Till Death Do Us Part
For half a century, in sickness and in health, the marriage of Baylor Medical School and Methodist Hospital produced first-class medicine for Houston and the world. But money, egos, and backstabbing came between them, and now both institutions—and all of us—are the poorer for it.
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But the other reason for the breakup has little to do with medicine and a lot do with the culture of both institutions and the personalities involved. “In Texas, it’s all about money and control,” said Kinn Moursund, whose grandfather helped found the medical center. Other people in Houston—frustrated doctors, angry board members, worried civic leaders, just to name a few—use different terms to describe the feud that could cost their city so dearly. “Shoot-out at the River Oaks Country Club,” for instance, and “a game of chicken that spun out of control.” Or “a pissing match.” Or, as one longtime local doctor tutored: “Men only care about two things: the length of their penis and how much money they make.” The one thing that almost everyone involved can agree on is that this is a story fueled by Texas-size quantities of testosterone.
IN THE BEGINNING, before there was a Texas Medical Center, “Methodist was a crappy little hospital, and Baylor was a crappy little medical school,” in the words of one local surgeon. Without millions from the local oil families, neither institution would have survived. But their fortunes would change with the arrival of Michael DeBakey in Houston in 1948.
Like a lot of doctors, DeBakey at first snubbed the recruiters from Baylor. He was already a bona fide star, an innovator who had revolutionized battlefield surgery and now was at New Orleans’ Ochsner Clinic and Tulane medical school. He was forty, fearless, and driven and expected everyone else to be that way too. DeBakey initially turned Baylor down because the school had no teaching hospital, residents, training program, or patients, relenting only when Hermann, Houston’s carriage-trade hospital, gave him a place to do his clinical teaching. But when he arrived, he found that Hermann doctors wouldn’t let him operate on their patients. DeBakey was so poor that his father had to buy his first (and only) Houston home, but he wasn’t going to put up with inanity. He found Methodist, then a small, unair-conditioned hospital on the edge of downtown, and began performing surgery there. To easygoing Texans, DeBakey’s work ethic was a shock: twelve hours on call at a minimum, setting the tone for Baylor medicine for years—hands-on, swift, and arrogant. “I’m intolerant of mediocrity,” he said at the time. “I don’t want to be around it.” The Methodist hospital supervisor, watching DeBakey at work, told her staff, “Give him anything he wants.”
Baylor—which had moved from Dallas to Houston in 1943—was housed in a former Sears store with only electric fans for cooling. Yet DeBakey had a confounding certainty about himself and the future. He knew that he could crack open a human chest and repair damaged coronary arteries with stitches as sturdy and as elegant as a French couturier’s. He knew too that on a particular patch of woodland he’d staked out in the late forties—you could bag a deer on this land at the time—he would build a new Methodist hospital that would draw the world to his door. And it did: The Duke of Windsor bragged, when he headed to Houston for surgery in 1964, “I’m going to see the maestro!” But it wasn’t only the rich who got his attention. The county charity hospital sits on the medical center’s northernmost end because of DeBakey—the city fathers didn’t want it to be included—and he was instrumental in scheduling patients of color for operations when Methodist, in its early days, was turning them away.
Meanwhile, he was bringing innovation after innovation in cardiovascular surgery to Baylor. He found a way to graft coronary arteries with small Dacron shields, for instance, patching—and healing—aortic aneurysms, then a major killer. But DeBakey was also a shrewd marketer: He traveled the world lecturing on his work, ginning up more patients, and he made the right contacts in Washington, bringing crucial federal grants to Baylor. By the mid-sixties, he was probably the richest surgeon in the world, but he was also a man who understood his mission in life. DeBakey never turned away a patient who couldn’t pay, and he established a rule for Baylor surgeons: They had to give 50 percent of their fees back to the school. Since DeBakey performed surgery at Methodist, the hospital also benefited enormously from his patients’ fees and occasional contributions.
Not every Baylor doctor was enthralled with DeBakey’s plan. One who chafed under his autocracy was Denton Cooley, a protégé and a colleague. The two gifted surgeons were very different men: Cooley was a hometown boy, with more pedigree, more charm, and more-striking good looks. He was also fast—faster than DeBakey—and could perform more surgeries than anyone had ever thought possible. In 1962 he moved his research to St. Luke’s—a lesser hospital in Methodist’s eyes—and established the Texas Heart Institute, though he remained on the Baylor faculty. At first, the rivalry was friendly: “Cooley had all the heart surgery in the world, and DeBakey had all the vascular surgery,” according to one surgeon. Doctors then estimated Cooley’s annual income at around $5 million a year, half of which, under DeBakey’s dictates, went to Baylor.
But in 1969 Cooley implanted an artificial heart in one of his patients, a 47-year-old dying man. DeBakey accused Cooley and an associate of using a heart he had been developing with federal grants in Baylor labs. Cooley claimed he had been working on his own artificial heart. DeBakey fired everyone who had been loyal to Cooley; Cooley was censured and left Baylor for good. This left the school short one star surgeon and, more to the point, perilously short of cash. Happily for Baylor, state leaders were worried about a projected doctor shortage. DeBakey promised to train more physicians in exchange for $2.5 million to cover their education. It was also during this time that DeBakey freed the school from Baylor University, which, as a religious institution, was reluctant to take federal grants.
Thereafter, the relationship between Baylor and Methodist flowered, but not without some difficulty. Baylor had other teaching relationships: with Ben Taub, the county charity hospital; the Veterans Affairs hospital; Texas Children’s Hospital; and TIRR, the Institute for Rehabilitation and Research. Possessive of Baylor doctors and residents, Methodist asked the medical school to make it first among equals, but Baylor refused. As a compromise, in 1970 the two institutions created a joint governance committee with private practitioners and faculty doctors and required that chiefs of service at Methodist also be the chairmen of the corresponding departments at Baylor. No one told Methodist’s private docs, who weren’t part of the Baylor faculty but brought their own patients to Methodist, about the change. When they found out, many complained bitterly that Baylor was muscling them out of the hospital. They resented taking orders from doctors who, in their view, spent more time on their narcissistic research than on patient care (and on generating income for the hospital). Baylor, in turn, saw the private doctors as shortsighted and, well, greedy. The great medical advances by DeBakey and Cooley could not have been accomplished in private practice, they argued; they would have been too busy with patients to do research. Advancing the cause of medicine was Baylor’s mission, and in the school’s eyes, Methodist just didn’t get it.
Still, the forces keeping Baylor and Methodist together were stronger than the forces threatening to drive them apart. In particular, each had something the other wanted. Methodist had money: an almost unheard of $2.6 billion in the bank by 2002, which could fund the programs and research to keep Baylor on top (but rarely did to Baylor’s satisfaction). Baylor had prestige, allowing Methodist to boast that some of the best doctors in the world practiced there. They were enmeshed, sharing patients, office buildings, board members, and doctors. DeBakey had what was essentially his own wing in the hospital’s Fondren-Brown Building, and other buildings suitable for use by Baylor doctors, patients, and projects seemed to be going up daily.
In 1973 Baylor signed a new thirty-year affiliation agreement with Methodist, and the future of one of the great medical school—hospital partnerships in the country appeared to be assured.
Four years ago Corbin Robertson Jr. was a man with the weight of history on his shoulders. He was a silver-haired, strong-jawed, strapping man—he had been an all-American linebacker at the University of Texas in 1967—but if he had been an introspective person, which he wasn’t, it might have occurred to him that this particular weight was getting pretty heavy. In 2001 he became Baylor’s board chairman, and he was also the president of family-owned Quintana Minerals. He was, in fact, the grandson of Hugh Roy Cullen, arguably Houston’s most famous oilman, whose name was engraved on numerous local buildings, including Baylor’s. Robertson could stride through the medical center and catch sight of his family’s contributions everywhere. In his mid-twenties—he is 57 now—he headed the fund-raising to equip a neurosensory center to be shared by Baylor and Methodist. He persuaded his friends to contribute $7 million to equip the Smith and Scurlock office towers, which were owned by Methodist, with Baylor as the lead tenant.
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