Ethical bankruptcy of hospital management

Two law suits, one in Texas and the other in New Mexico, put the spotlight on the role of hospitals in employee or patient safety.

In New Mexico, Colleen Heild, my friend who is an investigative reporter at the Albuquerque Journal, reports U.S. Bankruptcy Judge Robert H. Jacobvitz ruled a hospital management company, in this case Quorum Health Resources, “breached its duty to prevent the risk of harm to dozens of patients of an Alamogordo hospital who were unwittingly subjected to experimental procedures to alleviate back pain.”

The other case, which may not see a ruling for quite a while, involves the Dallas-area nurse, Nina Pham, who contracted Ebola after caring for Thomas Duncan at Texas Health Presbyterian Hospital. Duncan later died. The Dallas Morning News broke the story over this past weekend and ProPublica placed Pham’s lawsuit in a broader context — the violation of patient privacy.

The behavior of the hospitals’ management in these stories triggered memories of my experience during the 1960s while attending the Hospital and Health Administration Program at the University of Iowa. And these cases brought to mind why hospital management can be so bereft of ethics. As part of the Iowa’s program back then, the department head, the late Gerhard Hartman, consulted with hospitals throughout the nation. Those engagements were the basis for the second-year masters students’ “community study,” the report and recommendations Hartman made to his clients.

Under the supervision of doctoral students, masters candidates would do all the research and writing of those reports. Sometimes the project involved traveling to the community, which the team members financed themselves. The community study team also paid for the report to be typed and then the university department copier would print the report for presentation.

I know that Hartman never reimbursed the graduate students for the expenses involved in the study. I doubt he reimbursed the university for using its resources as well. In the 1970s, there were rumors that Harman had double-dipped, billing the clients and university for the same services. No one, of course, stood up to him at the time. The price would have been too high. But it set the tone for the ethics in the department and I have often wondered over the years whether it set the tone for generations of hospital administrators who came through the Iowa program.

Ethical bankruptcy of hospital management

Two law suits, one in Texas and the other in New Mexico, put the spotlight on the role of hospitals in employee or patient safety.

In New Mexico, Colleen Heild, my friend who is an investigative reporter at the Albuquerque Journal, reports U.S. Bankruptcy Judge Robert H. Jacobvitz ruled a hospital management company, in this case Quorum Health Resources, “breached its duty to prevent the risk of harm to dozens of patients of an Alamogordo hospital who were unwittingly subjected to experimental procedures to alleviate back pain.”

How Not to Handle a Crisis -- Hospital Style

About 47 years ago, I sat a University of Iowa classroom and listened to, Gerhard Hartman, the head of the Graduate Program in Hospital and Health Administration snidely criticize a story on a local health issue in the Iowa City newspaper. In the five decades that have passed since earning my Master’s, I’ve often thought about that classroom experience; and, more so, in the past 18 years as a professional journalist — reporter, editor and publisher.

Hartman, an economist, founder of the master’s program and chief executive of University Hospital was well known for his arrogance and his pleasure in putting people down. As I think back, I don’t believe any of my classmates understood that whatever errors Hartman thought were in the story might have just as well come from the editing as from the reporting. Or, from the sources themselves, whomever they were and if these sources were innocently misinformed or if they had successfully mislead the reporter.

No one was in a position to defend the reporter or the newspaper and had anyone disputed Hartman, it is possible they would have paid direly for it. It was 1967 and at that time and place, Hartman was pretty much the dictator. That graduate school paradigm had other elements and consequences that might be a blog topic for another time. Today, the memory provided a portal into a discussion of the “crisis” at Texas Health Presbyterian Dallas. It isn’t the Ebola crisis, per se, that bears discussion. It’s the leadership crisis at what The Dallas Morning News reports Sunday many see “one of the region’s more prestigious hospitals.”

Of course, the first crisis really was the hospital’s and the error that lead to the failure to properly diagnose and immediately treat Thomas Eric Duncan’s Ebola infection on Sept. 25, according to various media reports. Duncan returned two days later to be diagnosed with the virus and died Oct. 8. But, as we learned two nurses, Nina Pham and Amber Vinson, also contracted the deadly disease, the hospital’s pubic announcements were confusing, contradictory and, frankly, defensive. The lack of clarity seemingly within and outside the hospital was just what I would have expected after been in the industry for 25 years. Top hospital officials are trained to protect the institution and they are aided and abetted by laws that evolved over the years. Those laws have the consequences of using “privacy” to cover up problems.

Meanwhile, Presbyterian staffers and physicians spoke out, faulting the hospital for poor training, poor technique and confusion, according to the Huffington Post on Oct. 16. The hospital leadership pushed back, of course: “‘The assertions do not reflect actual facts learned from the medical record and interactions with clinical caregivers,’ Texas Health Presbyterian Hospital Dallas said in a statement.”

Over the years, I have grown disdainful of “statements” like this being issued by organizations under the gun for messing up. It’s the coward’s way — avoiding a real discussion with the public to which it is responsible. The Dallas Morning News made the full statement, issued at 4 a.m., available here.

Then, on Oct. 17, according to another News story, a further public relations push began with the hospital trotting out Dr. Daniel Varga, Presbyterian’s chief clinical officer, to admit the hospital’s errors.

“The hospital hired Burson-Marsteller, the global public relations firm, after a series of contradictory news releases, unanswered questions and growing criticism over how it treated Thomas Eric Duncan, the Liberian who died of Ebola at Presbyterian,” the Oct. 17 story reported.  So, with the report Sunday, including a letter to the community published in The News, we see the hospital in full PR crisis mode.

I don’t personally know the leadership at the hospital in Dallas or in Arlington, where Texas Health Resources, the huge parent organization is based. Here is what I do know:

·         The public was ill-served by the hospital’s attempt to look good in the face of a clear error or set of errors.

·         The news media may or may not have over reacted, but whenever a good journalist smells stonewalling or an attempt at disinformation and misdirection, he or she ratchets up the intensity of the reporting effort.

·         Knowing that Presbyterian wasn’t really coming clean as quickly as possible, the hospital and parent corporation brought the bad publicity and the lack of public confidence on itself.

·         The physicians running the emergency services, Emergency Medicine Consultants Ltd., as Texas Medicine Resources LLP, similarly invite the kind of scrutiny it doesn’t want for the same reasons that the hospital is in the same pickle.

I wonder how Hartman would have handled the situation.