Despite his problems at Kino, Carmona was promoted in 1997 to oversee the entire Pima County health system, but within two years, he had lost the confidence of county health commissioners. In the year before Carmona's negotiated resignation in July 1999, the financially strapped public hospital, which serves a largely indigent population, was running a monthly deficit of more than $1 million.
Carmona and "his top management team were simply not prepared to do what needed to be done," said Joel Meister, then a member of the Pima County Health Commission.
Carmona's supporters, however, said he was unfairly blamed for a long-troubled system.
His final battle there came in a dispute in May 1999 with county health commissioner Sylvia Campoy, who had reported to the county attorney allegations that a Kino doctor with a drug abuse problem had written false prescriptions to access drugs.Carmona had already dealt with the doctor on the issue two years before, and after an internal investigation, encouraged the doctor to report himself to the Board of Medical Examiners.
After Campoy reported the allegations, Carmona became irate, saying she had violated the accused doctor's confidentiality, an opinion shared by the Kino Community Hospital board and the Pima County Medical Society.
"What I got from Dr. Carmona [after reporting the case] was antagonism and ... threats," Campoy later told an investigator from the Arizona Department of Public Safety's prescription fraud unit, according to a state Board of Medical Examiners document obtained through Arizona's public records law. "I was screamed at, I was yelled at. I was told it was none of my business. I was told that I had breached peer review."Throughout the turmoil at his day jobs, Carmona served another highly public role as a part-time SWAT surgeon--a job that added tales of heroism to his resume, but was not without controversy.
Carmona joined as a volunteer in 1987. Four years later, Pima County Sheriff Clarence Dupnik requested and received a waiver from the Arizona Law Enforcement Officer Advisory Council allowing Carmona to become a commissioned deputy without taking the proficiency examination normally required of those who did not attend an academy.
Dupnik, council officials said, successfully argued that Carmona's role would be primarily medical: on hand to provide top-flight care "should an officer, suspect or victim sustain an injury."
But in several high-profile cases--before the waiver was granted and after the fact--Carmona acted exclusively as an armed law enforcement officer.
At the scene of a SWAT standoff with a suicidal man in 1988, Carmona and another deputy were the first to rush the man after he was shot by a police sharpshooter. Carmona ended up with a bullet in his leg.
In interviews he granted from his hospital bed the next day, Carmona corrected reporters who thought he had rushed in to give the man medical help. "Everyone thinks I was there as a doctor, but that's not the case," he told the Tucson Citizen.
The bullet apparently came from the suspect's gun, after he was dead and while Carmona and another deputy were disarming him. No blame was ever assigned in the shooting, and the sheriff awarded Carmona a citation--listed as a "Purple Heart" on his resume.
His most dramatic and attention-getting moment came in a 1999 shootout at a busy intersection in which he killed an armed motorist.
When Carmona was nominated for the surgeon general post, newspapers from coast to coast, including The Times, repeated an account of Carmona's actions at the scene originally published in the Arizona Daily Star.
Carmona, who was off duty, happened upon the scene of a minor car accident that quickly got out of hand. While going to assist one of the victims, the gathering crowd warned him that the man was armed. After a brief standoff, he shot the man.
According to the Daily Star, Carmona worked frantically--but unsuccessfully--to save the man's life.
The story seemed to distill Carmona's uncanny ability to serve the disparate roles of doctor and cop. But it wasn't true.
Carmona, in a transcript of his police interview at the scene, said that, immediately after the man dropped, he went to his car to reload his service revolver. He made it clear that he "never got close" to the man and continued to train his weapon on him "even though he wasn't moving."
No one in Tucson has suggested that Carmona had anything to do with the erroneous story. However, the published account assuaged concern within the local medical community about a doctor taking a life. And after his nomination was announced, the story also was used as evidence of Carmona's fitness for the job by a number of editorials in prominent newspapers.