December 3, 2025 • 27 mins
On this episode of Our American Stories, when you dial 911 in a medical emergency, you are using a system that did not always exist. Identical twins Alfred and Blair Sadler, one a physician and one a lawyer, worked with emergency medical services pioneers to shape modern EMTs, paramedics, and early 911 call centers, so that trained responders could reach people faster and save more lives. Here’s Alfred and Blair Sadler with their story.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
This is Lee Habib and this is our American Stories,
the show where America is the star and the American people,
and we love to hear your story. Send them to
our American Stories dot com. About your family, about the
town you live in, about the country you love. Your
stories are some of our favorites. Up next, the story
(00:31):
of how identical twin brothers, a doctor and a lawyer,
collaborated with scores of unsung heroes to modernize emergency medical services,
help create the physician assistant profession, help write the model
law for organ donation, and develop other programs that save
thousands of lives every year. Here's Alfred and Blair Sadler
(00:55):
with their story.
Speaker 2 (00:58):
Thank you very much.
Speaker 3 (00:59):
It's a pleasure for Blair and me to have an
opportunity to be with you today and tell our story.
I'm Alfred Sadler, I go by Fred, and my identical
twin brother, who was born four minutes after me in
New York City in nineteen forty one, is Blair.
Speaker 2 (01:21):
And I am a physician and Blair is a lawyer.
Speaker 3 (01:27):
Blair and I were medical students and law student respectively
in Philadelphia in our early twenties, and this led to
the idea that we might actually collaborate together. The first
issue that we addressed was the good Samaritan problem. And
what I'm referring to is that Christianity and the American
(01:49):
Bible talk about the good Samaritan who is encouraged to
stop at the scene of an accident and help someone
who is injured, even if it's someone of another persuasion.
But the law may have a different view of the matter. If,
for example, we stop and the patient doesn't do well
(02:10):
or dies, the family in our litigenous society might be
encouraged to sue us. So we looked into the laws
relating to this. There were different in different states, and
that is what launched our collaborative career.
Speaker 4 (02:26):
When I reflect back on how did we get started,
how did this idea actually take off to collaborate. We
talked in the book about four green lights. Four green lights,
four things that happened that had they not been giving
us a green signal, we never would have done this.
(02:48):
Fred's already mentioned the first one of those, which was
a joint presentation we did at mass General Hospital as
part of his surgical rotation on the Good Samaritan. The
legal and ethical issues in stopping to render aid and
an accident, and the chair of the Department of Surgery
afterwards saying, this is one of the best presentations.
Speaker 2 (03:10):
We have had.
Speaker 4 (03:12):
That really led us spark and we decided to pursue
the idea of collaborating in law and medicine. We developed
a paper describing a variety of medical legal issues such
as informed consent, human experimentation, euthanasia, organ transplantation, and definition
of death. I called Anthony Amsterdam, a leading pen law
(03:35):
professor and a mentor of mine who frequently argued cases
before the Supreme Court. I asked if we could meet
with him about our idea and he said sure, let's
have dinner. Fred and I came to the dinner with
two questions. First, did our medical legal collaboration idea make
any sense? And second, should we pursue such collaboration now
(03:55):
or should we wait until we're further along in our careers.
He reviewed the paper and said, you know, this is
a great idea. Even more important, he thought we should
pursue it immediately. That provided a major booster shot to proceed.
But where and how? We were aware that the US
Public Health Service had opportunities to become commissioned officers, but
(04:19):
they were typically for mds and PhDs in science, so
Fred took a chance. He called doctor Luther Terry, the
former Surgeon General who had become well known by fighting
the tobacco industry over cancer risks and placing the warning
on every pack of cigarettes smoking maybe hazardous to your health. Fortunately,
(04:40):
he was now dean of the medical school at the
University of Pennsylvania, of all places. He agreed to meet
with us and reviewed our position paper. He exclaimed, you know,
this is a great idea. I wish I had had
a doctor lawyer team working with me on the tobacco issues.
He put us in touch with the current Surgeon in
General and the current Director of NIH. We soon arranged
(05:04):
for three days of interviews in Bethesda and Washington and
received invitations to apply for jobs. We did, but just
four months had passed with no response, and I was
running out of time. My judicial clerkship in Philadelphia was
ending in July and I had to decide whether to
accept an offer from a Philadelphia law firm. So I
called the office of the Associate Director of NIH, who
(05:26):
agreed to meet with me. Just a month later, on
March twenty eighth, our twenty six birthdays, we received telegrams
offering US commissions in the U. S. Public Health Service
stationed at NIH in the Director's office in Bethesda. We
enthusiastically accepted began work on July first.
Speaker 3 (05:49):
When Blair and I arrived on day one on July
first of nineteen sixty seven, in the Director's office of
the NIH, we met with mister Joseph Murt who is
the outstanding leader of the planning office for Doctor Shannon
of the NIH, and he was our boss. And he said, gentlemen,
(06:12):
we have a problem, and put two newspaper clippings in
front of us, one from the La Times and one
from Minneapolis where pituitary glands were being taken from cadavers
who were being examined by the medical examiner to determine
the cause of death. And the medical examiner in every
(06:33):
state has the authority to do that when there's a
suspected homicide or foul play, or if there's a pandemic,
for example, and he has authority to do that, whether
the family objects or not. But there is no authority
as part of that statute in any of the states
(06:55):
which allows him or his assistance to take other tissues
that have no relevance to the cause of death, in
this case pituitary glass.
Speaker 1 (07:04):
And you're listening to the unlikely collaboration of identical twins
want a lawyer and want a doctor, who forever changed
how we view certain things about the medical and legal
professions and the intersection of both. When we come back,
more of the story of Alfred and Blair Sadler here
on our American Stories. Here at our American Stories, we
(07:32):
bring you inspiring stories of history, sports, business, faith and love.
Stories from a great and beautiful country that need to
be told. But we can't do it without you. Our
stories are free to listen to, but they're not free
to make. If you love our stories in America like
we do, please go to our American Stories dot com
and click the donate button. Give a little, give a lot,
(07:53):
help us keep the great American stories coming. That's our
American Stories dot Com. And we're back with our American Stories,
and we've been listening to the story from Fred and
(08:14):
Blair Sadler, identical twin brothers, a doctor and a lawyer
who helped innovate and change American emergency medical services. We
last left off with Fred sharing the story of how
pituitary glands were being taken without consent from cadavers by
medical examiners in California and Minnesota. Let's return to Fred
(08:37):
and Blair.
Speaker 2 (08:39):
That had happened in those two states.
Speaker 3 (08:43):
The press had found out about it, where assistance to
the pathologists were taking pituitary glands and sending them back
to Baltimore, Maryland, which is where the headquarters of something
the NIH was funding called the National Pituitary Agency located.
And they were doing this because although at only two
(09:03):
dollars per gland, if you send enough of these, and
the NIH was collecting seventy two thousand pituitary glands from
cadavers from around the country, you can make some money.
The reason that the NPA, the National Petuitary Agency, was
established was very straightforward. We're all familiar with unfortunate children
(09:27):
who are born with a petuitary tumor or a pituitary
problem which prevents them from making adequate human growth hormone
that we all need to grow to our full height,
and if we don't, we end up being very short.
So by grinding up the cadaver pituitary glands and obtaining
(09:48):
human growth hormone. Then enough could be administered to the
dwarfs by injection over a crucial period of time in
their growth.
Speaker 4 (10:01):
A noble purpose, to be sure, but it seemed clear
that some people in at least some coroner's offices were
not following the law. We were complete rookies on this issue,
whether it's medicine or law. When you were confronted with
a news issue, step one is due research. We went
to the Georgetown Law Library and we read everything available
(10:25):
on the variety of state laws dealing with autopsies and
organ donation. We also got advice from the leading authorities
on this topic, the ibanks, the Kidney Foundation, the Heart Association,
the tissue banks, even the funeral directors. During our research,
we discovered that the Commissioners on Uniform State Laws now
(10:46):
the Uniform Law Commission, had actually created a committee that
had been at work for a year on drafting a
model state organ donor law.
Speaker 2 (10:54):
Amazing.
Speaker 4 (10:55):
We met with Professor Blythe Stayson, the former dean of
the Michigan Law School, who chaired the committee. We reviewed
the many connections we had already made to health care organizations,
and that we had a mandate from NIH to explore
these issues and depth. He asked us to serve as
official consultants to the Commissioners. What an opportunity, and then
(11:19):
just two months later, doctor Christian Bernard performed the first
human heart transplant in South Africa, front page News, Time
magazine Man of the Year. There was tremendous public interest
and concern. A gallipole showed seventy percent of people, if asked,
(11:39):
would be an organ donor. But two New Yorker magazine
cartoons sent a different message, one of a patient in
a hospital bed with a large sign on top of
him reading patient asleep, not a heart donor, and another
was a bumper sticker cartoon that read drive carefully, doctor
(12:01):
Bernard may be watching. While humorous, they revealed an underlying concern.
Could people trust the healthcare system not to give up
on them prematurely if they were sick and were a
potential donor. We worked on multiple drafts over the next
several weeks and reviewed them with Stasen and his committee
(12:22):
and other experts. Ultimately, they approved it and recommended it
to the Commissioners. At its core, the Uniform Act is
a gift statute based on voluntary, informed consent. It provided First,
an individual could decide to donate all our part of
his body for transplantation or research upon being eighteen years
(12:45):
of age. Second, if no decision had been made by
the individual, the family could make the gift, and it
provided a specific definition of eligible family members. Third, it
stated that the donor's position could not be the same
aim as the recipient's physician, to avoid any conflict of interest.
(13:05):
That provided permission for definition of death to include brain death,
but did not include any specific definition of death, because
we knew that as science evolved, medical criteria would too.
In June nineteen sixty eight, just less than a year
(13:26):
after arriving at NIH with Blyth Station, we presented the
Uniform Anatomical Gift Act to the full body of the
one hundred Commissioners assembled for their annual meeting in Philadelphia.
It was approved unanimously. The American Bar Association approved it
one week later. The model law was enacted with little
(13:46):
or no change, by forty one states in the first year,
and by all fifty states and the District of Columbia
in three years. We testified before at least ten different
state legislatures during this period, as well as before the
US Senate at hearings commissioned by Senator Walter Mondale. The
(14:08):
uniform donor card was another key step. The law specifically
provided that a gift could be made by any written document,
including a card carried on the person. But what if
the cards were different and conflicting. As members of a
National Academy of Sciences at hoc committee, we convened what
turned out to be a pivotal meeting of twenty one
(14:31):
organizations with just one goal develop a donor card that
could be used by all in every state. The meeting
was a success and produced a simple legal document the
size of a driver's license. The streamlined that consent process
and could be used by all organizations. A potential crisis
of confusion and conflict had been avoided.
Speaker 3 (14:55):
We did not really realize it at the time that
we were working on the organi Transplant Law, with the
Uniform Law Commission and writing the Uniform Anatomical Gift Act,
that we were essentially dealing with very important bioethical alternatives.
Should we set up a system, which we did, which
(15:16):
was voluntary, which would allow us to donate and the
next of kin can also donate, or as a pair
of professors at UCLA, one of whom was a physician
and one of whom was a lawyer, argued that you'll
never get enough organs through voluntary donation, and therefore we
(15:37):
should switch to what some people call presumed consent or
opting out, which says that all of us are organ
donators unless we object. So the burden is on the
citizen to object to donating. And we felt that this
approach went against all American values, particularly altruism, autonomy, and trust.
(16:05):
We argued our position in Law Review articles and in
New England Journal of Medicine articles, and this helped support
the movement in all the states and in the District
of Columbia to pass the Uniform Anatomical Gift Act.
Speaker 1 (16:23):
And we've been listening to the story of fred Ann
Blair Sadler want a doctor, the other a lawyer, and
how they collaborated and innovated and changed all of our
worlds forever that organ donation card that we all take
for granted, My goodness, without that idea, without that work
that they did, what a different world we'd have and
how many less people would be alive. And by the way,
(16:47):
what a thing to do. That dialogue about getting the
citizen to opt out of organ donation.
Speaker 2 (16:54):
What a terrible idea.
Speaker 1 (16:55):
It would have ruined everything, and there would have been
great resistance. Is assumption that which is giving away our
organs to fight to do it right and to get
people to voluntarily do this and make this the status quo.
What a remarkable achievement by these twin brothers. And by
the way, you can pick up Fred and Blair's book,
Pluck Lessons we Learned for Improving healthcare and the world,
(17:20):
and you can get at your local bookstores, at Amazon
or any place you buy your books. When we come back,
more of the remarkable story of Fred and Blair Sadler,
twin brothers, a doctor and a lawyer who changed how
we live and how we die. Here on our American stories,
(18:08):
and we continue with our American stories in the story
of fred An Blair Sandler. Let's continue when we last
left off.
Speaker 2 (18:17):
We've talked a.
Speaker 4 (18:17):
Lot about organ transplantation and bioethics, but emergency medical character
as well was a similar remarkable experience. We were now
at Yale running the Yale Trauma Program, and it's remarkable
to reflect on where emergency care was in nineteen seventy
as hard as it is to believe, there was no
(18:39):
nine one one number. There were no EMTs or paramedics.
Ambulances were glorified station wagons, sometimes doubling as herses. There
were no residency programs in emergency medicine. There was no
system of trauma centers. Every day in the battlefields of Vietnam,
well trained medics were taking wounded soul soldiers to well
(19:00):
equipped trauma centers.
Speaker 2 (19:02):
Their cardinal rule was the golden hour. The golden hour.
Speaker 4 (19:07):
Get the patient to a well equipped trauma center in
one hour, and they had a chance. Ironically, no such
goal existed back home in the States. It was Scoop
and Hall, pick up the trauma patient, take them to
the nearest hospital, and hope for the best.
Speaker 2 (19:24):
No wonder that.
Speaker 4 (19:25):
A nineteen sixty six study by the National Academy of
Science is called accidents, the neglected disease of modern Society.
We began our comprehensive study in Connecticut by learning everything
we could about ems in the state. Working with nine
MPH students, we canvassed the state. Connecticut had thirty five
(19:46):
hospitals and one hundred and seventy nine ambulances, but there
was no coordination between them. In nineteen sixty eight, a
presidential commission had recommended a single telephone number nine one one,
and AT and T declared it was available, but only
a few systems had been established. In Connecticut, for example,
it served only fourteen percent of the population. So we
(20:08):
created and co chaired the state's first EMS Advisory Committee
and developed a seven hundred page report which we distilled
to a fifty two page summary, submitted it to the
governor entitled Emergency Medical Services in Connecticut.
Speaker 2 (20:21):
A blueprint for change.
Speaker 4 (20:23):
Key legislative support followed and funding, and in just five years,
six thousand ambulance personnel six thousand completed the new eighty
one hour EMT course in Connecticut.
Speaker 2 (20:40):
Our next problem found.
Speaker 3 (20:41):
Us, and that was that the Assistant Secretary for Health
wanted someone to look into the legal issues of the
fact that there were new types of health professionals called
physician assistants being trained to help the problem with the
acute doctor shortage that existed at that time.
Speaker 2 (21:02):
This is nineteen sixty nine.
Speaker 3 (21:04):
Medicare and Medicaid had been passed in nineteen sixty six,
which enfranchised millions of additional Americans for healthcare. Be it
the elderly, or be it poor people below a certain
poverty line. However, there were nowhere near enough physicians and
nurses to do so, and to train additional doctors would
(21:25):
have taken seven to ten years to do so. Very
bright and creative physicians and nurses decided to solve this
problem and at Duke, Professor Jane Stead and Professor Thelma
Ingalls from the Nursing School got together to teach.
Speaker 2 (21:49):
Nursings to learn a lot more.
Speaker 3 (21:52):
About medicine and give them a certificate as specially trained.
Speaker 2 (21:57):
And the plan at Duke.
Speaker 3 (21:59):
Was to this was in the late fifties and early sixties,
was to train additional nurses at Duke and then hopefully
this would become a national model. There was one thing
that had to be done to make this happen, and
that was that the program had to be accredited by
(22:22):
the accrediting body of nursing, which was the National League
for Nursing. The NLN arrived at Duke and surveyed the
program and did not accredit the program. They said there
was too much medical input, it was more of a
medical program than a nursing program, and therefore refused to
(22:42):
grant its stamp of approval. Naturally, doctor Stead was deeply disappointed,
as was Professor Ingalls. Professor Ingles left Duke and went
to the Rockefeller Foundation and did marvelous work over the
next forty years around the world. Doctor Stead looked for
(23:03):
an alternative to nursing and found it with the returning
military cormen. There were six thousand very well trained military
corman who, over a year and a half of training
at major medical hospitals, were working in Vietnam and on
(23:27):
the battlefield helping to save lives, with bullets often flying
over their head. They were starting ivs, giving blood and
stopping major injuries, and helping to transport these wounded soldiers
back to the base hospital as well as then helping
out at the base hospital. So doctor Stead decided to
(23:50):
use four of these returning cormen in nineteen sixty five
to start a new program called the Physician Assistant Training Program,
and was highly successful. We were asked by the Assistant
Secretary of Health, was this a solution to the national
shortage of healthcare practitioners in the face of the increased demand,
(24:16):
And we were asked to travel and got a chance
therefore to see these programs in action, but he specifically
wanted to know what the law should be. How would
these people be allowed to practice? And after thorough study
and working with our colleagues at Duke who were looking
at the same issues, we came up with a simple
(24:37):
amendment to the Medical Practice Act, which is the law
that allows a physician to practice in each state. And
the Medical Practice Act defines that a physician can operate, diagnose, treat,
and prescribe, which no other health professional can do. But
there's nothing in the law, and this was our amendment,
(24:59):
which would prevent a physician from delegating to specially trained
nurses or physician assistants those tasks for which the assistant
was well trained and that fell within the scope of
practice of the physician, and finally that both the assistant
(25:23):
and the physician would be responsible for that care. This
law took off and was passed in most all of
the states within a matter of a couple of years,
and allowed physician assistants or pas as they are known
in the vernacular, to practice under the auspices of the
(25:46):
Medical Practice Act.
Speaker 4 (25:50):
So from trained nine to one to one dispatchers to
highly skilled EMTs and paramedics to thousands of emergency care
physicians and nurses, to sophisticated ambulances that transport patients directly
to trauma centers. Emergency medical care in the US today
is really a jewel in our crown.
Speaker 1 (26:10):
At A terrific job on the storytelling and editing by
Greg Hangler, and a special thanks to Fred and Blair Sadler.
Their terrific book, Pluck Lessons We Learned From Improving Healthcare
in the World is available in bookstores, on Amazon dot
Com or wherever you get your books. And my goodness,
it's unimaginable to think that back in the nineteen seventies
(26:32):
when these guys were just getting going, that there were
no EMTs, no system of trauma centers, ambulances, Well, they
were just glorified station wagons that passed for hearses.
Speaker 2 (26:44):
Scoop and Hall.
Speaker 1 (26:46):
Well that's what they did with trauma patients, Scoop and
all the idea of treating them well. One groundbreaking study
in the seventies called accidents the neglected disease of modern society.
And into the breach step these two men, And kudos
to all the state legislators who fight back and forth
(27:07):
left versus right to get together and solve this problem,
and solve it fast. A great story about the intersection
of law and medicine and problem solvers. Two great problem solvers,
twin brothers, both the Saddlers. Here on our American Stories
This is Lee Habib and this is our American Stories,
the show where America is the star and the American people,
and we love to hear your story. Send them to
our American Stories dot com. About your family, about the
town you live in, about the country you love. Your
stories are some of our favorites. Up next, the story
(00:31):
of how identical twin brothers, a doctor and a lawyer,
collaborated with scores of unsung heroes to modernize emergency medical services,
help create the physician assistant profession, help write the model
law for organ donation, and develop other programs that save
thousands of lives every year. Here's Alfred and Blair Sadler
(00:55):
with their story.
Speaker 2 (00:58):
Thank you very much.
Speaker 3 (00:59):
It's a pleasure for Blair and me to have an
opportunity to be with you today and tell our story.
I'm Alfred Sadler, I go by Fred, and my identical
twin brother, who was born four minutes after me in
New York City in nineteen forty one, is Blair.
Speaker 2 (01:21):
And I am a physician and Blair is a lawyer.
Speaker 3 (01:27):
Blair and I were medical students and law student respectively
in Philadelphia in our early twenties, and this led to
the idea that we might actually collaborate together. The first
issue that we addressed was the good Samaritan problem. And
what I'm referring to is that Christianity and the American
(01:49):
Bible talk about the good Samaritan who is encouraged to
stop at the scene of an accident and help someone
who is injured, even if it's someone of another persuasion.
But the law may have a different view of the matter. If,
for example, we stop and the patient doesn't do well
(02:10):
or dies, the family in our litigenous society might be
encouraged to sue us. So we looked into the laws
relating to this. There were different in different states, and
that is what launched our collaborative career.
Speaker 4 (02:26):
When I reflect back on how did we get started,
how did this idea actually take off to collaborate. We
talked in the book about four green lights. Four green lights,
four things that happened that had they not been giving
us a green signal, we never would have done this.
(02:48):
Fred's already mentioned the first one of those, which was
a joint presentation we did at mass General Hospital as
part of his surgical rotation on the Good Samaritan. The
legal and ethical issues in stopping to render aid and
an accident, and the chair of the Department of Surgery
afterwards saying, this is one of the best presentations.
Speaker 2 (03:10):
We have had.
Speaker 4 (03:12):
That really led us spark and we decided to pursue
the idea of collaborating in law and medicine. We developed
a paper describing a variety of medical legal issues such
as informed consent, human experimentation, euthanasia, organ transplantation, and definition
of death. I called Anthony Amsterdam, a leading pen law
(03:35):
professor and a mentor of mine who frequently argued cases
before the Supreme Court. I asked if we could meet
with him about our idea and he said sure, let's
have dinner. Fred and I came to the dinner with
two questions. First, did our medical legal collaboration idea make
any sense? And second, should we pursue such collaboration now
(03:55):
or should we wait until we're further along in our careers.
He reviewed the paper and said, you know, this is
a great idea. Even more important, he thought we should
pursue it immediately. That provided a major booster shot to proceed.
But where and how? We were aware that the US
Public Health Service had opportunities to become commissioned officers, but
(04:19):
they were typically for mds and PhDs in science, so
Fred took a chance. He called doctor Luther Terry, the
former Surgeon General who had become well known by fighting
the tobacco industry over cancer risks and placing the warning
on every pack of cigarettes smoking maybe hazardous to your health. Fortunately,
(04:40):
he was now dean of the medical school at the
University of Pennsylvania, of all places. He agreed to meet
with us and reviewed our position paper. He exclaimed, you know,
this is a great idea. I wish I had had
a doctor lawyer team working with me on the tobacco issues.
He put us in touch with the current Surgeon in
General and the current Director of NIH. We soon arranged
(05:04):
for three days of interviews in Bethesda and Washington and
received invitations to apply for jobs. We did, but just
four months had passed with no response, and I was
running out of time. My judicial clerkship in Philadelphia was
ending in July and I had to decide whether to
accept an offer from a Philadelphia law firm. So I
called the office of the Associate Director of NIH, who
(05:26):
agreed to meet with me. Just a month later, on
March twenty eighth, our twenty six birthdays, we received telegrams
offering US commissions in the U. S. Public Health Service
stationed at NIH in the Director's office in Bethesda. We
enthusiastically accepted began work on July first.
Speaker 3 (05:49):
When Blair and I arrived on day one on July
first of nineteen sixty seven, in the Director's office of
the NIH, we met with mister Joseph Murt who is
the outstanding leader of the planning office for Doctor Shannon
of the NIH, and he was our boss. And he said, gentlemen,
(06:12):
we have a problem, and put two newspaper clippings in
front of us, one from the La Times and one
from Minneapolis where pituitary glands were being taken from cadavers
who were being examined by the medical examiner to determine
the cause of death. And the medical examiner in every
(06:33):
state has the authority to do that when there's a
suspected homicide or foul play, or if there's a pandemic,
for example, and he has authority to do that, whether
the family objects or not. But there is no authority
as part of that statute in any of the states
(06:55):
which allows him or his assistance to take other tissues
that have no relevance to the cause of death, in
this case pituitary glass.
Speaker 1 (07:04):
And you're listening to the unlikely collaboration of identical twins
want a lawyer and want a doctor, who forever changed
how we view certain things about the medical and legal
professions and the intersection of both. When we come back,
more of the story of Alfred and Blair Sadler here
on our American Stories. Here at our American Stories, we
(07:32):
bring you inspiring stories of history, sports, business, faith and love.
Stories from a great and beautiful country that need to
be told. But we can't do it without you. Our
stories are free to listen to, but they're not free
to make. If you love our stories in America like
we do, please go to our American Stories dot com
and click the donate button. Give a little, give a lot,
(07:53):
help us keep the great American stories coming. That's our
American Stories dot Com. And we're back with our American Stories,
and we've been listening to the story from Fred and
(08:14):
Blair Sadler, identical twin brothers, a doctor and a lawyer
who helped innovate and change American emergency medical services. We
last left off with Fred sharing the story of how
pituitary glands were being taken without consent from cadavers by
medical examiners in California and Minnesota. Let's return to Fred
(08:37):
and Blair.
Speaker 2 (08:39):
That had happened in those two states.
Speaker 3 (08:43):
The press had found out about it, where assistance to
the pathologists were taking pituitary glands and sending them back
to Baltimore, Maryland, which is where the headquarters of something
the NIH was funding called the National Pituitary Agency located.
And they were doing this because although at only two
(09:03):
dollars per gland, if you send enough of these, and
the NIH was collecting seventy two thousand pituitary glands from
cadavers from around the country, you can make some money.
The reason that the NPA, the National Petuitary Agency, was
established was very straightforward. We're all familiar with unfortunate children
(09:27):
who are born with a petuitary tumor or a pituitary
problem which prevents them from making adequate human growth hormone
that we all need to grow to our full height,
and if we don't, we end up being very short.
So by grinding up the cadaver pituitary glands and obtaining
(09:48):
human growth hormone. Then enough could be administered to the
dwarfs by injection over a crucial period of time in
their growth.
Speaker 4 (10:01):
A noble purpose, to be sure, but it seemed clear
that some people in at least some coroner's offices were
not following the law. We were complete rookies on this issue,
whether it's medicine or law. When you were confronted with
a news issue, step one is due research. We went
to the Georgetown Law Library and we read everything available
(10:25):
on the variety of state laws dealing with autopsies and
organ donation. We also got advice from the leading authorities
on this topic, the ibanks, the Kidney Foundation, the Heart Association,
the tissue banks, even the funeral directors. During our research,
we discovered that the Commissioners on Uniform State Laws now
(10:46):
the Uniform Law Commission, had actually created a committee that
had been at work for a year on drafting a
model state organ donor law.
Speaker 2 (10:54):
Amazing.
Speaker 4 (10:55):
We met with Professor Blythe Stayson, the former dean of
the Michigan Law School, who chaired the committee. We reviewed
the many connections we had already made to health care organizations,
and that we had a mandate from NIH to explore
these issues and depth. He asked us to serve as
official consultants to the Commissioners. What an opportunity, and then
(11:19):
just two months later, doctor Christian Bernard performed the first
human heart transplant in South Africa, front page News, Time
magazine Man of the Year. There was tremendous public interest
and concern. A gallipole showed seventy percent of people, if asked,
(11:39):
would be an organ donor. But two New Yorker magazine
cartoons sent a different message, one of a patient in
a hospital bed with a large sign on top of
him reading patient asleep, not a heart donor, and another
was a bumper sticker cartoon that read drive carefully, doctor
(12:01):
Bernard may be watching. While humorous, they revealed an underlying concern.
Could people trust the healthcare system not to give up
on them prematurely if they were sick and were a
potential donor. We worked on multiple drafts over the next
several weeks and reviewed them with Stasen and his committee
(12:22):
and other experts. Ultimately, they approved it and recommended it
to the Commissioners. At its core, the Uniform Act is
a gift statute based on voluntary, informed consent. It provided First,
an individual could decide to donate all our part of
his body for transplantation or research upon being eighteen years
(12:45):
of age. Second, if no decision had been made by
the individual, the family could make the gift, and it
provided a specific definition of eligible family members. Third, it
stated that the donor's position could not be the same
aim as the recipient's physician, to avoid any conflict of interest.
(13:05):
That provided permission for definition of death to include brain death,
but did not include any specific definition of death, because
we knew that as science evolved, medical criteria would too.
In June nineteen sixty eight, just less than a year
(13:26):
after arriving at NIH with Blyth Station, we presented the
Uniform Anatomical Gift Act to the full body of the
one hundred Commissioners assembled for their annual meeting in Philadelphia.
It was approved unanimously. The American Bar Association approved it
one week later. The model law was enacted with little
(13:46):
or no change, by forty one states in the first year,
and by all fifty states and the District of Columbia
in three years. We testified before at least ten different
state legislatures during this period, as well as before the
US Senate at hearings commissioned by Senator Walter Mondale. The
(14:08):
uniform donor card was another key step. The law specifically
provided that a gift could be made by any written document,
including a card carried on the person. But what if
the cards were different and conflicting. As members of a
National Academy of Sciences at hoc committee, we convened what
turned out to be a pivotal meeting of twenty one
(14:31):
organizations with just one goal develop a donor card that
could be used by all in every state. The meeting
was a success and produced a simple legal document the
size of a driver's license. The streamlined that consent process
and could be used by all organizations. A potential crisis
of confusion and conflict had been avoided.
Speaker 3 (14:55):
We did not really realize it at the time that
we were working on the organi Transplant Law, with the
Uniform Law Commission and writing the Uniform Anatomical Gift Act,
that we were essentially dealing with very important bioethical alternatives.
Should we set up a system, which we did, which
(15:16):
was voluntary, which would allow us to donate and the
next of kin can also donate, or as a pair
of professors at UCLA, one of whom was a physician
and one of whom was a lawyer, argued that you'll
never get enough organs through voluntary donation, and therefore we
(15:37):
should switch to what some people call presumed consent or
opting out, which says that all of us are organ
donators unless we object. So the burden is on the
citizen to object to donating. And we felt that this
approach went against all American values, particularly altruism, autonomy, and trust.
(16:05):
We argued our position in Law Review articles and in
New England Journal of Medicine articles, and this helped support
the movement in all the states and in the District
of Columbia to pass the Uniform Anatomical Gift Act.
Speaker 1 (16:23):
And we've been listening to the story of fred Ann
Blair Sadler want a doctor, the other a lawyer, and
how they collaborated and innovated and changed all of our
worlds forever that organ donation card that we all take
for granted, My goodness, without that idea, without that work
that they did, what a different world we'd have and
how many less people would be alive. And by the way,
(16:47):
what a thing to do. That dialogue about getting the
citizen to opt out of organ donation.
Speaker 2 (16:54):
What a terrible idea.
Speaker 1 (16:55):
It would have ruined everything, and there would have been
great resistance. Is assumption that which is giving away our
organs to fight to do it right and to get
people to voluntarily do this and make this the status quo.
What a remarkable achievement by these twin brothers. And by
the way, you can pick up Fred and Blair's book,
Pluck Lessons we Learned for Improving healthcare and the world,
(17:20):
and you can get at your local bookstores, at Amazon
or any place you buy your books. When we come back,
more of the remarkable story of Fred and Blair Sadler,
twin brothers, a doctor and a lawyer who changed how
we live and how we die. Here on our American stories,
(18:08):
and we continue with our American stories in the story
of fred An Blair Sandler. Let's continue when we last
left off.
Speaker 2 (18:17):
We've talked a.
Speaker 4 (18:17):
Lot about organ transplantation and bioethics, but emergency medical character
as well was a similar remarkable experience. We were now
at Yale running the Yale Trauma Program, and it's remarkable
to reflect on where emergency care was in nineteen seventy
as hard as it is to believe, there was no
(18:39):
nine one one number. There were no EMTs or paramedics.
Ambulances were glorified station wagons, sometimes doubling as herses. There
were no residency programs in emergency medicine. There was no
system of trauma centers. Every day in the battlefields of Vietnam,
well trained medics were taking wounded soul soldiers to well
(19:00):
equipped trauma centers.
Speaker 2 (19:02):
Their cardinal rule was the golden hour. The golden hour.
Speaker 4 (19:07):
Get the patient to a well equipped trauma center in
one hour, and they had a chance. Ironically, no such
goal existed back home in the States. It was Scoop
and Hall, pick up the trauma patient, take them to
the nearest hospital, and hope for the best.
Speaker 2 (19:24):
No wonder that.
Speaker 4 (19:25):
A nineteen sixty six study by the National Academy of
Science is called accidents, the neglected disease of modern Society.
We began our comprehensive study in Connecticut by learning everything
we could about ems in the state. Working with nine
MPH students, we canvassed the state. Connecticut had thirty five
(19:46):
hospitals and one hundred and seventy nine ambulances, but there
was no coordination between them. In nineteen sixty eight, a
presidential commission had recommended a single telephone number nine one one,
and AT and T declared it was available, but only
a few systems had been established. In Connecticut, for example,
it served only fourteen percent of the population. So we
(20:08):
created and co chaired the state's first EMS Advisory Committee
and developed a seven hundred page report which we distilled
to a fifty two page summary, submitted it to the
governor entitled Emergency Medical Services in Connecticut.
Speaker 2 (20:21):
A blueprint for change.
Speaker 4 (20:23):
Key legislative support followed and funding, and in just five years,
six thousand ambulance personnel six thousand completed the new eighty
one hour EMT course in Connecticut.
Speaker 2 (20:40):
Our next problem found.
Speaker 3 (20:41):
Us, and that was that the Assistant Secretary for Health
wanted someone to look into the legal issues of the
fact that there were new types of health professionals called
physician assistants being trained to help the problem with the
acute doctor shortage that existed at that time.
Speaker 2 (21:02):
This is nineteen sixty nine.
Speaker 3 (21:04):
Medicare and Medicaid had been passed in nineteen sixty six,
which enfranchised millions of additional Americans for healthcare. Be it
the elderly, or be it poor people below a certain
poverty line. However, there were nowhere near enough physicians and
nurses to do so, and to train additional doctors would
(21:25):
have taken seven to ten years to do so. Very
bright and creative physicians and nurses decided to solve this
problem and at Duke, Professor Jane Stead and Professor Thelma
Ingalls from the Nursing School got together to teach.
Speaker 2 (21:49):
Nursings to learn a lot more.
Speaker 3 (21:52):
About medicine and give them a certificate as specially trained.
Speaker 2 (21:57):
And the plan at Duke.
Speaker 3 (21:59):
Was to this was in the late fifties and early sixties,
was to train additional nurses at Duke and then hopefully
this would become a national model. There was one thing
that had to be done to make this happen, and
that was that the program had to be accredited by
(22:22):
the accrediting body of nursing, which was the National League
for Nursing. The NLN arrived at Duke and surveyed the
program and did not accredit the program. They said there
was too much medical input, it was more of a
medical program than a nursing program, and therefore refused to
(22:42):
grant its stamp of approval. Naturally, doctor Stead was deeply disappointed,
as was Professor Ingalls. Professor Ingles left Duke and went
to the Rockefeller Foundation and did marvelous work over the
next forty years around the world. Doctor Stead looked for
(23:03):
an alternative to nursing and found it with the returning
military cormen. There were six thousand very well trained military
corman who, over a year and a half of training
at major medical hospitals, were working in Vietnam and on
(23:27):
the battlefield helping to save lives, with bullets often flying
over their head. They were starting ivs, giving blood and
stopping major injuries, and helping to transport these wounded soldiers
back to the base hospital as well as then helping
out at the base hospital. So doctor Stead decided to
(23:50):
use four of these returning cormen in nineteen sixty five
to start a new program called the Physician Assistant Training Program,
and was highly successful. We were asked by the Assistant
Secretary of Health, was this a solution to the national
shortage of healthcare practitioners in the face of the increased demand,
(24:16):
And we were asked to travel and got a chance
therefore to see these programs in action, but he specifically
wanted to know what the law should be. How would
these people be allowed to practice? And after thorough study
and working with our colleagues at Duke who were looking
at the same issues, we came up with a simple
(24:37):
amendment to the Medical Practice Act, which is the law
that allows a physician to practice in each state. And
the Medical Practice Act defines that a physician can operate, diagnose, treat,
and prescribe, which no other health professional can do. But
there's nothing in the law, and this was our amendment,
(24:59):
which would prevent a physician from delegating to specially trained
nurses or physician assistants those tasks for which the assistant
was well trained and that fell within the scope of
practice of the physician, and finally that both the assistant
(25:23):
and the physician would be responsible for that care. This
law took off and was passed in most all of
the states within a matter of a couple of years,
and allowed physician assistants or pas as they are known
in the vernacular, to practice under the auspices of the
(25:46):
Medical Practice Act.
Speaker 4 (25:50):
So from trained nine to one to one dispatchers to
highly skilled EMTs and paramedics to thousands of emergency care
physicians and nurses, to sophisticated ambulances that transport patients directly
to trauma centers. Emergency medical care in the US today
is really a jewel in our crown.
Speaker 1 (26:10):
At A terrific job on the storytelling and editing by
Greg Hangler, and a special thanks to Fred and Blair Sadler.
Their terrific book, Pluck Lessons We Learned From Improving Healthcare
in the World is available in bookstores, on Amazon dot
Com or wherever you get your books. And my goodness,
it's unimaginable to think that back in the nineteen seventies
(26:32):
when these guys were just getting going, that there were
no EMTs, no system of trauma centers, ambulances, Well, they
were just glorified station wagons that passed for hearses.
Speaker 2 (26:44):
Scoop and Hall.
Speaker 1 (26:46):
Well that's what they did with trauma patients, Scoop and
all the idea of treating them well. One groundbreaking study
in the seventies called accidents the neglected disease of modern society.
And into the breach step these two men, And kudos
to all the state legislators who fight back and forth
(27:07):
left versus right to get together and solve this problem,
and solve it fast. A great story about the intersection
of law and medicine and problem solvers. Two great problem solvers,
twin brothers, both the Saddlers. Here on our American Stories
Host
Lee Habeeb
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