Merrill Odom Hines, MD: The Right Fellow for the Job

LIFE AND MEDICAL CAREER

Merrill Odom Hines was born in Jackson, Mississippi, on November 17, 1909. Despite his humble upbringing in rural Mississippi, Dr. Hines was determined to enter medical school. After graduating from Millsaps College, he won a coveted scholarship from the Commonwealth Fund, which allowed him to enter Tulane University Medical School, where he studied under Alton Ochsner and earned his medical degree in 1936 graduating as Class President (1, p143). After an internship and surgical residency at Baroness Erlanger Hospital in Chattanooga, Tennessee, he returned to Mississippi to fulfil his obligation to the Commonwealth Foundation by practicing as staff surgeon at Tylertown Hospital until 1944.

Dr. Hines served in General George Patton's Third Army during World War II as a battalion surgeon during the campaigns in North Africa, Sicily, and the D-Day landing in Italy. He contracted amebiasis with secondary pericarditis and was sent to New Orleans to recuperate in what proved to be the turning point of his life. He planned to rest a few months and then move to Chattanooga to practice. Instead, Dr. Hines spent a year refreshing his surgical skills as a fellow under the tutelage of Dr. Alton Ochsner at the recently formed Ochsner Clinic. The association with Alton Ochsner marked the beginning of a fruitful professional and academic career at Ochsner Clinic, the institution that he helped to consolidate as one of the most outstanding medical group practices in the world.

Under the auspices of Dr. Ochsner, Dr. Hines spent time at the Mayo Clinic studying colon and rectal surgery, and he subsequently created and became Chairman and staff surgeon of the Department of Colon and Rectal Surgery at the Ochsner Clinic. Ochsner became the second institution in the country to have such a department—the Cleveland Clinic was the third (1, p145).

Dr. Hines' devotion to patient care and to the success of the Clinic made him a very important figure and second-generation leader in the institution. He was named by the founders to work as Assistant Medical Director to Dr. Guy Caldwell in 1954. When Dr. Caldwell retired in 1960, Dr. Hines became the Medical Director and Chairman of the Board of Management, a position he kept for the next 15 years. As the Medical Director of the Ochsner Clinic, Dr. Hines presided over a major expansion of the group practice, the expansion of the Ochsner Foundation Hospital, and the consolidation of all Ochsner activities into a single campus in the early 1960s. He initiated the expansion of both Hospital and Clinic, and the staff doubled in size under his watch to about 120 physicians. He also continued to maintain an active clinical and surgical practice and was very involved in the educational programs of the Alton Ochsner Medical Foundation. He took a major role in championing the cause of the group practice, serving as an effective spokesman on its behalf. His efforts included a term on the Board of Trustees of the American Group Practice Association from 1966 to 1970.

Dr. Hines also recognized the need for providing formal education in management for the physician leaders of group practices. After the creation of the American Academy of Medical Directors, he was selected to serve on the advisory panel for the development of Physician in Management Courses under a grant from the Robert Wood Johnson Foundation. As a recognized medical statesman, he was invited by President Lyndon Johnson to be present in the signing of the Medicare Amendments to the Social Security Act in 1965, and he served as a member of the Social Security Administration's Health Insurance Benefit Advisory Committee. After proctology and colon and rectal surgery became an independent specialty in 1949, Dr. Hines was elected President of the American Proctologic Society (now the American Society of Colon and Rectal Surgery) and served as the President of the American Board of Colon and Rectal Surgery (1, p145). In 1983, Dr. Hines was selected to be the 46th recipient of the Distinguished Service Award of the American Medical Association. This award is one the most coveted honors bestowed on a practitioner of the healing arts (earlier recipients included Dr. Rudolph Matas, Dr. Michael DeBakey and Dr. Alton Ochsner.) After retirement, Dr. Hines continued fundraising and planning activities for the Foundation as Honorary Chairman of the Board. After a very prolific career, Merrill Hines died on December 16, 1999, at the age of 90.

MEDICAL DIRECTOR

Dr. Hines became involved in the management of the Clinic in 1954 when he was appointed Assistant Medical Director under Guy Caldwell, whom he succeeded in 1960 (1p146). The years that Dr. Hines led the institution were veryproductive and successful. Patients came in increasing numbers and the staff multiplied in size. Dr. Hines' challenge was to inspire the newcomers to practice with the enthusiasm and ability that the founders had demanded. Much of his administrative success was due to his insistence on better communications between the staff and the partners, calling on the founders and physician leadership to pull down the “iron curtain” behind which they had long operated. It was also clear to him that highly qualified physician leadership was essential for the success of the Clinic. He was very active in the recruitment of top talent, seeing to it that, in some cases, the physicians he hired had higher incomes that his own.

Dr. Hines also demanded quality. While he cultivated and enlarged the physician staff, he never flinched from discharging those who did not meet his high standards.

A surgeon who had been trained in prestigious institutions and who appeared highly qualified joined the staff. He had known the partners for years and was personally popular. In a short while he became influential in clinic affairs. But at the same time his performance in the operating room failed to meet the institutions' standards. After a while, internists were referring patients to out siders in order to avoid sending them to him for surgery. Some operating room nurses were reluctant to work with him. On the Ochsner campus the turn of events was far from secret.

“Somebody had to act, and I knew it was I,” Hines related afterward. The medical director suggested the man take a nonsurgical assignment, such as head of research and education, but the latter balked. The professional personnel committee investigated and found deficiencies in the surgeon's performance. He threatened to sue for libel.

Finally Hines forced a showdown. He obtained signatures from an overwhelming number of the clinic's doctors, who said they would vote to oust the surgeon from the partnership under a bylaw that provides for expulsion by three-fourths' majority. The man resigned.

“It was the most difficult decision I ever had to make, and at the same time was the most important one,” Hines said. “I didn't see how we could continue in business if we allowed an unqualified surgeon to operate, no matter who he was. When we admit a patient to our Clinic or Hospital, we must guarantee that the patient will be in competent hands” (1, p150).

No one, including the founders, was as intensely dedicated to the Ochsner institutions as Merrill Hines. The Ochsner Clinic represented a kind of medical Holy Grail to him, a concept of medicine in the ideal.

“He worked a 14-hour day, 7 days a week for many years. As his mandatory retirement date approached, he was miserable at the prospect of an existence away from Ochsner. The Foundation trustees created the unique position of Honorary Chairman of the Board, allowing Dr. Hines to continue fundraising and planning.”

Not even Alton Ochsner himself was given such a concession (1, p151).

QUOTATIONS (2)

PERSONAL RECOLLECTIONS

Dr. Hines was tall, with an impressive presence and a strong voice. He was not subtle. In the early 1980s, following specialty training at Ochsner Foundation Hospital, I (ER) was dealing with the United States Immigration and Naturalization Service in an ultimately successful attempt to obtain permanent resident status. These dealings were complex, and Dr. Hines kindly offered help in providing institutional support. He personally presented my case to Senator Russell Long to recruit his support. I will always remember how abruptly Dr. Hines behaved once when he called to say he needed an update on the status of my papers and I suggested we meet “in the next few days.” He told me that if I was so nonchalant about it he would do nothing further for me and abruptly hung up. I was stunned and speechless and held the phone in my hand for several seconds before I could react and call him back to tell him I was on my way.

Dr. William Brannan, urologist and former Chairman of the Ochsner Board of Trustees, gave us some of his impressions of Dr. Merrill Hines:

Merrill Hines was a very good, knowledgeable physician and a dedicated and capable surgeon. He was also knowledgeable of local politics and was very close to Dr. Ochsner, Dr. Burns and the other founders—he was pretty much their spokesman. When he was the Medical Director of the Clinic, I was the first Chairman of the Board elected by the partnership. Dr. Hines always respected my opinion and the opinions of those who came after me in that position. He could be very blunt as well as cordial and accommodating and gave many people the impression that he was rather domineering—he was not reticent about criticizing people. That's not all bad, but it could be irritating at times. But nobody wanted to cross him. He could get mad, depending on the situation and what he was being asked to do, but he was always a loyal supporter of those who were honest, hard working and reliable.

FINAL REMARKS

Merrill Hines spent 3 years in Tylertown, Mississippi, as a country doctor and surgeon, fulfilling his obligation to the Commonwealth Fund. As a country doctor, he learned “what it was to bring off a difficult delivery by lamplight in a sharecropper's cabin in a cotton field” (1p145), he learned compassion, and he realized that there was more to medicine than money and fame. These principles guided his long career as a physician. At Ochsner, Dr. Hines found what he was looking for and abandoned his plan for practicing in Chattanooga. He told Alton Ochsner, “Something tremendous is happening here and I want to be a part of it” (2). He was right, and he became a fundamental part of the success the institution enjoys today. Richard Freeman, long-time friend, once said, “Mo Hines gave so much of himself to this institution. It's been great for Ochsner, but it has been hard on Hines.” Dr. Hines disagreed, “No, it hasn't been hard on me. It's been a privilege to grow with Ochsner. I've been fortunate; I was in the right place at the right time. This institution is my life. I only hope I was the right fellow for the job.”

We believe that Merrill Hines was “the right fellow for the job.” As a young physician remarked, “For decades to come, Merrill Hines' ghost will be walking the Ochsner corridors. And Ochsner will be better for it.”