Interview with F. William Blaisdell, MD

Interview with F. William Blaisdell, MD

An interview with Dr. F. William (Bill) Blaisdell, former Chief of Surgery at SFGH. Topics discussed include developments in trauma and surgery, the development of the trauma program at SFGH, the nursing strike, and memorable cases.

13 May 2016

Oral History

SFGHOH 2016 003

.MOV

One hour

GB: Could you state your name and today's date.


WB: Yeah. Frank William Blaisdell, May 13th, 1916 [laughs], May 2016.


GB: Could you tell me a little bit about your career as a whole, and what part SFGH had in it.


WB: Well, I trained as a surgeon. My medical school was Stanford and most of my residency was at Stanford. They were then in the city, where Presbyterian Hospital is now. And most of my training, which was something like seven years, had my internship in Philadelphia, Philadelphia General. I had a year in Boston in mid-residency with Dr. Francis Moore, and when I completed my residency at Stanford I had a fellowship with Dr. Michael DeBakey and Denton Cooley in Houston, Texas. And from there, I was appointed chief of surgery at San Francisco VA Hospital and was there for six years until 1966, when I was appointed chief of surgery at San Francisco General.


GB: And you were chief of surgery until?


WB: 1978. 1966-1978.


GB: After that?


WB: I went to UC Davis as chairman of the department of surgery and retired from there in 2002.


GB: How or why did you start at SFGH? Why did you choose it?


WB: Well, [laughs] actually because I was out of a job at the VA hospital. We had some controversies there wherein the chief of medicine and I resigned because of some problems with administration and Bill Silen, William Silen, who just had left as chief at San Francisco General, had to go to Harvard, left the position open and so I was appointed as his successor. But incidentally, I was the first full-time chief at San Francisco General. Up until the time I was appointed, we had a geographic system at UCSF which meant that all the professors had to support themselves from private practice. That included William Silen, my predecessor, so he was, while chief, supporting himself with private practice and doing his research at the university. So he was only there, I might say, a modest number of hours a week. Whereas at the time of my appointment, we had gone to the full-time system, so I was given a full-time salary and I could devote my full time to San Francisco General.


Now that was essential because Medicare and MediCal had just come in, and the hospital could not bill for patients' surgery unless there was evidence of supervision of the residents, which meant you had to have a full-time surgeon involved in order for the hospital to bill. So that changed the whole psychology of things. The bill was passed, incidentally, in 1965, but it was implemented in July of 1966, exactly when I started at the General, so everything changed there. As a matter of fact, the clientele changed because the older patients basically made up the nicer part of the patient practice at the General. Older patients did not have insurance, there was no Medicare up until that time and so a large percentage of the patient population was oldsters. And all of a sudden Medicare took the patients that had always been on the private sector and they had access to private hospitals. So the nature of our practice changed dramatically.


In 1966 and 67, the Vietnam War was on. And at that point in time, there started the protests against the war, which was initiated in the Haight-Ashbury district. And that was simultaneous with the decision that psychiatric patients could be treated as outpatients. Whereas prior to 1965 or 66, psychiatric patients were pretty much housed in major medical facilities, it was decided that now they could be treated with new drugs as outpatients. And there were to be clinics set up as an alternative to the hospitals. So all of a sudden the crazies were released on the streets. And that happened simultaneously with the Vietnam War protests and introduced drugs to the streets because the psychiatric patients were being treated with uppers for depression and downers for agitation.


And drugs were adopted by the protesters against Vietnam War, and that created all kinds of problems for the city and changed the nature of our population. Because the city of San Francisco had been a relatively quiet place. Shootings and stabbings, for example, as admissions to the hospital were relatively infrequent. When I was chief resident at San Francisco General, perhaps we had one or two stab wounds a week and maybe one gunshot a week. And all of a sudden, 1966 and 67, the violence started in our city. The protests against the Vietnam War resulted in kind of the Patty Hearst thing in which the violence involved violence against the police department and bombs were set off in the police departments. We took care of many police officers that were shot, wounded, cars blown up and so forth. So the city went almost overnight from a benign place to a violent place, you might say. And by my records in 1966 and 67, the crimes of violence doubled over the previous year, doubled the next year, and doubled the following year.


So now we had our problem -- how to deal with this new nature of our practice. Previously we were in it for older patients, and a relatively benign city, now we're dealing with a violent city and having to reorganize to handle the overload of trauma. So we had one ambulance system at the time, it served the entire city. And the private ambulance sector only delivered patients from hospital to hospital. And every ambulance call was received as -- probably still is -- by the fire department, taken to San Francisco General Hospital, and if it were a private patient, and able to be transferred, then a private ambulance would take the patient from there. But we had all this violence among the hippies, and of course they weren't private patients exactly, and we had to reorganize and re-staff the emergency room. So we ended up increasing the number of residents we had in the emergency department and organized our staff to meet with the violence. Most of the violence occurred on the weekends and nights, so that was something that the private sector had no interest in dealing with. And so we had during most of my tenure, an entire monopoly, no one competing with us to take care of these patients. So that was kind of a history of the start of our trauma service.


One of the big problems was getting 24-hour anesthesia care because we had to have full services available in an instant. We had nurses and anesthetists available 24 hours a day, we needed more staffing by special anesthesiologists so we had to ensure that we had anesthesiology available, the operating room available, and enough staff in the emergency room to treat and triage the emergencies. And we had something like the bombing of the Chinese restaurant which all of a sudden generated something like 12-20 patients. And we had to triage those and decide who would go first and who could be put to one side for a while. And treat those with operations that needed an operation. And of course it involved a need for blood banking, blood available, that was one of the key bits of resuscitation that were necessary.


GB: How did you manage to get all of those staffing changes that you needed?


WB: Well, one of the things we did was go to the city for the additional help and since we were in the news all the time and it involved the private sector, it involved the police department and so forth, we were reasonably successful in getting our budgetary needs through the board of supervisors. As a matter of fact, the hospital as a whole started to justify increases everywhere on the basis that it needed to support a trauma service. So the medical service increased their capacity and their budgets by tagging on to the trauma service. And at that same time nationally, it started to be recognized that trauma was a separate disease. And Congress passed a budget to support trauma centers somewhere around probably 1970. So we applied for funds for research in trauma and managed to acquire what's called a program project grant that supported research by four or five of our faculty and to various individual problems involved in the care of trauma.


GB: Did the development of the trauma program have an impact on how the new hospital, the one that was completed in 1976, how that was designed?


WB: Well, the new hospital came into play about 1976. But the new hospital was on the drawing board when I first went to San Francisco General and it had something like 300 psychiatric beds in it. And probably a thousand beds. But in the course of the evolution of the construction of the hospital, the psychiatric beds were no longer needed and so most of those were cut out. But the hospital construction went on during most of this period and, as I said, was completed in 1976. Two years before I left. And we had in the new hospital, a markedly expanded emergency room. Went from relatively cramped quarters to a place where the nurses needed roller skates to get around.


GB: Was that helpful?


WB: Well, I would say yes and no. There were certain advantages of being compact, which we certainly were before we expanded the emergency department. But with the expansion of the emergency department, again you have more problems of staffing and staffing always lags a year or two behind whatever your needs are. No one will give you money in anticipation of your need, so you have to demonstrate some type of crisis in order to up your staffing. So I think our original problem with the new emergency room was adequate staffing because we had to cover far more space.


Things had also changed in emergency rooms. Emergency rooms up until 1966, when I went to the General, were staffed by surgeons. Surgery department, my department, was in charge of the emergency room. As a matter of fact, during my entire tenure, was a holdover from the historical need for surgeons staffing emergency rooms, medicine didn't have emergencies that needed emergency care. Our emergency room was staffed a junior medical resident, for example, and because the medical emergencies went immediately to the wards, there weren't such things as specialty care units, coronary care units or what have you, and so medical patients didn't really need anything on the emergency room that couldn't be delivered on the ward. So they were promptly sent through and patients that occupied the emergency room were gunshot wounds, stab wounds, patients with acute abdominal disease, appendicitis, cholestasis, and so forth that needed operations or needed to be observed to determine whether they needed operation. And the trauma patients the same thing pertained -- we needed to observe some trauma patients to determine whether they had internal injuries or not. And so that involved the use of the emergency room. And gradually as surgery developed its ICUs -- and we were the first to have an ICU -- the medical services followed and the cardiac services followed with their own specialty care units, and it was demonstrated that you had much more you could offer the emergency patient.


GB: Can you tell me about a memorable case or patient that you had during your time at SFGH?


WB: Well, we had lots of memorable cases. I can recall one. One of the things that we needed to support our trauma service was support of the public. And so we involved the news media in all of this because they helped demonstrate that the trauma service was for everybody. And I recall one time we invited a reporter and determined he was safe to participate and observe in the emergency department. And so he came and the first hour he was there, this gunshot wound of the heart was brought in and the patient was resuscitated from total cardiac arrest. Hustled him into the operating room, the reporter was allowed to follow, and we resuscitated him, sewed up a hole in the heart. And the next day, the patient was bright and alert and the reporter came and interviewed the patient and said, how'd you get shot? And it was allegedly the unloaded gun. This fellow had attempted suicide, but when he recognized what a notoriety it was, he said he shot himself with what he thought was an unloaded gun. At any rate, that made a lot of headlines.


A bomb went off in one of our police department offices and the shrapnel from the bomb hit a number of police officers, and we had one who had required major resuscitation and he was essentially dead when he was brought in. We got him back, but he was a dramatic case.


The Golden Dragon episode which I mentioned was two mobs that were accosting one another and one of the mobs apparently were in the restaurant, the Golden Dragon restaurant, and the other mob came in to attack. Of course, most the restaurant was filled with innocent people, and the mobsters all dropped below the table when they saw the opposition coming. So the Chinese gangsters opened up with machine guns or what have you and mowed down something like 18 people in the restaurant. A lot of them were flesh wounds and minor wounds, but all of a sudden we had all these catastrophes presenting at the emergency department. And again had to sort them out, recall all our staff in and had all our operating rooms running to take care of the problem. Amid one of the problems was a 90 year old Chinese waiter who was shot at the base of his neck and had total quadriplegia -- all of his extremities were gone. And a 90 year old with quadriplegia is non-salvageable. So he was put in one corner and allowed to die. Well, the next week, one of the Chinese activists raised the question, well, the Caucasians were triaged and taken care of first and the Chinese were left to die. And that made big headlines and so we were called to answer that particular question before the Chinese community. And fortunately for us, the chief of the emergency department was Dr. Robert Lim, Chinese. And our chief resident was John Bowie, also Chinese. And they were the ones that were triaging the patients. And so we went through this big harassment about how we favorably triaged Caucasians, then I introduced my staff that were responsible for the triage and everything went [whooshing noise]. Flat. So that was a dramatic moment.


We had a particularly dramatic moment for [mayor] Dianne Feinstein. Senator Cranston, who had sponsored the trauma bill in Congress in the Senate, had dedicated our trauma center. And so we had all the dignitaries out, including the board of supervisors and Dianne Feinstein, and as you probably know, her father was a surgeon and was actually chief at the county hospital on the Cal service before he became chairman of the department of surgery at UC. So Dianne was always a strong supporter of San Francisco General and after the dedication by Cranston, we looked after our prominent people and Dr. Donald Trunkey was assigned to Dianne Feinstein. He took Dianne down to a tour of the hospital and down to the emergency room and just then, this high school victim had been brought in, DOA. Don was involved in resuscitation efforts of this high schooler, and was unsuccessful. And just as Dianne and I got there, he walked out of the emergency room and said, if they'd only gotten him sooner. It turned out that our ambulance that was sent initially to pick up the high school victim, broke down. And the second ambulance that was available, the battery was dead. And so it was some 25 minute delay before they got an ambulance of some kind to the high school, and the high schooler died in the ambulance. It was the type of thing that, given another 30 minutes, we could have saved, and so Don [laughs] came out and just swore right in front of Dianne and she went back to the board of supervisors and we got a whole new set of ambulances. That was a dramatic moment.


Another dramatic moment Dr. Trunkey participated in, is when our residents finished their training many of them had an interest in trauma and so we sent them to other centers to learn what they were doing. Dr. George Sheldon was a prominent subsequent member of our staff and we had sent him to work in Boston with Dr. Francis Moore, and Donald Trunkey went to Texas to work in their emergency department, the same one that was involved with the Kennedy assassination. But it was prior to that. At any rate, Don came back with an interest in burns because the county hospital in Dallas has one of the first burn centers in the country. And Don was interested in burns and he said, Bill, we gotta start a burn unit. I said, okay fine, Don, we've got to sell that to the board of supervisors, go down and talk to our hospital administrator and see what he thinks about it. Well, Don went down, unbeknownst to me, talked to the hospital administrator and he said, no way. No way. We already got all these needs and I'm not going to put in my budget a request to support a burn unit. But Don didn't tell me that.


What he did was go back and, we had at that time an abandoned ward, and so he went and got to the basement, brought up a lot of equipment and invited nurses from various wards, including the operating room, to come and help staff it. Then he sent a note to the mayor, [Joseph] Alioto, asking him to come dedicate the new burn unit. Now, this is unbeknownst to our hospital administrator, board of supervisors or anything else, we just [laughs] flat out and out, apolitical. At any rate, the mayor's office accepted with alacrity, oh yes, dedicate new burn unit, yeah I'll be there. And so the dedication of the burn unit was scheduled and then Don came to my office and said, the mayor is coming out Tuesday or whatever it was to dedicate our burn unit. I said well, gee Don, how did you do that? And he said, well, I just put together all this stuff and I said, well, what did the hospital administrator have to say about it? Oh, he doesn't know about it. And I said, my god, you mean you haven't talked to Charles, does he even know the mayor is coming out? No. [Laughs] So I went down and I told Charles Monedero by name that the mayor is coming out to dedicate the burn unit. What? What? That can't be! And I said well, Trunkey has done that. And so Monedero had no choice but to show up and participate in the burn unit and put it in the emergency budget of stuff for our burn unit. But he came to me and demanded that Trunkey be fired and I said, Don Trunkey's on a university salary, Charles, he has his tenure as associate professor, I can't fire him. All he could do [laughs] was swear and that was kind of it.


We had a number of strikes that went on during my tenure. The first nurses' strike in the country took place a month after I assumed the job as chief of surgery. The nurses, at that time, were paid less than the street cleaners. They had never -- it was a matter of principle -- nurses had never struck for wages. And they were women, of course, there were no men in nursing to speak of, and over the years, their salary had just remained dormant and finally it got so bad that we got a new chief director of nursing. And at that time all the wards were little fiefdoms of nurses, there was no organized internal thing among the nurses. But the new director of nurses managed to pull together all the chief ward nurses and they organized a strike. And the strike lasted for three or four days, we had to move patients out, and the staff, the residents and so forth took care of them the best they could and made meals and so forth, but the nurses won the strike. And our director of nurses became chief of California Nurses Association and that ultimately led to strikes everywhere for underpaid nurses in various hospitals. So that was a major event. I don't know if that's been documented historically, that first nursing strike, but that should be, because that was a very important thing for stabilization of our nursing staff if nothing else.


One of the things that Dr. Sheldon did was demonstrate the importance of immediate opening of the chest of patients who had arrests from trauma. Now, the history of cardiac resuscitation went back thirty years or more and the original principle was if a surgical patient arrested under observation the chest was opened and cardiac massage was initiated. But then about 1960, John Hopkins demonstrated the effectiveness of closed cardiac resuscitation -- chest compression. And of course most cardiac arrests were medical, not surgical. And so closed chest compression became a means of attempting to resuscitate patients medical or surgical. And Dr. Sheldon when he was resident, had a stab wound of the heart come in and he immediately opened the chest and resuscitated the patient. And that initiated, with my support, a decision to open the chest in patients that came in in cardiac arrest from trauma, and we salvaged something like fourteen straight patients with open chest resuscitation. Of various types. But a lot of them involved the heart.


Pericardial tamponade is when you have a stab wound or a low-velocity gunshot wound of the heart, the bleeding occurs into the heart sac. And the sac surrounding the heart, the hole closes over so the bleeding occurs entirely in the heart sac, compresses the heart, so the heart contracts but then can't expand because it squeezes the blood into the chamber. By opening the chest, you relieve cardiac tamponade, but of course it results in exposure of bleeding and so we developed techniques of finger compression, and one of the things that we advocated was compression of the big veins coming into the heart so we could remove foreign bodies. And one of the ways of doing that is if you have, well, we have such things called bullet emboli, the patient in shock, for example, and a great vein -- and veins are low pressure bleeding and so they will often tamponade or close off the bleeding -- but if the bullet happens to end up in the vein, it can swerve off into the heart and end up in a pulmonary artery. And the bullets were often sharp edged after having penetrated a body, and so they cut through the artery that they're in so one of the things that we developed before we had cardiopulmonary bypass was simply to open the chest and temporarily clamp both veins, cut off the blood flow into the heart, the heart collapses and you can remove the foreign body. But you have to do that by count. You can only shut off the blood flow to the heart for a minute or so and so that was one way we had of dealing with cardiac trauma.


Another technique that we developed during that time was management of liver trauma. We had a number of jumpers -- kids getting high on drugs like ecstasy for example would think they could fly. Now we had a number of jumpers off of buildings and they would come in and in a number of instances the liver was torn off the vena cava. And there was no way of resuscitating those patients, but we developed a technique of isolating the liver by placement of the catheter through the heart and totally bypassing the liver so we could repair it. And repair the vena cava behind the heart. And so that was one of the developments that we had.


Another was torn aortas, also occur from falls from heights. And usually it occurs just distal to the big blood vessels to the brain. And that was a challenge. We weren't unique in that, developing surgery for that, but that required urgent surgery. And the tear of the big blood vessel involved again immediate resuscitation, taking the patient to the operating room, before they hemorrhaged to death, and repairing the aorta. And we had a number of those cases. So we had a lot of drama in terms of the development of our trauma center.


One of the advantages I had with my training which was in general surgery, very good program and training at San Francisco General, as I said we didn't have that much violence but even so we had a lot of trauma, stab wounds mostly. And then I had training with Dr. Francis Moore which involved fluid resuscitation and burns were his big thing in Boston, and then when I went to the premiere cardiovascular center in Houston and I had exposure to DeBakey and Cooley, I came away with expertise in managing big blood vessels and bleeding, which is the key to managing patients in trauma. That's where you can't wait. And so I went to the VA hospital and I was the first trained cardiac surgeon the VA saw so they gave me everything I wanted in the way of cardiac surgery. And we had the first cardiac center in the country in the VA system in 1960. With that, then that cardiovascular training helped me establish principles of care that my residents were exposed to.


GB: You started talking about this, but maybe there's a little bit more that you can say -- What kinds of new advances in techniques and medical science and medications, all of that, happened during your time at SFGH that changed how you worked?


WB: Well, one of the big problems was the development of critical care, because that was the key to management of patients post-resuscitation or major injury. One of the things that would happen in the past, after you had a patient come in in shock, and you poured all the blood into them and treated their injury, they later died of lung failure. And we were involved very early in the investigation of lung failure after trauma. And we developed, thanks to Robert Lim, a model in the dog which reduplicated the shock syndrome and so forth and reproduced the lung failure. And we discovered that the lung failure after trauma is due to, let's say -- with blood clot going to the heart, and the circulation is stopped as it is in shock, clot forms in places like the extremity, where blood is first deprived in shock, and that garbage that accumulates in a stagnant vein then is washed back into the lungs after resuscitation and is associated with lung failure. And so we had a model that reproduced that by shutting off circulation of the aorta of the dog for a certain period of time, then removing the clamp, the occlusion of the aorta, and seeing the dogs die of lung failure. And so we developed a concept of anticoagulation in many patients.


The lung failure, which resulted in leaky lungs, was very controversial. The problem was whether to give more fluids to post-op patients and result in more swelling and fluid in the lungs or whether to keep the patients dry, which we said might be reducing shock. And it was an issue regarding kidney failure versus lung failure. For example, if you gave a lot of fluid to patients with lung failure to stop kidney failure, then the lungs suffered. If you didn't give fluid to preserve the lungs from the excess fluid leak, you got kidney failure. And our feeling was that kidney failure was a manifestation of further shock, the kidneys went into failure after trauma because they weren't getting enough blood flow. And leaving somebody remaining in shock in order to protect the lungs resulted in preservation of shock, kidney failure, which we didn't have any real treatment for at that time, except dialysis. And we didn't have universal dialysis. That was another major controversy.


Renal dialysis really was beginning to be demonstrated effective about the time I went to the General Hospital and there were grants given to put patients on renal dialysis. But the criteria set up were very very strict, and for example our drug addicts were not eligible. And if they had any bad history, there was limited funds available, they had a limited number of dialysis possible, so at the General we had a very early dialysis unit, [but] the restrictions were such that we couldn't dialyze all patients. And again -- renal failure then wasn't a good deal.


I can recall one patient who was shot through his only kidney. That was another interesting case. We had a patient come in in shock, he was a minority, he was shot and when we opened him up for bleeding, found a shot through a solitary kidney. And it went right through the -- you might say the heart of the kidney where all the blood vessels were. But because it was his only kidney, and because we knew that because he was a drug addict he wouldn't have dialysis, we couldn't take the kidney out, so we closed the patient up and observed him, hoping that the bleeding from his kidney might stop and he might preserve renal function. Well it didn't, it continued to bleed into his urine and we had no choice but to take him back. So I called Dr. Fred Belzer, who was chief of renal transplant at that point in time, which was being developed at UC, and asked him to come over and help. So we went back, took out the solitary kidney and I gave it to Fred to repair on the back table and he looked at it and said, "I can't repair it," and threw it in the garbage can. And here I was, [laughs] I was the one at the operating table and had taken out the kidney. "My gosh Fred, why'd you throw it away? Let me look at it." So I went back, pulled it out of the garbage can, washed it off, and cleaned it up as best I could, and repaired some of the critical vessels of the kidney. And then Fred helped put it back in the patient's groin. Well, the kidney functioned, but the problem is that the kidney had been infected and so the patient regained renal function but he developed massive infection and so we ended up losing that. But that was the first autotransplant that we were aware of. We subsequently did two more autotransplants and wrote up three repairs of kidneys outside the body. That was another dramatic thing that we did.


I would say all kinds of things going around, as for new development in surgery was really coming into its own. Before World War II, most of the surgery in the United States was done by private practitioners with just medical training. When I went to Sacramento as late as 1978, the majority of surgery being done in Sacramento was done by private practitioners. California license, you licensed for practice of medicine and surgery and before I started my surgical training I thought I wanted to be a general practitioner and then I could do everything -- I could operate, take care of medical patients and so forth. And after my experience during my internship in Philadelphia, it was apparent that [if] you thought somebody had appendicitis, which was a simple operation, a general practitioner could do with minimal training, [and] it turned out you opened the patient and he had a perforation of his colon, obviously you weren't prepared to deal with that. So after my internship I said well, I need to take surgical training and after World War II, surgical specialization really came in in strength. Before that, yes, you could become a surgical specialist, but that, well, it's a lot of postgraduate years and you couldn't do that much but World War II and with antibiotics and blood banking opened up surgery so major surgery was possible. Open heart surgery developed. Vascular surgery developed. And the surgeon really came into his own and surgical specialists then branched out so you became super surgical specialists. Vascular surgeons and thoracic surgeons and so forth. But I had thoracic training at Stanford 'cause during my residency a chief resident did all of thoracic surgery. I had six months of my final chief year at Stanford where Gerbode was developing open heart surgery and I participated in that, and did actually some closed heart operations as a chief resident. And then I went to Houston where they were doing something like eight major vascular operations a day by DeBakey and Cooley was doing something like five open heart surgeries a day where the most anybody else was doing in the country were one or two open heart surgeries. That was all a period of rapid development of -- and transplant came in that period -- and the first transplant was done at Peter Brent Brigham, where I'd gone for a year. That was the first in the world and the surgeon there, Joe Murray, I had a chance to work with, though he wasn't doing transplants at that time, he had transplanted an identical twin and they had were on the brink of doing major transplants. But that was just starting. But anyway, that was all part of my training that I was exposed to.


GB: A lot going on at that time.


WB: Yes, and we invited Joe Murray, who won the Nobel Prize, in surgery actually he came to San Francisco General during my tenure and gave a talk.


GB: What do you think is the role of safety net hospitals today, hospitals like San Francisco General?


WB: Well, it's taking care of everything that nobody else wants to take care of. That's one thing. You know, it's the ultimate hospital for the care of people that are neglected in society. And there always will be those who are neglected in society. But it's also a place for organized care such as AIDS, for example, classic example. AIDS followed trauma as the big thing generating funds. And nobody else wanted to take care of AIDS, nobody else wanted to take care of trauma. The hospitals did, because financially it was viable but the surgeons didn't want to. Why would you want to work weekends and nights, for pete's sake? And for patients one of whom had no pay? So the General Hospital will always be the provider of the element of care which society has a problem dealing with. And there will be... classic example: the homeless, for example, who's taking care of them? San Francisco General. There's also ways, you know, where you require 24 hour staffing and private sector doesn't want to deal with it. Trauma's a classic example. That'll always be a strong point. Because the private hospitals, if they're smart, won't venture into it. 'Cause they can't provide the same thing as 24 hour coverage with residents and staff that the General does.


GB: So you would argue that the Affordable Care Act hasn't made SFGH somehow...?


WB: Well, the Affordable Care Act is great, and what we need is a system of one payer that [Vermont Senator Bernie] Sanders is advocating yes, but one payer system is politically out of reach at the present time. In my opinion, the aging of our population is going to blow the lid off the cost of health care. That is a huge problem. How are you going to take care of more and more people living to be 100 years old? My life and my cost of my care, I mean, we're breaking the bank in health care. You know, all of our costs -- I'm 88 now, going on 89 and my wife is the same age, and between her and me we've had millions of dollars of health care. And how is health care going to deal with that? I don't know. But that's the challenge that I see for the future and for how you're going to organize that, until it gets so costly that we can't afford all the inefficiency of multiple service carriers, all the paperwork. Dr. Frank Lewis, who you know about, had an excellent article saying, one system of health care immediately would save 40% of health care costs by eliminating all the need for paperwork and justification that goes with the current health care costs. But I think it's going to be another decade or so before that political system is broken down 'cause you're always going to have the private advocates, insurance industry, that's going to be lobbying for, until you -- [gestures at GB] you -- can't afford the cost of health care, can't afford to support me and my wife, are we going to see dramatic changes that we need. And meanwhile, San Francisco General is there to pick up the pieces, wherever they occur, whatever parts of health care neglect -- that is going to be a lot.


GB: So what would you hope to see in the future of SF General?


WB: You've got a brand new hospital. I inherited a brand new hospital in my tenure and 50 years later you got another brand new hospital, so. And that's a sign that the public supports the hospital. 'Cause of course obviously it had to get by the taxpayers, the board of supervisors, and so forth. That is representative of what the General Hospital means to the community as a whole. They've recognized -- at least the majority have -- that the hospital is there to pick up AIDS or to pick up trauma or infectious disease -- infectious disease will always be there, there will be new infectious diseases, that's the next one, yeah. That we'll see. The Zika virus, those patients. Something that San Francisco General has ready access to and will have to provide care for. Or right now the big challenge is psychiatry, too. I mean they're saying we need to hospitalize more psychiatric patients. That we need more beds for them. And we have all these sick patients lying on the streets.


GB: Because they were wrong, and you can't just treat them with these new drugs.


WB: Yeah, right, we had 300 beds at one night, I don't know how many we've got now, but, 50 maybe? Or less? Thirty? And my impression is, just reading the newspapers, not knowing any better, that we need far more beds in psychiatry.


GB: Is there anything else that you would like to add?


WB: No, I don't think so. I think San Francisco General is always going to be the bottom line of health care in San Francisco. And I think that's important for the public to recognize, and so I think one of the things we need to do is continue to publicize what we're actually doing for society and you can help with that. I think our doors should be open to news media and so forth so they have ready access, can see the importance of the hospital. And I said one of my faculty, Dr. Sheldon, who became head of everything you can be head of in United States surgery, I don't know if you know anything about him, you should. He became chairman of surgery at North Carolina, he became head of the American Board of Surgery, he became head of the board of regents at the American College of Surgeons, he was the first surgeon that headed the [Association of American Medical Colleges]. At any rate, anything you can be president of in American medicine, he was president of. I guess the only thing he missed was the American Medical Association, but. And he also recognized, I think, that one of the keys that we had in the trauma program was opening up our doors to the news media.


GB: All right. Thank you for your time.

Griffin Burgess

F. William Blaisdell, MD

Dr. Blaisdell's home, San Francisco, CA