“I didn’t try to make anybody mad.” But he did.
An Appreciation of Donald Rasmussen, MD
At His Memorial Service, Sunday, July 2015
By Craig Robinson
When I came to southern WV, as a VISTA volunteer, about 45 years ago,
and began talking with coal miners and their families, it did not take long
to understand that for many mining was literally taking their breath away -and their ability to work, their livelihood and then their lives. Neither WV,
nor federal law recognized, what came to called, "black lung", as a workrelated disease and there was no workers compensation.
In 1962, about 6 years before my arrival, Donald Rasmussen, had come to
Beckley to join a group of outstanding physicians associated with the then
Miners' Memorial Hospital in Beckley. The hospital and the physician
group was developed by the miners’ union’s Health Fund to bring excellent
medical care to the Appalachian coalfields.
Soon after his arrival, this young pulmonologist responded to what he was
seeing in his practice – what appeared to be an epidemic of disabling lung
disease among miners. He put together a laboratory to provide state-ofthe-art lung function studies to measure accurately the extent of the
miners' loss of breathing capacity; and he collected and studied the data
from first hundreds and then thousands of evaluations.
Then, in 1968, remarkably, he took his findings directly to the miners
effected -- educating and encouraging miners and their friends at
meetings and rallies to which he was invited throughout the central
coalfields. And he gave his authoritative testimony before the
state legislature and, later, the U.S. Congress.
The public education campaign based on Don’s work, and that Don carried
out with Drs Wells and Buff (who some referred to as the 3 Muskateers)
paved the way for the black lung movement and for the ensuing statewide
“wildcat” coal strike of February 1969. This was the largest strike in the
nation’s history against a government and was accompanied by large
rallies and marches in Charleston. Miners virtually occupied the state
capital. This movement forced the recognition of black lung as an
occupational disease in WV AND led to a cascade of positive events:
including – the Federal 1969 Coal Mine Health and Safety Act which
included first ever coal dust standards for mines and federal Black Lung
benefits for people already disabled and for those who would be disabled
in the future. And the BL movement led to the miner’s union reform effort
to change the union leadership which had opposed the grass roots
movement for black lung recognition. Don was, of course, quietly at the
center of all this.
While there were a number of factors that led to this mass mobilization
and the new legislation to protect and compensate miners, it is clear that
Don’s research about what was happening with southern WV coal miners
and his unique tactic of presenting his research results directly to the
victims themselves, was the critical factor. His was the single most
important piece of the work that contributed to the movement. The
Black Lung movement would not have happened without him. And
without the movement, the improvements, if they would come at all,
would have been much delayed.
Don, of course, would disagree. In the words of Dr. Greg Wagner, former
director of the NIOSH, “Don was a reluctant hero.”
Don would insist that he was not an advocate – he was just trying to be a
good doctor and do what was needed to care for his patients. And yes he
was a good doctor, a great doctor for his patients, BUT his ideas about
what it took to be a good doctor were uncommon ideas.
I worked with Don during the black lung movement days and later and
have talked with colleagues of his about what was so rare and so useful
about Don’s way of being a good doctor. This is what good doctoring
seem to mean to Dr. Rasmussen.
First, being a good doctor meant always being kind and generous of
spirit.
Dan Doyle, a family doctor, tells of being warmly welcomed to Don’s lab
shortly after moving to the area and spending a day or two with Don
learning about conducting and interpreting quality breathing tests. Dr.
Doyle became the medical director for a nearby Black Lung Clinic and
recounts how Don continued for the next decades to always be available
and willing to discuss a patient’s clinical situation, or testing protocols or a
federal or state compensation policy. He said it was honor to become part
of Don’s circle of colleagues.
And it wasn’t just generosity toward other dedicated physicians -John Cline, a black lung benefit attorney, recounts a typical encounter
when he was in Don’s office one the late afternoon. A clerk brought in a
large stack of medical records for Don to work on. Don just brightened and
said, “What have you got there?” As though she had just brought him a
fine gift instead of his evenings work. Don did not burden staff members
with complaints about his work load.
John also described how accessible and patient Don was as a teacher and
encourager of the steady stream of medical providers, law and medical
students, benefit counselors, attorneys, and policy makers that found their
way to Don’s office to learn from him.
Greg Wagner, who first met Don as a physician at Cabin Creek Health
Center, and later became the director of NIOSH in Morgantown, said that
Don conveyed a “constancy of generosity, kindness and integrity that was
extended to all.”
I know that I could detect no difference in his treatment of senators, fellow
professionals or coal miners or VISTA volunteers for that matter. He
appeared to connect with everybody, to listen carefully, and give the same
clear clinical explanations. In those early meetings with miners about
black lung policy or union reform, and later meetings about compensation
regulations and processes – he always honored the experience and
knowledge of the others in the room and, if his ideas dominated the
discussion, it was because they just made sense.
For Don being a good doctor also meant really understanding what going
on with his patients – it meant bringing rigorous research into his practice.
Dan Doyle notes that there is a major focus these days in healthcare on
something called “translational research” – that is, medical research that
can be translated into actions that help people. And that is exactly what
Don did, except he was not in an academic medical center. He did it
essentially on his own -- as part of his practice. And this, as Dr. Doyle
observes, was way before the Google search engine made quick work of
finding journal articles. He did not have big grants, he just did it on his
own time. In all, Don authored six articles about his research - published
from 1968 to 1971. Don’s research did translate into a huge positive
impact for his patients and all underground miners.
Finally, being a good doctor like Don Rasmussen took courage.
Taking his research results directly to miners, and to the public, greatly
agitated the coal industry and their medical and political allies. Don was
subjected to tremendous political fire and withering personal attacks from
medical societies, politicians and company and union officials. And he
endured personal threats when he was identified with the union’s reform
movement.
Through it all Don remained undaunted. He remained in place at his lab,
and continued telling the truth to power and to coal miners.
Over the years, with Don’s research conclusions upheld and endorsed by
major medical organizations and with the successful reform of the UMWA,
the only remaining criticism of Don, one can imagine, is heard in the
executive suites of coal companies and among their attorneys.
Even as Don’s health waned in the later years he continued to serve his
patients with same quality of care and he remained authoritative and
persuasive.
My wife, Judy, reminded me of an example of his continued
persuasiveness. There was a dinner meeting a couple years ago at our
house with Ted Koppel and Don and Carmen Rasmussen and some other
health professionals. The Koppels were exploring whether their foundation
would support starting pulmonary rehabilitation in some rural coalfield
communities.
Don and Ted had an extended person-to-person conversation about
miner's lung disease and the benefit of pulmonary rehabilitation. Despite
appearing to be rather frail at the time Don gave a compelling account of
black lung as a clinical and a political problem. Ted Koppel was visibly
moved by the encounter and his foundation proceeded to support new
pulmonary rehabilitation centers in southern WV.
Along with everybody here, I am terribly saddened to say good-bye to Don
Rasmussen - but I take heart in his legacy – in the knowledge and
understanding that he spread, in his constancy of purpose and his
example of personal courage and dedication to justice and to friends and
family. This will sustain us.