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 The Doctor Is In-For Now. By Chris Limberis IT WAS IN the depths of Pima County that Dr. Richard Carmona, the czar of the county's health system who has presided over a $14 million loss in the last year, made a surprising offer to his chief political benefactor, Democratic Supervisor Raul Grijalva. In the county's subterranean garage, Carmona told Grijalva--the conduit in the increasingly volatile relationship Carmona has with Sylvia Campoy, who heads the county's health care commission--that he would step down from his $190,500-a-year job. There, near the county's bottom, 12 floors beneath the perch that Grijalva has held for 11 years, Carmona says he told Grijalva: "If you tell me 'Rich, it's time to go,' I'm willing to. I'll go. There's no problem. There's no fight. There's no lawsuit. I'll just go away. I can go do something else. But he said, 'No. I want you to stay. We need you.' "
Last year, Carmona turned down a job as executive vice president
of a He says he continues to receive other offers in Tucson as well as from both coasts. Reports of the job with the UA and UMC came as Carmona's high-pitch, high-profile battle with Health Commission Chairwoman Campoy reached full force in the last two weeks. Thorny at best over the last several months over budget and management issues, the feud erupted last month when Campoy forwarded to the County Attorney's Office allegations about a Kino doctor writing bogus prescriptions. Carmona was furious that Campoy, whose Health Care Commission is purely advisory to the Board of Supervisors, did not discuss the issue with him first. The matter ended up in The Arizona Daily Star. He says Campoy's move stripped the doctor, the popular Kino internist Dr. Charles Blanck, of his rights to due process and privacy. Blanck had reported substance abuse problems to the state Board of Medical Examiners in 1997 and has been in a post-care monitoring program for alcoholism. Blanck also is Grijalva's personal physician. Carmona says the repeated battles have taken a toll. "There's a lot of distractions," Carmona says. "There is, you know, divisiveness that takes me away from things I should be doing. I definitely need more time for planning and prospective things. And instead I am thrust into a reactive mode where I have to be put on the defensive. "I'm doing my best. I want to stay because I've made the commitment here, but, on the other hand, reality prevails. If it's not working out for one reason or another I have to consider that in the future," he adds. Critics, including some on the commission, contend that it is Carmona's bundle of other activities like the SWAT team, the EMT service, the student health service and the lecture circuit, that cause the overcrowded schedule for the county's top doc.
"Does it not make the organization more credible that I publish articles, that I'm known nationally for what I do, that I'm called upon as a resource by professional organizations?" Carmona asks in his rapid defense. "I would argue that that's where your leadership should be. That of prominence." Meanwhile, Kino and the system are buried under debt topping $40 million. The system lost more than $1 million a month in the last year. Carmona claims he has streamlined administration and battled a 50-year-old culture of bureaucracy to make cuts. But while a few positions were consolidated in his top administrations, those left got hefty pay raises, a fact that looked particularly bad last year when he was cutting back home health workers. Grijalva stood by Carmona through all that. And, according to Carmona, the supervisor is still with him. Replaying his conversations with Grijalva, Carmona says: "I've said to him that I don't want to be the source of divisiveness. I don't want to be the source of the morale decreasing and if you feel it's time for me to move on, I'm happy to move on. OK? And there are no hard feelings. I mean I've done good, I think. You know we've hit an impasse. Maybe it's time to bring somebody else in. And I'm willing to recognize that. 'No,' he said. 'Absolutely not. I want you to stay.... I think we can get by this. I think you and Sylvia can solve your problems and I think we need to hold the course. It's not the time to change leadership.' " Grijalva disputes that he has urged Carmona to stay. "I've said that it's not my call," Grijalva says. "And the reason I've said that it's not my call is because I don't want to be part of the lawsuit, which is where this is going. It's not my call. I don't want to be the one who 'pressured' him to resign." Carmona, a former trauma surgeon at Tucson Medical Center whose 3-year-old position at the county grew from Kino Community Hospital administrator to chief of the entire, $245-million-a-year county health system, says he continued to press Grijalva. And Carmona says that he "understands" that Grijalva may quickly reverse positions. "I am aware of that. And I don't want to sound Polyannish. Yo no soy pendejo," Carmona says. "I understand exactly that. But I take the man's word at face value. At least for what he tells me." Not all of Carmona's time at Tucson Medical Center was pleasant. Nor was his departure. His lawsuit ended with a settlement in which he received several million dollars. Grijalva has said that Carmona is laying the groundwork for a lawsuit, but Carmona denies that. "Let me set the record straight on that. There is no intent," Carmona says. "Now, I'm not telling you that if I'm harmed that I won't. But I have no reason now. I don't want to." Instead, Carmona says he has sought mediation with Campoy. Grijalva, with connections to all parties, is a logical facilitator. "Let me just say, I've not asked him, I've begged him to intercede," Carmona says. "To set up a meeting and facilitate it. Or I've said, 'Let's get a third party who has nothing to do with any of us politically or in the health system that just has a vested interest in seeing it resolved. And let's just sit down and draw up the checklist and say how can we live together. What do we need to do?' I am 100 percent committed to doing that." Carmona entered the county health care bureaucracy under a previous Board of Supervisors, headed by Ed Moore and his Republican majority that included Mike Boyd and Paul Marsh. Boyd was Carmona's champion. Moore didn't support Carmona, but he and Carmona held regular discussions. And Grijalva and Democrat Dan Eckstrom, a strong backer of Kino and southside health services, were not necessarily cheerleading. Grijalva emerged as Carmona's point man, at least until Carmona's recent clashes with Campoy. And Carmona says he knows full well where he stands. "Well there's no question in my mind that when it comes to the question of the sword and if Raul is going to fall on hers or mine, I'm dead. There's no doubt in my mind," Carmona says. "He clearly has an allegiance to Sylvia. He's going to protect her. That's his track record for years. On the school board, everybody's told me about it, that every time that she's fallen he's been there to pick her up. When she got bounced from the school board, he found her a job in the health commission; he's got her a job with the city. I mean, he's her protector for whatever reason. So I'm not foolish. I understand what that means. But on the other hand, am I going to prostitute myself to keep the vote of a supervisor who I have had an excellent relationship with? I've told him what I feel is true." Despite his precarious position with Grijalva, there is no real drive to dump Carmona. Boyd has remained a supporter, although the recent controversies have caused him to question the county's continued wide role in health care delivery. Republican Ray Carroll says he "trusts" Carmona, though both deny their relationship is as cozy as Campoy recently said it was.
"I've done far more for Raul Grijalva and Dan Eckstrom than
I've done for Ray Carroll, simply because they have asked me to
be involved in their projects," Carmona says.
Of his relationship with Eckstrom, Carmona says: "You know, Dan's a funny guy. You just can't tell every day. When he wants me he calls. I respond. Usually he wants information. Occasionally he's asked me to participate in a community program. We've done surveys for him on the southside and other parts of the district. It's just that Dan's personality is such that you never get close to him. And that's just the way he is. I respect him. He works hard for his constituents. And when he needs me, I'm there." That leaves Democrat Sharon Bronson, the Board's current chairwoman. She has a deep and well-known dislike for Carmona. "Why do I stay?" Carmona asks. "I feel that there's still some unfinished business. You know, I grew up in an area like this. I was poor. I come from a Hispanic family and I just feel an allegiance to the population. Like there's still some unfinished business. Public health things. Prevention. Wellness. Primary care stuff. There's a lot of people that need care. So I have this commitment. But at some point, you know we hit the crossroad and maybe it is time to move." Carmona says he would expect the Board to honor clauses in his contract for 30-day notice and the $75,000 severance.
"Oh, for sure. But that's a business deal," Carmona
says. "Why should they renege on it?"
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Carmona is in discussions with officials from the University
of Arizona College of Medicine for a full-time position. He already
has faculty appointments in surgery, public health, and family
and community medicine and treats patients at the student clinic
during the school year.
When the Blanck issue blew open, for example, Carmona was somewhere
in New Mexico giving a lecture. Earlier this year, health care
commission members were not pleased that Carmona was out of state
during a couple meetings.
Eckstrom inherited his southside District 2 seat in 1988 from
Sam Lena, the Democrat who was the true patron saint of the county's
indigent health system and Kino Community Hospital. He has not
had any sharp confrontations with Carmona.
