Although they often act like sibling rivals these days, Johns Hopkins' two major medical leaders, Dr. James A. Block and Dr. Michael E. Johns, started off as best buddies.
Three years ago, Dr. Johns, the powerful dean of the Hopkins School of Medicine, urged Hopkins trustees to consider Dr. Block for the highly prestigious job of president and chief executive of the Johns Hopkins Hospital and Health System.
And when Dr. Block was named to the post, he went out of his way to acknowledge his new friend.
"The opportunity to work with the quality of people here, and with
Michael Johns in particular, was very difficult to turn down," said Dr. Block, who was leaving the presidency of University Hospitals of Cleveland.
Now these men are clashing in a battle that goes beyond personalities to the heart, soul and future of Hopkins.
Dr. Block is laboring to put the hospital and Hopkins' health system on a more secure financial footing. Dr. Johns is fighting to protect one of the nation's most important medical research institutions at a time when it feels most beleaguered.
And neither man, sources said, is convinced the other has the right vision for Hopkins.
Today, trustees of the board of the hospital and trustees of the board of the Johns Hopkins University are holding special meetings in an effort to end the conflict. Trustees are weighing a range of possible organizational reforms which may significantly alter the way in which Maryland's largest hospital is run.
"What we decide in the next 24 or 30 months may determine the fate of Hopkins," said Donald A. Henderson. He was dean of the Hopkins School of Public Health from 1977 to 1990, is concerned about Hopkins' future and is closely following developments there. "You'd damn well better have a team and not warring factions."
Although none of the trustees would comment publicly on what they are planning, they emphasized privately the need to have cooperative leadership between Drs. Block and Johns. Despite requests, neither Dr. Block nor Dr. Johns would comment for this article.
Whether the trustees agree on a major reorganization -- giving one leader clear authority over the hospital, health system and medical school, as Dr. Henderson and some other medical administrators have advocated for the past decade -- or settle for less ambitious steps remains to be seen. But the trustees' aim is to improve an institutional and personal relationship that is critical not only to the well-being of Hopkins but the city itself.
All agree that the hospital and university-based medical school must work together smoothly if Hopkins is to remain one of the finest academic medical centers.
"These two sides have to understand each other. Their fates are really intertwined," said Dr. David J. Ramsay, president of the University of Maryland at Baltimore, referring to medical schools and hospitals at all academic centers. "If the hospital fails, the medical school goes down. And vice versa. They can't survive without one another."
Yet some conflict is inevitable, medical administrators said.
"Almost all of a hospital's revenue comes from clinical activities, and its ability to generate clinical activities depends on its success in the marketplace," said Robert A. Chrencik, senior vice president of finance and systems at the University of Maryland Medical Center. Medical schools, which receive a lot of funds from tuition, grants and government contracts, "are not market-driven" in the same way, he said.
Insider vs. outsider
But the conflicts at Hopkins exceed the usual organizational tensions. Hopkins officials and others who are familiar with the problems point to these additional factors: differences in the backgrounds and ambitions of Drs. Block and Johns, marketplace pressures on hospitals and Dr. Block's ill-fated lawsuit against the Prudential Insurance Co. of America -- which made him many enemies within Hopkins.
"Johns came from inside the organization. He's got Hopkins blood from head to toe -- he's got the religion," one source said. Dr. Block, by contrast, is the outsider at Hopkins. "The first thing he did was trash the existing management. He took the culture and said, 'I'm not impressed,' " that source said.
This blunt appraisal, from someone who is not an ally of either man, aptly describes the different perceptions within Hopkins of its two medical leaders.
Dr. Johns, 53, epitomizes the academic side of medicine. A specialist in the treatment of neck and head tumors who has published more than 150 papers, journal chapters and books, he came to Hopkins 11 years ago from the University of Virginia. He was soon named associate dean and then, in 1990, dean -- one of the most distinguished jobs in U.S. medicine, giving him authority over 1,000 faculty physicians.