One Step at a Time
Dan Higgins, who almost lost his legs in Vietnam, knows health care from the inside out
Published in 2005 Northern California Super Lawyers magazine
By Rose Nisker on July 20, 2005
As co-chair of Paul Hastings’ National Healthcare Practice Group and lawyer for some of the largest health care enterprises on the West Coast, San Francisco attorney Dan Higgins knows the business of hospitals. He also knows, better than most of us, what it means to be a patient. At one time Higgins was so close to losing his legs that just the sight of his toes at the end of the bed was a profound blessing.
As Higgins describes it, his story starts out “very typical.” He was a small-town Arizona boy who had a strong itch to see what lay beyond the borders of his home. So in 1968, he dropped out of the University of Arizona, broke up with his girlfriend, and moved out to San Francisco. Quite soon after arriving, he was drafted and became part of the elite 173 Airborne Brigade, a paratrooper unit responsible for night ambushes along the Ho Chi Minh Trail that saw combat a few times a week. In the harrowing chaos of Vietnam he remembers learning quickly that “war is not political or ideological. For soldiers it’s a very personal, human experience.” He describes the awesome responsibility of being a sergeant — “20 years old and in charge of 20 mothers’ sons” — continually faced with decisions whose outcomes could put those sons in extreme danger.
After being wounded on two separate occasions — first a shot on the inside of his knee and later one in his arm — Higgins began to make friends with the doctors and nurses at the medical evacuation hospital. His respect for what they were doing extended to all the medical personnel serving in Vietnam. To this day he marvels at the power of even the simple medicine that American medics administered in the Vietnamese villages. “It was incredible to see how in places where people had nothing, even the most basic care that medics carried in their backpacks, gauze and antibiotics, could have such amazing effects.”
When a severe injury brought Higgins back to the hospital for a third time, treatment was unfortunately
not so simple. He had been thrown into the air by an explosion set off by a trip wire, the force of which hit him in the back of both legs. “I arrived at the hospital at about 11 o’clock p.m.,” he remembers, “but they were so busy that they didn’t operate on me until 2 o’clock a.m. When they rolled me into the operating room, I looked up and there was my friend, the surgeon who had worked on me the first time. When he saw the severity of my condition, he said, ‘Oh my God, Dan.’
“It was all extremely frightening,” he recalls. “My best friend had died a couple of hours earlier, the doctors and nurses were exhausted, the operating room was bloody.” His legs were in such bad condition that the surgeon could have easily amputated them. “It would have been perfectly medically appropriate and he could have said in complete good conscience we’re not going to be able to save these.” Higgins says he “was blessed to have that surgeon — he worked all night and saved my legs.”
While they managed to save his legs, the subsequent infection was tenacious. Higgins explains that “the doctor had to keep cutting at the muscle tissue to get in front of the infection.” It was so bad that Higgins signed a consent to have his legs amputated on three separate occasions. Yet each time he would wake up from surgery and, as he describes it, “there were my toes still at the end of the bed. That was my marker — I would look down and see whether there was one set or two sets or no sets of toes down there, and each time they were all there.”
Surviving the infection was a constant struggle, and at one point they asked Higgins if he wanted to see a chaplain in preparation for his death. But the only one available was a Catholic priest. Higgins grew up Protestant, and as he says, “there I was, this non-Catholic getting last rites.” Years later when he began working as a health care attorney, he had many Catholic hospitals as clients. In fact, in the mid-’80s he created the original merger that formed Catholic Healthcare West, now one of the largest health care companies in the country. He smiles at the serendipity of it all. “I always tell the Sisters about this non-Catholic guy who got last rites,” he says.
After being discharged, Higgins spent eight months recovering in an army hospital in Texas. His prospects for being able-bodied, however, weren’t so promising. The army doctor said, “You may walk for a couple of years while you’re still young with double leg braces and crutches, but eventually you’ll have to go back to a wheelchair because you just don’t have enough leg left to make it work.”
During his recovery time, Higgins also thought about what to do after leaving the hospital. Not surprisingly, he considered becoming a doctor but didn’t feel it was something he could do in a wheelchair. Instead, he decided to finish his undergraduate studies at Stanford and go on to law school.
In the first few weeks of his time at Stanford, a chance encounter led him to find a powerful outlet for his reflections on the war. While riding his bike through downtown Palo Alto, part of his self-imposed therapy regimen, he happened upon an anti-war rally. As he listened to the activists speak, he felt that “a lot of what they thought about the war was ill conceived. There were lots of really good reasons to be against the war, but there were actually better reasons than the activists had.” He was so stirred that he impulsively got up on stage to speak his mind. “I couldn’t help myself, I just went up to the mic — I didn’t have any prior public speaking experience at all — and just started talking about how they were right in principle but wrong on the facts,” he says. The crowd was so inspired by his thoughts that immediately afterward they mobbed him. He remembers the instant attention: “People converged on me and were gushing, ‘Wow, you’re a wounded veteran and you’re against the war and you know so much. Can you come to this event and speak at that event and meet with us tonight?’ In that one moment, I was catapulted into it.” He continued to speak and write about the war in Vietnam, and was eventually elected president of Stanford Veterans Against the War.
After getting his law degree from the University of Santa Clara, it would perhaps seem natural for Higgins to have gone directly into health care law, considering his interest in medicine. He started out, however, with ambitions in securities litigation. He went to work for a mid-sized firm in San Francisco as a first-year associate. On his second day at the firm, the senior partner approached
him with a proposition. The firm had a big health care practice and was strapped for people to handle the many hearings generated by a new health care procedure enacted in California. When offered the chance to help out with these hearings, Higgins was more than happy to accept. “If I stayed in the litigation department,” he recalls, “I would have been reading depositions all year — this way I would actually get to do hearings.”
At the time, in the late ’70s, California’s population was booming and so were its health care costs. In an effort to contain these costs, the new program stipulated that in order for a hospital to build new beds or acquire new equipment, it would have to go through a lengthy application process and receive government approval. The program relied on a state health care plan that specified the need of all districts in the state. If the plan showed there wasn’t a need for additional beds in a certain area, then no hospitals in that area could receive more beds. Unfortunately, the need was based on looking back at the population rather than looking forward and, with California growing so rapidly, this made for a flawed system.
And Higgins’ role in all this? “I ended up winning the very first case to get more beds for a hospital in a district where the state plan showed that there wasn’t a need.” With just this one case, Higgins created quite a stir. As he describes it, “I literally became famous overnight, everybody who had a bed application — and there were a lot of hospitals — wanted to hire the guy who knew how to do it. And I was a first-year associate. It really just launched my career.”
For Higgins, it was clear even then how connected health care law was to his own life. “When the client would have you come out and walk the halls of the hospital so you could visualize the need, boy, I sure knew how to walk hospital halls because I had lived in one for eight months.” Higgins was hooked. “It was extremely fulfilling. I never once thought about going back to securities litigation.”
In fact, as Higgins explains, “I ended up getting plenty of chance to do litigation.” He was involved in one of the biggest cases in the state that concerned five parties — three sizeable hospitals, a state agency and a local agency — with a trial that went on for 40 days, involved 25 expert witnesses and ended up dragging on for “a decade of unpleasantness,” as Higgins puts it.
Higgins’ passion for health care law continued to grow and as the health care system became more corporate, so did his practice. Considering health care is now the biggest sector of the U.S. economy, consuming about 15 percent of the GNP, Higgins feels his current place at Paul Hastings is an ideal fit. “A national firm like Paul Hastings is able to match the scale, capability and complexity of the clients that I deal with,” he says. “You just couldn’t do it from a smaller firm or even a large California firm.”
Being involved in health care for so long, Higgins has seen some major transformations in the system. “When I started, there were about 600 free-standing hospitals in California and now there are about six big health care systems and about 500 hospitals, with maybe 200 of those being free-standing and the rest being in the big systems.” While he feels it necessary to continually ask whether bigger is always better, he says, “Overall, I don’t think most of the hospitals would be doing nearly as well in their ability to meet patient and community and physician needs if they didn’t have the resources of big systems. The challenge is to keep those resources
connected to the local communities.” That’s why for him, even to this day, one of his favorite parts of the job is touring the hospitals. “Walking the halls and seeing the nurses and the patients always reminds me of what this is really all about.”
Higgins also stays connected to medicine in action through his work with an international organization called Interplast that provides free reconstructive surgery to children in developing countries. In addition to doing pro bono work for the organization, he sits on both the board and the executive committee. Along with the treatment of cleft lips and palates, Interplast deals largely with severe burns, a type of injury to which Higgins can most certainly relate. When he was wounded, he lost so much skin that a large part of his treatment was similar to that of a burn patient. Additionally, Interplast has one of its largest programs in Vietnam.
As for Higgins’ own health, to this day he has proved the doctors wrong about the need for a wheelchair. And that’s an understatement. He’s an avid hiker and mountain biker and recently even completed a course in ice climbing. For a guy who had just hoped to be able to “walk a bit and drive a car, be mobile enough to get around,” his abilities are astounding. In fact, as he describes it, his body runs contrary to the laws of physics. “I basically have no calf muscles,” he explains, “so really I shouldn’t be able to walk. It’s like how physics tells us that a bumble bee, because of its mass compared to its wing span, wouldn’t be able to fly, but it does.”
Recently, Higgins went on a hiking trip in Yosemite National Park. He climbed to the top of 14,000-foot Mount Dana using the less forgiving route up the back of the mountain, instead of the more-frequented, moderate trail. When he reached the peak, another mountaineer asked him about his slight limp, wondering if he had gotten injured on the rough terrain. Higgins laughs as he remembers standing there at the top of the mountain and replying, “Actually, I can’t walk.”
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