The Surgical Educator’s Recognition
The specific mention of the director emeritus of the American College of Surgeons calling Blount’s device “a most ingenious apparatus” is worth examining as an instance of recognition from a high-status American medical institution.
The American College of Surgeons (ACS) is one of the most prestigious surgical organizations in the United States, founded in 1913. Its director emeritus in the late 1940s or early 1950s would have been a significant figure in American medicine — someone whose opinion on medical devices and innovations carried substantial weight.
The fact that this recognition did not translate into adoption by the VA is a specific illustration of the gap between individual recognition and institutional action. The director emeritus’s endorsement was positive. It was not nothing. But it was also not the VA’s institutional decision-making process.
Medical device adoption in the VA required a different kind of institutional engagement than an individual expert’s praise. It required the procurement process, the budget approval, the institutional commitment to integration. An endorsement from a prestigious individual did not guarantee or substitute for these processes.
This is the specific failure mechanism that allowed the VA to say no to a device that the director emeritus of one of the most prestigious surgical organizations in the country called “a most ingenious apparatus.”
The institutional adoption process is not responsive to individual endorsements in the way that a commercial market is responsive to consumer enthusiasm. The VA was not going to adopt a device simply because an expert praised it. It required navigating institutional channels that were, for Blount, navigated against the specific headwinds of her race and gender.