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Focused on the presidency: Dr. Donald J. Palmisano

MD-JD brings a unique medicolegal perspective to the AMA presidency as physicians prepare to tackle tort reform, managed care and patient privacy in the coming year.

By Tanya Albert, amednews staff. May 26, 2003.

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New Orleans -- Medical school taught Donald J. Palmisano, MD, the skills he needed to become a physician, but failing his first gross anatomy exam taught him the lesson that has guided him through life.

"I told my dad I thought I wasn't smart enough to be a doctor," Dr. Palmisano recalls more than 40 years later. "He said, 'Son, you are smart enough. Do your homework, have courage and don't give up.' "

So he didn't.

Dr. Palmisano graduated from Tulane University Medical School in New Orleans in 1963, winning the Psychiatry and Senior Thesis awards. He went on to become an accomplished general and vascular surgeon, spending two years in the U.S. Air Force as chief of surgery for the 821st Medical Group. He received the Air Force Commendation Medal before setting up private practice in New Orleans. He now teaches at Tulane and was named one of the area's top doctors by New Orleans Magazine in 2001.

In June, he'll be sworn in as the American Medical Association's 158th president.

Those are just a small fraction of Dr. Palmisano's accomplishments in medicine. And he's been busy outside the operating room as well.

He received his law degree from Loyola University School of Law in New Orleans in 1982, attending classes while still practicing medicine.

He founded Intrepid Resources, a company that helps physicians, hospital and clinical groups nationwide manage their risks.

He earned his pilot's license and practiced acrobatic flying in the 1970s when he was part owner of an airplane. Of all his pursuits outside of medicine, however, he is probably most well-known for taking pictures.

If you see Dr. Palmisano, 63, at a meeting or at another function, he's likely to have his digital camera out, capturing the smiles of almost everyone he meets, then showing them the image so they can decide whether they are happy with that shot or want to try another. But his work in photography goes well beyond those snapshots.

His mother, now 90, loves photography and has an eye for framing a shot just right. Dr. Palmisano got hooked himself, taking shots of wildlife at the Audubon Zoo in New Orleans and elsewhere. He got particularly interested in macro photography, focusing on close-up shots of beehives, frogs, lily pads and other things found in nature.

People requested copies of his photos so often, he set up his own company, Nature's Reflections, in the 1980s and sold his artwork. His photographs, some of which have won awards, hang in numerous hospitals, including Methodist Hospital in New Orleans and in Florida Hospital Celebration Health, commonly known as Celebration Hospital, which borders Walt Disney World in Orlando, Fla.

His busy travel schedule -- he was on the road 27 days in April -- keeps him from spending as much time taking photos as he would like, but he still finds the time to pass his love of photography on to his grandchildren. He spends time with them at the zoo or in the backyard searching for lizards to be their photo subject. Family is important to Dr. Palmisano. He says the strong support of his wife, Robin, has helped him accomplish so many things.

And he says his family's support will continue to be a strength in the coming year as AMA president.

Friends believe his compassion, willingness to listen and desire to succeed are also key to his ability to serve physicians well at a time when doctors face tort reform, managed care and patient privacy issues.

"He's a Renaissance man," says Dr. Palmisano's partner, James E. Brown Sr., MD. The two have known each other since they were teenagers growing up in New Orleans. They started a practice together in the early 1970s.

"Nothing is beyond him if he sets his mind to it," Dr. Brown says. "When he hones in on a topic, he hones in on a topic."

National tort reform

Tort reform -- the AMA's highest legislative priority -- is one topic that Dr. Palmisano has honed in on again and again throughout his career.

His first brush with the issue was a personal experience early in his career. It was partially what motivated him to get a law degree. A patient he had never operated on named him in a medical malpractice lawsuit, claiming that he operated on the wrong breast.

The suit was eventually dropped, but while it was still working its way through the system, an insurance company denied Dr. Palmisano coverage because of the then-pending litigation. He wrote letter after letter asking for due process and eventually the company acknowledged the rejection was a mistake and offered to insure him.

Dr. Palmisano declined the company's offer because of the mistreatment. Then, through the state medical society, he got involved and played a key part in passing tort reform in Louisiana. He testified before the state Legislature and gave media interview after media interview about the topic. And in 1975, Louisiana lawmakers enacted tort reform that included a $500,000 cap on total damages, excluding damages for future medical care.

In the mid-1980s, more reforms were passed, such as allowing physicians to pay a patient's future medical expenses as the expenses occur rather than in one lump sum.

Dr. Palmisano and other physicians say the legislation has helped keep medical liability rates stable in Louisiana during this national crisis. He wants to continue efforts to pass similar reforms on a national level so physicians and patients nationwide can enjoy the same protection.

"The current system doesn't take care of patients," Dr. Palmisano says, with a New Orleans drawl similar to that of New Orleans singer Harry Connick, Jr. "It takes care of lawyers and a few patients who hit the jackpot."

As president-elect, he's spent the past year crisscrossing the country speaking at tort reform rallies at the state level. At the national level, he's met with President George W. Bush and Health and Human Services Secretary Tommy Thompson, testified before Congress and appeared on numerous national television news programs, including Nightline and Hardball. He's debated trial lawyers who oppose tort reform that caps noneconomic damage awards.

"I enjoy getting into the debate," says Dr. Palmisano, who also is an American Bar Assn. member. "I enjoy using what my dad told me, 'Do your homework, have courage and don't give up.' "

Dr. Palmisano has been doing his "homework" for more than 30 years.

In addition to lobbying on the topic in the mid-1970s, starting a risk management company and getting a law degree, he was one of the founding members of the Louisiana Medical Mutual Insurance Co., a physician-owned professional liability company.

Dr. Palmisano reviewed thousands of claims, lawsuits and medical review panel findings while he served as vice president of claims and as claims committee chair for LAMMICO. He's also written law review articles on medical liability.

"He's going to bring a lot more than an MD/JD because he was so involved with LAMMICO," says Baton Rouge, La., health lawyer Herbert J. Mang Jr., who co-wrote Informed Consent, A Survival Guide with Dr. Palmisano. "He knows what types of claims are being filed because he saw so many that were filed in the state."

Spreading the word

While tort reform is on the front burner now, doctors face a plethora of other issues -- managed care monopsony, uninsured Americans and patient privacy.

Those, too, will be pressing issues for Dr. Palmisano and the AMA in the coming year as he works to improve medicine for current physicians and the next generation of doctors.

"Regulations are strangling physicians," Dr. Palmisano says. "And at the same time that reimbursements are down, overhead is dramatically increasing."

But to change the system, Dr. Palmisano says the effort will take teamwork, and physicians in America need to unite like never before.

"Membership is not an option," Dr. Palmisano says. "You can't sit on the sidelines. Right now we are in a battle for ethical, science-based medicine."

Good communication will be key in uniting physicians who are often unaware of what the AMA is doing for them even if they aren't members, he adds.

Whether it is whipping out his Palm Pilot to show medical school officials the financial support the AMA has given the school or talking to physicians via e-mail, Dr. Palmisano has already started his communication mission.

He has spent the past two years generating his own newsletter from the road. In an informal e-mail once a week or sometimes more, he lets physicians know what he's testifying about and what he's seeing physicians encounter and tackle across the country. He often includes talking points on various issues that other physicians can use when they speak.

"And I learn from everyone who e-mails me back," Dr. Palmisano says.

At last count, 1,635 people get the e-mail.

Friends and colleagues say Dr. Palmisano brings energy and talent to AMA's top post.

"With his dual degree, he will bring excellent skills to the table and help the AMA," says W. Juan Watkins, MD, a Shreveport otolaryngologist who met Dr. Palmisano through the Louisiana State Medical Society in the mid-1970s. "He has a vision and works hard and never gives up."

He has, indeed, taken his father's advice to heart.

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