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Transforming a hospital system

It was not an easy birth.

The attending physician, a visionary doctor named Albert Farmer, died in the process.

Turf battles between opposing forces within the old University of Maryland Hospital produced a kind of fight-to-the death struggle that startled professional politicians.

“They were literally fighting over the bodies,” said U.S. Senator Benjamin L. Cardin, then speaker of the House of Delegates. There was no easy agreement on which of the hospital departments would treat which patients, among other disagreements.

Cardin served on a special committee appointed by then-Gov. Harry R. Hughes to help with the privatization of the hospital. Some of the best minds in government and private business were sent to help Dr. Farmer and others transform the failing old hospital.

The result? A vibrant, statewide health provider known as the University of Maryland Hospital System.

In danger of losing what remained of its prestige, the old hospital complex transformed itself into a nonprofit network of 11 academic, community and specialty hospitals with 15,000 employees, $2.1 billion in annual revenue and a Top Ten ranking among the 75 or so operations of its kind.

The system, preparing for a gala 25th birthday fete, includes not only the well-known Shock Trauma but also centers for cardiac care and cancer research, and a service for women and children. It has managed to strengthen its teaching arm and to expand its research efforts without sacrificing patient care.

Giving birth without a handbook

“Heal, teach, discover” has been its motto. “Grow’ might well have been added to the list.

There was little to guide this ambitious remake – little beyond an obvious need for change and the civic impulse that drives men and women to volunteer for sometimes arduous and usually anonymous public service. What they accomplished, no doubt taken for granted today, can be witnessed at the corner of Baltimore and Greene streets just west of downtown. And this is but a part of the new system.

At the time, only one other teaching hospital, Shands in Florida, had ever made the switch from state governance to a privately run entity.

“They were giving birth to something without a handbook,” says Mark L. Wasserman, a vice president for external affairs.

The idea – Dr. Farmer’s daring vision – was to cast off from the state and form a more entrepreneurial institution that could compete for dollars, scientists and doctors in the private marketplace.

Robert A. Chrencik, president and CEO of the system, says in a release:  “Privatization gave us the flexibility to be innovative, the ability to reinvest revenue from operations into patient care, and access to additional sources of funding such as the bond market so that we could revitalize our facilities and technology.”

An enduring contribution

The committee formed by Hughes included Frank Gunther, a businessman who had given much of his adult life to volunteer service of one kind of another; then-Del. Cardin; then-state Sen. Frank Kelly; Judge Allen Schwait, then a Baltimore lawyer; and the late Del. Howard P. Rawlings.

The system they helped create can be described in part by a partial list of its various components: the University of Maryland Medical Center, a 731-bed hospital in downtown Baltimore; the Baltimore-Washington Medical Center in Anne Arundel County; the Chester River Health System in Chestertown; Kernan Hospital in Baltimore; the Shore Health System in Cambridge and the Upper Chesapeake Hospital System in Bel Air and Havre de Grace.

A fundamental chore after the legislative blessing was to change the hospital’s culture, says Dr. Morton I. Rapoport, the system’s first president, who led the organization until 2003. The hospital staff had to embrace the goal of developing a competitive and innovative place, he explained.

Rapoport and others credited his predecessor, Dr. Farmer, as the critical change agent in the hospital.

Farmer was described as “a jewel of a man, intense but decent.” He and Rapoport were neighbors as well as close allies. On the day before the General Assembly passed the privatization bill, Farmer was stricken by a heart attack at his home. A heavy smoker, Farmer died despite the efforts of Rapoport, who had rushed to his aid.

People who contribute their time and vision to the community know they are unlikely to get much credit for their efforts. Rapoport has pointed out that the fates were particularly cruel in Farmer’s case. Even so, his extraordinary contribution to the physical and economic health of the state endures.

C. Fraser Smith is senior news analyst for WYPR-FM. His column appears Fridays in The Daily Record. His e-mail address is