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Hopkins to create medical czar post Move seeks to end infighting between hospital, med school


In an article in Wednesday's editions about restructuring a the Johns Hopkins medical center, The Sun incorrectly identified the previous institution at which the president of the Johns Hopkins Hospital and Health System worked. Dr. James A. Block was president of the University Hospitals of Cleveland before he came to Baltimore.

+ The Sun regrets the errors.

Senior trustees of the Johns Hopkins medical complex said yesterday that they will make one person responsible for all medical matters there, in the latest effort to end the bureaucratic infighting that has plagued the East Baltimore center.

The move, announced in a statement to Hopkins employees yesterday evening, comes after months of mounting tension between Dr. James A. Block, president of the Johns Hopkins Hospital and Health System, and many researchers and clinical department chairmen at the university medical school.

The new position will stand above both the hospital president and the medical school dean, and will report to the president of the university. Technically, the Johns Hopkins University, which includes the medical school, and Hopkins Hospital and affiliated clinics are two separate corporations with their own chiefs and trustee boards.

George L. Bunting, chairman of the hospital board of trustees, said the still-sketchy realignment was necessary for Hopkins to be able to move swiftly as a corporation to compete in a rapidly changing health care market. But he acknowledged that the move was sparked by a near-revolt against Dr. Block by some senior medical faculty. And unless Dr. Block is named as the new medical chancellor, the move would diminish his authority at the East Baltimore medical center. Dr. Block could not be reached for comment.

"Jim is willing to cooperate and work with the chancellor," Mr. Bunting said. "What we're trying to do is make for decisive decision-making within medicine by having a single focal point."

Job description

Mr. Bunting also said the move should clarify job descriptions as university trustees seek a replacement for university President William C. Richardson. Acting university President Daniel Nathans, a Nobel Prize-winning Hopkins geneticist, has ruled out holding that job on a permanent basis.

In all, the university is searching for a new president, a new provost, a new medical chancellor, a new medical school dean, and a new executive vice dean for the medical school.

The hospital and the medical school were forced closer two years ago with the creation of Johns Hopkins Medicine, a joint committee of senior medical professors and hospital officials. Last summer, that structure was revised to give it greater policy-setting authority, and the university president was named chairman to settle disputes between the medical school and the hospital.

Battles were so pronounced between the medical school dean and the hospital president that trustees commanded them to share the same office suite and support staff.

Some Hopkins researchers and physicians said they did not have confidence that Dr. Block would maintain Hopkins' tradition of innovation and discovery as he leads the medical institutions into the more competitive markets of managed health care.

Insurrection erupts

Faculty insecurity erupted into insurrection in January. After the announcement of the departures of the medical school's two top officials -- Dean Michael E. Johns and his chief deputy, Dr. David Blake -- some medical professors lobbied trustees to dismiss Dr. Block.

PD Dr. Johns will become an executive vice president for medical af

fairs for Emory University in Atlanta, a position much like the one created yesterday at Hopkins, and one he coveted here. Dr. Blake will leave to take a senior position at the Association of American Medical Colleges in Washington, D.C.

The chancellor-type position has been advocated by many health care experts nationally who say Hopkins' dual structure has created conflict at a time officials in the East Baltimore center must be unified.

"I don't know if it's a good idea, but it's a necessary idea -- the place is in chaos," Dr. Frank A. Oski, the past chairman of Hopkins' department of pediatrics, said. "There's nobody in charge and nobody to boost the morale of the people who are there."

As health care insurers seek to limit costs per patient, the Hopkins health system must create alliances with health maintenance organizations and primary care physicians' networks so that the hospital receives a greater flow of patients.

'Glad to see this'

"I didn't know what the next shoe would be, but as a fan of Hopkins I'm glad to see this," said Roger Bulger, president of the Association of Academic Health Centers in Washington, D.C.

"Hopkins has been attempting to meet these challenges with one arm tied behind its back," said Dr. Alfred Sommer, dean of the Hopkins School of Public Health. "The changes that this suggests should propel Hopkins beyond the capacity of most other academic medical centers."

It is not clear, however, that the new move will resolve Dr. Block's future at Hopkins, a subject that generated enough rumors last week that Mr. Bunting issued a statement denying that Dr. Block had been fired.

Hopkins observers said yesterday's move clearly undercut the stature of both the medical dean and the hospital president.

"It diminishes both other positions a little bit, so the dean is not quite what he was before, and the president of the hospital is not quite what he was before," said Dr. Paul R. McHugh, chairman of the psychiatry department at Hopkins. "I'm all for change, but if you keep changing governance every six months, you're not sure what's up."

"If I were in [Dr. Block's] position, and I were not made the new CEO of Hopkins medicine, I can't imagine that I'd stay on," said a Hopkins administrator who asked not to be identified. "I can only assume Dr. Block originally came to Hopkins from a leadership position at [the Cleveland Clinic] to be the leader of a significant institution at Hopkins."

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