2018 Distinguished Service Award:
H.A. Tillmann Hein, M.D.
Saturday, September 8, 9:30 - 10:00 a.m.
H.A. Tillmann Hein, M.D. was born in bombed-out Germany where food and shelter were scarce. From age 5 onward he worked for his and his brother's food. At age 16, sponsored by the Methodist Church, he spent a year in Seymour, TX, getting to know his future wife, Rebecca, and earning a high school diploma. Back in Germany, he graduated from secondary school with a Reifezeugnis and then, at the Westfälische Wilhelms-Universität, Münster, served as president of the student body at his department and became the youngest pharmacist in his state. Medical School at the Freie Universität of Berlin resulted in an M.D. degree, followed by research in Perinatal Pathology and a Ph.D. in Medicine degree. Postgraduate training in Germany concluded with Board Certification in that country, followed by residency training at Parkland Memorial Hospital in Dallas, TX, and Board Certification by the American Board of Anesthesiology.
Dr. Hein is married to Rebecca, a former teacher and school counselor. His daughter Bettina, a serial start-up entrepreneur is married to Andreas Göldi. They have 2 children, Louisa and Jakob. His son Florian, a banker, is married to Linda. They have 3 children, Anina and twins Ruben and Benjamin.
Dr. Hein's professional development can be described as a relentless quest to get and give honest answers. Involved in the then burgeoning field of pharmaceutical technology as a pharmacist, he heard the scope expansion ideology of his colleagues suggesting that it was his role to give medical advice to patients. He quickly realized that he was ill-equipped to do so and simply went to medical school. When having to decide on a medical specialty career, he was looking for the greatest and most important impact on life and saw that as the dividing line between life and death where anesthesiologists work daily.
In realizing that a physician's care of patients needs to be free from extraneous influences, he moved from Germany to the United States where he found the highest educational standards and the highest degree of physicians' freedom. He understood that freedom is not free and that it takes active participation in teaching, research and advocacy to preserve that freedom.
Every opportunity that he had he used to pass on clinical knowledge and skills to students, residents and fellows that would allow these trainees to become successful physicians.
When the AIDS epidemic struck, Dr. Hein conducted a study that showed retrograde migration of blood cells in flowing intravenous lines. This study received widespread attention, even in lay media, and as a result needleless injection systems were introduced. Policies were developed to guard against needle sticks and against using needles and vials on more than one patient. Likely, many lives were saved because of that.
Although initially described by European surgeons in the early 90s, laparoscopic cholecystectomy became rapidly popular in the US; however, with a surprisingly high number of fatalities. Experts opined that only very healthy patients should be subjected to this new surgical technique. As the chairman of a quality assurance committee, Dr. Hein was looking for the root cause of the severe complications. He found it in the lack of understanding by both surgeons and anesthesiologists of the dynamically changing physiology of the pneumoperitoneum. In a series of papers, including one on patients who were on the wait list for a heart transplant, the safe management of laparoscopic cholecystectomy was established. The advice was reversed so that now the laparoscopic approach was especially indicated for the very sick.
Ideas for research projects always came out of quality inquiries. It has been Dr. Hein's concept that bad outcomes should never be accepted, and that rather knowledge and technology needed to be improved. As a result, some 200 full papers, abstracts and posters, as well as 2 patents were presented and those have by now been quoted by almost 800 other researchers. In this process, Dr. Hein rose to the rank of full professor.
When asked to serve as an alternate delegate to the TSA House of Delegates and then later serve on committees, Dr. Hein followed those calls. As chairman of the Committee on Economics, he entered the then rather hostile environment of the Medicare Carrier Advisory Committee and became an effective advocate for anesthesiology by successfully modifying countless policies that otherwise would have made it difficult for anesthesiologists to practice. One stands out. In the 1990s, the federal Healthcare Financing Administration (HCFA) decided to reign in the abuses they perceived in regard to payments for "stand-by" services often not involving any personal contact of a physician with a patient. Unfortunately, anesthesiologists had also been labeled a "stand-by" service. That service, however, required a very intense personal interaction. Although, the American Society of Anesthesiologists had coined the term "Monitored Anesthesia Care", HCFA's policy draft threatened non-payment. Dr. Hein initiated a national protest and activities at several levels, but Medicare's attitude only changed when Dr. Hein began negotiating with the operational staff at the Medicare carrier and convinced them that the policy would increase their expenses as well. The result was the insertion of language into the policy that has since guaranteed payment and has made it possible for anesthesiologists to be involved in endoscopic procedures. It now has an annual impact of at least $3 billion on US anesthesiologists' revenue at Medicare rates, and has created jobs for 12,500 anesthesiologists and/or anesthesiologist assistants and nurse anesthetists. When faced with the threat of a 25% payment reduction by the Texas Workers Comp System, Dr. Hein orchestrated fundraising from the large groups to finance an actuarial analysis. Armed with that and a forceful presentation, Dr. Hein walked out of the Workers Comp Administration not with a 25% cut but with a 12% raise. By now, that action has had an impact of $200 Million on Texas anesthesiologists' revenue. Likely the largest impact on the economics of American anesthesiologists came in 2009 when, in rather intense negotiations, Dr. Hein was able to remove the infamous "public option" language from the final version of the Affordable Care Act, also called Obamacare. Had that provision become law, it would have had a negative impact of over $20 Billion per year, and to date over $160 Billion, on anesthesiologists' revenue. It is clear, that with such a drastic reduction in income, anesthesiologists would have left the field and medical students would not have entered it. American Healthcare would have changed. Dr. Hein was later asked to present an ASA award to the legislator who had shouldered the difficult congressional negotiations and had brought them to fruition.
Dr. Hein never campaigned for any office he held; he just answered the call to serve. When asked to serve as president of the Texas Society of Anesthesiologists, a serious opt-out threat came to his attention and swift action was needed. Again, a funding coalition of large groups was put together overnight, and a powerful lobby team was financed. The opt-out threat went away, likely saving the ASA at least $500,000.
In the advocacy arena, Dr. Hein has not only has reached into his own pocket but also does not tire to cajole other anesthesiologists to do the same and more. As a result, an increasing number of anesthesiologists understand the importance of political advocacy and open their homes for fundraisers and get involved at other levels. This bears fruit. At least three anesthesiologists thus became Texas legislators and a Maryland anesthesiologist serves in the US Congress. At a very critical juncture, three members of the US Congress called Dr. Hein from the floor of the house to solicit his advice on a pending vote.
Anesthesiologists are not just technicians to render patients insensitive to noxious stimuli. In Dr. Hein's opinion, they are real people and it behooves their professional organizations to address all aspects of their lives. Thinking about that, he included some 24 recommends in his president-elect speech, a record number. Several of these recommends have been implemented and may survive.
In addition to serving in various capacities at ASA and TSA, Dr. Hein has also served as president of Dallas County Anesthesiology Society, as a committee member at Dallas County Medical Society and Texas Medical Association, as Chairman of the Texas Surgical Quality Collaborative, as a member of the Board of Directors of the Sepsis Foundation, as President of the Dallas Goethe Center, and as Chairman of the Texas German Day Council. He is a Professor of Clinical Anesthesiology at the University of Texas Southwestern Medical School and has served as a Visiting Professor at several US and European Universities. He is a founding shareholder of several physician-owned hospitals and several start-up ventures developing novel monitors and pharmaceuticals.
Taking care of patients in need remains Dr. Hein's main activity. There is no greater reward to him than a timid smile from a child or the hand of a grandmother on his with a "bless you" on her lips.
Dr. Hein's activities would not have been possible without the unwavering support of his wife, Becky, and all of his family. His partners in Metropolitan Anesthesia Consultants in Dallas, TX always gave him free reign.
Several mentors have shaped Dr. Hein's work, motivation and stamina. In addition to his parents, there are Frances and Richard Fergeson, Stella and J.B. Bishop, Dr. Hans Bludau, Dr. Adolph Giesecke, Dr. Harold Boehning, Dr. Michael Ramsay, Dr. Robert Parks, Dr. Len Hughes and Dr. Tony Lehner. Dr. Hein feels that the Texas Society of Anesthesiologists has always been an extended family, and chiefly responsible for that impression are sisters Ann Becker and Christina Bacak.
Choose From Among 36.75 Hours
Of Continuing Medical Education
This CME activity meets the formal CME requirements for the State of Texas annual medical license renewal, including:
- Thursday Legislative Program – 3.0 CME hours
- Friday – Sunday Scientific Program – 16.25 CME hours
- Workshops – 8.0 CME hours
- Parallel Sessions – 9.5 CME hours
Included in the above hours:
Ethics Sessions – 4.25 CME Hours
MOCA® - 5.75 MOCA® Hours
MOCA 2.0® - 7.0 MOCA 2.0® Patient Safety Hours
Educational programs are jointly sponsored by Texas Medical Association and Texas Society of Anesthesiologists.