The Losers in the Shock Trauma FightDr....

THE BALTIMORE SUN

The Losers in the Shock Trauma Fight

Dr. R Adams Cowley must be spinning in his grave. The editorial in regard to the mauling of Dr. Kimball Maull (Feb. 27) would suggest that the highly politicized Emergency Medical System in Maryland might need a serious review soon lest it be dismantled.

I am a former chairman of the American College of Surgeons Committee on Trauma. During my tenure, EMS development with the "trauma center" as the crown jewel of the system was its major emphasis. To separate EMS from the trauma center is literal heresy.

I have followed closely the distinguished and productive career of Dr. Maull in Virginia, Tennessee and now Baltimore. It would seem that this talented man was given an impossible task:

1. To cast Shock Trauma in a solid academic mold with the University of Maryland.

2. To ensure that quality patient care was the primary focus of the system.

How could this be accomplished without the solid support of the governor, the university, the hospital system, and indeed Shock Trauma itself? Several pertinent questions should be answered if Dr. R Adams Cowley's integrated EMS system is to be salvaged:

1. Why separate the EMS system from its trauma center?

2. Who advises the governor and the legislature in these matters?

3. Is the leadership of the medical system interested in patient care or the bottom line?

4. Why is there such resistance to review by outside trauma experts? There are many parameters to measure the system, including valid outcome studies.

Maryland has had the great opportunity to be a paradigm in the care of the severely injured patient who frequently cannot speak for himself.

It seems that ugly politics will prevent that from happening. The devastation wrought on Dr. Maull is certainly cruel, but the real losers in this unseemly debacle are the severely injured people of Maryland.

C. Thomas Thompson, M.D.

Tulsa, Okla.

____________ This letter is prompted by my overwhelming distress at the news Dr. Kimball Maull's resignation as director of the Maryland Institute for Emergency Medical Services Systems.

I am a neurosurgeon, and I worked at Shock Trauma from July 1979 through June 1981. During my first year there, I did a fellowship in neurotraumatology at Shock Trauma. I was hired by R Adams Cowley and the University of Maryland Hospital. I had a joint appointment. I was to stay one year but was given the opportunity by Dr. Cowley to develop and open the neurotrauma intensive care unit at Shock Trauma.

I must honestly say that those two years were perhaps the most educationally rewarding and personally satisfying of my career. I immediately identified with Dr. Cowley's dream and truly believe that at that point in time Maryland had the best trauma system in this country and perhaps the world.

I did, however, have another observation. I had never seen such political mayhem in my life. I was concerned at that time that the bloodthirsty politics and the monumental ego battles with the Maryland state educational and health system would eventually undo Dr. Cowley's prize system.

Since leaving Shock Trauma in 1981, I have kept in close contact with the leaders of both Shock Trauma and the University of Maryland.

I had been asked on several occasions, both by the representatives of the University of Maryland Hospital and of Shock Trauma, to return and work there in the area of neurotrauma.

However, over the past decade, it became more and more

obvious that these political games were allowing stagnation and mediocrity to descend on this premier trauma center. The place became significantly inbred. There was no progression as a system when compared to newer and better systems.

The relationship between Shock Trauma and the University of Maryland Hospital continued to be one of "cat and dog" rather than of two strong teammates working together to achieve a common goal. My biggest concern was that the bridges of collaboration were never built between Shock Trauma and the University of Maryland Hospital that should have resulted in the world's best state-of-the-art trauma center.

When I heard that Dr. Maull was going to become director of emergency medical services, I was once again optimistic. I have known Kimball Maull for the past seven years, and I had been familiar with his work in trauma for many years prior to that. He is one of the most respected trauma experts in this country, not just in acute trauma care but in trauma care delivery systems. Even more important than that, he knew Dr. Cowley's vision and he had a perception of what new things needed to be done to bring Dr. Cowley's dream into the 1990s.

Sometimes the truth hurts. Sometimes the people who are working closest to a situation are the ones who are unable to see the failures, unachieved goals and the fact that there are new ways to do things. Kimball Maull's attempted changes were hard to accept. People in Maryland did not like hearing what other people around the country were able to see clearly -- that Dr. Cowley's dream had become tarnished.

In order to succeed, one must at times break from history. Sometimes that break means change of personnel and policies that have been long-standing. That is not easy. However, sometimes it is the only way to make progress.

I was even more optimistic when I heard the individuals that Dr. Maull was in the process of recruiting to work at Shock Trauma. He was serving as a magnet for some of the bright stars in trauma care. But, unfortunately, Maryland's history repeated itself.

The disgruntled people within the educational and health care system once again played politics. They have wheeled and they have dealed to the point where they dissected and dismantled a premier trauma system and trauma center. It has been going on for a decade and it is coming to fruition now. The resignation of Kimball Maull could be the final "nail in the coffin" of the famed Maryland trauma system.

So, to the people of the state of Maryland, I have only this to say: If you are wondering why your famous trauma system is in shambles, don't look at Kimball Maull. He was on your side. If you want answers, I would go to your elected state representatives; to your appointed health care leaders; and to the health care professionals within the university's educational system and ask them, "What happened?"

Thomas G. Saul, M.D.

Cincinnati, Ohio

The writer is a member of the committee on trauma for the American College of Surgeons.

Treatment of Arnick

As a lawyer member of the Judicial Nominating Commission for Baltimore County, I must take issue with your Feb. 19 editorial, "Aghast over Arnick."

You state that the commission "fell down badly on the job." You accused us of carelessness, for spending too little time in determining a candidate's temperament and demeanor, and said that we were not conscientious in our charge. The editorial concludes that "nominating commissions have to do a better job of assessing their choices."

Your criticism shows a fundamental misunderstanding of the function of the Judicial Nominating Commission.

It also unfairly suggests that the very able men and women who currently serve on the Circuit and District Court benches in Baltimore County were somehow nominated by dumb luck.

For a single judicial opening, commission members often donate days in conducting individual interviews of potential candidates. spend many more hours in preparation for those interviews. Each candidate must complete and submit an exhaustive questionnaire which probes all aspects of that person's professional as well as private life. Commission members personally contact references named by the candidates; very often the references are far more candid in their opinion of a candidate's demeanor and abilities than the applicant might suspect.

The commission does not have traditional investigative resources of the type suggested by your editorial; however, we use all of the informational tools available to us.

Most candidates avail themselves of the opportunity to also be interviewed by members of the Maryland State Bar Association, the Women's Bar Association and the Monumental Bar Association. In addition, a survey is conducted of the entire membership of the Baltimore County Bar Association. All of the information which is generated by these groups is used by commission members in the interview process.

One point which has been overlooked is the fact that the media, including your newspaper, publish the name of candidates who apply for judicial vacancies. Any member of the public can contact (and in the past has contacted) members of the commission to air his or her views about a particular candidate.

In my opinion, current and past members of Baltimore County's judiciary demonstrate that the system for nominating candidates for the governor's ultimate consideration has worked.

We are justifiably proud of our benches; they were not nominated by accident, by carelessness or by unconscientious commissions.

The Arnick affair is indeed very unfortunate for all involved. However, your editorial does not help matters by conveniently assigning blame to the commission or to the governor. The Judicial Nominating Commission will continue to serve the public as it has for many years; in my view, it has served the public well.

John J. Nagle III

Towson

____________ Thank you, Barry Rascovar, for your column, "Lessons from the Arnick Affair," in the Feb. 21 edition of The Sun.

If legislators have learned that the public won't tolerate a judge who calls women "lying b------," maybe they will start listening to us on other subjects also.

My hearty thanks also to the few who did listen and vote their consciences before the public outcry overwhelmed the rest.

Eleanor M. Lewis

Baltimore

'Summer in Baltimore

In response to your Feb. 24 editorial, "Dog Days of Winter," it may come as a big surprise to some of you, but there are many of us who detest summer. That's right, we hate Baltimore summers.

We, the faithful winter lovers, dread the onslaught of endless days of 98 degree heat, 98 percent humidity and poor air quality ratings with high pollen counts.

We cringe as the weather person happily exclaims, "Yes sir! Another heat wave has struck the city with no relief in sight. Better bring in the dogs, and if you have heart problems stay indoors."

Or, "It's so hot you could fry an egg on the sidewalk."

The question we ask is: How can anyone with any degree of sanity enjoy this? It's hard enough to just struggle through it.

The irony is that you summer lovers are also the same people who rarely actually go out in the swelter. You keep your central air conditioners at 60 all summer long and your car air conditioners blasting. Such hypocrisy.

Just as it seems to be trendy to be politically correct it is also trendy to be seasonably correct.

No people in their right mind actually like winter, do they? You bet.

It's time to come out of the closet, people. Admit to the world that you'd rather be cool than hot. Admit that being hot, sweaty, sluggish and irritable isn't really all that much fun.

Joseph S. Klaff

Ellicott City

Lippman on Re-writing the U.S. Constitution

Theo Lippman Jr. recently penned an op-ed piece that appeared in our local paper.

In this piece, Mr. Lippman complains that Montana "gun nuts" opposed a resolution before the Montana Legislature that would add Montana to the list of states officially calling for a U.S. constitutional convention.

Mr. Lippman agrees that a con-con could not be limited to the purpose of the call, and he asserts that when convened, the con-con should use its open license to purge the right to keep and bear arms from the U.S. Constitution.

In the famous Dred Scott decision, which many historians believe may have triggered the U.S. Civil War, the Supreme Court considered whether Dred Scott was a slave, and therefore property, or a free man -- a sovereign citizen like the rest of us.

In pursuit of its decision, the court noted that one of the classic tests by which to determine whether a person is a free man or a slave is that free men are allowed to keep and bear arms while slaves are not.

Mr. Lippman advocates giving a monopoly of force to the government which, axiomatically, would reduce the rest of us to the status of slaves -- unable to defend ourselves and unable to resist the lust of a government waxed tyrannous.

Apparently, Mr. Lippman has conveniently forgotten the dramatic lesson of Germany in the 1930s and 1940s, where the Jews lacked the will or wherewithal to defend themselves against a tyrannous government. One may see that the Jews paid a heavy price for this lack of will and/or ability to defend themselves.

One may presume that a person such as Mr. Lippman simply cannot conceive of, cannot even be told about, liberty and freedom as it is perceived by the sort of people who choose to live in Montana.

While the wimpy wish to be cared for by a strong government, with the concomitant sacrifice of freedom, may prevail on the East Coast, it is anathema to the people of the inland West. Thank you, we will keep our freedom, regardless of cost -- and a New York raspberry to those, like Mr. Lippman, who would so eagerly surrender our American heritage.

Yes, organizations of respectable gun owners did help kill the bill that would have added Montana to the list of states calling for a con-con. It wasn't difficult. We could not have asked for better testimony on our side than the local op-ed by Mr. Lippman. (Thanks, Theo.) When our legislators heard that representatives of East Coast newspapers wish to use the con-con to outlaw private ownership of firearms, the coffin of the resolution was sealed.

Gary S. Marbut

Missoula, Mont.

The writer is president of the Montana Shooting Sports

Association.

____________

Theo Lippman's rewrite of the Second Amendment (Feb. 22) has merit but no hope of passage. Since the present "right to bear arms" is plainly encompassed within a "well regulated militia" and can be further enforced by statute, I suggest:

Every person between the ages of 14 and 64 who possesses a "firearm" be required to fall out one Saturday a month with his or her firearm(s) for "regulated militia" training -- i.e., close order drill, manual of arms, physical training, firearm inspection, etc.

Then once a year require all militiapersons living north of the 40th parallel to attend a week's jungle training in Panama and all those south of the line attend equal Arctic training in Alaska.

All at their own expense of course in the best tradition of those embattled patriots who fired the "shot heard 'round the world."

I'll bet the NRA leadership in Washington will be really keen to get away from their car phones and luncheons to both actively officer the militia and subsidize the training.

Quentin D. Davis

Aberdeen

____________ It was indeed ironic that you chose the birthday of George Washington to run Theo Lippman's column calling for a new Constitution, one minus the Second and Fifth amendments. In contrast to Mr. Lippman's "improved" amendments giving all power and authority to the state, George Washington believed that the people should always be sufficiently armed to protect their form of government from would-be rulers.

Mr. Lippman's new, improved, Second Amendment would limit all arms to the police and military, and he claims he could write a better Fifth Amendment in his sleep. Not surprising. Adolph Hitler did it for him half a century ago, and others did it before him.

Although we've been warned often, we forget the lessons of Machiavelli and our own patriots and thinkers.

Philosopher James Burgh addressed the thinking of people like Mr. Lippman in the last century when he wrote, "He, who has nothing, and who himself belongs to another, must be defended by him, whose property he is, and needs no arms.

"But he, who thinks he is his own master, and has what he can call his own, ought to have arms to defend himself, and what he possesses; else he lives precariously, and at discretion."

As we look at our new president blithely breaking campaign promises and imposing taxes at a rate that makes good King George look like a philanthropist, we would do well to consider history's lessons and warnings about all-powerful police forces and armies.

Finally, Mr. Lippman overlooks another likely result of a runaway constitutional convention. The Second and Fifth amendments aren't the only threats to an oligarchy's ideas of "law and order."

We need only to look at the role television news coverage played in the instigation of the last year's Los Angeles riots to realize that the following is also a likely amendment:

"An uncontrolled Press being detrimental to an orderly and peaceful society, and unbridled speech being likewise a threat to rule of law, the right of the State to restrict the Press and Assembly of Citizens shall not be infringed."

Mr. Lippman conveniently forgot in his talk of Alexander Hamilton and James Madison that both referred to the Second Amendment as guarantor of the other nine.

Christopher A. Meissen

Colon, Neb.

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