A Tangled Web of Perversity by a Healthcare Company Owner - Subpoenaing Emails of Law Student Critics at NYU Law School, Where He is a Trustee

At Healthcare Renewal, we are largely calling for removal from healthcare of perverse managers and perverse management practices.  <br /><br />One of those practices is the attempted silencing of critics.<br /><br />I have first hand experience with a perverse but unsuccessful attempt myself, where the apparently (and IMO, and as protected by the 1st Amendent) megalomaniacal management of a once-reasonable hospital (I did my residency there 1985-7) sought to abridge my 1st Amendment rights regarding care of my late mother.  See my August 11, 2013 post "Who Would Have Thought, Comrades, That The Most Severe Form of Attempted Internet Censorship Could Originate in a Community Hospital, Abington Memorial, That Alleges Itself A Non-Profit Public Servant?" at <a href="http://hcrenewal.blogspot.com/2013/08/who-would-have-thought-comrades-that.html">http://hcrenewal.blogspot.com/2013/08/who-would-have-thought-comrades-that.html</a>.<br /><br />This recent story, however, is simply stunning in the audacity of its principal regarding "shutting up" critics, this time two law students at a law school of which he is a Trustee: <br /><br /><blockquote class="tr_bq"><b>Law School Trustee's Company Chills Critical Speech With Subpoena For Students' Personal Emails</b><br /><div class="storydate">Mon, Apr 21st 2014 1:14pm</div><div class="storydate"><a href="http://www.techdirt.com/articles/20140418/18013426963/law-school-trustees-company-chills-critical-speech-with-subpoena-students-personal-emails.shtml">http://www.techdirt.com/articles/20140418/18013426963/law-school-trustees-company-chills-critical-speech-with-subpoena-students-personal-emails.shtml</a> </div><br /><style type="text/css">P { margin-bottom: 0.08in; }A:link </style>A New York University trustee has found a way to chill speech critical of him and the [healthcare] companies he owns: <a href="http://www.dnainfo.com/new-york/20140417/greenwich-village/judge-orders-law-students-give-up-emails-after-criticizing-nyu-trustee" target="_blank">subpoena the personal emails of two particularly outspoken opponents</a>. <br /><blockquote><i>A New York University Law trustee's company wants two students to hand over their personal emails after they circulated a letter criticizing him, according to a subpoena.</i> <br /><br /><i>The law students, second-year Luke Herrine and first-year Leo Gertner, were targeted after they helped circulate a letter denouncing NYU Law School trustee Daniel Straus, who owns <b>Care One Management</b>, a home health aide and nursing home company embroiled in a labor dispute.</i></blockquote></blockquote><blockquote>The two students <a href="https://docs.google.com/forms/d/1X8Zb-03UyyAZi4CNz8LWRN4KHRhHraOO30WO310_Wfo/viewform" target="_blank">started a petition asking for the removal of Straus</a> from the Board of Trustees, pointing out that a law school should probably be associated with someone who respects the law, something Straus' companies seem to have trouble doing. His two companies, <b>CareOne </b>(<a href="http://care-one.com/">http://care-one.com/</a>)<i> </i>and <b>HealthBridge Management </b>(<a href="http://www.healthbridgemanagement.com/">http://www.healthbridgemanagement.com/</a>)<b>, have been cited at least 38 times by the National Labor Relations Board for violating federal labor laws. In addition, HealthBridge was held in contempt of court for refusing to allow 600 workers to return to their jobs at their pre-strike pay levels. </b></blockquote><br />"A law school should probably be associated with someone who respects the law" seems an oxymoron, not to mention protected speech under the First Amendment of the U.S. Constitution: <a href="http://en.wikipedia.org/wiki/First_Amendment_to_the_United_States_Constitution">http://en.wikipedia.org/wiki/First_Amendment_to_the_United_States_Constitution</a>.<br /><br /><blockquote class="tr_bq">CareOne's current legal battle with a local labor union, Service Employees International Union (SEIU), something that has dragged on for years at this point, <a href="http://www.nyunews.com/2014/04/18/served/" target="_blank">has seemingly turned into a convenient way for Straus to get back at his critics</a>. Of course, CareOne claims otherwise. <br /><blockquote><i>CareOne spokesperson Deborah Maxson said the deadline for the requested information is April 25.</i> <br /><br />“<i>Straus is not a party to the lawsuit and is not managing the litigation,” Maxson said.</i> </blockquote></blockquote><blockquote>Straus may not be a party to this lawsuit, but these are his companies, and there can be very little doubt that Straus would prefer the ongoing criticism of his business efforts be halted. I<b>f CareOne wants to use the excuse that Straus isn't a "party" to this lawsuit, then it needs to extend that same courtesy to the two students</b>, who also aren't a "party" to the ongoing legal fight. </blockquote><br />But they're defenseless students, and in healthcare matters, dissing a high-ranking healthcare management  person seems to be a crime that such persons cannot seem to tolerate.  (I won't get into the psychopathological issues that may come into play).<br /><br /><blockquote class="tr_bq">Then there's the content sought by the subpoenas. This, too, mentions Straus directly, even as CareOne claims this has nothing to do with him. According to a letter sent by the Board of Trustees to NYU administration, this is what CareOne is hoping to obtain: <br /><blockquote>“<i>The subpoenas <b>requested information regarding any contact the students may have had with SEIU and any activity they may have engaged in,</b> such as protests or meetings, <b>relating to Mr. Straus or CareOne...”</b></i> </blockquote></blockquote><blockquote>If Straus isn't "party" to this lawsuit, why does CareOne need information relating to Straus? Beyond that, the information requested bears all the hallmarks of <b>trying to use the power of the court to silence free speech. Protests and meetings, both activities covered by the First Amendment, </b>are mentioned specifically by the subpoena. </blockquote><br /><br />Perhaps some members of the generation after the "Greatest generation" have such low self-esteem that they have to bully mere students into submission.<br /><br /><blockquote class="tr_bq">For what it's worth, NYU has stepped up and has provided the students with the pro bono help of one of the school's lawyers. It also issued a very carefully-worded defense of the students, no doubt mindful of Straus' $1.25 million annual endowment. <br /><blockquote>“<i>The Law School is not a party to the litigation between Care One and SEIU, and will remain uninvolved in it," the school wrote in a statement to DNAinfo New York sent Thursday. "We vigorously support the right of our students to express their views and to organize and participate in lawful demonstrations and other protest activity, at the same time that we acknowledge that parties to litigation are permitted, subject to applicable rules and judicial oversight, to gather evidence in support of their case."</i></blockquote></blockquote><blockquote>Further statements reiterated NYU's support for its students' rights but also noted it considered Straus to be an "upright and honorable person." <br /><br />That said, <b>it seems that there is a clear -- and somewhat massive -- conflict of interest for Straus to remain on the board of trustees at NYU Law at the same time he's using the legal process to demand the email contents from two of its students</b>. </blockquote><br />Conflicts of interest are nothing new to healthcare. <br /><blockquote class="tr_bq"><br />As is noted by <a href="https://docs.google.com/forms/d/1Q-QfTZh1iJiN7sZNF21N42ceFFKz8GU7oJZc7ta6W0o/viewform" target="_blank">the students' new petition demanding the withdrawal of the subpoenas</a>, this sort of activity, undertaken by a "victim" of criticism, will discourage others from approaching anything remotely controversial. <br /><blockquote><i>Forcing students to turn over emails and other private communications in litigation that does not concern them can <b>chill free speech </b>on campus and make students think twice about raising their voice about controversial issues. <b>This is antithetical to NYU's mission of open academic inquiry and commitment to the public interest.</b></i> </blockquote></blockquote><div style="margin-bottom: 0in;"><br /></div><div style="margin-bottom: 0in;">That's assuming the mission of NYU and other universities still remains "open academic inquiry."  Many have begun to doubt that, and with good reason; e.g., see <a href="http://www.bloombergview.com/articles/2014-04-22/free-speech-zones-and-other-college-lies">http://www.bloombergview.com/articles/2014-04-22/free-speech-zones-and-other-college-lies</a> as just one example. </div><div style="margin-bottom: 0in;"><br /></div><blockquote class="tr_bq"><div style="margin-bottom: 0in;">Rather than address these concerns, Straus <b>is allowing (or directing) his company to shut down his critics by seeking personal communications from non-party NYU students.</b> Straus also has additional leverage with the university should this fail to keep future criticism at bay. Of course, there's always a chance NYU will side with the students and decide that Straus' companies don't really reflect the culture it's trying to instill in its students. But until this all plays out, <b>we're just witnessing the sort of tactics deployed by entities who would rather <a href="http://www.techdirt.com/articles/20140129/15052326039/university-yanks-professors-email-access-after-he-criticizes-school-chancellor-compares-his-statements-to-school-shootings.shtml" target="_blank">shut people up</a> than address their concerns. </b></div></blockquote><div style="margin-bottom: 0in;"><br /></div>I note the following statement on the web page of Care One Management:<br /><br /><blockquote class="tr_bq">"With a <b>focus on the highest standards, clinical best practices and strong management principles</b>, CareOne has developed a reputation as a premier health care company in New Jersey.<br /><br />With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities."</blockquote><br /><div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;"><div class="big dark">With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.</div>With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities.<br />- See more at: http://care-one.com/#sthash.mAHNhXEp.dpuf</div><div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;"><div id="content"><div class="col1 museo"><br /><br /><div class="big dark">With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.</div>With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities.</div></div>- See more at: http://care-one.com/#sthash.mAHNhXEp.dpuf</div><div id="stcpDiv" style="left: -1988px; position: absolute; top: -1999px;"><div id="content"><div class="col1 museo"><br /><br /><div class="big dark">With a focus on the highest standards, clinical best practices and strong management principles, CareOne has developed a reputation as a premier health care company in New Jersey.</div>With services that include post-hospital care, rehabilitation, assisted living, long-term care and a variety of clinical specialty programs, CareOne offers compassionate care in gracious, professionally managed centers and communities.</div></div>- See more at: http://care-one.com/#sthash.mAHNhXEp.dpuf P { margin-bottom: 0.08in; }A:link { } </div>In healthcare, I remind, the "shut people up" mentality results in patient injury and death.  It seems to me that this Trustee is not just setting a bad example for the legal profession, but it also throws the management of his healthcare organizations into question.<br /><br />-- SS

A Tangled Web of Perversity by a Healthcare Company Owner - Subpoenaing Emails of Law Student Critics at NYU Law School, Where He is a Trustee

At Healthcare Renewal, we are largely calling for removal from healthcare of perverse managers and perverse management practices.  One of those practices is the attempted silencing of critics.I have f…

Đọc thêm »

NYU Faculty Vote No Confidence in their President

Faculty at large American universities, in which most of the country's medical schools and teaching hospitals are embedded, are becoming increasingly concerned about the leadership and governance of their organizations, and whether the universities are putting their academic (and clinical) missions ahead of other concerns, like making money and rewarding top executives.<br /><br />In January, 2013, we <a href="http://hcrenewal.blogspot.com/2013/01/at-university-of-miami-faculty-without.html">discussed</a> a an informal, anonymous vote faculty at the University of Miami medical school expressing no confidence in their dean and his chief lieutenant.<br /><br /><b>The NYU No Confidence Vote </b><br /><br />The faculty of a major component of another big US university have just openly voted no confidence in their president, and are raising questions about their board of trustees.  The setting was New York University.  Some background comes from a New York Times <a href="http://www.nytimes.com/2013/03/10/nyregion/john-sexton-is-tested-by-nyu-faculty.html">article</a> this month:<br /><br /><blockquote class="tr_bq"> Embarking on an ambitious expansion at home, constructing a network of new campuses around the globe, wooing intellectual superstars and raising vast amounts of money, John Sexton of New York University<a class="meta-org" href="http://topics.nytimes.com/top/reference/timestopics/organizations/n/new_york_university/index.html?inline=nyt-org" title="More articles about New York University."></a> is the very model of a modern university president — the leader of a large corporation, pushing for growth on every front.<br />  <br /><div itemprop="articleBody">To some within N.Y.U., Dr. Sexton is a hero who has transformed the university. <i>The trustees have thanked him by elevating his salary to nearly <b>$1.5 million </b>from $773,000 and guaranteeing him retirement benefits of <b>$800,000 </b>a year.</i> </div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">But to others, he is an autocrat who <i>treats all but a few anointed professors as hired help, ignoring their concerns, informing them of policies after the fact and otherwise running roughshod over American academic tradition, in which faculty members are partners in charting a university’s course. </i></div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">'He has a very evangelical sense of purpose,' said Andrew Ross<a href="http://sca.as.nyu.edu/object/andrewross.html"></a>, a professor of social and cultural analysis, 'that does not extend beyond the concept that<i> the university should be an entity of his own making</i>.' </div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">'I think,' he added, 'when other administrations see that they say, Well that’s what leadership should be. And when faculty see that they say, That is not what university leadership should be.<i> It’s the style of a maverick C.E.O</i>.'</div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">The debate over Dr. Sexton’s presidency will come to a head this week. The faculty of the university’s largest school, Arts and Science, has scheduled a five-day vote of no confidence. Given Dr. Sexton’s international stature, the vote may serve as the most important referendum yet on the direction of American higher education. </div></blockquote><div itemprop="articleBody"><br />President Sexton lost the no-confidence vote, as noted in another NY Times <a href="http://www.nytimes.com/2013/03/16/education/no-confidence-vote-for-head-of-nyu.html">article</a> a week later:<br /><br /><blockquote class="tr_bq">The vote, 298 to 224 (with 47 abstaining), took place via electronic balloting from Monday through Friday. Full-time tenured and tenure-track professors were asked to respond to the statement: 'The faculty of Arts and Science has no confidence in John Sexton’s leadership.' Voter participation was 83 percent. </blockquote><br /></div><div itemprop="articleBody"><b>Top Executives Usurp Power from Faculty </b><br /><br />An <a href="http://www.nytimes.com/2013/03/21/opinion/the-war-at-nyu.html">op-ed </a>in the NY Times by a leading dissenting faculty member further explained the issues.  He charged that the President ignored faculty concerns about an ambitious plan to expand the physical plant of the university:</div><div itemprop="articleBody"></div><div itemprop="articleBody"><br /></div><blockquote class="tr_bq"><div itemprop="articleBody">How did Dr. Sexton lose the confidence of so many faculty members? By <i>ignoring us</i>. Of course, many professors everywhere feel overlooked by today’s generation of jet-setting university presidents. But we have very specific complaints: above all, Dr. Sexton has consistently refused to address concerns about plans to expand N.Y.U. offices and dorms into the part of Greenwich Village south of Manhattan’s Washington Square Park, where many of us live. </div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">This expansion plan is known as N.Y.U. 2031, indicating the year in which all the building will be complete. The very name told us that we’d be living on a construction site for a couple of decades. </div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">Not surprisingly, this did not go over very well with many faculty members. <i>We were also concerned about where the money would come from to pay for this expansion, as no business plan for the project has been made public.</i> </div><div itemprop="articleBody">Thirty-nine departments and schools passed resolutions last year against the 2031 plan. These resolutions were typically passed unanimously or nearly unanimously. And yet <i>Dr. Sexton’s response was a deafening silence</i>. </div></blockquote><div itemprop="articleBody"><b>Academic Values, Particularly Academic Freedom and Free Speech Ignored</b><br /><br /></div><div itemprop="articleBody">Furthermore, the faculty were concerned about plans to expand the university overseas to nations not known for their vigorous support of academic freedom and free speech:</div><div itemprop="articleBody"><br /></div><blockquote class="tr_bq"><div itemprop="articleBody"> Many of us are also concerned with Dr. Sexton’s plans to expand N.Y.U. overseas, including branch campuses in Abu Dhabi and Shanghai, with inadequate faculty involvement or oversight. <i>It is doubtful that faculty members would have chosen to build campuses in countries where academic freedom, and free speech generally, are so parlous</i>. </div></blockquote><div itemprop="articleBody"><br /><b>Executives Enriching Themselves at University Expense</b><br /><br /><br /></div><div itemprop="articleBody">Finally, the faculty were concerned about top university executives immodestly enriching themselves from the coffers of a non-profit university:</div><div itemprop="articleBody"><br /></div><div itemprop="articleBody"></div><blockquote class="tr_bq"><div itemprop="articleBody">As the faculty vote approached, more trouble arose for Dr. Sexton in the form of news reports about <i>lavish compensation for NY administrators.  The central but by no means sole figure in this scandal is Jacob J Lew, t</i>he Obama administration’s new Treasury secretary, who worked at N.Y.U. in the early 2000s for <i>a salary that eventually reached <b>$900,000,</b> larger even than Dr. Sexton’s at the time. </i></div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">Mr. Lew received<i> loans to buy a nice home, which apparently were largely forgiven. He also received a severance of some <b>$700,000 </b>when he left for a well-paid position at Citigroup</i>. Severance? For someone who leaves voluntarily? </div><div itemprop="articleBody"><br /></div><div itemprop="articleBody"> Dr. Sexton himself is to receive <i>a salary of more than <b>$1.4 million</b> this year, and a 'length of service' bonus of <b>$2.5 million</b> in 2015</i>. (Full disclosure: the university gave me a set of mugs when I completed 25 years of teaching.) And <i>he will receive <b>$800,000</b> a year after he retires. </i></div><div itemprop="articleBody"><br /></div><div itemprop="articleBody"><i>Other top administrators make similarly extravagant salaries</i>. Some experts believe <i>there may even be something illegal in the way Dr. Sexton has rewarded them; </i>N.Y.U.’s chapter of the American Association of University Professors has asked New York States’s attorney general to investigate. </div><div itemprop="articleBody"><br /></div><div itemprop="articleBody">All of which raises a question for many N.Y.U. faculty members: <i>Should administrators be able to enrich themselves like this at educational institutions? N.Y.U. is not a Wall Street firm, but a tax-exempt university that gets millions in taxpayer dollars, not least from student loans<a class="meta-classifier" href="http://topics.nytimes.com/top/reference/timestopics/subjects/s/student_loans/index.html?inline=nyt-classifier" title="More articles about student loans."></a>. </i>In fact, our students have the highest total debt load of any university in the country. Rather than expanding, or paying huge salaries to top administrators, why doesn’t N.Y.U. do more to help its alumni pay off their debts? </div></blockquote><div itemprop="articleBody"><br /></div><b>Forsaking the Academic Mission </b><br /><br />An <a href="http://www.insidehighered.com/news/2013/03/18/new-york-university-vote-no-confidence-raises-debate-about-ambitions-and-governance">article</a> in Inside Higher Education underlined how the dispute is really about the mission of the university in this brave new corporate era:<br /><br /><blockquote class="tr_bq">As Rebecca Karl, an associate professor of East Asian studies and history <a href="http://www.insidehighered.com/news/2005/03/16/summers3_16">recently told <i>Inside Higher Ed</i></a>, '<i>We’ve become very critical of the whole idea of ‘expand or die,’ which of course is a corporate maxim, but we don’t understand why it needs to become our maxim.</i>'</blockquote><br />Also,<br /><br /><blockquote class="tr_bq"> Mark Crispin Miller, a professor of media, culture and communication in NYU's Steinhardt School of Culture, Education and Human Development, who has been an outspoken critic of the Greenwich Village plan [said]. 'The fact is we see NYU as a school, <i>we see our mission as educational. Sexton and the trustees who support him view NYU as a bundle of assets whole value they will apparently do anything to maximize on paper. We believe that this approach is destroying this university.'</i></blockquote>By the way, maybe in retrospect the trustees' role should not be so surprising.  Back in 2011 we <a href="http://hcrenewal.blogspot.com/2011/12/they-think-we-are-imbeciles-and-they.html">posted</a> about a group of extremely rich corporate and finance leaders who attacked critics of their growing power as "imbeciles," among other terms.  Several of the individuals featured in the news article which inspired this post were trustees of New York University.  These included   Kenneth Langone and John Paulson.  A quick look at the<a href="http://www.nyu.edu/about/leadership-university-administration/board-of-trustees.html"> list of current trustees</a> shows that it includes  many top leaders of finance firms, including firms whose actions were alleged to have helped cause the great recession/ global financial collapse or have been subsequently accused of other financial shenanigans, e.g., Steven S Miller, a Vice President of JP Morgan Chase, and Maurice Greenberg (a life trustee), former leader of AIG, E John Rosenwald Jr (a life trustee), Vice Chairman Emeritus of JP Morgan Chase, and William R Salomon (a life trustee), honorary chairman of Citigroup.<br /><br /><b>Summary</b><br /><br />In summary, the issues that inspired the no-confidence vote against the President of New York University appeared to be allegations that university:<br />-  administration usurped power, particularly from the faculty<br />-  administration used this power to put corporate priorities, like expansion for its own sake, and increasing short-term revenue ahead of the academic mission<br />-  administration took advantage of their power to enrich themselves<br />-  trustees, who are supposed to exert stewardship that ensures the university upholds its mission, instead aided and abetted all this<br /><br />All of these should be very familiar issues to <a href="http://hcrenewal.blogspot.com/">Health Care Renewal</a> readers.  We have discussed the rise of <a href="http://hcrenewal.blogspot.com/search/label/generic%20managers">generic managers</a> of health care organizations, trained supposedly in general management skills, but not in health care, and indifferent at best to the values of health care professionals.  At times their power has gotten so great as to constitute a <a href="http://hcrenewal.blogspot.com/search/label/managers%27%20coup%20d%27etat">manager's coup d'etat</a>.   We have discussed how managers of health care organizations often put short-term revenue ahead of all other concerns, sometimes called <a href="http://hcrenewal.blogspot.com/search/label/financialization">financialization</a>.  In doing so, they may end up perpetrating <a href="http://hcrenewal.blogspot.com/search/label/mission-hostile%20management">mission hostile- management</a>.  We have discussed how managers are able to command often outrageous levels of  <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">executive compensation</a>.   <a href="http://hcrenewal.blogspot.com/search/label/boards%20of%20trustees">Boards of trustees</a>, who are supposed to exert stewardship over the organization, and see that its leadership upholds its values, often come from management backgrounds themselves, and are at best clueless about, if not hostile to the mission.  <br /><br />It is time for university faculty to defend their institutions' mission.  Students, alumni, and patients at academic medical centers, medical school clinics, and of academic health professionals ought to be equally fervent in support of the academic and academic health care missions.  Academic medicine needs to be lead and stewarded by people who understand that mission, value it, uphold it, and are accountable for that.  These leaders and stewards should eschew management fads, cronyism, and excess personal enrichment.<br /><br />Maybe the vote of no confidence at NYU is a small step on the path back to the academic and academic medical missions.  But do not expect those who are enriching themselves in the current system to go quietly.<br /><br />ADDENDUM - see also <a href="http://www.margaretsoltan.com/?p=39339">this post</a> by Prof Margaret Soltan on the University Diary blog.

NYU Faculty Vote No Confidence in their President

Faculty at large American universities, in which most of the country's medical schools and teaching hospitals are embedded, are becoming increasingly concerned about the leadership and governance of t…

Đọc thêm »

Conflicts of Interest, Government Leaders, and Private Health Care Organizations

There seems to be a small surge of stories about conflicts of interest regarding health care affecting government leaders who can affect health care.  <br /><br />The Institute of Medicine defined conflict of interest in medicine as "circumstances that create a risk that professional judgments or actions regarding a primary interest will be unduly influenced by a secondary interest."  So we will summarize these stories by first showing what each leader's secondary interests are, and then show how they may influence carrying out his leadership responsibilities.  (We used "his" because all examples are of male leaders.)<br /><br /><strong>Florida: Governor Scott and Solantic</strong><br /><br />Rick Scott, the new Florida Governor, apparently still has strong ties to a for-profit chain of urgent care centers, as <a href="http://www.palmbeachpost.com/money/gov-scott-shifting-clinics-to-his-wife-raises-1317326.html">reported</a> by the Palm Beach Post:<br /><blockquote>As Florida Gov. Rick Scott reorganizes health agencies, cuts spending and pushes for new free-market health policies,<em> his ownership of Solantic, the urgent care chain, increasingly poses conflict of interest questions.</em><br /><br />Solantic co-founder Karen Bowling says Scott has taken steps to distance himself from the chain. He stopped regular business calls with her after he was elected.<br /><br />'I don't talk to him anymore. Not since November. Really not much since April,' Bowling said.<br /><br />Scott left the privately held company's board of directors in January 2010, during his campaign.<br /><br />But the most important step the governor must take to avoid a conflict of interest, some ethics experts say, is to divest his Solantic interests.<br /><br />In January, <em>Scott did transfer his Solantic stock - to his wife</em>.</blockquote><br />There were obvious questions raised whether this transfer mitigated the conflict of interest:<br /><blockquote>Scott's efforts to distance himself appear to be designed to meet the letter of Florida ethics laws, if not the spirit.<br /><br />They may not succeed if challenged, warned legal and ethics expert Marc Rodwin, a law professor at Suffolk University who is the author of several books on health care and conflicts of interest.<br /><br /><em>'Placing his ownership in the name of his wife is not an effective way to control for conflicts of interest and not generally accepted because they are personally related,' Rodwin said.</em><br /><em><br /></em><br /><em>Rodwin said Scott's blindness to Solantic's daily business decisions likewise does not relieve his conflict.</em><br /><em><br /></em><br /><em>'His family still benefits from it,</em>' he said.</blockquote><br />There are a number of issues before Florida government about which there appears to be a risk that Governor Scott's actions could be unduly influenced by his family's ownership interest in Solantic:<br /><blockquote>From the moment he was elected, <em>Scott has said government has no business providing primary care.</em><br /><em><br /></em><br /><em>His budget proposal eliminated state support for the clinics. The county's health department director warns that may leave 30,000 adults without a medical home</em>.<br /><br />Scott's decisions as governor are likely to affect Solantic in other, perhaps more significant ways.<br /><br />Scott's budget would <em>curb growth in Medicaid spending, the state-federal safety net insurance program, by requiring most recipients to join private HMOs. Solantic accepts Medicaid HMO reimbursements, but not state Medicaid, so adding clients could broaden the clinics' customer base.</em><br /><br />But the greatest benefit for Solantic could come from Scott and other Republican governors' lobbying efforts in Washington.<br /><br />They want the Obama administration to give states waivers from the Affordable Care Act, and provide them with a massive block grant to expand health coverage in the way they deem best for their states. Money slated to go to business' health insurance tax credits and lower income consumers' insurance subsidies could pay for the grants - to the tune of billions.<br /><br />Obama has said he's willing to give the states waivers on a speeded-up timetable. His administration Thursday published new rules on how states could get that waiver.<br /><br />Scott's health policy adviser Michael Cannon, an economist with the Cato Institute in Washington, favors giving consumers health vouchers that they would use either as cash for direct-pay medical care or to buy insurance.<br /><br />The possible effect on Solantic and similar clinics could be huge, said Rodwin, the legal ethics expert.<br /><br /><em>'You have a major owner-operator of a set of clinics on the state level, and a major policy figure on a state level, making major changes that affect whether that kind of business will thrive or not, what their competition will be, and really reforming the whole health sector,'  Rodwin said. That's in my view a very dangerous role</em>.'</blockquote><br />Note that this is not the first whiff of scandal regarding Rick Scott's leadership role in health care.  As the article noted, Scott:<br /><blockquote>resigned as CEO of <a href="http://hcrenewal.blogspot.com/search/label/HCA">Columbia/HCA</a> amid a federal billing fraud investigation. Columbia/HCA ultimately agreed to the <em>nation's largest Medicare fraud settlement, a $1.7 billion criminal and civil penalty.</em><br /><br />Although the company had admitted to criminal wrongdoing, Scott himself was never charged, and he has denied knowledge of the illegal activities.<br /><br />Scott left Columbia/HCA with more than $5 million in severance and $300 million worth of stock and options.</blockquote>See our most recent detailed post on Mr Scott's history <a href="http://hcrenewal.blogspot.com/2010/05/how-did-ceo-who-presided-over-company.html">here</a>.<br /><br /><strong>Massachusetts: House Health Finance Committee Chair Walsh and Health Care Industry Lobbyists</strong><br /><br />The newly appointed chair of the Massachusetts House committee on health care finance has strong relationships to health care industry lobbyists, according to <a href="http://www.boston.com/bostonglobe/editorial_opinion/editorials/articles/2011/02/23/with_family_ties_to_lobbyists_walsh_doesnt_fit_health_post/">an editorial </a>in the Boston Globe:<br /><blockquote>Speaker Robert DeLeo has chosen a health-finance committee chairman, Steven M. Walsh of Lynn, <em>whose family is to lobbying what the Mannings are to NFL quarterbacking. Walsh’s father-in-law represents the state’s health insurers, while his uncle’s firm blocks and tackles for <a href="http://hcrenewal.blogspot.com/search/label/Steward%20Health%20Care">Steward Health Care</a></em>, new owners of the Caritas chain of Catholic hospitals. </blockquote><br />Again, there are a number of issues before the Massachusetts legislature about which there appears to be a risk that Representative Walsh's actions could be unduly influenced by his family's lobbying work:<br /><blockquote>Next to the budget, the thorniest issue the Legislature will deal with this year will be changes in health care financing. <em>Lawmakers will consider bills that may completely change how health care providers are paid. That shift — from fee-for-service payments towards a system based more on per-capita reimbursements — will set off a free-for-all among insurers, doctors, and hospitals.</em></blockquote><br />So,<br /><blockquote>Walsh’s admirable efforts ... [to improve legistlation regarding lobbying] don’t erase the conflict of interest he faces on health care issues. Walsh can try to separate family feelings and events from his official role, but the companies paying his uncle’s firm and his father-in-law are still expecting them to use every opportunity to make the strongest possible case for their clients. And <em>it’s no exaggeration that these clients — the state’s insurers and its newest hospital chain — have hundreds of millions of dollars at risk in the new payment system Walsh will be vetting</em>.<br /><br />Perhaps if the stakes were lower or the relationships more distant, Walsh could chair the health-finance committee without risking public confidence. But as it is, he will be in a position of representing the taxpayers’ interests against those of his close relatives.</blockquote>Note that we discussed Steward Health's possibly revolutionary role in commercializing physicians' practices <a href="http://hcrenewal.blogspot.com/2011/02/send-mercenaries-guns-and-money.html">here</a>, and how a former Massachusetts government health care agency official exited via the revolving door to join Steward Health Care <a href="http://hcrenewal.blogspot.com/2011/03/those-big-doors-keep-revolving.html">here</a>. <br /><strong>New York: Governor Cuomo's Advisor and Major Hospital Systems</strong><br /><br />New York Governor Andrew Cuomo has a close advisor whom he just appointed to a "Medicaid redesign team" whose clients include large academic medical centers/ hospital systems, <a href="http://www.nytimes.com/2011/02/23/nyregion/23cuomo.html">per</a> the New York Times:<br /><blockquote>When Andrew M. Cuomo married Kerry Kennedy in 1990, Jeffrey A. Sachs served as an usher. When Mr. Cuomo’s daughter Michaela was born, he asked Mr. Sachs to be her godfather. When his marriage fell apart years later, Mr. Cuomo stayed in Mr. Sachs’s triplex near the United Nations. <br /><br />Since Mr. Cuomo’s election as governor last fall, <em>Mr. Sachs, 58, has taken on a powerful role among his health care advisers as the administration confronts crucial decisions, including how to overhaul New York’s $53 billion Medicaid program.</em> <br /><br />But at the same time, Mr. Sachs, known to many in Albany as 'Andrew’s best friend,' is <em>working as a paid consultant to some of the biggest players in the New York health care industry, including Mount Sinai Medical Center, NYU Langone Medical Center and the state’s largest association of nursing homes</em>, all of which have financial interests at stake in the coming Medicaid changes. <br /><br />Mr. Sachs, whose firm is named Sachs Consulting, has never registered as a lobbyist, which would require him to divulge his clients and fees to the state ethics commission. </blockquote><br />Again, there are a number of issues before New York government about which there appears to be a risk that Governor Cuomo's actions could be unduly influenced by his friend, advisor, and committee member's consulting relationships with major hospital systems. <br /><blockquote>Mr. Sachs was also an early advocate of the “Wisconsin model” of Medicaid, under which the governor would <em>set a target for spending reductions and then appoint a task force of industry stakeholders to apportion the cuts</em>. The approach has political appeal for the governor, in that it entices would-be opponents of spending reductions to participate in the plan rather than protest it. But it also <em>endows the unelected team members with immense power</em>. <br /><br />Mr. Sachs made <em>recommendations to Mr. Cuomo and his aides about whom to appoint to the Medicaid team</em>, which Mr. Cuomo formed through an executive order in January. During the transition, Mr. Sachs also <em>helped assemble a four-person policy team</em> to begin meeting with state agencies about the best approach to reducing Medicaid spending</blockquote><br />Moreover, the Times article recounted cases in which Mr Sachs appeared to influence policy in ways that benefited his consulting clients. For example:<br /><blockquote>While he was helping Mr. Cuomo assemble his health care staff, Mr. Sachs’s name arose in an unusual personnel matter, one that held great interest for one of his clients, NYU Langone Medical Center. <br /><br />For at least a year, NYU Langone had had strained relations with Dr. Harold S. Koplewicz, a well-known psychiatrist who founded the hospital’s child psychiatry center but left in 2009 to start a competing research and clinical center. <br /><br />Relations worsened because Dr. Koplewicz, who also served as director of the Nathan S. Kline Institute for Psychiatric Research, a state-run psychiatric center in Rockland County that also has a research affiliation with NYU, refused to allow NYU to screen those he hired at the institute, among other issues. <br /><br />During an October meeting between Mr. Sachs and Dr. Koplewicz, <em>Mr. Sachs suggested the doctor resign from the Kline Institute</em>, people briefed on the meeting said. <em>Should he lobby too aggressively to keep his job, Mr. Sachs warned, Mr. Cuomo, then widely expected to win election, might choose to close down the institute. </em><br /><br />In a later meeting in December, Michael F. Hogan, state commissioner of mental health, told Dr. Koplewicz that he had been <em>warned by Mr. Sachs that his reappointment by Mr. Cuomo would be jeopardized if Dr. Koplewicz did not resign</em>, according to the people briefed. <br /><br />Afterward, Dr. Koplewicz wrote Dr. Hogan a letter detailing his accomplishments as director of the institute and complaining of the pressure being exerted by Mr. Sachs. <br /><br />'As you explained — and I appreciate your candor — <em>you have been pressured by NYU through Jeff Sachs to have me resign as a condition</em> for your reappointment as commissioner of mental health,' Dr. Koplewicz wrote in the letter. <br /><br />In a response sent the following day, Dr. Hogan did not dispute Dr. Koplewicz’s account but suggested that he had been insufficiently cooperative with NYU and the Office of Mental Health. <br /><br />'Accordingly, your service as director, Psychiatric Research Institute, will end effective Jan. 13, 2011,' Dr. Hogan wrote. <br /><br />Dr. Koplewicz and Dr. Hogan both declined to comment, though neither disputed the authenticity of the letters. </blockquote><br />This case is particularly disquieting because of Governor Cuomo's former role as a tough state attorney general who targeted white collar crime.<br /><br /><strong>Summary</strong><br /><br />US health care is hugely complex. The interests of its increasingly large commercial players can be strongly affected by the actions of government at local, state and national levels. <br /><br />We have previously discussed the pervasiveness of conflicts of interest throughout health care. It should come as no surprise that there are important conflicts affecting government leaders who have power over health care issues. <br /><br />Although there may actually be more laws and regulations about conflicts of interest affecting government leaders than about those affecting, say, leaders of academic medical institutions, the increasingly incestuous nature of health care leadership seems to add impetus to entwine the system in ever increasing strands of conflict. <br /><br />So, I humbly suggest, as a variation on a theme I have sounded before, that governmental leaders who have power over health care should put the health of patients and the population first, and should not have relationships that risk this mission in service of private gain.  Furthermore, leaders of civilian health care organizations, especially of hospitals, hospital systems and physicians' groups whose mission is also to improve care of individuals and society, should not seek to entangle government leaders in conflicts meant to serve private financial interests. 

Conflicts of Interest, Government Leaders, and Private Health Care Organizations

There seems to be a small surge of stories about conflicts of interest regarding health care affecting government leaders who can affect health care.  The Institute of Medicine defined conflict of int…

Đọc thêm »