Maull Gets Mauled

February 27, 1993

Dr. Kimball I. Maull's stormy but brief reign as director of Maryland's prestigious shock-trauma system is coming to an end. His critics are cheering. So are hospitals and other groups opposed to the dominant position in Maryland of Dr. Maull's trauma care network. They helped engineer his downfall. But in the process of unseating Dr. Maull, these opponents may have irreparably harmed the Maryland Shock Trauma Center.

Once, Maryland's emergency medical system was the best in the country, perhaps best in the world. Under founder R Adams Cowley, the book on treating critically injured accident patients was re-written. But many other trauma-care centers have long since passed Maryland's in serving as a model for others. Dr. Maull, a highly respected trauma surgeon but an abrasive administrator, was brought in to turn things around.

Instead, he became a victim of the highly politicized Shock Trauma culture here in Maryland. Dr. Cowley had been replaced by numerous medical chieftains who zealously guarded their little enclaves. When Dr. Maull tried to rein them in and address obvious management and administrative weaknesses, he got chewed up. When he tried to address clear shortcomings in medical procedures, especially among fire and rescue squads, he got hammered. When he tried to bring in his own outside team, the incumbents tomahawked him.

Picking up the pieces once Dr. Maull departs won't be easy. Dr. Cowley's shock-trauma network is being dismantled. The governor wants to dissect the network, turning the research and field operations over to a new state board and the clinical activities over to University Hospital. But that may not solve the problem.

Just a month ago, the Department of Fiscal Services released a report on emergency medical services. It strongly warned the legislature against splitting apart the shock-trauma system because this would risk "losing the preeminent status that Maryland enjoyed for so many years and could regain." The link between the field operations and the Shock Trauma Center are vital, the report said, in providing "the underlying strength of the system and foundation for growth."

Rather than dismembering a world-famous institution, the report urges the legislature to "act cautiously before making major changes to a system that has worked so well for the state." The best approach, it said, would be to create a "strong oversight committee with policy-making authority," much like the Maryland Higher Education Commission. The new oversight board would have the power to develop a statewide plan, fill gaps in the system and make needed improvements.

So far, little attention has been given to this sensible suggestion. Instead, the dissection of Shock Trauma continues. Dr. Maull's departure may not make much difference.

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