At this time Group Health's Board of Trustees met once, twice, or three times a week, for long hours, often ending up at two o'clock in the morning at downtown Seattle's Blackhawk Tavern. The trustees were highly involved in every aspect of Group Health, a fact not always appreciated by the medical staff.
In January 1952, the board authorized coverage for Longshoremen's dependents, despite the opposition to this by the chief of the medical staff, Dr. John Quinn. The board also contributed to the campaign of Fred Nelson for Renton Hospital Commissioner. (Nelson was a former trustee.)
Such donations to campaigns and causes roused the ire of the doctors. The staff pediatrician, Dr. Sandy MacColl fumed, "Staff puts out a good day's work in the interest of keeping the cost of medical care down and then sees the budget whittled into by numerous auxiliary functions such as the Cascade [Cooperative] League and other things not actually related to medical service" (Crowley, 77).
Additionally, the board pressed the medical staff to hire a "health educator" to further the preventive medicine program, and to implement a "family doctor" program. The medical staff opposed both of these ideas.
A Constitutional Crisis
The structure of Group Health was a recipe for conflict. The organization was actually two cooperatives in one. The self-governing medical staff was responsible for the conduct of its own members and for the delivery of healthcare services. It accepted the authority of the board (and through the board, the members) in matters of overall management and finances.
Conflict accelerated when the medical staff prepared to dismiss Dr. Allan Sachs, chief of surgery. Dr. Sachs was a difficult personality, authoritarian and habitually curt. This and probably not the quality of his work was the main reason the small and overworked medical staff wanted him gone.
Instead of attending a hearing scheduled by the medical staff, Dr. Sachs went to his friends on the board. The board debated what to do. Meanwhile, word of the proposed dismissal spread through the membership, with some members believing that anti-Semitism was an issue (Dr. Sachs was Jew.) The board met on April 5, 1951, resolved to not "give status" to the medical staff's action, and allowed Dr. Sachs to resign, granting him three months severance pay. On this occasion the board rubbed salt into the staff's wounds by reminding it that the current contract was up in fewer than two years. This was the constitutional crisis of a two-headed body.
However the board was not united in overruling the medical staff, which had acted within its legal rights after consulting with Group Health attorney Jack Cluck. On April 30, the board conducted a roll call vote on the Dr. Sachs matter. The vote was evenly split, four to four, with one absence. Thus was an impasse reached. The dispute settled into a kind of trench warfare over the next several months.
The Northrop Case
A similar case was that of the Group Health General Manager, Don Northrop. First the board praised his work, then Chief of Staff Dr. John McNeel resigned from the medical staff with a four-page letter of detailed criticism of Northrop's management. The board investigated the charges, ending with an all day meeting at the end of which the board voted to accept Northrop's resignation.
This produced an explosion on the part of the medical staff. Dr. John Quinn, the new Chief of Staff, faulted trustees for failing to give clearly defined directives to the manager and for trespassing into fields of operation and management. In his view the board's action was "ill-conceived, destructive, and reflecting a grave error in judgment" (Crowley, 82).
The conflict between the medical staff and the Board of Trustees threatened to destroy the organization. Seeing this, board member Paul Goodin took the unprecedented and technically illegal step of inviting three members of the medical staff to sit on the board. They accepted "unanimously and enthusiastically" (Crowley, 82). Northrop's tenure was extended and a Joint Conference Committee of board members and medical staff members was assigned to work out the differences.
The Joint Conference Committee was formalized as a permanent body on October 25, 1952. It became a key structure in Group Health governance, a vehicle that could formulate policies satisfactory to members through their Board of Trustees, and satisfactory to Group Health's idealistic -- and overworked -- medical staff.