Officials at the University of Maryland's medical complex in downtown Baltimore said yesterday that they had removed three senior academic leaders this year because they were insufficiently willing to address the pressures threatening the center's finances.
In a joint interview, the dean of the UM School of Medicine and the president and chief executive officer of the University of Maryland Medical System said they needed department chairmen to shake free of conventional wisdom and embrace new ideas.
"The team that's the right team to bring us into the year 1990 may not be the team that's right for us as we look to the year 2000," said Dr. Donald E. Wilson, medical school dean. "I would think people would applaud" such changes, he said. "In business, they do that all the time."
While being careful not to criticize any of the three former chairmen by name, Wilson and Dr. Morton I. Rapoport, hospital president, said the department chiefs' efforts promoting research, education and patient care were not matched by an entrepreneurial vigor.
"If our chairs are always sitting back and never being proactive, and whenever we bring an idea forward they find reasons not to [support] them, that's not showing vision," Wilson said. "We really have to maximize our ability to meet the challenges."
Since the start of February, the chairmen of medicine and surgery -- the medical school's two largest departments -- and the director of the cancer center have all been reassigned. Dr. John A. Kastor, the former medicine department chairman, and Dr. Ernest C. Borden, the former cancer center director, have maintained faculty appointments; former surgery chief AnthonyL. Imbembo was named an associate dean.
Wilson and Rapoport strenuously objected to an article in Friday's Sun that first reported the moves. University of Maryland physicians interviewed for that article said the shifts were done too swiftly and with little explanation. The two officials said yesterday that their explanations were brief because they did not want to criticize people who had served the university ably for many years.
When informed this month that the dean would look for his replacement, Kastor refused to continue in his job, forcing officials to move him back to faculty ranks instantly, Wilson said.
Imbembo and Kastor declined to comment yesterday, while Borden offered these remarks: "The staff of the cancer center continues to provide exceptional clinical care and conduct cutting-edge research. I look forward to continuing to work with these extraordinary physicians and scientists."
Paul Mark Sandler, a Baltimore attorney retained by Kastor, said he would meet tomorrow with the dean and the hospital chief to try to "resolve all differences amicably."
Intertwined school, system
While one is a not-for-profit hospital and the other is part of the state university system, the medical system and the medical school are inextricably linked. The medical school faculty serves as physicians for the hospital, for which the school receives fees making up one-third of its annual $274 million budget. Grants and contracts for research at the school exceeded $100 million last year.
Academic medical centers like Maryland face a dual squeeze on revenues -- for the past few years, there have been strong pressures to lower the cost of health care payments from insurers and government programs. That dynamic has led to tensions affecting research centers nationwide, including at the Johns Hopkins University.
Surprise at firing
Kastor's firing, announced last week by Wilson and Rapoport, set off shock waves among many faculty members. To some medical professors, the decision to fire Kastor appeared all the more surprising in light of two recent external reviews -- one of the medicine department, and one of the school's primary care efforts. The Sun obtained copies of those reports, each of which independently offered support for Kastor.
Last year, Wilson commissioned a routine review of the Maryland medicine department, which was completed Dec. 12. It was conducted by Dr. Daniel Hollander, former dean of medicine at the University of Kansas, with the chairmen of medicine departments at the University of Colorado in Denver and the University of North Carolina at Chapel Hill.
Kastor requested a separate review of Maryland's primary care efforts, which was provided to the department April 15. That report was done by Dr. Thomas L. Delbanco, the chief of general medicine and primary care at Beth Israel Deaconess Medical Center, a Harvard University-affiliated hospital in Boston.
Rapoport and Wilson dismissed the importance of those written reviews. "There are written reviews and there are verbal reviews," Rapoport said. "They don't always write what they say."
Added Wilson: "It's almost like getting letters of recommendations these days."
Both reviews noted that there was a perception among some administrators that Kastor was not adequately committed to working with UniversityCare, a new clinical enterprise designed to compete for patients, and other market-minded initiatives.
Yet both reports said Kastor appeared to be cooperating with such endeavors, although Delbanco called for greater emphasis on primary care.
In separate telephone interviews, Delbanco and two members of the Hollander panel stood by their previous assessments. "We thought Dr. Kastor was doing a good job," said Dr. P. Frederick Sparling, chairman of medicine at UNC's medical school. "He has a very fine department and it's gotten better under his tenure."
Dr. Robert Schrier, chairman of medicine at Colorado for 21 years, said Wilson hinted he was considering selection of a new medical chairman when the Maryland dean spoke with the Hollander committee in November.
"We didn't really consider that" in the report, Schrier said yesterday. "We wanted to do an evaluation independent of that view." Hollander could not be reached for comment.
Support for changes
But Wilson said the senior management of the medical school and the hospital -- including Dr. David J. Ramsay, president of the University of Maryland at Baltimore, and the hospital board -- backed the changes to ensure the downtown center's financial viability.
And the senior leadership will continue to evaluate leaders and programs at the medical complex for how they affect revenue for patient care: "To the extent that this is threatened, we threaten our very ability to be excellent," Wilson said. "Maryland is no longer a second-tier medical school. We [will not] stay there unless we have flexible money to put towards research and education."
Pub Date: 4/29/97