Hopkins hospital chief to quit in fall Block's position would be downgraded in reorganization

August 03, 1996|By David Folkenflik and Jonathan Bor | David Folkenflik and Jonathan Bor,SUN STAFF

Dr. James A. Block, president of the Johns Hopkins Hospital, says he intends to step down by fall -- his job diminished by a major reorganization of the East Baltimore medical complex.

Block says his likely departure is the natural consequence of a restructuring that essentially places the hospital under the Johns Hopkins University. Because the move puts the university's School of Medicine and the hospital beneath a single official, it significantly reduces his authority.

Hospital trustee chairman George Bunting said the medical "czar" is expected to be named by early fall and will likely hold dual titles: dean of the medical school and chief executive officer of the hospital and health system. This person will report only to the president of the university and a new committee made up of a select group of hospital and university trustees.

"I made it clear from the beginning that I did not consider myself a candidate," said Block, whose current title is president and CEO of the hospital and health system. In an interview, Block said that he was not forced out and that he retained the trust of many of the chairmen of the medical school departments.

"In my particular case, I have the managerial and business experience but not the academic experience" to become the senior medical official, Block said earlier this week. "It made sense for me to seriously consider looking at other options." Block's five-year contract does not expire until May, but he said he expects to leave Hopkins considerably earlier.

Block, 55, is a commanding and patrician leader who served as an early adviser to the Clinton White House. He significantly improved the hospital's finances and helped make it more competitive in the new era of managed care.

Hospitals across the nation are facing sharp reductions in revenue from government programs and insurers, sending administrators scurrying to cut costs and increase the volume of patients.

But some Hopkins officials and physicians say that several senior trustees encouraged Block's departure to placate riled medical professors who believed that academic values were under assault from Block's market-minded reforms.

Many trustees and officials play down the importance of internal conflicts at Hopkins.

"If you looked at a drop of water under a microscope, you'd never drink it -- you'd see all the microbes crawling around," Hopkins trustee A. B. Krongard said. "It's the same at Hopkins. When you step back, you see the greatest medical institutions in the world."

Needed restructuring

In creating the new administrative structure, trustees made it impossible for Block to continue without accepting a significant demotion. It is not clear whether the change was, as Block's critics maintain, a device to force him out, or was simply the result of a much-needed administrative restructuring.

"There has been no public announcement, while at the same time there is a private recognition that the deed is done," a senior university official, who declined to be identified, said in describing the conditions under which Block felt compelled to leave.

"The handwriting was on the wall as soon as the board of trustees decided that the new dean would be head of the hospital," said Dr. Neil Miller, a professor of ophthalmology, neurology and neurosurgery.

The issue remains touchy. Said H. Furlong Baldwin, the former hospital trustee chairman who hired Block and is his strongest backer, "I don't have anything to talk to you about."

William R. Brody, the university's president-designate, will take office Sept. 1, and several other senior medical positions will not be filled until after his arrival.

Block was brought to Baltimore in 1992 in large measure to assure the solvency of the hospital as the financial realities of the health care market began to change dramatically.

As long as there was enough money, Hopkins doctors said, administrators could carry out the conflicting missions of running a hospital profitably, educating future generations of physicians and conducting cutting-edge research.

Medical mission upheld

Tensions have flared into the open in recent years, even as the Hopkins hospital continues to run at a significant profit. By announcing that they would place the hospital under the university president and a medical chancellor, Hopkins trustees are attempting to show that the medical research mission would not be compromised.

"If you look at Hopkins' real strength, it's got an awfully good hospital, but what's unique about Hopkins is the academic aspect," said Dr. Lenox D. Baker Jr., a university trustee. Hopkins conducts more than $250 million in federally funded projects, more than any other medical school in the country.

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