Richard S. Ross, longtime Johns Hopkins medical school dean, dies at 91

Richard S. Ross, former dean of the Johns Hopkins University School of Medicine, vice president for medicine of Johns Hopkins University, and a renowned cardiologist who served as president of the American Heart Association, died Aug. 11. He was 91 and had been suffering from Parkinson's disease.

Ross was dean of the School of Medicine from 1975 to 1990. Under his leadership, the school doubled its space devoted to research, consistently was among the nation's top recipients of federal research funding, and undertook educational reforms and initiatives that stimulated a continued flow of top-notch, diverse applicants to Johns Hopkins.

"Dick Ross was a true Hopkins legend," says cardiologist Myron "Mike" Weisfeldt, former director of Johns Hopkins' Department of Medicine and himself a onetime president of the American Heart Association. "He grew up in the tradition he then led. He went from Cardiology chief to dean in a one-step advancement—quite an achievement in and of itself. His great characteristics were integrity and commitment. There were enough of both to infect all around him."

Before becoming dean, Ross made significant contributions as a clinician-scientist in the 1960s and early 1970s, a period he later would call the "most exciting" of his nearly 60-year career at Johns Hopkins. As director of Cardiology and head of its Wellcome Research Laboratory, Ross was among the researchers who pioneered the use of several novel methods of examining and treating heart conditions. Along with Radiology director Russell Morgan, "a real gadgeteer" who would go on to become his immediate predecessor as dean, Ross introduced coronary cineangiography, a method for "taking the first motion pictures of the heart," Ross recalled in a 1992 interview.

At the Wellcome Lab, Ross and fellow cardiologists Gottlieb Friesinger, J. Michael Criley, and O'Neal Humphries were also the first at Johns Hopkins to produce coronary arteriograms, a technique of measuring myocardial blood flow with dye injected selectively into the coronary arteries.

Criley, now emeritus professor of medicine and radiological sciences at UCLA, worked with Ross as a resident, fellow, and then member of the Johns Hopkins faculty, from 1958 to 1967, and describes him as "my mentor during my decade at Hopkins and for more than four decades thereafter."

"He approached challenges with calm and clear-eyed logic and led by example. He imparted these attributes to his trainees and through them to many others involved in the rapidly expanding field of cardiovascular medicine."

Cardiologist C. Richard Conti, who worked with Ross as a fellow and young faculty member from 1965 to 1974 and now is professor emeritus of medicine at the University of Florida in Gainesville, says, "Those of us who worked with him were always humbled by the way he could identify the crucial aspects of our research and simplify the presentation of our data so that everyone interested in the subject could fully understand it. He was a master at this."

Other areas of Ross' research included the relationship between coronary anatomy and prognosis in coronary artery disease, and the evaluation of surgical procedures for the treatment of coronary artery disease. He also was instrumental in organizing a multicenter, prospective, randomized trial to evaluate the use of coronary bypass surgery for emergency treatment of unstable angina pectoris.

Ross' expertise in cardiology was such that, in 1974, he was one of three physicians asked by John Sirica, chief judge of the U.S. District Court in Washington, D.C., to examine former President Richard Nixon at his home in San Clemente, California. The panel was asked to determine whether, as Nixon claimed, he was not well enough to testify during the Watergate investigations then underway. Ross and his fellow physicians determined that Nixon was, indeed, too ill to travel.

Even after becoming the medical school dean, Ross continued to see patients occasionally, maintaining relationships begun decades earlier. In 1990, he recalled that one patient of 30 years' standing had initially been treated with a plastic graft to replace a congenitally defective aorta. The man seemed fine for some 20 years, but then Ross picked up a change in the sound of his heartbeat. An X-ray showed that the graft was failing and had to be replaced. Ross said he often cited the case "as an example of why careful follow-up of a new procedure is important.

"This man kept saying, 'Why do I have to come back every year? Nothing ever happens.' Well, one year, something did."

Ross was born in Richmond, Indiana, on Jan. 18, 1924, the only child of Louis F. Ross, a physician, and Margaret Grubbs Starr, who had been educated at Vassar College in an era when few women from small Midwestern towns went east for schooling. His father was a general practitioner who developed an interest in psychiatry and became superintendent of the Eastern Indiana Hospital for the Insane in Richmond. "I often tell people I was born and brought up in an insane asylum," he would recall with a slight, bemused grin. "Many people hear this with great interest."

Ross went to Harvard in June 1942 and, because of the accelerated program during World War II, entered Harvard Medical School without finishing his undergraduate degree. He received his MD cum laude in June 1947. He then came to Johns Hopkins, intending to spend a year on the Osler Medical Service to train and observe the workings of a non-Boston hospital and ended up staying for the rest of his career, with just a few interruptions for military service and subsequent training. "There was a wonderful feeling of being part of a team, part of a unit. My best friends in the world are the people I knew on the Osler house staff," he recalled.

After completing his medical internship and residency at Johns Hopkins, Ross entered the Army Medical Corps as a captain in July 1949. He served as chief of Cardiovascular Medicine in the 141st General Hospital in the Far East during the Korean War. In 1951, he returned to Johns Hopkins for a second year of medical residency, and in 1952–53 was a fellow in Physiology at Harvard. He returned again to Johns Hopkins in 1953 to become the chief medical resident.

Ross became associated with legendary pediatric cardiologist Helen Taussig, an originator along with surgeon Alfred Blalock and laboratory technician Vivien Thomas of the celebrated "blue baby" operation, which gave birth to the field of cardiac surgery. Along with Taussig, he cared for adult patients with congenital heart problems who were coming to Johns Hopkins from all over the world because of Taussig's renown. He also joined her in studying pulmonary hypertension in the young patients who had undergone the blue baby operation. "Those were exciting times," Ross remembered in 1990. "I was fascinated by the physiology. It still turns me on. I enjoyed understanding it, explaining it, participating in it. It was a shining era."

He moved through the School of Medicine's academic ranks, achieving directorship of the Cardiovascular Division of the Department of Medicine in 1961 and full professorship in 1965, and was named the Clayton Professor of Cardiovascular Disease in 1969.

"He was the first real head of an organized clinical and research cardiology program," says Weisfeldt.

A man of medium height and closely cropped hair that turned white, Ross wore large eyeglasses that gave him a slightly owlish appearance, re-enforced by a resolutely calm demeanor. Meticulous in his leadership roles, he kept careful notes during every meeting he called or attended and would prepare a concise memorandum on it afterward. Occasionally emerging from behind his somewhat strait-laced appearance was a droll, puckish sense of humor. One of his favorite expressions was: "Proud turkey today, feather duster tomorrow."

When Ross became dean in 1975, he focused intently on what he termed the "synergistic triangle" of teaching, research, and patient care at Johns Hopkins that guaranteed its continued success. Looking back nearly two decades after his retirement in 1990, Ross in 2009 told an interviewer that the "great developments of my deanship were the growth of research and the growth of the clinical practice." During his 15-year deanship, Johns Hopkins went from seventh to first in National Institutes of Health research funding and from $20 million in clinical income to more than $100 million.

He also considered of vital importance his effort to encourage the creation of a single leader for all of Johns Hopkins Medicine rather than the historical dual, sometimes conflicting, leadership of a School of Medicine dean and a Johns Hopkins Hospital president. In 1997, seven years after Ross' retirement, the post of a single dean/CEO for Johns Hopkins Medicine was created.

Ross also oversaw the establishment of 29 new endowed professorships for senior faculty and created a $5 million fund to provide salary support for young Johns Hopkins physicians just beginning their research careers, ensuring the development of future generations of savvy scientists. What is known as the Richard Starr Ross Fund for Physician Scientists has given more than $9.2 million in grants to 140 young scientists since its founding in 1990, underwriting research in virtually every medical realm within Johns Hopkins, including anesthesiology, geriatrics, neurology, pediatrics, otolaryngology, oncology, surgery, urology, and more.

Focusing intently on improving the School of Medicine's reputation, Ross displayed a penchant for what later would be called marketing. He enjoyed "selling Johns Hopkins Medicine" as a brand, initially over the objections of more tradition-minded trustees and faculty.

"The dean's No. 1 job is to recruit people and to make sure that the people heading the departments are of the proper mold," Ross said in 2009. He noted that the founders of Johns Hopkins' medical faculty—William Osler, William Welch, Howard Kelly, and William Halsted—had "recruited a second layer of faculty, and the second layer recruited the third layer, and we're now about the fourth layer, so the lineage is clear.

"My job was to try to do as good a job as they did to perpetuate the spirit of intellectual activity and academic medicine. So I felt that was part of marketing, to increase the image. If you burnish the image, it may be easier to recruit people."

In addition, Ross helped continue a flow of stellar, well-rounded medical students to Johns Hopkins by dropping the Medical College Admissions Test requirement for applicants, approving a FlexMed program with greater study options, and expanding the enrollment of minorities. He also strongly defended the right of private medical schools to select their own students, vigorously opposing a 1977 federal government effort to compel U.S. schools to admit underqualified third-year American medical students who had received their initial training overseas.

In a 1990 interview with Hopkins Medical News, the School of Medicine alumni publication he founded in 1975, Ross summed up his medical education philosophy simply: "Select the best possible students, bright, well-rounded, motivated, imaginative people. Put them together with good faculty who enjoy teaching, and provide good facilities. Then leave it alone. Just let the process work. That's worked for 100 years."

To persuade the best new teachers and researchers to come to Johns Hopkins, Ross instituted a 10 percent "Dean's Tax" on the clinical faculty's revenues, giving him a steady stream of unrestricted funds. "It made it possible to recruit people, because you need a dowry" to do so, Ross said in a 2009 interview.

Ross also launched major construction projects to attract both faculty and students. These included a 10-story, 22-laboratory building on Rutland Avenue, across Monument Street from the Johns Hopkins Hospital, and later named the Richard Starr Ross Research Building; a new Hunterian Laboratory for Surgical and Pathological Research for experiments; the Asthma and Allergy Center on the Johns Hopkins Bayview Medical Center campus; the Denton A. Cooley Fitness and Recreation Center for students and faculty; and student lounge areas in the Preclinical Teaching Building.

In an interview shortly before his retirement, Ross said that he would like people to remember his deanship "as an exciting, pleasant, stimulating time to be part of the Johns Hopkins Medical Institutions." He also said that when asked if he liked being dean, his standard reply has been: "Yes, 51 percent of the time," and then, adding with a chuckle, "It's really much better than that, possibly 52 percent."

Author of more than 150 articles on cardiovascular physiology and disease, Ross was asked to serve as director of the National Heart, Lung, and Blood Institute early in his career, but he turned down the position to stay in teaching and research. Before becoming dean, he served as president of the American Heart Association in 1973–74 and as editor of modern editions of The Principles and Practice of Medicine, written originally by William Osler, Johns Hopkins' first physician-in-chief.

Ross received the American Heart Association's Gold Heart Award in 1976 and its James B. Herrick Award for Outstanding Achievement in Clinical Cardiology in 1982. In 2005, he received Johns Hopkins University's President's Medal, an honor reserved for people of distinguished achievement. Reflecting months later on the standing ovation given to him by the more than 300 former colleagues who attended the award's presentation ceremony, Ross displayed a rare moment of emotion, taking a deep breath before saying, "I was amazed at the number of people who appeared at the end of a busy day to attend the reception."

Ross also served on advisory groups for the National Heart, Lung, and Blood Institute and was chairman of its Cardiovascular Study Division as well as the Heart and Vascular Disease Panel. In 1974, he was appointed to the institute's advisory council and in 1980 became a member of the policy advisory board of its coronary artery surgery study. He was elected to membership in the Institute of Medicine of the National Academy of Sciences in 1975 and was corresponding member of the British Cardiovascular Society, the Cardiac Society of Australia and New Zealand, and the Sociedad Peruana de Cardiologia. He was a director of Merck and Co., the Equitable Life Assurance Society of the United States, Noxell, and Waverly Press.

Ross is survived by his wife of 65 years, Elizabeth McCracken Ross; their three children, Deborah R. Chambliss, Margaret C. Ross, and Richard "Mac" Ross; and five grandchildren.

A memorial service will be held at Johns Hopkins in the fall.

In lieu of flowers, the family asks that contributions be directed to The Richard Starr Ross Fund for the Physician Scientist at the Johns Hopkins University, School of Medicine Development Office, 750 E. Pratt St. 17th Floor, Baltimore, MD 21202 (checks payable to Johns Hopkins University).

Correction: An earlier version of this article incorrectly stated that Ross' tenure as dean was the second-longest in the history of the School of Medicine. We regret the error.