Aureomycin

It was raining softly 12 years ago, the day Jack McConnell, MD, had the epiphany. McConnell remembers how the rain had turned the dirt roads on Hilton Head, South Carolina, into mud, and how, as he drove out the back gate of his subdivision, he spotted a man walking along a path without an umbrella.

McConnell had a habit of picking up hitchhikers. It was payback of sorts for all the rides his family received when he was growing up in the hills of southwest Virginia. His father was a Methodist minister who never had a car. He told folks that he "couldn't support Mr. Ford" on a preacher's salary and send his seven children to college.

His father also was fond of asking his children at suppertime. "And what have you done for someone today?"--a phrase that became part of McConnell's muscle memory as he grew older. So, on that drizzly day 12 years ago, he slowed down without thinking and gave a ride to a man who would change his life and thousands of others.

The man's name was James. McConnell asked where he was going. "To look for a job. Any kind I can get." He said he had two children, and that his wife was expecting. Always the doctor, McConnell asked whether he had access to medical care. No, James said. "We have to take care of ourselves. No one else is going to help us."

After McConnell drove James to a work site, he thought about the other hitchhikers he had talked to since his retirement on Hilton Head. They were maids, waitresses, construction workers, and every one of them said they had trouble getting basic medical care. Someone should do something, McConnell thought.

Then he heard an echo from his past--"What have you done for someone today?" And, as he did in the 1960s, when he directed the development of Tylenol, and in the 1980s, when he helped create the first commercial MRI system, McConnell began to visualize a solution.

31 and counting

Twelve years later, McConnell is in the reception room of the Volunteers in Medicine Clinic on Hilton Head, the free clinic that grew from that rainy-day conversation with James. The place is humming, as usual. Gray-haired greeters man front desks, taking information from patients, or as McConnell likes to call them, "friends and neighbors who don't feel well."

Other volunteers escort patients to see doctors, dentists, and even a chiropractor. McConnell motions toward a colorfully painted room where children read books. "We don't have waiting rooms," he says. "If you call it that, then that's what happens, you wait. We call it a reception room, where people are received."

McConnell's brainstorm was to take advantage of the island's many retired doctors and nurses and build a clinic for residents who had no health insurance or didn't qualify for Medicaid. The clinic opened in 1994.

Last year, about 6,500 people were treated during 21,000 visits. Known for its golf courses and wealthy gated developments. Hilton Head also can boast that every one of its residents has access to basic, high-quality medical care.

The Hilton Head clinic has been such a success that it is now a prototype, or as one health policy analyst called it, "a national destination and training site." McConnell points to a map of the United States near the front door. Red pins mark where other communities have built free clinics based on the Hilton Head model. So far, 31 have opened. All are independently run.

Some are small; one in New Orleans caters only to low-income musicians. One of the newest is in Bend, Oregon, and has eight exam rooms and an electronic medical records system. At least 40 more clinics are scheduled to open in the next year or two. The Volunteers in Medicine Institute, a nonprofit group in Vermont that McConnell founded, helps communities through the process.

McConnell thinks the Volunteers in Medicine concept could evolve into a national movement because of two converging economic and demographic trends: the growing ranks of the uninsured and the large number of retired physicians and nurses.

"The idea works because everyone wins," he says. Hospitals save money because fewer nonpaying patients show up in their emergency rooms. (The Hilton Head Regional Medical Center estimates it saves S5 million a year because of the free clinic.) Retirees can practice medicine in an environment free of paperwork and bureaucracy. Residents who might have avoided seeking medical treatment because of cost or embarrassment can get help.

Largely because of McConnell and the Volunteers in Medicine Institute. Congress passed a law that gives volunteers in free medical clinics federal malpractice protection. (Regulators are still ironing out details about how the law will be implemented.)

"Our approach, if adopted nationally, could provide much, if not most, of the health care for the 45 million people who are uninsured, and at essentially no cost to the nation," he says. "Of all the things I've ever done, hands down, this is what I'm proud of most."

Tap dancing with Phish

Considering McConnell's many and diverse accomplishments, this is saying something.

McConnell is 79 years old and has a wiry frame. "I was never heavy enough to have a temper." He wears large gold-rimmed glasses and smiles often, or seems to be on the verge. When somebody greets him and asks how he is, he answers, "Better because of you." Friends and colleagues say he sometimes reminds them of a clergyman.

When he's not working with the Volunteers in Medicine Institute, he listens to Dixieland jazz and practices tap dancing on a floor he installed in his garage. He is married and has three children. One son played piano for the band Phish, which recently split up. In one of the group's last concerts, McConnell sang with his son and showed off his tap steps before a crowd of 35,000. "Life doesn't get much better than that."

McConnell knew from a young age that he wanted to be a doctor. When he was six, his mother fell ill. "I told her when I grow up, I'm going to take care of you." As a young man, he made good on that vow, receiving his MD from the University of Tennessee. He did post-graduate training in pediatrics at Baylor College of Medicine and went into the Navy. But he contracted tuberculosis in the process and was confined to a bed for a year.

"I listened to my Dixieland LP records and I read my Bible every day, sometimes several times a day." He also filled the hours by creating mental pictures of how he hoped his life would unfold.

After the Navy discharged him in 1952, he took a job with a shipping line as a ship doctor, and eventually set up his own practice in New Orleans. "I was having a fair amount of success, but then I noticed something wrong with eight of my patients." They were having problems with a new drug, Aureomycin, made by Lederle Laboratories, now American Home Products Corp. He called the company, and a vice president showed up at his office. The two talked and the executive was so impressed with McConnell that he offered him a job as a researcher.

"When I got there, they had very ineffective test routines for TB--too many false positives and negatives," he said. "Then I read about a guy in Sports Illustrated. He was a horse jumper, who also had a patent on a test to detect tuberculosis but didn't know what to do with it. So we redesigned it at Lederle and figured how to ship it safely around the world."

The result was the TB Tine Test, which is still used today.

Perhaps McConnell's most far-reaching commercial success took place in the early 1960s when he began to think about acetaminophen and its potential as a pain reliever.

"You have to remember that back then no one wanted to believe that it could compete with aspirin, which was like apple pie and the American flag." At the time, McConnell was vice president of new product development at McNeil Laboratories. He pushed for trials that eventually showed how acetaminophen caused less stomach bleeding than aspirin. He and his colleagues also figured out a way to coat pills so they would go down quickly without a bitter taste. The result: Tylenol tablets.

He choreographed another breakthrough in the 1980s. By then he was director of advanced technology for Johnson & Johnson, reporting directly to the chief executive officer. He thought about the damage caused by X-rays and learned that several scientists were using magnets to study soft tissue. He eventually put together a team that created the first commercial Magnetic Resonance Imaging system in the United States.

"The company wouldn't have gotten involved in the MRI without Jack's initiative," said Don Johnston, a vice president with Johnson & Johnson at the time. "He has always been interested in new things, and he knows people everywhere. He's very gregarious. If you dropped him into Alaska, the first Eskimo he met would be an old friend."

Near the end of his career, McConnell was an important cheerleader for genetic research. He helped draft federal legislation that led to the creation of the Human Genome Project. He was a founding trustee of the Institute for Genomic Research. Among other things, its researchers have mapped the genome sequence of pathogens that cause cholera, tuberculosis, meningitis, syphilis and Lyme disease.

"It was the challenge that I liked most about what I did. I wanted to do something that no one had done, but that needed to be done by somebody."

No time to retire

When McConnell retired in 1989, he figured he would settle down in Hilton Head and play lots of golf. But he wasn't wired for extended periods of leisure. "My father always used to say, "Don't drive your car using your rear-view mirror. You won't make much progress and you might hurt someone as you go along. He was right."

The clinic became his new mission. He gathered a group of residents and they sketched out a plan. Their first task: Study the problem. They surveyed 85 percent of the businesses on the island. They found that one in three residents, about 10,000 people, had little or no access to health care. That showed the need. Now, they had to build community-wide support.

To McConnell's surprise, a few doctors opposed the project, fearing that they somehow might lose paying patients. In a meeting with the area's physicians, McConnell said: "Just tell me how many of our nonpaying patients you want, and I will see that you get every one of them!" The doctors laughed and many eventually became the clinic's strongest supporters.

A more serious hurdle involved licensing retired doctors and nurses, McConnell knew that retirees wouldn't volunteer if they had to pay hundreds of dollars in licensing fees and spend hours taking tests. When the state's medical licensing board turned down his request for a waiver, he went to the state legislature. In short order, lawmakers created a special license for volunteer doctors in free clinics.

McConnell's team cleared another obstacle when the state's Joint Underwriting Association agreed to provide malpractice insurance for the entire clinic for just $5,000. That was important. McConnell knew doctors and nurses would be less likely to volunteer if their retirement savings were put at risk.

Creating a "spiritual base" for the clinic also was an important goal. One morning, after reading and meditating with his wife, McConnell came up with the clinic's vision statement, which is now prominently displayed on a wall in the examination area:

When the clinic opened in 1994, Elizabeth Taylor, an energetic woman who lived on the island all her life, was one of the first to walk through the doors. Ten years later, she still drops by to pick up her medication. "Everybody on the island brags about the place," she said during a recent visit. "It saves you money, and the doctors are caring. They don't just slam you in a room."

Comments like that make McConnell grin. Today, the clinic has a staff of 300 volunteers--doctors, nurses and a troupe of translators for the island's growing Latino population. Some volunteers chose to retire in Hilton Head mainly because of the clinic. He cites studies showing that the country has 160,000 retired physicians, 350,000 nurses, and 40,000 dentists. He says many are looking for meaningful ways to spend their retirements. "You don't quit being a doctor when you retire."

On a sunny day, McConnell drives down the same quiet two-lane road where he found James 12 years ago.

"There it is. He came out of those bushes." Nearby, are ramshackle homes with rusty metal roofs.

McConnell never learned James' last name. He tried to track him down a few times without any luck. He'll thank him if he does find him. "He made my life immensely more rewarding than it would have been."

Doctors who volunteer at the free clinics "think they're coming here to help the poor," he says. "But it's the patients who bring us gifts--a sense of purpose in life. When you do something for someone, every now and then you get this feeling that's impossible to define."

He pauses. "No, I think I know what it is. It's that touch on the shoulder from someone above saying, 'Thank you.'"

Tony Bartelme is a staff writer for the Post & Courier newspaper in Charleston, SC.

COPYRIGHT 2004 American College of Physician Executives
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