A Vision for the Future
From notes of Dr. Debra Fiser at the time of Dr. Robert Fiser’s death—
“Dr. Robert Fiser was raised in Morrilton, Arkansas and attended Arkansas Tech and Hendrix College. He graduated with honors from the University of Arkansas for Medical Sciences (UAMS) College of Medicine in 1966. He trained in Pediatrics at UAMS, William Beaumont General Hospital in El Paso, TX, and the US Army Medical Research Institute of Infectious Diseases. He continued his training with an Endocrinology Fellowship at the University of California Los Angeles, where he joined the faculty as an Associate Professor and Associate Program Director for the UCLA Clinical Studies Center. Fiser returned to UAMS in 1973. In 1975 he was appointed Chair of the Department of Pediatrics, the youngest Pediatric Department Chair in the country at the age of 32.
Fiser was widely known for his vision, boundless enthusiasm, and incredible energy. During his nineteen-year tenure as chair, the Department experienced dramatic growth. The number of full-time faculty members increased from 15 to more than 140. The number of residents increased from just 18 to 75. At the peak of his career, more than 80% of the practicing pediatricians in Arkansas had trained in his program.
Fiser was instrumental in the Department’s relocation to Arkansas Children’s Hospital in the late 1970s, a move that fostered growth in both institutions. During his leadership, the number of hospital beds at ACH increased from 60 to 240, and the Department’s budget grew from $800,000 to more than $20 million. Not only did the inpatient clinical service thrive in its new home, but the Department continued to grow in its activities outside the walls. Under Dr. Fiser’s direction, the Department implemented regional clinics which met in dozens of locations around the state and served over 2,500 children per year. He also founded the Child Health and Family Life Institute, funded with an annual $2.1 million grant from the state. This led to the evolution of the KIDS FIRST Program which at its peak served over 800 medically and developmentally at-risk preschool children per year in 11 sites around the state. At the same time, he established the Co-Mend program (which stands for community, medical, education, nursing and nutrition and development).
In addition to clinical programs, the research programs in the Department received much of his attention. Dr. Fiser worked with UAMS and Arkansas Children’s Hospital leadership to establish the Arkansas Children’s Hospital Research Institute and its new state-of-the-art space for it. He recruited scientific leadership for the program and a cadre of faculty to develop basic, clinical and applied research. Starting from a base with very little active research, the Department’s research funding grew rapidly and exceeded $7.5 million at the time he left the chairmanship.
In 1994, Fiser stepped down as Chair to become UAMS Assistant Vice Chancellor for Regional Programs. He became a Professor Emeritus in 2000. Among many honors, he served as President of the Southern Society for Pediatric Research and was later a recipient of that organization’s Founders Award. He was also named an inaugural member of the UAMS College of Medicine Hall of Fame in 2004.”
Dr. Robert Merrill stepped down as Chairman of the Department of Pediatrics in 1974, and Dr. W. T. (Tommy) Dungan assumed the role of interim chair. Dr. Robert Arrington, a medical graduate of UAMS and the Department of Pediatrics Residency Program, and who served as chief of the Division of Neonatology for 38 years, recalled: “They formed a search committee as they always do and they put Dr. Bob Fiser, a young Associate Professor who had recently joined the faculty, on the search committee and they looked for six months and they had several potential people to be interviewed. Nobody wanted this job because it was not a prime job in Pediatrics at that point – small faculty, trapped in the adult hospital, where only obstetrics was our counterpart.
The following attempts to document the years of Fiser’s leadership, as well as the subsequent years, in the words of many faculty members present during those years.
The Early Years
After about six months Bob Fiser told the committee: “You know, I think I could do just as good a job as anybody we’ve interviewed and I’m interested in it.” In March 1975, Robert Fiser was appointed the fifth full-time Professor and Chair of the Department of Pediatrics at the age of 32, the youngest Department of Pediatric Chair in the country. This appointment set off a chain reaction of growth of the Department of Pediatrics and Arkansas Children’s Hospital that continued for the next 40 years.
Dr. Fiser brought a vision as he assumed his new role, which included bringing “National Recognition” to Arkansas Children’s Hospital and developing a training program that would provide enough pediatricians to provide high-quality medical care for all children of Arkansas. He is remembered as a person of high energy, persuasion and a visionary.
Dr. J.B. Norton, one of Fiser’s first faculty recruits who arrived in 1975, recalled Fiser telling him: “I want to build a children’s hospital and I want to train pediatricians and I want to put a pediatrician in every town in Arkansas. I want you to help me recruit the best faculty I can recruit in various subspecialties. I want to train general pediatricians in a children’s hospital that will provide the highest technical and professional quality of care that we can so that, when these young men and women go out to small towns in Arkansas, they will know when they’ve got a really sick kid they can send it back to Little Rock and they will know that child will get the best possible care,” and that is what we did. “Bob encouraged us to do that in a way that was energetic, aggressive, assertive and fun.”
Dr. Rhonda Dick, a student and pediatric resident under Fiser, described his style as a leader; “He was a very strong leader, but he was also very down to earth. He was the type to be just as able to talk to the medical students as to the other attendings, very involved, very charismatic, very sure of himself, just someone we all looked up to and respected, but we felt comfortable talking to him, laughing with him. ‘Captain Bob-’ that is what we called him. ‘Captain Bob and the Starship Pediatrics,’ is what we said when I was a resident.”
Dr. Richard Jacobs, who was a student and pediatric resident under Dr. Fiser, who later became Chairman of the Department of Pediatrics in 2005, described Fiser’s style and approach to recruiting. “Dr. Fiser was a visionary, dreamer, entrepreneur, and a true leader. Dr. Fiser could sell fur coats in a desert! I mean he was a cheerleader and a salesman. I ran into Dr. Fiser during the first year of my fellowship at the Society for Pediatric Research meeting. I was presenting a platform presentation of my research. He came and sat in the front row and smiled during my entire presentation. Afterward, he came up and asked how things were going. He said, ‘When you finish I want you to go out and get all the job offers you can and then call me because I am going to beat every one of them. You’re coming back to be on the faculty with me.’” And Dr. Jacobs did join the faculty of the Department of Pediatrics in 1983 when he completed his fellowship. Dr. Fiser focused on recruiting the best of the residents who trained at Arkansas Children’s Hospital. Jacobs commented: “Of my residency group and of UAMS medical students who trained in pediatrics elsewhere, the number of people who came back after their specialty training is amazing and adds to the ‘legend’ of Dr. Fiser. These included Drs. Becky Rogers and Bonnie Taylor in Neonatology, Eileen Ellis in Nephrology, Debra Fiser in Critical Care, Ernie Kiel in Cardiology, and Larry Simmons in General Pediatrics among many others.”
Dr. Joycelyn Elders, the first female graduate of UAMS, and longtime faculty member of the Department of Pediatrics of UAMS who was named Surgeon General under President Bill Clinton made this comment about Dr. Fiser. “I think the best thing that ever happened to the Department of Pediatrics back then was Bob Fiser. He was smart, visionary, aggressive and probably took some risks that he shouldn’t have taken. But he did it in the interest of children and for the state of Arkansas to make things better and I am very proud of what he did. Dr. Fiser was a real mover and shaker in changing the culture of the Department of Pediatrics; he recruited a lot of great people to really make better tertiary care.”
Along with the amazing growth of the hospital and the number of faculty and residents, the early years were recalled as a time of mutual support. Dr. Debra Fiser, who received her medical degree from UAMS and later became Chair of the Department of Pediatrics in 1995 and Dean of the School of Medicine in 2006, recalls: “I think the thing that is very special about our Department is that we have historically had a culture that has really been almost a family type culture- one where people take care of each other, nurture each other.”
Fiser established that culture by focusing on the well-being and success of every one of his faculty. But it wasn’t all work and no play, Jacobs commented, “(i)t was really a fun time because the people that were really important loved this place and they loved the people and the kids in the state. … I think what was really cool and special about this place is that there was a group of people, (kind of a core), that had the same values and the same goals. They just liked each other, and they really got along.”
One of the best examples of how the faculty had fun in those years was the annual “Mardi Gras” party. Dr. Russell Steele was recruited to the Department of Pediatrics in 1978 as an Infectious Disease specialist. He and his wife Jenny were natives of New Orleans, and they had an annual party to celebrate Mardi Gras. Everyone on the faculty took this seriously and dressed appropriately. The food was authentic, prizes were offered for the best costumes, and there was even a parade around the house. (See pictures.) Dr. Rhonda Dick, who served as chief of the Division of Emergency Medicine for more than 20 years, recalled, “In the old days it was sort of a smaller kind of, I call it a ‘Good old boys network’ even though I am not a boy. We would have parties like at the end of the year for the graduating residents all day long out at Maumelle Country Club pool. We would spend the whole day out there swimming, playing golf—residents and attendings. We had parties like that with skits that made fun of each other. You know, we just had a lot of fun back then.”
Facility Growth
Tom East was hired by Dr. Bob Fiser to be his head administrator in May 1975, shortly after Dr. Fiser was named chair. East recalled the evolution of the Department in the early years.
“Bob had his vision for developing the department and in the beginning, everybody else pretty much had to fall in line because he was such a dynamic person, he could sell anything to anybody- legislators, chancellors, presidents, whatever, Board of Trustees — and he did that. He defined the word passion. He was not going to let ‘no’ stop him. He would always find a way, a different direction perhaps. But to get his vision accomplished, he would find a way to get it done. He had the ability to really pull people in and build a team of people. And he could talk to anyone. He pretty much was friends with everybody he talked to. He loved people. At that time, the department was about 15 faculty members and it was located on the main campus on the 6th floor of the University Hospital building. We were located behind the elevators at that time in a very small office suite.
Fiser was recruiting top-notch physicians from all over the United States and I guess one of our big initial headaches was how to expand space-wise because there was no way at the UAMS campus at that time in 1975 – there was not much room. So Bob took a huge interest in Arkansas Children’s Hospital, and along with Leland McGuiness, Chief Executive Officer at Children’s Hospital, they partnered together on how to share a facility, space, people, clinics, emergency services, that kind of thing. In those days, Bob and I would go over to Children’s to sit down with Leland McGuiness and work out how to pay for things, how to grow things, and how quickly to do it. At that time the Board of Children’s Hospital was a very significant group of people. It was obvious that it was going to take a lot of fundraising and a lot of effort to make a dream that Bob Fiser had to grow.
The first decision to be made was whether to stay at UAMS and expand that program or secondly partner really with Children’s Hospital in a much greater way than had ever been done in the past to enlarge the facilities. At that time Bob was adamant. He had made his mind up that he wanted to move the entire Department of Pediatrics from the main campus to Children’s Hospital which was a pretty radical thought at the time. Dean Tom Bruce preferred that the Department stay at UAMS and he suggested that he would go to the Board of Trustees at the University and try to sell the idea of building a children’s wing on the UAMS campus. The debate went back and forth, and a lot of people were involved in that debate including members of the Board of Children’s Hospital.
But ultimately the decision was made at that time to move and everybody pretty much was committed to that concept. That is what happened, and it is a huge story; it’s a dynamic story about all that took place because there was no money; there were really no facilities at either place at the time. So together a partnership between the two organizations began at that time in the late 1970s. Children’s jumped in and their Board got excited about it – the deal at that time was that they would provide the facilities, the nursing staff and the fundraising for growth. And Bob supported the deal; he would provide the medical professionals to complement that.
Bob did an outstanding job of bringing in a large group of fine young physicians. It was known that he could sell snow to a snowman. People knew that Bob had every priority. Everything was a priority for Bob. It was hard for people, me included, and other more administrative business folks to keep up with that. Because he was often off in every direction; he knew what he was doing but it was hard for a lot of people to keep up with that growth pattern that he established and that we tried to carry out. I think one of the main events that stands out for me would be the weeks and months that we moved formally and officially to Children’s Hospital. We started back in the late 1970s, working with Children’s to free up more space and they would gradually buy houses close to the hospital for physician offices. We gradually moved physicians over, Bob and I and the administrative team stayed at UAMS until the last at which point we pretty much said today we are moving from UAMS to Children’s Hospital officially. That was probably a proud moment and I think a very happy moment that Bob and I both had of finally seeing it come together that one goal had been met.”
Dr. Arrington recalled, “Bob Fiser moved over there in 1977 and then he began to move the rest of us over there and I moved over there; I was in the “blue house.” One of the Pulmonologists named Bob Warren was in the “blue house” and one of the General Pediatricians named Bob Glenn was in the “blue house.” So Bob Fiser, Bob Glenn, Bob Warren, and Bob Arrington were in the “blue house” so it was called the “Bobsy House.” There were other houses- one where the surgeons were, one for the orthopedic surgeons. They started bringing in portable buildings and making offices in the portable buildings.”
Program Development
Neonatal Intensive Care Unit (NICU) Transport
Dr. Robert Arrington described the start of neonatal transport and the first NICU at ACH. “The federal government back in ’74 or ’75 solicited proposals from states for federal funding to improve the outcomes of pregnancy, IPO grants. With the help of Senators McClellan and Fulbright, Arkansas got one of the thirteen IPO grants. It was a fair amount of money, $4 million over five years or something like that. Well, the problem was we did not have the facilities. Anywhere! The money came to the Arkansas Health Department and in the first year, we got $65,000 of that earmarked to buy a newborn transport van. Children’s didn’t have one. In fact, Children’s didn’t have a nursery. So then I had to look for someone to accept the ambulance. This was like ’76 or ’77. I went over there and visited with Leland McGinnis, the administrator at Children’s. I explained the situation, and we had to do something about newborn care here in the state and that I had the money to get this ambulance but I couldn’t find someone to run it. So I talked to him 20 minutes or so. At the end of the time he leaned across his desk and he said emphatically, “We will do it!”
So Children’s Hospital became the recipient of this van that we had bought with money through the Health Department. Then we began doing transports when we didn’t have a nursery at Children’s. We had gotten to a point at UAMS where we had to close the nursery because we didn’t have enough nurses. So David Pryor was the Governor and he formed a Blue Ribbon Committee to address the obstetric and newborn issues here in Arkansas. They developed a written proposal around a concept called “Regionalization” where you have levels of care from Level I, Level II and Level III which would include a Neonatologist and high-risk Obstetricians. The report was given to Governor Bill Clinton as David Pryor had become Senator. The Clinton administration got legislation passed in their first session and appropriated money to build a nursery at Children’s. It went into, what was called at that time, a “boy’s ward” and a “girl’s ward” on the first floor. They took one of those wards and built a twelve-bed nursery that opened in March 1980.
So finally our van had a place to bring babies back to. We began filling that nursery up very quickly and started doing more and more transports.” Steven Hanley documented in his History of Arkansas Children’s Hospital that the neonatal transport logged more than 9,000 miles in its first six months, transporting 55 newborns from hospitals across the state. Dr. Arrington went on to note, “Well first of all we ran out of room in the first 12-bed nursery. We had to expand it in(to) the girl’s ward and we went to a 30-bed nursery. Again we filled that up as we got more patients coming in with the transport system. So then we had to go upstairs and we added 17 beds; we had a 47-bed unit then. So we went from no nursery to a 12-bed nursery, to a 30-bed nursery, to a 47-bed nursery, to a 52-bed nursery, to a 75-bed nursery, to a 100-bed nursery and all of that was driven by the capability of doing transports quickly.
We have gone from the original two neonatologists; we now have 23 neonatologists. We have nine pediatricians in our section who take care of the less sick babies so we have a pretty big operation now.”
Cardiology
Dr. J.B. Norton, the first major recruit by Dr. Robert Fiser, served as Chief of Cardiology from 1975 to 1996. Dr. Norton recalled his early days at ACH. “There were a lot of major challenges. When I first arrived there was no facility at the little Children’s Hospital for subspecialists of any kind so I was based at the university hospital, which had a very meager pediatric facility. We didn’t have a real pediatric heart surgeon to work with. I needed to find a pediatric heart surgeon. I needed a facility to really care for the children with complex heart disease and I needed a cardiac catheterization lab. I explained what we needed at a board meeting at the Children’s Hospital. They were very supportive and said ‘Well gosh we can’t possibly put that kind of money’ – we needed about $400,000. At that time I became acquainted with a very wealthy man here in town through some committee work at our church. I knew Frank Lyon had the resources to help and I knew he had been very interested in philanthropy. I went to Frank Lyon one day at his office and I told him what I needed. He said, “Well Dr. Norton I am not going to give you $450,000, but I’ll give you $50,000 and I’ll help you raise the rest.” A week or so later his office called and said “Meet him at the airport, the private side of the airport, in the morning at seven.” I went to the airport and there was a private airplane of Worthen’s Bank President, George Worthen, who was on the board at Children’s and he and Frank knew each other. They brought along the Development Director from the Children’s Hospital and we flew to Tulsa. We went up to the Mabee Foundation in Tulsa and Frank Lyon told the guy there, he said “I want you to come across with some money for this gentleman. We are trying to build a Children’s Hospital and a first-class Children’s Hospital in Little Rock and we need you to help get it started.” We came away with $400,000.
With some of those early facilities that were really first-class, we were able to recruit Dr. Steve Vandeventer, a pediatric heart surgeon from Harvard, who brought a whole team with him. And then things just began to move very quickly and we were able to begin to do what Bob Fiser had originally asked us to do; to start training young people in general pediatrics, but letting them watch senior faculty take care of patients in the most sophisticated way. Working with the heart surgeon we became known, at least in my particular field, and I know other fields as well around the country as “Gee, Arkansas Children’s Hospital is doing first-class work.” We began to get referrals from other states and other places. Patients who had been to Houston, for example, found out that they could get good care right here. We had terrific support from the Children’s Hospital board in terms of increasing our physical plant and Bob Fiser made that happen.”
Dr. Richard Readinger was the first Cardiologist hired by Dr. Norton who joined Drs. Tom Dungan and Florence Char. By the time of his retirement in 1996, Dr. Norton had added eight new pediatric cardiologists, including Drs. Sylvia Angtuaco, Renee Bornemeier, Chris Erickson, Elizabeth Frazier, Ernest Keil, Michele Moss, Richard Readinger, and Paul Seib.
Radiology
Dr. Joanna Siebert, who served as Chief of Radiology at Arkansas Children’s Hospital beginning in 1976 recalled the early days of Radiology. “For us, it was exciting to start a department of Pediatric Radiology at Children’s. When I got there they had one x-ray room where you would do regular x-rays, just film, lamps, things like that. Then they had a fluoroscopy room where you did fluoroscopy looking into a mirror. I had done that maybe once or twice in my residency; it was kind of an ancient art. And we also just read films. There was no reading room where you could really do rounds very well but the hospital was very supportive. Very soon they were able to get another x-ray unit that was modern and the Cardiologists, Drs. Norton and Dungan needed a kind of special room. And so together we did it jointly where Pediatrics and Cardiology used that room. We had these big multi-film viewers where we would put the films, instead of into stacks, where we would read films and also clinicians would come in and look at their films on these big multi-film viewers. Each of our teams would have a special place on there so all of the films would be right there. It made rounds a lot easier. Radiology was being adapted to the needs of the clinicians instead of Radiology being adapted to the needs of the Radiologists.” Dr. Arrington recalls “The growth of Radiology played a giant role in what we were able to do in Neonatology. I remember the first time Dr. Siebert ever rounded with us in the nursery back before the digitization of x-rays. We had all these x-rays just all over the place and she couldn’t stand it. We would have to dig through them to find the comparative x-rays. So the first thing she did is get this thing called a “panorama scope” which is kind of like a scroll, a motorized scroll, and it had plastic that would go from one spool to the other so that you could put x-rays in it. So we went from having these piles of x-rays to having the x-rays in sequence, day-to-day, patient-to-patient. We could sift through their x-rays and compare them to previous days. This was her first innovation for us that made life so much easier in the nursery. And she built a tremendous radiology group. We started having daily rounds and we would go downstairs physically every day and look at every x-ray with a Radiologists.”
Other Programs
Several other important clinical programs at ACH had their start in the later 1970s. Dr. Daisilee Berry began treating patients in the Hematology/Oncology Clinic in 1976. Dr. Betty Lowe started the Rheumatology Clinic to assist in the treatment of children with rheumatoid arthritis and other connective tissue diseases. Dr. Watson Arnold, who served as Chief of Nephrology from 1978 to 1990, performed the first renal dialysis treatment in 1978, and the Children’s Renal Dialysis Center opened in 1979. The Arkansas Children’s Developmental Center opened in 1979 under the leadership of Dr. Pat Casey. The center’s multidisciplinary team provided diagnosis, evaluation, and recommendations for follow-up treatment for children with a broad array of developmental disabilities.
Residents
There were 18 residents in the 1975-1976 academic year. These included: Barry Allen, Zuhair Bakdoud, John Campbell, William Clardy, William Collie, James Crestwell, Jorge Figueroa, Eric Fraser, Richard “Whit” Hall, Morris Kletzel, Paulette Johnson, Paul Drew Meredith, Jarlath Mitchell, Richard Nestrud, Rosalina Pagtakhan, Sam Shultz, Paul Smith, and Vern Ann Williams.
The number of pediatric residents had grown to 37 residents in the 1979-1980 academic year.