A Publication of WTVP

Norman R. Johnson, M.D., was born in Kansas City, Mo. He earned his bachelor’s degree at Augustana College in Rock Island, Ill., in 1975, then went on to earn his medical degree in 1978 from the University of Illinois. He served his internship and residency at Saint Francis Medical Center and is board certified in internal medicine and geriatric medicine.

Johnson started a private practice in Pekin in 1981. The next year he formed the Delavan Medical Center and, three years later, The Medical Clinic in Morton and the East Peoria Multi-Specialty Group.

Johnson has held medical directorships with numerous nursing homes and medical complexes in Pekin, Canton, East Peoria, Morton, and Peoria.

He is president of Health Professionals, Ltd., a healthcare provider for correctional centers.

Johnson has been president of Opera Illinois, and is chairman of finance for the Central Illinois Medical Association. He also serves on the Illinois Department of Public Health Alzheimer’s Research Peer Review Committee and the Illinois Medical Society Political Action Committee.

His wife Brenda is president of Johnson and Vaughn Jewellers, and he serves as treasurer and board member of that company.

You have not always been a physician. What did you do before you went into practice and how did you get interested in medicine?

My wife Brenda and I were married shortly after high school and I began to work in the Quad Cities. Specifically I worked at Farm All Works for International Harvester and Moline Tool Company.

After a period of time I became somewhat dissatisfied with factory work and decided to enter college and gain an education. My grandfather was a dentist and my father was an osteopathic physician. I was always interested in medicine and so it became a natural goal for me.

After completing my undergraduate work at Augustana College in Rock Island, I went to the University of Illinois in Champaign and in the second year I transferred to the Peoria School of Medicine. I graduated in 1978 and entered an internal medicine residency at Saint Francis Hospital in Peoria, which I completed in 1981.

What particular sacrifices were necessary for you to begin college at age 29?

By age 29, most people are fairly settled in their life, and certainly this was true of Brenda and me. I was on the board of directors of the local country club and we had a number of pieces of investment real estate that we managed in addition to our usual jobs. We played golf on a regular basis and had an active social life.

When I began college, I continued to work full time in addition to my classes, and so life changed drastically at that time. Initially we cut back on the social activities including going out to dinner with friends and golf at the country club. Later it was necessary to sell our investment real estate and finally, even sell our home and move into a small apartment. Brenda continued to work two jobs and at times even had a third job on weekends to make ends meet.

How did you happen to choose Pekinas the location for your first office? How does a physician begin private practice? What’s involved in recruiting patients?

Developing a private practices is to a large extent a question of location. I surveyed a number of area including out-of-state sites such as Florida, but decided on Pekin as the best site. The main reason for this was that there had not been any new practices started in Pekin for a considerable length of time and the hospital was interested in recruiting new physicians and assisting in the development of the practice.

Recruiting patients initially really wasn’t a problem because many of the practices in Pekin were closed to new patients at that time and most of the doctors were working as hard as they possibly could.

Shortly after I opened the practice in July 1981, I began to recruit other physicians into the practice, and we were very successful.

Tell us about the other practices you’ve opened and the expansion of your offices into multi-specialty groups.

We opened offices in Delavan, Bartonville, East Peoria and Morton. After a period of time, we began to work with many of the specialists in a cooperative way so that they would come into our offices to see the patients. This allowed people to benefit from a “one stop shopping” concept in which they could see their cardiologist, gastroenterologist and have all of their x-rays and laboratory work done in one place without having to make more trips to other offices and fill out more paperwork.

The concept worked very well and all of the practices grew quickly.

A lot of your work is with the elderly in nursing homes. How did this come about? Do you also work with younger people who reside in nursing homes?

At the present time I am the medical director in nine long term care facilities and with a local hospice.

I do see a number of younger people in nursing home settings. These are usually young men and women who are handicapped in some fashion – either through mental retardation or sometimes severe head injury or catastrophic cerebral hemorrhage, but the majority of the cases are the elderly.

I have always enjoyed working with the elderly; they have special needs and concerns at that stage of their life.

What are some of their special needs and concerns?

Taking care of the elderly in a nursing home setting is quite different from caring for people who are ambulatory and come to the medical office.

The main differences involve very heavy handed micromanagement by governmental agencies. This includes even limiting medication doses, types of medications and treatments that can be used, and whether or not the government will allow elderly unstable persons to be restrained for their own safety.

Physicians do not have free will to practice as they want in a nursing home. They much practice within the system to try to help their elderly patients to the best of their ability. This requires a complete knowledge of the government’s rules and regulations.

What is the Illinois Department of Public Health Alzheimer’s Research Peer Review Committee?

This is a small committee of approximately eight to ten people who meet once a year to evaluate research proposals. Our job is to determine if the proposals have merit based upon a lengthy application process and then to allocate dollars to help pay for the research. Applicants can win up to $30,000 grants for their projects and these projects include all manners of research into Alzheimer’s disease, from biochemical studies at the cellular level through large population studies to look at the disease’s impact upon communities.

Since Alzheimer’s disease is such a devastating disease to the patient and to the family, I believe this is one of the most important areas of scientific research that is presently supported by the state of Illinois.

What changes have you seen in medicine over the past seventeen years and how do you think managed care will impact upon its future?

Managed care hold great promise to increase the quality of care and lower costs. Unfortunately at this time that promise has not been realized. In some areas costs have been contained, but occasionally that is at a reduction in the quality of care. At other times we have seen patients and physicians banding together to demand services that in reality are probably not needed.

The reality is that we still have too many patients requesting medicines and tests they do not need and too many doctors who are ordering unnecessary tests and medicines, either because they somehow profit from it, or out of fear of lawsuits. Also, we still have too many insurance companies that, if left completely unchecked, would reduce the quality of are to a dangerous level.

What is the solution to the problem of the high cost of medicine?

What is needed is a cooperative program between the three groups – all working together to hold costs down while providing the very highest level of care.

The truth is that more medicine is not better medicine. It is, in fact, bad medicine, and more testing that is unnecessary is not only of no benefit, but it is truly dangerous. Patients must be brought into the decision process and educated by the physicians. Business needs to come together with third party carriers, the physicians and the patients in a cooperative way to design a program of benefits that is satisfactory to all.

In the final analysis, when everyone works together in a close, cooperative way, then everyone, including patients, physicians, and businesses, need to benefit from that. That will be the final solution.

Do you see this happening anytime soon?

Probably not in the immediate future. At this time there are many doctors who simply do not understand the concept of true evidence based medicine. There are too many tests and too many medicines that are prescribed or ordered based upon mythology or fear and not based upon true scientific data.

In their defense, it is very difficult when you are facing an angry patient who has just read the latest magazine and has rushed immediately to his doctor to have an unneeded treadmill stress test or hepatitis C studies because that is what the article suggested.

You mentioned bringing business into this decision process. You are the president of Health Professionals, Ltd. What does your company do?

Health Professionals, Ltd. (HPL) is a managed care company that specializes in correctional medicine. We have contracts with the state of Illinois, the Federal Bureau of Prisons, and on February 1 we started a contract at the Peoria County Jail.

Basically we supply all health care including physicians, nurses, hospitalizations, consultative services, dental, psychiatry, physical therapy, etc. In addition, we have developed an aggressive utilization program that has helped to hold costs to a minimum while delivering the highest quality of care.

Are the health care people who work in the prisons employees of HPL or are they contracted? What specific qualifications are desired of health care people working in a prison setting?

The people who work in health care in prisons are made up of state employees and people who are employees of health care contractors such as HPL. The mixes vary from one prison to another. In some facilities all of the employees are employed by the health care contractor and in other facilities the state of Illinois may employ the majority of the nurses while the health care contractor may only supply the doctors, dentists and psychiatrists. But the state clearly seems to be moving toward more health care contractor employees rather than hiring more state employees.

The special qualifications that are needed for health care employees in a prison setting are maturity and experience. Many of the patients we work with are young, somewhat immature people, and it requires a mature evaluation by a nurse to really determine what the problems are.

Other than that, the employees have to have a healthy respect for the security requirements such as keeping track of their personal set of keys that allows them to move through locked doors, and they need to be certain that they always maintain a professional relationship with the patients.

Why did you start the company and how was it originally formed?

About two years ago Brenda and I had dinner with Dr. Steve Cullinan and Dr. Theresa Falcon. During that dinner we discussed various opportunities in correctional medicine. There appeared to be a real need for a physician owned and directed company that was sensitive to the special needs of corrections.

As we began to look at the market, it became apparent that there were no Illinois based companies that did this type of work. Because the Illinois Department of Corrections contracted with so many out-of-state vendors, we felt that there was a serious need – and that was the beginning of the company.

We were incorporated shortly after that and the four of us are all owners and deeply involved with the management of the company.

How dangerous is working in prisons from the standpoint of physical danger and dealing with litigious patients?

It is not as dangerous as it seems. First of all, there are correctional officers on duty and in the immediate area during any patient contact. The inmates know that if they say or do anything that seems out of line they could be put in a segregated cell. This is not something that they wish to have happen, so they are virtually always on their best behavior.

What one looks at the normal risks that a nurse in a hospital must go through, both from the standpoint of dangerous diseases as well as being scratched, kicked, or bitten by patients who are incoherent or mentally ill, it is probably actually safer to work in a prison.

From the standpoint of lawsuits in prison facilities, the main things that people sue for – including lost wages or medical cost – simply don’t exist, so there is no purpose in suing for those things. The only thing that could be sued for would be pain and suffering.

The Illinois Department of Corrections will hold the vendors harmless for the vast majority of nuisance lawsuits or other suits that occur where good medical care has in fact been delivered but there was possibly a bad outcome. Because of this, the risk of lawsuits in prison is actually lower than what anyone could imagine.

The risk of lawsuits is a little different. The inmates are usually just arrested, so consequently they are angry and more hostile. But we have developed programs to reduce the incidence of lawsuit risk there. This includes very aggressive documentation and far more frequent physician evaluation of the patients, up to and including daily evaluation if necessary.

You can never totally prevent lawsuits, but I believe we have put in place good solid programs that reduce the incidence to a minimum.

Do you think HPL will grow larger in the future?

HPL is just in its infancy. Fortunately, we were able to get started at a time when it was a little easier to begin these sorts of companies.

At this time, many states have put in place regulations that prevent a company from contracting with the state unless you already have contracts for correctional health care. It is sort of a Catch 22 – you are unable to start a new company unless you already have an existing company that does this line of work, and this prevents a lot of new companies from coming into the market.

How fast is that market growing now?

The state of Illinois is projecting a 33 percent growth rate over the next six years to a total of approximately 60,000 inmates by the year 2004. This is a combination of sentencing laws that require inmates to serve more of their sentence and a more aggressive “get tough” attitude from the public in general.

What are the consequences of a growing prison population combined with the possibility of limited health care for prisoners? With the difficulties you mention for new companies contracting with the state, can your company grow fast enough to keep up with the demand for health care for prisoners?

The state of Illinois provides excellent health care for prison inmates, and their health care is really not limited in any way. They are provided with a full range of services from mental health to dentistry to OB/gynecology services to any other medical services that one would have in an ambulatory setting. The standard care is always equal to the standard in the region in which the prison is located.

The second part of the question involves whether our company can grow fast enough to keep up with demand for health care for prisoners, and that is always regulated by the state of Illinois. They are the ones who determine staffing – for example, how many nurses, doctors and psychiatrists will be needed in a particular prison. Our experience to date is that the state is quite sensitive to the needs of the inmates and has increased staffing adequately whenever needed.

We do not anticipate any problems with the growth of our company and would expect that we would pick up many more contracts in the next bidding cycle.

What changes would you like to implement in the prison health care system?

At the present time I believe the biggest need in prison health care revolves around the care of the mentally ill patient. This is true in the county jails as well as in the Illinois Department of Corrections prison system.

While large volumes of dollars are presently allocated for psychiatric care, which includes psychiatrists, psychologists, and medication, I believe that a stronger emphasis on psychology counseling rather than prescription of strong psychotropic medication is frequently more beneficial. Our experience to date has indicated that we can reduce the use of psychotropic drugs by 70 percent to 90 percent in some cases by increasing appropriate counseling.

Recently we were awarded the contract at Dixon Correctional Center, which houses 700 mentally ill inmates. This is the largest psychiatric facility in Illinois and we are in the process of reevaluating the diagnosis and care of each one of these inmates to see if a more positive approach to their illness can be established.

Another problem that exists in the corrections system has to do with the care of the mentally ill at the level of the county jails. At this time if we have a person who is dangerously psychotic, there is no place to transfer this patient for good, aggressive psychiatric care, and since many of these people haven’t been formally sentenced because they are not “mentally fit” to stand trial, it is sometimes difficult to get them out of jail and into treatment.

It would seem to me that a better solution would be to have regional psychiatric care units for people who appear to be dangerously mentally ill. These facilities would not necessarily be jails, but they could he high security mental care facilities that were funded by the state, since most of these people do not have funds to pay for their own mental health. I believe that this system would allow jails to transfer patients that they are not equipped to handle at this time.

The Missouri legislature is considering a bill that would allow condemned inmates to donate bone marrow or a kidney in exchange for having their sentences changed to life in prison without parole. What are your views on that – politically and from a physician’s standpoint?

I am opposed to a bill that would allow an inmate to donate an organ in order to try to reduce his sentence. At this time, people in a condemned unit can be there for up to 20 years – many of these, in fact, are “life sentences,” and I think that this could easily become a form of coercion to force inmates to donate organs in an effort to prevent the death sentence. I believe this is wrong both morally and ethically.

You recently received the contract to provide on-site medical and psychiatric services to Peoria County Jail inmates. What percentage of your services are typically medical and what percentage typically psychiatric in this type of setting?

At this time over 90 percent of the services supplied to the Peoria County Jail inmates are medical. Prior to our receiving the contract there really were no routine on-site psychiatric services, and at this time we are just beginning to study this problem to determine what services are best.

We presently have a psychologist who is counseling inmates and doing psychiatric evaluations five days a week. Because of the heavy psychiatric load I believe we probably will end up needing far more psychiatric services, including routine weekly visits by board certified psychiatrists.

In addition to the routine medical and psychiatric services, we have also instituted a women’s health program that includes on-site OB-gynecology services to handle the problems of female inmates and our pregnant inmates.

How many jails and prisons do you currently service in Illinois? Nationwide?

At the present time we have contracts in three major prisons in Illinois managing over 7,000 inmates. The Peoria County contract is our first jail in Illinois. At this time we do not have any out-of-state contracts; however, we are actively pursuing those contracts.

You serve on the Illinois Medical Society Political Action Committee. What are some of the issues this PAC gets involved with? What are some of the group’s successes?

The real mission of the Illinois Medical Society Political Action Committee is to ensure the bills that go through Springfield have a positive impact on patients and health care.

An example of this would be the $500,000 cap on non-economic losses in malpractice suits. This clearly benefits patients by holding down the general cost of medicine by reducing frivolous malpractice suits. Unfortunately, this was overturned as being unconstitutional. However, other states presently have caps and I believe that this is one of those items that we will continue to fight for.

In addition to your medical work you are the president of Opera Illinois. How is the opera doing?

The opera is doing extremely well at this time. Starting last fall with our production of Tosca, you may have noticed an entirely new look for the opera with magnificent staging that adds to the overall richness of the operatic experience. From the time the curtain was first raised, the audience broke out into applause because you actually felt that you were inside the Great Church. And to the final scene on the foreboding battlements of the Castile St. Angelo, you were really drawn onto the action.

Our second performance, West Side Story, played to the largest audience that we have ever had at an operatic performance. Once again, the sets and scenery were magnificent and drew you scene-by-scene and set-by-set through the story to the tragic ending. We are very excited about our production of Aida on May 2, and next season will be a real blockbuster starting on October 24 with The Merry Widow. At that performance, Beverly Sills will be on stage prior to production to open our season and make a few comments. We are excited about that.

When and how did you get interested in opera?

I have been interested in opera for many years, but I never really had the opportunity to get involved in any meaningful way. When an opening developed on the board of the Peoria Civic Opera, I felt that this might allow me to contribute while at the same time learning more about this great art form.

Do you work with other arts groups in the area?

Brenda is on the board of Lakeview Museum as well as the board of the opera. We believe very strongly in the concept of giving back to a community that has been so good to us.

What activities do you do for relaxation?

Brenda and I enjoy dining out with friends, golf, ballroom dancing and spending time with our family. I also have a special interest in fishing. IBI