The Child Neurology Society presents the 2017 Arnold P. Gold Foundation Humanism in Medicine Award to David L Coulter, M.D. While Dr. Coulter has made wide ranging contributions to child neurology in the areas of neurometabolic disease, epilepsy, disability education, and ethics, he is best known for his dedication to and advocacy for children with intellectual and developmental disabilities. The CNS recognizes his career long commitment to the field of Neurodevelopmental Disabilities (NDD) and his dedication to the humanistic care of children with NDD and their families. In Dr. Coulter’s very first published article (JAMA, 1980), he pleaded for a humanistic approach to children with NDD. That dedication continues to define his career.
Dr. Coulter’s 11th grade biology teacher, Mrs. Lillian Olson, sparked his interest in biology and the brain. He received his Bachelor of Science in Biology degree from the University of Notre Dame in 1969, then received his M.D. degree from the Yale School of Medicine in 1973. A clinical rotation in neurology with Dr. Gilbert Glaser at Yale convinced him that clinical neurology would be his career choice. A later elective with Dr. Peter Huttenlocher ignited his interest in child neurology.
During his pediatric residency at Duke University (1973-1975), a clinical child neurologist, Dr. Jim Renuart, instilled in him the importance of developing a personal relationship with every patient regardless of disability. Dr. Russell DeJong offered him
a residency position at the University of Michigan and taught him how to become a neurologist. During this time, Dr. Coulter started and ran several free clinics for indigent children with neurological problems and also started a neurology clinic at the University’s
Student Health Service. Dr. Richard Allen, one of the founding members of the CNS and the division chief in Ann Arbor, became Dr. Coulter’s most influential mentor. They worked closely together every day for six years. Most of Dr. Coulter’s early publications were co-authored with Dr. Allen, including the first descriptions of benign neonatal sleep myoclonus and valproate-associated hyperammonemia. One of Dr. Coulter’s greatest personal honors many years later was presenting Dr. Allen with the Guthrie Award for lifetime achievement in neurometabolic disease on behalf of the American Association on Intellectual and Developmental Disabilities.
Both Dr. DeJong and Dr. Allen helped him move to a position at the University of Texas Medical Branch in Galveston, where he soon achieved both promotion and tenure. His career took off after that, defined throughout by the three fellowships completed along the way, including one in Cerebral Palsy at the University of Michigan (1978), Bioethics at Harvard Medical School (1997-1998) and the Schwartz Center’s Clinical Pastoral Education Fellowship at Massachusetts General Hospital (2012).
Dr. Coulter dedicated his career to the care of children with intellectual and developmental disabilities. He joined the American Association on Intellectual and Developmental Disabilities (AAIDD) in 1982 and would later become AAIDD President (2004-2005). He co-authored the 1992, 2002 and 2010 editions of the AAIDD manuals on the definition and classification of intellectual disability. He helped the U.S. Surgeon General create the 2002 report on health care for people with intellectual disability. Dr. Coulter provided free care for poor, disadvantaged and disabled children throughout his time in Texas (1981-1986) and subsequently at Boston City Hospital (1986-2000) where he was the Chief of Child Neurology. He moved to Boston Children’s Hospital and Harvard Medical School in 2001, where he continues to serve as senior staff neurologist and associate professor of neurology. Dr. Coulter served for 26 years as the neurologist for the Perkins School for the Blind and continues to serve as the neurologist for the New England Center for Children, a residential school for autism, both located in Massachusetts.
Dr. Coulter gave an invited lecture at the annual meeting of the Epilepsy Foundation of America in 1989 on “When Epilepsy is Not the Only Disability.” He later edited a special issue on epilepsy in persons with intellectual disability for the AAIDD journal and published an article in Epilepsia (1997) on the comprehensive management of epilepsy in persons with intellectual disability. Dr. Coulter co-edited the Journal of Religion, Disability and Health from 1999-2010. He argued for the “spiritual valorization” of people with disabilities in his eloquent and influential AAIDD Presidential Address (reprinted in Mental Retardation 2006). Dr. Coulter argued that the Golden Rule applies to all persons and that people with disabilities have the same spiritual value as those who are nondisabled. Dr. Coulter cited Wolf Wolfensberger, “one of the greatest names in the field of intellectual disability”, affirming that caring for patients with disabilities includes three messages: “(a) you are valuable, (b) you are as valuable as any other person, and (c) you are loved by those around you.”
When NDD became a recognized subspecialty, Dr. Coulter co-founded the NDD training program at Boston Children’s Hospital, now run by Dr. David Urion. Dr. Coulter won the coveted resident “Teacher of the Year” award twice (2005 and 2016). Both times he was recognized for his modeling of humanistic care of children with neurological disorders. He describes these awards as the greatest professional honors of his career.
In addition to being a prolific advocate for children with disabilities, Dr. Coulter is also an experienced ethicist and long-time member of the IRB and Ethics Committees.
He wrote the chapter on “Ethical Issues in Child Neurology” for the last three editions of Swaiman’s Pediatric Neurology. Dr. Coulter cites ethical issues as one of the greatest challenges facing young physicians today, because they will have to deal with the technological advances that are outpacing our ethical ability to evaluate them.
Humanism defines Dr. Coulter’s entire life from the time he was a child to the present day. He wrote, “Humanists try to share with others who they are as individual human beings and to walk with them as partners on a common life journey.” Furthermore, “Humanism is about having relationships with patients, children with disabilities, families, students, residents, colleagues, neighbors and everyone else.” He adds that these relationships “enlivened and sustained me throughout the years.” When he was an intern, Dr. Renuart showed him how to translate that passion for humanism into a lifelong medical career.
When asked many years later what he would do if he could not be a doctor, Dr. Coulter said he would become a hospital chaplain. As a clinical child neurologist at Boston Children’s Hospital, Dr. Coulter continues to use his chaplaincy training to help him try to be a more compassionate and caring physician.
Dr. Coulter expresses his humanism best in his poetry. He has been writing poems since he was 10 years old. Although most of his poems were initially hidden away in notebooks, he recently published the book: Disability, Doctoring and Patient Care: Poems from a Life in Medicine (2017). The book reflects how Dr. Coulter has used poetry to reflect on his life choices and his career. The poems also capture the bravery he has witnessed in his patients and his gratitude for all that they have shared with him.
In receiving this award, Dr. Coulter thanks first, and above all, his wife of 35 years, Dr. Mary Cerreto, a clinical child psychologist, expert in developmental disabilities. He also thanks his late father and mother, his siblings and a fourth grade schoolteacher who instilled in him the values that would last a lifetime.
Dr. Coulter cites ethical issues as one of the greatest challenges facing young physicians today, because they will have to deal with the technological advances that are outpacing our ethical ability to evaluate them.