Friday, January 15, 2010

Why Are Health Care Organizations' Ethics Codes News?

This just in from the Orlando Sentinel,
The head of Central Florida's largest blood bank told Florida senators Wednesday that she has completely overhauled the operation — from the boardroom to the bloodmobile.

'Believe me, I get it,' an apologetic Anne Chinoda told members of a committee investigating the business ways of Florida's Blood Centers and other blood banks across the state.

Chinoda said FBC now prohibits board members from doing business with the agency, has instituted nine-year term limits for board members and has put together a group to review executive compensation. She also unveiled a blood-donor bill of rights she promised to publicize.

Sen. Don Gaetz, chairman of the health regulation committee that asked Chinoda to appear, said he was pleased by her testimony. 'What we saw today was an admission of inappropriate practices in the past and a promise they will be fixed,' he said.

These new ethical standards were a response to a past controversy,
Gaetz's committee has been investigating FBC, which generates $100 million in revenues annually, and the statewide industry since the summer.

The inquiry was triggered in part by a series of stories in the Orlando Sentinel that showed FBC board members have sold millions of dollars in goods and services to the agency each year; that board members had no term limits; and that Chinoda was compensated nearly $600,000 annually. Her salary was not discussed at the hearing.

Like others in the industry, FBC gets its blood for free from donors, tests and repackages it. FBC then sells the blood to 70 hospitals and medical facilities in 21 counties in Central and South Florida.

How often do you hear pleas from local blood banks about urgent shortages?  How often do you donate blood, or feel bad because you did not or could not donate?  Many people who selflessly donate blood were likely unpleasantly surprised to find out that blood banks sell (at a high price) the blood they donated, and used the proceeds to pay their executives generous salaries, and pay vendors run by their board members.

Here was another example of a previously revered local, not-for-profit health care institution run apparently for the personal benefit of its top insider leaders.

Why was it news when the organization in question adopted a code of conduct that limited self-dealing by board members, limited board members to only(?) nine-year terms, and put in place some sort or organized process to set the CEO's compensation?  Do those not seem like they ought to be standard, and not  newsworthy practices?

Similarly, an article in the Newark Star-Ledger back in November recounted how  Hackensack University Medical Center in New Jersey, whose board members had been accused of self-dealing (see this post), and to which a New Jersey state legislator had been convicted of selling his services (see this post), had instituted "tightened ethics rules," including a provision that "board members will no longer be allowed to do business with the hospital."  Again, why should a rule like this be news?  One of the duties of board members of all not-for-profit organizations is the duty of loyalty, "a standard of faithfulness; a board member must give undivided allegiance when making decisions affecting the organization."  Overpaying crony executives and authorizing business dealings with one's own business seem to obviously violate this duty.

We have noted how the business culture of health care organizations has increasingly come to resemble the larger business culture in an era of laissez-faire capitalism and the rise of new oligarchs and robber barons.  So it is telling that it was also news when UBS, a large international bank enacted a code of ethics for its employees that required them to actually comply with "foreign tax reporting rules," (per Bloomberg.)

One would have once thought that health care organizations, given their responsibilities for human life and health, and their formerly sterling reputations, would have clear, comprehensive codes of ethics that are actually enforced.   But it is news when a health care organization develops such a code (and it still may be news when such a code is enforced.) 

This post summarized some current thinking on organizational ethics policies.  In conclusion, I asked readers to think about whether their own health care organization had anything resembling such a policy.  I suspect few could identify such policies. 

Health care professionals need to inquire why health care organizations, including drug, device, biotechnology and health care information technology companies,  health care insurers, to hospitals, academic medical centers, and medical schools, etc, almost never have real organizational ethics policies.  Of course, the suspicion is that lack of such policies makes it easier for insiders to direct the organization for their personal benefit.  At least if we could make such policies the norm, we could remind organizational leaders that they are supposed to be upholding the mission, not lining their pockets. 


MedInformaticsMD said...

It is always news when members of the Supeclass get caught red handed and slapped.

Anonymous said...

What I find interesting is that it is the leg work of the local media that uncovers these stories. Sadly this is a media that is under attack by economic forces that will only limit its ability to collect and do these stories in the future.

Nationally recognized blogs, such as HCR, have picked up this banner, often at a high personal price due to attacks by those with an interest in keep this information from the public.

The business press has covered these issues for years under the guise of changes in income. Most recently we see in the WSJ Health Blog:

January 15, 2010, 12:29 PM ET

Feds Accuse Doc of Faking Research On Pfizer & Merck Drugs

By James A. White

“It looks like Scott Reuben, the Massachusetts anesthesiologist said to have used phony research data in 21 published papers, has reached a plea deal with the feds.”

Hopefully there is a growing awareness of the corruption in the medical system. The system we now labor under is broken and needs to be fixed. This will only take place with the continued efforts by those without conflicts who wish to see a better system.

The local press needs to be supported in their effort and those with a national voice need to continue to make people aware this is not a local problem, but systemic.

Steve Lucas

arthur schafer said...

I don’t wish to disparage codes of ethics in general or codes of health care ethics, in particular. Nor do I wish to suggest that the moral integrity of individuals [= “character”] is unimportant.

But I do want to suggest that, most often, the moral ecology of an organization is far more important than the antecedent character or virtue of its individual members. So, if an organization (say, a police force) has a superb code of ethics but rewards (with promotions, merit awards and commendation) those who achieve a high conviction rate then we should not be surprised if many or even most of the police officers are soon caught up in such unethical behaviour as evidence-planting, in order to achieve success in this organization. A few highly virtuous individuals will refuse and they will become “moral heroes”. Actually, I want to withdraw the scare quotes. Those who refuse to become complicit with unethical practices, at risk of incurring the disapprobation of their colleagues and the censure and discipline of their bosses, really are moral heroes. But these people will mostly be eviscerated and spat out to live lives of obscure despair – that is the most frequent fate of the whistleblower (notwithstanding Erin Brockovitch, the person and the movie). More important, the unethical practices are likely to continue until or unless the culture of the organization shifts and members perceive that they will be rewarded for policing with integrity rather than merely with high conviction rates.

If you’ll forgive a political or quasi-political observation: the emphasis on individual responsibility, virtue and character tends to occur most often in the writings of right-wing philosophers and commentators. An awareness of moral ecology and the need to make systematic changes tends to be a mark of the left-winger or progressive. Let me re-iterate: I am not intending to disparage the importance of codes of ethics [of which I have drafted a good few in my time] nor to downplay the importance of individual integrity/character. I am intending, instead, to insist upon the even greater importance of moral ecology. Most of us, most of the time, will be as virtuous (or as villainous) as the prevailing norms of our culture or our sub-culture.

Arthur Schafer

Anonymous said...

I feel bad for local papers. I know a reporter on a big medical corruption story who was told to tone it down so that the hospital wouldn't "come after the paper." Clearly the Hospital could tie them up in expensive legal stuff based on nothing and the paper couldn't afford it.

Another paper refused to even look at the story because the hospital was such a big advertiser.

Crestere said...

You know... after reading this article, i`ve realised that this happens all over the world. I`m from Romania, and here this kind of things are happening everyday. We cannot do the right thing because some institution or company has more money than us. In Romania laws are changed by people with money :(