Truman Medical Center acted illegally when it sought to oust a department chair without affording him a hearing, a judge ruled last week.

Jackson County Circuit Judge John Moran found that the hospital denied due process to Dr. Martin Goldman, the head of Truman's radiology department, when it sought to remove him in December 1997.

The action was initiated by E. Ratcliffe Anderson Jr., the former director of Truman Medical Center and now the head of the American Medical Association, after Goldman sought Anderson's ouster in 1997.

Moran's ruling marks the second time this year Anderson has found himself embroiled in controversy. The ex-fighter pilot and former Air Force surgeon general drew flak in January when he fired the longtime editor of the Journal of the American Medical Association.

For Goldman, who recently accepted a position as chairman of the radiology department at Creighton University's medical school in Omaha, Neb., Moran's ruling is moot. But the ruling, with its strong endorsement of due process protections for hospital physicians, promises to reverberate through the medical community, which monitored it closely. Among the most forceful advocates of such protections for hospital physicians has been the AMA itself, which has long pushed for greater physician autonomy in the hospital setting.

"Now we have case law that establishes forever that all the doctors on Truman's medical-dental staff are entitled to due process," said Lisa Gentleman, a lawyer for Goldman with Welch Martin Albano & Manners.

`Destruction and chaos'

Goldman, reached at his home in Kansas City this week, was unsparing in his criticism of Truman, Kansas City's hospital for the indigent, and Anderson, whom he said "had created a lot of destruction and chaos" at the hospital.

Anderson was named dean of the University of Missouri-Kansas City Medical School and executive director of Truman, the medical school's teaching hospital, in November 1996. He was removed as dean of the medical school in November 1997 and left Truman to join the AMA in June 1998.

"I think the medical center is at least a few years behind now," Goldman said. "They spent one-and-a-half years trying to remove three department chairmen and spent an enormous amount of energy and public money trying to do so. And for no reason. We were all trying to make the center stronger."

A spokeswoman for the AMA said Anderson would have no comment on Moran's ruling.

Truman's new CEO and executive director, John Bluford, said the hospital would examine its bylaws in the wake of the ruling to see if they need to be amended.

"The only spin I can put on the ruling suggests to me that, according to our bylaws, we can't release a physician from administrative responsibilities for no cause," Moran said.

Moran's 17-page decision concerned Anderson's attempt to remove Goldman and two other department chairs at Truman, Peter Kragel of the pathology department and Stephen Hamburger of the internal medicine department. The three were among five physicians who called for Anderson's removal in October 1997 after problems at Truman and the medical school continued to fester under Anderson's watch.

On Dec. 22, 1997, the three sought, and were granted, a temporary restraining order barring Truman from dismissing them. A trial on whether to make the order permanent commenced last February.

Kragel and Hamburger reached confidential settlements with Truman during the trial. Goldman's case proceeded, and last week Moran found that Truman failed to afford him due process and acted without good cause.

In his findings of fact, Moran said there was substantial evidence that during Anderson's tenure the hospital's medical records department "was in crisis because inadequate resources were being devoted to filing of loose records." Moran cited testimony by the department's head "that were over 31 1/2 feet of loose filings in December 1997."

"Dr. Anderson failed to provide proper leadership in the Medical School at the time of an LCME (Liaison Committee on Medical Education) review in the spring of 1997 for which reason the Medical School was in danger of being placed on probation," Moran wrote. "The consequence of such probation would be disastrous to the future of the Medical School."

After Anderson moved against Goldman, Hamburger and Kragel, he was asked to explain his actions at a meeting of the executive committee of Truman's board in December 1997. Anderson "stood mute," according to Moran's opinion.

Nonetheless, the committee voted to initiate dismissal proceedings against the three. The vote flew in the face of overwhelming votes to retain them by both the medical-dental staff's executive committee and the professional standards committee.

Moran found that Truman's bylaws require that members of the medical staff be given a fair hearing at which they are apprised of charges against them and given a chance to respond.

Moran said the right derived from the standards of the Joint Commission on Accreditation of Health Care Organizations, the ethical standards of the American Medical Association and the Missouri Department of Health Regulations.

No lack of controversy

Moran's decision is the second setback for Truman recently. Last month, it agreed to pay $242,500 to settle federal settle civil fraud allegations. The federal government charged that Truman and Hospital Hill Health Services Corp., Truman's physician services organization, submitted inaccurately coded reimbursement claims for electrocardiogram services between 1994 and 1996.

Anderson, meanwhile, continues to stir up controversy. In January, he enraged many AMA members when he fired George Lundberg, the editor of the Journal of the American Medical Association for 17 years and widely regarded as the force behind the journal's rise to scientific preeminence. Anderson said the immediate cause was Lundberg's decision to run a paper reporting that many Midwestern college students surveyed eight years earlier did not consider oral sex to be "having sex."

Anderson said Lundberg had published the article for political reasons. The article coincided with President Clinton's impeachment trial.