The doctor with the iron hand

Commanding over the tiled trenches of Harborview Medical Center's emergency room is a doctor who, according to many, has done more for the health of King County residents than any other person.

Michael Copass is a juggernaut in a sweater vest, a man likened to a mix of Albert Schweitzer and Gen. George Patton, with four pagers and a radio strapped to his belt.

He has presided over the state's busiest emergency room for 27 years and helped design Seattle's Medic One system, which became an international model.

Copass fills so many roles that he can frequently seem a one-man majority, observers say, and a few begrudge his sway over the emergency medical and trauma systems.

They worry that his unwavering faith in the county's trauma system, with Harborview at its center, has left little room for debate or dissent about the system's design, even as the area grows and changes.

Copass has a hand in everything, from training medics to coordinating the transport of patients to local hospitals during an emergency, to running a trauma center that sees more than 3,500 patients a year - about two-thirds of King County's trauma patients and nearly all of its most critically injured.

Copass was chairman for four years of the council that helps determine which hospitals in the county can treat trauma patients. He sits on the committee that checks the quality of work at the facilities, including his own. He has taken to the air in helicopters as medical director of the Airlift Northwest service he organized here in 1982.

His deep involvement in most aspects of the system - and his insistence that no one but Harborview should routinely treat the most severe injuries - has created many admirers and a few detractors.

His infamous temper wins few friends. But making friends, he retorts, is not his priority.

A professor of neurology at the University of Washington, Copass grew up in Seattle. He took over Harborview's emergency department in 1973 at age 34. The city had already started a novel paramedic program that would rush aid to people suffering heart attacks. Copass expanded the system to apply to other emergencies, training select firefighters to be the "long arms" of doctors.

He also established a rigorous paramedic-training program that requires roughly 3,000 hours of education. As a result, the program "60 Minutes" once called Seattle the best place in America to have a heart attack.

Copass helped launch Airlift Northwest, which transports patients to Harborview from around Washington, Idaho and Oregon, and from as far away as Alaska and Wyoming. He helped shape the trauma system that cares for people injured in car accidents or falls, by burns, bullets or knives.

"It's hard to speak about him in normal human terms," Tom Gudmestad, the operations-medical-services officer for King County Medic One, once said of Copass.

He is so deeply imbedded in the system that the state carved out an exception for him when the trauma regulations were written. While other medical directors who preside over designated trauma centers must be board-certified in emergency medicine or a relevant specialty, Copass, a neurologist, does not. A clause was added that allowed for a qualified physician who had experience running a top-level trauma center.

Copass' own habits have contributed to his reputation.

He arrives at Harborview by 6 a.m. each day to check records of patients admitted the previous evening. He rarely leaves before 9 p.m. during the week to head home and dine with his wife, Lucy. At 61, Copass works seven days a week. He says he keeps his demanding schedule because "I have a back and two legs."

For as long as anyone can remember, he has worn the same uniform every day: khaki pants, a white oxford shirt, a tie and a button-down sweater, always sleeveless.

His watchfulness is the stuff of legend. His pagers keep him linked to Harborview and Airlift Northwest, and a pager and radiophone tie him to emergencies involving the city's Medic One system. An ER doctor recalled one late night at Harborview when he was ruminating over a victim's treatment with a medic in the field. Out of nowhere Copass' disembodied voice growled: "Give the Valium."

In the ER's radio room, among a bank of beige telephones, sits a single black phone. It is labeled simply "Copass." The medical residents loathe its ring, for when it does there is only one person at the other end. The call is not social.

It is not easy to work under Copass, say those who have done so. He is unforgiving, his temper as mythic as his ubiquity. A former firefighter called him the Bobby Knight of emergency medicine - referring to the volatile Indiana basketball coach - and Copass has described himself as "short, fat and angry."

Even at a near whisper, his voice seems to rumble at the rear. His volcanic criticism, writ large in the hallways and in nose-to-nose encounters, has made medical residents cry and medics tremble.

A red grease pencil is "one of his weapons of choice," Gudmestad said. Sometimes after his merciless critique of a patient's treatment, so vigorously has Copass wielded the pencil that the scribblings resemble blood from an unstaunched wound, Gudmestad said.

"I have a fuse that, as everyone around here knows, is a millimeter long and always lit. It's just barely controlled," Copass conceded. During a recent interview, he stopped speaking suddenly and hammered his fist against the wall five or six times. The offending noise on the other side of the wall stopped immediately.

Copass wears large eyeglasses that magnify an owlish stare. Without a word he can shatter unfired confidence, but he is also a well-spoken man whose dry wit can flash and then vanish again.

Copass has described his temper as his Achilles' heel, but he believes he is not harsh. What he cannot abide is mistakes in medicine, and his old-school fury serves a purpose, many former pupils say.

"If you made a mistake and got your butt chewed out, I guarantee that unless you're not human, you will never, ever forget and make that mistake again," said Dean Brooke, a medic with Bellevue Fire Department for 12 years. An old joke among medics is that they "will run out of ass before Copass runs out of teeth." Though he has heard it before, the phrase makes Copass smile.

He demands that his charges treat Harborview's many poor and luckless patients with respect. He reminds them often that a hospital should treat all without prejudice. Each patient gets a "Mr." or "Ms." before his or her name.

Those who find themselves opposite Copass on an issue, and even those who frequently support him, say he is a formidable opponent. And those who would criticize him are reticent to do so with their names attached, saying they fear repercussions.

"For a lot of people, it's a love-hate relationship" with the man, said Dr. Charles Pilcher, medical director of the emergency room at Evergreen Hospital Medical Center in Kirkland. Although he questions whether the Harborview-centered trauma system supported by Copass has proved worthwhile, Pilcher describes himself as a "great fan" of Copass.

"He's a tenacious guy," added Sanderson Jeghers, former president and chief executive officer of Overlake Hospital Medical Center in Bellevue.

"He knows what he wants and knows how to get it. Like Tiger Woods, he brings the level up for everybody."

Jeghers butted heads with Copass in 1993, when the current trauma system was being designed. Overlake was snubbed in its quest to treat severe trauma injuries.

Copass was able to marshal the resources to fit his vision, Jeghers said. His vision, however, did not include what Overlake thought its community needed. "Where we disagreed was when he said he knew the micro-needs of the community of Bellevue," Jeghers said.

While Copass is confident in Harborview's ability to handle any number and any type of case that comes through the door, a handful of hospital officials wonder if the system should have more backup.

"The question is not if Harborview needs help. It's can the rest of us function appropriately - do we have the resources, do we have enough player experience - to function without Harborview? We talk about that a lot," said Julie Hagglund, a nurse and trauma coordinator for Evergreen and a member of the regional committee that monitors the quality of trauma care systemwide.

Conflict is inevitable when someone tries to put together and manage such a far-reaching program as Copass has, others said.

"I think he's got people that he's bumped up against and sometimes run over, in his mission," Gudmestad said. "But again, that simply goes with the position that he's in."

Copass has not striven to be huggable. "I'm not a part of the good-ol'-boy club," he said. "I do my job: My job is to help people live a better life."

Chris Solomon's phone message number is 206-515-5646. His e-mail address is csolomon@seattletimes.com

Susan Kelleher's phone message number is 206-464-2508. Her e-mail address is skelleher@seattletimes.com