Only hours after a judge ruled that three Maryland Shock Trauma Center doctors could go back to work for at least a week, the man who fired them said he was justified because they tried to block his plans to improve the state's emergency medical care.
Appearing cool at the end of a week of controversy, Dr. Kimball I. Maull yesterday characterized the three doctors as people living in the past who resisted his efforts to bring Shock Trauma into closer cooperation with the University of Maryland Medical System.
"These individuals opposed my efforts to begin to work collaboratively with other elements of our system," Dr. Maull said at an afternoon news conference. "That is why I took the actions that I did."
Dr. Maull, who took the helm of Maryland's trauma system in February, on Tuesday gave the three doctors 72 hours to get out.
His remarks yesterday came after Baltimore Circuit Judge Richard T. Rombro granted the doctors a temporary injunction that keeps them at their jobs at least until next Friday. Then, the judge will hold a hearing on the doctors' claims that the firings violated their contracts. University lawyers say the contracts don't exist.
The judge did not rule on the validity of those claims, saying only that the contractual dispute was complicated and that neither Dr. Maull nor the citizens of Maryland would suffer if the doctors kept working through next week.
Judge Rombro's ruling came as a huge relief to the doctors, who said they were warned that the locks on their office doors would be changed by 5 o'clock yesterday.
The physicians are Howard Belzberg, a clinical care specialist; C. Michael Dunham, a surgeon, and Ameen Ramzy, another surgeon who directed the statewide emergency medical system for many years until stepping down in May.
"I'm very relieved that I can go back to work today," Dr. Belzberg said after the ruling, his words interrupted by the beeping of his hospital pager. "I'm glad to see there is some protection from political pressures for people who have to do clinical jobs."
Dr. Maull did not hide his disappointment with the court action.
"The workplace is not a good place for disgruntled staff," he said. "I'm not pleased with the ruling, but in the finality, I think we will prevail."
Dr. Maull went on to discuss what he feels are the changes that must be made at the Maryland Institute for Emergency Medical Services Systems, which includes the 138-bed Shock Trauma Center and the statewide network of trauma centers and rescue personnel.
He said that in an era of dwindling resources and soaring health care costs, it was important to move Shock Trauma into closer collaboration with the adjacent University of Maryland Medical Center.
One important goal was to end duplication with University, whose own emergency room has handled a steady stream of gunshot victims and other trauma patients from West Baltimore.
On July 1, he said, Shock Trauma began receiving all trauma patients who, in the past, would have gone to University.
These patients have been added to the center's historic patient load -- people flown in from all regions of the state with life-threatening injuries, mostly from auto accidents.
Dr. Maull blasted critics who said the merger would overload Shock Trauma, forcing helicopters to take seriously injured patients elsewhere. The consolidation, he said, meant "two or three" additional patients a day.
He said the decision to consolidate wasn't his alone: The state required it for efficiency's sake, when it granted Shock Trauma approval in 1984 to build a tower so it could get out of its cramped quarters inside University hospital.
The new building was opened in 1989, but Dr. Maull said key staff members resisted the mandate.
Cooperation, he said, means sacrificing some of the autonomy that Shock Trauma has enjoyed within the university medical system since its establishment 30 years ago by the late Dr. R Adams Cowley.
The three physicians, Dr. Maull said, wanted to hold onto the center's time-honored autonomy -- a posture he characterized as "independence for independence's sake." Dr. Maull said he did not contemplate any further firings.
Dr. Maull said admitting knife and gunshot victims to Shock Trauma means that some physicians there will not only work longer hours, they'll make less money.
Inner city trauma victims, Dr. Maull pointed out, usually don't have insurance.
But, he said, "it makes little difference if someone is shot with a gun or is run over by a car," he said. ". . . We're the trauma program. Patients ought to be coming here."