HAGERSTOWN — Dr. Dan McDougal had a strategy for dealing with insurance companies that put doctors through a game of “Mother May I” to get procedures approved.

When a company said it wouldn’t pay for a CT scan or an MRI unless its staff authorized it first, McDougal, medical director for Antietam Health Services, would call the insurance company’s medical director, who usually was in another state, and ask for the spelling of his name and his Maryland medical license number. When the medical director said he didn’t have a Maryland license, McDougal threatened to call the state board of licensure and stressed the serious consequences of practicing medicine without a license.

“There’d be this long pause, and then they would all say the same thing: ‘What do you want?’” he said.

In every aspect of McDougal’s career, that answer has been the same — the right care for patients.

“I was taught at (Johns) Hopkins how to take care of people, how to practice medicine properly, and I’ve never let go of that, but in fact, I’ve lashed back at insurance companies and administrators who try to compromise care,” McDougal, 64, said during a recent interview at his home near Williamsport.

For that dedication to improving access to medical care in this community, and for his adept leadership and kind, generous spirit, McDougal has been named The Herald-Mail’s 2009 Person of the Year.

“I just think he’s always cared about giving the best care to people that can be given, and sometimes the system makes it really hard to do that,” McDougal’s wife, Penny, said.

In addition to his work at Antietam Health Services, McDougal is a volunteer physician at the Community Free Clinic of Washington County, where, until recently, he also served as medical director.

In February, McDougal was diagnosed with amyotrophic lateral sclerosis, more commonly known as Lou Gehrig’s disease, an incurable, fatal neuromuscular disease.

As his body grew weaker, McDougal was forced to leave Antietam Health Services and the free clinic, but he has continued to advise the free clinic staff and to ensure the clinic’s continued success by setting up an endowment fund that raised nearly $100,000 in a matter of months.

“He gives so much and asks for nothing in return,” clinic medical receptionist Tammy Ebersole wrote in her Person of the Year nomination, one of four submitted on behalf of McDougal.

The child of a short-lived World War II romance, McDougal was born at a hospital in Bethesda, Md., but as an infant was adopted by a family in California. He grew up on the beach surfing and playing beach volleyball and basketball. On foggy days, he headed to the library, where, as an athlete interested in how the body worked, he pored through anatomy books and discovered his interest in medicine.

McDougal was a straight “A” student in high school, and was accepted to Stanford University on a scholarship at a time when only one out of every 35 applicants was admitted. He attended year-round, majoring in physiology, with a minor in art history.

It was Stanford, McDougal said, that gave him the self-confidence that helped him stand up to insurance companies and serve as a medical director later in life.

Learning to lead

“They drilled into you that society needs leadership, and you’re it,” he said.

McDougal graduated from medical school at the Milton S. Hershey Medical Center of Penn State University in 1971. After graduating, he was drafted and spent two years in the U.S. Air Force working at a detox center, where he treated many Vietnam veterans.

“It’s a little-known fact, but the Viet Cong didn’t beat us; drugs did,” McDougal said.

After that, McDougal completed a residency at the University of Maryland Medical Center, spent two years as a rheumatology fellow at The Johns Hopkins Hospital, and went into private practice in Baltimore, practicing internal medicine and rheumatology, or joint and tissue medicine.

But McDougal’s experience at the military detox center stayed with him, and when he was offered an opportunity to practice addiction medicine at the Greater Baltimore Medical Center, he jumped at the chance.

Unlike many addiction specialists, McDougal said he never used illegal drugs, never smoked a cigarette or drank alcohol. Still, he said he was able to understand addicts in a way that won the respect of patients.

McDougal said addiction is a genetic disease, predetermined by neurochemistry, and the most important part of treating addicts is orienting them to think of addiction as a disease with which they were born.

“You come in as an addict, you’ll go out as an addict, and all you have to do is keep away from the substance,” he said.

Despite McDougal’s talents, work in addiction treatment was scarce, and in 1998, he accepted a job as medical director for Antietam Health Services, the for-profit arm of Washington County Health System, and moved to Washington County.

As medical director, McDougal’s job was to advocate for physicians and to lend a physician’s perspective to Antietam Health Services’ administrative decisions, said Michael S. Zampelli, health system vice president and head of Antietam Health Services.

How to do that was left open for McDougal to decide, so he zeroed in on addressing a long-standing grievance of his — unfair practices by insurance companies.

One of his biggest successes, he said, was confronting Blue Cross about its noncompliance with a 1994 Maryland law that requires insurance companies to treat “mental” ailments, such as insomnia, anxiety and addictions, the same as physical ailments.

The state of Maryland was one of Blue Cross’s biggest customers, so McDougal set up a meeting with a Blue Cross official and the Maryland attorney general.

“I showed them the law and I said, ‘The State of Maryland is violating Maryland law,’” McDougal said.

Within weeks, Blue Cross had reprogrammed its computer system so it paid for the so-called mental ailments, he said.

“That benefited every physician in Maryland,” McDougal said.

One insurance company went so far as to put McDougal’s name and picture on the wall and forbid any of its employees from talking to him, but even with that company, McDougal said he managed to get whatever approvals he needed after threatening to orchestrate a meeting arbitrated by the Maryland insurance commissioner.

“I don’t think he ever encountered a barrier that he wasn’t willing to take a crack at overcoming,” Zampelli said.

McDougal didn’t stop at battling insurance-related hurdles for insured patients. He also recognized the need for help for the vast number of patients left uninsured by the system, and he poured his energy into the Community Free Clinic, which treats uninsured county residents at no charge.

McDougal was recruited to volunteer at the clinic shortly after he moved to the county because of his experience with addiction medicine, and he quickly became an indispensable resource in a variety of areas, clinic Executive Director Robin Roberson said.

McDougal volunteered at the clinic every Tuesday from 3 to 8 p.m., seeing about 15 to 20 patients in that time, about double the typical clinic provider’s load, Roberson said.

He relished the freedom the clinic gave him to spend as much time as he wanted with each patient, said Adam Roberson, Roberson’s husband and program director at the free clinic.

“It’s more than just come in, here’s your medicine and send you on your way,” Adam Roberson said. “He would get to know the patient, empathize with their situation.”

Dr. John Reed, a physician who worked with McDougal both at the clinic and in his role at Antietam Health Services, said that approach stemmed from McDougal’s perspective on medicine.

“I think he has a great love of just taking care of patients, and really sort of knowing who they are and where they come from,” Reed said. “He has a great ideal of knowing that ultimately, medicine is a calling ... It’s a call to serve, above and beyond anything else.”

McDougal joined the clinic’s board of directors, and about six years ago became its medical director, in charge of overseeing medical operations.

In addition to keeping his Tuesday hours, McDougal often stopped by the clinic during lunch to work through piles of paperwork that needed his signature, and he always was available to answer other providers’ questions and offer advice, Adam Roberson said.

McDougal said Zampelli was generous in accommodating his work with the free clinic.

“We understand how important the work the free clinic does (is) for this community, so when we saw the passion he had for it and combined that with the critical services it provided, we made an effort to provide as much of Dan as we could,” Zampelli said.

McDougal helped double the number of volunteer providers by taking his colleagues on a tour of the clinic, then taking them out to lunch and talking to them about the clinic’s mission until they agreed to sign up, Robin Roberson said.

He also used his connections at Robinwood Medical Center, The Johns Hopkins Hospital and the University of Maryland Medical Center to get many free clinic patients care that wasn’t available through the clinic — often free of charge.

McDougal said one of his proudest moments at the clinic was hearing back from a colleague at The Johns Hopkins Hospital that he would do aortic valve replacement surgeries for free for two clinic patients who could not afford them otherwise.

About three months ago, McDougal met with the president of The Johns Hopkins Hospital to ensure the hospital would continue to work with the free clinic when McDougal isn’t around to initiate the connection, Robin Roberson said.

“I think he’s just absolutely a true humanitarian,” she said. “He is one of the kindest people I have ever met. He tries to help anyone that he can.”

Providers who worked with McDougal at the clinic described him as even-tempered and always willing to share his knowledge and experience.

“Dr. McDougal just never minded being interrupted and would teach the rationales of what the physiology is,” said certified registered nurse practitioner Mary Perkins, one of the four people who nominated McDougal for Person of the Year.

Teacher and healer

Lance Thompson, a registered nurse who worked closely with McDougal, said McDougal would explain the interactions of various medications or inform him about different diagnoses and what the outcomes might be.

“He is definitely a teacher as well as a healer,” Thompson said.

“Dan the Man,” as Thompson calls him, also is known for taking the clinic staff out to lunch and to a big dinner each year, for giving patients straight and thorough answers about their medical conditions, and for being a good conversationalist and listener.

“He’s just an easy person to talk to,” Adam Roberson said. “We could just sit and talk about anything or about nothing at all.”

Outside of work, McDougal’s passions are his wife, Penny, whom he met when she was an assistant in his anatomy class, and his children, Amy McDougal Hutchens, 38, and Colin McDougal, 39.

Hutchens said McDougal’s career success never came at the expense of his family.

“He had the same level of dedication to us as a family as he did to his medical endeavors,” she said. “He literally spent every minute that he was not at the hospital or with patients with his family.”

In his free time, McDougal did fix-it projects around the house and taught his children to use various tools, sometimes with disastrous results, Hutchens said. At a tribute dinner for McDougal in October, Hutchens had the audience laughing with tales of tool-related mishaps, such as the time her father stirred up a nest of carpenter bees with a staple gun and the time he accidentally glued his scalp to the inside of his boat while waiting for an epoxy adhesive to cure.

Boating is another hobby for McDougal, who owns a 25-foot cabin boat that he takes out on the Chesapeake Bay.

McDougal said he has been considering writing a book about how to take care of a boat, but others have suggested that he should write about how he dealt with insurance companies.

Colleagues said McDougal has never been ostentatious, and in fact drove the same small car for more than 20 years.

“He’s a tall man, never heavy, drove this little Fiero,” Thompson said. “It was always funny to see this big guy get out of this little car.”

McDougal spent a lot of time keeping in shape, with a workout that included 10 minutes of hitting a speed bag with 3-pound weights in his hands, 20 minutes of free weights and an hour of jogging or speed walking with 10-pound barbells in each hand, he said.

It was during one of these workouts about two years ago that McDougal noticed the first symptoms of ALS.

“All of a sudden, I couldn’t do it any more,” he said. “And I started to get these spasms everywhere, which prompted me to go to Hopkins, and that’s where the diagnosis was made.”

Since then, the disease has progressed rapidly. One of the muscles from his vocal cords is slack, slowing his speech and making his voice hoarse, and for the past three or four months he has been unable to eat or drink, taking in everything through a tube in his stomach.

“I can feel that I’m getting weaker and weaker,” he said.

Funding the clinic

Still, McDougal said he wanted to return to the clinic after the holidays to practice for one or two hours a week.

“We’re very, very excited of just the thought of his presence in the clinic ’cause he’s greatly missed,” Robin Roberson said.

Adam Roberson said it was after the October tribute dinner that McDougal really got his spark back and decided to renew his medical license, which he had placed on inactive status.

Robin Roberson said that when she started planning the tribute dinner, her idea was to use it to raise money for the ALS Association, but McDougal said he would only let her do it if she used the proceeds to start an endowment fund for the free clinic. The clinic does not receive state or federal funding and has been struggling from a decrease in contributions at a time of record need, Roberson said.

The dinner raised about $47,000, and a few weeks later, an anonymous donor dropped off a matching check for another $47,000, Robin Roberson said.

The clinic will use the interest from that account to help fund its operating expenses in perpetuity, Robin Roberson said.

“It’s always been a vision of mine for the clinic to have an endowment, but we’ve never been financially stable enough to take money from operations to open one, so this is truly a gift,” she said.

As The Herald-Mail’s Person of the Year, McDougal received a crystal bowl and $1,000 to donate to a civic cause of his choice. Naturally, McDougal chose the free clinic.

McDougal advocates comprehensive, continuous care

When it comes to fixing health care in the United States, Dr. Dan McDougal has two words.

“If you remember nothing else from me, remember — comprehensive and continuous,” he said. “That’s what medical care needs to be.”

McDougal, The Herald-Mail’s 2009 Person of the Year, said he has a strong opinion about what has gone wrong with health care in this country, and it’s not what is being discussed in Congress.

“They’re talking about all the wrong subjects,” McDougal said. “They’re completely missing the problem.”

McDougal had a long career in private medical practice capped off by a decade of working with uninsured patients at the Community Free Clinic of Washington County and fighting insurance-related hurdles as medical director for Antietam Health Services.

He said the problem is a decreased emphasis on primary care, which he described as the only form of medical care that can be both comprehensive and continuous.

“What they’re missing is they’re seeing medical care as a whole, and primary care needs to be different, off to the side, and they need to really feed it, water it, make it thrive,” he said.

That would involve increasing the amount that insurance companies pay primary care physicians, freeing them from restrictive policies and establishing incentives for going into primary care, he said.

Currently, the typical office visit would cost an uninsured person about $80 in cash, but if paid through an insurance company, the physician gets only about half that — somewhere in the $40 range, McDougal said.

“In general, the office is structured around $40 to $45 reimbursement, and so that’s all the patients get,” he said. “If you doubled the pay of primary care, they could spend more time with each patient and really do the comprehensive and continuous.”

By comprehensive, McDougal said he means having a doctor take responsibility for the full spectrum of a patient’s wellness.

“I make sure you have your swine flu shot, I make sure you have your flu shot, I make sure you’re up to date on your other vaccinations. We talk a little bit about drinking, and bar hopping, and that sort of thing.”

Continuous means the patient comes in for regular checkups and the doctor will “keep at ’em” to follow through with care, he said.

This system would save money in the long run by preventing patients from developing more serious conditions that require specialized care, McDougal said.

In addition, it is less expensive to have primary care doctors handle routine illnesses than for those patients to see specialists, he said.

But with the growing shortage of primary care physicians, people might one day have no choice, he said.

He said new medical school graduates are opting for other specialties with higher pay and shorter hours.

“In 10 to 15 years, it’s possible we could have a complete collapse of primary care in the State of Maryland,” McDougal said. “So the main thing is they have to rebuild primary care.”

No one seems to be talking about that issue, McDougal said.

“I listen to these debates, and they’re so off,” he said. “And the so-called experts, they’re so ignorant. They don’t know what they’re talking about.”

McDougal said any version of the health reform bills passed by the House and Senate in 2009 is bound to fail to achieve its goals.

“They need different laws,” McDougal said. “I’m disappointed that the Senate or the House or the cabinet hasn’t called me to explain to them what they can do that will make a difference.”

McDougal said the government should regulate insurance companies in the way it regulates automobile construction, where each car must have safety features such as seat belts and airbags.

“They need federal regulations about health insurance that say if you sell a policy, it has to have this, this, this, just like the automobile builders,” McDougal said. “They can’t just build their own car; they have to build it through the government specifications.”

In addition to higher pay for primary care, the legislation should include mental health parity so that conditions such as anxiety and depression must have the same coverage as appendicitis, McDougal said.

In addition, he said, insurance policies all should have the same price, regardless of whether the buyer works for General Electric or runs a lawn care service.

Another reform could be to give physicians a tax credit for a charitable donation whenever they take care of a patient for nothing, McDougal said.

“That would encourage free care,” he said.

Dr. Dan McDougal is the 11th person to be named The Herald-Mail’s Person of the Year, which is awarded each year to someone who makes a positive contribution to the community.

The 10 previous recipients are:

• John Waltersdorf

• Mike Callas

• Norman Shea

• Art Callaham

• James G. Pierné

• John F. Barr

• John R. Hershey Jr.

• Lois Smith Harrison

• Elizabeth Morgan

• Frederick C. Wright III