Meet F. Gary Cunningham, M.D.

F. Gary Cunningham officially became the fifth Chair of Obstetrics and Gynecology on September 1, 1983, after serving as acting and interim chair during the previous year.

A graduate of Louisiana State University School of Medicine in New Orleans, Dr. Cunningham was drawn to Southwestern Medical School by the opportunity to study maternal-fetal medicine with Dr. Jack Pritchard and to work with faculty members like Drs. Norman Gant, Paul MacDonald, and Peggy Whalley. Fellowship completed, he elected to stay in Dallas and joined the faculty in 1973.

In 1983, with deliveries at Parkland Memorial Hospital exceeding 11,000, and the economy in its greatest recession since the depression of the 1930s, the challenges facing the new chair were daunting.

In a Center Times interview with Jamie Friar, M.D., Ph.D., Dr. Cunningham described the situation he faced — “The first challenge that we all face is fiscal security. … One of the biggest problems that the entire University faces – this certainly is no secret – is the cutback of federal, state and even local funds.” But, he approached these challenges with characteristic optimism.

“We have a very good department here and a lot of good people. I’m looking forward to keeping the department’s national and local structure where it is. I have a good legacy to follow.”
F. Gary Cunningham, M.D.

In order to help him focus on the contemporaneous problems, he made two key appointments — Dr. Kenneth Leveno as Vice Chair for Parkland Affairs and Chief of Obstetrics, and Dr. Barry Schwarz as Vice Chair for Financial Affairs. A strong central core emanated from the trio of Dr. David Hemsell as Chief of Gynecology, Dr. Paul MacDonald as Director of the Cecil H. and Ida Green Center for Reproductive Biology Sciences, and Dr. Stephen Heartwell as Director of Family Planning Services.

These appointments proved fortuitous as over the next 20 years, the Department secured a stable fiscal base. And, at the same time, building upon the legacies of Drs. Pritchard and Whalley, Dr. Leveno transformed the Parkland obstetrical service and created a unified system that integrated prenatal, delivery, and post-partum care.

Kenneth Leveno was the architect of a prenatal care system that would eventually be accessed by more than 97% of all women delivering at Parkland. He expanded the high-risk antenatal unit established by Dr. Whalley in 1971 and was instrumental in the development of a low-risk delivery unit and a nurse midwifery program at Parkland.

Under his watch, the Department’s ultrasound unit merged with the Department of Radiology, and Rigoberto Santos-Ramos, M.D., who founded the unit in 1971, became the first director of the joint Division of Pelvic Ultrasound. As people became more and more aware of the role of heredity in pregnancy, the Prenatal Genetics Clinic begun by Jan Friedman, M.D., and Mary Jo Harrod, Ph.D., in 1978, expanded to provide Parkland patients with access to prenatal screening and counseling.

Passionate about ensuring the best care possible for patients, Dr. Leveno challenged physicians to measure and improve the quality of care they provided. And, his computerization of obstetrical data facilitated quality improvement and outcomes research and focused international attention on the obstetrical practice at Parkland Memorial Hospital.

Because Parkland’s patient population was largely uninsured, this base could do little to help the Department’s bottom line. If patient-care was to provide the funding the Department needed, it would have to come from elsewhere. And, with that knowledge, Gary Cunningham with the able help of Drs. Barry Schwarz, Alvin “Bud” Brekken, and strong Division Chiefs launched the Department on a private-practice expansion that continued throughout his tenure.

With the opening of the Aston Ambulatory Care Center in 1984, the Faculty Clinic consulting services begun in 1974 moved from the strip mall on Stemmons Freeway into the 6th floor of Aston. Services expanded to include in vitro fertilization (IVF) — a relatively new practice that had gained in popularity following the birth of the first “test tube baby”, Louise Brown, in 1978.

Then late in 1991 with overcrowding at Aston an issue, the Department turned to St. Paul Medical Center. Under the leadership of Larry C. Gilstrap, III, M.D., the private obstetrical and high-risk programs moved to the 3rd floor of Professional Office Building 2. In response to the increased demand, St. Paul Hospital expanded its antepartum unit for complicated pregnancies as well. And, the Department was on its way to building a university obstetrical and maternal-fetal medicine service.

Meanwhile back at Aston, the expanding fertility practice required laboratory and treatment-room space in order to offer the latest in office-assisted reproductive technology (ART). In advance of the 1993 relocation of gynecological services to newly renovated space on the 5th floor, the physician team providing general women’s health care increased from two faculty members to seven. And, in 1998, under the leadership of Karen Bradshaw, M.D., and Bruce Carr, M.D., a Women’s Center, designed to integrate health care for women over 40, opened on Aston 6. A year later, the Center became the Lowe Foundation Center for Women’s Preventative Health Care, in honor of the Foundation’s endowment.

Cancers of the female reproductive system had been a focus of the Department since its founding in 1943. But, it would take 29 years before gynecological oncology was officially recognized as a subspecialty and became a division of the American Board of Obstetrics and Gynecology.

Initially treatment was confined to Parkland patients. But later, a referral and private practice was opened at Aston and at the Harold C. Simmons Comprehensive Cancer Center. In 1991, with the hiring of David Scott Miller, M.D., as Chief of Gynecologic Oncology, cancer-treatment facilities at Parkland were improved and enlarged; and in 1992, a gynecologic oncology molecular biology laboratory at the Simmons Cancer Center brought basic-science research to the clinical practice. The benefits of this research, as well as the protocols of the National Cancer Institute’s Gynecologic Oncology Group, accrued to both Parkland and private patients.

As with obstetrics and maternal-fetal medicine, the gynecological subspecialties maintained practices at both Parkland and UT Southwestern — ensuring that all women had access to quality women’s health care. Recognizing the need for expertise in treating congenital anomalies and diseases affecting the reproductive health of females from infancy through age 18, in 1990, a pediatric gynecology service emerged at Children’s Medical Center under the leadership of Karen Bradshaw, M.D., and later Mary Jane Pearson, M.D., and Ellen Wilson, M.D.

Traditionally, women who suffered from pelvic floor disorders such as pelvic organ prolapse, incontinence, or pelvic pain, sought relief from their primary gynecologist. In 1994, the American Board of Obstetrics and Gynecology acknowledged that training for treatment of these interconnected disorders required special expertise, and it established the Division of Female Pelvic Medicine and Reconstructive Surgery. Dr. Joseph I. Schaffer introduced this new subspecialty — commonly called urogynecology — to UT Southwestern and Parkland Memorial Hospital in 1997. Within four years, several thousand patients had been evaluated and the impact of vaginal delivery on pelvic floor disorders studied. While building the first new division in decades, Dr. Schaffer also launched basic and clinical research ventures and a fellowship training program.

True to Dr. Jack Pritchard’s mantra that excellence in patient care would bring about excellence in academics, the Department remained at the forefront of basic and clinical research. In 1986, the Green Center moved into expanded facilities in the new Cecil H. and Ida Green Biomedical Research (Y) Building. A special patient suite allowed researchers to collect fluid samples over extended periods. State-of-the-art laboratories and conference facilities enabled recruitment of additional faculty, expansion of research studies, and teaching of more post-doctoral fellows.

Vacated laboratory space in the Department was quickly occupied by Ph.D. faculty that included Ayalla Barnea, Roger Bawdon, E. William Byrd, C. Richard Parker, Jr., and William Rainey II. Basic research investigations led to national recognition for the Department and brought John C. Porter, Ph.D., a National Institutes of Health (NIH) Merit Award for his work on aging and molecular neuroendocrine impairment in 1989.

The Green Center continued to flourish under Dr. MacDonald’s leadership. Then, two years after his death, the Cecil H. and Ida Green Center for Reproductive Biology Sciences was moved to the Department of Pharmacology when David Garbers, Ph.D., became its new director in 1999. (The Center returned to Ob/Gyn in 2010, following the death of Dr. Garbers and the appointment of W. Lee Kraus, Ph.D., as director.)

Former Green Center Ph.D. faculty members, A. Stefan Andersson, M. Linette Casey, and Judith Head, along with R. Ann Word, M.D., remained in the Department. Energized by their relocation to newly renovated laboratories in the Cary (F) Building, these researchers were motivated and productive. With the help of Carole Mendelson, Ph.D., the longest continuously funded project to study the initiation of human parturition (initially funded in 1974) was renewed by NIH. And, the collaborative efforts between basic scientists and clinicians continued.

Clinical studies accelerated as the Department was accepted into several NIH-sponsored clinical consortia — the Gynecologic Oncology Group (1989), the Maternal-Fetal Medicine Units Network (1996), the Cooperative Multi-Center Reproductive Medicine Network (2000), the Female Contraceptive Clinical Trials Network (2004), and later the Pelvic Floor Disorders Network (2006). These gave patients access to contemporaneous NIH treatment protocols as well as to the Department’s own evidenced-based studies. Begun by Dr. Pritchard in 1955, the practice of analyzing the effectiveness of popular treatment regimens was now thoroughly engrained in the Department’s persona.

Dr. Cunningham actively participated in these clinical studies throughout his chairmanship. A leading authority on pregnancy-associated hypertension and hematological disorders complicating pregnancy, he also mentored many residents and fellows — some of whom later joined our faculty while others went on to become division chiefs, chairs, and deans of other medical schools.

It came as no surprise then, that when Dr. Jack Pritchard retired, he turned over the reins of Williams Obstetrics — the seminal textbook in obstetrics — to Dr. Cunningham. While chair, Dr. Cunningham oversaw the publication of the 18th (1989), 19th (1993), 20th (1997), and 21st (2001) editions. He continued as the textbook’s chief author/editor after stepping down as chair, and went on to publish the 22nd (2005), 23rd (2010), and 24th (2014) editions — then, started working on the 25th.

Recognizing the significance of the contributions made by pioneering members of the faculty, Dr. Cunningham named the first professors emeritus to honor these retired titans. In 1990, Jack A. Pritchard, M.D., (Chair 1955–1970) became the first professor emeritus. He was followed by Peggy J. Whalley, M.D., in 1992, and John C. Porter, Ph.D., in 2003.

As the reputation of the Department and its faculty grew locally and nationally, it attracted philanthropy. During Dr. Cunningham’s tenure, endowments went from six to 16 with the addition of two distinguished chairs, two chairs, three professorships, four endowed funds — including the Jack and Signe Pritchard Fellowship in Maternal-Fetal Medicine (1985) and the Norman F. Gant Research Fund in Obstetrics and Gynecology (1994).

The untimely death of two beloved junior faculty members gave rise to the Tommy Melancon Library for Parkland residents (1990) and the Annelle Ahmed Fund for Faculty Scholars in Obstetrics and Gynecology (1998). The Department also lost two former chairmen — Paul C. MacDonald in 1997 and Jack A. Pritchard in 2003. Their passing brought more philanthropy as former students, colleagues, and friends paid tribute to two giants of reproductive medicine. The MacDonald professorship created in 1987 became the Paul C. MacDonald Distinguished Chair in Obstetrics and Gynecology in 1999. And, the Jack A. Pritchard Professorship in Obstetrics and Gynecology initially funded in 1975 became a Chair in 2004.

When Dr. Cunningham assumed the chairmanship in 1983, he knew he would face challenges. But little could he have imagined the events that he would witness during the next two decades. This period in UT Southwestern history was marked by unprecedented expansion and technical advancement. From the opening of the James W. Aston Ambulatory Care Center with its centralized billing system in 1984, to expansion of Parkland in 1985, to the opening of Zale Lipshy University Hospital in 1989 — facilities emerged to meet growing needs and create new venues for patient care.

Physical expansion led to expansion of support services. The world and UT Southwestern were entering an electronic age. With input and support from the Department’s business operations spearheaded by Judy Wagers, M.B.A., between 1989 and 1996 the University’s business operations went from a dysfunctional paper-based system to one that integrated purchasing, accounting, inventory, and personnel functions and included electronic signature, routing, and approval capabilities. While more sophisticated systems are available today, there was nothing like the home-grown business automation of UT Southwestern during this time period.

Then, in 2000, UT Southwestern purchased the assets of St. Paul Hospital. The way was paved for the University to assume operational responsibility for the hospital in 2005. In advance of that change, the Department’s St. Paul and Parkland residency programs were combined in 2004 under the leadership of George D. Wendel, Jr., M.D. This marriage created the largest obstetrics and gynecology residency in the United States. The residency program Dr. Cunningham had once directed was now responsible for training one out of every 50 Ob/Gyn residents in the country and delivering more than 18,300 women annually — 16,223 at Parkland and 2,098 at University Hospital St. Paul!

Throughout his chairmanship, Dr. Cunningham, like his predecessors, continued to cover the high-risk service at Parkland Memorial Hospital. When the burdens of administration became intrusive, he loved to escape to the wards at Parkland where he had honed his knowledge of reproductive medicine. Parkland was home to him. With Parkland deliveries exceeding 16,000, there was opportunity to teach, do more clinical research, and provide patient care. He was in his element. And, so, after 22 years as chair, Gary Cunningham resigned effective December 31, 2004, to devote more time to teaching and the clinical practice he loved, and to Williams Obstetrics.

Gary Cunningham will be remembered as the Parkland-based physician, who built the Obstetrics and Gynecology private practice at UT Southwestern; the chair who brought the Department through recession and into the new millennium; the man who fought tenaciously for the health and well-being of all women, but especially for those who were indigent and underserved.