Tuesday, December 01, 2009

Diversity Nightmare And Federal Antidiscrimination Laws: Cleveland Clinic CEO Delos M. Cosgrove Would Proudly Discriminate Against Fat People

The following stunning quote appeared in the Nov. 27, 2009 Newsweek article "The Hospital That Could Cure Health Care" about the Cleveland Clinic:

[Cleveland Clinic president and CEO Dr. Delos M. Cosgrove, a former cardiac surgeon] has even taken on the most intractable driver of American health-care costs: Americans. Having already banned the hiring of smokers (a dictate enforced by urine tests for nicotine), Cosgrove declared this year that if it weren't illegal under federal law, he would refuse to hire fat people as well. The resulting outcry led him to apologize for "hurtful" comments. But he has not backed down from his belief that obesity is a failure of willpower, which can be attacked by the same weapons used to combat smoking: public education, economic incentives, and sheer exhortation.

My thoughts come from the perspective of a former fitness-for-duty evaluator and drug testing officer (Medical Review Officer) for the regional transit authority in a very large city, and a hiring manager in the hospital and pharmaceutical sectors. I find a profoundly discriminatory statement that a hospital CEO would "refuse to hire fat people" if he could get away with it, and that he refuses to hire smokers and forces people (presumably candidates) to take a urine nicotine test, totalitarian and highly abhorrent.

Nothing about smoking or obesity [except in very specialized job situations for the latter] makes a person unfit to work in a hospital.

This attitude is exactly why we have federal anti-discrimination laws, to protect people from biased autocrats like this.

I should add that talent apparently is irrelevant to this autocrat; if a person is overweight, this self-righteous SOB would send an applicant out the door. So much for talent management if he could get his way.

One wonders if he would also send current employees who are overweight out the door - if he could get away with it.

A May 2008 USA Today article entitled "Weight discrimination could be as common as racial bias" here made the point that:

Weight discrimination, especially against women, is increasing in U.S. society and is almost as common as racial discrimination, two studies suggest.

Reported discrimination based on weight has increased 66% in the past decade, up from about 7% to 12% of U.S. adults, says one study, in the journal Obesity. The other study, in the International Journal of Obesity, says such discrimination is common in both institutional and interpersonal situations — and in some cases is even more prevalent than rates of discrimination based on gender and race. (About 17% of men and 9% of women reported race discrimination.)

Among severely obese people, about 28% of men and 45% of women said they have experienced discrimination because of their weight.

"Weight discrimination is a very serious social problem that we need to pay attention to," says Rebecca Puhl of the Rudd Center for Food Policy and Obesity at Yale University, a co-author of both studies.

... Institutional discrimination involved health care, education or workplace situations, such as cases in which people said they were fired, denied a job or a promotion because of their weight. Interpersonal discrimination focused on insults, abuse and harassment from others.

This raises several questions:

  • The CEO of an organization sets the tone. What does such a statement about "fat people" do to staff morale?
  • As a result of this CEO's stated preferences, is there subtle or covert discrimination against overweight employees at the Cleveland Clinic, preventing promotions and/or causing or contributing to situations of constructive discharge?
  • Is there subtle or covert hiring discrimination against overweight candidates, with the hiring managers knowing the CEO's expressed views?
  • One also wonders if this CEO has similar attitudes towards gays, minorities, and people with physical and emotional disorders that also would not affect their ability to perform their jobs.
  • How well does the Cleveland Clinic respect other aspects of diversity considerations in its hiring, firing, and job promotion practices?
  • What kind of care and quality of staff interactions do overweight people receive/experience at the Cleveland Clinic?

This CEO will not be "curing healthcare" any time soon IMO, since a primary consideration is compassion. He seems somewhat deficient in that attribute.

He also seems deficient in the characteristic known as business wisdom, especially in an era of competition and trigger-finger litigation.

His statement could be used by competitors to steer people away from the Cleveland Clinic and its affiliates. It could very likely also be used in support of discrimination lawsuits against the Cleveland Clinic and its affiliates by current, former, and potential employees (as well as by overweight patients, conceivably) which can be very expensive and damaging to an organization's reputation.

In addition to all of the problems exhibited by healthcare leaders as covered on this blog, I add a new one apropos to this CEO's cerebral anatomy: fathead.

-- SS


Anonymous said...

Toby just wants their money when they are hospitalized! They are also good substrate for the Clinic's ORs.

Toby would have to pay his environment workers and patient care technicians better so they do not have to eat pasta every night to make ends meet.

Anonymous said...

Weight bias is much more common in the medical community than one would expect. I am a weight lifter and carry a little extra weight, while maintaining a good waist size. This has not stopped doctors form making rude and unsolicited comments about my lack of will power, or unhealthy life style. If only they would ask first. One doctor, on a first visit, told me that without a BMI of less than 20 I could not expect to live.

In a newspaper article, some time ago, it was noted that much of the house staff at the Cleveland Clinic are not covered by employer provided insurance. So it is OK to work there, just don't come back for treatment.

Some companies, under the banner of caring for their employees, have begun to fire smokers. My reality as a business person, is they are lowering their insurance cost, and really don't care one wit about their employees.

While still in my mid-fifties I remember a time when smoking was more than acceptable and people had memories of not having enough food. While I look around today and am appalled at the physical condition of many young people I realize this is due to many of the same social factors that promoted smoking and over eating decades ago.

We have outlawed discriminating on the bases of race and religion. We have become such a PC country that we over look rude, or even criminal behavior, in the name of tolerance.

It appears that some people still have a need to be able to point at another person and prove their superiority due to some superficial outward appearance.

Steve Lucas

InformaticsMD said...

Toby would have to pay his environment workers and patient care technicians better so they do not have to eat pasta every night to make ends meet.

I once had a chief of medicine who appeared to despise fat people. He ended up a key figure in a huge healthcare scandal due to generally poor judgment, and now apparently practices medicine in a nursing home somewhere.

-- SS

Roy M. Poses MD said...

When I put on my clinician hat, I spend a lot of time trying to help people quit cigarettes. While it is clear that cigarette smoking is a significant personal health hazard, and a major population level cause of disease, dysfunction, disability and death, it is extremely hard for most smokers to quit. Similarly, while the causes of obesity are not yet clearly understood, it is very hard for most obese people to lose weight. The issues are not simply will power, motivation, or character.

Furthermore, it is not clear why smoking per se, much less obesity, should make an individual unfit to be employed by a hospital. (Of course, the hospital can ban smoking on hospital property.)

So why would the hospital ban employees who smoke (on their own time), or want to ban obese people, other than to reduce their own health care costs?

If Dr Cosgrove is concerned about these issues, maybe he should consider expanding clinical services to help smokers quit and obese people lose weight.

But to most health care CEOs, money is more important than patients' health.

InformaticsMD said...

Some companies, under the banner of caring for their employees, have begun to fire smokers. My reality as a business person, is they are lowering their insurance cost, and really don't care one wit about their employees.

And their employees will care not one whit about the employer, too, with the long term implications that brings. I am convinced there are way too many airheads sitting behind executive desks.

We have outlawed discriminating on the bases of race and religion. We have become such a PC country that we over look rude, or even criminal behavior, in the name of tolerance.

My belief is that people who discriminate against the obese are a hair's breadth away from discrimination against others due to a fundamental character flaw. One wonders what the Cleveland Clinic CEO's elementary school teachers would say about how he treated "fat kids" in the schoolyard.

So why would the hospital ban employees who smoke (on their own time), or want to ban obese people, other than to reduce their own health care costs?

See the above.

-- SS

Anonymous said...

His EHR company feels the same way so this isn't shocking to me. The CIO of the EHR not only spoke on BMI for the entire company I've suddenly seen a massive uptick in the number of folks leaving who have a high BMI. Sounds like a match made in heaven.

Anonymous said...

We’ve now had aspartame available for 30 years . . . why aren’t we thinner? GMO foods have stealthily made their way into our food chain . . . with scientists now pointing out that the ‘downstream’ consequences of GMO technology (one of which may be obesity) have not been evaluated? Are we fatter because of ‘better living through chemistry [biotechnology]? We’ve had “supersize-me” fast-food promotions for a decade . . . is this a factor? We’ve had wage stagnation for more than a decade . . . are our food choices influenced by affordability and seeking “more bang for the buck” rather than “more nutrition for the buck?” Two-wage-earner families have become the norm, and the numbers of working single mothers have increased tremendously. Who truly has time to incorporate healthy eating into fast-paced living? Dr. Cosgrove apparently seems more than willing to let his biases influence ALL his thinking. Evidently, all fat people suffer from lack of will-power (ergo, they are weak and undeserving of employment???) We constantly hear that obesity CAUSES diabetes; why has no one postulated that perhaps diabetes CAUSES obesity. Latent, undetected (T2) diabetics have an over-abundance of unused insulin circulating in their bloodstream—a condition that creates unmitigated HUNGER. So, which came first . . . the chicken or the egg.

Anonymous said...

Recently, I read a quote from the CDC chastising the citizenry for an obesity epidemic that is a huge risk factor that causes Type 2 diabetes. Is it possible—if we “follow the money”—that the CEO of the Cleveland Clinic is hoping to qualify big time for CDC research grants?

There may be a great contradiction/misinterpretation related to a risk factor which implies causal relationship and a resulting symptom (obesity). Facts indicate that 70% of overweight Americans DON’T develop diabetes, albeit they may have increased risk for heart disease, high blood pressure, stroke and cancer. Let’s quit treating symptoms and instead find cures. CURE, however, is a dirty four-letter word for most medical professionals. They treat cures as the causal agent/risk factor that will kill the golden goose. What’s wrong with a profession that forgets the TOTAL patient and accepts failure to cure in favor of the money generated by treatment. How would a doctor like it if their Lexus or Rolls dealership kept them coming back for “maintenance” on ever-decreasing intervals, where money is made each time service is recommended. Sadly, patients (unlike car-owners) cannot trade away their problems.

Brent H.

Anonymous said...

The comments have reminded me of my very first economic class, that was taught by a foreign born instructor. He had a very interesting take on America. He made it very clear that it cost more to be poor.

With no credit, a person may not take advantage of sales, but must buy at the time of need. Cars are purchased based on price, not on operating cost. The result is large autos often in need of repair.

Carbs and starches are cheap, so this is what the poor eat. Dining out is done at a fast food place. Smoking is a release from the tedium of the situation.

Today we see these same drivers in health. Culturally the focus is on computers, so why take a walk when you can pull up a web cam of a park. Improving weight control and smoking is an economic and cultural issue, as much as a medical issue.

My question is: Why are we just now dealing with this issue when an Egyptian economics professor, in a business program, was discussing this over 35 years ago?

Steve Lucas

Michael Kirsch, M.D. said...

I took heat in Cleveland when I publically criticized the Cleveland Clinic's anti-smoking crusade. Going after folks for what they do on their private time should be irrelevant and out of bounds. Of course, he would have squeezed his rotund employees down to an acceptable BMI, but for obesity being a protected class. Why stop at cigarettes? Should employees be permitted to ingest trans fats or drive an SUV? Shouldn't there be a moral code that employees need to follow 24/7 also? What if an employee watches racy movies? Would this be grounds for dismissal? www.MDWhistleblower.blogspot.com

InformaticsMD said...

Michael Kirsch, M.D. wrote:

"Why stop at cigarettes?"

Indeed. Why stop at anything at all? Why not discriminate against people because you don't like their appearance, or because you stereotypically believe some aspect of their appearance (say, skin color) indicates indolence making them unsuitable for employment?

Basically, the Cleveland Clinic's CEO was either saying that overweight people are lazy and lack willpower and therefore are unsuitable for employment, or that he simply doesn't like their appearance.

Either one is grounds, in my mind, for this CEO's dismissal on the basis of bigotry - a cousin of racism.

nutrprofe said...

There are plenty of obese employees at the Cleveland Clinic. They are well aware of Toby's uncharitable attitude towards them, and it does nothing good for morale. None of them have been scared thin, or shamed thin. Many of the Clinic's obese employees are also black, drawn from the surrounding neighborhood which are 90% black. Some of them suspect that Toby's "weightism" may be a facade for racism.