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Squaring Off Over Nominee

Senate: As hearings on Bush's pick for surgeon general near, there are many allies and critics.


TUCSON — When Health and Human Services Secretary Tommy G. Thompson first sat down to talk with Richard Carmona about becoming surgeon general, the candidate seemed almost too good to be true.

An up-from-nothing New York City street kid from Harlem. A high school dropout turned decorated Vietnam War veteran turned trauma surgeon. A moonlighting SWAT team member who shot a suspect dead to protect others and dangled from a helicopter in a daring mountain-side rescue.

White House aides touted the father of four, married to his high school sweetheart, as a real-life Indiana Jones.

"You interview this guy, and it's like reading a novel," Thompson told reporters gathered for the White House announcement of Carmona's nomination in March. "I said, 'Are you really real?' And he said, 'Absolutely.' "

But a close look at Carmona's extraordinary career, based on dozens of interviews and hundreds of documents, reveals a more complex answer to that question. With his Senate confirmation hearings set to begin Tuesday, many who know him well, here in his adopted hometown, say they know another side of the man:

An administrator who was forced out of two top management jobs. A boss who had an uncommon rapport with patients but infuriated colleagues. A surgeon who took years to earn board certification. A combination doctor and sheriff's deputy whose exploits were not quite as sensational as the newspaper accounts.

A larger-than-life personality, he has left in his wake many bruised egos and hard feelings. His critics point out that he has benefited at many turns in his life from rules being bent in his favor. He got into medical school without a college degree. He became a sheriff's deputy without taking the examination. He ran a trauma unit for eight years even though he hadn't passed board exams.

But he also made staunch allies. When his job was eliminated as head of Tucson Medical Center's trauma unit in 1993, he sued for breach of contract, eventually winning a multimillion-dollar settlement and a full-page apology in a local newspaper from hospital officials. The judge who mediated the settlement, Larry Fleischman, ended up a good friend. He dismissed controversies that have followed Carmona throughout his two decades here as rooted in envy and jealousy.

"Sometimes the story is that there is no story," said Fleischman, now a lawyer in private practice. "He is the real deal."

A number of Carmona's former co-workers and employees, however, describe a man whose instinct is to escalate hostilities rather than resolve them. When President Bush said at the White House nomination ceremony that Carmona would bring "a strong management background" as head of the 5,600-member corps of public health officers, former colleagues interviewed here say they were stunned.

Concerns about Carmona's professional record led one Tucson doctor to write to Sen. Edward M. Kennedy (D-Mass.), the chairman of the committee reviewing Carmona's nomination.

Charles W. Putnam, a University of Arizona surgery professor who has worked with Carmona, told Kennedy in the letter that he did not want as his surgeon general someone "who was removed from his two previous administrative appointments ... because he could not work in an effective or even a civil manner with health professionals and other constituencies of those positions."

Carmona, on standard White House orders to nominees, has declined interviews before his confirmation hearing.

It is clear that Carmona, 52, had a rocky tenure in Arizona--first as the head of Tucson Medical Center's trauma unit, and later as head of Kino Community Hospital and then the entire Pima County health system.

Carmona has acknowledged in interviews that not everyone likes him. Some former supervisors and colleagues, however, say the conflicts have been more than simple personality clashes.

Tensions between Carmona and others at Tucson Medical Center began soon after he was hired in 1985 to help start the hospital's trauma unit, eventually becoming one of only two hospitals here designated to treat the most severe injuries.

Within a year, Carmona sued the hospital over the terms of his contract. The disagreement was resolved out of court, and Carmona stayed on, earning a reputation that led hospital officials to "strategize" how to deal with "issues with our street fighter," according to a hospital memo.

Several people who clashed with Carmona, contacted for this report, refused to speak on the record, citing Carmona's reputation for suing or threatening to sue people he believed had wronged him.

Court and hospital records show a history of conflicts between Carmona and other doctors, who complained about his lack of cooperation, "high handedness," "unwillingness to communicate" and "his escalation of disagreements in an effort to prove he was right."

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