Posted by Michael Kennedy on March 16th, 2012 (All posts by Michael Kennedy)
When I was a medical school junior, we had a rotation on the Neurology service at LA County Hospital. One of my classmates was planning a career in neurology but the reason it was so popular with the students like me who were interested in surgery was that we got to do tracheostomies. A number of patients with severe neurological lesions would require respirators or had trouble with airway secretions requiring a tracheostomy. This was our one chance to do surgery, even a minor procedure as things go. It was good practice and I later did a lot of tracheostomies, some quite difficult and rushed.
Our resident was a very interesting guy named Dick Boggs. He was tall and looked a lot like Orson Welles did when he was young and making “The Third Man.” Boggs was quiet and aloof but let us do trachs and work up any patient we wanted to. I had some very interesting cases. One was a woman who showed all the signs of alcoholic neuropathy, which is very similar to diabetic neuropathey. It was a popular rotation for juniors. Boggs was popular among the residents and was elected the president of the Interns’ and Residents’ Association, which under his leadership took on some of the characteristics of a union.
At the time, intern and resident pay was very low and, aside from a new dormitory that was built for single house staff, we were on our own. I was married with one child, born in March 1965, so I was really on my own. My wife quit her job as a teacher in January 1965 and I was working after hours doing histories and physicals at private hospitals for $7 per hour. Fortunately, my tuition was covered by scholarship but living expenses were tight. We lived on $200/month contributed by our parents, $100 from my father and the same from Irene’s parents. Half of that went for the rent of our two bedroom house in Eagle Rock, near Pasadena. I’m spending some time on details to emphasize what Boggs accomplished for us all.
He was finishing his neurology residency in June and had been accepted for a fellowship with D. Denny Brown, a world famous neurology professor at Boston City Hospital. Boggs’ future was assured. From a position of immunity from retaliation, he conducted negotiations with the LA County Board of Supervisors, who decided what we would be paid and even if we would be paid. This was still the “old days” of medicine. Some states would not grant a license to a medical graduate until proof was seen that he had completed an internship. We were all “hes” of course although there were three women in the class ahead of us.
The Supervisors were determined that we had no right to ask for more money. We had a dining room where food was free and they had built a dormitory a year before that even had a tennis court.
In this photo of the hospital, the dorm can be seen at the far edge to the left. It was about 12 stories high and quite nice. It was torn down recently and it had been converted to offices in recent years. The tennis court became a parking lot years ago.
As far as they were concerned, we were students and should be paying them for the privilege ! Of course, no provision was made for married students or those with children. This was a growing trend but married residents with children were not all that new. A very close friend of my parents was an orthopedic surgeon by virtue of the support of a grateful patient who paid for his family expenses when he went back to do his orthopedic residency in the 1930s. He was later a very successful orthopedist including team physician for the Chicago White Sox for years. His son, Joe Jr, is a well known professor of psychiatry at Harvard. I still think of him as “Joey” playing in the water on family vacations at Grand Beach MI in the 1940s when he was four. That was a long time ago.
When Boggs appeared before the Board, that was the argument he got. We were all students and had no right to a salary, even a small one. What we did get was the result of their generosity and nothing else. They thought that would be the end of it but Boggs was undeterred. His response was, “If we are students, we should act like students.” The hospital was nearly full with a capacity of 3500 beds. The census was kept under control only by discharging patients after their acute illness was resolved. No effort was made to evaluate simple chronic diseases that affect all big city hospital populations. Anemia, mild urinary tract infections and the like. Abnormal liver enzymes were so common that when a new test, protein electrophoresis, became available, we discovered a new disease.
Boggs’ response to the Supervisors was, “if we are students, we have no obligation to provide less than excellent care just to help keep the hospital budget under control.” Henceforth, no patient would be discharged with a hemoglobin of less than 10 grams or a Blood Urea Nitrogen (BUN, a basic renal test) that was higher than normal. Both conditions were common and both would now be completely evaluated before discharge.
In a week, the hospital was filled to the rafters. The nursing load was enormous and the medical students all pitched in to help with bedpans and meals and other chores. The Supervisors threatened Boggs with terrible retribution until they discovered that he was immune to their pressure. In about two weeks, they gave in and intern salaries went from $195/ month to $395, which was good news to me. Internship was a 24 hour a day job so I would have lost my little outside sources of income. In fact, if one takes the 1966 dollar and multiplies it for inflation, that’s not a bad salary. I estimate that the dollar today is worth 10% of its value in 1966. The calculation gives a rough estimate of $50,000 per year in present day value.
Boggs would have another effect on my career although one I did not take advantage of. I graduated at the head of my class and was seriously interested in doing a residency at one of the prestigious hospitals in the East. I arranged to spend half my senior year of medical school at the Massachusetts General, at the time considered the top hospital in the country. A faculty member at USC told me there was no chance that a USC student would ever be accepted there but I knew he had failed to be accepted, coming from Tufts, so I discounted his advice. Another faculty member who had trained at the Mass General was encouraging and wrote letters for me. He also suggested that I arrange to spend six months there, if possible.
I sublet my house and the family trekked to Boston with stops at various historic sites accompanied by friends as we made a summer vacation of it. In Boston, I rented an apartment on West Cedar Street a short walk from the MGH. The area had recently had a huge slum clearance project completed and it looked like a bombed city. The Scollay Square Station of Kingston Trio fame was a block away. I heard some blood curdling tales from the residents about the days before slum clearance. One rule was never to treat a drunken longshoremen before taking away his hook. It was still a busy Emergency Ward and I spent three months there. I scrubbed in surgery, made rounds with the staff and got to know them well. The great northeast blackout of 1965 occurred one afternoon right in the middle of M&M Rounds. The only lights on in Boston for hours were bulbs on a huge Edison Company sign across the Charles River.
My experiences in Boston should be another post but I learned one serious lesson. MGH paid its interns even less than LA County. The intern salary was $750 per year ! Plus, of course, clean white uniforms. I concluded that this was impossible for me but I was still interested in Johns Hopkins in Baltimore. There was housing and a salary. The neighborhood was terrible, of course, as is almost all of Baltimore. The windows of the house staff apartments were barred.
When we got back to California, my wife rebelled. She said she was not leaving Los Angeles again no matter what. If I went east for training, I went alone. Eventually this led to divorce 12 years later. A friend who had barely gotten into USC as an alternate, did well and went to New York for his internship. He has now retired as the president of the University of Colorado. He is now president of Alpha Omega Alpha, the medical honorary society. The loss of opportunity gnawed at me and added to other issues.
The postscript is bizarre. Dick Boggs went to Boston in July of 1965. He was unhappy with the same salary structure that discouraged me so he repeated his tactics ( called the “Heal-in” in Los Angeles) with all the Boston teaching hospitals. The result was that salaries were increased for the year I would have been an intern and they exceeded the Los Angeles County salaries. I would have made $495 per month if I had followed through on my application to the Mass General. I did submit the application for Johns Hopkins and later learned I was accepted. They were puzzled why I did not arrive.
The real final chapter to this story is so bizarre that I will use Wikipedia to support the story. Years later, something happened to Dick Boggs that I have not been able to understand. He was convicted of murder for hire and died in prison a few years ago.
Boggs lured drunk Ellis Henry Greene, 32, into his office, disabled him with a stun gun, and suffocated him with the help of conspirator Melvin Eugene Hanson on April 16, 1988. The doctor then called paramedics, and falsely identified Greene as Hanson. He had forged medical records, and included the real Hanson’s birth certificate and credit cards on Greene’s body. The detectives called to the scene were initially suspicious of Boggs’ story. They reasoned that doctors don’t usually handle patients that early in the morning, and the temperature of the body couldn’t correspond to the time of death given by Boggs; it was also pointed out on a “Forensic Files” episode that Boggs wouldn’t be expected to be treating a heart patient. The coroner’s report however ruled that the death was due to a heart attack caused by natural causes. Hanson’s business partner John Hawkins (in a Columbus, Ohio clothing store chain “Just Sweats”) was called in to identify the body, which he did. Unknown to the police, Hawkins was working with Boggs and Hanson.
This Wiki version is not accurate. There was no suspicion of foul play at first but the detective who was called to the scene took routine fingerprints of the corpse. He was astonished when he got a “hit” in the FBI database and it was the wrong person ! The Wiki version then repeats speculation from the time period after this discovery.
Why in the world would Dick Boggs, who should have been well launched on a Neurology career twenty years after I knew him, get involved in a tawdry scheme like this ? The money wasn’t enough to explain his interest. There were rumors, I later heard, that Boggs had had a personality change and had been cruising gay bars for several years. His marriage was intact but, apparently unhappy. I have no explanation. He was a cold, rather unsympathetic guy in our relationship but I was a student and he was a chief resident destined for far better things. What happened?
After I saw the story in the LA Times, I wanted to contact him and see if he would talk to me. I never quite got up the courage. I’ve known a few physicians who got into trouble. One medical school classmate, who was always weird, murdered his girlfriend many years ago. A very well known woman pediatric surgeon discovered her equally well known scientist husband was molesting young girls. But Boggs, I’ve never been able to understand. Now, I’ll never know.