Why Corrupt Health Care Leadership May Persist? - An Example from Rhode Island

We have previously posted about the travails of Roger Williams Medical Center here in Rhode Island. The Medical Center is currently operating under a federal deferred prosecution agreement (see post here). Its former CEO, Robert Urciuoli, was just convicted of conspiracy and multiple counts of mail fraud in federal court (see post here). The original indictment said that these offenses started as early as 1998. A report today in the Providence Journal suggested why misconduct such as this may be allowed to persist so long in today's health care environment.

There was other evidence of Urciuoli's misconduct before the turn of the last century, but even a persistent physician whistle-blower who also was president of the hospital's medical staff and a member of its board of trustees was unable to get law enforcement interested in it.

[It is interesting that one reason this story has come out is that one of its principals, former Rhode Island Attorney General Sheldon Whitehouse, is locked in a close election contest with Senator Lincoln Chafee for the latter's Senate seat. Chafee has made corruption in government and health care a campaign issue.]

To quote from the Pro Jo,

[Medical staff president and board member Dr Philip] O'Dowd had brought allegations regarding Urciuoli to the Roger Williams board.

A subsequent review by Boston law firm Goodwin Proctor & Hoar found that Urciuoli had misspent thousands of dollars on golf trips, family dinners and stays in luxurious hotels such as The Breakers in Palm Beach, Fla.

Urciuoli also may have committed 'a serious fraud upon the hospital, the review concluded, when he billed $5,998 for an eight-day sojourn to the Scottsdale Princess Resort in Arizona for a nonexistent health-care conference.

Urciuoli agreed to repay the hospital $16,000 and kept his job. O'Dowd, who wanted Urciuoli fired, went to the attorney general.

Meanwhile, members of the executive committee were meeting with the attorney general's office. They provided [Sheldon] Whitehouse with documents and information, and brought in the Boston lawyer who had led the internal review. But the hospital refused to provide the lawyer's final report, saying that it was protected by attorney-client privilege.

Dr. Philip O'Dowd said that he met three times with Whitehouse, then the Rhode Island attorney general, in the fall of 1999 and presented him with documents regarding possible crimes by Urciuoli, the hospital's president.

But rather than investigate, O'Dowd said, Whitehouse told him that the matter would best be handled civilly because hospital leaders did not want to press criminal charges.

O'Dowd, who was a Roger Williams board member and president of the medical staff, faults Whitehouse for listening to the hospital's executive committee, whose members he compares to 'the foxes saying everything was fine in the henhouse.'

'When [the executive committee] said that they didn't want to press criminal charges, that became a legal fact in the case,' said Whitehouse. 'Any reasonable prosecutor could have foreseen its effect on disabling a criminal prosecution, by having the purported victim deny that there had been a crime.'

Whitehouse says that his office determined that it would have been difficult to prove criminal intent without the hospital's backing. Another former attorney general, James O'Neil, disagrees.

'The man [Urciuoli] went golfing, then came home and reported he had been at a health-care conference when there was no conference,' said O'Neil, ...'What more do you need? A prosecutor has to infer intent it's not stamped on a document.'

First, to be charitable, this seems to be a case in which a government law enforcement official showed excessive deference to some members of the leadership of a local hospital. Perhaps he still viewed hospital leaders as they were in decades past - dedicated, generally poorly paid "superintendents" or "directors" of thread-bare institutions dedicated to their patient care and academic missions, not the business oriented, lavishly remunterated, sometimes ruthless leaders of today. This view of a hospital as an impeccable, white, shining institution on a hill may cause many in the public, and even in law enforcement, to deny the gritty reality of how hospitals and other health care institutions are too often lead today. And some hospital leaders, like perhaps Mr Urciuoli, might be inclined to hide behind these outdated views of these institutions, until they are caught.

Second, it may be that Attorney General Whitehouse somehow blurred the identity of the hospital with that of its top leaders. Note that because the few members of the hospital's executive board declined to press charges, Whitehouse seemingly gave up on criminal prosecution, even though it was the hospital, not the board members, which may have suffered a loss, and even though at least one other board member, Dr O'Dowd, was urging criminal prosecution. We have noted before how some health care leaders seem to have an almost royal view of their dominion over their organizations - l'hospital ce moi [pardon the bad French] (see previous post here).

Unpleasant as it may be, we need to open health care professionals' and the public's eyes to the sort of leaders who may run some health care organizations today, and to remind hired managers of their role, and that they are neither the owners nor the kings and queens of their institutions.