Doctor leaves behind big shoes to fill

Departing neonatologist Dr. Allen Merritt was driving force behind buildup of program to handle area’s most fragile newborns

Kayley Mendenhall / The Bulletin /

Published Nov 26, 2006 at 04:00AM

Robert Anderson keeps a photograph of his infant son Carson posted on his refrigerator. Although Carson is now a healthy 7-year-old, the photo of the newborn hooked up through various tubes to a menagerie of machines serves as a valuable reminder.

“That’s my Thanksgiving picture,” Anderson said.

The thanks his family owes, he said, is to Dr. Allen Merritt. The neonatologist treated Carson, who was born with a strep infection, for 11 days in St. Charles Medical Center-Bend’s neonatal intensive care unit in 1999.

“He’s still my hero,” Anderson said. “If you could see what I’m seeing right now, (Carson) eating his cheeseburger and being a goofball. It wouldn’t have happened without him.”

After a decade of long hours, hard work and countless sick babies struggling to survive, Merritt is leaving Central Oregon for a professorship at Loma Linda University in California.

The doctor is credited with building the St. Charles Medical Center-Bend neonatology program to a level that could handle the sickest babies.

He helped hire and train nurses, respiratory therapists and perinatal flight nurses to make the neonatal intensive care unit a success.

That team is still in place and will continue to treat premature and sick newborns backed by local pediatricians until Cascade Healthcare Community, parent company of the hospitals in Bend and Redmond, hires a new neonatologist to take Merritt’s place. During the interim, which could be up to six months, the unit will drop from a Level IIIb to a Level IIb facility, meaning the smallest babies — those born before 32 weeks of gestation — will have to be treated in Eugene or Portland.

The decision to leave, Merritt said, was based on a variety of factors, including a desire to spend more time with his wife and two college-age sons and to get back to his true love of teaching.

“I really enjoy teaching. It’s my passion. I’m pretty darn good at it,” Merritt said. “I had 20 years of academic experience before this. This has been a very important part of my career.”

The hospital group is actively searching for two new neonatologists, said Dr. Kathryn Beattie, vice president of medical affairs for Cascade Healthcare, and wants families to know they will receive quality care at the hospital while that search continues.

“We are really working hard to maintain as much service as possible for the community,” Beattie said. “The program is being managed by very experienced physicians who were with Dr. Merritt from the beginning. We have neontaologists from Eugene and Portland working with us to help support the perinatal flight team and who will be moonlighting to give the pediatricians a break.”

For families like the Andersons, who consider Merritt one of their own, replacing him is unthinkable.

“He’s leaving behind some pretty big shoes,” said Capri Maxwell, whose son Jonathan Smalling was born premature and was treated in the neonatal intensive care unit by Merritt for nearly three months. “We’re not just losing our doctor, we’re losing our friend.”

A straight dose of medicine

Maxwell started having problems with her pregnancy at 19 weeks.

She spent six weeks on bed rest before giving birth to Jonathan at just 25 weeks of gestation. A full-term pregnancy is 40 weeks.

“Jonathan was delivered and immediately handed over to Dr. Merritt,” Maxwell said. “He was really upfront and really honest about things ... He laid it out. He said, ‘He may not make it, but I’ll do everything I can to make sure he does.’ “

In the five years since Jonathan’s birth, Maxwell said she has taken her son to see Merritt on an almost monthly basis. Jonathan has struggled with ongoing health problems and spent Christmas last year in the hospital with an infection in his ear.

Merritt was there with the family, even though he wasn’t scheduled to work Christmas Eve.

“He gives his all to these kids,” Maxwell said. “I have no doubt that Jonathan wouldn’t have survived if Dr. Merritt had not been on staff.”

Giving his all has led to years of working all hours most days of the week. Merritt, who turned 60 in July, said he is simply tired of spending so much of his life on call. Some of his colleagues at Central Oregon Pediatric Associates have filled in for him over the years, but Merritt said he has basically been on call six days a week.

“You have to be dextrous at any point of the day or night. Babies don’t make appointments,” Merritt said. “There is very, very, very little margin of error.”

Since he began working at the St. Charles-Bend neonatal intensive care unit in 1996, Merritt said the number of annual deliveries has increased by about one-third from 1,200 a year to about 1,800 a year.

He said he began asking for help in 2000, and a second neonatologist was recruited to the community in 2004. Dr. Girija Natarajan worked here for only 18 months before leaving the community for personal reasons, but Merritt said having her available to provide back up was a welcome relief.

“It’s very hard to be your best six nights a week,” Merritt said.

Growing pains

As the community has grown, the hospital’s family birthing center and neonatal intensive care units have run out of space to handle the increased patient load. New moms and babies must be moved from the family birthing center to another floor for recovery to make space for other patients to deliver.

Merritt was frustrated by delays in a project to expand the facility that pushed back construction by several years. That construction has now begun and is scheduled to be completed by early 2008, but administrators predict it will be full the day it opens.

Merritt said he has felt that pediatrics has not been a priority for the hospital administration. A crunch for space on peak days, he said, led to a fear that the team he created could no longer do its best work.

“Regardless of how good your team is, if you don’t have a soccer field to play on, you can’t win,” he said.

Jim Diegel, CEO of Cascade Healthcare, said he can certainly understand why Merritt and many other physicians and nurses were frustrated with slow movement on the family birthing center expansion.

“The major issues with the delay in getting the family birthing center started were financial. Every time we designed it, it was well over budget and we would have to go back in and redesign it,” Diegel said. “Fortunately it’s out of the ground and on its way now.”

Now that construction is under way, Beattie said she wants the community to know the hospital realizes that the expanded family birthing center is important.

“We recognize it is a very strong need,” she said. “We are probably going to hit 2,000 babies this year.”

Even when the neonatal intensive care unit was filled with babies, Anderson said Merritt made his family feel like Carson was his only priority. Maxwell said she felt the same way.

“There wasn’t a day when he didn’t see my son when he was in the NICU and it was three months,” she said. “I hope Bend knows what it’s losing.”

The scientist

Bambi Will said her first impression when she met Merritt was that he was a “science dude.”

Will was hospitalized while pregnant with twins. They were born at about 25 weeks and Merritt was one of the first doctors the Wills spoke with about their situation.

“He was very scientific, very matter of fact, but still kind,” Will said. “It was pretty intimidating at first. The prognosis wasn’t good. We really appreciated how honest he was.”

In fact, when her daughter, Bailey, had to be transferred to Oregon Health&Science University for heart surgery, Will said she was struck by how difficult it was to get information about her situation from the staff there compared with Merritt’s team. She and her husband fought to bring the tiny baby back to Bend where they felt comfortable.

“Dr. Merritt, we had 100 percent confidence with him,” she said. “We didn’t have to question, didn’t have to wonder, didn’t have to ask anybody else.”

Merritt, who is described by parents as always whistling or humming while he works, said his attitude about treating newborns is a simple philosophy of positive thinking.

“Doctors get too much of the credit. These little babies require a team, a focused system of care. It incorporates the parents, advances the whole philosophy about being positive,” Merritt said. “You could look at it like, ‘How could this kid make it?’ to, ‘We’re going to do everything possible to help this kid make it.’ “

Before Merritt, St. Charles had a neonatal program built by local pediatricians, said Dr. Dale Svendsen, a colleague of Merritt’s at Central Oregon Pediatric Associates. The physicians at the time were already treating babies through the use of ventilators, which Svendsen said was rare for a town the size of Bend.

“When Dr. Merritt came, obviously, that’s his area of expertise,” Svendsen said. “He took that to the next couple of levels up, bringing in a lot of new technology and cutting edge therapies for the neonates.”

Merritt came to Bend from a position as medical director of the neonatal intensive care unit and professor at the University of California, Davis School of Medicine.

Over the years, he has instructed physicians and nurses here to use treatments not even practiced in some of the largest neonatal units in the country, Svendsen said. One of those involved cooling the body temperatures of babies who suffered a lack of oxygen for a period of time during birth.

“That was a new and helpful treatment,” he said. “I don’t think the people in Bend realize that they had, with his care here, that they had one of the state of the art neonatal intensive care units in the country.”

Merritt said he is interested in research and writes at least two or three medical papers every year. With his new university position, he hopes to have more time to devote to that work.

Always an advocate

Over the years since her first child was born premature and cared for by Merritt, Lynette Cauble said she has gotten to know the man as more than a doctor.

He has treated her oldest, Jack, since his birth and has also been her daughter Sophie’s pediatrician. He was present when her third child, a little girl named Romi, was born, although he is no longer working as director of the neonatal intensive care unit. His contract with the hospital ended Nov. 1 and he will leave Central Oregon Pediatric Associates within the next few months.

“As a favor to the family, he came in for the delivery. It was huge to us,” Cauble said. “I know he’s leaving ... I wanted him to complete our family.”

Cauble always calls Merritt the “puzzle finder.” He figured out that she had a rare, pregnancy induced blood disorder that caused Jack’s white blood cell count to drop.

“There was at the time only six other case studies in the world,” Cauble said. “We were pretty much the only positive outcome for the parent or the child, meaning one or the other died. It was a pretty intense time for us.”

Having just moved to Bend from California, the Caubles didn’t know many people here. Merritt gave them his home phone number, which they taped to the wall in Jack’s nursery. And he connected them with community resources and other parents dealing with premature babies.

“What he believes in is, quite honestly, is bringing medicine to all levels of society,” Cauble said. “He believes every human being deserves the same kind of care.”

It’s the commitment to that fundamental belief that led Merritt to serve on the Deschutes County Commission on Children and Families, and eventually he was appointed to serve on the Oregon Commission on Children and Families, where he has held a seat for six years.

Through that position, Merritt has advocated in Salem for sustained funding for programs like Ready, Set, Go, that support early childhood development.

“There has been no stronger advocate for early childhood development, for making sure that all kids regardless of economics get what it is that they need,” said Mickey Lansing, executive director of the Oregon Commission on Children and Families.

Merritt is concerned, he said, that the philosophy of medicine is shifting to be more focused on the bottom line and less on patient care, nationwide and in Central Oregon. When looking at a patient’s chart, Merritt said his last priority is the form of payment or insurance.

“No one in our society should say that a child, simply because of who their parents are, shouldn’t be given care,” Merritt said. “Medical principles are about serving people, not serving the almighty dollar.”

As he prepares to leave Oregon, Merritt is continuing to make connections with organizations here that serve those without access to health care. He and his wife are keeping their Bend home and will return for vacations. They plan to move back to the area after he retires.

He hopes to work with Ochoco Health Systems, parent organization of federally qualified health centers in Bend, Prineville and Madras that seek to help those without access to health care. He wants to continue treating patients when he returns to what he calls one of the nicest places in the country to live.

“I’m positive about the reasons for leaving,” Merritt said, contemplating what he will miss most. “This is a great community. These are lovely families.”