'Conspiracy' at Mary land Shock Trauma

November 20, 1992

ARITICLES and editorials in The Sun and The Evening Sun suggest my recent demotion by Dr. Kimball Maull as chief of neurotrauma at the Maryland Shock Trauma Center was related to findings of poor survival rates at Shock Trauma. I write to refute these suggestions.

Dr. Maull has stated publicly that I have been demoted because he does not share my "philosophy" regarding the management of trauma patients. He was made aware of changes at the center before his arrival and again shortly after his arrival. (I preceded Dr. Maull here by nine months.) He expressed unqualified support. He also approved of the fact that I eliminated research projects on patients that had not received institutional approval, and that I would not sanction the use of experimental surgical techniques without appropriately approved clinical protocols. Finally, he is fully aware of the fact that the data on which the debate on survival rates focuses was collected prior to my arrival and thus cannot be attributed to my stewardship. Yet, by his unconscionable silence regarding my demotion, he has left the contrary impression.

Dr. Maull has acted in breach of my contract, a contract for which I left a stable, tenured professorship to commit myself to serving the people of Maryland. He has done this for one reason: My removal permitted him to turn the position, and the neurotrauma programs and assets of Shock Trauma, over to Dr. Anthony Imbembo, chairman of the Department of Surgery, University of Maryland School of Medicine, to be used to recruit a chairman of the Division of Neurosurgery at the medical school. In exchange, Dr. Imbembo joined with Dr. Maull to create the program whereby all trauma patients who enter the University of Maryland Medical System will be taken care of at Shock Trauma, regardless of the severity of injury. This is contrary to the system created by Dr. R Adams Cowley, in which only the most serious and critically ill patients were to be taken to Shock Trauma, a system I have admired for years.

Marylanders should be concerned by this conspiracy to merge Shock Trauma with the School of Medicine, because of the vastly different commitments required of the two institutions. Shock Trauma, by its mandate, is committed primarily to the immediate care of seriously injured people. That commitment should not be diluted by the requirement to care for the less seriously injured. While it has other missions of education and research, its foremost priority is care of the seriously injured.

The primary commitment of the University of Maryland School of Medicine is to academia, to teaching and research. There exists no exclusive dedication to receiving and promptly treating serious and sometimes critically injured patients. This operating principle in no way impugns the commitment of individual clinical faculty to the patients they serve. But if a medical school faculty member wishes to advance professionally, he or she must produce academically. There's little credit in promotion and tenure considerations for the number of patients cared for or the number of dollars that flow to the university because of that care.

Dr. Maull's conclusions regarding survival rates were arrived at through flawed methodology, aptly characterized as comparing apples and oranges. Unfortunately, the press has not provided a critical analysis of the facts. Dr. Maull was cautioned by the analysts against drawing the very conclusions he drew. Dr. Maull acknowledged in a recent medical staff meeting which I attended that the data collection system used at Shock Trauma was incompatible with that used in the systems to which Shock Trauma was compared.

Dr. Maull, as a physician and a scientist, knows the lack of validity his revelations had. He has brought disrepute to Shock Trauma and its dedicated staff. He is reported to have said that he would destroy Shock Trauma if necessary to bring change. He has frightened the public. He has done this with a callous and irresponsible calculation to consolidate his power base, and for no other reason.

The care of patients at Shock Trauma is constantly monitored by the quality assurance and risk management programs at the University of Maryland Medical Systems (UMMS). If the care has been poor, and if these programs failed to detect it, Dr. Morton Rappaport, as head of UMMS, is ultimately responsible.

Clark Watts, M.D.

Baltimore

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