Parallel Lines

March 3, 1997


Opening the Heart Itself
Managing Money and Medicine
Coming of Age
Missions Accomplished


Since Charles Hatcher first came to Emory more than 30 years ago, his own path to success has mirrored that of the health sciences center.


Charles Ross Hatcher, Jr., grew up in Attapulgus, a small shade-tobacco town five miles above the Georgia-Florida line. An only child, to whom perfect grades and athletic success came easily, he never doubted he could do whatever he set out to do. And what he set out to do, from early on, was to become a heart surgeon and do good things for his home state and for medicine in general. A gifted surgeon, brilliant administrator, and strategist extraordinaire, he has done all this and more.

In June, on his 66th birthday, he stepped down as vice president for health affairs, director of the Robert W. Woodruff Health Sciences Center, and CEO of the Emory University System of Health Care, a three-pronged leadership position the newspapers often shortened to "Emory health sciences czar." He remains at Emory as director emeritus of the health sciences center and senior adviser to the university president and board of trustees, who refused to give up access to his wit and astute judgment.

"I was lucky," he says. "I was in surgery and at Emory when there were great things to be built. I got to be Sir Lancelot, which is a lot more fun than being King Arthur."

Opening the Heart Itself

Charles Hatcher, Sr., saw the wisdom in his son's plan to become a physician; after all, the leading doctor in nearby Bainbridge was near retirement. He was less excited about his son's plan to move to Atlanta and become a medical school professor ("All that training just to be a schoolteacher?") and not at all certain about his son's enthusiasm for heart surgery, since the rapid advances of medicine in the 1940s and 1950s made it seem likely that heart surgeons would one day be out of business.

Charles, Jr., however, saw a different future. He was inspired by the accomplishments of great surgeons like Johns Hopkins' Alfred Blalock, known for developing the "blue baby" procedure, and Harvard's Dwight Harken, who could repair mitral valves with speed and grace. During his first year of internship at Johns Hopkins in 1955, the heart-lung bypass machine was introduced, permitting heart surgeons to open the heart itself, painstakingly, artfully, reconstructing as needed.

After his impressive performance as Halsted chief resident in cardiac surgery, Hopkins wanted to keep him on the faculty. Instead, he drove to Atlanta-and was told no surgical positions were open at Emory. Back in Baltimore, though, considering what to do next, he received an urgent note from Emory President Walter Martin, who had been his history professor at the University of Georgia and who had just gotten word of the unsuccessful visit. A meeting was quickly arranged with Dr. Elliott Scarborough, director of The Emory Clinic and then Robert W. Woodruff's personal physician, and with Dr. Osler Abbott, head of cardiothoracic surgery. Charles had not realized that cardiothoracic surgery was a separate section from surgery at Emory. When his credentials were presented to that section, he was hired as an assistant professor on the spot, at a salary of $13,000 a year.

On July 1, 1962, young Dr. Hatcher moved into a little office in the basement of The Emory Clinic, and at 8 am the next day he performed Georgia's first successful correction of tetralogy of Fallot, the "blue baby" operation, thus ushering in a new era of open heart surgery for the state of Georgia. In the months that followed, he operated continually, with joy, unabated confidence, and growing recognition.

At the end of his first year, he was summoned to Dr. Scarborough's office and asked why in the world a friend of Robert Woodruff's had to go to New Zealand for heart surgery. A surgeon in Auckland and another in London were replacing faulty heart valves with valves from cadavers instead of the mechanical ones used by American surgeons brave enough to do the procedure at all. The results looked so promising that Dr. Scarborough ordered him to "learn how to put in those homographs and get back as soon as you can. I'm not prepared to tell Mr. Woodruff there is any heart surgery that can be done in the world that you can't do here at Emory."

Well, of course not. The young surgeon saw just one procedure in London and rushed back home. He too achieved good results with valve replacements. He subsequently performed Georgia's first double, then triple valve replacements, and, in 1970, the state's first coronary bypass, all at Emory University Hospital.

In 1971, then 41 years old, Dr. Hatcher was named chief of cardiothoracic surgery and encouraged to recruit surgeons as much like himself as possible. Emory quickly became one of the country's largest centers for open heart surgery, accepting the sickest of patients while achieving mortality figures that were the envy of all. Fewer than 1% of other centers could match Emory's statistics.

Dr. Hatcher continued to perform surgery throughout his rise in the administrative ranks, even during the early years of his vice presidency, until it was clear he couldn't keep leaving meetings with the board of trustees or the governor or one of the center's major donors to help solve a surgical emergency. It was hard to give up the joy of surgery and the sense of himself as a "young Dr. Kildare, on top of the world," striding into the operating room, putting everything right, seeing the patient later with color in his cheeks. "I would have been happy," he says, "to have remained a heart surgeon all my life."

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Managing Money and Medicine

Dr. Hatcher had been elected to partnership in the clinic only one year after his arrival at Emory, and in 1976, he was unanimously elected clinic director. As head of cardiothoracic surgery, he had demonstrated that he understood how to build a team among the most headstrong of physician specialists and to make a division work financially as well as medically. The former was something new for Emory medicine, which traditionally had been good at patient care but fairly inept at earning money.

Mr. Woodruff, legendary leader of The Coca-Cola Company, understood the importance of both good medicine and good business. He had provided support to build The Emory Clinic partly so Atlantans could get at home the medicine for which they had been traveling to the Mayo Clinic or Johns Hopkins. But he also made it clear that he expected clinic members, all of them medical faculty, to use the clinic to support themselves and to stanch the flow of red ink in the medical school.

Within a decade of taking the helm of the clinic, Dr. Hatcher had quadrupled billings. The clinic began to provide millions of dollars to the medical school annually, eventually surpassing any other clinic in the country in support of its affiliated medical school. The impact of clinical dollars was and is a major force in the growth of the health sciences center.

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Coming of Age

The Woodruff Medical Center had been established in 1966, soon after Dr. Hatcher's arrival at Emory. This new structure provided an organizational umbrella for the schools of medicine, dentistry, and nursing; the Yerkes Primate Research Center; and Emory University and Crawford Long hospitals. (The clinic stayed to the side as a private but highly intermeshed partner.) The center director was Dr. Garland Herndon, who served as the first vice president for health affairs and who had taken over as Mr. Woodruff's physician following the death of Dr. Scarborough. Dr. Herndon's willingness to be on 24-hour call for Mr. Woodruff, and their daily breakfast meetings in which Mr. Woodruff heard the latest center news, epitomized the close relationship of the center and the philanthropist.

In 1983, with Dr. Herndon's health failing, then President James Laney asked Dr. Hatcher to act as interim director. For more than a year, Dr. Hatcher rose before dawn, performed surgery, taught young surgeons, kept the division of cardiothoracic surgery among the country's busiest and most successful, managed the affairs of the thriving Emory Clinic, and, once or twice a week, walked across the street to the Woodruff Administration Building to spend half a day holding together the affairs of the medical center.

With Dr. Herndon unable to resume his duties, a national search was conducted for a successor. The search committee recommended that the interim director be made permanent, and President Laney offered Dr. Hatcher the position. At the time, because of the prominence of the clinic and its financial contributions to the medical school and the university as a whole, to be leader of the clinic in many ways was to be more powerful than vice president. Money was no incentive; Dr. Hatcher had served as interim director without additional salary. Yet in those afternoons as interim director, he had seen the potential to expand Emory's roles as an academic health sciences center, especially as a research institution. The only stumbling block was that Dr. Hatcher wanted to continue heading both the clinic and the Woodruff Medical Center, arguing how closely they were interrelated. President Laney insisted he choose-university or clinic, not both.

A compromise, negotiated in large part by Jimmy Williams, president of SunTrust Bank and chair then and now of the health sciences board of trustees, gave both institutions what they most wanted. In 1984, Dr. Hatcher became vice president for health affairs and director of the newly renamed Robert W. Woodruff Health Sciences Center. He gave up directorship of the clinic but retained a role as chief financial officer. He also remained chief of cardiothoracic surgery, only in 1990 handing over those reins to Dr. Robert Guyton, one of the young surgeons he had recruited.

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Missions Accomplished

Taking the helm of the health sciences center was for Dr. Hatcher much like coming into the new era of heart surgery he had experienced earlier. He had to fill immediate needs while looking for new procedures, programs, and people to make Emory stronger for the future. The Hatcher years at the health sciences center have been characterized by growth and momentum, with a challenging last act few in health care saw coming. Highlights of accomplishments include the following: Creating and maintaining a structure for the medical school's rapidly expanding training programs- In addition to Emory's own hospitals and clinic, Dr. Hatcher deftly fielded relationships with four very different affiliate hospitals, each with its own mission, needs, and view of exactly how big a brother Emory should be.

The relationships have worked surprisingly well, perhaps because the hospitals' medical staff saw a leader who was first and foremost a physician, administrators saw a peer who truly understood the financial realities of health care, and they and everyone else involved saw they were working with an immensely sure-footed politician. This was nowhere more obvious than when he renegotiated a contract with Grady Memorial Hospital that allowed Emory physicians to provide services and train medical students and residents through the year 2013 while providing access to physicians and students from Morehouse School of Medicine.

Matching what Emory offered with what society needed-The hardest decision on Dr. Hatcher's watch was closing the dental school in 1990. The world didn't see how the picket signs and lawsuits distressed him but saw instead his confidence that the decision was best for Emory and for Georgia, which had another fine dental school in Augusta. Perhaps his most dramatic decision was a reverse image of this closing the same year: the creation of Georgia's first school of public health.

Making the health sciences center a major research institution-When Dr. Hatcher took office in 1984, Emory was focused more on patient care and teaching than on research. In fact, until the mid 1980s no one had bothered to add up the total number of dollars brought in by research grants and contracts. In 1986, the first year a tally was made, the entire university received roughly $50 million. For 1995-1996, the medical school alone received $87.3 million, and the health sciences center received $116.8 million, about 88.5% of the total for the entire university.

Revamping physical structures-During the Hatcher years, the face of the health sciences center campus changed markedly. Patient care areas expanded, with construction of a second clinic building and major expansions at both Emory and Crawford Long hospitals. When friend and philanthropist O. Wayne Rollins made inquiries about Emory's needs, the answer was immediate: Help us a build a facility for basic science research. The resulting $40 million Rollins Research Center along with a subsequent $40 million renovation and addition to the Woodruff Memorial Research Building for clinical research almost tripled Emory's laboratory space. Thanks again to the Rollins family, the school of public health had its own building within five years of its inauguration. More recently, construction has added underground lab space as well as research and clinical space on Clifton Road.

Helping Emory play a responsible role in development of the medical and scientific community-Through Dr. Hatcher, Emory helped support establishment of Morehouse School of Medicine by providing clinical education for Morehouse students as that school's MD program was being implemented. He also was influential in wooing the American Cancer Society to Atlanta and to the Clifton Corridor that passes through the medical campus.

Establishing and maintaining a patient care program that would meet the needs of Atlanta and the region-Patient care was where Emory had always excelled, but the health care scene was in enormous flux. Academic centers were particularly challenged by the new environment of managed care and fewer more so than Emory, which had concentrated on specialized medicine and depended on referrals.

At a time when he would have enjoyed stepping back and surveying all that he had built, Dr. Hatcher began to work to reshape health care at Emory to meet the times. The clinic changed from a referral-only center to one where patients could make their own appointments and where companies and insurers could establish managed care contracts. A previous plan to build another clinic facility on campus was scrapped in favor of establishing primary care clinics throughout the city. Both Crawford Long and Emory hospitals were brought under one CEO, with a mandate to consolidate services and generate cost savings. And affiliations were established with hospitals throughout the region.

Many challenges still lie ahead, but Dr. Hatcher can look back knowing he left the health sciences at Emory in good order for his successor. In the months before he stepped down from the vice presidency, he was the guest of honor at numerous parties, the subject of many speeches. He was wined and dined, toasted and roasted. He was the right person for the right time, they said. And Emory would not be where it is today without him. Dr. Hatcher would add, the reverse is also true.

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By Sylvia Wrobel, reprinted from Emory Medicine Magazine, pp 10-15, Autumn 1996

For more general information on The Robert W. Woodruff Health Sciences Center, call Health Sciences News and Information at 404-727-5686.


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