Sanford and Israel: Godfathers of East Texas cardiology

Published on Saturday, 26 July 2014 23:28 - Written by Will Knous Special to the Tyler Morning Telegraph

When they first moved to East Texas, Dr. Fagg Sanford and Dr. Noah Israel used to regularly cover for one another at Mother Frances Hospital, and not because they are good friends and colleagues.

They took turns walking the hospital halls because they were the only two cardiologists available in Tyler in 1983.

Now, after decades serving the cardiac patients of East Texas, they are joining forces again with an affiliation agreement between the Louis and Peaches Owen Heart Hospital at Trinity Mother Frances, where Sanford practices, and Cardiovascular Associates of East Texas, the group Israel founded.

“I still remember making my rounds while wearing my tuxedo on the Saturday morning of my wedding,” Dr. Sanford with a laugh. “Dr. Israel came and covered for me that day, and the week after so I could go on my honeymoon.”

Thirty years ago, the face of the medical community in Tyler was much different than it is today. What has blossomed into the city of Tyler’s Medical District would be nearly unrecognizable three decades ago, when Drs. Sanford and Israel first came to East Texas.

The towering concrete structures and the glass-covered facades reflecting the midday Texas sun on passersby below were nowhere to be seen. The East Texas medical community was present, prominent and in possession of a good reputation.

But at the time, and in the eyes of new Mother Frances Hospital administrators Lindsey Bradley and Ray Thompson, there was a glaring need on the horizon — a cardiology program.

“My wife and I were searching all over the United States for a place to live and work,” remembered Dr. Israel. “We were seeking a vibrant community with a feel of a city; a place that offered good schools, live theater, live orchestra and was within two hours of a large city. We sent out numerous letters throughout the U.S., to places that fit. One of the nicest letters we received in return was from Mother Frances Hospital.”

Dr. Sanford said, “I was an assistant professor of medicine in cardiology at Southwestern, but I’d made the decision to return to clinical practice, because I enjoyed patient care.

“I enjoyed some aspects of the academic world: building a program, working on ways to deliver better care. My supervisor at Southwestern at the time was from Tyler, and advised me to take a look — he’d heard a rumor that Mother Frances Hospital was considering putting together the area’s first heart program. There was a need for cardiac care in East Texas, and they wanted to build a program from the ground up.”

Dr. Israel was in training in Houston and was persuaded to make the trip north to meet with administrators. Around the same time, they invited Dr. Sanford from Dallas for the same purpose. The entire group had dinner together and hit it off.

“I met with the administrators first, and I thought it was a once-in-a-lifetime opportunity,” Dr. Sanford said. “We were at dinner, and they told me another cardiologist from the Northeast who had Texas roots (Israel’s wife is from East Texas) was considering the move as well.”

Dr. Israel said, “We took the trip to Tyler, and as soon as my wife and I came here, we fell in love. I met with Mr. Bradley and Mr. Thompson, and I also was in touch with a number of the internists — they were very welcoming. The medical community was superb. It offered really intelligent physicians and hospital systems that were, to me, far advanced for a community of this size.”

At the time, relocating from an established heart care center represented a gamble for two promising cardiologists. There was no established program, no heart surgery available and none of the resources that went with advanced cardiac care.

Israel arrived a few months ahead of Sanford. The pair was anxious but confident they’d made the right choice.

“During this time in Texas, when you wanted to have a heart program, a catheterization lab, a surgical program, you were required to go to Austin and request a certificate of need,” Dr. Sanford said. “We hired the necessary attorneys and advisers and began that process. Simultaneously, the construction on the Dawson Towers at Mother Frances was underway, and we shelled in a space on the third floor for what we hoped would be the new cath lab.”

The state approved, and the lab opened in August 1983.

A surgeon was recruited from Houston who brought a team with him. They recruited nurses internally and externally to staff the cath lab, the intensive care unit and operating room suites. They added Dr. Ken Kummerfield, another cardiologist working in Galveston with impeccable credentials. They essentially started the heart surgery program from scratch.

“Initially, there was some resistance to cardiology in Tyler because people couldn’t understand why we would need it,” Dr. Israel said. “Houston is a mecca of cardiology; Dallas isn’t too far. This was before the evolution of stents or intervention or thrombolytics.

“When a heart attack came in, you didn’t have much to offer the patient beyond blood thinners and maybe some nitroglycerin or beta-blockers. You couldn’t take them to the cath lab and open something up — that was just not available. But because we did have a program started, when that technology became available, we were able to offer it.”

Dr. Sanford said, “When I actually became interested in cardiology, the tools of the cardiologist were the mind, the ability to communicate and take a good history and physical, the stethoscope and the EKG. Echocardiography was just coming into play. Cardiac catheterization existed, but in limited capacities. That was the sum total of cardiology.

“That stuff is what we kind of imported to Tyler. Our first cath lab used 35 mm X-ray film run through a complicated processor larger than my desk, and we’d get results hours later and examine them in a dark room with a noisy old projector. Echocardiogram machines were giant boxes with green oscilloscopes. EKG machines made long strips that needed to be taped together by hand.

“Now, we’re all digital with connected records. I can look at an echo or cath on my phone. A lot of the superfluous things have fallen by the wayside, and technology — when used right — gives us more time to focus on the patient. We now have more ability to do the right thing for the patient.”

Dr. Israel said, “I never dreamed when I started practice that we’d be able to do what we do now. There are diseases now that are non-existent that we used to see regularly. There are complications of a heart attack we don’t see anymore because we’re able to help patients so early on.

“It’s gratifying in the fact that you can have someone who comes in with cardiogenic shock, half dead, arresting ... and three or four days later, they walk out of the hospital. It is so vast what we can offer patients due to the skills and technology developed over the years. A lot of this is teamwork.”

And now, more than 60 years of combined expertise and experience are working together again for the betterment of East Texas, as CAET and LPOHH come together.

Dr. Sanford is an East Texas boy, born and raised an hour north of Tyler. He completed undergrad at SMU and medical school in Dallas. Dr. Israel attended the City University of New York, the University Autonoma of Guadalajara for medical school and then residency at Danbury Hospital in Connecticut. From the look of them, from the way they sound when they speak, the casual observer might be fooled into thinking they didn’t have a great deal in common.

They have been colleagues and friends for 30 years, from their first days spending long hours walking the halls as the only two cardiologists in town to their founding of private practices that flourished over the years.

But their focus has always been as sharp as a scalpel: cardiac care in East Texas.

“Some things change; some things don’t,” said Dr. Israel, sitting in an empty conference room at the end of another long day of heart procedures. “The monitors change, the technology changes ... our hairlines change.

“But what doesn’t change is our desire to be the best and to offer the best to our patients. That doesn’t change. That is what it was like back then, and that’s what it’s like here and now.”