The firing of three prominent doctors at the Maryland Shock Trauma Center Tuesday appears to be the most dramatic shot in a long-festering dispute over who will run the renowned hospital and what type of patients it will serve.
Tensions between staff and administration, although building for
several years, boiled anew July 1 when top officials of the University of Maryland Medical System ordered that the affiliated center begin accepting patients with mid-level and even minor injuries.
"It can include minor gunshot wounds, minor bumps and bruises, even a bump on the head," said a Shock Trauma employee who asked to remain anonymous.
Since its birth a quarter century
ago, Shock Trauma had been reserved for the most critical trauma patients while those with less seri
ous injuries went next door to the emergency room of the University of Maryland Medical Center.
Since the change went into effect, University's emergency room has concentrated solely on patients with non-traumatic emergencies.
Yesterday, Lt. Gov. Melvin A. Steinberg said he was "outraged" over the firings and what appears to be an effort to dilute the mission of Shock Trauma, the 138-bed hospital
in downtown Baltimore. He blasted Dr. Kimball I. Maull, who took over five months ago as head of the Maryland Institute for Emergency Medical Services Systems, the broad network that includes Shock Trauma, satellite trauma centers across the state and the ambulance and helicopter personnel who transport patients.
"This is really a national and international model," said Mr. Steinberg. "I don't want to see it completely destroyed. I'm shocked and amazed at the actions of Dr. Maull. . . . He's done irreparable harm to this system that cannot be recaptured."
Tuesday, Dr. Maull gave three doctors -- surgeons Ameen Ramzy and C. Michael Dunham and critical-care specialist Howard Belzberg -- 72 hours to leave. The three were among a cadre of doctors who have opposed efforts by the university's leadership ZTC to direct policy and dilute the autonomy that Shock Trauma had enjoyed since its founding.
"I was abruptly terminated," Dr. Belzberg said yesterday. "I was given 72 hours notice after 10 years of service to get out of the building. Two weeks earlier, I had specifically asked Dr. Maull if there was any problem with my clinical, moral or ethical performance and he said, 'No.' " Dr. Belzberg said he and his two colleagues had retained an attorney, and had not decided whether to take legal action.
Yesterday, Dr. Maull released a brief written statement: "Time is at hand for the infusion of new ideas and expertise at the Shock Trauma Center. Recent staff terminations reflect changes necessary to allow this to happen."
In an interview last week, top university officials including Dr. Morton Rapoport, the medical system's chief executive officer, said it was cheaper and more efficient to run a single trauma center and an emergency room dedicated to other medical problems.
But one longtime Shock Trauma employee said that shifting patients with non-critical injuries means more money for the medical system. The reason, according to the source, is that the system can charge patients about 18 percent more for room and board if they are treated at Shock Trauma rather than at University.
In contrast, UMMS officials last week said that Shock Trauma often bills its patients less. The average daily bill for a Shock Trauma patient was $966 last year, compared with daily charges at University that ranged as high as $1,115 but as low as $509, they said.
Last Friday, Gov. William Donald Schaefer announced the creation of a commission to oversee the emergency medical system and investigate reported tensions within it. Mr. Steinberg said he thought there was an understanding between the governor and trauma officials to delay all personnel changes at Shock Trauma to give the commission time to make recommendations.
Four days later, Dr. Maull fired the three doctors.
"I thought there was a gentleman's agreement -- let's sit tight on everything," Mr. Steinberg said. "What is happening here is just an abuse of power."
The same day he fired the doctors, Dr. Maull assembled nurses, social workers and other Shock Trauma personnel to explain some of the changes under way. Sources at the meeting said Dr. Maull declared that the request for a personnel moratorium was unacceptable because he works for the state Board of Regents, not the governor.