O&P’s Family Tree

Hard work, flexibility, and love for family are the keys to success. In the late 1800s and early 1900s, when some O&P businesses first opened their doors, traveling salesmen, mail order, and hand-written patient charts were the norm. Today, computers and practice-management software guide the industry, and the Internet, to a large degree, has replaced the traveling salesman. Aluminum and plastic parts were unheard of until roughly five years after World War II ended, when both materials began to be incorporated into devices, bringing a sea change to O&P device design and development. In the beginning, patients paid their own bills. With the emergence of employer-sponsored health insurance plans in the 1930s and 1940s, and the creation of Medicare in the mid 1960s, that also has changed. Yet for all these changes, the pull of the O&P profession can be hard to resist-particularly among family members. For those O&P families whose commitment to the profession spans several generations, their longevity can be characterized by hard work and the ability to adapt to change. The O&P EDGE talked with several O&P family businesses that are at least three generations in the making and asked them how they have weathered changes and kept the passion for the profession alive across multiple generations. [caption id="" align="alignnone" width="200"] Otto K. Becker in 1929 coming to the United States.[/caption] [caption id="" align="alignnone" width="200"] Otto K. Becker. Photographs courtesy of Becker Orthopedic.[/caption] Becker Orthopedic Setting the Stage for Central Fab Otto K. Becker, a mechanical engineer educated in Essen, Germany, founded Becker Orthopedic in 1933 in Huntington, West Virginia. Otto had initially worked for a man named William Jahnig in Huntington who owned an orthopedic patient care business. After Otto became proficient in O&P, he started his own patient care business, according to his grandson, C. Rudy (Rudy) Becker IV, vice president of sales and marketing at Becker Orthopedic, Troy, Michigan. In the beginning, Otto had a difficult time getting the O&P field to embrace his components and concept of central fabrication because it was common for practitioners to fabricate their own components and/or orthoses, according to Rudy. Back then, he says, if orthotists needed orthotic components, they could import them, but that took time and expense and most practitioners just made their own. "It was my grandfather's choice to start manufacturing his own line of orthotic components because he was trained as an engineer. He didn't do it out of necessity but rather because he loved engineering new products," he says. "My grandfather attended trade shows in the early years to establish the brand for the company. He worked hard to get people to stop building orthoses and component parts on their own and use his component parts and concept of central fabrication instead." Becker Orthopedic was one of the first companies to exhibit at the American Orthotic & Prosthetic Association (AOPA) National Assembly and the American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting, Rudy says. [caption id="" align="alignnone" width="150"] C. Rudy Becker IV[/caption] Becker Orthopedic began with a single location and two employees. All of Otto's children and grandchildren worked for the company "at one time or another," says Rudy, who, along with his brother and sister are the third generation. Today, the company employs 174 people. It has become primarily a manufacturing company, but it still remains close to its roots with five patient care offices in the greater Metro Detroit area. Becker's other divisions include Becker Oregon, Becker Orthopedic of Canada, Becker Orthopedic UK, and Becker Metal Works. According to Rudy, the biggest changes to clinical care since the family business began have been the acceptance of central fabrication, component parts, and the introduction of prefabricated products to the field-changes that would surely have made Otto proud. Bristol Orthotics & Prosthetics One Family Business Gives Rise to Another... [caption id="" align="aligncenter" width="350"] Becker Orthopedic in 1945, Detroit, Michigan.[/caption] Jerry Graybeal started Bristol Orthotics & Prosthetics, Tennessee, in 1980 as an extension of the growing family business, Kingsport Brace and Limb, Tennessee, according to his son, Will Graybeal, BBA, CP. The business originated as part of the Fillauer Companies Inc., Chattanooga, Tennessee. Carlton Fillauer had hired Will's grandfather, Bob, or "Papaw" as he was known to Will, to work in the Fillauer patient care facility in northeastern Tennessee in the 1960s. Papaw and Carlton were longtime friends, Will says. [caption id="" align="alignnone" width="250"] Photograph of Will Graybeal courtesy of Bristol Orthotics & Prosthetics.[/caption] In 1975, Papaw started Kingsport Brace and Limb with support from the Fillauer family and the local physicians who knew him, Will says. Will's grandmother, Rozella, was also a big help when Papaw started the original business. Rozella recently retired and sold Kingsport Brace and Limb to Jerry, Will says. As a child, Will remembers working with his father and Papaw. In 1994, when Will was 16, Pawpaw died. Although Graybeal says he "went to boarding school after Papaw died and wanted to be a vet or get into the music industry," his decision to continue in the family business was easy. One night in 1995, a year after Papaw died, Will had a dream he was working with Pawpaw seeing patients. "I grew up working in the shop, but I didn't want to do it for a living until I had the dream," he says. "The next day I called my dad and said when I get home this summer, I want a job. He sent me a bunch of O&P magazines to study." That summer, Will's father sent him to work at the Kingsport office, where the teenager thought he would begin working with patients. That didn't happen. "I got to pour plaster, bust out molds, laminate, and sweep up," he remembers. "The guys in the shop treated me like one of the guys, even though I had grown up there and was the boss' son." Will is now the president and CEO of Bristol Orthotics & Prosthetics, and today the Graybeal family has about 30 employees scattered between five locations in northeast Tennessee and southwest Virginia. Three generations later, Will says he is convinced that the way his grandfather did business is reflected in his own. "I have a few limb patients who started out with Papaw, then went to my dad, and now to me. To this day, I feel like [Papaw's] teachings and his ways with people are with me." Drew Hittenberger & Associates From Horses to Humans [caption id="" align="alignnone" width="350"] Before World War II, most orthopedic appliances were made of wood, metal, and leather. Photographs courtesy of Drew Hittenberger & Associates.[/caption] Before World War II, orthoses and prostheses were handmade, and the profession comprised small limb and brace shops. As a result, production was slow and costly. But the Hittenberger family didn't look at what it did for a living as "a business." As Herman Hittenberger once said, "We saw it as a way to help people. We didn't see it as a money-making thing." Drew Hittenberger & Associates, Orthotic & Prosthetic Services, Petaluma, California, dates back four generations when Drew's great grandfather, Carl Hittenberger, pioneered an orthopedic appliance company 110 years ago in San Francisco, California. His company, C. H. Hittenberger & Company was one of the first of its kind on the West Coast. Originally trained as a saddle maker in Germany, Carl realized that with the invention of the automobile, big changes were about to happen. As remembered by his grandson, Herman Hittenberger, "He switched from horses to humans because they weren't much different." Carl's son, Carl "C.H." Hittenberger, went into the family profession and began working for his father at an early age. At 17, he moved to the East Coast, where he worked for several years to learn more about the trade. He returned to California and bought the family business from his father. C.H. is probably best known for the "Flightwood Limb," a design that was considered the "lightest leg of its time" in the early 1920s. World War II changed how orthoses and prostheses were made. Before the war, most orthopedic appliances were made of wood, metal, and leather. When the war ended, "plastics came in and changed everything," Herman once said. "Then we started using fiberglass, and hardly anyone knew what [that] was." C.H. and his wife Marie had two children, Martha and Herman. Both joined the family business. Like his father, Herman apprenticed in the shop, learning the skills of metal forging, grinding, and shaping as well as wood and leatherworking. In the 1970s, Herman's children Drew and Tina joined the company. By 1978, the company employed more than 100 people, was operating a central fabrication facility, and had 15 offices throughout Northern California. In 1980, Drew, CP, BOCO, left the family business and moved to Seattle to conduct research on amputation surgery at the Prosthetic Research Study (PRS), Kingston, Washington, and the University of Washington, Seattle. In 1987, he returned to private practice. In 1988, his father asked him to return to the family business to develop marketing programs and design a new central fabrication facility. The following year, Drew left the family business once again and started his own practice in Petaluma, Drew Hittenberger & Associates. In 1990, Herman and Martha sold the family business to NovaCare, headquartered in Mechanicsburg, Pennsylvania. Leimkuehler Inc. Passing Along a Passion for Patient Care [caption id="" align="alignnone" width="200"] Paul Leimkuehler with parallel bars in 1954. Photographs courtesy of Leimkuehler Inc.[/caption] Paul E. Leimkuehler lost his left leg above the knee during World War II fighting in the Battle of the Bulge. While recovering at McGuire General Hospital, Richmond, Virginia, he ventured into the lab and helped fabricate his own prosthesis. In 1948, after being discharged from the Army, Leimkuehler bought a prosthetic company in downtown Cleveland, Ohio. Thirteen years later, he purchased the property at 4625 Detroit Avenue in Cleveland and built the facility that still serves the company's patients today. One of the biggest challenges Paul faced early on was bringing a greater sense of professionalism to his O&P business, according to his son, Bob Leimkuehler, CPO, LPO. The last thing his father wanted to be was "an ambulance chaser," Bob says, so Paul started to develop professional relationships with orthopedic physicians in the area, educating them about orthotics and prosthetics. When Paul started his business, they carved wood sockets with pulling tools and carved feet from wood blocks. Over the years, the company has adapted to technological advancements in components, materials, and fabrication, but "it still comes down to taking care of our patients on an individual and personal basis," Bob says. "When dad started the business, he did what was best for each patient." [caption id="" align="alignnone" width="300"] Leimkuehlers[/caption] It wasn't much of a question for Bob whether he wanted to continue in his father's footsteps. "I worked for my dad early in my life and decided that I wanted to continue helping others, so I went to prosthetic and orthotic school and became a CPO," says Bob, who has been in the profession for 37 years. When his father started his business, he had four employees. Currently Leimkuehler Inc. has 20 employees and three locations. Bob' sons, Jim and Greg, also work in the family business. Jim is a business manager. Greg is a certified orthotist and is finishing his prosthetic residency. Paul's guiding philosophy has not been lost on his son and grandsons. "With current regulations, credentialing, accreditation, coding changes, and day-to-day business decisions, it is easy to get overwhelmed," Greg says. "The care of the patient is what we do as healthcare providers. Listening to our patients and working as a team is how we change lives in our profession." Snell's Orthotics & Prosthetics Three Centuries of Combined O&P Expertise [caption id="" align="alignnone" width="200"] Pop Snell and his wife Alta. Photographs courtesy of Snell's Orthotics & Prosthetics.[/caption] R.W. "Pop" Snell recognized a business opportunity when he saw one. Pop started in the O&P field in Memphis, Tennessee, in 1911, when he was offered the artificial limb, orthopedic bracing, and truss part of the surgical supply business where he worked at the time. "He saw it as a business venture," says W. Clint Snell, CPO, president of Snell's Limbs and Braces, Shreveport, Louisiana, and Pop's grandson. "Pop was an entrepreneur and salesman at heart." The family business has faced its share of challenges over the course of its century in business, says Clint, whose O&P career spans more than 42 years. Initially, there were the challenges associated with managing the growth of a storefront business to hiring a sales force and developing the technical skills to take the manufacturing process in-house, Snell says. World War II brought a number of changes to the O&P industry, he says: new materials; a more scientific approach to socket design; the introduction of gait principles into device design; and the use of hydraulics to control prosthetic knees' motion, to name a few. Formal education was required to keep pace with these rapid changes, Clint says. In the 1950s, the polio epidemic increased the demand for orthotic care so much that the Snells adopted a multi-shift work schedule, maintained a specialized workforce, and developed labor-saving tools and techniques in an effort to keep up. [caption id="" align="alignnone" width="580"] Price list shows transfemoral and transtibial repairs, as well as other miscellaneous repairs.[/caption] The Snell family business traces its sales evolution from the traveling salesmen in the 1950s, to mail order, to the Internet. Fabrication has gone from hand forged-"not unlike the skills used by blacksmiths," Clint says-to mass production during the 1940s, to computer-aided design and manufacturing today. Hand charting and hand billing have been replaced by computers and practice-management software designed to help provide more complete documentation and comprehensive care while encouraging compliance with today's various regulations and legal requirements. [caption id="" align="alignnone" width="350"] Snell family at the American Orthotic & Prosthetic Association (AOPA) National Assembly in 2011.[/caption] "Prior to computerized record keeping, manual charts and business records were the only paperwork available to track a patient's care, which was spotty at best," Clint says. "I worked part time during high school, and I really enjoyed working with my hands and helping people. Seeing them come into the office requiring assistance and leaving under their own power was something I wanted to be able to do." Clint's son, Chris, now works with his father in their Louisiana office. The most important thing that Clint has passed along to his son is caring for the customers' needs. "That is the absolute most important thing," Chris says. From the Snell's company beginnings in Louisiana, more than 100 employees are spread among facilities in Mississippi, Tennessee, and Arkansas. Along with Clint, current owners include Ted Snell, CP, Pop's great-grandson, and Frank Snell, CPO, FAAOP, Pop's great nephew. Facilities include CFI P&O, Memphis, Tennessee; Snell's Orthotics & Prosthetics, headquartered in Shreveport, Louisiana; and Snell Prosthetic & Orthotic Laboratory, headquartered in Little Rock, Arkansas. As of 2011, the staff had more than 1,100 years of collective knowledge and experience, according to Clint. Winkley Orthotics and Prosthetics [caption id="" align="alignnone" width="140"] Greg Gruman[/caption] Necessity Spurs Invention Winkley Orthotics and Prosthetics was founded in 1888 by Albert Winkley after three unsuccessful attempts at starting an artificial limb business. Albert, who had gone into the livery business in Faribuilt, Minnesota, was an amputee himself as a result of a farming accident. He was unhappy with the limbs he had purchased in Chicago, Illinois, which was the closest place that fabricated prostheses at the time, so he developed the idea of wrapping his residual limb in leather and then stepping into the leather socket of his prosthesis. This eventually became the Winkley "slip socket" and was well received because it helped reduce friction and chaffing inside the socket. With this innovation, a new company was born; Winkley Company became the first prosthetic company west of the Mississippi, says Greg Gruman, CP, president and CEO. The company started with a dozen employees and one office. Today, it employs 48 individuals with more than 120 years of collective experience among eight offices, says Greg, whose great-grandfather, Lowell Jepson, purchased horses from Winkley. Jepson went to work as the business manager and promoter in 1888 so Winkley could spend time with patients and work with his hands. After several years, Winkley returned to the livery business and sold his interest to Jepson, who had no sons, but one of his sons-in-law came into the business after World War I. [caption id="" align="alignnone" width="350"] The Winkley Limb Co. in Minneapolis, circa late 1800s. Photographs courtesy of Winkley Orthotics and Prosthetics.[/caption] "That was my grandfather Gruman," Greg says. The biggest challenges then-as they are today-are sales and marketing related, he says. How do you announce a start-up? Promote a new product or service? "Before the turn of the [20th] century, we used walking sandwich boards and paid barkers who would meet every train coming in to Minneapolis and try to spot people on crutches," Greg says. The company used newspaper clipping services and newspaper ads to market their company. They mailed letters to potential clients and then sent them a catalog. If possible, the company would have a salesperson visit a client in person. "We also hired many salesmen who worked around their hometowns as well as on the road," he says. "They were trained how to take casts and measurements at the clients' homes and then mail everything back to the 'home office' for the manufacturing process." Eventually it became necessary to start branch offices in those cities, Greg says. In the 1920s, the company had more than a dozen offices throughout the Midwest, Florida, New York, Connecticut, and Canada, he says. By the mid 1970s, these offices were sold to the managers or closed when business fell off, he says. Greg says the biggest change for Winkley over the years has been the amount of labor involved in the fabrication of each device. "Most everything used to take hours, if not days, to build," he says. "The parts were simpler, and the difficulty was the skill necessary to fit and assemble everything into a nice-looking package." [caption id="" align="alignnone" width="350"] Making modifications at Winkley's, circa late 1800s, early 1900s.[/caption] Now there is much less labor involved, but the parts are more complex. "We still spend about the same amount of time with the patients, but doing different things," he says. "Today we spend more time explaining options and costs. We do more gait training and follow-up appointments. In the old days, we simply mailed out the finished product, and the client did the best he could with it." Greg says he was a "reluctant participant" initially in the family business, but that changed after one year. "I am the fourth generation," he says. "My son and daughter are well on their way to being certified and soon to be fifth-generation owners." Greg believes that because they are involved in the same profession, he got to know his father better. He feels more connected to his aunts, uncles, grandparents, and great grandparents as well. "We have a shared experience in the family business," he says. "We have all had to react to and master contemporary problems and build the business for the next generation. There is shared sacrifice, commonality of purpose, and pride in the end that is similar for each generation." Betta Ferrendelli can be reached at linkEmail('betta','opedge.com'); Editor's note: The number of O&P families that span three or more generations are too numerous to cover comprehensively in the pages of our magazine. If you'd like to share your family's story, send an e-mail to linkEmail('editor','opedge.com, and'); we may be able to add your family's story to our extended online coverage.

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