A year ago, when Johns Hopkins Hospital snared the husband-and-wife medical team of Sam Ritter and Rebecca Snider, the hospital seemed well on its way to restoring the luster to its once-proud division of pediatric cardiology.
"The recruitment of you and Rebecca represents our commitment to the growth of the division as a national leader," Frank Oski, head of pediatrics, wrote Dr. Ritter as negotiations to hire the couple neared an end.
Ten months after Drs. Ritter and Snider began their new jobs, they were informed that they were through at Hopkins as of the end of this month.
What went so wrong so fast is unclear. The couple said they never were given an explanation for their dismissals, and Hopkins declines to provide one. Doctors at Hopkins say privately that Drs. Ritter and Snider, considered exacting and impolitic by some, alienated too many people at the hospital. There also have been suggestions that the pediatric cardiology division failed to attract the number of new patients that Hopkins officials expected after the couple's arrival.
The fallout has been a $110 million lawsuit by the couple against Hopkins and officials there. They are alleging wrongful discharge, breach of contract and defamation, claiming that they were the victims of an effort to soil their professional reputations. Hospital officials, while denying the allegations, said they "will not be provoked into discussing this academic matter further in the media."
Drs. Ritter and Snider said their terminations have placed their once-stellar careers in jeopardy. "People must think we're drug addicts or murderers or embezzlers," Dr. Snider said tearfully. She then expressed her deepest worry: "Are [we] ever going to be able to practice medicine again?"
For Hopkins, repercussions from the episode also may be serious. Several nationally known pediatric cardiologists -- a small subspecialty with only about 1,000 practitioners -- said the unusual dismissal of such high-level employees has tarnished Hopkins' image in academic medicine and all but destroyed its ability to build a first-class pediatric cardiology division.
"As far as academic pediatric cardiology at Johns Hopkins, it is probably dead," James Seward, director of the echocardiography laboratory at the Mayo Clinic in Rochester, Minn., wrote to Hopkins in one of several letters the hospital received in support of Drs. Ritter and Snider. "The good name of Johns Hopkins has certainly taken a beating."
That good name, at least in the area of pediatric cardiology, was at one time considered unassailable, thanks to the pioneering work of Helen Taussig. Often called "the mother of pediatric cardiology," Dr. Taussig achieved enduring national fame in 1944 when she and another Hopkins surgeon performed the first so-called blue baby operation, a procedure to open constricted arteries to the heart.
Her presence at Hopkins attracted top-notch medical students, many of whom went on to chair pediatric cardiology divisions around the country.
Hopkins' reputation in pediatric cardiology remained strong after Taussig's retirement in 1963, but those in the field agree that in the last decade the division no longer was seen as a national leader.
"The service has really languished in the last decade," said Amnon Rosenthal, chief of pediatric cardiology at the University of Michigan, who lured Dr. Snider there in 1983.
Hopkins' decline in pediatric cardiology did not just mean a loss in prestige. Cardiac surgery is the most common serious procedure performed on children older than 1 month, according to the National Association of Children's Hospitals and Related Institutions. A less-than-stellar reputation in pediatric cardiology meant that Hopkins, which was pre-eminent in other areas of medicine, was missing out on a lot of potential business.
When the hospital launched its national search last year for a new director of pediatric cardiology, Dr. Ritter, 44, and Dr. Snider, 45, who were married in January 1993, contacted Hopkins. They were told that the hospital might hire both, which would enable them to live together for the first time.
Dr. Ritter was the newly appointed director of pediatric cardiology at Cornell University's New York Hospital. Admirers considered him knowledgeable and an effective teacher.
Dr. Snider was a professor of pediatrics at Duke University Medical Center in Durham, N.C., and considered one of the foremost experts in echocardiography, a nonsurgical method of creating an image of the heart using sound waves. She had written several textbooks in the highly specialized area and lectured to doctors around the world about ways to better diagnose children's heart problems using the test.
Although colleagues admired her expertise, several said that Dr. Snider could be demanding and impolitic. "I don't think she suffers fools gladly," Dr. Rosenthal said. "She may not always be as tactful as some other individuals, but nobody is perfect."
In September 1993, after months of negotiations, Dr. Oski made the appointments: Dr. Ritter as the Helen B. Taussig professor of pediatric cardiology and director of the division, and Dr. Snider as a professor of pediatrics and director of a new, pediatric echocardiography laboratory. Dr. Ritter's compensation was to be $200,000 a year and Dr. Snider's, $160,000. They were also to be paid $25,000 to cover moving expenses.
Hopkins received high marks for the appointments.
"Johns Hopkins got two of probably the 10 world-famous cardiographers to go to that institution," said Dr. Stuart Septimus, a pediatric cardiologist affiliated with the Du Pont Institute in Wilmington, Del., and a friend of Dr. Ritter and Dr. Snider. "They certainly got premier faculty."
The selections were seen as a signal from Hopkins that it planned to re-establish its pre-eminence in pediatric cardiology.
"Their appointment itself was seen as a significant improvement of the division," said Michael Heymann, professor of pediatrics at the University of California in San Francisco, where Dr. Snider trained.
At issue in the lawsuit is how permanent Hopkins intended the appointments to be. Hopkins said the couple were hired only for a year as visiting professors, a claim Drs. Ritter and Snider said is ludicrous.
"We were brought here to be full tenured professors," Dr. Snider said. "It is insulting to believe we would leave our jobs to come for anything less. We came here expecting this to be our homes forever."
To support that contention, in their lawsuit they submitted numerous documents suggesting that Hopkins was envisioning a long-term relationship. In one letter to Dr. Ritter, Dr. Oski spoke about compensation into 1995. Dr. Oski also wrote, "Appointment at the rank of professor carries tenure." He cautioned, however, that their appointments had to be approved by the "professors appointment and promotions committee."
The lawsuit may well turn on the question of whether the appointments were temporary. But a more provocative question is what happened during their 10 months that so displeased the hospital.
Officials at Hopkins, including Dr. Oski and Michael Johns, dean of the medical school, declined to be interviewed. Members of the search committee also would not discuss the matter. One member, cardiac surgeon Duke Cameron said, "I think we should respond so you have the full picture," but after checking with hospital officials, he said he had been advised not to grant an interview.
Acting director accused
In their lawsuit, Drs. Ritter and Snider accused Jean Kan, the acting director of pediatric cardiology before their arrival, of launching a whispering campaign against them. The same accusation was leveled against Catherine DeAngelis, associate dean of the medical school.
The derogatory comments, the lawsuit contended, undermined the two in their new jobs. They alleged that Dr. Kan, who has now been appointed to Dr. Ritter's position as head of pediatric cardiology, told members of the cardiac surgery unit that the couple complained that some operations performed by Hopkins surgeons were "defective." Dr. Ritter and Dr. Snider contended that they never made such statements, and alleged that Dr. Kan attributed the comments to them to "create enemies and dissension."
Their lawsuit also contended that false statements about them have damaged their reputations, making it impossible for them to find new jobs. The lawsuit recounted a phone call Dr. Snider received from a doctor at a "distant medical school" who asked her, "What did you do, defraud Hopkins?"
Dr. Ritter denied any suggestion that he and his wife were incapable of working well with others, though he added, "When you come in and organize and make any changes in a program -- when that is precisely what you are brought in to do -- you're bound to have people who were disgruntled and who will spread innuendo about you."
Whatever friction existed within the division, Drs. Snider and Ritter said they were unprepared for what happened on Oct. 18, when they were simultaneously handed letters from Dr. Oski announcing that their employment at Hopkins would end Dec. 31.
"I was in total shock; I couldn't believe this was happening," Dr. Snider said.
Both husband and wife said they were not told what Hopkins' grievances were. Dr. Ritter said that Dr. Oski told him that he had opposed the action. "Oski says he was blindsided," Dr. Ritter said.
While Drs. Ritter and Snider said no one in the administration had ever expressed dissatisfaction with them, not everything was going well in their division.
Dr. Ritter appeared to be off to an uncertain start in efforts to expand the division's reach into the Baltimore suburbs. One prospect was for Hopkins' pediatric cardiologists to see patients on a part-time schedule at Greater Baltimore Medical Center (GBMC) in Towson, where the specialized treatment had been available on an infrequent basis.
In April, Dr. Ritter made a presentation to a panel of GBMC doctors and administrators, as did the chairman of the pediatric cardiology division at University of Maryland Hospital, which got the business.
Stephen R. Amato, chief of pediatrics at GBMC, said many factors went into the decision to choose University of Maryland Hospital, including a feeling that while Hopkins wanted the contract, Maryland wanted it more.
There also was a suggestion that Dr. Ritter failed to sell himself HTC to GBMC. Recalling Dr. Ritter's comments to the hospital committee, Dr. Amato said guardedly, "He did a very adequate job."
Dr. Ritter contended that Hopkins had little chance of getting the GBMC business and that he was told as much when he took the Hopkins post. "I went out there [to GBMC] anyway to see if it could be salvaged," he said. "Clearly, they had made up their minds before we got there."
Dr. Ritter and his wife now are spending their days in their Laurelford home in a wooded area of Baltimore County, revising one of the textbooks Dr. Snider wrote and wondering how their once-limitless prospects had, in their view, become so drastically diminished.
"That's why we filed the lawsuit," said Dr. Ritter. "To find out why this happened."