CHARLESTON, W.Va. - Dr. James Felsen got his start as a physician making house calls on horseback at the bottom of the Grand Canyon.

He treated elderly American Indians as a doctor with the Indian Health Service in Arizona in the late 1960s. At the time, he realized the tremendous potential of community public health programs. He was making a difference.

So he abandoned plans to become an orthopedic surgeon or emergency medicine doctor, and dedicated his life to public health.

"I decided this was going to be too much fun," Felsen recalled. "I couldn't miss this."

Over the past 40 years, Felsen has watched huge advancements in medical science and technology, but his high hopes for an American health care system of excellence never materialized.

"As Larry the Cable Guy says, 'We just didn't get 'er done,' " Felsen said last week.

Felsen, executive director of the Kanawha-Charleston Health Department from 2000 to 2003, has now written a new book that chronicles his long-time service in public health and offers a prescription to fix much of what's ailing the nation's health care system.

In "De-spamming Health: Reforming the Health System from the Bottom Up," Felsen writes that America's health care crisis - high costs, waste, duplication of services - won't be solved in Washington, D.C., or under the domes of state capitols.

It's up to people in local communities to band together, to identify the most pressing health issues, to develop initiatives to tackle the problems, according to Felsen.

"My whole motivation for writing the books is I think Americans are so overwhelmed and frustrated by the complexity of the health system," he said last week at his house in Sissonville.

"Costs are out of hand, businesses are closing, and people are slipping through the cracks unable to navigate the system," Felsen added. "If we're going to solve this, it's going to come from local communities."

The first step: Bring patients, payers (insurance companies, government health insurance programs), practitioners (hospitals, doctors, nurses, other health professionals, and the public (business and civic leaders) together to examine "priority problems and the causes of those problems in the population."

In Kanawha County, for instance, Felsen suggested targeting violence (including sexual and spousal abuse), obesity, drug and alcohol abuse, mental illness, and ineffective and futile patient care.

Each year, Felsen believes, local health boards should release a report about the health problems that plague the community, and what the agency is doing about them.

CHARLESTON, W.Va. - Dr. James Felsen got his start as a physician making house calls on horseback at the bottom of the Grand Canyon.

He treated elderly American Indians as a doctor with the Indian Health Service in Arizona in the late 1960s. At the time, he realized the tremendous potential of community public health programs. He was making a difference.

So he abandoned plans to become an orthopedic surgeon or emergency medicine doctor, and dedicated his life to public health.

"I decided this was going to be too much fun," Felsen recalled. "I couldn't miss this."

Over the past 40 years, Felsen has watched huge advancements in medical science and technology, but his high hopes for an American health care system of excellence never materialized.

"As Larry the Cable Guy says, 'We just didn't get 'er done,' " Felsen said last week.

Felsen, executive director of the Kanawha-Charleston Health Department from 2000 to 2003, has now written a new book that chronicles his long-time service in public health and offers a prescription to fix much of what's ailing the nation's health care system.

In "De-spamming Health: Reforming the Health System from the Bottom Up," Felsen writes that America's health care crisis - high costs, waste, duplication of services - won't be solved in Washington, D.C., or under the domes of state capitols.

It's up to people in local communities to band together, to identify the most pressing health issues, to develop initiatives to tackle the problems, according to Felsen.

"My whole motivation for writing the books is I think Americans are so overwhelmed and frustrated by the complexity of the health system," he said last week at his house in Sissonville.

"Costs are out of hand, businesses are closing, and people are slipping through the cracks unable to navigate the system," Felsen added. "If we're going to solve this, it's going to come from local communities."

The first step: Bring patients, payers (insurance companies, government health insurance programs), practitioners (hospitals, doctors, nurses, other health professionals, and the public (business and civic leaders) together to examine "priority problems and the causes of those problems in the population."

In Kanawha County, for instance, Felsen suggested targeting violence (including sexual and spousal abuse), obesity, drug and alcohol abuse, mental illness, and ineffective and futile patient care.

Each year, Felsen believes, local health boards should release a report about the health problems that plague the community, and what the agency is doing about them.

"There's no one that looks at what's changing, what's making people sick, where is the patient care system breaking down, how much are we spending?" said Felsen, who grew up in upstate New York and accompanied his father - also a doctor - on house calls. "Reform will come only when each community regains control and drives the agenda."

Though much of the book details Felsen's work with the Indian Health Service and U.S. Public Health Service, Felsen also mentions his experience as Kanawha County's health chief.

Felsen said the health board spent too much time on the "few services" the department provides and little time addressing major health issues in the area.

He quotes one former board member as saying, "All I have ever done for years is come to these meetings to approve pay raises."

Felsen writes that he would receive numerous phone calls and e-mails from Kanawha County Commission President Kent Carper, asking him to look into significant health issues, such as the collapse of the former Shawnee Hills behavioral health agency.

"[Carper] had a reputation for being an arrogant, abrasive and contentious fellow who wanted everything his way, and was a bit of a gadfly," Felsen writes. "I was actually pleased when he asked me to look into those issues. At least somebody representative of the public was asking us to study community health issues."

The health board abruptly fired Felsen in 2003 amid plans to crack down on smoking in Kanawha County restaurants. Felsen and some board members disagreed sharply over the proposed regulations.

Felsen said he previously sparred with the board when he tried to pass along information about major health issues in the community.

"They didn't have a clue what I was talking about," Felsen said. "I wanted to assess problems in the community and set priorities. That's what health boards should do. They were mainly interested in a few little things."

Felsen said the Kanawha Coalition of Health Care Improvement is an organization that holds promise for improving the local health system, but the group's "scope and resources" are limited.

He doesn't endorse universal health care coverage, except in the case of catastrophic injury. He worries that universal health care might create huge administrative costs for low-dollar services. Local health care systems already can't serve all patients, he said.

"It makes little sense to hasten their meltdown by increasing demand through expanded insurance coverage before reforming these systems," Felsen said.

Felsen hopes the "general public and those involved in social activism" will read his book - available for purchase at Amazon.com and www.localhealthcarereform.com. Former U.S. Surgeon General C. Everett Koop wrote the foreword. Felsen worked under Koop in Washington.

"This stuff is my passion," Felsen said. "We have to start in each community and do what we can ourselves."

Reach Eric Eyre at erice...@wvgazette.com or 348-4869.