Monday, November 06, 2006

Why Corrupt Health Care Leadership May Persist? - Silencing the Whistle-Blower in Rhode Island

We have posted before, most recently here about the leadership problems afflicting our local Roger Williams Medical Center. Its former CEO was just convicted of conspiracy and mail fraud. The hospital is operating under a federal deferred prosecution agreement under the supervision of a federal monitor.

After the CEO was convicted, more details keep coming out about the techniques he used to maintain his power. A new Providence Journal article described what happened to Dr Phillip O'Dowd, former president of the medical staff and board member of the hospital, after he dared to blow the whistle on this case.

After an internal report commissioned by the board of trustees found that then-hospital CEO Robert Urcuioli had billed the hospital for a trip to a medical meeting that was never held, O'Dowd had gone to then-Attorney General Sheldon Whitehouse. Below is the story in the words of the article (somewhat re-ordered).
O’Dowd said he visited Whitehouse three times with folders of evidence.

He said Whitehouse listened politely, but 'hardly said a word.'

Just before he left the last time, O’Dowd recalled saying: 'If you don’t prosecute this in the criminal arena, when you announce your decision, I am going to bark like a dog and squeal like a pig. I am going to try to get every TV camera and every radio person and every print journalist in town and I am going to make the arguments to them that I am making to you. This won’t go away. I’m stubborn. I’m right.'

O’Dowd said his term on the hospital board ended Dec. 31, 1999, and he was fired days later.

He said the cited reason was anger-management problems, but he viewed his dismissal as punishment for pursuing a criminal case against Urciuoli. Asked yesterday whether he had anger issues, he said: 'I did have anger-management problems. I was very angry at the management.'

O’Dowd would not identify his lawyer. But state Democratic Party Chairman William Lynch acknowledged yesterday that he represented the doctor at the time.

[O'Dowd received]... a severance agreement offering him $184,994 on the condition that he not criticize the hospital or then-Attorney General Sheldon Whitehouse’s handling of the case.

The Feb. 17, 2000, agreement ... said:

'Dr. O’Dowd agrees that if the Rhode Island attorney general negotiates or enters into an agreement with Mr. Robert Urciuoli or the Hospital with respect to certain issues … Dr. O’Dowd shall not comment upon or criticize the terms, conditions or circumstances leading to … such an agreement or the conduct of the negotiations.'

Coming to light in the closing days of Democrat Whitehouse’s campaign to unseat Republican [Senator Lincoln] Chafee, the don’t-talk clause was immediately seized upon by Chafee as evidence that Whitehouse had 'cut a deal' to 'muzzle' a whistleblower.

Neither Chafee nor O’Dowd had proof that Whitehouse had a direct role in crafting the agreement. But Chafee said: 'The timeline just supports the allegation that as soon as the whistleblower, the good doctor trying to look out for the nonprofit institution … is muzzled, the attorney general is free to announce his civil settlement.'

After days of ignoring Chafee’s comments about his alleged mishandling of this and other cases – including a judge’s disqualification of the wiretap evidence gathered on Whitehouse’s watch against a former Lincoln town administrator accused of bribery – the Whitehouse campaign issued this statement slamming Chafee for raising what were characterized as false and irrelevant issues in a campaign of national significance:

'We’re at war, seniors are hurting, but Lincoln Chafee refuses to address these issues and instead has chosen to base his campaign on a series of baseless, negative attacks.'
I will not comment on the Iraq war or the plight of senior citizens.

However, it does seem that Dr Phillip O'Dowd joined the ranks of health care whistle-blowers when he tried to get a criminal investigation of the CEO's conduct started. And as has happened before to health care whistle-blowers, his reward was to lose his job, and then to be offered a monetary settlement only in exchange for a pledge of silence. (See the "Cost of Courage" series published by the Pittsburgh Post-Gazette for other examples.)

Clearly, to fight health care corruption, which cases like that of Mr Urcuioli suggest is a systemic problem, we will need to protect the people who have the courage to blow the whistle on the perpetrators.


Anonymous said...

In a front page article of the Nov. 3, 2006 WSJ, Narcotic "Lollipop" Becomes Big Seller Despite FDA Curbs, we can find all that is wrong with our current drug marketing system. The drug in question is Actiq, a "lollipop" narcotic, designed for use by cancer patients for the immediate relief of pain.

The article highlights it's use by a pregnant woman with a known history of addiction. The fast action of the drug, easy delivery, and the ensuing withdrawal her newborn child suffered due to her taking this prescription medication.

Buried in the article is the fact that a Mr. Brennan pushed to publish his audit findings showing that this drug was, in fact, being prescribed not by oncologist, but by a host of other doctors, for off-label use. He was later fired and offered a cash settlement, and job-search assistance if he agreed to keep his findings quiet. He has now been labeled "a former disgruntled employee."

We then find this statement:

"Stephen Leighton, a general practitioner in Winston-Salem, N.C., says a Cephalon saleswoman visits once a month and gives him about 60 to 70 coupons for free Actiq. Patients can trade each coupon for six Actiq sticks. Dr. Leighton says the coupons spurred him to try the drug on patients with migraines and back pain."


"Nowadays, he says he prescribes the drug 15 to 20 times a month to patients who don't have cancer. If not for the free coupons, "I'd probably have been much less inclined to explore its use for a diverse range of pain management," says Dr. Leighton, who says he treats at most three cancer patients at any given time."

So here we have an addictive drug being pushed for off-label use and the whistle blower fired. One can only hope that Cephalon suffers the same fate as Schering-Plough:

"In August, the Justice Department fined Schering-Plough Corp. $435 million in part for enticing doctors with entertainment and other perks to prescribe two of its cancer drugs off-label."

Steve Lucas

Anonymous said...

I´m very tensed what comes out in America. In Germany theres a comparable discussion and here it´s only get worse.

My Sitewith a lot health articles in german and english