Alan D Tice, MD
Dr. Alan Tice arrived in Tacoma in 1979 as the first infectious disease specialist in Pierce County.
At that time, AIDS was not even a blip on the medical radar and patients with severe infections often required weeks of treatment in hospitals at great expense to our health care system.
Challenges lie ahead, as well as a distinguished career in medicine.
While Dr. Tice, board-certified both in internal medicine and infectious diseases, already was expert in medications and protocols in the treatment of severe infections, few realized in 1979 the medical challenges on the near horizon that involved the life-draining epidemic of AIDS.
At the same time, few could foresee the potential for treating other infections in outpatient settings, including even at home, rather than in hospitals. Dr. Tice had that vision.
Now, more than three decades later, AIDS no longer is front-page news as it was in the epidemic ‘80s and ‘90s, and the outpatient infusion therapies developed by Dr. Tice and his colleagues in Tacoma is everyday medicine, saving millions in dollars and lives.
A letter from Nicholas P. Christy, MD, professor of medicine from Columbia University School of Medicine in January 1979 supported Dr. Tice’s application for membership in the Pierce County Medical Society. Dr. Christy’s recommendations portended of things to come:
“Dr. Tice’s personal qualities are exactly those one hopes to find in young physicians. He was outstanding in his devotion to his duties, and equally outstanding in his concern for the welfare of patients. This concern manifested itself in his painstaking care of them, and in his considerable knowledge of their family, social and personal problems. (Dr. Tice) is a great deal more than a skilled technician. He also embodies many of the best qualities of the physician’s duty to be a teacher. He took time and pains with interns and medical students who were under his charge.”
Dr. Tice more than lived up to Dr. Christy’s predictions in coming years, forging a medical legacy in Tacoma. He built his practice with a deep knowledge of antibiotics and their uses combined with love for his patients.
He and his partners at Infections Limited put infectious disease care and treatment on the map in Pierce County, and his work here expanded beyond to the world of global medicine.
But to his Tacoma colleagues and friends, Dr. Tice was always “Alan,” dedicated to his work, analytical, with a sense of humor, a power to persuade others, and, most of all, “kind and caring” for his patients.
“Alan was a true pioneer in medicine, a visionary, who became recognized as an expert throughout the world for his work in infectious diseases,” said longtime friend and medical colleague Dr. James Komorous, a Tacoma dermatologist.
But the next 20 years of hard work and long hours in doing the right things in medicine took a toll in Tacoma. By the late 1990s, it was time for new challenges -- a new perspective of life for Alan and his family.
After deep reflection, including a much-needed sabbatical, Alan and his wife, Constance, and their high-school-age daughter, Amanda, moved to Honolulu in 2000.
The doctor wanted more time with his family and to enjoy Constance and Amanda at home.
But far from retiring, Alan continued his work in Hawaii, with patients in a new clinic, sharing his broad knowledge through teaching, consulting, lectures and writing, and in his new career as an associate professor of medicine at the John A. Burns School of Medicine at the University of Hawaii.
For the next decade, Dr. Tice, a weekend runner in Tacoma, continued his professional marathon in the race called medicine.
Amanda moved on to complete her education at the University of Chicago, her mother’s alma mater, and moved to New York for her professional life. Meanwhile, Alan and Constance enjoyed their beautiful home in Honolulu as Alan continued his work.
Sadly, Alan’s health declined. In his final few years, the caring doctor himself became a patient, with long hospital stays and quiet reflective times in his ocean front home.
On March 30, he died at age 69 in Honolulu following a long battle with multiple myeloma.
Dr. Tice’s medical odyssey ended, but the fruits of his labor live on.
In reflection, Dr. Peter Marsh, a Tacoma colleague and business partner, recalled Alan’s career-crowded years in Tacoma:
“Alan traveled both nationally and internationally for many years lecturing on outpatient infusion therapy,” Dr. Marsh said.
Colleagues say outpatient IV therapy was Dr. Tice’s best-known contribution to global medicine.
Doctors Tice and Marsh and their colleagues indeed had built that legacy in Pierce County.
Dr. David Law, a Tacoma internist and friend, said “I could never understand what brought Alan to Tacoma. With his Harvard background, excellent medical training and his interest and drive in research and innovation, Alan was excellent university material.”
Alan’s grandfather, father, uncle, brother and sister all were physicians.
Alan, who was raised in Iowa, had followed a similar career path after graduation from Harvard and the Columbia College of Physicians and Surgeons. He trained in internal medicine at Roosevelt Hospital in New York and New York University. He completed his fellowship in infectious diseases at Tufts New England Medical Center and spent several years teaching at Brown University’s School of Medicine before moving to Tacoma in 1978.
But why had Dr. Tice chosen Tacoma?
“I now believe Alan was driven by the challenge of raising the level of medical care in our community,” a lifetime focus that Dr. Law believes not only influenced local medicine but had a profound effect on the treatment of infectious diseases in the U.S. “and the world.”
Dr. Marsh agreed that Dr. Tice’s efforts in Pierce County made the Tacoma practice they founded, Infections Limited, famous throughout the nation.
Dr. Tice and his partners had taken those first critical steps by creating the first office-based antibiotic infusion program in the Western United States.
Doctors Tice and Marsh and their Infections Limited colleagues also created the first office-based microbiology lab in the country.
“Tests that were referred to the University of Washington became available in half the time at half the cost,” Dr. Marsh said.
“Alan was highly respected as a teacher and a clinician,” Dr. Marsh said. “Alan was bestowed the Clinician of the Year Award by the Infectious Disease Society of America.”
In those busy decades of the ‘80s and ‘90s, Dr. Tice carried a full patient load, while lecturing throughout the world, in demand because of his pioneer work in outpatient infusion therapy.
During those years, AIDS also had taken center stage in the medical landscape, and Dr. Tice assumed the primary provider role in treatment of this mysterious, stigmatized and deadly disease in his home county.
Dr. Frederico Cruz-Uribe, director of Pierce County’s health department from 1992 to 2007, worked with Dr. Tice on many public health issues.
“During the initial years of the AIDS outbreak, Alan stepped out when others hesitated. He took stands when others were quiet. Alan established contact when others kept their distance. Alan embraced AIDS challenges when others were frozen in fear. He pushed policy change when others said we need to wait,” Dr. Cruz-Uribe said.
“I often accompanied Alan when he visited his AIDS patients,” he said. “It was inspiring to see the depth of commitment and just the simple caring that characterized every visit.”
While the battle against AIDS was raging, Dr. Tice remained in the front lines, work that earned him special recognition from the Pierce County AIDS Foundation in 1997.
He founded the Pierce County Medical Society’s AIDS Committee in 1987. He served as chair through 1992, and remained an active member until he left Tacoma.
Dr. Tice trained Pierce County practitioners treating AIDS by organizing an annual CME conference from 1989 through 1999, with 250 attending the first year, despite a snowstorm.
For many years, he directed an annual infectious disease CME course for physicians, sponsored by Infections Limited.
And he participated in continuing medical education conferences speaking on many infectious disease subjects.
He organized programs for office staff, teachers, service clubs, fire departments and many other groups and organizations to educate them about HIV-AIDS. Although he provided care to more AIDS patients than any other single provider in Pierce County, Dr. Tice made efforts to increase patient access to other physicians. His goals were to educate those physicians on ways to provide better care in treating patients with AIDS and to coordinate community support services for those patients.
Sue Asher, director of the Pierce County Medical Society, recalling those early years, said:
“I was always in awe of Dr. Tice’s ability to be so far ahead of everyone else, and I always wondered what he wrote so constantly on those little pieces of paper he kept in his shirt pocket. He was always making notes. He would call one of our CME staff members at all hours of the night. We often joked about when he slept.”
All these efforts, obviously, reached far beyond hands-on medicine.
During his years as a member, then chairman, of the Infectious Diseases Society of America’s (IDSA) Clinic Affairs Committee, Dr. Tice represented the organization in developing the Harvard-Resource-Based Relative Value Scale in defining medical fee payment in his specialty.
He was liaison to the American Society of Internal Medicine and testified before Congress and the Health Care Financing Administration on behalf of the IDSA.
He always was a prolific writer, with hundreds of articles, abstracts, book chapters and written contributions in such prestigious publications as Encyclopedia Britannica, the New England Journal of Medicine, Journal of the American Medical Association, Scientific American Medicine, Infectious Diseases, Hawaii Medical Journal, among many others.
And he was founder, president and executive director of the Outpatient Intravenous Infusion Therapy Association (OPIVITA) from its founding in 1989 and was a prolific writer and editor for the association’s newsletter.
His research included more than 60 clinical trials in infectious diseases, with advanced studies in OPAT, HIV, viral hepatitis, methicillin-resistant staphylococcus aureus (MRSA) and vaccines.
Dr. Tice’s love of his work and for his patients in Tacoma was outlined in a goodbye article published in this Bulletin in December 2001 after he made the agonizing decision to leave his beloved practice. It was just time to “go in a different direction,” he said then, but his dedication to his work continued in Hawaii until illness overcame him.
Dr. Tice’s work had crossed the universe of medicine in Pierce County. Countless colleagues had sought out his expertise and that of others at Infections Limited for help in caring for their own patients.
Dr. Tice especially relished the award he received in 1990 for “exceptional service and recognition in teaching” presented to him from a grateful Tacoma Family Medicine Residency Program.
His social circle included the impromptu Point Defiance Runners, a beloved group of joggers who gathered on weekend mornings at Point Defiance Park. Alan was one of the founders of the group, which over the years included more than a dozen medical colleagues, attorneys, teachers, an architect, a music teacher, building contractors, a landscaper, carpet salesman and a journalist, among others.
During those Point Defiance jogs in the ‘80s and ‘90s, many of the conversations were about medicine, but most were the kind of banter normal among friends enjoying a good run and sharing in the beauty of the park.
Alan joined with those friends in running the annual Sound-to-Narrows race, including costume division entries dressed as “M&Ms” and “killer bees.”
Even after moving to Hawaii, Alan continued to forge his jogging ties to Tacoma and to his beloved Point Defiance Park, where he had pounded out countless miles on the wooded trails.
Alan coordinated with Dr. David Law to raise funds for a modern, replacement drinking fountain across from the Japanese pagoda and near the rose garden and Owen Lodge. He asked architect Ilmar Reinvald, a longtime friend and former neighbor, to design the commemorative fountain site, complete with plinth and plaque naming runners who shared in the beauty of the park on those countless Point Defiance Runners weekend jaunts.
The new drinking fountain – some call it “Alan’s fountain” -- remains today, serving joggers who run those same trails. The fountain has a drinking spout at a normal height, a lower one to serve children and the handicapped and a doggie bowl (complete with its own water source) at the bottom – a touch of compassion and humor.
Alan’s death brought a flood of memories from Tacoma friends even though he moved to Hawaii more than a decade ago.
Dr. Komorous, who developed a friendship with Alan bordering on “brotherhood,” said:
“With our wives and families, we shared Sunday night dinners for more than 10 years. We skied together and spent countless hours running and talking at Point Defiance. Our children who are now adults still talk about our annual spring weekend trip to Fort Worden State Park with the other runners’ families and their children.”
Those feelings never changed despite the departure of Alan, Constance and Amanda.
“When I visited Alan in Hawaii last summer and again in January, it became obvious to me that other than his family and friends, his work in medicine consumed his life,” Dr. Komorous said. “I’m not sure he had ever watched a Seahawks football game.”
In January, when Dr. Komorous saw Alan for the last time, “we spent the last day in his room watching four ‘Nova’ TV episodes. We critiqued each one in great detail -- typical Alan.”
Dr. Cruz-Uribe provided other insight into Alan:
“I was attending a conference at the convention center in downtown Tacoma. Walking down one of those long halls looking for my meeting room, I spotted him. He was sitting by himself in an empty room in the dark, talking to himself and making hand gestures for emphasis,” Dr. Uribe said.
“I shrugged my shoulders and walked by. It was just Alan being Alan, I thought. I saw him later and asked him if he had a good conversation with himself. He looked at me as if I were 5 years old and showed me his newest toy -- a phone with an ear insert.
“I tell this story as I had the opportunity to work with Alan over a 10-year period. It was always memorable because Alan was a most unusual man. You learned never to be surprised by anything he did. Alan had his own way of doing things -- sometimes hard to understand immediately,” Dr. Cruz-Uribe said.
“But he was bright -- brilliant actually -- and quirky, and he spoke with a rapidity that often made it difficult to keep up. He could change the subject moving from one topic to another without pause …
“However, his most unusual trait was the depth of his compassion for people in need,” Dr. Cruz-Uribe said. “We need more unusual physicians like Alan.”
Dr. Law agreed when reflecting on Alan, his long-time colleague and friend:
“He was and still remains a role model for physicians,” Dr. Law said. “His deep knowledge of medicine was not limited to his specialty area and infectious disease. All my colleagues are hard workers, but Alan had that special ability to offer inspiration to others in medicine. He had such a futuristic mind. A chat with Alan often resulted in the feeling that one should do more to improve the world that surrounds them.”
When the Tices left for Hawaii, Alan told this Bulletin: “The hardest part of leaving Tacoma was saying goodbye to my patient family.”
Sadly, Alan’s big Tacoma family – patients, colleagues and friends – have had to say goodbye to him.
Aloha … dear friend.
By James Komorous, MD and Roland Lund
The authors thank Dr. Peter Marsh, Dr. David Law and Sue Asher for their assistance
Source: Pierce County Medical Society Bulletin May/June 2013