he
figured he would settle down in Hilton Head and play lots of golf. But he
wasn't wired for extended periods of leisure. "My father always used to
say, "Don't drive your car using your rear-view mirror. You won't make
much progress and you might hurt someone as you go along. He was right."
The clinic became his new mission.
He gathered a group of residents and they sketched out a plan. Their first
task: Study the problem. They surveyed 85 percent of the businesses on the
island. They found that one in three residents, about 10,000 people, had little
or no access to health care. That showed the need. Now, they had to build
community-wide support.
To McConnell's surprise, a few doctors
opposed the project, fearing that they somehow might lose paying patients. In a
meeting with the area's physicians, McConnell said: "Just tell me how many
of our nonpaying patients you want, and I will see that you get every one of
them!" The doctors laughed and many eventually became the clinic's
strongest supporters.
A more serious hurdle involved
licensing retired doctors and nurses, McConnell knew that retirees wouldn't
volunteer if they had to pay hundreds of dollars in licensing fees and spend hours
taking tests. When the state's medical licensing board turned down his request
for a waiver, he went to the state legislature. In short order, lawmakers
created a special license for volunteer doctors in free clinics.
McConnell's team cleared another obstacle
when the state's Joint Underwriting Association agreed to provide malpractice
insurance for the entire clinic for just $5,000. That was important. McConnell
knew doctors and nurses would be less likely to volunteer if their retirement
savings were put at risk.
Creating a "spiritual
base" for the clinic also was an important goal. One morning, after
reading and meditating with his wife, McConnell came up with the clinic's
vision statement, which is now prominently displayed on a wall in the examination
area:
May we have eyes to see those rendered
invisible and excluded, open
arms and hearts to reach out and include
them, healing hands to touch
their lives with love, and in the process,
heal ourselves.
When the clinic opened in 1994,
Elizabeth Taylor, an energetic woman who lived on the island all her life, was
one of the first to walk through the doors. Ten years later, she still drops by
to pick up her medication. "Everybody on the island brags about the
place," she said during a recent visit. "It saves you money, and the
doctors are caring. They don't just slam you in a room."
Comments like that make McConnell
grin. Today, the clinic has a staff of 300 volunteers--doctors, nurses and a
troupe of translators for the island's growing Latino population. Some
volunteers chose to retire in Hilton Head mainly because of the clinic. He
cites studies showing that the country has 160,000 retired physicians, 350,000
nurses, and 40,000 dentists. He says many are looking for meaningful ways to
spend their retirements. "You don't quit being a doctor when you
retire."
On a sunny day, McConnell drives
down the same quiet two-lane road where he found James 12 years ago.
"There it is. He came out of
those bushes." Nearby, are ramshackle homes with rusty metal roofs.
McConnell never learned James' last
name. He tried to track him down a few times without any luck. He'll thank him
if he does find him. "He made my life immensely more rewarding than it
would have been."
Doctors who volunteer at the free
clinics "think they're coming here to help the poor," he says.
"But it's the patients who bring us gifts--a sense of purpose in life.
When you do something for someone, every now and then you get this feeling
that's impossible to define."
He pauses. "No, I think I know
what it is. It's that touch on the shoulder from someone above saying, 'Thank
you.'"
Tony Bartelme is a
staff writer for the Post & Courier newspaper in Charleston, SC.
