In one case, hospital administrators cited his "bullying" of a nurse who said he failed to diagnose a young boy's skull fracture in 1991. Carmona demanded Angie Calvino's resignation after she complained to colleagues about his medical judgment, rather than reporting her concerns to the hospital's confidential peer review committee, court records show.
In a mediated agreement, Calvino agreed to a demotion if Carmona did not report her to the State Nursing Board for not following protocol, according to those familiar with the case. However, court records show that a few months later Carmona did report her, and Calvino remained demoted.
In his court filings, Carmona had his own complaints about the workplace.
Carmona, of Puerto Rican descent, alleged age and racial discrimination against himself and others. He filed a civil rights complaint with the Arizona attorney general's office saying race was used as a factor when his job was eliminated--allegations he later dropped.
Also an ongoing issue between Carmona and the hospital was the status of his board certification for general surgery, which he did not receive until May 1993, eight years after he had finished his residency. Typically, physicians pass the examinations within a year or two.
Individuals who have reviewed Carmona's records say he failed the exam twice before passing it. Carmona responded through administration officials that he passed within the window allowed by board rules.
At one point, legal documents show Carmona sought certification in another field--emergency medicine--but his application failed because of a dispute concerning board guidelines.
In a sworn statement, Carmona said he had worked 5,000 hours as an emergency physician. When the American Board of Emergency Medicine sought to verify those hours with Keith Kaback, the hospital's medical director of emergency services, Kaback replied that Carmona had worked virtually no hours as an emergency physician.
Carmona, through administration officials, said he was encouraged by another hospital official to apply because he had done most of his work as a trauma surgeon in the emergency room. But board officials said, because emergency doctors must treat a wide range of ailments, their guidelines clearly state that doctors who are called to the emergency room for specific cases may not count those hours toward qualification.
HHS spokesman Bill Pierce said Carmona's application had been preliminarily approved until another doctor who had been competitive with him--an apparent reference to Kaback--wrote to the board and complained.
Ultimately, the hospital decided to eliminate Carmona's job in preparation for merging its money-losing trauma program with nearby University Medical Center's. An interoffice memo that predates his July 1993 departure indicates that some University Medical Center officials preferred not to deal with Carmona. But the decision was unpopular with his patients, who rallied in his defense, some comparing him to a saint.
He sued and prevailed on grounds that his contract guaranteed lifetime employment unless he was removed for cause, winning a confidential settlement and a printed public apology. People familiar with the settlement say a media report of a $3.9-million award is "in the ballpark."
Two years later, Carmona was hired as chief executive officer and medical director of Kino Community Hospital in Tucson. There he clashed repeatedly with the hospital's longtime chief of surgery, Eric Ramsay. They fought over staffing and the residency program. Internal memos made available to The Times also show that Carmona chastised Ramsay for maintaining offices that were "dirty and unkempt without the slightest bit of an attempt to tidy" them.
After working under Carmona for a year Ramsay resigned, ending a 37-year association with the hospital.
"Never in my entire medical career have I seen such gross interference by a hospital administrator without the slightest attempt to reach a cooperative understanding," Ramsay said in a letter to Carmona dated March 7, 1996, the day he quit. "Clearly you need a lot of help and instruction in how to manage your current position for which you have had no training or previous experience."
Carmona also battled with home health-care workers over a proposal to cut their hourly wages from $10 to as little as $6 an hour. After the workers complained publicly--noting that Carmona recently had raised the pay of top aides--he issued a warning.
In a memo, Carmona threatened to transfer their work to the private sector if the aides continued "to maliciously and falsely spread rumors ... in hopes of discrediting us and/or destabilizing our organization." The Tucson Weekly printed excerpts from the memo after he threatened to sue them for saying he retaliated against dissidents.