Dr. Joan Hodgman, an influential pediatrician at Los Angeles County-USC Medical Center who helped define the field of neonatology and guidelines that improved the standards for newborn care, died Aug. 10 of amyotrophic lateral sclerosis, commonly known as Lou Gehrig's disease. She was 84.
A longtime resident of Arcadia, Hodgman died at a family cabin in Oregon, according to her daughter, Ann Schwartz.
Hodgman spent 60 years at County-USC, including three decades -- from 1957 to 1986 -- as director of its newborn division. She played a central role in developing its intensive care unit for sick and premature babies -- the first in Los Angeles and among the first in the nation -- and led efforts that dramatically reduced the hospital's infant mortality rate.
A prolific researcher and USC professor of pediatrics who wrote or contributed to more than 300 articles and books, she was particularly known for her studies on sudden infant death syndrome. She also was a leading voice in debates over the ethics of saving extremely damaged babies, often raising painful questions about when heroic measures should be abandoned.
"The name Joan Hodgman is recognized by every neonatologist throughout the world," said Dr. Lawrence Opas, County-USC's chief of pediatrics and director of graduate medical education at USC's Keck School of Medicine. "She was one of the great sages."
Hodgman was born Sept. 7, 1923, in Portland, Ore., and grew up in San Marino.
The daughter of an Army Corps engineer, she was raised to believe that "being a woman shouldn't stand in her way," said her cousin, Irene Hartzell. She entered Stanford University at 16 and earned a bachelor's degree in 1943 before pursuing her medical education at UC San Francisco, where she was one of the few women in her class.
She moved to Los Angeles in 1948 and completed her pediatric residency at County-USC in 1950. After two years of private practice, she returned to County-USC as head physician for pediatrics in 1952 and became director of its newborn division in 1957.
She quickly recognized the need for a specialized setting to care for the sickest babies. Around 1961, more than a decade before neonatology became a recognized subspecialty, she organized a newborn intensive care unit and began developing protocols for diagnosing its tiny patients.
Early in her career she saw "that we didn't know everything about these babies," said Dr. Bernard Portnoy, a pediatrician and longtime colleague. "She built up, with her students and colleagues, a group of symptoms and signs that alerted us to what we could do in terms of keeping these little babies alive."
Within 10 years, her efforts resulted in a 50% decrease in the infant mortality rate, which affected thousands of babies. By the late 1970s, County-USC was delivering nearly 20,000 babies a year, with as many as 50 newborns in the intensive care unit at a time, Opas said.
Hodgman was known for her teaching as well as for her clinical excellence. "My image of her is doing this detailed examination and making me repeat the examination until I got it right -- and I'm not a neonatologist," said Opas, who met Hodgman as an intern more than 30 years ago. "She definitely left a mark on my career and countless other pediatric residents over the 60 years she was at County hospital."
As medical advancements enabled doctors to save more severely debilitated newborns, Hodgman began to consider the ethics of saving them. The urgency of the issue became clear to her one day in 1979 when she walked in on a medical team pounding on the chest of a 3-day-old who had already been subjected to several heart resuscitation attempts. "Seeing all those people pounding on that poor baby gave me a violent physiological reaction," Hodgman recalled in a 1985 Times interview. "I said, 'Stop! What in the world are you doing?' " The doctors looked at her and then at the baby before walking away.
The incident opened a discussion of whether all that can be done medically should be done when an infant's vital functions are so compromised.
"She was very much interested in making that a debatable question," said Toke Hoppenbrouwers, a longtime colleague and research collaborator at County-USC. "That in itself was not too easy because we had a hospital where a lot of people would under no circumstances give up the fight. But she was willing to question it and do the research to support the need to face these questions."
An athletic woman who enjoyed physical challenges -- she taught Portnoy how to body surf and water skied well into her 70s -- Hodgman was known for frequently challenging accepted wisdom.
"I feel that we should try not to give care that is futile," she said. "I don't see futile care in terms of dollars and cents -- which in one sense it is -- but as an issue of compassion that is centered on appropriate care."
In 1999, Hodgman received the Apgar Award from the American Academy of Pediatrics, the highest honor in neonatology. Named after Virginia Apgar, the inventor of the Apgar Score for evaluating babies in the first moments after birth, the award is given annually to a person whose career has had a continuing influence on the well-being of newborn infants.
A widow at 47 who never remarried, Hodgman was diagnosed with Lou Gehrig's disease last year but continued to work until she retired in February.
In addition to Schwartz, Hodgman is survived by another daughter, Susan Di Pietro; a brother, Donald; and four grandchildren.
Memorial donations may be sent to the Joan E. Hodgman Endowed Scholarship Fund at the USC Keck School of Medicine, c/o Michael Mayne, 1975 Zonal Ave., KAM 300, Los Angeles 90089.