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Chapter XXXVIII. Consolidation of Stanford University Medical Center: July 1, 1968

  1. Appointment of Dean Robert J. Glaser

Appointment of Dean Robert J. Glaser

When Dr. Alway stepped down as dean on August 31, 1964, Dr. Sidney Raffel, Professor and Executive Head of the Department of Medical Microbiology, was appointed Acting Dean effective September 1, 1964. He filled the vacated deanship on a temporary basis while a nationwide search for a new Dean was being conducted under the direction of University President J. E. Wallace Sterling.

Suspense and speculation by the medical faculty regarding the replacement for Dean Alway ended on February 18, 1965 with the announcement by President Sterling that Dr. Robert J. Glaser, 46, President of Affiliated Hospitals Center and Professor of Social Medicine at Harvard Medical School, had been appointed Dean of Stanford University School of Medicine effective July 1 1965.

The announcement also noted that Dr. Glaser had been appointed University Vice President for Medical Affairs and Professor of Medicine, these appointments also to become effective on July 1, 1965.

With the appointment of Dean Glaser, Dr. Raffel relinquished his appointment as Acting Dean and resumed his regular duties as Professor and Executive Head of the Department of Medical Microbiology on July 1, 1965.

"Dr. Glaser brings to Stanford an unusual combination of academic and administrative experience," said President Sterling. "He is nationally recognized for his concern to bring to patient care the best that medical science and teaching can provide. " [1]

"He has had experience in building a medical center, having completed one at the University of Colorado where he served as Vice President for Medical Affairs and Dean. For the past two years he has been associated with an ambitious and unique project which envisions a new kind of hospital complex in the vicinity of Harvard Medical School. The Stanford University School of Medicine is fortunate to be able to draw on Dr. Glaser's talents as scientist, teacher and administrator."

A graduate of Harvard College in 1940; and Harvard Medical School, magna cum laude, in 1943, Dr. Glaser received his American Board of Internal Medicine certification in 1951. Over the past 20 years, he has held important medical school faculty posts at Washington University, University of Colorado and Harvard.

He joined the Washington faculty in 1945, during his second year of residency in medicine at Barnes Hospital, St. Louis. During the next 12 years, he was promoted to become Associate Professor of Medicine and Chief of the medical school's Division of Immunology. He was named Assistant Dean of the Washington Medical School in 1947, and served as Associate Dean from 1955-1957.

In 1957 Dr. Glaser was appointed Professor of Medicine and Dean of the University of Colorado School of Medicine. Two years later he was also named the University's Vice President for Medical Affairs.

While at Colorado, he was the major planner of a $20 million hospital and research structure which included a 450-bed hospital and a major outpatient wing.

In July 1963, Dr. Glaser became President of the Affiliated Hospital Center, Inc. in Boston and Professor of Social Medicine at Harvard Medical School. His work was concerned with the process of affiliating six Harvard teaching hospitals, an arrangement involving Harvard Medical School and the Boston Lying-In, Children's Hospital Medical Center, Free Hospital for Women, Massachusetts Eye and Ear Infirmary, Peter Bent Brigham and Robert Breck Brigham Hospitals.

Throughout his professional life, Dr. Glaser has devoted much of his research activity to rheumatic diseases. He was Chief of the Rheumatic Fever Clinic in the Washington University Clinics and a consultant to the State of Missouri and University of Illinois programs for crippled children. Dr. Glaser also has served as a member of the Scientific Advisory Council of the Rheumatic Fever Institute and the Committee on Prevention of Rheumatic Fever and Bacterial Endocarditis of the American Heart Association. At the time of his Stanford appointment he was a member of the National Health Research Facilities Advisory Council of the U. S. Public Health Service.

His publications include more than 40 papers, a number of them dealing with experimental streptococcal infections and rheumatic fever, and medical education.

Dr. Glaser is a member of Alpha Omega Alpha, the medical honor society, and editor of Pharos, the society's national publication. He is also a member of numerous clinical societies and associations.

Considering the education, experience and accomplishments of Dean Glaser, it is difficult to conceive of a candidate better prepared than he to become Dean of Stanford Medical School in 1965.

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A University Hospital

Dean Glaser recognized from his earliest observations of the Stanford program that the Palo Alto - Stanford Hospital did not function as a "university hospital."

Therefore when, in October 1966, he published a comprehensive Plan for the Next Decade, he placed acquisition of "A University Hospital" first on his list of concerns, for reasons given in the following excerpt from the Plan. [2]

The advances of medicine have, if anything, made the teaching hospital an even more important part of medical education than it was twenty-five years ago. The expansion of clinical medicine, and the resultant growth in residency and fellowship programs in many clinical fields, calls for an adequate number of University-controlled beds in the Medical Center.

The number of beds available to us at present -- about 200 -- in Palo Alto-Stanford Hospital, is grossly inadequate to the fulfillment of our educational mission. Without the valuable clinical facilities available to us at the Palo Alto Veterans Administration Hospital and at the San Mateo and Santa Clara County Hospitals, we could not possibly carry on at our present level. We do not expect to increase our postdoctoral programs significantly, but we badly need more beds in the Medical Center itself if we are to fulfill our potential in this activity. We have determined that approximately twice our present allotment of beds, i. e., a total of 450 to 500, should be obtained without further delay.

When the School moved to the campus, and the present hospital was built as a joint venture with the city of Palo Alto, it was hoped, despite the diverse objectives of the two owners in respect to hospital beds, that a single facility could serve both. Experience has clearly demonstrated that this is not the case.

The present administrative structure is unwieldy, and is not satisfactory to either the community staff or the University staff. Consequently, the University has indicated to the City its interest in acquiring the Palo Alto portion of the hospital. If the City elects not to sell, the University will have to expand its portion of the present hospital. In either case, the operating agreement between the City and the University will be significantly altered so that the University will ultimately have an autonomous facility that will constitute the Stanford University Hospital.

The situation is complicated by virtue of the fact that the community physicians, who make up the Palo Alto staff, also must have more beds; further, their needs, like those of the University, must be provided for before any change in the current arrangement can be accomplished.

Whatever the steps taken to provide more beds for the Medical School, we look forward to the prospect of an active clinical faculty.

The Problem

From its opening in 1959 the dual ownership of the Palo Alto - Stanford Hospital by the City of Palo Alto and the University resulted in a clash of professional cultures and standards that created complex administrative problems and a host of contentious issues. Faculty and Palo Alto physicians competed for patients and access to beds, and for control of clinical laboratories and ambulatory services. Inpatient teaching programs were impeded and required subsidies. These Town-Gown tensions were only palliated by the intervention of endless joint committees.

In October 1966, as we have seen, Dr. Glaser recommended the purchase by the University of Palo Alto's share in the Palo Alto-Stanford Hospital as the solution to the problem. This idea was received with interest by the Palo Alto City Manager and Council. A crucial issue within the City Council became the question of whether beds could be made available for Palo Alto patients, admitted by Palo Alto Medical staff doctors, if Stanford obtained complete ownership and control of the hospital. It became clear that Palo Alto would not approve the purchase unless some guarantees were made on this matter.

To explore the possibility of purchase of the Hospital by the University, a joint committee was appointed by the two owners, the City and the University. In this case, the committee was composed of administrative rather than policy or professional personnel. The key individuals on this committee were Dean Glaser and the City Manager, Jerome Keithley. [3]

In the spring of 1968, under the urging of Dean Glaser, this committee reached consensus on the text of a complicated Agreement between the Board of Trustees of Stanford University and the City of Palo Alto. This document recorded in detail the conditions under which the City of Palo Alto would transfer the Palo Alto Hospital and related assets to Stanford University. [4]

In view of the complexity and importance of the Agreement Dr. Glaser, the acknowledged prime mover in this transaction, was asked to explain its conditions to the Council of the City of Palo Alto. This he did so convincingly that the City Council approved the Agreement by a vote of eight to one. The following is the press release announcing the settlement: [5] [6] [7]

Stanford University Becomes Owner of Hospital Facilities
1 July 1968

After nearly three years of negotiations with the Palo Alto City Council, Stanford University finally assumed complete ownership of the jointly owned 580-bed Palo Alto-Stanford Hospital on 1 July 1968.

photo of Dr. Robert J. Glaser observing the mayor of Palo Alto signing the agreement making Stanford the sole owner of the Stanford University Hospital photo of Stanford University Hospital, 1968

Under the terms approved by an 8-to-1 vote of the City Council, Stanford paid $1 million in cash to the City and assumed $3,500,000 worth of hospital construction bond payments over the next 20 years, and provided guarantees for specific community hospital services for the next 40 years.

All community physicians currently on the hospital staff retained their affiliation for the remainder of their professional careers. A total of 370 beds previously used by patients of community physicians continue to be available to them.

Agreement between Stanford and the City came on the eve of Dr. Wallace Sterling's retirement as President of the University, and Dr. Robert J. Glaser's assumption of new responsibilities as Acting President. The appointment of Dr. Glaser as Acting President was effective September 1, 1968 upon the retirement of President J. E. Wallace Sterling.

In a joint statement, Drs. Sterling and Glaser said, "We are extremely gratified that a solution has been reached. The union of the hospital with the medical school provides a unique opportunity for all concerned."

Viewed in retrospect, It was President Sterling's continuing confidence in and support of the Medical School that made possible its move to the campus in 1959. The final crucial step of consolidation in 1968 through acquisition of a university hospital was taken essentially entirely under the tireless auspices of Dean Glaser with memorable results.

At the time of the announcement of the University-City agreement, Stanford University Hospital became an entity and the Board of Trustees designated the entire center, including both the School of Medicine and the Hospital, as the Stanford University Medical Center.

With the adoption of the full-time system in 1956, the move to the campus in 1959, and the consolidation of a university teaching hospital in 1968, the school was in conformity with all the major Flexnerian principles that included the following familiar items:

(1) Each medical school should be an integral part of a parent university.

(2) The medical school should have a university teaching hospital.

(3) The university, medical school and teaching hospital should be in the same location (that is, no "divided schools")

(4) The medical staff of the teaching hospital should be members of the medical school faculty regarding which all power of appointment and promotion rests with the university.

(5) The primary faculty in the school should be salaried (that is, on a strict full-time basis, including the faculty of clinical departments).

(6) Research and teaching should be inseparable because the approach of the investigator and the clinician should be the same.)

It should not be inferred from the above that rigid adherence to Flexnerian principles is a necessary condition for academic excellence, (Harvard Medical School being a notable exception), but experience has shown the principles to be valuable guidelines.

For another set of important guidelines, we should keep in mind the following formula so successfully applied during the Alway years:

  • Recruit a distinguished, research-oriented faculty.
  • Implement an innovative curriculum.
  • Attract exceptionally able students.
  • Commit to the endless pursuit of excellence.

Results of the Consolidation

Resolution of the hospital issue had the immediate beneficial effect of enabling the University to proceed with expansion and modernization of the present facility. Consolidation had the further effect of making available existing beds and other clinical resources essential to the teaching, patient care and research programs of the School, and without which these programs had been previously inconvenienced and even restricted.

Despite this temporary handicap to clinical programs, after the move to the campus in 1959 the School grew steadily in national stature until it attained and continues to hold a respected place in the front rank of medical education, scientific achievement and clinical medicine. Its potential for future progress was immensely enhanced by the consolidation which finally brought the Stanford program into full conformity with the highest standards, thus assuring the capacity of the School to contribute maximally to the furtherance of the historic revolution in the medical sciences ushered in with the 19th century (as described in Chapter 5).

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