As AIDS, tobacco-related illness and organ transplants created a medical tempest in recent years, Dr. David N. Sundwall has literally been one of the admirals guiding federal health policy through troubled waters.
In fact, until recently, Sundwall, a Utah native, was a two-star admiral in the Commissioned Corps of the Public Health Service, just a step lower than U.S. Surgeon General C. Everett Koop, to whom he was a top assistant.At the same time, he was the administrator of the Health Resources and Services Administration and oversaw its $1.5 billion annual budget and 2,300 employees.
In those positions, he implemented much of the health law he helped write while working five years in Congress on the staff of the Senate Labor and Human Resources Committee, which was then headed by Sen. Orrin Hatch, R-Utah.
Now, Sundwall is the new vice president and medical director of the American Health Institute, a coalition of non-profit hospitals interested in research, educational programs and lobbying Congress.
All that isn't bad for someone who is still officially on leave of absence from the University of Utah School of Medicine and still considers himself in Washington "only temporarily" on a sort of long sabbatical. He even still votes in Utah via absentee ballot.
"I never really planned a career in public health. It all started by accident, really. One thing led to another, and I'm still here," he said.
Sundwall's unplanned odyssey into national politics started after the 1980 elections when the Republicans won control of the Senate.
"Sen. Hatch was catapulted into the chairmanship of the Labor and Human Resources Committee over some other people who had more seniority but who chose other assignments. So he asked for a Utah doctor to serve as an adviser."
Sundwall said Hatch asked for recommendations from the medical school and medical associations in Salt Lake County and Utah, but they disagreed about whether the adviser should be an academician or a physician with a practice in the community.
"I was told later that mine was the only name they could agree on. I taught at the U., so that obviously pleased the medical school. My dad was a well-known family practitioner who had delivered 5,000 babies in Salt Lake County, and I practiced family medicine too."
Sundwall said the Senate job sounded exciting. But he didn't know whether he wanted it because he considered himself more liberal than Hatch and hadn't even voted for him. It would also cut his pay roughly in half.
"I came to talk to the senator. At that time, he had a reputation of being a very serious, staunch, starched conservative. But I was surprised to find him very friendly and open. I told him I hadn't voted for him and that I didn't have any experience in politics.
"He said he wasn't hiring my for my politics, but for policy. He said if I gave him good policy, he would make good politics out of it."
Sundwall decided to come to Washington "for a year or two."
But when the major package of health bills that he helped prepare during his first two years was vetoed by President Reagan, "the senator asked me to stay on and help do it right. I did," Sundwall said.
He stayed in the Senate another three years, working on legislation about such topics as AIDS and ethics concerns about organ transplants. One of the people he became acquainted with in that work was Health and Human Services Secretary Otis R. Bowen.
Bowen was impressed enough with him that he soon offered Sundwall the job of leading the Health Resources and Services Administration, one of six major divisions in the Public Health Service.
There he implemented much of the policy he wrote in Congress - ranging from a network to share information on organs that are needed and organs that are available, to pilot programs to develop care systems for those with AIDS or HIV virus.
"I found that writing and implementing policy is very different. Talking about how things should run is much easier than actually being responsible for running them. In Congress, people question if money is being well-spent. Running programs, I had to prove it was."
The position also automatically made him a top assistant to Surgeon General Koop, one of the more flamboyant and outspoken surgeons general in recent history.
"Koop has restored pride to the Public Health Service," Sundwall said. "He has great integrity and a tremendous sense of humor. He's not the stern Old Testament prophet that he looks like.
"He figured that if you are going to have the corps, it should have a professional attitude and more pride."
One way he did that was to have most members of the Public Health Service wear uniforms, which look much like Navy uniforms but are specifically for the independent corps of the Public Health Service.
Sundwall said the corps was created in 1889 to revitalize public health hospitals, which had been created for merchant seamen. Although the corps is not part of the fighting military, it is entitled to military benefits such as shopping at commissaries and even free flights on military aircraft as space is available.
"I had my division 100 percent uniformed, which had been optional and had fallen out of use. I found it did help create a professional attitude," Sundwall said.
While work there was challenging, Sundwall said it still did not "pay what medical doctors are used to earning." He is finally paid that again in his new job at the American Healthcare Institute, where he is working on educational programs and lobbying for non-profit hospitals.
As he looks back on his experiences and how he landed in Washington, he said, "I meet with people who are interested in careers in public health, and they ask me how I did it. Honestly, I say I was just always in the right place at the right time."