Transcript of interview with Dr. Darville Knowles by Lisa Gioia-Acres, October 9, 2008 and November 9, 2008

An Interview with Dr. Darville Knowles An Oral History Conducted by Lisa Gioia-Acres Heart to Heart Oral History Project Oral History Research Center at UNLV University Libraries University of Nevada Las Vegas ©Heart to Heart Oral History Project University of Nevada Las Vegas, 2009 Produced by: The Oral History Research Center at UNLV - University Libraries Directory: Claytee D. White Editor: Gloria Homol Transcriber: Kristin Hicks Interviewers: Emily Powers, Lisa Gioria-Acres, Claytee D. White ii These recorded interviews and transcripts have been made possible through the generosity of Dr. Harold Boyer and the Boyer Foundation. The Oral History Research Center enabled students and staff to work together with community members to generate this selection of first-person narratives. Participants in the Heart to Heart Oral History Project thank the university for the support given that allowed an idea of researching early health care in Las Vegas the opportunity to flourish. All transcripts received minimal editing that included the elimination of fragments, false starts and repetitions in order to enhance the researcher's understanding of the material. All measures have been taken to preserve the style and language of the narrator. In several cases, photographic images accompany the collection and have been included in the bound edition of the interview. Claytee D. White, Project Director Director, Oral History Research Center University of Nevada Las Vegas - University Libraries Table of Contents Darville Knowles, born 1948 in Miami, Florida; parents taught in Dade County School District; one brother, now a lawyer in Miami; parents divorced, 1961; mother moved to Las Vegas, 1962; no housing for blacks anywhere but West Side; Hank Greenspun, editor of Las Vegas Sun, printed story of recruited teacher who couldn't find a place to live; end up as borders with another black family on West Side; shocked at segregation in Las Vegas regarding housing, schools, and entertainment; comparing segregation in Miami to that in Las Vegas; grandmother's experience in the U.S. compared to her life in Bahamas 1_3 Comments on limited opportunities for black med Students in Miami; offered scholarship to U. of Florida, 1965, but chose to attend Howard University in Washington, D.C.; discussion of grandmother's outlook on prejudice; examples of glaring differences in funding for white schools v. black schools in Miami; desegregation of track and field events, but not contact sports; mention of educational opportunities for self and brother in high school which fell flat because of distance and time 4-7 Graduation from Stanford Medical School, 1974; internship at Jewish Hospital of St. Louis; call from Dan Wilkes, pathologist in Las Vegas, urging a look at Las Vegas for opportunities; tried St. Louis, Atlanta, Houston, and Los Angeles before deciding to come to Las Vegas; arrived Las Vegas, March, 1982; established practice at Sunrise Hospital right away g_12 Comments on health of Las Vegans regarding air quality, eating habits, and level of education; opinions regarding early education on food choices and exercise; changes in the practice of medicine due to HMO's and managed medical care; discussion on desired changes in health care management; opinions and comments on the future of medical practice 12-17 Discussion of research done at Stanford on Sickle-cell Anemia; comments on AIDS in Las Vegas; opinions on election of Barack Obama; anecdote regarding out-of-state doctors and their "offices" in motel rooms; changes in medical practice in Las Vegas since 1982; comments on increase in respiratory ailments; mention of Nathan Adelson's desire to see Sunrise Hospital grow; further opinions on the future of health care regarding HMOs and tightly managed care; differences between Canadian health care and U.S. health care 17-25 Discussion on HIPAA laws and insurance companies; possibility of hack-proof computers for doctors, using DNA to determine future health problems, and resulting changes in medical practice; comments on treating anxiety and illness relating to current economic downturn; negative side of pro bono work; closing comments on side interests which include writing murder mysteries 26-31 iv Preface Dr. Darville Knowles was born in Miami, Florida, in 1948. His mother and father were schoolteachers in Dade County. After their divorce in 1962, Darville's mother relocated to Las Vegas with her two sons and took a teaching position here. Dr. Knowles comments on the differences between Miami and Las Vegas as far as segregation regarding housing, education, and job opportunities. He also mentions that his grandmother had emigrated from the Bahamas and that she impressed on them to make their own situation and community better. He recalls that track and field athletics were desegregated before the contact sports, such as football and basketball. Darville and his brother Michael (a lawyer in Miami) both graduated from college. Darville attended Howard University and Stanford University Medical School and completed his internship at the Jewish Hospital of St. Louis. Dan Wilkes, a family friend and pathologist in Las Vegas, convinced Darville to look at Las Vegas for job opportunities. After trying St. Louis, Atlanta, Houston, and Los Angeles, Dr. Knowles finally settled in Las Vegas in 1982 and "grew' his practice at Sunrise Hospital. Dr. Knowles comments on health problems in Las Vegas related to eating choices, lack of exercise, and poor air quality. He describes how HMOs have changed the practice of medicine and gives his opinions on how health care should be addressed by Congress. He also discusses the future of medicine, the research he was involved in, and the AIDS crisis. Dr. Knowles talks about how medicine has changed since 1982, the large number of respiratory problems that he treats, and comments further on HMOs and the fixture of medicine in Las Vegas. He also shares that he found time to author a murder mystery and has plans to write more. 1 This is Lisa Gioia-Acres. Today is October 9th, 2008. I am here conducting an oral history interview with Dr. Darville Knowles, K-N-O-W-L-E-S, for the oral history department at UNLV and the Heart to Heart oral history project. Hi, Dr. Knowles. Good afternoon. How are you today? Fine, thank you. Thank you so much for inviting me to the office. A lot of times I go to people's home. But now I'm here at your place of work and that's terrific. Wonderful. Prior to getting your information about your life as a physician here in Las Vegas, I wondered if you'd take a few minutes of your time to talk about your early life? Give me some specifics. Who was mom? Who was dad? What were their occupations? How many brothers and sisters and things like that? And where were you born? I'm Dr. Knowles, M.D. I was born in Miami, Florida, in 1948. My mom was a schoolteacher in the district of Miami, Florida, which is Dade County. My dad was also a schoolteacher in the same district, Dade County in Miami, Florida. And I have one brother, a younger brother. He's five years younger than I am. And he's a lawyer in Miami, Florida. We have no sisters. The reason I came to Las Vegas is my mom and dad got divorced in 1961-62, and my mother said she was looking for better opportunities. We lived in Florida, which was strictly segregated at the time. And because of the unusual situation where Florida did not admit black students to their graduate programs, such as University of Miami, University of Florida, Florida State, the state got around some of those restrictions by stating that any black person who wanted to get an advanced degree such as a master's degree, if they got accepted to a school outside the state of Florida, then the state of Florida would pay for it. So, therefore, my mom and dad both got their master's degrees at New York University. I traveled to New York when they were students when I was younger. My grandfather happened to live in New York, also. So after my mom and dad got divorced, she looked for the place where she thought had the most opportunities. At that time it was either Anchorage, Alaska or Las Vegas, Nevada. So she said well « 2 Cold or hot. That's right. She said I think I could deal with the heat a little better in Las Vegas than the cold in Anchorage, Alaska, and so she made some inquiries. Actually, the city of Las Vegas needed schoolteachers at the time. They didn't have any teachers who had master's degrees. And she came to Las Vegas and did her interview and so forth and they accepted her into the school system. The story gets even more interesting because the school system recruited us. We thought we were leaving the segregated south to be in the west, but when we came to Las Vegas, no one would rent us an apartment. You couldn't live anywhere in Las Vegas if you were black, other than in West Las Vegas. And so we went around and looked at apartments near the school and we looked at places all over Las Vegas, which was fairly small at that time. And they did not have any apartments for rent on the West Side. So we actually lived in a motel for about a week. Then she complained to the school board that they recruited her, brought her out here, and now we can't have a place to live. That's when we first met Hank Greenspun, who was the editor of the Las Vegas Sun. He ran our story in an editorial - I wish I had had the foresight to keep one of the papers -- and the headline read, "School recruits teacher and no one will rent her and her two sons a place to live." That ran in the paper for a while, and still no one rented us a place until we looked on the West Side. There weren't any apartments and you had to know someone or someone had to move out of a house and so on. So we lived with a family that I still keep in touch with and, in fact, they are my patients now. We really thought of the family as our Godparents. And their kids are my God-kids. Is it a white family? Black. No white families lived on the West Side. When I say west, when you're talking about west now, we're talking about true west, which means west of Decatur. But in the early days of Las Vegas, West Side would actually geographically be north. Why they called it west was because it was west of the city, but it's not actually west. It's not North Las Vegas, but it's between Las Vegas and North Las Vegas. But that was called the West Side. So we lived with those people until a house came up for rent. We moved in with them and the school board did reimburse us for our expenses at the motel for the week we had to stay there. 3 And then my mom started teaching in the school system here. What year did you arrive in Vegas? 1962. So your family was shocked to find that there were still social issues going on that would prevent you from upward mobility. Oh, absolutely. Absolutely. We just had no idea that Las Vegas was totally segregated. The schools were segregated. Housing was segregated. Entertainment was segregated. I'm fascinated with this part and we're going to pick this up again. But can you go back and talk about your childhood? What impressions did you have growing up and what kind of experiences did you have as a black child in Florida? In Florida? Well, the thing is Florida was totally segregated. Okay. They had all-black high schools. But because the population of Florida was fairly large ~ I think as I remember there were six black high schools « all the teachers were black. All the administrators were, also. And the city was segregated, but it was a little different in that you had a huge influence of Jewish people from New York who would either winter in Miami or move there to retire in Miami. So the city wasn't completely southern. It was southern in its location, but not southern so much in terms of everyday interactions. You could go to most stores in downtown. You could shop in almost all the stores. Miami Beach was a different story, even though Miami Beach was predominately Jewish at the time. Miami Beach has a totally different history in that my grandmother, who was a schoolteacher in the Bahamas and then immigrated to the United States, didn't have a certificate to teach here. So she worked as a housekeeper in Miami Beach. She often laughed because blacks were not allowed free access to Miami Beach except if you worked there. She always thought it was ironic because at the time ~ maybe it was 50 percent Jewish and 50 percent white in Miami Beach. And she had come to the States I think in the early 20s. And she said at that time Jewish people were not allowed on Miami Beach. But what Jewish people did was buy property either under their name, which was often changed to an Anglo-American name, or they would have friends of theirs buy the property and then sell it to them. So that's how they got a foothold in Miami Beach and that type of thing. 4 But I can't say I liked Miami because it was very limited. The only universities you could go to when I was matriculating were the black universities, which were good schools. And the year I graduated was the first time that white schools — which was 1965 from high school and that was the first year that white recruiters actually came to our high school to recruit kids to go to University of Florida and University of Miami. I knew I always wanted to become a physician. When I was in high school we had speakers come from the University of Miami to give programs to show students what medical residents did, and my friends and I that were interested in science did those things. I really don't think the residents knew that no matter what we did at that time we couldn't go to the University of Miami, although they had a program for black students to observe the residents making their rounds. My aunt was a head nurse at the university hospital, which is interesting, too. So, obviously, they hired black nurses, but no medical students. And blacks could go to the hospital, which was Miami - what was the name of the hospital? - Jackson Memorial Hospital. I think the hospitals were desegregated shortly after I was born in the early 50s because I was bom in a black hospital, which was Christian Hospital. But my brother, five years later, was bom at Mount Sinai Hospital in Miami Beach. So I think in terms of the hospitals and pediatricians I remember my brother having - sometimes we'd have a black pediatrician and sometimes we'd have a -- so the medical profession in terms of who would be accepted as patients, you could go to any doctor or any hospital, but you couldn't get the training. I was offered a scholarship to University of Florida in 1965, but I decided to go to a black undergraduate university. So I went to Howard University at that time. And where is Howard? That's in Washington, D.C. So let's see. What else? What was the household attitude? How did your parents approach that social condition back then and how did they discuss it with you and your brother? That's an interesting question. My grandmother -- my father's parents -- came from the Bahamas, but he was actually bom in the States, and my mother emigrated from the Bahamas at an early age, so I think we had a really different outlook on it. My grandmother always instilled in us that you just make your community better. My grandmother really wasn't a pioneer of integration. 5 She just wasn't. She said if you want to make it in any society or America, you just make your own situation better. And that's what she always told us to do. She never understood it or never — the things she didn't like were that you were denied the opportunity. But she didn't see the need where you would have to patronize a white store or grocery store or pharmacy. Or demand access to? She thought you should have the access to it, but she didn't think that other than just a legal way of getting it that ~ protests and marches, she just said, well, I don't understand why you're protesting because the communities at that time in the 60s in Florida were fairly self-contained. You had black doctors. You had black police officers. You had black lawyers. You had black pharmacists. You had black movie theaters. So there were opportunities for both. Right. Maybe different than in other communities where there were no similar opportunities. Right. Oh, no, no. And before my dad became a schoolteacher, he owned a grocery store and that type of thing. So everything that you needed was accessible. But the thing that was a problem is that white schools were funded better than black schools. And I remember one time going to a meeting where ~ I had to be in maybe 10th or 11th grade. And they had a lot of the parents there and they were talking to the school board. They showed glaring examples of where the white schools had more equipment for the chemistry class. The biggest example that was evident, because you didn't know how many microscopes one school compared to the others, was that all the white schools got classical instruments to play. I'll never forget that. They got violins and cellos and that type of thing. And none of the black schools had any violins and no violin instructors. So they said, well, that's not fair. Sometimes we would get books and you could see where the other schools had the books first. They would say, Property of North Miami High School." After the books were outdated, then we would get them, so that was quite an issue. They didn't desegregate the schools until about three or four years later, but they desegregated some of the athletics, like track and field. They didn't desegregate football, baseball, basketball, but for some reason track and field. I guess because those are non-contact sports 6 because you didn't have to touch the other person. You could do that and you wouldn't be aggressive and that type of thing. So they integrated track and field in I think my junior year in school. I think in '64. And we were happy because our school won the state meet. It was really interesting because on the news they would have high school sports. And, of course, the black schools were never mentioned. In the audience — I mean you're sitting in the bleachers, you know, you re all kids, teenagers and things like that ~ and we were sitting up there with the white kids. There wasn't any animosity, really. And the white kids were just astonished. They said, gee, you guys won the track meet and we never even heard of your high school. We didn't even know your high school existed. And it wasn't like we were a small high school. There were over 2,000 people at my high school. There were almost 800 people in my graduating class. That's big. That's a big high school. And they thought it was just absolutely unbelievable. They said we never got any sports of you guys, blah, blah, blah. So we didn't even know you had good athletes at your school. We absolutely didn't know you had a high school. And then I remember I played in the band. They used to have band camps. Then they started integrating the band camps. They used to have Red Cross Camps. And they integrated those, too. So anyway, where were we? Okay. We were in high school. Did you play sports? No. I was in the band. Did your parents instill in you at an early age that you would be going to college and getting a higher education? That was pretty much a no-brainer. I mean we didn't even think about that. What grade levels did your parents teach? My mom initially started with elementary school. She came out here and was elementary school, then Special Ed and learning disabled and high school. She taught at Basic High School. My dad started in elementary school. I mean it's pretty interesting coming from a segregated society or whatever in Miami. All of my high school friends, our little circle, we just didn't even think about it. You know, after high school you go to college, end of story. And all of them did. We're really proud of our Class of 7 65. We just had a reunion. We had lots of doctors and dentists. In fact, one of the graduates of my class, one of my classmates, he's the mayor of Tallahassee. So quite a lot of inroads were made by that class because it was the first class that was really able to really get a little outreach. Oh, I forgot one thing when I was in high school, I think 1 Oth grade or 11 th, because they had no black students at University of Miami — that's hard for people to understand now because almost all the athletic teams there are black — University of Miami, University of Florida, Florida State. I mean the whole football -- And it wasn't that long ago. I think that's the most incredible thing. Yeah. The whole football leagues are probably 60 percent African-American now. They offered me an opportunity. I went to some classes when I was in high school, I think 10th or 11th grade, because they wanted some black students to come to University of Miami. But we didn't have a car in our house at the time. The bus ride from our house to University of Miami was like three hours each way ~ and the classes were in the evening after high school classes ended. I tried that for a couple of weeks, but I said I can't; this can't be done. And the other thing is they were actually looking for students to ~ not during my time, but when my brother was coming in - not necessarily bus, but to attend some magnet schools or something like that at the time. They came around to the house- my brother was five years younger than me, so he had to be in junior high school or maybe just starting junior high school. They had tested kids all across the state of Florida, and he's always been really good at tests. Actually, the people from the state came to the house. And they said, you know, your brother tested - I guess they talked to my parents - my mom at the time ~ and said, oh, your son tested so high on the score that they wanted him to go to this special school. They came two or three times. But the school was so far from our house that it was just not feasible to do. And they also wanted him to skip some grades, but my mom said no. He had skipped one or two grades already and he was going to graduate ~ you know, predicted in the future he would graduate high school at like maybe 15 and a half. And she said, no, I don't think it's good for him to go to college at 14. He just wouldn't fit in, that type of thing. It may be hard enough fitting in with the change he's making. Sure. So he went to - they had integrated Jackson High School. I was in college at that time 8 because we're five years' difference in age. So he went to an integrated high school. It was only integrated for a few years because then he had the "white flight." So then the high school quickly turned from integrated to being all black in about two years and that type of thing. What is your brother's name? Michael. Can you tell me the origin of your name? Oh, it's a family name. It's my grandfather's name and my father's name. So you knew early on that you wanted to be a physician. Oh, yes. Was schooling difficult for you? No. I enjoyed it. I was, you know — they call them nerds now. Science nerd. Yeah. That's pretty much what I've been all my life. And you went to Howard University for undergraduate. And where did you go for medical school? Stanford University. Was that difficult to get into? Oh, you mean in terms of ~ Your background, your education? Or were you top of your class? Yeah. I did good. I did good in my class. Then for medical school you had to take a test to see how you did with your sciences and so forth and so on. Obviously, I did okay with that, too, because at that time Stanford was only admitting like 90 students to a class. So I was one of the 90 students. And when did you graduate Stanford? In 1974. Did you think about going into the service at all? Was that ever a consideration? No. That's the time of the Vietnam War. So we were all acting up about that. We didn't want to go into the service. We didn't want to have anything to do with the service. We hated the whole Vietnam War thing and so forth and so on. So no one that I knew thought about going into the 9 service. Maybe one or two guys in the class because what was offered at that time was the government had the capability to draft you out of medical school. It didn't happen often, but they could do it. And they had a plan called The Berry Plan where if you signed up for The Berry Plan they would guarantee you that you wouldn't be drafted out of medical school, but you had to go into the Army Medical Corps for two years. So a couple of guys opted for that. And would you spell Berry Plan? I think it's B-E-R-R-Y. But I said, well, I'll just take my chances. If they want to draft me out of medical school, which would be a really ridiculous thing to do, then they could. No one ever got drafted out of medical school, but they had that capability. So they kind of held that over you and said, okay, if you sign up for two years, we guarantee you that you won't get drafted and you can finish your medical education. So you took your chances and you made it. Sure. Sure. I took my chances, which most people did. So you're in Washington, D.C. You're about to graduate. What did you specialize in? Well, I thought initially I was going to go into psychiatry. But 90 percent of people when they enter medical school do not know what specialty they want to go into. You think you want to do this or you think you want to be a surgeon and you find out that's totally not what you want to do. So I found out very early that I didn't want to be a psychiatrist. I just liked internal medicine because you see a lot of different people and address a lot of problems. It's more like problem solving than anything else. What's the difference between internal medicine and a family practitioner? Family practitioners do a little more in that they can assist in surgery. They see children. They do some OB/GYN. They do more things. Internal medicine, the name is a misnomer because it's hard for you to understand what is meant by internal medicine because what you do is a specialty in treating adults. And you think of pediatrics as a specialty in treating diseases of children. Internal medicine is a specialty in the treatment of adults. But you don't do surgery. You're licensed to do surgery, but you don't do surgery. Where were your parents at the time that you graduated high school? Were they still together in Florida? No. I think you said they ended in '62 or something. 10 Right. But the deal was that in '62 I was 13, 14 and I was actually a junior ~ No. Probably a freshman or sophomore. Well, I had skipped some grades, too. So at 14 I was a junior. So I only had one — no. In '62 I was 14. So now that I think about it and get the dates straight I guess my parents actually divorced before I was in high school. But anyway, the deal was that I wanted to stay with my group and I didn't want to move to a new city and make friends all over. So we came to an agreement, my mother and I, that my brother and I would stay with our grandmother in Miami until we graduated high school. Then she would come out here before we even graduated high school and establish her life. We would finish high school with our grandmother. Then when we got in college, well, it didn't matter because you're going to have a whole new group of friends then. Then when we got in college we established our residency here. So I am confused then. You came out to Miami in '62. So where did you graduate high school? In Miami. So my mother moved here in '62. And so when the newspaper article came out and it said teacher with two sons, you weren't really with her? We were actually with her, but we came just to look for some housing. But we would spend the school time in Miami with the grandmother and then the summers we would live here with our mother. Yeah, that is confusing. You stayed in Miami to finish your schooling. That's right. So your mother was already in Las Vegas when you graduated from Stanford. Yes. Is that what made you come to Las Vegas? Oh, you mean to practice medicine? No. That's another long story. After I finished medical school, then I had to do my internship, which I did at the Jewish Hospital of St. Louis, the Washington University-affiliated hospital. And I never thought I would live in Las Vegas because it was small. It was dusty. It didn't seem to have a lot of opportunities even then because it was — now it was 1970. And I would come home just for visits. But the city started to grow a little bit in 11 the late 70s, 80s. And having grown up here, I knew a lot of doctors here. My family knew doctors and teachers. And I got a call from Dan Wilkes, who was a pathologist here at the time and a member of our church, Christ Episcopal Church, which is right on Maryland Parkway. He told my mother that I should look at Las Vegas for opportunities. And I said, no, I don't want to come to Las Vegas. Dan Wilkes told my mother that I was really being very stubborn — and Dan Wilkes is a very soft-spoken man, very soft-spoken man — and that I was just being pretty dumb if I didn't look at Las Vegas. He was a really good family friend and I said I don't believe Dan Wilkes said that because I never heard him say anything derogatory about anyone and I've known him since I was 15 years old. And she said, oh, no, he said it. I said, well, if he said that I'm coming to look. So I came to Las Vegas and there were a lot of opportunities then because the city had started to grow a little bit more. There was a need for a larger medical community. So I tried St. Louis. I liked St. Louis. The weather was awful. I tried Atlanta. For me it was a little too crowded. I looked at Houston, Texas. I didn't like it. And I looked at Los Angeles, California, where a lot of guys from Howard who were doctors had formed a large clinic. And they said, oh, we'd love to have you come out. I knew them in undergraduate school. They said, oh, it would be great if you came out and did internal medicine because we have this specialty and that specialty. I just didn't like Los Angeles. I just did not like Los Angeles. So I came home basically. Came to Vegas. And what year was that? I'm sorry. 1982, March 1982. And was it easy for you to get settled here? Absolutely. Tell me what you did. I came to Las Vegas. I finished all the tests you had to test for to be a doctor in Las Vegas. At that time it was legal for the hospitals to help you get started. So the hospitals told me what I needed to do. And I came actually to this building. Well, this building hadn't been completed. And this is Sunrise Hospital Diagnostic Center. That's where we are located. That's correct. But they had two buildings across the street, which they still owned or own. And they had little offices set up for you until this building was completed, which I think was late 12 March of '82. That's how I started. I just came over and I've been in this building almost uninterrupted since 1982. Have you been busy? From the first couple of days. How has the population growth of Las Vegas affected your practice from when you first got here to how it is presently? My practice — I don't think it's been affected at all. The only thing in Las Vegas, your patient load used to — it's not doing it as much now — it used to decrease in the summer because so many people would winter here and then they would leave for the summer. Your average patient daily census would go down some, but not so much anymore. And, plus, growing up here and my mom being a schoolteacher here ~ Is she still teaching by the way? No. She's deceased. So I don't know if I have more schoolteachers than anybody in Las Vegas, but I think I do. How healthy are the people in Las Vegas in your opinion? Horribly unhealthy. Tell me why. What are you seeing? Well, I'll give you an example. When I first moved as a physician here - I don't know how they got my name -- but the Pulmonary and Respiratory Center in Denver, Colorado --1 don't know how they got my name; maybe they got it from the hospital; I'm not sure -- they used to refer, oh, two or three patients a month to me from Denver, Colorado, to evaluate when they moved to Las Vegas because they were advising them to move from Denver because