Shock Trauma Aftershocks: A Fight for Control

March 14, 1993|By JONATHAN BOR

On a chilly day two weeks ago, the halls of the Maryland Shock Trauma Center were humming with news that the brief reign of Dr. Kimball I. Maull was about to end in what amounted to a coup from above.

He had offended many of the center's doctors as he tried, in a style notably lacking in finesse, to topple the fiefdoms and end the turf battles that had characterized the center for years.

Now, it appeared he had offended his bosses, too, and the result was that he was about to become a former director, relegated, as he later put it, to pondering a new future while hanging towel racks at home.

With a bittersweet grin, a doctor dressed in baby-blue scrubs said he and his colleagues had gotten exactly what they wanted -- Dr. Maull's ouster -- and now they were really in trouble. He noted that the staff was losing its chief protec- tion against what it feared most: attempts by governor, legislators and officials of the University of Maryland Medical System to carve up Shock Trauma and the emergency medical network.

The worst possibility, in the doctor's view, was that the University of Maryland Medical System would win full control over the Shock Trauma Center. Always a part of the medical system, Shock Trauma had been run like an autonomous state. This gave it an air of separateness, a sense that the staff was engaged in a heroic mission that only its members could appreciate and preserve.

And a sense that Shock Trauma was clearly superior to the university hospital next door.

"Sure they want this place," he said. "It's the diamond of the system. The concern is that they're trying to build an empire and they want to steal it from the citizens of Maryland. Just imagine what would happen if we were taken over by them.

"We would become just like them."

In the aftermath of Dr. Maull's forced resignation, attention has turned to the General Assembly, where legislators are considering two bills that would dramatically alter the complex relationships linking Shock Trauma, the university medical system, the university itself, other hospitals, a glitzy Medevac fleet, Gov. Wil- Jonathan Bor covers medicine for The Baltimore Sun.

liam Donald Schaefer and the citizens of Maryland.

At stake is the care given to thousands of sick and injured Marylanders across the state, including almost 3,000 who are taken by ambulance and helicopter to the Shock Trauma Center itself.

Often, it seems each party in the debate claims the others are con- cerned solely with power and money, while it alone cares about patients. And one doesn't have to take sides to notice the intense and often vicious rivalries.

"I've been involved in church politics, union politics and electoral politics, but academic politics is by far the worst I've ever seen in my life," said Del. Lawrence A. LaMotte, sponsor of a bill about the Shock Trauma system, who once served as assistant to the chancellor at the University of Maryland Baltimore County.

"The egos are the most vicious on all sides. It's the nature of the beast."

The organizational chart is so Byzantine that officials with the state medical society got it all wrong when they testified last fall before a gubernatorial commission that was considering Shock Trauma's future. So it's not surprising that any attempt at restructuring will prove equally confusing.

"It's like putting your hand into a mess of wire and trying to follow the blue one," said Dr. James D'Orta, a personal friend of Gov. William Donald Schaefer who led the commission.

An emergency physician at Franklin Square Hospital, Dr. D'Orta popped up in news stories over the years as a doctor who frequently joined disaster relief teams, such as the ones that aided earthquake victims in Armenia and Mexico City. Suddenly, his evolving friendship with the governor placed him in a far different type of mess.

The current system puts an entity known as the Maryland Institute for Emergency Medical Services Systems (MIEMSS) at the center of emergency medicine in Maryland. Its director controls Shock Trauma, a research center and the statewide network of rescue personnel, ambulances and helicopters that whisk patients from accident scenes to emergency rooms across the state.

The system was carved out two decades ago by Dr. R Adams Cowley, the charis-matic Shock Trauma founder who thought it made sense to place the premier trauma hospital at the hub of the emergency medical network. Under him, MIEMSS became what one observer called "the Taj Mahal of emergency medicine."

But critics said the scheme gave Shock Trauma the power to determine where injured patients were taken. And this, they felt, meant he could ensure that the highest-paying patients (suburban accident victims) went there, while lower-paying patients (inner-city gunshot victims) went to other hospitals.

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