Dr. Rich Carmona told his story to a crowd of 350 healthcare providers at Xerox’s Midas+ Annual Symposium in May 2016. I was fortunate to be able to spend time with him afterward to learn more about his fascinating life story, including his tenure as Surgeon General.
Rich dropped out because,
“…on my block, if you found a high school graduate, it was a reportable event. Nobody went to high school.”
Born to a poor family that moved from Puerto Rico to New York, Richard Carmona grew up “running the streets” of Harlem. He was often hungry and, at one time, homeless. His teeth were full of cavities because there was no money to send him to a dentist.
In 1967, at the age of 17, he joined the army and was trained as an infantryman. Not satisfied with being just regular infantry, he volunteered for jump school and became a paratrooper. Still not enough of a challenge, he signed up for training in the Special Forces, but there was a snag. To complete his Special Forces training, he needed a high school diploma. This was motivation enough for him to earn his GED from the US Army and become a full-fledged Green Beret.
After his training, he was deployed to Vietnam where he served as a medic and weapons specialist. The war was raging and medics there sustained a high casualty rate. As if that wasn’t risky enough, Rich ended up working independently in a remote area “doing things that he wouldn’t do for another 30 years.” His experiences could fill a book — from performing an amputation at the age of 19 to delivering twins in a rice paddy after a ferocious firefight was over.
He returned from Vietnam as a combat-decorated veteran (two Purple Hearts and a Bronze Star). He says the Army
“taught me how to be a citizen, taught me duty, honor, country…really shaped me to be the person I was.”
Rich was planning on making the military his career, but his Army teammates urged him to go to college. He decided to give it a try even though he wasn’t exactly your dream applicant. He had no transcript or SAT scores. It was no surprise that he got rejected from every college that he applied to except for one, Bronx Community College. Once there, he had to take remedial courses with kids that were several years younger than him. It was humbling, but he studied hard and became an A-student, earning his AA in Nursing.
To support himself during this time, he worked as a paramedic, a registered nurse, a physician’s assistant, an ocean lifeguard, and a teacher. He taught everything, including skydiving, scuba diving, first aid, and CPR — all possible because of skills he learned in the military.
After college, Rich applied to medical school. He got ‘into a bunch,” deciding to attend one of the most prestigious in the country — the University of California at San Francisco (UCSF). He was 27 years old when he enrolled. So there he was again, the “old guy” in the class, amid freshly minted brilliant college graduates, years younger than him. He says he wasn’t the smartest person in his class, but he had one big advantage that he acquired in the Army. He was the most disciplined and focused. He graduated number one in his class at UCSF and was awarded the highest honor, the Gold Headed Cane, by his classmates.
From treating trauma to advocating prevention
After a residency in General and Vascular Surgery and fellowship training in Trauma, Burns, and Critical Care, Rich joined the faculty at the University of Arizona in Tucson in 1985 to become the first director of the new trauma program. Never satisfied with “just” one job, he served as medical director of the police and fire departments. He is also a fully qualified police officer and swat expert. He received honors for his bravery at the National Association of Police Organizations TOP COPS award ceremony in 2000.
After a decade of taking care of trauma patients, Rich realized that almost everything that he was treating was preventable. Three out of every four patients that he took care of didn’t have to be there. They were there “because of bad decisions that they had made that day — shooting and stabbing each other, blowing each other up, domestic violence, and drug deals gone bad.” Who would know better than a kid from the streets of Harlem?
There were also the “chronic” bad decisions that had been made their whole lives (e.g., being sedentary, smoking, not wearing seatbelts or helmets). These people would come in with a heart attack, stroke or diabetes ketoacidosis.
“We got really good at resuscitating them. If you show up with a pulse, we can probably save you, but we can’t save you from yourself.”
It was discouraging when, after long and costly hospital stays, these patients would be discharged only to repeat the same behaviors and end up back in the hospital again. Rich came to realize that “most of the disease and economic burden that we have in society were related to poor behaviors whether acute or chronic.” He also realized that he needed to make changes in his own life. He had become cynical, referring to himself as a “repairer of society’s indiscretions.” He began to wonder,
“What would the world be like if each citizen pursued optimal health and wellness and did the best they could through appropriate decisions with an infrastructure that supported them to remove all that’s preventable?”
So, ever pushing to know and do more, Carmona decided to go back to graduate school and get a master’s degree in public health. About the same time, the local public hospital was targeted for closure. Rich and his colleagues fought with the board of supervisors to keep it open. The supervisors acquiesced, appointing him Chief Executive of the hospital instead.
He right-sized the hospital and county health care system and added new revenue streams, such as a sports medicine clinic. He brought the finances from red to black in two years. He said he did it each by looking at metrics measuring outcomes and holding doctors and administrators accountable.
The White House calls
One day, he had a voice message from the White House. When he called back, he was told he was being considered as a candidate for the Surgeon General of the United States. His first thought there must be another Rich Carmona somewhere in the country. After the usual round of interviews with VIPs and politicians, he made the “short list” for the position. Sometime later, the President’s Chief of Staff called and asked him what his family was doing on March 26th because President George W. Bush wanted him to come to Washington DC so that he could announce that he had nominated Rich Carmona for Surgeon General of the United States. Rich’s response? “You’re sh*ttin’ me!”
In the anteroom, waiting for the Senate confirmation hearing, the chairman of the nominating committee, Teddy Kennedy, came in to give him some sage advice. One of the things he told him was that if and when he comes to Washington DC and wants to have a friend, he should bring a dog!
Ultimately, Rich Carmona became the first Surgeon General to be confirmed for the position unanimously. Now that the arduous confirmation process was over, he had to prepare to do the job. That meant putting together a portfolio of activities that he wanted to focus on to present to both the President and the Congress.
He chose five areas to work on: prevention, preparedness, health literacy, health disparities, and global health, including health diplomacy. These choices reflect what Richard learned about the relationships between health, education, culture, and economic status based on his own experiences with poverty, homelessness, hunger, and the lack of access to healthcare.
Part two of this story explores how Dr. Carmona’s focus on these five focus areas played out during his tenure as the 17th Surgeon General of the United States.
Originally posted on The Doctor Weighs In.