Minutes after the March 22 crash of USAir Flight 405 at New York's LaGuardia Airport, Dr. James A. Block had torn his way out of the sinking airliner and waded the icy waters of Flushing Bay to safety.
Dr. Block -- then president of University Hospitals in Cleveland and soon to become president of Johns Hopkins Hospital and Health System -- found himself in an ambulance beside another, more seriously injured crash victim, racing to Elmhurst Hospital in Queens.
Unaware of his own injuries, he pitched in to help treat the other man, at one point helping to resuscitate him when he stopped breathing.
It wasn't until he got to the hospital and was handed a mirror that Dr. Block, 51, became aware of his own lacerated head and hands, broken nose and hypothermia. He was hospitalized for 10 days.
Three and a half months later, safely settled into the comfortable ground-floor office of Hopkins' former president, Dr. Robert M. Heyssel, Dr. Block still marvels at it all.
"I didn't have any sense of being injured at all," he said. "In that kind of a situation, you just function on a different level."
To former associates in Cleveland and in Rochester, N.Y., Dr. Block has always seemed to function on a different level, breathing new life intohealth-care institutions.
Dr. Block is a "visionary," said Dr. Paul F. Griner, chief executive officer at Strong Memorial Hospital in Rochester. At the same time, "he is politically astute and very diplomatic. He understands the politics of change and he's able to . . . bring people to consensus very effectively."
But he is more than a skilled institutional mechanic, they say.
"He is dedicated to the care of the less fortunate. He sees health care as a mission as well as a business," said Dr. Donna I. Regenstreif of the Hartford Foundation in New York, who worked with Dr. Block in Rochester.
Tall, slim and soft-spoken, Dr. Block might pass for a Kennedy. His thick crown of white hair makes him easy to spot at crowded functions.
He says he enjoyed wading into a crowd of Hopkins employees at a recent welcoming party. But he strikes some as cool and aloof.
"I knew of his accomplishments from Rochester, but I thought he was a little standoffish," said Dr. Edgar B. Jackson Jr., associate chief of staff at University Hospitals in Cleveland.
"I learned later it was shyness. The only people who dislike him do not know him," he said. "The deeper you go, the better he looks."
He looked good to the trustees at Hopkins, who picked him in January to take over July 1 as president of an institution twice ranked by doctors in a U.S. News and World Report survey as the nation's best.
Dr. Block's domain -- the Johns Hopkins Hospital, Francis Scott Key Medical Center and Johns Hopkins Medical Services Corp. -- also constitutes one of Maryland's biggest private employers, with 14,000 full-or part-time employees and gross revenues of $612 million in 1991.
He'll work beside Dr. Michael Johns, dean of the Johns Hopkins School of Medicine, who oversees Hopkins' teaching and research.
"The opportunity to work with the quality of people here, and with Michael Johns in particular, was very difficult to turn down," Dr. Block said.
"I also have a certain sense that these are extremely difficult and challenging times in America, and health care is not immune from the stresses of a society facing very fundamental change," he said.
HTC "Dr. Johns and I are keenly aware that we have to re-evaluate what we're doing, adapt and lead" in addressing issues of health-care affordability and access, biomedical science financing, AIDS, drug abuse and violence in children, he said. "This [Hopkins] is an institution that has to thrive."
Taming the giants
Although he was trained in pediatrics, Dr. Block is fascinated by large, complex organizations and has spent most of his medical career trying to make them work better.
"To the extent that you can help them unleash their remarkable talent and energy, it's very exciting and very rewarding," he said.
L Institutions do seem to thrive under Dr. Block's leadership.
While head of ambulatory services at the 400-bed Genesee Hospital in Rochester from 1971 to 1979, he transformed the hospital's ailing outpatient clinics into a thriving physicians' group practice, adding middle-class patients to what had been mostly Medicaid and charity clientele.
In 1979, Dr. Block tackled rising health-care costs and stifling state regulation as president of the nine-hospital Rochester Area Hospitals Corp. (RAHC).
Inspired in part by Maryland's Health Services Cost Review Commission, RAHC won government approvals for a cooperative regional rate structure that controlled hospital cost inflation while allowing hospitals to profit from more innovative and efficient operations.
Costs at Rochester hospitals remain below the national averages.
As president at Hopkins, Dr. Block said, he will ask other Maryland hospitals and physicians to consider similar "cooperative efforts" to create a "reliable, integrated health care delivery system . . . at a very affordable price."
That won't mean new acquisitions by Hopkins, he said, but he declined to say exactly what he has in mind. His ideas are "too preliminary" and might create "unnecessary anxiety," he said.
During seven years as president of the University Hospitals Health System Inc., he led development of several cooperative ventures linking University with other Cleveland hospitals and their staffs.
He led 19 separate institutions in a collaboration that will move diverse services for the elderly to a central campus at a closed state mental hospital.
He also invited the community-based Hough Norwood Health Care Center to run University Hospitals' outpatient clinic, turning a money-loser into a profit center, and winning trust in the community.
When Dr. Block arrived, Dr. Jackson said, poor patients at University,
most of them black, had no ongoing relationships with a doctor, and were assigned to staff physicians.
Today, nearly everyone admitted through Hough Norwood has his or her own physician.
"They feel much more welcome and comfortable, so they're not as likely to stay away from care and get terribly ill before they show up. It also reduces costs," Dr. Jackson said.
"In the last two years, the black community sees University Hospitals more as its ally, its partner, and a place where we [blacks] are welcome," he said.
Dr. Block said he has been "very impressed" by Hopkins' East Baltimore initiatives in housing, economic development, schools, health care, mentoring and summer jobs.
He wants to strengthen those, he said. But "more importantly, I want to work with the [community] leadership in defining priorities and how we can work together to address them."
Developing a vision
Figuring out how to fix large institutions takes thought, Dr. Block said.
"I do a lot of my work when I'm alone, primarily thinking about issues these institutions may be facing" and developing a "strategic vision" for the future. "I'm a great believer in road maps.
"I try to develop that vision through a process that involves many people. . . . That's the great strength in an institution like this, if you can but tap it," Dr. Block said.
Once he's determined where he wants to go, say former colleagues, Dr. Block can be compelling.
"He is very persuasive," said Sara E. Hartman, a health care consultant who worked with Dr. Block in Rochester. "He does his homework."
He is also "quintessentially political," said Dr. Regenstreif. "That's not to say he engages in sleight of hand, but he knows when to compromise, and when to hold out."
He's a terrific boss, she said, "if [you] feel secure in your abilities and . . . where it is you're supposed to be going."
Sailor, reader, father
When he's not operating on great institutions, Dr. Block and his wife, Mollye, may escape to their summer home in New York's Finger Lakes region. He has a power boat, but says he may now try sailing on the Chesapeake Bay.
The Blocks have four children: Brandon, 25, Pamela, 23, Rebecca, 18, and Abby, 12. He has purchased a new waterfront town house in Fells Point.
Most of his spare time is devoted to reading, usually modern fiction.
Great authors and good literature "give us greater insights into -- ourselves," he said. "I find it frequently helps me in my work."
One author he read recently observed that "much of our interactions with each other are no more than a struggle for each others' ears, and if we would but listen to each other, novels would not have to be written."
"Novelists are very good listeners," he said. "It's a very important skill for all of us."