Dr. Stanford Roman, medical director of D.C. General Hospital for 2 1/2 years, is resigning at the end of the month in bitterness and frustration over the slow pace of improving medicine at the city's only public hospital. He becomes the sixth high-ranking city health official to resign since August.
Roman cited a chaotic financial system, budget cuts, a lack of strong advocacy for the hospital from its own governing commissioners and widespread public apathy about the hospital's future as reasons for his departure.
Roman, 38, will become an assistant dean of Dartmouth College's medical school, a job that he said was made even more attractive by the difficulties he faced in Washington.
Roman's departure at a time when the long-criticized hospital has just begun to make recognized improvements leaves the city government with the prospect of recruiting a replacement during a time of an alarming trend in city government.
Roman is one of 1,800 city employes to resign for various reasons since June, 239 of whom worked in the city's Department of Human Services, which administers many of Washington's health programs for the poor.
The financially strapped city government must attract and maintain top professionals in the face of budget cutbacks limiting pay increases and benefits and a requirement that most new city employes live in Washington where housing costs are among the highest in the area.
Nevertheless, Gilbert Hahn Jr., the D.C. Hospital Commission chairman, said the hospital will attract an equally talented medical director. "We'll be sorry to let him go," Hahn said."But I'm sure we'll get another good man for the job -- or woman."
Robert Johnson, executive director of the hospital, said however, "It's generally a long process to recruit and find a medical director. We were searching for a year before he was selected."
Roman said the limited benefits and relatively low salary, $50,116, might make the search more difficult.
D.C. General holds a special place in the city's history, having served as doctor, nurse and druggist for Washington's working and unemployed poor for more than a half-century.
With the coming of high technology medicine, however, the aging hospital was unable to maintain quality medical care equal to other city hospitals. In the 1970s, its ailing condition caused a public controversy that led to efforts to improve care and expand the hospital's impact into the neighborhoods of those who for generations had relied on D.C. General for whatever care they received.
As cheif medical officer of the sprawling 557-bed hospital, Roman led the battle to upgrade it. He drastically improved outpatient care and lagging staff morale, hospital doctors and administrators said.
They credit him with cutting in half waiting time in the city's busiest emergency room, recruiting experienced and dedicated doctors and bringing outside research funds to the hospital for the first time.
During his stay, D.C. General also regained the accreditation it lost in 1975, when the hospital was embroiled in a lawsuit regarding the poor quality of its care.
Although these achievements have won Roman the praise of the hospital's 11-member governing commission, his parting comments about D.C. General's future and its commissioners are critical.
"I found myself getting bitter about the hospital," Roman said. "I found the hospital making major strides, but it doesn't have a constituency. It doesn't have people fighting for it. I think there's a complacency all around; there seems to be a fear of standing up for what you believe.
"I planned to stay maybe three or four years, to do some things I could do to help the inistitution," he says. "But the level of intensity of the things that need to be changed at D.C. General can make you tired, I mean exhausted."
So Roman is leaving because of the depth of the very problems he was hired to solve. The massive 65-acre hospital campus, planted near RFK Stadium between the old and new D.C. jails, treated an estimated 200,000 cases last year, between 250 and 300 a day in the emergency room alone. Seventy-one percent of its patients come from the impoverished far Northeast and Southeast communities, one-third of them without any insurance or other means of payment.
Despite its crucial role in serving the poor, the hospital has been plagued by overcrowding, understaffing, inadequate equipment, and loss of experienced personnel to better salaried positions.
Roman says he has been increasingly disheartened by weak leadership in the city's health community. He compares D.C. General's supporters unfavorably to those of New York's Harlem Hospital, where he worked for six years, and Boston's city hospital, which he left in 1978.
"It's not like New York or Boston, where you have everybody from the elevator operator to the executive director fighting for the hospital, and people out there in the community fighting for the hospital.
"It's called chutzpah. If you ask folks where they work they'll say Harlem Hospital; the fact that they get a paycheck from the City of New York doesn't mean a damn thing. They're not afraid to take an adversarial relationship to City Hall."
Although Roman wins high praise for the job he has done, some hospital commissioners have disagreed with his criticism. For instance, commissioner James L. Hudson, a lawyer, said, "I think the government is responsive, but I think all public institutions are under budgetary constraints and the hospitals aren't exempt."
Yet, budget tightening has led to troubles for D.C. General. For instance, city budget cuts in October trimmed the city-run disease prevention, venereal disease and tuberculosis clinics, sending even more patients to D.C. General. Moreover, the city's chaotic financial system sometimes has failed to pay the hospital's suppliers on time, Roman said.
"Last month we ran out of hepatitis serum and had to borrow from another hospital," the result of a payment mixup, Roman said. "When a hospital runs out of medicine, it isn't the same as running out of paper clips.
"One of the problems is that a clerk can literally move from being a clerk in the Department of Labor to being a clerk at D.C. General Hospital without ever asking the question, What's different about working in a hospital?'" Roman said.
"He's done a terrific job with the hospital," said commission member Natalie Spingarn, echoing the sentiment of others on the 11-member D.C. General Hospital Commission set up to run the institution since the hospital lost its accreditation in 1975.