Shock and Trauma at the Shock-Trauma Center


R.A. Cowley would love it. Only he could fully appreciate the delicious irony of the situation at the famed shock-trauma center he founded.

Here is his successor, the surgeon he wanted as his heir, running into a buzz saw of opposition from disgruntled doctors. Why? Because Dr. Kimble I. Maull wants to shake up the trauma center and return it to a leading-edge role.

Does Dr. Maull back down? Nope, he charges ahead, like a bull in a china shop, dismissing three physicians who tried to undermine him, telling the governor to butt out of this minor flap and firmly planting his mark on the R Adams Cowley Shock Trauma Center. He has a clear vision of what he wants, and no one is going to stop him.

Sound familiar? It should. That's how Dr. Cowley operated, too. He was a one-man wrecking crew if someone got in his way. He did not suffer fools or foes for very long. As he told colleagues, "Only a dog needs to be loved." Results, not his popularity, were all that mattered.

And he succeeded, brilliantly. Over the vehement opposition of other hospitals, jealous physicians, possessive bureaucrats and busybody legislators he carved out a new field of medicine -- emergency medical services.

Employing innovative techniques, Dr. Cowley declared war on behalf of critically injured accident victims. By getting patients into the operating room in that first "golden hour," and by throwing teams of surgeons into the battle, Dr. Cowley performed miracles. More often than not, he won the war. Thousands of lives were saved.

Along the way, he collected enemies. It didn't faze him. He was smart enough to win the loyalty of a governor, key legislators and firefighters and paramedics. Only when he was slowing down, when his own Shock Trauma doctors turned against him in 1989 for creating "general chaos" did Dr. Cowley step down. He died last fall.

Now some of those same doctors are seeking another scalp: Dr. Maull's.

Their complaint is ironic: they don't want Shock Trauma to

change. Yet this is an institution created out of change -- a dramatic re-thinking of how to treat critically injured accident victims. Dr. Cowley's whole life at the Shock Trauma Center was about change. He kept the place in constant turmoil.

Time, especially in today's high-tech medical world, does not stand still. Dr. Maull came to the Baltimore center this spring with an impressive reputation. To his surprise, he discovered that the Shock Trauma Center's own reputation as a national leader was an illusion. It's a very good operation, but no longer at the top of the field.

The place can't attract the best interns. It has become too inbred. Few surgeons are tops in their specialties. Vital field services have big gaps: only in three counties (Baltimore, Anne Arundel and Prince George's) can accident victims be assured that all EMS units are trained and equipped to keep them breathing by cutting a hole and inserting a tube into the trachea. In fact, in Baltimore City none of the EMS units can perform this life-saving step: they lack the equipment.

Other changes are inevitable at Shock Trauma. When the state built the $35 million Cowley center, part of the agreement was that Shock Trauma would begin admitting people with serious knife and gunshot wounds who had been treated at University Hospital in the same building. After all, why have duplicate trauma centers? But Shock Trauma doctors fought this state mandate tooth and nail.

Dr. Maull quickly worked out a deal with the hospital to end that duplication. And since he was hired jointly by the University of Maryland and University Hospital, he saw no reason to continue Dr. Cowley's long-running feud with these two entities. The frugal 1990s dictate a new strategy for securing Shock Trauma's future.

This is an era of severe government deficits, a time when the public is demanding accountability. Yet Shock Trauma had been notorious for its lack of accountability and its free-spending ways. It insisted on total independence.

That is now changing. Interdependence is the key word. And there is a strong effort to depoliticize what are essentially medical matters.

Dr. Cowley was superb at getting what he wanted from the politicians and winning public acclaim. The doctors who turned on Dr. Cowley, and now on Dr. Maull, have also been adept at gaining wide media coverage and rallying politicians and the EMS network to their side. They even hired their own lobbyist. Other area hospitals, sensing a weakness, have jumped at the chance to strip University Hospital of its links to Shock Trauma. The whole thing has been a circus.

At this stage, Dr. Maull lacks the political skills that served R A. Cowley so well. But other parallels are quite striking. The same terms used at Dr. Cowley's funeral could be applied just as easily to Dr. Maull -- arrogant, determined, difficult to get along with; so determined to make shock-trauma work; he fought huge, impossible odds; and he was a medical pioneer for shock-trauma.

It seems ludicrous to claim that Dr. Maull is plotting to turn Shock Trauma into a run-of-the-mill emergency room or that he is out to demolish the statewide EMS system. Nor is it likely this highly respected leader in trauma medicine is fronting for scheming administrators to bring more trauma patients to University Hospital. Yet these are the whispering campaigns under way.

The circus at Shock Trauma is likely to continue. Dr. Maull's foes will see to that. But, what the heck. As R A. Cowley used to say, "You can tell the pioneers by the arrows in their backs."

Barry Rascovar is editorial-page director of The Sun.

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