For 79 in this picture, the good doctor looks as energetic and fit as a tiger. Go get 'em, Dr. Kutz! It seems to me that we here should at least give this extraordinary man, our new CEO, a fair fighting chance to show what he can do for CTGI shareholders and, in the interim, withhold judgment. The linked version of the piece has a number of other great pictures. Thanks for the ref.
Dr. Joseph E. Kutz CEO of CSMG and President of CSMG & LTC
HAND CHOSEN By Joe Atkinson August 2007
Photos By Patrick Pfister
Would you like something to drink, Dr. Kleinert?” Standing in the eighth-floor conference room of his downtown office, Dr. Harold Kleinert cocks his head to the side, considering the question. Then his face — drawn and wrinkled with age, but with eyes that still pierce with sharp intelligence — plays into a mischievous smirk.
“Can I get a beer?” Kleinert asks.
The room erupts in laughter, which eventually ends with Kleinert settling instead for an ice water. He then pulls a wad of trash from his pocket, and begins playfully eyeing the trash can 20 feet away. “I’ll give you $5 if you make that,” says Bill Sandbach, chief executive officer of KleinertKutzHandCareCenter, the same man who offered Kleinert a drink earlier.
The doctor doesn’t respond; he simply smiles to himself, and drains the shot.
He’s used to hitting the mark. Kleinert, 85, and his partner, Dr. Joseph Kutz, 79, have spent the better part of 50 years revolutionizing hand surgery. Working from downtown Louisville, they have achieved numerous firsts in the field of hand care. They’ve introduced new techniques, repaired injuries once thought unfixable, and built the largest, most respected training ground for hand surgeons in the world.
And the truly amazing part? They’re still at it.
Both Kutz (left) and Kleinert still regularly see injured-hand patients. Despite very different personalities — Kleinert is playful and mischievous in interviews, while Kutz has a more staid, serious demeanor — the two share an unshakable work ethic. Both are in the office every day by 6:30 for morning lectures; both regularly work at least eight- to 10-hour days. One more reason their practice has become the most trusted and respected name in hand care.
“When I was trying to decide where to train,” says Michael Fitzmaurice, a fellow at Keinert Kutz’s teaching arm, the Christine M. Kleinert Institute, “my chairman told me, ‘If you’re a surgeon and you get your hand injured, where are you going to go? You’re going to go to Kleinert and Kutz.’”
At the clinic, Kleinert sits with a middle-aged woman, staring intently at her middle finger. “Do you know which of your parents to blame for this?” he asks, barely glancing up from the finger. “It’s genetic.”
The patient came into Kleinert Kutz complaining that a few small lumps on the finger had become increasingly tender. She’d been to other doctors; one had even been giving her cortisone shots to try to bring down the swelling. But within 30 seconds of first glancing at her hand, Kleinert has the problem pegged: osteoarthritis.
The first hand transplant in the United States, performed in January 1999 by a team headed by U of L/Kleinert Kutz surgeons Drs. Warren Breidenbach and Tsu-min Tsai. He explains that the bones in the woman’s fingers are rubbing together and tells her that this is causing the joint to create fluid, which pools to form the little bumps. Then he calls in one of his practice’s fellows — students in the Christine M. Kleinert Institute (named for Dr. Kleinert’s mother) — who split their time between seeing patients and learning from the senior hand surgeons. Using the woman’s hand as a prop, Kleinert carefully explains the malady and its diagnosis to the physician in training.
The scene is a perfect illustration of why people from around the world get their injuries treated at Kleinert Kutz — and why doctors from around the world train here. “I didn’t intend to create a monster,” Kleinert says. “It just grew and grew.”
Every year, 70,000 to 80,000 patients come to Kleinert Kutz; of those, approximately 13,000 will be new patients. The clinic performs between 8,000 and 9,000 hand surgeries annually. And that’s just the beginning.
In addition to having 15 of the world’s best hand surgeons on staff, the practice has trained another 1,100 physicians who are performing these specialized surgeries around the world. “Most of the best people, they came here,” says Yousheng Fang, a 38-year-old program fellow from Shanghai, China, who recently graduated from the Kleinert Institute. “Almost all of the hand surgery professors in Japanand the Asian countries — they trained here.”
To hear the doctors tell it, their practice came about through a series of happy accidents. Kutz came to Louisvillebecause of a botched application, and Kleinert landed him as a fellow in his fledgling practice only because someone else couldn’t pay him enough. Even their first groundbreaking surgery was born of convenience and serendipity.
Drs. Kutz and Tsu-min Tsai examine the hands of a patient. Kleinert arrived in Louisvillein the early 1950s as an instructor in the University of Louisville Medical School. He quickly moved into hand surgery and realized that it was an untapped specialty. In fact, at the time, only two practices in the country (one in Chicagoand one in California) had any reputation for operating on hands. Elsewhere, Kleinert says, this work usually fell to the youngest resident who, the doctor says, “would take the injured hand to the operating room, where there was an anatomy book. You would turn the page to the hand, and go to work. That was the extent of hand surgery.”
So Kleinert asked the powers-that-be at the university about starting a hand clinic and received their blessing. It opened in 1953, with Kleinert planning to run it for two years, then possibly head back to his home state of Montana. Fortunately, he stayed a few years longer, and was still here when a young medical graduate named Joseph Kutz began applying for residencies. Kutz planned to take a position studying under a top Detroit-area surgeon, but filed his application one day too late. The Michigandoctor called him and pointed him toward Louisville, where a former associate was practicing. “So that was how I came to Louisville,” Kutz says. “I sent in an application to another program too late, or else I’d probably still be in the Detroitarea.”
By 1960, Kleinert was so busy — and had so many patients — that he didn’t feel he could maintain his commitments to the university. So he left the university to enter private practice, and began taking on fellows.
At the same time, Kutz was attempting to decide on a specialization. He had interests in general surgery, in cardiovascular work, and in hands. He received an offer to become a cardiovascular fellow, but the position provided no pay. With a wife and three kids at home, Kutz needed money — and Kleinert came forward with a chance to be a paid fellow in his hand surgery practice.
“So I spent a year with him,” Kutz says. “And after a few months, we started rotating services, and (I was) rotating practice with him. And at the end of that program, I was looking at some places to go, and had set up to go into practice in Lexington. Just before I decided to leave, a counselor in our office had us over for dinner.
“He asked Dr. Kleinert why he was going to let me go to practice in Lexington, and why (he wasn’t asking) me to stay with him? So Dr. Kleinert turned around and asked me to stay with him. That was how we got started.
“That was in 1964.”
Back in the clinic, Kleinert is attempting to schedule surgery for his female osteoarthritis patient. She is on board for going in as soon as possible; Kleinert, however, is about to take his first month-long vacation in the practice’s history. He’ll be gone into August, leaving the patient two choices: wait, or use another surgeon.
One might expect the patient to jump at the opportunity to see a younger doctor — one who doesn’t have personal memories of the Great Depression, perhaps. But this patient never blinks. “When are you coming back?” she asks.
“We’ve had patients ask, after he leaves the room, ‘How old is he?’” one of Kleinert’s nurses says later. “And we tell them the truth — he’s 85. But we’ve never had anyone ask for a younger doctor. I think they know the reputation.”
The “reputation” for the Kleinert Kutz practice — both founders still perform some surgeries — is one of medical breakthroughs. Among other milestones, the practice’s doctors performed the nation’s first successful hand transplant, pioneered work in primary reconstruction using tissue from other parts of the body, and handled one of the world’s first cross-hand re-plantations (by taking a person’s functioning right hand off a damaged right arm and using it to replace the same person’s damaged left hand on a healthy left arm).
The first “first” was an accident. It happened in the early 1960s, when Kleinert and Kutz were doing almost all of the hand-care work in the city. They attended at every hospital and were called in to consult on just about every accident or emergency that came up.
So they didn’t always have the time to do multiple procedures on the same injury — something that was, at the time, standard practice for certain tendon injuries. This applied particularly to what is described as the “no man’s land” area of the hand, from the upper half of the palm to about the middle of the fingers. There are two tendons there. For injuries that affected both, the known procedure was to fix one, then close the wound and go back later to do a graft on the second.
“But at the time, we were so busy, we started going in and repairing both of them at once,” Kutz says. “And in repairing both of them, I guess we just had a slightly more meticulous technique, as we had been working in vascular surgery. So we started having our patients move their hands earlier, and it was in doing that where we started getting added good motion from the fingers that normally would have been repaired a month or two months later with a graft.
“So we looked at it, and we wrote up a paper to present to the Hand Society (American Society for Surgery of the Hand).”
Kutz wrote the paper and took it to the meeting. Because the idea flew so far in the face of what was known at the time, representatives of the society demanded that the more experienced Kleinert give the paper. And when he did, no one believed the results were possible.
“So they sent a committee the next year to look at all of our patients and to evaluate them before and after to see if what we said was true,” Kutz recalls. “They went back the following year and reported that they had seen it, they agreed with it, and one of the fellows actually reported back to say, ‘If I had my flexor tendon cut, I’d go to Louisville to have it fixed.’”
That changed everything for Kleinert Kutz.
By now, the two surgeons and their clinic have been on the cutting edge of hand surgery for nearly a half-century. These days — while Kleinert and Kutz still are heavily involved in every aspect of the practice — much of the envelope-pushing is handled by other doctors on staff. Bringing the best doctors from around the world to be part of the practice helps keep them on top. One such doctor is Tsu-min Tsai, who has won a national award for research on blood flow to the nerves.
“I was in Japan, giving a paper about total hand transplant in 1975. Joseph Kutz was in attendance and he met me,” Tsai says. “I was seeking some chance to go to another country . . . and they asked me to do a replant (reattaching a finger or hand), and I did it, and they were very impressed. So they said, ‘We really want you to come to Louisville.’
“I came in 1976. Before I came, the success rate in replantation was about 42 percent; in the six months after I came in here, the success rate was raised to 86 percent. Dr. Kleinert says it was due to better techniques.”
Reminded of this recently, Kleinert laughed, and acknowledged that Tsai’s arrival had a lot to do with the improved statistics. “In fact,” Kleinert says, “the re-plantation we had him do (during his visit) was so difficult, no one here thought the hand could be saved. But Dr. Tsai said, ‘I can do it,’ and he did. That’s when I said, ‘We’ve got to have this guy!’”
Tsai is one of the 15 surgeons on staff, and one of the reasons that — even as Kleinert and Kutz have reached, passed and ignored the traditional “retirement age” — the practice remains on top. Doctors like Tsai also draw many aspiring hand surgeons to Kleinert Kutz for fellowships. At any given time, there are about 20 fellows enrolled in the clinic’s program. (Currently, there are exactly 20.) Because of medical regulations, only eight of those are allowed to come from inside the United States, which means that about a dozen in every cycle enter the country just to study at Kleinert Kutz.
“The faculty that they have, if you look at any book on hand care — any text and most of the articles — the guys who have been here are the ones quoted,” says Fitzmaurice, who recently graduated from the program. “You get a good mix. Everybody has their own expertise, and you get to rotate with the guys who are in the top of their field.
“They’ve pioneered this field, and we get to train under them. For me, that’s amazing. There isn’t any other place in the world where you can have that.”
Fellows begin every day attending lectures. They then move into the clinic, where they work with the surgeons. Throughout the course of the program, fellows rotate among the various doctors, giving them exposure to every method, technique and specialization available at Kleinert Kutz. And once they are finished, not only are they qualified hand doctors — Fitzmaurice, for example, already has started in his own practice in Arizona since graduating at the end of June — but they are instantly highly respected in their field.
“It’s just wonderful; you spend one year here and you are a hand surgeon,” says Fang, who also graduated at the end of June. “Even if before you come here you have nothing to do with hand surgery, after one year here you are a hand surgeon.” Fang returned to Shanghai in July as associate professor at one of the most famous universities in China.
Reaching even more people, both Kleinert and Kutz have traveled the world to lecture, operate and interact with students. Kleinert estimates that he’s operated in nearly every country in the world. (“Not bad,” he says, “for a guy from Montana who, at 12, wondered if he’d ever see the ocean.”)
When they’re in town, the famous surgeons arrive for lectures at 6:30 every morning. “If I ever thought this was work, I probably would have quit a long time ago,” Kutz says. “But each day is a challenge. Even yesterday, I saw something I had never seen before in a patient. It’s these things, and the challenge of teaching, that keep us here.
“And the young men and women that are coming today — particularly those from overseas who have been doing a lot of work — are challenging because they come up with new ideas. So you get up every morning and come into a 6:30 conference with the idea that you’re going to learn something and maybe teach something.”
Which is why Kutz doesn’t expect either man to retire soon. “My wife always says the same thing,” Kutz adds. “She tells people, ‘The day he drops over dead in the operating room, I’ll bury him.’”
Freelance writer Joe Atkinson may be reached at jwamedia@yahoo.com.
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