Birth of UCI College of Medicine

Dr. Victor Passy, M.D., interviewed by Dr. Michael Seffinger, DO

March 28, 2003

Dr. Seffinger: Friday, March 28, 2003. We are at UCI medical library, and Dr. Passy is going to talk about his involvement with the 41st trust fund that was developed. Dr. Passy, would you introduce yourself and tell us a little bit about yourself and then...
Dr. Passy: My name is Dr. Passy, I am an ex-DO, I received my MD degree in 1962 when the affiliation merger between the MD’s and DO’s took place. Since I am here basically to expound on the 41st Trust and the 41st society, why don’t we go right into that? After I had graduated in 1959, I did my internship at LA county at 1960, and during that time in my internship- my residency which was at LA county- the merger between the MD’s and DO’s took place in 1962. At that time, with the merger taking place, the college was called the California College of Medicine, which was an entity of California and not affiliated with any University at that time. There were some universities that were looking at CCM-, which is what it was called, CCM, California College of Medicine- as part of the medical school. Long Beach was looking at us, Bakersfield, a school in the valley that was looking at us, and also Irvine- University of California at Irvine, that was looking at us to be part of their University system as a medical school. Finally in 1963, 64, 65- when we were still California College of Medicine- University of California at Irvine elected to choose us as their medical school and we accepted. That was in 1965. We didn’t move to the campus in Irvine until 1967. In those two years a lot of things happened because here we are, a University of California affiliated with Irvine. The doctors that were alumni that were graduating really had no affiliation with anyone and they did not have an affiliation with the California College Medical Association. At that time they needed something to gather all of the alumni from the school and put them into one society so they could be voiced as an institution, as a unit so they could accomplish what they wanted to accomplish in terms of medicine. So they originated, and there were 40 medical societies in the Los Angeles area. So what they did was they originated a 41st medical society to encompass all the alumni and faculty from the school. They merged into a medical society, and that is how the 41st medical society originated. (I can’t remember all of the names of the people who first started and who were the presidents- and we can always get that.) But nevertheless, there were things that needed to be done to politically and legislatively make us a whole. Through the years this occurred. Now there were monies that were accumulated in this society through the 41st medical society. They had a fund that was working. During these years the hospitals and the clinics that we were using for the training of the emerging physicians was sold and the money that they accumulated from that – I can’t remember how much it was. Bob do you remember how much they sold that for?
Dr. Steedman: Well, from selling all of the properties out there and other properties we had adjoining the college of osteopathic physicians and surgeries property, and then the money that was in the membership at that time. It was my impression that it was somewhere between 2-3 million dollars.
Dr. Passy: I don’t know what it was at that time that the 41st trust was at first identified, but they needed a trust to put this money into. But I do know that as of August 1, 1983 the trust assets were approximately $486,000. Since then, it may have grown.
Dr. Seffinger: So this is different than the alumni association funds that were built up. It was funds from the sale of property, from things that they deemed was somehow related to the alumni in that it went to the people who ran the 41st trust fund were the alumni, right.
Dr. Passy: It was run by the board of trustees
Dr. Steedman: …of the California College of Medicine.
Dr. Passy: Let me read something from the proposed regents’ agenda. As a member of the educational committee, that was read in 1983. “Consent for appointment to successor trustee to the 41st medical trust, California College of Medicine support foundation in Irvine, California.” So, they gave it to the support foundation of the Irvine campus in 1983. In December of 1964 was when the first 41st trust established the 41st medical trust. One of the purposes of the trust was to apply the trust corpus and income for the support and expansion of the California College of Medicine. That was back in 1983.
Dr. Seffinger: I recall that there was a trust fund that was begun back in 1962 or 1963 Or around there.
Dr. Passy: Well, 1962 was when the 41st society was formed.
Dr. Seffinger: And did they start having funds built up somewhere around there because in 1970 I heard that Dr. Tobis’ lab was started with some funds from that …that was the first use of the funds. Now was it from the 41st society funds or not?
Dr. Steedman: There was a stipulation made of some funds that they – and I can’t quote specifically- that they had to be used for research of osteopathic manipulation.
Dr. Passy: You have to understand one other thing. When this trust fund first began – not the 41st- when the trust fund was formed, it was formed to proceed for only 20 years. After 20 years, the trust fund will have been disintegrated and given to another facility.
Dr. Seffinger: So, was that 20 years starting from 1960, 70 or 80?
Dr. Passy: 1964.
Dr. Seffinger: So lets get one stream of thought correct. When the amalgamation occurred in 1962, there was a desire of the people getting their MD degrees, to form a fund for research on manipulation. Or that the research would be continued on, at UC Irvine or the California College of Medicine. At the time, they didn’t know whether it would be used here or not. Then there was a push the next several years to become a part of a University and one of the things was to do better research, was one of the goals.
Dr. Passy: There was a letter from the attorney who was the Attorney James Cordey, who is the deputy attorney general for Los Angeles. And he writes regarding the 41st medical society trust, “as we discussed in a telephone conversation in November of ’84, I am enclosing your review and comment of the attorney generals’ office documentation pertaining to the termination of the 41st medical society trust. This is a trust that only lasted twenty years, from 1964, when it first began. Since there are no private beneficiaries in the trust, it is my understanding that the trust is subject to the supervision of the attorney general’s office, pursuant to Cal. Govt. Code- something or another. As a background, the trust was established on December 31st of 1964. And it is required to terminate no later than December 31st of 1984. The trust was funded from the grant of property from the 41st medical society for the purpose of furthering the unification of Doctors of Medicine and Doctors of Osteopathy and to support the California College of Medicine, now known as University of California at Irvine, School of Medicine”. (I have enclosed in this folder the information on how this has all come about.)
Dr. Seffinger: Okay, good.
Dr. Passy: So, that’s when it all turned over. For the benefit of the medical school, doctors of osteopathy.
Dr. Seffinger: very general.
Dr. Passy: Correct. Then it goes on, then there are letters from James McDaniels, who is another attorney, to Dr Grunigen. Termination of the 41st medical trusts after the 20 years. I think this is what needs to be: “note also, it is my understanding that”- and this is a letter from Buster, who is chairman of the Board of Trustees, back in 1986- “enclosed is the copy of the formal acceptance of the trust assets subject to specific conditions from the 41st medical trust which I signed on behalf of the CCM foundation. It is my understanding that all assets involved in all cash and not the sum, have been received by the CCM foundation staff at CCM. Please note” (and this is important.), “the foundation agreed to retain the principle intact and to use only the income from the transferred funds, for the purpose of musculoskeletal research and education with particular emphasis on manipulative therapy.”
Dr. Steedman: but it was there before.
Dr. Passy: It was there. He is just reiterating it to make sure that when it’s transferring from the 41st trust, to this new trust after 20 years. That was written by Robert Meserve, who was on the Board of Trustees. I think he died.
Dr. Seffinger: Was he one that was for the change of the degree from DO to MD.
Dr. Passy: Yes, he was.
Dr. Seffinger: And then he wanted to maintain that. So, why would they want to do research in musculoskeletal manipulation, when most people were not using at that time?
Dr. Passy: Well, because they didn’t want to lose it. They didn’t want to lose the fact that they thought there was something in musculoskeletal treatment in the advancement of medicine. And they thought that if we all became MD’s that aspect of treatment would be lost, and they didn’t want that. And at the time, no one really proved the fact that physical therapy, physical manipulation aided in the well being of people. They didn’t have the science behind it to prove it, and that’s what they wanted to do here. That’s why, over the years when we had the monies delegated, we added $50,000 a year to open up research- to open up the field to find out, to really pinpoint the fact, why and how did musculoskeletal treatment help in the treatment of patients with illnesses. Over the years, we’ve been doing this and we’ve not come up with anything. We’ve had research people come up and do various things, but it didn’t really prove that point. And then we came to the Samuel Institute of Complementary and Alternative Medicine Foundation. They had something that we thought would help us. And you came back to us and said, “hey, in order to prove something you’ve got to know where’ you’ve been, what’s been done so then you can go in and determine what it is you really need to prove.” And that’s where we are now and that’s what we hope the Samuel Institute of Complementary and Alternative Medicine will do that for us.
Dr. Seffinger: So when the fund began, they must have started funding projects back since 1964, early 70’s- we don’t know. But is there a record of the products of this fund?
Dr. Passy: I have records from 1984.
Dr. Seffinger: …from 1984 on. So, what kind of research projects- what attempts were made? What kinds of things have been learned? Is there any kind of focus?
Dr. Passy: we didn’t really learn anything because the research that we were funded was not really the research we were looking for.
Dr. Seffinger: Aha!
Dr. Passy: Most of the research was done by Dr. Stanley VanDeNort. For about four years he had the monies delegated to his department, to help promote the background of what we wanted to prove. All of the things that he gave us were really not that effective.
Dr. Seffinger: That’s about when I was a resident here and started working with him with...
Dr. Passy: I have projects of what that were submitted to us of what they did with that money.
Dr. Seffinger: We know about the somato-sensory evoked potentials and we were working on that, and Arnold Starr was working on some of this stuff as well. And that’s when I was introduced to this. So, I know there was somewhere...
Dr. Passy: I started on this in 1983 I think-sometime in there- the fall of 1982. And we really did not accomplish anything. We were spending these monies and nothing was coming back because all the research had been done, but it was not tended towards Osteopathic- physical musculoskeletal manipulation, to prove that it really helps the patients’ illness.
Dr. Seffinger: Or to even ask the question, of whether it does or not.
Dr. Passy: That is correct.
Dr. Seffinger: We don’t know how it works. What kind of projects would you like to – looking back at where you’ve been and looking at what the attempts have been- if you were to design a study that the 41st trust fund you feel, was really going after what would that study look like? Have you thought about that?
Dr. Passy: Well, I’m not much of a researcher. But if you’re asking me a question, that I could just pick out of the air and come up with some answers, I would say, “hey, how about coming and showing me that if I take a pill and you could tell me and show me scientifically that the pill is fixing the neuromuscular modality of that arm, so that it would be working better after I manipulated it, before and after I manipulated it” - then you could tell me that. But I’m not sure that you’ve got that pill. That’s the pill that I want to find, or the physical manipulation that I want to see.
Dr. Seffinger: So there has got to be some measure of a change in physiological function, before and after...
Dr. Passy: And not just hearsay, something scientific, that you can show.
Dr. Seffinger: Have you been paying attention much to what has been going on around the globe about manipulation?
Dr. Passy: I haven’t. No. I’m not much of a researcher.
Dr. Seffinger: These are things I have questioned and I have been looking at all the literature possible on the subject. So, I’ll be glad to share that with you at some point- and update you. I have actually tried to put it all together in a book, which I will get for you and bring to you so you can see what has been accomplished, to date and where we are going from here. I think it’s unique though, that the profession has set up this fund to begin, and ask the question. This is important. And I’m interested to know the response of who was interested in helping you out. …Well, people. We know Dr. Van DeNort was interested and he helped out a lot.
Dr. Passy: The person who really pushed it, the person who really wanted to answer that question more than anyone was Forrest Grunigen. He was the guy that made sure that this 41st trust was directed in the right way. He was on the Board. He was always making sure that I was on the right track in terms of getting this together. It was his need, his feeling that if you are gonna do anything, let’s get this done, then we can go into medicine- then we can get to where we are going. He wanted to make sure that this object was identified.
Dr. Seffinger: And he didn’t do manipulation, per say...?
Dr. Passy: Well, I think he did, initially. I’m not sure if he was doing it later in his years. Do you know if he was?
Dr. Steedman: I thought he did, early on.
Dr. Passy: yeah, I thought he did too.
Dr. Steedman: Connie Callas, by the way, is the name of the individual that got me into the Alumni Association. Connie Callace and Bob Dreibelbis were the two...
Dr. Seffinger: I’m finding that there is a lot of devotion to the concepts of osteopathic medicine and manipulation, by the people who are part of the merger and this whole change of opening the doors of the profession. They can do any kind of training, yet there was no interest in continuing with the profession- the AOA or anything like that- it was a definite decision to do some of this profession but not the other parts of this profession. In other words, not the politics of the profession, but the science of the profession. It seemed to me there was a clear-cut decision based on those two factors. One was, yeah, we believe in the science and the value of the healthcare potential, but we don’t like to be associated with it, politically.
Dr. Passy: You have to understand when the merger came about, there was an osteopathic theory and all of us- the ex-DO/DO’s- did this manipulative therapy and they were the ones doing it. But as we merged, a good portion of the people who were merging went into specialties. And in the specialties, they sort of eliminated a lot of the physical manipulation that they were ordinarily taught to do. And you sort of lost it in your practice. There are a few physicians though, who even in our community today- Richard Kammerman, who was doing physical therapy, manipulation up until he retired a little bit ago. And we may be able to talk to him, and see what his thoughts are in terms of proposing and moving ahead, and finding out what manipulative therapy does.
Dr. Seffinger: What about the relationship then with the AOA and COA/CMA-there was like a disconnect, it wasn’t related to this other theory of practice of medicine, right? It was like a political situation that was totally different.
Dr. Passy: I don’t think that it was so much political. I think it was the fact that they were all in one group and none in another group even though they practiced the same kind of medicine. You know, we’re going to be doing one kind of thing and you’re going to be supporting another group and not that they can’t merge, but I feel that there is a little animosity in that kind of thing where someone would be a member of the COA and AMA or CMA and I’m not sure if that could apply today. I don’t know.
Dr. Steedman: If I could just add one little thing. I don’t think that there was any doubt in at least 75 to 90 percent of the individuals in our class that learned manipulation that didn’t believe it really had a place. One of the things that the osteopath always did is they put hands on to their patients. Many of the specialists that were not osteopathic could frequently take a history and everything else and never put their hands on a patient to come up with a diagnosis. The other thing is that there were individuals that would come in and have bodily problems; postural problems based on the basis of the posture and how the posture would get out of line. We know today that if somebody has been doing one thing a long period of time, such as working on a computer or they have been in court as a court reporter, or everything else, they are having all kinds of problems related to the spinous process and there’s no doubt that the basics of manipulation help and so many of them today have been incorporated into physical therapy. The things that we initially were taught which was actually joint movement and everything else never started off initially - initially it was deep massage and then it was something called tapotement and tapotement was actually massaging and getting those muscles relaxed and then petrissage the same thing and petrissage was manipulating everything with your fingers and then there was a form of tapotement that was continual stimulation and these things did relax the muscles to take the spasm out of the muscles that were compressing the nerves and compressing vessels and we know that’s true today. All these athletes are out there and they get these muscle spasms and things. What do they do? They don’t have the time to go through all this, they get it sooner or later, but they block it with Lidocaine. The Russians use Brown’s Solution, which was procaine, a long period of time and they used that and injected these muscles, got them relaxed, got the circulation back, relieved some of the problems, the postural problems and then they would manipulate them to get these things back in place.
Dr. Passy: That’s what we need, we need to scientifically...
Dr. Steedman: Well, I understand that, but you know the physical therapists are using it all and they have the clinical knowledge of how these things really help even with thoracic outlet syndrome they have all these postural things they do and everything else. The nerve problems, one situation where you have a reflex sympathetic dystrophy of the arm, if these people are started early enough on physical therapy and blockade and everything else, they don’t lose finger tips and they don’t lose function of their arms and everything else. It’s their improvement I think this is why many individuals wanted to see it go on. Physicians got away from it because for what they would pay for a treatment on a patient and do manipulation in comparison to taking the written history and physical was nil. So they had a lot of patients coming in wanting manipulation and it became less and less because insurance companies stopped paying as much for it.
Dr. Passy: Did you apply it?
Dr. Steedman: I used this with my family. I went to other physicians when I had problems. There were many areas where this really benefited the patient. Where the controversy was, and some of the concerns of us on the West Coast in contrast to Kirksville, there were physicians that were convinced, and they might have been right, and they had cases to where they could manipulate patients for acute appendicitis and hopefully get the circulation coming from those nerves, those retroperitoneal nerves, intercostals nerves, that would help the patient treat appendicitis. Now that was a stretch. We were worried about that. If this got out there, there were going to be kids that would rupture, but it was definitely there as a potential. Today we’ve gone back to where they don’t often go in and take out their appendix of anyone who ruptures. Now they drain it. They use hot packs. They use other things and of course they have antibiotics and they use antibiotics. The reason that Andrew Taylor Still came up with the ideas of this profession is because the mortality was so high associated with its basic procedures. The pharmacopoeia was about five times what the PDR is now. Whenever you have a pharmacopoeia like that, that means nothing is working and that’s the reason why they started having a following because they didn’t give all these medications. They stopped bleeding, you know, blood money, and they went to manipulation on these people and more people survived because so many people were dying from the effects of the medication. So, I think this is why everybody is trying to see is there something and, of course, they went off a little on the deep end. They didn’t combine the two, but then in the modern times we came out here they found that combining the two medical situations was obvioiusly appropriate and everything else and osteopathic medicine. You end up with excellent PM&R programs that are there, the excellent physical therapy’s taken care of, after all traumas are there, after surgeries are there, and I think this is what counts. Not as many people will turn somebody and take their leg and cross it over to the other leg and push their shoulders the other way and give them a manipulation, but when it’s done right it’s unbelievably successful and the patients are so satisfied. You have to make sure what is causing the discomfort, that it’s not a cancer of the spine that’s sitting in there, that it’s not somebody that has a caudal, you know, a discontinuation and caudal stenosis, and spinal stenosis, but if it’s not there and other things are clean and a lot of x-rays are viewed a lot of people still pass it, and I think this is why they knew there was something there, there was no doubt that medicine got better after they stopped all the pharmacopoeias and everything inside and that was the time that people were dying from surgery because they still were becoming so infected and everything else.
Dr. Seffinger: Did you see manipulation used in other problems other than back pain or other musculoskeletal conditions while you are at L.A. County Osteopathic Hospital?
Dr. Steedman: Yes, I saw it tried, I saw it tried. I had a senior resident ahead of me, Dr. Richard Rains, an amazing individual. He was my senior. He was the third year resident when I became the first year resident and he had been seeing a patient at the old county hospital who they had tried absolutely everything on. The individual had multiple surgeries and he surely had something called an ileus and the ileus of the bowels just wasn’t starting, he was distending, he was still swallowing air, some of the other things that the M.D. physicians hadn’t really come up with, a nasogastric tube would have helped him a great deal, and then rectal flushes would have helped, but he couldn’t get things moving. This one day this physician had Dr. Reins touch this patient with tubes everywhere, took him out and put him on the gurney. He knew that he didn’t have cancer of the spine or anything else and he did all the massages, he did everything and finally he took and manipulated this individual a couple of times and with the second manipulation and with some of the interns that were going on rounds with the students were there, this guy starts passing all sorts of gas and everything else. Everything started. His bowel started going out and you know he did this. He didn’t go to a book. He didn’t try to show individuals, but, it was one of those things that the guy got better with this. An isolated incidence but many people tried that afterwards. And so, there is something there with the spine stimulation and everything else. Look what we use with TENS. You know transcutaneous electrical nerve stimulation. You know, we’re stimulating these people with all the pain and severe back aches and all the surgeries they’ve had, the disks and everything else and by stimulating the muscles which is a form of osteopathy they get better. You control that pain, you take that spasm out, and pretty soon they take away the distortion of the spine, but get somebody with a disk, they’re like this, and such pain and it spasms.
Dr. Passy: I’ll never forget when I was still in my senior year at medical school, I went to visit my cousin in Seattle and they took me to a place east of the mountains which is beyond the desert and we took the whole family. On the road, it was about an eight hour ride, so we stopped over night at some little hotel. My cousin was getting some pain, gastric pains and it was really hurting him. It was lasting two, three hours and he couldn’t handle it any more. And I didn’t know what to do. So, I just thought well hell, maybe I could sort of move that gas around a little bit so I put his buttocks up on the pillows and I very gently started to massage his belly and musculature. After about three to five minutes the flatus came out and his belly went down. He felt like a new man. But, I’m sure if he went to the emergency room someone would be giving him shots here and shots there, putting tubes down, yeah.
Dr. Steedman: See this, that’s manipulation as well. It wasn’t just to the spine, wasn’t just to the back and this is one of the reasons why these individuals wanted this money to go to research, to come up with an answer of why this has been so beneficial to some of the people. I feel guilty. I still use it. I use it with my wife at home. She’s a defibrillator and a pacemaker representative. She sparks all, day long in bed again. She has hips that kill her. Why, you keep giving her pills and that’s not going to help it, she’s in spasm. And I’ll work her back and do everything for her back and everything else. She’ll do the same thing for my neck and I teach her the way to do it. And I’ve done it for many, many people. And it does help, but as a cardiac surgeon I can’t really go make rounds on all my people and get in there and do manipulation, but it’s there and recently I had, I still have a bad neck problem. I’ve done everything to my neck and back. I’ve busted it multiple times trying to do those things that I couldn’t while I was going through medical school afterwards, getting bucked off of horses and flipping off a roof when I was diving into a pool and etc. So, I mean I really believe in this. There are times when my back goes into spasm and even when I’m doing thoracic cardiovascular surgery, my back would get so bad that I can hardly do that anastemosis on the back of the heart. And at the surgical conference at the American College of Surgeons they had a big display of a certain item that would help these spasms and it was essentially a massager, but also get warm on this thing. Whenever I get these spasms, it’s my thoracic spine which is partially fused now from all these accidents, I could get the nurse to come on up and massage my back for about 40 to 50 seconds. It would take the spasm out of the muscle and I could continue to work. If I had to take a muscle relaxant, like Robaxisal or something similar, I’d have to wait 30 to 40 minutes before it did anything.
Dr. Passy: We need to scientifically find out why...
Dr. Steedman: The nurses are continually massaging the back of surgeons to relax the muscles so that they can operate. And this is one of the reasons we want to know ‘why does it help us’, is it the same basis that Andrew Taylor Still had before, and there were books that came out after that, that discussed what happens when you use the deep massage, the manipulation and everything else and how you release the spurs and decrease…and these areas become fibrotic if you don’t do this. The muscles actually scar.
Dr. Seffinger: Yeah, I’ll share with you what I know about that. If you want to read those books and articles that’s what I’ve been focusing on for the last 20 years. When I came into the profession I was interested in the research aspects of it so I’ve been hanging around all the people who do research and picked up all their information, their helping me along this path, so I’ll be glad to share that with you as well. What do you think you could do then? Is this Forty-First Trust Fund also now ending in 20 years? Is it a different type of fund now that it’s not a 20 year fund? What happens now?
Dr. Passy: That fund that says the changing ended 20 years ago which was 1984. This new one has no ending. It’s going on and on and on as long as we have money in it. If I’m not mistaken we have about a million dollars in that fund of which the interest we prepare every year for research. Current market value $1,050,000 and that was in 1999.
Dr. Seffinger: Have you ever considered consulting with people who have this particular interest and set up a research program to get questions answered methodologically.
Dr. Passy: We’ve been trying to get people to come and take these research grants and do something with it for the last 20 years.
Dr. Seffinger: Those individuals that you have worked with aren’t really specialists in that particular field and there are people that are specialists in that field.
Dr. Passy: Well then, maybe you can help us. That’s why we have you and...
Dr. Seffinger: Maybe you can consult with those people to make this plan. That’s what I was doing, but maybe that’s what you need is to set up a research plan and what needs to be done first, second, third, and fourth to get the questions answered.