When our 100 bed hospital opened in late 1971, Dr. Calvert was a solo pathologist filling this role alone. In  the late 1970s, our hospital desired to gain administrative control of the lab. During two years of contract negotiations in early 1980s, the pathology group was made to be "resource medical directors" (rather than "in charge", leadership medical directors). In about 1980, Dr. Carter accepted the position of being the new Medical Director of a downtown Chicago Hospital which had failed Joint Commission inspection of its administratively run lab for the second time and was under threat of sanction. Dr. Carter resurrected that lab as a real pathologist leadership medical director. He joined the group here in Lexington in 1984 and was instrumental in converting the directorship back to a true pathologist leadership medical directorship. There have been at least two serious non-pathologist attempts to alter this directorship situation. But, we remain a fully leadership medically directed lab now (4/2005) serving the busiest ER in South Carolina, one of the highest-volume birthing centers in South Carolina, a 110-doctor MSO, and over 300 acute-care general hospital beds.

Here is one example of a single simple but important director's memo with decisive leadership direction on a single computer issue . Since 1971, there have been multiplied hundreds of such directorate memoranda; and there have been vast numbers of less formal medical-directing verbal & written communications within our group & lab in order to maximize efficiency toward the optimization of patient diagnosis & care tailored to our unique set of circumstances. Communications flow there-from to other components of the Lexington catchment area, the Lexington County Health Services District (LCHSD), and to physicians [example] and their offices.

DHEC, CLIA, JAHCO, CAP, AABB and other accreditation organizations have extensive (wide & deep) requirements for directorship responsibilities. Medical directorship is facilitated by having additional pathologists secondarily responsible for each area/subdivision of the lab. Our group is very extensively involved in all areas, the involvement falling under the following example headings (not a complete list):