Shock Trauma firings are as American as money


MARYLAND spent $80 million to build, equip and support the world-class R Adams Cowley Shock Trauma Center. Now, so the story goes, the bean-counters want to use the center as a place to treat hangnails and fallen arches.

What jealous doctors and hospital planners couldn't do in the early 1970s, petty bureaucrats and administrators may be close to accomplishing this year. This time they may pull it off because the pioneering gut-fighter, the eponymous Dr. Cowley, is no longer around to schmooze with governors and legislators to keep his monument alive.

The sacking last week of Drs. Ameem Ramzy, C. Michael Dunham and Howard Belzberg had nothing to do with the practice of medicine or the saving of lives. The firings appear to be as American as money.

The other side of the story is that the three doctors were booted because they were end-running their bosses and undermining the system. For example, not too many years ago they hired their own lobbyist, Alan Rifkin, Gov. William Donald Schaefer's former legislative officer, to plead their separate case in Annapolis. Toward the end, the doctors turned against Dr. Cowley, too, and those familiar with the bitter situation say that the late Dr. Cowley might also have given them the heave-ho.

The hospital business is legalized body-snatching. A hospital with empty beds is like a drawer without cash. But Shock Trauma is no ordinary hospital. It's a specialized treatment center for the critically injured. Drs. Ramzy, Dunham and Belzberg argued their case in the press to keep it that way.

And that's what bothers the pencil-necks who run the University of Maryland Medical System, the now-private institution with which Shock Trauma is affiliated. Because many of us weren't mowed down by run-away dump trucks or torn apart by bullets in drug-deal shootouts, a few beds in the 138-bed center remained empty. Now they are preparing to sell time shares in Shock Trauma.

The hospital business is as much about bottom lines as the corner supermarket or a giant insurance company. Very simply, the system can charge more and goose its cash flow if it books patients into Shock Trauma instead of the regular hospital.

Dr. Cowley spent 25 years massaging five governors to realize what is now an eight-story, free-standing Shock Trauma Center of 130,000 net square feet, complete with its own heliport.

The building cost $45 million, the sleek new helicopters $35 million, and the General Assembly even raised Maryland's license tag fees to support the Medivac choppers. That's a lot of money for a state-of-the-art M*A*S*H unit that is in danger of becoming a first-aid center administering to cuts and bruises and the removal of splinters.

Once before, in March 1973, University Hospital's chief of surgery, Dr. G. Robert Mason, who was technically Dr. Cowley's boss -- if it could be said that Dr. Cowley had a boss -- ordered the Shock Trauma Center downgraded to a lower-echelon ambulatory care unit.

True to medical politics, the Medical and Chirurgical Faculty of Maryland (the state medical establishment) put its lobbyists to work to scuttle Shock Trauma and bury Dr. Cowley at the same time. Dr. Cowley didn't play by the rules, or at least by Med Chi's rules.

But Dr. Cowley and Shock Trauma were rescued by Gov. Marvin Mandel. The governor issued a hastily-prepared emergency executive order which countermanded Dr. Mason's order by removing Shock Trauma from the surgery department and reconstituting it as an independent center with its own budget. Dr. Mason quit and went to California.

The University of Maryland's Board of Regents, which then oversaw the hospital system, tried and tried again in 1984 to convert Shock Trauma into a high-priced bed-and-board medical hotel. Again the effort was blunted by Gov. Harry R. Hughes, who had appropriated the money to build the new R Adams Cowley Shock Trauma Center.

Dr. Kimball I. Maull, the Tennessee trauma surgeon Dr. Cowley wanted as his successor, has been on the job six months. Dr. Maull has none of his predecessor's inside knowledge of Maryland's political power structure. After the firings, Dr. Maull was quoted as saying he works for the Board of Regents, not the governor. In Maryland, that's seditious talk.

Even the medical system's administrator, Dr. Morton Rapoport, is in complicity with the free-market notion that greater efficiency and higher profits dictate a broader use of the highly specialized center. To support his case, though, Dr. Rapoport has the medical system operating in the black even though Shock Trauma is a money loser.

So concerned was Governor Schaefer about the squabble in the hospital complex that he created a commission to review the system and investigate the heightened tensions. But the dismissals undercut the commission and violated what insiders viewed as a cooling-off period.

Shock Trauma began in 1965 as a two-bed experiment in high-tech medicine. Today, many thousands of patients later, it is the national standard against which the federal government judges all others. Dr. Cowely served as the consultant to Congress and the White House.

Shock Trauma has saved the lives of the down-and-out as well as the high and the mighty. Among them are the sons of former U.S. Sen. William Proxmire and Maryland Treasurer William S. James; the former chief clerk of the Maryland House of Delegates, James Mause; Baltimore County Councilman Charles A. "Dutch" Ruppersberger; and a regiment of Baltimore police officers who were shot or injured trying to make the streets safe.

When Dr. Cowley began his work at Shock Trauma, the center's mortality rate was 73 percent. Today it's below 9 percent.

But the rate may soar again. To put a few more bucks on the books, the bureaucrats may risk killing the one outstanding medical claim the University of Maryland Medical Systems has.

Frank A. DeFilippo writes a column on Maryland politics.

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