An Experiment In A Cooperative Juvenile Amputee Clinic
Edward T. Haslam, M.D.
All or almost all the clinics participating in the child amputee research program appear to present a strongly unified organization. Typically, they represent the efforts of a dedicated orthopedic surgeon or pediatrician to fill a void in available services or were called into being by a state organization to meet a need in a particular area.
I am certain, however, that there are many cities in the United States where the situation is similar to that which applied in New Orleans until recently. In our city, services for the juvenile amputee were available for a number of years but on a diffused decentralized basis. The children were treated in regular crippled children's clinics or as office patients, according to their financial status. The vast majority of the cases were on the Crippled Children's Program since the parents could not usually provide the necessary finances to cover the high cost of repairs and frequent prosthetic replacements.
During those years the orthopedists engaged in the treatment program recognized the desirability of establishing a Juvenile Amputee Clinic. They agreed that the management of the patients would be more effective if the orthopedists could see the children in conjunction with the prosthetists, the physical and occupational therapists, the medical social workers and others who were involved in their care.
Orthopedic surgeons in other areas with similar motivations may find the following account of the evolution of the New Orleans Juvenile Amputee Clinic to be of interest.
The problems which complicated the establishment of a separate Juvenile Amputee Clinic related to the availability of administrative and paramedical personnel and of orthopedists particularly interested in this problem; space and organization. A first step toward a solution was made when Tulane University School of Medicine established an Amputee Clinic which met once a month in a newly organized rehabilitation demonstration and teaching unit supported by the National Foundation for Infantile Paralysis. The Crippled Children's Section authorized the director of this unit to see juvenile amputee patients who were on their program at this clinic instead of elsewhere.
With this beginning, approximately 18 juvenile amputees were rendered service over a period of a few years. However, this operation was at a disadvantage in that it did not include participation of the Louisiana State University School of Medicine, or of several of the Tulane University clinical faculty, who held their crippled children's clinics elsewhere and would have found attendance at this clinic extremely inconvenient if not impossible. It had the added disadvantage of being solely an outpatient clinic.
With the establishment of the New Orleans Crippled Children's Hospital on March 10, 1955, a new opportunity arose. The Hospital had adequate space to accommodate a new clinic and a majority of the orthopedic surgeons in New Orleans were members of the staff. Physical and occupational therapy facilities were good and inpatient as well as outpatient management was possible.
A committee was eventually appointed to consider long-range plans for the Hospital, and the establishment of a Juvenile Amputee Clinic was included as one of its recommendations. A committee was appointed to implement this recommendation and a clinic meeting twice a month was established, in which four Hospital staff members saw the patients they had previously treated elsewhere. It was an official Crippled Children's Clinic and its services were available to children all over the state who were referred by their orthopedists. The case load and organization ultimately improved to a point where we became a participating clinic in the Child Amputee Research Program.
At present Dr. Daniel Riordan and Dr. Truman Kerr hold clinic on the second Friday of each month and Dr. Hammond Newman and the writer hold clinic on the fourth Friday of each month. Each patient is under the direct care of one of the participating doctors, but communication and cooperation is such that in emergencies patients of one clinic are seen by the other team. To facilitate correspondence, the Chairman of the Juvenile Amputee Committee at the Crippled Children's Hospital represents the clinic as a whole. The writer is currently serving as chairman, having succeeded Dr. Rufus Alldredge, who deserves much credit for his work in developing the clinic.
This clinic organization has made it possible for each of us to see more diverse and interesting problems than we would have encountered in the treatment of our own patients only. Residents from the training programs of both Tulane University and Louisiana State University Schools of Medicine attend the clinics and also derive the benefit of seeing additional cases.
Although we have been in operation as a participating clinic for only six months, the procedures described appear to be functioning satisfactorily. Thus, our experience illustrates one means of starting a clinic when the community has several groups of orthopedists who would not ordinarily find a common meeting place in which to conduct a clinic.
Edward Haslam is Clinic Chief, Juvenile Amputee Clinic, Crippled Children's Hospital, New Orleans, Louisiana