The day the residents resigned still resonates at UMMC

Nearly 40 years ago, a group christened “the Recalcitrant Residents” shaped the course of an entire medical center department with one audacious and unprecedented act. They submitted a letter of resignation to Norman C. Nelson, MD, vice chancellor for health affairs at the University of Mississippi Medical Center (UMMC). In part, the letter read:

“… for reasons that we are prepared to detail and document, we are convinced that the quality of orthopedic education which we seek to attain is not available to us under existing conditions … and we are further convinced that the potential to develop an adequate program is not possible so long as Dr. P.S.D. (called ‘the Chief’ in this article) remains as director of the program. His lack of guidance, direction, and concern for his educational responsibilities have frustrated and hampered our efforts to realize our full professional potential and have caused us to question the integrity of the teaching process.

“We, therefore, herewith resign as residents in orthopedic surgery effective this date (July 7, 1976)….”

All 11 orthopaedic residents at UMMC signed the letter. A recent on-campus reunion brought together all but one, among them Country Tom, the Kid, Zeus, the Hulk, Little Willie Dynomite, and Turkey.

As suggested by their colorful nicknames for each other, they were a tight-knit fraternity; they had to be in order to survive a conflict whose upshot resonates to this day in the UMMC department of orthopaedic surgery and rehabilitation—and in the arcs of their own lives.

In the end, a future governor became involved, all 11 residents left UMMC, their chief departed some months later, and the state college board named a distinguished successor to lead the withered program: James L. Hughes Jr, MD, now UMMC professor emeritus of orthopaedic surgery, who also addressed the reunion gathering.

Recalling the uprising
John P. Barrett Jr, MD, was a third-year resident under the Chief and the leader of the Recalcitrant Residents, a name pinned on them by a reporter. His brother Gene R. Barrett, MD, now a UMMC professor of orthopaedic surgery, was also one of the group.

In his written account of the uprising, Dr. Barrett described his life as a resident during the Chief’s regime: “(Y)ou were stuck in the muck. It was just sticky mud, it just got you dirty and you could not get out of it. It was horrible. I hated it.”

Eventually, UMMC investigated the Chief “to determine whether he underreported income he received from treating private patients,” as reported by The New Physician in 1976. The Mississippi Medicaid Commission probed allegations of fraud linked to his surgery fees as well.

But the residents’ complaints were as much, or more, about the Chief’s abilities as a teacher and leader. A sampling of their 14 charges follows:

• He harassed and humiliated his trainees in the presence of others, including patients.
• He was unavailable for night and weekend emergencies.
• He discouraged residents’ research interests.
• He frequently delivered threats of dismissal “over the most trivial incidents.”

“He never had our orthopaedic interests at heart, ever, for any reason,” wrote Dr. Barrett.

The Chief had his supporters, though. The papers of the late, legendary James Hardy, MD, chair of surgery at the time, feature testimonials from the Chief’s former students and patients, as well as from the chief of the division of neurosurgery, and the chair of the department of radiology.

During the set-to, the official position of the Medical Center’s administrators was that they “knew nothing about any problem in the orthopaedic department and that the residents did not take their complaints ‘through channels,’” The New Physician reported.

This contradicts Dr. Hardy’s words, as recorded in his autobiography, The Academic Surgeon. He wrote: “The residents’ move abruptly brought to a head a situation which I had long realized was an unhappy one, although I had not known the depth of the problem.

“It was a singular experience,” he continued, “it seemed to me, that the orthopaedic residents had engaged an attorney (Mr. Winter) without first presenting their complaints to the University Administration.”

William Winter was a former lieutenant governor of Mississippi. The fact that the residents thought they needed a lawyer reflected their state of mind.

“Here’s 11 guys bucking the system, and we had nobody to support us,” recalled Byron Thomas Jeffcoat, MD. “We were against the establishment. It was a tough thing to make those decisions. But we did it.”

The revolt was provoked after the Chief apparently broke a promise to let Hugh Brown, MD, take over the pediatric orthopaedic service. It was a position that Dr. Brown, a pediatric and spine specialist, had been seeking for months.

When Dr. Brown told Dr. Barrett he was resigning, Dr. Barrett made the decision to quit. Soon, every resident was on board.

The following Sunday, The Clarion-Ledger/Jackson Daily News ran an article headlined: “Med Center Residents Resign, List Charges.” In it, the Chief’s attorney was quoted: “… (I)n my opinion the acts of these gentlemen constitute a malicious and slanderous activity against a physician of wide professional recognition.”

The impact today
Even today, at least one question remains: Did anyone really win?

The administration stood by the Chief, at first. Originally, the residents wanted only to be given credit for all their work and be allowed to leave. Eventually, though, they followed their attorney’s advice to “shoot a little higher” and pushed for the Chief’s dismissal.

At one point, the administration agreed to take 8 of the 11 residents back. The group declined this deal as well and resigned as one. The Chief voluntarily gave up his position and went on leave for 3 weeks. The Medical Center allowed him to take a sabbatical from Sept. 1, 1976, until March 1, 1977, before putting him on unpaid leave. When his contract expired, he left for good. It’s not clear how—or whether—the events of this time figured in his departure.

In July 1976, the residents’ cause gained credibility when the Mississippi Orthopedic Society adopted a resolution stating that they had “acted in good faith” and that “their only motive was to improve their orthopaedic training program.”

Finally, they did receive credit for their work and all entered well-established orthopaedic residency programs within the year. Many would practice in Mississippi.

One of the 11, Douglas W. Rouse Jr, MD, later said: “I think the problem was solved. It just took a few more years than we thought it would.”

That seems to be the consensus—that the program, which, by 1987, had grown from a division to a department under Dr. Hughes’ leadership, got a shot in the arm from the residents’ rebellion.

At the reunion, George V. Russell Jr, MD, current chair of the department, said, “Your sacrifice enabled a great program. Jim (Dr. Hughes) created a heck of a program and handed the baton to Bob (Robert A. McGuire Jr, MD), who was the consiglieri, the fixer.”

Summing up, Dr. Barrett added: “I have great respect for the dean, especially for what he did afterward. The orthopaedic department became what we always hoped it would be—one of the strongest departments around.”

Still, for a long time afterward, at least one of the 11 rebels pondered the wisdom of the insurrection. Sometime in the mid-1990s, William Marshall, MD, brought his doubts to the late Wallace Conerly, MD, who was vice chancellor at the time. “Did we make the right decision?” he asked. As he recalls, “Dr. Conerly said, ‘Yes, you did.’”

Adapted with permission. The original article was written by Gary Pettus, UMMC writer/editor, and appeared in News Stories on the UMMC website on April 13, 2015.