Trauma center: a power struggle between doctors and administrators embroils Mission Hospital--one of the best--and costs its CEO his job.

• Author: Martin, Edward
• Position: COVER STORY

He never hears the sirens or sees the black smoke billowing above the tangled metal. Five days before Christmas, Jeff Brown had been riding beside co-worker Mark Thompson in their heavy Ford construction truck with Asheville's holiday lights sparkling in the distance. Darting down South Tunnel Road with police in pursuit, an SUV had veered the wrong way down the exit ramp onto Interstate 240. It slammed into the truck, killing both drivers instantly.

[ILLUSTRATION OMITTED]

Brown lies motionless as rescuers race flames to free him. Breathing through an emergency tracheotomy, he's rushed two miles to Mission Hospital, where trauma surgeons will remove his ruptured spleen to stem internal bleeding, ventilate his bruised lungs and close the gaping wounds of compound fractures. "They reconstructed my face from my nose to my throat," says Brown, 37, who awakened from a coma four days later. At their home in nearby Skyland, his wife fills in the blanks in his shattered memory, rattling off surgeons' names and their roles. "They saved his life," she says.

His story isn't unique. One of the state's best hospitals, Mission admitted 44,000 patients last year. But there's another tale here, not of miracles but the volatile mix of medicine and money, of independent-minded doctors and strong-willed administrators colliding like the vehicles that nearly took Jeff Brown's life. A yearlong conflict, with skirmishes dating further back, has been waged in cyberspace, country-club locker rooms and amid muffled echoes in hospital hallways. It has wrecked relationships and left deep scars of distrust. Mission is searching for a replacement for its CEO, once a rising star among the nation's hospital executives. His job and possibly his career are among the casualties.

Some of the issues are unique to Asheville, but many are universal, such as the shifting, symbiotic relationship between doctors and the places where they treat their patients. "Certainly, over the next 10 years, a very large number of physicians will become employed by health systems," says Steve Shaber, a health-care lawyer with Poyner Spruill LLP in Raleigh and consultant to the 12,000-member North Carolina Medical Society. "Everybody--physicians, administrators, practice managers, hospital trustees--is desperately trying to get control of health-care costs that are growing at roughly three times inflation."

But more than that fueled this fight. Simmering grudges and perceived slights, not to mention the traditional tension over the balance of power between doctors and administrators in large hospitals, played a part. "Nobody is happy with what has happened here," says William McCann, president of the Buncombe County Medical Society. "Nobody is proud of this. We all wish it hadn't happened. Now we're working to see that it doesn't again." Though he represents about 800 members, as an allergist he has limited dealings with the hospital and was more an observer than a combatant.

But many physicians--more than 700 admit and see patients at Mission and about 90 are employees--see themselves down in the trenches with their profession in peril. "Doctors are feeling very unsettled," a senior hospital administrator admits. "To them, the world as they have known it is totally disappearing." Alan Baumgarten, a family practitioner who is Mission's medical chief of staff, agrees. "Historically, 20 to 25 years ago, physicians were the No. 1 go-to for hospital administrators. They had a much larger say in the management."

Then, most hospitals stood alone, governed by rubber-stamp boards of businessmen and run by CEOs hand in hand with local doctors whose portraits

would hang in the hallways after they died. Hospitals rarely competed. Then health care grew up. Driven by market forces, hospitals merged into networks to negotiate with insurers and increase patient volume to justify expensive equipment. Mission Health System is now North Carolina's eighth-largest. Though dwarfed by the...