Medical Fight Produces More Shock and Trauma

PETER A. JAY

February 07, 1993|By PETER A. JAY

HAVRE DE GRACE — Havre de Grace. -- Doctors are like skunks, in that when they get into fights the whole neighborhood notices.

Right now, in Maryland, there's a major medical altercation going on concerning the famous Shock Trauma Center, and the docs and their associates have been throwing so much god-knows-what at one another other you can smell the fallout all over the state. It's been pretty ugly, and it isn't over yet.

The most visible disputant is Dr. Kimball I. Maull, who was brought in from Tennessee by the private University of Maryland Medical System to take charge of Shock Trauma. This he did with more energy than tact, leaving Maulled, shocked and traumatized casualties in his wake.

He declared Shock Trauma's reputation over-rated. He fired three well-regarded trauma specialists from the center's staff. In the process of asserting his authority, he tromped on the toes of a lot of the dedicated people who provide emergency medical services out here in the hinterlands. Responses to all this soon followed.

The dismissed physicians started shooting back, fire-and-rescue workers got their dander up, a gubernatorial commission was thrown together, and -- surprise! -- the legislature decided to get into the act. The cumulative impact of all this hoo-ha has been considerable. Whether it will turn out to have been constructive as well remains to be seen.

The Shock Trauma Center is only the most glamorous part of a extraordinary network of professionals, skilled volunteers and high-tech equipment that gives Marylanders with life-threatening injuries a better-than-ever chance for survival and recovery.

Let's say I overturn a tractor on myself while spreading manure on a hillside, and I am lucky enough to have a neighbor see the accident. I can expect that within minutes, paramedics from the Level Volunteer Fire Company will be at my side, and within minutes more -- if I'm badly enough hurt to require it -- I'll be on my way by helicopter to Shock Trauma.

This is incredible care. It's saving the lives of Maryland accident victims right now, even as the feuding docs flex their egos and the politicians take sides. And what's most distressing about the Maull-focused turf battle is that it is pointlessly tarnishing the reputation of a truly magnificent system.

One especially hateful allegation that's been flying around lately is that because the beds at Shock Trauma are so filled with gunshot victims from the Baltimore drug wars, helicopters coming in from highway accidents out beyond the Beltway are being waved off to other hospitals.

The University of Maryland Medical System allows this to happen, I've been told in all earnestness by people who really believe it, in the name of greed. Because the private (but non-profit) UMMS gets reimbursed by the state for caring for the shot-up drug dealers, the theory goes, it has no incentive to keep beds free. And so helicopters carrying battered suburban motorists or careless tractor operators get sent elsewhere. Perhaps those they carry die while the drug-pushers live.

This is an explosive and racially-charged assertion, for it implies a competition for vital health services between poor city residents, mostly black, and more affluent suburbanites, mostly white. But that's not what's happening. The emergency-services people I know, whatever their view of Dr. Maull, report no problem whatsoever in getting patients to Shock Trauma.

Shock Trauma keeps a careful count of helicopter wave-offs, or "fly-bys." There were 197 in fiscal 1990, before the new building ,, at the University of Maryland Medical Center opened, and only eight in fiscal 1991. There were 30 in fiscal 1992. This year there had been 41 as of Nov. 1, but of those, 16 occurred in one hectic 48-hour period in July when the summer highways were especially bloody.

In Baltimore, responsibility for handling trauma cases is divided between four city hospitals. Shock Trauma gets cases from the city's southwest quadrant. There are, not surprisingly, quite a few of them. Most involve gunshot wounds -- "penetrating trauma," rather than the "blunt trauma" that comes in from the highways. For a city hospital to turn away such cases would be unconscionable.

Medically, the system seems to be working fine, though the political uproar goes on. Some of the fuss is ideological, coming from people who can't stand the much-needed cost-consciousness that the privatization of the University of Maryland Medical Center in 1984 has brought about. (The medical staff, all faculty members of the University of Maryland Medical School, remain public employees.) Prickly personalities provide more friction.

Currently, Dr. Maull oversees Shock Trauma through his position as director of the Maryland Institute for Emergency Medical Services Systems, an agency of UMMS. The legislature may well seek to take Shock Trauma away from him by requiring that it be VTC headed by a gubernatorial appointee. Or perhaps UMMS will offer some pre-emptive changes of its own. Basically, however, that's only window-dressing.

The Shock Trauma Center today bears the name of the late Dr. R Adams Cowley, who conceived it. Dr. Cowley, an equal-opportunity battler who fought with everyone, was as prickly as they come. But he was also a leader -- and it's leadership, more than political or administrative tinkering, that's called for now.

Peter Jay's column appears here each week.

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