If hospital administrators can't remove clinical department chairs, how can they turn around a hospital that needs to head in a new direction?
That's the question trustees and administrators have been asking themselves at Truman Medical Center in Kansas City, Mo., since a local judge ruled earlier this month that Truman's former chief executive officer, E. Ratcliffe "Andy" Anderson, did not have authority to remove three department heads in 1997.
Jackson County (Mo.) Circuit Court Judge John Moran said that Truman, the two-hospital, 327-bed public facility in Jackson County, violated the due process of three physicians on its staff when it tried to dump them as department chairmen. Before the hospital could carry out the changes, the doctors obtained a restraining order.
Martin Goldman, M.D., chief of radiology; Stephen Hamburger, M.D., chairman of internal medicine; and Peter Kragel, M.D., chairman of pathology, sued Truman, alleging the CEO retaliated against them because the doctors had signed a letter urging his removal as hospital administrator and dean of its affiliated medical school.
Anderson later became executive vice president of the American Medical Association, where he made headlines in January by firing the longtime editor of the Journal of the American Medical Association, George Lundberg, M.D.
John Bluford, Truman's CEO since March 1, said the judge's ruling was a great disappointment to the hospital and raised serious governance questions. "Can any board of directors release a department chair, a clinical chief, of administrative responsibilities for no cause? Once you get through all the personalities in this case, that's the issue.
"This judge, by my reading, is saying, 'No, you can't. You've got to show cause.' If that's the case, we need to look at our bylaws and clarify any ambiguities that led to this decision."
Bluford said the hospital hasn't decided whether to appeal the decision.
Anderson was traveling abroad on AMA business and was not available for comment.
Anderson's tenure at Truman was brief but eventful. His appointment as executive director was announced in August 1996. At the same time, he was named dean of the University of Missouri-Kansas City School of Medicine, which shares a building with the hospital. Medical students and faculty make up Truman's clinical staff.
Anderson, the former surgeon general of the Air Force and a fighter pilot during the Vietnam War, succeeded James Mongan, M.D., who became president of Massachusetts General Hospital in Boston.
Truman serves the indigent population of Kansas City. Most of its reimbursements come from Medicaid or Medicare, with help from disproportionate-share payments and local taxes.
Anderson walked into a hornet's nest at Truman. The hospital was unprepared to compete in the age of Medicaid managed-care, which the state of Missouri was then introducing. And the medical school was on the verge of losing its accreditation from the Liaison Committee for Medical Education. The committee had been quietly warning for years that University of Missouri-Kansas City medical students were not getting proper instruction in biological sciences, and the university failed to correct the deficiencies.
Anderson tried to rectify those problems, but university authorities and physicians on staff resisted the changes, sources in Kansas City said.
On Nov. 6, 1997, the chancellor of the university, Eleanor Schwartz, fired Anderson as medical school dean, provoking a unanimous resolution of protest by the Truman board.
Anderson left Truman for the AMA in August 1998. It was Anderson's willingness to stand up and take the heat that appealed to the AMA when it went looking for a new executive vice president after the Sunbeam Corp. endorsement fiasco, AMA trustees said at the time.
E.J. Holland Jr., a healthcare lawyer and Truman board member for 25 years, said that he hadn't read Moran's decision but that he took issue with its findings.
Holland, who is now vice president for employee benefits at Sprint, the telecommunications giant, was formerly an employment lawyer representing hospitals. "My understanding is hospital administrators and boards have the authority to remove department chairs at will and for no cause.
"That is how the hospital's board viewed it, it's how Anderson viewed it, it's how I viewed it," he said. "A good plaintiff's lawyer would try to muddy this with a lot of extraneous things such as due process and other employment-law-related issues. This is not about employment law. This is about governance."
Holland said there was never any effort to terminate the physicians' employment. "All they wanted to do was remove them as department chair. It was simply about relieving them of their administrative duties."
The three physicians filed their lawsuit in December 1997, before the hospital's executive committee had even decided the issue, Holland said. The restraining order prohibited the executive committee from proceeding.
Plaintiffs Hamburger and Kragel have already settled and left Truman, Bluford said. Terms of the settlements weren't available. Goldman's employment with the medical school ends at the end of April.
Whether Truman decides to appeal the decision, the issue is irrelevant. The three doctors and the administrator who tried to fire them are gone or leaving.