UNIVERSITY OF WISCONSIN-MADISON ARCHIVES
ORAL HISTORY PROGRAM

Interview #1064
FARRELL, PHILIP M.

FARRELL, PHILIP M. (1943-)
Professor of Pediatrics and Population Health Sciences (1977-); Chair of Pediatrics (1985-1995) Dean of UW School of Medicine and Public Health (1995-2006)
At UW: 1984-

Interviewed: 	2009 (3 sessions)
Interviewer: 	Anne Peckham
Index by: 	Stephen A. Pierce
Length: 	3 hours, 58 minutes

Abstract: In his three October 2009 interviews with Anne Peckham, Phil Farrell reflects on his development as a pediatrician, his research, and his roles as an administrator at the University of Wisconsin-Madison School of Medicine and Public Health. He recounts his early interest in medical research which led to career-long NIH funding and foundational work in the creation of neo-natal intensive care units around the country, and discusses early influences that encouraged his development as a researcher and clinician. He then summarized major moments of leadership and administration in his career at UW, including moving the NICU from St. Mary’s, his cystic fibrosis research, chairmanship of the pediatrics department, deanship of the Medical School, curricular development, creation of the UW Medical Foundation, administrative changes in the medical school, campus planning and development, and the Blue Cross/Blue Shield settlement. Throughout, he offers his perspectives on major campus and state political figures and how the Medical School has related to them through its history.  This interview was conducted for inclusion into the UW-Madison Oral History Program.

Key Words: St. Louis MO; St. Louis University; pediatrics; University of Wisconsin-Madison; St. Mary’s Hospital; Sterling Hall bombing; National Institutes of Health (NIH); Paul di Sant’Agnese; neo-natal intensive care units (NICU); Gordon Durzon; Richard Zachman; Ronald McDonald House; David Ward; dean Martin; clinical practice plan; Governor Tommy Thompson; Health Star initiative; Blue Cross/Blue Shield of Wisconsin; Governor Jim Doyle; Patricia Mulcahy; American Family Insurance; American Family Children’s Hospital; Donna Sollenberger.

First Interview Session (October 26, 2009): Digital File

Time	Keywords
00:00:00	Start of Interview/Interviewer’s Introduction

00:00:18	[no question] Farrell began by explaining that, having finished as dean of UW’s School of Medicine and Public Health (hereafter Med School), he felt it was a good time to tell his story. Born in St. Louis to a general practitioner and RN there, he described himself as a “late bloomer” who developed an interest in health care while working at St. Louis’ insane asylum after a mediocre elementary education.

00:04:04	[no question] Recalling speaking to a pharmacist about his job, he said the pharmacist encouraged him to study medicine, which he did at St. Louis University.

00:04:58	[no question] Immediately attracted to research when he entered med school, he discussed getting involved in a biochemistry and nutritional research project on chickens with nervous system disorders. Unusual for his age and experience, he co-authored a publication and did a major medical presentation.

00:06:46	[no question] Farrell started med school in 1964, immediately looking to get an MD/PhD degree. While he wanted to get involved in an NIH grant with the new dean of the med school at St. Louis, the threat of being drafted into the Vietnam War prevented him from doing so—rather he continued with his clinical studies and had to work on completing his BA (in order to get the PhD). This worked out to keep Selective Service off his back, allow him to continue his research later, and receive two degrees the same year.

00:13:17	[no question] Continuing to talk about his med school years, he said that in 1969, he did a pediatrics clerkship that got him excited about pediatric medicine as well as by research. This led his advisor to suggest he apply to the University of Wisconsin-Madison for a residency.

00:15:58	[no question] While his training in St. Louis was heavy in research, he said it also instensely emphasized clinical medicine, spending much time in St. Louis city hospital, which he described as a “baptism by fire” that made internship and residency seem like a piece of cake comparatively.

00:18:04	[no question] Continuing to talk about his med schooling, he talked about receiving some fellowships. These fellowships from NIH, which he said continued for 50 year throughout his career, helped reaffirm his interest in and identity as a researcher and solidify his belief their researchers should secure their own extramural funding.

00:21:26	[no question] Beside fellowships, affirmation on the part of other faculty-level researchers confirmed his interest in research.

00:22:02	[no question] He explained his other interest in UW, which occurred when he was involved in the nursery at St. Louis city hospital and wondered why infants could die because they couldn’t be ventilated when adults wouldn’t.  He became interested in Madison’s cutting-edge NICU research.

00:24:28	[no question] He continued by reviewing his early residency years at UW (beginning in 1970), where he did the majority of his training at St. Mary’s Hartford Research Lab and at Madison General Hospital. He found being a resident fairly easily due to his intense clinical training, so he used his elective time to continue research.

00:27:33	[no question] While covering the NICU at St. Mary’s, he related, he attended an autopsy during which he met Dr. Dick Zachman, who studied an enzyme very similar to the one he’d researched for his PhD. Zachman was able to put Farrell on his NIH grant in 1971 and the two published an important piece of research.

00:31:14	[no question] During this time, he said, his wife delivered their third child premature- ly at St. Mary’s with the disease he was studying at the hospital. This only strengthen- ed his resolve to understand the disease (respiratory distress syndrome) and its cure.

00:33:23	[no question] In July 1970, after interviewing for a fellowship at NIH, he got a call from Paul di Sant’Agnese offering for Farrell to work in his lab in 1972. This also allowed him to be deferred from the Vietnam War (he took a post as a public health officer that he continues to serve in today).

00:35:44	[no question] Another experience he described as his most memorable professionally was being on call when Sterling Hall exploded, but since he was in the basement of the hospital, he slept through it.

00:38:15	[no question] He recounted moving to the NIH lab of Paul Sant’Agnese (pediatric metabolism), which was a combination of excellent clinical training and research experience.  He described the efficiency of the program, his co-investigators, and the work he did there which led to some important findings and significant publication (on Vitamin E in cystic fibrosis and pulmonary surfactants).

00:42:06	[no question] During his second year at NIH, he was offered by Sant’Agnese to stay for a 3rd year, which he described as very valuable, travelling to make presentations of his research. But while this experience was good, he was also offered a position as chief of the Section of Biology and Clinical Nutrition at the National Institute of Child Health and Human Development, a position equivalent to Sant’Agnese at NIH.

00:46:05	[no question] Against the advice of everyone, he said, he turned down several other university positions offered him at this time to take a professorship at UW in 1966. He did this because there was an opportunity at UW to develop a neo-natal pulmonology program and Madison was attractive to his family.

00:48:12	[no question] After accepting the position at UW, he said, conflict arose over the NICU at St. Mary’s. He delayed joining the faculty at UW until this was settled.

00:48:55	[no question] He discussed delaying his move to UW in order to apply for research grants—he had a technician hired to develop his research lab here before he left NIH. He also talked about how fortunate it was for him that the construction of the new clinical sciences center was delayed during his first year so that he could concentrate on his clinical work and not get overwhelmed with both that and labwork. He talked about being one of the first clinicians to move his patients to the new hospital. Contrary to popular opinion, the move went very smoothly and the children were thrilled to be in the new facility. 

00:55:09	[no question] He related other benefits of the new facility, which placed his research lab only about 100 feet from the hospital ward and outpatient clinics, a similar situation to his labs at NIH. [end tape 1/begin tape 2]. He marked this as a transfor-mation from a chronic care unit to a general hospital model, a shift that made UW Hospital one of the best medical centers in the country.

00:59:06	[no question] He noted that it was never a hardship for him to be the attending physician at Madison General’s neo-natal unit for a month at a time since his lab was so close to the ward.

01:02:05	[no question] He discussed the reason why the NICU had been moved from St. Mary’s to Madison General by the university, and suspected that while the vision was right the way it was carried out was a mistake. But the move was significant for him because he was asked by dean Donald Brown to staff a committee that would try to resolve the challenge of the conflict with St. Mary’s. He talked about the financial reasons why the NICU never got resolved into a joint venture—it basically came down to money since NICU was a moneymaker for the hospitals. But he said he learned a lot about administration from these “white-knuckle” meetings.

01:08:37	[no question] Continuing to talk about the value of this committee service, he noted that after a few years he was appointed chair of pediatrics (1985) when the current chair resigned suddenly (and his research was thriving). With dean Brown worried about filling the position, he allowed Farrell to spend his first few months of chairmanship in Paris at a sabbatical at the College de France. This came at an unfortunate time since his research program was at its peak.

01:13:25	Question: Collaboration with other schools? Answer: He said much of their basic research was being done at the Primate Lab, and this research involved many depts. 

01:15:35	[no question] He talked about changes he made in the pediatrics department to resolve financial issues surrounding its clinical services. This allowed clinicians to get better salaries and the department to expand with new faculty.

01:17:51	[no question] He said these were great years for UW pediatrics, one of the things being able to reach out to the community and establish a Ronald McDonald House. This increased his visibility in the state, and allowed Madison to serve all the hospitals in Madison. He said, contrary to McDonald’s worries, the project was one of the best successes in the history of Ronald McDonald House.

01:23:37	[no question] After these successes, he said, he knew he shouldn’t be chair of pediatrics for much longer for a number of reasons he explained, and applied for a sabbatical in epidemiology.

01:25:30	[no question] Leaving during a period of turmoil for the new dean of the UW Med School, he quipped that by the time he returned, the school had lost two associate deans and he was being considered for the position of dean, both at UW and at also the Medical College of Wisconsin in Milwaukee.

01:27:52	[no question] Continuing to talk about becoming dean of the Med School, he talked about why the position was appealing to him, how he was disconnected from the controversy and how he became senior associate dean under Martin first. The key figure in the considerations, though, he said, was David Ward, who was worried about the future of the Med School and Hospital. Many in the medical school and the administration had lost confidence in Dean Martin, and in 1994 relieved him.

01:33:33	[no question] He discussed considerations for the deanship of the Medical School, which was a competition between him and Joe Sacket. He discussed why Martin, who he considered brilliant, wasn’t successful in the position partly because of his leadership style. He recalled talking candidly with David Ward about his desire to become dean, and Ward’s desire that he calm the Med School turmoil down.

01:40:26	[no question] After taking on the job, he was grateful that his wife was extremely supportive despite her concerns about him giving up his research agenda; he also felt very supported by all the chairs of medical departments and got some good advice from David Kindig.

01:43:28	[no question] He talked about “the most intensive period” of his career between October 1994 and August 1995, during which he encounted an administrative nightmare which he slowly tried to rectify, which he thought got noticed.

01:47:20	[no question] He recalled being asked to meet with Ward and Wayne McGown at Olin House in February 1995—during this meeting he was asked to analyze the HealthStar facilities initiative. He thought even this work, which he didn’t really have time for, helped him in the search for a med school dean since he knew the campus plan and also knew how to raise money.

01:51:36	[no question] He explained how the search went: Ward appointed a lot of disgruntled faculty from the med school on the search committee, which immediately broke into four factions. Once he made the short list, he was able to garner support from the chairs and from David Ward.

01:54:08	[no question] Once in the deanship, he felt that the job wasn’t all that difficult, since he’d had a 10-month head start as interim dean, thought he still had to be cautious in making changes.

01:57:34	End of First Interview Session

Second Interview Session (October 28, 2009): Digital File

Time	Keywords
00:00:00	Start of Interview/Interviewer’s Introduction

00:00:10	[no question] Farrell reviewed major organizational changes he’d made while dean of the Med School, most of which he said began early in his deanship. The first change was the reaccreditation of the Med School. When he reviewed the previous accredita-tion process, he realized how many changes the School would need to undergo to get reaccredited, including curriculum, facilities and chairmanship issues. 

00:03:07	[no question]  He overviewed curriculum changes that needed to occur, including linking clinical and basic science education so that students got clinical experience during their first two years, an integrated curriculum that was becoming more the norm. He talked about grants they got to carry out these changes, especially on the Milwaukee campus. He explained how student morale had dipped when Martin was relieved, and the process of restoring student morale. These factors led to full accreditation after the site visit.

00:07:49	[no question] Discussing major organization changes, he explained problems with the current clinical practice plan, which allowed each of the 14 departments to operate legally separately, which  led to billing problems and difficulties when patients had to go from department to department. In the early 1990s, this became a controversial topic and the UW Medical Foundation was created to bring all 14 units under one clinical practice plan and support the Medical School. This also gave him a good amount of discretionary money as the dean.

00:11:57	[no question] Continuing to talk about the clinical practice plan, he explained that he had to decide whether to support the creation of the UW Medical Foundation, which would eliminate the independent departmental units and create a uniform compensa-tion plan. This might cause opposition from the faculty who had to vote for or against the plan. He recalled agonizing over the decision, and decided in the end that the middle ground was to come out on the side of the new plan.

00:14:31	Follow up: Who determines compensation for the staff? Answer: It wasn’t the same for all staff, but there was a formula generated by the Foundation that regulated compensation on the basis of teaching, research, etc. He explained why he liked the changes that were introduced, which encouraged research and interdepartmental activity. The practice plan was passed and he felt it was the right move.

00:19:04	[no question] He said concurrent with this the UW Hospital and Clinics Authority was created, often described as the “semi-privatization of the hospital.” He argued that this didn’t entail the hospital becoming privately, but was a complex organization that allowed the hospital to operate efficiently. He talked about the important political advocacy of Gov. Thompson when it came to pushing the Authority through.

00:22:02	[no question] Continuing to talk about organizational changes, he discussed the Health Star initiative which proposed to rectify the shameful deficiency in medical facilities on campus that almost jeopardized accreditation. He reviewed David Ward’s challenge to him to take this on during his interim deanship.

00:24:26	[no question] He said his first move on Health Star was to review the old campus plan from the 1970s. He learned that some of the parking lots in West Campus were intended to be buildings, but when he planned new buildings, he knew he’d have to integrate a whole-Med School approach to even the education buildings in order for them to be acceptable to the administration.

00:26:40	[no question] He talked about deciding to call the Education Building the “Health Sciences Learning Center,” which would incorporate the library and increased classroom space for the med school but also nursing and pharmacy. The research building would be called the “Interdisciplinary Research Complex,” which appealed to David Ward.

00:28:23	[no question] He talked about calling the plan Health Star, though it carried some negative connotations from his predecessor. The plan would total $150 million, of which the Med School would raise half—he was able to get unanimous approval from the campus planning committee.

00:31:16	[no question] The same day he propose this plan, he put in a request to be granted the WARF building (which WARF was going to gift to the university) to house community and population health programs. He called this “the biggest bargain in the school’s history.

00:33:33	[no question] He observed that the real issue was whether the school could get the money to implement the Health Star plan. He was aided in this by UW’s allowing them to draft concrete plans that they could show donors; they also helped in his conversation with Gov. Thompson, who loved engaging in the details of construction projects.  He noted that during his entire deanship, they were able to raise about $750 million. He talked about negotiations he had with Thompson and how the total raised exceeded $100 million (partly in order to finish the School of Pharmacy).

00:40:50	[no question] He explained how the IRC was changed to WIMR (Wisconsin Institutes for Medical Research), which he liked since it reflected the medical research conducted there and didn’t have to fret about antithetical attitudes toward the word “medical” directed toward the School.

00:42:43	[no question] The final organization change he addressed was the issue of instilling accountability for teaching on the part of (especially research) faculty. This they did by a mission based budgeting system, which departments wouldn’t be used to, being used to getting the same amount every year. He said this potentially controversial move was voted in by all sides, thinking that they would gain out of it.

00:47:25	[no question] He explained that the Med School was “loaded with money” during most of his deanship, especially from research grants. This only improved as the Hospital generated more revenue.

00:49:27	[no question] The biggest windfall, however, came from the Blue Cross/Blue Shield settlement, which he first learned about in May of 1999. He explained how Blue Cross, during its conversion to a public corporation, agreed to donate an equity value of the company to the state of WI, which they decided to donate to the two medical schools of WI (UW and Medical College of Wisconsin). He talked about the value of the gift, and how UW was equipped to take on the challenge of becoming a school of public health and not just a Med School.

00:55:41	[no question] He discussed the hard work it took to actually get access to the Blue Cross/Blue Shield money, going all the way to the WI Supreme Court. They then organized a rigorous agenda of spending the Blue Cross money, following the oversight ruling of the insurance commissioner and putting together their own oversight committee in 2002.

01:01:00	[no question] He discussed challenges posed once they’d received the money. Since the infrastructure of UW Med School made it difficult for it to be a public health school, he proposed to use a small part of the settlement for building, but community organizations who wanted access to the money also objected, and with them Gov. Jim Doyle. [end tape 3/begin tape 4] He continued his story about meeting with Gov. Doyle, who’d decided the Blue Cross/Blue Shield money shouldn’t be used for facilities development. He agreed to this and felt that it was a good decision.

01:07:33	[no question] He discussed how they organized the first five-year plan that involved community organizations partnering with faculty to pursue programs. This plan went quite well.

01:08:56	[no question] Though the first five-year plan was going well, he said he realized that WI didn’t have a school of public health; so he asked for the name of the Med School be changed to the School of Medicine and Public Health. This faced some opposition from the mayor of Milwaukee, who felt that the school of public health should be located in Milwaukee.

01:13:29	[no question] He felt it was remarkable that they’d been able to keep a good relationship with high-level leadership like Jim Doyle and Tom Barrett. He thought a big lesson he’d learned was to invest in building relationships.

01:13:28	[no question] He summarized the lessons he’d learned—that the Med School had to advance despite the Madison campus, in which they’d struggled to be accepted. He also said that faculty were willing to embrace change as long as it wasn’t pushed too hard or fast and if they feel they’re part of a team.

01:16:35	[no question] Continuing to talk about lessons he’d learned, he said that one’s vision shouldn’t be restricted by financial developments. He felt this had hurt the pediatrics department in the early days.

01:21:12	[no question] He mentioned that one of the key funding developments in the Interdisciplinary Research Complex was Tommy Thompson’s role as Sec. of HHS, which gave them a construction grant. 

01:23:28	[no question] He also credited his wife with helping him through many of the challenges they faced, especially by encouraging him to spend time with medical students, which he thought was a major reason he’d had success negotiating major structural changes and had good relationships with alumni.

01:25:01	[no question] He reflected on retiring from the deanship after almost 12 years, rather than the 10 he expected—largely due to helping recruit and train the new dean.

01:26:11	Question: Cystic fibrosis screening presentation? Answer: He explained that just as his successor was chosen, his NIH grant was renewed. He’d used the grant money to study newborn screening for cystic fibrosis, a project that had been highly successful. He found it satisfying to return to his roots, treating newborn babies.

01:28:50	Question: Are you practicing clinical medicine? Answer: Not as much as he liked, in part because there were plenty of talented young clinical faculty willing to take cases.

01:30:24	Question: Anything else? Answer: He noted that he was happy he’d stayed at UW, noting how hard it was to move from institution to institution.

01:32:02	End of Second Interview Session

Third Interview Session (October 29, 2009): Digital File

Time	Keywords
00:00:00	Start of Interview/Interviewer’s Introduction

00:00:17	[no question] Farrell expressed that he wanted to add that, though he’d gone through a “roller coaster” of ups and downs as dean, the beginning of his deanship was the most intense and difficult.  But he felt he’d been prepared for this job by administrative experience he’d had beforehand. 

00:02:39	[no question] He reviewed how the Med School was under probation when he came into the deanship, which he felt might have been deserved considering how dysfunc-tional administration had been under his predecessor. 

00:05:11	[no question] He reviewed how he decided early on to bring in some new personnel in order to be more responsive to the campus and the state. Among these, he brought in his secretary from pediatrics, Carla Aiken, and assistant dean for human resources Patricia Mulcahy. These changes allowed them to get off probation, which led to the largest hiring action in the history of the Medical School, the merger with Physicians Plus Medical Group (1997).

00:09:26	[no question] He continued by discussing his hiring of Gordon Ridley, who was very accustomed to working with hospital administration, as associate dean of administra-tion. This was important since he, Ridley and John Torphy worked closely together on the Health Star initiative and the Health Sciences Learning Center.

00:12:55	[no question] He felt the investment of effort working with campus (Ridley and Torphy) paid dividends when the possibility of a new Children’s Hospital arose. Though a number of people said moving the hospital location couldn’t be done, Donna Shalala was behind it, and he remembered his experience with the Ronald McDonald House to encourage himself that it could be done.

00:15:42	[no question] He emphasized that the intense period of the first few years of his dean-ship (especially rectifying the administrative difficulties in the Med School) laid the groundwork for all of the success of his later deanship including half a billion dollars’ worth of construction. He encouraged future deans to “hit the ground running.”

00:19:34	Question: The lead gift from American Family? Answer: He discussed how the initial gift was $10 million, but eventually ended up being $20 million and resulted in the naming of the hospital.  He talked about objections to having the building named after an insurance company. Shalala also committed capital funds from the university totaling $35 million as well, and he discussed other funding streams.

00:23:03	[no question] He observed that this funding wouldn’t have happened without Donna Sollenberger, CEO of UW Hospitals and Clinics, who had some ulterior motives in that the new hospital cleared out critical space in the clinical sciences center. It also eased problems that existed with emergency medical services and parking on the east side of the medical complex.

00:26:47	[no question] He added that every one of the buildings built during his tenure was built by multiple sources “patched together” (rather than state funding), but started by a big lead gift that made it initially feasible. 

00:28:39	End of Third Interview Session

End of Oral History #1064