David Gangeness: At the roots of non-metro clinical pharmacy practice

Dr. David Gangeness recognized as a fellow of the American Society of Health-System Pharmacists in 1991.

Alumnus Dr. David Gangeness remembers the room he was in when he learned about the PharmD program at the University of Minnesota, a “perfect fit” for his pursuit of “knowledge, science and patient care.” When he accepted an invitation to interview for the program, he joined a small group of fellow applicants, some of whom had never been to Minnesota.    

“People from all around the country were there because it was a very prominent PharmD training program— the Weaver Minnesota PharmD program, well known,” Gangeness said. “The program was very challenging in so many ways; it was a bunch of overachievers that were invited to be part of this program. And really it was trend setting— we were leaders in clinical pharmacy.” 

Prior to joining the PharmD program, which he graduated from in 1980, Gangeness earned his bachelor’s degree in pharmacy from the University in 1978. He enjoyed Henderson-Hasselbalch equations, Latin phrases, and “a lot of the basic pharmacy stuff that was old school but part of the program.” He worked 2,500 hours as an intern at the University of Minnesota hospital, compounding intravenous liquids, chemotherapy, and more— “foundational experiences that would allow me to develop clinical programs in the future,” Gangeness said. In an internal medicine rotation at Regions Hospital, then called St. Paul-Ramsey Medical Center, he worked every day for 80 days in a row, rounding with the medical team, drawing serum for drug levels, attending to poison cases and sleeping next to the elevator. The way to advance clinical pharmacy, he noted, is to be present where the doctors are and hear the questions they receive. Gangeness knew after finishing school that he wanted to live in a small town; the problem was clinical pharmacy practice at the time was concentrated in the metropolitan area. 

“Minnesota was an incredible program. Everything I learned was a springboard to serving clinical pharmacy in Rochester, in Duluth, even through very difficult times,” Gangeness said. “All of these cumulative experiences helped me, because when I went to places outside the metro, they didn't have clinical experiences and a lot of them didn't even have up to date distributive systems set up.”

He went on to become the founding clinical pharmacist at Mayo St. Mary’s in Rochester, the largest hospital in Minnesota. While St. Mary’s had a hospital pharmacy residency, a first-class drug distribution system, and five pharmacies within the hospital, it had no clinical pharmacy residency and hired Gangeness to develop one. He created the residency training program, bringing in the surgical, respiratory, and medical pharmacies and medical staff. At the same time, he determined the clinic could be overdosing  its patients on acetaminophen and became one of the first pharmacists to present to a crowd at Mayo’s medical Grand Rounds. Trained for cardiovascular emergencies, unique for a pharmacist then, he responded to codes in the hospital with the medical team. He recalls one code in particular concerning an elderly woman who stopped breathing. The rest of the team couldn’t determine why, but Gangeness correctly determined that the dose of morphine was too large for a person of her size and drew up and administered Narcan. 

“Within a couple minutes, she was wide awake and wondering what was going on. That's what clinical pharmacy is about. Everyone else is thinking medically,” Gangeness said. “You have to be part of the process to make an impact.”

That period led him to work on a book of emergency pharmacology for advanced cardiac life support, which he published in 1984. When Gangeness moved north to work at St. Mary’s Medical Center in Duluth, he faced a blank slate. 

“I came and was kind of like a firefighter— I was highly trained, knew how to put out fires, had protective gear, how to save lives, all that, but when I went to Duluth, there was a limited fire station, no physical equipment, no fire engine…The director was a visionary yet they were given very few resources,” Gangeness said. 

Reminiscent of his college days, Gangeness was on-call and went to work at the hospital nearly every day for four years, he said. When staff pharmacists began showing interest in learning pharmacokinetics, he developed a training program in which they underwent written and verbal tests to understand both the critical knowledge and nuances and how to make decisions about dosing, work with the doctors, nurses, and laboratory technologists to ensure drugs were properly administered and drug levels drawn.  

Dr. James Cloyd, a professor at the college and director of the Center for Orphan Drug Research, met Gangeness as a first-year PharmD student in 1978. Cloyd said Gangeness’s advancements at Mayo St. Mary’s in Rochester “had a major impact in improving drug therapy at that institution” and that he built “an outstanding clinical practice” at St. Mary’s Medical Center in Duluth, adding that Gangeness precepted a number of the college’s BS and PharmD students. 

“David was instrumental in introducing clinical pharmacy to greater Minnesota medical centers,” Cloyd said. “His many contributions to pharmacy practice have left an indelible mark on Minnesota pharmacy.”

Reflecting on his career in pharmacy, Gangeness remarked that his passions have always been driven by a thirst for scientific knowledge. He also more clearly recognizes the “lifelong impact” of teaching, from the perspectives of both mentor and mentee. 

“I'm not the only one to have done new things and gone into areas that were extremely challenging,” he said. “It's incumbent upon those of us who have been there to pass along that knowledge and encouragement, because there will always be challenges.”