THE STORY OF THE DEPARTMENT OF SURGERY AT THE NEW JERSEY MEDICAL SCHOOL

By: David H. Livingston, MD FACS
Wesely J. Howe Professor and Chief of Trauma and Surgical Critical Care (1995-2022)
Emeritus Professor (2022-present)
Department of Surgery
Rutgers New Jersey Medical School

The history and success of the Department of Surgery at the Rutgers-New Jersey Medical School (NMJS) is integrally linked and intertwined to that of the NJMS itself if not the history of undergraduate medical education in New Jersey. Thus, to provide the appropriate context and understanding for the story of the Department, a short digression into the story of medical education in New Jersey and NJMS is required. The history of the Department of Surgery outlined in this article will focus predominantly on the formative years from 1969 to 1994 under leadership of the inaugural chair, Dr. Benjamin F. Rush, Jr. although the notable events and chronology of the department following Dr. Rush’s’ tenure will be included.

As noted by others, New Jersey is the only one of the original 13 colonies which does not have one or more medical schools that were founded before 1900 (1). New Jersey is surrounded by two of the oldest medical school in the United States (Columbia founded in 1765 and University of Pennsylvania founded in 1767). It is ironic that Rutgers (Queens College), geographically in the middle, was founded in 1766. In fact, there were several opportunities for Rutgers to provide undergraduate medical education in New Jersey well before the takeover in 2013, all of which were declined.

While there were graduate medical training programs (residencies) in New Jersey, undergraduate medical education (medical schools) did not occur until 1954 when incorporation papers were filed to establish the Seton Hall College of Medicine and Dentistry of New Jersey (SHCMD) as the state's first medical school. That same year the citizens of New Jersey had an opportunity to create the first state supported medical school but that $25M bond issue was soundly defeated. Whether it was because this was the only item on the ballot during the non-presidential election year, or some other reason was not identifiable by this author.

The SHCMD first class entered in 1956 and the school was able to recruit a prominent chair of medicine, Dr. Harold Jaegers, from Georgetown. This author could not find any mention of the first surgical chair. The school got off to a rocky start with the deaths of the first dean and president of Seton Hall in 1959. By the early 1960’s with the champions deceased and mounting debt of $7 million dollars, Seton Hall wanted out of the medical school business. Rutgers was given the opportunity to take it over declined.  In 1964, Governor Richard Hughes signed the New Jersey College of Medicine and Dentistry Act of and the state purchased the SHCMD for $4 million and the school was renamed as the New Jersey College of Medicine and Dentistry (NJCMD). To put this into perspective, that was the equivalent of about $40 million dollars today. A rather bargain-basement price for a medical school and demonstrates the beginning (which has continued to the present day) of the state of New Jersey underfunding and failing to properly support medical education.

Despite this change in ownership, there were further hard times ahead for the fledgling NJCMD. At this time, the medical school was in Jersey City with the Jersey City Medical Center (JCMC) being its primary clinical site.  In January 1966, the school’s clinical departments were faced by a 48-hour vacate order from JCMC.  This resulted in an incredible scramble to identify clinical sites for the students which escalated all the way to the White House. George F. Smith, President of Johnson & Johnson, and Orville Beale, President of Prudential Insurance Company, met at the White House with President Lyndon B. Johnson, who personally directed that the East Orange Veterans Administration Medical Center be at the disposal of the medical school. The Newark City Hospital was the other clinical site for the school and became the homes of the clinical departments. The strong connection between NJMS to the public hospitals in Newark continues to this day. It should be noted in 1966, Rutgers opened a 2-year medical school in New Brunswick, despite declining to take over the SHCMD two years earlier.

While this stabilized the school for a time, the fate of NJMS was at a crossroads and faced with a monumental decision that would have far reaching implications. On one hand, it was offered a large tract of land on the Geraldine R. Dodge estate in Madison to build a new medical school. By all reports, this was the faculty’s choice. On the other hand, there was a push by then Mayor Hugh Addonizio and the powers in Newark for the school to remain in the city. There is much speculation as to how and why the ultimate decision was made but as we all know, the medical school remained in Newark. It is this author’s contention that “classic New Jersey politics and influence” was the likely reason. In September 1970, during this ongoing process and long before the completion of current NJMS campus, Mayor Addonizio was tried and convicted on federal corruption charges. He was sentenced to ten years in federal prison and fined $25,000 for extortion of $1.5 million in kickbacks. An ironic footnote is that the prosecutor for that trial was Herbert J. Stern who will ultimately oversee the dismantling of the University of Medicine and Dentistry of New Jersey (UMDNJ) decades later.

Once the decision to build the school in Newark was finalized, several other things occurred. Rutgers wanted to divest itself of its medical school in New Brunswick and under Governor Hughes, the Medical and Dental Act of is 1970 signed. This act resulted in the NJCMD and Rutgers Medical School being combined to create a new entity known as the College of Medicine and Dentistry of New Jersey (CMDNJ). At this time, the city of Newark was able to divest itself from the Newark City Hospital and “sold” it ot to CMDNJ for $1. This facility was renamed the Harrison S. Martland Medical Center became the school's principal teaching facility.  In the next year, 45.7 acres of Newark's Central Ward was transferred from the Newark Housing Authority to construct a permanent campus for CMDNJ. The campus did not break ground until 1973 and was not dedicated until 1976. The cost of the school is reported to be about $200 million with most of the cost being reimbursed by the federal government. The first class of CMDNJ (1970) included 113 students, 28 of which were considered minority students, demonstrating the school's commitment to diversity since its inception. 

With this preamble and background, the successful recruitment of Dr. Benjamin F. Rush, Jr by the fledgling school and his arrival in July of 1969 was a monumental achievement. The consensus by all those interviewed for this article was that his impact on his arrival cannot be overstated.  Dr. George Macheido (class 1971) simply said that “He put the New Jersey Medical School on the map. At the time, the medical school was not highly rated or thought of and almost no students stayed for surgical or many other residencies. Dr. Rush turned that around”. Dr. James Oleske (class 1971) followed with “He was just an inspiring physician and teacher and the first chair with a real national reputation. The students saw that. They saw what the school could be. Even though he was a surgeon, he was a strong supporter of Student Health Clinic which the students felt was incredibly important.”

Dr. Rush’s brief biography is outlined in FIGURE 1. The recruitment of Dr. Rush is even more amazing given the time frame it occurred and history of the medical school. Newark was still barely recovering from the events of the summer of 1967 during the time that Ben was being recruited. There was no university behind the medical school, the school was in disarray split between Jersey City and Newark and there was no true “university hospital”. Students and residents were scattered, and the department faculty consisted primarily of local surgeons working in multiple “loosely” affiliated hospitals (United, St. Michaels, Newark-Beth Israel, Martland and the East Orange VA).  While some had a regional reputation, many were not “full time”. Dean Johnson (class of 1972) stated, “There was a real push to recruit a full-time chair in the Department of Surgery and to get someone of Ben’s caliber was huge”. One can only wonder how those what was said during those recruitment dinners and to convince Ben to come to Newark. There are notations that Dr. Rush was given a chair of surgery (??) but by all accounts this chair either never materialized or the promised funds never arrived. Despite this, Ben took the job! As it turned out, Dr. Rush was the ideal person to take the helm and it likely is the single greatest decision made by the New Jersey Medical School.

While those interviewed could not shed light on that issue, a subsequent profile of the Department of Surgery in 1977 helps to understand Dr. Rush’s motivation (2).  “A marked advantage in establishing and fostering a new school is the great satisfaction that each step upward provides. There is no past track record and no one here is intimidated by the specter of a Halsted, Cushing, Phemister or other giant who previously occupied the chair. It can be, and is, and exciting and yeasty environment for the departmental and sectional chairmen to develop new programs.”  What has been forgotten by many was that the recruitment of Dr. Rush was actually a “two for one” in that he brought Dr. Ben Rigor with him from University of Kentucky as the Chief of Anesthesia. In those days, Anesthesia was a division within the Department of Surgery and thus the recruit stabilized and allowed the growth of two vital departments.

While Dr. Rush’s arrival was eagerly awaited by many, the students had less than flattering things to say about the Department of Surgery. From the 1969 yearbook “The Department of Surgery mirrors the basic problem of NJCM: quality people lacking cohesiveness. We encountered individuals, but individuals cannot impart the concept of total surgical patient care.
Junior subspeciality rotations were not of equal quality and senior surgery had its strong points and holds promise with Dr. Lazaro fighting continuous battle against impending chaos.”  Dr. Rush’s first yearbook message set forth his goals for the department which exemplifies his overall approach to academic surgery. “The goal of any medical school service must be to set an example of excellence…The role of our Surgical Service is to render patient care as close to the ideal as possible… Thus, in patient care on a Surgical Service, the diagnosis of the disease, the selection of patients for operation, the preoperative preparation, postoperative care, and follow up care probably equal or exceed in importance the operative act itself. It is my hope that we will constantly improve our ability to establish or confirm diagnosis; to identify those patients who cannot tolerate surgery; to select accurately the most physiological and appropriate procedures for the disease under treatment to conduct the operation precisely and to carry out the patient through the postoperative period with a thorough understanding of the physiological and biochemical changes we have created….” Students being what they are replied in the same yearbook “The attempts of Dr. Lazaro and Dr. Malfitan to achieve these goals (education of the students) have been greatly augmented the addition of Dr. Benjamin Rush. However, the basic lack of varied clinical material, the almost complete lack of discussion, instruction and involvement …of the house staff and the incompleteness of the patient doctor relationship….before Martland deserves the…title of teaching hospital”.  However, by 1971, Dr. Rush was named Faculty of the Year and the dedication in the yearbook recognized the incredible change he brought to the department and the school (FIGURE 2). 1971 was also a pivotal year at NJMS in that more students chose to stay and train as residents. Dr. George Macheido was the first such student to enter the surgical residency program.

The faculty that Dr. Rush inherited was incredibly varied and diverse at a time when most academic surgical departments were comprised of mainly white middle-aged and older men. Some members of that department included Dr. Anita Falla, first woman pediatric surgeon in New Jersey who would go on to become Chief of Pediatric Surgery, Dr. Rene Joyeuse (https://en.wikipedia.org/wiki/Ren%C3%A9_Joyeuse) who had a fascinating story going back to WWII, Dr. Victor Parsonett, who was the first surgeon to implant a permanent pacemaker in NJ and would later perform New Jersey’s first heart transplant and, Dr. Saurel Placide, a Haitian orthopedist who would later complete his career at the Brooklyn VA (FIGURE 3). Two additional members of the department, Dr. Christine Haycock (https://en.wikipedia.org/wiki/Christine_E._Haycock) (FIGURE 4) and Dr. Eric Lazaro (FIGURE 5) deserve special mention It should be noted that Ben embraced and continued this legacy of recruiting and promoting diversity throughout his career.

The first decade of Dr. Rush’s tenure was a time of great growth and change. By the end of that decade, the NJMS campus, including the new University Hospital in Newark, were finally completed and operational. Almost all the surgical residents were now graduates of American medical schools and the department research portfolio increased from zero to over $1 million dollars. Dr. Rush recruited several faculty members who would go on to have long and productive careers at NJMS and elsewhere including Dr. George Macheido (who stayed following residency as the first “home grown” faculty member), Drs. Ken Swan and Robert Hobson recruited from the military and Walter Reed and Dr. Paul Bolanowski. These individuals along with several of the original faculty became the backbone of the department through that decade.

The 1980’s began another decade of growth and change in the Department Surgery.  As was observed and reflected in other medical schools across the country, many former divisions became departments in their own right. These included orthopedics, ophthalmology, and anesthesia. Several other pivotal changes occurred in the 1980’s which would help shape the department for decades to come. The first was the creation of a trauma fellowship in 1982. This was more than a decade before ACGME accreditation and the American Board of Surgery developing the added qualifications certificate for Surgical Critical Care. Although there is no official (or unofficial) list of programs in 1982, to this author’s knowledge there were only a handful of such programs around the country, most being filled by “word of mouth”. The third fellow (1984-1985) was C. Clayton Griffin, MD.  Following completion of his fellowship, Dr. Griffin was subsequently hired by Dr. Rush as Chief of Trauma. While this was a controversial choice, appointing such a junior faculty member to such an important position, it demonstrated Dr. Rush’s prescience into what the department and the state required. There is no doubt his military experience in Korea and taking care of trauma in Newark for the previous 15 years, played an important role in understanding what was needed. Dr. Griffin was a spectacular administrator as well as surgeon and with some other trauma surgeons (Dr. Steve Ross from Cooper and Dr. Jeff Hammond from RWJ) they developed the statewide trauma system as well as Jemstar aeromedical program. By both design and a bit of luck, New Jersey has had a robust and non-competitive trauma system from its inception. This system also included being one of the earliest states to verify their trauma centers by the American College of Surgeons instead of developing an internal statewide body such as Pennsylvania or not have a verifying body until recently such as New York. Lastly, Dr. Griffin secured Wesley J. Howe Chair from Becton-Dickenson as the first truly endowed chair within the Department of Surgery which was bestowed to Dr. Rush. Unfortunately, Dr. Griffin’s tenure as Trauma Director was short lived as he died suddenly in the fall of 1989.

Following Dr. Griffin’s death, Dr. James Blackwood served as the interim trauma director until Dr. Rush recruited Dr. John Siegel from Maryland Shock Trauma in the spring of 1991. This recruit was also championed by then Dean Ruy Lourenco and Dr. Seigel also became the chair of Anatomy (later renamed Anatomy, Cell Biology, and Injury Sciences). This dual role and allegiances would eventually prove to be too much of a conflict and soon following the arrival of the Dr. Edwin Deitch (second chair of Surgery) Dr. Siegel was replaced by Dr. David H. Livingston.  Dr. Livingston assumed the titles of Wesley J. Howe Professor and Chief of Trauma and Surgical Critical Care as well as being the Trauma Medical Director of the New Jersey Trauma Center at University Hospital. He held these positions for over 25 years until his retirement in 2020. During that time-period, the Department gained a national and international reputation as a premiere academic trauma center. Both the Trauma Center and the Trauma Fellowship have been continuously accredited and verified for over 30 years.
Dr. Rush also made several other pivotal recruits in the 1980’s which include Dr. Frank Padberg (1981), Dr. Joyce Rocko (1983), Dr. David Livingston (1988), Dr. Solly Baredes (1988) and Dr. Eric Munoz (1988).  The other major event in 1988 that would shape the department was the return of Dr. Dorian Wilson (NJMS class of 1982 and graduate of the surgical residency in 1986) from his transplant fellowship in Pittsburgh. Dr. Wilson brought with him and helped recruit Dr. Baburao Koneru (1988) to begin New Jersey’s first liver transplant program. In the ensuing years, the transplant service first under the leadership of Dr. Koneru and presently under Dr. James Guarrera has been another shining star in the Department.  Under Dr. Guarrera’s leadership, the Rutgers-NJMS liver transplant service was ranked first in the nation in 1 year survival (https://www.rutgers.edu/news/nations-top-liver-transplant-program-rutgers-affiliated-university-hospital).

The other event that was peripheral to the department but would have intermittent impact over the next three decades was the recruit of Dr. F. Carter Nance to be the Chair of Surgery at St. Barnabas in 1985. Under Dr. Nance’s leadership, the surgical residency at St. Barnabas became a stronger and more academic residency. Dr. Nance and Dr. Rush enjoyed a tremendous professional relationship and there was reciprocal teaching between the two departments. The St. Barnabas residents rotated at UH for trauma and emergency medicine and the NJMS residents rotated in the burn center at St. Barnabas. During this time and into the early 1990’s Newark Beth Israel hospital became affiliated with St. Barnabas and the general surgical rotations under the leadership of Dr. Donald Brief was considered one of the premiere teaching services in the program. Unfortunately, a clash of philosophies and egos between UMDNJ President Dr. Stanley Bergen and St. Barnabas CEO Ron Del Mauro resulted in the dissolution of any ties between UMDNJ and St. Barnabas. Dr. Nance was also removed as chair at St. Barnabas in 1995. Like when the clinical departments were told to vacate JCMC back in the 1960’s, the surgical residents had to be dispersed to the remaining training sites. It is certain that this dissolution did neither institution any favors nor improved residency training in both programs. The two departments did not reconnect until the creation of the new RBHS-North Surgical residency in 2018 and represents 20+ years of wasted educational and patient care opportunities.

In 1994, Dr. Rush stepped down as chair and Dr. Edwin Deitch was recruited from the University of Louisiana at Shreveport (FIGURE 6). Dr. Rush remained in the department for the next several years, completing work on his last NIH grant which culminated over 30 years of continuous funding. At the time of his recruit Dr Deitch had a national reputation, was NIH funded and was a past-president of the Society of University Surgeons. He would later go on to become president of the American Burn Association and The Shock Society. The first half of Dr. Deitch’s tenure was another period of great growth in the department with respect to faculty and research. At one time the department was in the top 10 surgical departments in the country with respect to NIH funding including a P50, center grant, a T32 trauma training grant and the CREST trial. Like other academic medical centers, this time period also saw the divisions of Neurosurgery, Otolaryngology and Emergency Medicine split off from General Surgery to become their own departments. By the early to mid-2000’s there was an exodus of faculty in the department paralleling the larger unrest within UMDNJ itself. This resulted in a somewhat downward spiral in academic productivity and clinical services within the department and in 2011 Dr. Deitch stepped down as chair to be replaced by Dr. Anne C. Mosenthal as interim chair.

At the time of her appointment, Dr. Mosenthal was the seventh woman chair of surgery in United States. She had a national reputation as one of the founders of palliative care in surgery and had been a faculty member within the department since 1994. Following a national search, she was appointed chair of surgery in 2013. Dr. Mosenthal also took the reins of the department at another critical time, that is the dissolution of UMDNJ and the takeover by Rutgers. Dr. Mosenthal not only successfully navigated this incredibly complex political environment but stabilized the department but increased recruitment and retention of faculty in all divisions. Major achievements under her leadership include: the resurrection of liver transplant program and the recruitment of Dr. James Guerrera, fund raising and establishing the Benjamin F. Rush, Jr. Chair of Surgery, expanding clinical footprint in New Jersey, resurrection of general surgical care at EOVA, and the development of current surgical residency combining NJMS with the St. Barnabas program.  Dr. Mosenthal left the department in 2020 to become Chief Academic Officer and Academic Dean at Lahey Health and Dr. James Guerrera assumed the role of interim chair.
Dr. Guerrera was another chair of national reputation and continued much of the work that was established in the department. He continued to grow the department and its research portfolio. He was also the chair of the search committee which brought the current chair, Dr. Dan Jones from Beth-Israel Deaconess to Rutgers-NJMS in 2022. Dr. Jones continues the legacy of Dr. Rush in being nationally recognized as a clinical surgeon and educator. He is past-president of the Association of Surgical Education and the Society of Alimentary and Gastrointestinal Surgeons (SAGES).

From this history, it is obvious that the New Jersey Medical School had a tumultuous birth and childhood well into its adolescence.  Political forces, egos, external agendas and its unwavering commitment to city and population of Newark were the crucible that helped forged the department of surgery as well as NJMS itself. Despite or because of these issues the department has thrived and continually attracted a diverse and nationally recognized faculty. As with all the past chairs and paralleling the external events in medical education, Dr. Jones assumes the leadership at a time of uncertainty and change. Rutgers, after over two hundred years of being a reluctant participant in medical education, now plans on consolidating both medical schools under one umbrella with the first class planned for 2028. Whether this is again driven by egos and political forces, or savvy leadership is up for debate. There is great concern among the faculty that what has made the department of surgery at NJMS unique; its commitment to education, diversity, academic excellence and research and the city of Newark itself may be at jeopardy. It has been 55 years since Ben Rush was recruited to NJMS. One can only hope that his legacy and words “The role of our Surgical Service is to render patient care as close to the ideal as possible” will continue to ring out for many years to come.

Acknowledgment: This manuscript would not have been possible without the help of following individuals

• James Oleske, MD, NJMS class ‘71
• George Macheido, MD, NJMS class ‘71
• Dean Robert Johnson, MD, NJMS class ‘72
• Pat Murphy, DNP
• Frank Padberg, MD
• F. Carter Nance, MD
• Bob Vietrogoski, NJMS Archival Librarian
• Stephen Modica, NJMS Librarian

REFERENCES

• Schwartz RA. The New Jersey Medical School. Acta Dermatovenerol Alp Pannonica Adriat. 2005;14:69-74.
• Rush BF Jr. Remarks of the guest editor. Am Surg. 1977;43:543-4.

FIGURES

FIGURE 1                  Dr. Rush outside his tent during his time in Korea and his short biography

FIGURE 2                  From the 1971 yearbook. Dr. Rush became the student’s favorite faculty within 2 years of arriving at the New Jersey Medical School

FIGURE 3                  Some notable members of the Department of Surgery in 1969

FIGURE 4                  Dr. Eric Lazaro

FIGURE 5                  Dr. Christine Haycock

FIGURE 6                  Founding chair of the Department of Surgery at St. Barnabas (Nance) and the subsequent Chairs of the Department of Surgery at the New Jersey Medical School (Deitch, Mosenthal, Guerrara, and Jones)