OP-EDS

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July 12, 2002

The cowboy surgeon general

Dr. Richard Carmona is a trauma surgeon who took eight years to gain board certification after failing the exam twice. Dr. Carmona is also President Bush's nominee for Surgeon General.

One might imagine that, when he was a four-year-old, Richard Carmona had a bad day and his well-meaning preschool teacher told a tearful Mrs. Carmona that "[Richey] . . . just doesn't play well with others," citing repeated incidents of block-throwing and refusal to participate in naptime."

After all, according to the AP, a colleague at the University of Arizona, Dr. Charles W. Putnam, "charged in a letter that Carmona is unfit for the job of Surgeon General due to his lack of experience in health policy and 'concerns about character issues,' including an inability to work 'in an effective or even a civil manner; with others."

So he's not the friendliest. So he's maybe a little socially, er, challenged, you say. So was Albert Einstein, from all reports. Surely nobody will claim that his lack of certain interpersonal skills detracts from his intellectual prowess. So why can't we have a Surgeon General with a brusque demeanor? What's wrong with a Surgeon General, upon learning of his nomination, says, "It is as if the fairy godmother reached out and touched me and cast me in the best Disney movie ever made"?

I don't care if the prime spokesman for public health is the rudest or most flippant man alive. I worry about his repeated failed attempts at certification. I worry that the same colleague who raised questions of Carmona's character also suggested that Carmona lacks the proper experience for the job. Furthermore, I worry about Carmona's attitude, which his detractors classify as a "cowboy" mentality.

Carmona served as a Green Beret in Vietnam, an experience which supporters say exemplifies his dedication to public service, and continues to serve as a deputy sheriff. In 1999, according to the AP, he intervened in a roadside altercation and returned fire after one of the combatants shot at him. The Bush administration contends that he then attempted to treat the man, who, as was later discovered, was a mentally ill murder suspect; a police interview indicates that Dr. Carmona returned to his car to reload his gun instead.

I won't take the position that, as a doctor, Carmona should have recognized signs of mental illness. As a trauma surgeon, Carmona would have had little need for knowledge about mental illness. But surely he should have recognized signs of humanity. If another option was available (such as returning to his car!), Dr. Carmona was violating the Hippocratic oath by shooting; this oath, which one swears upon becoming a doctor, includes the sentence: "I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm." His violation of those words has led some of his detractors to brand him a "cowboy."

But didn't cowboys have ethics? I thought cowboys always kept their word. Maybe I've seen too many John Wayne movies.

Cowboy or respected medical professional, either way, Carmona is one of a very few doctors unwilling to take the stance that guns are a menace to public health. Such a stance worries other medical professionals, who contend that such a position is irresponsible and dangerous.

His plans, should he be confirmed, are unspecific. He worries about major issues of public health, including AIDS, the nursing shortage, smoking, and obesity, but proposed no specific plans for dealing with any of these issues during Senate confirmation hearings. He also told the Senate Health, Education, Labor, and Pensions Committee that he plans to help prepare the public for future bioterrorism attacks, contrary to President Bush's orders to Congress to shift bioterrorism issues to Homeland Security from Health and Human Services.

Before I continue, I should confess: I disagree almost entirely with the politics of nearly every member of the Bush administration. Ashcroft's nomination terrified me, because of my feelings about his politics, but I have never claimed that he lacked the skills and knowledge to perform his job. I know nothing of Carmona's politics. What I fear in his impending appointment is not simply his beliefs, of which I know nothing, but his utter unfitness for the job of Surgeon General.

It took him eight years and three attempts to gain board certification. He interprets the Hippocratic oath in a way most doctors would consider irresponsible at best; at worst, they would claim that his job as deputy sheriff is in direct contrast with his job as a doctor.