Trustees at the Martha's Vineyard Hospital scrambled to contain the damage this week in the aftermath of last week's announcement by a respected Vineyard surgeon that he will sever his contract with the hospital.

Richard Koehler, a highly skilled laparoscopic surgeon who has been something of a medical superstar on the Island for the last seven years, said last week that his decision to leave was rooted in irreconcilable differences with hospital chief executive officer Kevin Burchill. Mr. Burchill responded bluntly that Dr. Koehler could be replaced. Hospital trustees were silent.

The standoff between the tough-talking CEO and the proud surgeon bubbled into the Vineyard community like lava, and this week the letters to the editor began pouring in. Virtually all of them were in support of Dr. Koehler.

The fallout got even worse when it was revealed late yesterday that Oak Bluffs police chief Joseph Carter had resigned as a member of the board of trustees.

"It's sort of hypocritical for me to stay on the board when you consider what I am supposed to stand for and vote for. It's a tough issue and I can't do it alone," said Chief Carter yesterday afternoon. He said his resignation stems partly from conflicts with his own time commitments on the weekends, but also from the current crisis at the hospital. "This is about the amount of time I have to give coupled with the personal struggle over how people see me and my role in the community and how this situation is being handled. I wish I could wave a magic wand, but it's really clear that it has reached a level of tension that is intolerable for this community. We're a small Island and in large part this is about people getting along - and this is not a very good example for us to read. It must end and it must end quickly," he said.

At a press conference on Tuesday morning, six days after Dr. Koehler's announcement, hospital trustees finally spoke.

"I think there is this perception that somehow the board is detached, but that is not so," said Sandy (Earle) Ray, the treasurer of the hospital board.

"This is as an involved a board as you are going to find. . . . We do have our internal problems to some extent, but my feeling is that all this will get resolved," said hospital board chairman Fred B. Morgan Jr.

"We are here to talk about the big picture in the community; there is a perception that things are coming apart, but the sense that we have is that the opposite is true," said Tim Sweet, who is the board secretary.

The press conference was held at the Farm Neck golf club, where Mr. Sweet is the manager. Mr. Burchill was not present.

In an open letter to the Vineyard community last week, Dr. Koehler announced that he would invoke a voluntary six-month termination clause in his contract with the hospital, ending his work there on July 8. Dr. Koehler's wife, Kathleen Koehler, is also a physician on the Vineyard with a private practice in gastroenterology. She is not employed by the hospital.

On Tuesday the three hospital trustees gave their own version of events at the Vineyard hospital. All three said the hospital is on better footing now than it has been in many years, and they credited Mr. Burchill for most of the work.

"We are no longer concerned about the hospital being a failure, and when Kevin came in here we had decided that we needed a CEO who could stand up to various factions and do what needed to be done. And certainly this CEO has accomplished many things," said Mr. Morgan.

The three trustees said they had continued confidence in Mr. Burchill and his ability to guide the Vineyard's only hospital into the future. They admitted there is a problem at times with Mr. Burchill's style, but they also said Mr. Burchill was handed a difficult job.

"There are some tough decisions that have had to be made," said Mr. Ray.

"He needs to ask people who are already working harder than they should to make do with less, and that is a really hard position to be in," said Mr. Sweet. He continued: "But this isn't about the the unraveling of things at the hospital, this is a bump in the road, and we are going to have more bumps. But people should not misinterpret these bumps as disasters."

Mr. Sweet directed brief remarks to the current bump in the road with Dr. Koehler.

"We won't address the individual issues with the public, that wouldn't be fair," he began, adding: "I think Kevin and Richard Koehler are equally caring and passionate about what they do, so there is going to be conflict - and I think Richard's concerns have brought all this to a head. There is no question that he is a skilled and respected surgeon who has contributed enormously to the hospital, and no one questions that value. Kevin Burchill is a man who uprooted his wife and two kids to come to Martha's Vineyard, and he has had to say no on a daily basis where previously yes was the answer."

Mr. Sweet also said: "Kevin has been characterized as blunt and I don't think that's unfair - I would add passionate. Does his passion bubble over? Well, when he goes to his next career I don't think posting to the diplomatic corps will be in the offing."

He concluded: "The practice of medicine and the business of medicine are no longer complementary, they are adversarial. But unfortunately what has happened today is some of these issues have become personal, and that is regretful."

The trustees also spoke to the recent contract dispute between Mr. Burchill and the nurses, a dispute which bubbled into the Vineyard community two months ago when Mr. Burchill went public with it.

The dispute is now in federal mediation and is still unresolved - and hospital nurses are working without a contract. But trustees said yesterday that they are now confident that there will be a positive resolution.

"It's change and it's hard and no one is comfortable with changing - but we all recognize the value of the nurses - the hospital is no better than the quality of the nurses and we all understand that. We are open-minded about the course that needs to be taken here," Mr. Sweet said.

Trustees also flatly countered any notion that the dispute between Dr. Koehler and the hospital will turn into a legal dispute. The trustees released two short statements issued by Dr. Koehler and Mr. Burchill which essentially confirmed that there is no legal dispute.

The statements were reportedly the result of a Monday meeting between Mr. Burchill and Dr. Koehler.

"The issue of an impending legal action against me by the Martha's Vineyard Hospital was of grave concern to me and to my family. After discussions last night with Kevin Burchill, I can report that this is not the case, although there are serious issues that remain to be resolved between us regarding the future of our relationship," wrote Dr. Koehler in his statement.

"There is no pending legal action by Martha's Vineyard Hospital against Dr. Richard Koehler. We are both satisfied, based upon our discussion last night, that there is a basis for moving forward and a mutual understanding of the concerns that need to be addressed," wrote Mr. Burchill in his statement.

"There has never been any pending or impending legal action contemplated by this institution against Richard Koehler - that is simply not true," said Mr. Sweet.

Trustees had no other details about the meeting between Mr. Burchill and Dr. Koehler, and they could not say whether the statements signal the possibility that Dr. Koehler may reverse his decision to leave.

Discord is not a new theme at the Vineyard hospital, which has been buffeted by problems over the years, much of it rooted in perennial financial troubles, poor relations with the Vineyard community and poor decision-making by boards and managers. The darkest chapter came about four years ago when the hospital board invaded protected endowment money in an effort to keep the institution afloat. The hospital was later forced to declare Chapter 11 bankruptcy to settle a mountain of debt that nearly closed the institution.

Today the hospital continues to operate at a loss, but trustees said this week that the financial picture is far more sound, and that fund-raising monies are deployed successfully to offset the red ink on the bottom line. They also noted the recent critical access designation - led by Mr. Burchill - that will recoup "real time" money for the hospital in Medicare dollars.

They said the hospital is in better shape than many of its counterparts across the region, but they also acknowledged that it is probably past time to take the next step.

"We've replaced the carpet, we've fixed the glass, we've repaired the leaks, but we are still operating in the equivalent of a MASH tent, and that needs to change," said Mr. Sweet. He described his own vision:

"Ideally to be the best of what a small community hospital can be. There is a potential on this Island to build a facility that would fulfill that vision - but the business of medicine will not support it alone. Unless this community buys into it, we will not get there."