The Dismemberment of Shock Trauma


February 28, 1993|By BARRY RASCOVAR | BARRY RASCOVAR,Barry Rascovar is editorial-page director for The Sun.

Maryland's pioneering shock-trauma emergency-medica service could be in the process of self-destructing.

Powerful internal and external forces are tearing Shock Trauma apart. What remains could be a mere shell of the previous powerhouse that once stood as a model for others to emulate in the treatment of severely injured accident victims.

The latest crisis, over the firing of Dr. Kimball I. Maull as shock-trauma director, is just another indication of how complex and frustrating this issue has become. Much of the problem revolves around the giant egos of shock-trauma physicians, many of whom are after fame and fortune and resented Dr. Maull's attempts to impose discipline and centralized management.

There are plenty of other factors at work, too: a long-standing effort by University of Maryland Medical System to gain firm control of the Shock Trauma Center; an effort by other hospitals to divert more shock-trauma patients to their facilities; the stubborn refusal of local fire and rescue squads to take orders from a central command; an effort by three fired physicians and an alumni group of shock-trauma patients to end the center's ties to University Hospital.

Dr. Maull was poorly equipped to deal with these forces. He clearly is a star in the shock-trauma field as a surgeon. But you can't run a highly politicized emergency-medical system that is filled with prima donnas the same way you'd take command of a surgical team.

"His motivations were good," said one individual close to the scene, "but his style and execution were horrendous. His management skills are lacking."

He also arrived in Maryland from Tennessee last year with a distinct handicap: he didn't know the extremely hazardous political and medical terrain. Had Dr. Maull come to Shock Trauma years earlier to serve as the deputy and heir-apparent to Dr. R Adams Cowley -- as Dr. Cowley wanted -- things might have been different.

But matters had already gotten out of hand before Dr. Maull even reached Shock Trauma. In Dr. Cowley's last years, power was seized by EMS warlords who were deeply entrenched and intent on running the show. As soon as Dr. Maull started to make changes, the howls of protest started. They never stopped.

Finally, in August, Gov. William Donald Schaefer demanded that the bickering end. But before then, he undercut Dr. Maull's authority with a public chewing out. This only encouraged his critics.

Then the governor named a commission, with his personal physician in charge, to come up with a solution. Instead of clarifying the situation, it compounded matters. The opposition smelled blood. Everyone, it seemed, was out to undercut Dr. Maull and seize some portion of the EMS system.

That's the way it still stands. Dr. Maull is on the way out. He dared to tell us that the Shock Trauma Center is no longer among the tops in its field. He dared to try to make improvements. Champions of the status quo didn't want to hear it. They won, aided by outside forces anxious to benefit from Shock Trauma's dismemberment.

Now the governor and his commission are pushing a bill to split the shock-trauma system in half with a new, outside board running the field-services segment and University Hospital getting its wish to gain direct control of the operating rooms. Community hospitals almost surely will get more emergency cases shunted their way, allowing them to build up the prestige of their own EMS surgical teams; fire and rescue squads remain stubbornly independent.

The net result could well be a leveling-down of the Shock Trauma Center.

Stripped of its supervision of field services and its research institute, with other hospitals receiving more trauma patients, and folded firmly into University Hospital, the famed center could become just another high-tech emergency room. Recruiting top-flight surgeons might prove impossible, especially after the way Dr. Maull was mugged almost from the day he arrived. Other regional hospitals are sure to try to seize on this situation to promote their own emergency medical centers.

Shock Trauma no longer has the strong political support it needs from the governor, or from top legislative leaders. It is too weak to fend off rival hospitals, ambitious physicians, independent-minded rescue squads.

This has all the trappings of "deja vu all over again." Many of the same forces that tried to thwart Dr. Cowley in his efforts to establish Shock Trauma in the 1960s and 1970s have resurfaced with a vengeance. No one wants to let the Shock Trauma Center be the star of this show any longer. Instead, everyone wants equal billing -- even if it means destroying the unique medical institution Dr. Cowley strove so hard to protect and nurture.

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