Emory Report
September 6, 2005
Volume 58, Number 2


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September 6 , 2005
Bridge Building

BY eric rangus

The School of Law, located in Gambrell Hall at the corner of Clifton and N. Decatur roads, and Emory Hospital are separated by about a quarter-mile stretch of Clifton.

That’s the geographical distance. The symbolic gap is a bit larger.

“There is such a potential that is underutilized at Emory,” said Stan Riepe, a professor in the Division of Digestive Diseases in the School of Medicine (SOM). “We’ve got a great law school and a great medical school, but we have virtually no communications or interactions between the two.”

Riepe perhaps knows this better than anyone on campus. He graduated from SOM in 1974 and has spent more than 20 years on the SOM faculty and in practice at Emory Hospital. Last May, he graduated from Emory’s School of Law.

“There have been so many changes in medicine, and I’ve felt like physicians many times were not in control of the decisions that were made impacting their work and how care was being provided,” Riepe said, regarding his motivation for wanting to study law more than 20 years into his professional career. “I was really interested in how those decisions were being made, who was making those decisions, and if the decision was not what I thought was appropriate, what recourse I had. As a physician, I didn’t feel like I had the knowledge base. I felt those decisions were being more or less dictated to us.”

Riepe learned the legal nuances of practicing medicine, and along the way he discovered that doctors and lawyers do not have to be on opposing ends of conversations. And perhaps he could be a conduit to get these conversations started, at least on the Emory campus.

“I’d like to see if we could attract speakers or produce papers that might influence policy,” Riepe said, regarding his vision of joint law and medical school work. “We have the CDC and the Rollins School of Public Health—all kinds of resources.”

The eventual beneficiaries of this work, Riepe said, would be patients. “As far as getting physicians and lawyers together—both educators and people who practice—to come up with fairer solutions, I think we’re going to have to take the patients’ interests to heart a little more,” he said. “Unfortunately, this system is driven financially, but the patient seems to be the one who is losing out.”

As such, the bulk of Riepe’s law-school research delved into themes such as arbitration and malpractice liability and an issue related to malpractice: policing the medical profession. The medical malpractice system, Riepe said, is focused on assigning fault, thereby assigning liability. He said the focus should be on helping patients, no matter how they suffered an injury.

“Take, for example, workman’s compensation,” he said. “There is not a specific fault assigned to the company. If you have an injured worker, that’s the fact. He needs to be compensated. You don’t necessarily have to assign fault, and perhaps you can improve the working conditions.

“I toy with the ideas of all this no-fault, medical liability insurance,” he continued. “Assigning fault is a separate issue. Let’s compensate you on the degree of your injury—separate the fault from the potential for improving care.”

Tied into this is the process of regulating how physicians practice medicine. With malpractice insurance rates incredibly high (along with the threat of lawsuits, should mistakes be made), there is an effect on clinical care.

“There have been articles coming out recently saying that physicians, because of a potential liability issue, practice defensive medicine,” Riepe said. “That changes costs; it’s questionable whether it’s a deterrent to quality of care, and I was interested in what regulatory bodies are involved in overseeing physicians and what motivates physicians to disclose errors.”

Riepe said the system needs to change, and with that change will come improvement. “If you have a system where a physician admits an error that’s stigmatizing, punitive and individualistic, a physician is not going to be enthusiastic about admitting an error,” he said. “That’s pretty much human nature. This system isn’t going to improve unless you can admit an error as being something that’s going to happen when you are a human being and not punished because of it. Let’s use this in a productive manor. But there is not a single solution. There are a lot of interests involved.”

Riepe isn’t yet sure how he wants to use his new law degree, although he said doctors and lawyers definitely need to work in a more integrated fashion (if they are the same person, that’s just a bonus). He has taken the bar and will find out if he passed in October. He could then practice law, but isn’t sure that’s the direction he wants to take.

For full-time students, the law school is a three-year program. Riepe took four, and while he didn’t get to participate in a lot of activities because of his medical responsibilities (joining societies, for instance), his fellow graduates fully accepted him. He also participated in graduation ceremonies on Monday, May 16. It was the cap of a very long, exciting weekend.

Riepe’s day before graduation was a whirlwind. On Sunday morning, he flew to Chicago where he was presented with the Master Endoscopist Award by the American Society for Gastrointestinal Endoscopy (ASGE), the preeminent professional organization dedicated to advancing the practice of endoscopy.

Riepe is considered a pioneer in the use of the Endoscope, a tool that has revolutionized the field of gastroenterology. Through the use of a lighted flexible tube with a computer chip on the end that is inserted into the intestinal tract, electronic signals are sent to a computer that displays images on a video screen. Using those images, a physician can directly examine almost any part of the digestive system, obtain biopsies and remove polyps.

“It is a great privilege to have received this award,” said Riepe, one of three honorees on the evening. “I have spent my career trying to improve both my personal technique and my ability to impart this to gastroenterology trainees. I hope it has been with some degree of measurable success.”

Following the ASGE ceremony, Riepe flew back to Atlanta, but because of various delays, he didn’t get home until after 1 a.m. the next morning—just enough time for a few hours of shuteye before Commencement began at 8 a.m.

Riepe’s rooting section included his two sons, ages 13 and 14. “Graduating again was a lot of fun,” said Riepe, who also has a 26-year-old daughter. “I think it was a nice thing for them to see. Very few kids get to see their parents receive a degree. [Many people] put off having kids until graduating from college, but this shows them nothing’s impossible.”

While Riepe has balanced work and school for the last four years, he has made opportunities to spend quality time with his sons. Riepe works with Boy Scouts of America as a merit badge counselor and late last month rafted down the Nantahala River in North Carolina with the scouts.

He also assists coaching his sons’ travel hockey team, which is based in Duluth. A native of Illinois, Riepe’s passion for the sport—although dormant for many years—is easy to see. After his sons got into it a few years ago, he once again laced up his skates.

“Once you’re on the ice, your brain just shuts out the world,” said Riepe, who had to relearn to skate in order to keep up. “I figured that if I wanted to spend any time with my boys, I might as well relearn. I love it.” Like all youth ice hockey coaches, Riepe is certified by USA Hockey, so stepping behind the bench is not something done casually.

Riepe’s sons are big fans of their dad as well, but did they do anything to celebrate his law school graduation, like buy him a present (as many parents do for their graduating children)?
“Heavens, no; I probably had to buy them new hockey sticks,” Riepe said, before turning serious again. “My present was them being there.”