Though final contract details, including Kaiser's salary and contract length, still need to be ironed out, board members said Kaiser is their final choice for the job.

In addition, the board elected operations committee member Neal Fatin as chairman.

Fatin, 45, has been an informal spokesman for the board for several months and is CEO of Buffalo Cardiology and Pulmonary Associates in Amherst. He joined the ECMC board in January 2002.

Kaiser, the hospital's current medical director, has been filling in as temporary chief since November. As permanent CEO, he soon will be charged with restructuring the hospital as a profitable enterprise while preserving a high standard of care for all patients.

"You have a guy who has a lot of experience and has a real good sense of business," Fatin said.

As an ECMC employee for the past two decades, Kaiser is no stranger to the desperate financial condition of the public hospital, which houses the region's top-level trauma unit.

"There's no question we have many, many challenges here," Kaiser said, "and I am confident that with the support of our board, (County Executive Joel) Giambra and the County Legislature, we have all the right pieces in place to move the hospital to the next level."

Kaiser beat out two other noteworthy candidates for the job, including Charles Van Vorst, former CEO at Millard Fillmore Hospitals; and Lorraine Auerbach, who has been associated with a number of California health care facilities for 30 years.

Fatin said these finalists for the top job weren't offered the position for a number of reasons. Among them, differences of opinion regarding their hospital tenure, their vision for the hospital's future and their opinions regarding collaboration with other health care facilities and physicians groups.

In one case, salary was also an issue, but not a deciding factor, Fatin said.

Kaiser, a Clarence resident, said he will have two immediate goals as chief.

"The top priorities will be to focus on the infrastructure of the facility and to identify areas in which we can make some very quick and meaningful improvements," Kaiser said.

He also wants to maximize incoming revenue, he said.

Fatin, a Buffalo resident, said his focus will be to make sure ECMC becomes a major player in collaborative efforts to deliver more efficient and regional health care.

While Kaiser has limited financial experience running a major hospital, Fatin said the board and chief financial officer should be able to provide assistance in that area.

Fatin also said the board thought it was important to have someone with a strong medical background running the hospital, someone who understands the underpinnings of quality health care.

"We wanted to take some of his fresh approach," Fatin said.

Though Fatin and others had recommended that Kaiser apply for the CEO position after it came open, Kaiser said he was initially reluctant.

"I didn't want the job because I felt it was in the best interest of the hospital to find the most experienced CEO available," he said.

But in the time he has served as interim chief, Kaiser said, he gained confidence in the leadership team that developed and continued to enjoy his work.

Fatin said Kaiser's willingness to take the chief executive's job was one of the biggest reasons Fatin agreed to serve as chairman.

Fatin is also director of the Board of Child and Family Services and was past vice chairman of the Millard Fillmore Foundation.

The biggest challenge ahead for both the hospital administration and the board will be pushing forward Giambra's agenda for turning the hospital into a public benefit corporation, a more independent, non-profit organization that would give the hospital more flexibility in raising money and containing costs.

Until the hospital unions express written support for such a restructuring effort, Giambra and the County Legislature are unwilling to commit $9 million to covering the hospital's deficit for 2003.

Kaiser said he is not about to shrink from the hard issues facing a hospital where he has spent his entire career.

He graduated from the University at Buffalo Medical School in 1979, completing his residency in general surgery and anesthesiology through the UB training program.

He joined ECMC staff as an anesthesiologist in 1983 and became clinical director of the anesthesiology department in 1989. He has served as medical director since September 2001.

"ECMC is a very unique place to practice medicine," he said. "Part of it is the types of people we care for as a Level 1 trauma center. We take care of people no one else wants. There's a certain feeling that we're doing something valuable. I can't see working anywhere else."