Knocking the Moose Off the Table: the Downfall of a Hypocritical Health Care Leader

A story that got prominent coverage over the last few days says something about the leadership of health care organizations, as long as one puts the information in a new sequence. So, starting with an article in the New York Times,

Mr. [Randall L] Tobias, 65, is a former chairman and chief executive of Eli Lilly & Company and of AT&T International. He served as the chairman of the board of Duke University from 1997 to 2000.

And per the Boston Globe,

Business Week called him one of nation's top 25 managers in 1997. His book, 'Put the Moose on the Table,' which advocates addressing difficult issues in a forthright manner, became a best seller.

Note that in the book, Tobias listed his "prerequesites for leadership," starting with "(1) inspires confidence, trust, and consistently displays the highest ethical standards...."

Back to the Times,

President Bush nominated him in July 2003 to lead a $15 billion program to fight AIDS worldwide.

At the time, some AIDS experts said Mr. Tobias did not have much experience with AIDS or Africa.

Then, as director of United States Foreign Assistance, he held the rank of ambassador.

In January 2006, Mr. Bush said he would nominate Mr. Tobias to be the administrator of the Agency for International Development. That position gave him the rank of deputy secretary of state.

The policies Mr Tobias pursued were often controversial. From the Boston Globe,

Bush persuaded Tobias to take charge of his five-year global AIDS initiative known as PEPFAR, or the President's Emergency Plan for AIDS Relief, which is now on track to spend $18 billion. During his tenure, AIDS treatment, care, and prevention programs were started, but there were also bruising battles with activists over policies relating to generic drugs and abstinence-only initiatives, as well as charges of favoritism in giving grants to evangelical Christian groups with little experience in Africa.

But [Harvard Professor Jim Yong] Kim, who formerly was director of HIV/AIDS programs at the World Health Organization, said that some of Tobias's policy decisions also had negative impacts on the fight against AIDS. 'I completely disagreed with their all-out attacks against making generic drugs more available' by refusing to use the WHO's system for testing the efficacy of medicines, he said.

Michael Weinstein , president of AIDS Healthcare Foundation , a Los Angeles-based group with extensive experience in treating AIDS patients, said that Tobias's policy to test all generic medicine through the US Food and Drug Administration 'meant that fewer people received drugs.'

[Furthermore,] The Bush administration's policy requires that groups receiving US money 'have a policy explicitly opposing prostitution and sex trafficking.' That policy, said [Center for Health and Gender Equity Executive Director Jodi] Jacobson and others, has led to the closure of numerous programs that had been teaching job skills to sex workers, forcing many prostitutes out of brothels and into the street.

Why was Tobias in the news lately? Back to the Times,

The head of the Agency for International Development, Randall L. Tobias, resigned abruptly on Friday for what he said were “personal reasons,” but an administration official said Mr. Tobias’s name had come up in an investigation of a suspected Washington prostitution ring.

On Friday night, ABC News said Mr. Tobias had confirmed on Thursday that he was a customer of an escort service.

A woman from Vallejo, Calif., Deborah J. Palfrey, has pleaded not guilty to charges that she operated a call-girl service in Washington, and has threatened on her Web site to sell her client list to raise money for her defense.

Mr. Tobias told ABC that he used the service for massages, not sex, according to the network’s Web site.

And back to the Globe,

Randall L. Tobias , the Bush administration official responsible for foreign assistance who resigned late Friday because of his use of an escort service allegedly involved in prostitution, was ridiculed as a hypocrite yesterday because he supported US policies that forced overseas organizations not to help prostitutes.

'I think it is somewhat ironic and hypocritical that he would patronize an escort service while he was denying funding to organizations who want to help prostitutes, and supporting a policy that obviously forbids fraternizing with prostitutes,' said Jodi Jacobson....

I am afraid that this case illustrates the psychology of all too many of the leaders of health care organizations. Tobias' downfall is ironic precisely because he failed to follow the rules that he, himself, set out, both in his leadership of the AIDS effort and in his best-selling management book. Too many health care (and other) leaders seem to think that they are not subject to the rules that apply to the ordinary folk, and that what they say need not be what they do. Thus the title and subject matter of Mr Tobias book now seem like something of a sick joke.

As F Scott Fitzgerald said, "the very rich are different from you and me."

As long as health care leaders feel no need to be do what they say and say what they do, and think they are above the common folk and that the rules do not apply to them, health care will be run for the leaders' benefit.

The need for representative, transparent, and accountable health care leadership has never been greater.