Dr OH “Bud” Frazier: An American Legend

Recent articles published by ProPublica, a highly respected non profit newsroom

that produces investigative journalism , detailed the failings of the Baylor St. Luke’s
Medical Center heart transplant program that resulted in poor patient outcomes
from the once top-rated program. This rightly focused on the individual patient and
families that the Baylor St Luke’s heart transplant program failed in their advanced
heart failure journeys.

Unfortunately, those heartbreaking stories of betrayal and disappointment by the

patients and families are the result of a very complicated larger story.

In my opinion, the shocking story of the Baylor St Luke’s CHI transplant program is
one of greed, careerism, corporate takeovers, appalling administrative oversight,
failure of leadership, poor hiring practices, completely avoidable lawsuits, and the
inevitable public distortions of their underlying mission, all of which have occurred
as medicine has become perverted into “big business”.

In this era of corporate medicine patient care has been reduced to “patient volume”
and “RVUs” (relative value units) . “Profit” is euphemistically called “margin” and the
relentless focus on “margin” and patient volume , rather than on the individual
patient and the development of patient centered programs has driven much of the
poor decision-making that has resulted in the abysmal failures highlighted by the
article.

Succession planning at St Luke’s has long been a problem; the question of how to
replace surgeons with the stature of Drs Cooley and Frazier has been an open and
lingering question. I personally brought candidates with national and international
reputations to the hospital that would have been excellent choices to succeed these
giants and to lead the Baylor St Luke’s program into a new era. They were not
considered for reasons that remain a mystery. Dr “Bud” Frazier was not asked to
participate as a member of the selection committee.

Moreover, there a dizzying and chaotic revolving door of chief administrators

between 2008-2015; some temporary appointments, some permanent that did not
last longer in the job than a blink of an eye. It was impossible in that environment to
establish consistent leadership and build patient centered programs.

Make no mistake about it, the patients that present to a transplant program have
very complicated health care problems and they are very sick. They are afflicted
with a morbid and mortal disease that generally confers an inevitably downward
spiral leading to a difficult and lingering death. Many of the patients have multiple
diseases including malignancies, genetic diseases, pulmonary disease and renal
failure that add to the complexity of their care. Transplant programs are the very
last chance for these desperately ill patients. Transplant medicine is a team sport
and good outcomes depend on a stable and well functioning team as well as well
trained, competent and dedicated clinicians. The revolving door of clinician and staff
departures and arrivals at the Baylor St Luke’s Medical Center during the years
preceding the poor outcomes was completely unprecedented and made the goal of a
stable and well- functioning team of trained, competent and dedicated clinicians
impossible to achieve. The resulting poor outcomes in the heart transplant program
in such a chaotic environment were inevitable.

Those of us that choose to work with, and dedicate our professional lives to this
group of patients are familiar with death and defeat. To put it into perspective; heart
failure is a disease that currently affects 5.7 million patients in the USA alone and we
make a new diagnosis of heart failure in almost a million patients annually in this
country alone. The mortality of this deadly disease still means that half of the newly
diagnosed patients will die within 5 years. This is a condition that is just as fatal as
advanced lung cancer. Those of us that have chosen this work accompany these
patients on this medically and personally challenging journey, and we do what we
can to cheat death, and to remain optimistic and hopeful even in the face of
substantial loss.

“Bud” Frazier is the son of a schoolteacher and hails from a small town in Texas. He
was a high school football hero and after his medical training he served as a combat
surgeon in Viet Nam. He came back from his time in the military deeply moved and
distressed about the wholesale death and destruction he witnessed as a young
surgeon. He developed a deep love of history and philosophy and was never without
a book stuffed in his pocket. I think this kept him sane.

I did not know Bud during his formative years as a surgeon when he worked with
Dr Cooley, but I met him when he was clearly at the top of his game. I moved to
Houston in the mid 2000’s and was trying to start an advanced heart failure
program at the University of Texas. I did not have a surgeon on faculty that had an
advanced heart failure skill set. He generously gave me his cell phone number and
offered that I could contact him whenever I needed help. And, in fact, I did call him-
many times. I called him when other surgeons had surgical complications that
resulted in intractable cardiogenic shock. I called him when I had young patients
with no options. I called him when a middle-aged ambulance driver ruined his heart
with a late presentation of a huge heart attack. At that time Bud had a bad knee, but
he, without hesitation, limped over- often in the middle of the night, reviewed the
case with me, and never refused to help, or to accept the patient as a transfer to St
Luke’s in an attempt to salvage the patient’s life. Bud has never ever walked away
from the bedside of a patient who needed him. He has never given up hope. He hates
death, and that may be a failing in some circumstances, but he simply does not stop
trying.

Bud is a believer in the battle to triumph over this nasty, insidious disease. He was a
pioneer of continuous flow circulatory therapy and his ground breaking work since
the 1970’s in this area has led to the current therapy (the modern left ventricular
assist devices) that have now been implanted in more that 24,386 (as of May 2018)
patients in the USA alone. In the past no one thought continuous flow could work-
after all, how on earth would a patient survive without a pulse ?, but he persisted to
support this fledgling technology in his dogged fashion despite massive opposition
and even occasional scorn from colleagues. His seminal work and seminal
contribution to this field of medicine has saved tens of thousands of important lives
and has provided hope, where there was little, to countless patients and families.
Others have become very rich indeed as a result of this technology, Bud and his
lovely wife Rachel, have not profited in this way. While other surgeons in the
Medical Center drive Ferraris to work Bud drives a Volkswagen Beetle. His
motivation is borne out of his selfless dedication to combating this terrible disease.

Bud is my kind of clinician and healer, all the way. He is kind, he is committed, he is
scientifically and academically rigorous, he is egalitarian and he has a service heart.
He doesn’t care if a patient is a pauper or a king. It is of no importance whatsoever
to him. Never was. He is, at his core, a humble man that believed in finding solutions.

This man is a legend. He is responsible for saving lives of patients that have
mattered very much irrespective of from whence they came or their station in life.

His career has spanned decades. I am at the age myself where I increasingly view
perfection as the enemy of the good. Is Bud perfect? Probably not- if he were he
might have foreseen the huge changes occurring in medicine around him, and within
the very institution to which he dedicated his career. In all fairness, much of the
mess that was described in the article was simply out of his control, as medicine has
became a corporate endeavor, and our work as clinicians has became increasingly
regulated and micro-managed by professionals that do not seem to grasp very much
about what really goes on in patient care.

Bud Frazier has a legacy that should not be discounted. His legacy has encompassed
the best of what medicine has been. His reach will extend into the future with the
scientific and technological advances that he pioneered, and that should not be lost
in the debacle at Baylor St Luke’s Hospital.

Deborah Meyers MD FRACP FACC