10 Fascinating Facts About 'St. Elsewhere'

While shows like ER and Grey’s Anatomy may get the lion’s share of accolades when it comes to hospital dramas, those shows walked a path laid out by St. Elsewhere (1982-1988). The NBC medical series followed the staff of St. Eligius, a run-down teaching hospital in Boston whose staff struggles with personal and professional crises.

The show gave some crucial early breaks to future big names like Denzel Washington, Mark Harmon, Bruce Greenwood, and David Morse, and also allowed for Howie Mandel to be (occasionally) serious. For more on this landmark drama, scrub up and keep reading.

1. St. Elsewhere terrified its cast before the pilot was even finished.

St. Elsewhere, which was co-created by Joshua Brand and John Falsey (who would later co-create Northern Exposure), was originally pitched to NBC as “Hill Street Blues in a hospital.” That show, about a police precinct, had been a critically-acclaimed hit for NBC beginning in 1981. But shooting the pilot proved to be difficult: Venerable character actor Norman Lloyd, who would quickly become co-anchor of the show as wise Dr. Daniel Auschlander, tried speaking with an Austrian accent; Josef Sommer played Auschlander’s friend, Dr. Donald Westphall; and David Paymer played resident Dr. Wayne Fiscus.

After reviewing footage, producer Bruce Paltrow—the late father of actress Gwyneth Paltrow—didn’t like what he saw and re-cast the Westphall and Fiscus roles, hiring Ed Flanders and Howie Mandel, respectively. The shake-ups wound up frightening the remaining cast members, who worried they might be getting fired, too. None were, although the show did wind up having quite the mortality rate for its characters. (The changes nonetheless proved beneficial: NBC picked up the series.)

2. David Morse’s character was named after a dog.

As Dr. Jack Morrison, David Morse got the lion’s share of the show’s most tumultuous plot lines. He was widowed, assaulted, nearly bounced out of residency, victimized by a home invasion, and still managed to be one of the hospital’s bigger optimists. His nickname, “Boomer,” apparently came from an NBC series called Here’s Boomer, which featured a title character who happened to be a dog. Producers evidently felt Morrison’s need to please was canine-like, and it became something of an in-joke.

3. Howie Mandel thought St. Elsewhere was a sitcom.

Mandel was a successful stand-up when he went in to audition for St. Elsewhere. Because it was produced by Mary Tyler Moore (MTM) Enterprises, Mandel just assumed it was a sitcom set in a hospital. “It went badly, I thought,” Mandel told Entertainment Weekly in 2012. “I also thought: ‘Their new comedy? Not that funny at all!’”

4. St. Elsewhere had to carry a disclaimer for some episodes.

When St. Eligius was taken over by a massive health care company dubbed Ecumena, real health care giant Humana filed a lawsuit claiming trademark infringement. A judge ruled the show should carry a disclaimer, which appeared at the end of episodes: “Ecumena is a fictional company that does not represent any actual company or corporation."

5. Ed Flanders’s butt was a concern.

Just before departing the show as a series regular in 1987, Ed Flanders’s Donald Westphall decides to tell Ecumena penny pincher Ronny Cox just what he thinks of the direction the hospital is going: He pulls down his pants and suggests Cox “can kiss my ass, pal.” The scene, one of the few times naked buttocks had been glimpsed on television, was the subject of much discussion at NBC, which ultimately opted to allow it. It required 20 takes for Flanders to get the scene just right.

6. William Daniels had a second successful show on the air the same time as St. Elsewhere.

Daniels, who played cantankerous-but-brilliant surgeon Dr. Mark Craig, won an Emmy for St. Elsewhere. But it wasn’t the only primetime NBC series Daniels appeared in. He was also the voice of K.I.T.T., David Hasselhoff’s artificially-intelligent car, in Knight Rider.

While it was possible for Daniels to go unrecognized as the talking car, St. Elsewhere afforded him no such anonymity. “I don't know why the character got that popular,” he told The Orlando Sentinel in 1988. “He yells at everybody and they love it. Now, I even do that on the street. Personally I'm slightly withdrawn and rather shy, so I found the best way to deal with this high visibility was to just play the character. People come up and I say, ‘What do you want? You want an autograph? Oh, all right, give it here.’ They just start giggling. They love it.”

7. St. Elsewhere killed off a character in order to be medically accurate.

St. Elsewhere had a lot of name actors but only one secret weapon: Florence Halop, who played the perpetually-afflicted patient Mrs. Hufnagel. Tearing into doctors and residents with a sharp tongue, Mrs. Hufnagel was originally scheduled for just one appearance. Halop's performance, however, convinced producers to bring her back 22 more times. Eventually, though, the show's medical advisor suggested that Hufnagel had to go. It was unrealistic that the character would keep coming down with various maladies without expiring. Poor Mrs. H was crushed in a folding hospital bed.

8. St. Elsewhere had one of the most peculiar endings to any television show in history.

If you want to experience St. Elsewhere as a first-time viewer, you should back away now. If not: When the series concluded in spring 1988, audiences discovered (SPOILER!) that St. Eligius and its inhabitants were really figments of Tommy Westphall’s (Chad Allen) imagination. Tommy, the son of Donald Westphall, was on the autism spectrum, and seemed to conjure up the hospital’s dramas within a snow globe in his possession. Because St. Elsewhere crossed over with shows like Cheers and Homicide: Life on the Street, it’s been argued that a good portion of television is all inside Tommy’s head—a fiction within a fiction.

9. St. Elsewhere viewers almost got a much different ending.

Although the ending that actually aired proved to be one of the most controversial conclusions to any television series in history, that wasn’t always the idea. Producers Tom Fontana and John Masius originally thought of an ending that would flash-forward in time and see Dr. Auschlander in the year 2013, where he’s alive at the ripe age of 101. St. Eligius is part of a hospital conglomerate, and satirical mentions of a slightly dystopian future abound. Paltrow dismissed the idea.

While it seems like a stretch, the notion turned out to be prescient: Actor Norman Lloyd, who played Auschlander, didn’t pass away until 2021; he was 106.

10. St. Elsewhere squeezed in one last joke.

At the end of each episode of St. Elsewhere, the MTM Enterprises mascot—a cat named Mimsie—appears in scrubs, a running joke for MTM shows that was a satirical take-off of the MGM lion. (On Hill Street Blues, Mimsie wore a police officer's cap.) For the series finale, poor Mimsie appears to be on life support before flatlining.