M.D.s and D.O.s Today

Steven Kamajian, DO, interviewed by Dr. Michael Seffinger, DO

at the Doral Resort Hotel at Palm Springs, CA
February 21, 2007

Dr. Seffinger: Dr. Kamajian, would you like to introduce yourself and tell us about how you got involved with the osteopathic profession.
Dr. Kamajian: My name is Steven Kamajian. I graduated from the Philadelphia College of Osteopathic Medicine in 1978, started at Philadelphia in 1974. My older brother was two classes ahead of me at PCOM and that is how I got introduced into the osteopathic profession. I had never seen a DO or met a DO until my brother got involved with the process and became involved with the medical school, but the college I attended, St. Josephs University was all of two miles away from PCOM and I spent a lot of time on the campus as a college student. I was born in Waco, Texas. My date of birth was May 6, 1952. My father was in the army-air force at the time and he traveled a bit. I ended up in Philadelphia, educated again in public schools in the Philadelphia suburbs, went to St. Josephs University down the street from PCOM and then went to PCOM. I did my internship at Zieger-Botsford in Farmington Hills, Michigan. It was originally Zieger Osteopathic Hospital in Detroit and as the neighborhood in Detroit became depopulated they purchased land in the western suburbs of the city and built in Farmington Hills, Michigan Botsford Hospital. About ten years later Zieger closed and I was one of the last classes that were trained at both hospitals. I did my family practice residency at Metropolitan Hospital in Philadelphia and after the family practice residency; I did an additional year in geriatrics which was basically an MD hospital, but with Metropolitan as my sponsoring hospital.
Dr. Seffinger: About what year was that?
Dr. Kamajian: I finished in 1981 and came to California without a license in July, 1981. The licensing exams were two weeks or three weeks after I arrived. I originally came out here and went straight to COMP because that is where they had the pre-exam refresher courses. Now all of us in Philadelphia that went to California for licensing, basically all we had to do was, since we had the National Boards and the Pennsylvania license, was pass the manipulation exam. The director of the OMT department, which is what it was called in those days, was Nicholas Nicholas, D.O. in Philadelphia. We were all apprehensive about Viola Frymann, D.O.. I am quoting a rather off colored comment, but I remember asking Dr. Nicholas before I left Philadelphia, because we went back to Philadelphia. I went from Metropolitan Hospital back to PCOM and said, “Listen I need some help even though we had a manipulation department at Metropolitan Hospital I said, “They are going to ask us cranial manipulation and I don’t know anything about cranial manipulation. So I asked Nicholas Nicholas and I--
Dr. Seffinger: Because Dr. Frymann was on the licensing board or something?
Dr. Kamajian: She was on the licensing board and apparently there--
Dr. Seffinger: or tested?
Dr. Kamajian: She was doing the oral exams.
Dr. Seffinger: Oral exams. Okay. So she was one of the doctors giving the oral exams for doctors coming into the state to get their licensing.
Dr. Kamajian: Right and several of my contemporaries from Pennsylvania had come to California, ran into Dr. Frymann and had grief. So on their advice I went to Philadelphia, talked to Nicholas Nicholas. I said, “Dr. Nicholas, what should I do if anybody asks me about cranial manipulation?”
Dr. Seffinger: Because that was her specialty.
Dr. Kamajian: That was her specialty and Dr. Nicholas in direct quotes said, “Whoever asks you any questions about cranial manipulation, tell them to get f----d and call me.” And that was a direct quote which I didn’t think was going to work so I took the refresher course instead, ha, ha, ha. And Dr. Ethan Allen and there was another Dr. Allen and I can’t remember his first name. He was part of the faculty teaching this refresher course at the then newly established COMP. While I was at COMP I ran into Earl Gabriel, D.O.. Earl Gabriel had been a family practitioner in Allentown, Pennsylvania and I had done a family practice rotation with him as a third year medical student, so I knew him prior to coming to California. So I saw Dr. Gabriel you know we were good buddies as student and attending could be. I used to tease Dr. Gabriel even back in Allentown that he had the prettiest wife in the world and he didn’t deserve her so he remembered that. Anyway to make a long story short, about three weeks later I was living in San Diego. I had rented an apartment in San Diego on Pacific Beach at the Oakwood apartments in Pacific Beach. I didn’t have a license and I was rapidly running out of money. I took the licensing exams and I was still hanging around San Diego when I got a phone call from Earl Gabriel and he said, “Steve, come up to Pomona, we have an emergency.” I drove back up from San Diego one morning to Pomona and with Dr. Gabriel who was working on Gary Avenue at the school clinic at the time. They had hired a rheumatologist from South Jersey who had worked at COMP for maybe four months or five month and about the third week of July of 1981 he had a heart attack. They didn’t have any clinicians. They didn’t have anybody to do the work. And Earl said, “We need a family practice guy here now.” He knew I was board certified in family practice. I had been board certified in 1980 before I finished my fellowship in Geriatrics. So Earl knew that I had this extra training and he said, “Can you come up and work our clinic for me?” I said, “I can’t because I don’t have a license.” He said, “Well, you took the test last week, I’ll call Sacramento, make sure they issue a hand certification and we will give you an emergency malpractice insurance and an emergency medical license.” So, he brought in O.J. Bailes and O. J. Bailes and him got on the phone in my presence and called somebody in Sacramento.
Dr. Seffinger: Who was O. J. Bailes?
Dr. Kamajian: O. J. Bailes was the Dean at COMP at the time. He was a man in his 50s that had practiced in rural West Virginia and I’m not sure that this guy had ever physically been in a hospital in his life. But O. J. called up with Earl to Sacramento to somebody, probably Matt Weyuker. I don’t know where the paperwork...
Dr. Seffinger: It would be the licensing board.
Dr. Kamajian: I’m not sure that they were that distinctly separated at that point. But he called somebody. I got a temporary license and I was living in Pacific Beach in San Diego and commuting to Pomona everyday. I did that for about a month and I then tended my resignation. At which point Dr. Bailes told me that if I resigned they were going to pull my license, and I would have to wait three or four more months before I could get an active license because it would somehow or other get lost. So I ended up being stuck at COMP. Now, what happened is my older brother got married on October 7th of that year, so I figured okay I’ll stay there through October 7th, through George’s wedding because he got married in Boston And I said, I’ll go back to Boston and come back out and by then I’ll have my license. Well, I went out and the license still wasn’t available. They said, “Well, you’ll have to wait until the end of October to get the license.” And finally the end of October rolled around and I finally get the license and by that point I had started doing some other work. You know working at COMP in those days was not that much of a challenge. We had a small clinical practice where we maybe would see 20 patients a day, community patients and medical students and the faculty at COMP. I started looking around Pomona; I originally was commuting up and down from San Diego; that was not tenable. I started looking around Pomona thinking where can I go. I did something which was probably totally irrational, but I had worked at Doctor’s Hospital in Montclair by that point, Ontario Community Hospital by that point and the little itty bitty Park Avenue Hospital which the school or somebody owned.
Dr. Seffinger: Dr. Eby.
Dr. Kamajian: Dr. Eby had lost it to Dr. Lee and I think Dr. Lee was operating it at that point. And I really couldn’t tolerate any of those hospitals after I had been in Pennsylvania. So what I did was I went to the MD family practice board directory and found that there was only one hospital in the area that had family practice residency program which was Glendale Adventist. So I didn’t want to live in Pomona and I couldn’t commute from San Diego so I went out to Glendale Adventist and said, “You know this is a nice hospital.”
Dr. Seffinger: You didn’t want to practice in San Diego?
Dr. Kamajian: I did want to practice in San Diego, but I didn’t have the money to make the transition in mid year. Nobody was hiring. You have to understand this was during Reagan’s administration. The economy was not good.
Dr. Seffinger: Ronald Reagan as governor?
Dr. Kamajian: No he was president at the time. The first year that he had taken over as president of the United States the economy tanked big time. So I was trolling for work. I was interviewing with virtually all the hospitals in San Diego, all the hospitals in Orange County. Nobody had financial assistance programs that were for family practitioners especially for DO family practitioners. I interviewed at hospitals from Chula Vista in San Diego County as far north as Ventura County Hospital up to Lancaster which is in Los Angeles County and then Riverside/San Bernardino. I was all over the place.
Dr. Seffinger: So you were asked to be interviewed or you applied?
Dr. Kamajian: I was going to every single hospital to see if I could get a financial package.
Dr. Seffinger: Oh, I see.
Dr. Kamajian: To help me start up or if they had practices for sale or doctors that were hiring. When I got to Glendale, here was a nice hospital with a family practice residency. And I thought okay as a bachelor I could live in Hollywood or in West Hollywood or somewhere where there is some action which Pomona didn’t have and work out of Glendale Adventist. Basically what I did was I rented an apartment. The Oakwood Apartments in San Diego was where I was. I rented the Oakwood Apartments on Barham Boulevard in Studio City area and that was a great place for a bachelor. In those days, that was an easy commute to anywhere I wanted to go. I could get from there to Pomona in 30 minutes against traffic. I started doing some rather creative things. I didn’t want to go to Doctor’s Hospital in Montclair on Saturdays and Sundays to make rounds. So when I admitted people I figured out, “Well, I’ll bring them to Glendale Adventist and put them in Glendale Adventist.” So I put them in my car and drove them to Glendale Adventist to admit them. Now I’m leaving out a strategic piece of information, about six months went by where I was trying to get on the staff of Glendale Adventist and the AOA actually wrote a letter to Glendale Adventist threatening to sue them because they wouldn’t give me an application. There was no method for a DO to apply for staff privileges at Glendale Adventist and the AOA wrote a very firm letter saying that if you are accepting Medicare dollars you have to give him at least an application. So I got the application, but when I get the application I get it from the hospital attorney and the hospital administrator, I think his name was Vern Roth and what they asked me to do when they gave me the application, they said, “You know, you can have the application, but you cannot apply with your current name. You have to change your last name if you are going to apply for the staff of this hospital.”
Dr. Seffinger: Really!
Dr. Kamajian: “We don’t let people like you on the staff.” This is a direct quote. This is in 1981.
Dr. Seffinger: Now, this was the lawyer that said that?
Dr. Kamajian: The hospital administrator.
Dr. Seffinger: or the hospital administrator? This was 1981?
Dr. Kamajian: This was in the fall of ’81 probably November or December.
Dr. Seffinger: Your last name is spelled?
Dr. Kamajian: K-a-m-a-j-i-a-n
Dr. Seffinger: And they saw that and that told them something.
Dr. Kamajian: It is too ethnic, we don’t--
Dr. Seffinger: Too ethnic. Did they want Smith or something or?
Dr. Kamajian: Smith or Jones or Johnson or something like that.
Dr. Seffinger: Really.
Dr. Kamajian: and I was too stupid at the time. I probably should have started a lawsuit on that one. But they actually gave me a change of name document.
Dr. Seffinger: Wow!
Dr. Kamajian: That’s how convinced that this is something I should do. They gave me this thing I guess they got it from some standard document center of some sort, but it was a—I said, “Are you asking me to create a fictitious business name” because I thought that was what they were originally telling me to do. But they said, “No, we want you to change your last name if you are going to work here.”
Dr. Seffinger: So it didn’t bother them that you were a DO?
Dr. Kamajian: Well, it bothered them a lot, but they didn’t want to get their Medicare funding cut off because the AOA had threatened to sue them. I couldn’t get the application until the AOA sent them a letter.
Dr. Seffinger: So they were willing to accept the application from a DO, but not a DO with that last name.
Dr. Kamajian: With that last name.
Dr. Seffinger: To them it said some kind of ethnic background. Did they know what your ethnic background was?
Dr. Kamajian: In those days no, because there were no Armenians in Glendale in those days. In fact there weren’t hardly any Armenians in that part of L.A. County. Anyway, the paradox to that if you flash forward to 2007 is that today I’m Chief of Staff of the hospital there and 30% of the communities are Armenian, ha, ha, ha. It’s not because of me. But anyway so we are somewhere in August of 1981, Dr. Gabriel had gotten me working in the clinic I was teaching the medical students at that time, third year and fourth year medical students seeing the sick medical students, their family members and the sick faculty members and the sick administrative staff members so I gradually got to know everybody in the medical school community as their doctor. Now about October of 1981 John Covington came out from Philadelphia. John Covington had been a, if I’m not mistaken, a Vietnam War Veteran and a practicing clinician in the Philadelphia area for probably about 18 or 20 years. Philadelphia was hit horribly hard by the first couple of years of Mr. Reagan’s administration. The economy in Philadelphia tanked catastrophically and John like a lot of physicians at that point were looking for alternative ways of conducting their life and he came out to California and was hired as the Director of Out-patient Clinics. I was working in the clinic as the only single doctor in the clinics so he immediate became both my partner in the clinic and my boss. He reported directly to O. J. Bailes and Dr. Bailes reported directly to Dr. Pumerantz. I was operating without a contract. I was operating as basically a per diem basis here. Dr. Covington came out and said, “You have to have a contract.” I said, “Well, I don’t really want to stay here.” He says, “Well look, you are going to earn good money. Do something else on the side. Stay here. Do the morning shift here. Go do the afternoon shifts somewhere else.” He said, “I don’t like waking up in the morning.” So I would get to the clinic at 8:00 or 9:00 o’clock every morning and see patients until noon then go off to Doctors Hospital in Montclair; make rounds; come back and maybe one or two days a week stay until 3:00 or 4:00 in the afternoon and the rest of the time I would take off and go someplace else. Well the first someplace else I went was right after I came back from my brother’s wedding in October, I went to work for a guy by the name of Jerry Boyajian. Jerry had an office practice in the Silver Lake section of Los Angeles on Sunset Blvd. Jerry was a man in his late 60’s at the time who was a DO that had surrendered his license and became an MD.
Dr. Seffinger: How do you spell his name?
Dr. Kamajian: B-o-y-a-j-i-a-n. In fact he is still alive, but he has dementia now. It wouldn’t be too profitable in interviewing him. But Jerry had established a practice in the Silver Lake area in the late 1940’s early 1950’s and he was one of those fellows that was the last of the old fashioned family practitioners who still did cholecystectomies, you know, did D&Cs, did tonsillectomies, he spent a lot of time in operating rooms, in fact as he became older he became notorious for operating an enormous abortion mill in his office. He would do 18 to 20 abortions every week in his office in addition to doing the surgical work at the hospitals. But he was a man who really considered as he used to say, seeing blood as part of the medical profession. He wasn’t happy with just pharmaceutical treatments. But Jerry was an older fellow that was still very active in three hospitals, Hollywood Presbyterian, Hollywood Community and Glendale Community Hospital. Now Glendale Community Hospital was the old DO hospital in Glendale and somewhere in about 1978, ‘79 during the time period when COMP was getting started the DOs that were residual DOs, the left over DOs in the Glendale community tried to give Glendale Community Hospital to COMP. Now the kicker was that Glendale Community Hospital had rebuilt in the 1970’s so it was basically a brand new facility occupying at Chevy Chase and Adams in Glendale one full square city block, but in addition to that city block that the hospital sat on there was a second paved city block that was a parking lot and a third square block of apartment buildings that used to have been the nurses and interns apartments which the hospital had been renting out. Because they had borrowed money from the federal government in the 1970s to rebuild the hospital and this was 78’, 79’ the hospital wanted to give their entire estate to the DO school, but something somewhere along the line Dr. Pumerantz and whoever was reviewing it at the time said, “We don’t want this.” So the only other hospital in the community that was a non profit that was willing to take it over, Glendale Community Hospital is what it was called, Glendale Memorial would not take it over because they did not want to have anything to do with DOs. Glendale Adventist took it over. Well Glendale Adventist shrewdly absorbed for about 2-1/2 million dollars three square blocks of property eliminated their competition in one of the four hospitals that were in the city, sold the real estate, sold the apartment building complexes and sold the parking lot to Glendale Community College. It became the south campus of Glendale Community College. So the hospital ended up making more money liquidating the real estate by far than the debt that they accrued and they converted Glendale Community Hospital over the next two or three year time period from acute/medical/surgical/obstetrics to a specialty hospital. They converted it into an alcohol, drug and psych rehabilitation facility. So Jerry Boyajian was still working; he was sort of the tail end of the last medical/surgical physicians working there. When Glendale Community got absorbed, all the doctors that were on the staff of Glendale Community de facto that grandfathered into Glendale Adventist as clinicians. So I got there just while this transition was taking place and some very bizarre things started happening. One of the bizarre things is the doctors at Glendale Adventist had a closed shop and they were not accepting young doctors in the community period. So here I show up for my first medical staff interview. They knew I had threatened to sue the hospital to get the application. They knew I refused to change my last name. My medical staff interview was conducted by a couple of people, one of which was a DO who had become an MD, General Surgeon, I can’t remember his name. He used to wear a bolo tie. He was the General Surgeon at South Glendale and two other MDs, so my formal interview was in about January of ’82 or December of ’81. I’m not sure exactly, before or after Christmas. The first question they asked me during the interview was could I speak English.
Dr. Seffinger: Oh my goodness.
Dr. Kamajian: The second question they asked me is was I on welfare. I said, “What do you mean by that?” They said, “Are you receiving your welfare checks yet?” And I said, “Why?” They said, “If you come into this community, we guarantee you that we are going to put you on welfare.” That was my formal interview at Glendale Adventist and it got much more hostile after that. One of them said to me, “Well, we see that you even lied on your application, you said you were born in Waco, Texas.” I said, “What do you mean I lied on my application.” They said, “Well you know nobody’s born in Waco, Texas.” I said, “Well, if somebody is going to be lying about something they are not going to pick Waco, you know they might pick New York City they may pick Chicago, but I was born on an Army Air Force base and I was delivered by an officer in the army.” Well they said, “You are going to have to give us your birth certificate.” I said, “That is not part of the standard applications here.” The interview got very nasty. To make a long story short, I worked with Jerry Boyajian, M.D. for one year in his office and did his hospital work with him, basically at Glendale Community Hospital rarely at the big hospital at Glendale Adventist but being on Glendale Community gave me privileges at Glendale Adventist which is two miles physically distant. I left Jerry Boyajian and continued to work at COMP. And now we are into probably the spring or May or so of 1982—
Dr. Seffinger: So these guys after the interview, did they finally—
Dr. Kamajian: They couldn’t block it
Dr. Seffinger: They couldn’t.
Dr. Kamajian: The reason they couldn’t block it was when they went through the training documentation that I submitted, remember I said that I did a year at MD institutions in Philadelphia? Well they said, “We don’t accept your pediatric training. It’s signed by the Director of Children’s Hospital in Philadelphia. We won’t accept your neurology training; well that’s University of Pennsylvania. We won’t accept your orthopedic training, that’s Thomas Jefferson University.” I went through all these things. They said, “We can’t accept your training” and I said, “Why not? They’re MD institutions.” They said, “Well, how can you be trained by DOs then?” “Well, I actually have a sponsoring hospital.” They said “Well that’s not good enough.” Well in those days the DO family practice residency was one year, so I did a rotating internship and a one year family practice residency. Then I became certified in Family Practice and then I did the one year extra in geriatrics. They said, “We don’t recognize your family practice residency training as Board Equivalent.” I said, “Well, it doesn’t matter I’m Board certified by a Board that the Medicare recognizes as a certifying entity and that the fact is that extra year that I did in geriatrics would make me equivalent into a three year program internship residency in geriatrics; that would make me the equivalent of anybody that you could graduate from your programs.” So I argued and argued and argued. Anyway to make a long story short, because of I think initially being isolated with Jerry at Glendale Community and Jerry having enough clout to say, “Listen I need coverage down here,” got me on the staff at the Community Hospital and then I sort-of piggy-backed into Glendale Adventist. Now here we are in this very odd situation where I leave Jerry now; for the next six years while I was on the staff at Glendale Adventist no one would take call for me or with me. There weren’t any other DOs there. There wasn’t anyone else who wanted to be associated with me. If I would refer someone to an oncologist -- I remember Jerry Wada, M.D., this is a classic story. Jerry Wada was an oncologist that I would refer patients to because he was the only oncology group. He would tell the patients, you can’t continue being in this community if you don’t pick a real doctor. You can’t work with a DO. We don’t like it. Now here you have an attending accepting a consult telling the patients they have to switch the attending physician. Now flash forward twenty-five years later Jerry Wada who is in his twilight of his practice life picks Boris Bagdassarian as his colleague who is a DO, an Armenian DO at that.
Dr. Seffinger: How do you spell that?
Dr. Kamajian: Boris B-a-g-d-a-s-s-a-r-i-a-n.
Dr. Seffinger: So he came around. It took him a quarter of a century.
Dr. Kamajian: It took him a quarter of a century. Anyway so we are in 1981 the hospital started having some problems. They had decided to open up an alcohol and drug rehabilitation center at Glendale Adventist and Chevy Case campus and they wanted it to fail. The politics were that if they could get it to fail. I was still working at COMP and I get called in by O. J. Bailes. O. J. tells me, “I want you to apply for staff membership at Arcadia Methodist Hospital.” He knew that I had got on the staff of Glendale Adventist. He says, “I want you on staff at Arcadia Methodist.” And I said, “Why is that?” He says, “Well there is one of the students here in a second year class whose family lives in Arcadia and they want to set him up in practice in Arcadia, but they don’t want him to be the test case they want you to be the test case.” That took almost two years to get on the staff of Arcadia Methodist, but I ended up bopping and weaving a little bit here because what ended up happening was after I left Jerry Borajian and I kept my privileges at Glendale Adventist, but I didn’t know what the hell I was going to do next. I didn’t want to stay in Pomona. There were very clear reasons why I didn’t want to stay in Pomona. Dr. Pumerantz had made very graphic and public statements to everybody, politicians, anybody that would listen, that he intended to have a medical school in Pomona where a 100% of the employees were graduates of the school and I was not a graduate of his school.
Dr. Seffinger: So you found out that Dr. Pumerantz --
Dr. Kamajian: was not going to be encouraging people that were non-COMP alumni for long term careers at the college. Meanwhile, as I mentioned earlier, I was very close with Earl Gabriel and Earl had his own internal political issues that were going on at the school. Jerry Bailes and I were having some significant problems. Dr. Bailes actually sent me a memo saying that he did not want me to teach certain things. He did not want me to order certain tests and I had a series of confrontational meetings with him. His basic argument was that he was trying to create clinicians that could diagnose patients the way he did without diagnostic tests. He said, “I don’t want you to order another echocardiogram on a patient, I don’t want you –” He said, “You have to make these diagnoses with a stethoscope.” And I said, “Dr. Bailes, that’s now how medicine is practiced in urban America.” I said “There is no reason for me to practice that way.” So Dr. Bailes and I were sort of at logger heads with Dr. Covington acting as a buffer between us and Dr. Covington would always say to me, “Steve, you are 29 years old, chill out, and don’t take things so seriously. This is the nature of politics when you are in an organization. There is always going to be somebody at the top that’s fighting the civil war when you are fighting another war. You’ve got to let them retire or wait until they learn.” He says, “You know, let them say anything then do whatever you feel like,” which left some very peculiar meetings. But that’s where we were clinically. So I was still working at Pomona during the day, Dr. Covington was at that point desperately trying to figure out clinical rotations for students because we are graduating students, but we had no place to send them for clinical rotations in their third and fourth year. In those days there weren’t that many DOs in California. There were hardly any MDs that would take them on rotations, nobody owed any family practitioners or anybody any favors and they wouldn’t take kids on clinical services. So what they were trying to do was buy a hospital or buy access to hospitals outside of Doctor’s Hospital and Ontario Community Hospital and the little, itty, bitty Park Avenue Hospital in Pomona. And things came up. One day Dr. Covington said, “A lady donated 12 acres of land at Dana Point to the school, if we would move the school down there.” Well, of course we didn’t move down there. I don’t what ever happened to that land. I don’t know if they even secured the land. But I know there was a lot of conversation about the land in Dana Point. There was a DO, Bryn Henderson who was practicing in Orange County. Bryn called me up one day after I left Jerry Boyajian and said, “Look, there is a guy by the name of George Santoro, M.D. in Fountain Valley and George was a man at that point about 61 years old, a family practitioner who was an MD/former DO who had actually did his internship at Glendale Community Hospital with Dr. Malteras, one of these preceptors. So we all go through this enormous loop and Bryn calls me up and says, “Look, this guy Santoro has had a heart attack. He needs someone to help him in his practice. He wants to sell his practice and retire. Why don’t you come down here, work with him, in a year he’s going to retire.” So I changed directions. I still kept the privileges at Glendale Adventist; stopped admitting there and started working with George Santoro in Fountain Valley. I would get up in the morning, leave the Barham Boulevard Oakwood Apartments, drive from Pomona, from Pomona to Doctor’s Hospital in Montclair, from Doctor’s Hospital in Montclair to Fountain Valley Community Hospital and from there back up to Glendale at night, maybe once in awhile still covering for Boyajian and seeing his patients in the hospital. So I made this enormous triangular drive every day. Well while I was with Santoro, Fountain Valley’s Hospital board decides that they wanted to go into affiliation with COMP. They are going to donate three medical buildings, the hospital, the medical/office buildings and a five acre parcel of land behind the hospital to COMP if COMP would move from Pomona to Fountain Valley. But the catch was the president of the board of Fountain Valley Hospital wanted to be listed as a co-equal with Dr. Pumerantz, and that terminated the deal. Meanwhile, Covington was going nuts because this was the sweetheart deal he was looking for. He wanted to do something where he could have a good hospital, and a good location, and really, they hadn’t spent that much money on buildings in Pomona yet; this is an opportunity to get out of Pomona before there were too much investments. But the comments that Covington gave to me was that basically Dr. Pumerantz nixed the deal on two levels; basically number one, he wanted no co-equals and number two, the line that Covington quoted me was that Dr. Pumerantz, and this is hearsay, I didn’t hear this myself, that Dr. Pumerantz said that in Pomona nobody wants my job, but in Fountain Valley everybody in the world would want my job, in Dana Point everybody in the universe would want my job, so we stayed at Pomona. Meanwhile, these opportunities were coming and going and there was I believe if I remember correctly, the Horowitz family was in Los Angeles –
Dr. Seffinger: Right.
Dr. Kamajian: The Horowitz family had a small hospital in Watts that came up for sale and they negotiated and negotiated, I think we are a couple of years ahead of the story, but at some point Dr. Covington had made all the negotiations and had sat down and negotiated to purchase the hospital for COMP, at the last minute Pumerantz backed out and Dr. Covington bought the hospital. He managed to operate it for a period of about eight months to a year-and-a-half and lost his shirt and later went to work for the California prison authority and died rather young. Anyway, I don’t know where we are in these stories, but I’m kind of rambling here.
Dr. Seffinger: Yes, you were in 1982, you were going year by year. You’ve talked about some of the challenges you’ve had. You’ve talked about some of the failures and some of the successes, so we’ve covered some of the things that we wanted to. You had some goals in mind of developing a practice and did you eventually develop a practice that you were satisfied with?
Dr. Kamajian: Well the interesting thing is that Glendale Adventist had some internal fights. They were converting the Chevy Chase campus into an alcohol and drug rehab unit. Everybody in the hospital was fighting over who would get it, but the hospital administrators had decided they wanted it to be a failure. So they basically gave me a call one day and they said, “Steve we have decided that you are going to be the medical director of our alcohol and drug rehab unit.” And I knew absolutely nothing about alcohol and drug rehabilitation and to make matters worse they said we are giving you in charge of the adolescent and the adult unit. I knew absolutely nothing about adolescent alcohol and drug rehabilitation. But in those days insurance companies paid in full for long periods of stays in hospitals. My understanding was that they were expecting me to go in there, have the thing fold, but we developed a series of business strategies which were very innovative. The corporation that ran it was called the Care Unit Corporation which was a big chain. I helped them to develop what was then called the Care Unit Hair Dryer. Are you familiar with that?
Dr. Seffinger: No.
Dr. Kamajian: They couldn’t figure how to market these damn alcohol and drug rehab units. So I sat down with there marketing people one day and said, “Well, who do you talk to about your problems.” Well the most common person people talk to is your bartender. Well, no bartenders going to want you to be sober. So the other person people talk to is their hair dresser. Well it’s illegal for a doctor to refer a patient to any place in a hospital and get a kickback for that referral, but it’s not illegal for a hairdresser to make a referral. So we made up these hair dryers that said, “Care Unit hair dryers.” So we gave it to every beauty salon in the city of L. A. with an 800 number on it. People were there, my husbands a drunk, my kids are drunk, I have all these problems, you know, when you get touched it is the miracle of being a DO is when you touch people they talk, when a hair dresser touches somebody they talk. And we were getting all these referrals from hair dressers and our Unit took off and we started making a lot of money and so I was working at COMP, so when I took this contract with Glendale Adventist, I signed it in the name of COMP. So the money I was billing for went to COMP. But just like everything else COMP screwed up. In the four year time period that I worked full time for COMP, three of the four years, a 100% of the clinical billing, hospital, nursing home, and care unit was never billed. This had an enormous impact on me because one of the years I signed a contract I was supposed to get paid a percentage of the care unit work and a percentage of the clinic work. They never billed. And then when they finally did bill they assigned the family practice residency – to the family practice clinic they assigned the entire anatomy department. So Dr. Bailes said, “Oh yeah, we agreed to give you a percentage but you didn’t define what your overhead was.” So they gave everybody a clinical appointment. If you notice all the academic faculty at COMP has a clinical appointment, well a large reason for that is they were channeling all their salaries to the outpatient clinics. So they were having the clinics support those departments. Anyway those are other stories in screw-ups. But COMP blew so much billable income in the days when it was fee for service billing that it was tragic, absolutely horrendously tragic. There was a microbiologist and I can’t remember his name, but they made his wife the director of billing for the clinics. She had no experience even in medical terminology, let alone billing.
Dr. Seffinger: Do you think there was a trust issue about getting other professionals to come in to run their finances?
Dr. Kamajian: COMP from the top to the bottom in those days was a 100% amateur hour. There was not a single person at COMP in any job anywhere that held a similar job anywhere else in his life whether it was Dr. Pumerantz, or Dr. Bailes, or Dr. Gabriel or Dr. Covington. You work your way through all the secretarial staff to the library staff not a single person had ever held a similar position.
Dr. Seffinger: Why do you think so?
Dr. Kamajian: I can give you several theories. If the person at the top is the most amateurish doing on-the-job-training, he sure the heck doesn’t want anybody else to look better than him. Dr. Pumerantz really didn’t know what he was doing. He learned as he went along. Dr. Bailes sure the hell didn’t know what he was doing. Dr. Gabriel knew what he was doing, but nobody listened to him.
Dr. Seffinger: Do you think it had to do with the political and social economic environment in terms of people being prejudiced against DOs and they’re not sure who to trust. They were only taking people that were related or family members or friends or people they could rely on and those people just had to learn how to do the job because they seemed to trust that they were reliable and faithful.
Dr. Kamajian: That’s a good theory. I hadn’t heard that before. My personal theory on it was that we were dealing with personal insecurities. I really thought that a lot of these people really didn’t want anybody to look over their shoulders that knew what they were doing. I sure the hell didn’t have the experience in clinical management or in program development. But I had constant conflict with Dr. Bailes. Dr. Pumerantz at one point called me into his office and told me that 100% of the moon lighting work I was doing had to be turned over to COMP. And I told him no, I was paying for separate part-time malpractice policy. I said, “It had nothing to do with the school.” We had conflict over those issues. I can’t say that Dr. Pumerantz was ever mean to me, but he was very firm in his opinions and we disagreed. I disagreed with Dr. Bailes on almost anything clinically. I disagreed horrendously with Dr. Frymann. When I first went to COMP and I sat in on her lectures I remember sitting in the back of her class as she was giving a lecture at one time. At the end of the lecture I walked up to her and I said, “Dr. Frymann do you have any double blind studies on anything you just said, because you presented all as factual.” And Dr. Frymann’s response to me was, “God is neither blind singly or doubly.” And I said, “Dr. Frymann, what does that have to do with what we are talking about?” And she walked away. I had no clue what some of the people that were on the faculty were thinking or doing. Dr. Eby was having conflict with Dr. Lee because he had signed over his hospitals and expected them to be given to COMP and basically he was angry that they were not. There were several other young and older DOs in the community that were at each others throats. There were problems getting political bang for the buck in the places that we were strong, like Doctor’s Hospital in Montclair and Ontario Community Hospital. We just were not getting the bang for the buck that we should have been getting because we were not cooperating with each other. And people were coming from horrendous distances to work in some of these places. Nazareth Asorian, D.O. was the Chairman of Surgery at COMP. He was living in Long Beach. He was doing surgery in Ontario and Montclair. He was driving up from Long Beach to do emergency appendectomies. I was driving in from Studio City. Alan Menkes, D.O. was driving in from Apple Valley at the time. Nobody wanted to live in Pomona. Pomona Valley wouldn’t let us on the staff in those days if we were going to bring medical students and Pumerantz told us we were not allowed — I could get on the staff, but Pumerantz would not let me get on the staff with them paying the dime, if I couldn’t take medical students with me. So we had all these kind of bizarre things going on in this cauldron.
Dr. Seffinger: Now the Seventh Day Adventist’s asked you to run the Alcohol and Drug Rehab Unit, but you didn’t have experience doing that either?
Dr. Kamajian: No.
Dr. Seffinger: So were they functioning similar to the way COMP was functioning? Somebody didn’t want somebody who was knowledgeable or—you know, to take on a position that was outside of their organization to come into it.
Dr. Kamajian: It was very bizarre because what Glendale Adventist did by putting me there, is it eliminated the conflict between the people who were fighting for the position. There were some very powerful older physicians that wanted the job. This was a fee for service job where you could put someone in the hospital for three months and bill every day for three months. They assigned it to me and I neutralized the politics by assigning the billing to COMP.
Dr. Seffinger: And they were okay with that?
Dr. Kamajian: Everybody was okay with that because they saw I wasn’t profiting myself.
Dr. Seffinger: Wow!
Dr. Kamajian: And COMP screwed up by not doing the billing so everybody was - - but what –
Dr. Seffinger: Charity work.
Dr. Kamajian: It was worse than charity work because these were insured people with indemnity insurance that we were not billing.
Dr. Seffinger: Oh.
Dr. Kamajian: That had been very carefully screened by the financial handlers of the Care Unit Corporation.
Dr. Seffinger: Wow. Now how did you get involved with OPSC?
Dr. Kamajian: OPSC was embryonic in those days and Richard Eby and his wife, Maybelle and Maybelle’s mother and sister of Maybelle were all my patients and basically through Dr. Eby, who was sort of this perpetually happy guy that introduced me to the political end of the state situation. Earl Gabriel, D.O. was a good mentor too. John Covington, D.O. was also a good mentor, but, spun off. He left rapidly. He was warned by Dr. – oh what’s Michael’s father’s name? Michael in San Diego? His father was the Dean of PCOM. He was a former AOA president.
Dr. Seffinger: Feinstein?
Dr. Kamajian: Feinstein. Michael Feinstein, D.O.. Michael Feinstein’s father warned Covington that any conflict he had with Pumerantz, the AOA would not back him. The AOA supported COMP according to Earl Gabriel but it didn’t matter what happened at COMP, they were going to back COMP because they wanted a presence in California. They were not going to support any conflict at COMP, they were not going to listen to anybody at COMP, they wanted COMP to go forward no matter how we did it. So, I don’t know where we are with all this? I know that –
Dr. Seffinger: Well, I want to know how you got involved with OPSC and you got to actually be the managing editor of the state journal.
Dr. Kamajian: No that happened probably fifteen years later, or twenty years later.
Dr. Seffinger: So there must have been some lead up to that.
Dr. Kamajian: Well I was, when we had a, I think we used to call it S(U)BCOMA, San Bernardino County Osteopathic Medical Association; Los Angeles County Osteopathic Medical Association was called LACOMA. I got involved with those county meetings. I also attended all the OPSC meetings. I came to Palm Springs every year, I came to wherever it was, it used to be in Huntington Beach, or wherever it was we were having meetings for the fall conference and I went to all of them. And I knew Norm Vinn. Norm had also done his internship at Botsford and he went to PCOM. He was the class above me at PCOM and the class leaving Botsford when I was coming into Botsford. So I knew Norm from the Jurassic period of my life. And Norm would always meet me at these meetings and there were a couple younger fellows that were always like said “Steve, do something.” So I always tried to show up at meetings, I always talked to people, you know I was teaching at COMP, I knew all the students, you know the first four years of graduates, I knew all the students and I knew all the students that graduated four years later. There was that strategic time period, I knew all the students at COMP, that were just seeding the state. I was a good teacher.
Dr. Seffinger: What did you teach?
Dr. Kamajian: I was, for a time period, the only clinician in the outpatient clinics at COMP in family practice. And in those days, the family clinicians were responsible for teaching physical diagnosis so I was responsible for all of the history taking skills and physical diagnostic skills the students were learning. Which I’m very good at, I’m very good as a clinician.
Dr. Seffinger: Do you teach them how to apply OMT as well?
Dr. Kamajian: From the very beginning of my practice life, I’ve always used OMT. I employ OMT as a diagnostic tool, not just a treatment tool. And always encourage them to remember that it’s not just a treatment protocol. Also, by being the only clinician in your outpatient clinic, that knew anything about medicine because there was Lorane Dick probably didn’t know one prescription pharmaceutical from another, and a couple of other people, Dr. Clark, who were really good with manipulation but you wouldn’t trust them with a clinical diagnosis that had anything to do with non-musculoskeletal diseases. I took care of all the faculty and all the students and all their family members and all the politicians and all the board members and all the donors and all the donors that needed house calls and everybody else who needed house calls.
Dr. Seffinger: So you were the primary care physician for COMP?
Dr. Kamajian: Yeah.
Dr. Seffinger: And all those related to it?
Dr. Kamajian: And the interesting thing was, is that I also was the person everybody had sent to there were high school students and college students that needed letters of reference to go to COMP. So not only did I get to know the first four graduating classes and the classes that graduated the four years after that, but if you look at a lot of the people who went to COMP, I wrote their letter of reference. People are scattered all over the place.
Dr. Seffinger: So then OPSC and Norm Vinn recruited you to be involved with OPSC?
Dr. Kamajian: Right.
Dr. Seffinger: And when did you become managing editor of the DO Journal?
Dr. Kamajian: I really have to look that up. I honestly don’t remember the year. It would probably be-I honestly don’t remember. I have to go back and look.
Dr. Seffinger: Sometime in the 1990’s?
Dr. Kamajian: Yeah. Either in the late 1990’s. OPSC had gone through some harrowing time periods and I had in the meantime worked my way up to different organizations and worked my way up to become chairman of the family practice department at Glendale Adventist. I had started a series of free clinics for the homeless poor and the working poor in both LA and Ventura counties. I became very active in the free clinic programs in California. And through a series of extraordinary political efforts on dozens of organizational parts I had made arrangements to go up to Sacramento to help co-sponsor a bill through the free clinic association of California on indemnifying physicians who took care of people for free. At that point there were 17 states that had very sophisticated Good Samaritan laws that if you worked in chartered free clinics for free, you could never be sued. And the purpose of those indemnification entities that were through state law, was that most of our free clinics in California spend the vast majority of our cash budget on malpractice insurance, which we would rather spend on patient care. So we got this appointment with a series of committee chairs and I was actually a witness in the state senate under Bill Locklear in one of these meetings. Matt Weyuker was the OPSC’s executive director and I had contacted Matt verbally and in writing and he knew me from the days at COMP, this was in the 90’s. And I told him I was going to show up with the chairman of the board of the Adventist Corporation from Roseville. I was going to show up with the Bishop of the AME Church of California. I was going to show up – and I listed all these people. I said, “Matt can you get us at the airport? Send the limo, come yourself, we are going to the state senate as witnesses.” I called him multiple times. “Yes Steve, yes Steve. No problem.” I called him the day before I showed up, he never showed up. We ended up at the airport in Sacramento and having to take taxis into the city. He had supposedly set up meetings for me with the –every state senator and state congressman has a chief of staff in their office. Matt supposedly had set up meetings with the chief of staffs of the people who were going to be interviewing us in the senate hearings and he didn’t. I went nuts. I just, I actually physically went over to the OPSC office and nobody was there. Matt was not to be found. I finally found one person a week later who has since gone on to create a consulting business and she told nobody- Matt had not been in the office for six or seven months and was habitually lying to everybody at that point about what he was doing. So here I was finally you know, I got more involved after that. I just became very angry that we were paying somebody not to do anything. We were paying his wife not to do anything. And when we finally had an opportunity where we could have a presence, he wasn’t anywhere around. He might have been in Palm Springs at the time. And he was double dipping. He was a consultant for COMP and he was an executive director of the state association at the same time. Pumerantz was paying him and we were paying him. He wasn’t doing work for anybody.
Dr. Seffinger: How involved did you get? Did you become part of the board?
Dr. Kamajian: I became part of the board of OPSC. I became also very active. I became the president of CACOFP. I’ve been the president three times of ACOFP [American College of Osteopathic Family Physicians]. The California-
Dr. Seffinger: The California’s division of ACOFP.
Dr. Kamajian: The California division of ACOFP. I’m still on the board of ACOFP.
Dr. Seffinger: Were you president of OPSC.
Dr. Kamajian: Never the president of OPSC because what I was doing was I was moving my way up the Adventist corporate ladder.
Dr. Seffinger: Right.
Dr. Kamajian: Which has been a fifteen year track for me. And in addition to that I’m the president or chief executive of three separate free clinic corporations now. So I had these free public charities, I have the Adventist corporate track, and I have my own family practice over here. And in the intervening time periods I have started IPAs, I’ve sold IPAs, I’ve started medical groups, sold a medical group, got married, got divorced, had kids, and all the other things that people do in their life. And the end result is that it’s been a heck of an adventure.
Dr. Seffinger: How long were you managing editor of the California State Journal?
Dr. Kamajian: I think two or three years.
Dr. Seffinger: And did you do anything different with that when you got a hold of it?
Dr. Kamajian: My basic theory with that journal is a reflection of me as an individual. I’m a generalist and I get back to things that were more general. What are we doing? Why are we doing this? Why are we still here? What is the purpose of it? I had heard from too many of my former students, interns at Glendale Adventist, residents at Glendale Adventists, that they didn’t want to have anything to do with the DO profession any more. The DOs had never done anything for them, they were pissed off that they had spent two years of tuition for their third and fourth year of medical school and then had to set up their own clinical rotations. They were pissed off that there wasn’t any state employment entity like there was with LACMA [Los Angeles County Medical Association] or CMA [California Medical Association] where you could go and there was sanctity from work. The common theme was what are they doing for us? And my constant retort and my editorial retort to them was, “You can’t practice without us because your license wouldn’t be there. You have to work with us to protect your license because your license is a very fragile thing.” I’ve had two decades of conversations with senior DOs around the country and the basic presumption is that the DO profession at some point will cease to exist because we have stacked the cards against ourselves. There will be more DOs that have never been apprenticed to a DO in their life than there are DOs that have been apprenticed to a DO. The model that I was taught by was the model of an orchestra conductor. You can take all the orchestra conductors in the world and put them together and trace back who trained them, you come back to one conductor in the 1810 time period in Vienna. And I can’t remember the guy’s name, but all modern orchestra conductors learned basically as the sorcerer’s apprentice, one standing behind another. You have to have someone standing behind you to help show you how to move your baton. Somebody that corrects you, somebody that beats you over the head and says, “This is not how you do it.” Then you take that information, you internalize that art and you express it in a way that somebody else can experience. You make it personal. Being a DO involved taking the science of the osteopathic profession, the science of the allopathic profession, the science of physiology, all the other sciences of pharmacology, internalizing it and expressing it in such a manner that our patients experience something different. The basic thesis was that the patient should be able to feel the difference. Not just by us touching them, but by us being in the room with them. But the younger DOs have never been apprenticed under the sorcerer. So there is now a strategic mass of unconnected or disconnected DOs that really don’t give a damn. In fact, they’re indignant in many cases, that they paid twenty, thirty, forty thousand dollars a year in tuition and received nothing in exchange for it. And the dilemma ultimately becomes right now, when I was writing those editorials, is trying to communicate not just to the people that are in the choir, but to the people that might hear the song on the radio. That there’s something more to this.
Dr. Seffinger: I think you also talked with some of the DOs that became MDs as they were aging and had retired, and you got their impressions.
Dr. Kamajian: Yes, many.
Dr. Seffinger: And those were a little bit different than the impressions from the DOs , state DOs, that were from other states even, you have two different view points being expressed to from people that had been DOs in life, some of them became MDs.
Dr. Kamajian: You know it’s very fascinating, when I was in Philadelphia at PCOM, the Dean was Archie Feinstein. And Archie, above his desk in his office in Philadelphia had his California MD license, framed over the desk. He never practiced in California; he never surrendered his Pennsylvania license.
Dr. Seffinger: Well his MD license was not recognized in Pennsylvania, just for California.
Dr. Kamajian: It was more for decoration.
Dr. Seffinger: Yeah, and he had a DO license in Philadelphia.
Dr. Kamajian: You know here was the line that I received from the old guys, it’s that we get tired and our wives get tired, going to cocktail parties explaining who we were and what we did. We just got tired of it. And for those that didn’t want to do it, didn’t want to flip over, there was a herd mentality, well I’m the only one standing here like this anymore, and there was like 70 or 80, maybe 88 or I don’t know the exact number that didn’t surrender their license. But some of the others, like there was this psychiatrist I met in Woodland Hills, short little stocky Italian guy that was a great farmer, better farmer than psychiatrist, but he told me he had to give up his DO license to become an MD because he was the only guy in the community that was still a DO. Here was a psychiatrist that became insecure. It was like, have some balls guys, you know. But they get tired, their wives get tired, their wives probably push them in many cases, you know this is more prestigious. Don’t underestimate the power of that as an influence. All of the sudden, instead of being in the church explaining to everybody in the church who you are, well now you’re Dr. Kamajian, you know you’re an MD, very easy, you know. Everyone understands that. You don’t have to start your conversations every time you introduce yourself to somebody explaining who you are or what you do.
Dr. Seffinger: How did you reply to that?
Dr. Kamajian: I always believed in truth in advertising, because I didn’t become an MD, and I’m not an MD; I take great pride in being a DO. It’s led to some hilarious problems for me; I think I told you about my problem in late 1999. California switched a lot of their MediCal patients to an HMO model. And I was in Glendale at the time, and my office is in Montrose. Well I went to my office one day, and there had to be, easily, 30 or 40 angry Chinese-speaking people in my waiting room. And they all had come up from Monterey Park. And on their MediCal cards, they had been assigned to me. So I called Sacramento to find out “why were you assigning these people to my practice, it’s a long distance, it’s 40 miles.” They said, “Well we assigned it based upon three criteria. We assigned it basically number one on specialty, and there isn’t anybody in the San Gabriel Valley that’s a pediatrician that signed up for MediCal. So we’re sending all the people from the San Gabriel Valley with MediCal to family practitioners. So your family practitioner was sending families of pediatric patients to you.” “Well I accept the specialty issue, but what about the other two criteria’s?” “Well, the other one was geography, we looked at your city code, and MONT, you know, that’s Monterey Park.” I said “No, look at the zip code, Montrose is not Monterey Park.” You know they start with the first three letters, but look at the rest of the spelling here, I mean, what if I was at Monterey, California. These people are driving forty miles to my office practice. I said, “What’s the third criteria?” They said, “Well, we picked it based on ethnicity.” I said, “What’s the ethnicity?” “Well, we looked at your last name.” “And what was my last name?” “You’re Dr. Do.” And I said, “I’m doctor Do? That’s my degree, you idiots!” You know, I said “Who the hell would name their kid Kamajian Do? What kind of Chinese name is that?” They wouldn’t change it; I actually had to drop MediCal for a period of six months, because I was having people rioting at my office. They were driving up from Monterey Park, to Montrose, angry that I couldn’t speak Chinese, pissed off about the drive. And I was telling them, “Look, I’m not Chinese.” And that’s the state of California.
Dr. Seffinger: So, given all of this and your experiences are quite wide-ranging, what advice do you think you would like to share with future osteopathic and also future allopathic physicians, if any?
Dr. Kamajian: Well, I always get corny, and I wrote this in one of my editorials in the OPSC journal. And I alluded to it a little bit earlier. Medicine has to be the proverbial three-legged stool. Science, without science nothing’s valid. Business, even when I operate the free clinics, there are bills to pay. If you are doing missionary work, there are bills to pay. So there has to be a business component of what you’re doing, you can’t be just blindly assigning cost. You can’t order screening MRIs of breasts in place of mammographies. It’s fifteen hundred dollars a breast; it’s not a screen test. And the third thing is the art. Now art involves communication. If we’re interacting with our patients in a way that we are affectively communicating with them, we are communicating with the knowledge that becomes usable for the patient. As DOs we have a different capacity to provide a differential diagnosis to the patients. We have the differential diagnosis that most MDs have, the differential diagnosis that most chiropractors have, the differential diagnosis that even some philosophers have. We have very practical skills. There’s a term my sixteen-year-old daughter uses, which is popular with her classmates which I have never heard before; I’m just learning. When you think in the box, and you think outside of the box, we still are limited, because you recognize the box is there. Teenagers today use a term which is fascinating. They want to be unlimited. And the term that they use is ‘aboxic’. To not recognize the box exists is the ultimate manifestation of your ability to be creative. If Dr. Still, as an artist, presented anything for future generations, was the ability to suggest to us that we need to be ‘aboxic’, we need to be unlimited. Every single time I’ve ever been given a challenge or somebody looks at me, whether it’s Dr. Pumerantz in a business sense or anybody else in a clinical sense, they say “This can’t be done; that’s not how we do it. We don’t let people like you on the staff of this hospital; I’m the chief of staff now. We don’t do that this way, we’ve never done it this way, we can’t do it this way. We don’t take care of the poor in this community. We don’t take care of the homeless in this community.” I’ve got a pharmacy now that provides $25,000 a week in free pharmaceuticals. Well how do you get that? There’s ways to do it. If you think within the box, if you recognize the box is there, you’re in the box or out of the box, you’re not unlimited. If you’re ‘aboxic’, you’re unlimited. Our profession is an ‘aboxic’ profession. And it’s limited by our internal limits, our inability to communicate with each other and our unwillingness to have courage. There are certain things which we all have to have. And I’m going to sound stupid to you, but my basic rules in life is that you have to worship god, you have to be honest, and first and foremost you have to be honest to yourself. Third, as an adult, you have to have the ability to say no. You can’t say no, you’ll never get anywhere in life. And last but not least, you never enable other people. We’re such preoccupied being political sometimes that we don’t say no to people. We enable them to continue to be doing stupid things, because it’s hard to be harsh sometimes. I think the younger DOs have to have the ability to remember that Dr. Still in his life, was a very religious person. The ability to recognize that there’s something more than us. The ability to be honest and to be consistently honest in everything that we do, meticulously honest, especially to ourselves. The ability to say no, the ability not to enable. If we stick to that pattern, this profession is an ‘aboxic’ profession. If we are not honest to ourselves, or other people, if we don’t have the ability to say no, if we enable people to be putzes [idiots-ed.] and to make stupid mistakes, we run the risk of becoming a very ‘boxic’ profession, or an entombed profession even.
Dr. Seffinger: What about to MDs? Do you anything to recommend to MD students?
Dr. Kamajian: You know, to my MD students, to my MD residents, I always remind them that my primary clinical skills are in patient history taking and physical examination. But I have something to offer them, and DOs have something to offer them in a differential diagnosis, both from the meticulous redundancy in the way that we’re taught to do medical histories, and in our physical examination, including other things. And that we are a resource, that while rare, it’s still not something that they should pooh-pooh or ignore. There are times when there are clinical challenges where you need resources that are extraordinary. And DOs bring extraordinary resources to the table if they know what they are doing, if they had been the sorcerer’s apprentice. I don’t know if any of that makes sense to you.
Dr. Seffinger: Yeah, well you’d like them to learn it in medical school? Or just respect it and refer to DOs? Or..?
Dr. Kamajian: Either way. I think that clearly they cannot ignore the skill sets or the advantage to their patients.
Dr. Seffinger: Are there any documents that you have that you’d like us to include in this? Or that you know more there might be, or are there any people that we should contact? Do you know of any further resources for this project?
Dr. Kamajian: I think Earl Gabriel’s wife is still alive, but she hasn’t talked to anybody in years. And I’m sure if she’s still in their house, there must be thousands of tons of documents he has, because he was the former AOA president. And he was the first clinical dean at COMP and he knew a lot about everything. I think that John Covington’s wife probably has destroyed most of their documents. And I know that John’s files of COMP were destroyed. The documents that I have are personal to me. They’re financial documents, how I was screwed and stiffed by COMP multiple times. I have kept them for tax reasons, because there were lots of times where I had paid financially projected incomes for quarterly tax payments and never achieved them. They were off by logarithmic factors. So I had to request refunds from the IRS. I don’t know I have little to add other than what I have said.
Dr. Seffinger: Okay, is there anything else that you’d like to say while your thoughts are rolling?
Dr. Kamajian: Well, I’m worried about the osteopathic profession by continuing adding more medical schools. My biggest fear is that they’re doing what happened to Hurricane Katrina: if you keep putting water underneath the dam, sooner or later the dam bursts at the bottom not at the top, and undermines the foundation of the dam. What happened in Katrina, is when the tidal surges came up, they didn’t go over the top of the dams in New Orleans, because the dams had not been sufficiently reinforced, they went underneath the bottom of it, and the walls fell over. We’re undermining our profession profoundly and incompetently, for the sole purpose of generating tuition money. You’re ruining the fine art that will probably cease to exist in my lifetime. I think that if you talk to the people at the AOA that are honest, and their basic theme is “we want to keep it going; we don’t want it to end on our shift.” But it’s going to end. Thank you.
Dr. Seffinger: Thank you very much.