In an unusual move, the Harbor Hospital Center has dismissed the director of its medical department in a dispute that pits the more than 200-member medical staff against the hospital administration.
The director insists, through an attorney, that the dismissal was without reason or due process.
The dispute, which has been heating up for several months, apparently involves a philosophical difference in how a hospital should be run and a personality clash between Dr. Victor R. Hrehorovich, 51, who headed the hospital's department of medicine for 15 years, and L. Barney Johnson, the chief executive officer.
It has prompted reports that the "sole reason" for the termination of the doctor's employment and tenure April 17 was to quash a "no confidence" vote against Johnson and the hospital before it could go before the full medical staff membership April 18.
Earlier, the "no confidence" vote had been cast unanimously by the medical executive committee, headed by Hrehorovich. It had arisen, sources say, over concerns for what the executive committee believed to be improper and irresponsible practices in providing quality medical care to patients in the hospital.
As far back as February, sources say, the medical staff voiced concern about the financial and administrative policies of the South Baltimore hospital, the quality of care, an inadequate JTC number of nurses, high turnover in administrative support staff, untimely delays in X-ray and laboratory reporting, access to emergency-room service and what was described as "a confrontational administrative style."
Hrehorovich, a Harvard Medical School graduate, was elected by Harbor Hospital Center physicians a year ago to a two-year term as medical staff chairman. He contends he has been fired contrary to medical staff bylaws that assure department heads tenure until they are 65, once they have passed a two-year trial period.
In a letter to Johnson dated July 25, Dr. Marvin Schneider, chairman of the state medical society's council, a major committee, said the state medical society "protests the unilateral actions taken by the administration of Harbor Hospital Center in its non-compliance with the properly and legitimately adopted hospital medical staff's bylaws."
As a result of the council's review of the matter, Schneider wrote, this policy statement was unanimously approved: "When a hospital has established, through the negotiation and adoption of medical staff bylaws, specific procedures . . . it cannot then unilaterally avoid following these procedures."
And, Steven M. Nemeroff, a partner in a Washington law firm that Hrehorovich has hired as counsel, said yesterday the doctor still has not been given a reason for his dismissal and has had no response to a request for reinstatement to the department head post, which pays about $120,000 a year.
Through his attorney, Hrehorovich also contends the hospital and Johnson also violated the hospital's employee policy manual, which permits discharge for just cause only.
On April 17, Hrehorovich was removed from his department head post, which had twin responsibilities of providing, through attending physicians, medical care for the hospital's patients and the graduate training of some 300 doctors in their specialties.
Hrehorovich has refused to discuss the details that led to his firing. Johnson was not immediately available for comment.
Clark E. Jeunette, the hospital spokesman, says, "The board of trustees still feels the action they took was proper within their authority. I'm talking about the hospital's bylaws."
Asked why the board dismissed Hrehorovich, he replied, "Now you're getting into that sensitive area that I can't discuss with you."
Nemeroff says the "sole reason for the termination of Hrehorovich's employment and tenure was to quash a 'no confidence' vote against Johnson," who has been the hospital's chief executive officer since July 1984. Before that, he was second in command at Holy Cross Hospital in Silver Spring.
On April 18, the medical staff passed a resolution of "no confidence" in the administration of the hospital and Johnson's administrative leadership.
The "no confidence" vote had been under discussion by the medical staff's committee since April 3, and involved the staff's concerns about the availability and quality of care in a community that includes many low-income families who are uninsured, Nemeroff says. "The treatment of these patients is not encouraged by the hospital," he says.
On April 26, according to Nemeroff, the medical executive committee by a unanimous vote advised the hospital and Johnson that the medical staff disagreed with the dismissal of Hrehorovich.
Hrehorovich, also the editor of the Maryland Medical Journal, published by the Medical and Chirurgical Faculty, the state medical society, remains at the hospital as chairman of the medical staff, which is not a paid position, and as an attending physician.
He is a board-certified physician in five specialties -- internal medicine, infectious diseases, pulmonary disease, critical care and geriatrics.