Monday, March 16, 2009

Some Conflicts Grow in Brooklyn

From the New York Daily News, here is a new twist on the conflicts of interest story. This is about two leaders of Wyckoff Medical Center in my hometown of Brooklyn, NY, the hospital's chief of surgery, Dr Addagada Rao, and its CEO, Rajiv Garg.

It turns out that Dr Rao has another position, this one far away at Spartan Health Sciences University, a medical school located on the Caribbean island of St Lucia:

The $400,000-a-year chief of surgery at Brooklyn's Wyckoff Heights Medical Center heads a Caribbean medical school that hopes will funnel medical students - and their money - back to New York, the Daily News has learned.

The surgeon, Dr. Addagada Rao, is the president of Spartan Health Sciences University in sunny St. Lucia. Last year he became one of a handful of owners in hopes of bringing third- and fourth-year medical students to Wyckoff to train - and to aid its ailing coffers.

'My association with Spartan is to fulfill my lifelong goal to educate all who are able and willing to pursue a career in medicine...' Rao is quoted on the medical school's Web site.

Mr Garg also has a role at Spartan,

Garg, 49, has been Wyckoff's $500,000-per-year CEO since November and is also an investor in Spartan. He told The News he stepped down as Spartan's chief operating officer after he got the top job at Wyckoff.

Meanwhile, the Daily News alleged:

Rao, 67, is in a position to make hundreds of thousands of dollars from the dual relationships.

The ability to train in New York is a big draw for offshore medical schools - especially if the school has an established connection with a hospital, experts said.

The state has approved Spartan students to do only 12-week stints in New York hospitals. Students pay between $4,000 and $5,000 for the training.

Wyckoff - and Rao - could make far more money if the state okays a pending request for Spartan students to do their full two years training at New York hospitals.

Dr Rao was asked about these relationships, and responded,

he saw nothing wrong with having outside financial interests.

'I disclosed this to the hospital,' he said, but declined to offer further details.

Asked if the hospital's board of trustees, of which Rao and Garg are members, approved the arrangement, he said: 'That was not necessary.'

It is still a little hard for me to understand how someone could be chief of surgery at a NY hospital and simultaneously the president of a Caribbean medical school, but setting that aside...

This story illustrates another twist on conflicts of interest affecting the leaders of not-for-profit health care organizations. Many of the smaller not-for-profit hospitals, of which there are thousands in the US, may have minimal conflict of interest policies, which may be minimally enforced, without much transparency or accountability. The coziness of the leadership culture of such smaller institutions may preclude anyone within the culture from asking tough questions. The results may be total confusion as to whose interests particular leaders are serving. In particular, the interests of each hospital's patients may get lost in the shuffle. In this case, the interests of medical students may also get lost in the shuffle. Although the institutions involved may be small, and hence the conflicts may seem small in terms of their monetary value, they aggregate to contribute to the moral miasma that now is the atmosphere of health care.

1 comment:

Anonymous said...

Dr. Roa: " he saw nothing wrong with having outside financial interests."

So let's see, Harvard students are concerned about the bias and quality of information given by their professors with financial conflicts. HCR Monday, March 09, 2009 The Color of Money: What Sort of School Doesn't Pay Its Faculty to Teach?

From the WSJ Health Blog : March 11, 2009, 9:04 AM ET A New Low in Drug Research: 21 Fabricated Studies

Scott Reuben says never mind.

"Baystate Medical Center in Springfield, Mass., has asked several anesthesiology journals to retract the studies, which appeared between 1996 and 2008, the WSJ reports. The hospital says its former chief of acute pain, Scott S. Reuben, faked data used in the studies. "

Again from the WSJ Health Blog:  March 13, 2009, 1:18 PM ET JAMA Editor Calls Critic a ‘Nobody and a Nothing’

Jonathan Leo, a professor of neuro-anatomy at tiny Lincoln Memorial University in Harrogate, Tenn., posted a letter on the Web site of the British Medical Journal this month criticizing a study that appeared in JAMA last spring. The study concerned the use of the anti-depressant Lexapro in stroke patients. In addition to identifying what he said was an important omission in the paper — that behavioral therapy worked just as well as the drug when compared head to head in the study — Leo also pointed out that the lead author had a financial relationship with Forest Laboratories, the maker of Lexapro, that was not disclosed in the study.

From the NYT's: March 13, 2009, 6:45 am ‘Cost-Effectiveness Analysis’ and U.S. Health Care By Uwe E. Reinhardt

"In Congress, however, the word “cost” in this connection remains anathema. This is despite the fact that that same Congress rings its hands in despair over the millions of American families priced out by the ever-rising cost of health care, and over the bigger chunk of the federal budget taken up by Medicare and Medicare.

So, in the end, the offensive term “cost-effectiveness analysis” was stricken from the bill."

So it appears that when it comes to financial conflicts, or preserving personal income, there is no moral or ethical limits. Deception and half-truths are the norm. I cannot help but be reminded by the line from the Wizard of Oz: Pay no attention to that man behind the curtain. I am the all powerful Oz.

It appears many in the medical community wish to pull the levers for their own gain and students, patients, and the public at large are expected to pay the cost.

Steve Lucas