Friday, March 23, 2007

Funny Sorts of Ombudsmen at the CDC

We have previously posted (most recently here) about allegations of mismanagement at the US Centers for Disease Control and Prevention (CDC).

The Atlanta Journal Constitution just reported an unusual exchange between Dr Julie Geberding, the head of the CDC, and US Senator Charles Grassley, the senior Republican on the US Senate Finance Committee. It seems that Senator Grassley requested a briefing from the newly hired CDC ombudsmen, but Dr Geberding refused the request.

In a March 5 letter to Grassley, Geberding said the two contract employees the CDC has hired to serve as interim ombudsmen believe that briefing the senator would violate standards of practice for ombudsmen and render them unable to continue to do their jobs effectively.

'While I am respectful of your desire to get further information, I am also sensitive to these principles — especially because CDC's Ombudsman Office is in a critical stage of development,' Gerberding wrote.

The big problem with that argument is that the ombudsmen already had agreed to brief Geberding.

Grassley's letter questions the validity of the ombudsmen's reasoning, stating that he is neither the subject of the ombudsmen's inquiries 'nor a potential cause of employee angst at CDC.' He notes that the ombudsmen have met and briefed Gerberding. Many employees blame Gerberding and her leadership for problems at the agency.

'Dr. Gerberding, am I missing something here?' Grassley asked in his letter. 'Why would two individuals claim preserving their objectivity as Ombudsmen requires refusing to brief Congress, but allows meeting with you to discuss their findings?' Grassley wrote, adding that he's not surprised that few CDC employees have 'felt comfortable approaching these two men to seek their help on their problems with CDC management.'

In my humble opinion, it's a funny sort of ombudsman who reports to the leader of his or her government agency, but cannot report to Congressional oversight. I would imagine any half-way rational CDC employee would be very hesitant to say anything to the ombudsmen that might be the slightest bit offensive to the leadership of the CDC.

Thus, the CDC still appears to be an agency whose leadership does not easily tolerate criticism. Given the scientific basis of the agency, this would appear to be yet another example of mission-hostile management, US government agency style.

But it seems that in many kinds of health care organizations, not just in the US, not just government agencies, the worst sin is to criticize the management. Given the ineptness, and worse of the management of many health care organizations (some of which has been featured on Health Care Renewal), is it any wonder that health care is in a mess?


Anonymous said...

How does the CDC get away with not listing advancing paternal age, as at least a possible risk factor, for non-familial autism and non-familial schizophrenia given the extensive research linking neural developmental disorders and de novo mutations with advancing paternal age? One of many researchers in this area is Dr. Dolores Malaspina, whose work was published first in 2001, said in 2006:

"The most irrefutable finding is our demonstration that a father’s age is a major risk factor for schizophrenia. We were the first group to show that schizophrenia is linearly related to paternal age and that the risk is tripled for the offspring of the oldest groups of fathers.7 This finding has been born out in every single cohort study that has looked at paternal age and the risk for schizophrenia. The only other finding that has been as consistently replicated in schizophrenia research is that there is an increased risk associated with a family history of schizophrenia. Since only 10% to 15% of schizophrenia cases have a family history, family history does not explain much of the population risk for schizophrenia. However, we think that approximately one third or one quarter of all schizophrenia cases may be attributable to paternal age. Paternal age is the major source of de novo genetic diseases in the human population, which was first described by Penrose8 in the 1950s. He hypothesized that this was due to copy errors that arose in the male germ line over the many cycles of sperm cell replications. These mutations accumulate as paternal age advances. After the Penrose report, medical researchers identified scores of sporadic diseases in the offspring of older fathers, suggesting that these could occur from gene mutations. Particular attention was paid to conditions in last-born children."

and also wrote in 2006,

"Finally, we examined if paternal age was related to the risk for autism in our cohort. We found very strong effects of advancing paternal age on the risk for autism and related pervasive developmental disorders (Reichenberg et al., in press). Compared to the offspring of fathers aged 30 years or younger, the risk was tripled for offspring of fathers in their forties and was increased fivefold when paternal age was >50 years. Together, these studies provide strong and convergent support for the hypothesis that later paternal age can influence neural functioning.."

The history of a connection between autism and paternal age did not begin with Abraham Reichenberg's study published in 2006.

We are having an increase in the number of children diagnosed with autism and also a huge increase in the number of men fathering children 35 years to 49 and 50 and over and yet paternal age does not come up on the autism page at all.
I'd like to ask Dr. Julie Geberding or an ombudsman about that.

MsMelody said...

I thought the office of the Ombudsman was merely "windowdressing" to give the appearance of complying with whistleblower regulations and, at the same time, reassuring consumers/patients that "somebody" will aid them, "somebody" works for them.

In an almost decade-long fight to gain interest and assistance for Type 1 diabetics who cannot do well or cannot survive on rDNA insulin, the mewlings that are regurgitated to this captive/helpless group are unconscionable. FDA has managed to aid these people by providing "personal importation"--a complicated process, with severe restrictions, and many hoops. After 9-11, DHS also entered the picture--so now FDA-CDC-DHS-USDA can use finger-pointing and successive, circular direction to keep a needful patient jumping to their tune.

One other comment: should a consumer/patient actually get a response from a Gerberding underling that is not satisfactory and needs further assistance, getting a follow-up phone call accepted or a letter answered becomes "mission impossible."