Dr. Fernando Daniels III, the former medical director, was not accused of leaking the patient records, but was held responsible because he oversees EMS quality assurance, the administrators said.
The records detail recent instances of what evaluators said has been substandard care administered by firefighter-medics, who have become the linchpin for a restructuring of the fire and EMS staff. Fire Chief Adrian H. Thompson initiated the restructuring in 2002, and the latest phase began in May.
Wrongful disclosure of patient records violates the federal Health Insurance Portability and Accountablility Act. Violations can carry a $100,000 fine and/or five years in prison.
Fire officials said Dr. Daniels had been "separated" from the department late Friday. They did not elaborate.
Chief Thompson would not confirm the reason for Dr. Daniels' firing, saying it was a personnel matter. He said he felt EMS needed a change of leadership.
"We thought he brought it to a certain level," Chief Thompson said of Dr. Daniels. "I thought to bring it higher, we needed to make a change."
The medical director is responsible for the quality of care administered by the emergency medical technicians and paramedics, the development of medical protocols and the oversight and training of all medical providers in the department.
According to knowledgeable sources in the department, Dr. Daniels had grown disenchanted with Chief Thompson's plan to rely increasingly on firefighters trained as paramedics to provide emergency care, adding that the medical director fell out of favor with the fire chief.
"He understood what I was trying to do," Chief Thompson said, repeating the statement when asked whether Dr. Daniels supported his plan.
Yesterday, the department announced that Dr. Clifford H. Turen, medical director of the Maryland Fire and Rescue Institute, would fill Dr. Daniels' position.
Dr. Turen gave his unqualified support for the EMS system that Chief Thompson advocates.
"I believe that EMS should reside within the fire department," he said. "In my discussions with the fire chief and the city administrator, it was clear that the ... fire department is going to dual-role cross-train. It was made clear to me the direction that it was going in, and that's the direction it's going in."
Assistant Chief of Operations James B. Martin said the records leak was discovered last week, when city officials received copies of the records and inquired about them. Chief Martin said the patient records have been locked down at the department's quality-assurance office since then.
He said it was not known where the leak originated, but that quality assurance was a "focal point."
Kenneth Lyons, president of the American Federation of Government Employees Local 3721, said the firing was a "cover-up," because Dr. Daniels was warning fire administrators about inadequacies in patient care administered by firefighters.
"He was about to expose a significant problem in the equation," said Mr. Lyons, whose union represents the city's 400 medics.