Volume 24x • No. 1xxJanuary 2000

Bauer appointed to reconfigured vice president's post;
dean sought

Doctors can help spur health legislation,
says Eshoo

Facilities upgrade planned for medical school facilities

Ramona DOYLE

The Division of Pulmonary and Critical Care Medicine has increased outpatient volume more than sixfold since 1990. On the inpatient side, the service has grown as intensivists with pulmonary experience have found treatments for once futile conditions. This month Fact File talks with Thomas A. Raffin, division chief; Ramona Doyle, associate director of the Stanford Lung and Heart-Lung Transplantation Service; Stephen Ruoss, associate director of the intensive care units; and Ann Clark, chest clinic manager.


1. The Division of Pulmonary and Critical Care Medicine treats 4,000 outpatients annually - up from 600 in 1991 - in the Stanford Chest Clinic. Fourteen faculty members are based at Stanford and the Palo Alto Veterans Affairs Health Care System, while four faculty members are based at Santa Clara Valley Medical Center (SCVMC). A fifth member is being recruited at SCVMC.

2. The division is one of two clinical units - anesthesia is the other - that provides coverage in Stanfords medical and surgical ICUs. Norman Rizk, professor of medicine in the Division of Pulmonary and Critical Care Medicine, is medical director of the ICUs. The division's associate ICU medical directors include Stephen Ruoss and Ann Weinacker, both assistant professors of medicine. Three associate medical directors, Frederick Mihm, Ronald Pearl and Mike Rosenthal, come from the Department of Anesthesia.

3. The Stanford Lung and Heart-Lung Transplantation Service is based in the division and is directed by James Theodore, professor of medicine.

4. A new director of the adult cystic fibrosis program, Noreen Henig, assistant professor of medicine, has just been hired.

5. Major research efforts in the division are led by Peter N. Kao and Glenn D. Rosen, both assistant professors of medicine. Kao's laboratory investigates molecular mechanisms of tissue inflammation and repair relevant to pulmonary diseases, such as asthma and lung fibrosis. Rosen studies apoptosis (programmed cell death) signaling pathways in lung epithelial cells and in lung cancer cells.

6. Four fellows with an academic career goal in pulmonary or critical care medicine are accepted each year in the division's three-year pulmonary and critical care medicine training program.

7. The Stanford Center for Biomedical Ethics is housed within the division. Raffin is co-director along with Ernle Young, clinical professor of medicine and a longtime hospital chaplain. Medical anthropologist Barbara Koenig, associate professor of medicine (research) in the division, is the center's executive director.

8. The division's attending physicians at the Veterans Affairs Palo Alto Health Care System (VAPAHCS) are Rajinder Chitkara, Ware G. Kuschner, Priscilla Sarinas and Michael K. Gould. The division co-directs the medical/surgical ICUs and runs the pulmonary service and chest clinic at PAVAHCS. Division attending physicians at Santa Clara Valley Medical Center are William Jenson, Carl Kirsch (chief), Frank Kagawa and John Wehner.

9. Thomas A. Raffin, professor of medicine, received his undergraduate degree and medical degree (1973) from Stanford University. He joined the faculty at Stanford as associate director of intensive care units after completing his residency at Peter Bent Brigham Hospital in Boston and a fellowship at Stanford in respiratory medicine. In 1980, Raffin was named assistant chief of medicine for clinical programs. Five years later, he was promoted to associate professor, and in 1995 he was named professor of medicine and, by courtesy, of molecular and cellular physiology. In 1988 he became acting chief of the Division of Respiratory Medicine and in 1991 was named head of the newly formed Division of Pulmonary and Critical Care Medicine. Raffin serves as co-director of the Stanford Center for Biomedical Ethics. His research interests include the basic biology of neutrophis and the mechanisms of neutrophil-mediated pulmonary injury. He is also involved in studies of ethics, specifically end-of-life issues. He has authored numerous scientific papers and has received five teaching awards at Stanford.

10. Stephen J. Ruoss, assistant professor of medicine, came to Stanford in 1993 from a faculty position at the University of California, San Francisco. He received his medical degree from the University of Washington School of Medicine, Seattle, in 1981, and completed house staff service as chief resident at Boston VA Medical Center four years later. Ruoss served as a pulmonary and critical care fellow in UCSF's Department of Medicine and Cardiovascular Research Institute from 1986-89. In addition to his current attending and administrative duties in the ICU, Ruoss pursues active research on atypical mycobacterial lung infections and the epidemiology of pulmonary fibrosis.

11. Ramona Doyle, assistant professor of medicine, received a MSc degree in physiology while a Rhodes scholar at the University of Oxford, England, in 1984. She received her MD from Emory University in Atlanta in 1988. Doyle finished her residency in 1991 at UCSF, where she also completed a clinical fellowship in pulmonary and critical care medicine in 1994 and a research fellowship in 1995. During her fellowship years, she served as an attending physician in the AIDS and general internal medicine screening clinics at UCSF, as well as an emergency department attending physician at several San Francisco hospitals. She joined the Stanford faculty in 1995. Her primary research interests center on pulmonary hypertension and lung transplantation, but she is also interested in studying ICU outcomes, pulmonary manifestations of HIV infection and acute lung injury/ARDs. Doyle also pioneered and teaches a creative writing course for medical students.

12. Ann Clark came to Stanford as a staff nurse shortly after she received her bachelor's of science degree in nursing from the University of San Francisco in 1979. She was appointed an assistant nurse manager in 1981 before being promoted to her current post as clinic manager for the pulmonary and cardiovascular medicine services. 13. Physicians may contact the chest clinic at 725-7061. For the new patient coordinator, call 723-6983; for the division academic offices, call 723-6381.

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