Dr. Richard H. Koehler, a highly skilled laparoscopic surgeon whose arrival on the Vineyard seven years ago was hailed as a new era in medicine on the Vineyard, announced this week that he will sever his contract with the Martha's Vineyard Hospital because of irreconcilable differences with hospital chief executive officer Kevin Burchill and the hospital board of trustees.

"Our real issue is with the direction that Mr. Burchill's actions are taking this hospital and the future of this hospital's true responsibilities to this community," Dr. Koehler wrote in an open letter to the Vineyard community that is published in full on the Gazette editorial page this morning.

Dr. Koehler said he will invoke a voluntary termination clause in his contract with the hospital that requires him to give the hospital six months notice. He said he will end his work at the hospital on July 8.

In his letter, Dr. Koehler refers to an impending legal dispute between him and the hospital. "It is not my intent to burden you, the community, with the details - nor would it be appropriate to do so via this venue," Dr. Koehler wrote in part. He did say that the dispute centers on administrative and not clinical issues.

"No one in this administration, to date, has chosen to impugn my clinical reputation," he wrote.

"If there is one message I want to be sure and get across, it's that this is a much bigger problem than Richard Koehler and Kevin Burchill - really my feeling is the dialogue that needs to take place is between the public and the board," said Dr. Koehler in a telephone conversation with the Gazette yesterday.

Dr. Koehler's intended departure from the Vineyard means the loss of two doctors from the Vineyard community, because his wife, Dr. Kathleen Koehler, is also a doctor with a private practice in gastroenterology. She does not have an employment contract with the hospital.

"I am not going to comment on any accusations that are pending or potentially in the offing between Dr. Koehler and the Martha's Vineyard Hospital. We wish him the very best in his future career aspirations. Certainly it has been said in a number of other settings that Richard is a fine surgeon and I wish him the best in whatever practice setting he chooses to become involved in," said Mr. Burchill in terse reaction to Dr. Koehler's announcement yesterday.

"I am not ready to comment. There are two sides to every story, and at the appropriate time I will comment," said Fred B. Morgan Jr., chairman of the hospital board of trustees.

Dr. Koehler's announcement comes against a backdrop of disquieting reports about internal problems at the hospital and tense relations between staff and management. Dr. Koehler pointed to the problems in his letter. "Staff resignations, firings and devoted nurses forced to work without a contract. If that is a style of hospital that you, the community, are comfortable with and feel is ‘necessary' for ‘change,' then you have the right leadership in place," Dr. Koehler wrote.

Mr. Burchill responded: "I have tried to put a workmanlike business approach to things that have not been addressed in a number of years in this organization, such as rental agreements and subsidies - if that is cold in Dr. Koehler's opinion, he is entitled to his opinion, but I disagree."

Mr. Burchill said he was not surprised at the announcement. "I think surprise would be an overstatement. I think it was certainly not unexpected - the timing of it, however, was somewhat unexpected," he said.

He also said bluntly that Dr. Koehler can be replaced.

"I don't necessarily view it as a loss - people come and people go; that is the nature of employment," he said.

The hospital CEO downplayed any suggestion that the loss of Dr. Koehler will translate to a negative impact on hospital revenues. He indicated that he already has his sights on making a job offer to Steven Eisenstadt, a plastic surgeon who recently moved to Chilmark with his wife, who is an anesthesiologist

"Hopefully we can enter into an employment agreement with this surgeon; it is somewhat of a buyer's market," Mr. Burchill said.

Dr. Koehler said the silence from the hospital board is deafening. "To maintain silence at this point - after a while it's not an effective defense. If the public is satisfied with the board's responses to date and if the board is satisfied with what is happening at the Martha's Vineyard Hospital, then you can't argue with that. Then they've got the right people and I need to move on," he said.

He also made open reference to a recent consultant report that is reportedly critical of relations between hospital management and the medical staff. The report was never made public.

"My biggest concern with the board is their lack of response to their own report. At some point your silence condemns you, especially if there is a real conflict between what that report says about relationships between this institution and what they are saying in the public. If they have a strategic planning committee report that they paid a lot of money for and they are not willing to release - I guess I would ask the public to listen and make up its own mind about that. I would ask the public to listen and decide whether there is no other way to do it," he said.

Dr. Koehler acknowledged his own shortcomings.

"I would never pretend to be the easiest person to work with, and I would never say I am perfect. But sometimes you have to retreat from a battle to win a war, and I am willing to retreat from this battle," he said.

Asked if his decision to leave could possibly change in the next six months, Dr. Koehler would only say: "My decision to resign from my contractual relationship with the Martha's Vineyard Hospital is irrevocable."

Two years ago Dr. Raymond (Rocco) Monto, an orthopedic surgeon on the Vineyard who is also known for his highly skilled work, severed his contract with the hospital and opened his own independent practice on the Vineyard. Dr. Monto still performs surgery at the hospital, but he has opened his own orthopedic and physical therapy clinic in West Tisbury.

The prospect for a similar move by Dr. Koehler is somewhat different, because the surgical work that he does requires a closer relationship with an acute care hospital with operating room facilities.

Dr. Koehler is considered an expert in laparoscopic surgery and achieved recognition among his peers. He has published papers on his work in medical journals and he is frequently invited to lecture on his work in hospitals around the country.

On the Vineyard Dr. Koehler led an effort two years ago to develop a disaster protocol for emergency medical workers.

In his letter, Dr. Koehler concluded:

"We came here seven years ago with the sincerest of intentions to work our hardest and become a permanent part of this community. Unfortunately, the recent events that have transpired at the hospital have dictated otherwise for our future. It will be very, very hard for us to leave the friends we have made and the patients we have cared for - many of whom are one and the same."