Leon (Leo) Felson

(1918-1979)

Biography

The youngest of Sol and Esther Felson’s children, Leon had to keep up with his high achieving brothers and sisters almost from the moment of his birth. That he did so was a credit to him and to his siblings who were there for him at every point along the way. He was particularly close to his sister Louise who became his “second mother.” Leon (nicknamed “Leo”) was an engaging youngster and she was quick to show off his accomplishments to friends and family.

Leo had a style and a smile all his own. Physically, he looked a lot like his father with whom he was very close. They shared the love of classical music and would spend hours together listening to recordings. Leo, born with perfect pitch, enjoyed singing, and harmonizing as well.

“Here comes another Felson” were words that Leo would hear from teachers all through his elementary, junior high and high school years. Along with those words were the expectations that a “Felson” could be counted on for an outstanding performance. Leo did not disappoint them. He always scored the highest level on tests that measured his knowledge and mental abilities. Away from school, there were always enough brothers and friends around to play baseball, a passion of the Felson family to this day.

The Second World War

Illness forced Leo to drop out of college. When he regained his health, he set site on joining his brothers who were already in the army. Because all the local army (and Navy) doctors knew about Leo’s history of rheumatic fever, his enlistment was turned down. Determined more than ever to serve his country in time of war, he tried for the Marine Corps. When doctors failed to find a trace of his heart murmur and he was able (by stretching) to meet the minimal Marine height requirement of 5 feet, 6 inches, he was accepted.

So began a series of experiences that would have a great influence on Leo. While still training to become a Marine, he married Evelyn (“Evie”) Tannenbaum. They had many of the same interests, not the least of which was music. “Harmonizing” in song and supporting each other through good and bad times was the couple’s hallmark.

Assigned to the Pacific Theatre to become a forward observer of naval gunfire, Leo was scheduled to be among the first wave as the US invaded Japan. Because the expected rate of mortality for an all out invasion was 80%, the dropping the bomb on Hiroshima may have saved his life. Shortly thereafter, an uprising of hatred against the Japanese living in China resulted in Leo being sent there to keep the peace. This period of his life had a profound influence on him. He loved China and the Chinese people and ended up with some proficiency in the language. He also became interested in Chinese history and art and sent some wonderful examples of this home to Evie.

After the War

Leo returned to Evie in Cincinnati and entered engineering school, purposely changing his direction from his older brothers who had all become physicians. Before graduation, he realized that this choice of career of was not people–oriented. A friend suggested that Leo’s talents and interests might best be served in the new field of hospital administration. Leo applied and was accepted at Northwestern University, which was known as the best school in this field.

The fall term was beginning so Leo had to leave a very pregnant Evie in Cincinnati. Soon after, Evie was able to join him with their son David, born September 16, 1952. The very proud father now had a double incentive to achieve. While going to school in Chicago, he worked as an apprentice at Mount Sinai Hospital and felt his career was headed in the right direction.

First Stop … Kansas City

After graduation from Northwestern, Leo took a position at the Menorah Medical Center in Kansas City, Missouri. He started as an assistant administrator and was later appointed interim Director. At Menorah, he was very involved in the integration of both black patients and doctors into the hospital’s population.

Three years later, in May 1959, Leo was appointed administrator of the Kansas City General Hospital, municipal system, serving both indigent blacks, and whites in separate hospital facilities. He closed the hospital designated for blacks and encouraged black patients and doctors to use the “white” facility, which they did. In the Kansas City times he described his action as “advised by both social and political viewpoints.”

For Leo the threatened closure of General Hospital would be his first alert to the role politics plays in healthcare. The city manager, presumably a non-political appointee, abruptly fired the city health commissioner. This firing indicated that the city manager was, in fact, controlled by politicians, possibly remnants of the Pendergast machine, which had dominated Kansas City for many years. Leo contacted Rabbi Samuel Mayerberg, a longtime civic leader. Ignoring threats of bodily harm, Rabbi Mayorberg led a public protest. The results: the exposure and resignation of the health commissioner replacement, a physician who had falsified his public health training.

Each day in November 1959, the Kansas City Times wrote a story (usually on page one) regarding the city health commissioner crisis. Informed by a friend in the mayor’s office that he, too, was about to be fired, Leo worked behind the scenes to encourage and direct support for the hospital and its independence from politics.His job was saved when he used his connections among Jewish politicians.

The next push to close General Hospital was in 1960 and was instigated by the most powerful man in the city council who probably controlled the city manager. Again, there was public protest against the closing. To keep the hospital open, a committee consisting of Leo and a group of civic leaders and physicians proposed an independent tax-supported public health district combining city and county services and supported by a property tax levy. A link between the hospital and the University School of Medicine was also suggested.

There were other issues Leo had to face during his term as administrator. A scandal involving the sale of drugs including narcotics from the hospital pharmacy was one. After an investigation by Federal agencies, the pharmacists were fired. Newspaper accounts tied Leo’s name to the scandal but he was cleared of all involvement.

When Leon left Kansas City in early 1962, he was praised for several specific accomplishments including bringing corporate involvement and sponsorship to wards in the hospital. One editor noted:

People who barely glanced at the building on the hill for the first time learned the crying needs of this community problem. Leon Felson through his tireless efforts touched all who came in contact with him… he set a new standard in hospital administration.

The mayor awarded Leo the keys to the city and a resolution of encomiums was passed unanimously by the city council. As he left Kansas City, the proposed association between General Hospital and the university medical school that he had championed was established and a nonprofit corporation was founded to run it.

The Next Challenge…Milwaukee

In 1962, Leo became executive director of Mount Sinai Hospital in Milwaukee where he worked until 1970. During this period of his career he was able to accomplish a number of health care innovations.

He started a regular dialogue among the cities hospital administrators and was able to spearhead a cooperative effort that led to the development of a shared computer system for hospital accounting. This example of early hospital–based software consisted of a central computer with terminal at each of Milwaukee’s hospitals feeding in their data. Leo then approached representatives from IBM Corporation regarding the development of the necessary program for the centralized computer. Because of his persistence, he was able to convince the powers that be that there was a nationwide demand for such a program and that IBM’s investment with more than pay for itself. Leo was right and ultimately the accounting program, SHAS, was installed in 300 hospitals throughout the country. Writing to the editor of Mount Sinai’s publication, The Tablet, IBM executive Eric Butaloff credited “your executive Director Leo Felson for his vision and tenacity and for his contribution to overcoming one of the biggest hurdles in the healthcare field, a coordinated system of accounting”.

In quick succession, Leo started a home healthcare program and was involved in the evaluation of its advocacy and cost. This led to his helping to write an article in the Journal of the American Medical Association (JAMA) that showed home care offered equivalent effectiveness for less cost than inpatient hospital care. He was also able to develop a health forum, which meant that national experts came to Milwaukee to talk about specific diseases and community health problems.

Lastly, Leo became enthused about HMOs as a means to reduce unnecessary cost in healthcare. It was 1970 and he was director of St. Mary’s Hospital, a large Catholic healthcare provider in Milwaukee. It was also a time when there were few such organizations, if any, in the Midwest. So, Leo helped to develop Compare HMO, the first Blue Cross/Blue Shield sponsored HMO in the US. Hired as a consultant for Wasau insurance company, he advised them on how to develop an HMO for its employees. As a result of the widespread adoption of this HMO, hospital admissions in the area dropped by 40%.

His work with HMOs Continues and Ends in Chicago

Excited by the promise of HMOs as a means of reducing healthcare costs, Leo was happy to bring his cause to Illinois. He was recruited to assist in the state’s comprehensive healthcare planning and to develop prepaid healthcare plans. This job eventually let him to his final position at a nascent HMO in Chicago, Ravenswood Prepaid, which was one of the first HMOs in the state.

With his death from cancer in 1979, Leo is remembered as a pioneer in his field, a man known for initiating new and innovative ideas and always willing to challenge convention. A memorial lecture in his name brings well-known authorities in the field of hospital administration each year to Milwaukee.

Leo was much loved by his family, friends, colleagues, and employees. In turn, Leo’s strong feelings of affection and respect for people were best summarized by his nephew, Marcus Felson, with this tribute:

The life and death of Leon Felson offer some important lessons for us all. He was steadfastly devoted to patient and community, not self advancement nor those superficial pursuits which so often divert public administration from its deepest purposes. So many would-be public servants have been idealistic without achieving results or pragmatic without pursuing ideals. Leon Felson, on the other hand, was one of the few who would be characterized as an idealistic doer, a principled pragmatic, a problem solver. His work was an interesting mix of general purpose and detailed planning guided by empathy for others. Thus he was able to introduce a number of health care innovations and to help disseminate these to communities besides his own.

A mundane example helps to illustrate how Leon Felson though and acted. He once discovered that poor medical record processing interfered with patient care in his hospital. He further learned that the personnel involved were either too busy or not busy enough, that poor cooperation was the heart of the problem. Leon met quietly and informally with employees to devise a plan, respecting their dignity and appealing to their best qualities. Leon was able to turn an administrative tangle into a smooth, efficient and prompt operation with no increase in personnel costs.

Thus did he work on dozens of specific problems. More importantly, he introduced several health care systems innovations by appealing again and again to the best in people and thereby getting them to put aside petty jealousies and fears. Among these innovations were some of the earliest programs of home care, cost reduction, computerization, comprehensive racial integration, as well as metropolitan disaster plans with radio contact, state-wide prepaid planning, and more. As a pioneer of health maintenance organization, Leo proved that hospital costs could be cut in half with no loss to quality of care, in cooperation with physicians and other key personnel. As a hospital administrator, he was able to build two different hospitals into university-affiliated medical centers

Yet Leo’s professional life had many setbacks Perhaps the best proof of his devotion to duty was his perseverance despite such setbacks.

Even in dying, Leo was concerned for others. Though terribly ill himself, he sought legal advice for a nurse’s aide with a property problem. He looked after his wife and son’s interests despite his pain, maintaining a clarity of intellect to the end. His setbacks in career and in health he bore with dignity and grace, always proceeding to work on the next problem. So let us be inspired by his example. In mourning a death, we can also celebrate a life.

A postscript from his son David

My father had many many wonderful qualities.  As you can tell from the above history, one of his main professional themes was championing new technologies and new approaches to knotty problems, (the computer approaches to accounting and HMOs as a solution to high costs and lack of preventive focus of health care). The other theme was a dedication to progressive social change which included integrating the hospitals in Kansas City and standing up against the Pendergast political machine there.  In Milwaukee, his last job was as administrator of a prominent Catholic Hospital;  his tenure there was cut short because of his support for an abortion clinic within hospital grounds.