Beacon of Hope: Years of Change and Renewal
Reassessment and Renewal
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Founding Years 1944-1953
Growth Years 1953-1969
Years of Change and Renewal
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For the Clinical Center, the task of renewal fell initially to Dr. Thomas C. Chalmers, a Harvard hospital director and gastroenterologist who was brought on as Masur’s successor in February 1970. Although Chalmers lacked an NIH background or PHS status, his initial efforts to upgrade clinical services were strongly supported by the new NIH director, Dr. Robert Q. Marston, who blocked administration efforts to assess Clinical Center research patients for insurance reimbursement.104 Chalmers modernized clinical practice by establishing guidelines for transplant operations and preparing for computerization of medical records.105 To restore morale among Clinical Associates, he transferred the responsibility of blood drawing to technicians and nurses, reinstituted patient-oriented clinical rounds, and pressed for formal residency training. 106 When the nursing staff shortage reached a crisis point in September 1972, Chalmers launched a drive to recruit 150 new nurses in eight months and to reorient the service in the long term toward acute care.107 These goals were largely met by 1975, but Chalmers’ efforts to centralize clinical research oversight ran up against the increasing interpenetration of NIH administrators into hospital operations. The Medical Board, since 1969 responsible to the NIH Deputy Director for Science, allowed research oversight to devolve to the institutes. Rather than develop its own standards, the Board followed the lead of congressional mandates for the extramural program.108

Dr. Chalmers’ most ambitious modernization initiative was his 1970 proposal for an “ambulatory research center” to be built over the main entrance on the north side of the original building. Extending the main building floors into this area would provide space to relieve overcrowding and new therapy centers for the burgeoning Outpatient Department. But the most radical feature of Chalmers' concept involved expanding employee health care programs and using NIH personnel “for innovative research in preventative medicine” and “for research in diagnostic programs.”109 Congress appropriated planning funds through NCI at the end of 1971, and when these were reprogrammed Chalmers secured $3.5 million the following year for architectural services.110 The administration blocked the funds’ release during 1973 while pressing again for insurance reimbursement from research patients. In January, Marston left the directorship, but his replacement, Dr. Robert S. Stone, a management professor at the Sloan School at MIT who had previously directed the New Mexico School of Medicine, also defended Clinical Center policy of not charging research patients.111 As the Watergate investigation began to paralyze government in the fall of 1973, Dr. Chalmers quietly reduced the patient census and secured appointment as Dean of Mount Sinai School of Medicine in New York City in October.112

Chalmers’ successor, Dr. Robert S. Gordon, Jr., was the first of four successive internal candidates to head the hospital after 1973. Clinical director for NIAMD since 1964 and Medical Board chairman for 1970, Gordon continued the work of reorganizing the hospital administration and upgrading clinical services after his appointment in January 1974. Convinced that a clinical research resurgence would revitalize the operating departments and attract higher quality staff physicians, Gordon teamed up with NIH Deputy Director for Science De Witt Stetten, Jr., to campaign for intramural funding for the clinical service departments through the National Institute for General Medical Science. A special congressional mandate could not be arranged, and several of the departments preferred to specialize in support services while allowing senior physicians to augment their salaries by contract work with the institutes.113 Gordon also tried to give the clinical directors a stronger role in ensuring the quality of patient care and providing research oversight.114 While these traditional gambits of centralized clinician responsibility and categorically defined basic research were now less availing, ever more sophisticated clinical applications emerged at this point as a clear trend. A contract was awarded in March 1975 for design of the addition to the Clinical Center, planned to accommodate 200,000 outpatient visits annually. Another was awarded the following June for the first hospital-wide computer system to process patient data, research information, and routine administration.115

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