By Jennifer Vogel
Editor's note: This is another story in a series called "Profiles in Health" — a look at how health care leaders experience the American health care system as consumers and patients. The series is part of the Healthy States project, American Public Media's focus on information, insight and experiences in health.
Al Vogt breezes along the nature-themed hallways of Cook Hospital, the facility he has run for 25 years. He shows off remodeled examination rooms, a lively senior care wing, and the hospital's new emergency department. "People come to northern Minnesota to find out how to jump into a boat and get fish hooks stuck in their fingers," he says. "And to clunk their heads on everything."
Located in a city of 600 people in what most consider the wilderness, an hour and a half north of Duluth, Vogt has spent his career making the case that this 14-bed hospital must continue to exist. Besides employing 135 people, the hospital serves a 2,500-square-mile area of pine and rock with an older- and poorer-than-average population.
Driving long distances to larger cities for medical care isn't an option for many, he says. "Some people don't have cars. Or they can't afford the gas. For a number of individuals up here, Social Security is their only income."
For Vogt, who started at the hospital nearly 40 years ago as lab supervisor, the rural health care mission is personal. Not only were two of his kids born here, but now that the 65-year-old is retiring at the end of January, he expects to return as a patient himself, both as he faces the normal vagaries of aging and as he continues to treat the multiple myeloma cancer he was diagnosed with five years ago.
Vogt has championed technological innovation, by running a well-equipped lab and by installing electronic medical records. He also has implemented telemedicine, which allows him, and other patients, to see specialists at larger hospitals via the Internet. Vogt's oncologist is in Duluth. "We can talk by video," he says. "I can do all my labs or imaging or testing up here in Cook and transmit all that stuff to him." Of his staff, he says, "These are people I trust. These are people I know. I'll come to Cook every time."
Stepping away from his life's work won't be easy, despite jokes about housecoats and bunny slippers. He is thoroughly embedded in Cook. And though he's boisterous and displays a handy sense of humor, he grows serious, even solemn when talking about the responsibility that comes with small town relationships. "You get to know the little old white-haired ladies that make the lutefisk on Thanksgiving and carry it to you doddering," he says. "They become all your friends. I'm taking care of friends. I'm taking care of people that I love. And I don't want to ever let them down." One of Vogt's friends, a woman who once did marketing for the hospital, suffered a stroke and then was stricken by Alzheimer's disease. She lives in the hospital's nursing home and though she recognizes no one, Vogt visits her each morning and reminds her of the things she used to enjoy, like dancing. "Alzheimer's is such a deadly horrible thing," he says. "But at the same time, (the hospital staff) wanted her in Cook so that we could take care of her. Because we know that we could do better than anybody else. And that is the kind of love that creates the personality of our organization."
Raised in Glencoe by a mother who was a nurse and a father who was a road grader operator and farmhand, Vogt served in the Marine Corps during the Vietnam War, specializing in radio and cryptology. He was a forestry student at the University of Minnesota when he met his wife, Beryl, who is originally from Cloquet. Vogt says the word 'Beryl' "actually is a jewel in the breastplate of the Jewish high priest. Beryl is a gem. And she is that."
It was Vogt's mother-in-law who found the lab supervisor job at Cook Hospital--Vogt had trained in the field--and urged the couple north in 1976.
In Cook, Vogt learned to do things like cut the logs he burned for heat, a practical necessity. "This was not just like this is a romantic thing; here is a fireplace, I've got my bearskin rug and I look great kind of a thing," he says. He also, with a couple of friends, built the house on 20 wooded acres he shares with his wife.
Describing himself as more "Marlboro Pillsbury Doughboy" than "Marlboro Man"--a crack about his physique--Vogt remarks on how self-reliant one must be in the wilderness, "without the convenience of a thousand different outlets or stores or fix-it places. When things need to be fixed, you learn how to fix them. You learn how to live."
Cook Hospital opened in 1959, founded by a local doctor who raised the funds, Vogt says, by setting up a makeshift toll booth on Highway 53, which runs through town, and going to local bars to collect money from anyone he'd delivered as a baby. Demonstrating the kind of community support that continues to keep the hospital afloat, additional funds came from citizen boxing matches and variety shows.
The drive to maintain that community spirit has propelled Vogt's career. He moved quickly up the hospital ranks, becoming assistant administrator in 1986 and CEO in 1989. He earned his health administration degree from Metropolitan State University in 1990.
Vogt forged relationships with other northern Minnesota hospitals, reasoning that by working together, they would all do better. He helped found Sisu, a medical technology collaborative based in Duluth, as well as two formal hospital coalitions. The most recent, Wilderness Health Inc., is expressly designed to help independent hospitals thrive. Last year, he was named a "rural health hero" by the Minnesota Department of Health, which described him as an "entrepreneur and a collaborator extraordinaire."
Vogt has been a big voice in the conversation around how best to provide rural health care, especially as small hospitals join growing health systems. He is known as direct and passionate. "I learned in the Marine Corps to make a decision, stand by it, and be accountable," Vogt says.
"Al has demonstrated the value of relationships," says Mary Klimp, administrator at Mayo Clinic Health System in New Prague. "It's not always what you can get, often it's what you can give. People recognize that in Al. He is a small man, but he fills a room rather quickly with his humor."
Klimp remembers her early days as CEO of the hospital in International Falls, about 70 miles from Cook. "He was the first one to reach out to me," she says. "I learned so much from him. He deflects praise to make you feel like you are doing something for him, and that is not the truth. We started out as colleagues and I forget we are colleagues. We are very good friends. We have laughed together and cried together and shared the highs and lows of our families."
"He leaves a tremendous legacy that will be hard to replicate," she says of his impending retirement. "He's incredibly innovative. Somebody else might say, 'Cook has 600 people, why do they need a hospital?' They not only have a hospital, but they have a thriving hospital. He is a tireless advocate."
Vogt is retiring because he wants to spend time with his family, but also because he fears he no longer has the stamina needed to keep Cook successful amid radical changes in health care. "I love challenges," he says. "But the complexity is requiring incredible amounts of energy that sometimes I don't have because of my cancer. Even more importantly, it's going to take people engaged from the very ground floor to do the innovative and creative thinking to try to put the right kinds of systems in place so that we can continue to be an independent hospital, a very strong independent hospital."
Cook's assistant administrator, Teresa Debevec, will take over as CEO. She has been championed and mentored by Vogt, who calls her "one smart cookie, I tell you." Standing next to the desk in her office, she says, "We are very fortunate here to have an administrator like Al. He is dedicated. He gets into everything and understands your role. We have developed a true friendship. We are going to miss him a lot. It's going to be different here without him."
"I'm very proud," Vogt says, walking toward the hospital's front desk. "I'm very pleased. I'm most proud of my staff."
Asked what he wants people to know about him as he departs his job, he says, "I care. I will do the best I can no matter what it takes. Sometimes I make the right decisions and sometimes I make the wrong decisions. But what you see is what you get."